Clarifying my position on antibiotics for the large number of individuals on the parenting subs who become emotional & hostile on this subject. (Oct 2022)

Michael Harrop

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The problem has even spread to the mods of /r/ScienceBasedParenting who previously created some fantastic rules to make that sub a haven from the type of unintelligent, emotional, anti-scientific behavior that is now rampant there.

GBS is an easy example. 1 in 200 babies are thought to be at risk for severe outcomes, so all 200 mothers are given antibiotics just in case. This is 400 people being permanently harmed in order to attempt to save one life.

First of all, there should be major debate on where the cut-off should be for "justified harm to innocents in order to save one person". Harming 400 to save 1 seems VERY extreme. I think that most people would agree with this. Thus the popular reaction seems to be to deny that the 400 are even being harmed. Unfortunately, it's well-established that they are. It's unconscionable that a handful of people are quietly deciding that harming 400 to save 1 is acceptable. Even if it was "harm 60% to save 40% that would be extremely debatable. Where the appropriate cut-off is, I don't know. But we do know that the gut microbiome impacts and regulates virtually every aspect of human health, function, and development https://humanmicrobiome.info/intro/. So damaging it is not something to take lightly.

Cost-benefit analysis is an essential part of intelligent, evidence-based, ethical decision-making. Discarding it for emotion & fear-based decisions is incredibly harmful, unintelligent, and anti-scientific. It is neither intelligent nor ethical to attempt to keep everyone alive at all costs. There are certain costs which are too great. And that's a big, debatable grey area that should be heavily and widely debated, not swept under the rug.

Whether or not you agree on treatment with antibiotics in a particular case, lying about the facts should be anathema in any science-based discussion. You cannot make ethical, informed decisions based on misinformation. Spreading misinformation because you're emotional about the implications of the truth is incredibly harmful, unintelligent, and anti-scientific.


Secondly, GBS is a good example because it's a case of antibiotic overuse – antibiotic use where the evidence does not support it's use. Antibiotic overuse is rampant. It's a recognized problem, but very little is done about it, and it's almost always only raised as a concern in regards to antibiotic resistance, despite collateral damage likely being a much greater concern.


But for a moment we'll assume that antibiotics for GBS is well-proven to be evidence-based to save the 1 out of 200 infants.

So we have 200 babies, and one of them is sick/weak enough to die.

a) You're a healthy parent and willing to let yourself, your child, and 398 other people be permanently harmed in order to save 1 infant.

Is that noble? Is it intelligent? Is it ethical?

b) You're an unhealthy parent so you're scared about your unhealthy child dying. You don't care about the 398 other healthy children & mothers who will be permanently harmed to save yours.

I would think there is nothing noble or intelligent or ethical about this (b) position. The obvious solution would be to not create an unhealthy child if you're unhealthy. And it's depressing that so many people are so selfish to be unwilling to do that. I want a mini-me. So what if it will be sickly and suffer. So what if there will be consequences for many others. I want one.


Either way, the outcome is that 400 people are now permanently harmed. And we know this harm compounds over generations. Harms from antibiotics are vast, and make you more reliant on those antibiotics to do the job of the now-damaged immune system and missing microbes that the antibiotics killed off.

So antibiotic use must increase even further now that you've made this decision.

This is a downward spiral that seems to be playing a major role in the exponential rise in chronic disease and general poor health & brain function. The result is Idiocracy. It's an unsustainable approach that is causing us to head in the direction of societal & planetary collapse and extinguishing of the human race.

How would you reverse it if there is no one left who is undamaged by this policy? I've personally been damaged from it and have been trying to find such undamaged people who might hold the ability to reverse it. After screening over 50,000 people I still haven't found one. Many people think such individuals don't even exist in modern society anymore, and thus believe that excluded tribes are the only hope.

Well, that's not reliable either. They have pathogens, and some emotional geniuses gave them antibiotics as well; based on the same unintelligent, unscientific thinking (but even worse since antibiotics were never studied to be effective and safe on that demographic, and they knew very well that a major value of that population was their lack of exposure to antibiotics).

There is also evidence that not even FMT can reverse all the damage done from antibiotics [1]. And even if it could, damage done during the developmental stage of life is far more permanent – Eg: you can't unbake a cake.

What is the main problem? What is my position?​

Someone [purposely] misinterpreted my position to be "parents should let their children potentially die of easily curable infections rather than using antibiotics".

That is not my position. The main problem is unnecessary antibiotic use.

What does that mean?​

Antibiotic overuse is when evidence does not support the use of antibiotics for a particular case.

NO ONE benefits from non-evidence-based antibiotic use. It is only harmful. Well, the people/companies making money off the usage temporarily benefit (to the detriment of a large portion of the population).

Your emotions for your child are completely irrelevant, and will in fact do far more harm than good. Protecting your child and making the best decisions for your child requires you to be logical and unemotional.

Antibiotic overuse is rampant, according to current prescription guidelines (see below). This doesn't even cover the fact that current guidelines are likely FAR too lenient (Eg) due to the fact that nearly all of them only factor in antibiotic resistance and ignore collateral damage.

Antibiotics should be the last option, limited mostly to well-established life-threatening cases. Not handed out like candy as one of the first options, as is currently the case.

There needs to be major focus on researching and switching to alternatives, but that can't happen until people start taking the harms of antibiotics seriously.

AI:​

Dr Martin Blaser mentions in his book "Missing Microbes" that this issue may only be balanced out if parents start suing doctors/hospitals for antibiotic overuse. Personally, I don't find that to be a tenable solution (for a variety of reasons).

I said that I don't see the issue being solved until the entire medical system is replaced with AI because individuals of all professions are far too flawed to be making such important decisions.

Someone responded that AI will never replace human doctors and statistical decisions are ruthless for the individual. This is false, and a good example of why most people are not qualified to be making these sorts of decisions.

A statistical decision is the most optimal and ethical one. Your emotions add nothing of value; only harm.

If a statistical analysis weighs all the evidence, does a cost-benefit analysis, and concludes that the costs outweigh the benefits in X case, and a human overrules that due to emotions, the human is only doing harm by making an objectively incorrect decision.

The follow-up comment in that chain saying "My hospital's Epic system has told me just about everything under the sun is sepsis" shows a flaw of their Epic system. It shows that the Epic system is currently far too unsophisticated and not advanced enough. That says nothing for the potential that AI has.

Note that my claim is not that AI is currently ready to replace everyone in the medical system. I never predicted when such a thing may transpire. I merely said I don't see these issues being solved until it does.

As long as humans continue to advance without major societal collapse, AI replacing the medical system and most other current-jobs is inevitable. Not only are humans flawed, but we're severely deficient when compared to AI – IE: our memory. There is far too much data for humans to review and take into account https://forum.humanmicrobiome.info/threads/doctors-are-not-systematically-updated-on-the-latest-literature-what-t.27/.

Another example of poor reading comprehension and emotion taking over a person's ability to calmly and rationally engage in productive discussion. Ask yourself why you lack the ability to engage in emotionless, objective, logical analysis and discussion. Could it be that your biological functions are damaged? IE: the gut-brain axis. What if everyone, or even merely a majority of people, were similarly malfunctioning? Wouldn't that be cause for alarm? Can you see how that would be extremely problematic for you individually if everyone reacted to you, or to things you care about, that way?

Antibiotic overuse:​

“Antibiotics are among the most commonly prescribed medications for children, but prior research has suggested that nearly a third, if not more, of outpatient pediatric prescriptions for antibiotics are unnecessary”. Adults too [2016][Jan 2019][Mar 2019][Dec 2019]. https://archive.ph/Nyvse#selection-723.1-723.2

GBS: https://humanmicrobiome.info/maternity/#gbs-group-b-strep

For ear infections: https://humanmicrobiome.info/antibiotics/#antibiotics-for-ear-infections

Time to consider the risks of caesarean delivery for long term child health (2015): https://www.bmj.com/content/350/bmj.h2410 - I could not find any evidence that this recommended review took place.

Swedish 2010 article mentioning prophylactic antibiotics aren't always given during surgeries, including c-sections, but seems to be advocating for more use of them: https://www.sbu.se/sv/publikationer/vetenskap-och-praxis/antibiotika-ratt-profylax-fore-operation-kan-minska-resistens-och-infektioner/ - only recognized harm of antibiotics is resistance. "Today there are too few studies to safely conclude if antibiotic prophylaxis is cost effective, even if some result point in that direction".

The cited PDF: Swedish Council on Health Technology Assessment https://translate.google.com/translate?sl=auto&tl=en&js=y&u=https://www.sbu.se/contentassets/ea33b7102afb40b2ad43fe3d9566b386/antibiotikaprofylax_sammanfattning.pdf says "The scientific evidence is insufficient to assess the effect of antibiotic prophylaxis in several surgical procedures where it is used today. The lack of empirical studies means that there is no evidence for efficacy of antibiotic prophylaxis."

2008 Swedish article says antibiotics should only be given for GBS under certain conditions: https://www.dagensmedicin.se/artiklar/2019/03/01/tumme-upp-for-antidot-och-sglt-hammare/

BMJ's GRADE system was mentioned to me but the only thing I was able to find was a 1990 article saying antibiotics aren't always necessary during c-sections https://www.bmj.com/content/300/6716/2. Yet as far as I know, they are given out 100% of the time in the US. Also, the article ignores collateral damage done to the human microbiome, but that's not surprising considering it was written in 1990. But I cannot find one written in the past 10 years.

Antibiotic prophylaxis (2001) https://www.ncbi.nlm.nih.gov/books/NBK6917/ "Controversy exists about the necessity of antibiotic prophylaxis in clean operations. The argument against the prophylaxis is the low wound infection rate of 2% and less. However, it is well recognized that 40% of wound infections occur after clean operations"

WHO 2018 guidelines: https://www.who.int/infection-prevention/publications/ssi-prevention-guidelines/en/ - "A systematic review of 57 studies from both high-income countries and LMICs identified the following factors associated with an increased risk of SSI (surgery site infection) in adjusted analysis: a high body mass index; a severe score according to the US National Nosocomial Infections Surveillance (NNIS) risk index; severe wound class; diabetes; and a prolongation of surgery duration"

So it's primarily extremely unhealthy people who need antibiotics. Thus, indiscriminately giving them to everyone is doing unnecessary harm to healthy people.

"In the USA, about one in two women is prescribed an antibiotic during pregnancy or at term" (2019): https://gut.bmj.com/content/early/2019/01/22/gutjnl-2018-317503.long

69 Percent of Kids in the US Exposed to Antibiotics Before Age 2 (2014): https://www.healthline.com/health-news/childhood-antibiotics-exposure-raises-obesity-risk-092914#1 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/1909801

Children receive a mean of 2.7 antibiotic courses by age 2, and 10.9 by age 10 (2018): https://web.archive.org/web/20190423131149/https://www.mdedge.com/ccjm/article/189671/infectious-diseases/our-missing-microbes-short-term-antibiotic-courses-have-long/page/0/1

Australian babies given antibiotics at some of the highest rates in the world (2017): https://www.theguardian.com/society/2017/jul/28/australian-babies-given-antibiotics-at-some-of-the-highest-rates-in-the-world - https://doi.org/10.1111/jpc.13616

Antibiotic Use in Children – A Cross-National Analysis of 6 Countries (Dec 2016) https://www.jpeds.com/article/S0022-3476(16)31256-2/fulltext "We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents"

Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations (2017): https://www.mja.com.au/journal/2017/207/2/antibiotics-acute-respiratory-infections-general-practice-comparison-prescribing "Antibiotics are prescribed for ARIs at rates,–9 times as high as those recommended by Therapeutic Guidelines"

Fifty-two percent of CF infants prescribed antibiotics for symptoms (respiratory) had a virus. (Feb 2019): https://www.cysticfibrosisjournal.com/article/S1569-1993(18)30804-X/fulltext

In a Poor Kenyan Community, Cheap Antibiotics Fuel Deadly Drug-Resistant Infections. Overuse of the medicines is not just a problem in rich countries. Throughout the developing world antibiotics are dispensed with no prescription required. One study found that 90 percent of households in the neighborhood had used antibiotics in the previous year. (April 2019): https://www.nytimes.com/2019/04/07/health/antibiotic-resistance-kenya-drugs.html

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment in a randomized trial of preterm infants (Jan 2021, n=98) https://www.nature.com/articles/s41598-021-80982-6 "A majority of preterm neonates receive antibiotics after birth without clear evidence to guide this practice"

The REASON study is the first trial to randomize symptomatic preterm neonates to receive or not receive antibiotics in the first 48 hours after birth. These results suggest early antibiotic use may impact the gut-brain axis with the potential for consequences in early life development. (Sep 2020, preprint) https://doi.org/10.1101/2020.04.20.052142

When a patient tests positive for bacterial meningitis, family members and other close contacts are often prophylactically treated with antibiotics https://www.eurekalert.org/pub_releases/2020-08/cnh-cnh072820.php

Good article covering overuse, abuse, and harms of antibiotics: https://www.nytimes.com/2019/03/15/health/antibiotics-elderly-risks.html

An antibiotic commonly found at low concentrations in the environment can have major impacts on gut bacteria https://www.eurekalert.org/pub_releases/2019-10/uoo-mol101019.php "suggest that because of the physical activity of the intestine, contamination by antibiotics induces much larger changes to the gut microbiome than one would suspect from simply studying bacteria alone. In a sense, the gut amplifies the effects of weak antibiotics." Sublethal antibiotics collapse gut bacterial populations by enhancing aggregation and expulsion (Oct 2019, zebrafish)

Informed consent:​

As /u/bestplatypusever helpfully pointed out, I neglected to mention the informed consent issue:
Aside from the cost / benefit, one point missing is informed consent. Providers and parents are focused entirely on the (scary and overblown) near term effect of potential infection and are entirely ignorant on the long term health ramifications of abx use. If a parent was told, your baby may get an infection and the abx makes this less likely, while the abx also makes far MORE likely they develop asthma, allergies, and potentially any chronic condition linked to the biome - that parent may opt out of the abx rx. But no one tells them that and guaranteed most prescribers don’t even know. Meanwhile pharma and their public health captives certainly don’t want people learning this info because the chronic health conditions that stem from abx use just lead to more and more lifetime prescriptions. To focus on cost / benefit assumes positive intent - that industry or regulators actually WANT to help people be healthier. There really is no evidence of that!


Original 03 Oct 2022 (44 comments).
 
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