Some of the most common medical treatments we rely on are out of date and may even be bad for us, says Dr Paul Offit, a leading U.S. paediatrician and expert in immunology and virology, who developed the vaccine against rotavirus, an infection that can cause life-threatening diarrhoea in children and babies.
Here, Dr Offit examines various treatments to help YOU ask your doctor the right questions about your care…Full course of tablets is often unnecessary
This is the advice in the UK school curriculum: ‘Always complete the full prescription, even if you feel better, because stopping antibiotics early promotes the growth of drug-resistant bacteria.’
But the opposite is true. The longer the course of antibiotics, the greater the chance bacteria will learn to become resistant.
The misconception about how long to give antibiotics began with one of the first patients to receive them. In 1941, Albert Alexander was given penicillin to cure a rampaging Staphylococcus aureus infection that had initially invaded a sore in his mouth.
The new drug worked, but the doctors only had four days’ worth — not enough to eradicate the infection.
After the drug ran out, the resurgent infection killed Alexander. When the drug’s discoverer, Alexander Fleming, received his Nobel Prize in Medicine in 1945, he said: ‘If you use penicillin, use enough.’
The longer the course of antibiotics, the greater the chance bacteria will learn to become resistant
Clinicians interpreted this to mean that they should continue antibiotics until well after the patient appeared to be getting better, to avoid a relapse.
But in their quest to survive, bacteria have a variety of strategies. They make antibiotic-destroying chemicals. They change proteins on their surface so antibiotics can no longer attach. They create an internal pump that spits out antibiotics.
Perhaps worst, these resistant bacteria teach neighbouring bacteria to become resistant. This sparks the central horror of antibiotic resistance.
It’s often not the bacteria doctors are treating that become resistant; it is others that live on the surface of the skin, nose, throat and intestine. These bacteria (such as E. coli, Klebsiella and Proteus) are common causes of urinary tract, abdominal and blood infections.
Perhaps the best strategy to reduce antibiotic resistance is to abandon the archaic notion of the ‘antibiotic course’ and give antibiotics only for as long as necessary, says Dr Paul Offit
And often it’s not the bacteria that cause the symptoms; it is our immune response that triggers inflammation and fever. When these abate, it means the bacteria are no longer breeding. Therefore antibiotics are no longer necessary and all they are doing now is creating resistant strains and increasing the risk of side-effects.
Perhaps the best strategy to reduce antibiotic resistance is to abandon the archaic notion of the ‘antibiotic course’ and give antibiotics only for as long as necessary.
One of the first experts to decry the old approach was Dr Martin Llewelyn, a professor of infectious diseases at Brighton and Sussex Medical School. In 2017, in the British Medical Journal, Llewelyn wrote that the length of treatments should be determined by how quickly the patient recovers, and should not be an arbitrary length determined at the start of the illness.
With cystitis, for example, in 2007 a study in the journal Archives of Internal Medicine, based on 340 women with the infection, concluded that three days of antibiotics was enough to cure it.
More recently, in 2018, a multinational research team studied 500 women with cystitis and concluded that five days’ treatment was adequate. Now advisory groups, including the European Society of Microbiology and Infectious Diseases, recommend either three or five days of antibiotics for cystitis, depending on the antibiotic used.
There are now specific numbers of days of antibiotic treatment recommended by advisory groups for other common bacterial conditions — for example, sinusitis (five to seven days), skin infection (five days) and school-aged children’s ear infection (three days).
The best advice for cystitis, pneumonia, sinusitis, cellulitis and ear infections is to stop antibiotics when symptoms begin to improve.Don't depend on high SPF creams
Given that sunscreen reduces the body’s exposure to the ultraviolet radiation that causes skin cancer, medics have assumed that studies would clearly show sunscreens prevent cancer.
But in 1999, a Harvard Medical School review of the research found two studies that showed sunscreen prevented the most dangerous type of skin cancer — melanoma; three showed it made no difference, and six showed that sunscreen actually increased melanoma risk.
Subsequently, Philippe Autier, a Belgian epidemiologist, compared sunbathers given lower-factor SPF10 sunscreen with a group who used higher-protection SPF30.
He found that those who used SPF30 stayed longer in the sun than those who used SPF10, presumably because they felt less likely to get sunburnt.
SPF30 users were also more likely to sunbathe around midday, when solar radiation is greatest. SPF10 wearers were more likely to sunbathe later in the afternoon, when it is less intense, Autier reported in the British Journal of Cancer in 2000.
But although all the bathers avoided sunburn, that doesn’t mean they were below the levels of solar radiation that cause melanoma.
Dermatologists had assumed that sunburn led to melanoma, so the more times someone was sunburnt over the course of their life, the greater the risk of this cancer.
But lab studies by researchers at Cancer Research UK’s Manchester Institute, in 2014, showed that even SPF50 sunscreens don’t prevent melanoma, they only slow the process by which UV light causes it. Sunscreens had provided a false sense of security.
As Cancer Research UK has warned: ‘People tend to think they are invincible once they have put on [sunscreen] and end up spending longer out in the sun, increasing their overall exposure to UV rays.’Aspirin isn't a heart attack preventer
Should people with risk factors for heart attack or stroke — but who have had neither before — take daily low-dose (75mg) aspirin?
A burst of positive evidence has left many believing it will do more good than harm. Sadly, that is often wrong.
In 2009, researchers in Oxford reported that their meta-analysis of previous evidence indicated that people taking daily aspirin reduced their risk of a second stroke or second heart attack by about 20 per cent.
Thanks to such clear evidence, doctors began to recommend that people who had suffered a stroke or heart attack should receive daily low-dose (‘baby’) aspirin.
Evidence also appeared to back giving low-dose aspirin to people who hadn’t suffered a stroke or heart attack but were at high risk, such as those with diabetes, hypertension or high cholesterol.
For example, a 1989 Harvard Medical School study suggested daily aspirin would cut their risk by 44 per cent. But subsequent research failed to support this.
And while low-dose aspirin may sound harmless, it isn’t.
In 2016, a seven-year Oxford University study of 15,000 adults with diabetes warned that although the tablets cut heart attacks by a very modest amount, they raised the risk of potentially serious bleeding, such as intestinal haemorrhage, by nearly a third.
Aspirin benefits people who have already had a stroke or heart attack so much, this added protection outweighs the significant bleeding risks.
That is not true for people at risk of a stroke or heart attack but who haven’t had one. Therefore, only take daily low-dose aspirin if your doctor recommends it.
Tooth decay begins with bacteria in plaque, a thick substance that sticks to teeth and gums. These bacteria interact with starches and sugars in food to erode the outer surface of the tooth, causing holes (cavities). If untreated, cavities can cause pain, inflammation and tooth loss.
To treat cavities, dentists drill out the decayed material and fill the hole with either a composite resin — which is the colour of teeth and made from the sap of fir and pine trees — or an amalgam, which is silver in colour and made by mixing powdered tin, copper and silver with liquid mercury.
Amalgams can be placed more quickly than resins and mercury also slows the growth of bacteria, making it less likely the tooth will erode further. But despite their advantages, mercury amalgams have always been controversial as, in some forms, mercury is toxic.
Mercury dental fillings can also be vaporised after brushing teeth or eating acidic foods.
So, the question is: does mercury vapour from amalgams cause harm? The World Health Organisation (WHO) has adopted a safety limit for mercury vapour of 25 micrograms (μg) per square metre of air per day.
Given that symptoms of mercury toxicity have never been observed below exposures of 100μg of mercury