As a young mother comforts her feverish and uncomfortable infant, a doctor enters the dimly lit exam room. The child’s mother and the bedside nurse look at him expectantly.
“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritablity,” the physician explains to the now crying mother. “We need to start treatment right away and admit him to the hospital.”
After answering the distraught mother’s questions and discussing her child’s treatment plan, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.
“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”
Written in barely legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word “antibiotics”.
“What do you mean? This child is sick and he needs antibiotics stat!”
“Sure doc, but which one, how much and how often? Where did you go to medical school again?”
“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every day and are pleased with the results. Now you are wasting precious time that could be spent caring for this sick child!”
The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.
Naturally, the above situation is absurd, and the nurse is completely correct in questioning the physician on his order for “antibiotics”. What antibiotic, or antibiotics, are appropriate and at what dose? Through what route, oral or parenteral (e.g. intravenously or intramuscularly), should the antibiotic be administered? How often should it be given and for what duration? Five days? Two weeks? To condense the large number of antibiotics available in a hospital pharmacy into one all-encompassing term makes no sense.
Antibiotics are drugs, often consisting of completely different chemical structures with significantly different side effect profiles. There are varying degrees of safety and effectiveness with each individual antibiotic depending on the bacteria/virus/fungus being treated, the location of the infection, the age of the patient, and the presence of co-morbid conditions such as renal or liver disease. Calling for “antibiotics” in this fashion would never happen outside of a poorly written (is there any other kind?) medical drama on Lifetime.
As new antibiotics have been developed over the years, they are studied scientifically on an individual basis. Sure there are classes of antibiotics that work via similar mechanisms, such as breaking down a bacterial cell wall, or that might be effective in killing or delaying the growth of the same types of bacteria, but nobody would make a blanket statement, let alone write an order, like the one written by our fictional physician. Unfortunately, this kind of thinking is rampant in the world of so-called complementary and alternative medicine.
The “It’s All Good!” fallacy is employed by individual practitioners, lobbying organizations and even government agencies sympathetic to alternative medicine as a means of deceptively gaining a foothold for their favorite implausible and unproven therapies. Their targets are the hearts and minds of consumers as well as a growing number of practicing medical professionals. Buoyed by media-fueled public awareness that lacks appropriate context, the growing popularity of a variety of bogus therapies, funding from the National Center for Complementary and Alternative Medicine (NCCAM) and clever marketing, the most ridiculous of ideas are now masquerading as medicine in even our most hallowed academic institutions.