Dear Dr. Roach: I was shocked recently when I read an article from a reputable source implying that sooner rather than later (and maybe already), doctors who have a patient who could be treated successfully only with massive doses of antibiotics would be required to allow the patient to die rather than run the risk of creating a generation of bacteria that are resistant to antibiotics. In other words, one person must die for the sake of many.
While I understand the logic of this, I also find it profoundly disturbing on many levels, and wonder what your comments might be. J.F.
Answer: As physicians, we are obliged to act primarily in the best interests of our patients not ourselves, and not society. Therefore, in the case of a patient who would die without the only effective antibiotic, our primary duty would be to use the antibiotic in hopes of saving our patient, recognizing that this may reduce the effectiveness of the antibiotic in the future. Of course, we should take great pains to isolate the patient so that this hypothetical resistant super-bug does not get out and spread to other people. This happens in hospitals every day now.
Hospitals have systems in place to restrict certain antibiotics to life-threatening situations when only those antibiotics are effective. This is done to minimize the risk of developing bacteria that are resistant to all our antibiotics. Unfortunately, despite this, there occasionally are times in the hospital when there are no effective antibiotics, and people die because of highly resistant bacteria despite all our best attempts. We would never let someone die because of the possibility of resistance. We would never withhold a potentially useful antibiotic if it was expected to help. This is part of the physicians ethics.
Dear Dr. Roach: Please address a baby boomer health concern: hepatitis C. A television advertisement stated that a blood test can reveal its presence and that there is effective medication to cure it. How does hepatitis C affect a person? E.B.
Answer: Hepatitis C is far more common than most people realize. In the United States, about 1 percent of adults have chronic infection thats approximately 3 million people. The number is slightly lower in Canada.
About half of people with hepatitis C do not know that they are infected, as it frequently has no symptoms for many years. Because hepatitis C may lead to severe complications including cirrhosis, liver cancer, liver failure and need for transplantation identifying people early so that they can be treated has become a priority, especially since new treatments have become available that are very effective and have few side effects.
You mentioned baby boomers, and they indeed are a high-risk group who should be screened for hepatitis C. (Definitions of baby boomer vary, but people born between 1945 and 1965 are recommended for screening.) If thats you, ask your doctor if you have already been screened, and if not, request it.
Apart from people born during this time, other people who should be screened for hepatitis C include anyone with HIV infection, anyone on hemodialysis, anyone incarcerated and people from high-risk countries, especially Central and East Asia, the Middle East and North Africa. Screening is easy and safe: a simple blood test. Finding out that you are negative is a relief. Finding out that you are positive is potentially life-saving.
Dear Dr. Roach: Are synthetic pain medications more addictive than natural opiates? I feel they are. I face going back on pain medications. Is there any new research on new non-opioid pain medications? A.F.
Answer: An opiate is a drug derived from the opium poppy. These include opium, heroin, morphine and codeine. An opioid includes opiates, but also synthetic drugs that work on the same receptor in the brain. Synthetic opioids include oxycodone, hydrocodone and fentanyl. All the natural and synthetic opioid drugs have not only the ability to help relieve pain in the short term, but also can be accidentally or deliberately misused, with the possibility of serious consequences, including death more than 42,000 deaths per year in the U.S. alone. These are dangerous drugs that need to be used with extreme caution and only after considering other options. New evidence shows that opioids are not effective for chronic non-cancer pain for most people (although a few people do well).
Although NSAID drugs and acetaminophen (Tylenol) are pain relievers, they are not very effective for severe pain. Often, pain specialists use combinations of medications, also using medications approved for other conditions but which may help relieve pain. Anti-depression and anti-seizure medicines frequently are used. There are ongoing trials on new medications.
