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The ethics of antibiotic use and abuse

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Antibiotics save lives! But like anything else, too much of a good thing stops being so. Since their introduction into our medical field, they have transmuted from miracle cure to the fall back medicine for just about anything: the cold, the flu, even general, undiagnosed feelings of malaise. As abuse and misuse of this medication leads to serious consequences, ethical questions arise as to whether they ultimately do more good than harm.

Among its many uses, antibiotics are often recommended as a safe, pre-operation precaution. For example, people with heart valve disorders are advised to take antibiotics before dental procedures. The scraping of the gums can loosen bacteria into the blood stream bringing the bacteria to the heart and causing inflammation. Neurosurgery, which has a very low incidence of infection, also recommends antibiotics due to the severity of the infections when they do occur. Meningitis, abscess formation, and death can result from neurosurgery related infections. In general, most types of surgery support the use of antibiotics to prevent potential infections. (Savitz, Rivlin, Savitz, 2002)

However, despite the very well-intentioned and life-saving use of antibiotics, many still oppose their use. Those physicians prefer impeccable disinfecting techniques and list the creation of antibiotic-resistant bacteria, super-infections, and negative drug reactions as cons to the pros. Drug resistant bacteria that survive the antibacterial drug can spread. They become even more dangerous, especially to those with compromised immune systems, such as patients in hospitals. Antibiotics also kill bacteria which keep us healthy by killing the damaging bacteria. Invasions by these types of bacteria cause super-infections. In addition, doctors must ensure that the antibiotic that is prescribed is in fact appropriate for the particular bacterial strain present in the hospital. Otherwise, the drug does not work on the patient. Many physicians do not practice this step allowing the infection to occur anyway. (Savitz, Rivlin, Savitz, 2002)

Ethical questions with regards to the patient arise when considering the risk of infection without their use and potential super-infection with use. Ethical conflicts to society and community at large come into play with the creation of resistant bacteria. (Savitz, Rivlin, Savitz, 2002)

Ethical issues also arise when dealing with the extent of efficacy of the drugs as clinical studies and research can be influenced by grants and financial incentive. This is especially true when making statements about specific conditions. Such is the case with children’s ear infections, as stated by Dr. Cantekin about a study he participated in with Dr. Bluestone. His position is that Dr. Bluestone manipulated information to show effectiveness as a result of large financial incentives from drug companies. The “results” of his study led to millions of children taking this medicine, unnecessarily participating in the creation of drug resistant bacteria that is dangerous for everyone. (Crossen, 2001)

While shunned and ostracized initially, the medical community has come to agree with Dr. Cantekin. In fact, antibiotics are little more effective than no treatment in the case of ear infections. Later review of the data of the study showed a 92.5% cure rate for those not treated and 96% cure rate for those who were treated with the drugs. Antibiotics are now recommended only if the ear infection does not clear in a few days. Even with use of antibiotics, doctors only suspect that they prevent complications related to ear infection such as meningitis, hearing loss, or death. There is no actual proof that lack of complications is due to antibiotic use. (Crossen, 2001)

Ethics also come into question when applied to the misuse of antibiotics on livestock. Allowing antibiotic use on animals allows farmers to cram animals into over populated, filthy cages. Lack of drug use would make this impossible as the animals would get each other sick. In other words the animals stay “healthy” as a result of the drugs, not as result of clean and healthy living conditions. Other side effects of this use are water and air pollution, and again the creation of antibiotic-resistant bacteria. This is harmful not only to the animal due to insufferable conditions, but also to humans. Animal meat tainted with drug-resistant bacteria can be transferred to humans through consumption, cross contamination via other foods that may come into contact with the meat/bacteria, waste that surrounds farms that seeps into ground and ground water, rodents, insects, etc. (Anomaly, 2009)
While producing cheap food is beneficial in the short term, the long term effects of the rampant use of antibiotics are deleterious. The annual death from MRSA infection has surpassed the number of people that die from AIDS. Drug resistant tuberculosis has also spread around the globe. (Anomaly, 2009) Antibiotics can and do save lives, but their abuse are proving to cause serious, long term effects that can affect not only us but also future generations.

References

Anomaly, J., Harm to Others: The Social Cost of Antibiotics in Agriculture. Journal of
Agricultural and Environmental Ethics. (2009) Retrieved 3/21/14 from
www.evergladesuniversity.com. Document URL
http://search.proquest.com.ezp-01.lirn.net/docview/196577769?accountid=1...

Crossen, C. The Treatment: A Medical Researcher Pays for Challenging Drug-Industry Funding
--- He Said Antibiotics Weren't Good for Kids' Earaches; His Peers Found Otherwise ---
Now, His View Gains Ground. Wall Street Journal (January, 2001). Retrieved 3/21/14 from
www.evergladesuniversity.com. Document URL
http://search.proquest.com.ezp-01.lirn.net/docview/398811334?accountid=1...

Savitz, S., Rivlin, M., Savitz, M. The ethics of prophylactic antibiotics for neurosurgical
procedures. Journal of Medical Ethics (2002). Retrieved 3/21/14 from
www.evergladeslibrary.com. Document URL:
http://search.proquest.com.ezp-01.lirn.net/docview/216358965?accountid=1...

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