Chronic disease and poor health citations.
I wrote up this document for my US legislators that lists the problems, suggested solutions, background information, similar legislation, financial impacts, etc.
It seems that people's who's job it is to increase public health are failing. Fewer people may be dying from infectious disease, but the vast majority of the population is now extremely unhealthy, poorly developed, and poorly functioning.
The data supports it. Your eyes should support it unless you're living in a bubble or your perception has been warped due to unhealthy becoming the new norm.
How to get guidelines and practice updated based on the latest research?
Completing antibiotic courses: There seems to be significantly more evidence against than for. Yet it seems like this hasn't disseminated through the medical system nor the public.
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.
Antibiotics for dental work: https://www.washingtonpost.com/national/health-science/did-his-artificial-hips-put-him-at-risk-of-infection-when-he-saw-the-dentist/2016/10/07/1a0d4b54-60a5-11e6-9d2f-b1a3564181a1_story.html - no evidence they help yet dentists are randomly giving them out. Another in 2019.
Antibiotics for GBS is not evidence-based [1][2]. This single abuse of antibiotics results in 30% of mothers and infants being given antibiotics unnecessarily during a period that is critical to gut microbiome and immune system development. Just 3 people are responsible for this, and they are refusing to address concerns about the validity of their recommendations.
Damage to our host-native microbiome is likely a major contributor to the drastic increases in chronic disease and general poor health; plus recommended actions: https://forum.humanmicrobiome.info/threads/while-antibiotic-resistance-gets-all-the-attention-the-damage-being-do.50/
Previously someone said "people who's job it is are doing it". Well, I don't see any evidence they are. Where are the reassessments of caesarean as was called for 5 years ago? Where are the evidence-based changes to policy for antibiotics for GBS?
Moreover, where is the systematic review of the literature and updating of doctors and changes in practice? Where are the systematic reductions in procedures and prescriptions deemed unnecessary with potential harm? [1][2][3][4][5]
None of these things seem to exist. Specifically in the US, but in a number of other countries as well. Eg:
A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice (2017): https://catalyst.nejm.org/implementing-evidence-based-practices-quickly
We don't have 17 years to fix these systemic microbiome and chronic disease problems. They are spiraling out of control, and if we lose our host-native microbiome that's been evolving alongside us for thousands/millions of years we may never get it back. There are also numerous societal problems that arise from a poorly functioning population.
Other examples here, including:
"As a doctor for 17 years I have slowly and reluctantly come to the conclusion that as it stands now we have a complete healthcare system failure and an epidemic of misinformed doctors and misinformed and harmed patients" - Aseem Malhotra
There's been a ton of new microbiome research in the past 4 years. It doesn't seem like guidelines and practices are keeping up with it.
Most of the guidelines seem to only take into account the threat of
antibiotic resistance. Up to date guidelines would take into account the known damage of antibiotics that extend far beyond resistance.
Patients can't be expected to read and interpret the literature
themselves. My experience with this is that it is not effective to try
and spread info to patients in a non-systematic way. Patients can't be
expected to be well informed on these issues, nor to have the time, desire, and cognitive capacity to review and interpret research. They also seem to often make
emotional decisions contrary to the evidence, even on the rare occasions
when they do review it. Though I know even some doctors who work close to these patients do the same.
It's incredibly important for there to be a body of experts who's
primary job it is to review the latest literature and update guidelines
accordingly (and those guidelines need to be readily enacted), but there
seems to be severe deficits, if not a complete absence of such. Eg:
c-section rates that vary drastically from hospital to hospital within
the same country/state [1][2].
Previously I was arguing something related (informed consent, and
reducing unnecessary procedures where antibiotics are required), and at
least one person misconstrued my argument to mean I was advocating
against antibiotics during surgery. They mentioned BMJ's GRADE system to
me so I went ahead and checked what I could find.
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.
I also found:
Antibiotics are the main cause of life threatening allergic reactions during surgery (2018): https://doi.org/10.1136/bmj.k2124
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"
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/
Swedish Council on Health Technology Assessment https://translate.google.com/translate?sl=auto&tl=en&js=y&u=https%3A%2F%2Fwww.sbu.se%2Fcontentassets%2Fea33b7102afb40b2ad43fe3d9566b386%2Fantibiotikaprofylax_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."
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"
The medical system is doing massive harm to people by ignoring all of this.
How are laypeople supposed to bring forward concerns of this nature to be addressed?
The only avenue I know of is reddit. Subs like /r/PublicHealth. Which I tried, but the majority of people there didn't seem able to comprehend and process this information. They seemed stuck in their existing mindset where none of this is a problem.
Most of the responses and behavior there were extremely immature. Akin to plugging their ears and closing their eyes, rejecting everything that goes against their preconceived notions. Very sad and alarming to see this behavior from what should be a forum filled with science degree holders who are responsible for millions of lives. None of the issues I raised were addressed with any substance. This is not the behavior of people who take seriously the heavy responsibility they bear.
I think that experience supports one of my main points throughout my writings, which is the societal consequences of the vast majority of people being poorly functioning. It is a self-perpetuating problem due to poorly functioning people being responsible for decisions that detrimentally impact huge swaths of society.
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