Maybe this time the hysteria will be useful?

My residency required each of us to do a presentation on the topic of our choice as a “senior project.”  (I suspect this is probably common practice with most residencies.)  For some strange reason, I decided to do mine on bioterrorism.  I focused primarily on anthrax and smallpox, and had a little quiz that I gave out all about those diseases, how they might spread within a population, and what might be done if they were weaponized.  In my memory, it was blandly well-received in the manner of most of the senior projects.

And then, some short while later someone started sending out envelopes with strange white powder that turned out to be anthrax.  Because I had not so long before , completely at random, done a presentation on that very topic, suddenly I was the department’s go-to guy to field the numerous very distressed phone calls from families wanting to have a stockpile of Cipro to ward off the apocalypse.  It was… disorienting.

I have a history with “We’re all going to diiiiiiiiiiie!!!” medical events.  My response to each new one, from SARS to swine flu, is generally the same — you’re probably not going to die.  I’m sure I’ll change my tune if there’s ever a “Contagion”-esque catastrophe pretty fast, but my default assumption most of the time is that the vast majority of people will experience worldwide medical crises through nothing more than their television or computer screens.  (I will now await the inexorable hand of Nemesis, no doubt waiting to crush me for my hubris.)

I have a similar reaction to news stories that boil down to “new study finds that something you’ve probably used/taken/consumed will kill you horribly in the next ten minutes.”  (My patience is no greater for their happier cousin, the “new study indicates regular consumption of food/beverage/supplement will make you live forever” story.)  We’re all going to shuffle off this mortal coil sooner or later, but playing the odds the impact on that event of almost all of these newly-discovered factors will almost certainly be negligible.  Eat your steak, drink your coffee, watch some TV, get some exercise, blah blah blah.  Try to live well before you croak.

My reaction to this story was not much different:

A new study finds that a widely used antibiotic, azithromycin, may increase the likelihood of sudden death in adults, especially those who have heart disease or are at high risk for it.

The increased odds of death are small, but significant enough that the authors of the study say doctors should consider prescribing a different drug, like amoxicillin, for high-risk patients who need antibiotics. People at high risk include those with heart failure, diabetes or a previous heart attack, and those who have undergone bypass surgery or have had stents implanted. In such patients, the drug may cause abnormal heart rhythmsthat can be fatal. Just how the drug might disrupt heart rhythm is not known, the researchers said.

I should insert my usual caveat here — I’m not an internist.  I haven’t taken real care of an adult patient in over a decade.  And the study does seem to indicate a real, if small, risk of sudden cardiac death in certain patients following use of the drug.  So I’m not pooh-poohing it, nor am I in any position to do so with authority.

But for once I’m kind of hoping maybe there’s a little bit of mild panic?  Maybe a small “but I’ve taken that medication, and now I’m going to diiiiiiieeeeee!!” reaction?  Because few things drive me more bonkers than seeing a patient who (against our stated recommendation) went to some local emergency department for their cold and walked out with a prescription for azithromycin, or hearing from a parent “I had the same symptoms and my doctor gave me a Z-pack.”  Lazy, lazy, lazy, and bad medicine.  It is much harder to explain to some patients that their symptoms are viral and will resolve with time than to just scribble out a prescription, and people like azthromycin because it’s easy to take.  Never mind that other antibiotics work better and are more appropriate, if an antibiotic is even needed at all.  Nope, I get regular requests for a Z-pack.

So just this once, maybe there will be some upside to people worrying about a risk they don’t really face.  Maybe there will be some reluctance to prescribe an otherwise ridiculously over-used medication.  And so I’m kind of hoping people take this one report a little bit more seriously than they need to.