Overkill: When Modern Medicine Goes Too Far by Paul Offit M.D.
I am admittedly a huge fanboy of Paul Offit, an infectious disease guru at Children's Hospital of Philadelphia, one of the preeminent pediatric hospitals in the world.
His latest book Overall: When Modern Medicine Goes Too Far, is a collection of medical facts that are already known to the well-read individual, but fly in the face of wrongly-held, out-dated, commonly-believed medical concepts.
The majority of the incorrect information was previously considered the standard of care, but newer and better science and studies have clearly demonstrated updated - often conflicting - medical truths.
I have summarized some of the more salient facts here as a quick read for the over-worked and under-rested parent, so that they can take better care of their precious little ones without having to read the whole book (although I highly recommend it).
Chapter 1: Treating Fever Can Prolong or Worsen Illness
Fever-reducing medicines are found to prolong and worsen infections in experimental animals and people. Societies that use fever-reducing meds suffer a 5% increase in flu cases and deaths. Researchers have estimated that avoiding fever-reducers during a flu season would save about 700 lives in the USA and about 40,000 lives worldwide every year.
In my pediatric practice I only recommend fever-reducers for two reasons:
- If a fever is affecting a child’s activity level to the point they refuse to drink, fever-reducers may help perk a child up to encourage fluid intake to stay hydrated
- As a litmus test. The activity level of a child is a great way to assess how serious an infection truly is. If a child’s activity level is down, a fever-reducer can help perk them up (even if for just 30 minutes), which should reassure a parent that their fever source is very likely non-serious. If a child's activity level continues to be depressed despite taking a fever-reducer, it is a good idea to touch base with your pediatrician.
Chapter 2: Finishing the Antibiotic Course is Often Unnecessary
The thinking used to be that antibiotic courses needed to be fully completed per doctor’s order to prevent antibiotic resistance from occurring. Many health organization including the World Health Organization in 2016 used to ingrain this idea into doctor's and patient's heads alike.
However, multiple studies for many different types of infections in both adults and children have shown that finishing the antibiotic course is unnecessary
Pediatric Urinary Tract Infections
In 2002, Australian investigators reviewed the results of ten studies of 650 children, and they found that for a bladder infection there was no difference between 2 to 4 or 7 to 14 days of antibiotics when measured by the elimination of bacteria from the urine and for resolution of clinical symptoms.
Other Pediatric Infections
Studies now show that for adults and as well for children old enough to describe their symptoms, the best advice for diseases such as bladder infections, kidney infections, pneumonia, sinus infections, skin infections, appendicitis, and ear infections is to stop the course of antibiotics when symptoms begin to improve.
When the immune system, working synergistically with the antibiotics, has defeated the bacteria, the signs and symptoms of inflammation, such as fever and accompanying symptoms will abate and at this point the bacteria are no longer actively reproducing.
Chapter 3: Antibiotic Drops Don’t Treat Pinkeye
About 70% of people who develop conjunctivitis (pinkeye) will visit their doctor. Most will receive an antibiotic that costs the healthcare system between $377 and $857 million each year!
The most common cause of conjunctivitis is allergies - every year up to 40% of Americans suffer from allergic pinkeye. The second most common cause is viruses - about 80% of infectious pinkeyes are caused by viruses. The least common cause of pinkeye is bacterial.
A simple rule for differentiating the 3: allergic is itchy, viral is accompanied by other cold symptoms, and bacterial causes thick, purulent discharge. Unfortunately there is a lot of overlap. But even so, the studies show that antibiotics don’t treat bacterial conjunctivitis.
In 2012, researchers from the University of Edinburgh reviewed all of the existing studies on conjunctivitis and they found two high-quality studies, one of which was performed in children.
In July 2005, researchers from Oxfordshire in the U.K. divided 320 children into 2 groups. One group was given antibiotic drops every 2 hours for the first day and then 4 times a day until the infection resolved. The other group was given a placebo eye drop. Seven days later, 86% in the antibiotic group and 83% in the placebo group were cured - an insignificant difference.
The adult study from Switzerland and the Netherlands found the same result.
As a consequence of these studies, the American Academy of Ophthalmology now recommends watchful waiting for those suffering from acute pinkeye, whether it’s caused by bacteria or not.
Complications of using antibiotic eye drops include irritation, emergence of antibiotic resistant strains, and expense of the medication. In general, patients are probably better off using cheaper over-the-counter lubricating eye drops or cold compresses for comfort.
Unfortunately (and incorrectly), many work places and schools will not allow return until drops have been utilized for 24 hours.
Chapter 8: Embrace Allergenic Foods for Infants
In 2000, medical advisory boards in the United States put out recommendations to avoid peanut-containing foods early in life. By 2008, overwhelming evidence proved that this recommendation was useless and not decreasing the incidence of peanut allergies.
In 2015, researchers from the U.K. published a groundbreaking study called the LEAP trial, for “Learning Early About Peanut Allergies.”
Between 2006 to 2009, 640 infants between 4 and 11 months old who had eczema or egg allergies or both were divided into 2 groups. One group consumed 6 grams of peanut protein per week until age 5; the other group was instructed to completely avoid all peanut-containing foods.
At the end of the study there was an 86% reduced risk of developing peanut allergies in the group that was fed peanuts early on. In other words, eating peanuts early in life decreased the risk of peanut allergies later in life.
Chapter 10: Avoid Reflux Medicines for Fussy Babies
All babies cry and all babies spit up, but very few require treatment for gastroesophageal reflux disease (GERD). If they are gaining weight appropriately, there is low cause for concern.
Evidence clearly shows that reflux medicines do not work to treat fussy babies. In fact reflux medicines are known to cause several concerning side effects:
- Decreased stomach acid which increases the risk of bacterial infections such as pneumonia and necrotizing enterocolitis. Acid kills bacteria, so reducing it increases the risk of infection.
- Reflux medicines change the healthy bacteria living in our intestines (the microbiota) which can have downstream effects on obesity, allergies, diabetes, and other medical problems.
- More recently, a study of 850,000 babies found that those who received reflux meds were at higher risk of bone fractures.
It is much safer to burp frequently, position upright after feeds, thicken feeds, and if breastfeeding avoid milk, eggs, coffee, and spicy foods - all of these things can be discussed in more detail with your pediatrician.
Chapter 18: Don’t Ice Sprains
The acronym RICE (rest, ice, compression, elevation) was originally developed by a Baylor College of Medicine doctor named Gabe Mirkin. Because of the easy-to-remember acronym, it was widely used as the standard of care for sprains. However, clear evidence since has demonstrably refuted the RICE method, leading to Dr. Mirkin himself no longer recommending to follow his original advice.
Multiple well-done studies from New Zealand, Ireland, Amsterdam, and Taiwan have shown that icing sprains delays healing.
The key to healing is inflammation, which recruits helpful immune cells to the damaged area by increasing blood flow. Increased blood flow also promotes the manufacturing of collagen, which is necessary to create new, healthy ligaments and muscles.
Therefore, anything reducing blood flow, such as rest, ice, compression, and elevation, actually stymies the healing process. Of course all of these things lessens the initial pain, so people are still tempted to employ these techniques. However, for faster healing, you are better off using warm compresses, stretching, and movement to promote blood flow to the injured area.
The remaining chapters are not quite as relevant to pediatrics (or the truth is better known - such as the teething chapter) but they are equally compelling. I have listed them below as the chapter titles themselves express the salient information which can be expounded upon by reading the actual book. The book itself is a quick read and well catalogued with studies that drive each point home. It is time well spent and the dividends will lead to better health for the whole family.
Modern medicine continues to progress at an exponential rate, but as Paul Offit clearly demonstrates, sometimes it is important to take a breath and make certain that in proactively treating things we are not causing more harm than good.
Chapter 4: Vitamin D Supplements Aren't a Cure-all
Chapter 5: Supplemental Antioxidants Increase the Risk of Cancer and Heart Disease
Chapter 6: Testosterone for "Low T" is Dangerous and Unnecessary
Chapter 7: Baby Aspirin Doesn't Prevent First Strokes or First Heart Attacks
Chapter 9: The False Security of Sunblock
Chapter 11: Prostate Screening Programs Do More Harm Than Good
Chapter 12: Thyroid Cancer Screening Programs Do More Harm Than Good
Chapter 13: Breast Cancer Screening Programs Aren't Exactly as Advertised
Chapter 14: Heart Stents Don't Prolong Lives
Chapter 15: Surgery For Knee Arthritis is Unnecessary
Chapter 16: Don't Remove Mercury Dental Fillings
Chapter 17: Vitamin C Doesn't Treat or Prevent Colds
Chapter 19: Teething Doesn't Cause Fever
