Dr. Marc answers readers’ question every other week. To send a query, click here.
Dear Dr. Marc,
In the UK, if you go to the doctor with a minor infection, you are quite likely to be sent home with the advice to rest up and drink plenty of fluids. In the US, it still seems to be the case that you are likely to be prescribed an antibiotic, almost by reflex. Given the concerns of developing resistance to antibiotics, are practices changing in the US? If not, why not?
There does seem to be a mutual tendency on the part of both patients and doctors here in the United States to shovel antibiotics at minor respiratory infections. This may be due in part to the presence of atypical bacteria, as well as the perception (real or otherwise) that the pills make a difference. Certainly you are correct that overuse of antibiotics can breed resistant strains.
Perhaps the difference between the US and the UK can be accounted for by the tendency that still exists here to buy into the “American dream.” Here we like to believe that our products are magic elixirs, almost like a gift the doctor is dispensing to the patient for coming to see him. Each new shiny pill is the latest and greatest. We can be cured of our minor ailments, made better and perhaps stay young longer, all by taking a little tiny pill. Perhaps In the UK many patients are less expectant, and therefore more realistic.
Dear Dr. Marc,
I’m turning 50 next month and the issue of colonoscopy has come up. How important is it for everyone to take that test? Additionally, what are your opinions about the camera pill version?
New York City
Generally, this column is not a forum for straight medical questions. But I am a practicing internist, and further, I have experienced a colonoscopy, at age 46. Also, some might say that this question is, in fact, a political one, in that one of the reasons for recommending colonoscopy for everyone over 50, some people might argue, is to generate income for doctors and colonoscope makers.
I don’t buy that. We live in a society with a preponderance of colonic disease, including cancer. This may well have to do with the American diet, but until we change something, scrutinizing the colon for those with a family history of polyps or cancer is a wise idea. For everyone else, much data suggest that 50 is a good place to start, with repeat studies at least every five to ten years. I don’t think the virtual colonoscopy done by CT scan is equivalent; it is promising, but studies don’t support it sufficiently…yet. Further, the prep for the virtual is almost the same, and, as my patients tell me, the prep is the most difficult part. Having experienced both the prep and the colonoscopy, I think fear and anticipation are far worse than either the prep or the procedure itself. I recommend this procedure; it is a rare chance to see close-up exactly what we, our food, and our environment are doing to our innards.