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When my son Ben came down with another killer sore throat this past summer, he went to his doctor for an antibiotics prescription. He’d suffered this condition in the past, and he knew just what would help ease his painful symptoms. Both he and his doctor agreed this sure sounded like strep, so without even waiting for the throat swab test results for the group A Streptococcus bacteria that cause strep throat, Ben left the doctor’s office with a prescription for antibiotics in hand.
But were antibiotics the appropriate treatment for Ben’s painful problem?
The virtually universal recommendation for antibiotic drugs to treat strep throat – or increasingly, sore throats of any cause – is not actually founded on scientific evidence, but rather on a small population of employees at Wyoming’s Warren Air Force Base during the 1940s.
For more than a decade, virulent strains of group A Streptococcus caused unprecedented rates of throat infections among the base trainees, and history’s worst epidemic of rheumatic fever.
Dr. David Newman, in his article called Antibiotics for Strep Do More Harm than Good, picks up on this story:
“Military researchers at the base seized the moment, executing a provocative series of trials that tested the potential of antibiotics to prevent post-streptococcal rheumatic fever. Roughly 2% of the trainees given placebo in their studies developed rheumatic fever, while under 1% of trainees given antibiotics experienced the disease. For every 50-60 trainees treated with antibiotics, the researchers had successfully prevented one case of rheumatic fever. It was a small, but decisive victory. Identifying and treating ‘strep throat’ quickly became a staple of medical education, and little has changed since then.”
Trouble is, since the isolated Warren Air Force Base experience, in large recent studies tracking tens of thousands of strep throats in the general population (many of whom received placebos or no treatment at all) there hasn’t been a case of rheumatic fever reported in a study for nearly 50 years. And when the incidence dropped to less than one per million in 1994, the Centers for Disease Control and Prevention stopped even tracking rheumatic fever entirely.
Dr. George Lundberg, MedPage Today’s Editor-at-Large, also observes that the length of time a person with sore throat is symptomatic prior to recovery is four to seven days, whether or not strep is found and regardless of whether antibiotics are used. Dr. Lundberg warns:
“One million prescriptions for antibiotics for sore throat may prevent one case of rheumatic fever. But they may cause 2,400 cases of significant allergic reactions up to and including anaphylaxis, 50,000 to 100,000 cases of diarrhea, and some 100,000 cases of skin rash.”
For more on unnecessary treatments for medical conditions that don't warrant them (from back surgery to cough syrup) read the rest of this article by Carolyn Thomas on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED.
