I want to sell you a car isn’t it
gorgeous it’s got the best gas mileage
of anything on the market today all the
high-end specialty services that you
want there in this car it’s exactly what
you need to get you where you’re going
and I know that’s why you came here
today was to get something like this
in fact I’ve sold one to every person in
your situation that’s come to see me for
the last several months at least now
there is one downside I mean we can sell
you this car today you can drive at home
we’ll figure out the qualifications and
all the financing sometime in the future
but if it turns out that you don’t
actually qualify to buy this car and you
keep driving it that amazing gas mileage
that it has is really gonna start to
drop off in fact that’s not just for
your car or even just for the cars that
I’ve sold to people around here that’s
for all of these cars all around the
world the manufacturers even saying now
that perhaps if we keep accidentally
giving these cars to people that don’t
really qualify for them they’re
eventually just gonna stop starting all
together and there’s one other thing I
probably shouldn’t even mention it it
almost never happens but if you happen
to drive this car and not qualify
there’s this off chance that you’ll
develop a really nasty limp that you’re
gonna have for the rest of your life but
you’re still interested right so I know
this sounds like a ridiculous situation
but this is more akin to one of the most
important situations that we’re facing
in our health care system today than you
might realize
take a minute and think about the last
time that you went to see your primary
care physician because you weren’t
feeling well maybe you had a cold or
your allergies were acting up maybe it
was even the dreaded flu
try to think back and remember what did
you want in that moment
out of that interaction so that you
would feel like you’d been well cared
for and gotten some value for your copay
if you’re like most Americans you wanted
more than just some reassuring words in
fact recent studies have shown that
Americans are looking for either an
in-office treatment a referral to a
specialist or a prescription to take
home in order to leave happy from their
doctor’s office according to a 2016
study over 90% of providers are feeling
that pressure and giving in 90% of
general care practitioners have given
patients a prescription even if they
didn’t really want to and 70% of those
prescriptions were for antibiotics even
if the provider couldn’t tell exactly
what infection the patient had or even
if they had one at all
and within that 50% of the time these
prescribers had been giving antibiotic
prescriptions even when they knew that
the patient probably only had a cold or
the flu which are diseases caused by
viruses and antibiotics won’t help those
this is a pretty staggering thing to
stop and think about especially when you
realize that there are over 260 million
courses of antibiotics prescribed each
year in the United States that’s enough
for five out of every six Americans to
get a course of antibiotics every year
and according to a recent study one out
of every three of those courses of
outpatient antibiotics is either
inappropriate or completely unnecessary
and don’t think that this is just
doctors offices or an outpatient side
hospitals are suffering the same issues
when it comes to antibiotic misuse the
World Health Organization says that over
half of the patients admitted to u.s.
hospitals receive at least one dose of
an antibiotic during their stay and that
same report goes on to say that half of
those antibiotics
products are again either unnecessary or
inappropriate all of this antibiotic
misuse on both the inpatient and the
outpatient side it’s not without
consequences
the more we expose bacteria to
antibiotics without appropriately
killing them or overuse these
antibiotics the more the bacteria become
accustomed to them they evolve they
become more resistant in fact each year
over 2 million Americans become infected
with bacteria that are resistant to the
first line of antibiotics that we would
choose to treat them those resistant
infections those resistant infections
they cost our health care system over 20
billion dollars in excess healthcare
costs and lead to 23,000 deaths each
year so with all of this talk that you
see in the media recently about
so-called superbugs these incredibly
resistant bacteria for which there’s no
treatment and people are dying every day
you might start to think that this is a
really modern problem that we’re facing
but in fact that’s just not true
in fact this gentleman Sir Alexander
Fleming the man who discovered
penicillin and the father of modern
antibiotics
he called this 172 years ago in an
interview that he gave with the New York
Times in 1945 to paraphrase what dr.
Fleming said was that as people become
more accustomed to this idea of
antibiotics they’re gonna start thinking
that they need them maybe even when they
don’t and they’re gonna start asking for
them specifically and as we start
handing out these antibiotics more and
more the bacteria are going to continue
to evolve and grow and they’re going to
get smarter and eventually the
antibiotics that we have just aren’t
gonna work anymore and people are going
to start to die we’ve seen that exact
scenario that he talked about play out
over the last eight decades this graph
is an example of perhaps the most
commonly discussed resistant bacteria
it’s called methicillin-resistant
Staphylococcus aureus
you’ve probably heard about it it’s most
commonly referred to as mersa in the
public okay
Merce is not special in any way it
doesn’t show some unusual trend in fact
it’s actually pretty typical of what
we’re seeing with all bacteria around
the world and that is as we expose them
more and more to these antibiotics a
higher and higher percentage of them are
becoming resistant to those antibiotics
and we’re having to move on to find new
treatments and those treatments are
difficult to come by but what’s the big
worry big farmers gonna come and just
save us all right it’s not a big deal
they’re just gonna create some new
antibiotics and they’ll just treat the
resistant bacteria that way yeah if only
it was that simple first of all we need
to talk about the fact that it takes an
extremely long amount of time to develop
a new drug especially an antibiotic
sometimes as much as a decade from
inception to actually hitting the market
then there’s the fact that antibiotics
really don’t make money for the drug
companies think about the way that
medications are used to treat things
like high blood pressure or diabetes
typically when a patient starts one of
those they take them for the rest of
their lives that’s in direct contrast of
the way that we use antibiotics where
the patients usually only take them for
a few days or maybe a few weeks it’s
much harder for the drug companies to
make a profit when you’re taking
something for days instead of decades
and then there’s the fact that when we
do finally get some new antibiotics to
come to market the prescribers that
write for them they usually squirrel
them away and keep them only for their
sickest patients only bringing them out
when absolutely necessary so that they
don’t fall victim to these same
resistance patterns that we’re seeing
with other antibiotics so when you add
all these things up it’s no surprise
that over the past thirty five years
we’ve seen the rate of new antibiotics
hitting the US market dropped from
roughly four per year down to only one
every other year please don’t get me
wrong I am NOT saying that we need to
stop using
antibiotics far from it antibiotics are
miraculous things they are life-saving
medications that we use every day in the
healthcare system
to save people and to treat them but in
order to do that we need to use them
appropriately something has to change in
the cavalier attitude with which we’re
currently treating them think about the
rain forests or rare animals any number
of more popular things that have become
rare and endangered over the last
several decades when we see these things
happen and we all band together as a
united people and we say we need to stop
this before we lose these precious
things and often these often these tasks
of moving towards preserving them are
referred to as stewardship so we find
ourselves at a crossroads we now realize
that creating new antibiotics is
probably not going to be able to occur
fast enough to keep us up with the
bacteria as they evolve and so we have
to forge a new path and that new path is
called antimicrobial stewardship so
antimicrobial stewardship is defined a
lot of ways but it’s often that we look
at the fact that we need to not only use
antibiotics appropriately but we need to
monitor that utilization and see where
we’re going see if it’s making any
improvement and the major goal of this
stewardship effort is that we have good
clinical impact we’re getting good
effectiveness out of the antibiotics and
we’re not seeing under the negative
consequences whether that be toxicities
or increases in resistance so in its
most simple terms antibiotic stewardship
can be described as patients getting the
correct drug to treat the specific type
of infection that they have and the
specific bacteria with which they’re
infected to do that we need to give them
the correct dose and give it via the
most appropriate route whether that be
oral
or injection or something else and we
need to use these antibiotics for the
shortest amount of time possible to
still be effective so now that we have a
general understanding of where we stand
and how we’re stacking up against the
bacteria how can we as individuals as
patients and is just people in this
world becomes stewards of antibiotics
specifically but of our healthcare in
general let’s go back to that car lot
where we started and see some specific
tasks that we might be able to take
really the first question that we need
to answer is do I even need a new car to
begin with do I have an infection at all
and if I do is it the type of infection
that an antibiotic can treat remember
antibiotics only treat bacteria but
things like the common cold or the flu
those are caused by viruses and
antibiotics won’t treat them then
there’s the fact that things like coughs
runny noses ear infections bronchitis
even though these are often caused by
minor bacterial infections they’re often
what’s considered self-limiting meaning
that a healthy person in general with
good nutrition and some rest
they can fight off those infections
without actually needing an antibiotic
at all so what we need to start doing is
having these conversations with our
healthcare providers we need to start
establishing a role of do we need an
antibiotic or is it possibly better to
take a stance of watchful waiting give
it a few days see if we get better
instead of starting that antibiotic on
day one not all antibiotics kill all
types of bacteria it’s very important
that whenever possible we have our
health care providers collect a culture
of some cells from our body that they
can send to a lab so they can grow the
specific bacteria that’s causing the
infection that we have that bacteria can
be
by the lab and then test it against a
myriad of antibiotics to see which ones
kill it best
once the provider has that type of
information they can be very specific in
selecting the most appropriate
antibiotics to kill the bacteria that’s
infecting our body without accidentally
causing some of the other unintended
consequences so as patients we need to
get more accustomed to the idea that
perhaps in the middle of the course of
antibiotics that we’ve been prescribed
the phone’s gonna ring and we’re gonna
get a call from the doctor saying you
know I need you to stop that one and go
back to the pharmacy I know it’s going
to be another copay but this is
important we need to change the
antibiotics that you’re on so that we
can be the most targeted and selective
that we need to so that we can be
healthier people overall and get you
healthy as soon as possible dosing
antibiotics is not a trivial task not
only do we need to take into account the
fact that even the same antibiotic might
have different doses to treat different
bacteria and different infections around
your body but you also need to make sure
that you always share with your
healthcare provider what medications
you’re taking even if those are
over-the-counter medications or
supplements because that sort of
information could really play into the
way that antibiotics are dosed we also
need to realize the fact that every once
in a while we might need some bloodwork
to figure out how well our organs are
functioning where specifically our
kidneys and our liver and every once in
a while we also need to get bloodwork to
monitor antibiotics to see that we’re
getting the appropriate levels in our
body by taking the doses we are without
causing toxicity to us but while still
killing the bacteria appropriately so
now that we’ve established that we need
to take the right dose of antibiotic and
that we need to use it in the most
appropriate way possible we need to talk
about how long we take those antibiotics
certain antibiotics can be used to treat
things such as simple urinary tract
infections and as quick as three days
but some more complicated infections
such as those in the bones sometimes
required
for weeks or even months we need to be
able to have open conversations again
with our providers to discuss do I
really need this prescription for 14
days or even 10 days is there a shorter
treatment course that I could be on that
would be just as efficacious but won’t
put me at risk for any of the downside
that antibiotics can bring and finally
be nice to your healthcare providers
they have your best interest at heart
they want you to be happy and healthy as
much as you do don’t pressure them into
giving you a prescription for an
antibiotic or for any other medication
for that matter
study after study year after year we’ve
seen that they’ll probably just give it
to you if you ask and that’s not good
for you it’s not good for the rest of
the world so going forward be stewards
of your antibiotics take an active role
in your healthcare openly discuss with
your health care providers whether you
have in real infection that can be
helped by an antibiotic what dose of
antibiotic what you need to treat that
infection and what’s the shortest amount
of time that you can be on that
antibiotic while still getting a good
outcome in doing this you can to become
an antimicrobial steward
[Applause]
[Music]
[Applause]
[Music]
gorgeous it’s got the best gas mileage
of anything on the market today all the
high-end specialty services that you
want there in this car it’s exactly what
you need to get you where you’re going
and I know that’s why you came here
today was to get something like this
in fact I’ve sold one to every person in
your situation that’s come to see me for
the last several months at least now
there is one downside I mean we can sell
you this car today you can drive at home
we’ll figure out the qualifications and
all the financing sometime in the future
but if it turns out that you don’t
actually qualify to buy this car and you
keep driving it that amazing gas mileage
that it has is really gonna start to
drop off in fact that’s not just for
your car or even just for the cars that
I’ve sold to people around here that’s
for all of these cars all around the
world the manufacturers even saying now
that perhaps if we keep accidentally
giving these cars to people that don’t
really qualify for them they’re
eventually just gonna stop starting all
together and there’s one other thing I
probably shouldn’t even mention it it
almost never happens but if you happen
to drive this car and not qualify
there’s this off chance that you’ll
develop a really nasty limp that you’re
gonna have for the rest of your life but
you’re still interested right so I know
this sounds like a ridiculous situation
but this is more akin to one of the most
important situations that we’re facing
in our health care system today than you
might realize
take a minute and think about the last
time that you went to see your primary
care physician because you weren’t
feeling well maybe you had a cold or
your allergies were acting up maybe it
was even the dreaded flu
try to think back and remember what did
you want in that moment
out of that interaction so that you
would feel like you’d been well cared
for and gotten some value for your copay
if you’re like most Americans you wanted
more than just some reassuring words in
fact recent studies have shown that
Americans are looking for either an
in-office treatment a referral to a
specialist or a prescription to take
home in order to leave happy from their
doctor’s office according to a 2016
study over 90% of providers are feeling
that pressure and giving in 90% of
general care practitioners have given
patients a prescription even if they
didn’t really want to and 70% of those
prescriptions were for antibiotics even
if the provider couldn’t tell exactly
what infection the patient had or even
if they had one at all
and within that 50% of the time these
prescribers had been giving antibiotic
prescriptions even when they knew that
the patient probably only had a cold or
the flu which are diseases caused by
viruses and antibiotics won’t help those
this is a pretty staggering thing to
stop and think about especially when you
realize that there are over 260 million
courses of antibiotics prescribed each
year in the United States that’s enough
for five out of every six Americans to
get a course of antibiotics every year
and according to a recent study one out
of every three of those courses of
outpatient antibiotics is either
inappropriate or completely unnecessary
and don’t think that this is just
doctors offices or an outpatient side
hospitals are suffering the same issues
when it comes to antibiotic misuse the
World Health Organization says that over
half of the patients admitted to u.s.
hospitals receive at least one dose of
an antibiotic during their stay and that
same report goes on to say that half of
those antibiotics
products are again either unnecessary or
inappropriate all of this antibiotic
misuse on both the inpatient and the
outpatient side it’s not without
consequences
the more we expose bacteria to
antibiotics without appropriately
killing them or overuse these
antibiotics the more the bacteria become
accustomed to them they evolve they
become more resistant in fact each year
over 2 million Americans become infected
with bacteria that are resistant to the
first line of antibiotics that we would
choose to treat them those resistant
infections those resistant infections
they cost our health care system over 20
billion dollars in excess healthcare
costs and lead to 23,000 deaths each
year so with all of this talk that you
see in the media recently about
so-called superbugs these incredibly
resistant bacteria for which there’s no
treatment and people are dying every day
you might start to think that this is a
really modern problem that we’re facing
but in fact that’s just not true
in fact this gentleman Sir Alexander
Fleming the man who discovered
penicillin and the father of modern
antibiotics
he called this 172 years ago in an
interview that he gave with the New York
Times in 1945 to paraphrase what dr.
Fleming said was that as people become
more accustomed to this idea of
antibiotics they’re gonna start thinking
that they need them maybe even when they
don’t and they’re gonna start asking for
them specifically and as we start
handing out these antibiotics more and
more the bacteria are going to continue
to evolve and grow and they’re going to
get smarter and eventually the
antibiotics that we have just aren’t
gonna work anymore and people are going
to start to die we’ve seen that exact
scenario that he talked about play out
over the last eight decades this graph
is an example of perhaps the most
commonly discussed resistant bacteria
it’s called methicillin-resistant
Staphylococcus aureus
you’ve probably heard about it it’s most
commonly referred to as mersa in the
public okay
Merce is not special in any way it
doesn’t show some unusual trend in fact
it’s actually pretty typical of what
we’re seeing with all bacteria around
the world and that is as we expose them
more and more to these antibiotics a
higher and higher percentage of them are
becoming resistant to those antibiotics
and we’re having to move on to find new
treatments and those treatments are
difficult to come by but what’s the big
worry big farmers gonna come and just
save us all right it’s not a big deal
they’re just gonna create some new
antibiotics and they’ll just treat the
resistant bacteria that way yeah if only
it was that simple first of all we need
to talk about the fact that it takes an
extremely long amount of time to develop
a new drug especially an antibiotic
sometimes as much as a decade from
inception to actually hitting the market
then there’s the fact that antibiotics
really don’t make money for the drug
companies think about the way that
medications are used to treat things
like high blood pressure or diabetes
typically when a patient starts one of
those they take them for the rest of
their lives that’s in direct contrast of
the way that we use antibiotics where
the patients usually only take them for
a few days or maybe a few weeks it’s
much harder for the drug companies to
make a profit when you’re taking
something for days instead of decades
and then there’s the fact that when we
do finally get some new antibiotics to
come to market the prescribers that
write for them they usually squirrel
them away and keep them only for their
sickest patients only bringing them out
when absolutely necessary so that they
don’t fall victim to these same
resistance patterns that we’re seeing
with other antibiotics so when you add
all these things up it’s no surprise
that over the past thirty five years
we’ve seen the rate of new antibiotics
hitting the US market dropped from
roughly four per year down to only one
every other year please don’t get me
wrong I am NOT saying that we need to
stop using
antibiotics far from it antibiotics are
miraculous things they are life-saving
medications that we use every day in the
healthcare system
to save people and to treat them but in
order to do that we need to use them
appropriately something has to change in
the cavalier attitude with which we’re
currently treating them think about the
rain forests or rare animals any number
of more popular things that have become
rare and endangered over the last
several decades when we see these things
happen and we all band together as a
united people and we say we need to stop
this before we lose these precious
things and often these often these tasks
of moving towards preserving them are
referred to as stewardship so we find
ourselves at a crossroads we now realize
that creating new antibiotics is
probably not going to be able to occur
fast enough to keep us up with the
bacteria as they evolve and so we have
to forge a new path and that new path is
called antimicrobial stewardship so
antimicrobial stewardship is defined a
lot of ways but it’s often that we look
at the fact that we need to not only use
antibiotics appropriately but we need to
monitor that utilization and see where
we’re going see if it’s making any
improvement and the major goal of this
stewardship effort is that we have good
clinical impact we’re getting good
effectiveness out of the antibiotics and
we’re not seeing under the negative
consequences whether that be toxicities
or increases in resistance so in its
most simple terms antibiotic stewardship
can be described as patients getting the
correct drug to treat the specific type
of infection that they have and the
specific bacteria with which they’re
infected to do that we need to give them
the correct dose and give it via the
most appropriate route whether that be
oral
or injection or something else and we
need to use these antibiotics for the
shortest amount of time possible to
still be effective so now that we have a
general understanding of where we stand
and how we’re stacking up against the
bacteria how can we as individuals as
patients and is just people in this
world becomes stewards of antibiotics
specifically but of our healthcare in
general let’s go back to that car lot
where we started and see some specific
tasks that we might be able to take
really the first question that we need
to answer is do I even need a new car to
begin with do I have an infection at all
and if I do is it the type of infection
that an antibiotic can treat remember
antibiotics only treat bacteria but
things like the common cold or the flu
those are caused by viruses and
antibiotics won’t treat them then
there’s the fact that things like coughs
runny noses ear infections bronchitis
even though these are often caused by
minor bacterial infections they’re often
what’s considered self-limiting meaning
that a healthy person in general with
good nutrition and some rest
they can fight off those infections
without actually needing an antibiotic
at all so what we need to start doing is
having these conversations with our
healthcare providers we need to start
establishing a role of do we need an
antibiotic or is it possibly better to
take a stance of watchful waiting give
it a few days see if we get better
instead of starting that antibiotic on
day one not all antibiotics kill all
types of bacteria it’s very important
that whenever possible we have our
health care providers collect a culture
of some cells from our body that they
can send to a lab so they can grow the
specific bacteria that’s causing the
infection that we have that bacteria can
be
by the lab and then test it against a
myriad of antibiotics to see which ones
kill it best
once the provider has that type of
information they can be very specific in
selecting the most appropriate
antibiotics to kill the bacteria that’s
infecting our body without accidentally
causing some of the other unintended
consequences so as patients we need to
get more accustomed to the idea that
perhaps in the middle of the course of
antibiotics that we’ve been prescribed
the phone’s gonna ring and we’re gonna
get a call from the doctor saying you
know I need you to stop that one and go
back to the pharmacy I know it’s going
to be another copay but this is
important we need to change the
antibiotics that you’re on so that we
can be the most targeted and selective
that we need to so that we can be
healthier people overall and get you
healthy as soon as possible dosing
antibiotics is not a trivial task not
only do we need to take into account the
fact that even the same antibiotic might
have different doses to treat different
bacteria and different infections around
your body but you also need to make sure
that you always share with your
healthcare provider what medications
you’re taking even if those are
over-the-counter medications or
supplements because that sort of
information could really play into the
way that antibiotics are dosed we also
need to realize the fact that every once
in a while we might need some bloodwork
to figure out how well our organs are
functioning where specifically our
kidneys and our liver and every once in
a while we also need to get bloodwork to
monitor antibiotics to see that we’re
getting the appropriate levels in our
body by taking the doses we are without
causing toxicity to us but while still
killing the bacteria appropriately so
now that we’ve established that we need
to take the right dose of antibiotic and
that we need to use it in the most
appropriate way possible we need to talk
about how long we take those antibiotics
certain antibiotics can be used to treat
things such as simple urinary tract
infections and as quick as three days
but some more complicated infections
such as those in the bones sometimes
required
for weeks or even months we need to be
able to have open conversations again
with our providers to discuss do I
really need this prescription for 14
days or even 10 days is there a shorter
treatment course that I could be on that
would be just as efficacious but won’t
put me at risk for any of the downside
that antibiotics can bring and finally
be nice to your healthcare providers
they have your best interest at heart
they want you to be happy and healthy as
much as you do don’t pressure them into
giving you a prescription for an
antibiotic or for any other medication
for that matter
study after study year after year we’ve
seen that they’ll probably just give it
to you if you ask and that’s not good
for you it’s not good for the rest of
the world so going forward be stewards
of your antibiotics take an active role
in your healthcare openly discuss with
your health care providers whether you
have in real infection that can be
helped by an antibiotic what dose of
antibiotic what you need to treat that
infection and what’s the shortest amount
of time that you can be on that
antibiotic while still getting a good
outcome in doing this you can to become
an antimicrobial steward
[Applause]
[Music]
[Applause]
[Music]
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