Lab Notes #8: Real Perils in Virtual Healthcare

When Facebook-esque likes drive healthcare, doctors and patients both lose. A recent study in the Journal of Pediatrics (summarized here) indicates that children (and parents, I presume) consulting with a telemedicine doctor received Rxs for antibiotics at a much higher rate than children meeting with doctors face-to-face.

Which begs a few questions:

  • Does the Hippocratic oath apply in telemedicine?
  • What are the risks of antibiotic overprescription for the patient? 
  • How is your medicine cabinet connected to fauna downstream?

Yes, of course the oath applies to all medicine, but the Hippocratic oath is a bit more complicated than “do no harm”–a phrase coined by Hippocrates. The oath itself is a bit more specific:

“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

In brief, then: care relates to benefits and the abstention from that which is harmful. The harm of antibiotic overprescription arrives in multiple forms. Let’s take two–and let’s delight in the fact that research scientists use the term “gut.”

First, a healthy gut ecosystem includes bacteria variety in the trillions and drive our immune functions, metabolism, and our capacity to ward off chronic diseases. (All important stuff.) Researchers in Copenhagen found that antibiotics can completely wipe your gut clean of bacteria. After six months, most of the bacteria returned, but some beneficial bacteria didn’t, and “new potentially non-desirable bacteria colonized the gut.” This antibiotic punch to the gut, then, correlates strongly with obesity, diabetes, asthma and gut inflammatory disorders. Yikes. The original report appeared in Nature Microbiology.

The numbers: the telemedicine industry is predicted to grow at a rate of nearly 15% through 2023. Nice work if you can get it–and I get it. US residents have cellphones aplenty, face rising healthcare costs, and need self-care options in remote locations. The structure of virtual healthcare drives tele-docs to deliver shorter visit times and high satisfaction rates. And what delivers satisfaction? Prescriptions, which are administered too often for viral infections, which–as “Dr. Mike” highlights in a recent video–only work against bacterial infections. The patient’s gut bacteria goes poof in service to the doctor’s social proof.

Second, the human body processes antibiotics with limited efficiency, so up to 80% wash through unadulterated and into the water table–which we can think of as a metaphorical watering hole where plasmids, integrons, and genomic islands (cellular stuff) are the patrons, and antibiotics are the alcohol. Antibiotics disarm the patrons of their natural inhibitions, raise the general rates of mutation and recombination and, in turn, expand the “resistome”: it’s a new term for “the collection of all the antibiotic resistance genes and their precursors in both pathogenic and non-pathogenic bacteria.”

In other words, mischievious prescribing of antibiotics produces new bacteria that humans will be ill-fit to combat naturally or with the help of their doctors.

Stay strong, readers! And thanks for checking in!