Resisting
RESISTINGMedical
THE MEDICAL
DARK AGE
Professor Chris Del Mar
Professor Paul Glasziou
Alarming statistics have prompted
Bond University researchers to
explore ways of fighting the threats
of overdiagnosis and antibiotic
resistance.
DARK AGE
FEATURE
IT’S said to be as great a threat as terrorism
and climate change, and if you’ve ever
taken antibiotics for the common cold,
you’re part of the problem.
Bond University’s Centre for Research
in Evidence-Based Practice (CREBP) has
been following the problems of antibiotic
resistance and overdiagnosis under a close
microscope since its inception in June 2010.
CREBP Director Professor Paul Glasziou
heads up research on overdiagnosis. He says
that if patients actually understood what
the medical system was doing, ‘we would
have a revolt on our hands’.
Professor Chris Del Mar takes the lead on
research into antibiotic resistance. He warns
that the issues are so pressing that, if they
aren’t addressed, the world will return to a
‘dark age’ of medicine.
“We’re getting to the stage now where
some infections don’t have an antibiotic
available to treat, which means we are
returning to the dark ages in medicine of
the 1930s and earlier,” says Professor
Del Mar.
“People are dying of infections that 20
years ago we were able to treat very easily,
and the number of people dying is huge.
“In America and Europe 25,000 per year
are dying directly because of infections
that can’t be treated, and the same
proportionate number to our population in
Australia.”
Professor Del Mar says common medical
practices could soon be void because of this.
Banking on discovering new antibiotics isn’t
smart either, as he says their development
hasn’t been fruitful over the past decade.
“Many medical procedures such as
chemotherapy, hip replacement or heart
valve surgery could no longer be safe
because they would be too dangerous
without antibiotic cover and infection could
be catastrophic,” says Professor
Del Mar.
“We think a technique called shared
decision-making is very important, where
doctors are frank about benefits and harms,
and we’re currently trying to gain more
evidence about how effective antibiotics are
through systematic reviews, because at the
moment the harms especially aren’t very
clearly articulated,” he says.
“If you look at the information in a coldblooded way though, you can already tell
in most cases of acute respiratory infection
that you are better off not using antibiotics.
“Resistance develops as soon as antibiotics
are discovered, but the good news is that
when we cut down their intake, resistance
also quickly dissipates.”
“They didn’t quite understand how
universal the effects were and how they
also could be contributing to the problem
– around 45 per cent of the Australian
population were prescribed antibiotics in
2013.”
CREBP Director Professor Paul Glasziou
says antibiotic resistance is one of four
big neglected areas of health, the other
ones being non-drug treatments, waste in
research and overdiagnosis, which
have long been his specialisations. As the
focal areas of the CREBP, they all feed into
each other.
“There’s an overdetection, for example, in
what we call cancer but it won’t actually
harm people,” says Professor Glasziou.
Bond University Research Fellow Malene
Hansen has been tackling the issue with
Professor Del Mar since starting at the
CREBP in July 2014.
“Thyroid cancer is one such diagnosis that is
increasing three-fold but its mortality rates
are going down.
Hansen and Professor Del Mar are chief
investigators on a related study that’s
tracking 30 general practices in Queensland,
eight of them on the Gold Coast.
“The issue often comes down to the lack
of global rules for changing the definitions
of diseases and disorders, so when the
definition of something like depression
changes, they don’t consider the benefits
and harms of doing so.
“We’re trying to see if certain interventions
like shared decision-making, delayed
prescribing and visual appeals such as
posters placed in waiting rooms – ‘we do
antibiotics properly’ – are effective,” says
Hansen.
Another Bond Research Fellow, Amanda
McCullough, is a physiotherapist whose line
of work has included respiratory infections
for some time. She says the work is centred
on changing mindsets.
“Across the two systematic reviews we have
undertaken we discovered that most people
thought antibiotic resistance was someone
else’s problem,” says McCullough.
“We are now working with others to set
up a standard for how you define diseases,
otherwise financial interest often conflicts.”
Professor Glasziou equally expects
overdiagnosis to be a big talking point
around federal budget time next year, in
light of the Medicare Benefits Schedule
Review Taskforce being ‘well aware’ of the
problems.
“A blended payment system could be part
of the solution where doctors are paid for
having patients on their books and the
patient gets as much care as they need from
there, which is the Oxford system.”
“The Chief Medical Officer in the UK has
stated that she thinks antibiotic resistance
now poses as great a threat to the West as
terrorism and climate change.”
Professor Del Mar believes the problem
often comes back to general practice,
where doctors feel under pressure to
prescribe antibiotics.
“Patients routinely overestimate the benefits
of treatment and we have a bias towards
doing something, so doctors feel under
pressure to act. Then there are economic
pressures and the perceived benefit of
conducting the consultation quickly.”
Nevertheless, Professor Del Mar says
it should be ‘quite possible’ to reduce
antibiotic prescription in Australian general
practice by 50 to 90 per cent ‘without much
trouble at all’.
BACK ROW: Dr Ray Moynihan, Professor Chris Del Mar, Professor Paul Glasziou and Dr Rae Thomas
FRONT ROW: Dr Amanda McCullough, Associate Professor Elaine Beller, Professor Tammy Hoffmann, Assistant Professor
Chrissy Erueti, Research Administrator Melanie Vermeulen, Dr Malene Hansen
www.arch.bond.edu.au
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