No such thing as free antibiotics

[Star Ledger]

Experts: No such thing as free antibiotics
by Amy Ellis Nutt/The Star-Ledger
Saturday January 10, 2009, 10:23 PM
TONY KURDZUK/THE STAR-LEDGER

"FREE ANTIBIOTICS"
And just above the announcement, these words:

"You didn't pay for the germs, why pay for the antibiotics?"

Stop & Shop pharmacies became the first grocery chain in New Jersey to give away free antibiotics starting Jan. 2 to customers with a prescription. Less than a week later, Wegman's announced its own no-cost antibiotics program, and on Friday, ShopRite joined the budding trend.



"People are coming from everywhere," said Shilvanti Patel, a pharmacist at the Union Stop & Shop. "We're getting a very, very positive response from it. Even doctors are calling to find out about the program."

The supermarkets say their aim is to make life easier for customers, especially during hard economic times, but public health experts say they may be making a dangerous situation worse.

Antibiotics are natural and synthetically made substances that fight bacterial infections by killing or slowing down the growth of germs. For years, however, the effectiveness of some antibiotics has dramatically decreased through overuse, which is why public health experts fear the advertising of free antibiotics only encourages their undiscriminating use.

"I'm categorically against it. It's outrageous," said Stuart Levy, a leading researcher in drug-resistant germs and the author of "The Antibiotic Paradox." "We've been trying to curb overuse of antibiotics for years."

Levy emphasizes that antibiotics are never effective against viral infections, and because most colds are viral and not bacterial, the distribution of free antibiotics sends the wrong message to consumers and degrades the reputation of a precious medical resource.

"This shows disrespect for these drugs, to get something this valuable for free," he said. "It makes them look like aspirin or over-the-counter drugs, and it's even worse than that because they're free."

Martin Blaser, former president of the Infectious Diseases Society of America and currently chairman of the Department of Medicine at NYU's Langone Medical Center, agrees with Levy.

"This is a terrible idea," he said. "Supermarkets are doing it to get people into their stores based on an idea that antibiotics just have all these great benefits. But antibiotics have costs, and I don't just mean financial. Widespread use of antibiotics accelerates the development of resistance in disease-causing bacteria and we can't afford that in this country."

Antibiotics, Blaser explained, create a kind of "selective pressure" for resistant bacteria. While the drugs kill off most of the germs that have given rise to an infection, there are always a few mutants whose DNA allows them to ward off the drugs. These "supergerms" survive and re-produce, increasing in number and strength every time they come in contact with another antibiotic.

The free-antibiotics marketing trend began in 2006 with the Michigan-based Meijer store chain, followed in 2007 by Publix Super Markets, headquartered in Florida. Stop & Shop, which has more than 50 stores in New Jersey, announced its program on Jan. 2 (to run to March 21), informing not only customers but some doctors by fax, e-mail and letter.

Within hours after Wegman's announced its program, Ariel Williams, a technician at Wegman's in Princeton, said the store was getting "a lot of calls and quite a few customers."

Jo Natale, a spokesperson for Wegman's, said the idea for the free antibiotics grew out of the success of lowering food prices last year.

"We got such a great response, we wanted to find other ways to help employees and customers," she said. "This is the peak season for these prescriptions, impacting family and children ... So far the feedback has been great."

Wegman's estimates its program could save customers as much as $1 million, although the price of the nine generic antibiotics it is offering free of charge are low-cost. Even without insurance, the drugs vary between $9 and $14 for a 14-day supply.

Natale said the issue of antibiotic overuse was discussed before the company announced its plan, but was set aside.

"We trust that physicians will only prescribe medications when they are needed," she said.

Blaser, however, argues that many times it is the patient, or the parent of a sick child, who puts pressure on a doctor for an antibiotic prescription, even though a large majority of the most common infections are not even bacterial.

"Most ear infections are viral -- 70 to 80 percent -- and an antibiotic provides no benefit," he said. "Same with colds."

Marta Meyers, a physician with Madison Internal Medicine in Morristown, says the supermarkets' programs, "from a medical point of view, shouldn't be an issue. There's still a free market in this country."

While she acknowledges that her profession, in the past, has given out antibiotics like "sugar pills," she adds if doctors are practicing good medicine, the grocery chains' programs should not be a problem.

"It will absolutely not affect the way I practice medicine," said Meyers. "I almost never give out antibiotics for upper respiratory infections because most of them are viral."

But Meyers also is a realist.

"I still think a lot of doctors, especially at walk-in centers and in emergency rooms, are giving them out indiscriminately," she said. "I see it all the time."

Faith Weiner, the senior director for public relations at Stop & Shop, is adamant the company's program is all about helping beleaguered customers.

"We understand the economy is incredibly challenging to people who are not used to being challenged," she said. "We know there are customers who are not filling prescriptions ... and we want to be a solution center."

Weiner said her company, too, had talked about the issue of antibiotic resistance, but felt the program was limited to a time when people were most at risk for infections. Patel, the Union pharmacist, claims no one -- neither doctors nor patients -- has brought up the issue of supergerms or drug resistance, and she does not believe the program necessarily leads to over-use.

"I don't see where people are asking doctors for antibiotics just because they're free," she said.

Infectious disease specialists emphasize the damage caused by antibiotic overuse is not contained to the antibiotic user.

"This is the one drug that's a societal drug," Levy said. "Misuse is not a problem just for the individual but for society. You may not suffer, but someone else will. I think this is a huge mistake in terms of public health. It counters all the educational efforts and improvements we've been making over the past few years. This is certainly not a step in the right direction."

Scientists are still trying to unravel the mysteries of bacteria, the oldest and most successful life form on the planet.

Recent research suggests antibiotic overuse may cause a disturbance in the balance between a person's good and bad bacteria and have harmful repercussions beyond merely the creation of supergerms.

"The body is home to more bacteria than human cells -- about 10-1," said Blaser. "So we're mostly bacteria. Antibiotics affect resident bacteria in ways not completely understood. Some reports show children with asthma have had lots of antibiotics. There are possible connections between bacteria and obesity, and also diabetes. These are all the hidden costs of antibiotic overuse."

For Stop & Shop's Weiner, however, the controversy regarding overuse of antibiotics is something the management of the company decided was best left to the physician.

"We're not passing judgment on who over-prescribes,"she said. "We'll leave the over-prescribing discussion to physicians and patients. This is about supporting people who otherwise couldn't take advantage of the medicine they need."

Blaser's suggestion: "If you want to give something free, give someone a book on preventive medicine. Give things that will improve the public health, not hurt it."

http://www.nj.com/news/index.ssf/2009/01/experts_no_such_thing_as_free.html

[Guest]

The best antibiotics is your immune system that comes free with your body. Stay healthy is the key; exercise regularly, eat healthy foods, play safe, and "don't worry be happy".