Antibiotics make you fat

The eye-catching title of my article for the Daily Mail today on why frequent courses of antibiotics may not be such a good idea, highlights a new and emerging set of problem with these drugs.

It’s not just weight gain that becomes more likely. There’s an increase in the risk of auto-immune disorders as well as a drop in your long term ability to fight off infections. But there is more to it.

What the article didn’t go into was the wider underlying problem with an exclusively pharmaceutical approach to health that keeps cropping up, especially if you are sixty and over – when your pill intake can start rising rapidly. The problem is a serious flaw in what counts as evidence based medicine. The same one highlighted in my article a couple of weeks ago on the widely used acid-suppressing drugs known as proton pump inhibitors (PPIs).

The big drug idea in both cases is that you find a problem – infection/heart burn – and whack it – antibiotics/PPIs – and that’s it. Job done. Boxes for passing the science based medicine test all ticked with some controlled trials.

This is not to say they don’t work. They do. Brilliantly. Infection goes away, blessed relief from heart burn. As in any war collateral damage – side-effects – are an unfortunate necessity but a price well worth paying for victory.

Credulous scientific medicine denier

So what’s wrong with that? Part of the problem is what might be called “mission creep” to keep up the military analogy. When a drug works very well short term to deal with a specific problem there is alway marketing pressure to widen its application as much as possible to drive up sales. More side effects emerge and the number needed to treat for one to benefit rises too. PPI’s are a classic example.

A more fundamental problem is the attitude to health that lies behind the casual issueing of prescriptions for drugs that block or affect key body systems. You don’t have to be a wacky, sandal-wearing, credulous, scientific medicine denier to believe that reducing stomach acid to 10% of normal for decades is likely to cause problems.

You just need to have a basic respect for the human body which is a good starting place for promoting health. However such considerations aren’t factored into the scientific medicine model. The assumption is that any such blocking is fine until warning flags go up and even then proving the problem is serious is almost guaranteed to take longer than the licencing.

The asumption that kocking out whole populations of beneficial gut bacteria with antibiotics could be done with impunity is a bit more understandable since their importance has only become come clear relatively recently. But how long will it take before the message filters down?

However the failing of the scientific medicine model goes wider. It only looks at drugs in isolation. True it may flag up harmful drug interactions but its narrow focus on the randomised trial means funds to research what happens when you reduce the effectiveness of two organs at once – stomach and guts – are almost impossible to find. Yet this happens to millions every year.

“Science becomes dangerous only when it imagines that it has reached its goal,” is one of the lines in George Bernard Shaw’s play The Doctor’s Dilemma – currently being revived at the National Theatre. Science based medicine in its present form imagines that it can tell us that antibiotics and PPI’s are safe and effective – it’s becoming clear that for many that is a dangerous idea.