Could Western Culture's Attitude Around Antibiotics Increase IBD Risk?

Antibiotic exposure is a risk factor that came up repeatedly during my time at Digestive Disease Week. I mentioned it in my recap of Pediatric IBD sessions, but there were many other sessions where it was a focus as well. 

I surveyed my followers with IBD and about ⅓ of them said they think their onset of early IBD symptoms correlated with a time of heavy antibiotic usage. Of course, this isn’t a scientific study, but I thought it was interesting that this is a factor the IBD community can identify firsthand. The CDC has identified the overprescribing and improper use of antibiotics to be an issue in the United States. In a 2022 study, the CDC reported that at least 28% of all antibiotics prescribed in an outpatient setting were unnecessary. That is 28% of people unnecessarily exposed to a key IBD risk factor.

A lot of our country’s reliance on antibiotics as a first line of treatment can be linked back to the flaws within our healthcare system. Instead of focusing on an underlying issue, our culture is prone to immediately jumping on a “quick fix.” Providers are incentivized to see as many patients as possible. It is easier and quicker to write a prescription and send a patient on their way as opposed to taking a holistic look at the patient’s health to identify other potential causes for their symptoms. This isn’t to fault providers. There are many of them who wish to take a more holistic approach, but the way our healthcare system works doesn’t allow them to. Patients are not blameless in this either. As patients we are conditioned to have a medicine to fix just about everything. If we go to a doctor for a cold and they tell us to go home and get some rest, we leave grumbling about how we made the trip and made a copay just to be told to go home and get some rest. It is almost like we want them to unnecessarily tell us we have a sinus infection so we can get some antibiotics and feel like we are doing something to heal quicker. I have actually heard people leave urgent care complaining that they couldn’t get an antibiotic prescription and planning to just “go see another doctor until they get one.”  Moving away from antibiotic overuse is a cultural shift. It can’t just be on the provider or patient side, it has to be a collaborative effort. 

There also needs to be more openness in the discussion of natural (or non prescription remedies). So often if you mention a natural or holistic treatment, a provider will dismiss the suggestion. Of course sometimes these treatments are totally bogus and not worth your time, but in other scenarios they could have potential benefits with few to no downsides. For many of these holistic treatments, we are still lacking evidence based research that support them. It is responsible of a provider not to suggest something without supporting evidence, but it is also irresponsible for them to shut down the conversation altogether. With the CDC pushing us toward less antibiotic use, will there in turn be more money and research dedicated to other holistic treatments? 

The last factor I want to touch on is insurance coverage for medications. So often, antibiotics are not only a seemingly “quick fix,”  but also a cheap one. Insurance companies are more likely to cover antibiotics than they are any type of alternative treatment. Even if a doctor recommends something like acupuncture to help with sinus pain, it is not likely to be covered under many insurance plans. Do you know what is covered? That 7 day supply of an antibiotic to treat a “potential sinus infection.” 

Again, I want to reiterate that this is not the fault of providers or the fault of patients. We as a society have gotten to this point and need to recalibrate on what is best for our country’s health as a whole. I am also a firm believer that antibiotics are 100% necessary in some situations. I will give my kids antibiotics if they need them. I take antibiotics when I need them. Antibiotics can save lives when used appropriately. Just like so many things in American culture, we have taken them to one extreme. If we can find a way to balance antibiotic use, I predict our society will see positive health benefits. To get there though, we have some big changes that need to be made. 

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