Virumax

Virumax was the name of the fake drug we parodied in the Placebo Journal. Five days of nothing that really does nothing for your virus.  The bottom line is that people who go to the doctor want something for the effort.  They do not like hearing “it’s just a virus”.  A recent article talked about this same issue.   Although almost 90 percent of Americans know that antibiotics are effective for treating bacterial infections, more than a third also erroneously believed the drugs can fight viral infections such as the common cold or the flu.  This comes from a new poll, which surveyed 1,000 adults by phone and more in focus groups, and was conducted by The Pew Charitable Trusts in collaboration with the CDC.  Here are some more results:

  • Only 25 percent of respondents had heard “a great deal” about antibiotic resistance, one-third had heard a “fair amount” and a full 41 percent had heard very little or nothing at all.
  • Even though the majority of respondents knew that unnecessary use of antibiotics could harm their health, less than half realized that this could also harm other members of the community.
  • Many participants wrongly believed that individuals build up tolerance to antibiotics, when it is the bacteria themselves that become resistant.
  • Eighty-six percent of Americans know that the full prescribed course of antibiotics should be finished even when symptoms have vanished, but many said they did not actually abide by this rule.

What disturbs me the most about this is that doctors are to be held accountable for UNPROVEN patient satisfaction surveys.   Trust me, now that I am working in an urgent care I have found that patients are NOT satisfied unless they get their antibiotics.   We are damned if we do and damned if we don’t.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Virumax

  1. Jan Cheeseman
    November 18, 2012 at 10:36 pm

    I believe I have a different point of view on why the public believes they know more than their doctor does. I am a registered nurse, and I work for a company who specializes in chronic disease management. Our “real” customers, the insurance companies, want to save money on ER visits, and admissions to hospitals.
    My company is paid by select insurance companies, to have nurses and health coaches call their members. Our colleagues have the responsibility for educating, and motivating members to change unhealthy behaviors. Motivational Interviewing is the tool we were trained to use. I am still surprised by how ignorant many of the members are about their own health.
    I believe in ongoing health education,from kindergarten through high school. I also believe the best instructors would be healthcare professionals, such as nurses and doctors. I can imagine the hassle of where the money would come from, and what kind of materials could be included, but there has to be a change.

  2. Vance
    November 15, 2012 at 5:03 pm

    Let me join in on this one. This is a great thread- thanks Doug.

    First of all, I’m the antibiotic Nazi. (“NO Antibiotics for you!”) I was even on the cover of the Placebo Journal (heavily photoshopped) and I wrote the 2 page editorial on patient antibiotic entitlement, about how I almost got in a fist fight over it once.

    I agree that it’s getting better- I have more and more patients receptive to waiting a while with conservative care, and I agree that spending time telling them all the bad stuff abx can do generally helps them understand and agree.

    I also find that sending them out with *something* is helpful. Maybe a free nasal sinus rinse kit (NeilMed will send you free samples). Or print them out some patient info on URI’s, off of MD consult or UpToDate.com/patients, and put that in their hand. Or give them a script for some kind of unproven (i.e. Placebo) drug for their symptoms such as cough medicine or something if they clearly want a prescription. If they demand antibiotics, you can also write them a script for your placebo antibiotic of choice (mine is usually doxy) and tell them not to fill it for a week (and you can even note ‘don’t fill before’ dates on the prescription). BUT…there is a cost to this stuff, and that is the bigger issue in this conversation. The cost to getting patients off the abx is spending TIME educating them. We’re expected to see more and more patients in less and less time. How much quicker is it to throw a z-pak at them (or call one in and avoid the office visit altogether) than to set down and really educate them on the risks of unnecessary abx use? That’s at the heart of the problem. Docs are either in too big of a hurry to do it right, forced to hurry so fast that they don’t have time to do it right, or they’re too lazy to do it right. (Or, like me, they do it right and are penalized for providing the correct care by losing money.)

    Lastly, as a happy rural doc (not exactly southern–Northern Kansas), I agree wholeheartedly with Dr. Conrad. Rural life is without question America’s best kept secret. Everyone, please continue to spread all the negative stereotypes you can possibly conceive about rural/southern America. YES, even doctors are inbred hillbillies who sleep with first-degree relatives. YES, our grocery stores mainly carry pigs feet, deep fried crap, and Twinkies. YES, I cling to my guns and religion (actually this one is true), YES all our kids are exactly like Honey Boo Boo (Actually this show is helping my cause immeasurably!) NO, we don’t have running water. YES, Indians still live in teepees and scalp strangers first, and ask questions later. YES we are insanely backwards, and ANYBODY moving here should expect within a week to experience exactly what happened to Ned Beatty in “Deliverance” but probably worse, because Burt Reynolds won’t be there to shoot the hillbilly with a broadhead and compound bow. STAY AWAY! ENTER KANSAS AT YOUR OWN RISK!

    • November 16, 2012 at 9:58 pm

      hey, as someone from the Deliverance part of North Carolina (yes, it was filmed just south of were i live and one of my group’s patients was actually in the movie!) we resemble that comment. but, even rural folks want antibiotics, and even more important in this area, plenty of vicodin for your cough and sore throat…

    • Pat
      November 17, 2012 at 12:42 pm

      Thanks Vance, for helping to spread the “bad” word!

  3. Doug
    November 15, 2012 at 12:21 pm

    While I’m not in an ER or urgent care office..I’m in private practice FP where we do a good portion of urgent care over 16 years….I’m finding people increasingly receptive to not being put on antibiotics. I find they have heard about antibiotic resistance and when I preface my “no antibiotic” speech by saying, “Ya know, we’re having a tremendous problem with antibiotic resistance that’s developed because of the heavy antibiotic use when we didn’t really need it” they are very open to waiting…even moreso when I start referencing side effects, diarrhea etc.

    What would actually facilitate this even more and be a tremendous tool for us in the trenches is a CDC media presence basically saying, “You’re doctor may choose to treat you without antibiotics” and explain why. THis would give the extra currency and clout we need in order to reduce unneeded antibiotics.

    I would also say that an AMA or CDC campaign to do the same thing for narcotic overuse would also be helpful. A media campaign to say, “Your doctor may choose to avoid narcotic pain medicines in treating your condition.” and then review the facts of abuse and overdose deaths. When people can see that and we can refer to that it would be a tremendous tool in fighting against the narcotic difficulties we are having.

  4. November 15, 2012 at 12:04 am

    In the ER/urgent care, we are screwed. It’s patient satisfaction vs. the science of reproducible results…although, I guess those stupid surveys constitute their very own “science” to administrators.

  5. November 14, 2012 at 6:15 pm

    You’re kidding us! As much as has been out there in news articles and even in entertainmant regarding the horrors of such things as MRSA, one would have to be blind, deaf, and dumb to not have heard the “R” in that stands for “resistent”.

    Systemic fungal infections are another risk of excessive use of antibiotics. Mostly, I’ve seen that it’s MDs who give people multiple rounds of multiple antibiotics, then some of these quacks give more antibiotics to “treat” the fungus! Antibiotics are useless against fungus and yeast, as they are to viruses and prions.

    Prescribed antibiotics are only part of the problem, since a great deal of unneeded antibiotics are used in agriculture as well.

    It was in the south though where I went to the hospital and came home with MRSA – I suspect it’s more rampant there.

  6. Bill Ameen, MD
    November 14, 2012 at 11:02 am

    Hi Dr. Doug,
    Now studies show that Southerners get more antibiotics than anyone else in the U.S. Are people sicker down here? I know they smoke more because of lower tobacco taxes. Are doctors more willing to give antibiotics to get patients out of the office? Whatever the reason, the spread of urgent care clinics is probably just going to make the problem worse because people can come right to us instead of giving symptoms time to resolve while waiting for a bloody appointment!! I do a lot of CBC’s to convince people they have viruses! Or maybe, just maybe, Southerners are more stupid than people from other regions! There, I said it, as a Southerner myself!
    Bill Ameen, MD

    • November 15, 2012 at 12:00 am

      Nah, US citizens are accelerating in their collective dumbness.

      Not sure that there is any reproducible finding to show Southerners are any dumber (Katrina vs. Sandy?), but I do wholeheartedly enjoy the spreading of that stereotype. Along with all of us dating our sisters and taking snakes to church, I endorse anything that will give others pause before moving down here. Give me our homegrown stupidity over what the rest of the US is pleased to bestow upon us anytime.

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