The Scan by 2 Minute Medicine®: Overprescribed and Understocked, A Costly Message, A Bad Wrap and Mauna Loa Erupts Again!

The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.

Overprescribed and Understocked

The Story: Ever since a team of Oxford scientists isolated penicillin back in the 1940s, antibiotics have been a staple of the medical system. The so-called “wonder-drugs” revolutionized the treatment of bacterial infections, curing illnesses that once would have led to serious suffering and death. But even in modern society, access to anti-bacterial medications isn’t guaranteed. In the midst of the current pediatric emergency crisis, due to the triple threat of  RSV, flu, and COVID-19, several important medications are running low. Unfortunately, many common antibiotics are now being added to the list of depleted medications.

What are Antibiotics?

Antibiotics are medications that are used to treat bacterial infections. These medications work in one of two ways: they either kill the infecting bacteria (bactericidal) or prevent the bacteria from growing and reproducing (bacteriostatic). Amoxicillin is one of the most commonly prescribed antibiotics and is also one of the latest medications to fall into short supply. Amoxicillin is used to treat a wide variety of bacterial infections, including pneumonia, ear infections, urinary tract infections, and more. Although antibiotics play an important role in our fight against infections, they still come with risks. One study found that antibiotics were the culprit of nearly 14% of all ED visits regarding adverse drug events (ADEs) and the most common cause of ED visits related to ADEs in adults under 50 years old. Over three quarters of these visits were due to allergic reactions. Some symptoms of antibiotic allergy can include red and/or swollen skin, vision problems, itching, and symptoms of anaphylaxis such as wheezing and trouble breathing.

How Common are Allergic Reactions?

Although ADEs associated with antibiotics account for a significant number of ED visits, there are still misconceptions surrounding antibiotic allergies. For example, amoxicillin falls into the class of penicillin antibiotics, which are well known for their high prevalence of allergies. In fact, approximately 10% of Americans report having an adverse reaction to penicillin antibiotics. Characteristics of a true allergy include reactions that occur within an hour of dose administration, hives, angioedema, and anaphylaxis. Even those who have a true allergy tend to outgrow their intolerance, with 80% of patients losing their sensitivity within 10 years. The incorrect labelling of penicillin allergies can result in the need to use different, and sometimes broad-spectrum, antibiotics, which can have important implications on antibiotic resistance.

What is Antibiotic Resistance?

Antibiotic resistance occurs when bacteria develop ways to avoid the effects of antibacterial drugs. This poses a major threat to human health, because as bacteria become resistant to the common medications we use, we could be left defenseless against certain pathogens. Resistance develops when bacteria are exposed to antibiotics, but not at a high enough dose to kill them. This gives the bacteria the opportunity to undergo changes to resist the drug in future encounters. Overprescribing antibiotics, such as in viral infections when the medications are not warranted, can contribute to antibiotic resistance. In fact, some research suggests that a third of antibiotic prescriptions in the United States are unnecessary. Although there is a significant fear of antibiotic resistance, you can do your part in supporting the cause by always taking your antibiotics as prescribed, never skipping doses, and never taking someone else’s antibiotic prescription. Hopefully the current shortage will not only bring awareness to the importance of these medications, but also highlight how best we can do our part to prevent increases in antibiotic resistance.

A Costly Message

Virtual medicine and online technologies have helped the healthcare system adapt to the changes imposed by the COVID-19 pandemic. Technologies like MyChart, which allows patients to view their medical records online and message their healthcare providers, have skyrocketed. However, these accessible technologies are suddenly becoming less so, as the Cleveland Clinic recently announced that they will be billing insurance companies for messages on MyChart that require clinical expertise to answer. Messages that will now be incurring a fee include those related to changes in medications, new symptoms, updates on long-term conditions, requests for completion of medical forms, and more.

Although many of the MyChart messages will be covered by insurance companies, for those without insurance, sending a message to your physician through the secure platform could cost up to $50. The change brings up questions about healthcare accessibility, in a country where approximately 10% of people do not have health insurance and where healthcare inequalities are significant. However, others are highlighting the stress that physicians experience now that they are in constant contact with their patients. Research shows that since the pandemic, messages on electronic health record platforms have increased over 150% and each message is associated with over 2 minutes spent on electronic health systems. There is concern that this added workload may contribute to physician burnout, which can also have negative impacts on performance. As such, many feel that new billing models are necessary to keep up with the post-pandemic demands. Only time will tell the impact of the billing change, and whether other medical centers will also start billing for electronic messages.

A Bad Wrap

Each year Spotfiy releases their annual Spotify Wrapped: a personalized review of each customer’s listening experiences. Although we all love to see how high we rank among listeners for our favourite artists, you might also be concerned with just how much time you’ve spent with your headphones in this year. Research has shown that repeated exposure to loud music, such as blasting your favourite song for the hundredth time, can result in noise-induced hearing loss. In fact, one study found that nearly a quarter of people ages 12-34 are at risk of hearing loss due to listening habits and over 15% of youth ages 12 to 19 already have features suggestive of noise-induced hearing loss. You might be wondering: am I at risk of hearing loss?

Repeated exposure to loud sounds can result in damage to the hair cells in the inner ear– the cells responsible for detecting sound and transmitting it to the brain. Exposure to sounds above 85 decibels can cause this damage and lead to noise-induced hearing loss over time. To put that in perspective: normal conversation is around 60 decibels, meanwhile mobile phones can often reach a maximum of around 110 decibels. Some strategies for reducing the risk of hearing damage include using noise-canceling headphones, trading in the earbuds for over-the-ear headphones, and setting volume limits on your listening device.

While the obvious symptom of noise-induced hearing loss is difficulty hearing, ringing in the ears (tinnitus) and difficulty in school are also common outcomes. Although hearing aids are the most common treatment for hearing loss, new medications are being tested to treat the condition. A drug called ebselen demonstrated the capability in phase 2 trials to reduce the severity of temporary noise-induced hearing loss. Even with advances in treatment, the rise in noise-induced hearing loss is of great concern. It is expected that the cost of treating hearing loss will increase five-fold by 2030.

Mauna Loa Erupts Again

Mauna Loa, the world’s largest active volcano, is erupting for the first time in nearly 40 years. The volcano, located in Hawaii, currently poses no immediate danger to humans. However, local residents have been warned to stay indoors or wear masks due to air pollution that can pose a threat to human health. Pele’s hair, the name for very thin glass fibers produced by erupting volcanoes, can cause irritation and inflammation when inhaled, while volcanic ash and volcanic smog (vog) also poorly impact air quality. Of great concern is the high concentrations of sulfur dioxide contained in vog, which can cause irritation to skin and mucous membranes, such as the nose, mouth, and lungs. When inhaled, sulfur dioxide can cause airway restriction, which is even more pronounced for people with restrictive airway diseases, such as asthma. Prolonged exposure to these pollutants in poorly ventilated areas can lead to suffocation.

Not only do these irritants lead to concern for lung health, but they may also have impacts on cardiometabolic health. Investigations into the 2018 Kilauea volcanic eruption showed that vog has a much wider geographical reach than just nearby neighbourhoods, impacting bigger populations than we once thought. Short-term exposure to fine particulate matter found in vog can lead to heart attacks, strokes, heart failure, and increased blood pressure. Therefore, the current volcanic eruption may have widespread consequences not only on lung health, but also on the cardiovascular system.

Although the active volcano poses no immediate risk to humans right now, residents remain on high alert and prepared to evacuate if necessary. In the meantime, staying indoors and masking remains a priority to avoid irritants and their devastating consequences.

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