11 Mar Strep and Rheumatic Fever : Not

My cousin Ed brought his daughter Arianna to visit for my daughter’s birthday. Ed has had a very deep influence on my thinking. About 25 years ago we went for a run together and he talked to me about his study of the history of physics. He explained that as scientists get a deeper understanding of something, the science becomes increasingly specialized. As such the scientists working in the different fields become less connected with each other. This leads to such a specific focus that the whole picture gets lost in the mix. The focus is on such exacting threads of complexity that balance is lost and there is no one who can see, or comprehend, the quilt that is formed from those threads.

This idea has stuck with me on a very deep level, and I use it as a device to help me to step out of the frames that shape not just our thinking about science, but about life in general. We were talking about life, and our film “Story of Pain” this weekend. My wife and I have two daughters; Fiona, who is wildly expressive of her feelings and Harper who is not. Fiona rarely gets sick, and when she does she gets better with rapidity. Harper used to get strep a half dozen times a year, and it often seemed like she would never get better. At a certain point we got more and more worried about the amount of antibiotics she was taking. I did some research about antibiotics and strep and found two important pieces of information. The first was that the reason that antibiotics are recommended for strep is that there is a fear that it can lead to Rheumatic fever. The other piece of information was that strep resolves itself on average about 16 hours faster if one takes antibiotics. It is also suggested that people wait 24 hours after taking antibiotics to go back to school or work to avoid transmission.

Each time that we take antibiotics our resistance to them grows, as does our societal resistance. As such, I was reticent to give them to her because her incidence of getting strep kept increasing. I went back to look at the information on rheumatic fever and all I could find was a 1940’s study on a military base in which 3% more of the people who had strep and didn’t take antibiotics got rheumatic fever than those who did take them. This was it. This was the data that led to standard care calling for antibiotics to ward off rheumatic fever.

As our younger daughter Harper began to mature, and become more comfortable in school, and with herself, she got strep less and less. She had it once this fall, and we didn’t give her antibiotics. She was sick for a couple of days and she got better. Ed knows that I have a chip on my shoulder about the orthodoxy that turns science into a religion. So when I talked about not giving Harper antibiotics he cautioned me not to throw the baby out with the bathwater; that I shouldn’t ignore the long held understanding that it was dangerous to not take antibiotics. When I told him about the lack of data supporting antibiotic use he simply couldn’t believe it. He gave me a lot of push back, so we sat down at our computers to look. As a history of science professor at Notre Dame, he has access to science literature that I don’t. He couldn’t find anything either.

Ronald Reagan said “Trust but verify”. I think that in order for our medical system to work more effectively we need to ask some harder questions so that we can verify things more fully. We need healers who can look at the whole person. There are reams of studies that tell us very clearly that when we are under stress we are more susceptible to illness, and heal more slowly from wounds. This is not to say that stress causes illness instead of viruses and bacteria. However, there is a relationship between our ability to ward off and heal from illness that is related to our emotional/mental state. Doesn’t it make sense to have a medical system that figures out methods to help us understand this connection and treat us based on it? If instead we pretend that the mind and the body are not intimately related, we will continue to suffer needlessly.