Health Experts Are Explaining Drug-Resistant Bacteria Poorly

This week marks the first ever World Antibiotic Awareness Week—an effort to teach people about microbes that can withstand our most potent drugs and cause untreatable illnesses. The threat has certainly been getting a lot of media time: Headlines warn of millions of deaths, while health experts invoke an “apocalyptic” threat that’s bigger than terrorism or climate change.

But what happens when these drumbeats of doom reach the ears of listeners? To find out, The Wellcome Trust, a biomedical-research charity based in London, commissioned a consumer-research company to look at what people understand about antibiotics and how best to talk to them about the problem of resistance.

The team interviewed dozens of people around the U.K., from a mix of genders, ages, educational backgrounds, either in pairs or in larger focus groups. Their findings, summarized in a publicly available report, make for disconcerting, fascinating, and ultimately invaluable reading.

For a start, the interviewees largely don’t know how antibiotics work or haven’t thought about it. Most don’t make a distinction between bacterial and viral infections, let alone understand that antibiotics are useless for the latter. Instead, they gauge their need for antibiotics based on the severity of their illness. If they feel really bad, if they aren’t getting better, or it over-the-counter drugs aren’t working, it’s time for a prescription.

“I just know when I have been suffering for two or three weeks that I need more than Lemsip,” said one woman. “They’re stronger than anything else; it has to be antibiotics at this point.”

This makes life very hard for doctors. Patients will kick up a fuss if they are denied prescriptions, or exaggerate the nature of their symptoms to secure one. But very few of them self-identify as someone who badgers their doctors for antibiotics. They feel they know their own bodies, so they only ask for antibiotics when they genuinely need them. And a prescription reassures and vindicates them—it’s proof that they are genuinely ill, and that their disease is treatable.

Their understanding of antibiotic resistance is even worse. The researchers asked them about it and got blank faces in response. When probed—and here’s the bit that really shocked me—almost everyone assumed that it’s the person who becomes resistant to antibiotics, not the microbes. You take enough of something, they reasoned, and your body gets used to it and builds up a tolerance. It’s such an intuitive idea that even after they read simple descriptions that explained how bacteria become resistant, they reverted to the resistant-patient idea.

As misunderstandings go, this is a pretty serious one, because some people reasoned that if they don’t finish their courses, they’re less likely to become “resistant.” Ironically, that decision could increase the odds of developing an actual drug-resistant infection by leaving a pool of surviving microbes that have experienced and withstood the antibiotics.

The fault, arguably, is on us—science journalists, scientists, doctors, communicators, and everyone else who’s beating the drum about this impending threat. We’re not doing it very well.

Doom-laden statements don’t work; the interviewees were far too desensitized to messages of medical doom, and quickly dismissed them as media scaremongering. The term “superbugs” felt abstract and confusing; it made them think about swine flu or Ebola—threats that either seemed to pass with little incident, or happened to people living far away. Statistics about drug-resistant infections causing millions of deaths were hard to grasp, and provoked skepticism rather than concern. “Where do they pluck these numbers from?” one person asked.

The dire warnings and grandiose (but arcane) language only served to make people think of antibiotic resistance as an irrelevant, sensationalized problem that’s unlikely to affect them. Even if they accepted that the problem is real, they were confident that scientists would sort it out. Why engage with it, especially if they couldn’t do anything about it? (Remember that most of them didn’t see their own antibiotic-seeking behavior as anything out of the ordinary.)

A few messages, however, resonated more strongly. When they heard that everyday problems like cuts and scratches, or routine operations like hip replacements and C-sections, could become deadly if infected by drug-resistant microbes, they took notice. These everyday effects, which Maryn McKenna describes beautifully in her TED talk, really hit home. “This is going to affect us all,” said one couple. “My dad had a hip replacement and infection.”

And when they heard that antibiotics might “kill your body’s good bacteria and leave you more susceptible to infections,” some of them started thinking twice about needing or taking the drugs.

Perhaps more surprisingly, they responded strongly to names and pictures of actual drug-resistant bacteria. They’ve either heard of the bugs themselves, like MRSA or E.coli, or the illnesses they cause, like gonorrhea, urinary-tract infections, or diarrhea. Suddenly, these problems felt closer to home. And when they saw images of actual cells, they could picture the threat.

All of this suggests that if scientists and doctors want people to take antibiotic resistance more seriously, they need to change how they talk about it—starting with the term itself.

On the back of the research, the Wellcome Trust has stopped using the phrase “antibiotic resistance” in its public communications. “We say drug-resistant infection,” says Mark Henderson, the organization’s head of communications. “If you change the noun to infections or germs, and make resistant the adjective, you make a huge difference to people’s ability to work out what’s going on. It’s opened my eyes to how much more research we need to be doing on public-health communication.”

And perhaps the best and clearest messages came from the interviewees themselves, when asked how they would explain the concept of resistance.

Bacteria are getting stronger.

Antibiotics won’t work anymore.

You could die.