Preserving the Health of the Public and Our Specialty Free

Walensky et al. tackle one of the most pressing challenges facing our specialty [1]. How do we ensure its future? Two important additions to their salient points are worth considering. First, preserving our specialty is a critical public health imperative, driven by the communicability of infections, which differentiates them from all other medical illnesses. Antibiotics—and only antibiotics among all drugs—are a societal trust [2]. Overuse and misuse by individuals cause harm to everyone else in society. Every time we round on antibiotic stewardship, we are reminded of how critical it is that people specially trained in antibiotic use help preserve these drugs and prevent their misuse. Every time a terrifying new disease emerges into the public consciousness (human immunodeficiency virus, Ebola, West Nile, Zika, myriad bacterial superbugs, resistant fungi, etc.), we are reminded how needed people with our expertise are to preserve the public good. As a specialty, we have not successfully branded ourselves, and have not effectively implanted into the public consciousness the uniqueness and importance of our role in the health of the public. This shouldn’t be “about us”; it should be about serving and preserving the public good. This message should be a focus of all of us as individuals, and of the societies that represent us collectively.

Second, the reality is that economic market forces will determine the relative attractiveness of our specialty compared to others over time. But by what means can we ensure that market forces are aligned with recruiting and retaining talent in our field? The authors correctly suggest that enhancing reimbursement for cognitive specialties will help. But how? It is time for us as a specialty to acknowledge that we have not taken ownership over the very instruments that make our specialty so important to the public good. When a new cancer drug is approved, only an oncologist can prescribe it. When the newest, fanciest “bla-bla-bla-mu-mab” is approved to treat a rheumatologic or inflammatory disorder, only the specialists who treat those disorders will prescribe it. But when a new antibiotic is approved, any person with a license to practice medicine, or licensed as an allied health professional, can prescribe the drug. The paradox is striking. Antibiotics are the most powerful, life-saving drugs in all of pharmacopoeia [3, 4]. No other treatments come close to matching their power to reduce morbidity and mortality. And when they are misused, we waste that power—we simply give it away and lose it for future generations. Yet these precious, societal trusts can be prescribed by anyone and do not require any special training or expertise to use.

It’s too late to put the penicillin genie back in the bottle. But at the very least, we should be advocating for statutory and/or regulatory reform for all newly approved antibiotics, such that they can only be prescribed by someone who has been trained or certified to have expertise in their use. Such a requirement will establish an economic driver to align market forces with the need to ensure top talent continues to enter our field, enabling us to steward the health of the public for the foreseeable future. It is time for us as individual practitioners, and for the societies who represent us, to make this a priority issue for policy reform going forward.

Note

Potential conflicts of interest. AcB. S. reports personal fees from Cempra, The Medicines Company, Medimmune, PTC Therapeutics, Tetraphase, AstraZeneca, Merck, Genentech, Forge, other from Motif, BioAIM, Synthetic Biologics, and Mycomed, outside the submitted work. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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