Doctors can confuse the heck out of the public. For instance, both of these statements are true:
1) The most important thing doctors can do to protect their patients from acquiring disease in hospital or medical office is to wash their hands before and after seeing each patient
2) People use too much soap and other cleaning products on their children (and probably themselves).
How can both of these be true? It’s because statement #1 is talking about preventing the spread of germs that harm us, while statement #2 is about acquiring the normal germs that everyone needs to promote health.
Our health has significantly improved over the last three centuries because we’ve stopped the spread of pathogens -- bacteria, viruses and fungi – that can harm us.
Clean water is the number one improvement in health – until 1950 Philadelphia (and most everywhere else) poured pure untreated sewage and industrial waste directly into our waterways.
I had a perfect walk down the beautiful Schuykill River Park from Spruce Street to the Art Museum last month and my only worry was that a speeding bicycle would mow me down. In 1930, the city sewers opened directly into the river at Walnut Street and the animal slaughterhouses on the west bank dumped their offal into the same tidal Schuykill at Arch Street. No one could walk down that stretch without being assaulted by the worse stench imaginable and no one living by the river could avoid the infections that the river spread to the adjoining neighborhood. Fewer people have died from germs when you take the improved sanitation along with vaccines and antibiotics, but our idea of what germs do comes from those images of spreading plagues.
Anyone who works in a medical facility has to wash their hands before they enter the patient’s room and when they leave. Even more importantly, they have to wash their hands with lots of water and some soap when they go to the bathroom. The Centers for Disease Control believes that the awful diarrhea and vomiting of norovirus and similar germs that sweep through nursing homes and closed societies such as cruise ships is primarily transmitted by toilet and door handles contaminated by careless people who do not wash their hands. Likewise, baby caretakers have to wash their hands thoroughly after food preparation and using the bathroom, or they can get their children very ill. Raw chicken touched by their mothers is the primary source of salmonella poisoning in infants.
But, as I have said in these pages many times, human beings need good germs (called the human microbiome) to help us digest our foods, prevent the bad bacteria from infecting us and to prevent our own immune system from overacting and causing disease such as asthma, eczema and probably inflammatory bowel disease.
A recent article shows that the baby’s placenta, which was formerly thought sterile actually is one of the sources of the baby’s normal germs. Does giving the mother a lot of antibiotics during pregnancy interfere with this process? We do not know.
An article in the New York Times last month describes people who used a skin tonic that looked, felt and tasted like water, but contained billions of cultivated Nitrosomonas eutropha, an ammonia-oxidizing bacteria (AOB) that is most commonly found in dirt and untreated water. The tonic was supposed to restore the normal skin bacteria that so many of us scrub away.
The researchers insisted that many of us smell bad because we have washed off all the germs that eat up the stinky odors we all make. I know that many mothers use perfumed creams and soaps on their babies and use soap several times a day (all of which can cause allergic reactions and make eczema much worse) when all they have to use most of the time is water.
Sometimes even getting rid of a pathogen can lead to an unforeseen outcome. When I went through medical school, we were told that ulcers of the stomach and small intestine was caused by “stress.” Then 30 years ago, two Australian doctors showed that Helicobacter pylori, a bacteria that lived in the small intestine was the actual cause of these ulcers. So doctors attacked everyone with this germ and any stomach symptoms with prolonged courses of antibiotics, and new doctors have never seen a case of these ulcers in the United States. But H. pylori was attacked by the immune system and when the immune system has nothing to attack, it attacks the normal body. So in societies without H pylori, asthma (which is at least partially an autoimmune disease) frequency has gone way up, almost tripling in some cases.
So, noble readers, wash your hands more and wash your kids with soap a lot less (you can use as much water as you want on your kids). And do not demand an antibiotic when you go to the doctor, but instead question your doctor if he or she gives you an antibiotic about whether it is really needed.
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