Over 25% of people lie to get antibiotics—and their lies aren't even good

Dishonesty all around

Given the magnitude of the deception, the findings raise concern that the ill-gotten antibiotics could contribute to the rise of antibiotic-resistant infections. Misuse and overuse of antibiotics are known to drive the development and spread of drug resistance. This week, the Centers for Disease Control and Prevention released an updated report on antimicrobial resistance threats, finding that drug-resistant bacteria and fungi are now causing 9.7 million infections and 50,800 deaths in the US each year.

But in the accompanying commentary, Linder said that an even more concerning consequence may be the “erosion of trust” between clinicians and patients. Linder acknowledged that drug resistance is a concern, but said that on the basis of an individual patient, in most clinical circumstances, the development of drug resistance is “probably irrelevant.”

To Linder, the more pertinent question doctors must face is: “Is this prescription more likely to help my patient or hurt them?” The answer is that it’s more likely to hurt; unnecessary antibiotics provide no benefit, but pose risk of adverse events, allergic reactions, and disruption of healthy microbiomes, which can provide an opening for opportunistic pathogens, such as Clostridioides difficile (which is classified as a “serious threat” in the CDC’s newly updated antimicrobial resistance threat report.)

“For these non-antibiotic-appropriate diagnoses, prescribing antibiotics is medically incorrect and could itself be considered a form of dishonesty or lying mainly to assuage the patient,” Linder wrote. That dishonesty is corrosive, he said, quoting philosopher Sissela Bok, who wrote extensively about lying and, even specifically, about lying to get antibiotics. In 1978, Bok noted that antibiotics are “sometimes used as placebos” and many parents “come to believe that they must ask for the prescription of antibiotics every time their child has a fever or a cold.” But Bok argued that when clinicians prescribe medications more likely to harm than help, such “practices lacking in candor” threaten “the entire institution of medicine.”

Linder concludes by reminding readers that “Clinicians’ obligation is to act in patients’ best interest, even if patients are hoping we do something different, even if patients do not like it, or even if patients lie about their symptoms.”

Thorpe and colleagues, meanwhile, conclude with a call to address the reasons patients lie in the first place, writing: “Strategies to improve communication about antibiotics are needed to address patient concerns, support understanding of appropriate antibiotic use, and strengthen patient-clinician relationships.”