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Some kids are getting too many antibiotics, and some Americans are drinking WAY too much

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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

Some kids are getting too many antibiotics, and some Americans are drinking way too much. This is Healthcare Triage News. 


Our first story's about pharyngitis, or sore throats. 

#1: Even when we overtreat, we overtreat
If kids have strep throat then sure, they should probably get antibiotics. Penicillin works great, 'cause resistance is still almost non-existent. But only about a third of sore throats are caused by strep, the rest are pretty much viral, and no antibiotics should be used for that. 
In a study published recently in JAMA Pediatrics, researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1997 through 2010, to look at visits to the doctor for sore throat, and they also looked at whether antibiotics were prescribed. They found almost 12 million pediatric visits for pharyngitis. That's about 200 per 1000 children, or 20%. Sore throats are common! About 70% of the visits were for kids less than 12 years of age. 
You know where this is going, right? 
Antibiotics were prescribed in 60% of the visits. Penicillin, which is all that's needed for Group A strep, was used only 61% of the time. Its use decreased from 65% at the beginning of the study to 52% at the end. 
Since only about a third of those visits likely needed any antibiotics at all, that means that many of the 60% of kids who were given antibiotics, did not need them. Since Penicillin is all that's required to treat strep throat, that means that many of the kids given antibiotics were prescribed a drug that's way more broad-spectrum than they need. Even when we over-treat, we over-treat.

#2: Most people don't drink much

Our second story's about alcohol, and boy it's a doozy. A recent article by Christopher Ingraham in the Washington Post covered some information in a new book called "Paying the Tab" by Philip J. Cook. He used data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine alcohol use in the United States.
Let's start with the fact that the most tee-totalling 30% of Americans drink no alcohol whatsoever. None! The next 10% consume, on average, about one drink a year. The next 10% consume only seven drinks a year.

So if you have two alcoholic drinks every three months, you're likely in the top half of alcohol consumers in the United States. I mean, wow!

The next 10% still drink, on average, less than a drink a week. The 10% after that (putting you between the 60th and 70th percentile) consume two alcoholic drinks a week. To remain in the eighth decile, you still have to drink less than one drink a day.

But then it gets more interesting. The ninth decile consumes, on average, 15 drinks a week, or just a bit more than two drinks a day. The National Institute for Alcohol Abuse and Alcoholism defines "social drinkers" as women who consume no more than seven drinks a week and three in a day. For men, it's no more than 14 drinks a week and four in a day.

That means that even in the ninth decile, it's likely that most drinkers aren't problem drinkers. It's much, much more alcohol than the rest of Americans are drinking, but it's still in the range of okay.

It's in that last decile that things go off the rails. Remember, that the ninth decile consumes 15 drinks a week, but that last decile? 74 drinks a week on average. 74!

A glass of wine with dinner every night puts you in the top 30% of drinkers in America. But to make the top 10% you need to drink two bottles of wine a night, and that would still put you in the bottom part of that top 10%.

We're talking about 24 million Americans here. 74 drinks a week is more than four and half bottles of Scotch a week. It's three cases of beer a week. It's ten beers every day. On average!

These 10% of Americans drink more than half of all the alcohol consumed in the United States every year. These 10% are not healthy. They're costing us a lot of money in health problems, and they're spending a ton on alcohol itself. If those 10% of Americans could reduce their drinking to that of the next decile, then overall alcohol sales in the United States would fall by 60%.

They need help! We should make sure they get it.