The first bacteria in which penicillin resistance was found happened just four years after the drug started being mass produced.
That was back in 1947. Since then, public health officials have seen a number of other drug resistant pathogens increasing worldwide.
The original mental model behind antibiotic use was that epidemics or diseases in general would be less of an issue to public health. When disease is not overwhelming the population, public health is good and the need for antibiotics goes down. In the beginning, antibiotics worked very well against pathogens and doctors would routinely prescribe them, people would take them anytime they were sick and if doctors did not prescribe them, patients would demand a prescription. Over the years and an unintended consequence of prescribing antibiotics so frequently is that some bacteria mutated making it resistant to antibiotics. This is shown by the reinforcing loop in the low left hand side of the diagram. This should also be noted as the delay in initial unintended consequences of the mental model.
Today, we are seeing not only drug resistant bacteria but “superbugs”. Superbugs are the result of drug-resistant pathogens becoming resistant to almost all antibiotics making it harder for health care providers to find treatment options for their patients. Pathogens have become “superbugs” after the once drug resistant drugs became resistant to the alternative antibiotics prescribed to treat the disease. “Superbugs” are especially common in hospitals and nursing homes. The latest problem is MRSA, a staph bacterium that triggers infections so virulent they can turn deadly within days. The effects of “superbugs” feed back into the original mental model that health care providers were trying to avoid- outbreaks of disease/epidemics. When the rate of disease is up, the public health is down and researchers will continue to develop new antibiotics. Unfortunately it will only be a matter of time before those antibiotics become obsolete against pathogens.
I think this is a very interesting topic and a good example of a significant problem in the world of medicine. Your explanation of a specific part of the problem seemed very accurate, showing how the resistant pathogens caused a huge problem. Your mental model is probably pretty close to how public health officials viewed the environment they were in. One suggestion I might make is the variable names do not seem very clear. The way some of the factors were phrased makes it difficult to say whether they were increasing or decreasing. You could fix that by adding something like “the number of” to the names (i.e. the number of superbugs or the number of recorded epidemics). The variable “public health” is also too ambiguous because I am not sure how you would increase or decrease public health. I believe you were talking about if public health was good then that would affect the need for antibiotics, which is a good connection. You might want to change it to the number of public health issues or something along those lines.
ReplyDeleteOne other thing I would have liked to see is the numbers on how widespread this problem was or how this problem was handled in different region, unless it was viewed more globally. Overall I think you did a great job representing this problem and considered the appropriate variables involved. Good causal loops!
Great job Heather, this is a really solid post and an excellent CLD.
ReplyDeleteYour diagram makes great sense, and goes above and beyond because you recognize that not only is there a general reinforcing loop around antibiotic resistant bacteria but a separate reinforcing loop for REALLY BAD "super" bugs.
I see James's point about the variable name "public health", I guess meaning he would like a more specific one like "perception of public health" or "number of sick people", but I think for a general posting/CLD like this assignment, your variables are great. They are all noun phrases, they all contribute to the problem, and they can all go up or down.
As far as your causal connections, they are clear, they all make great sense, and they are backed up well by your text.
Your mental model of antibiotic use and prescription is a good one and, I think, really accurate. I worked in a pediatrics office on and off for four years and what you say about patient demand for antibiotics is 100% true. It's almost as if people realize what antibiotics due over time but are not as concerned with long term consequences as getting their kids sniffling to stop ASAP. This is unfortunate, but I can also understand it because what parent would want to let their kid suffer sick when there are effective treatments out there? It's tough to find a balance between short term and long term gains, and between individual health and overall public health. I think you have captured the complexity of this problem and distilled it down to a nice mental model.
Obviously this CLD and posting is perfect for this assignment, but if you were to expand on this research for a future assignment I bet there are some interesting things you could look at. One would be the consequences (positive or negative) of NOT using antibiotics at all to prevent bacterial mutation, and what effect this would have not only on actual public health but public pressure on doctors to treat patients. Another could be the economic costs of having to constantly do more and more research to defeat "superbugs" that have found a way around the last year's antibiotic, etc.
Anyway, fantastic job, interesting and accurate. Have a great day and I'll see you in class!
Also, sorry I spelled "do" wrong ("due") in my 5th paragraph (haha). My mistake.
ReplyDelete