Keeping Our Eyes on the Antimicrobial Stewardship Ball: Dr. Tom Price as the next secretary of HHS

This is a guest post from Judy Guzman-Cottrill. Dr. Guzman-Cottrill is a Professor of Pediatrics at Oregon Health & Science University and also an infection prevention and healthcare epidemiology consultant for the Oregon Health Authority’s HAI Program, where she serves as the Medical Director for Ebola and Emerging Pathogen Preparedness. 

Many healthcare providers ponder what the incoming 2017 administration will mean for their work, including myself. Dan and Eli have already written several blog posts about public health funding threats. As my description above says, I'm a hybrid of sorts: a part-time pediatric infectious disease clinical faculty member at Oregon Health and Science University, and a part-time consultant to the Oregon State Health Department’s HAI program.

First, we’ve all been thinking about our patients and their families. The next administration’s plan for the Affordable Care Act seems to change constantly. During President-Elect Trump’s campaign, he promised to completely repeal the ACA within his first hundred days in office. Post-election, he has suggested that the ACA will be repealed or amended. After meeting with President Obama, Mr. Trump has stated that he will maintain the continued coverage for preexisting conditions and young adult coverage on parents’ plans until 26 years of age. Most recently, however, Mr. Trump selected Dr. Tom Price to serve as secretary of Health and Human Services. What will his leadership mean for our patients, including those who rely on Medicaid and Medicare? Dr. Price has also supported changes which would not require insurers to cover pre-existing conditions. Almost more concerning to me is that Dr. Price is a member of the Association of American Physicians and Surgeons (AAPS), an organization that vehemently opposes antibiotic stewardship legislation, has publicly opposed the IDSA Lyme Disease guidelines on several occasions, and whose executive director has publicly supported a potential link between MMR vaccine and autism as recently as 2015. Important note: It is unclear to me which of these specific stances are also personally supported by Dr. Price. It would be good to know.

What about public health, MDRO prevention, and infection prevention? I already mentioned the AAPS opposition to antibiotic stewardship legislation. Will all of our hard work be left to the wayside? Over the past decade, I've been amazed by the accomplishments our field has made in improving judicious antibiotic use. Our surgical and critical care colleagues are finally starting to feel comfortable with shorter days of antibiotic therapy, and narrower spectrum. Hospitals are starting to fund physicians and pharmacists along with the informatics experts necessary to develop and maintain effective stewardship programs. During clinical rounds, even ID consultants are asking themselves, “Does this patient really need more antibiotics? Or am I prescribing them a personal anxiolytic?!” Stewardship progress is everywhere, including NICUs across the country, partnering with the CDC, to decrease antibiotic exposure in neonates. I worry that Dr. Price, an orthopedic surgeon, will tout stewardship as needless control over physicians who should prescribe antibiotics to whomever, whenever they please.

ID clinicians and public health colleagues, let’s all keep an eye on Dr. Price. We should be strong, vocal advocates for our at-risk patients and our public health programs, to ensure that our infection prevention and healthcare epidemiology work continues into the next decade.


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