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

A significant number of patients in the US lie to their doctors to get antibiotics they likely don’t need, according to two new studies. While that may not be a startling revelation, the studies drills down on the phenomenon, finding that the lies patients tell are generally bad ones—and yet, they work almost all the time.

根据两项新的研究，美国有相当数量的患者为了获得他们可能并不需要的抗生素而对医生撒谎。虽然这可能不是什么惊人的发现，但这些研究深入探讨了这一现象，发现患者所说的谎言通常都很拙劣，但它们却几乎每次都能奏效。

In the two linked studies published Friday in JAMA Network Open, a team of researchers led by Alistair Thorpe at the University of Utah analyzed online survey data from over 1,000 adults. They found that over a quarter of people reported having lied to a clinician at least once to get an antibiotic prescription for themselves or a child in their care.

在周五发表于《美国医学会杂志网络开放版》（JAMA Network Open）的两项相关研究中，犹他大学的阿利斯泰尔·索普（Alistair Thorpe）领导的研究团队分析了来自 1000 多名成年人的在线调查数据。他们发现，超过四分之一的人表示，为了给自己或受其照顾的儿童获取抗生素处方，至少向临床医生撒过一次谎。

Patients lied by either exaggerating symptoms, making up symptoms, or—most often—both. But interestingly, the lies people told to get antibiotics involved making up or exaggerating symptoms of infections that wouldn’t be treated with antibiotics. For example, the most common falsehoods were symptoms associated with colds, such as fever, cough, and sore throat. That’s despite the fact that colds are caused by viruses, not bacteria—which antibiotics treat.

患者撒谎的方式要么是夸大症状，要么是编造症状，或者——最常见的情况是——两者兼有。但有趣的是，人们为了获得抗生素而编造或夸大的症状，往往是那些根本不需要用抗生素治疗的感染症状。例如，最常见的谎言是与感冒相关的症状，如发烧、咳嗽和喉咙痛。尽管事实是感冒是由病毒而非细菌引起的，而抗生素只能治疗细菌感染。

Further, while the data suggests many patients were being dishonest, clinicians responded with what could be considered their own form of dishonesty; in most cases, the dubious fibs led to antibiotic prescriptions. Specifically, 77 percent of adult patients and 87 percent of caregivers said their lies worked, leading them to get the antibiotic prescriptions they wanted.

此外，虽然数据表明许多患者并不诚实，但临床医生的回应也可以被视为他们自己的一种“不诚实”；在大多数情况下，这些可疑的谎言最终都换来了抗生素处方。具体而言，77% 的成年患者和 87% 的护理人员表示他们的谎言奏效了，使他们获得了想要的抗生素处方。

“These findings signal a significant issue for health professionals making antibiotic prescribing decisions and for the fields of antimicrobial stewardship and public health,” Thorpe and colleagues concluded.

索普及其同事总结道：“这些发现表明，对于做出抗生素处方决策的医疗专业人员，以及抗菌药物管理和公共卫生领域而言，这是一个重大问题。”

Detailed deception For the study, the researchers reviewed survey responses from 1,371 online respondents and found 959 responses that were valid and complete. Of those, 268 (28 percent) respondents reported misrepresenting their symptoms to get antibiotics. Of those, 108 reported exaggerating symptoms, 19 reported fabricating symptoms, and 141 reported doing both.

详细的欺骗行为：为了进行这项研究，研究人员审查了 1371 名在线受访者的调查回复，并发现其中 959 份回复是有效且完整的。在这些受访者中，有 268 人（28%）表示为了获得抗生素而虚报了症状。其中，108 人表示夸大了症状，19 人表示编造了症状，141 人表示两者兼有。

In a separate analysis of 263 respondents who identified as caregivers, 63 (27 percent) reported misrepresenting symptoms of a child to get antibiotics. The most common reported reasons for lying were that people: felt their illness or the illness of a child in their care was particularly severe; believed that antibiotics were the only thing that would help them; believed antibiotics would help them return to responsibilities (work/school) faster; or felt they should have personal autonomy (thinking they know more about their health status than the clinician or feeling like they should get to decide their own treatment).

在对 263 名自认为是护理人员的受访者进行的另一项分析中，63 人（27%）表示为了给孩子获取抗生素而虚报了症状。人们撒谎的最常见原因包括：认为自己或受其照顾的儿童病情特别严重；认为抗生素是唯一能帮助他们的药物；认为抗生素能帮助他们更快地恢复工作或学习；或者认为自己应该拥有个人自主权（认为自己比临床医生更了解自己的健康状况，或者认为自己应该有权决定治疗方案）。

Those who misrepresented their symptoms tended to be younger and feel their symptoms were not taken seriously by clinicians. They were more likely to believe that antibiotic resistance is a hoax, such as a scare tactic by the government or a gimmick by drug companies to justify charging more for antibiotics. People who lied were also more likely to have more underlying conditions, view lying as more acceptable, and report needing help reading health-related materials.

那些虚报症状的人往往更年轻，并觉得自己的症状没有受到临床医生的重视。他们更有可能认为抗生素耐药性是一个骗局，例如政府的恐吓手段，或者是制药公司为了证明提高抗生素价格合理而制造的噱头。撒谎的人也更有可能患有更多基础疾病，认为撒谎是可以接受的，并表示在阅读健康相关材料时需要帮助。

On the other hand, those who didn’t report misrepresenting their symptoms tended to have greater antibiotic knowledge and aversion to taking antibiotics. For people who reported misrepresenting symptoms, the online survey gave them additional questions about the types of symptoms they fabricated or exaggerated. The most common falsehoods, reported by 65 percent of dishonest patients, were to misrepresent cold-related symptoms. After that were misrepresented stomach symptoms (49 percent), joint or muscle pain (46 percent), eye symptoms (34 percent), rashes and other skin conditions (32.5 percent), urinary symptoms (31 percent), or a general feeling of being unwell (37 percent).

另一方面，那些没有报告虚报症状的人往往拥有更多的抗生素知识，并且对服用抗生素持抵触态度。对于那些报告虚报症状的人，在线调查向他们提出了关于他们编造或夸大症状类型的额外问题。65% 的不诚实患者报告称，最常见的谎言是虚报与感冒相关的症状。其次是虚报胃部症状（49%）、关节或肌肉疼痛（46%）、眼部症状（34%）、皮疹和其他皮肤状况（32.5%）、泌尿系统症状（31%）或普遍感觉不适（37%）。

Respondents could also report not remembering what they lied about. “To be clear, none of these are specific indications for antibiotics,” Jeffrey Linder, of Northwestern University Feinberg School of Medicine, wrote in an accompanying commentary, highlighting that these lies shouldn’t have helped patients get unnecessary antibiotics. “In fact, of the 8 categories offered that patients could have exaggerated or made up to get antibiotics, only 1 of them (urinary symptoms) clearly justified antibiotic prescribing,” he wrote.

受访者也可以表示不记得自己撒了什么谎。西北大学范伯格医学院的杰弗里·林德（Jeffrey Linder）在随附的评论中写道：“需要明确的是，这些都不是使用抗生素的具体指征。”他强调，这些谎言本不应帮助患者获得不必要的抗生素。他写道：“事实上，在患者可能为了获得抗生素而夸大或编造的 8 类症状中，只有 1 类（泌尿系统症状）明确证明了开具抗生素处方的合理性。”

While symptoms of respiratory infections can be due to bacterial infections in some situations—namely, acute sinus infection, strep throat, or pneumonia—those conditions have specific clinical guidance and/or associated tests to confirm the diagnosis, Linder highlights.

林德强调，虽然呼吸道感染的症状在某些情况下可能是由细菌感染引起的——即急性鼻窦炎、链球菌性咽炎或肺炎——但这些疾病都有具体的临床指南和/或相关检查来确认诊断。

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.

普遍的不诚实：鉴于欺骗行为的严重程度，这些发现引发了人们的担忧，即这些通过不正当手段获得的抗生素可能会助长抗生素耐药性感染的增加。众所周知，抗生素的滥用和过度使用会推动耐药性的产生和传播。本周，美国疾病控制与预防中心发布了一份关于抗菌药物耐药性威胁的最新报告，发现耐药细菌和真菌目前每年在美国导致 970 万例感染和 50,800 例死亡。

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 m

但在随附的评论中，林德表示，一个更令人担忧的后果可能是临床医生与患者之间“信任的侵蚀”。林德承认耐药性是一个问题，但他表示，对于个体患者而言，在大多数临床情况下，耐药性的产生“可能无关紧要”。对林德来说，医生必须面对的更相关的问题是：“这份处方更有可能帮助我的患者还是伤害他们？”答案是它更有可能造成伤害；不必要的抗生素不仅没有益处，反而会带来不良事件、过敏反应以及破坏健康微生物群的风险。