To the editor:
Nutrition Action, the publication of the Center for Science in the Public Interest, has a monthly feature called “Food Porn” that provides commentary on new dietary assaults. In this letter, I would like to address the issue of “surveillance porn” as it applies to patient care and marketing. My biases first: I am a strong supporter of nonproprietary public health–based surveillance of diseases such as influenza1 and have served as a paid consultant for the Wisconsin State Laboratory of Hygiene, a public health agency.
My attention was recently called to a Web site (Respiratory Tract Infection Alert [www.rtialert.com]) that monitors activity of 3 common acute respiratory infections (ARIs)—pneumonia, bronchitis and sinusitis—thus allowing “consumers, physicians and others to stay one step ahead of respiratory tract infections.” This surveillance system, created by Surveillance Data Inc. and sponsored by Bayer, provides week-by-week ratings (0 to 10) of respiratory infections using respiratory tract infection (RTI) incidence data. The sinusoidal curve of RTI incidence on their homepage, in my mind, offers strong support for the viral origins of most ARIs. Nevertheless, one click away sits the “Advice for this Respiratory Season” downloadable consumer brochure.
This brochure blurs the line between bronchitis and acute exacerbations of chronic bronchitis (AECB), directing the reader to antibiotic therapy and citing a reference for AECB therapy.2 Most current evidence, however, points away from antibiotics use for episodes of acute bronchitis.3 For sinusitis, the brochure reader is again directed to antibiotic use: “Early diagnosis and effective antibiotic treatment of acute bacterial sinusitis are imperative for the prevention of chronic sinusitis and associated complications” (referencing the American Academy of Otolaryngology, Head and Neck Surgery, Patient Information, 1996). The value of antibiotics in acute sinusitis, however, is controversial.4
At my last count, there were at least 4 proprietary influenza surveillance systems, 2 associated with rapid antigen test kits and 2 associated with antiviral drugs, as well as this new arrival (associated with a new antibiotic). With the advent of new technologies for diagnosis and treatment of ARIs, I have concerns regarding the potential misuse and misdirection through proprietary surveillance. Subtle changes in definitions or the interplay and substitution of diagnoses (eg, acute bronchitis and AECB) may have significant effects on patient expectations and physician prescribing patterns.
Please use caution in the interpretation of surveillance information and pay attention to the source. Commercial sources of surveillance data may not provide patients with the best and most cost-effective options for disease management.
Jonathan L. Temte, MD, PhD
University of Wisconsin
Department of Family Medicine
Madison