Alternatives to drugs

This issue looks at antibiotic resistance, opioid prescribing, and patients' social needs.

There may be no more traditional vision of health care than a doctor providing life-saving medicine, but this issue is all about improving patient health by methods other than handing over drugs.

Our main story delves into the growing, and terrifying, challenge of antibiotic resistance in the ICU. Critical care and infectious disease experts offer their advice on balancing the priorities of treating dangerous infections quickly and effectively and stewarding antibiotics to avoid immediate adverse effects and long-term ineffectiveness.

Additional tips on stewardship of dangerous medications are provided by a feature article on how hospitals are responding to the opioid epidemic. The article describes recent changes to inpatient opioid prescribing practices, including targeted clinician education to reduce opioid prescriptions and increased monitoring for related adverse events.

This month's other feature story moves away from medications to focus on the most basic things people need to be healthy—food and shelter. Recognizing how the provision of these necessary resources can keep people out of the hospital, health systems around the country have launched efforts to help. A speech last year by the Secretary of Health and Human Services suggests that these pilots could be the start of a larger government-funded effort to spend health care dollars on patients' social needs.

Speaking of funding, this month's Q&A and Success Story both look at providing better care at lower cost. The Success Story describes a successful effort to eliminate unnecessary telemetry, while the Q&A looks at whether the way hospitalists are paid might affect the value of their care. If you have thoughts to share on this issue, or anything else in hospital medicine, please send us an email at

Stacey Butterfield