How Norway Fought Staph Infections 595
eldavojohn writes "Studies are showing that Norway's dirtiest hospitals are actually cleaner than most other countries', and the reason for this is that Norwegians stopped taking antibiotics. A number of factors like paid sick leave and now restrictions on advertising for drugs make Norway an anomaly when it comes to diseases like Methicillin-resistant Staphylococcus aureus (MRSA). A Norwegian doctor explains, 'We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better.' Norway is the most MRSA free country in the world. In a country like Japan, where 17,000 die from MRSA every year, 'doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.'"
Stop with the drugs already (Score:5, Insightful)
Re: (Score:2)
The American psyche (and that of some other countries) has learned that nothing can be done on its own, though: anything bad is medicalized, and anything medical needs either a pill or surgery to solve it.
Re:Stop with the drugs already (Score:5, Insightful)
No doubt, it's part of the incredible healthcare costs in the U.S.
Compared to when I was growing up, it seems that people go to the doctor for even the most trivial complaint these days. The fevers I had as a child that got "we'll give it a day or two and see how it is" are now treated like some sort of emergency. Cuts and scrapes that used to mean some iodine and a band aid are treated as if they were an emergency.
I haven't had medical treatment of any sort in over 20 years. It's not that I'm some sort of superman, just that I don't buy in to the hype.
Re: (Score:3, Insightful)
My father is a Doctor, so I'm not even sure what it would have been like growing up any other way. It basically meant that we could easily "ask a doctor" for something trivial, and not actually have to go see one unless it actually was serious enough. Kinda got spoiled that way, and also helped to avoid unnecessary treatment.
Some day when I have kids, I really do wonder how I would react given a lack of at-home medical advice.
Re:Stop with the drugs already (Score:5, Insightful)
Also with your father being a doctor, he has incentive to give you medical advice which is in your best interest, rather than the advice which makes him the most money (as mentioned in the article)...
Re:Stop with the drugs already (Score:4, Insightful)
This mechanism has been weakened in the modern era, though, because the one who determines whether or not the doctor is good or not is often only paying indirectly nowadays (either through insurance or government). The patient doesn't directly see the costs, and therefore has less incentive to seek out better care, If the illness is not severe enough.
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... and insurance company ...
It's in the insurance company's best interests to make healthcare as expensive and scary as possible. After all, you might break your leg some day and then who knows how many thousands of dollars that will cost you. Oh, btw, your premium is increasing to $1000/mo. Cost of healthcare going up and all that.
Re:Stop with the drugs already (Score:5, Insightful)
Not all non-life-threating illnesses help build your immune system. I'm sick and tired of this idea that the immune system is like a muscle that you can build up over time or weaken by taking antibiotics. This is a failure on the public's part for understanding how the immune system actually works.
MRSA would have exsited with or without antibiotics. It is all just a matter of time. Things evolve, get use to that fact. So do immune systems. If I could point to a large contribution to the flood of antibotics, it would be peoples lack of understanding of how medicine works. People walk into a doctor's office and say, "fix me, fix him, fix her, fix us..." They want instant results, not results that take 24, 48, or 72-hours to take effect. Doctors, as much as they would love to tell you, can't say you're over reacting go home and call me in a week. That's an awsome way to get sued in the US. The moment that people come to the understanding that the only medication that develers instant results is used in leatal injections, will be the opprtunity to educate people to just, "take it easy, stay home, get rest, drink plenty of fluids, and go to the hospital or follow up with your doctor if your symtomps presist or get worst."
People and the "instant get better" thought process are the real problem of over medication. If no one shows up to the hospital, how do we over medicate? MRSA is just another evolving part of nature, nothing can be done about that. And I dare say that antibiotics do not work the way that you so claim them to work. I would like to see the person who has acquired immunity to something that is treated with antibiotics like Gengreen.
Re:Stop with the drugs already (Score:5, Insightful)
MRSA would have exsited with or without antibiotics.
Do you even know what MRSA means?
Re:Stop with the drugs already (Score:5, Informative)
A poor wording, admittedly, but the GP is right that even without widespread antibiotic use, MRSA would still exist. It just would not be a prevalent strain, as it would not have any advantage over all the other, non-resistent strep strains, so it would be maybe one bacterium out of every thousand instead of better than one in two. Same goes for C diff and other problematic strains. Whether that's a meaningful distinction or not is another question.
Re: (Score:3, Interesting)
Beta lactam antibiotics are derived from a naturally occurring substance. In the true spirit of evolution, an organism may produce a substance that inhibits its competitors in the ecological niche it occupies. This gives it a competitive advantage. Likewise, if an organism mutates to become resistant to this substance, it can reassert itself i
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It's not just humans that want/need to kill undesirable bacteria.
fungi, bacteria etc have been killing each other for the past billion years or so.
I think he does. (Score:5, Informative)
The GP poster had a very well thought out, and reasonable argument. For those who do not know, MRSA is Methicillin Resistant Staphylococcus Aureus - a "resistant" version of a common skin flora bacteria that everyone has. It is resistant to the common penicillin (PCN) antibiotic families, and thus has to be treated with another antibiotic, that breaks down the bacterias cell wall in a different way, with an antibiotic such as Vancomycin. MRSA is comonly found now in gyms, locker rooms common surfaces, etc, but there are multiple strains of it. THe whole culture of having germicidal stuff in all our cleansers and soaps, doesn't help either.
MRSA first surfaced in Japan, where antibiotic (ABX) treatment of anything, was over prescribed, and thus developed there. As far as the USA goes, he is correct in the assumption in that people will undoubtably sue for appropriate behavior like that. People sue for anything nowadays.
Re:Stop with the drugs already (Score:5, Informative)
No, MRSA would not have EVER existed without antibiotics. It is a specific set of mutations that reduce the overall vitality of the bacteria in exchange for resistance to antibiotics. Without antibiotics, MRSA would be at a distinct evolutionary disadvantage over regular old SA. Things do evolve, but they evolve towards greater fitness, not lesser. The less frequently SA is in the situation where methicillin resistance is a deciding factor in survival, the less advantageous resistance to it will be. If those situations only happened where an infection was actually life threatening, the resistance wouldn't have evolved. Many people would have an extra day or two of infection (and fewer medical bills) and those who have a SERIOUS infection would have a MUCH better outcome.
As for the immune system being like a muscle that needs to be exercised, there is a decent and growing body of evidence to support that conclusion and even a good idea of the mechanisms behind it.
I agree that patients with an instant fix mentality to minor illnesses (that can't be instantly fixed anyway) are a part of the problem, but on the other hand, they are simply deferring to the experts like they are told to.
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They want instant results, not results that take 24, 48, or 72-hours to take effect. Doctors, as much as they would love to tell you, can't say you're over reacting go home and call me in a week. That's an awsome way to get sued in the US.
You meant "lose a little business in the US." That's what drives the overperscription, not fear of being sued. Doctors get sued for malpractice for everything, and IANAL, but I think refusing to prescribe unnecessary antibiotics is one of the easier cases to win. It's about greed, not fear of liability.
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Re:Stop with the drugs already (Score:5, Informative)
Endure non-life-threatening illnesses without drugs, it helps you build an immune system. Taking drugs means your body never learns to fend for itself, like a spoiled brat.
Sigh....will the non-trained, please refrain from discussing what they don't know?
As a physician:
A) I have little financial incentive to precribe any given antibiotic. No one pays me to give out X number of Zosyn(tm) or Y number of Levaquin (TM) prescriptions per month. Most antiobiotics have limited roles and you can't just throw any drug at an infection.
The most I get is some free pizza to listen to new drugs that are being released or for new indications for existing antibiotics. And trust me, these guys don't sway my opinion very much....the best argument I hear is that this drug has to be dosed fewer times a day which equates to better compliance both for out-patients and in-patients.
B) I do often get requests for antibiotics from patients, family, or other allied-heathcare workers and nurses.
My standing advice for the things that sound like a cold or the flu is to treat it that way for 2 weeks. If someone gets worse, or dosen't get better, they need to see me, or someone else in a professional setting.
C) I see a large amount of non-complicance with antibiotics....just because you feel better, don't stop taking the antibiotic!
D) That being said...there is also a large amount of debate and very poor data on what are the optimal durations for different types of infections (these are mostly _complex_ infections with poorly localized sources, or difficult to treat sources like bone-infections (osteomyelitis)).
E) One must be careful in certain situations that seemingly simple infections not treated with antibiotics may, on occasion, _rapidly_ become dangerous infections. I have lost count of the number of cases where "It was just a pimple three days ago" and now the person comes in with an abscess the size of a golf ball, or a case of necrotizing fasciitis (aka flesh eating bacteria).
F) there is an amazing amount of ingnorance about the difference between a viral (cold, flu, measles) infection and a bacterial one (pneumonia, abscess, cellulitis/fasciitis) to name just a few.
So how do I sum up my issuses?
1) Yes as a whole we do prescribe too many antibiotics...but mostly because of outside pressure....the patient, the threat of a lawsuit... or the fact that an unhappy patient will just so shopping somewhere else for what they think they need...which leads to:
2) Most people are poorly informed about basic medicine. The think they know more than the doctor....and yes you may know _your_ body better than I, the 4 years of medical school and 7 years of residency I have endured means that I know the average body better than you, and I know one hell of a lots more about the things and aliments that affect your body than you do. Which leads to:
3) Don't play doctor. You should have stopped that by the time you left the 1st grade. If something isn't right, get it checked out. It is better to treat in the early stages of a disease rather that trying to salvage a patient who has left some thing go. Now this doesn't mean come to my office at the drop of a sniffle, rather use good judegment that when something doesn't seem right...get a professional opinion.
4) While we may not have all the answers, our training is usually better than then your opinion. If you disagree, please ask questions. Most physicians cut to the chase and give you the treatment....if you don't understand or feel you need to know more, or don't agree with the treatment...say something. I love explaining things to patients....within reason....you're not going to get a medical school education in one office visit.
As a patient you should learn about your health from a reputable source. Not every website is worth the electrons used to transmit it....
Sites like emedicine, mdconsult, or webpages from most hospitals or professional (and I mean
Re:Stop with the drugs already (Score:5, Funny)
Lies,
That writing was far to neat for any kind of doctor.
"The Cult of the Amateur" is real. (Score:3, Insightful)
Thank you for the great comment!
I would like to suggest that your "don't play doctor" point is actually part of a much larger problem in our culture these days: a lack of respect/understanding of education/training. They look at you and think, "This just looks like some guy/girl. What makes him so special? I'm a precious snowflake." Well, what makes a physician special is tons of education and a license to practice medicine granted by experts in the field. Yes, experts. They exist. However, increasingly,
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It's funny reading your message because I deal with doctors while working are they are the worst, the WORST, at respecting the expertise of other disciplines.
Second of the list? Lawyers.
The plural of anecdote is not data... (Score:4, Interesting)
I recently went to India with friends and was the only person not to get Sick.
Every single one of my travel companions had the GermX out and sanitized their hands after they did ANYTHING. When I separated from the group for the second half of the trip, I don't even think I washed my hands most of the time. I had a GREAT time walking out beyond the tourist traps into the 'old city' and trying stuff in the little shops. The Indians looked at me like they had never seen a white person trying 'their' food and the white people I told the story to just kept telling me "You're going to get sick. You're going to ruin your trip." (As they excused themselves to rush back to the bathroom). The water in the mountains (Sikkim) tasted... nothing short of amazing. It put all the bottled water to shame.
I live the bachelors life and grew up in a dirty ole farmhouse. Sour cream/Jelly/AppleSauce has mold on the top? Scrape off the top and eat the rest. I've accidentally left milk out during the day and just come home, swish it around and put it back in the fridge. (As long as the taste isn't affected too much.) Unless I'm cooking for or around other people or expected to shake hands etc, I rarely wash my hands. Hell I'll go from #2 to the dinner table as long as the TP didn't break. Growing up I ate dog food, with the dogs, rolled around in the mud and put who knows what into my mouth.
And guess what. I'm NEVER sick. No headcolds, no flus, no coughs, no phlegm. I'm not allergic to peanuts or other household items because my body is bored (it's just a theory). Compared to my college roommate, who grew up in what sounded nothing less than a clean room, who was sick when the weather changed. HAD to have the bottom bunk because of random nose bleeds in the middle of the night. Took a dozen or so pills for everything and still was always sick. Went through tissue paper at a box a week.
Re:The plural of anecdote is not data... (Score:5, Insightful)
Re:The plural of anecdote is not data... (Score:5, Interesting)
Please, please, please stop repeating that "your immune system is fragile/angry because Mommy and Daddy didn't love you enough to let you crawl on the dirty kitchen floor" BULLSHIT. Your personal health history is just one data point. Just because you lived like a pig as a child and you now have very few health problems doesn't mean that theory applies to everyone.
I grew up exposed to plenty of mud, dirt, animals and hay. Guess what? I am allergic to nearly everything that my asthma doctor has tested me for. Trees, pollen, animal dander, etc. I also take medications every day to keep my asthma in check. Why didn't the mud and dust and the hay loft impart a Superman-like immune system to me? Because your theory is BULLSHIT. I know why I have the health problems that I have: genetics. I inherited these "features".
Another data point for your "clean kids are sick kids" theory: While I am alllergic to just about everything and I take Advair morning and night to keep my bronchii happy, my brother has none of these issues. We grew up in the same house, exposed to the same mud, wood smoke, hay, grass, etc. Why am I allergic to a great number of things when my brother (just a few years younger than me) is allergic to nothing and had never had a problem breathing in his life? Explain that one to me... The answer is genetics, not exposure to mud.
>Compared to my college roommate, who grew up in what sounded nothing less than a clean room, who was sick when the weather changed. HAD to have the bottom bunk because of random nose bleeds in the middle of the night.
Your college roommate probably grew up in a "clean room" because his parents found out early in his life that he had certain health problems and made adjustments to his living conditions to minimize his symptoms. Did he grow up without carpeting in his bedroom? No stuffed animals? No pets in the house? Did he have to wash his hands after petting the neighbor's cat? Was he told to stay out of the hay loft? These are most likely reactions to his health problems and definitely not the cause of them. He lived in a "clean room" because it was one of the ways to minimize his symptoms.
I am very glad that you have excellent health. But please stop spreading that "clean kids will have weak immune systems" myth. Thank you.
Re:Stop with the drugs already (Score:4, Insightful)
Re:Stop with the drugs already (Score:4, Interesting)
Vaccines and antibiotics are fundamentally different (flu shots and other vaccines are not part of the superbug problem), but the mindset remains the same.
Actually, they're opposites - popular culture pushes people away from vaccines (the second most effective medical intervention in human history) because they "cause autism" and other such nonsense, and toward antibiotics (that generate superbugs) even for viral infections that they're totally ineffective against.
The logical, manipulative answer is obvious - tell a bunch of uneducated celebrities that vaccines don't cause autism, but that antibiotics do cause it. :)
Re:Stop with the drugs already (Score:5, Insightful)
It appears that years of media scaremongering and anti-vaccine lobbies have gotten through the youth crowd quite effectively.
Re:Stop with the drugs already (Score:4, Insightful)
Please do explain to me what you mean by "anti-vaccine lobbies." A lobby or lobbyist is a representative of a monied interest. What monied interest out there profits from NOT selling something? Because the anti-vaccine idea is all about not purchasing vaccines. Please tell me who these lobbyists are.
While I don't agree with the notion that only financial interests can be considered lobbyists, in this case we can certainly identify such interests. Notably in Norway a campaign agains the H1N1 vaccine was fronted by individuals that were making money of selling various more or less bogus 'natural' or 'spiritual' remedies against the illness. They clearly have a financial interest in attempting to discredit scientific medicine as it is in direct competition with their offering.
Re:Stop with the drugs already (Score:5, Insightful)
Please do explain to me what you mean by "anti-vaccine lobbies." A lobby or lobbyist is a representative of a monied interest. What monied interest out there profits from NOT selling something? Because the anti-vaccine idea is all about not purchasing vaccines. Please tell me who these lobbyists are.
I'm not the OP, but I can probably answer that question for you. There are several "Anti-vaccine" groups that have a lot of money and could be considered "Lobbyists".
1. The well meaning, but ultimately wrong, "Vaccines cause Autism" group. I don't know that they actually have a formal lobbying group, but they are numerous, vocal, and have several politicians at least paying lip service to them.
2. The "Anti-modern Medicine" folk. They are a sub set of the "Anti-modern Science" population that don't trust what they don't understand and have made an emotional (thus irrefutable) decision to go back to old style medicine. That old medicines either didn't work, or worked becuase of chemical compounds that are the basis of many "Modern" drugs is a fact lost on them based on the origin of their decision (Emotion vs. Reason).
There is a lot of overlap between the groups, and collectively there is a lot of money involved. Many of those that vocally espouse either view point are not actually believers, but cynical con-men who are selling all of their dupes vials of distilled water and passing it off as a better "Safer" alternative.
I'm not saying I disagree that the case for Swine-Flu was overblown. I go the vaccine, but only because I have a 4month old at home, who's immune system isn't developed enough to handle any flu (I got the seasonal flu vaccine as well). However, before this year I'd never gotten a flu vaccine, and I've seen some pretty convincing explanations on why we shouldn't bother giving it to the elderly, the group that everyone says needs it most (Hint: rates of flu fatalities in the elderly have not changed since before the existance of the flu vaccine).
More on what the OP said. Vaccines and antibiotics are different. Vaccines exercise the immune system while minimizing the risk of severe problems, whereas antibiotics fight infection on behalf of the immune system potentially reducing the immune systems effectiveness on repeat challenge in the future. I've been of the opinion that antibiotics are abused by human medicine, and the cause of MSRA like "Super-Bugs" and not any of the usual scape goats. However, I have to admit that I'm involved in animal agriculture and understand why and when antibiotics are fed to animals, one of the popular whipping boys in the EU and increasingly in the US.
[Soapbox]That direct administration of antibiotics in a reckless manner to humans cuts out several degrees of separation between potential antibiotic resistance gene appearance, and the human population seems to be lost on anyone involved in policy. That the complete ban of antibiotic use in animal agriculture in the EU almost a decade ago hasn't resulted in any changes in the prevalence of antibiotic resistance gene prevalance or rate of spread in either the livestock or human populations is very telling, but being ignored for the most part by the legislator both in the EU (who'd have to admit they were wrong in order to reverse there knee-jerk decision) and to a lesser extent the US (who are simply ignoring the science so that they can jump on the bandwaggon being driven by the EU). Hopefully they'll see this as further confirmation that HUMAN use of antibiotics like candy is the primary problem and legislate accordingly, but I doubt it.[/soapbox]
Re:Stop with the drugs already (Score:5, Insightful)
Modeling shows that use of antibiotics in livestock at worst will decrease the amount of time it takes for a resistance gene to appear by 2 to 5 years (they will appear anyway, it's just a matter of time). Whether the appearance is either as a result of a novel mutation or of selective pressure in favor of a previously existing gene is immaterial (although the later is more likely). Once the gene appears and enters the human population (transfer to the human population is slow are rare, because the species that can set up permanent or semi-permanent populations within the intestines of human and swine are surprisingly different) the rate of transfer between humans is no different than if the gene originated in humans. It's not the existence of MRSA that is the problem per se, but the occurrence of MRSA in immune compromised populations like the elderly, who spend a lot of time in hospitals where MRSA is almost ubiquitous. MRSA poses little risk to a healthy adult.
It is the excessive use of antibiotics by human medical professionals that have turned hospitals into islands of MRSA. And it is the usual lack of generally good hygiene that results in MRSA spread between individuals outside of the hospital. The best suggestions I've seen for guidelines are to ban the use of New classes of antibiotics in animals until we start finding bacterial strains that are resistant in humans. By that point the horse will already be out of the barn and use in animals will cause no further risk to humans. However, the last draft I saw of the regulations proposed by the FDA was to let antibiotics be used in animals UNTIL the appearance of resistant bacteria, and then a complete ban (around 2004). I don't know if the FDA's guidelines have been revised, but I do know that there are several Democratic Representatives that keep trying to slip an EU style ban into unrelated bills as a rider.
Eliminating the use of antibiotics in livestock for which resistance genes are already common is pointless. The genes are already in the human population and a ban does nothing to stop their existence or spread. All you do in that case is increase the production costs of animal agriculture by increasing weaning mortality, days-to-market, feed costs, management costs, etc. This has been shown to be true in the EU. No reductions have been see in resistance gene prevalence in livestock, their handlers, or the general population as a result of the ban, and despite 2-3 years with similar performance to that pre-ban, all of the production criteria I mentioned have experienced a decrease since then. A lot of money is being spent trying to find alternative to antibiotics, but nothing has come close to matching it and that money could be better spent on finding new antibiotics or in some other area of research.
Re:FDA is somewhat right (Score:4, Informative)
No it doesn't. Other selection pressures completely overwhelm it. It's a bit like why humans don't grow bone armors despite this making them more resistant to bear attacks: bear attacks are too rare to cause a selection pressure strong enough to overcome the downsides.
Antibiotics originated from the ecosystem. Penicillin was named after the mold that produces it, a common enough mold that some got into a petri dish accidentally.
Re:Stop with the drugs already (Score:4, Insightful)
People with breathing issues should be cautious.
Actually, that might be a good enough reason for other people to get vaccinated as well. Even if it's mostly people with risk factors that develop serious cases, having more people vaccinated reduces the spread of the flu in general, and that will mean fewer people with risk factors will catch it as well. The group of people who are at risk is not isolated from the rest of the population so their risk is not independent of how the flu spreads in the population in general. The normally healthy person might have a rather mild case himself but someone with higher risk could still contract the virus from him, and that's all the more likely if more people around them are infected. Also, just not being in contact when you have the flu is not enough due to the incubation period.
That's one reason I'll probably take the vaccine when its available to me sometime soon. Also, even though the first wave of the flu has been quite mild -- more or less on par with any yearly flu -- we don't know exactly yet what the second wave is going to be like. Other major flu pandemics have also had second or third waves, and those might be more devastating than the first one.
Don't get me wrong. I've been mostly just annoyed by what has sometimes approached hysteria around H1N1. I'm the last one to advocate panicking or useless measures whose only purpose is to create a false sense of security, or convince the public that something is being done. I do believe, however, that vaccinations against H1N1 are likely to actually save lives, perhaps someone else's even if I'm not at much risk myself.
As for antibiotics, TFA is probably spot on.
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... lobbies haven't chipped away at the naïveté of youth.
There, fixed that for you. Now go get vaccinated and get off my lawn.
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We need to start ignoring the chicken-littles of this world. Scratch that. We need to start SHUNNING the chicken-littles of this world. Maybe then they'll get the message.
Re:Stop with the drugs already (Score:4, Insightful)
Re: (Score:3, Insightful)
Please, stop spreading your bullshit, uninformed nonsense. Thank you.
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You know, there's a lot of misunderstanding about that. I've got the family genealogy back to about 1575, and a lot of the adults in the family lived into their 70's or eighties and a surprising number even longer than that. But the average age of death? Still about age thirty. You know why? Infant and child mortality. Lots and lots of dead babies and very young children. But for those who made it to adul
The People Problem (Score:5, Insightful)
Re:The People Problem (Score:5, Insightful)
Re:The People Problem (Score:5, Insightful)
Bravo +1 to the poster. (Score:5, Interesting)
I'm a surgeon in the USA, and fell exactly that way, as do the majority of my colleagues. I also feel the same way about companies advertising for artificial hips and knees.
Some patients will actually say.
"I want the Jack Nickolaus artificial knee." They just have no freakin idea why they want it, or what about it makes it appropriate, or inappropriate for some people.
I also think that the abmulance chasers should not be allowed to sue for any drug that has been approved by the FDA (unless there was some form of malice used to approve it).
Ahhh - such is life.
Re: (Score:3, Insightful)
If someone was as careful as possible why should they be sued?
I agree if it com
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I completely disagree. The FDA is not some magical organization that can predict every single possible negative consequence of every single drug ever sent to their offices. If a drug slipped by that happens to cause severe problems in some patients 10 years down the road, then they should be able to sue someone. Everyone may have been as careful as possible, but there was still something overlooked, or some mistake made, and that has consequences.
If it was proven that the drugs companies were knew about thi
Re: (Score:3, Funny)
I've always subscribed to the notion that any company should be able to truthfully advertise their product whenever and however they see fit, with two notable exceptions:
1) Interstate billboards
2) Pharmaceuticals
Seriously, in what universe is it either ethical to advertise a medical treatment directly to the masses? Every prime-time TV commercial is engineered for the specific purpose of duping y
Re:The People Problem (Score:5, Interesting)
Yes, compared to their US conterparts Norwegian doctors are really stingy with antibiotics.Off course, part of what allows them to be - apart from the whole mindset - is a) that Norwegians can take up to three sick days off* without a note from their Doctor, and b) Norwegians have a single Doctor they need to relate to** so the Doctor knows the patient better and the patient knows the Doctor. In fact we - my better half and I - seldom gets away with any less than half an hour in the Doctors office; with as much time spendt catching up since last time as on the actuall medical stuff.
Compare this to my inlaws who has to go to the Doc-in-a-box if they are feelign poorly, sit among other sickly people and wait for a Doctor - any Doctor who happen to be free - to have a look at them, give them a note and send them home (after a detour to work to hand in the note); probably with a prescription for a drug choosen not mainly on basis of what will help the most, but on what their insurance will cover. The staff isn't interested in making usre the patients gets the best care - it's all about processing them fast. So yes, I can see how easy it is to prescribe aome broad specter antibiotics if someone comes in with a fever - if it's an infection it'll knock it down, and if it's caused by something else you'll get the placebo effect. The patient is happy (and sick), the Doctor has done his job in ten minutes and my inlaws has spent half a day to get two days off work... whereas I could have picked up the phone, called my boss and told him I would stay home, rolled over and let my body handle it.
And yes, I know I'm overgeneralising - but I'm trying to get a point across and that often work better if done with broad strokes.
*) Part of the horror of a 'socialist healt care system'.
**) Another part of the horrible 'socialist healt care syste' - if you don't like your Doctor you can go online to change; up to two times a year, more if you move.
Re:The People Problem (Score:4, Informative)
I'm guessing you're from UK which is the second drug store in the World. Don't think US is better since it's the #1 with an open shot.
Can't be the UK, as (AFAIIA) prescription medicines can't be advertised, and generally people trust the doctor to choose the appropriate medicine anyway so there's no point advertising to the people.
Most medical ads on British TV are for cough, cold, indigestion, flatulence, heartburn etc; and also health insurance. The NHS also runs give-up-smoking ads (especially at this time of year) and general "be healthy" (exercise, wash hands etc) ones.
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Agree one hundred percent.
I think that patient education now is better than it was 10-15 years ago. Unfortunately, a lot of damage has been done in that time period.
MRSA is bad. God help us when vancomycin resistant S. aureus becomes widespread.
Re:The People Problem (Score:5, Funny)
I take as many antibiotics as possible specifically to breed better super bugs.
And only a time travelling Bruce Willis can stop me now.
Re:The People Problem (Score:4, Informative)
Re:The People Problem (Score:4, Informative)
Re: (Score:3, Interesting)
Doctors prescribing antibiotics for individuals at home has likely had little impact on things like MRSA or C. diff. Those superbugs are almost nonexistent outside of hospital and nursing home environments. What this tells us is that antibiotics are overprescribed for people in hospitals and nursing homes. Why is this? Usually because people are much more likely to get a bacterial
" from the they-fired-adrian-monk dept. " (Score:3, Insightful)
This isn't to say antibiotics are a bad idea altogether. Just that they are very much over prescribed and that a much better way of dealing with an unknown infection is to watch it closely to see if it goes away on its own before you bring out the drugs. Of course, this flies directly in the face of capitalism where companies want to sell more drugs and create targets like superbugs that require ever more powerful drugs which can then be patented and used to essentially extort the life from people and governments; pay us or die... Ah, unintended side effects.
Re: (Score:3, Insightful)
Mod parent up.
Antibiotics kill bugs by entering the cells and altering them. Because of this the bugs that are more difficult to penetrate proliferate after their stronger but more susceptible cousins all die off.
Antiseptics, like alchohol or hydrogen peroxide or bleach physically destroy the cell walls of the bugs, there is no way to develope a resistance without developing a completely different cellular wall which, so far does not exist.
Soap even kills 99% (or close to it) of bacteria by emulsifying the
This will work until Big Pharm (tm) patents it. (Score:4, Funny)
I can see it now: Method and process for reducing MRSA infections by not using drugs.
Don't even try it without paying.
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Surgical procedures are not patentable in Europe. Medicines potentially are, as is any equipment used in the procedure.
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But apparently it's rocket science to not give patients antibiotics when they've got a throat ache.
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How did they do this? (Score:3, Interesting)
I've heard a number of international folks complain that antibiotics are almost never prescribed in the UK and yet a number of UK hospitals have had MRSA outbreaks. Does anyone have a league table of the cleanliness of each country's hospitals?
Re: (Score:3, Insightful)
The UK's hospitals suffer from the class system. Some hospitals are real shit tips and some are very nice. It's not necessarily the bad areas that have bad hospitals. As I recall Addenbrookes hospital in Cambridge was one of the dirtiest a few years ago. Despite being a fairly rich area I think
Re:How did they do this? (Score:5, Interesting)
In the UK, cleaning was almost universally outsourced, because of some management ideology about core-functions. It turns out that cleaning *is* a core function of a hospital (see a previous poster about the training of Norwegian cleaners) and should not be left to the cheapest bidder.
ALL hospitals have MRSA (Score:3, Informative)
Hospitals do not have MRSA because "hospitals are dirty." Look at it logically. MRSA can be very difficult to treat. If cleaning hospitals would keep doctors from having to treat MRSA cases, they would clean hospitals. The fact is they do clean them, very thoroughly ... but it doesn't work. MRSA has the tenacity of a cockroach. Studies have shown that even the most over-the-top, costly cleaning measures still do not get rid of 100 percent of MRSA in hospitals. It is simply a fact of life.
Here is something e
Re: (Score:2, Interesting)
MRSA has absolutely zilch to do with the cleanliness of hospitals, and using a generalism such as this is just lazy, please research before you comment.
The problem is the world press being the morons that they are have associated MRSA with a hospital being dirty, the real cause of MRSA in hospitals is letting too many darn visitors into wards without making them scrub up first. Reduce visitor numbers and impose strict rules about washing of hands/contact with patients etc and the MRSA infection rate would
Re:If this is what Universal Health Care is like.. (Score:4, Informative)
Norway also has universal health care, you know. In fact, Norway's is actually much more strongly government-run than the UK's: it's a single-payer system, and many decisions are taken centrally rather than left to hospital/doctor discretion.
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Yeah - single payer if you have time to wait. That's why the company I work for pays hundreds of NOK for my health insurance every month.
Re:If this is what Universal Health Care is like.. (Score:5, Interesting)
TFA is painting a picture about Norwegian hospitals that are easy to misinterpret. Yes, floor ar streaked and scratched, there is some dust on cabinets and blood pressure monitors.
Howevery, there it is still not dirty and messy as can be interpreted by the article. Cleaning staff in Norway actually have a 3- year education in cleaning! Translated school information site [google.com] They learn how to spot the difference between dangerous and non-dangerous dirty surfaces. Think in your own home: The dust on the TV isn't dangerous, but the food spills on the kitchen counter can be. The cleaning staff is simply authorized and empowered to perform the important cleaning first, and leave non-dangerous dirt until they have the time to take care of it.
Re: (Score:3, Funny)
you know (Score:2, Insightful)
This article is so RIGHT (Score:5, Informative)
Anybody who knows anything about biochemistry and/or pharmaceuticals knows that novel drugs that are SAFE and EFFECTIVE are enormously expensive to develop and clinically test. It's idiotic to use these medical tools, which have finite effectiveness due to resistance development, unless they are truly necessary.
Antibiotic-resistant bacteria develop their resistance at a cost - a resistant organism that can out-survive normal bacteria in the presence of antibiotics will probably die out in a normal environment if it hasn't already gained an overwhelming majority. The mutations that provide antibiotic resistance will, in most cases, make the organism less fit or efficient than an unresistant strain in an antibiotic-free environment. The fact that Norway's policies are working is partial proof of this.
In short, people are idiots and everyone should really be following the example the Norwegians have set here.
Re:This article is so RIGHT (Score:5, Informative)
Doctors prescribe antibiotics not because they are necessary, but because they are heckled by patients who want a prescription to justify their trip to the doctor's office
Except when I asked the pediatrician why he was prescribing antibiotics for my son's cold, he said, "To protect against secondary bacterial infections."
Which, of course, we refused.
Still, it goes to show that not all Conventional Wisdom is actually correct.
Re: (Score:2)
I think there was a time in the U.S. when hospitals, lawyers, and drug companies couldn't ( or didn't ) advertise.
Re:This article is so RIGHT (Score:4, Funny)
'Doctors prescribe antibiotics not because they are necessary, but because they are heckled by patients who want a prescription to justify their trip to the doctor's office and because they are encouraged by pharmaceutical companies to move their products.'
It appears to me that training in professional ethics should be included in the medical curriculum and perhaps required (and enforced) for licensing.
And when the arm has to come off... (Score:2, Interesting)
...because the dogbite was infected (as they usually are)? Oh, well. Prosthetics are pretty good these days. This very nearly happened to an acquaintance of mine. Fortunately three days in the hospital on an antibiotic drip saved the arm. Twenty years ago they would have given her antibiotics in the ER as a matter of course for an animal bite.
Re:And when the arm has to come off... (Score:5, Informative)
...because the dogbite was infected (as they usually are)?
And this is an exception to the rule. Another obvious exception is surgery, where antibiotics are used to prevent postoperative infections and organ rejection.
The idea is that your sniffles don't require azithromycin, that your cough and throat ache don't need penicillin, and that your fever doesn't need ampicillin.
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You get an infection, your immune system goes into overdrive to beat it and will soon start attacking the transplanted organ. You will soon afterwards reject the organ. Case and point, you can't do an organ transplant without antibiotics, whether or not you consider it a proximal or distal necessity. Organ transplant patients are often drowned in antibiotics if they get so much as a fever, since their immunosuppressant drugs
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It's balancing risks of one kind versus risks of another kind. Yes, giving antibiotics to everyone who comes in the ER with any sort of wound would kill some infections that wouldn't otherwise be killed. But it will also result in other infections being much worse as those same antibiotics lose effectiveness. Just giving everyone antibiotics will result in fewer amputations due to dog bites, perhaps, but more amputations due to MRSA.
What exactly the proper level of antibiotic prescription---which antibiotic
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It could well be that the persons treating your friend should have prescribed antibiotics in the first place, or maybe they should have been more aggressive with local wound care, flushing out the area with st
Punny... (Score:3, Funny)
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Sterile saline? You're kidding me, right?
Your skin is your greatest protection against infection. When it is broken, like with a dog bite, the chances of infection go up exponentially. You don't need a wonky immune system to get infected in these circumstances. And you speak out against antibiotic use in this context?
A wash with sterile saline will do virtually nothing if the infection has already taken root.
Infection was the biggest killer during wars until the advent of antibiotics. And it wasn't just bec
Hmm... (Score:5, Informative)
I would be interested to know, though, how much the favorable microbial climate there is due to medical attitudes toward antibiotic use, and how much comes down to antibiotic use(and ideally nonuse) in the agricultural sector. At least in the US, medical antibiotic misuse is quite visible, and makes for a good morality tale(lazy, impatient, whiny consumers demand quick fix, need to learn more patience); but most livestock are given a constant low dose of various antibiotics(pretty much the best scenario for antibiotic resistance) for most of their lives. Then they are chopped up and ground together, to spread anything that they might have evolved evenly through the food supply(and, since a fair few antibiotic-resistance adaptations occur on bacterial plasmids, rather than in their core genomes, they can spread from species to species pretty quickly).
The problem is comparatively invisible, since most people don't see what goes on inside the barn, while a great many doctors are more than happy to encourage(at least generally, if not always when they have a distressed parent and some crying sniffling baby to deal with) responsible antibiotic use; but over half of US-produced antibiotics go into livestock rather than humans(and the numbers might actually be worse than that sounds, since it could well be that bulk agricultural antibiotics are more likely to be produced in cheaper offshore locations than are the more heavily regulated, and more profitable, human ones).
It would be very interesting to know what the Norwegian agricultural sector is up to in this respect, and how much of an effect that has.
Re:Hmm... (Score:5, Interesting)
I have a wife who have worked, and is working, in the these medical fields. According to her, we (Norway) have some of the strictest laws regarding veterinary use of antibiotics. We had some problems with overuse of antibiotics in the fish farming sector some years back. Since then things have gotten even tighter. In many other countries use of antibiotics as a preventative medication in food is the norm. This is not legal in Norway.
The effect of this is not studied, at least to our knowledge, in any scientifically accurate way. However, I believe this is one of the reasons we do not have problems with MRSA in Norway. There are few natural places where you can be infected i nNorway, whereas in USA you can get MRSA from spending time at the beach!! Ref: http://pagingdrgupta.blogs.cnn.com/2009/02/16/mrsa-on-the-beach/ [cnn.com]
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The main reason for using antibiotics on cattle is because they are fed corn, which changes the pH of their stomachs enough that different types of bacteria can survive in them. If the cattle were simply fed grass for two weeks before butchering, their stomach pH would return to normal. There would be essentially no antibiotics left in their system, no bad bacteria, and the cows would be much healthier overall when they were processed for human consumption.
Completely grass-fed cattle have significantly le
Same thing applies to anti-bacterial soap (Score:3, Informative)
At the other end of the spectrum (Score:5, Interesting)
On holiday in Malaysia my son was sick so we took him to a doctor. The doctor couldn't really do anything. My son was reacting to the climate and refusing to eat solids but he gave us a bottle of antibiotic dispensed from his surgery "just in case"
So I queried that and he quickly said oh well don't worry about it if you don't think he needs it. It seems that everybody in Malaysia just gets antibiotics automatically when they go to the doctor. My wife grew up in Malaysia and when she gets a cough she gets it for weeks at a time.
I wonder how... (Score:2)
MD (Score:4, Interesting)
As a medical doctor, I can attest to a general over-prescription of antibiotics. I work in Sweden, where we generally don't use as much antibiotics as other parts of the world, but I would say that we use far too much anyway. I am a surgical resident, who is often on call and have a lot of out-patients. The demand from patients that you prescribe some kind of antibiotics is huge, absolutely huge, even for simpler infections where there is little evidence that it will actually shorten the length of illness or level of symtoms. Trying to educate a patient on the matter in a few minutes is no easy task, and other than a general sense of responsibility, nothing keeps one doing just that. Even then, I often hear of my patients going to a different doctor after one or a couple of days and then getting a prescription, even if they haven't gotten any worse. I don't think that there is any easy fix to this problem. People expect a life free of disease, and if they do get some minor illness, they expect immediate recovery. (I am speaking very generally here, of course...)
I fought MRSA for six months (Score:3, Interesting)
At first the doctors blew it off as a normal infection even though I rarely get infections of any kind and it felt severe to me. The first few times they just perscribed regular antibiotics which knocked it back but it'd come back in two or three weeks. Finally some one though to check it out and it turned out to be MRSA so they gave me yet another antibiotic which followed the same knock it back comes back in a couple of week pattern. I was then told there was a better one for MRSA so they tried that. Same pattern but in the meantime I moved to another state and wound up with a new doctor that didn't trust her memory. She looked it up and said they were all using the wrong antibiotics and even the one she was going to perscribe was no longer recommended. Finally that series worked and I've been MRSA free for four months. Also I got a secondary infection from all the antibiotics that no one spotted inspite of complaints from me about another problem. That required medicine other than antibiotics to cure. Basically I received five different antibiotics mostly from doctor incompetence. And they wonder why antibiotics are over used? A lot of the problem too is doctors not believing patients. I rarely go to doctors but they still at first thought I was overreacting when I said I thought it was a serious infection. It was in my jaws and throat and I had trouble breathing and swallowing and even wound up going to the hospital once when my throat closed up. They still didn't take it seriously until the tests came back showing MRSA. Even then they didn't give me the right antibiotics. I also now have several scars on my face from later infections that could have been avoided if they had gotten it right the first time and not been so quick to blow me off. Medicine in the US is a train wreck. Did you know tens of thousands of patients die in hospital from neglect every year? I think the last number I heard a few years back was 80,000. That's a disgrace.
Article is confusing (Score:4, Insightful)
As I understood it, there are 2 separate things Norway is doing to fight MRSA, and they are not related (although the article doesn't point that out):
1. Norway is tracking the spread of Staph and quarantining victims to limit the spread.
2. According to the article, Norway isn't prescribing modern antibiotics. This ensures that the Staph that is being passed around Norway probably isn't resistant to antibiotics. This does not make Staph less problematic or control its spread in any way. I'm all for stemming the overuse of antibiotics, but this article smacked of propaganda--or it simply didn't tell the whole story.
What? Of course it does. (Score:5, Interesting)
If you get staph in Norway, it's treatable. If you get it in the US it isn't. How does that not solve the problem?
Um, this is real easy to go to far with (Score:2)
The major difference in life expenctancy between the middle ages and today is the control of infections. In oh say 1200 AD, if you got a scratch on your finger and it got infected you were likely doomed. You would die from it.
Warfare was pretty horrible as well, because even a minor slash from a bladed weapon was pretty much a death sentance. It might take a couple of months, but you would almost certainly die.
Simple things that are easily treated today like impetigo [kidshealth.org] could indeed be fatal.
We have had ant
Tip for USA (Score:5, Insightful)
...or even better give placebos (Score:3, Interesting)
If the patient asks for antibiotics for a cold, the doctor can try to talk them out of it and if that fails he should just lie and give them a placebo and write it as such in their journal :P
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A Danish study showed you can cut sick days in kindergartens by half by forcing all children to wash their hands twice a day.
Damned Danish commies! How dare they force their poor children to do something as horrible as murdering all those innocent bacterias!
Did someone in Norway really say 'Tylenol' ? (Score:5, Interesting)
Re:Did someone in Norway really say 'Tylenol' ? (Score:4, Insightful)
Or was a quote altered to push a US (only?) brand?
Aspirin was once a trademark, too. Still is, in some places.
Most Americans know "acetaminophen" as Tylenol in the same way that they know "acetylsalicylic acid" as aspirin.
Re:Did someone in Norway really say 'Tylenol' ? (Score:5, Informative)
Nobody says 'Tylenol' in Norway (since it doesn't exist here), but we do say 'Paracetamol'. It was probably an adaptation by the journalist so the majority of US readers would know that a simple analgesic can be used as a doctor's visit consolation prize. That being said, isn't 'Tylenol' on its way to become a generic word? Just curious ...
US hospitals are already on this (Score:3, Insightful)
When I lost my insurance... (Score:4, Interesting)
About 5 years ago, I had to give up my health insurance (Kaiser Permanente HMO, really) because we moved to a more rural area where they don't have local infrastructure. I didn't get regular health insurance from another company because my Kaiser coverage had been subsidized through an old employer plan, and everything else was too expensive. I worried that I'd get really sick and not have my HMO coverage, because I was used to going a few times a year for various things.
Fast forward 5 years later, and I haven't been to a doctor or hospital at all in that time. I seem to get sick less often than I did before when I'd go to the HMO 3 or 4 times a year with minor ailments, and when I do get sick it's less serious and goes away faster. I've had no antibiotics in that time, just OTC meds (but I avoid fever-reducers unless my fever goes above 102, because fever is one of the body's natural defense mechanisms against microorganisms).
The net result is that me and my immune system are happier, healthier, and wealthier, now that we're not over-relying on doctors and antibiotics. I also believe my household's complete lack of over-cleansing is part of the recipe for good health--people who clean obsessively and use that antibacterial cleanser are destroying harmless bacteria which usually "crowd out" the harmful strains, or at least leave them a minimal space to grow. But when your household is super-clean and a harmful bacterium arrives, it has room to grow everywhere since there's no existing bacterial ecosystem to compete with. Who knew that my stereotypical geeky tendency towards slight messiness and wearing the same clothes 2 days in a row thanks to all-night gaming/writing sessions might increase my health...
I'm sure I'll have to visit the doctor or hospital eventually when something serious happens. Until then, I see my seemingly better health now than when I was going to the doctor several times a year as an anecdotal vindication of the hypothesis that too much cleanliness and hygiene and antibiotic use can be as bad or worse than none, because our immune systems need to develop and thrive by exposure to lesser bacteria in order to be ready to take on serious ones.
It's not just the antibiotics that are a problem (Score:5, Interesting)
My point is, these days with every small hiccup in orderly behavior, you get closer and closer to being tossed off a cliff into the pit of mental abnormality. Once you're in that pit, you're free game for doctors to control the way you think. I have friends that have gone through light bouts of depression but now will probably be on dangerous medication for the rest of their lives. I myself am on a dependancy-forming drug that alters the way I think and has a high risk of diabetes and liver failure. Years ago, there were no fancy drugs or somesuch to be prescribed for mental health conditions. For the most part, people just dealt with their issues. I would have gotten over my stress-related issues. Perhaps it would have involved a nervous breakdown, but the modern route put me through much worse.
I suppose I'm on the business end of the whole mental health thing, so I'm bound to be biased. Even so, you do not want to get involved in this stuff. I have yet to hear of anyone that has actually been helped, or even not hurt by psychiatrists.
rx abx if it's friday (Score:3, Interesting)
Correction to many erroneous posts (Score:5, Interesting)
I happen to be a bit of an expert in this field - no shit
below is from memory; if people are really interested, i can pull out some references from the scientific literature that back all of this up
MRSA stands for "methicillin resistant Staphylococcus aureus", and it was 1st detected in the UK in the (i think ) '60s
lets backup a bit
the human body is covered, inside and out, with bacteria, which can be harmful, neutral or beneficial - for instance, vitamin B12, a requirement for life, is made by bacteria.
All humans carry Staphylococcus epidermidis; ~ 20% also carry S aureus, which prefers to live in moist places like the inside of the nose (anterior nares) throat, axilla, groin and rectum. Epidermidis is pretty harmless, except for people with implanted devices like catheters; since epi likes "surfaces" it tends to colonize the surface of catheters.
Most people have either epi or aureus, but not both,and these two bugs are a small part of the total skin microflora.
In general, having S aureus on your skin or in your nose does not seem to be harmful; however, if you have a cut, and aureus gains entry to the bloodstream, this is a very serious matter. S aureus , whoose genome is sequenced, carrys a host of "virulence factors" that make it a particularly dangerous infection in the blood; in th era before antibiotics, the mortality rate for aureus septicemia was over 50%, and perhaps 80% in some hospitals (!).
That is, ify ou were a physcian in the most advanced medical center in the world in the 1940s, and a healthy patient got an aureus infection in the blood - perhaps due to infection of a surgical site , where the skin is open- there was a 50% chance that pateint would die. Aureus also tends to grow on the heartvalves, which is the disease known as endocarditis; i should think it obvious that having a film of bacteria on your heart valves is not a good idea.
It is easy to see how penicillin, which was very effective, was viewed as a miracle drug. However, within a few years, aureus became resistant to penicillin, and hospitals were starting to see epidemics of untreatable penicillin resistant aureus.
Luckily, the pharmaceutical compnaies and thier scientists had variations of penicillin - the first was methicillin; since then, dozens of beta lactam antibiotics, the mot advanced of which are the carbapenems and fifth generation cephalosporins (wikipedia is good here) have ben developed.
Staph took 10-20 years to become resistant to methicillin; however, when staph do become resistant, they do so by aquisition of a virus like element (SCCmec) which often carries resistance to a whole host of other antibiotics, so that MRSA is actually a bug that is resistant to many drugs. (technically, SCCmec encodes a replacement for PBP2a, PBP2a', which has a lactam resistant transpeptidase function; but no transglycosylase). the origin of SCCmec is unkown.
The drugs of choice for MRSA are vancomycin, daptomycin and colistin; ceftobiprole, approved in canada and switzerland , is supposed to be very effective.
Vancomycin is very $ and nephrotoxic; the others are worse.
If one looks at different countrys around the world, one sees that some countrys - in particular the netherlands and the scandanavian countrys - have very low rates of MRSA, that is most of the aureus is methicillin sensitive.
However, if you look in detail - and believe me, a lot of scientists have looked very hard - it is hard to find one particular reason why these countrys have low rates of MRSA; rather, it seems to be due to a "bundle" of practices. In general, these countrys have good antibiotic stewardship - drugs are not prescribed unless you need them; they spnd a lot on controlling outbreaks, and they are very carefull to test people from outside the country, who might hve MRSA, when they enter the hospital.
In the US, the statistics on how many people get MRSA and how many die have been compiled by several authors; the most well known is monica klevens of the CDC.
Now it