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Biotech Medicine Science

How Norway Fought Staph Infections 595

Posted by timothy
from the they-fired-adrian-monk dept.
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.'"
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How Norway Fought Staph Infections

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  • by edwebdev (1304531) on Sunday January 03, 2010 @03:54PM (#30634130)
    So much of modern antibiotic use (at least in the U. S.) is hugely irresponsible. 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.

    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.
  • Hmm... (Score:5, Informative)

    by fuzzyfuzzyfungus (1223518) on Sunday January 03, 2010 @03:57PM (#30634144) Journal
    Clearly, it sounds like Norwegian hospitals are on the right track, with respect to antibiotic handling.

    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.
  • by Nutria (679911) on Sunday January 03, 2010 @04:02PM (#30634168)

    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.

  • by ciroknight (601098) on Sunday January 03, 2010 @04:02PM (#30634174)

    ...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.

  • by Numbah One (821914) on Sunday January 03, 2010 @04:03PM (#30634178)
    Regular soap works just fine to get hands clean and get rid of most of the germs without speeding along the survival of the fittest contest among the bacteria.
  • 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.

  • by teg (97890) on Sunday January 03, 2010 @04:19PM (#30634316) Homepage
    FWIW, in Norway it doesn't matter what the patient believe on that matter. All antibiotics are prescription only. Also, ads are not allowed for prescription drugs.
  • by wronskyMan (676763) on Sunday January 03, 2010 @04:30PM (#30634406)
    They are prescription only here as well but many patients will bully doctors into doing this; doctors also err on the side of caution because of lawsuits. Agree on the ads - if only doctors are allowed to make the decision, they should be the only ones ads are targeted at (in medical journals, etc).
  • by dgatwood (11270) on Sunday January 03, 2010 @04:40PM (#30634452) Journal

    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.

  • by Anonymous Coward on Sunday January 03, 2010 @04:44PM (#30634476)

    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

  • I think he does. (Score:5, Informative)

    by spineboy (22918) on Sunday January 03, 2010 @04:54PM (#30634556) Journal

    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:Tip for USA (Score:1, Informative)

    by Anonymous Coward on Sunday January 03, 2010 @05:06PM (#30634696)

    " A Belgian Doctor once told me he believed antibiotics should be given as a prevention to all kindergarten kids. "

    That's weird because I'm Belgian and here there is a very very strong media-wide anti-antibiotics campaign from the ministry of health.
    Doctors will never give you antibiotics unless you're almost dying :) I've never seen any Doctor here give any antibiotic easily ...

  • by IrquiM (471313) on Sunday January 03, 2010 @05:14PM (#30634752) Homepage

    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.

  • by sjames (1099) on Sunday January 03, 2010 @05:30PM (#30634902) Homepage

    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.

  • Re:Tylenol (Score:1, Informative)

    by Anonymous Coward on Sunday January 03, 2010 @05:52PM (#30635090)

    AKA acetaminophen.

  • by PCM2 (4486) on Sunday January 03, 2010 @06:02PM (#30635186) Homepage

    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 else you might not know: There are two types of MRSA infections. There are nosocomial infections, which are the ones you get in hospitals; and then there are the other kind, which you pick up "in the wild." Wild MRSA and hospital MRSA are two different strains of the bacteria. You might cut your hand on something at home and come down with a resistant staph infection, but it would be a different infection than the kind you might catch in the hospital. The stuff you get in the hospital exists only in hospitals. It is specifically evolved to exist in those environments. And -- at least in the U.S., I can't speak for elsewhere -- it exists in every hospital. It's very likely that this development was inevitable.

    I get tired of hearing people who have never studied the problem saying things like "if only everybody would wash their hands, nobody would get sick" or "if only nobody would take antibiotics, nobody would get sick." Things like that sound nice -- and it's true that washing your hands is a good idea, and it's true that antibiotics are often prescribed when they are not necessary -- but but to talk this way is to grossly oversimplify the problem.

    Antibiotics have saved countless millions of lives. Are they over-prescribed? Perhaps. But all that means is that we are squandering the potential of one of the great discoveries of science. It doesn't mean that taking antibiotics is somehow "bad," or that antibiotics are somehow "making us sicker," which seems to be what so many people insinuate today.

    If antibiotics don't work as well as they used to because bacteria are developing resistance, we should be sad for that. But recognize that the battle we are fighting here is essentially Man vs. Evolution. Back in the 1950s, public health professionals actually announced that the discovery of antibiotics was going to mean the end of human disease. We can see now that this was a pretty foolish thing to say. We now realize that we need to revise how we treat many diseases, and prescribing fewer antibiotics may be one way to do that. But we will also need to keep revising how we treat disease, probably throughout the lifespan of humanity.

  • by Anonymous Coward on Sunday January 03, 2010 @06:13PM (#30635298)

    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 ...

  • by xaxa (988988) on Sunday January 03, 2010 @06:29PM (#30635456)

    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.

  • by kkwst2 (992504) on Sunday January 03, 2010 @08:22PM (#30636362)

    It is not just people with breathing issues. While the mortality rate for H1N1 may be similar to other flu strains, who it hits hard seems to be different, with young people 2-25 and pregnant women hit particularly hard. We've seen several healthy people with no known risk factors be completely devastated by H1N1. It's certainly no polio and may have been sensationalized, but if you think healthy people are not dying from it, you're wrong.

  • by interkin3tic (1469267) on Sunday January 03, 2010 @11:15PM (#30637406)

    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.

  • by ultranova (717540) on Monday January 04, 2010 @06:08AM (#30639106)

    Once resistance appears in humans, having a bit of antibiotic in the food supply provides the selection advantage needed to make the resistant strain common.

    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.

    Think of an antibiotic as a secret that humanity must hide from the ecosystem.

    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.

Never tell people how to do things. Tell them WHAT to do and they will surprise you with their ingenuity. -- Gen. George S. Patton, Jr.

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