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)
The People Problem (Score:5, Insightful)
" 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.
you know (Score:2, Insightful)
Re:Stop with the drugs already (Score:4, Insightful)
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:The People Problem (Score:5, Insightful)
Re:Stop with the drugs already (Score:2, Insightful)
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:How did they do this? (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 it's the fact it had a lot of people in general going through it, but the area does have a fair amount of poor people and homeless and the last time I went in there (as a visitor) the support staff was shit.
I suspect there was too much corner cutting on support staff to keep budgets down which you can't really do in a busy hospital, imo.
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?
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.
Re:The People Problem (Score:5, Insightful)
Tip for USA (Score:5, Insightful)
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.
Norwegian model may not work well in USA. (Score:1, Insightful)
If the USA adopts the same restrictive immigation policy that Norway has, then the Norwegian model for controlling MRSA will work well.
What is ultimately killing Americans is not MRSA but rather is politics. Nothing -- not even deaths from MRSA -- can restrict the flow of immigration.
Re:Stop with the drugs already (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.
US hospitals are already on this (Score:3, Insightful)
Re:" from the they-fired-adrian-monk dept. " (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 lipids in the cell walls. Anti-bacterial soap is only marginally more effective.
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...
It has nothing to do with capitalism and everything to do with doctors not following their hippocratic oath because they feel pressured by their patients. They have not only the right, but the legal duty to tell a patient "No" if they don't need a particular medicine. If they had a spine to begin with, given that it was they who went through six years of schooling on this crap and not their whiny patients, it wouldn't be a problem.
The bottom line is, capitalism or no capitalism, one of the primary jobs of a doctor is to ensure that a patient gets only the medicine that they need. They take an oath that covers this before they start practicing medicine. Frankly, doctors who hand out prescriptions to patients who don't need them should lose the right to practice medicine.
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: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:2, Insightful)
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.
Yeah. That's why everybody had a life expectancy > 100 years before antibiotics were discovered.
Re:Stop with the drugs already (Score:4, Insightful)
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:3, Insightful)
Please, stop spreading your bullshit, uninformed nonsense. Thank you.
Re:Stop with the drugs already (Score:2, Insightful)
I agree. Lately (or over the past year rather) on Slashdot we've seen a disappointing trend in one sentence comments making factually wrong sweeping generalizations of scientific topics being modded to +5 insightful. Another AC posted earlier saying that we can longer say the Slashdot audience is scientifically knowledgeable and I completely agree. Slashdot mods are starting to go for Fox News arguments: "hurr, I haven't gotten the flu shot in ten years and I've never gotten the flu, therefore, it must be a conspiracy by big Pharma and the Obama administration!" You guys are no better with your logic than the anti-evolution crowd that always gets flamed here.
Sad.
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]
Pay Pri Care Dr's more -or- PERFORMANCE-based Pay? (Score:1, Insightful)
The woman who heads Washington DC's Educ Dep't has such a plan for teachers (ie, to pull in more great teachers), but her intention is also tied up with removing tenure (so they can get rid of lousy teachers).
Another way to solve at least the over-prescription problems in any pill-based country's medical care system is to increase the number of doctors, eg, by:
1. creating many more places for future students at medical school, but... ALSO:
2. link getting such a place with an agreement to serve for a year or two in places where doctors are scarce
Sorry, PCP / Doctor 603, I - for one - am NOT prepared to buy into your (subtle):
"Pay me more or - I swear! - I'm, gonna [continue to] over-prescribe anti-biotics!!!"
More doctors - graduating from med schools with more places for them to study - is a MUCH better place to send the cash you might like to pocket, for your entertainment, etc.
Think:
1. China's Barefoot doctors (past? or still going? Many, low-cost, low-skilled medics),
2. In traditional (ie, Pre-Mao) China, I'm told that patients only paid their doctor when well again, &
2. Have a look at India's "McDonald's-style" eye-care, for its many people with vision problems
as recently documented, eg, in a recent talk at "TED India" (It's now at: http://ted.com/ [ted.com] )
(Altho NOT the same, its org'l model translates easily to primary med care)
If we're ever going to see genuine & significant improvement in our levels of health,
it's going to be by finding & training more genuinely good people (eg, children of
folks, who've died and/or gone bankrupt at the hands of overcrowed &/or greedy
medical "care" - such as it is - businesses)
Such people might be motivated to work for the patient's good - no matter what -
rather than look for excuses to over-medicate, eg, "You need to pay me more!"
Doctor 603, by me, you ought to be in a differnt business, where human health
is NOT put at risk, by your greedy demands for a raise.
You've signed a contract to practice medicine, in patients' interests, not yours!
If you can't do that for the amount you agreed to, you've breached your contract
and should go elsewhere; maybe change profession.
---
By contrast, I'm told that some doctors (eg, in Britain's health care system) are
paid more when patients health RISES &/or when more of them STOP smoking.
Are you prepared to sign a PERFORMANCE-BASED pay agreement like that?
I have NO qualms about you earning more, as your patients' health increase,
but a plea for more money, that holds patients' health hostage, is just WRONG.
Get the AMA & your employer to buy into Performance-Based Compensation
(PBC's) and you'll win our support as you achieve the intended health rise.
In the case of Staph, you or a loved-one could have a car crash NEAR an
infected hospital, & THEIR lives could be more at risk if they needed some
IMMEDIATE emergency surgery, and got it in such a place.
Ie, fixing the system is also in YOUR interest, so, stop begging for more $$$'s
and - like the rest of us - start demanding better Community Health, already!
It's got to feel better (both for you & all of us), than focusing only on the $$$'s.
Try it, you'll like it.
Re:The plural of anecdote is not data... (Score:5, Insightful)
Re:Same thing applies to anti-bacterial soap (Score:2, Insightful)
Re:Tip for USA (Score:1, Insightful)
In the US, we can't even get a single congressman to read an entire bill before voting on it. How in the hell are we supposed to have confidence in some clusterfuck of a system passed, only to be figured out later to be worse later on? Before we trust a government healthcare system, we must have reason to trust our government officials in office. Clearly, we can't!!!
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.
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.
Re:Bravo +1 to the poster. (Score:3, Insightful)
If someone was as careful as possible why should they be sued?
I agree if it comes to light that someone was truly negligent or intentionally caused harm then something should be done about that but if due diligence was made and someone wasn't omniscient enough to see something obscure why should they be punished simply because someone was hurt somewhere? Do you think the Chinese butterfly researcher should be sued for the hurricanes in the Atlantic caused by his butterflies? Sometimes bad things happen and there's no one you can or should be able to sue. Tough luck. You certainly shouldn't sue the ones who were trying their best to help you.
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.
"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, it seems, we see people lacking even basic qualifications being elevated to high levels of power/responsibility (*cough* Sarah Palin *cough*). We see trained journalists losing out to "citizen journalists" like the hacks at Boing Boing.
We as a society have invested much of our history to devising ways to ensure that we have at least a basic meritocracy, that qualifications are clear and standard, but it seems that a lot of people just are turning their backs on that and thinking they can do better with Wikipedia. It's terrifying.
And to anyone else reading this: Most doctorates are very hard to get, and you don't get them without knowing a lot. Toss a license on there, as in the case of your physician, and these people are Better Than You. Get over it.
Re:"The Cult of the Amateur" is real. (Score:3, Insightful)
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.
Re:Stop with the drugs already (Score:3, Insightful)
... 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:If this is what Universal Health Care is like.. (Score:2, Insightful)
I am an American that has been living in Norway for about 10 years now and think this comment is inaccurate. From my experience, I agree there are decisions "made centrally" but doctors in Norway do have a significant say in how a patient will be treated. There are guidelines, but its not system where disease\infection "A" with specific symptoms "B" and "C" must be treated in a government approved way (like looking it up in a manual). The doctors are involved and make decisions on treatment.
I only say this because universal health care is a touchy subject in the States currently and I have heard arguments stating that the "government" not your doctor will be making decisions while referring to systems in other countries, this is not true imo.
Ironically for Americans that are lucky enough to have health insurance they are willing to trust their health care to a private insurance company that is looking to turn a profit. I would trust my health to the government over a private business worried about their bottom line anyhow... But that is another discussion.
Re:Bravo +1 to the poster. (Score:3, Insightful)
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 this possibility and did not reveal it then yes they should be held responsible. On the other hand if a drugs company did everything realistically possible, given the tools available at the time to ensure the limits of side effects or documented everything then they should be protected. I say this because drugs companies aren't gods and are trying to find the best solution they can for a system they don't fully understand. When being prescribed medicine there is a risk factor that needs to be taken into account: are the side effects better than not taking the medicine at all?
If you expect drugs companies to make perfect medicine, then I ask you to reverse engineer an OS for a known issue with the absence of the creator's documentation (no MFC docs, no Linux docs etc), and then guarantee your patch will be perfect.