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Biotech Medicine Science

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.'"
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How Norway Fought Staph Infections

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  • by Anonymous Coward on Sunday January 03, 2010 @04:40PM (#30634004)
    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.
    • by Trepidity ( 597 )

      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.

      • by sjames ( 1099 ) on Sunday January 03, 2010 @05:39PM (#30634442) Homepage Journal

        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)

          by Octorian ( 14086 )

          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.

          • by Bert64 ( 520050 ) <bert&slashdot,firenzee,com> on Sunday January 03, 2010 @06:39PM (#30634972) Homepage

            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)...

            • by zach_the_lizard ( 1317619 ) on Sunday January 03, 2010 @08:53PM (#30636158)
              It may be in the doctor's best interest to treat the symptoms and keep the disease going for some time, but the patient (and insurance company and government, if the patient receives medical money from them) has an incentive for actual treatment. If the patient does not feel as if he is getting any better, he has the option of leaving, which helps to keep the doctors in line. I have done this myself to doctors that I feel are not helping me recover, but only hacking away at the branches and not striking ot the root of the problem.

              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: (Score:3, Insightful)

                by Anonymous Coward

                ... 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.

    • by Anonymous Coward on Sunday January 03, 2010 @05:10PM (#30634252)

      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.

      • by Galactic Dominator ( 944134 ) on Sunday January 03, 2010 @05:15PM (#30634282)

        MRSA would have exsited with or without antibiotics.

        Do you even know what MRSA means?

        • by dgatwood ( 11270 ) on Sunday January 03, 2010 @05:40PM (#30634452) Homepage 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.

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

          by spineboy ( 22918 ) on Sunday January 03, 2010 @05:54PM (#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.

      • by sjames ( 1099 ) on Sunday January 03, 2010 @06:30PM (#30634902) Homepage Journal

        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: (Score:3, Informative)

        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.

    • Sure, but good luck getting that done for work/school. Yeah, even the most strict of workplaces will let people take a sick day every now and then if you look and sound sick, but if you get sick more than twice in a month generally they want to see a doctors note. Its honestly pointless to go to the doctor, pay money and not do anything about it to make you feel better. Schools are usually worse, especially at the university level, because not only are you sick and not getting the classes you pay for, profe
    • by Anonymous Coward on Sunday January 03, 2010 @05:44PM (#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

      • by mjwx ( 966435 ) on Sunday January 03, 2010 @09:15PM (#30636332)

        As a physician:


        That writing was far to neat for any kind of doctor.

      • 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,

        • Re: (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.

    • by 0100010001010011 ( 652467 ) on Sunday January 03, 2010 @06:40PM (#30634988)

      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.

      • by Mr. Freeman ( 933986 ) on Sunday January 03, 2010 @07:48PM (#30635604)
        Of course, it could be random coincidence or that you just happen to have a stronger immune system than the average person, but I guess your nonsense rationale sounds better. Also, remind me never to have dinner with you. You might enjoy the taste of your own shit, but I don't.
      • by scottv67 ( 731709 ) on Sunday January 03, 2010 @09:11PM (#30636298)
        >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).

        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.
  • The People Problem (Score:5, Insightful)

    by LtCol Burrito ( 1698596 ) on Sunday January 03, 2010 @04:47PM (#30634050) Journal
    While the doctors writing out scrips for antibiotics does play a role, one of the major factors should be patient education. A lot of people think that antibiotics should be used for minor complaints, such as colds. In addition, one major cause of superbugs is the failure of patients to complete a course of antibiotics. They feel better, so they simply stop taking the medications.
    • by Anonymous Coward on Sunday January 03, 2010 @05:02PM (#30634172)
      And why do you think they act like that ? I don't know about the US but here TV ads for antibiotics where everywhere a couple years ago, pretty much telling you to take some even when you weren't sick because hey ANTIBIOTICS ARE GOOD FOR YOU. The whole idea of allowing medical companies to run ads and pay doctors to promote their stuff is a recipe for disaster.
      • by trollebolle ( 1210072 ) on Sunday January 03, 2010 @05:20PM (#30634332)
        Norway's answer to the people problem is to ban ads for medicine that are regulated in any way, like antibiotics. Medicine must be prescribed by a doctor (you can't by antibiotics in a convenience store), and the doctor don't get patients that want a certain medicine after watching a TV ad. Advertisement for medicine is considered to be too dangerous to be allowed, as the decision regarding medical treatment should be left to the doctor, not the pharmaceutical companies through aggressive marketing.
        • by spineboy ( 22918 ) on Sunday January 03, 2010 @06:00PM (#30634620) Journal

          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, Funny)

          by Eil ( 82413 )

          Norway's answer to the people problem is to ban ads for medicine that are regulated in any way, like antibiotics.

          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

    • 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.

    • by Anonymous Coward on Sunday January 03, 2010 @05:09PM (#30634240)

      I take as many antibiotics as possible specifically to breed better super bugs.
      And only a time travelling Bruce Willis can stop me now.

    • by teg ( 97890 ) on Sunday January 03, 2010 @05:19PM (#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 @05:30PM (#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).
    • Re: (Score:3, Interesting)

      by dgatwood ( 11270 )

      While the doctors writing out scrips for antibiotics does play a role, one of the major factors should be patient education.

      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

  • by Anonymous Coward on Sunday January 03, 2010 @04:49PM (#30634068)
    Firing Adrian Monk is exactly the opposite of how they conquered MRSA. Bleach and alcohol hand sanitizer wipes are much more powerful tools than penicillin and vancomycin. The idea is simple: bugs don't become superbugs if they are a) dead, or b) never exposed to agents which cause them to become superbugs.

    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)

      by Bigjeff5 ( 1143585 )

      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

  • by IronClad ( 114176 ) on Sunday January 03, 2010 @04:51PM (#30634096) Homepage

    I can see it now: Method and process for reducing MRSA infections by not using drugs.

    Don't even try it without paying.

    • Surgical procedures are not patentable in Europe. Medicines potentially are, as is any equipment used in the procedure.

      • Re: (Score:3, Funny)

        by ciroknight ( 601098 )
        Technically this is a business method, which is patentable in most locales. It's not surgery to not give patients antibiotics when they've got a throat ache.
        • But apparently it's rocket science to not give patients antibiotics when they've got a throat ache.

          • It's no more rocket science than the other stupid, ridiculous and trivially obvious patents out there like the "one click" patent. Just pointing out that, in theory, it is indeed patentable in many countries.
  • by Sits ( 117492 ) on Sunday January 03, 2010 @04:53PM (#30634112) Homepage Journal

    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)

      I'm not sure about the antibiotics thing. I found it very easy to get antibiotics in the UK. Mind you I had a chest infection twice so it's not like I was asking for them for a scrape on my knee or something silly.

      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
    • by PCM2 ( 4486 )

      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

  • you know (Score:2, Insightful)

    by nomadic ( 141991 )
    It's a bit like a tragedy of the commons thing. In an aggregate level, it's better to take far less antibiotics. But for any individual it's more beneficial than not to take them for that individual.
  • by edwebdev ( 1304531 ) on Sunday January 03, 2010 @04:54PM (#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.
    • by Nutria ( 679911 ) on Sunday January 03, 2010 @05:02PM (#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.

    • I think there was a time in the U.S. when hospitals, lawyers, and drug companies couldn't ( or didn't ) advertise.

    • by Mikkeles ( 698461 ) on Sunday January 03, 2010 @05:14PM (#30634276)

      '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.

  • ...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.

    • by ciroknight ( 601098 ) on Sunday January 03, 2010 @05:02PM (#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 Trepidity ( 597 )

      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

    • Actually dog bites are usually NOT infected and one usually does not give antibiotics for them. Of course, no strategy is perfect and antibiotics do clearly work when indicated. It wasn't all that long ago when people routinely died from pneumonia, something we often don't hospitalize patients for.

      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)

        ColdWetDog? "come back to BITE you"? LOL. Oh, you're TOO MUCH!
      • 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)

    by fuzzyfuzzyfungus ( 1223518 ) on Sunday January 03, 2010 @04:57PM (#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.
    • Re:Hmm... (Score:5, Interesting)

      by geirnord ( 150896 ) on Sunday January 03, 2010 @05:32PM (#30634410)

      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]

    • Re: (Score:3, Interesting)

      by jfreaksho ( 263517 )

      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

  • by Numbah One ( 821914 ) on Sunday January 03, 2010 @05:03PM (#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.
  • by MichaelSmith ( 789609 ) on Sunday January 03, 2010 @05:04PM (#30634186) Homepage Journal

    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.

  • Defensive medicine plays into the over-prescription of antibiotics in the US?
  • MD (Score:4, Interesting)

    by Anonymous Coward on Sunday January 03, 2010 @05:07PM (#30634222)

    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...)

  • by Anonymous Coward on Sunday January 03, 2010 @05:14PM (#30634278)

    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.

  • by piojo ( 995934 ) on Sunday January 03, 2010 @05:20PM (#30634330)

    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.

  • 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)

    by spectrokid ( 660550 ) on Sunday January 03, 2010 @05:21PM (#30634342) Homepage
    In Scandinavia, most doctors are government employees. They have no incentive for prescribing anything and can freely tell their patients to bugger if they ask for useless drugs. Yes, there are disadvantages to "communist" healthcare, but this story shows there are also some clear advantages. A Belgian Doctor once told me he believed antibiotics should be given as a prevention to all kindergarten kids. A Danish study showed you can cut sick days in kindergartens by half by forcing all children to wash their hands twice a day.
    • 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

    • Re: (Score:3, Interesting)

      by Mishotaki ( 957104 )

      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!

  • by yakumo.unr ( 833476 ) on Sunday January 03, 2010 @05:42PM (#30634466) Homepage
    Or was a quote altered to push a US (only?) brand?
  • by tomhath ( 637240 ) on Sunday January 03, 2010 @05:48PM (#30634504)
    TFA misrepresents the real reason for the low MRSA rates in Norway. Antibiotic use plays a part, but old fashioned hygiene and quarantining infected patients [findarticles.com] is by far the most important factor. Hospitals all over the US are already on this, it has nothing to do with whether or not health care is "free".
  • by SirWinston ( 54399 ) on Sunday January 03, 2010 @06:29PM (#30634886)

    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.

  • by Lord_Jeremy ( 1612839 ) on Sunday January 03, 2010 @06:38PM (#30634968)
    When I started showing signs of mental health issues and went to see a psychiatrist, their reaction was essentially throw the book at me. They put me on wave after wave of things I can't even pronounce, some of which had horrifying side effects. Eventually, I had such a bad psychological reaction to one of the meds that I had to be admitted to the emergency room. That night, my attending physician signed me over to an insanity ward and I spent three weeks there, unable to leave. Seriously, I was not allowed to leave because I was considered a "danger to myself and others". I can assure you this was not the case at all until people started messing with my head.

    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.
  • by 602 ( 652745 ) on Sunday January 03, 2010 @06:49PM (#30635058)
    I'm a primary care physician in the US. There are a number of logistical issues in the decision whether to prescribe antibiotics. They revolve around the ease of followup. It would be nice to always be able to say "You'll probably be fine. If you get sicker, come back." But if it's a Thursday or Friday, or if the patient lives an hour's drive from the clinic, or if I'm about to go on vacation, or if my schedule is overbooked for the next few days, I'm much more likely to prescribe an antibiotic. We need better access to care. Among the things that would help that would be (1) single payer insurance, so people could get care anywhere, and (2) better compensation for primary care providers (PCPs) which would result in (a) more of them, relative to specialists and (b) less need for existing PCP to overbook their schedules to make ends meet.
  • by cinnamon colbert ( 732724 ) on Sunday January 03, 2010 @07:23PM (#30635400) Journal

    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

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