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How Norway Fought Staph Infections
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.'"
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.
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.
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.
I can see it now: Method and process for reducing MRSA infections by not using drugs.
Don't even try it without paying.
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?
Last night I dreamed I ate a ten-pound marshmallow, and when I woke up the pillow was gone. -- Tommy Cooper
Slashdot, are you serious? What's next, knock-knock jokes?
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.
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.
...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.
Warning: this article may contain humor, sarcasm, parody, and perhaps even irony. Read at your own risk.
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.
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.
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.
http://michaelsmith.id.au
Defensive medicine plays into the over-prescription of antibiotics in the US?
Don't provide the selection process (i.e. an environment laced with antibiotics everywhere), and the population of bacteria doesn't evolve antibiotic resistance, or at least resistance remains at relatively low frequency in the population compared to the stains of bacteria that don't have it, because there is no particular advantage.
Then, when you *really* need it (i.e. hospitals and truly serious illness), you can whack those bacteria with a huge antibacterial hammer that will *work*.
What we need to change is the economic selection process that encourages doctors to over prescribe this stuff to the detriment of their patients in the long term (i.e. the drug companies and $$$).
count me out!!
What I heard about hospitals in the UK is that they indeed are dirty,
From TFA:
"I don't know, therefore Aliens" Wafflebox1
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...)
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.
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.
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
ColdWetDog? "come back to BITE you"? LOL. Oh, you're TOO MUCH!
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.
A cat can't teach a dog to bark.
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 could indeed be fatal.
We have had antibiotics of one sort or another since the late 1800s and they have steadily improved. Today you can pretty much be assured that you aren't going to die from a scratch or cut. The problem is that we certainly have gone too far with antibiotic use, especially for trivial things. But do not even think about "living without antibiotics" or some such nonsense. It has been tried and the results are lots of people die from really trivial stuff.
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.
10 ?"Hello World" life was simple then
TFA is painting a picture about Norwegian hospitals that are easy to misinterpret. Yes, floor ar streaked and scratched, there is some dust on cabinets and blood pressure monitors.
Howevery, there it is still not dirty and messy as can be interpreted by the article. Cleaning staff in Norway actually have a 3- year education in cleaning! Translated school information site They learn how to spot the difference between dangerous and non-dangerous dirty surfaces. Think in your own home: The dust on the TV isn't dangerous, but the food spills on the kitchen counter can be. The cleaning staff is simply authorized and empowered to perform the important cleaning first, and leave non-dangerous dirt until they have the time to take care of it.
Germs and infections may also be less common due to the cold Scandinavian climate.
Shut the fuck up, one hospital means all hospitals in the UK are dirty? I don't know how you can even be serious.
I don't take antibiotics for that scratch on my finger, but I do wash the finger after going to the toilet, etc. Probably ten times every day. And the tap water I use to wash it is, while not disinfected, pretty clean. I think the difference is in the number of things in our environment which we wash and clean all the time. We don't allow dead animals in our water supply, etc.
http://michaelsmith.id.au
As usual, Garry Trudeau said it best. (Yeah, I carefully selected the bandwidth provider.)
Or was a quote altered to push a US (only?) brand?
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.
Think in your own home: The dust on the TV isn't dangerous, but the food spills on the kitchen counter can be.
Where on the grossness scale does this lay?
"I don't know, therefore Aliens" Wafflebox1
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 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".
Damn you and your Norwegian logic! *burble* Socialists!
Quack, quack.
If you get staph in Norway, it's treatable. If you get it in the US it isn't. How does that not solve the problem?
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.
..........FULL STOP.
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.
..........FULL STOP.
The things that have cut down deaths by diseases since the middle ages are, in order of effectiveness:
1. clean drinking water
2. the water closet
3. hygiene in the form of washing with soap primarily
4. antibiotics
5. everything else
Antibiotics are the _last_ defense, not the first. I have never taken antibiotics in my entire life and that's not at all rare for men in their 30s here in Sweden. In fact, almost all of the antibiotics I know my friends and family have been prescribed have been for post-op or urinary tract infection which still calls for antibiotics it seems (women seem buggy in this respect :P ). It is also illegal to use low level doses of antibiotics when raising cattle, chicken, etc.
About 3 on a scale to 10 with 10 being the worst :-P
Could, perhaps this be the cause of the smell? This seems to be a single incidence, and is not portrayed as the norm for the hospitals. It is clearly used to paint a picture to increase the contrast between clean/lots-of-MRSA and unclean/healty-hospitals. Don't read to much into it...
However, I see your point in this beeing unhygienic.
In every case where bacterial resistance has been traceable, it's been found to originate in agriculture. Agribusiness uses literally TONS of the latest antibiotics to produce more beef, more chicken etc.etc. cheaper and at higher profits.
In the meantime, the corporate controlled press extolls these stories about how withholding antibiotics from sick people cures the problem.
That's B$.
At worst, antibiotics in clinics and hospitals select for the resistant organisms that are already there. Why are they there? Because the patients and staff bring them in after being infected at home from eating the bugs in the food they buy at the grocery store.
The problem needs to be stopped at the source. Sick people make good targets for this kind of propaganda, but the problems will continue to grow as long as we fail to recognize the true causes.
If you don't believe me, run a google search on antibiotics and resistance and agriculture. That'll make you sick...
At least in Soviet Norway MRSA not kill you! *cough*cold-hearted ultra-capitalst *cough*
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
On behalf of all people capable of understanding the ramifications of natural (or in this case, artificial selection): "Duh." Good story about a country which resists the temptation to medicate into oblivion, with obvious positive results. Drugs have their place, but blasting any and everyone with them JUST IN CASE THEY *** MIGHT *** help is not... a good... idea.
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.
This is blinging
I swear, as each day goes by, I see more and more good things about Norway. I guess it's my new backup country if the good ol' USA ever collapses, just becomes a tool for corporations (much more than currently), or goes Big Brother on me.
Norway also has tons of oil it just digs off sea bed to pay for universal healthcare. I always find it when Texans (who also have oil) argue for state tax cuts or Norwegians argue for universal healthcare.
These ideas are easier to implement in certain places than others.
Not saying that advertising for antibiotics is a bad idea or that there should be no healthcare, but there are costs to everything.
Tylenol means paracetamol, in case someone else wondered too.
Swedish plasma phys. PhD student; MSc EE; knows maths, programming, electronics; finance interest; seeks opportunities
About 5 years ago, I had to give up my health insurance (Kaiser Permanente HMO, really) because we moved to a more rural area where they don't have local infrastructure. I didn't get regular health insurance from another company because my Kaiser coverage had been subsidized through an old employer plan, and everything else was too expensive. I worried that I'd get really sick and not have my HMO coverage, because I was used to going a few times a year for various things.
Fast forward 5 years later, and I haven't been to a doctor or hospital at all in that time. I seem to get sick less often than I did before when I'd go to the HMO 3 or 4 times a year with minor ailments, and when I do get sick it's less serious and goes away faster. I've had no antibiotics in that time, just OTC meds (but I avoid fever-reducers unless my fever goes above 102, because fever is one of the body's natural defense mechanisms against microorganisms).
The net result is that me and my immune system are happier, healthier, and wealthier, now that we're not over-relying on doctors and antibiotics. I also believe my household's complete lack of over-cleansing is part of the recipe for good health--people who clean obsessively and use that antibacterial cleanser are destroying harmless bacteria which usually "crowd out" the harmful strains, or at least leave them a minimal space to grow. But when your household is super-clean and a harmful bacterium arrives, it has room to grow everywhere since there's no existing bacterial ecosystem to compete with. Who knew that my stereotypical geeky tendency towards slight messiness and wearing the same clothes 2 days in a row thanks to all-night gaming/writing sessions might increase my health...
I'm sure I'll have to visit the doctor or hospital eventually when something serious happens. Until then, I see my seemingly better health now than when I was going to the doctor several times a year as an anecdotal vindication of the hypothesis that too much cleanliness and hygiene and antibiotic use can be as bad or worse than none, because our immune systems need to develop and thrive by exposure to lesser bacteria in order to be ready to take on serious ones.
"It's a damn poor mind that can only think of one way to spell a word."--Andrew Jackson
In many cases, they aren't. If there's any identifiable group more committed to old, ineffective ways of working, I can't think of one off-hand. Part of that culture includes working interns to death for so many hours that truck drivers aren't allowed (for safety reasons) to come near them and prescribing pills for every little problem because it makes the patient shut up and go away happy. They're prime candidates for drug company advertising, and enthusiastic participants in the scam.
I've calculated my velocity with such exquisite precision that I have no idea where I am.
It's cold in Norway. Bugs die quicker.
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.
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.
Finally, something could be considered reasonable advice with a little thing called FACTS to back it up. It's the kind of thing I come to Slashdot for. So little of it is found here though.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
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.
In South Australia, one (bright & well-educated) former Carer, working in community-based homes for people with Intellectual (& sometimes additional) disabilities, noticed that - while almost all of the Clients received SOME form of medication, each day... ...the twin daughters of a couple, that happened to be medical doctors where the ONLY Clients to receive ONLY Vitim C (ie, no other pills or non-food med's).
This was true across all of the care facilities this carer was rotated through (quite a few), in the time this Carer spent in this industry.
Another story (this one dated) from SA's government (then institutionalized) care for such Clients:
Before we all learned (in media) of the health risks & other implcations of Smoking, SA's gov't care facilities (looking after Intellecually disabled adults) actually had a policy of "normalisation" that translated (on the ground) into teaching their Clients to SMOKE.
It's a strange - if procedurally "normal" - world, sometimes. ;-)
> and is not portrayed as the norm for the hospitals.
Oh, but of course it is. If not, they would all clamor for socialized medicine!
(fwiw, I worked in a hospital kitchen for many years, driving food to the wards. Unpleasant smells were very rare, and I never saw soiled bedsheets in the corners.)
xkcd is not in the sudoers file. This incident will be reported.
One of the things that modern medicine has done which I think most people would agree has been highly effective is vaccines against virii. As a kid growing up in the U.S., I think I got something like 8 different vaccinations. Those vaccinations protect against a lot of those things which used to kill people, which don't anymore.
This is basically implied in your #2, but I'd just call out modern sewer and waste water treatment systems, as well as garbage collection. I'm not sure, but I think things like pest/rodent control probably played a big role too - wasn't the bubonic plague spread by rodents?
As for antibiotics, I do agree with you - they are sort of a last line of defense for severe/rare cases.
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.
Breakfast served all day!
That ain't nothing compared to Bayer + HIV.
So, if I have Runny Nose, Swollen Sinus, Coughin and the like for 3-weeks straight, can't sleep, feel miserable, am eating right (organges etc), and every morning I wake up, blow my nose and blood shoots out, my eye feels like someone is stabbing me repeatedly in the face and my chest feels like someone is sitting on it most of the time, then what? And before you answer, I've been to multiple doctors and noone know what the goddamn problem is. I've lived most of my life this way. I spend 90% of the year feeling like someone has poured battery acid in my sinuses and down my throat. The entire right side of my face around my eye and sinus throbs nearly continuously and everything I eat makes my stomach feel like I just drank molten steel. I've been working a full-time job since I was 14 years old, I served in the military (with distinction) and I continue to be successful. Meanwhile, I'm in constant pain and feel almost no pleasure in anything I do. So, seein' as you know all there is about doctoring, what can I do?
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
most Americans are terrified of because they are huge pussies that live in a culture of fear.
Really? Are you so sure of that? Or is that what you'd like to believe? How many military campaigns have you served in? Have you even served in the military? What dangers (real) have you had to face in your life?
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
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
You mean all the philippinos and siri lanken low paid workers actually got 3 years of education when it comes to cleaning?
It might be that you need that kind of qualifications for operation rooms etc, but the majority of the cleaning stuff I seriously doubt got that kind of qualifications.
On top of that some hospitals are cutting back on cleaning staff, to cut costs.
So even though Norway is great a place to live, but some of these articles makes it look like some Utopian place.
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/ )
(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.
Although I agree with most of what you said, these agents don't actually cause a singular bug to somehow become a super bug. What they do is alter the environment enabling a favorable evolution of bugs into bugs that can survive in that new environment.
The problem is when we aren't clear about what we are saying (as people who are supposed to be "informed"), patients don't generally respond the correct way (e.g., they can stop taking vaccines, because they're just like antibiotics, and all that stuff causes bugs to mutate, right?).
Antibiotics, like all tools, have a purpose (e.g., can't use soap and hand sanitizers to clean out your lungs or other internal organs of a bacterial infections), and I agree they are overused, but sometimes the tradeoff is worth it.
Although part of the problem is the advertisement and promotion deluge (one-size-fits-all, buy my most profitable product, all your peers are doing it, why don't you), education of patients/consumers is a real problem. There are really no incentives for patients to get eduated in most healthcare systems and unforutnatly we all pay for it (this is not unlike people not having any incentives to get educated about the mortgage market).
When people are more educated, they tend to make better decisions, but sadly, there needs to be a motivation to get educated. Right now, either the health-care insurance company and/or the government is determining all the "options" and paying the bill.
Because we can't trust patients to be educated, we defer to the medical establishment. From the medical estabishment's point of view dispensing anti-biotics is cheaper than talking to a doctor for a few moments (since the doctor is making $100+/hour) or have a doctor supervise the advancment of an unknown infection and avoid the anti-biotic even though it may be more expensive in the long run to society (it is of course cheaper for the patient to take the anti-biotics as well).
Not really sure how to change this, in a culture where people demand things right-now, whatever is best for me, damn the consequences to society, who cares about deferred gratification. Perhaps what we are really doing is taking a page from the bacteria and are evolving people that are resistant to so-called super-bugs. We've been able to avoid some forms of evolution by our use of technology, but perhaps there are limits to technology that we will hit and then we'll have to adapt...
Although capitalism might be to blame for this, I don't think the fault is with the companies, it's with the customers. They are getting what they want, it's just that the customers are short sighted and what they wan't isn't that great for society as a whole.
Maybe we can conclude that we should cap-and-trade antibiotics? or we should declare some non-resistant bacteria as endangered species?
Often, doctors prescribe antibiotics because patients or parents of patients simply want to "see them do something."
Or, if nothing is done, and a patient dies of complications, the doctor is sued for not doing "enough."
If I were a doc, I'd do the same damn thing.
"I also think that the abmulance chasers should not be allowed to sue for any drug that has been approved by the FDA"
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.
-1 disagree is not a modifier for a reason. -1 troll, flaimbait, redundant, overrated are NOT acceptable substitutes.
I think the recommendation is to withhold antibiotics where they are not needed, not for all sick people.
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.
..that a big pharma representative is on his way to Norway right now with a vial of MRSA extract and a press release statement that says, "We toldja so, buy new UberMed (tm) today and you'll all be safe".
Am I really the first one to point out that (at least here in the US) it is a common practice to feed antibiotics to cattle in order to fatten them up more quickly? Gee, ya think that some of those farmers might be constantly coming in contact with small amounts of those antibiotics and develop MRSA or worse!?
E = m * c^(Hammer)
knock-knock
who's there?
landshark
ahh!!!!!
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.
>Years ago, there were no fancy drugs or somesuch to be prescribed for mental health conditions.
And people suffered with their problems. They beat their kids. Or they drank heavily. Or they beat their wife. >For the most part, people just dealt with their issues.
I'm going to have to disagree with you there. I don't think life was all sunshine and rainbows before the first Prozac pill was handed-out. I think a lot of people who needed help were just miserable, treated themselves with alchohol or were prescribed some other medications that did not help.
> 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.
I have been helped a great deal both by psychiatrists as well as by medications like anti-depressants. The psychiatrist that helped me through some very rough times in my life has kept me from falling apart. He has also provided some valuable insight that I would have not otherwise had. I have recommended this guy to other people who were in a bad spot and he has helped them as well.
You do a great disservice to people who may be suffering from depression, anxiety or other disorders by telling them that "well, i've never heard of no one who got halped!" Speaking from personal experience, it's hard enough to admit that things have spiraled out of control and that you need help. It takes a lot of balls to make that first phone call and make an appointment. Your statement just made things that much harder for someone who is working-up the nerve to make that call.
If you worked with a mental health professional and you did not get the results you were seeking, FIRE HIS/HER ASS. There is no law that says you have to stick with the first doctor you talk to. I have worked with many docs on the medications. It took me quite a few tries to find a guy that I like working with who is also very, very smart when it comes to the drugs. Don't feel the least bit of guilt about saying to your doc, "Sorry, you aren't cutting it for me. I won't be coming back to see you." You are the consumer. You are the person paying for the "service". If you don't like the service you are getting, take your money somewhere else.
In addition to my own personal success with both medications as well as "talk therapy", I know quite a few friends who have been helped by mental health professionals. Getting professional help is far better than the solutions available in the past: drink yourself numb, beat your family or chew on the barrel of a firearm.
"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.
And they received no better information on artificial knees before coming to that half-baked conclusion.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)
It does happen
Behold, one of the fundamental problems with today's world:
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.
Translation: "It's *always* someone's fault and, goddamnit, they owe me money for it!"
Dude try some exercise, and if you can not quit your meds:
1- buy a mg scale on ebay
2- weight a pill
3- crush it
4- go to 1 but remove 2% of its original weight each weak
OMG that's like tens of dollars.
I'm home on break, staying at my parent's house. They're the type with hand sanitizer everywhere. Every sink. Stepmom carries it with her. Wash your hands before you eat, after you pet the dog, after you clean your room, etc. Spare antibiotics abound in the medicine cabinet from not finishing them before.
The whole house is ALWAYS sick. I haven't had even the /sniffs/ in 5 years, and the last time I did, I waited until the docs had to keep me in the ER because I had gotten sepsis. I took my whole bottle of antibiotics like I was told.
A lil dirt never killed anyone.
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.
Much of my income is based on performance, Anonymous Coward, so get off your high horse. What I mainly resent is specialists with an equal amount of training making 5 times the money I make.
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.
Jumpstart the tartan drive.
That's why you come to us psychologists. ;) No drug-prescribing here.
if right or wrong, they may be nasty bacteria free, but they
still stink.
You forget the effect of residual antibiotic in food.
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.
To really solve the problem, we need to ban antibiotics WORLDWIDE for anything other than full biohazard containment situations. If somebody recently treated with antibiotics is allowed to use a toilet connected to the normal sewerage system, then that antibiotic is getting out into the environment. Absolutely every bit of waste generated by an antibiotic-treated patient needs high-temperature incineration.
Think of an antibiotic as a secret that humanity must hide from the ecosystem.
"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."
My child was helped immensely with their problems by a psychiatrist. We employed both drug and non-drug strategies, and it made a big difference. As my child matured, they also learned strategies to deal with the condition themselves. Much of the effort was simply a matter of understanding the nature of the illness, trying to avoid the usual triggers, recognizing the development of an acute episode, and then acting appropriately to deal with it. Most importantly, before accepting the drug aspect we tried double-blind tests, and revisited the issue with a new double-blind test each year. On principle, we did not want to use drugs, and there were some mild side-effects from them. However, each time we did the double-blind test it definitely made a net positive difference, both from our perception, my child's perception, and those of third parties that were not informed that a test was in progress. It was obvious when they were on the drug versus on the placebo when we compared observations. It simply worked. It was a choice between using it or letting our child suffer through the illness, which might lead to other psychological/social problems because of the way the illness affected their interaction with other people. We were already faced with significant issues when we sought help.
It's been close to a decade now and it has worked out fine. Do I worry about the possibility of long-term side effects from taking a drug for so long? Heck, yeah. But I have to weigh that against the very likely development of some other serious problems if we didn't, and my child will soon be old enough to make the decision about the drug entirely on their own. Given that they've been involved in the decisions all along, to the extent their age allowed, I doubt they will change their mind about it, but they will be free to do so.
I'm sorry to hear about your bad experience, but, no, it doesn't always turn out that way. I suspect that it depends greatly on the individual psychiatrist and the individual case. Your advice to generally avoid medications is wise, and I share the sentiment, but sometimes drugs are necessary and genuinely effective (see above -- there was also an occasion when my cold developed into pneumonia, and antibiotics were necessary then too). The hard part is figuring out when they truly are necessary and are doing some good, or the opposite. When you are dealing with a crisis you don't always have the luxury of a double-blind test, and if your body is changing over time or you have bad side-effects, it might not be possible to do such a test properly. Mental health is one of those areas that is exceedingly difficult for medicine to deal with because the problem is so incredibly complex. It's not surprising that the results are mixed, especially when compared to other areas of medicine. This is not a reason to reject the utility of drugs entirely. It's a reason to be cautious about them. Ditto for any medical advice.
My grandmother was 87 years old when she passed away. Her only regret was not living long enough to see any great-grand-babies.
I was the driver for her weekly injection, and saw that she was "just going through the motions" of treatment for her husband and children. She didn't really care whether she finished out the year or not.
I went to the pharmacy for a prescription of ... thalidomide towards the end of her treatment experience. Thalidomide was banned for many years because it caused birth defects. Then someone found out that it extends the life of MM patients by "2 months", and now some company has a patent on methods to keep fertile women from getting it. The pharmacy charged $2309.99 for a one-month supply. If she survived a month, she would have gotten another prescription for $2309.99. That's $4819.98 for $2 worth of pills.
Don't be sorry about my grandmother - I would have encouraged hospice care as soon as she got her diagnosis. The funny thing about hospice is that some people get better as soon as they start. My grandfather loved hospice care, and lived for about 2.5 years before he finally passed away. Grandma was already dead, and Grandpa had never gotten so much attention...
Consider: someone is profiteering off your father, and there are other aspects of his condition that should be addressed. Linus Pauling (2x Nobel Laureate) wrote a book on Cancer & Vitamin C. Other researchers now advocate large doses of Vitamin D as an effective, gentle
and safe cancer treatment.
There are also significant psycho-somatic aspects of any treatment program. Pharmaceutical-based medicine treats bodies, and mostly ignores the mind's role in treatment.
Read the quote again: while your dad's doctors might care about him, the medical-industrial complex does not. All they care about is how much they can make off him. The complex ignores the cheap, effective treatments in favor of the flashy, expensive, experimental treatments, that don't really work anyways.
Learn the rules so you know how to break them properly.
www.teslabox.com
I think that's probably exactly right; no real mention of such things, though, not that you'd expect it - probably just assumed it was normal and had to be dealt with.
I've fallen off your lawn, and I can't get up.
One thing the article fails to mention is that Norway also reduced the use of antibiotics in animal feed.
I would not be surprised if that has also had something to do with Norway having low rates of drug resistant infections.
http://jac.oxfordjournals.org/cgi/content/full/43/2/243
this little graph from the article is the most telling I think.
(The graph on the right is about 1/3 less drugs then on the left)
http://jac.oxfordjournals.org/cgi/content/full/43/2/243/FIG1
In the UK, the issue is the public sector unions.
No amount of cajoling will make nurses wash their hands between patients. There has to be some form of sanction. But the UK health industry is nationalized, therefore it is represented by the government employees trade union, and that is opposed fiercely to all discipline of all sorts. There are thus no sanctions whatever, and the result is that despite endless government initiatives, hand wash stations all over the place in hospitals, hands are not being washed. And there are still infections. It is one of the great unspoken risks about going in for surgery in the UK.
In fact, if you go in to one of the few hospitals that pre screens patients for MRSA, the people doing the screening, the first thing they ask is if you have been in hospital recently. If you say no, they tell you that you will almost certainly be clear. The main vector of infection in the UK is the National Health Service. If you know many people who have been hospitalized, you find that many of them have been infected. And many more die of it than is admitted. The cause of death on the certificate will be the proximate cause. Whether they had a bad case of MRSA when they died of it, who knows?
As long as people on wards dealing with patients have no sanctions to fear from not washing their hands, enough of them will not bother to make it impossible to really change matters, and as long as they are all represented by Unison with its close links to the Labour Party, there will be no sanctions.
So we will see people talking about contracting out of hospital cleaning services - an obsession with Unison, but irrelevant, and we'll also hear about over prescribing of antibiotics, also not the problem. Do something to make these guys wash their hands, and the operative word is MAKE, and the problem will vanish overnight.
Show me your bill or name the doc who said "for X dollars, I'll diagnose you and discuss your treatment, but it will be an additional Y dollars to write a prescription."
Jesus was all right but his disciples were thick and ordinary. -John Lennon
Has your wife had a Mantoux test recently?
When my father started as a medic the common antibiotic prescription was in the 250mg range, after a few years it became 500mg. Today prescriptions are common in the 1 gram range and sometimes it's not even enough.
When my father first started his career as a medic the common prescription for antibiotics was in the 250mg range, after a few years it became 500mg and today we are at 1gram prescriptions and sometimes it's not even enough.
This has been resisted. Can you blame anybody for being suspicious when people with obvious financial incentives are resisting a double-blind trial?
They haven't done a double-blind trial regarding vaccinations causing alien abductions. Almost everyone who claims to have been abducted was vaccinated. Coincidence? I think not.
Autism doesn't show before vaccinations start. Then, when it does occur, parents, not wanting to blame themselves (if Autism is caused by genetics, then the parents gave it to them, if environment, then the parents exposed them to it), point to the most recent thing they didn't have control over. It's not rational. They are resistant to a trial because statistical anomalies happen. Why risk one when they firmly believe vaccinations can't be the cause of autism? And even if the trial showed they are safe, you'll still have the irrational campaigning against them. They have nothing to gain, vindicated or not, by running the trial, and they do have something to lose.
And nothing stops you from buying 10,000 vaccinations and doing the trials yourself. If it's such an important issue, why haven't you (or the money behind the anti-vaccination movement) done it already?
Learn to love Alaska
That's between 17 and 170 USD. Last year, my company paid about 10 to 100 times what yours did for my insurance. I don't know what it went up to this year yet. And my estimation is that someone in the US with health insurance will still pay more of their own money on medical care for seeing a doctor than you would without insurance. And there are wait lists in the US too, even when you are paying, depending on what you are having done.
Learn to love Alaska
this valium isnt working I need your wife Mary J
Yet another variable: Norway is a long, thin, crinkly country divided by deep fijords. There was no road from one of the country to the other until the mid sixties (I have been trying to find a reference for this, but I can't). If you live in a long, thin ribbon of a country, like the valleys in Switzerland, or Old Kingdom Egypt, you have fewer direct neighbors. Taken to extreme, you would have two nearest neighbors if you were 1D creatures, six if you lived on a close-packed plane, and twelve if you are packed in 3D. We know that some human interactions are modified by the connectivity of the territory: 'the tragedy of the commons', for example, did not happen in Swiss valleys with common high and low pastures, because if you overgrazed your commons, your two neighbors would be much more likely to notice and object. The article suggests that MRSA attacks in Norway usually came from outside, but could be contained. While I support Norway's attitude to antibiotics, I fear their solution may not work as well in a flatter country with more visitors.
Even if it doesn't help, it will relax you and take care of spots on your face as well! :-)
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.
Not even "if you have these symptoms, it might be an enlarged prostate, so see our web site at prostateinfo.example"? Then how do people even know whether their pains are A. a normal part of life that one shouldn't try to treat, or B. symptoms of a disease that warrants seeing a doctor?
Unlike genuine alien abductions, there is actually a plausible mechanism (autoimmune disease) for vaccination to cause autism. Alien abduction claims (presumably not genuine abductions) are associated with schitzophrenia, which could in some cases be caused by autoimmune disease and thus caused by vaccines.
You can't just run a trial, at least here in the USA. You need FDA approval, which means going up against the vaccine industry lobby..
The "statistical anomalies" argument is shit. You're essentially tossing out a key pillar of modern science. If you really want to disregard modern statistics, please note that you're missing out on the chance that things go the other way, with vaccines shown to prevent autism.
http://www.justice.gov/usao/ma/Press%20Office%20-%20Press%20Release%20Files/Nov2009/JenningsTorrinoSentencingPR.html
I've felt that the drug companies have been the problem with healthcare for quite some time. If they spent half as much on advertising and bribing doctors, we just might have CURES for REAL diseases like cancer. Instead they are happy dispensing medications that really only minimize a set of symptoms or worse yet serve to strengthen the diseases in patients that do not have the knowledge or discipline to accurately administer their medication. The FDA used to keep companies from mentioning the name of their medication in their advertisements, the problem then became that they just made ads describing diseases and scared everyone into seeing their doctor. The first thing that needs to happen (BEFORE HEALTH CARE REFORM) is someone should make these companies stop bribing the doctors and doctors and drug companies should be held more accountable for the consequences of medications.
STAPH doesn't stand a chance against it and it won't fuck up your bacterial flora in your gut like anti-biotics will (thus further weakening your immune system).
If it was proven that the drugs companies were knew about this possibility...
And how exactly do you plan to do this without depositions, document requests, interrogatories, and live testimony? There are obvious problems with the idea that you shouldn't be allowed to sue someone until you gain information you can only get in the course of suing someone...
I know your ignorant so I forgive you.
Ditto.
Chemo is far more involved than 'just a shot'. That "$65 for 15 minutes of time" is an old metric, fading out in the 80's at the latest. There are two flaws with it in modern times. First, that $65 was probably the billed amount. Very rare is the insurance who actually pays that amount. The allowed reimbursement is probably 25% of that. Second is the time. That's probably for a level II visit, which can take two minutes or it can take two hours. It has to do with the types of questions and problems worked on during a visit.
I notice you still didn't point out, except in reference to administering chemo, where you had to pay for getting a shot. A shot would refer to allergy shots, vaccinations, possibly some pain injections, but chemo is, AFAIK, different. (I've never worked in oncology, so I'm not sure, but this is my understanding.) Were you charged for materials? Probably. But why not? Only under communism is all value derived from worker input. In the real world, things have value, and must be paid for. If the oncologist could not charge for the drugs, that "$65 for 15 minutes" would probably be at least an order of magnitude higher.
You seem to have a lay or patient's understanding of the process, and really don't know what goes on behind the scenes. I can't fault you for that, as physicians have spent millenia pretending that they practice near mystical rituals that the average person cannot and should not understand. They have only themselves to blame. And yes, there are many docs who are incredible assholes and greedy cocksuckers. I've probably met far more than you have, and it's one of the big reasons I no longer work in that industry.
But to slander an entire profession due to a misunderstanding of the economics and running across a few bad apples does no service to anyone.
FWIW, I could continue to try to explain some of this, as I see that despite the wall of text, there are a few things I've left out. But if you'd rather just continue being angry, I can spit venom as well. Given the choice, I think we'd both be better off with the former.
Jesus was all right but his disciples were thick and ordinary. -John Lennon
I'll add the other side to your story. (Full disclosure: a member of my family has worked in mental health, though without prescribing any drugs.) Both in people I've known personally and in case studies written by a doctor who believed that many of the worst mentally ill people are not "untreatable" despite the psychiatrists' opinions, it has been clear to me that meds sometimes provide a vital breathing space, so the patients can at least make good use of the hardware inside their heads, and thereby get themselves better, given a software expert (that is, a therapist) who can reverse engineer the bad software in their heads and help them uninstall it.
The problem seems to be that therapists who have enough imagination and perseverance (and, in extreme cases, enough physical courage) to help these patients, and enough respect for them to prescribe minimum rather than maximum amounts of medication, are scarce and expensive. You think drugs are expensive? They are, but the cost of a therapy session can pay for a lot of pills. So there tends to be a bias towards pills. Easier to whack the hardware with a hammer than investigate the software ... but running bad software on good hardware still isn't going to work -- and please don't take that personally! Plus it may take time, and money, to tell whether the problem is in the hardware or the software (or in both).
I have also heard stories, by a Stanford professor no less, where anti-psychotic meds were prescribed in "wanton" doses in mental institutions. So although I've never been through what you have, I am sure your stories are as real as mine. On the lighter side ... well, it wasn't light for him ... I once knew someone who suffered from depression, so his doctor had him sent home from work on (quite generous) disability pay; the only problem was that most of the things that made him feel good and could have lifted him out of depression were part of his job. Argghhh.
I'm sorry if you think I've done people a disservice. Perhaps you are right, perhaps the majority of people that seek help receive it and are better off. Unfortunately, I have problems accepting that. All anyone can say about this is based on their own experiences. While you've had a great experience and have come out a healthier person, I've had a shittier experience and I feel like I'm much worse off then I was two years ago. At the moment, I'm pretty much stuck with my current doctor because the hospital she works at is the only place I've found that takes my health insurance. Alas, therapy and meds are extremely expensive. It's come to the point where I need to see her to get more medicine, yet every time she tries to wean me off I have an episode.
I suppose you're right. Normally I'm much more balanced and neutral about issues like this, but my experiences with mental health professionals has really set up some unpleasant opinions. As I said in another reply, I've been pretty much backed into a corner at this point. Last week the doctor tried again to wean me off of my medication, this time in combination with a less dependancy-forming med. Unfortunately, I had a panic attack accompanied by a seizure. Fortunately, I was with family at the time, else I might've ended up in the hospital again. Probably the most traumatizing thing in my whole experience was the first hospitalization. I wonder if you could keep your perspective if your child was admitted to the ER and then you were told you could not see them for three weeks. I'm sorry, but I am the sum of my experiences.
To date, my psychiatrist has tried three times to wean me off of my meds. Each time, within a few days I have an episode. When I was put on this med, I was in the hospital under the care of a different psychiatrist. When he prescribed it, he said if I didn't take it they would sedate me and give it intravenously. This was after I already had a bad reaction to other medicine and they weren't sure what was going to happen.
I'm replying to my own comment because I sort of feel bad. Some of the other replies have made a good point that not everyone will have as bad an experience as I have. When I was in the hospital, I met a lot of other people that had been through similar things. In many cases, they started out with a small problem but their condition was exacerbated by doctors' recommendations. I remember specifically one woman who had an anxiety disorder like me, but became extremely depressed and started cutting herself after her doctor put her on something. Since then she had been on perhaps a dozen different meds and sported scars up her arms and legs. I relate this story just to give my OP some additional perspective. Of course I realize that many people, maybe even most people lead better, happier lives because of assistance they've received from mental health professionals. Even so, please don't forget that there are at least some cases where more harm has been done than good.
The "statistical anomalies" argument is shit. You're essentially tossing out a key pillar of modern science. If you really want to disregard modern statistics, please note that you're missing out on the chance that things go the other way, with vaccines shown to prevent autism.
Huh? What pillar of modern science am I tossing out? "A common misconception is that a statistically significant result is always of practical significance, or demonstrates a large effect in the population." (from http://en.wikipedia.org/wiki/Statistical_significance). That's a well known key pillar of modern science. A single study showing a statistical significance is determined to be practically significant (which is wrong some set percent of the time) and if the result were statistically significant, but small enough that any reasonable application of logic would dictate that we continue vaccinating, it would be illogically hailed as proof that modern medicine is trying to kill us all and vaccinations make us worse than not having them, even if that is the exact opposite of what is found.
The key pillar of modern science you are missing is that the population has no clue of modern science and will misunderstand anything you say and believe anything if you tack, "think of the children" at the end.
You can't just run a trial, at least here in the USA. You need FDA approval, which means going up against the vaccine industry lobby..
Then don't do it in the US. If you can't convince the FDA, then the problem is with your asking or the FDA. Has anyone ever asked and been turned down? Or are you making up boogeymen? And are you even sure it has to be approved by the FDA? It's not a drug trial. It's a study about an approved drug.
Learn to love Alaska
(blue screen)
We interrupt this program to bring you a lexical note on impractical application from the local citizens board of reasoned inquiry.
(slight pause)
Universal health care.
(title displayed in white letters on blue screen in a very easily legible font)
(switch to empty studio with talker on a chair)
(close up of face)
Universal as defined by the politicians.
(pause during which talker must smile and then stop smiling)
(back to full body view of suited talker sitting casually with one leg over the other in the otherwise empty studio)
Which of course isn't really anything like universal at all, never mind that it's enclosed by the borders of a rather piddly country on Earth (brief full screen picture of map of Europe with arrow pointing at Norway) populated by moose (brief full screen picture of moose), polar bears (brief full screen picture of polar bears), and people speaking strangely while trundling around with far too few clothes on (slightly longer black screen); it's also enclosed by the minds of the politicians (full screen cartoon of empty head), the minds of the bureaucrats (full screen cartoon of empty head with cobwebs), the minds of the doctors (full screen cartoon of empty head except for a naked women sticking out), the details of the system (full screen cartoon of byzantine clockwork), the available funding (sound of a few coins going "pling") and in turn the available taxation levels (sound of slot machine paying out a torrent of coins), the ability of people to pay their part that is required as direct payments after they've paid tax on their welfare checks and if they have anything left over from what wasn't spent on heavily taxed alcohol (slight pause), and of course also the ability of people to actually make use of it which to many that are ill is far from as easy as it seems to healthy people.
(insert appropriate picture of "ill" person that is not able).
(close up on face)
So, not really universal at all then but it just sounds so much better that way that some people seemingly get well just by (slight emphasis) not (slight emphasis over) thinking about it.
(blue screen same as used at the start without title)
### Feel free to use this in any way you deem appropriate, it felt so much like a Monty Python sketch
### Kind regards from Norway.
(back to studio)
Oh and for that matter it isn't called universal health care in Norway, it's called "offentlig helsetjeneste" (o(h)-fff-eh-n-"thl"-EE-"ghh" heh-L-seh-tch-eh-n-eh-ssstt-eh) which means public health service. Not universal, public.
(full screen picture of a pub)
("and now for something completely different"-styled interlude zooming in on the pub for the next sketch)
Years ago, there were no fancy drugs or somesuch
Instead they'd zap your brain with voltage so high the convulsions break bones, or just give you a good ol' lobotomy. None of this new-fangled "pill" stuff. And, hell, who needs that fancy shmancy electricity business? Just stick 'em crazies in a centrifuge and let it rip!
I suppose that's true, although my grandfather had lots of depression problems that he just dealt with, and he lived a long and apparently happy life. I guess it depends on what you were cursed with and how well you could deal with it on your own. My point was that a lot of people were probably forced to deal with their demons themselves and were thus able to overcome then.