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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.'"
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.
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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...)
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.
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/
Or was a quote altered to push a US (only?) brand?
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?
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.
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.
Being a Norwegian married to an American, I feel I have a grasp of both sides of the issue - although I'll admidt that I don't have first hand experience of the US health care system.
Yes, compared to their US conterparts Norwegian doctors are really stingy with antibiotics.Off course, part of what allows them to be - apart from the whole mindset - is a) that Norwegians can take up to three sick days off* without a note from their Doctor, and b) Norwegians have a single Doctor they need to relate to** so the Doctor knows the patient better and the patient knows the Doctor. In fact we - my better half and I - seldom gets away with any less than half an hour in the Doctors office; with as much time spendt catching up since last time as on the actuall medical stuff.
Compare this to my inlaws who has to go to the Doc-in-a-box if they are feelign poorly, sit among other sickly people and wait for a Doctor - any Doctor who happen to be free - to have a look at them, give them a note and send them home (after a detour to work to hand in the note); probably with a prescription for a drug choosen not mainly on basis of what will help the most, but on what their insurance will cover. The staff isn't interested in making usre the patients gets the best care - it's all about processing them fast. So yes, I can see how easy it is to prescribe aome broad specter antibiotics if someone comes in with a fever - if it's an infection it'll knock it down, and if it's caused by something else you'll get the placebo effect. The patient is happy (and sick), the Doctor has done his job in ten minutes and my inlaws has spent half a day to get two days off work... whereas I could have picked up the phone, called my boss and told him I would stay home, rolled over and let my body handle it.
And yes, I know I'm overgeneralising - but I'm trying to get a point across and that often work better if done with broad strokes.
*) Part of the horror of a 'socialist healt care system'.
**) Another part of the horrible 'socialist healt care syste' - if you don't like your Doctor you can go online to change; up to two times a year, more if you move.
Everything in the world is controlled by a small, evil group to which, unfortunately, no one you know belongs.
In the UK, cleaning was almost universally outsourced, because of some management ideology about core-functions. It turns out that cleaning *is* a core function of a hospital (see a previous poster about the training of Norwegian cleaners) and should not be left to the cheapest bidder.
Patriotism is a virtue of the vicious
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
>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.