Slashdot Mirror
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.
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.
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.
...because the dogbite was infected (as they usually are)?
And this is an exception to the rule. Another obvious exception is surgery, where antibiotics are used to prevent postoperative infections and organ rejection.
The idea is that your sniffles don't require azithromycin, that your cough and throat ache don't need penicillin, and that your fever doesn't need ampicillin.
"Victory means exit strategy, and it's important for the President to explain to us what the exit strategy is." G.W.Bush
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.
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.
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.
Nobody says 'Tylenol' in Norway (since it doesn't exist here), but we do say 'Paracetamol'. It was probably an adaptation by the journalist so the majority of US readers would know that a simple analgesic can be used as a doctor's visit consolation prize. That being said, isn't 'Tylenol' on its way to become a generic word? Just curious ...
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
Of course, it could be random coincidence or that you just happen to have a stronger immune system than the average person, but I guess your nonsense rationale sounds better. Also, remind me never to have dinner with you. You might enjoy the taste of your own shit, but I don't.
-1 disagree is not a modifier for a reason. -1 troll, flaimbait, redundant, overrated are NOT acceptable substitutes.
>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.