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How Norway Fought Staph Infections

timothy posted more than 4 years ago | from the they-fired-adrian-monk dept.

Biotech 595

eldavojohn writes "Studies are showing that Norway's dirtiest hospitals are actually cleaner than most other countries', and the reason for this is that Norwegians stopped taking antibiotics. A number of factors like paid sick leave and now restrictions on advertising for drugs make Norway an anomaly when it comes to diseases like Methicillin-resistant Staphylococcus aureus (MRSA). A Norwegian doctor explains, 'We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better.' Norway is the most MRSA free country in the world. In a country like Japan, where 17,000 die from MRSA every year, 'doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.'"

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595 comments

Stop with the drugs already (5, Insightful)

Anonymous Coward | more than 4 years ago | (#30634004)

Endure non-life-threatening illnesses without drugs, it helps you build an immune system. Taking drugs means your body never learns to fend for itself, like a spoiled brat.

Re:Stop with the drugs already (1)

Trepidity (597) | more than 4 years ago | (#30634032)

The American psyche (and that of some other countries) has learned that nothing can be done on its own, though: anything bad is medicalized, and anything medical needs either a pill or surgery to solve it.

Re:Stop with the drugs already (4, Insightful)

sjames (1099) | more than 4 years ago | (#30634442)

No doubt, it's part of the incredible healthcare costs in the U.S.

Compared to when I was growing up, it seems that people go to the doctor for even the most trivial complaint these days. The fevers I had as a child that got "we'll give it a day or two and see how it is" are now treated like some sort of emergency. Cuts and scrapes that used to mean some iodine and a band aid are treated as if they were an emergency.

I haven't had medical treatment of any sort in over 20 years. It's not that I'm some sort of superman, just that I don't buy in to the hype.

Re:Stop with the drugs already (2, Insightful)

Octorian (14086) | more than 4 years ago | (#30634480)

My father is a Doctor, so I'm not even sure what it would have been like growing up any other way. It basically meant that we could easily "ask a doctor" for something trivial, and not actually have to go see one unless it actually was serious enough. Kinda got spoiled that way, and also helped to avoid unnecessary treatment.

Some day when I have kids, I really do wonder how I would react given a lack of at-home medical advice.

Re:Stop with the drugs already (1, Interesting)

Ethanol-fueled (1125189) | more than 4 years ago | (#30634106)

The college I attended posted "OMG FLU Get VACCINATED!!!!1!" flyers everywhere and students were writing things like "bullshit" or "never got one, still alive" on them with magic markers. Glad to see years of media scaremongering and ultrapowerful pill-pushing lobbies haven't chipped away at the cynicism of youth.

Re:Stop with the drugs already (3, Insightful)

edwebdev (1304531) | more than 4 years ago | (#30634156)

Vaccines and antibiotics are fundamentally different (flu shots and other vaccines are not part of the superbug problem), but the mindset remains the same.

Re:Stop with the drugs already (5, Insightful)

dexmachina (1341273) | more than 4 years ago | (#30634164)

Er, preventative medicine is entirely different from treatment medicine. Vaccinations and antibiotics are entirely different compounds. The article is about letting certain illnesses run their course naturally, not saying, "Well, screw it let's just not bother with the whole medicine thing." Unless of course you'd like to see a resurgence in polio.

It appears that years of media scaremongering and anti-vaccine lobbies have gotten through the youth crowd quite effectively.

Re:Stop with the drugs already (1, Troll)

introspekt.i (1233118) | more than 4 years ago | (#30634206)

... lobbies haven't chipped away at the naïveté of youth.

There, fixed that for you. Now go get vaccinated and get off my lawn.

Re:Stop with the drugs already (0, Troll)

Ethanol-fueled (1125189) | more than 4 years ago | (#30634482)

Are you the guy who sprays Lysol everywhere whenever someone sneezes at work?

You might actually develop your own immune system if you quit huffing that noxious crap :)

Re:Stop with the drugs already (2, Insightful)

FrozenGeek (1219968) | more than 4 years ago | (#30634208)

Not just colleges. Our HR department sent out company-wide notices at least once a week when the H1N1 scare began, telling us to get vaccinated and how to protect ourselves. Then management wonders why our sales reps refuse to shake hands with our (tenuous) customers.

We need to start ignoring the chicken-littles of this world. Scratch that. We need to start SHUNNING the chicken-littles of this world. Maybe then they'll get the message.

Re:Stop with the drugs already (1)

bhtooefr (649901) | more than 4 years ago | (#30634386)

I was doing a temp job at a company where company policy was actually that nobody was allowed to shake hands, because of H1N1.

Yeah, really.

Re:Stop with the drugs already (5, Insightful)

Anonymous Coward | more than 4 years ago | (#30634252)

Not all non-life-threating illnesses help build your immune system. I'm sick and tired of this idea that the immune system is like a muscle that you can build up over time or weaken by taking antibiotics. This is a failure on the public's part for understanding how the immune system actually works.

MRSA would have exsited with or without antibiotics. It is all just a matter of time. Things evolve, get use to that fact. So do immune systems. If I could point to a large contribution to the flood of antibotics, it would be peoples lack of understanding of how medicine works. People walk into a doctor's office and say, "fix me, fix him, fix her, fix us..." They want instant results, not results that take 24, 48, or 72-hours to take effect. Doctors, as much as they would love to tell you, can't say you're over reacting go home and call me in a week. That's an awsome way to get sued in the US. The moment that people come to the understanding that the only medication that develers instant results is used in leatal injections, will be the opprtunity to educate people to just, "take it easy, stay home, get rest, drink plenty of fluids, and go to the hospital or follow up with your doctor if your symtomps presist or get worst."

People and the "instant get better" thought process are the real problem of over medication. If no one shows up to the hospital, how do we over medicate? MRSA is just another evolving part of nature, nothing can be done about that. And I dare say that antibiotics do not work the way that you so claim them to work. I would like to see the person who has acquired immunity to something that is treated with antibiotics like Gengreen.

Re:Stop with the drugs already (5, Insightful)

Galactic Dominator (944134) | more than 4 years ago | (#30634282)

MRSA would have exsited with or without antibiotics.

Do you even know what MRSA means?

Re:Stop with the drugs already (4, Informative)

dgatwood (11270) | more than 4 years ago | (#30634452)

A poor wording, admittedly, but the GP is right that even without widespread antibiotic use, MRSA would still exist. It just would not be a prevalent strain, as it would not have any advantage over all the other, non-resistent strep strains, so it would be maybe one bacterium out of every thousand instead of better than one in two. Same goes for C diff and other problematic strains. Whether that's a meaningful distinction or not is another question.

Re:Stop with the drugs already (0)

Anonymous Coward | more than 4 years ago | (#30634262)

While you're right (to a certain extent), I want to point out that it is not at all the issue discussed in this article

Re:Stop with the drugs already (1)

Darkness404 (1287218) | more than 4 years ago | (#30634382)

Sure, but good luck getting that done for work/school. Yeah, even the most strict of workplaces will let people take a sick day every now and then if you look and sound sick, but if you get sick more than twice in a month generally they want to see a doctors note. Its honestly pointless to go to the doctor, pay money and not do anything about it to make you feel better. Schools are usually worse, especially at the university level, because not only are you sick and not getting the classes you pay for, professors usually are unsympathetic to your cause even with a doctors note.

Re:Stop with the drugs already (5, Informative)

Anonymous Coward | more than 4 years ago | (#30634476)

Endure non-life-threatening illnesses without drugs, it helps you build an immune system. Taking drugs means your body never learns to fend for itself, like a spoiled brat.

Sigh....will the non-trained, please refrain from discussing what they don't know?

As a physician:

A) I have little financial incentive to precribe any given antibiotic. No one pays me to give out X number of Zosyn(tm) or Y number of Levaquin (TM) prescriptions per month. Most antiobiotics have limited roles and you can't just throw any drug at an infection.

The most I get is some free pizza to listen to new drugs that are being released or for new indications for existing antibiotics. And trust me, these guys don't sway my opinion very much....the best argument I hear is that this drug has to be dosed fewer times a day which equates to better compliance both for out-patients and in-patients.

B) I do often get requests for antibiotics from patients, family, or other allied-heathcare workers and nurses.

My standing advice for the things that sound like a cold or the flu is to treat it that way for 2 weeks. If someone gets worse, or dosen't get better, they need to see me, or someone else in a professional setting.

C) I see a large amount of non-complicance with antibiotics....just because you feel better, don't stop taking the antibiotic!

D) That being said...there is also a large amount of debate and very poor data on what are the optimal durations for different types of infections (these are mostly _complex_ infections with poorly localized sources, or difficult to treat sources like bone-infections (osteomyelitis)).

E) One must be careful in certain situations that seemingly simple infections not treated with antibiotics may, on occasion, _rapidly_ become dangerous infections. I have lost count of the number of cases where "It was just a pimple three days ago" and now the person comes in with an abscess the size of a golf ball, or a case of necrotizing fasciitis (aka flesh eating bacteria).

F) there is an amazing amount of ingnorance about the difference between a viral (cold, flu, measles) infection and a bacterial one (pneumonia, abscess, cellulitis/fasciitis) to name just a few.

So how do I sum up my issuses?

1) Yes as a whole we do prescribe too many antibiotics...but mostly because of outside pressure....the patient, the threat of a lawsuit... or the fact that an unhappy patient will just so shopping somewhere else for what they think they need...which leads to:

2) Most people are poorly informed about basic medicine. The think they know more than the doctor....and yes you may know _your_ body better than I, the 4 years of medical school and 7 years of residency I have endured means that I know the average body better than you, and I know one hell of a lots more about the things and aliments that affect your body than you do. Which leads to:

3) Don't play doctor. You should have stopped that by the time you left the 1st grade. If something isn't right, get it checked out. It is better to treat in the early stages of a disease rather that trying to salvage a patient who has left some thing go. Now this doesn't mean come to my office at the drop of a sniffle, rather use good judegment that when something doesn't seem right...get a professional opinion.

4) While we may not have all the answers, our training is usually better than then your opinion. If you disagree, please ask questions. Most physicians cut to the chase and give you the treatment....if you don't understand or feel you need to know more, or don't agree with the treatment...say something. I love explaining things to patients....within reason....you're not going to get a medical school education in one office visit.

As a patient you should learn about your health from a reputable source. Not every website is worth the electrons used to transmit it....
Sites like emedicine, mdconsult, or webpages from most hospitals or professional (and I mean national) organizations (e.g. American Cancer Soc, NIH, The Mayo Clinic, Johns Hopkins, etc) are the place to start.... I warn all of my students and junior residents not to use fly-by night websites...and I include Wikipedia in that...go to a professional source...and if you can't recognize the name, use caution with the information...a lot of people out that have agendas...and the chance of someone repeating the success of something like Lorenzo's oil in their basement is pretty slim.

While Voltaire said, “The role of the physician is to amuse the patient while nature cures the disease” it of often my job to assist nature.

Norwegian model may not work well in USA. (1, Insightful)

reporter (666905) | more than 4 years ago | (#30634478)

The Norwegian model may not work well in the USA. The USA has an open-border policy with regards to immigration: e. g., Barack Hussein Obama lifted the ban [hrw.org] on admitting foreigners who are HIV-positive. Immigration is a powerful vector for injecting diseases into the country receiving the immigrant. Persons who harbor colonies of MRSA bacteria without symptoms bring the problem to the shores of America, replenishing the supply of the critters.

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.

The People Problem (5, Insightful)

LtCol Burrito (1698596) | more than 4 years ago | (#30634050)

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.

Re:The People Problem (5, Insightful)

Anonymous Coward | more than 4 years ago | (#30634172)

And why do you think they act like that ? I don't know about the US but here TV ads for antibiotics where everywhere a couple years ago, pretty much telling you to take some even when you weren't sick because hey ANTIBIOTICS ARE GOOD FOR YOU. The whole idea of allowing medical companies to run ads and pay doctors to promote their stuff is a recipe for disaster.

Re:The People Problem (0)

Anonymous Coward | more than 4 years ago | (#30634284)

I'm guessing you're from UK which is the second drug store in the World. Don't think US is better since it's the #1 with an open shot.

Re:The People Problem (5, Insightful)

trollebolle (1210072) | more than 4 years ago | (#30634332)

Norway's answer to the people problem is to ban ads for medicine that are regulated in any way, like antibiotics. Medicine must be prescribed by a doctor (you can't by antibiotics in a convenience store), and the doctor don't get patients that want a certain medicine after watching a TV ad. Advertisement for medicine is considered to be too dangerous to be allowed, as the decision regarding medical treatment should be left to the doctor, not the pharmaceutical companies through aggressive marketing.

Re:The People Problem (1)

LukeWebber (117950) | more than 4 years ago | (#30634512)

Interesting. I don't believe that advertising is allowed for prescription drugs here in Australia, except inside actual pharmacies, and antibiotics are pharmacy-only medications. Nevertheless, antibiotic use is still high, and staph is a major problem in our hospitals.
I think that it's still a case of patient expectations, even absent the advertising pressures.

Re:The People Problem (1)

MMC Monster (602931) | more than 4 years ago | (#30634184)

Agree one hundred percent.

I think that patient education now is better than it was 10-15 years ago. Unfortunately, a lot of damage has been done in that time period.

MRSA is bad. God help us when vancomycin resistant S. aureus becomes widespread.

Re:The People Problem (5, Funny)

Anonymous Coward | more than 4 years ago | (#30634240)

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

Re:The People Problem (0)

Anonymous Coward | more than 4 years ago | (#30634430)

That's just your plan to get it on with Bruce Willis!

Re:The People Problem (3, Informative)

teg (97890) | more than 4 years ago | (#30634316)

FWIW, in Norway it doesn't matter what the patient believe on that matter. All antibiotics are prescription only. Also, ads are not allowed for prescription drugs.

Re:The People Problem (1)

maxume (22995) | more than 4 years ago | (#30634388)

The closest thing to advertising of antibiotics in the U.S. is news coverage of Cipro in relation to terrorism. I guess the web site advertises it, but it is pretty tame:

http://www.cipro.com/scripts/index.php [cipro.com]

(I'm sure there are similar sites for other drugs)

Re:The People Problem (1)

Trepidity (597) | more than 4 years ago | (#30634530)

There's plenty of advertising for antibiotics in the U.S., of the normal 30-second-TV-ad variety. You've never seen an ad for things like Zithromax? Oversight does seem to be tightening [bizjournals.com] to some extent, though.

Re:The People Problem (3, Informative)

wronskyMan (676763) | more than 4 years ago | (#30634406)

They are prescription only here as well but many patients will bully doctors into doing this; doctors also err on the side of caution because of lawsuits. Agree on the ads - if only doctors are allowed to make the decision, they should be the only ones ads are targeted at (in medical journals, etc).

Re:The People Problem (2, Interesting)

dgatwood (11270) | more than 4 years ago | (#30634518)

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

Doctors prescribing antibiotics for individuals at home has likely had little impact on things like MRSA or C. diff. Those superbugs are almost nonexistent outside of hospital and nursing home environments. What this tells us is that antibiotics are overprescribed for people in hospitals and nursing homes. Why is this? Usually because people are much more likely to get a bacterial infection in those environments in the first place, people are in worse health and are thus unable to fight those infections off on their own, and thus more people legitimately need antibiotics in those environments.

The only way to truly prevent resistant strains of antibiotics is to get people out of hospitals and nursing homes and back into individual homes where they are not at such a high risk of infection. In general, the absolute worst thing you can do for your health is go into the hospital. Between the constant lights and noises, nurses coming in every two hours when you should be sleeping to check your vitals (which are the same as they were the last time the b*****ds woke you up), the shared air handling with seriously sick people, the awful food that you don't want to eat, etc., it's a wonder anybody ever escapes hospitals alive.... :-D

And the USA's new system (-1, Troll)

SnarfQuest (469614) | more than 4 years ago | (#30634054)

If you get sick, the government isn't going to want to waste money it could better use on helping Meicans safely cross the border illegally, so they'll just euthenize you. Thus, we'll have lower rates than any other country, once we replace our disease ridden population with those hardy mexicans.

Re:And the USA's new system (-1, Troll)

Anonymous Coward | more than 4 years ago | (#30634498)

White Americans are too busy watching their niggerball heroes on the Talmudvision to care. Mexicans are the symptom - Jews are the disease.

" from the they-fired-adrian-monk dept. " (3, Insightful)

Anonymous Coward | more than 4 years ago | (#30634068)

Firing Adrian Monk is exactly the opposite of how they conquered MRSA. Bleach and alcohol hand sanitizer wipes are much more powerful tools than penicillin and vancomycin. The idea is simple: bugs don't become superbugs if they are a) dead, or b) never exposed to agents which cause them to become superbugs.

This isn't to say antibiotics are a bad idea altogether. Just that they are very much over prescribed and that a much better way of dealing with an unknown infection is to watch it closely to see if it goes away on its own before you bring out the drugs. Of course, this flies directly in the face of capitalism where companies want to sell more drugs and create targets like superbugs that require ever more powerful drugs which can then be patented and used to essentially extort the life from people and governments; pay us or die... Ah, unintended side effects.

This will work until Big Pharm (tm) patents it. (3, Funny)

IronClad (114176) | more than 4 years ago | (#30634096)

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

Don't even try it without paying.

Re:This will work until Big Pharm (tm) patents it. (1)

jonbryce (703250) | more than 4 years ago | (#30634134)

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

Re:This will work until Big Pharm (tm) patents it. (2, Funny)

ciroknight (601098) | more than 4 years ago | (#30634150)

Technically this is a business method, which is patentable in most locales. It's not surgery to not give patients antibiotics when they've got a throat ache.

Re:This will work until Big Pharm (tm) patents it. (1)

Mikkeles (698461) | more than 4 years ago | (#30634180)

But apparently it's rocket science to not give patients antibiotics when they've got a throat ache.

Re:This will work until Big Pharm (tm) patents it. (1)

ciroknight (601098) | more than 4 years ago | (#30634226)

It's no more rocket science than the other stupid, ridiculous and trivially obvious patents out there like the "one click" patent. Just pointing out that, in theory, it is indeed patentable in many countries.

Re:This will work until Big Pharm (tm) patents it. (1)

Carewolf (581105) | more than 4 years ago | (#30634420)

Business methods are even less patentable than software patents. Again only a local US brainfart

How did they do this? (3, Interesting)

Sits (117492) | more than 4 years ago | (#30634112)

I've heard a number of international folks complain that antibiotics are almost never prescribed in the UK and yet a number of UK hospitals have had MRSA outbreaks. Does anyone have a league table of the cleanliness of each country's hospitals?

Re:How did they do this? (1)

burni2 (1643061) | more than 4 years ago | (#30634138)

What I heard about hospitals in the UK is that they indeed are dirty, I think there were some scandals in the past 10 years about this situation.

If this is what Universal Health Care is like... (0, Troll)

Nutria (679911) | more than 4 years ago | (#30634202)

count me out!!

What I heard about hospitals in the UK is that they indeed are dirty,

From TFA:

Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Re:If this is what Universal Health Care is like.. (3, Informative)

Trepidity (597) | more than 4 years ago | (#30634298)

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.

Re:If this is what Universal Health Care is like.. (5, Interesting)

geirnord (150896) | more than 4 years ago | (#30634348)

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 [google.com] 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.

Re:If this is what Universal Health Care is like.. (1)

Nutria (679911) | more than 4 years ago | (#30634502)

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?

faint stench of urine and bleach waft(ing) from a pile of soiled bedsheets dropped in a corner

Re:If this is what Universal Health Care is like.. (2, Funny)

msimm (580077) | more than 4 years ago | (#30634536)

Damn you and your Norwegian logic! *burble* Socialists!

Re:If this is what Universal Health Care is like.. (0)

Alarindris (1253418) | more than 4 years ago | (#30634392)

Shut the fuck up, one hospital means all hospitals in the UK are dirty? I don't know how you can even be serious.

Re:How did they do this? (2, Interesting)

Anonymous Coward | more than 4 years ago | (#30634230)

MRSA has absolutely zilch to do with the cleanliness of hospitals, and using a generalism such as this is just lazy, please research before you comment.

The problem is the world press being the morons that they are have associated MRSA with a hospital being dirty, the real cause of MRSA in hospitals is letting too many darn visitors into wards without making them scrub up first. Reduce visitor numbers and impose strict rules about washing of hands/contact with patients etc and the MRSA infection rate would nose dive...

Re:How did they do this? (0, Flamebait)

thetoadwarrior (1268702) | more than 4 years ago | (#30634234)

It's because a lot of their support staff can hardly speak English but they're well aware their job is shit and they're getting paid peanuts.

They're not all bad though. I think it's just some hospitals in densely populated areas.

Re:How did they do this? (2, Insightful)

thetoadwarrior (1268702) | more than 4 years ago | (#30634214)

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

The UK's hospitals suffer from the class system. Some hospitals are real shit tips and some are very nice. It's not necessarily the bad areas that have bad hospitals. As I recall Addenbrookes hospital in Cambridge was one of the dirtiest a few years ago. Despite being a fairly rich area I think it's the fact it had a lot of people in general going through it, but the area does have a fair amount of poor people and homeless and the last time I went in there (as a visitor) the support staff was shit.

I suspect there was too much corner cutting on support staff to keep budgets down which you can't really do in a busy hospital, imo.

Re:How did they do this? (1)

thoughtfulbloke (1091595) | more than 4 years ago | (#30634250)

Despite low antibiotic use, the U.K. is let down by hospitals not suited to the isolation part of the solution- shared rooms and rapid turnover. Some figures are available here [dh.gov.uk]
In New Zealand, since 2001, the use of antibiotics has been minimised, and we saw a large fall in MRSA in 2003-2004.

Re:How did they do this? (0)

Anonymous Coward | more than 4 years ago | (#30634428)

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?

Really? When I was in the UK I got a sore throat and went to the doctor to see if it was strep. I thought he would do a throat swab and culture (like they do in the USA) but instead he just prescribed some penicillin right away. From my perspective, at least, this is over-prescription of antibiotics.

Last night I dreamed I ate a ten-pound marshmallow (0)

Anonymous Coward | more than 4 years ago | (#30634118)

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?

you know (2, Insightful)

nomadic (141991) | more than 4 years ago | (#30634128)

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.

Re:you know (1)

maxume (22995) | more than 4 years ago | (#30634188)

I'm not sure that is true, the last course of antibiotics I took unsettled my digestive system quite a bit, and I'm not real sure it helped me any otherwise.

Re:you know (1)

tcolberg (998885) | more than 4 years ago | (#30634434)

I suppose Tragedy of the Commons might be one way to describe the situation. But since we're not dealing with a free good, I think the Prisoner's Dilemma [wikipedia.org] is a better fit. As per Wikipedia:

The prisoner's dilemma is a fundamental problem in game theory that demonstrates why two people might not cooperate even if it is in both their best interests to do so.

This article is so RIGHT (5, Informative)

edwebdev (1304531) | more than 4 years ago | (#30634130)

So much of modern antibiotic use (at least in the U. S.) is hugely irresponsible. Doctors prescribe antibiotics not because they are necessary, but because they are heckled by patients who want a prescription to justify their trip to the doctor's office and because they are encouraged by pharmaceutical companies to move their products.

Anybody who knows anything about biochemistry and/or pharmaceuticals knows that novel drugs that are SAFE and EFFECTIVE are enormously expensive to develop and clinically test. It's idiotic to use these medical tools, which have finite effectiveness due to resistance development, unless they are truly necessary.

Antibiotic-resistant bacteria develop their resistance at a cost - a resistant organism that can out-survive normal bacteria in the presence of antibiotics will probably die out in a normal environment if it hasn't already gained an overwhelming majority. The mutations that provide antibiotic resistance will, in most cases, make the organism less fit or efficient than an unresistant strain in an antibiotic-free environment. The fact that Norway's policies are working is partial proof of this.

In short, people are idiots and everyone should really be following the example the Norwegians have set here.

Re:This article is so RIGHT (4, Informative)

Nutria (679911) | more than 4 years ago | (#30634168)

Doctors prescribe antibiotics not because they are necessary, but because they are heckled by patients who want a prescription to justify their trip to the doctor's office

Except when I asked the pediatrician why he was prescribing antibiotics for my son's cold, he said, "To protect against secondary bacterial infections."

Which, of course, we refused.

Still, it goes to show that not all Conventional Wisdom is actually correct.

Re:This article is so RIGHT (1)

visualight (468005) | more than 4 years ago | (#30634194)

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

Re:This article is so RIGHT (0)

MichaelSmith (789609) | more than 4 years ago | (#30634228)

I wonder if the climate in Norway plays a part? Maybe bacteria find it harder to move between individuals because of the cold, while in the tropics they could live longer on surfaces and propagate more quickly.

Re:This article is so RIGHT (1)

hitmark (640295) | more than 4 years ago | (#30634528)

not sure, as most places where people gather are heated in any case.

Re:This article is so RIGHT (3, Funny)

Mikkeles (698461) | more than 4 years ago | (#30634276)

'Doctors prescribe antibiotics not because they are necessary, but because they are heckled by patients who want a prescription to justify their trip to the doctor's office and because they are encouraged by pharmaceutical companies to move their products.'

It appears to me that training in professional ethics should be included in the medical curriculum and perhaps required (and enforced) for licensing.

Re:This article is so RIGHT (0)

Anonymous Coward | more than 4 years ago | (#30634450)

It appears to me that training in professional ethics should be included in the medical curriculum and perhaps required (and enforced) for licensing.

it is.

Re:This article is so RIGHT (1)

Darkness404 (1287218) | more than 4 years ago | (#30634438)

but because they are heckled by patients who want a prescription to justify their trip to the doctor's office

Well of course they are. When was the last time you actually had an enjoyable doctors visit? The service is terrible, the people either dumb it down to first-grade language (you are sick and are coughing) or speak in a language that no one who has had less than 2 years of pre-med can understand, you spend over half the time going over basic things like height, weight, etc. spend less than 3 minutes with a real doctor who diagnoses you in 10 seconds, and then you are stuck with a bill, which, even with insurance, the copay can be $30 or more. So of course people want results, if I have to leave work early, get told I can't work (yeah, like your employer is going to believe that...), I'd better be getting at least something to make you feel better.

In short, people are idiots and everyone should really be following the example the Norwegians have set here.

Which will lead to more people getting sick. Look, have you ever had to tell your employer you are sick? Even when you are really sick it takes a lot of convincing, most of the time they will still want you in for half a day or so. And its not like in this job market people can easily quit and find a different job.....

Re:This article is so RIGHT (1)

bnenning (58349) | more than 4 years ago | (#30634496)

Look, have you ever had to tell your employer you are sick?

Sure, never been a problem.

Even when you are really sick it takes a lot of convincing, most of the time they will still want you in for half a day or so.

You work for idiots. That's not at all typical.

And when the arm has to come off... (1, Interesting)

John Hasler (414242) | more than 4 years ago | (#30634142)

...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.

Re:And when the arm has to come off... (5, Informative)

ciroknight (601098) | more than 4 years ago | (#30634174)

...because the dogbite was infected (as they usually are)?

And this is an exception to the rule. Another obvious exception is surgery, where antibiotics are used to prevent postoperative infections and organ rejection.

The idea is that your sniffles don't require azithromycin, that your cough and throat ache don't need penicillin, and that your fever doesn't need ampicillin.

Re:And when the arm has to come off... (1)

Trepidity (597) | more than 4 years ago | (#30634204)

It's balancing risks of one kind versus risks of another kind. Yes, giving antibiotics to everyone who comes in the ER with any sort of wound would kill some infections that wouldn't otherwise be killed. But it will also result in other infections being much worse as those same antibiotics lose effectiveness. Just giving everyone antibiotics will result in fewer amputations due to dog bites, perhaps, but more amputations due to MRSA.

What exactly the proper level of antibiotic prescription---which antibiotics, in which cases, etc.---is a tricky question, but lots of people have spent a lot of effort trying to quantify both sides of the equation. An anecdote is not really a good counterargument, especially as there are plenty of balancing anecdotes (I have one) of people losing arms or dying due to MRSA as a direct result of antibiotic overprescription.

Re:And when the arm has to come off... (0)

Anonymous Coward | more than 4 years ago | (#30634232)

Nice straw man, dumb fuck. They're talking about not prescribing antibiotics when somebody has a cough or some lame shit most Americans are terrified of because they are huge pussies that live in a culture of fear.

Re:And when the arm has to come off... (1)

ColdWetDog (752185) | more than 4 years ago | (#30634236)

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

It could well be that the persons treating your friend should have prescribed antibiotics in the first place, or maybe they should have been more aggressive with local wound care, flushing out the area with sterile saline. Or your friend had a wonky immune system for one reason or another. Lots of potential factors in any given patient encounter.

So careful with the anecdotal stuff, it might come back to bite you.

Punny... (2, Funny)

toiletsalmon (309546) | more than 4 years ago | (#30634304)

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

Re:And when the arm has to come off... (1)

YesIAmAScript (886271) | more than 4 years ago | (#30634376)

Sterile saline? You're kidding me, right?

Your skin is your greatest protection against infection. When it is broken, like with a dog bite, the chances of infection go up exponentially. You don't need a wonky immune system to get infected in these circumstances. And you speak out against antibiotic use in this context?

A wash with sterile saline will do virtually nothing if the infection has already taken root.

Infection was the biggest killer during wars until the advent of antibiotics. And it wasn't just because lots of people happened to have wonky immune systems.

Re:And when the arm has to come off... (1)

MichaelSmith (789609) | more than 4 years ago | (#30634456)

But wasn't that because people in those times were so dirty? They didn't have the habit of washing regularly. They didn't have access to clean, fresh water to wash in. They were covered in bacteria so small injuries tended to give them big infections. Sure, a major injury is going to get infected even today, but small ones are no big deal for us.

Also I have this idea that our drinking water is disinfected with ultraviolet light. I am sure that would help too.

Re:And when the arm has to come off... (0)

Anonymous Coward | more than 4 years ago | (#30634292)

The best reaction to an isolated incident that is logically distinct from the vast majority of incidents is to apply the correct solution for that incident to all cases. Hopefully those in charge also add some measures that are entirely ineffective but make the general public feel better.

Re:And when the arm has to come off... (1)

Nemyst (1383049) | more than 4 years ago | (#30634418)

You know, this is why they do something called follow-up care. When you get something which could potentially be dangerous, you get watched for the time normally necessary for the infection to start showing symptoms. Giving antibiotics left and right for every dog bite (which are very seldom infected) would only end up creating resistant illnesses and THEN you'd be utterly screwed. You'd get bit, get antibiotics, still get infected, get more antibiotics and end up with an arm gone. I'm sure that's what you want to happen.

Hmm... (5, Informative)

fuzzyfuzzyfungus (1223518) | more than 4 years ago | (#30634144)

Clearly, it sounds like Norwegian hospitals are on the right track, with respect to antibiotic handling.

I would be interested to know, though, how much the favorable microbial climate there is due to medical attitudes toward antibiotic use, and how much comes down to antibiotic use(and ideally nonuse) in the agricultural sector. At least in the US, medical antibiotic misuse is quite visible, and makes for a good morality tale(lazy, impatient, whiny consumers demand quick fix, need to learn more patience); but most livestock are given a constant low dose of various antibiotics(pretty much the best scenario for antibiotic resistance) for most of their lives. Then they are chopped up and ground together, to spread anything that they might have evolved evenly through the food supply(and, since a fair few antibiotic-resistance adaptations occur on bacterial plasmids, rather than in their core genomes, they can spread from species to species pretty quickly).

The problem is comparatively invisible, since most people don't see what goes on inside the barn, while a great many doctors are more than happy to encourage(at least generally, if not always when they have a distressed parent and some crying sniffling baby to deal with) responsible antibiotic use; but over half of US-produced antibiotics go into livestock rather than humans(and the numbers might actually be worse than that sounds, since it could well be that bulk agricultural antibiotics are more likely to be produced in cheaper offshore locations than are the more heavily regulated, and more profitable, human ones).

It would be very interesting to know what the Norwegian agricultural sector is up to in this respect, and how much of an effect that has.

Re:Hmm... (1)

tantrum (261762) | more than 4 years ago | (#30634246)

I don't have any exact data to show, but i know that we don't use anything near the us/eu when it comes to use of antibiotics in farming.

I think we use _a_lot_ of the stuff for breeding salmon though.

Re:Hmm... (1)

elygre (711543) | more than 4 years ago | (#30634358)

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.

Some statistics from http://www.xmag.no/id/130.0 [www.xmag.no] (dated December 2007):

- To produce/breed/farm 600.000 tonnes of salmon, Norway uses approximately 1 tonne of antibiotics
- To produce a similar amount of salmon, Chile uses approximately 1.200 tonnes of antibiotics

(The article is really about the social responsibility of Norwegian salmon farmers operating in Chile, and the antibiotics statistics are there to demonstrate that these farmers operate differently and under different rules in Chile than in Norway.)

Re:Hmm... (5, Interesting)

geirnord (150896) | more than 4 years ago | (#30634410)

I have a wife who have worked, and is working, in the these medical fields. According to her, we (Norway) have some of the strictest laws regarding veterinary use of antibiotics. We had some problems with overuse of antibiotics in the fish farming sector some years back. Since then things have gotten even tighter. In many other countries use of antibiotics as a preventative medication in food is the norm. This is not legal in Norway.

The effect of this is not studied, at least to our knowledge, in any scientifically accurate way. However, I believe this is one of the reasons we do not have problems with MRSA in Norway. There are few natural places where you can be infected i nNorway, whereas in USA you can get MRSA from spending time at the beach!! Ref: http://pagingdrgupta.blogs.cnn.com/2009/02/16/mrsa-on-the-beach/ [cnn.com]

Same thing applies to anti-bacterial soap (3, Informative)

Numbah One (821914) | more than 4 years ago | (#30634178)

Regular soap works just fine to get hands clean and get rid of most of the germs without speeding along the survival of the fittest contest among the bacteria.

Re:Same thing applies to anti-bacterial soap (1)

maxume (22995) | more than 4 years ago | (#30634268)

Resistance to triclosan hasn't really been documented (it is the chemical in those soaps, and it is an antibacterial, or maybe a biocide, not an antibiotic):

http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns [wikipedia.org]

It still probably isn't worth using it.

At the other end of the spectrum (4, Interesting)

MichaelSmith (789609) | more than 4 years ago | (#30634186)

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.

I wonder how... (1)

introspekt.i (1233118) | more than 4 years ago | (#30634192)

Defensive medicine plays into the over-prescription of antibiotics in the US?

What do you know -- evolution works (0)

Anonymous Coward | more than 4 years ago | (#30634200)

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 $$$).

MD (4, Interesting)

Anonymous Coward | more than 4 years ago | (#30634222)

As a medical doctor, I can attest to a general over-prescription of antibiotics. I work in Sweden, where we generally don't use as much antibiotics as other parts of the world, but I would say that we use far too much anyway. I am a surgical resident, who is often on call and have a lot of out-patients. The demand from patients that you prescribe some kind of antibiotics is huge, absolutely huge, even for simpler infections where there is little evidence that it will actually shorten the length of illness or level of symtoms. Trying to educate a patient on the matter in a few minutes is no easy task, and other than a general sense of responsibility, nothing keeps one doing just that. Even then, I often hear of my patients going to a different doctor after one or a couple of days and then getting a prescription, even if they haven't gotten any worse. I don't think that there is any easy fix to this problem. People expect a life free of disease, and if they do get some minor illness, they expect immediate recovery. (I am speaking very generally here, of course...)

I fought MRSA for six months (3, Interesting)

Anonymous Coward | more than 4 years ago | (#30634278)

At first the doctors blew it off as a normal infection even though I rarely get infections of any kind and it felt severe to me. The first few times they just perscribed regular antibiotics which knocked it back but it'd come back in two or three weeks. Finally some one though to check it out and it turned out to be MRSA so they gave me yet another antibiotic which followed the same knock it back comes back in a couple of week pattern. I was then told there was a better one for MRSA so they tried that. Same pattern but in the meantime I moved to another state and wound up with a new doctor that didn't trust her memory. She looked it up and said they were all using the wrong antibiotics and even the one she was going to perscribe was no longer recommended. Finally that series worked and I've been MRSA free for four months. Also I got a secondary infection from all the antibiotics that no one spotted inspite of complaints from me about another problem. That required medicine other than antibiotics to cure. Basically I received five different antibiotics mostly from doctor incompetence. And they wonder why antibiotics are over used? A lot of the problem too is doctors not believing patients. I rarely go to doctors but they still at first thought I was overreacting when I said I thought it was a serious infection. It was in my jaws and throat and I had trouble breathing and swallowing and even wound up going to the hospital once when my throat closed up. They still didn't take it seriously until the tests came back showing MRSA. Even then they didn't give me the right antibiotics. I also now have several scars on my face from later infections that could have been avoided if they had gotten it right the first time and not been so quick to blow me off. Medicine in the US is a train wreck. Did you know tens of thousands of patients die in hospital from neglect every year? I think the last number I heard a few years back was 80,000. That's a disgrace.

Article is confusing (3, Insightful)

piojo (995934) | more than 4 years ago | (#30634330)

As I understood it, there are 2 separate things Norway is doing to fight MRSA, and they are not related (although the article doesn't point that out):

1. Norway is tracking the spread of Staph and quarantining victims to limit the spread.

2. According to the article, Norway isn't prescribing modern antibiotics. This ensures that the Staph that is being passed around Norway probably isn't resistant to antibiotics. This does not make Staph less problematic or control its spread in any way. I'm all for stemming the overuse of antibiotics, but this article smacked of propaganda--or it simply didn't tell the whole story.

Re:Article is confusing (1)

piojo (995934) | more than 4 years ago | (#30634522)

Sorry to reply to myself, but I didn't read the whole article before. Apparently they do give out antibiotics in the most extreme cases, and that seems much more reasonable than "we don't have MRSA because we just let our Staph victims die."

What? Of course it does. (4, Interesting)

BoxedFlame (231097) | more than 4 years ago | (#30634544)

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?

Um, this is real easy to go to far with (1)

cdrguru (88047) | more than 4 years ago | (#30634340)

The major difference in life expenctancy between the middle ages and today is the control of infections. In oh say 1200 AD, if you got a scratch on your finger and it got infected you were likely doomed. You would die from it.

Warfare was pretty horrible as well, because even a minor slash from a bladed weapon was pretty much a death sentance. It might take a couple of months, but you would almost certainly die.

Simple things that are easily treated today like impetigo [kidshealth.org] could indeed be fatal.

We have had 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.

Hang on (1)

MichaelSmith (789609) | more than 4 years ago | (#30634394)

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.

Re:Um, this is real easy to go to far with (1)

jabuzz (182671) | more than 4 years ago | (#30634426)

Wrong the major improvement in life expectancy has been the reduction of infant mortality. Basically if you got past five you had good chance to live to long life. However your chances of getting past five where pretty dire.

Re:Um, this is real easy to go to far with (1)

maxume (22995) | more than 4 years ago | (#30634510)

They are a little thin, but the numbers listed here suggest that a ten-year old living today can expect to live about 15 years longer than a ten-year living in 1850:

http://www.infoplease.com/ipa/A0005140.html [infoplease.com]

The 60 years that the 1850 era ten-year old could expect to obtain isn't that bad, but the 75 years that today's ten year old can expect is still better.

I wish this question had offered a bigger bounty:

http://answers.google.com/answers/threadview?id=439616 [google.com]

It would make the lack of meaningful answers more interesting. Infant mortality may well be the most significant factor, but it certainly doesn't appear to be the only significant factor.

Re:Um, this is real easy to go to far with (1)

hitmark (640295) | more than 4 years ago | (#30634508)

iirc, the infection risks where greatly reduced already before the discovery of antibiotics, thanks to improvements in staff hygiene, and stricter handling and cleaning of tools.

Tip for USA (5, Insightful)

spectrokid (660550) | more than 4 years ago | (#30634342)

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.

Cold climate? (1)

kprsa (1379613) | more than 4 years ago | (#30634390)

Germs and infections may also be less common due to the cold Scandinavian climate.

Doonesbury (1)

dtmos (447842) | more than 4 years ago | (#30634448)

As usual, Garry Trudeau said it best [answersingenesis.org] . (Yeah, I carefully selected the bandwidth provider.)

Did someone in Norway really say 'Tylenol' ? (4, Interesting)

yakumo.unr (833476) | more than 4 years ago | (#30634466)

Or was a quote altered to push a US (only?) brand?

US hospitals are already on this (2, Insightful)

tomhath (637240) | more than 4 years ago | (#30634504)

TFA misrepresents the real reason for the low MRSA rates in Norway. Antibiotic use plays a part, but old fashioned hygiene and quarantining infected patients [findarticles.com] is by far the most important factor. Hospitals all over the US are already on this, it has nothing to do with whether or not health care is "free".
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