Saturday, January 09, 2010

The Norwegian approach to superbugs

I suspect that this does not tell the whole story. What happens when someone gets a serious infection that only an advanced antibiotic can stop? This sounds more like cost control to me. Nobody disputes that antibiotics are overused but they do have their place

“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.” This is how an Associated Press story, published in the New York Times last week, begins. The next sentence comes as a surprise:

“Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospital of Europe, North America and Asia this year, soaring virtually unchecked. “The reason: Norwegians stopped taking so many drugs.

“Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway's public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

“Now a spate of new studies from around the world prove that Norway's model can be replicated with extraordinary success, and public health experts are saying these deaths--19,000 in the U.S. each year alone, more than from AIDS--are unnecessary.

“‘It's a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort’,said Jan Hendrik-Binder, Oslo's MRSA medical adviser. ‘But you have to take it seriously, you have to give it attention, and you must not give up. . . . '

“Norway's model is surprisingly straightforward. “-- Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.” Many antibiotics simply are not available.

When Dr. John Birger Haug opens the dispensary at Aker hospital, one sees “a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What's here? Medicines considered obsolete in many developed countries. What's not? Some of the newest, most expensive antibiotics, which aren't even registered for use in Norway, ‘because if we have them here, doctors will use them,’ he says. . . .

“Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind. “In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece. “In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004”

Could the Norwegian solution work here? Yes—if patient safety came first in U.S. hospitals. Why am I so sure?

“In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,’” he said. ‘You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.’”...

Although it may seem a “no-brainer,’ the Norway solution has not been widely adopted in rest of the U.S. health care system. AP reports: “Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway's solutions in varying degrees, and his agency ‘requires hospitals to move the needle, to show improvement, and if they don't show improvement they need to do more.’"

And if they don't? "Nobody is accountable to our recommendations,’" Jernigan told AP, "but I assume hospitals and institutions are interested in doing the right thing.’"


Big talker finally given the boot

This couldn't happen to a nicer fraud. She is constantly shooting her mouth off and pretending to know what she does not know. She claims that TV and computers are harmful despite evidence pointing the other way. In a polite British way, her colleagues have finally had enough of her. The fact that she was a financial bungler as well as a scientific fraud would seem to have been the last straw. The financial bungling is a bit of a surprise in a smart Jewish girl but her lack of scientific depth is too. Her main talent seems to be for self-promotion and that can easily wear thin in Britain. Background on her here

Baroness Greenfield has lost her job as the director of one of Britain’s oldest and most venerable scientific institutions, The Times has learnt. The neuroscientist and peer, who is one of Britain’s most prominent female scientists, was served with redundancy papers yesterday by the Royal Institution of Great Britain (RI), where she was director, the organisation confirmed last night.

Her position at the head of the institution where Michael Faraday and Sir Humphrey Davy once worked is to be abolished after a review of its managment structure and a financial crisis that could threaten its survival. The RI’s trustees decided that the position of a full-time director was no longer affordable in the light of funding problems that has left it more than £3 million in the red. Its chief executive, Chris Rofe, will now head the organisation.

Lady Greenfield, who could not be contacted for comment, is understood to have consulted employment lawyers about the decision, which she is considering challenging.

When contacted by The Times last night, Mr Rofe confirmed that Lady Greenfield was being made redundant. He said: “The trustees of the Royal Institution of Great Britain have completed the first stage of a governance review and as a consequence have concluded that the requirement for the functions of the role of director as currently defined has ceased to exist. We are therefore sad to announce that Baroness Susan Greenfield left the RI on 8th January 2010.

“Baroness Greenfield has played a leading role, not only in the development of the RI, but also in the wider scientific community through her work in popularising science. Baroness Greenfield leaves with our thanks and we wish her all the very best in her future endeavours. “Over the coming months the organisation will focus on strengthening its finances, fundraising, and addressing the organisational governance to ensure the Ri continues to deliver its many, diverse and renowned activities in scientific research, education and public engagement.”

Lady Greenfield’s departure follows heavy losses incurred by the RI during a £22 million refurbishment project she masterminded, which left it so short of funds that its auditors have raised questions about its ability to continue operating. In its most recent submission to the Charity Commission, its auditors said that its future viability would depend on rapid improvements in its finances that could not be guaranteed. “If the charity is to continue as a going concern, the financial projections for the three years ending 30 September, 2011, need to be met,” the audit report said. “There is a significant uncertainty as to whether these projections will be achieved.”

RI sources told The Times that its trustees considered that its precarious finances meant the organisation could no longer afford to employ a senior scientist as a full-time director. Some are also understood to have doubted whether it could improve its financial position under Lady Greenfield’s continued leadership.

Lady Greenfield, 59, has a reputation as one of Britain’s most colourful and influential scientists, but also as one of the most outspoken and controversial. The Professor of Pharmacology at the University of Oxford, who studies disease of the brain, regularly appears on television and is acknowledged by her peers as one of the most talented communicators of science of her generation.

Her unconventional approach to courting publicity, however, has annoyed as many scientists as it attracts, some of whom claim that her talent for self-promotion outweighs her scientific credentials. She has been rejected as a candidate for fellowship of the Royal Society, the elite national academy of science.


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