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Disease is Never Fatal (Health)
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Boreades


In: finity and beyond
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Hatty wrote:
On a sociological note, a doctor interviewed on the news explained, rather lamely I thought, that patients 'demanded antibiotics'. It would seem that GPs nowadays aren't in the driving seat.


It's not like the era of Dr. Findlay's Casebook any more. Most doctors are now fearful of any complaints from patients, as it automatically gets added to their profile, and will be "considered" during their annual revalidations. Complaints also go to the GMC, and doctors are fearful of the GMC as the medical inquisitors.
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Hatty
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In: Berkshire
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The medical establishment has mentioned the need to 'educate' patients yet it's not GP surgeries where antibiotics are dished out in profligate amounts but hospitals which by definition treat huge numbers of patients.

Some patients are inevitably referred to different departments of the same hospital, each with its own treatment and of course drugs. It presumably doesn't make a hap'worth of difference whether the odd GP is prescription-happy.
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Boreades


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You are correct to say GPs nowadays aren't in the driving seat. It's true, the prescribing often starts in the hospitals. But once the initial prescription has been done (to speed up the initial treatment and to get bums off beds) (bed blocking and quota management), all subsequent prescribing will be done back in the community via GP practices. Or, as is increasingly the case, by Nurse Practictitioners, which GPs sarcastically call Noctors.
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Chad


In: Ramsbottom
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Hatty wrote:
I'm not sure I've grasped the medical science (or even if this is the right thread) but whole populations are apparently becoming more resistant to antibiotics.

Person A regularly takes antibiotics, he'll need stronger and stronger doses and eventually be resistant to all the currently prescribed ones, but if B very rarely has to take antibiotics, why would his resistance be affected by A's predicament?

It isn't people who become resistant to antibiotics... it's the bacteria they carry (and pass on to other people). You end up with resistant strains of bacteria not resistant populations of humans.
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Mick Harper
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It isn't people who become resistant to antibiotics... it's the bacteria

This is patently untrue. Since antibiotics have been around for umpteen years and they have been dished out wholesale to man and beast in conditions perfect for Darwinian mutation theory and still, still, they overwhelmingly work, we have to look for other explanations.

The most obvious is that these resistant strains were around all the time but they've been able to flourish now that their cousins are copping it.
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Boreades


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In the news this very morning, NICE has issued new guidelines:

Calls for NHS to curb inappropriate antibiotic prescribing. Healthcare professionals should encourage sensible use of antibiotics and cut back on unnecessary prescribing of the drugs to help tackle the rise in antibiotic resistance, says NICE.


http://www.nice.org.uk/news/article/calls-for-nhs-to-curb-inappropriate-antibiotic-prescribing

"Soft-touch" and "hazardous" doctors should be disciplined for prescribing too many antibiotics, a leading NHS figure says.


http://www.bbc.co.uk/news/health-33961241

This puts GPs between a rock and a hard place. If they follow the NICE guidelines, and prescribe less antibiotics, they will inevitably get more complaints from "entitled" patients. "The doctor was nasty to me".

Anecdotal evidence from a GP colleague:

Already (this morning) had 3 long discussions with less than happy patients with sore throats and coughs wanting anibiotics. Their world view if unfortunately not based on rationality and science. Very difficult to have a rational conversation with someone who doesn't have a basic grasp of science. Education system needs to address this. Its inevitable that I will get it wrong at times having to assess patients in the benign early stages of what turns out to be sepsis. Even with good safety netting many patients are very unforgiving if you don't get it right at first presentation. Many think they are already half dead after 24 hrs of viral laryngitis and can't grasp that there is not a magical cure.
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Chad


In: Ramsbottom
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Mick Harper wrote:
It isn't people who become resistant to antibiotics... it's the bacteria

This is patently untrue.

Sorry Mick, but I fail to find an untruth in that statement.

My reply may have been a little lazy (I was just trying to point out that people don't become resistant to antibiotics) and I certainly didn't mean it imply that mutation was the cause of bacterial resistance to antibiotics, but whatever the cause (and I tend to agree with your thoughts) we are left with resistant bacteria not resistant people.
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Chad


In: Ramsbottom
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Whatever happened to phage therapy?

I remember watching a documentary years ago on the subject and it certainly looked to offer an answer to antibiotic resistance.

Could it be something to do with the fact that phages are not patentable drugs?
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Chad


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Chad wrote:

Could it be something to do with the fact that phages are not patentable drugs?


Obviously not.

http://tgs.freshpatents.com/Bacteriophage-bx1.php
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Mick Harper
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Could it be something to do with the fact that phages are not patentable drugs?

Dunno about that but we are always being told that nobody is inventing antibiotics any more 'because the drug companies prefer concentrating on more profitable drugs'. This is odd because one would think that a new antibiotic would be hugely profitable in itself (because it could treat zillions of different conditions) and if it also happened to fill the breach re diseases now untreatable because of resistance then the drug companies could charge the earth for it.

But even so, if Big Pharma really doesn't find antibiotic research profitable, then clearly governments (or a group of governments since this is supranational) have a clear interest in shovelling a few billion in. As this is not happening then presumably we have come up against some natural limit re antibiotics but if so why is nobody saying so? They don't want to scare us or Careful Ignoral?
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Ishmael


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The real story here is that this is all likely a non-story, like Peak Oil and Global Warming. Antibiotics are not becoming less effective. They are only less effective within some environment, such as hospitals.

Microorganisms are part of a whole which is the Earth. They relate to their host environment and other microorganisms. That whole is a predefined template that nature does not wish disturbed. She will adjust the microorganism population temporarily to respond to a threat but will quickly return it to its normative condition once the threat is removed.

The bugs we want to kill will adapt under long term exposure to antibiotics in conditions where those are under constant use but, as soon as the environment changes, or as soon as the bug exits the building, so to speak, the population returns to its normal, susceptible state.

All they need to do is allow hospitals to "lie fallow" for one year out of seven. Everything will return to normal and we can get back to killing patients the old fashioned way.
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Wile E. Coyote


In: Arizona
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Ishmael wrote:
They are only less effective within some environments, such as hospitals.

People are normally in hospital as they are very ill.

People within a GP surgery are normally healthy but with a minor worry or ailment.

The drugs seem to miraculously work better on one of these two categories for a reason, and I doubt it is to do with the building.
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Boreades


In: finity and beyond
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Ishmael's instinct (likely a non-story) may well be substantiated by the kind of facts that have yet to surface in the BBC's GP-bashing propaganda.

For the types of antibiotics in question, in a European league table of the rate of reported cases per K of population, the UK is lowest in the league table. This is something the NHS should be proud of.

So, why is the story surfacing now? NICE is not playing nice because a previous attempt of theirs to reduce prescribing of antibiotics had zero effect. It couldn't possibly mean a government agency is ineffective, it must be the GPs' fault. Plus, they're an easier target to pick for the general public already weaned on stories of "fat cat" GPs with salaries of £100K+. Those stories usually skip over facts like that is a gross income of a GP's business before they pay for trivial things like premises and staff payrolls.
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Mick Harper
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Policy in Britain is irrelevant if Darwinism is correct. The mutations can occur anywhere and will arrive here shortly thereafter. There is zero possibility of getting world-wide action since it pays every country to shovel the antibiotics down (especially in animals). When is an administrator (who presumably will be a Darwinist) going to admit the battle is lost when it so obviously is (if Darwinism is correct)?
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Boreades


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My instinct is that policy in Britain is largely irrelevant for commercial reasons. I mean agricultural business reasons, not medical. Britain is literal on the receiving end of thousands of truck-loads p.a. of intensively-reared young livestock from elsewhere in Europe, with higher rates of the usage of antibiotics and higher rates of diseased livestock.

This is, by the way, the vector by which Avian Flu reached Britain, not by some strange migration route for wild birds that went east-west, as we were frequently told via DEFRA and the BBC.
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