Scantlings

For all the MDs in the group, after reading the attached documents should I be afraid, should I be complacent, should I be comparing the chances of being struck down by a super-bug to other prosaic risks in my life? Could some of you provided a level-headed perspective if you have the time and inclination??

https://www.washingtonpost.com/news/to-your-health/wp/2016/05/26/the-superbug-that-doctors-have-been-dreading-just-reached-the-u-s/?postshare=3471464289168129&tid=ss_tw

Too late to be afraid.

It's like global warming, we had the first warnings in the early seventies, that was the time to do something.

Now the response has to be adaptive as well as preventive.

US is moving on antibiotic use in agriculture, too late but still necessary.

But that won't control use overseas, and restricting food imports won't work because people can carry the bugs in their bodies.

The logical response is government funding for new antibiotic research, as there is market failure here for the pharma companies, evidence based use of antibiotics in medicine, and control of agricultural and industrial use of antibiotics.

Much more tractable problem than climate, but scary enough in the big picture. Yet another instance of the Tragedy of the Commons. We have known about this risk for decades, but the market places no value on public health.

Practical advice is stay out of hospitals. ...maybe that's not so practical.

Thanks, guys, I would actually phrase the macro-level problem a bit differently. Generally, we don't actually charge either individuals or companies for the subsequent damage they do to the commons. Only after a major disaster does our government step in and actually apply penalties to those who do significant harm to something like a river, forest, or in this case the efficacy of antibiotics. Indeed, I'm not sure out legal system has any way to predict "harm", it must happen first and then one knows how much to sue for. This is clearly idiotic, but the way our society works.

As to staying out of hospitals, when my Granddaughters were born we found a maternity hospital that doesn't let sick people in. Thinking that the risks would be greatly reduced over a general hospital like Stanford. I've no idea if that's rational, but it made my lovely Admiral relax a bit.

BeauV wrote:Thanks, guys, I would actually phrase the macro-level problem a bit differently. Generally, we don't actually charge either individuals or companies for the subsequent damage they do to the commons. Only after a major disaster does our government step in and actually apply penalties to those who do significant harm to something like a river, forest, or in this case the efficacy of antibiotics. Indeed, I'm not sure out legal system has any way to predict "harm", it must happen first and then one knows how much to sue for. This is clearly idiotic, but the way our society works.

As to staying out of hospitals, when my Granddaughters were born we found a maternity hospital that doesn't let sick people in. Thinking that the risks would be greatly reduced over a general hospital like Stanford. I've no idea if that's rational, but it made my lovely Admiral relax a bit.

I see this as an economic, rather than a legal, problem. Pharmas, ag businesses, and health providers, made money by abusing these drugs and did not pay for the damage, because we, as a society, don't charge for despoiling it. Oh, well.

Your thinking on the hospital was correct. Sounds very exclusive and old school.

Orestes Munn wrote:

BeauV wrote:Thanks, guys, I would actually phrase the macro-level problem a bit differently. Generally, we don't actually charge either individuals or companies for the subsequent damage they do to the commons. Only after a major disaster does our government step in and actually apply penalties to those who do significant harm to something like a river, forest, or in this case the efficacy of antibiotics. Indeed, I'm not sure out legal system has any way to predict "harm", it must happen first and then one knows how much to sue for. This is clearly idiotic, but the way our society works.

As to staying out of hospitals, when my Granddaughters were born we found a maternity hospital that doesn't let sick people in. Thinking that the risks would be greatly reduced over a general hospital like Stanford. I've no idea if that's rational, but it made my lovely Admiral relax a bit.

As I see it, pharmas, ag businesses, and health providers, made money by abusing these drugs and did not pay for the damage, because we, as a society, don't charge for despoiling it it. Oh, well.

Your thinking on the hospital was correct. Sounds very exclusive and old school.

I'm guessing that there will be a massive growth in "Private Hospitals" for those who can afford them. Obviously, specialization like getting healthy moms and babies out of the same building with infected people could be a good first step, but if this really starts to take hold we'll have a second tier of hospitals which are "cleaner" for those in our country who simply don't care what it costs. It's fascinating to note that this is precisely the way medical care is provided in Russia. There's the not-so-good for the not-so-wealthy, and then there are "special" places for those who have money. This offends my sense of how the United States should act, but I have to admit I told my daughter to ignore the fact that her insurance didn't fully cover her maternity hospital.

BeauV wrote:

Orestes Munn wrote:

BeauV wrote:Thanks, guys, I would actually phrase the macro-level problem a bit differently. Generally, we don't actually charge either individuals or companies for the subsequent damage they do to the commons. Only after a major disaster does our government step in and actually apply penalties to those who do significant harm to something like a river, forest, or in this case the efficacy of antibiotics. Indeed, I'm not sure out legal system has any way to predict "harm", it must happen first and then one knows how much to sue for. This is clearly idiotic, but the way our society works.

As to staying out of hospitals, when my Granddaughters were born we found a maternity hospital that doesn't let sick people in. Thinking that the risks would be greatly reduced over a general hospital like Stanford. I've no idea if that's rational, but it made my lovely Admiral relax a bit.

As I see it, pharmas, ag businesses, and health providers, made money by abusing these drugs and did not pay for the damage, because we, as a society, don't charge for despoiling it it. Oh, well.

Your thinking on the hospital was correct. Sounds very exclusive and old school.

I'm guessing that there will be a massive growth in "Private Hospitals" for those who can afford them. Obviously, specialization like getting healthy moms and babies out of the same building with infected people could be a good first step, but if this really starts to take hold we'll have a second tier of hospitals which are "cleaner" for those in our country who simply don't care what it costs. It's fascinating to note that this is precisely the way medical care is provided in Russia. There's the not-so-good for the not-so-wealthy, and then there are "special" places for those who have money. This offends my sense of how the United States should act, but I have to admit I told my daughter to ignore the fact that her insurance didn't fully cover her maternity hospital.

I don't think that will happen. In this country, the economic power and expertise will continue to reside in the big houses, but people will die, for sure.

In my former life I worked for J&J for 10 years in devices and pharma in AsiaPac and Australia/NZ

Out here is global budget land, the private hospitals and out of system hospitals are thriving. The public ones are just surviving and trying to manage the load. Bumrungrad hospital really kicked-off VIP/Medical Tourism medicine and you see it developing really fast in Hong Kong, Singapore and even China.

Our R&D guys were saying that thanks to the public healthcare system, which used to be capitation systems, meant that countries like Taiwan, Korea, Japan, Hong Kong, Singapore had some of the most drug resistant populations.

We bought a large vaccine company. All the basic health stuff was terrible business because you had to give a lot of it away for free and the ones who did pay, didn't want to spend a lot of money. Where was the money? Annual flue vaccines. Guess what the new 100M USD biologics plant in Western China is going to produce?

I guess capitation only works with competent providers. Maybe those guys thought they were saving money by overtreating.

A former psychiatrist colleague of mine once described many physicians as "benevolent psychopaths:" Anything for the patient in front of them with no thought for the clinic or the community. That's still what we want as consumers and how we view the common good, especially when we think we are helping someone.

Orestes Munn wrote:I guess capitation only works with competent providers. Maybe those guys thought they were saving money by overtreating.

A former psychiatrist colleague of mine once described many physicians as "benevolent psychopaths:" Anything for the patient in front of them with no thought for the clinic or the community. That's still what we want as consumers and how we view the common good, especially when we think we are helping someone.

I was amazed at how many antibiotics the doc's pushed at my mom for every sniffle. Given her overall health was't going to allow a prolonged fight if something got a grip on her, I guess I can understand but Lynne and I can count on one hand the number of times we have either sought or been offered antibiotics for common, mostly viral illnesses. I guess the measage is out there for the Docs. I am amazed by the number of folks that complain and badger their doc's for antibiotics for them and their kids to treat every cold.

Then again, we seem pretty healthy overall. Some allergies and very rare and mild colds is about it beyond wearing things out.

BeauV wrote:...It's fascinating to note that this is precisely the way medical care is provided in Russia. There's the not-so-good for the not-so-wealthy, and then there are "special" places for those who have money.

Sounds like Sweden.

BeauV wrote:This offends my sense of how the United States should act.

Beau, you sound like Bernie Sanders.

OM, is the government funding the development of new antibiotics?

kdh wrote:OM, is the government funding the development of new antibiotics?

Yes, but not at what one would necessarily consider crisis levels. There is European investment, as well.

https://www.niaid.nih.gov/topics/antimi ... fault.aspx

Orestes Munn wrote:I guess capitation only works with competent providers. Maybe those guys thought they were saving money by overtreating.

A former psychiatrist colleague of mine once described many physicians as "benevolent psychopaths:" Anything for the patient in front of them with no thought for the clinic or the community. That's still what we want as consumers and how we view the common good, especially when we think we are helping someone.

Pure driving revenue. It used to be more patients, more scrips, more reimbursement for the hospital and reimbursement was used as a profit center. As you might guess, that didn't last long and now it's all global budgets and drg.

kdh wrote:

BeauV wrote:This offends my sense of how the United States should act.

Beau, you sound like Bernie Sanders.

I guess I do - that's pretty funny!! (As I prepare for a bit of Evil Private Equity pillaging this morning.)

There is a simple logic to this:

1) I do believe that healthcare is a right and not a privilege, which ought to be provided by any society with a sense of community and decency. (this is probably the root of the issue)

2) I do not believe that rich folks should have "more" or "better" rights than everyone else. (I think this is true of all the fundamental rights, also known as the Freedoms which Norman Rockwell did a great job of illustrating.)

3) Therefore, everyone should get the same quality of healthcare.

I think I was brought up on images like this, and still believe they say something quite important to us all. This is particularly true in this "ME FIRST" phase of our society, with certain politicians and candidates being poster children for putting themselves first.

BeauV wrote:3) Therefore, everyone should get the same quality of healthcare.

Would you prevent people from seeking out services as your family did for the births of your grandkids?

Same care for everyone, like worldwide?

I give to humanitarian groups: Doctors without Borders, Partners in Health, Oxfam, NuDay Syria, as there are so many worse off than anyone in this country.

Instead of giving to those charities pay that money in taxes to pay for hermetically sealed delivery rooms for all in the US? Not so much.

kdh wrote:

BeauV wrote:3) Therefore, everyone should get the same quality of healthcare.

Would you prevent people from seeking out services as your family did for the births of your grandkids?

Same care for everyone, like worldwide?

I give to humanitarian groups: Doctors without Borders, Partners in Health, Oxfam, NuDay Syria, as there are so many worse off than anyone in this country.

Instead of giving to those charities pay that money in taxes to pay for hermetically sealed delivery rooms for all in the US? Not so much.

What's quality? Wait times? Hospital food? Outcomes? No one really shops outcomes.

Around here we shop reputation. Mass General, Dana Farber.

Adele was born at Brigham and Women's. Ann neglected to tell me that her mother had short labors. If there had been a Red Sox game the night Ann's water broke I would have delivered the baby on the Mass Pike.

Zeke Emanuel has some interesting comments and proposals on super bugs:

http://wpo.st/nJ7d1

Interesting article.

http://www.abc.net.au/news/2016-10-27/h ... ak/7970504

We had several cases of young males who died from unexplained "leukaemia" with immune suppression in Tassie in the late '70's, always suspected this may have been the cause.

I had a good friend, a doctor who died of a brain tumor about seven years ago, who was serving as an intern in one of New York City's hospitals in the late '70s. He used to talk about the first few patients who showed up with a disease no one could diagnose. Later, he said it was probably HIV. He did say that the preserved blood and tissue from those patients, figuring that someone would be able to diagnose them later. "We didn't know what it was. But we knew someone would figure it out eventually." I still remember those words over a few beers.

Olaf Hart wrote:http://www.themercury.com.au/lifestyle/health/a-female-patient-passes-wind-in-surgery-and-the-fart-ignites-the-laser-being-used/news-story/c11341a1824d857f54fa904422a08f11

Must have been some fart. I have never been able to get more than a little flash. I can just imagine the M&M conference.

Other links from there make me think it's National Enquirer Australia Edition. Mother wants 15-yr old to have designer vagina. Next they'll be all about aliens and Donald Trump's third eye.

Ish wrote:Other links from there make me think it's National Enquirer Australia Edition. Mother wants 15-yr old to have designer vagina. Next they'll be all about aliens and Donald Trump's third eye.

Unfortunately the Mercury is supposed to be Tasmania's no 1 newspaper... It is however owned by Murdoch which is ten points against it.

The three papers in Tassie are:
The Mockery (Mercury)
The Exaggerator (Examiner)
The Aggravate (Advocate)

None of them are really known for their quality of proof reading or investigative journalism.