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Not good

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Not good

Postby kurt_w » Mon Mar 19, 2012 12:28 pm

The headline and "hook" to this article are a bit annoying (like the article about the fistfight in the luxury box at the Chicago Symphony, this one seems to exude a sense of shock at the realization that the wealthy might not be immune to the afflictions of the lower classes).

But the subject is deadly serious:

Drug-resistant "white plague" lurks among rich and poor

The WHO has convened a special meeting on Wednesday to discuss whether the emergence of TB strains that seem to be resistant to all known medicines merits a new class definition of "totally drug-resistant TB", or TDR-TB.

If so, it would add a new level to an evolution over the years from normal TB, which is curable with six months of antibiotic treatment, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB).

What's so frustrating about that progression, says Lucica Ditiu of the WHO's Stop TB Partnership, is that all drug-resistant TB "is a totally man-made disease". [...]

"The doctors, the healthcare workers, the nurses, entire healthcare systems have produced MDR-TB. It's not a bug that has come from nature. It's not a spontaneous mutation. It came about because patients were treated badly -- either with poor quality drugs, or not enough drugs, or with insufficient observation so the patient didn't finish the treatment course," said Ditiu.


We need to figure out how to provide health care more cheaply (in the US) and more equitably (everywhere). But we also need to be figuring out how to provide it more effectively.
Last edited by kurt_w on Mon Mar 19, 2012 1:35 pm, edited 1 time in total.
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Re: Not good

Postby Peanutbutter » Mon Mar 19, 2012 1:15 pm

The WHO has convened a special meeting on Wednesday


I hope they don't get fooled again.
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Re: Not good

Postby David Marshall » Tue Mar 20, 2012 11:14 pm

@kurt_w

You're on to something. I have concerns that we are not realizing what is happening to Wisconsin's historic stature with regard to public health awareness, but hopefully we will be able to deal with this eventuality:

http://yourlife.usatoday.com/health/sto ... 53655170/1
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Re: Not good

Postby bleurose » Fri Mar 23, 2012 8:45 am

Many types of treatment available to us today must be strictly followed if success/cure is the desired outcome. Unhappily and more often than one would think, people simply stop taking drugs once they start to feel better in the mistaken belief that they are "cured". Well, they must be if they are feeling better, right? "Feeling better" means the treatment is working, not that it has been completely successful at eliminating the bug.

There was something to be said for the past practice of utilizing sanitoriums for TB patients: they were removed from general society and so avoided infecting others and they were in a supervised environment. Too bad that back in the heyday, there weren't any effective drugs because the medical staff could have ensured regular adherence to treatment schedules.

I have no easy answers to this. Is there a case to be made these days for confining such patients to ensure that complete treatment takes place? It certainly goes against a lot of what we seem to hold dear, like individual liberty. But what about society at large? Is there any obligation there by the individual for the greater good?

I have little confidence that regulatory agencies/courts/local health boards (pick your poison) will make the "right" decision about this. In a related situation (use of antibiotics in agricultural animals), they all missed the easy punt. Veterinarians were NOT the culprits in that situation and yet THEY were the ones constrained from using one of the tools of their profession. The easy over-the-counter availability of antibiotics at feed stores where producers can get them with their weekly orders with no need for a prescription is where the crux of the problem was. As far as I am aware, that availability has not been addressed, but by golly, let's put all sorts of constraints on the one group which knows how to use these drugs and had been doing so. And of course, god forbid we pull the human medical community up short for THEIR indiscriminate use of antibiotics for decades; gee, do you suppose that had anything to do with the emergence of drug-resistant bacteria? Hmmm, let me think now....OF COURSE IT DID! Result: chip shot field goal missed, problem still there.

So not much confidence that any sort of logical solution will prevail.
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Re: Not good

Postby green union terrace chair » Fri Mar 23, 2012 1:53 pm

bleurose wrote:I have no easy answers to this. Is there a case to be made these days for confining such patients to ensure that complete treatment takes place? It certainly goes against a lot of what we seem to hold dear, like individual liberty. But what about society at large? Is there any obligation there by the individual for the greater good?

I have this same difficulty with immunizations. I support people being able to make their own health decisions for them and their children, but not being immunized doesn't only impact that person, it impacts the whole population.

Immunizations only increase a person's resistance, it doesn't make them 100% immune. So having potential carriers in a population is a threat to those who have been immunized. Not only from getting the disease directly, but also in helping to produce new strains that can infect the immunized more easily.
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Re: Not good

Postby Prof. Wagstaff » Fri Mar 23, 2012 8:21 pm

The solution is to better educate people, not just about the specifics of antibiotics and immunization, but about biology in general. Is it really any surprise that in a country where only 40% of the population accepts the fact of evolution there are also lots of people who don't understand how antibiotics work?
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Re: Not good

Postby bdog » Fri Mar 23, 2012 9:06 pm

Prof. Wagstaff wrote:The solution is to better educate people

And the educators need to have a solid understanding of human behavior.

As Sheena Easton crooned, "You can lead a horse to water, but you can not make him drink".
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Re: Not good

Postby fennel » Fri Mar 23, 2012 9:25 pm

bdog wrote:
Prof. Wagstaff wrote:The solution is to better educate people

And the educators need to have a solid understanding of human behavior.

As Sheena Easton crooned, "You can lead a horse to water, but you can not make him drink".
That's only because the horse found the free koolaid first, via Fox Nooz, and (while very hungry) is no longer thirsty. Jim Jones would be jealous. His followers had no afterlife.

R is for Replicant.
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Re: Not good

Postby David Marshall » Fri Mar 23, 2012 10:39 pm

Well, will the private sector take or take care of the commons? Given their accountability to the markets I know what my guess is.
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