Posts Tagged World Health Organisation

Resistance Is Futile

1928 was a happy year for humanity as this was the year that a nondescript mould called Penicillium notatum was found to have antibacterial properties. This mould would prove to be the first in a long line of what we now know as antibiotics. Antibiotics are a group of drugs that kill bacteria for us either by interfering with their cell wall, mucking up their DNA or messing with their metabolic processes so they cease to function. Unfortunately they do not affect viruses.

Before the discovery of antibiotics people died from all sorts of minor complaints such as small infected skin wounds (before penicillin1 in 9 skin infections killed people), mild burn infections, tooth abscesses and infected insect stings. Unfortunately, according to a recently published World Health Organisation report (http://www.who.int/drugresistance/documents/surveillancereport/en/), that time could be returning as more and more bacteria are laughing in the face of the antibiotics we use.

The natural world uses a marvellous tool to adapt to changing circumstances. It is called natural selection and it is based on genetic diversity. This means that when a disease comes along it rarely kills everyone. Some people will be naturally resistant to it. They will survive and breed and, before you know it, most people will be resistant and the disease will no longer kill people. Unfortunately the same is true for bacteria and antibiotics. In any given bacterial population some bacteria will be resistant to a given antibiotic. Using that antibiotic will kill off the sensitive bacteria, leaving the resistant ones behind to proliferate. This activity can be accelerated by increasing the use of antibiotics, especially when they are prescribed for conditions that cannot be resolved by antibiotic use, such as the common cold or flu, both of which are viruses and completely unaffected by antibiotics.

If you are prescribed antibiotics, to delay the onset of resistance appearing, it is vital to take your full dose and complete the prescription, even if you feel better ahead of time. Otherwise you have not killed the bacteria but only wounded them, allowing them the opportunity to strike back bigger and better than before.

It is also important to practice effective preventative medicine to minimise the number of times that antibiotics are needed. An example of this is gonorrhoea. More than one million people are infected with gonorrhoea around the world every day. Resistance of this bacterium to all antibiotics is becoming more and more common. Prevention is simple and obvious. All it requires is a condom. Preventative measures for other diseases can include vaccination, washing your hands with soap and water, wearing your protective gear at work, not allowing your pets to stick their tongues down your throat, washing your hands with soap and water, observing good hygiene when preparing food, washing your hands with soap and water, and sticking with bottled water if you are uncertain of the quality of the water supply. Oh, and did I mention washing your hands with soap and water?

Dr. F. Bunny

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Turn Your Head And Cough

Socialized medicine seems like a pretty good idea to me and I cannot really understand why so many people are opposed to it. I recently finished a Lionel Shriver book entitled, “So Much For That”. One of the main characters is diagnosed with mesothelioma and, if the book is at all accurate about US health care, then it truly boggles the mind that one chemotherapy treatment could cost as much as $40,000! Who can afford that? And the idea that your place of employment should fund your health care also seems bizarre.

While the Australian system of Medicare is not perfect it certainly seems to work a lot better, based on the World Health Organisation’s Disability Adjusted Life Expectancy (a measure of the number of years of life expected to be lived in full health, or healthy life expectancy): http://search.who.int/search?q=disability+adjusted+life+expectancy+&ie=utf8&site=who&client=_en_r&proxystylesheet=_en_r&output=xml_no_dtd&oe=utf8&getfields=doctype&as_q=filetype:pdf . Using this index Australia comes in at number two (behind the Japanese), whereas the US pops up at number 24.

While I have no major complaints about Medicare the Australian government decided some years ago that it was tired of funding Australia’s health care and wanted the public to carry more of the burden i.e. take out more private health cover. Instead of using the carrot method by lauding the advantages of private health care they chose to use the stick method by fining tax payers an additional 1-1.5% of their incomes if they did not have private health insurance at the end of each tax year. And the longer you wait to take it out the more expensive the cover becomes.

I admit that private cover can be useful for things like dental and optical, as they are not covered by Medicare (why is beyond me. Don’t most of us have eyes and teeth?). Unfortunately being insured for those extras does not remove the surcharge. For that you need to take out full private cover, and what do you get for it? Virtually nothing.

Private health insurance is supposed to cut waiting lists. I still had to wait six weeks to see a cardiologist (lucky I wasn’t having a heart attack) and my son had to wait three months to see a wrist specialist. The private insurance covered none of these costs, leaving me $500 out of pocket after my son’s MRI and X-rays. Obviously the amount Medicare reimburses patients for a specialist consultation is based on what they were charging in the 1950s.

Apparently private health cover lets me choose my own doctor and hospital, but who has the background knowledge to decide between Sleep Apnoea Specialist A and Sleep Apnoea Specialist B? Don’t we just let our GP choose for us? And once I had my Sleep Apnoea Specialist he told me which hospital I would be visiting for my sleep test, a hospital that left me $800 out of pocket for one night’s stay.

Ironically, when I had my nose surgery that specialist did give me a choice of hospitals. I could wait three months and have the surgery in his nice inner city private hospital, which would still have left me hundreds of dollars out of pocket, or I could wait three months and go to the nice rural public hospital where the entire procedure would cost absolutely nothing, because it then fell under the Medicare umbrella. Needless to say I chose the room with the kangaroos grazing outside and the birds chirping merrily in the trees.  

I imagine they chirped so merrily because they weren’t being ripped off by private health insurance companies, backed by the government. Maybe it is really a three way conspiracy with the health funds in bed with the government and the accountants. Much as I would like to make it a four way conspiracy veterinarians, naively, appear to put their clients’ interests first. Instead of pushing for twice yearly check-ups veterinarians have discovered that their vaccinations work too well, only requiring boosters every three years, meaning that you don’t need to bring Rover or Puss in Boots back for a booster every year. How stupid is that?

Dr. F. Bunny

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