Drug Resistance On the Rise. Do The Finns Have the Answer?

Hate to heap on more bad news about the general decline of world affairs, but you know what they say: don't kill the blog aggregator.

There have been more and more reports about a growing resistance to antibiotics and vaccines; many of these articles, like the TIME piece, have a "no need to get worried yet, but..." tone.

That may be because there's no real risk to the individual patient at this time. However, the stories combined indicate a troubling prognosis for the country as a whole. For instance, the antibiotic-resistant strains of Neisseria meningitidis discussed in the NEJM resist not to the drug used to treat people infected with N. meningitidis, (which causes meningitis and sepsis) but to inoculate people who may have been exposed to the sick patient. This is comforting if you're a person with meningitis, but not great if you're a public health professional trying to prevent an outbreak. And while the reported incidences of resistant N. meningitidis is pretty small, that's only because very few states test for drug resistance, so it's hard to tell how many cases we're actually dealing with.

Moreover, there's really not much an individual can do - and health journalism loves nothing more than an "actionable" tip. Yes, you should only use antibiotics prescribed to you, and use them exactly as prescribed (that means finishing a 30-day course of drugs even if you feel better on day 19). But what's really needed is a system that helps us track where and when resistant strains of bacteria and viruses appear, and a unified plan amongst the nations doctors to help prevent over-prescription of antibiotics and vaccines.

Mike the Mad Biologist over at ScienceBlogs makes the case for such a system by comparing our methods Finland's national health care system. (Making sure to note that he's "not talking about how health care is paid for ... but a uniform system of record keeping and informatics protocols.")

Of course, make noises that sound like nationalization and people tend to freak out. That's what happend when President Obama provided funding in the stimulus to fund the much maligned National Coordinator of Health Information Technology position. That person would oversee the digitization of health records, making this type of data collection easier. (That's not the only benefit of having records digitized - doctors could received up-to-date medical information in real time (not, as the Bloomberg article implies, order doctors on how to proceed) and records could be easily accessed between hospitals (so that if you break your leg in Tahoe, the ER doc has access to the record from your primary care physician in Atlanta). Both should cut down on medical errors and administrative red tape - a benefit to you in the short term. Meanwhile, the ability to monitor national uses of medications will benefit us all in the long term.

For that to happen, however, the project will need a lot more money and a lot more time. Until then, be prepared to read a lot more "no need to worry, but..." stories.



Photo of N. meningitidis © 2006 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology