Rather on drug resistance, psychology and Norwegian fish farms

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Dan Rather Reports, HDnet’s investigative series, has devoted its latest episode to antibiotic overuse and the resistance it has created. A transcript of the hourlong program is available in PDF format. Rather focuses first on primary care physicians and upon understanding the psychological and economic pressure they’re under when they choose to prescribe antibiotics that might not be strictly necessary. When he talked to Dr. Rita Mangione-Smith of Seattle Children’s Hospital, she illustrated that those forces can and have overcome clinical good sense.

In the 1990s, it was really bad. Okay, there are a couple of studies that were done – that were published in the Journal of American Medical Association, in JAMA, that showed that if you looked at national level data, we were, you know, prescribing antibiotics in greater than 50 percent of outpatient visits for most children with colds. And antibiotics do nothing for colds.

Rather extends this focus on psychology to his investigation of antibiotic-averse Norway as well. Norway, as you have likely heard, has kept antibiotic use and resistance so low that even good old penicillin can be relied upon there to fight many bacterial infections. While others have focused on Norwegian central policy, Rather also considers how Norwegian mores and attitudes toward medical intervention have helped that country’s physicians resist the temptation to overprescribe antibiotics.

As Gunnar Simonsen, head of that country’s microbial resistance surveillance system, told Rather, “Many Norwegians will not like to take drugs unless strictly necessary. That’s not a kind of an official policy. That’s how we were brought up.” Simonson said the other pillar of his anti-resistance campaign was simply infection control – fewer bacterial infections means fewer opportunities to use antibiotics.

In addition to primary care physicians, Rather looks at that other great breeder of resistance: large-scale livestock feeding operations. Here, he contrasts the well-known American story to that of Norway, where antibiotic use in industrial fish farming was slashed 97 percent from 1994 to 2008. Over that same time, farmers say they actually increased fish survival rates by replacing the antibiotics with vaccines. Prevention instead of cure.

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