Forget anti-vaxers, now we have anti-antibiotics

[Wolfie]

The government.

I think that they are trying to turn it around to "You pay it in taxes so you are paying for it."

[OkToBeTakei]

The county I live in offers several free flu clinics for those 65 and older. All you need is proof of age and residence. No insurance cards are required.

The rest of our county's residents who have no insurance are assured a locked in rate of 25 USD this year. Anyone on our state's Medicaid program gets free flu shots. There are usually disparities between state to state in the US for flu vaccine costs to the uninsured.

Does not sound tremendously different to the UK. I would not mind paying for it. I am quite happy that the vulnerable aspects of society are covered by the NHS. The option to pursue it via a GP and pay for it seems fair.

The UK mortality rate for H1N1 in 2009 was 138 deaths in 540,000 cases. Of which the data was felt to be flawed due to the difficulty of isolating the virus.

2011/12 A H3N2 had the lowest mortality rate and was primarily in the over 65 age group due to secondary respiratory complications..WHICH was attributed to the 25% of that demographic who did not choose to be vaccinated. You can lead the horse to water...The poorest uptake of the vaccine was pregnant women.

As the saying goes...There is NOWT AS QUEER AS FOLK

[OkToBeTakei]

I find this question amusing going along with your avatar.

If it's in Canada, I would assume it's part of the national healthcare- so it's paid out of tax money. The US clinics are paid through a variety of sources, often county healthcare funds (it's cheaper than dealing with a lot of sick people, and the loss of work and toll on the economy).

Hehe I should change my Avatar for every thread I forgot it was there and cannot see it. It is not a statement incidentally just an internet joke.

[Arete]

OKTBT, your right, the way our county choses to deploy its resources is not much different than NHS on the flu shot. The poor and sick go first for free. Those who are covered by private insurance often have a benefit of a free flu shot (meaning no out of pocket expense). The county has made an effort to crack down on the disparity in pricing, so now if you are a flu shot provider you are forced to charge one standard price.

The fact is though, the US CDC recommends the shot for all people over age 6 months where it is not medically contraindicated. It behooves us from a cut and dry economic perspective to ensure all our citizens have easy access to a flu shot. No one should have to choose between meat for the kids and shots for the kids. But you know we have a lot of work to do on health care availability. Sigh.

[OkToBeTakei]

OKTBT, your right, the way our county choses to deploy its resources is not much different than NHS on the flu shot. The poor and sick go first for free. Those who are covered by private insurance often have a benefit of a free flu shot (meaning no out of pocket expense). The county has made an effort to crack down on the disparity in pricing, so now if you are a flu shot provider you are forced to charge one standard price.

The fact is though, the US CDC recommends the shot for all people over age 6 months where it is not medically contraindicated. It behooves us from a cut and dry economic perspective to ensure all our citizens have easy access to a flu shot. No one should have to choose between meat for the kids and shots for the kids. But you know we have a lot of work to do on health care availability. Sigh.

Yes the more I read here the less I ever wish to moan about the NHS.

But I can see no reason why the US CDC would recommend that other than the economic fact. More especially if they are advocating this recommendation without offering to pay for it.

IF a healthy adult does suffer some complications from influenza then the NHS is always there to pick up any huge cost this may incur..ICU etc. The incidence of this is very small and the cost much less than offering blanket FluVac to a low risk group...Economics. NHS is a business to some extent. Even the amount of miserable people attending GP surgery for anti-virals would be more cost effective.

This makes me believe it is the possible economic impact rather than the intrinsic health risk which drives the US CDC. As Mitt said ER is free care right? (sarcasm)

I am slow to trust any blanket recommendation in relation to vaccination..by government. My own country included. I am neither pro no anti vaccination. I don't think it is that black and white.

On a side note I processed 232 FluVac forms today to find out my Anaphylaxis training is out of date, first refresher DEC 6th. Cut of for efficacy FluVac? Oct. Yes I do it as part of my job..which would make you think I would be singing the right song.

[Arete]

With regard to cost, you can't only factor in the number of healthy adults who get the flu who wind up in the hospital or the doctor's office seeking Tamiflu. By the time s/he winds up in the hospital, they may have spread the infection to other more vulnerable members of the population, and they go to the hospital and incur costs as well. This direct transmission number is harder to quantify, but if more member of a population are vaccinated, more unvaccinated members are protected.

There have been several studies in the US that focus on specific nosicomial transmission events. They isolate the flu strain in the provider and the flu strain in the patients and they are found to be the same. In one study, where 5 confirmed cases were verified, the total costs came out to 6 million USD. One death from secondary complications. I wish I still had the journal to cite it. I get really cray-cray when I hear about health care providers refusing to vaccinate, and am glad that US facilities are starting to see the light and demanding they vaccinate.

In a previous life, I deployed programs in hospitals to educate providers on the importance of hand washing between each and every patient. You would think this of all things would have been a no-brainer. Who were the worst offenders even after multiple education efforts? The surgeons, and I am talking by a wide margin. So I never assume that the general population is practicing good infectious disease control, even after education.

[emmiedahl]

I think we can probably vaccinate AND do other preventative measures at the same time. Double up!

One of the reasons that I think vaccination for the flu is pushed so much in the US is that the typical person might not go to the doctor when they have a bad case. And then it may become a medical emergency. We don't really do preventative care here so little things can get expensive very quickly. I had H1N1 (I am pretty sure, at least, because I was exposed to it and ended up very ill a while later) and probably should have gotten some medical care, but the price tag was overwhelming. I did recover, but if I hadn't then I would have ended up in the hospital. A trip to the doctor is $100, plus whatever tests and medications they want to give you, so people without insurance are always balancing their budget with their health needs. This leads to a lot of gambling (I know that a $20,000 hospital visit is more than a doctor's visit, but maybe I can get better without a doctor if I drink some herbal tea!!!) and wishful thinking.

I think perhaps people in places with socialized medicine are more likely to get help when they need it, before it becomes a major issue.

[lovefromgirl]

ETA: since you edited while I was responding. At Walgreens and the University center you have to pay for it. Not everyone lives in a big city. I checked in my city and there is one 3 hour session, no repeat. So no, it's not what I would call providing flu shots for free for everyone... certainly different from Europe.

Wait, even my broke-ass city has immunization clinics through the health department -- pretty sure it's sliding scale, too. This is Rochester, home of a thousand boondoggles (and Maggie Brooks). What modern city have you washed up in that hasn't even got a health department doing clinics?

-- she who will get her TDaP booster/flu shot once this fscking canker sore quits playing merry hell with her immune system. ugh.

[eta] Apparently Rochester is some kind of beacon on a hill when it comes to its health department. Mea culpa, and may that change at some point. If we can do it, surely others can find room in their budgets.

[emmiedahl]

Wait, even my broke-ass city has immunization clinics through the health department -- pretty sure it's sliding scale, too. This is Rochester, home of a thousand boondoggles (and Maggie Brooks). What modern city have you washed up in that hasn't even got a health department doing clinics?

-- she who will get her TDaP booster/flu shot once this fscking canker sore quits playing merry hell with her immune system. ugh.

I live in a modern city whose health department merely has lists of places where you can pay to get the shots. I don't think this is unusual. When I lived in another similarly-sized city in Northern California, you could get shots at the health department but you had to pay for them unless you have Medicaid.

[OkToBeTakei]

With regard to cost, you can't only factor in the number of healthy adults who get the flu who wind up in the hospital or the doctor's office seeking Tamiflu. By the time s/he winds up in the hospital, they may have spread the infection to other more vulnerable members of the population, and they go to the hospital and incur costs as well. This direct transmission number is harder to quantify, but if more member of a population are vaccinated, more unvaccinated members are protected.

There have been several studies in the US that focus on specific nosicomial transmission events. They isolate the flu strain in the provider and the flu strain in the patients and they are found to be the same. In one study, where 5 confirmed cases were verified, the total costs came out to 6 million USD. One death from secondary complications. I wish I still had the journal to cite it. I get really cray-cray when I hear about health care providers refusing to vaccinate, and am glad that US facilities are starting to see the light and demanding they vaccinate.

In a previous life, I deployed programs in hospitals to educate providers on the importance of hand washing between each and every patient. You would think this of all things would have been a no-brainer. Who were the worst offenders even after multiple education efforts? The surgeons, and I am talking by a wide margin. So I never assume that the general population is practicing good infectious disease control, even after education.

I agree to some extent..but the vulnerable are protected in the UK..so we may be differing in that view. Protected, meaning offered free vaccination, the uptake is a different matter and the efficacy of the vaccine is not anywhere near absolute. Influenza is a nasty illness but it is not normally a fatal one in a relatively healthy child/adult. Mortality rates reflect that. It is very much a 1st world issue as others like to point out. But within the confines of this discussion we are in the 1st world..and to that end we have developed along with some amazing advances in modern medicine the inability to suffer any illness that can conceivably be prevented and this generally for socio-economic reasons rather than our mortality as it would be in other countries. The very fact we are able to protect our vulnerable or should do is now not enough..we all want rid of the embuggerance of illness. I do as well.

The hand wash thing made me cheer :D MRSA C-Diff...I think you know the cure as well as I :D

[OkToBeTakei]

I think we can probably vaccinate AND do other preventative measures at the same time. Double up!

One of the reasons that I think vaccination for the flu is pushed so much in the US is that the typical person might not go to the doctor when they have a bad case. And then it may become a medical emergency. We don't really do preventative care here so little things can get expensive very quickly. I had H1N1 (I am pretty sure, at least, because I was exposed to it and ended up very ill a while later) and probably should have gotten some medical care, but the price tag was overwhelming. I did recover, but if I hadn't then I would have ended up in the hospital. A trip to the doctor is $100, plus whatever tests and medications they want to give you, so people without insurance are always balancing their budget with their health needs. This leads to a lot of gambling (I know that a $20,000 hospital visit is more than a doctor's visit, but maybe I can get better without a doctor if I drink some herbal tea!!!) and wishful thinking.

I think perhaps people in places with socialized medicine are more likely to get help when they need it, before it becomes a major issue.

Absolutely true Emmiedahl...re your final sentence. i think the NHS knows this and balances it with the cost of mass immunisation. I cannot imagine that type of dilemna.

It does reinforce though..my thought that it is an Economic rather than public health issue with the CDC ..Do they make revenue from any pharmaceutical companies? Half joking when I ask ?

[Wolfie]

Anybody notice how anything to do with healthcare always results in a vaccine debate?

[Arete]

The CDC is neither funded nor gets revenue from pharmaceutical companies. They have the thankless job of informing both parties in our government that public health does not mold to party expectations.

OKTBT, on the C. diff, preach it! :clap: There is nothing worse than trying to convince some of the Doctors God that germs don't care how many years they went to medical school. :P

[emmiedahl]

Absolutely true Emmiedahl...re your final sentence. i think the NHS knows this and balances it with the cost of mass immunisation. I cannot imagine that type of dilemna.

It does reinforce though..my thought that it is an Economic rather than public health issue with the CDC ..Do they make revenue from any pharmaceutical companies? Half joking when I ask ?

I don't think they make revenue per se, but pharmaceutical companies are major lobbyists in Washington.

The CDC and federal government do not, to my knowledge, pay for vaccinations in most cases. So it costs them nothing to recommend it, the way it certainly costs your NHS. I know some state and local governments are paying to vaccinate their public, but those are completely different agencies with completely different funding sources. Remember, the US needs to reinvent the wheel at every level of government. So, with a population in which many people will be buying their own vaccine, and many people will not be seeking medical care unless they are deathly ill, the recommendation makes sense in our population where it might not make sense in some European countries.

[OkToBeTakei]

Anybody notice how anything to do with healthcare always results in a vaccine debate?

Hehe yes. It's all good until everything goes boom. It is such an emotive and contentious issue. But it is interesting to see other peoples views agree or not. We all make those decisions based on our own choices. I have found in real life that nobody will agree, it is no different here. It is very difficult to be in any way objective. If you read this thread as the other vaccination thread it is generally people posting their view through a veil of their own experience. You can never tell somebody who has has looked at their own child being ill...that any choice they make is wrong. So yes....always a trigger subject.

[Arete]

I just did a little math for fun. So, taking the 2008 US numbers of 200,000 hospitalizations for flu cases. Multiple them by a 50,000 dollar hospital stay for 5 days (10,000 a day is not outrageous in my area, trust me), you get a cost of 10 billion dollars.

Vaccinating 80% of the US population (300 million) would cost 7 million dollars at today's going rate. I suspect even adding the cases of flu that will still be seen in this population, 6 million dollars is peanuts as a preventative investment.

Edited to correct information. The US did not have 200,000 flu cases in 2008, it had 200,000 hospitalizations for flu cases in 2008.

[OkToBeTakei]

I don't think they make revenue per se, but pharmaceutical companies are major lobbyists in Washington.

The CDC and federal government do not, to my knowledge, pay for vaccinations in most cases. So it costs them nothing to recommend it, the way it certainly costs your NHS. I know some state and local governments are paying to vaccinate their public, but those are completely different agencies with completely different funding sources. Remember, the US needs to reinvent the wheel at every level of government. So, with a population in which many people will be buying their own vaccine, and many people will not be seeking medical care unless they are deathly ill, the recommendation makes sense in our population where it might not make sense in some European countries.

I think if they thought the cost of treating it rather than preventing it was more the NHS would be vaccinating big time. Which is why I think I am being cynical on your behalf if you understand me?

[OkToBeTakei]

I just did a little math for fun. So, taking the 2008 US numbers of 200,000 flu cases. Take 100,000 of these, multiple them by a 50,000 dollar hospital stay for 5 days (10,000 a day is not outrageous in my area, trust me), you get a cost of 5 billion dollars.

Vaccinating 80% of the US population (300 million) would cost 7 million dollars at today's going rate. I suspect even adding the cases of flu that will still be seen in this population, 6 million dollars is peanuts as a preventative investment.

I am assuming all 100,000 were men? With man flu? (sorry all good men patients out there)

Why would they be in hospital Artejo?

[Arete]

Actually they were 200,000 hospitalizations, not cases. Sorry, that was my error. So these are the worst cases in for the most part the most vulnerable populations, the elderly first, immunocompromised and the very young who developed complications from the flu requiring more intensive care. From a cost perspective, 6 million dollars to vaccinate 80% of our citizens is small change that would also help keep the number of overall cases lower. Sure, these are US numbers. I don't know the number of hospitalized cases or number of people the NHS covers.

[Buzzard]

The CDC is neither funded nor gets revenue from pharmaceutical companies. They have the thankless job of informing both parties in our government that public health does not mold to party expectations.

OKTBT, on the C. diff, preach it! :clap: There is nothing worse than trying to convince some of the Doctors God that germs don't care how many years they went to medical school. :P

I've stayed out of this because I fall firmly in the NO ANTIBIOTICS UNLESS NO OTHER OPTION camp but I need to chime in on C Diff. I get my vaccines, take all my other pills, but antibiotics almost killed me. Nearly 2 years ago I was given Cipro for a stomach bug when I didnt need antibiotics at all. I had gone to the ER and had a shitty doc who just wanted to move on rather than admit me. By the time I got to my Dr, 2 days later, and they bugged out that I was on Cipro, it was too late. I developed C Diff, and not just any strain of it, it was resistant to flagyl and vancomyacin. 11 hospitalizations (the shortest being 4 days and the longest 12), 2 surgeries (one where I lost some of my liver), countless CAT scans, pill camera swallows, flouroscopes, 2 endoscopies, 3 colonoscopies, medications with a retail value of well over 50k and nearly 4 months out of work... I now need weekly IV iron, b complex injections, prescription D, IBS meds (I never had that prior to c diff), and there is a high likelihood that there will be more surgery in the future and any infection can be dangerous - because I cant take antibiotics.

All this because I took 3 days worth of Cipro. Any antibiotic that acts on your system leaves you open to very, very dangerous creatures. C. Diff is on the rise and its becoming more and more resistant. 17k people die from it annually. I had never heard of this evil creature until it was too late - people need to be aware that yes, they can kill the bug that you have - but that you may wind up with a MUCH worse one. Lysol doesnt kill C.Diff, only bleach does. Its a sporing mother fucker... and its everywhere...

ETA cite to my 17k deaths statement

http://www.nytimes.com/2012/03/20/healt ... d=all&_r=0

[OkToBeTakei]

Actually they were 200,000 hospitalizations, not cases. Sorry, that was my error. So these are the worst cases in for the most part the most vulnerable populations, the elderly first, immunocompromised and the very young. From a cost perspective, 6 million dollars to vaccinate 80% of our citizens is small change that would also help keep the number of overall cases lower. Sure, these are US numbers. I don't know the number of hospitalized cases or number of people the NHS covers.

Gosh my apologies...that is a large number. As I have previously said the NHS vaccinates all vulnerable groups. But it does not make up 80% of our population.

[OkToBeTakei]

I've stayed out of this because I fall firmly in the NO ANTIBIOTICS UNLESS NO OTHER OPTION camp but I need to chime in on C Diff. I get my vaccines, take all my other pills, but antibiotics almost killed me. Nearly 2 years ago I was given Cipro for a stomach bug when I didnt need antibiotics at all. I had gone to the ER and had a shitty doc who just wanted to move on rather than admit me. By the time I got to my Dr, 2 days later, and they bugged out that I was on Cipro, it was too late. I developed C Diff, and not just any strain of it, it was resistant to flagyl and vancomyacin. 11 hospitalizations (the shortest being 4 days and the longest 12), 2 surgeries (one where I lost some of my liver), countless CAT scans, pill camera swallows, flouroscopes, 2 endoscopies, 3 colonoscopies, medications with a retail value of well over 50k and nearly 4 months out of work... I now need weekly IV iron, b complex injections, prescription D, IBS meds (I never had that prior to c diff), and there is a high likelihood that there will be more surgery in the future and any infection can be dangerous - because I cant take antibiotics.

All this because I took 3 days worth of Cipro. Any antibiotic that acts on your system leaves you open to very, very dangerous creatures. C. Diff is on the rise and its becoming more and more resistant. 17k people die from it annually. I had never heard of this evil creature until it was too late - people need to be aware that yes, they can kill the bug that you have - but that you may wind up with a MUCH worse one. Lysol doesnt kill C.Diff, only bleach does. Its a sporing mother fucker... and its everywhere...

Similarly Buzzard I did not comment on the title of this thread..just it's recent off-shoot.

I am so sorry for your health issues. C-Diff and MRSA are endemic in the UK...the only way you can hope to get any anti-biotic is via culture. This is the way it should always have been. Indiscriminate use of anti-biotics has indirectly led us to this stage. Anti-biotics are a wonderful intervention...the holy grail..right up until MRSA hits..and then the use of 2 other groups will exacerbate the resistance. Just when you find one C-diff hits. We even have a name for it..Hospital acquired ..nice.

[Arete]

I'm sorry Buzzard, and I back you 100% that antibiotics are not to be taken indiscriminately. Personally, I like to wait for a culture to come back verifying that 1. the infection is actually bacterial 2. the antibiotic being prescribed is going to work. I could start raving about MRSA and it would make my discussion of the flu look like conversation over a civilized tea. There is no excuse for hospital personnel not to follow hand washing protocol, NONE. That is the first line of defense in containing hospital acquired infections. Antibiotics are the second line you pull out when the first line has been breeched, they are not meant to be preventative.

Your ER doctor should have to answer for what happened.

[Buzzard]

I was once (like - 2 years ago) guilty of the "give me a pill" culture. Now I bug out when they want to give amoxicillian to the kids in my life because the "bubble gum medicine" has one of the highest c diff risks. Yes, antibiotics have a place, but the benefits need to be VERY carefully weighed against the risks. Had I known then what I know now, there is no way I would have taken those pills. I was sick, but I felt much better after the IVs and Zofran. I would have gone home and waited to see my doc on monday.

I'm not saying NEVER take them. I'm just saying google MRSA and C. Diff and see what they are and ask your dr if the risk of contracting this type of creature is worth it. If you make an educated decision that it is, then you've made a choice based on all the facts. I didnt get the C. diff in the hospital, I got it in the community and there are more and more cases of community based infections every month. Be careful...

[Arete]

There is also no excuse to prescribe antibiotics for stomach issues. Antibiotics fight bacteria, period the end.