Wednesday, 6 May 2020

Change your world by choosing to think positively

'Organic farming methods are beneficial for the environment but they also reduce the need for antibiotics as young animals are allowed to stay with their mother until weaned. Farmed pigs, for example, are weaned early before their immune systems are mature and are therefore vulnerable to infections and consequently antibiotics are routinely added to the feed of farmed swine'. The use of antibiotics in farmed animals differs greatly from country to country. The UK allows the prophylactic, or disease prevention, use of antibiotics in animal feed, whereas Holland imposes fines on vets who do this. In 2005, the United States Food and Drug Administration announced a ban on the use of the antibiotic enrofloxacin in poultry because it was in the same antibiotic class as ciprofloxacin, used to treat people who have contracted CA-MRSA. As a physician, I'm in a profession that is aggressively overseen by powerful regulatory boards from the hospital itself, private medical associations, and the government. Simply maintaining those regulatory standards is exhausting, not to mention expensive. In addition, I'm taxed, I pay licensing fees, I pay malpractice insurance, and I pay all sorts of allowances that further drive up the overhead costs of being a doctor. Likewise, a hidden rivalry between physicians and hospitals does nothing to alleviate the problem of costs. You see, as a consumer you have options: if you want to go to hospital A one week and hospital B the next week, you are able to. However, in an age of connectivity, it is often the case that those two hospitals will fail to communicate with each other regarding what treatments you've received. This lack of communication results in duplicate diagnostic tests and treatments, all of which are billed for. Your life literally depends on accurate and efficient communication among health systems. So why don't they behave in a way conducive to your well-being? The fact is, hospitals are in competition against each other (like businesses or institutions in other fields) and don't necessarily want to work together. Where the conspicuous leaders are called power-hungry bitches, these women are called weak-willed doormats, meek pushovers who settled for less. And, just like that, the message is flipped: you don't take up enough space. Hell, there is a whole industry built on telling us we should be more. That what we have isn't enough, what we love is too ordinary, how we live is pedestrian. Contentment is rebranded as mediocrity.

We digest this idea that, by pulling a few levers, we could (and should! ) transform our lives into a new, shinier version, because unless we are daily reaching for the stars, we are living like plebeians and bringing unhappiness upon our dumb little lives. Women are expected to thread this impossible needle of being just enough for whomever is asking, a Goldilocks prototype who always picks the right chair. We are expected to push the needle but not too far, challenge the status quo but not too dramatically, and lead in strength but not if it makes someone uncomfortable. Hold my earrings! One US pharmaceutical company22 produces both antibiotics. Even though we may never have heard of the word 'zoonotic' before, we now need an awareness of the potential transfer of MRSA between humans and animals. We can't turn back time to undo any of the costly mistakes that have been made by farmers, pharmaceutical companies or governments. We are living with this uncomfortable reality. MRSA is an acronym for methicillin-resistant Staphylococcus aureus, and refers to strains of this bacterium that are resistant to the antibiotic methicillin, and to other members of the beta-lactam class of antibiotics. MRSA is often referred to in the press as a 'superbug', meaning a bacterium resistant to several antibiotics. MRSA infections are classified as either hospital/healthcare- associated MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA), although this distinction is more complicated than simply where the infection was caught. MRSA was first reported in the United Kingdom in 1961,1 and in the United States in 1968. 2 A combination of its virulence, ease of transmission and antibiotic resistance has resulted in MRSA becoming a major problem in the healthcare setting and in the community. The name staphylococcus, from the Greek staphyle, meaning a bunch of grapes, and kokkos, meaning a berry, indicates the appearance of the bacterial cells when viewed using a microscope. This results in redundancy and waste, and can be detrimental to your health. Institutions are also in competition in terms of research. Not only might they fail to discuss your ailment with each other, they may resist sharing research findings. There may be many researchers working on finding a cure for the same disease, but one hospital will decline to share its findings with another institution because they're both racing to discover it first. This kind of opposition can also be detrimental to patient health.

In general, free-market competition spurs innovation and keeps prices down. In the particular case of health care, however, it also creates redundancies that drive prices up. This is due to a lack of transparency about prices, making it impossible for patients to compare the costs of doctors, treatments, and hospital stays. To remedy this problem, President Donald Trump recently signed an executive order calling for price transparency so that consumers can see how much hospitals actually charge insurers. Transparency will force health care providers to stay competitive and will therefore help rein in costs. While it is true that women have historically been shrink-wrapped into a tidier version of traditional domesticity, it is also true that there is no one-size-fits-all message for how much space women should take up. That's just silly. Any notion that we should shrink or expand on demand to meet some prototype of empowerment (either less or more) harms the community of women immeasurably. To those wired to lead and live large--let's call them Mega Women--telling them to be smaller is absurd. Are we going to call up Oprah and Kamala and Reese and Michelle O and Malala and Tina and Beth and tell them their power is outsized? That they missed the meeting on appropriate lady rules and should tone it down? I pity the misguided soul that attempts to tether Shonda Rhimes. Some women were meant for bigger spaces, because they were born with big personalities, big ideas, and big capacity. Where would we be if Mega Women hadn't powered through opposition to build and create, lead and influence, disrupt and reform? What world would we live in if they didn't push past boundaries for more? It was first described and named in 1880, as the most common cause of abscesses and infected surgical wounds; Louise Pasteur, the French microbiologist, who was the first to grow S aureus in a laboratory, called the resulting bone infections, now known as osteomyelitis, a 'boil in bone marrow'. The bacterium's specific name, aureus meaning golden, refers to the golden-yellow colonies (visible clumps of bacteria) it forms on certain laboratory growth media. The full name of this bacterium is often shortened to Staph aureus, S aureus or sometimes just Staph. Prior to the development of penicillin in the 1940s, S aureus infections could result in serious and often fatal disease.

Most strains of S aureus were sensitive to penicillin, and remarkable recoveries were achieved, but it was soon noted that resistant strains were emerging. By the late 1950s, about nine out of every ten S aureus strains isolated from infected patients were penicillin resistant. A modified form of penicillin called methicillin (also called meticillin), was introduced to treat penicillin-resistant strains, but it needed to be injected and could cause kidney damage, so antibiotics such as oxacillin or flucloxacillin were developed. Resistance to methicillin was first recorded in the 1960s, but did not become a major problem in hospitals until the 1990s. Penicillin, and other antibiotics in the same class, kill S aureus by stopping the synthesis of a compound which is an integral part of the bacterial cell wall. Of course, we also want competition to keep spurring the scientific community to continue researching and developing new medical technologies. If we can lower our costs by reducing redundancy and price gouging with improved transparency, we will offset the expected price increases from our future innovations. A huge part of our spending is on conditions that could be avoided with changes in our diet, lifestyle, and environmental factors. Those environmental factors include food choices--the vending machines in our office buildings, the kinds of restaurants and markets in our neighborhoods. People like to blame Big Food and Big Soda for tempting us. Then Big Pharma waits in the wings to give us a pill for the ailments we develop because of poor diets. Then people grumble about the rising costs of such treatments. If a doctor does prescribe you a medication (which is very likely, whether you need it or not), you are the last stop on a long money train: pharmaceutical companies, insurance companies, pharmacy benefit managers, and pharmacies, all of them wanting a share of the profit. The United Nations estimates that, by 2030, the estimated global economic toll of noncommunicable diseases--including cancer, cardiovascular disease, mental illness, and obesity-related illness--could reach $47 trillion. In the United States alone, four out of every five deaths are attributed to a noncommunicable disease. One without Scandal and Bossypants and the right to vote and preach, I'll tell you that right now. That world would be a disaster; we are all beneficiaries of Mega Women and their Mega Lives. What about the opposite end of the spectrum? To the women thriving in a quiet, private life, let's say Modest Women, insisting they loom larger is preposterous.

Why should they? Who said the Mega Women are the only ones who register? Why should our most gentle, behind-the-scenes women be peer pressured into expansive spaces they don't want to fill? We've conflated big with important, but that is a false equivalency. There isn't a person or community on earth that hasn't been nurtured by Modest Women who occupy humble spaces, supporting their people in ways that may be hidden to the watching eye but run deep as the ocean in their actual lives. This cell wall compound, called peptidoglycan, maintains cell wall integrity, especially in the 'Gram-positive' bacteria. The beta-lactam core of the antibiotic binds to specific sites on the bacterial cell wall, named penicillin-binding proteins, causing disruption of cell wall synthesis. This causes the cell walls to leak or collapse, resulting in death of the bacterium. Antibiotic resistance develops because there are countless different strains of bacteria. If one has a genetic mutation which gives it a survival advantage, such as being resistant to an antibiotic, it will survive, and eventually most strains will carry the resistance genes. There are two mechanisms by which the bacteria develop resistance to penicillin, methicillin and other beta-lactam antibiotics. Some strains produce an enzyme known as penicillinase, which breaks open the ring structure of the antibiotic, rendering it ineffective. Other strains alter their own proteins so that antibiotics are unable to bind to them and bacterial cell walls are not disrupted. resulted in strains resistant to penicillin and all beta-lactam antibiotics. MRSA also became resistant to members of the beta-lactam sub-group of antibiotics known as the cephalosporins. 2 Naturally, Big Pharma wants to profit from those dollars. Because Big Pharma sees more money in long-term treatment, they develop and tout medications for conditions that could be prevented by changes in diet and lifestyle; they know most people will prefer to take a pill. They are betting against the American people, and they do so because they can count on us not to do the right thing for ourselves.

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