Learn to speak before you can walk
65 per cent of Maltese think that antibiotics can cure colds and the flu
If the Labour Party can’t find enough people who write fluent English to keep its website Maltastar going, then it should shut it down or switch to Maltese.
Maltastar’s voice is the voice of the government in waiting, and right now, that voice makes the government-in-waiting look really stupid.
Let’s hear a sample of how it speaks, from yesterday’s edition and a report on Gavin Gulia’s tour of the shops in Paola, and calls from shop-keepers for tax incentives.
Gulia said that the businessmen that spoke to him explained how these incentives needed to be implemented now; due to the crisis currently being felt in the business sector. He explained how they also spoke about the fact that costs are increasing while the actual selling of products have decrease. Dr Gulia concluded by stating that this factor is being added on due to the exaggerated water and electricity tariffs and the increase price of products and services directly influenced by the government.
It’s terrible, from start to finish.
It’s not just the grammar, syntax, punctuation and spelling, but words used wrongly in literal translations from Maltese (‘exaggerated water and electricity bills’) and worst of all, the clumsy thinking which is reflected in the clunking way those sentences are put together.
You can tell that the person who wrote this report hasn’t got a clue what s/he and Gavin Gulia are talking about here.
I read those lines five times before concluding that this is what the writer means.
Shopkeepers and café-owners in Paola (not businessmen, for heaven’s sake, because that implies a slightly bigger league than a boutique in Paola, though Marlene Mizzi and the Labour Business Forum clearly don’t think so) have renewed calls for tax incentives promised by the government. They say that this will help relieve the pressures of a situation in which running costs increase while sales fall. Dr Gulia told reporters that the new water and electricity rates are making difficulties worse by increasing costs to operators, forcing them to raise prices.
Of course, I might be wrong. Most of the time, it’s hard to tell what Maltastar means, but for small mercies we should be grateful. At least this report was pleasantly devoid of interrogation marks used instead of full-stops.
TAKE A PILL
What we suspected is now official. Malta is the top consumer of antibiotics in the entire European Union. Well, not the very top consumer, because we are narrowly beaten to first place by neighbouring cissies, mummy’s boys, cold-fearers and scarf-wearers in May, the Italians.
We are 15 full percentage points above the EU average in consumption of antibiotics. A Eurobarometer survey carried out last December tells us that an eye-popping 55 per cent of the population took antibiotics at least once in 2009. With the Italians, it was 57 per cent.
A vision of an Italian man, coat collar turned up against the biting 20C wind, scarf neatly folded at his throat, chin turned down into it, vest neatly tucked in and mamma’s antibiotics in his pocket, springs unbidden to mind.
Italians, in their absolute horror of un raffredore, beat only the Maltese with our ‘Le, ta, ma mmurx niehu xi rih’. You’d think we all lived in Lapland and not the southernmost points of the European Union, or that colds can kill an unsuspecting Maltese or Italian while leaving a German or Swede unscathed.
I mock because it is precisely this irrational fear of colds, coupled with lack of understanding of how they are caught and what they can do to you (not much, really) that drives the Maltese and Italians to pharmacy counters in their hundreds of thousands, to pick up a course of antibiotics.
How many people here actually take antibiotics for seriously infected wounds, say, rather than at the first hint of a tickle in the throat and a sniffle?
It doesn’t help that most Maltese don’t know the difference between a virus and a bacterium, and that colds and influenza are caused by the former while antibiotics fight only the latter.
Taking antibiotics to fight off a virus is like drinking milk for the same purpose. Yet people persist in doing so. How do they get them? They go to a friendly pharmacist who hands them over without a prescription or they nag and kvetch at their GP until he gives in and writes one out.
The same survey shows that last year, 17 per cent of those Maltese who took antibiotics did so to ‘cure’ a cold, while 26 per cent took antibiotics to ‘cure’ influenza.
When asked whether antibiotics can cure colds, 65 per cent of survey respondents said that they do. This highlights a serious shortcoming in our education system. You don’t need to take biology at O-level, surely, to learn at school about bacteria and viruses, how they cause disease, that nothing can kill a virus, that antibiotics kill only bacteria, and that colds and flu are caused by viruses only.
This is basic knowledge for life, essential knowledge, unlike some of the rubbish that children are forced to learn by rote, mainly from a book called Qawsalla.
Children are not going to learn this stuff from their parents because their parents don’t seem to know about it either. They’re the ones buying the antibiotics for sniffles. If you teach children, they will teach their parents in turn – strangely, with some issues that’s the direction it’s got to take and not the other way round.
A European Commission health official told the press: “This is very bad news as it seems the Maltese are becoming very dependent on antibiotics and this may be causing repercussions….In Europe, antibiotics are usually used only as a last resort.”
So where antibiotics are concerned, it appears that Italy and Malta are not culturally part of Europe. European health authorities are trying to fight inappropriate antibiotic use because it is the direct cause of the development of ‘super bacteria’ like MRSA, which are resistant to all antibiotics.
And MRSA, unlike the head-colds which we try to treat with antibiotics, is a real killer. It actually destroys people’s bodies and ends their lives.
The European Commission report on antibiotic use in Malta says that in 2003, “Malta reported that antimicrobials sold without prescription were believed to be a relevant source of inappropriate use of antibiotics. The situation remained the same in 2008.”
This means that between 2003 and 2008 nothing was done to educate people by means of a public information campaign. Either that, or any attempted campaign was completely ineffective.
The surest way to solve this problem is also the least complicated, time-consuming and cost-effective: driving the message home through a public information campaign on television and radio.
Remember ‘post it-tfal huwa wara’? Before that campaign, we had children riding in the front seats of cars all over Malta. It was a common sight: children on mummy’s lap up front, children riding next to daddy, two children squashed into the front seat – but after the campaign had run its course, you never saw one. Children on the front seat became a thing of the past.
The Public Health Department needs to do the same thing with antibiotics. It’s the only way.
This article is published in The Malta Independent today.
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On the cold issue, it’s quite a non-revealing fact keeping in mind the geographical proximity and some cultural affinities – I can only say one thing in Italian, “buon sangue non mente”.
That their English is horrendous is a well known fact. We all heard their deputy leader ‘l-ex kummissarju wannabee’ speaking at a forum lately. His speech was delivered reading a text and the pronunciation was beyond belief. It made me squirm. Full marks for today’s article.
Il cop- Inspector Gadget is now ‘Leader wannabee’.
Like their colleagues in Malta, the Italian left is not an alternative government at all.
‘You’d think we all lived in Lapland’, very good, Daphne. Fits right in with ‘mommy’s boys’. Cute.
“nothing can kill a virus” – except antibodies, but you can’t buy them.
In general you’re right about excessive antibiotic use, but there are instances where the weakening of the immune system due to a cold or flu leads to seconday bacterial infections of the respiratory system where the use of antibiotics is entirely justified.
Occasionally a GP will prescribe a course of antibiotics for the flu, precisely because he suspects the occurrence of such secondary infections. This is probably the cause for the mistaken perception that antibiotics “cure” the flu.
[Daphne – And is it only in Italy and Malta that people are subject to the high risk of such secondary infections, necessitating a preemptive strike in the form of a course of antibiotics? Or are doctors just looking for an excuse to prescribe them, for reasons that don’t bear close scrutiny?]
Well, I haven’t seen this survey so I cannot comment on it’s accuracy or about what conclusions can be made from it. What I did read is your article and purely from the information in it, one can reach certain conclusions.
For one it doesn’t take a genius to surmise that if so many Maltese simply shuffle off to the pharmacist to strong-arm him out of their dose of antibiotics one can hardly attribute the 15% difference entirely to the Maltese doctors’ reckless prescription habits. This is an obvious logical conclusion.
You imply that the temperate climate of Malta is less conductive to infections of the common cold than frigid Lapland. The major requirement for catching a cold however is the actual presence of the cold virus and not the cold temperature itself. Given the dusty, windy and overpopulated condition of the Maltese islands, it is far more likely to come across a marauding batch of germs than it is in Lapland – be they viruses or bacteria.
So in a nutshell, yes, it is more likely to get secondary bacterial infections in a country like Malta than in a cleaner, cooler and less densely populated country.
It’s not only the public who cause this problem – so many GPs here prescribe antibiotics for flu and “bad colds”.
Pharmacists are also to blame because they should know better too – I myself witnessed a case when a customer asked for Augmentin for her daughter’s cold because her doctor wouldn’t write a prescription for it.
I actually butted in, and and told her it was because they are friggin useless for colds.
Naturally the only answer I got was “ghall-xejn ta mohhok!”
Sometimes you prescribe an antibiotic for a cold/viral infection in the hope that it targets the bacteria that the virus has “hijacked” for replication of its DNA …
I hope you’re not a doctor.
Cold and influenza viruses infect cells and cannot infect bacteria. Viruses that infect bacteria do exist but they do not have a direct effect on humans.
So no, there is absolutely no point in prescribing (antibacterial) antibiotics for a viral infection when the person concerned is otherwise healthy.
Actually, Daph, I think the reason why we take so many antibiotics is because that is all our doctors prescribe. Fir-rahal it’s a running joke that doctors X, Y and Z all prescribe antibiotics for any given circumstances – headaches, stomachache, influenza, chicken pox and even animal bites – so much so that we’re all immune to it by now!
You might have added that binging on antibiotics at the first sneeze also has long term repercussions, in the sense that the body becomes immune to normal doses and will require higher doses for treatment. This then leads to complications with organs such as the kidneys.
I agree with the TV campaigns part especially where our roads and driving is concerned. I remember there was a campaign on the proper way to approach a roundabout and this had an immediate positive effect.
Maybe we need a refresher because at the Sliema/San Gwann roundabout it’s becoming messy again.
The national obsession with medicine in all its shapes and forms is as unhealthy to the Maltese population as it is lucrative for the pharmaceutical industry. Apart from the futility of taking antibiotics to cure a cold, many medicines cause unnecessary stress to the human body by upsetting the natural acid-alkaline balance.
Combined with an already terribly acidic diet (high in animal protein, low in alkalizing fruit and vegetables), no wonder our nation is plagued with heart disease and cancer among other “inherited” ills. It’s about time national food and drug policy is given a major overhaul.
An information campaign aimed at the general public might be effective. But since most antibiotics are obtained with a doctor’s prescription, wouldn’t that suggest a dfferent target audience?
The Ministry of Health had sent flyers advising doctors and dentists against the excessive prescriptions and use of antibiotics. As stated somewhere before, some pharmacists should be reined in this campaign.
What you’re saying is not quite right. There is actually a difference between purchase and consumption. In Italy statistics show high purchase volumes of all medicinals, not just antibiotics.
The interesting part of it is that seventy per cent of medicine purchased is not consumed. There is a very simple reason for this, Prescription medicine is practically free of charge, therefore even when you need a course of, say, five antibiotics – one per day for five days, you end up with a box of 20 and sometimes 50, and the rest get thrown away.
In fact I suspect there is a racket of some sort, because I always thought it was odd to have packets of 20 antibiotics in the first place! I have cupboards full of medicine. Since a box costs one or two euros nobody even bothers to find out what their medicine chest contains, to avoid purchasing the same medicine the next time they’re sick. You simply buy another box and throw it away.
Unlike Malta, here in Italy doctors hardly ever prescribe antibiotics.
I was amazed at the ease with which Maltese paediatricians prescribed antibiotics for my son the couple of times he was taken ill in Malta. Here I was always told that colds and the flu are viruses and need to just take their course, because no amount of antibiotics will cure them. In fact I have not given my son antibiotics since 2008, the last time he was sick in Malta.
GPs in the UK will not prescribe antibiotics for colds. You will simply be told to go away, drink more water and get on with it.
Another great article. If I may I would like to add one more thought.
It is true that antibiotics don’t kill the common cold virus, but it equally true that people mistakenly conclude that they have a cold when they cough persistently, feel sore throats, ear infections or sinus infections just to name a few. These symptoms are common in Malta perhaps due to the climate.
Since these infections are caused by different types of bacteria, appropriate antibiotics will help. People keep buying them because they will feel a relief of their symptoms within a day.
Something tells me the Eurobarometer survey didn’t ask the correct questions or the surveyed people described their symptoms as a common cold.
“65% of Maltese think antibiotics cure flu and colds.”
This is one of those instances in which the actions of single individuals can damage other individuals.
Nature seems to point that the right way is against individualism.
The problem of antibiotic abuse has never been really tackled well. In the Maltese scenario, one should make some considerations.
1) There is a huge commercial interest in pharmaceuticals, especially in antibiotic sales. Some companies offer large profit margins for certain antibiotics. Ask any pharmacist.
2) GP prescriptions are not audited or checked by anyone.
3) Some GPs are totally cut off from medical research and current practices.
4) The vast majority of patients taking antibiotics for viral illnesses do so on doctors’ orders.
5) In children, there is a vast difference in prescription trends by GPs as opposed to paediatricians. The latter are far more cautious and only prescribe antibiotics for bacterial infections.
Even now, bacterial tonsillitis in the UK is treated with Ampicillin in most cases, because resistance to it hasn’t yet developed in the UK population. In Malta, this drug is a dinosaur…extinct, because it is no longer effective on Maltese people. What is particularly worrying is the fact that the newer and stronger antibiotics are slowly becoming ineffective too…heading for the same fate as Ampicillin.
The authorities should ban the practice of having GPs in rooms within the pharmacy premises, as they face pressure to write out prescriptions which will increase the host pharmacy’s sales; audit prescriptions; and restrict antibiotic use as we do with psychotropics (the green form).
http://news.google.com/newspapers?nid=2026&dat=19990107&id=ccwqAAAAIBAJ&sjid=s9AFAAAAIBAJ&pg=6565,473999
http://www.ibtimes.com/contents/20091110/antibiotic-overuse-threatens-modern-medicine-experts.htm
Interesting links
“Post l-antibiotics huwa wara”? That would lead to a rise in sales of suppositories.
An information campaign would be ideal, but I am afraid that potentially it can be jeopardized by doctors / pharmacies / importers of medicines if it has a negative impact on their bottom line.
We have been hearing this for donkey’s years: there is no cure for the common cold…full stop, period. A couple of day’s rest is all that one should really need.
Mind you there are specific antiviral drugs for specific viruses.
This article reminds me of something that happened to me while I was at boarding school in England. I went to see a doctor regarding a recurrent cold I had and he asked me where I was from.
As soon as I said Malta he quickly thought it would be a good time to point out that in England they don’t give out antibiotics for nothing like the Maltese doctors do.
Was the campaign aimed at stopping children sitting on the front seats of cars ever directed at Gozo? If so it was singularly unsuccessful.
The proposed empowering of pharmacists to prescribe medicines without the hassle of examining the patient is hardly conducive to the more rational use of medicines or to the reduction of over prescribing of antibiotics by those who would be the main direct beneficiaries of the increased sales.
So true! You don’t see much of the ‘ibla erba antibiotics ha jghaddilek’ culture outside of Malta. Others just go straight for Vitamin C-rich foods/drinks/supplements, analgesics for headaches, warm drinks (sometimes with alcohol) and a lot of rest.
This also reminded me of when someone (Maltese) in the group I was travelling with fell ill during a trip to the US. On going to the pharmacy and asking for some antibiotics (the Maltese way) the pharmacists were startled. GPs also refused a prescription.
I also don’t get the ‘ara tiehu rih’ or ‘dawwar xi haga m’ghonqok’ concerns. I never understood how going outside (even at 5 degrees, never mind 15 degrees) after a hot shower, or taking a shirt off outside after sports, and so on and so forth; can give you the flu. In fact I do these sorts of things all the time with no consequences.
I’m not at all an expert, neither do I have direct experience, and I might be totally wrong about this. However I suspect that some parents overdo it when dressing up their infants ‘ghall-kesha’. You’d think these kids had just been teleported from Antarctica, clothes and all. Imbghad ghax telghalu d-deni…
[Daphne – You can only catch a cold if you feed the virus into your nose or mouth, usually via your hand. You can stand outside naked in Antarctica and you will not catch a cold (but you will freeze to death). Feeling very cold can depress your immune system, making you more susceptible to any cold viruses on surfaces you touch, but if you a tough nut, it won’t make any difference. The best way to avoid catching a cold is to avoid touching public surfaces like door-handles, stair-rails, escalator rails, public telephones, ATM machine buttons (wrap a tissue round your finger) unless you can wash your hands immediately.]
L-uniku haga li ghandek iddawwar m’ghonqok f’dal-pajjiz hija habel…
Never thought of that one :)
No wonder those intelligent people at Maltastar.com call Daphne Sahhara ghax bl-artikli li tikteb vera issahhar lin-nies. I never read an article this good from anyone who works for maltastar.com
Troy, you are 100% right regarding your statement of the ‘100 Euros in an envelope please’ because I heard the same story this week from a person I know very well. Did you know that 007 is an uncle of Toni Abela?
Riya, yes I know they’re uncle and nephew, but I guess IAN FLEMING does not.
‘Naturally the only answer I got was “ghall-xejn ta mohhok!”’
Din bomba kienet David. Aqta kemm dhaqt meta qrajta. Prosit my friend.
Taljani ghaggieba izjed minna! I always said that the closest God ever came to making a mistake was to give Italy to the Italians . . . beautiful country, ‘orrible folks.
Excellent article. However instead of a mediocre tv info ad, I would suggest an emotional campaign that scares people out of their wits, similar to the one we had a few years ago about stealing electricity.
Buisness should not be shackled by excessive bureaucray – Joseph Muscat
http://www.maltastar.com/pages/r1/ms10dart.asp?a=8445
Buisness? bureaucray ?
Please do not put all doctors in one basket. it is true that there is the occasional bad egg, something that happens in every profession, but the great majority are dedicated to their patients to the extent of using a considerable amount of what could be their personal time to keep up to date with the latest medical knowledge.
Antibiotic use is only the visible tip of the maltese iceberg of abuse of medications in general. While there are some medical practitioners who do prefer to prescribe antibiotics when they have a reasonable doubt that the condition may have a bacterial element, many others prefer monitoring the situation and prescribe only if there is a clear need.
Most of the abused medications are ‘over the counter’ medications such as painkillers, cough mixtures, steroid creams and suppliments. Most homes I have visited have drawers full of the stuff and none of it obtained on prescription – and these include also antibiotics bought from a ‘helpful’ pharmacy to keep around ‘just in case’.
I agree that there is the need to educate the population that a healthy lifestyle and proper hygiene can go far in preventing most of the more common medical problems and that they should exercise care in the choice of health professional to assist them in this.