Solution to Killer Superbug Found in Norway

Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway's public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway's model can be replicated with extraordinary success, and public health experts are saying these deaths -- 19,000 in the U.S. each year alone, more than from AIDS -- are unnecessary.

Kirsty Wigglesworth, AP

Dr. Lynne Liebowitz, a microbiologist, works in Queen Elizabeth Hospital in Kings Lynn, England.

"It's a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort," said Jan Hendrik-Binder, Oslo's MRSA medical adviser. "But you have to take it seriously, you have to give it attention, and you must not give up."

The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.

Now, in Norway's simple solution, there's a glimmer of hope.

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Dr. John Birger Haug shuffles down Aker's scuffed corridors, patting the pocket of his baggy white scrubs. "My bible," the infectious disease specialist says, pulling out a little red Antibiotic Guide that details this country's impressive MRSA solution.

It's what's missing from this book -- an array of antibiotics -- that makes it so remarkable.

"There are times I must show these golden rules to our doctors and tell them they cannot prescribe something, but our patients do not suffer more and our nation, as a result, is mostly infection free," he says.

Norway's model is surprisingly straightforward.

-- Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

-- Patients with MRSA are isolated, and medical staff who test positive stay at home.

-- Doctors track each case of MRSA by its individual strain, interviewing patients about where they've been and who they've been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What's here? Medicines considered obsolete in many developed countries. What's not? Some of the newest, most expensive antibiotics, which aren't even registered for use in Norway, "because if we have them here, doctors will use them," he says.

He points to an antibiotic. "If I treated someone with an infection in Spain with this penicillin, I would probably be thrown in jail," he says, "and rightly so, because it's useless there."

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.

"We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better," Haug says.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array -- 42 different brands at one downtown 7-Eleven -- of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren't allowed to advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: "Penicillin is not a cough medicine," says the tissue packet on the desk of Norway's MRSA control director, Dr. Petter Elstrom.

He recognizes his country is "unique in the world and best in the world" when it comes to MRSA. Less than 1 percent of health care providers are positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.

"So far we've managed to contain it, but if we lose this, it will be a huge problem," he said. "To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can't prevent infections. In the worst-case scenario, we are back to 1913, before we had antibiotics."

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Forty years ago, a new spectrum of antibiotics enchanted public health officials, quickly quelling one infection after another. In wealthier countries that could afford them, patients and providers came to depend on antibiotics. Trouble was, the more antibiotics are consumed, the more resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin. Usually harmless, the bacteria can be deadly when they enter a body, often through a scratch. MRSA spreads rapidly in hospitals where sick people are more vulnerable, but there have been outbreaks in prisons, gyms, even on beaches. When dormant, the bacteria are easily detected by a quick nasal swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway's solutions in varying degrees, and his agency "requires hospitals to move the needle, to show improvement, and if they don't show improvement, they need to do more."

And if they don't?

"Nobody is accountable to our recommendations," he said, "but I assume hospitals and institutions are interested in doing the right thing."

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia's hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it's time to add screening and isolation methods to their controls.

The CDC needs to "eat a little crow and say, 'Yeah, it does work,'" he said. "There's example after example. We don't need another study. We need somebody to just do the right thing."

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But can Norway's program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It's here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they've continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they've had one.

"I was shocked, shocked," Liebowitz says, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

When word spread of her success, Liebowitz's phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.

"It's really very upsetting that some patients are dying from infections which could be prevented," she says. "It's wrong."

Around the world, various medical providers have also successfully adapted Norway's program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff -- not just doctors -- responsible for increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

"It's kind of a no-brainer," he said. "You save people pain, you save people the work of taking care of them, you save money, you save lives, and you can export what you learn to other hospital-acquired infections."

Pittsburgh's program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.

"So, how do you pay for it?" Muder asked. "Well, we just don't pay for MRSA infections, that's all."

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Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after her 5-week-old daughter Madeline caught a cold that took a fatal turn. One day her beautiful baby had the sniffles. The next?

"She wasn't breathing. She was limp," the mother recalled. "Something was terribly wrong."

MRSA had invaded her little lungs. The antibiotics were useless. Maddie struggled to breathe, swallow, survive, for two weeks.

"For me to sit and watch Madeline pass away from such an aggressive form of something, to watch her fight for her little life -- it was too much," Reimer said.

Since Madeline's death, Reimer has become outspoken about the need for better precautions, pushing for methods successfully used in Norway. She's stunned, she said, that anyone disputes the need for change.

"Why are they fighting for this not to take place?" she said.

Now Hiring: US Census Workers

If you need a job and are good with people and numbers, the government might have work for you. The U.S. Census Bureau just began the process of hiring more than one million temporary workers for its 2010 population count. If hired, you'll get good pay, flexible hours, paid training, mileage reimbursement and the sense of doing something to help out your country. Best of all, you don't have to go very far - the jobs are right where you live.

Every 10 years, the Census Bureau takes on the massive project of attempting to count every person who lives in the United States. While most get forms mailed to them, not everyone fills them out properly or at all. You'll go door-to-door in your community to encourage people to fill out their questionnaires and help them with any questions they might have. You will also conduct brief interviews with some residents to help learn more about them for the survey.

In exchange for your hard work, you'll earn anywhere from $10 to $20 an hour. The Census Bureau has a neat interactive map on its website where you can see how much the job pays near you. Be prepared to work anywhere from 20 to 40 hours a week and mainly nights and weekends - after all, that's when people are home. The length of the job depends on how much work there is to be done in your area.

If this all sounds good to you, you're not alone. Nabbing a census job might not be easy in this current economic slump. There's a deluge of qualified workers - many with years of professional experience and degrees - also applying.

Here are the qualifications, according to the Census website:

• You are able to read, write, and speak English.
• You are a U.S. citizen.
• You are a legal permanent resident, or non-citizen with an appropriate work visa, and you possess a bilingual skill for which there are no available qualified U.S. citizens.
• You are at least 18 years old.
• You have a valid social security number.
• You take a written test of basic skills.
• You have a valid driver's license.
• You pass a background check.
• You commit to four days of training. You will be paid for training days. Training can be held either during daytime hours or during evening and weekend hours.

There's also a multiple-choice test you'll have to pass. It quizzes your reading, clerical, number and organizational skills. You can take a practice test on the Census Bureau website. Being bilingual can also help your chances of landing the job.

Ready to apply? Just head to the Census Bureau website, print and fill out the appropriate forms and then call your local census office to schedule an in-person interview and test. Good luck!

States May Be "Big Losers," but Cities Still Gain

The Census Bureau's tally of state population changes, released just before Christmas, has become more fodder for some long-suffering states. Five of the nation's largest states were dubbed "the biggest losers," meaning they saw the highest imbalance between people moving out and people moving in.

Not surprisingly, none of the losing states is exactly a picture of economic health. California topped the list, losing more than 98,000 residents. Michigan, Illinois and Ohio lost more than 170,000 between the three of them. New York and New Jersey combined to lose almost 130,000, and Florida lost 31,179.

Sure, it's fun it is to pick on insolvent California, seedy Illinois, and New York, with its Wall Street villains and laid off media mavens. But a closer look at the data reveals a more complex picture.

For one thing, four of the five "losing" industrial stalwarts ended the last fiscal year with more residents than they had twelve months earlier. Yes, more people moved out of these states than moved in. But the number of people born in the states exceeded the number of people dying.

That's right: California's population grew by one percent, Illinois' by half-a-percent, New York's by four-tenths of a percent, and Ohio's by a handful of buckeyes (a tenth of one percent). Michigan, in a sign of the true ravages from the auto industry's failure, actually lost population overall.

Remember your high-school statistics: one should always question the data. The losers, in other words, are gainers.

And that sends our hunt for long-term appreciation in home values in a different direction. Chris Jones, vice president for research of an urban-advocacy group called the Regional Plan Association, points out that big cities are growing and pulling their close-in suburbs along -- even if those suburbs sit in neighboring states.

"State boundaries have little correlation with the economic regions that drive migration," Jones said. "They don't tell you a lot about very big differences within the states."

The Census Bureau concedes that it has not broken down the changes in population to show whether cities in "loser" states are getting bigger or rural areas in "gainer" states are getting smaller. It will produce that data in May 2010, a Census spokesperson told me.

The biggest total population gainers? Texas, North Carolina, Georgia, Florida and Washington state. The common thread among the winners is that they have fast-growing cities with satellite suburbs, fueled by boomers and empty-nesters move back to spruced-up downtowns. Texas, for example, claims three major urban centers that are all working to make their neighborhoods more transit and pedestrian-friendly and revitalize their downtowns.

Even Nevada, despite its real estate crisis, grew by one percent as Las Vegas became a more diversified economy with more downtown living.

"The types of public spaces and recreation that are traditionally in cities are much more aligned with consumer preference trends than they were 20 years ago," said Jones. "You have an aging population of baby boomers looking for a home that's smaller and more convenient to amenities and transit."

Add to that the fact that many people are marrying and having kids later than they used to, and suddenly cities -- not states -- start looking like the interesting variable. A vibrant metropolitan center with close-in suburbs that lie across state lines teaches us more, perhaps, than counting U-Hauls that drive across state lines.

A Resurgent Dollar Could Be 2010's First Surprise

This past year sure was packed with stunning turnarounds: Few foresaw a soaring stock market but tumbling approval ratings for President Obama. And it may have one last twist in store for investors.

Many investors saw a crumbling dollar as a sure bet in the wake of the Federal Reserve's unprecedented liquidity injections, but over the last month the greenback has instead mounted a sharp turnaround. And while the mainstream sentiment remains negative on the currency, a high-profile minority of investors – with both more bullish and bearish economic outlooks than most -- are now betting that the rally will continue into the new year.

The convergence of views about the dollar from investors in both contrarian camps and who correctly anticipated the stock market rally may be revealing about the year ahead. While the status quo predicts a gradual downward move for the greenback amid a limp economic recovery, any surprises -- whether positive or negative -- could lead to a sharp reversal. And if 2009 was any indication, investors should remember that things rarely play out in the smooth way that the consensus predicts.

The dollar has already gained about 5% against a basket of currencies during the last month. Butanother 10% move upwards for the greenback could be in store, according to Barton Biggs, the managing partner of powerhouse hedge fund Traxis Partners. Biggs, who suspects an economic recovery could be much stronger than is widely believed, has been bullish on stocks and sees the S&P 500 gaining another 10% as well.

Bounce Now, Bomb Later

But even Marc Faber, who predicts the dollar will ultimately be worthless because of the Fed's money-printing, sees a strong if temporary bounce on the horizon for the greenback. Eventually, though, Faber sees the Fed's liquidity injections driving up inflation, and he expects investors to ditch assets like cash and Treasuries in favor of equities as a result.

Noted analyst Robert Precther of independent forecasting firm Elliott Wave International, sees the Fed running out of ammo in the face of a collapsing economy in the year ahead. The resulting deflationary environment will send investors racing to the safety of the dollar, Precther argues.

However, some bullish investors say the start of the year could bring a stronger rebound in jobs than most predicted. One in that camp is Charles Schwab Chief Investment Officer Liz Ann Sonders, who recently wrote that panicked companies went overboard in cutting jobs amid the downturn. Judging by the GDP declines and correlating job losses during prior recessions, she noted, employers may have fired 30% more workers than they should have.

Now that business confidence is recovering, "many companies concede they didn't just cut employment to the bone, but into the bone," Sonders wrote. Surprisingly strong recent jobs reports and blistering temp hiring may be testament to the sharp rebound that lies ahead. And the resulting Fed tightening of liquidity in response could further shore up the dollar.

Bad News for Commodities?

The impact of a rising dollar on other assets remains unclear. While a rise in the dollar usually led to a fall in stocks for much of the year, that correlation has abated recently. Commodities like oil and gold -- the latter was especially seen as a play on a crumbling dollar -- could get hit hard by a resurgent greenback.

But whether the year ahead brings a brisk recovery or more chaos, a sharp rally in the greenback -- left for dead not long ago -- could be in store.

3-D TV Soon to Be a Reality

ow that 'Avatar' has blown everyone's minds from the big screen, it looks as if the small screen will soon be jumping on the 3-D train, too.According to HD Guru, DirecTV's newly launched satellite will not only include over 200 HD channels, but will also include the country's first HD channel in 3-D. We're having trouble breathing right now.

Of course, the 3-D-ification of your HDTV won't happen all that smoothly. If you already have a DirecTV box, you'll have to get a firmware upgrade to support the programming, once the satellite begins operating in March. But, of course, you'll also have to have an HDTV capable of playing 3-D programming.

Don't worry. The market's on it. Sony, Samsung, Mitsbuishi, LG, and other TV producers are slated to unveil a ton of new 3-D-enabled displays at next week's CES 2010. While 2009 may have been the year of celebrity deaths, bailouts and auto-tune, 2010, so far, is shaping up to be simply the year of 3-D TV.

Eight Fast-Food Miracles and Missteps From the Decade

Photo: Yoppy, Flickr.

This decade has been a Golden Age for the fast-food industry, even though the new century hasn't been kind: The Nacho Cheese/Beefy Goodness/Deep-Fry Vat Complex has been blamed for America's obesity.

The industry has been forced to display calorie counts on menus and switch to trans-fat oils. Books have been written revealing the unseemly side of the quick-eats business.

Yet the fast-food industry has thrived, heralding a Renaissance of budget-friendly cuisine engineered to be portable, comforting and tasty. It's nosh scientifically designed to please your brain's pleasure centers.

But fast food is so much more than just empty calories, heart disease and obscene mash-ups of salt, sauce and Soylent meat. Our country's huts, shacks and drive-thrus represent a slice of the American Dream -- a decadent indulgence and convenient luxury that the entire socioeconomic strata can enjoy.

Walk through one of these establishments at noon near Wall Street in New York City and you'll find college students, bike messengers and Masters of the Universe soaking up the grease. It unites us as one big, fat family.

Over these surprisingly short years, we've seen the boundaries pushed, and trends tested. We've snacked on toasted subs, candy-laced milkshakes and piles upon piles of patties -- and those are just the obvious examples. Some innovations soared and some crashed. Here are eight soon-to-be legendary examples. ...

Best of the Decade: The McGriddle

McDonald's has always been the industry juggernaut, and it got that way, partially, by constant modernization of its menu. It scored big with a new breakfast item: the awesomely named McGriddle, which is egg, cheese and bacon sandwiched between two syrup-infused pancakes. Sweet, savory and satisfying, it's a delicious wonder of science and smarts -- almost challenging the Egg McMuffin for breakfast supremacy.

Crunchiest: Taco Bell Crunch Wrap Supreme

The most bite for your buck, Taco Bell is constantly rearranging its core ingredients and flavors into all-new monstrosities. And one of its most celebrated flavors is "crunch."

Taco Bell's Crunch Wrap is a self-contained grilled tortilla hexagon filled with nacho cheese, beef, sour cream, lettuce and tomato. It is an extremely crunchy, one-handed meal that symbolizes the simple glories of this fast-food mainstay.

Most Disappointing: KFC Famous Bowls

Kentucky Fried Chicken spent a lot of the aughts trying to diversify its menu, rebranding itself as "KFC" in order to de-emphasize what made it famous.

While stumbling through this identity crisis, it introduced its most notable and disappointing menu item. The KFC Bowl resembled a small human trough or a Dickensian pot of gruel filled with mashed potatoes, corn, cheese, gravy and chicken strips, all slopped together. Flavors and textures failed to meld properly. It was a hand-sized tub of gloppy sadness.

Trendiest: Wendy's Baconator

Wendy's is to fast food what The Who is to classic rock: huge, but not the Rolling Stones or the Beatles.

They jumped on the "bacon makes everything better" bandwagon, and they did it simply. The burger was just two patties and cheese, but while most bacon sandwiches have at least three ribbons of pig, Wendy's had six strips of bacon. Double the pork. The great thing about the Baconator is you knew exactly what you were getting: a vehicle for bacon.

Biggest Gamble: Domino's Bread Bowl Pasta

Domino's became famous and successful for delivering piping hot pizzas, but it wanted more. It remains to be seen whether its attempts to expand beyond injecting crusts with cheese will be successful. Until then, America continues to be invited to try a crown of bread filled with pasta.

It's a bold statement that says carbs are good, and twice the carbs are better. Plus, cheese. The fact that it's served in an edible container makes it unique among its peers. And it can be yours in 30 minutes or less.

Strangest: Burger King Chicken Fries

Micky D's biggest competitor got weird this decade, taking chances on a wonderfully creepy ad campaign featuring a mute in a plastic mask.

One such risk was so-called chicken fries, whereby Burger King took chicken parts smashed into shapes somewhere totally new. Served like french fries, these meat sticks were an attempt to reinvent the art of dunking things. Ultimately, it failed if only because it was just so ... bizarre.

Most Fattening: Hardee's Thick Burger

Hardee's has always languished in the shadows of giants. Attention was paid when Hardee's rolled out this 1,500 calories coronary on a bun.

The burger made the news, and attracted criticism. The truth is, it was a very basic concept: two thirds of a pound of beef, cheese and mayo. Nothing special per se, except that it set a precedent that its competitors keep imitating.

Lamest: Any Salad

Walk into any fast-food restaurant and find the fridge where you can see prepackaged salads cooling. It's a safe bet those salads have been there since the fridge arrived from the home office.

The fast-food industry responded to accusations that it had conspired with our base appetite to hijack our free will by offering "healthy choices."

Ironically, the assorted, tepid Mediterranean, Mandarin and house salads were frequently as caloric as the burgers, fries and nuggets. These salads were just meant to placate the hysterical. There are plenty of places to eat a fresh, healthy salad. A burger joint is not one of them.

Debating the President's Hawaii Vacation: Should Obama Be in Washington?

At a morning story conference for Politics Daily, our colleague Lynn Sweet mentioned that in the wake of the abortive terrorist attack aboard Northwest Flight 253 on Christmas Day, President Obama has been on the receiving end of criticism for remaining on holiday in Hawaii while details of this crisis unfolded. I covered the White House for 15 years, and remember hearing this criticismleveled at George W. Bush -- and at Ronald Reagan. As we went round the horn, Lynn suggested we all jot our thoughts down. So here they are, starting with Lynn and ending with me, Carl Cannon.

Lynn Sweet: The foiled Christmas Day terrorist attack on Detroit bound Northwest Flight 253 -- and President Obama's admission that the U.S. intelligence and screening systems failed -- is a big policy, performance, and political problem for the Obama White House. But it's not made worse by Obama continuing his vacation in Hawaii. There is no rational reason for him to have to be physically working in the White House Situation Room or the Oval Office. But telecommuting does raise questions about the optics; the Obama message machinery is calculating that the vacation hit is small compared to how he handles the overall security crisis.

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This is the second time a Hawaii vacation created trouble for Obama. Ten years ago, on Dec. 29, 1999, then-Illinois state senator Obama was in the midst of a Democratic primary for a congressional seat. Gov. George Ryan called a vote to make illegal gun possession a felony. Ryan was counting on Obama's support. The measure failed by five votes with Obama one of them. Rather than return to Illinois from his Hawaii vacation, Obama decided to stay in Hawaii because his then 18-month old Malia had the flu. Obama was blistered for missing the vote, contributing to his only election loss.

Jill Lawrence: Do you know how you get when you work seven days a week? When it's been months since you left town for a relaxed or at least a different setting where your laptop and BlackBerry don't necessarily call out to you? I know how I get and I don't want a president in that state of mind. I can't fault President Obama for wanting some down time, nor can I fault him for where he went -- back to his home state of Hawaii. He needs this time and we need him to take it. The play and family time will do him good even if he has to interrupt it five times a day to deal with the latest attempted terrorist attack.

Related: Republicans Go Bonkers Over Obama and Flight 253 by David Corn

All presidents confront the competing demands of their jobs and the mind-body imperative to slow down. Remember George H. W. Bush speeding around a Maine lake in his cigarette boat (gas per hour: 25 gallons or $200) after Iraq invaded Kuwait, threatening its oil as well as its sovereignty? And how about his son, uttering this immortal series of sentences as he stood on a green seven years ago in a striped golf shirt: "We must stop the terror. I call upon all nations to do everything they can to stop these terrorist killers. Thank you. Now watch this drive." OK, that's the theater of the absurd. But we do need to get a grip on the difference between "optics" and "reality." One reality is that presidents are never entirely on vacation. A second is that there's no good time for presidents to take vacations. A third is that our presidents must have them.

Walter Shapiro: Imagine if Barack Obama had frantically grabbed the carefully wrapped presents and hustled his puzzled daughters onto Air Force One for the rushed Christmas Day trip back to Washington as soon as he learned about the thwarted terrorist attempt on Flight 253. Then what? Obama might have looked to the media like a tough take-charge president, but he probably would have spent a frustrating day or two hanging around the White House Situation Room, waiting for reliable information about the security lapses that allowed Umar Farouk Abdulmutallab to board the flight to Detroit. In short, a panicked retreat from Hawaii might have revived that post-9/11 catch phrase "...or the terrorists will have won." My point is not to offer a permanent blank check for extended presidential vacations. A vacationing president, for the most part, is exposed to a narrower range of policy options because he has the opportunity to speak to fewer people face-to-face before he makes a major decision. The absence of the president from Washington inspires an uncharacteristic feeling of mild lassitude among staffers who are left behind. Also, as Obama has demonstrated in Hawaii, it is much easier for a vacationing president to avoid taking questions from reporters. But those are reasons for not moving the capital to Hawaii or Crawford, Texas. It is not a criticism of Obama's failure to over-react to the Christmas Day near-miss.

Melinda Henneberger: I am only now realizing how canny George W. Bush was to spend his vacations clearing brush in Crawford, so that in case of a national emergency, at least no fair-minded person couldcriticize him for having more fun than was seemly under the circumstances. Since we are forever accusing our elected officials of doing absolutely everything for PR reasons, it strikes me as unfair in the extreme that the charge against Obama now is that after a foiled terror attempt, he should have "hotfooted'' it back to D.C. for appearance's sake. And it's not like most of thosecomplaining about Obama's vacay in the state where he was, yes, born, would be even a smidge happier if he'd spent the whole of his Christmas break in a pup tent on the snow-covered South Lawn, or in a bunker with his national security team. So good for him for understanding that and staying put.

Bruce Drake: Physically being in Washington is beside the point. What Obama needed to do, and he could have done it from anywhere, is get out in front of this early to project the sense of urgency and what was being done, in the way he later did on Monday and Tuesday. The question of whether Obama should have broken off his vacation reminded me of 1981 when Ronald Reagan was president and two U.S. F-14s, flying 60 miles off the coastline of Libya, shot down two Libyan jet fighters that attacked them. Reagan was in Los Angeles during his summer sojourn and the incident occurred at 11:04 p.m. Pacific time, when he had turned in for the night. White House Counselor Edwin Meese notified Vice President Bush and National Security Council members but did not wake Reagan up until 4:24 a.m. Reagan said that was all right because no presidential decision was required. But Reagan biographer Lou Cannon wrote that Nancy Reagan, senior adviser Michael Deaver, and Chief of Staff James Baker were "furious" because they realized the "public relations importance of demonstrating Reagan had his hand on the presidential throttle." Instructively, when a Soviet jet fighter shot down a North Korea airliner with 269 people aboard in 1983, Reagan cut short his vacation at his Santa Barbara ranch and returned to Washington, perhaps because memories of the Libya incident were still fresh.

Patricia Murphy:: Should President Obama take his family on vacation to Hawaii during the Christmas holidays? Of course he should. I don't begrudge the president time off, and good for him if he has roots in a tropical paradise that also happens to be on American soil. But I do confess to being deeply troubled by Obama's business-casual demeanor in Hawaii since the terrorist attack over Detroit on Christmas Day.

In the days following the incident, Obama hit the links, attended to a friend's child's beach injury, and eventually addressed the attempted bombing from a makeshift podium wearing a vacation-friendly open-collared shirt. Even then, his response was oddly mahalo. After his advisers initially assured the nation "the system worked," he then promised that those involved in the attack would be "held accountable," a phrase that brings to mind tax evaders, not mass murderers. The next day, Obama finally gave vague, but menacing, accounts of "human and systemic failures," but he was only catching up to the American people, who were already wondering how any of this could happen.

It is clear that the intelligence community didn't "connect the dots" before the attempted bombing, but the Obama team does not seem to have connected the dots since then. Was it because they were in Hawaii on vacation? I don't know, but I would feel a lot better if somebody would put on a tie.

Carl M. Cannon: Maybe conservatives are picking on Obama for going on vacation because they are still irritated by the incessant carping against George W. Bush by liberals and in the media for his working vacations in Crawford. (I went down there twice, and believe me Bush was working -- meeting aides, working the phones, and taking one and two-day trips on Air Force One all over the country.) And, just maybe there's some truth to the old bumper-sticker saying, "Annoy a liberal: Work hard and be happy." Either way, in my view, this line of attack is ill-considered and a-historical.

The last two presidents we had who couldn't relax and took politics everywhere with them, including the golf course and the beach, were Bill Clinton and Richard Nixon. Clinton was impeached, Nixon forced to resign. The presidents who preferred Rancho del Cielo and Warm Springs, Ga., to life in the White House were Ronald Reagan and Franklin Roosevelt -- perhaps the two most successful 20^th century American presidents. Reagan spent nearly a year of his two terms in office at his Santa Barbara-area "ranch in the sky." Roosevelt loved Warm Springs so much he went there to die. Presidents need their "Shangri-La," which, incidentally was the name FDR gave to the place we know as Camp David. Vacationing helps their minds and their souls, something the American people know well -- and Lord knows we want mentally healthy presidents.