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Totally Drug-Resistant TB Emerges In India
ananyo writes "Physicians in India have identified a form of incurable tuberculosis there, raising further concerns over increasing drug resistance to the disease (abstract). Although reports call this latest form a 'new entity,' researchers suggest that it is instead another development in a long-standing problem. The discovery makes India the third country in which a completely drug-resistant form of the disease has emerged, following cases documented in Italy in 2007 and Iran in 2009."
We just haven't found a drug to fight it. And before people get on the anti-antibiotics bandwagon, if we didn't use antibiotics, then the simplest infection would be "Totally Drug-Resistant".
Now if you want to speak of the "overuse" or preventative use of antibiotics, then go ahead.
There is no "I disagree" mod for a reason. Flamebait, Troll, and Overrated are not substitutes.
And its about time she exacted her vengeance upon us. We live in exciting times! Enjoy them while you are still alive
And yet the food industry and the pharmaceutical industry would have us believe that the overuse of antibiotics is harmless ...cough.
Silence is a state of mime.
The only silver lining is that it's not even more deadly. At least we can learn about the effectiveness of quarantine methods in the modern era before something even more deadly shows up. Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.
If video games influenced behavior the Pac Man generation would be eating pills and running away from their problems.
Isn't the real story that it's in three countries, and that they are geographically disparate?
Or... does the disease only affect countries that start with the letter I?
I was wondering why "Bob" kept coughing.
SJW: Someone who has run out of real oppression, and has to fake it.
This will be unpopular....
I understand that we are supposed to be a society of victimology, where it's more important that a single victim feel good about themselves than it is to save society, or the species, as a whole, but...
Maybe it's time to go back to the pre-antibiotic known-working fixes for contagious diseases for which there is no cure, i.e.: sanitariums and leper colonies? At least that way, in two hundred years, there will still be people around to feel morally outraged at the excesses of their ancestors.
-- Terry
But evolution is just a theory that's out there. It isn't actually true.
Right?
The only silver lining is that it's not even more deadly. At least we can learn about the effectiveness of quarantine methods in the modern era before something even more deadly shows up.
Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.
A cure for antibotic resistant bacteria may simply be to stop all antibotic dosing and infect them with a large dose of a non-resistant from of the bacteria. Obviously, this will post will be riped off and used in an all new episode of House. Especially, since it would be pretty dangerious.
An incurable air transmittable disease in a high population density region.
I could ramble aimlessly about this general topic for a while, but instead to farm karma more efficiently I think I'll make an obscure, off topic point that I think is interesting by analogy: this directing of evolution also occurs at an environmental scale. Life may find ways to survive in the presence of all the chemicals we dump into the ecosystem, but it will be more vulnerable to other stressors as a result, including those through which it would normally survive. In combination with the on-going loss of diversity caused by more direct damage to the environment, life as we know it is pretty cornered.
It's a little as if we're extremely incompetent first-year med students trying to eliminate a patient's symptoms (i.e. the planet's inherent imperfection for supporting modern life) and we're on the verge of unintentionally killing off the infection that's actually responsible. (Admittedly, this is a lousy analogy, but it's important to realise that it's happening.)
Bio questions? Ask me to start a Q&A journal. Computer analogies available for most topics!
So...the non-resistant Indians die and leave a super-race?
Oh, there is also nearly totally drug resistant MRSA in India and the WHO in the EU has now found 80% of travellers coming back from India have MRSA in their gut.
Wonderful new low cost product solutions from India. Ain't we happy?
Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.
I had not understood this to be true. I keep hearing that strains of bacteria become resistant to all antibiotics. not just a queue of 3, then the next strain is resistant to a 4th antibiotic, but no longer resistant to the first. Evolution does seem to favor specialization, but traits are only lost if they hinder. I don't know exactly what the mechanism of resistance is, but i don't know that each kind of antibiotic requires some new organ to exist resulting in lumpy slow bacteria.
For those interested in exactly how prevalent this sort of thing is, be aware that drug resistant TB is in almost every country in the world; it's just really bad in those particular three countries. This journal article from 2006 has maps showing the incidence rates per country.
Bio questions? Ask me to start a Q&A journal. Computer analogies available for most topics!
I am not surprised that they found a drug resistant TB strain in India. The only thing that surprises me is why not every disease is drug resistant in India.
Many poor Indians would pop anti-biotic tablets like candies after buying them for few cents from an over the counter store (its in direct contrast to the US system where even after paying a fortune you don't get antibiotics). They are often cheap, more or less affective and gets them rid of the problems...but not always.
Antibiotics would require you to finish an entire course, else they become ineffective for ever. There are uneducated idiots in India who would pop one or two tablets and never heed to advice by the pharmacist (and at times they would not have enough money to buy the complete course too).
So why are we surprised that there is an emergence of a strain that no antibiotics can cure? Most likely the previous commenter is right - they haven't found an alternative antibiotic yet. I am sure some random Indian lab would develop it in a few months, but it won't work for long - its more of a systemic problem than a medical issue.
We've had drug resistant TB in the UK. That includes one case in Basingstoke, where a family friend works as a nurse. The patient is (or was, this was two years ago) an intravenous drug user.
It's the energetic cost. Think of climbing Everest, an electric heater and generator+fuel might be very useful, but the weight you have to lug around is really prohibitive to doing it, so you only take what's necessary to survive up there.
Unless you choose to add silly requirements like "the patient must survive the treatment".
#DeleteChrome
in india antibiotics are used as if it was water
Yeah, I've heard about this. In particular, about them being given out like M&Ms, even for viral infections where the doctors knew damn well that they'd do nothing useful, but wanted to pander to the patients. That's not even the OP's "overuse", it's blatant and irresponsible misuse that was obviously going to cause major grief at some point- well, here we are.
I've heard it said that such people had no other option, but since their only "option" didn't work, the doctors would have been more responsible giving them placebo sugar pills. Wouldn't have helped those particular patients any more, but it would have caused less harm to the same demographic of poor people in general that this TB is now most likely to hit.
At any rate, if it hadn't already been in the headline, I'd have guessed (rightly) that it had started in India- this isn't remotely surprising.
"Slashdot - News and Chat Sites Deviant". (Click "homepage" link above for details).
There was this nice experiment in which viruses in a test tube with an artificial environment (with viral materials for wiral reproduction) eventually shed all the parts they needed to enter and use living cells, which made them reproduce faster and outpace their slower-reproducing, cell-infection-capable siblings...and then when they deprived them of said materials and reintroduced live cells, the "more evolved" viruses were out of luck.
Ezekiel 23:20
And, to make things even worse, the standard from what I've seen among the Indians I have worked with is to take the antibiotics until starting to feel better, then stop taking them. This results in recurrent infections of resistant bacteria. I've also observed this a lot with people from the Caribbean.
"Trolls they were, but filled with the evil will of their master: a fell race..." -- J.R.R. Tolkien on Olog-hai
Stop feeling so superior (and stop being so condescending to others).
Developed countries abuse antibiotics by feeding them to animals for better yields and by doctors kowtowing to worried patients with viral infections.
There are "uneducated idiots" (to use your phrase) everywhere.
As another poster pointed out, drug-resistant TB is everywhere. http://jid.oxfordjournals.org/content/194/4/479.full.pdf
I don't read your sig. Why are you reading mine?
Evolution takes a time, it takes time for an adaptation to happen by chance before it may be expanded within a population through selection, which also takes time. In general the stronger the selective pressure the faster the spread of the change and the more complex the change the slower the initial adaptation happens. Most drugs apply massive evolutionary pressure.
Resistance comes at a (usually small) cost, in energy or efficiency, which depends on the method of resistance, but the same mechanism may through adaptation confer resistance to related drugs within a class. This means that adding extra dugs from a class to the set resisted may come at next to no energy cost, but new classes of antibiotics come at a higher cost both in energy and time.
Because of the difference in cost it takes much longer for resistance to pass from the population than it does to spread, so you need to take the drug out of circulation for long enough the resistance trait to completely disappear, which I think is at least a decade, and we have yet to do this deliberately. We have however done this unintentionally with some of the older less safe drugs and they are nowadays used as drugs of last resort in some cases.
It was also mentioned on NPR that one of the patients with the drug-immune TB in India actually checked themselves out of the hospital and they can't find them.
Here's to you our new "Patient Zero"
In a previous thread I wrote a response to a similar question which I'll paste here. The question was a bit different (concerning how fast drug resistance would be lost over time), and related to organisms other than TB (for instance, TB drug resistance isn't plasmid-mediated, as far as I know) -- so my reply doesn't directly respond to your question. However, the gist is the same -- with prolonged evolutionary selection, drug resistance mechanisms with high costs will be gradually replaced by more efficient solutions.
Loss-of-function or alterations of form are indeed one of of the possible mechanisms, and tends to be the more easily-evolved type, so you will often see those appear (and disappear) the fastest. However, occasionally you see mutations that are "free" to the bug, and represent a genuine evolutionary advance that will stick around, possibly forever.
Outside of this, resistance mechanisms are mostly plasmid-encoded factors for things such as antibiotic-degrading enzymes, efflux pumps, and other such defenses. The evolutionary cost for these can range from very high to trivially low, depending (does your enzyme soak up lots of resources to make, or is it highly efficient? Is it permanently switched on, or does it come with an induction mechanism that only triggers when appropriate?). In addition, many bacteria can swap plasmids around, allowing for more genetic versatility.
So the short answer is, that there is no short answer. How fast resistance disappears when antibiotics are no longer used, will depend on each particular situation. However, over time quick-and-dirty solutions will tend to be replaced by more evolutionarily elegant adaptations.
I think this comment is racist.
I wonder if there would be benefit to making antibiotics that are combined with an opiate painkiller. The drugs would only be available to be taken at a hospital or clinic. The patient would need the painkiller, but returning for their antibiotic would reward them with the opiate. The final few days of antibiotic would have progressively smaller opiate doses to wind them down.
It's probably a bad idea, but protecting antibiotics is important enough to consider radical changes in prescription methods.
It doesn't hurt to be nice.
Vaz dis experiment done on a Nuclear Wessel?
(unable to attribute quote)
Apparently, so is this new strain of TB.
SJW: Someone who has run out of real oppression, and has to fake it.
I was actually thinking about biological weapons the other day, and how useless they tend to be. The US has smallpox cultures somewhere (which are often cited as one possible biological weapon), and yet when I pondered things, I came to the conclusion that a new strain of TB would be the most effective biological weapon one can use: 1.) we know it works, 2.) it's not hard to culture a drug resistant strain, and 3.) plausible deniability is there.
I'd be greatly interested to see if the strains from all three regions were comparable. Perhaps someone is testing out a new weapon on various populaces, tinkering with it until they get it just right. Hmm. Mostly brown people are being infected (arguably, a Sicilian's Mediterranean skin color could find itself in this grouping). Interesting. And testing on a diverse set of people: Asian, Middle-Eastern, and Mediterranean / European to ensure that no individual group confers an evolutionary advantage that might stunt the plague's process if / when it is released on a worldwide scale. Perhaps they are trying to cook up an evolved Black Plague? All we need is a breakout in Africa, and someone would have a weapon to set humanity back several hundred years.
Has anyone seen a dirigible flying around in an odd place?
I am John Hurt.
That's all this is. Problem, Reaction, Solution. Watch for it!
All the same shills will come out, CDC, WHO, abc, bbc, cnn, cbs, fox, pbs, nbc
You will see the studio hens cluck cluck cluckin their way to public demand something be done.
The solution won't be pretty. Needles and fema camps.
Antibiotics are a big problem with our system of commercial drug development.
1. We've got lotsa antibiotics. Most of them are generic and cheap. Nobody wants to buy a new, expensive antibiotic until the old ones stop working. Then you want it in a hurry. But drug development takes years.
2. New drugs only make significant money for the discoverer until they go out of patent. And much of the patent term is used up in testing before the drug even gets onto the market. So from a business point of view, it doesn't make sense to invest in developing a new antibiotic until the old ones stop working and there is a large demand (see #1)
3. It is hard to make a lot of money from antibiotics, because they are curative--people take them only for a short time, and then they get well. If you charge enough money per dose to make back your development costs, it looks like you are profiteering on human misery. So while pharmaceutical companies may invest a bit in antibiotics, but it simply does not make a lot of business sense to invest heavily in that direction.
4. Antibiotic development is hard, which means expensive. We think of bacteria as primitive, but in reality they are some of the most evolutionarily advanced things on the planet. They have a short generation time, so they evolve fast. Rather than primitive, they are stripped down for performance--more like the latest Formula race car than a model T. Bacteria been fighting a pitched battle with other bacteria, fungi, and viruses since before we crawled out of the ooze. They're gotten very good at offensive and defensive chemical warfare, and they are hard to hurt. Most of the stuff we've got that works, we swiped from the fungi (who also evolve fast), and maybe tweaked a bit.
I think that what we need is a publicly funded not-for-profit vaccine development enterprise. But we have to approach it realistically, in full awareness of the pitfalls of drug discovery and the fact that often you'll spend a billion dollars developing a new drug, only to find out when you finally get it into human testing that it doesn't work very well, or else has some unanticipated horrible toxic effect.
I don't think it's wholly necessary that the life will be more vulnerable to other stressors in presence of "all the chemicals we dump into the ecosystem". This may (or may not) be true on a smaller timescale. I'm sure there's lots of everyday stuff in our environment that would be deadly to organisms from just a few hundred million years ago... It's hard to predict how the life may adapt (or fail to). Overly pessimistic views I'd think are just as bad as overly optimistic ones.
A successful API design takes a mixture of software design and pedagogy.
Oops. Title should have been "The pitfalls of antibiotic development"
Wow, you invented vaccination!
If the "old" antibiotic is not present in the environment, then the normal mutations may get rid of the resistance without any selection pressure to the contrary. Presumably it may be a quicker process, since acquisition of resistance is very highly selected for, thus it has a high chance of "catching on" once the mutation occurs.
A successful API design takes a mixture of software design and pedagogy.
Yeah, I've heard about this. In particular, about them being given out like M&Ms
I heard about that too, but it was in the good ole US of A - because patients expected them from their doctor for every sniffle. And I have a colleague who still swears by them and says the proof is that every time he gets antibiotics from his doctor he gets better within a few days.
Ah well, but he smokes and is fat too so he won't be a burden on the health system for very long.
thegodmovie.com - watch it
I wouldn't get too scared of totally drug resistant (TDR) -- incurable -- TB strains just yet. I'm more upset that these strains were created by poor care of people who initially did not have TDR TB. The cases I've read about were all ones in which improper treatment was employed when dealing with the disease and this allowed them to essentially evolve TDR strains in these patients. Only in one or two cases was it communicated from the patient that incubated the strains to others (e.g. family members, talk about tragic!!). At least one of the patients lived with the disease for 8 years before it killed them -- and that long treatment period is exactly what enabled the evolution in the first place.
As someone pointed out the real story here should be about misuse of antibiotics. Poverty and ignorance can greatly interfere with antibiotic treatments. Ideally starting a regimen of antibiotics should mean that the medical/social system (be it universal healthcare supplied by the government or private insurers) is so fully committed to curing that patient that the cost of the individual doses is immaterial. However that ignores reality -- many medical/social systems require (co)payment. Sometimes patients lose the ability to make those payments mid-treatment.
Perhaps what can be done is changinge the way the medical/social system charges for antibiotics. That might mean, for example, the patient pays a fixed cost up front and does not pay by the dose. Then the medical-social system uses as many doses as necessary -- possibly losing money in some cases -- until the patient is cured. So long as tracking the average cost of complete treatment and charging accordingly is possible the medical-social system in question can come out even or with a profit.
Finally, even if they get all the doses they need there's the situation where patients don't follow directions when taking antibiotics. There are all sorts of behavior and situations that result in this. Unfortunately there's no "deterministic" way to prevent this that also preserves basic human rights. The best we can do is battle ignorance for eternity.
I too learned initially that one should expect increased metabolic load from organisms resistant to antibiotics, and that over time resistance patterns should decrease in the absence of selective pressures.
Unfortunately, MRSA, VRE and pan-resistant acinetobacter (and more I can't remember) are able to compete well against sensitive organisms.
Many resistance mechanisms are naturally occurring, and enterococcus seems to be a natural reservoir for these mechanisms. Many pathogens like acinetobacter are easily competent for transformation (they will acquire environmental DNA) to get these mechanisms.
So while we can hypothesize that there will be energetic requirements of resistance, I question how strongly this works in our favor.
It's always something with these scientists. It used to be the Swine Flu, Whipping cough, West Nile Virus, Anthrax, etc... and all these organizations demand money and grants to 'fix' these epidemics. As soon as they get their money you never hear from them about these diseases again. I wonder how much of that is due to the fact that they did their job and stopped the epidemic vs they stopped scare mongering because they finally got their money.
I wonder if there would be benefit to making antibiotics that are combined with an opiate painkiller. The drugs would only be available to be taken at a hospital or clinic. The patient would need the painkiller, but returning for their antibiotic would reward them with the opiate. The final few days of antibiotic would have progressively smaller opiate doses to wind them down.
Hmmm. So you'd require anyone taking antibiotics to become in-patients at the local hospital? They wouldn't be able to legally drive there, perhaps more than once a day, because they'd be under the influence.
Why would they require a painkiller? I've had infections that didn't result in much, if any, pain.
You want to "wind them down" at the end. Just how hooked would you expect someone to get with just three days of treatement? You're trying to force people to take the entire course of treatment, but the same people who would stop after three days when getting pills to take at home will stop after two days if they have to take time off work every day to drive to a hospital to get a pill.
Insurance is the very definition of getting someone else to pay for you.
I'm not sure you understand how insurance works. Whether or not insurance means getting someone else to pay for you depends entirely on how much you've paid into the system, and how much insurance payout you (successfully) claim.
In a very simple example, if I've paid $150/mo for five years and only make one claim of $500, of which only $200 is over my deductible, the insurance company is ahead by $8,800.
In the specific context of TB vaccinations, I rather doubt that the cost of a child's vaccination will exceed the revenue brought in by the parents' insurance payments for that month.
Cheers,
"What in the name of Fats Waller is that?"
"A four-foot prune."
Total Drug Resistant (TDR) TB cases arose in Italy in 2007, Iran in 2009, and now in India. In the 1990s, cases of Extensively Drug Resistant (XDR) TB emerged in 58 countries with 25,000 new cases per year.
http://en.wikipedia.org/wiki/Extensively_drug-resistant_tuberculosis
TDR TB does not respond to any first-line antibiotics (e.g. isoniazid and rifampicin) nor second-line (e.g. levofloxacin and ciprofloxacin), which can be quite toxic in their own right. The TDR TB bug appears to be a 'new entity' which is invulnerable to the mechanisms used by any first or second line antibiotic, requiring third-line chemotherapies which promise to be yet more toxic.
http://en.wikipedia.org/wiki/Tuberculosis_treatment
'Third line' antibiotics are so-called because they're either ineffective, unproven, or expensive, and require close attention during treatment to avoid crippling or crippling the patient. Thus the spead of bacteria treatable only by third line antibiotics is A Very Bad Thing, especially for the 33% of the world infected with TB who also live in the Third World.
Part of the problem is that there is no real incentive to develop new antibiotics for drug companies. Its not going to be a blockbuster for them and isnt going to cover its development costs.
95%+ of the time Penicillin V, erythromycin or metronidazole will solve the problem, so you have a very small market. You can't compete with these generics on price, they'll cost pennies.
Secondly antibiotics are curative - One course and you are done for years or life if its only for rare infections. Much better to spend the money to develop something for a chronic disease that treats but doesn't cure or lessens symptoms.
Its going to require a huge government backed research effort, or patents for new antibiotic drugs that are as long as music copyright.
Any vaccine will ruin a test for antibodies. What we need is a direct test for the bacteria.
It lives in the lungs... FOR GOD SAKES!
Not just there. My grandmother-in-law had a dormant colony discovered in her rectum. Whee.
"What in the name of Fats Waller is that?"
"A four-foot prune."
I was thinking they should be administered as a subcutaneous pellet like long term contraceptives. This would ensure that the entire course is taken.
-- Braden's law of data: All data spends some of its lifetime in an excel spreadsheet.
Perhaps even better, we all know how useful a parka can be for surviving in the arctic circle. Now try walking through the desert or swimming while still wearing that parka.
Any vaccine will ruin a test for antibodies. What we need is a direct test for the bacteria.
It lives in the lungs... FOR GOD SAKES!
Not just there. My grandmother-in-law had a dormant colony discovered in her rectum. Whee.
Well some Indian had clearly blown smoke up her ass at some point in the past.
In her case, it would have had to have been a "feather" Indian, not a "dot" Indian -- she spent most of her life in Texas, and never left North America.
"What in the name of Fats Waller is that?"
"A four-foot prune."
Your mentioning of the toxicity of 3rd line antibiotics got me thinking - what's the possibility of using a Bacteriophage*? Non-toxic, and evolves to keep up with it's target, utterly unlikely to evolve to affect humans, scales to the size of the infection, etc... I know they have to be targeted for that particular strain of bacteria, but it seems to me that it'd be a worthy effort.
*Virus that targets bacteria, basically
I don't read AC A human right
Actually, it's not only hard, but at present, downright impossible to make such predictions. However, being pessimistic about our effect on the planet in this regard isn't really a big deal, since we already know quite certainly that we affect the environment in some catastrophically bad ways; we are, for example, currently overbooking the planet by two and a half binary orders of magnitude (i.e., six times) its ability to sustain first-world lifestyles. Only once we've got some of these more apparent and easily rectified problems under control should we allow ourselves to stop being paranoid about our impact on the world around us and reassess—while it might seem like a good idea to make sure we know exactly what our target is before marching off, we unfortunately cannot sit around twiddling our thumbs forever while waiting to do so; environmental contamination has already driven countless exotic species to extinction (one of the most prominent but least photogenic examples being the Yangtzee river dolphin), and hesitation can really only make things worse.
Bio questions? Ask me to start a Q&A journal. Computer analogies available for most topics!
You are splitting hairs here - you take an insurance with the only goal to have somebody else pay for your problems covered by the insurance. Your reasoning that "whether or not somebody else pays depends on how much money you have paid" applies to everything that is free except for charity. Free sample at walmart: if you buy the product that wasn't really free. Free journal, if you buy something from the advertiser, that's not really free either. Free police assistance, if you use it once in your life, you have overpaid that in taxes ...
Oops. Title should have been "The pitfalls of antibiotic development"
Or rather, "The pitfalls of antibiotic development". :-)
But we obviously get what you mean. Thanks for a very interesting and informative post. I think your idea is a good one and some debate on the topic would be great.
(sardaukar86 posting as AC to avoid undoing mods)
It may be time to halt international travel. The world is made to small by high speed travel. every tourist brings risk as well as potential for an epidemic. In addition to stopping tourism and business travel I guess it would mean that wars would be by robots only. We just can't have any fun any more.
This has been discovered not to be true. Bacteria are initially less fit, but will eventually have compensatory mutations, fixing the mutation in the population.
I dug this title off of an old pdf from when I was in undergrad, I don't know if you can find it easily, but it is from
"Current Opinion in Microbiology 2003, 6:452–456
This review comes from a themed issue on
Antimicrobials
Edited by Patrice Courvalin and Julian Davies"
The title is:
Persistence of antibiotic resistant bacteria
Dan I Andersson
There has likely been significant research since 2003, but I've not citations of it at this time.
I think this comment is racist.
No, curry-munching rice nigger, THIS is racist, you stupid black cunt. Stop being such an over-sensitive cry-baby niglet. Every time you soft-cock indian scumbags whine about racism, I kill one of your ugly dirty black shit-colored babies.
The whole world knows what filth you maggots are, you demonstrated that with your lies when Canada kindly helped set you up with 'power-only' CANDU reactors only to have you dirty nig-nogs immediately begin producing weapons.
Never trust a black bastard and a filthy, dirty Indian doubly so.
I think this comment is racist.
How is this racist? I'm not being a prick, I genuinely do not understand your position as the joke doesn't reference colour or culture and everyone knows India has been winning all the call-centre contracts around the world for ages now.
I'm asking because without your side it just looks like you're seeing insults where none exist.
(sardaukar86 posting AC because I've moderated)
Indian Forward caste regime prefers their people to be poor/subservient/defenseless.
Otherwise they'll vote for their conscience.
Govt funded universal health insurance system without copayment for ~1 billion Indians in Private/Corporate hospitals costs only ~$10 billion (govt budget is ~$270 billion).
https://www.cia.gov/library/publications/the-world-factbook/geos/countrytemplate_in.html
Casteism
That's enough to blow the idea out of the water.
Someone else's idea below of long-duration time-release subcutaneous capsules (comparable to long-duration contraception) is more likely to be workable.
Birds are not dinosaur descendants;birds are dinosaurs, for all useful meanings of "birds", "are" and "dinosaurs"
On the other hand, you don't take out insurance in order to get a "free" TB vaccine.
There was an Italian case from as early as 2006. Fastcompany.com had written about it.
It was a middle-class and middle-age woman who had regular TB and was treated with Antibiotics. Normal treatments failed and she was send to a special hospital near the Alps. There she became better until her TB evolved the antibiotics stopped working.
She has been suffering for the entire treatment until departing into history.
Agreed about overbooking. Hmm, binary orders of magnitude, never thought of these.
A successful API design takes a mixture of software design and pedagogy.
The may be a line of help with Phage Therapy - Bacteriophages or "phage" are viruses that invade bacterial cells and, in the case of lytic phages, disrupt bacterial metabolism and cause the bacterium to lyse [destruct]. Phage Therapy is the therapeutic use of lytic bacteriophages to treat pathogenic bacterial infections. Note the details about Phage therapy in the Republic of Georgia in “A Planet of Viruses”
Read: Phage Therapy – Everything Old is New Again http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095089/
Can J Infect Dis Med Microbiol. 2006 Sep-Oct; 17(5): 297–306. Andrew M Kropinski, PhD PMCID: PMC2095089 Copyright © 2006, Pulsus Group Inc. All rights reserved: Abstract - The study of bacterial viruses (bacteriophages or phages) proved pivotal in the nascence of the disciplines of molecular biology and microbial genetics, providing important information on the central processes of the bacterial cell (DNA replication, transcription and translation) and on how DNA can be transferred from one cell to another. As a result of the pioneering genetics studies and modern genomics, it is now known that phages have contributed to the evolution of the microbial cell and to its pathogenic potential.
They're handy when you need to exaggerate something.
Bio questions? Ask me to start a Q&A journal. Computer analogies available for most topics!
I see way too many comments on here suggesting that antibiotic resistance is caused entirely by misuse of antibiotics. This might be nitpicking, but that argument is not really correct. Misuse of antibiotics exaggerates bacterial evolution towards solving the problem of resisting those drugs. But, bacteria reproduce at incredible rates. Even if everyone took their antibiotics for the entire 10 day cycle (or whatever it is for a given drug), it's not inconceivable that they could spread germs midway through their treatment, and that the spread germs were among those weakened but not killed. The bacteria would still form resistance, it just might take much longer. E.g. instead of it taking say 20 years for a bacteria to develop resistance, with proper use it might take 200 years. When you consider all the lives that are bettered over that hypothetical 180 years, it's a real tragedy that people misuse drugs, but that doesn't mean bugs would stop evolving if only people were properly educated.
Wrong again. You take an insurance policy to share risk with thousands of other people. The actuarial people in the insurance company know that for every 1000 people 1 will get TB, 1 will get something and so on. So they calculate the cost of treating all the various things that can happen to that group of a thousand people based on the best stats they have, and then they divide the cost between that thousand people and add a bit for profit.
So really its more of a buying club. Which is why it the US should have went with a public single payer health insurance company like Canada has.
I'm glad the toilet was next door.
A successful API design takes a mixture of software design and pedagogy.
Yeah, agreed, that is a better idea.
It doesn't hurt to be nice.