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Imagining the Post-Antibiotic Future
Hugh Pickens DOT Com writes "Health authorities have been struggling to convince the public that the threat of totally drug-resistant bacteria is a crisis. Earlier this year, British chief medical officer Sally Davies described resistance to antibiotics as a 'catastrophic global threat' that should be ranked alongside terrorism. In September, Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: 'If we're not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.' Now Maryn McKenna writes that we are on the verge of entering a new era in history and asks us to imagine what our lives would be like if we really lost antibiotics to advancing drug resistance. We'll not just lose the ability to treat infectious disease; that's obvious. But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. We'll lose any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. We'd lose any major open-cavity surgery, on the heart, the lungs, the abdomen. We'd lose implantable devices: new hips, new knees, new heart valves. We'd lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We'd lose the safety of modern childbirth. We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. 'And it wouldn't be just meat. Antibiotics are used in plant agriculture as well, especially on fruit. Right now, a drug-resistant version of the bacterial disease fire blight is attacking American apple crops,' writes McKenna. 'There's currently one drug left to fight it.'"
If this is a threat that "should be ranked alongside terrorism" then I'm not even going to waste my time reading about it.
Too many antibiotics in the food supply is a major part of what's causing this problem in the first place!
It's not that Origin of Species is exactly a new book. By the time we developed the antibiotics evolutionary biology was well understood.
I guess as usual , no-one was thinking about long-term consequences.....also I wonder how did my grandparents managed to be successful farmers - earning the most money in the whole family while supporting themselves and the families of their sons with agricultural products (I don't remember my family buying much flour, cheese, meat , fruits and vegetables for decades) without antibiotics. I mean they hardly used machines let alone chemistry...
Sorry for the provocation, but is there anyone who still thinks that free market capitalism is any good in anticipating (let alone solving) global long-term issues?
The loss of effective antibiotics is a genuinely 'catastrophic global threat'; terrorism is a largely imaginary risk for most people with considerably less chance of negatively affecting their life than going near a road. If terrorism was a single fire ant on your leg then widespread drug resistant bacterias would be a pissed off Hippo stomping you into the ground.
Do we blame politicians for not treating this as important and instead pissing billions away on 'the war on terror' or do we blame ourselves for being so ignorant that we (on average) don't care about this major issue but throw our support behind whoever promises to spend most on protecting us from often imaginary bogeymen.
... to divert the billions of dollars of the "fight" against terrorism directly into medical research.
Easy solution: Ban the use of antibiotics in the meat industry.
Of course then people wouldn't get their insanely cheap meat anymore.
Boohoo - what a disaster.
We suffer more in our imagination than in reality. - Seneca
This is going to be a self made tragedy.
How many times have people gone to the doctor for a cold but the doctor gave them antibiotics almost as a placebo. How many times have people not used the entire bottle of antibiotics? Some ranchers give antibiotics to their live stock as a matter of course so that they can get fatter faster.
Then of course after the Ronald Reagan/Margret Thatcher revolution everything has to be about profits. Well there isn't much profit in antibiotics. If you have a really good antibiotic then the medical comunity will be likely not to perscribe it. They would want to save it for the really nasty bugs. Even if it is perscribed a lot people will only get one bottle and then stop taking it after their infection goes away. The drug industry would rather come up with something like statins; that is something they can put rich people on for the rest of their lives (I am sure there are some in the industry that would rather keep giving out statins than to cure heart disease.) Don't even get me started on creationsits' heads exploding because their bacterial infections are actually evolving.
We already have kids basically getting killed off because they picked their scabs on a minor cut and then got the wrong type of bug. Before antibiotics any little cut was a possible death sentence. Looks like if something isn't done (and I am not holding my breath) we are going to get back there sooner rather than later.
Saying something is as scary as terrorism is like saying it's as dangerous as marijuana.
Marihuana? The Mexican devil-loco-weed? Assassin of youth? A cause of homicidal mania in our formerly upstanding young men of good character, and most widely used by the Negro, to stoke its lust for depraved violation of White Womanhood?
Truly a terrifying threat, sir!
(This post brought to you by the 1930s)
The market is partially causing this; in India there are antibiotics plants that spew waste into gutters and that waste has plenty of punch to make the local bacteria resistant. Also in India (and other places where drugs are available without prescription) it's not uncommon that people treat infections with a single pill because they don't know any better.
What we need to do is educate people on how antibiotics work and stop unnecessary usage of antibiotics right now. It's counterproductive to feed lifestock antibiotics by the bulk when the problems are treatable otherwise (I'm looking at you corn subsidies and packed to brim handling facilities among other things). Also would be really interesting to see what happened if we phased out some of our antibiotics for a decade; would the resistance still be there in enough scale?
Will the market save us by producing something be it at a price, or, is this too big and needs to be done by government money and research?
Antibiotics are arguably an example of a situation that (while not meeting the classic definition of 'market failure') is not a market victory.
If the price of an antibiotic is relatively low, it becomes economically viable as a growth enhancer/mortality reducer in high-density agricultural applications, likely burning through its effectiveness relatively quickly (with some help from being handed out to treat patients whining about the sniffles and being reflexively used on basically anybody admitted to a hospital; but veterinary uses are the big one). If the price is relatively high, you see a strong incentive for poorer users (especially in the 'developing' world) to try to make do by 'stretching' inadequate supplies across longer times or more patients than the supplies can provide adequate doses for. You also have more incentive for diluted and fraudulently labelled, or outright faked, versions to make it into the supply chain.
On the supply side, I don't know why it isn't working; whether biology is just being a stubborn bastard and we'd need to throw ten times as many scientists at the problem, or whether the ROI on penis pills and hair loss and pimping minor rebadges of old drugs is better than doing research; but the steady advances in increasingly resistant bacteria have not caused the invisible hand to keep pace with new drugs (particularly new drugs with novel mechanisms, which would get us further ahead in the arms race than incremental tweaks on resistance-threatened mechanisms.)
The prophylactic use of antibiotics has long been identified as a problem and yet people couldn't manage to stop their ridiculous fear of "getting sick." You know, getting sick once in a while isn't so bad. Keep your immune system strong and healthy and getting sick is a minor inconvenience. Instead we've got a system of marketing driven by ridiculous fears. Sure, wash your hands. But with anti-bacterial soaps all the time? What could possibly go wrong? Certainly not a weakened immune system resulting from a decreased demand load right?
And the crap they allow in the livestock industry? Holy crap. How is that NOT supposed to get into our water and our food?
"Before antibiotics any little cut was a possible death sentence." Really? I wouldn't go quite that far. Conventional remedies took care of the vast majority of such things when I was a child. Iodine, mercurochrome, hydrogen-peroxide and all manner of antiseptics seem to do the job nicely. Of course things needed near-immediate attention and all that but so what? Why do we have to believe "give me a shot and I'll be just fine!" and continue on as if there would be no other effects?
One of the real kickers for me is the scares we've had over the past what? 20 years now? Talking about superbugs and MRSA and all that? Name one thing that has been done to really combat the trend? I know what *I* have done -- I have ensured my practices are nearly opposite of what ever soccer mom does. You won't find "anti-bacterial soap" in my home. There is only the standards like Irish Spring and Ivory. I will not feed into the unrealistic fear pushed onto the public to sell more product. And when I do take medications, I will be sure that (1) I actually need it and (2) it will be far more effective on me because I don't have any acquired resistance.
If marijuana were legal, drug cartels would not be interested in it because anyone could grow his own with little effort. How many criminal alcohol cartels exist currently? And how many existed during prohibition?
Hopefully our biotech is starting to get to the point where we can tailor viruses to specific targets, at least some of the time. Things like this give me some hope. If we can do that, we can do at least some of that kind of tailoring.
PHEM - party like it's 1997-2003!
The summary says:
We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock
This the source of the problem, not the effect.
Yes, it does turn out that dosing meat animals with antibiotics even when they are not sick will increase their weight (and hence production) by about 10%, This is a small increase-- but the margin on meat production is low enough that it makes a difference in profitability, and hence if some of the farms do it, pretty much all of them follow.
So, we're losing the ability to use antibiotics because we're spraying them across the landscape, not to cure sickness, but as a fattening agent for cattle.
and protect them from the conditions in which the animals are raised.
This is actually a much smaller use of antibiotics. But, yes, the idea is that we can save money by not bothering with sanitation and health in cattle, but instead just dose them with antibiotics.
Anonymous wrote:
As ranching employs a significant number of people in some states, and agrobusiness has great clout with Congress, this just isn't going to happen. Plus, the average American is not going to accept such a sudden stop to his high meat intake.
Actually, it's a very small effect-- eliminating antibiotic use on cattle would have only a trivial effect on price. The problem is that the low margin on meat production means that if one cattle-production factory does it, everybody has to do so to keep up.
http://www.geoffreylandis.com
Not a market victory, but a classic game theory problem.
With antibiotics in industry, it is in any individual company's best interest to have everyone else move away from it. If a company uses lots of antibiotics while others do not, not only does it make their own product cheaper and fattier, but they will get more time out of the antibiotics. So no company (outside luxury brands) has an interest in being the one or group of ones to stop the practice since all it will do is help some competitor who does not play along. Same goes in health care unfortunately.
The sad part is there are people out there that think this very thing. That you're "playing with god's will" if you use antibiotics in such manners.
It's amazing the way someone can believe in an absolutely omniscient, allmighty God Who completely knows the past, present, and future, Who endowed mankind with intellect and reason ... and then think this God had no idea mankind might use and apply that intellect and reason. How do people rationalize such beliefs?
It is a miracle that curiosity survives formal education. - Einstein
A likely cause of this drug resistance is use of antibiotics to increase growth rate in livestock. It has been recently shown that for certain livestock simple sanitation methods can be superior to the use of antibiotics. It is also likely that there are superior methods to antibiotics for all livestock,
To follow your profit motive, most of the antibiotics in the US, 80%, are sold for agriculture. While we can assume that antibiotics for agriculture are sold for less than human use, and so the pharmaceuticals firms will not go immediately bankrupt if agricultural uses are outlawed, we can assume the shock to the sector will be significant.
Given that antibiotics in humans has become a minor part of the business, it is not unreasonable to assume that researchers must find an alternative.
"She's a scientist and a lesbian. She's not going to let it slide." Orphan Black
Those of us who have been in and around the industry have seen this developing for a long time. The solutions are straightforward but face enormous resistance from those currently benefiting from how antibiotics are currently misused.
1) Ban the use of antibiotics in livestock except to actually treat disease. As the article notes, >60% of all antibiotics by volume are used to fatten livestock in the absence of disease. Because the USDA regulates livestock production rather than the FDA it becomes a jurisdictional quagmire to try to limit use in livestock. While there isn't much antibiotic left in meat when it goes to market, the runoff from stockyards provides the perfect mixture of bacteria and diluted antibiotic (and metabolites) to create resistant strains.
2) Stop prescribing antibiotics in novel classes for routine things like ear infections and sinus infections. Studies show that most of those will clear up on their own without antibiotic treatment, but nobody wants to be the guy who feels miserable but doesn't get a Z-Pak or some fluroquinolones as treatment.
3) Ban these ridiculous anti-bacterial soaps and things that contain triclosan. It's creating cross-antibiotic resistance and isn't even that effective at killing bacteria during primary use because people don't leave it on long enough.
4) An earlier poster asked if the lack of corporate investment to find new antibiotics is a market failure, and the answer is yes. Besides the enormous dysfunction that permeates big pharma in general, the reality is that antibiotics are generally not nearly as profitable as once-a-day drugs that last a lifetime. Either provide regulatory incentives for antibiotic development or do more of the research at the government level or both.
5) In the long run, we need a completely different approach to managing bacterial infection. An earlier poster mentioned phages, and there are multiple different research avenues that show some promise if we can get them going.
Software Shouldn't Suck
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Frontline did a story on this on PBS. It's worth a watch. Everyone should. Effectively, theirs not much researches can do I'm afraid. Nothing short of genetic engineering and what not, the chemical common denominators used as antibiotics (while not harming the host) is pretty much useless to these new evolved forms of bacteria.
Life is not for the lazy.
The market is definitely causing this. True story:
I know a guy who is a MD and worked most of his career as an antibiotic researcher. His team came up with a new antibiotic that killed everything they tested it on. When he brought the research to the VPs and the CEO, the CEO told him, "You expect me to spend millions of dollars to bring this drug to market only to have the damn doctors keep it in reserve so they can use it as a last resort?"
So, yeah this is a market epic fail. ROI > life. To the morons running these companies, the equation is as simple as that.
So, your anecdote is that you've never had your life save by antibiotics. So what? Are you suggesting that the scientists are saying that 100% of the population will die without antibiotics? No, they are saying that many more people will die without them than with them. This seems self-evident to me, but apparently people like you are more difficult to convince. You do seem easily convinced by anecdotes, however, so, I'll see your anecdote with a couple of my own.
When he was about 5, my son was running on the deck and tripped. As he slid along the desk, a very then (willow) tree branch got shoved up into his leg about 4 inches or so. I pulled out as much as a could, but a good inch or so of tree branch broke off and got left behind. Our choices were to treat the infection and let his body gradually dispose of the foreign substance or cut his leg open and remove the branch. Either way, without antibiotics he would have been quite unlikely to survive.
As a child my mother got strep throat. Her family could not easily afford a doctor and so that waited to see if she would just get better. Instead, it developed into scarlet fever. She had to spend a year of her childhood confined inside and on heavy antibiotics or she would have died.
I myself have had numerous infections: strep throat (many times, mostly as a child), bronchitis, etc. At least one of these would have been fatal without antibiotics.
So, by these anecdotes, three of every four people will die without antibiotics, right? Wrong. Anecdotes aren't statistics, so stop trying to marginalize real issues with "well it's never happened to me" bullshit, OK? We are all very impressed that you've lived 50 years and never needed antibiotics except for preventative purposes, but you are not the norm.
That is pretty dangerous. I knew this guy who had some marijuana. People came to his house with guns, took it from him, made him cut off his dread locks, and then he had to pay some guy in a suit to negotiate for him so they wouldn't put him in a cage.
Marijuana is really dangerous. Stay away from that stuff.
"I opened my eyes, and everything went dark again"
Of course if the medical profession wants to get the public to take note, just tell them that we won't be able to treat syphilis anymore. If common STDs become untreatable and declared an epidemic, then the public will take notice.
Getting close with gonorrhea already.