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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!
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.
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?
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?
The trouble is that antibiotics and livestock seems to have allowed the industry to be completely negligent of conditions and the health of their animals. I have no doubt that your grandparents will have treated theirs such better than hormone pumped, antibiotic loaded factory farm livestock we have today. Then again, antibiotics can also save herds from infectious diseases.
In the same way you can't compete with Walmart on price using a hand loom, it seems you can't compete with agri-business without using some of these techniques.
The only solution seems to be to regulate it, and I believe some countries are already doing so in part. That and advances in synthetic or vat grown meat would go towards solving a lot of problems and help remove anti-biotics from the food chain.
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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It's not that Origin of Species is exactly a new book. By the time we developed the antibiotics evolutionary biology was well understood.
Market forces vs. scientists sounding the alarm: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” -- Fleming while accepting his Nobel prize in 1945
Non-Linux Penguins ?
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"