A Post-Antibiotic Future Is Looming (www.cbc.ca)

New submitter radaos writes: A gene enabling resistance to polymyxins, the antibiotics of last resort, has been found to be widespread in pigs and already present in some hospital patients. The research, from South China Agricultural University, has been published in The Lancet. According to research Jian-Hua Liu, "Our results reveal the emergence of the first polymyxin resistance gene that is readily passed between common bacteria such as Escherichia coli and Klesbsiella pneumoniae, suggesting that the progression from extensive drug resistance to pandrug resistance is inevitable." Work on alternatives is progressing — Dr. Richard James, former director of the University of Nottingham's center for healthcare associated infections, writes, "Until last month I was still pessimistic about our chances of avoiding the antibiotics nightmare. But that changed when I attended a workshop in Beijing on a new approach to antibiotic development based on bacteriocins – protein antibiotics produced by bacteria to kill closely related species, and exquisitely narrow-spectrum."

Comments

Yeah, that's the problem

[drinkypoo]

when I attended a workshop in Beijing on a new approach to antibiotic development based on bacteriocins â" protein antibiotics produced by bacteria to kill closely related species, and exquisitely narrow-spectrum."

While we've been working on making the better antibiotic, Russia has been working on phage therapy. Of course, we are the ones with the resources to develop it, not them. It should arguably be the other way around. The problem with this idea though, which is also the same reason we have antibiotic resistance today, is that you have to identify the problem before you can use it. We have an inadequate number of medical personnel pretty much everywhere in the world, and they already can't keep up with illness even using broad-spectrum antibiotics that historically have enabled them to help people without identifying a specific pathogen. They certainly don't have the time or training to do any better. We need more medical personnel, or nothing we do to try to fight these resistant illnesses is going to make a difference because we won't have the manpower to implement it.

Re: Yeah, that's the problem

[bill_mcgonigle]

Of course, we are the ones with the resources to develop it, not them.

Were that it so - "we" strongly disincentivize new drug development by throwing $1B roadblocks in the way of new ones. Sure, it's to help the profits of the few big pharma corps that can fund it, but the real losers are real - people who track these things have the current FDA cost at net-balance 20 million avoidable deaths (and people say the Aztecs were barbaric). As always, attempts to impose control create chaos.

They certainly don't have the time or training to do any better.

That's not likely to change fast enough. Putting the funding into automated microassays and realtime manufacturing technologies might be the better option. We used to think that distance was a barrier but aerobots might be taking down those walls - a lab pickup or drug delivery can be a hundred miles out now, or pretty soon.

Re:Yeah, that's the problem

[DarkOx]

Well the good news is we might get our freedom back. Some major insurers are talking about leaving the exchanges because they can't make any money at it. Others are talking about another round of big premium hikes. Its going to suck in the short term and good people are going to lose coverage and find themseves subject to tax penalties.

With a little luck though the terrible law that crushes peoples religious freedom and their freedom to do what they wish with there personal property will go down in the flames it deserves. Obama will have the legacy he deserves, "A paternalistic freedom hater we were all better off without."

Re:Yeah, that's the problem

[drinkypoo]

Wow. Didn't take long at all for the first "Thanks, Obama!" post.

It doesn't matter who you blame it on, the ACA is a shitty excuse for a national health care system. The insurance companies are part of the problem, and the ACA makes them a mandatory part of the solution. Anyone should be able to see that's a horrible failure, regardless of partisan identity.

Re:Yeah, that's the problem

[Anonymous Coward]

Republicans and Democrats alike have been promising a solution to run-away health care costs for over 50 years.
I see it as a small win that we finally got something instead of nothing.
Now if the Republicans want to make it better that'd be great.
Too bad they seem more intent on taking away the little that we got.

Re:Yeah, that's the problem

[Anonymous Coward]

If the government can tell me I have to have auto liability insurance, then I don't see it can't tell me to have health insurance too.
Hospitals treat everyone, even those that can't or won't pay.
My "religion" tells me I shouldn't have to pay higher hospital bills and higher insurance premiums just to cover the freeloaders who refuse to buy their own insurance.
So either we start telling hospitals to turn away those who can't pay, including possibly letting them die. Or we make sure everyone has coverage.
Which one do you choose?

Re:Yeah, that's the problem

[Applehu Akbar]

We keep hearing about phage therapy being a possible replacement for antibiotics, but then the news never reappears as actual pharma development. Any idea why?

Re:Yeah, that's the problem

[PvtVoid]

With a little luck though the terrible law that crushes peoples religious freedom and their freedom to do what they wish with there personal property will go down in the flames it deserves.

Because nothing says "religious freedom" like denying other people health care. If only we could keep our taxes from paying for school for girls!

Re:Yeah, that's the problem

[Crowd Computing]

Phage therapy's main advantage is its problem. It can't be mass-produced by the pharmaceutical industry for sale to doctors with the diagnostic ability of a search engine. You have to target the pathogen and not just group it with the likely suspects and hope that it's susceptible to the broad-spectrum antibiotic.

Re:Yeah, that's the problem

[Ol Olsoc]

Wow. Didn't take long at all for the first "Thanks, Obama!" post.

It doesn't matter who you blame it on, the ACA is a shitty excuse for a national health care system.

I think at best, its a foot-in-the-door solution.

Imagine the reaction if some group who shall not be named manages to repeal it, and people who were at one time locked into a job because some pre-existing condition meant they could never be insured again if they ever had to switch employers.

It does suck, but it sucks by the results of the work done to make it suck.

And that, friends, is not the fault of the current occupant.

Re:Yeah, that's the problem

[Ol Olsoc]

... affordable care act ...

Wow. Didn't take long at all for the first "Thanks, Obama!" post.

The turtles have been replaced - It's "Thanks Obama's" all the way down.

Re:Yeah, that's the problem

[The Real Dr John]

The US is the only highly developed nation without national universal health coverage as a human right. Here in the US it is much more important for insurance companies to be highly profitable than it is to take care of everyone. And as long as voters keep putting the corporate controlled politicians in office, we will continue to get corporate controlled legislation.

Re:Yeah, that's the problem

[Anonymous Coward]

Other than telling the poors to die quickly, what exactly was the Republican plan?

Re:Yeah, that's the problem

[Ol Olsoc]

The US is the only highly developed nation without national universal health coverage as a human right.

And we really do need to be careful how long we remain highly developed. We did not achieve development under the present system of governance. The United States at it's zenith, would be called a socialist quagmire by persent day politicians.

Re:Yeah, that's the problem

[drinkypoo]

We keep hearing about phage therapy being a possible replacement for antibiotics, but then the news never reappears as actual pharma development. Any idea why?

In my opinion there are two main problems, both covered in sibling comments. Both of them have been covered by sibling comments to yours, so I'll link to them as I go. There is a technical problem, and as usual, a political problem.

The relative difficulty of the approach is the technical problem. Modern medical care often seems to best be represented by a shotgun. You fire a big cloud and hope you hit something. Problem is, even in the best case a broad-spectrum antibiotic punches your gut right in the... guts. Since it's become apparent that digestive health is strongly linked to immune health, that's a big problem. So we really need a more targeted approach anyway, if we want to move medicine forward. It might not be phage therapy, but short of achieving the universal nanotech assembler and being able to create little robots for this purpose, it seems the most realistic approach. Still, the increased complexity creates an inherent cost disadvantage, so the bombing of guts will continue until further notice.

The political problem is that you can't make a buck off phage therapy, or at least, it is dramatically more difficult than printing money selling crappier derivatives of old drugss. They have purchased legislation that makes it dramatically cheaper to bring derivatives to market — they require less testing, and don't even have to prove that they are as efficacious as the drug they "replace", let alone moreso. Before you could use a custom phage on a patient in this country you would have to have a complete trial, by which time they would already be dead. Pharma will obviously fight any legislation intended to make it easier to bypass this process for a single patient, so only patients participating in studies will receive phage therapy any time soon.

Re:Yeah, that's the problem

[ColdWetDog]

We keep hearing about phage therapy being a possible replacement for antibiotics, but then the news never reappears as actual pharma development. Any idea why?

Because it doesn't really work. The idea is great in the test tube - a specific virus against a specific bacteria. But two problems pop up - we often don't know what the specific bacteria is for a couple of days (until it's grown in culture) or at all in many cases. Then, if you do have a good idea, you have to get this large (megadaltan) thingy into the innermost recesses of the body without said body saying "oh no you don't" and mounting an nice immune response (which can make the original infection worse, see 'cytokine storm').

Maybe, one of these days, researchers will manage to overcome these obstacles, but it has been a long slog with nothing to show for it so far.

Re:Yeah, that's the problem

[currently_awake]

Americans are fine with giving trillions to the banks (Communism) and giving billions per year to big agribusiness (export subsidies=Communism) and having public roads (Communism), but don't you dare have publicly funded medicare. The biggest issue is many Americans have no idea what Socialism is, and don't recognize it when it's shoved down their throats.

Re:Yeah, that's the problem

[currently_awake]

So you won't have cheap antibiotics (due to the agricultural sector wanting that extra % in profits), and the replacement will be expensive and not subject to generic production. I see nothing that big pharma would object to here.

Re:Yeah, that's the problem

[Bing Tsher E]

The 510K equivalency approval process insures that the only drugs, therapy, or devices that are affordable to bring to market are things that are already in the system. This is convenient for the Big Drug/Device companies that own the patent portfolios for said technologies.

The Clinical Trials process is chock full of middlemen and bureaucrats wringing megabucks out of it. I remember when a new wave of 'Regulatory Affairs' turds descended on the company I worked for. Up until then we were basically a skunkworks type operation. The reg people came in and basically said 'halt.'

Re:Yeah, that's the problem

[Bing Tsher E]

The United States at it's zenith, would be called a socialist quagmire by persent day politicians.

What you refer to as 'at it's zenith' is probably that short post-WWII period when the rest of the world had been leveled by war and the US was the only remaining industrial power, correct? Yes, we could 'afford' 90% income taxes on some of the most productive people during that period, because the whole world economy was sort of loony.

Re:Yeah, that's the problem

[Bing Tsher E]

Because nothing says "religious freedom" like denying other people health care.

Nothing says freedom more than not being forced to pay for other people's 'stuff.'

We all get to die. It's sorta mandatory. How we die is for the most part dependent on our behavior and choices we make, with some chance thrown in there.

How expensive we can make it on the others around us when we are dying is a matter of how much we can coerce other people into spending on us.

Re:Yeah, that's the problem

[Alomex]

Yes, we could 'afford' 90% income taxes on some of the most productive people during that period,

Most productive? At least half of them where heirs sitting on their inheritance. The productive people were American workers making quality products... until managers and union bosses decided to start trading quality for profits and higher benefits, thus opening the door to heavy foreign competition.

Re:Yeah, that's the problem

[CrimsonAvenger]

The US is the only highly developed nation without national universal health coverage as a human right. Here in the US it is much more important for insurance companies to be highly profitable than it is to take care of everyone.

And do you know why we don't have a National Health System?

Hint: it has nothing to do with the EEEVIL Insurance Companies, and a great deal to do with a piece of government interference in the marketplace that happened before most of us were born (probably before a lot of our parents were born.

Once upon a time, there was a War. It was so big it was commonly referred to as a "World War". Specifically, it was World War Two.

In that war, the government pretty much took control of the economy, so as to make the "armored cars and tanks and jeeps and rigs of every size" that were needed to fight that war. Part of this was "wage and price controls".

Now, wage and price controls were arguably necessary. We were fighting a war, after all. But it became impossible to hire talent, since you couldn't offer them more money to work for you (wage controls, remember?).

Then some bright guy started offering company-paid health insurance as a fringe benefit not covered by the wage controls. By the time the war was over, health insurance as a fringe benefit (at the professional level) was pretty well entrenched. And it's been getting more entrenched in society every year.

Frankly, a National Health System is needed. But blasting that particular fringe benefit out of existence is going to be a royal pain, and likely take a long time and probably a long period of a really crappy economy (think Great Depression Part Deux)....

Re:Yeah, that's the problem

[The Real Dr John]

Don't leave out the part about lobbying, PAC money and bullying by the insurance companies. It is a major issue at this point. I agree that it is going to have to get even worse before most Americans wake up and realize what has been done to them by corporate control of the government and money in politics. Even the news media are now owned by huge corporations, including defense contractors (e.g., GE), and so the news isn't what it used to be either.

Re:Yeah, that's the problem

[ProzacPatient]

In my state there are only one or two insurance companies participating in the healthcare exchange and even their crappiest plans with outrageous deductibles and HSA accounts are unaffordable, and to make matters worse my employer also dropped their PPO plan and replaced it with a high deductible insurance plan with an HSA so, for me personally, I found it was cheaper to not buy into the system and just pay all my own healthcare on top of the tax penalty instead of having to pay for all my healthcare anyway on top of outrageous premiums for insurance I'll likely never get to use.

Anyway I figure with the tax penalty there might be the chance the money going to the government will do some good whereas if I bought into the ACA healthcare exchange my money would only be used to buy some insurance executive another gold plated sports car.

Re:Yeah, that's the problem

[Applehu Akbar]

What that means is that phage development will not come from the US. Since the Chinese created the unstoppable superbug problem by feeding the last-resource antibiotics to pigs, perhaps they will be the ones to push phage development in out absence.

Re:Yeah, that's the problem

[dryeo]

The same sort of thing happened in Canada with wage and price controls leading to fringe benefits such as medical, dental etc being used to lure workers much as in America. Yet we ended up with universal medical coverage.
Other examples probably include Australia and New Zealand though I don't know the specifics.

Re: Yeah, that's the problem

[cyber-vandal]

What will you do if you get a chronic condition that doesn't kill you but means you can't work. Will you be respecting other people's freedom by committing suicide immediately?

Re: Yeah, that's the problem

[cyber-vandal]

I wonder how many deaths would be caused by unregulated drugs.

Re:Yeah, that's the problem

[Ol Olsoc]

Yes, we could 'afford' 90% income taxes on some of the most productive people during that period, because the whole world economy was sort of loony.

Especially the most productive ones who inherited the money.

That argument is a little specious. A lot of today's most wealthy therefore most productive in your estimation, pay a smaller percentage of their taxes than I do.

Plus, I have a little trouble with the idea that if we will be poor if we don't adopt the 1 percenters and far right worldview that Americans make too much money now as it is. We have to believe completely contradictory things.

If you want to believe that you need to be poor so that these most productive people are more wealthy have at it.

Re:Yeah, that's the problem

[HiThere]

Perhaps, but while the "Affordable Care Act" is better than what we had previously, it's *NOT* a good act. It's lousy. It guarantees that the health insurance companies get to keep their profits, when they should be totally cut out of all basic health care as an unnecessary expense. Perhaps they are a reasonable approach for major medical, but when I checked into dental insurance I found that it was a total waste of money. They wouldn't cover unexpected or major dental problems, and they were much more expensive than just paying the dentist for routine care.

So my guess is that insurance companies shouldn't be allowed anywhere near the health care system in any branch. Perhaps for cosmetic surgery, but even there I have my doubts.

Re:Yeah, that's the problem

[darthsilun]

If the government can tell me I have to have auto liability insurance, then I don't see why it can't tell me to have health insurance too.

States can require auto insurance in order to register a car. If you read the 10th amendment, all powers not delegated to federal government are regulated to the states. Some states do not require auto insurance anyways.

Two states do not require auto insurance. If you choose to not buy it, you're required to show other means to pay for any damage or injury you cause. Pretty much the same thing as insurance in my book.

Difference is the Federal government is requiring it, even if you don't register a car. So there is no way to avoid it and I missed the section of the Constitution giving the Federal government the right to force us to buy health insurance.

The Supremes have already confirmed that the ACA is constitutional. Your bona fides as a constitutional scholar who somehow knows better than they do are what, exactly?

You can't even claim "general welfare" because for the majority of people it hurts them.

The majority? You have a citation from an objective source for that, right? Off hand it seems to me that the people who don't have insurance are actually hurting me! When they don't pay for their health care, the provider a) has to write it off, b) charge everyone else – i.e. the responsible members of society – more, in order to operate in the black.

Just giving you an answer in case you really didn't know the difference. I've heard others ask the same thing before.

You don't win bonus points by being a patronizing.

Re:Yeah, that's the problem

[LunaticTippy]

You should recalculate. Accidents and health problems happen to everyone. I broke my foot and it cost $100,000 to fix. You think paying a few hundred a month for insurance sucks, imagine how paying a few hundred thou feels.

I thought I was healthy and could do better things with my money than buy stupid insurance. Thanks to the vagaries of my work situation I happened to have a high deductible insurance plan that saved me from a crippling financial blow.

Re:Yeah, that's the problem

[dsmatthews9379]

"While we've been working on making the better antibiotic..."

Except you haven't, many good candidate molecules get shelved for no other reason than they would complete with existing products and would cost a lot of money to get to market. It is when the shelves become empty of likely candidates to replace drugs in use that you have a problem.

It seems as if the entire idea of antibiotics is broken, but it isn't, it is just that it is an arms race where the enemy can be tricked into forgetting how to defend itself against older weapons. One paper discusses cycling three drugs to trip up the mechanisms behind resistance.

Re:Yeah, that's the problem

[Wycliffe]

There is a rather simple way of unwinding this rather quickly. Currently health insurance is tax deductible if paid by the employer but many times is not tax deductible if paid by the employee. This needs to be immediately reversed. If employers had to pay taxes on health insurance and employees didn't then they would have a major incentive to switch this back around. This would help. The second thing that needs to happen is the "pool" shouldn't be tied to your employer at all. It makes no sense that switching from a job working for IBM to the equivalent job working for HP causes all your benefits, plans, deductibles, etc.. to change. It also makes no sense that my employer gets to pick my plan. The Affordable Care Act was supposed to get rid of preexisting conditions. If preexisting conditions go away then it should just be a matter of choosing a plan for your "risk class" based on age, etc... and get the employer completely out of it. The insurance companies aren't the real problem. If we can get the employer out of it then the government and insurance companies would both be much better behaved. Unfortunately, the biggest obstacle to this is perception as people are going to yell and scream that companies are just trying to save money if they drop their health insurance even if the companies give them a matching raise at the same time.

Re:Yeah, that's the problem

[PvtVoid]

Shhhh! You're spoiling the demagogue-ing.

Re:Yeah, that's the problem

[DNS-and-BIND]

Socialism means work. Work for the benefit of everyone in society, instead of selfish you keeping it all for yourself. You know all those people who get the free money for doing nothing right now? When socialism happens, they're all going to start working. Otherwise they can starve to death by neglect or intent. Who do you think first came up with the phrase, "useless eaters"? Socialism doesn't mean free money for the people, no no no. It means work, hard work.

Re:Yeah, that's the problem

[Maxo-Texas]

Most of the money held by the top 1.67% is not in salary. It's not a result of productive work.

Most of it is invested in a way prioritized to cause the rest of society to 'race to the bottom' through a combination of automation, offshoring, and elimination of choice (80/20 selling) with the 80% being much lower quality goods than we used to get.

Re:Yeah, that's the problem

[Pseudonym]

Well I don't know about the Republican plan, but a Republican plan was much like Obamacare, only less watered-down. RomneyCare was, of course, based on Nixon's health care plan which was never passed.

Oh, you mean the current crowd of what-passes-for-Republicans? Yeah, pretty much what you said.

Re:Yeah, that's the problem

[jandersen]

The problem with this idea though, which is also the same reason we have antibiotic resistance today, is that you have to identify the problem before you can use it.

Well, that is of course one of the many practical problems, but the real, undelying problem is that we, idiotically, allow short-sighted, economic interests take priority over anything else. We have known for decades that overuse of antibiotics will, by necessity, produce bacteria that are resistant. We have also discovered that bacteria exchange useful genes, seemingly across species barriers, much like we use social media. In spite of this, we have allowed, not only over-prescription of antibiotics to human patients, when they are not useful, but we have for decades allowed farmers to use these drugs a growth-enhancers. We act like idiots - we know what we shouldn't do, and we just do it any way. Idiots.

This is also, is I may say so, an example of how free-market ideology can be harmful: it encourages short-term greed and discourages us from thinking about long-term consequences. All in all, it is shameful.

Re: Yeah, that's the problem

[sjames]

Quite a few, I'm sure. The optimal level of regulation will be somewhere between none and what the FDA is doing.

Re:Yeah, that's the problem

[NewYork]

USA is the only country in the world that didn't ratify Rights of the Child.
http://en.wikipedia.org/wiki/C...

Re:Yeah, that's the problem

[Montezumaa]

Yes, because the US Supreme Court is never wrong.

The truth is, the US Supreme Court justices that voted to uphold the ACA were wrong. If you want me to explain how they were wrong(and provide "citations"), I suggest you go and discover the answers for yourself; I don't provide free education.

Re:Yeah, that's the problem

[Agripa]

You can't even claim "general welfare" because for the majority of people it hurts them.

You also cannot claim "general welfare" because it is a condition and not an enumerated power just like "necessary and proper".

Of course with "interstate" meaning the same thing as "intrastate" in the commerce clause and "private" meaning the same thing as "public" in the 5th amendment, "general welfare" means anything they want it to mean.

Questions...

[Feral Nerd]

A gene enabling resistance to polymyxins, the antibiotics of last resort, has been found to be widespread in pigs and already present in some hospital patients.

Is that a roundabout way of saying that some complete and utter moron has been feeding the antibiotic of last resort to pigs in order to boost his profit margins and the resulting resistant bacteria are now spreading to humans? I could be wrong about that of course since I am not a bacteriologist, so for what other reason would polymyxins resistance be widespread in Chinese pigs and now spreading to humans?

Re:Questions...

[rmdingler]

Likely as not, the myopic minority in a particular sector are to be humanity's undoing.

I mean, bacon is tasty, no doubt... but in the grand scheme of things, plausibly not worth watching a loved one perish via a slow death from antibiotic-resistant pathogens that we could neutralize a few short years ago.

It is ever difficult to impress people barely making a living in the present with tales of doomsday futures.

Re:Questions...

[Psychotria]

Is that a roundabout way of saying that some complete and utter moron has been feeding the antibiotic of last resort to pigs in order to boost his profit margins and the resulting resistant bacteria are now spreading to humans? I could be wrong about that of course since I am not a bacteriologist, so for what other reason would polymyxins resistance be widespread in Chinese pigs and now spreading to humans?

Essentially, yes.

China is one of the world's largest users and producers of colistin for agriculture and veterinary use.

(Source: TFA)

Re:Questions...

[dgatwood]

It's the tragedy of the commons. You have a group of sociopathic businesspeople who consider their profits more important than the survival of the human race, so they give prophylactic antibiotics to animals that aren't even sick. The downfall of humanity will be greed.

Re:Questions...

[Razed By TV]

That is exactly what is happening. The researchers were monitoring pigs in farms and discovered the resistance to polymyxin/colistin. Colistin is used in pig farms in China, so it is doubtful to be just a coincidence. The researchers found 1 in 5 pigs carried the resistant E coli strain, and 1 in 7 samples of raw meat contained it.

I was never really scared of getting trichinosis since modern medicine can deal with that. This, on the other hand...

Re:Questions...

[Applehu Akbar]

"Is that a roundabout way of saying that some complete and utter moron has been feeding the antibiotic of last resort to pigs"

Yes, this is actually happening in China. There was a BBC mention of it recently.

Re:Questions...

[MightyMartian]

It's why, when a sociopath is discovered, they should immediately be removed from society permanently. Take Valeant Pharmaceuticals. The evil monsters that ran the company decided that profits far outweighed mitigating human misery, and it was only when shamed shareholders began to respond negatively that the sociopaths were forced to back down. Such monsters should be removed from society, or at the very least banned from any position where they have even the smallest amount of influence or authority over others. Perhaps we can re-employ them cleaning sewers.

Re:Questions...

[drinkypoo]

Such monsters should be removed from society, or at the very least banned from any position where they have even the smallest amount of influence or authority over others. Perhaps we can re-employ them cleaning sewers.

That's a job that's going to be done by robots soon anyway. If we instead seized the profits from monsters like these and used it to help fund a COLA then there would be nothing inhumane in the least about telling them that they are not permitted to own or operate a business of any sort in the future. They can work for someone else or they can sit around in their mud hut or concrete apartment (what do you propose they get for free, anyway?) with their thumb in their arse thinking about how much better they had it when they were just working and not trying to fuck anyone over. There's not even any need to "punish" anyone, just grab the gains and use them for good — but do, as you say, prevent them from causing more harm.

Re:Questions...

[gumbi west]

Isn't there a simple solution to this? We just drop your patent protection when you sell it or it becomes widely available for use on farms. If that's not enough we could go after other parts of the portfolio.

Re:Questions...

[dryeo]

There are occupations where having a sociopath is an advantage. For example surgeons, where a lack of empathy can be an advantage when cutting into people.

Re:Questions...

[HiThere]

It is ever difficult to impress people barely making a living in the present with tales of doomsday futures.

While true, it *is* understandable. The problem is it's equally difficult to impress those currently getting extremely wealthy. And they're the ones with the power to change things.

Re:Questions...

[HiThere]

It takes more than a lack of empathy to make a sociopath. And a surgeon who operates unnecessarily is not a benefit to society.

Re:Questions...

[HiThere]

Wouldn't that be forbidden by the TPP?

Re:Questions...

[rmdingler]

Sure. I'm betting the profit margins for the Chinese pig farmer are pretty slim. Adding a few extra pounds per animal, or keeping an extra few animals alive per season, make a huge difference in his family's quality of life.

Individually choosing to forego the antibiotic advantage may not even be an option for one farmer, who's tiny personal sacrifice would be essentially insignificant, and likely place him at a disadvantage to his nearest competitors.

No, this is something the people who make the rules need to get behind, and you'd think they would, as their children will be as susceptible as the poor.

Re:Questions...

[dryeo]

It takes more than a lack of empathy to make a sociopath.

Yes, there's also aggression and violence, or at least the genetic alleles for them. They can show up as a murderer or just an asshole.

And a surgeon who operates unnecessarily is not a benefit to society.

Yes, but on the other hand a surgeon who can distance themselves from the fact that they're millimeters away from killing someone and concentrate on doing the job right ca be an advantage.
The case I was thinking of was actually a neuroscientist who is a pro-social psychopath, lots of murderers in his family including Lizzie Borden. See eg http://www.smithsonianmag.com/... for an interesting short read.

Re:Questions...

[Wycliffe]

Wouldn't that be forbidden by the TPP?

It shouldn't be if we're talking a US company selling to US consumers. Plenty of European countries have put restrictions on exporting of "lethal injection" drugs to other countries, it seems reasonable that we could similarly restrict the sell of off-label use of antibiotics by fining them or limiting their patent protection. Even though I wonder how many antibiotics are still under patent protection. Many of them should be generic by now. Doing something like fining them would actually hurt the real problem with antibiotics which is that there is no money in it. Once people start dying by the 10s or 100s of thousands per year then there will be plenty of money to develop new antibiotics. When only a handful of people both contract an antibiotic resistant strain AND live long enough to be able to buy your drug, there is not much incentive to develop new ones.

Re:Questions...

[volmtech]

It's not greed, just survival. For some unknown reason antibiotics have a synergistic growth effect on animals that are not sick so antibiotics are feed to healthy animals. In the real world most businesses are barely profitable so any action that can increase profits is used to avoid bankruptcy.

With population pressures and increasing antibiotic resistant bacteria our whole food producing system may have to be overhauled. This aside from the massive carbon dioxide emissions from modern agriculture that must be addressed.

In many ways Capitalism is destroying the Earth and with all of us dependent on a healthy world more socialism will be needed. As a Conservative Republican this pains me but our very survival depends on this. Instituting this without concentration camps and killing fields will be difficult.

Re:Questions...

[RockDoctor]

Then you'd immediately get "false flag" operations happening as the corporate pigs fight amongst themselves to damage each other's business interests. The drugs will still be released, but by other companies seeking to damage the genuine manufacturer for other corporate strategy reasons.

Re:Questions...

[dgatwood]

It's not greed, just survival. For some unknown reason antibiotics have a synergistic growth effect on animals that are not sick so antibiotics are feed to healthy animals. In the real world most businesses are barely profitable so any action that can increase profits is used to avoid bankruptcy.

Horses**t. The first farmers who did this did it because of greed, trying to make a bigger profit. Later farmers might have felt that it was the only way to survive, but only because the first farmers did what they did.

If your business isn't making a profit, you raise prices until it does. If you can't do that, it means either that you're doing something inefficiently or that somebody else is cutting corners. If it is the former, you need to fix the inefficiency. If it is the latter, you need to clearly differentiate your products from those others in the marketplace so that your customers know why your products cost more. Either way, cutting the same corners that everybody else does invariably results in a race to the bottom, not just in terms of cost, but also in terms of profit margins and quality. Once your business goes down that path, you might as well close the business and give the money back to the shareholders, because it is a hopeless cause, and your business is no longer contributing anything of value to the world as a whole that could not be contributed just as easily (and more efficiently) by your competitors in your absence.

The cause of the post-antibiotic future

[Misagon]

The reason why antibiotic-resistant strains have been forming and allowed to be a problem is that people have been misusing antibiotics.

A small scale problem is that antibiotics have been used by human patients that would not benefit from them. Other patients have stopped or cut down on using antibiotics when they have started to feel well - but before the strain has been fully eradicated. In some countries, antibiotics have even been available over the counter without prescription.

A large scale problem is the over-used of antibiotics in agriculture. Livestock are given antibiotics in their feed as a precaution, and this is still going on on a large scale in most Western countries.
Antibiotics-resistant strains are widespread, even the norm in many parts of the world.
Seriously, this has to stop! We need to treat this problem seriously. If a resistant strain of bacteria is found on a farm then that farm should be put in quarantine and the stock of animals should be destroyed, like what happened when Mad Cow Disease - but instead this is seen as normal. Diseased eggs and meat are the norm, and I am not talking about third-world countries. I am talking about Western Europe and the USA.

Re:The cause of the post-antibiotic future

[Gaygirlie]

A large scale problem is the over-used of antibiotics in agriculture. Livestock are given antibiotics in their feed as a precaution, and this is still going on on a large scale in most Western countries.

Such use has been illegal in Finland for a long time and as such Finland is, at least in this matter, one of the Good Guys(TM). Unfortunately, it's just a matter of time before the resistant strains spread here, too; we are not helping this problem develop and spread, but as long a single country continues to feed antibiotics to their livestock as a daily routine a resistant strain will sooner or later emerge and spread.

If it weren't China, it'd be somewhere else

[MikeRT]

Odds are good that in most industrialized countries, feeding this sort of antibiotics to pigs to maximize profits would be highly illegal. On top of that, even many industrial farmers would maintain sufficiently high standards that they wouldn't need to resort to something that extreme. It's probably one of the few things they could do in the US that would have the federal government step in and kick their ass in court.

But the reality is that there is just nothing to stop a bunch of ignorant, short-sighted, greedy fools in some third world country from buying these antibiotics and doing it. With the global supply chain, there's even incentive to try to do it for the export market. Unless industrialized countries are prepared to treat such shenanigans and the failure to stop them by the authorities of poor countries as an act of war or one legitimizing sanctions, there's no credible threat powerful to stop it.

Super Bacteria...

[Anonymous Coward]

This is why you want to avoid using anti-bacterial soap, sprays, and aerosols unless it's absolutely necessary.

Re:Super Bacteria...

[Hognoxious]

Antibacterial does not necessarily equal antibiotic.

Re:Super Bacteria...

[gumbi west]

In soap it does.

Re:Super Bacteria...

[Hognoxious]

Bollocks. Alcohol and hydrogen peroxide are NOT antibiotics in the sense that anyone with a clue uses the word.

I've taken anti-biotics once.

[Anonymous Coward]

I'm still only 29, so I guess I have yet to need them, but I've taken anti-biotics once in my life and can't help but feel a tad angry at the misuse which could potentially cause my death one day.

Re:I've taken anti-biotics once.

[ColdWetDog]

I'm still only 29, so I guess I have yet to need them, but I've taken anti-biotics once in my life and can't help but feel a tad angry at the misuse which could potentially cause my death one day.

Get ready for even more angst. Antibiotic misuse, increasing pollution, increasing occurrences of nano particles in the environment. Climate change. Plastics leaching hormonal analogs. The third - worlding of American medicine (assuming you live in the good ol USA). Nuclear proliferation. Kim Jun-Il. Donald Duck, er Trump.

You're gonna be lucky if you make it 45.

Not exactly just as a precaution

[PeterM from Berkeley]

Antibiotics are not fed to animals solely as a precaution. Animals that are fed antibiotics gain more weight, faster. This works on people too. Feed people antibiotics and they gain weight.

California, in the USA, recently banned such agricultural use of antibiotics and so have some countries in Europe.

It really is as someone said, greed/lust for profits/need to compete with others using antibiotics is the real reason why resistance is showing up.

-PM

30,000 or more dead in the USA per year

[PeterM from Berkeley]

Dead from antibiotics resistant bacterial infections. 3,000 people died in 9/11 in one particular year.

USA spent $2T on subsequent wars.

So it seems that $100T is "justified" in spending to combat antibiotic resistance, right? (Frankly, I'd be happy to see $20B increase.)

And it pretty much has to be Government supported investment, the market case just isn't there for a drug company to develop new antibiotics. How do you make your billions back from a drug which people just take for a little while, while they are sick?

Drug companies just want to develop drugs that make them lots of money, drugs that people will take every day or will take in huge quantities. So if a drug company DOES develop an antibiotic, they'll soon sell it for agricultural use to help animals gain weight--that's the only way they can ever make money.

Free market economics pretty much dictate that antibiotics will be misused if developed at all, that is why we have to have PUBLIC investment in new antibiotics.

-PeterM

The trouble with non-antibiotics

[goombah99]

Replacing antibiotics with proteins and possibly phage is a doomed proposition if done as a simple substitution. The advantage that antibiotics have that proteins can never match is they are low molecular weight chemicals. thus you don't have to give someone a high mass dose, it can be absorbed in the gut or membranes, and it can get into cells. Furthermore proteins are relatively easy to decompose without inventing any custom hardware, they are also easy to recognize specifically (which is also why they can provoke an immune response if not properly humanized). Thus proteins are not substitutes and start out with many many orders of magnitude handicap in molecular weight and accessibility. Therefore to overcome that one needs to exploit protein therapies in different ways. proteins are good at things like catalysis. The intital activity of a chemical is stochiometric in which one chemical binds one receptor. But an enzyme can turn over many many reactions, so one can, if used right, have a manyfold activity. (on the otherhand, this advanage is not clear cut, since the receptors bound by standard chemicals may amplify the signal as well, and many desired targets medical for proteins will be stochiometric binders not catalytic enzymes). A big big advantage of proteins is their potential for specificity which will both diminish their side effects and could concentrate them into a specific target area. Imagine for instance protein therapeutic which only affected a certain pathogen and left the other bacteria in your gut alone. Finally, if the protein is large enough then it can remain in the circulatory system longer before the body removes it. But that also means higher molecular weight which can be bad.

Phage are even higher molecular weight. But they can reproduce. And presumably they might be tailored to only infect the bad bacteria as their host for reproduction. But they also might become antigens and your own body would clear them.

Both of these therapies have killer applications and are not to be dismissed. Their extreme specificty will completely change medicine even more than antibiotics did. But they are not in the near future any sort of replacement for antibiotics.

Re:The trouble with non-antibiotics

[wierd_w]

You know, there are still naturally occurring chemicals out there that exhibit broad spectrum antibiotic capabilities, that are not 'cillins, 'mycins, or 'oxins. Many of these are low molecular weight oliphins that show very strong inhibition on a wide assortment of disease organisms.

Take for instance, lemongrass oil. Stuff kills the shit out of MRSA on culture plates-- handily beats vancomycin in efficacy in the microgram quantities.

Better understanding of this and other oliphins, and how they cause such profound inhibition, would lead to a new class of broad spectrum antibiotics.

But do we do that? No. We keep doing in medicine research what japanese RPG makers do with games. "Stick to what we know, even though the handrwiting is on the wall."

It isnt because researchers arent actively looking for new classes of antibiotics-- it's because we arent devdeloping the discoveries made.

Re:The trouble with non-antibiotics

[wierd_w]

Just a few citations to back the prior post.

www.sciencedirect.com/science/article/pii/S1995764510601290
jac.oxfordjournals.org/content/47/5/565.short

www.sciencedirect.com/science/article/pii/0378874184900576

onlinelibrary.wiley.com/enhanced/doi/10.1046/j.1365-2672.1999.00780.x/

The stuff actually does work.

You underestimate the power of greed

[PeterM from Berkeley]

Sorry to say it, but "most industrialized countries" feed antibiotics to animals routinely.

There are only a FEW industrialized countries which ban this, notably in Europe, notably NOT in North America (though the Republic of California just enacted a ban.)

It's NOT just a third world practice! Routine feeding of antibiotics to animals makes them gain weight faster. Market win! Industrial farmers LOVE using antibiotics.

Your mistake was underestimating the force of greed-induced stupid.

--PM

Re:You underestimate the power of greed

[Anubis IV]

Aside from the obvious logical fallacy you're engaging in (i.e. pointing out that someone, such as a third-world nation, does something does not mean that the something is unique to them), your insinuation isn't even backed up by the facts of the matter, since meat exports are largely the domain of developed nations. To use your own examples...

Countries ordered by rank:
Beef Exports: Brazil, Australia, the US, New Zealand, Canada, and the EU account for almost 60%
Chicken Exports: Netherlands, Germany, France, the Czech Republic, Belgium, and the US account for about 65%
Pork Exports: The EU, the US, Canada, Brazil, China, and Australia account for almost 95%

In all three cases, you can account for over 50% of the annual global exports market just by looking at the developed nations in the top 10 rankings. No need to even consider the long tail on the graph (I didn't; I listed no nations beyond the top 10). I included Brazil in my lists, since by your own admission it's not a third-world country (even though it actually is, if we're going by the strict definition for what a third-world country is), but if you want to exclude it, the only list it would significantly impact would be beef, since it accounts for roughly 20% of the world's supply.

Sources:
http://beef2live.com/story-wor...
http://www.indexmundi.com/agri...
https://rankingamerica.wordpre...
http://www.indexmundi.com/agri...

Phage therapy, is it of limited use?

[PeterM from Berkeley]

Phage therapy is essentially the use of viruses against bacteria. This seems like a wonderful idea and quite specific against specific bacteria.

For antibiotics we often want something broad-spectrum, because it takes time and a lab test to determine what germ is causing the problem. Precious time and uncertain results from the lab test.

So right off the bat phage therapy is less useful.

I wonder right also if the human host would mount an immune response to the phages used, effectively defending the very bacteria that the phages were intended to attack. It's a foreign antigen, after all, even a virus, why WOULDN'T your immune system attack it?

So might it be the case that phage therapy would only work once on a given person, for a particular phage?

So I'm not sure phage therapy really would be an effective replacement for the antibiotics we used to have. Helpful, certainly, but of limited use, maybe?

--PeterM

Temporary moratoriums on certain antibiotics help?

[PeterM from Berkeley]

Maintaining antibiotic resistance is costly, and populations of bacteria which are not exposed to antibiotics will drop the capability after a while or be out-competed by competitors without the baggage.

So maybe a world-wide complete ban on use of some of the older antibiotics that are now mostly useless would help? Bacteria resistant to those old antibiotics might become rare due to lack of selection pressure.

Then, after 20 years of rest, maybe those antibiotics could be rotated back into use, because they've again become useful?

--PeterM

Affordable Care Act

[golodh]

Lets remember that, unfortunately, the ACA is the very best that could be achieved after about 20 years of US political football games concerning national health insurance.

Remember how it was being villified by certain luminaries as leading to "Death Panels"? And when certain folks tried to kill it for being "unconstitutional"? That's the level of sanity of the political environment it was conceived in.

And even now we get posts from people who somehow don't like it (for whatever reason) but who still shy away yanking collective health insurance from a couple of milion people. Couldn't be their sense of ethics getting in the way. They're not like that. Something to do with political fallout I guess.

For better or worse, the insurance companies are simply the privatised face of national health insurance. And privatised means "for-profit". Which in turn means "maximise revenue and minimise expense". Bad news for anyone taking out or trying to claim on insurance. Fair enough. So what's your alternative? Want to set up an NHS-style system in the US? Perhaps sen. Bernie Sanders will look on that idea with favour, but absolutely no-one else will. Also be prepared to be branded a Communist, Socialist, Atheist, Satanist, Jihadist, Terrorist or simply all-round Un-American. Just a warning.

You might want to think about imposing more regulation on those insurance companies. Such as more financial transparency. Or some sort of nation-wide re-insurance. Well, good luck with either idea.

Sorry but in the mean time the ACA is what we've got. Lets try to smooth out its rough edges while we mull over what to replace it with, shall we?

Re:Affordable Care Act

[Anonymous Coward]

Sorry but in the mean time the ACA is what we've got. Lets try to smooth out its rough edges while we mull over what to replace it with, shall we?

Nope, it is so bad I doubt you will get any majority of the country to agree to any plan the government has from this point on except full repeal of the ACA. We gave you a shot, you wrote it in secret, and it is complete trash. When working as a private contractor with a wife you have to spend $26K before you get 1 cent of coverage paid for, it is a failure.

Its done and we won't vote for anyone who promises to "fix it". Perhaps if instead you worked with others to put it in place at first this would be different, but going around calling us racists because we didn't like it cause it sucked was not your best plan to get others to work out the problems to fix it with you later.

Re:Affordable Care Act

[eth1]

I think they really missed a trick with the ACA. What they should have done was figure out how much the Medicare tax would have to be if everyone was covered under Medicare. I'm guessing the increase would be less than what people have to pay for private insurance, given that Medicare currently covers only the absolute most expensive possible demographic for healthcare. Then give people the option of using Medicare just by increasing their tax to the calculated amount. If it's cheaper, there would be a stampede away from private insurers, and we'd basically have our national healthcare without people feeling as if they'd been forced into it. Hopefully getting some extra money in the system would also make it possible to compensate providers better.

Re:Affordable Care Act

[golodh]

@Anonymous Coward

I'm sorry but I have trouble following any of the claims you make here. They're far to broad and a-specific for that.

(1) if you look here https://en.wikipedia.org/wiki/... you'll find that the ACA reduced the number of un-insured people by a few million. Not bad for a piece of complete trash, eh? Care to re-uninsure a few million first while you think of something brilliantly better?

(2) how are you worse off than without the ACA unless you want to be un-insured?

(3) care to substantiate the "racists" part?

(4) please provide a link to the insurance company's website that offers you such horrendous coverage

Re:Affordable Care Act

[golodh]

@eth1

You may be right, I just don't know. I'm fairly certain there would be no political majority for that. In fact, the ACA structure of using private companies as insurers makes it a lot easier to swallow for any sort of conservative, thus making it politically feasible instead of politically infeasible.

I am also sensitive to the general argument of letting the private sector do what it can ... and stepping in with government regulations only where absolutely needed.

Part of that is because government bureaucracies function in a much more complex environment than straightforward for-profit companies (e.g. they need to be fair, equitable, compliant with policy etc. etc.). That tends to drive them to complicated procedures and structures that for-profit companies avoid at all costs. In other words: you trade efficiency (and cost-effectiveness) for more equitable treatment of clients.

There's something to be said for that, but in the current climate I'd very much prefer to have an efficient 80% solution in place while trying to take the rough edges off than not having anything, or creating inefficiencies through a new layer of bureaucracy.

Government programs that disburse money also have way of being abused for political gains. As in: "Make government-controlled entities splurge cash on those parts of the electorate you need votes from, hide the costs, and saddle other parts of the electorate with the bill". Sometimes that's justified, but often it isn't.

Think e.g. pork-barrel funding awarded to states. Don't get me wrong: in some way way it's a legitimate way of pumping federal money into weaker sections of the US economy (e.g. Southern and rural states). But it's vulnerable and needs constant scrutiny. Which it doesn't always get.

Turning insurance over to private enterprise has the advantage of keeping it at arms' length from politicians, at the cost of making people dependent on commercial insurers. Well if you find a better (more efficient) solution (and can somehow show it can't be abused) which is also politically feasible (i.e. won't be shot on sight by conservatives), please let us know.

Re:Affordable Care Act

[golodh]

@Anonymous Coward

I don't want to sound like a sourpuss, but I'm quite skeptical about "medical deregulation", "loosening prescription restrictions", and "tearing down licensing laws".

I happen to think that medication is one of the few areas where people really are totally incompetent to medicate themselves, and that it would be irresponsible to allow anyone but a trained physician to prescribe drugs, and that prescribing drugs should only take place within a medically correct treatment plan.

As a case in point: almost all of our woes with antibiotics-resistant bacterial strains are due to gigantic and totally irresponsible prescription in the livestock industry, irresponsible and profligate prescription of antibiotics where they aren't needed (doctors being pressured into prescribing antibiotics for the common cold), and ignorant patients aborting their antibiotics treatment the instant they feel better (as opposed to completing the treatment).

I think it's fair to say that if (ignorant and lazy) people had not been able to influence prescriptions, we would not now have any antibiotic resistance to speak of.

I'm happy to discuss increasing competition, but only from fully qualified suppliers. I believe that any other suppliers should be ruthlessly suppressed.

Re:Affordable Care Act

[NoOneInParticular]

The problem with this approach is that it gives no incentive to healthy people to get insured. With voluntary insurance, you will only get insurance when you're sick, and prices will skyrocket. Private insurance found their own way to force people into insurance, and that's called pre-existing conditions. You'd better get insured while you're healthy, because you will not be covered if you suddenly get sick. The only way healthcare can financially work is if healthy people pay for the sick.

Antibiotic resistance

[Dunbal]

Polymixin use in humans is extremely rare. Guess where this resistance is coming from? Veterinary use of prophylactic antibiotics to boost livestock yields.

Easy solution

[Anonymous Coward]

don't give last-resort medicine to farmers, keep it in highly controlled conditions only (like: only administer in hospitals)

Re:Temporary moratoriums on certain antibiotics he

[ColdWetDog]

Yes, sort of. But that turns out not to be a big deal (from the bacterium's point of view). Even when bacterial growth is metabolically limited, the increased metabolic cost of a couple of plasmids is quite small. Yes, mutations in the antibiotic resistant gene will essentially be silent and could be competed out, but with several hundred plasmids holding dozens of 'cassettes' of antibiotic resistance, this is a slow process.

So, this strategy does work to an extent but not as well as you would like and as soon as the antibiotic goes back on line, the problem restarts pretty quickly.

consider silver colloids . . .

[swell]

For thousands of years silver was the antibiotic of choice. Unfortunately nobody can patent silver, so pharmaceutical companies opted for other methods of germ fighting.

According to sciencemag.org "Silver ions perform their deadly work by punching holes in bacterial membranes and wreaking havoc once inside. They bind to essential cell components like DNA, preventing the bacteria from performing even their most basic functions."

In particular a recent article reveals that dead bacteria containing silver ions cause massive death among neighboring bacteria creating a zombie effect. This exciting news for sick people will probably fail to impress the medical establishment because silver still isn't patentable or profitable. http://news.sciencemag.org/bio...

Recent studies of silver suggest that it is not as effective as some would have you believe. Again, who pays for those studies--the medical establishment--can you believe their conclusions? They begrudgingly admit that silver is harmless when used sensibly. Corporations in the US have only one mandate under the law--provide a profit for their shareholders. Is this the correct attitude for a medical institution?

Re:consider silver colloids . . .

[Killall -9 Bash]

Chlorine bleach is the most effective anti-microbial I am aware of. I don't recommend drinking it.

Re:consider silver colloids . . .

[TarPitt]

and as a side effect, you can join the Blue Man group without having to wear any body paint

As soon as rich white people start dying..

[Anonymous Coward]

Then you'll see some action.

Re:Not that anybody cares...

[HiThere]

You misunderstand the problem. Being a vegetarian won't protect you against human-to-human transmission, and these aren't disease organisms that survive cooking anyway. The mentioned organisms are already infecting people. (Of course, there are probably others that haven't yet made the jump.)

IIUC the current disease is minor. The problem is that bacteria share genes beyond species boundaries, so it can easily spread to something serious.