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

[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

[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

[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

[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

[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

[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?

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...

[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...

[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...

[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.

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.

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.

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

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

[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.

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.