'Without Action on Antibiotics, Medicine Will Return To the Dark Ages' (theguardian.com)

Four years ago professor Sally Davies, England's chief medical officer, gave the world a sombre warning of the growing threat posed by bacteria evolving resistance to life-saving antibiotics. If this were left unaddressed, she argued, it would lead to the erosion of modern medicine as we know it. Doctors and scientists had long warned of the problem, but few outside medicine were taking real heed. Consumption of antibiotics rose 36% between 2000 and 2010, writes Ed Whiting, director of policy and chief of staff at Wellcome, a biomedical research charity based in London. He notes that much of the progress in the field is yet to be made: We urgently need new antibiotics. No new classes of antibiotics have been approved since the early 1980s. Between 1940 and 1962 about 20 classes were produced, but industry backing has decreased significantly since that golden age. The pipeline of new treatments is all but dry, the void fast exploited by resistant bacteria. A concerning number are now resistant to drugs reserved as the last line of defence, and the most vulnerable are in greatest danger -- the young, old and critically ill. Blood infections caused by drug-resistant microbes kill more than 200,000 newborn babies each year. The reason for the lack of interest from the pharmaceutical industry is simple: the economics don't add up. Developing new antibiotics is scientifically challenging, time-consuming and costly. The medicines we so badly need cannot be allowed to be sold in volume; they must be conserved for real need, with fair access guaranteed. This limits their retail value. Many early-stage projects will fail, making them a risky bet. Even those that are successful will take at least a decade to produce medicines that are safe for human use.

Comments

Markets...

[beheaderaswp]

Oh... you mean markets cannot solve every problem on the planet?

Maybe if we spent a bunch of government grant money on the problem we could make it better?

Naw... the market always works... right? It's not like penicillin was discovered at St Mary's Hospital using government money.

Wait.... It was.

Re:Markets...

[interkin3tic]

We could take a huge chunk of the threat out by intelligently regulating antibiotic use in farm animals. But I've been accused of being an evil socialist elitist bent on destroying all american jobs. Why do I hate jobs and love big government so much? Why can't I just accept that jobs heal all sickness, we don't need laws, just jobs jobs jobs jobs?

Re:Markets...

[interkin3tic]

It does indeed sound like at least some libertarians argue antibiotics are the only medicine government should regulate.

But as an excuse, relevant industries definitely would argue "it'll solve itself" or close enough. Big agriculture lobbyists are likely arguing that to republican lawmakers right now, saying "look, we've 'voluntarily' reduced our use of the emergency antibiotics, so we don't really need to go *chuckle* 'organic' right? We'll take steps to reduce it on our own while saving jobs in your district, hint hint."

The claim doctors make is similar: "People are demanding antibiotics less, we just need to educate the people (who are ignorant and stubborn enough to still be demanding antibiotics for every cough and thus are never going to listen). If I tell them no, they'll just go to someone who will say yes! It's hard being a doctor!" Somehow that's the justification I get when I say "Hey, how about we put doctors in jail for prescribing antibiotics without a lab test showing it's bacterial?"

So yes, I think it's worth pointing out that the free market will never solve any problem more complex than "Which of these apples are cheaper?" because people ARE that ignorant, and selfish interested parties DO suggest the problem will solve itself.

Re:Markets...

[dargaud]

Plus, the antibiotics given to animals are very weak so you're comparing apples and oranges.

No. It's now be proven that some antibiotic resistances came from particular farms. And they are not 'weak': they are supposedly given in small quantities, but the 5$-hour workers shoveling it in the feeds don't necessarily respect the quantities. When you know that without antibiotics 1 out of 9 skin infections in humans lead to death, you really have to wonder if feeding this to cows is worth it.

Re:Markets...

[PPH]

the antibiotics given to animals are very weak

That's bad. Very bad. Because now you've created an environment which knocks off the weak strains of bacteria making room for more robust strains. If you can't administer something strong enough to kill them all, just don't bother.

How about giving farm animals a bit more living space? And more of that outdoors. So when a chicken gets sick, they don't pass it to half a million other chickens crammed in the same factory.

Re:Markets...

[Anonymous Coward]

Penicillin was discovered by accident, yes!

But the discovery itself was not obvious, and it was made by someone highly skilled, who had been trained and supported in decades of government science.

The discovery isn't even the most important thing, though. It was developed into a useful drug not by Fleming but by a chain of other people who were also supported by government science.

(Fleming was, as it happens, my father's supervisor for a time during the final stages of his medical training; he has told me in the past that Fleming didn't court the credit he has been given, and continued to credit where it was due, because the drug was actually mass produced through the work of others just as skilled as him.)

Re:Markets...

[angel'o'sphere]

And after over 20 years of 'struggling' with the EU, the US still have not grasped why the EU has an import ban on meat 'contaminated' by antibiotics.

Re:Markets...

[tempo36]

Oh boy. You really just made up some shit about antibiotics didn't you? Full disclosure...actively practicing inpatient medical provider here with family practice background and infectious disease training. I prescribe antibiotics.

First off, Amoxicillin is very narrow spectrum. It is also prescribed incredibly commonly despite your claim to the contrary. It is one of the most common pediatric outpatient antibiotics specifically because of it's narrow spectrum of activity and excellent safety profile. It will not knock out "almost any infection you could have." It kills gram positive organisms almost exclusively. Since it is susceptible to penicillinase producing organisms, resistance is reasonably common. Further, it has no, or little, effect on most gram negative organisms because it acts on the components of the bacterial cell wall which are present primarily in gram positive only organisms. Calling it "strong" or weak implies a misunderstanding of antibiotics. While we often use "strong" to imply broad spectrum, any antibiotic is "strong" if it is used against an appropriate organism.

Your suggestion that the newer antibiotics are strictly narrow is flat out wrong. The newest antibiotics in common clinical use are the carbepenems which came into clinical use in the 80s and they are vastly broad spectrum.

The "old" antibiotics are not particularly broad when compared to the newer generations of carbepenems which we utilize heavily in the hospital. Some old antibiotics are narrow spectrum, some are broad. You're making a vague and unsubstantiated claim.

The only thing you are correct in is that you are right that we often prescribe narrow spectrum antibiotics when possible so as to avoid resistance patterns. But this isn't "strong" versus "weak" antibiotics, this is just good antimicrobial stewardship.

Re:Let it return to the dark ages

[interkin3tic]

There's a point to be made here. The dark ages bit is hyperbole, the vast majority of what goes into you being healthy is prevention, sanitation, gloves, and not throwing your feces into the street.

A lot of people these days seem okay with returning to the dark ages in terms of science and learning vs religion anyway. And they don't seem very sympathetic to sick people either. Maybe instead remind them that before antibiotics, soldiers died of infections nearly as often as they did of battle. Right wingers still care about soldiers right? At least in terms of their health BEFORE they fight?

Re:Not the END

[HiThere]

True, medicine would only be returned to about its state in 1910, or perhaps 1900. Operations, even minor ones, would be a bad gamble with death...even when the best choice. Anesthetics would continue to be known and effective, but any incision could be fatal. Perhaps UV could substitute for some antibiotic uses, and strong poisons could be used to swab down surfaces, and disposable gloves and clothing could minimize risk. And... But we're already doing most of those things, and bacteria still get through.

Re:Let it return to the dark ages

[Cro Magnon]

There's a point to be made here. The dark ages bit is hyperbole, the vast majority of what goes into you being healthy is prevention, sanitation, gloves, and not throwing your feces into the street.

Agreed! Having feces-free streets helps all of us, even those who don't need antibiotics. I think it's called turd-immunity.

other therapies

[DrYak]

The worst part is, if a new antibiotics is discovered, it might help you right now, but after a couple of year, because of over use(*), the bacteria will eventually evolve some resistance against it. So the next patient with the same kind of infection will be again in the same situation...

Maybe time to dust off alternative therapies, like phage therapy ? (**)
Cue in citation of your favorite strategist (Churchill, Sun-Tzu, Machiavelli, etc.) commenting about the millennia-old proverb that the enemy of your enemy is your friend.

---

(*) : over-prescription, industrial/agricultural use, etc.

(**) : phage are like viruses but specialize in infecting bacteria. So phage therapy is basically curing your sickness, by making your sickness itself sick, with its own sickness, in a kind of pathogen-ception.

Re:other therapies

[Wootery]

It depends. It's pretty rare for a bug to be resistant to all available antibiotics.

Give it time.

proper management of antibiotic use reduces the threat significantly.

We don't have proper management. Hence the article, no?

Re:Profit

[lgw]

You've misunderstood "austerity". Austerity works as follows:

* We don't have the tax revenues to pay for half the programs the government wants to fund.
* We had been borrowing money for the other half.
* No one will lend us any more money, because we're clearly never going to pay our debt off given our spending history.
* We're stuck, no possible/I. way to keep spending at current rates

But, hey, maybe if we show lenders some evidence we're capable of spending less, cutting some programs we like, maybe they'll lends us at least a little. That's better than cutting half the programs to get back to tax revenue, right?

Austerity isn't some weird tickle-down economic theory or anything. It's what you do because you must, as for one reason or another, you can't print money to make up the shortfall.

Re:Please

[Waffle Iron]

So you believe that a million years of evolution happened over night and now there are superbug boogeymen ready to eat you alive????

No, 75 years of bacterial evolution happened in 75 years. That's probably around 1e6 generations, a number which was sufficient for humans to evolve from rather primitive mammals, and it's certainly more than enough generations to to breed superbug bogeymen ready to eat you alive. (Certain bacteria were in fact always able to eat you alive, it's just now they've bred resistance to a handful of chemical road bumps we came up with.)