This resistance scares me a great deal, especially as a new dad. I'm hopeful that in the coming years we'll be able to target bacteria and viruses more specifically using nano-technology and other tools at a cost effective level (admittedly I don't have a lot of knowledge in this area but I'm hopeful.)
If all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacterials every 50 years or so depending on the resistance trends we see crop up and hope we don't lose too many humans in the process. At any rate, I'm glad lots of smart people are working on this problem.
There is reason for guarded optimism if we can eliminate, or at least drastically reduce, irresponsible use of antibiotics:
The capacity to resist antibiotics extracts a small metabolic/competitive "tax" on bacteria. In the presence of antibiotics, the costs of this tax are outweighed by the obvious benefits of antibiotic resistance.
In an environment without antibiotics, the costs of the tax outweigh their benefits, so these antibiotic-resistant bacteria will eventually be outgrown by "normal" bacteria.
If we can discipline ourselves to use antibiotics only when necessary, gradually antibiotic-resistant bacteria should become less common. Unfortunately, I doubt this will happen until the antibiotic-resistance problem becomes much more serious.
The Wiki article you linked specifically mentions Linezolid isn't necessarily effective against many Gram-negatives (the resistant bacteria):
Linezolid has no clinically significant effect on most Gram-negative bacteria. Pseudomonas and the Enterobacteriaceae, for instance, are not susceptible.[90] In vitro, it is active against Pasteurella multocida,[2][91] Fusobacterium, Moraxella catarrhalis, Legionella, Bordetella, and Elizabethkingia meningoseptica, and moderately active (having a minimum inhibitory concentration for 90% of strains of 8 mg/L) against Haemophilus influenzae.[87][90] It has also been used to great effect as a second-line treatment for Capnocytophaga infections.[43][92]
You basically have polymixins (colistin) and, depending on resistance profile, fosfomycin and tigecycline. Colistin is avoided if possible because of nephrotoxicity, but as usual, medicine is a field heavily involved in balancing risks and benefits.
For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary.
For the first time in the memory of anyone alive today, we're going to see medical science step backwards. We're going to be more vulnerable tomorrow than we are today, and we did it to ourselves.
> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary.
Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.
This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
> Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
This is one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospital trip where someone didn't catch something new at the hospital.
The difficulty is avoiding treatment and not diagnostics. If your method of avoiding treatment is never going to the doctor, ie, never being diagnosed, you don't really know when your problems are life-threatening.
This is what I don't completely understand. Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? Or, do I not understand the vectors properly?
The way I perceive these stories is that hospitals are actually extremely dirty on a microbial level (as is most of the world), it's just counter-intuitive because I think a lot of people take for granted that a hospital is imagined to be a super sterile place. MRSAs could potentially reside on every surface; an act as simple as touching a bed railing could get you infected. You then have patients in recovery with healing wounds/depressed immune systems, which need antibiotic treatment of some kind when they have an infection. But it's not like you cannot become infected by a MRSA outside of a hospital, you can, and the same antibiotics won't work effectively for you just as they don't work effectively in the hospital. So the first step in my mind is making sure the hospital is 'clean'.
> Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital?
We do. We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin.
Bacteria are just bloody durable, and people are shedding new bacteria into the environment at really absurd rates.
>We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin.
And the bacteria which survives all of this, i think it should look something like this:
That kind of solution is part of the problem. Resistent bacteria are normaly outcompeted by non-resistant ones, except when there is antibiotics on the enviroment. As a consequence, the mere act of keeping something always sterilized (as well as possible) helps the resitent bacteria growth.
But, of course, you can't avoid keeping a hospital sterilized.
Maybe the solution is to have the procedure in a place that is a hospital. You'd want some environemnt that isn't shared by other sic people, and is only sporadically sterilized.
Yep, I have no idea how to actualy do that. There are all kinds of issues, but I'd guess that you can solve nearly all of them with tech.
I worked at a hospital for awhile, and one of the things I found interesting, though, is that the departments balance each other out. For example, our hospital did obstetrics more as a service to the community, since other hospitals were much further, but they always lost money on it. So maybe the reason we don't see surgery centers or things like that as often is that medical institutions are more stable providing a broader range of services.
It's not an impossible scenario but have the decency not to wrap this 'End of the world fantasy' as a fact or certainty.
There have been plenty of those before you and there will be plenty more to come. Y2K, Nuclear War, Swine Flu, Global Warming, Apocalypse, take your pick.
Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union, which isn't to say that such conditions could never arise again. And of course the risk of a smaller scale nuclear war is still very real.
In each of these cases there seems to be a tendency to think that just because total disaster has not yet occurred, that the risks are nonexistent.
Of those, though, two of the threats were real and mitigated before the impact could be realized (nuclear war and Y2K), and one of them is a fairly recent scientific theory that is still trying to be understood (climate change).
In the 80s we acted faster on freon/CFCs than we have on climate change in the ensuing 30 years, with less danger to human life and less evidence. The only thing that's new about climate change as a scientific theory is the annual increase in the pile of evidence that it's happening and we're the cause of it.
Absolutely horrible example because .com owns .gov and the primary patent for CFC production expired in 1979, obviously lots of money is going to be poured into encouraging the use of patented CFC replacements, such as making the use of CFCs illegal. I'm not questioning the science of it, I'm explaining why .com and .gov worked together really hard on banning CFCs in the early/mid 80s, because HCFCs and HFCs are more profitable. The historical about-face is documented and hilarious how .com strongly denied CFCs could have any effect therefore .gov wouldn't ban them until the patent expired, then suddenly everyone agrees we need to use the more expensive HFCs and HCFCs.
I'm quite sure around the time HFC and HCFC patents expire we'll all have to suffer thru very well industry funded explanations of how R-141b causes excessive pr0n browsing or some such nonsense, so for the children, we'll all have to switch a new, ever more expensive refrigerant.
I'm sure if the patent for CFC production expired in 2020 we'd still be pumping the classic stuff out, along with an industry funded denial movement and probably an alignment on political party lines to prevent any progress, etc.
Bringing it back on the original topic the best way to get .com (and since the merger, .gov) to fund antibiotic research in the modern real world would be to genetically engineer bacteria genome to contain an encoded .avi of the SuperBowl or an encoded Miley Cyrus .mp3 or something like that. Maybe glycophosphate resistant MRSA would get some attention from the usual suspects.
If someone could figure out how to patent global warming or global cooling we'd be on to something...
This is nonsense. Some large portion of industry would be happy enough to not pay royalties.
There are also at least several countries with little regard for patents and significant industrial bases that none the less signed on to treaties to limit and cease the production of CFCs...
But sure, Dupont made the US government strong arm India and China into paying for their new refrigerants. And Russia too.
Exactly. Those are two specific things that needed to be eliminated. Climate change deals with a lot of bad actors, and a very broad category of changes.
I think it's too easy to say that overuse of antibiotics is what brought us here. In the article it says that companies stopped developing new antibiotics when development costs became too high to justify given the narrow market.
Now, if doctors were to use antibiotics only for very serious infections, a last resort method, then pharmaceutical companies wouldn't have had the incentive to develop even the drugs that we now take for granted, because the market would have been so incredibly small to not give them enough reason to invest in development.
I think we would've ended up in this very same position anyway, it was just a matter of time.
I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).
People use antibiotics to treat things that are not helped by antibiotics.
Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm.
Obviously unnecessary use of antibiotics is unnecessary (a fact I alluded to), but that's not what I was responding to. You're putting words in my mouth there. I said the call for "emergencies only!" antibiotics was overkill. If I took your point differently than you intended, maybe you would like to rephrase.
> we're helpless and the world is again going to be a scary place
Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective:
>Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic.
When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.
I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.
Also many chronic diseases are autoimmune diseases, like asthma or type 1 diabetes. In such patients the immune system gets weaker when in crisis, leaving them vulnerable to infections.
This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.
Remember, it takes 8-12 years and $1,000,000,000 on average to whittle 10,000 drug candidates into 1 fully tested FDA approved drug.
If a company is going to spend a decade and a billion attempting to develop a "management" antibiotic for continual profit, I'm willing to bet the profit motive exists for another company to make a normal antibiotic... that most doctors would happily prescribe over the ridiculous multi-year option...
It's a big risk and I doubt some company will attempt to make a maintenance drug out of antibiotics.
Unless you're implying that profit motive means they simply won't try because it's not insulin or something, which is ridiculous. Profit motive... there is profit to be made in a new antibiotic, there's the motive. Not every pharma company will just let money sit on the table in favor of older drugs nearing the end of patent protection.
Basically Pfizer, one of the last companies working on antibiotics for gram-negative bacteria, pulled out due to pressure from shareholders, because there's little money to be made here. You spend billions of dollars on creating an antibiotic, and upon its release the recommended instruction is to "use it as less as possible"? -- there's no money in that obviously, there's more money in cholesterol drugs, ADHD drugs, and other drugs you'll continue taking for a long long time.
I feel bad to steer the discussion this way -- but this it, this perfectly underscores one of the scary faults of capitalism. Everyone wants to see a nice smooth growth curve. Growth is prioritized higher than long-term stability of society. We need to fundamentally re-think this.
No we don't - this is just where we need to fund government laboratories to research drugs in areas which drug companies do not presently find profitable.
Having read this and the article on autonomous corporations, I suddenly understand that the future of capitalism is extinct humans and very financially well-off computers.
Keep in mind that Pfizer's strategy is in response to the incentives offered by the marketplace including regulations set forth by the FDA and patent office. It's not a free market that sense.
It's not hard for the FDA to streamline approval process so that development costs are lowered or for them to offer extended periods of market exclusivity so that costs can be recouped over a longer period of time.
The FDA has already moved on the regulatory aspect and companies have responded. Antibacterials is a much more attractive market now than it was 5 years ago.
If that's what's necessary for the company to develop such an antibiotic, why not? State-of-the-art cancer drugs can cost that ore more.
I'd rather pay $5k and live, to not being able to do anything.
I worked for Pfizer, for 2 years in clinical trials to get Linezolid on the market. This was for treating MRSA infections. I was in close contact with nurses & doctors who seemed to think it worked well. Back then (around 10 yrs ago), there was almost no MRSA resistance, unheard of from what I remember.
Then I left and lost track of it all. Wikipedia now says it's 100USD / pill.
If there's really a lot of resistance to Linezolid, that would be quite shocking.
In my project there was a lot more MRSA in "poorer" parts of the country, in hospitals with lower hygiene standards. Hospitals also refused to report their MRSA stats ("it doesn't exist here", not wanting to be known as a place where it's found since it is related to hygiene).
I suppose that's true, but it seems like a perverse incentive to me. Drug companies have a financial incentive to wait for people to die rather than taking action that will prevent people from dying.
Really? The most profitable drug ever is Lipitor which is entirely based on reducing the threat of future health problems. High cholesterol does nothing to you in a short timeframe, but will greatly increase your likelihood of death 20-30 years from now.
Maybe GP didn't have the best wording, but I would classify those both as emergencies appropriate for antibiotic use -- you may only think them not because antibiotics are seen as so commonplace.
Non-emergencies:
* sore throat
* lots of chickens packed in one place
Those examples both qualify as necessary and emergent.
What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).
I'm not sure how prevalent your example is these days.
I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn.
They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.
What I'm saying is that we should have treated antibiotics, as a worldwide community, like a stockpile with a finite lifespan and only a limited availability. As few uses as possible, with the goal of saving lives, not making people "feel better".
What I'm imagining is something like the Department of Energy, or even the CDC here, regulating the ability to prescribe antibiotics and establishing rules that must be followed for their use. Antibiotics would not be a privately exchanged commodity, but a highly regulated resource managed for the public good.
So, would this hypothetical future involve antibiotics for your hypothetical cases? Probably? Possibly? If doctors discerned that the cause of the swelling was bacterial infection, if the bladder infection was threatening to the wife's future well-being? Then I'd suppose so.
But you wouldn't get antibiotics just for being alive like you do now. They practically hand them out like candy at doctor's offices.
Oh, you have a cough? Have a z-pak. Doesn't matter if it's a viral infection going around, who cares if giving you this drug just ensures that some day in the future we won't be able to treat someone who is actually dying with azithromycin. What's important is that taking these pills will make you feel like we're doing something to help.
I think it would be more accurate to characterize antibiotics as effective, not just profitable. You are completely ignoring the actual benefit of antibiotics and acting like they created profits without actually benefiting the patient
> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary
Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?
Being somewhat pessimistic here. As someone who actively hacks DNA, I believe that we can address this problem responsibly with the development of new and novel antibiotics for antibiotic-resistant bacteria. There are significant challenges in the biology but there is technology being developed that will significantly reduce the cost and time needed to develop new antibodies.
For example, my company TeselaGen (http://teselagen.com) has developed a cloud based platform for biologists to design, build, and test a large combinatorial set of DNA constructs. Some of our customers use our software today to easily and effectively test an incredible number of DNA devices for identifying and developing useful antibodies.If you have an understanding of genetics and cloning you can try out the software yourself.
I remember hearing about Soviet research into phage therapy, where bacteriophages are cultured to consume particular strains of bacteria. I believe the treatment is only in use in a couple ex-Soviet states. Is this a reasonable avenue once we're essentially dealing with only MRSA-like infections?
I believe the MRSA-like infections you're thinking of are the Gram-negative bacteria [1] mentioned in the article. Based on the Wikipedia page for phage therapy [2], it should be an effective treatment option where the bacteria have polysacharride layer in the cell envelope, which most antibiotics cannot penetrate. There's more in the treatment section [3], which doesn't mention phage therapy however.
I'm hopeful this leads to new default treatments, since I have had allergic reactions to the last 3 antibiotics I have been prescribed. They do a great job fighting what they were designed to fight (for me), but then I get a week of a really itchy rash, cortisone shots, and cortico steroids.
> Another reality is there’s not much money to be made in making new antibiotics, so we saw a lot of drug companies who left the field of antibiotic development because of this combination of factors, that it was getting really hard to discover, to develop new antibiotics, and you don’t make a lot of money in selling these drugs, so the market really wasn’t there.
To me this seems like the big problem here. Antibiotic resistance is an inevitability regardless of our usage rates - there's too much selective pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have to constantly be developing new antibiotics just to keep pace.
I suspect this problem will self-correct eventually, with the unfortunate side-effect that the cost of effective antibiotics will skyrocket for awhile.
That being said, we're obviously not doing ourselves any favors by dispensing them like candy, especially to the agricultural industry. It definitely encourages cycles - Effective antibiotics are rare and therefore profitable so tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes down because there's so many options/patents expire -> Overuse -> Resistance develops quickly and we're left with few effective options.
I was wondering if resistant bacterial strain would drop resistances against one antibiotic if we stop using it for long enough. Maintaining a resistance comes at a cost for a living organism (synthesizing an enzyme), so the bacteria that would drop it would be promoted.
It seems like a plausible approach, if you could coordinate antibiotic use. But if we were capable of coordinating antibiotic use, we could correct the practices that got us to this point in the first place.
> Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle.
I am more optimistic than that.
Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will.
But, this will come with a genetic cost to the bacteria.
The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us.
Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time).
This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances.
>The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do not necessarily evolve optimally all of the time. It is possible that an evolutionary step towards resistance might also improve the fitness of the germ overall (for example, by further optimizing the efficiency of a metabolic pathway). That evolutionary step might have been inevitable, but required additional selective pressure or the presence of a more active mutagen to actually occur.
Your claim is sort of assuming that each bug is already optimal for its environment, and any change must therefore be deleterious in some regard, but I hold that neither fact is necessarily true.
I appreciate your point and I don't disagree with you (+1). However, the issue is complicated and I wanted to present another side to the original post.
I think it's likely that those two claims are mostly true in bacteria. Since bacteria evolve quickly and have experienced a lot of evolution, I believe they are likely near-optimum and therefore the second claim (IMHO) follows from that: changes would typically be deleterious.
On the other hand, even allowing for that, it's possible we could be allowing them to escape a local maximum and reach a more-optimal state.
And, there is a more significant criticism you could make:
Even if I am right on both points, a population that evolved to be heterogeneous (with some small percentage of wildtype being resistant) could likely have the best of both worlds ;)
Plasmids are only one of the ways that bacteria adapt.
Adapting antibiotic resistance can take as little as a single nucleotide mutation in the right part of a bacterial genome. Many of the known antibiotic resistance mechanisms involve small mutations to critical proteins.
There is a catch here however, any resistance a bacteria has, has implicit cost to the bacteria in the form of copying the resistances' dna into new cells. This costs the organism energy and time to copy. If it confers no benefit it will be dropped from the genome.
Bacteria both evolve resistance quickly, they also lose it just as quick. Because unless it directly is needed in the here and now, the bacteria that remove it and survive without it outcompete the rest of the bacteria.
This is my understanding at least, a real bacteriologist can comment what I inevitably got wrong. But the recent study that used existing antibiotics in a certain way to kill bacteria is a great demonstration of bacteria not being able to select for all simultaneously and retain the old resistance in the future.
I'm not overly concerned about bacterial resistance given there are ways we can work around it.
> Bacteria both evolve resistance quickly, they also lose it just as quick.
Alas, experiments have shown that it is possible for resistant strains to strongly reduce the cost of resistance maintenance. If there are no naive invaders, this can lead to an evolutionary stable situation where the maintenance of resistance is less costly than losing it.
See Lenski's (old) review "Bacterial evolution and the cost of antibiotic resistance"
This makes the assumption that evolution results in a perfect organism, which it does not. Instead, it results in a "good enough" organism.
The definition of "good enough" for bacteria has changed over the last 50 years, so these changes are occurring now. It doesn't necessarily require a cost, or at least not a cost that matters to humans.
I'm not going to watch the documentary to see the full quote, but taken on its face, this is a false statement. There continue to be many infections which will still be treatable by antibiotics for the foreseeable future.
I have to agree. There are many antibiotics in the pipeline right now as well. The recent GAIN legislation and other FDA initiatives have spurred the development of new antibiotics.
Antibiotic resistance will continue to be a problem (obviously), but we're going to have effective antibiotics available to us for the coming decades.
I wish he mentioned the massive dumping of antibiotics into our food supply via feedlots, et cetera. You think the fact that all the meat we eat is swimming in antibiotics for its entire life has something to do with this antibiotic resistant bacteria in our stomachs? It'd be a damn shame to undo one of the miracles of the twentieth century so your chicken sandwich is fifty cents cheaper.
I know the article tries to explain things in a way a layman can understand, but the wording when it comes to evolution is quite poorly chosen IMO. Saying thinks like 'Bacteria, like any living organism, want to survive' and 'bacteria will always change in order to survive', are just incorrect and will result in big misconceptions.
To my knowledge, bacteria don't have an agenda, they don't want to survive and they certainly don't change in order to survive. Instead, they change at random, which sometimes helps an individual to survive and sometimes not.
I wouldn't be so hard on him. Teaching physics, we often find ourselves saying things like "the ball wants to roll down the hill". It seems to be natural to talk in terms of agency when trying to make concepts intelligible to the relative layman.
Yes, but the ball rolling down the hill is not very contentious, whereas evolution is (at least in the US), and wrongness explaining it makes dismissing it easier.
It's very hard to get the phrasing right. There's always a certain amount of random mutation going on, which can lead to better fitness (or not). However individuals with better fitness end up reproducing more, so mutations that lead to such better outcomes end up surviving.
This coupled with multiple ways that bacterias can use to protect themselves against antibiotics, like enzymes, better shielding, or even pumping the antibiotics out, also increases the chance for successful mutations. And they've also developed this mechanism for spreading their DNA around to other bacterias.
The result is almost the same as if bacterias would have an agenda. Although it can happen for mutations to lead to worse fitness in contact with older and forgotten antibiotics. And it can also happen for these random mutations to drive a whole population to extinction. But these two outcomes have a much lower probability than bacterias becoming highly resistant to all antibiotics.
I don't see why we can apply these words and ideas to humans but not to bacteria.
Our feelings (wants) and actions are a result of evolution just the same as bacterial action.
We may choose not to ascribe feelings to bacteria, but the origin of the motivation is precisely the same as it is in humans - the motivation to survive and reproduce is universal to organisms.
I think as a rule people aren't as stupid as "common knowledge" would like to pretend.
My 18mo daughter has had a half dozen ear infections and two staph infections. Antibiotics each time.
Would it be better to leave a staph infection untreated with antibiotics? How? Lance and clean the infection site... and then what?
Or ear infections? I had frequent undiagnosed ear infections as a small child and now have reduced hearing to thank for it. My entire life I've had people annoyed with me asking them to repeat themselves. Some ear infections may clear up on their own. The ENT has told us this is unlikely in 12mo or younger ages since cranial structures aren't in place that allows excess fluid to drain. We can let her have a fever for a day or two, and give Tylenol, but all that's going to do is delay the necessary antibiotics. We could also have tubes inserted in her ears, but it's not like those are without risks or downsides either.
Since people don't have to play the lottery with their hearing or their lives anymore because they have access to antibiotics now sure, maybe that has some scary consequences. But it's not like people are popping them for a headache or skinned knee. And insulting people may make some feel superior, but it doesn't actually solve anything or even hint at a possible solution. You don't just "ride these things (staph) out" and hope for the best. There are consequences to going all granola "nature will take care of itself".
The thing with Tragedy of the Commons -- which is exactly what the antibiotic situation is -- is that the decisions which are optimum for each individual actor in isolation are suboptimal on the whole.
I think I've been prescribed antibiotics for an obviously viral infection one time in my adult life. I can count the number of times (in my late 30s) that I've been prescribed antibiotics as an adult on one hand.
When you factor in that people just don't go to Dr's all that often in the US, especially the poor, I'd need to see some actual data before I believe this is a grossly American problem. Because given other factors, you'd be forgiven for thinking something doesn't add up with that characterization.
I would for example, imagine it's much more of an issue in the UK with people having cheap convenient access to the NHS.
In the US I'd have to find a Dr, and if I'm uninsured that means spending a half-day at the ER, and then I'd have to take that Rx to a Pharmacy, who's going to offer me a generic at an uninsured price that's probably somewhere around my grocery budget.
If it's an issue at all (comparable to countries with socialized medicine) in the US it would almost have to be an exclusively middle to upper class behavior.
That's a good deal of the population that just doesn't play the game.
Honestly, framing this as a Stupid Fat American problem reads like "Are Antibiotics Going to Kill Your Children?!? Find out tonight on XYZ News at 6PM!!!". Those stories are definitely out there and pretty pervasive. It would be pretty ironic if Geeks with Superiority Complexes were being feed their dogma by "common knowledge" based on soundbites from the nightly news...
Not to dismiss this as a problem. But insulting people (even comparably low quality-of-life Americans) doesn't get us any closer to a solution. And blaming those people, already stretched thin by work hours, insurance costs (if they even have it), day care, trying to ensure they get to sit down for a family dinner, go to work sick so they can afford the time off for a family vacation that they're the problem because they're just dumb Americans is... It's to express in words how petty and mean spirited that comes off as.
Amoxicillin hasn't been prescribed by our Dr after it failed to do anything for the first ear infection. The Pharmacy isn't just going to substitute different antibiotics for you either.
So $230 for the course. So sure. Amoxicillin is cheap. So is Tylenol. What's your point? After the Dr's visit you're still likely out at least $100, not to mention time off work, and that's if the "cheap stuff" even works. You can't get this stuff OTC.
I stand by my statement: Without data I think it's a lot easier to believe that places with socialized medicine and generous labor laws for things like sick time are much more likely to see abuse.
I don't know much about the varieties of ear infections babies get, but if the ear infection is viral, I can't see how an antibiotic would help. I used to have a problem with ear infections and I've had a doctor tell me the infection is viral and then offer me antibiotics in the same breath.
I'd like to know what this will do for bacteriophage therapy. Georgia has been the center of phage research since the 20s and has a massive bank of phages for all sorts of infections. Can someone more knowledgeable of this topic explain why the end of antibiotics is such a problem if there's already a decent alternative? What are the downsides to phage therapy?
This is very serious. But consider the worst-case outcome:
No more anti-biotics, for anyone.
That is, we go back to the era before anti-biotics, life in the 1920's. Maybe mortality rates will go back to that era, and maybe higher. But thankfully we aren't talking about a plague. At least not yet.
Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics, but (unknown to him) I didn't take them. I healed fine. And so it was in the 20's and before that. Plenty of people survived and thrived before anti-biotics. And life will go on when we don't have them anymore.
No doubt these super bugs have had to give up certain advantages to attain what is (for their species) a very specialized survival mechanism. Which means that if we ease off of the drugs for a while, the bacterial populations will compete, and the less drug resistant ones will thrive. Then we can use our drugs again. Or that's the idea.
What I'd really like to see are the internal assessments of big pharma of these gram neg bugs. Why isn't it economically feasible to create new drugs for them? This article makes it sound like there is a large and growing market of suffering people who'd be more than willing to spend every last cent for a pill to make the pain go away. And if the prospect of people willingly bankrupting themselves for drugs doesn't perk big pharma's interest, I don't know what would.
> "Why isn't it economically feasible to create new drugs for them? "
It's not that you couldn't make a profit off them. It's that the opportunity costs can't be justified (today).
There's a finite amount of R&D funds available to any firm. And if I'm maximizing profit, I'm not going to spend my money on difficult research, seeking and developing a drug useful to a handful of patients in 4% of hospitals, that's taken for a few weeks by each patient.
Not if I can instead spend it tweaking known drugs, useful to 30-50% of the entire population, that they'll take for the rest of their lives. (e.g. blood pressure medicine)
And particularly not when CDC, WHO, et al are actively campaigning for changes to antibiotic handling/prescription/use which may well mean your potential future market for "a better antibiotic" is actually smaller than today's.
I think you seriously underestimate just how many lives antibiotics save. Sure, for your tooth extraction they were completely unnecessary and your doctor is either a bit of an idiot or there were other compelling reasons to suspect that antibiotics might be beneficial. But healthcare-wise I would not want to go back to the 1920, no sir. Without antibiotics, medical routine procedures will become life-threatening again (that said, I don’t share the article’s pessimism; yes, it’s bad – but there will be solutions).
One of the best ways to combat the problem is to speed-up detection speeds of bacteria. Lots of companies are tackling this problem. One of them I've been following has made enormous progress in reducing these detection times.
They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24 hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours. Etc.
This is a really big deal, and should be getting more visibility. I think the good news here is it opens the door for a more targeted approach. Current antibiotics are a nuclear option, they wipe out the good with the bad. Thats very bad when a majority of the cells in our body are good bacteria that play a role in our immunity and health. You can see how this leads to a reliance on the nuclear option.
If this is the end of the Age of Antibiotics, I hope its the beginning of the Age of Probiotics. Working with the good bacteria and developing more targeted strategies of taking out the bad. Snipers, not nukes. (Im no scientist but perhaps learning from how good bacteria fight off bad bacteria is a good place to start) http://www.sciencedaily.com/releases/2010/03/100324094717.ht...
There are a number of reasons to over-use antibiotics:
1. Patients ask for them. For a long time, the thinking went 'What's the harm?' in giving Mr. Jones some penicillin for what's probably a viral infection.
2. There is the potential for lawsuits, and the desire to have 'done something' to cover your ass, but I think this is widely exaggerated as a threat.
3. It's hard to diagnose many conditions. Like juries think all crimes get the full CSI treatment, patients often think doctors can just pop down to the lab and find out what you have, like in House. The answer is that's often hard, expensive, and failure prone. So they give antibiotics, especially broad spectrum ones, because of the subset of things you might have, antibiotics can treat some of them.
4. This is really 3b, but it's also possible, when you have no clue what your patient has, to try different antibiotics to try to get a handle on things. This...ends up using a lot of antibiotics.
5. Doctors, at their core, want to treat their patients. To make them better. They're trained to deal at the individual level - antibiotic resistance is a population level concern.
Meanwhile tons of antibiotics are used in factory farming. I'm not sure why it has ever been legal to use massive amounts of antibiotics on animals that aren't sick yet.
A thought occurs to me- do we know it to be true, that a constant life-long supply of antibiotics results in the development of greater numbers of resistant strains of bacteria?
Think about it. We always say humans who don't finish their prescription are allowing some of the most resistant strains to survive, when taking the full prescription would generally finish off everything (even the moderately resistant strains) preventing selection. Farm animals that never stop taking antibiotics never provide that window of opportunity for unresistant strains to take hold and then undergo selection due to antibiotic regimes that are ended too soon.
Maybe I've got the wrong idea here, but is this particularly different from, say, a petri dish full of sulfuric acid, and a petri dish that periodically has some acid introduced for a short period of time? Drop a culture in the first dish, and they all die. Drop a culture in the second dish, and they have time to develop resistance.
In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection and no sign of bacteria in their systems, unless they are severely immune compromised.
As you can imagine, doctors initially got into trouble with this because there is no test that you can use in clinic that says "this patient just has a viral infection". Nevertheless, there are clinical criteria that we can use to come to the same conclusion, and the tide changed years ago with regards to inappropriate antibiotic use for routine viral illnesses.
It gets much dicier in-hospital when someone has a SIRS response and you need to presumptively treat them for sepsis.
I would be curious to know: of the antibiotic resistance burden that comes from human antibiotic use (specifically in countries where abx are physician-prescribed and not available over the counter), how much of this burden comes from broad treatment of presumed serious infections, and how much comes from treatment of presumed non-serious infections or even postsurgical prophylaxis?
Resistance is a funny thing: there's nothing specifically wrong with going nuts with the antibiotics provided everything gets dead.
The problem is much more with people who only take partial courses or are non-compliant, because if you don't clear the infection then round 2 is full of the slightly more resistant members of the species.
Sure, but my question is about epidemiology. Rather than assuming that most resistance comes from "bad"/noncompliant/non-adherent/choose-your-euphemism patients, it would be interesting to know what the current burden of resistance can actually be attributed to (separating out resistance due to livestock antibiosis, countries where people can just buy antibiotics over the counter, etc).
The function of antibiotics in agriculture isn't to prevent infection (or at least, not primarily to prevent infection) but to fatten the animals up for slaughter.
I'm just pointing out that the antibiotics aren't strictly being used for disease-prevention (hence better hygiene alone might not eliminate their use).
The obvious answer is: You can't profitably slaughter diseased animals (at least for human consumption, with various complex exemptions that massively reduce value)
So treating with broad-spec antibiotic prophylaxis increases your healthy-at-slaughter-date yield, especially under cost-optimised industrial feedlots.
More incrementally, (if perhaps still somewhat controversially), normal gut bacteria accounts for some fraction of the energy intake provided by animal feed. By killing them off, it frees up nutrients for the host. Other mechanisms including reduced immune load may also be involved.
Quoting from [1]:
> According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to "help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals". Although the mechanism underpinning their action is unclear, it is believed that the antibiotics suppress sensitive populations of bacteria in the intestines. It has been estimated that as much as 6 per cent of the net energy in the pig diet could be lost due to microbial fermentation in the intestine (Jensen, 1998). If the microbial population could be better controlled, it is possible that the lost energy could be diverted to growth.
User shabble has some ideas (in a sibling comment to this one), but reading that gives me the impression that this is a little bit of a theoretical concept. It's not. It's very widely practiced, with the explicit intent of "promoting growth".
E.g., a search like [1] calls up a large number of references to it.
It's the threat thereof that persuades compliance. If you try hard enough to do & keep doing something illegal, there is no limit which the state is unwilling to go to in coercing compliance.
It's your basic (American, right-) libertarian argument against the state doing anything that limits business. I think its application in a case like this nicely encapsulates the flaws in the philosophy, or at least the ability of its adherents to apply it sensibly.
What? How did you make that leap from "nobody's gonna beat a vet with a rubber hose" to assuming I'm a hardcore libertarian? I'm for the reduction of antibiotics through government regulation. I think business should be restricted when it comes to doing harm to society.
With such a leap, I can only logically assume you replied to the wrong comment.
No, I was responding to you with an observation about the comment above yours. There's nothing about your post that indicates adherence to libertarianism.
If it's outlawed (as suggested above), he refuses to pay the fine, persists in doing it, and goes to great lengths to refuse subsequent incarceration, then yes he will face something akin to getting beaten with a rubber hose.
It's no secret that if you defy the authorities they escalate the amount of coercion they use. You just need to follow the progression far enough to get to the violence.
They start with a polite court summons, then send a police officer to your home, and if you don't come quietly they'll physically force you. If you manage to resist that, well now you're resisting arrest so it doesn't even matter what the original summons was for. They'll escalate to tasers, nightsticks, maybe tear gas. You probably need guns on your side to resist past that point, which means the police get their guns out, and they've got more guys and more guns than you. You most likely end up dead, but definitely not resisting anymore. At no point will they say "Gee guys, this is just too much effort, guess we better let him do whatever he wants."
There is implied violence in every government directive. You don't usually see it because almost nobody has the will and the means to push it that far, but it's still there. I think people would do well to remember that when casually calling for things to be made illegal.
That said, I actually agree with the idea of banning antibiotics in agriculture. It's quite important, and a classic market failure/tragedy of the commons situation that you sadly do need government to solve.
Yes, so we're talking about someone who would be committed enough to resisting authority to provoke violence. This is different than saying "if you break a law, it will result in violence" or even the more extreme "instituting a law is a violent act", which is what the original comment in this tree suggested. I realize what you're saying, but I think at this point it's argument just for argument's sake.
Also, in this case, the individual dosing livestock with antibiotics is actually harming society, in which case I think it would be okay to physically detain him/her from doing so, rather than just saying "this is just too much effort, guess we better let him do whatever he wants". In most scenarios though, I don't think this would be necessary.
If I go to an Apple store and decide I can pick up an iPad and get out, because I've been nice to everybody and I deserve it, similar things will happen, starting with "Excuse me sir," verbal arguments, guards, armed guards, and (if I decide to defend my right to my iPad with armed force) eventually a shoot-out match.
So, we could equally say that there is implied violence in every transaction. (Well, yes sometimes the violence is leased from the government, which will happen if I bring my armed thugs to raid an Apple store. And I'd consider that a good use of the government's resource.)
I think it'd funny that the libertarian definition of violence includes everything the government does, but it doesn't include their own 'social contract' stuff. "The right to swing your fist ends at my nose" - this requirement, for example, sounds nice and fluffily individualistic, but what happens if you violate it? You are taken to court, and if you continue to not comply, you go through the usual escalation of things. So using the same standards of proof, "don't hit me" is an act of violence.
The same goes for the requirements for a free market - which involves perfect information on the part of the purchaser. If you withhold information, you've violated the requirements... and if you continue to not comply, the system requires escalation, and libertarianism in particular relies heavily on the courts to fix things post facto, and of course, courts need to be able to enforce their dictates. So not providing perfect information to the market is an act of violence, using these flawed "chain-of-events-that-end-in-foo-are-literally-foo" terms.
The libertarian redefinition of 'violence' really needs to be abandoned.
Nonsense. Jaywalking is illegal, I do it every day, and have done for most of my 40 years on this planet. The state hasn't yet seen fit to bother coercing my legal compliance in this matter. It's hardly going to unlimited lengths to stop this illegal activity.
I didn't say it would go that far, I said there was no limit to how far it might should it choose to. There are plenty of horror stories regarding jaywalking prohibition enforcement. In some places, the state does indeed go to remarkable lengths to stop that activity.
If you're arguing it that way, then giving livestock antibiotics or dumping polluted waste is also violence by your definition: by these actions, they're coercing others to die without their permission.
So if it had been "making it illegal for corporations to spill contaminants in local water supplies", this would also be considered violence, in your eyes?
I, for one, think we should pass laws that prevent people from doing harmful things to society..
If someone is going to put a single bullet in his gun, spin the cylinder, point it at someone and fire then I think I would subsequently be quite justified in restraining them even if the gun didn't happen to go off that time. Likewise if the person was doing something that had a 1 in 60 chance of killing 10 people, and likewise if what they were doing had an tiny chance of killing millions of people.
I think it's an appropriate response to life and death issues, when, on one side of the scale are the potential deaths of millions.
My ex-girlfriend's dad died of an infection, quite possibly a superbug. I was there with her and her mom the second he stopped breathing. Go and be there at the moment of death by infection of someone you know, then tell me how you feel about people who needlessly weaken antibiotics.
Antibiotics in animal farms should be banned world wide.
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiotic free meat.
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
I'm curious as to just exactly how you think the US is going to convince China, Russia, India, etc to ban antibiotics? The US could obviously afford to do so, as the incremental cost in the price of animal protein (due to smaller yields) could be absorbed by modifications to eating habits or redistribution models (i.e. food stamps).
I'm not sure the same could be said in some of the countries that are much larger and have huge difficulties with food production/distribution already.
Antibiotics in animal farms should be banned world wide.
Why? The problem isn't giving antibiotics to animals. Antibiotics are useful for animals the same way they are useful for controlling disease in humans. The problem is abuse of antibiotics.
The issue is any antibiotic that could be used to cure humans should be used for nothing but curing humans. Every use of it rolls the dice that the bacteria will evolve an immunity to that drug. There isn't any "safe" use. Bacteria will eventually evolve and we can only reduce the amount of evolutionary pressure being applied.
So in short, yes the problem is giving it to animals.
But we derive real utility from using antibiotics with animals. First in preventing blights in our food supply (which has been the downfall of many nations of antiquity) and second in controlling diseases that can jump to humans.
If there is no safe use, then what matters is risk vs. reward, right? There is real utility (reward) to using antibiotics on animals, and I don't see how we can simply blanket rule it out.
Of course, they're given to animals to keep them healthy enough so we can eat them.
If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.
> If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
You are cutting the amount of meat and dairy available for human consumption, not food. Eating animal products is not a terribly efficient way of getting nutrients.
There's a bill introduced in the Senate that would restrict antibiotics that are approved in humans from being used in agricultural in a prophylactic way.[1] A similar bill has been introduced in the House[2] by Rep. Louise Slaughter who has degrees in microbiology and public health.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
I'm sure the rural interests have the same thing to say about urban interests & the House. Which, really, means things are working as intended.
As intended is rather irrelevant to the question of whether or not it's a good system. Unless you think that the so-called founding fathers were infallible?
A system which gives representation to rocks and cows rather than to people is undemocratic. That's not just my opinion man, it's a statement of fact. The House doesn't over-represent urban interests it represents them in the proportion that people of the country live there.
Your post smacks of the fallacy of the golden mean fallacy, which is unfortunately a serious problem in the United States today. There aren't two sides to every issue. Often some people are just wrong.
Of course it is undemocratic. This country wasn't built to be a perfect democracy. Allowing urban voters to dictate policy affecting rural voters under the name of democracy just because there are more urban voters could turn out to be a very bad idea, because urban voters are not necessarily well-informed on issues that apply to rural America. This in turn be bad for everyone, as the urban voters depend on rural America to produce food.
The debate over firearms is a simple example. Urban voters do not see why rural voters cannot simply depend on the police to maintain law and order. Rural voters on the other hand do not see why urban voters think the police can respond in time. The difference is their context. Urban voters are probably right- in the context of a city.
(I am not arguing about firearms, I just thought the debate was an easy illustrative example of how your context matters)
There aren't two sides to every issue. Often some people are just wrong.
I'm sure you are conveniently always on the side that is right? :)
Antibiotic resistance shows up among the unhealthiest communities first. They act as the necessary incubators that resistance needs to develop. In a person with a working immune system, the time frame of antibiotic and pathogen contact is very small compared to the time frame of antibiotic and pathogen contact in an immunocompromised patient.
To put the above into simple English: Our problem isn't that we give antibiotics out like candy, it's that we give them to the elderly, people with AIDS, the poor, etc. This massively increases the chance of antibiotic resistance developing.
What can we do about it? To start with, run the numbers, make some cost-benefit calculations, and think about the problem. There may be technical as well as social solutions.
Not thinking about the problem, making it harder for the healthiest people to get antibiotics, and pretending that you are doing something is also a viable option. It's what we're doing now.
I correctly described the situation. I think it's ugly too. Do you have a fix? Because that's what we need, a fix, not cheap moralizing.
Moralizing doesn't save anyone from gangrene and sepsis and a slow death. It doesn't prevent the diarrhea to dehydration to death sequence. It doesn't do an ounce of good for anyone.
God forbid say your dad is sick- Will you go and tell him- 'Dad, you better die for the sake humanity and than take these antibiotics and have you pain reduced'.
If you are poor, will you tell your kid- 'Sorry son, I have to sacrifice you for the sake of humanity, no more antibiotics for you'
The parent comment to yours is correct. Poor have better immune systems, because theirs is trained to handle such situations from their birth than yours and mine which live well sanitized environments and have never been exposed to them before.
That's at least true in a country like India. I'm not sure where you live, poor people dying out of fatal infections is one thing. But its also a fact, some that requires me or you take a sick leave doesn't even bother them.
They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility)
They drop a bit of bacteria on the zero antibiotic section.
A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans.
A good illustration. Your phrasing "The bacteria has developed resistance to the antibiotic" is of course better understood as "the descendant bacterial cells have been ruthlessly selected for resistance to this antibiotic." But that is not an invariant characteristic of bacteria. It is perfectly possible to completely wipe out a population of bacteria in a particular place so that the bacteria have NO descendants.
I've always been under the impression that bacteria pay a heavy evolutionary tax for their resistance. So what would happen if you then took a sample from the 1000x section of jelly and then another sample of your initial bacteria and put them on opposite sides of nutrient jelly slab. Would the new bacteria be completely overwhelmed?
Would infecting someone with a non resistant strain, letting it sit for a while and then hitting them with antibiotics knock the infection low enough that your immune system could wipe up the rest?
The problem is in situations where you want to use antibiotics, time is not on your side. There has been some work done on this idea, though I cannot recall the specifics.
Its difficult to say if they've reached the end of their 'maximum optimization limit' or a local maximum.
The beauty of evolution is not to be stopped by limits, but to run near infinite instances of optimization algorithms over infinite time scales to over come the limits that exist.
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[ 4.9 ms ] story [ 231 ms ] threadIf all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacterials every 50 years or so depending on the resistance trends we see crop up and hope we don't lose too many humans in the process. At any rate, I'm glad lots of smart people are working on this problem.
The capacity to resist antibiotics extracts a small metabolic/competitive "tax" on bacteria. In the presence of antibiotics, the costs of this tax are outweighed by the obvious benefits of antibiotic resistance.
In an environment without antibiotics, the costs of the tax outweigh their benefits, so these antibiotic-resistant bacteria will eventually be outgrown by "normal" bacteria.
If we can discipline ourselves to use antibiotics only when necessary, gradually antibiotic-resistant bacteria should become less common. Unfortunately, I doubt this will happen until the antibiotic-resistance problem becomes much more serious.
Linezolid has no clinically significant effect on most Gram-negative bacteria. Pseudomonas and the Enterobacteriaceae, for instance, are not susceptible.[90] In vitro, it is active against Pasteurella multocida,[2][91] Fusobacterium, Moraxella catarrhalis, Legionella, Bordetella, and Elizabethkingia meningoseptica, and moderately active (having a minimum inhibitory concentration for 90% of strains of 8 mg/L) against Haemophilus influenzae.[87][90] It has also been used to great effect as a second-line treatment for Capnocytophaga infections.[43][92]
For the first time in the memory of anyone alive today, we're going to see medical science step backwards. We're going to be more vulnerable tomorrow than we are today, and we did it to ourselves.
Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
This is one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospital trip where someone didn't catch something new at the hospital.
I think generally, everyone avoids hospitals at all costs.
The way I perceive these stories is that hospitals are actually extremely dirty on a microbial level (as is most of the world), it's just counter-intuitive because I think a lot of people take for granted that a hospital is imagined to be a super sterile place. MRSAs could potentially reside on every surface; an act as simple as touching a bed railing could get you infected. You then have patients in recovery with healing wounds/depressed immune systems, which need antibiotic treatment of some kind when they have an infection. But it's not like you cannot become infected by a MRSA outside of a hospital, you can, and the same antibiotics won't work effectively for you just as they don't work effectively in the hospital. So the first step in my mind is making sure the hospital is 'clean'.
Yes yes make everyone wear gas masks and space suits the entire time, staff and patient alike...
We have robots that do that now.
http://loyolamedicine.org/newswire/news/uv-light-robots-kill...
Bacteria are just bloody durable, and people are shedding new bacteria into the environment at really absurd rates.
And the bacteria which survives all of this, i think it should look something like this:
http://www.imdb.com/media/rm617979392/tt0088944?ref_=ttmi_mi...
But, of course, you can't avoid keeping a hospital sterilized.
Yep, I have no idea how to actualy do that. There are all kinds of issues, but I'd guess that you can solve nearly all of them with tech.
I worked at a hospital for awhile, and one of the things I found interesting, though, is that the departments balance each other out. For example, our hospital did obstetrics more as a service to the community, since other hospitals were much further, but they always lost money on it. So maybe the reason we don't see surgery centers or things like that as often is that medical institutions are more stable providing a broader range of services.
There have been plenty of those before you and there will be plenty more to come. Y2K, Nuclear War, Swine Flu, Global Warming, Apocalypse, take your pick.
In each of these cases there seems to be a tendency to think that just because total disaster has not yet occurred, that the risks are nonexistent.
Why? Did the weapons magically disappear? That outcome is much more likely in the 2010s than the 1980s, for example.
I'm quite sure around the time HFC and HCFC patents expire we'll all have to suffer thru very well industry funded explanations of how R-141b causes excessive pr0n browsing or some such nonsense, so for the children, we'll all have to switch a new, ever more expensive refrigerant.
I'm sure if the patent for CFC production expired in 2020 we'd still be pumping the classic stuff out, along with an industry funded denial movement and probably an alignment on political party lines to prevent any progress, etc.
Bringing it back on the original topic the best way to get .com (and since the merger, .gov) to fund antibiotic research in the modern real world would be to genetically engineer bacteria genome to contain an encoded .avi of the SuperBowl or an encoded Miley Cyrus .mp3 or something like that. Maybe glycophosphate resistant MRSA would get some attention from the usual suspects.
If someone could figure out how to patent global warming or global cooling we'd be on to something...
There are also at least several countries with little regard for patents and significant industrial bases that none the less signed on to treaties to limit and cease the production of CFCs...
But sure, Dupont made the US government strong arm India and China into paying for their new refrigerants. And Russia too.
Now, if doctors were to use antibiotics only for very serious infections, a last resort method, then pharmaceutical companies wouldn't have had the incentive to develop even the drugs that we now take for granted, because the market would have been so incredibly small to not give them enough reason to invest in development.
I think we would've ended up in this very same position anyway, it was just a matter of time.
I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).
Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm.
(http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm)
> Untreated gonorrhea can cause serious and permanent health problems in both women and men.
That seems like a reasonable use of an antibiotic. But maybe we should have been working out how to get people to use condoms.
Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective:
>Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic.
When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.
Not if you get killed by an infection first.
If a company is going to spend a decade and a billion attempting to develop a "management" antibiotic for continual profit, I'm willing to bet the profit motive exists for another company to make a normal antibiotic... that most doctors would happily prescribe over the ridiculous multi-year option...
It's a big risk and I doubt some company will attempt to make a maintenance drug out of antibiotics.
Unless you're implying that profit motive means they simply won't try because it's not insulin or something, which is ridiculous. Profit motive... there is profit to be made in a new antibiotic, there's the motive. Not every pharma company will just let money sit on the table in favor of older drugs nearing the end of patent protection.
I've actual found there's a fair amount of interest in antibiotic development among drug companies.
Basically Pfizer, one of the last companies working on antibiotics for gram-negative bacteria, pulled out due to pressure from shareholders, because there's little money to be made here. You spend billions of dollars on creating an antibiotic, and upon its release the recommended instruction is to "use it as less as possible"? -- there's no money in that obviously, there's more money in cholesterol drugs, ADHD drugs, and other drugs you'll continue taking for a long long time.
I feel bad to steer the discussion this way -- but this it, this perfectly underscores one of the scary faults of capitalism. Everyone wants to see a nice smooth growth curve. Growth is prioritized higher than long-term stability of society. We need to fundamentally re-think this.
It's not hard for the FDA to streamline approval process so that development costs are lowered or for them to offer extended periods of market exclusivity so that costs can be recouped over a longer period of time.
The FDA has already moved on the regulatory aspect and companies have responded. Antibacterials is a much more attractive market now than it was 5 years ago.
Then I left and lost track of it all. Wikipedia now says it's 100USD / pill.
If there's really a lot of resistance to Linezolid, that would be quite shocking.
In my project there was a lot more MRSA in "poorer" parts of the country, in hospitals with lower hygiene standards. Hospitals also refused to report their MRSA stats ("it doesn't exist here", not wanting to be known as a place where it's found since it is related to hygiene).
Interesting stuff.
Really? And whose lives are you willing to play that game with?
Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set?
Your wife, with a bladder infection so severe it's bleeding and she has a fever?
"Sorry, son - your suffering is for the betterment of mankind. I'm pretty sure you'll survive."
"Sorry, honey - let's just see if you can make it another week or two."
Non-emergencies:
* sore throat * lots of chickens packed in one place
What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).
I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn.
They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.
Last year NY state started putting out "when does my child need antibiotics?" pamphlets that they have in the exam rooms.
What I'm imagining is something like the Department of Energy, or even the CDC here, regulating the ability to prescribe antibiotics and establishing rules that must be followed for their use. Antibiotics would not be a privately exchanged commodity, but a highly regulated resource managed for the public good.
So, would this hypothetical future involve antibiotics for your hypothetical cases? Probably? Possibly? If doctors discerned that the cause of the swelling was bacterial infection, if the bladder infection was threatening to the wife's future well-being? Then I'd suppose so.
But you wouldn't get antibiotics just for being alive like you do now. They practically hand them out like candy at doctor's offices.
Oh, you have a cough? Have a z-pak. Doesn't matter if it's a viral infection going around, who cares if giving you this drug just ensures that some day in the future we won't be able to treat someone who is actually dying with azithromycin. What's important is that taking these pills will make you feel like we're doing something to help.
Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?
For example, my company TeselaGen (http://teselagen.com) has developed a cloud based platform for biologists to design, build, and test a large combinatorial set of DNA constructs. Some of our customers use our software today to easily and effectively test an incredible number of DNA devices for identifying and developing useful antibodies.If you have an understanding of genetics and cloning you can try out the software yourself.
[1]: http://en.wikipedia.org/wiki/Gram-negative_bacteria [2]: http://en.wikipedia.org/wiki/Phage_therapy [3]: http://en.wikipedia.org/wiki/Gram-negative_bacteria#Medical_...
To me this seems like the big problem here. Antibiotic resistance is an inevitability regardless of our usage rates - there's too much selective pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have to constantly be developing new antibiotics just to keep pace.
I suspect this problem will self-correct eventually, with the unfortunate side-effect that the cost of effective antibiotics will skyrocket for awhile.
That being said, we're obviously not doing ourselves any favors by dispensing them like candy, especially to the agricultural industry. It definitely encourages cycles - Effective antibiotics are rare and therefore profitable so tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes down because there's so many options/patents expire -> Overuse -> Resistance develops quickly and we're left with few effective options.
I am more optimistic than that.
Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will.
But, this will come with a genetic cost to the bacteria.
The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us.
Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time).
This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances.
We humans are not out yet.
I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do not necessarily evolve optimally all of the time. It is possible that an evolutionary step towards resistance might also improve the fitness of the germ overall (for example, by further optimizing the efficiency of a metabolic pathway). That evolutionary step might have been inevitable, but required additional selective pressure or the presence of a more active mutagen to actually occur.
Your claim is sort of assuming that each bug is already optimal for its environment, and any change must therefore be deleterious in some regard, but I hold that neither fact is necessarily true.
I think it's likely that those two claims are mostly true in bacteria. Since bacteria evolve quickly and have experienced a lot of evolution, I believe they are likely near-optimum and therefore the second claim (IMHO) follows from that: changes would typically be deleterious.
On the other hand, even allowing for that, it's possible we could be allowing them to escape a local maximum and reach a more-optimal state.
And, there is a more significant criticism you could make:
Even if I am right on both points, a population that evolved to be heterogeneous (with some small percentage of wildtype being resistant) could likely have the best of both worlds ;)
"In nature, plasmids carry genes that may benefit survival of the organism (e.g. antibiotic resistance),"
Plasmids cost energy, they are dropped in the course of natural selection if they stop conferring an advantage.
More quickly than you might think, too.
If we stop using antibiotics, the bacteria will become less resistant.
Adapting antibiotic resistance can take as little as a single nucleotide mutation in the right part of a bacterial genome. Many of the known antibiotic resistance mechanisms involve small mutations to critical proteins.
http://www.cbsnews.com/2100-205_162-6014559.html
I really recommend everyone here read Power, Sex, Suicide, mitochondria and the meaning of life. Amazon link (no affiliation/referral) http://www.amazon.com/Power-Sex-Suicide-Mitochondria-ebook/d...
Bacteria both evolve resistance quickly, they also lose it just as quick. Because unless it directly is needed in the here and now, the bacteria that remove it and survive without it outcompete the rest of the bacteria.
This is my understanding at least, a real bacteriologist can comment what I inevitably got wrong. But the recent study that used existing antibiotics in a certain way to kill bacteria is a great demonstration of bacteria not being able to select for all simultaneously and retain the old resistance in the future.
I'm not overly concerned about bacterial resistance given there are ways we can work around it.
Alas, experiments have shown that it is possible for resistant strains to strongly reduce the cost of resistance maintenance. If there are no naive invaders, this can lead to an evolutionary stable situation where the maintenance of resistance is less costly than losing it.
See Lenski's (old) review "Bacterial evolution and the cost of antibiotic resistance"
The definition of "good enough" for bacteria has changed over the last 50 years, so these changes are occurring now. It doesn't necessarily require a cost, or at least not a cost that matters to humans.
Antibiotic resistance will continue to be a problem (obviously), but we're going to have effective antibiotics available to us for the coming decades.
To my knowledge, bacteria don't have an agenda, they don't want to survive and they certainly don't change in order to survive. Instead, they change at random, which sometimes helps an individual to survive and sometimes not.
This coupled with multiple ways that bacterias can use to protect themselves against antibiotics, like enzymes, better shielding, or even pumping the antibiotics out, also increases the chance for successful mutations. And they've also developed this mechanism for spreading their DNA around to other bacterias.
The result is almost the same as if bacterias would have an agenda. Although it can happen for mutations to lead to worse fitness in contact with older and forgotten antibiotics. And it can also happen for these random mutations to drive a whole population to extinction. But these two outcomes have a much lower probability than bacterias becoming highly resistant to all antibiotics.
Our feelings (wants) and actions are a result of evolution just the same as bacterial action.
We may choose not to ascribe feelings to bacteria, but the origin of the motivation is precisely the same as it is in humans - the motivation to survive and reproduce is universal to organisms.
Not sure where the thread is but the story here: http://www.nature.com/news/silver-makes-antibiotics-thousand...
My 18mo daughter has had a half dozen ear infections and two staph infections. Antibiotics each time.
Would it be better to leave a staph infection untreated with antibiotics? How? Lance and clean the infection site... and then what?
Or ear infections? I had frequent undiagnosed ear infections as a small child and now have reduced hearing to thank for it. My entire life I've had people annoyed with me asking them to repeat themselves. Some ear infections may clear up on their own. The ENT has told us this is unlikely in 12mo or younger ages since cranial structures aren't in place that allows excess fluid to drain. We can let her have a fever for a day or two, and give Tylenol, but all that's going to do is delay the necessary antibiotics. We could also have tubes inserted in her ears, but it's not like those are without risks or downsides either.
Since people don't have to play the lottery with their hearing or their lives anymore because they have access to antibiotics now sure, maybe that has some scary consequences. But it's not like people are popping them for a headache or skinned knee. And insulting people may make some feel superior, but it doesn't actually solve anything or even hint at a possible solution. You don't just "ride these things (staph) out" and hope for the best. There are consequences to going all granola "nature will take care of itself".
I think I've been prescribed antibiotics for an obviously viral infection one time in my adult life. I can count the number of times (in my late 30s) that I've been prescribed antibiotics as an adult on one hand.
When you factor in that people just don't go to Dr's all that often in the US, especially the poor, I'd need to see some actual data before I believe this is a grossly American problem. Because given other factors, you'd be forgiven for thinking something doesn't add up with that characterization.
I would for example, imagine it's much more of an issue in the UK with people having cheap convenient access to the NHS.
In the US I'd have to find a Dr, and if I'm uninsured that means spending a half-day at the ER, and then I'd have to take that Rx to a Pharmacy, who's going to offer me a generic at an uninsured price that's probably somewhere around my grocery budget.
If it's an issue at all (comparable to countries with socialized medicine) in the US it would almost have to be an exclusively middle to upper class behavior.
That's a good deal of the population that just doesn't play the game.
Honestly, framing this as a Stupid Fat American problem reads like "Are Antibiotics Going to Kill Your Children?!? Find out tonight on XYZ News at 6PM!!!". Those stories are definitely out there and pretty pervasive. It would be pretty ironic if Geeks with Superiority Complexes were being feed their dogma by "common knowledge" based on soundbites from the nightly news...
Not to dismiss this as a problem. But insulting people (even comparably low quality-of-life Americans) doesn't get us any closer to a solution. And blaming those people, already stretched thin by work hours, insurance costs (if they even have it), day care, trying to ensure they get to sit down for a family dinner, go to work sick so they can afford the time off for a family vacation that they're the problem because they're just dumb Americans is... It's to express in words how petty and mean spirited that comes off as.
30 pills - $5.90. So a normal cycle would be about 3 dollars. In the United States. Antibiotics are so inexpensive.
Here's what my daughter was prescribed: http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm...
So $230 for the course. So sure. Amoxicillin is cheap. So is Tylenol. What's your point? After the Dr's visit you're still likely out at least $100, not to mention time off work, and that's if the "cheap stuff" even works. You can't get this stuff OTC.
I stand by my statement: Without data I think it's a lot easier to believe that places with socialized medicine and generous labor laws for things like sick time are much more likely to see abuse.
You do need to get a prescription though, which doctors don't dole out with a smile. Companies don't have to pay to advertise drugs though.
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics, but (unknown to him) I didn't take them. I healed fine. And so it was in the 20's and before that. Plenty of people survived and thrived before anti-biotics. And life will go on when we don't have them anymore.
No doubt these super bugs have had to give up certain advantages to attain what is (for their species) a very specialized survival mechanism. Which means that if we ease off of the drugs for a while, the bacterial populations will compete, and the less drug resistant ones will thrive. Then we can use our drugs again. Or that's the idea.
What I'd really like to see are the internal assessments of big pharma of these gram neg bugs. Why isn't it economically feasible to create new drugs for them? This article makes it sound like there is a large and growing market of suffering people who'd be more than willing to spend every last cent for a pill to make the pain go away. And if the prospect of people willingly bankrupting themselves for drugs doesn't perk big pharma's interest, I don't know what would.
It's not that you couldn't make a profit off them. It's that the opportunity costs can't be justified (today).
There's a finite amount of R&D funds available to any firm. And if I'm maximizing profit, I'm not going to spend my money on difficult research, seeking and developing a drug useful to a handful of patients in 4% of hospitals, that's taken for a few weeks by each patient.
Not if I can instead spend it tweaking known drugs, useful to 30-50% of the entire population, that they'll take for the rest of their lives. (e.g. blood pressure medicine)
And particularly not when CDC, WHO, et al are actively campaigning for changes to antibiotic handling/prescription/use which may well mean your potential future market for "a better antibiotic" is actually smaller than today's.
MRSA was a bit of a wakeup here in the UK, but the main 'solution' was concentration on cleaning hospitals rather than developing new anitbiotics.
It is my opinion that unfortunately it will require high profile people to start dying before support is galvanised.
It would seem from the outside that HIV/AIDs started to be addressed when superstars like Freddie Mercury started succumbing.
They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24 hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours. Etc.
http://nanologix.com/test_results.html
Stopping these problems before they get the chance to spread is how I believe these infections will be slowed, as antibiotics become less effective.
If this is the end of the Age of Antibiotics, I hope its the beginning of the Age of Probiotics. Working with the good bacteria and developing more targeted strategies of taking out the bad. Snipers, not nukes. (Im no scientist but perhaps learning from how good bacteria fight off bad bacteria is a good place to start) http://www.sciencedaily.com/releases/2010/03/100324094717.ht...
1. Patients ask for them. For a long time, the thinking went 'What's the harm?' in giving Mr. Jones some penicillin for what's probably a viral infection.
2. There is the potential for lawsuits, and the desire to have 'done something' to cover your ass, but I think this is widely exaggerated as a threat.
3. It's hard to diagnose many conditions. Like juries think all crimes get the full CSI treatment, patients often think doctors can just pop down to the lab and find out what you have, like in House. The answer is that's often hard, expensive, and failure prone. So they give antibiotics, especially broad spectrum ones, because of the subset of things you might have, antibiotics can treat some of them.
4. This is really 3b, but it's also possible, when you have no clue what your patient has, to try different antibiotics to try to get a handle on things. This...ends up using a lot of antibiotics.
5. Doctors, at their core, want to treat their patients. To make them better. They're trained to deal at the individual level - antibiotic resistance is a population level concern.
Think about it. We always say humans who don't finish their prescription are allowing some of the most resistant strains to survive, when taking the full prescription would generally finish off everything (even the moderately resistant strains) preventing selection. Farm animals that never stop taking antibiotics never provide that window of opportunity for unresistant strains to take hold and then undergo selection due to antibiotic regimes that are ended too soon.
Maybe I've got the wrong idea here, but is this particularly different from, say, a petri dish full of sulfuric acid, and a petri dish that periodically has some acid introduced for a short period of time? Drop a culture in the first dish, and they all die. Drop a culture in the second dish, and they have time to develop resistance.
[1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...
It gets much dicier in-hospital when someone has a SIRS response and you need to presumptively treat them for sepsis.
I would be curious to know: of the antibiotic resistance burden that comes from human antibiotic use (specifically in countries where abx are physician-prescribed and not available over the counter), how much of this burden comes from broad treatment of presumed serious infections, and how much comes from treatment of presumed non-serious infections or even postsurgical prophylaxis?
The problem is much more with people who only take partial courses or are non-compliant, because if you don't clear the infection then round 2 is full of the slightly more resistant members of the species.
I believe there are some labs-on-chip that can detect multiple(even thousands) bacteria and/or viruses. I'm not sure if they are in commercial usage.
I'm just pointing out that the antibiotics aren't strictly being used for disease-prevention (hence better hygiene alone might not eliminate their use).
So treating with broad-spec antibiotic prophylaxis increases your healthy-at-slaughter-date yield, especially under cost-optimised industrial feedlots.
More incrementally, (if perhaps still somewhat controversially), normal gut bacteria accounts for some fraction of the energy intake provided by animal feed. By killing them off, it frees up nutrients for the host. Other mechanisms including reduced immune load may also be involved.
Quoting from [1]:
> According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to "help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals". Although the mechanism underpinning their action is unclear, it is believed that the antibiotics suppress sensitive populations of bacteria in the intestines. It has been estimated that as much as 6 per cent of the net energy in the pig diet could be lost due to microbial fermentation in the intestine (Jensen, 1998). If the microbial population could be better controlled, it is possible that the lost energy could be diverted to growth.
[1] http://www.fao.org/docrep/article/agrippa/555_en.htm
User shabble has some ideas (in a sibling comment to this one), but reading that gives me the impression that this is a little bit of a theoretical concept. It's not. It's very widely practiced, with the explicit intent of "promoting growth".
E.g., a search like [1] calls up a large number of references to it.
[1] https://www.google.com/search?q=how+do+antibiotics+fatten+an...
>We [sic] should also fine doctors for...
Why is violence an appropriate response to these non-violent issues?
Edit for clarity.
With such a leap, I can only logically assume you replied to the wrong comment.
C'mon. Do you really think every food regulation is being watched by military police who will come and beat you up if you break said regulation?
They start with a polite court summons, then send a police officer to your home, and if you don't come quietly they'll physically force you. If you manage to resist that, well now you're resisting arrest so it doesn't even matter what the original summons was for. They'll escalate to tasers, nightsticks, maybe tear gas. You probably need guns on your side to resist past that point, which means the police get their guns out, and they've got more guys and more guns than you. You most likely end up dead, but definitely not resisting anymore. At no point will they say "Gee guys, this is just too much effort, guess we better let him do whatever he wants."
There is implied violence in every government directive. You don't usually see it because almost nobody has the will and the means to push it that far, but it's still there. I think people would do well to remember that when casually calling for things to be made illegal.
That said, I actually agree with the idea of banning antibiotics in agriculture. It's quite important, and a classic market failure/tragedy of the commons situation that you sadly do need government to solve.
Also, in this case, the individual dosing livestock with antibiotics is actually harming society, in which case I think it would be okay to physically detain him/her from doing so, rather than just saying "this is just too much effort, guess we better let him do whatever he wants". In most scenarios though, I don't think this would be necessary.
So, we could equally say that there is implied violence in every transaction. (Well, yes sometimes the violence is leased from the government, which will happen if I bring my armed thugs to raid an Apple store. And I'd consider that a good use of the government's resource.)
The same goes for the requirements for a free market - which involves perfect information on the part of the purchaser. If you withhold information, you've violated the requirements... and if you continue to not comply, the system requires escalation, and libertarianism in particular relies heavily on the courts to fix things post facto, and of course, courts need to be able to enforce their dictates. So not providing perfect information to the market is an act of violence, using these flawed "chain-of-events-that-end-in-foo-are-literally-foo" terms.
The libertarian redefinition of 'violence' really needs to be abandoned.
I, for one, think we should pass laws that prevent people from doing harmful things to society..
If people who abuse antibiotics will lead to us having no good antibiotics, then they will inflict extreme violence on the entire human race.
My ex-girlfriend's dad died of an infection, quite possibly a superbug. I was there with her and her mom the second he stopped breathing. Go and be there at the moment of death by infection of someone you know, then tell me how you feel about people who needlessly weaken antibiotics.
(just trying to keep the discourse here as balanced as it would be if this discussion was out of HN)
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiotic free meat.
I'm curious as to just exactly how you think the US is going to convince China, Russia, India, etc to ban antibiotics? The US could obviously afford to do so, as the incremental cost in the price of animal protein (due to smaller yields) could be absorbed by modifications to eating habits or redistribution models (i.e. food stamps).
I'm not sure the same could be said in some of the countries that are much larger and have huge difficulties with food production/distribution already.
Why? The problem isn't giving antibiotics to animals. Antibiotics are useful for animals the same way they are useful for controlling disease in humans. The problem is abuse of antibiotics.
So in short, yes the problem is giving it to animals.
If there is no safe use, then what matters is risk vs. reward, right? There is real utility (reward) to using antibiotics on animals, and I don't see how we can simply blanket rule it out.
If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.
http://en.wikipedia.org/wiki/Ishmael_%28novel%29
You are cutting the amount of meat and dairy available for human consumption, not food. Eating animal products is not a terribly efficient way of getting nutrients.
There are better ways of ensuring the supply of food than the abuse of antibiotics in livestock.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
[1] Preventing Antibiotic Resistance Act of 2013 -- http://thomas.loc.gov/cgi-bin/query/z?c113:S.1256.IS:/
[2] Preservation of Antibiotics for Medical Treatment Act of 2013 -- http://thomas.loc.gov/cgi-bin/bdquery/z?d113:H.R.1150:@@@L
I'm sure the rural interests have the same thing to say about urban interests & the House. Which, really, means things are working as intended.
A system which gives representation to rocks and cows rather than to people is undemocratic. That's not just my opinion man, it's a statement of fact. The House doesn't over-represent urban interests it represents them in the proportion that people of the country live there.
Your post smacks of the fallacy of the golden mean fallacy, which is unfortunately a serious problem in the United States today. There aren't two sides to every issue. Often some people are just wrong.
The debate over firearms is a simple example. Urban voters do not see why rural voters cannot simply depend on the police to maintain law and order. Rural voters on the other hand do not see why urban voters think the police can respond in time. The difference is their context. Urban voters are probably right- in the context of a city.
(I am not arguing about firearms, I just thought the debate was an easy illustrative example of how your context matters)
There aren't two sides to every issue. Often some people are just wrong.
I'm sure you are conveniently always on the side that is right? :)
To put the above into simple English: Our problem isn't that we give antibiotics out like candy, it's that we give them to the elderly, people with AIDS, the poor, etc. This massively increases the chance of antibiotic resistance developing.
What can we do about it? To start with, run the numbers, make some cost-benefit calculations, and think about the problem. There may be technical as well as social solutions.
Not thinking about the problem, making it harder for the healthiest people to get antibiotics, and pretending that you are doing something is also a viable option. It's what we're doing now.
Do you realize what you've just said? Are you arguing that we shouldn't have had given antibiotics to people that needed antibiotics?
Also, I don't know how your society is or does, but in our country the poor have a better immune system.
Moralizing doesn't save anyone from gangrene and sepsis and a slow death. It doesn't prevent the diarrhea to dehydration to death sequence. It doesn't do an ounce of good for anyone.
Immunocompromise (poor, sick, elderly, AIDS, etc.) + long-term antibiotic use = Antibiotic resistance.
That equation is death, and we need fixes, not the crap in your comment above.
"Also, I don't know how your society is or does, but in our country the poor have a better immune system."
No doubt you live on Mars or Venus.
God forbid say your dad is sick- Will you go and tell him- 'Dad, you better die for the sake humanity and than take these antibiotics and have you pain reduced'.
If you are poor, will you tell your kid- 'Sorry son, I have to sacrifice you for the sake of humanity, no more antibiotics for you'
The parent comment to yours is correct. Poor have better immune systems, because theirs is trained to handle such situations from their birth than yours and mine which live well sanitized environments and have never been exposed to them before.
That's at least true in a country like India. I'm not sure where you live, poor people dying out of fatal infections is one thing. But its also a fact, some that requires me or you take a sick leave doesn't even bother them.
"Defeating the superbugs" (http://www.bbc.co.uk/programmes/b01ms5c6) has a segment showing bacteria developing resistance to antibiotics.
(http://v6.tinypic.com/player.swf?file=24goih4&s=6) (Sorry about the lousy host; YouTube's content sniffing detects this as BBC property and blocks it.)
They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility)
They drop a bit of bacteria on the zero antibiotic section.
A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans.
It's an excellent, scary, bit of video.
Would infecting someone with a non resistant strain, letting it sit for a while and then hitting them with antibiotics knock the infection low enough that your immune system could wipe up the rest?
The beauty of evolution is not to be stopped by limits, but to run near infinite instances of optimization algorithms over infinite time scales to over come the limits that exist.