> Last year, the chief medical officer for England, Prof Dame Sally Davies, said the rise in drug-resistant infections was comparable to the threat of global warming.
Perhaps I lack proper context, but drug-resistance terrifies me significantly more than global warming. Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes. In contrast, we know what a world without antibiotics looks like, and it's pretty horrifying.
The worst case scenario for global warming is that it's an extinction-level event and civilization ends. The worst case scenario for antibiotic resistance is that people live with the medical uncertainties our grandparents and great-grandparents lived with.
Assuming everyone understands that, it's an interesting case study in psychology as to why the second one might be scarier than the first one.
> The worst case scenario for global warming is that it's an extinction-level event and civilization ends.
I don't buy that. Beginning of a new dark age with a breakdown of civilization and loss of advancements? Yes. Extinction-level event? No.
> The worst case scenario for antibiotic resistance is that people live with the medical uncertainties our grandparents and great-grandparents lived with.
No, actually the worst case is that the antibiotic period breeds superbugs that are both more virulent and harder to kill than those that came before. Antibiotic resistance comes about because of unintentional selective breeding of bacteria. We don't really know what other traits we are unintentionally selecting for. We could potentially be breeding a wordwide pandemic and not realize it. Which could bring about a new dark age with a breakdown of civilization and loss of advancements.
>> The worst case scenario for global warming is that it's an extinction-level event and civilization ends.
>I don't buy that. Beginning of a new dark age with a breakdown of civilization and loss of advancements? Yes. Extinction-level event? No.
Extinction-level event is a scientific term which refers to the rate of extinctions and the associated loss of biodiversity, it doesn't necessarily mean that we all die. And if you think there's a meaningful distinction between "civilization ends" and "breakdown of civilization"... wow, okay.
> Extinction-level event is a scientific term which refers to the rate of extinctions and the associated loss of biodiversity, it doesn't necessarily mean that we all die.
By the scientific definition, I will agree that climate change can be an extinction event. However, I still stand by my assertion that it will not end civilization.
> And if you think there's a meaningful distinction between "civilization ends" and "breakdown of civilization"... wow, okay.
"Civilization ends" is total and permanent. "Breakdown of civilization" is partial and temporary. That is why I referenced a dark age. We have been through civilization breakdowns before, albeit not since we became globally connected.
One thing to keep in mind is that all the easily-accessible sources of petrochemical energy have already been tapped. With our existing bootstrapped infrastructure, we can get at far less accessible energy sources. If we lose that infrastructure, it seems very very likely to me that humanity will never get back to its present state.
> the worst case is that the antibiotic period breeds superbugs that are both more virulent and harder to kill than those that came before.
If anything, antibiotic-resistant strains of bacteria would generally be less fit in a world without antibiotics. E.g., sulfa drugs inhibit DHPS which is involved in producing what eventually becomes formic acid. Bacteria can resist sulfonamides by eliminating their dependence on DHPS, but then they depend on folic acid being present in their environment, and it won't always be available in human blood.
There have been several studies showing that, while this might generally be the case, there are strains of CA-MRSA that show no strong selective disadvantage compared to their wild-type, susceptible brethren.
While Venus' atmosphere is worth study, due to the theory that it underwent some sort of hyperactive climate change a few billion years ago, there are limits to the comparison:
- Venus is about 3/4 the distance from the Sun as Earth.
- Venus has slow, retrograde rotation that leaves a given portion of the surface exposed to the Sun for 56 Earth days at a time.
- Venus has no magnetic field, which causes the loss of water vapor and other light gases due to the solar wind
The currently published worst-case scenarios result in a couple degree centigrade increase until 2100; and in a millenium would turn my hometown into an equivalent of Florida. Granted, Florida itself would likely be a desert after such changes, but civilization would definitely be possible, and it's nowhere comparable to melting lead.
I would bet that most people feel like global warming is a problem for their great grandchildren but antibiotic resistance could actually have a negative effect on themselves.
I'm sure you can find some individual scientists who want to get in front of a camera tot ell us it's the end of the world, just like you can some individual scientists who say it's all crap. I want to see what's in the IPCC's 99.9th percentile of things going wrong.
The last scenario talks about, if I recall correctly, the oceans becoming more welcoming to bacteria that produce hydrogen sulfide. Sorry, I don't remember the details, but will update tonight from the book at home if I remember.
Thumbnail sketch of the event: something (possibly massive volcanic eruptions near in time to a significant meteorite impact) deoxygenated the water enough to cause a substantial marine life die-off. The death of so much marine life in such a short time encouraged sulfate-reducing bacteria, which would have released significant amounts of hydrogen sulfide into the atmosphere. Hydrogen sulfide would have killed plant (and, therefore, animal) life and weakened the ozone layer, exposing the suriving flora and fauna to further UV radiation.
"96% of all marine species[5] and 70% of terrestrial vertebrate species becoming extinct."
There is some concern regarding a risk (I have no idea how big the risk is) that anthropogenic global warming could "tip the scales" of the global ecology towards the conditions that allow for a Permian-Triassic-style cascade.
Possibly because antibiotic resistance is seemingly imminent, and global warming is only a threat over a much longer timeframe. I can't say definitively whether this accurately reflects reality, but intuitively it makes sense for people to feel this way.
Can you cite about that worst case scenario? All that I've heard of global warming consequences is a metre or two rise in sea level, flooding of the related areas + changes in agriculture (currently fertile areas suffer, but northern countries may even increase fertility) i.e., a major pain, but nothing near extinction or civilization ending. It would happen slowly enough (over a century) and require some migration further inland (or infrastructure megaprojects - we can have cities below sea-level, see Netherlands for example), but in the long term we would have the same quality of life, just for a smaller global population due to agricultural changes.
Antibiotic resistance, on the other hand, kills our wellbeing and lifespan by making common medical procedures/surgeries impossible, and does so permanently.
Well human populations have gotten significantly larger, more dense, and we have far more/faster travel. The worst case is a plague that also ends civilization.
> The worst case scenario for global warming is that it's an extinction-level event and civilization ends.
WHAT?? What kind of nonsense have you been reading?
The worst case is coastal flooding, some people have to move inland, and some plant and animal species go extinct. Perhaps some areas become desert (but people live in incredibly hot areas now, so those places will still be habitable).
Other plants and animals will move into the now vacant environment niches. Yes, it's a loss of a species, and yes, a loss of coastal land.
> The worst case is coastal flooding, some people have to move inland, and some plant and animal species go extinct. Perhaps some areas become desert (but people live in incredibly hot areas now, so those places will still be habitable).
The distinction between "best case" and "worst case" is meaningful and I'm not sure you understand it.
What you're describing is a credible best case scenario - basically a very gentle extrapolation of what's happening right now into the future - and not the worst case.
Something like the clathrate gun effect playing out in one of the very bad ways that's hypothesized (or one of the many other hypothesized killers which we believe we've observed in the fossil records, in the earth's crust, in ice, and so on - there's too much to discuss here), and the subsequent effects of that on our environment and later on our politics as the bottom falls out of everything, represents a worst case.
If you just go ahead and decide all those hypothesis are bullshit, well, ok. In that case the notion of a worst case doesn't have a lot of meaning.
Otherwise things like: Atmospheric expansion from heat could increase the drag on the moon causing it to fall on us, could be considered worst case scenario too.
People really really love thinking of all possible things that could go wrong - the more disastrous the better (see: Hollywood; black holes from the super collider; or the atmosphere igniting from nuclear tests). But the earth is rather large, it's rather resilient, it's been through a lot and it's still here and working.
Even if the fact that the earth has survived until now proved it will keep surviving forever (I'm still alive and kicking but I don't think that means I'll live forever), looking at history shows plenty of species going extinct..
Where's your pessimism? Climate change can no doubt be considered a factor in stoking conflicts over resources. It's quite possible we'll start seeing larger and more dangerous conflicts being fought over water, going into the future. This is true regardless of climate change, but climate change and food shortages aren't going to help.
It really only takes one war to escalate too far to bring about a nuclear conflict, which could clearly have significant effects on the viability of civilization.
> Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes.
This is factually untrue. There is a greater scientific consensus on the origins of anthropogenic climate change than there is on the origins of many common diseases.
The climate change trends are very well known, the models that existed 15 years ago have worked extremely well at predicting current climate trends, and the impact in the food supply chain is being well documented, not to mention the myriad other observed changes in ocean acidity, coastal degradation, Arctic and Antarctic surface ice, Andean permafrost, and desertification, just to name a few areas studies by completely different specialties which are confirming the predictions.
Models working well? Frankly laughable. Global temperature rising for almost 25 years at half the central rate predicted by the IPCC in 1990 and no global warming at all for half the RSS satellite record.
Since you mention consensus (is that how to do science? Maybe we should introduce elections for new theories) - but still let's proceed; only 64 (or 0.5%) of 11,944 scientific abstracts published since 1991 state that most of the global warming since 1950 is manmade.
And at any rate, if we want to make it a war or words, at least all the statements that refute your contrarian assessment actually seem to get into the nitty-gritty details of their statistical analysis and comparison between multiple proposed models, instead of the purposeful misrepresentation of the climate denialist that say that there is a single unique IPCC model, when that is laughably false.
For the second statement, again: the meta-analysis performed on the research papers shows a 98% consensus rate.
From personal experience, I've spent 8 years in a University where exact and natural sciences are the main focus, and I have yet to hear a single climatologist, oceanographer, or physicist say that there is insufficient evidence of anthropogenic global warming.
The only people who seem unusually unconcerned about it are geologists, however there is an interest bias in them: A) they don't deny it, but they consider the global timescales and for them another mass extinction event like the one that is inevitably coming is just business as usual, B) there's an extraordinarily high number of geologists working in the mining and oil business and their bottom lines would be clearly affected more than any other industry of researchers.
I agree. I recently had to take antibiotics for the first time in as long as I can remember. Without them I probably would have been in significant/debilitating pain for the foreseeable future. At the same time I happened to come across a really long detailed article about antibiotics explaining about the dangers of resistance and life before antibiotics. If we don't fix this or find an alternative solution we'll essentially be going back in time in our health care.
My concern with this line being drawn is the risk of people drawing a line between them and then transferring the overwhelming amount of skepticism of climate change to such a serious topic as this. All we need is to give the anti-vaccine nuts another reason to shit all over herd immunity.
I get what your're saying (I think) but vaccine != antibiotic. We're not (that I've heard) seeing the emergence of vaccine-resistant polio for example.
Polio? Maybe not yet, but "vaccine resistance" isn't the same thing as antibacterial resistance. Antibiotic resistance is generally created through contact with the antibiotic but stuff like polio, measles, mumps, and rubella just need an unvaccinated host coming into contact with vaccinated people long enough. Once the unvaccinated host's disease mutates enough (and it never stops mutating), it will start jumping to vaccinated hosts whose immune systems no longer recognize the threat as one it has prepared for by the vaccine [1][2].
Oddly enough, I can't find a single reference to farms using antibiotics as a growth enhancer in this article. Isn't that the single biggest source of antibiotic-resistant bacteria?
Agricultural use of antibiotics has definitely been an issue, but perhaps they're trying to state narrow conclusions in the name of scientific rigor. Fortunately, in the US at least, the practice is being discontinued. http://www.fda.gov/animalveterinary/guidancecomplianceenforc...
In California, though, there is much stronger action stirring in the state legislature, although it will need far more public support to become a possibility:
From what I understand, it isn't usually used as a growth enhancer (I may be wrong) but used because of the way livestock is maintained. When you have cows being kept standing in one place to maintain lean meat, they develop infections more so than being able to walk somewhere other than their own feces. So to keep production up and infections down, the livestock gets pumped full of antibiotics.
Huge amounts of ionophores [1] are used as feed additives. That class of drugs is not used therapeutically in humans. I think other antibiotics are also used quite extensively as feed additives, but I'm less clear on them. If you search on 'vancomycin feed additive', you see discussion about replacing it with other drugs.
There are health benefits to the animals (the drugs prevent 'bloat'), but they also increase the weight gain per pound of feed, which the farmer (rancher? lot manager?) is going to take into account.
BTW, you can already see a shift in the industry from calling out the antibiotic use as a growth enhancement, to calling it a preemptive use to prevent sickness. It just happens that when you collect animals together in high density feedlots to fatten them up - it does create increased illness rates - in addition to being a vector for breeding and spreading resistant bacteria.
So the label has changed, but the end effect of pouring tons of antibiotics into conditions that breed resistance is still there unless we change conditions in feedlots.
One alternative to antibiotics that may work, but will have a tremendous difficulty in clearing the regulatory burden for approving new drugs and medical procedures, is bacteriophage therapy.[1]
Nobody's going to fund or approve this in the West anytime soon:
- phage therapists often use cocktails of phages to treat their patient. This type of treatment isn't even on the FDA's map - it even takes years for compounds of conventional drugs to be approved.
- phage therapists often prepare customized phage cultures to treat a specific patient's infection. The FDA would likely view this a a crime and prosecute anyone trying it.
- phage therapies have been around for over 100 years and are likely unpatentable. No drug company will fund R&D on the technique and no venture capitalist will fund a scrappy startup.
For those with a computational/hacker background wanting to make a difference:
There is actually a lot of opportunity in the Computational Biology/Drug Development/Genomics space, with the caveat that it is a very difficult field (especially for company creation). It's a lot easier for CS folks to build another no-SQL database than it is to build a ML framework for, say, cancer prediction, but the opportunity is there. A lot of folks in this space come from the bio side, and teach themselves programming. Very few folks come from the CS side, and partner with the biologists. As a result, there is a giant gap between what is possible for a computer scientist and what is currently being executed. The state of the art in this space will probably make you all very sad.
I will pay $$ for engineers to work on this:
I have a side project working with an academic lab to develop a new antibiotic to target drug resistant beta lactamase (the primary protein associated with drug resistance) using a relatively novel computational approach. Sadly I've been distracted by my primary job, but if you are interested let me know. I am based in SF.
Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing.
Therefore, much like the potentially developing WW3 in Ukraine, or Ebola outbreak in Africa, or rape culture in India, this kind of news is fairly useless. It just creates negative feelings with no positive outcome.
I'm happy to be convinced otherwise - what can I do about this?
The best thing you can do is keep informed, and keep others around you informed. Many people don't realize this is such a rapidly progressing issue. In fact, many people may not even know that they are improperly taking their Antibiotics and what the side effects are to doing so.
If more informed I feel like the public could do a bit better at turning down Antibiotics when they aren't necessary, and using them properly when they are. Just that action would go a long way.
Edit- I would also like to add that a lot of people don't realize just how easy it is to get an infection, and education could go a long way in keeping it from happening in the first place. It reminds me of that guy on reddit with the horrible case of necrotizing fasciitis that he ended up with after retrieving a football from a koi pond. His day by day imgur chronicle was both interesting and horrifying.
It doesn't have to be that way, and waiting around for "someone else to handle it" will likely lead to a Tragedy of the Commons.
Call your representatives [US: 0,1] or regional government representative (I just called my senator, and on hold for house rep now), tell them we need an emergency crash program to develop new, tightly-regulated antibiotics so that infection doesn't become the leading cause of deaths in 2025. Because it takes years and billions to develop new antibiotics, this is something companies will not pursue on their own initiative. If not, it'll be a return to the 19th century. Good luck with that.
You're not going to have new antibiotics without biotech or pharmaceutical companies helping.
The government needs to provide incentive for antibiotic research, right now regulatory and reimbursement issues are making the therapeutic area very unattractive.
Pressure your government (where ever you may be) to make responsible use of antibiotics a priority.
The misuse that terrifies me the most are antibiotics used on livestock. Particularly the antibiotics that are also used on humans. In my opinion antibiotics should not be used as a growth promoter and only used to help sick animals.
> should not be used as a growth promoter and only used to help sick animals
The issue is that a lot of animals get sick from being crammed together in small areas, unable to move, while living in their own feces and urine. If we regulated animal treatment better and required certain living conditions for animals they wouldn't get sick nearly as often and wouldn't need nearly as many antibiotics.
As it stands, regulating antibiotics to be used only on sick animals wouldn't change much since an incredibly large percentage of livestock are often sick (as a consequence of living conditions).
I don't eat meat or consume animal-derived products for this reason. This is where the next pandemic is mostly likely to originate, and it's completely preventable.
Unless you also avoid meat for other reasons, wouldn't it be better to eat meat, but only from those farmers that raise livestock in humane, sustainable conditions (organic/free range/...)? That would increase competition and support their business models.
New mechanisms of action are needed, more specifically, mechanisms that evolution cannot biologically defeat. Consider an agent like bleach, 99.99% effective because the makeup of a cell does not really permit it to protect against such a caustic agent. Clearly bleach can't be used as an antiobitic but I use it to illustrate the point that a evolutionary-unlikely antibiotic mechanism would be worldly profound.
You're right, but here's the problem: things that are robust to evolutionary change tend to kill everything (e.g. chlorine). There's a tension between finding targets that are specific to an organism, but well conserved, so that the organism can't simply evolve away from the specific threat.
This is really the alpha and the omega of antibiotics and antiviral research: finding the specific lethal target that can't easily be changed. It's damned hard, and it's why most of our antibiotics have been generated by nature, not by rational design.
I used to do antibiotic drug discovery for a living. You hit the nail on the head.
I'll go so far as to say that we've found all of the important bacterial targets (e.g., ribosome, peptidoglycan, DNA gyrase & a few others).
That's probably an overstatement....but I (and many others) spent a large amount of time/$/effort looking for antibacterial targets that might have been overlooked. In the end, my conclusion was that we've already found the softest, most vulnerable targets within bacteria and we've known about them for a long time.
What to do? I think 2 things. Find new ways to hit the existing validated targets (people are doing this, but it ain't easy). The only other "idea" that I've had (and I'm sure others have had it, too), is that maybe we can find multiple "weak" targets that, when hit in combination, are just as good at inactivating a single "thing" like the bacterial ribosome. But that's probably even more difficult than finding new ways to hit well-validated targets.
It's easy to kill bacteria, viruses, cancer, you name it. We have lots of tools that can kill them, from guns to flame throwers to acid. The trick is killing them without also killing the patient, as you say.
The primary source of antibiotic abuse is in farm animals.
Do you really want to help? Start eating less meat, and tell others to also do so. Tell them why. Tell them to also tell others. When there is less demand for meat, then there will be less land devoted to animal feed/grazing, and more to food crops. Less animals that can be infected, less antibiotics used, etc, etc.
Want to really help solve it? Don't eat meat. Get others to stop eating meat.
Invest in faux/lab-grown meat companies. Disease free meat can be grown. We just need to make it profitable.
Honestly, this is the future. Farming like this is unsustainable, not only for the antibiotic reasons.
(I'll spare everyone the ethical/transhumanist discussion.)
red meat is high in iron and anemia is not nice.
of course there are other sources of iron, i'm just saying that stopping eating meat should go with balancing diet.
If your doctor is prescribing you an antibiotic, you can ask them what the pros and cons are of taking it. If you are willing to deal with the cons, then maybe don't take the antibiotic. Usually, the con will be that you feel sick for a bit longer. Note though, that you might need them to get over whatever it is you have.
"People were generally aware of the link between overuse of antibiotics and increased resistance. Only 8% of respondents did not agree that if antibiotics are taken too often they are less likely to work in the future. But many people (43%) incorrectly believed that antibiotics were effective in viral conditions."
I will echo lucky's sentiment - staying educated, and educating others around you, goes a big way. I know people very close to me who still believe it's okay to stop taking antibiotics the moment they feel better, rather than finishing out the entire prescription.
I'd like to believe that buying meat / other foods that aren't treated with antibiotics could make a difference as well, but I'm not sure how much impact that would have.
>> "Whilst I totally appreciate the seriousness of this, I still don't get what exactly I can do about this. Most likely, nothing."
I think you can help by informing others. If you know a family member not completing their course of antibiotics for example explain to them why it's so important.
Not sure why swombat got downvoted, he makes good points. Heck, once in a while, an HN submission for along the lines of "Why reading news is harmful and why you shouldn't read it" goes by, and it gets upvoted a lot.
What can the general public do about this? It's not like I can go to my family physician and tell him to use less antibiotics (he already doesn't; I'm in the Netherlands), and expect to make any kind of meaningful difference. This is one of those "tragedy of the commons" kind of problems that can only be solved if everybody cooperates.
Donate to research groups that are working on ways of controlling bacterial and viral infections that are a step beyond the present status quo. Things like DRACO [1] spring to mind. Present day fundamental (as opposed to translational) biomedical research is very cheap in comparison to the state of things even a decade or two ago. Small fundraising groups can make a big impact now.
Be educated about it, and educate others. Eventually, you will be called on to vote on something, and some intrenched interest will try to convince you that it is an encroachment of big government on the sovereignty of job creators. Good luck trying to teach them then.
That's true for pretty much all significant news. And it's not like we are helpless, it's still possible to invest in new antibiotics and strictly control the ones that still work.
I think to make a dent in this problem we need to change many aspects of our culture and how we live: 1) that any annoying problem should have an immediate and rapid solution so that we can get on with our lives, 2) that we as people need to live in a bubble ecosystem from the rest of the natural world.
1) I stopped taking most medicines awhile ago because I realized that by relying on symptomatic relief, I wasn't actually listening to the needs of my body. Now when I feel a cold coming on, I start sleeping at 9pm, eat healthier, and reduce stress levels. Instead of popping a pill, I've learned to recognize that I'm deviating from "healthy" activity and had better get on track. The result? I haven't been sick in years and years, and am probably overall a more healthy, less stressed out person.
2) I often wonder to what degree language affects perception. Like the word dirty having such a negative stereotype yet so associated with dirt (i.e., soil). I feel like we often want such high levels of sterility that are just absurd, and do more to harm us in the long run. As part of a project, I interviewed farmers who said food safety experts are so draconian they expect cannons that shoot into the air to prevent birds from flying over with the risk of droppings. One food safety inspector commented that the farm was too "dirty." Can you imagine? I understand we don't want to get sick, there are bad things in the world, but I think we're pushing too far into the other end of the spectrum.
The threat we now are facing with these resistant strains of bacteria are the main reason I got interested in the Public Health field. I am only in my second semester, going part time, but look forward to trying to address the growing need for infectious treatment "reform."
We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
Given the amount of antibiotic resistant bugs that live in hospitals, I'm highly skeptical that longer hospital stays will result in decreased colonization with resistant species.
Antibiotic resistance is a fact, what else can you expect given the game rules. What is less well known is that majority of people do not need antibiotics anyway and that majority of those who were taking them probably didn't need them too. Advice that recommended AB's before for stuff like otitis, helicobacter infection or even common cold (given for this disease because of opportunistic infections) is now changing without any problems, if anything, for the better.
AB's should be saved for those few moments in life where you really need them and is not something you want to do every few months like majority of people, particularly kids.
There are far better ways to strengthen your body and immune system without risks that are overwhelming with AB's (which are way better known today after we have some bits of microbiome) - nutrition and supplements. Even measures like using viruses as antibiotics are probably better then popping AB's like candies.
This news is probably beginning of the "next big big pharma thingy" that will come to rescue and will typically, yet again, use inappropriate tool for the job. The only good that will come out of it are probably not going to be, however, lives saved but science advancement.
Here is a link to the World Health Organization media release[1] about the new WHO report, which links to a fact sheet summary[2] of the findings, and to the full report.[3] What's new here is the comparative data from different countries. It has been known for a while that multidrug-resistant tuberculosis is a grave problem in India,[4] for example, but the new report makes clear that antibiotic-resistant microorganisms that cause major human disease are present all over the world.
Some of the other comments posted here ask, well, what can we do about this? A submission to Hacker News from 189 days ago linked to a PBS report about the views of a Centers for Disease Control and Prevention epidemiologist in the United States[5] who advocated specific policy changes, some of which have been adopted since then. The discussion of that submission (including one of my highest-karma-ever comments[6]) provides more perspective on some biological evolution issues that are being brought up again in today's discussion here.
In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance. Either eat mainly vegan or spend the few extra dollars to buy meat that isn't gross. Remember, it is MORE EXPENSIVE in the long run to buy that cheap meat. When you have a routine infection that can't be cured with antibiotics, the hospital bills will be far more then the few dollars you saved. Eat less meat. Oh, and you'll massively reduce your carbon footprint as well, and you'll use less land and water, and you'll be healthier (if you cut out red meat). It really is a no brainer.
You make a bold statement in a thread that is based on a news report passing information on a new World Health Organization report. This thread includes a link to the full report,[1] and the report is a document with a good table of contents and is a searchable .PDF document besides. So you and everyone here can check my work when I say that your statement
In America, the number one thing you can do is stop eating factory farmed meat. That is a huge contributor to antibiotics resistance.
goes beyond the available evidence. But props to you for saying "In America," in that statement, because it is plain that in some other parts of the world, where the problem of antibiotic-resistant bacteria is most severe, the main cause of the problem is misuse of antibiotics in human medicine rather than meat production. (India especially is an example of that kind of problem.) More details of course can be found in the report. Methinks the statement is based just a bit too much on propaganda by vegan activists. I encourage everyone in our community of thoughtful discussion here to check the fine article and the linked references before radically altering their personal diets.
In his book "Eating Animals" Jonathan Safran Foer dedicates a lot of time to this. Remember, he is not a vegan. This shouldn't be important but there are few groups that get more irrational hate than vegans. He cites multiple studies and if you are really concerned it's a quick read. One study showed how effectiveness of a specific antibiotic was at ~99% and then only 10 years after it being introduced into livestock feed the effectiveness shot down to 80%. So we went from about a 1 in 100 chance of it not working to around 1 in 5. That is a massive and terrifying difference. I urge you to read more. Clearly this is an issue I care about. I firmly believe this is the most likely cause of my unnecessary death. Far more than war or terrorism. Protect yourself, your loved ones, your children, your grand children. Stop eating meat that is fed antibiotics.
"few groups that get more irrational hate than vegans"
This, like most stereotypes, is built around a core of experience, and then expounded. With a lot of vegans, its often not that they're wrong about what they say, its how they convey it. This came up today in another HN discussion on smoking as well. Its ok for them to not like things, just don't be a jerk about it.
On topic, while I agree that we may very well all die, this can also be looked at in a different perspective. When the antibiotic in question was first introduced, it had effectively a 5/5 chance of working. After ten years, it then had a 4/5 chance of working. Like most power laws, in maybe 10-20 years, it will have a 3/5 chance of working, ect... with a decay rate that slows with time.
Like all evolution, antibiotic resistance is driven primarily by the rate of survival and reproduction in the population. If resistance against AntibioticA is a strong predictor of survival (like when its newly introduced, and highly effective), then lots of bacteria will develop the immunity. As it gets used less, due to limited effectiveness, then it will become less of a predictor, and less bacteria will multiply with that as a trait.
Its not like evolution is "free" either. Often times, if an organism becomes heavily specialized in fending off one threat, then they leave themselves open to invasive species or perpendicular threats. I firmly believe that we have intelligence (I really do) and that while natural evolution is powerful, we already have many of the tools necessary to understand, and adapt along with it. We just need to be able to understand why they're changing, how they're changing, and how we can exploit that process for our gain.
I went vegan for a few months and abandoned it because everyone else was unable to have a conversation with me about anything other than meat. Everyone felt an unprovoked need to justify their eating habits to me. Social groups were uncomfortable picking a restaurant without asking if I was okay with it even though I would much prefer to just not eat and hang out with people. Without any comment from me, my eating habits became a constant source of discussion and concern.
There just isn't any way to be politely vegan. Everyone else automatically assumes that you care why they aren't.
You stopped being vegan because you wanted to. Not exactly crushing social pressures. Been vegetarian or vegan for 17 years, it is pretty easy to go have a meal with friends and be polite.
I have a feeling that the social context for veganism is extremely different, in a way that can be difficult to imagine, across different social groups (different cities, age cohorts, ethnic groups, social classes, religious backgrounds, etc.).
Most of my friends are well-educated secular urban middle-class 30-year-olds who are somewhat left-wing by U.S. standards. Most of them know dozens of vegetarians and at least several vegans. On average, they seem to view my veganism somewhere on a spectrum from "mildly eccentric" to "extremely admirable".
When I go to other countries, I'm more likely to meet people who are surprised that I'm vegan. Some of them say that they didn't know that that was possible (!) or that they have never met a vegan in person before.
I have also met some vegetarians and vegans, mostly from immigrant families, who said that they had to hide their dietary practices from their families because their families would be so upset about it. (When I went vegetarian 26 years ago, my grandmother expressed a fair amount of concern for my health, although she'd at least met other vegetarians before.)
I think it's easy to generalize from our experience about how other people "normally" react to particular dietary practices, but our experiences with people's reactions (positive, negative, confused, hostile, indifferent, curious) may be a narrow local view.
One time I had a discussion in Latin with a Catholic priest who worked at the Vatican. (I don't speak Italian and he doesn't speak English, so Latin was our best common language.) When he learned that I didn't eat animals, he cited Genesis 9:3 as a reason that vegetarianism was faintly ridiculous. It took me a minute or two to understand that he was absolutely, completely serious.
Well, I dunno, maybe you run in different circles than I do-- I have some good vegan friends, and have been vegan for periods in my past. I've had a lot of good times and meals with vegans.
But I also live in a rural Texas town, and when I was in college, yes, there were very real social pressures not to be vegan, from family to social groups.
It is easy enough to just discount these pressures, but like most choices that marginally impact the folks around you (what are you really going to order at the steakhouse where you've gone for your brother graduation? Oh you're just gonna not eat? "How fucking rude", says your uncle.) these force are real and impact folks choices.
Not eating meat is easy to understand. What throws a lot of people off is vegans, unlike vegeterians, not eating eggs and cheese. That's really a doozy. It just doesn't make sense (and not that it implies that vegans care and non-vegans don't).
Cheese is made from milk. Milk is produced by mammals that have recently given birth. Cows are not an exception. Every dairy product you have consumed is built from milk stolen from a calf.
That calf is immediately separated from its mother, and usually shipped straight into a veal crate. If you consume dairy you support this.
The mother is milked for as long as she can be, but eventually she'll need to be impregnated again. This is a traumatic experience, but it's not like animal agriculture industry tries to make it better. The devices they use are called "rape racks" in the industry.
If your vision of dairy production is a straw-hatted farmer sitting on a three-legged stool milking Ol Betsy you're delusional. But you're also pretty common. Most people have the same sort of view of animal agriculture that non-technical people have about the Cloud.
Some people are vegans for health reasons, based on books like The China Study. Others just think we don't treat our egg layers and dairy cows very well. (I'm not a vegan, and don't want to get into a debate over whether they're correct. I'm just saying they have their reasons.)
Its ok for them to not like things, just don't be a jerk about it.
When I was a vegan, I would typically mention that fact, and then also add, "but I don't mind if you eat meat and I won't criticize you for it". Lots of people didn't believe me at first, having been on the business end of a lot of criticism from "well meaning" vegans and vegetarians.
>This, like most stereotypes, is built around a core of experience, and then expounded.
No, like other stereotypes, it is wrong, and mostly perpetuated by the same myth-engines that power urban legends.
>With a lot of vegans, its often not that they're wrong about what they say, its how they convey it. This came up today in another HN discussion on smoking as well. Its ok for them to not like things, just don't be a jerk about it.
I've had people go off on me just for saying that I was vegan. It has nothing to do with what, how, when, or why you say it; it has to do with what people hear.
you've really never heard these claims before? they are widely accepted as fact by now. There are many sources, just take 10 seconds to google it. "its better for the environment to eat a salad in a hummer than a cheeseburger in a prius"
I think you either misread my comment or I wasn't clear. Obviously you are correct, it's not that your personal resistance will increase, it's your actions that contribute to the overall resistance.
Your comment was clear, but logically problematic.
> When you have a routine infection that can't be cured with antibiotics, the hospital bills will be far more then the few dollars you saved. Eat less meat.
It is like saying don't drive a car, because in the long run it will cause you to die of global warming.
Eating factory farm meat contributes to the cultural acceptance of such goods being produced in the way they are, that produces bacterial immunities to antibiotics due to the mass utilization of factory farmed meat.
And:
Driving gasoline powered automobile contributes to the cultural acceptance of such goods being produced using the engine technology they are, that emits greenhouse gases that cause global warming due to the mass utilization of gasoline powered vehicles.
An individual won't have a significant impact on either, but if you aren't swayed (the guy reading this on HN) we are completely fucked, because the community here is supposed to be one of the more rational and long term considerate groups of people. To expect average joe burger flipper to stop eating meat and driving cars because of the long term macroscopic ramifications of their usage is hypocritical if we don't practice what we preach.
He's advocating that you stop eating the meat because eating the meat supports the producers of the meat who are deciding to overuse antibiotics irresponsibly.
I never understand how "Stop eating factory farmed meat" means you have to "eat less meat" - why not just eat better sourced high quality meat?
It seems especially strange in a place like HN where you'd think that supporting the alternative grass-fed, non-factory farmers would be the entrepreneurial thing (and encourage more farmers to do it).
Meat is not the problem. The quality of the meat is. There are ways to solve that problem outside of eating less meat.
Right, I agree. I was merely responding to the parent's assertion that people just go ahead and eat as much meat as they do now but make it higher quality.
I think in this case, it's the quality of meat that's the issue. But there's another very important issue with meat: it's one of the most inefficient forms of sustenance. Animal agriculture is the single largest source of greenhouse gases - larger than the entire transport industry, including planes. It takes 11 times more fossil fuels to create 1 calorie from animal sources than from plant sources.
I'm sorry for linking to a PETA page (especially since it's a very buzzfeed-y one), but [this page][1] has links to a lot of good sources.
> I never understand how "Stop eating factory farmed meat" means you have to "eat less meat" - why not just eat better sourced high quality meat?
I do, but it means I can afford to eat far less meat. Like, twice a week. Which is fine, and also I enjoy it more[0].
Organic chicken is stupid expensive here (compared to pork or beef) and so is bacon (compared to factory bacon, which I agree is in fact stupid cheap). So I get mainly sausage and other cheaper cuts like pork belly.
But if you have the money to spend, go for it, vote with your dollars or something? :)
[0] unlike organic vegetables, the flavour difference of organic meat vs factory meat is (to me) extremely noticeable.
In practice, when it comes to antibiotics you are correct. But lets be honest, quality meat isn't always an option, especially going out to a restaurant, so the solution in reality is to eat less meat. There's also things like land usage, water conservation, carbon footprint, health, etc... there are a lot of reasons why you should eat less meat if you live in a first world country.
This is completely incorrect, nations that have halted agricultural mass application of antibiotics have seen a huge decrease in antibiotic resistant bacterial present in the animals.
This is because antibiotic resistance has a high biological cost to the bacteria, and they get out competed by bacteria without that adaptation when antibiotics cease being present.
The bugs are very easy to kill - when not in a person.
The bacteria are also less competitive, so all you have to do is stop using the antibiotics and you will make it less likely for them to survive in the hyper competitive farm waste.
As long as you stop making them the resistance will die off as "not worth it".
It's more expensive to society, not to the individual. And that's really debatable because the cattle are going to be fed antibiotics regardless whether you buy meat or not.
I have heard of tick bites causing an allergy to beef, and I've heard of people having reactions to meat because of a pre-existing allergy to the antibiotics used during production, but I have never heard of someone becoming allergic to an antibiotic due to consumption. That seems rather improbable, if not entirely impossible. Also, I can't imagine any medical professional claiming to possess the ability of pinpointing an instigator for the development of a penicillin allergy, because the cause is unknown.
I hate to be so negatively argumentative, and I especially hate having to defend McDonald's, but I honestly think you are trying to make an association that does not exist based on information that was not factual. Or you're trolling, in which case congratulations are in order for getting me to type all of this.
Sorry, my first post was poorly written and I should have spent some more time on it before I hit post.
This is an assumption I have which is in no way scientifically proven.
I read an article a few years ago about McDonalds drastically reducing the amount of Penicillin used in its cows which lead me to believe that my consumption prior to that may have caused it.
I may have just become allergic to Penicillin for no reason but I do find it coincidental.
It wasn't just poorly written, it was pure FUD bullshit.
We don't yet know all of the ways that allergies are "activated" but we've yet to record an antibiotic allergy developed from consuming meat. Antibiotics get metabolized by the organism they are given to, they don't get magical protection from oxidation or other chemical processes, and they sure as hell can't survive the insane heat meant to kill all living organism on it when it is cooked (especially at McDonalds).
Some allergies are known to be caused or exacerbated by repeated exposure, e.g. tomato allergic contact dermatitis becomes common in people who handle or prepare tomatoes for a living.
Although parent's claim is difficult to confirm, it's not impossible.
Eczema is the reaction to exposure of a substance for which the immune system is intolerant, but exposure is not the cause of the intolerance. As I explained in more detail in my other comment, over exposure to the tomato may stress the immune system to the point that symptoms become severe, but the tomato is not creating the original intolerance.
> I have never heard of someone becoming allergic to an antibiotic due to consumption.
It may be rare, but I don't think we can dismiss it just because it's rare.
Seems to me the salient question is whether any of the antibiotics that are used on livestock are even related to penicillin. I don't know the answer, but if they're not, that would certainly cast doubt on the claim.
When I say improbable, I don't mean that it can happen but is rare. I mean it's improbable (or impossible) for it to ever happen at all, because that's just not how the body works. Allergies aren't developed by ingesting the item responsible for the reaction. The body doesn't see penicillin for the first time and arbitrarily decide to say "screw it, I'm out."
If you have a noticeable reaction, it's because your immune system mistakenly (or properly) identifies the ingested substance as harmful and is being overzealous about fighting it. But how your immune system will react to any particular foreign body is already established prior to ingestion.
So, could someone develop a more severe reaction after such prolonged exposure and stress being put on their immune system? No doubt. But the over exposure did not create the intolerance, it just temporarily exacerbated it.
All that said, I just looked up whether antibiotics from the penicillin family are used in livestock. It seems that regulations require any poisons, drugs or other contaminants with the potential to be passed to the consumer through ingestion, must both be a relatively low dosage and completely out of the animal's system prior to slaughter.
In general I'm not aware that we know all the causes of allergies.
> It seems that regulations require any poisons, drugs or other contaminants with the potential to be passed to the consumer through ingestion, must both be a relatively low dosage and completely out of the animal's system prior to slaughter.
What do you think "completely" means? It doesn't mean zero or even "undetectable"; it means there's some threshold level, anything below which is considered acceptable.
If you trust the people who are setting those thresholds, you have a lot more faith in the system than I do.
That paragraph doesn't contradict me. The contrast in percentages is actually showing the true number of people with latex allergies. The allergy presents itself more often in healthcare workers because the prolonged exposure is exacerbating an existing mild allergy. This causes the immune system to produce and maintain a greater amount of the relevant antibodies, at which point a latex allergy test will return positive. The latex itself, however, is not what caused the allergy to develop in the first place.
As for the livestock regulations, I completely agree with you. I'm still going to eat steak every day, but I agree nonetheless.
It can happen, but increased presence of symptoms is not the same thing as developing an allergy. Exposure does not cause a nonexistent allergy to become existent, it causes a mild allergy to become an aggravated mild allergy. The allergy was already there, it just wasn't presenting noticeably until exacerbated by prolonged exposure.
For the person suffering from the allergy, this seems to be a distinction without a difference. The allergy wasn't severe enough to notice, and then later, it was.
This is really quite frustrating. This whole argument is about you clinging to this pedantic distinction between "causing" an allergy and "exacerbating it to the point that you could notice it", as if that were somehow critical, when it has no practical impact at all.
As far as I can see, nothing you've said has had anything to do with the original hypothesis. 'sschueller said "I became allergic to penicillin because of U.S meat." We have no idea whether that's true -- as 'sschueller him/herself subsequently admitted -- but I still don't see that we can dismiss it out of hand. Your argument amounts to saying that the claim can be dismissed because it was improperly phrased. That's pointless pedantry at best.
I'm sorry that you're frustrated, but it is your own fault for apparently misreading nearly everything that has been said. I plainly described relevant (and true) reasons for why sscheuller's statement was not only false but physiologically impossible. Everything I said is directly related to his statement. So your insistence that I've made no points relevant to the topic at hand is foolish, at best.
The thing you're having trouble accepting is that we actually do know that his statement is false, because it's literally not possible, because that's not a physiological thing that happens. I don't understand how many different ways I can explain this to you.
It's not pedantry, it's a pretty important distinction. Spreading the disinformation that exposure can cause the development of allergies has potential to create confusion and even be harmful to the public. Take, for instance, the anti-vax movement. It was started by small bits of disinformation and ballooned into something with deadly consequences.
You are having a semantics argument that doesn't exist. I am explaining physiology to you, which you are not accepting. So you're right, this has been pretty pointless. But that doesn't make you any less wrong.
Read my previous post again. You missed the part where I acknowledged the distinction you think I'm not getting.
Let me say this as clearly as I can. For the purpose of setting public policy on how much of what antibiotics may be used in livestock, your precious distinction is of no consequence. It doesn't matter whether exposure to low levels of penicillin, or related compounds, causes a truly de novo allergy, or merely exacerbates an existing one that was so mild as not to be noticeable. The sufferer does not know the difference, and from the point of view of public policy, either outcome, in significant numbers, is unacceptable.
If you have a counterargument to this point, make it. Otherwise I will take it as agreed.
This is really starting to feel like a Twilight Zone episode. I'm going to chronologically boil this down for you.
1. Person makes claim that an allergy was developed by ingesting meat.
2. I inform claimant that is not possible.
3. You declare that it is.
4. I debunk this declaration using well known and understood science.
5. You deny this science, while providing evidence that backs up the science.
6. I try to explain science again.
7. You change your stance from "it's possible" to "okay, it's not possible, but there's no difference."
8. I explain to you why there is a difference.
9. You not only disregard that difference, but all of a sudden decide that we're talking about public policy instead of debunking the original claim that a person developed an allergy by ingesting meat.
Do you really not see how unreasonably difficult you're being? You have twisted things at every turn.
My entire point from the beginning has been that allergies are not developed through exposure, which is a very important distinction. Just because you, personally, don't want to believe that the distinction is important, doesn't mean it isn't. Disinformation is always harmful, and I find your indifferent attitude toward perpetuating disinformation quite disturbing.
In my opinion, this is a "No true Scotsman" fallacy.
You are claiming that someone who develops an allergy must have had an allergy to start with. But the only thing that backs up this claim is your own definition.
I would suggest that allergy ought instead to have a clinical definition: if you can observe symptoms, you have an allergy. This definition is the only one that makes practical sense: if you could not observe symptoms, why would you care? The immune response definition that you give does not match up well with what medical professionals would call allergies - not at all.
It's clear that repeated exposure can cause an allergy in this sense, and you have presented no valid argument to debunk that.
So every few weeks we get these news but this isn't reversible anyway i guess. Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ? How likely is it that new antibiotics will be developed ?
By reading articles like these it sounds like we are facing a massive increase in deaths from illnesses, yet the general public doesn't seem to care much. Genuinely curious.
People are already dying from simple infections - about 25,000 people per year die in europe from anti-biotic resistant infection.
> The European Centre for Disease Prevention and Control estimates that antimicrobial resistance (AMR) results each year in 25 000 deaths and related costs of over €1.5 billion in healthcare expenses and productivity losses.
Does this basically mean a lot more people will die from simple infections starting 1-2 years from now ?
No, the problem is not that severe right now. In fact, some of the antibiotic resistant infections have decreased over the last few years.
This is something we need to worry about 5-10+ years from now. It is inevitable that bacteria will become resistant to current antibiotics. The only way to keep ahead of them is to create new antibiotics.
Exactly. But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug. This is a "going to the moon" type thing that needs to happen if we intend to survive. Because that's what's at stake.
(1) You say it can't be left up to market economics, but two of the big hurdles to new antibiotic development are government regulations: (I) In the past the FDA was not very responsive to the resistance problem, if you had a new drug, you went through a normal review; luckily they have changed their approach recently (II) The way that Medicare and Medicaid pays for antibiotics doesn't encourage investment in novel agents
(2) I have to push back on the "going to the moon" type thing. This is more like we've already been to the moon and we need to go back and do something different. Drug companies know how to develop new antibiotics (not to say it's easy, but they have ideas) and they know how to get them approved. There are new discoveries all the time. We just need to create an ecosystem that encourages further investment.
Edge cases. The big picture is that it's not happening fast enough, which is why the government will need to step in and will need to assume a leadership role to push hard on this.
That's not going to happen. The gov't will change the regulatory and reimbursement environment but the heavy lifting will be done by academic and pharmaceutical researchers.
>But because of the difficulty, time and capital requirements, this is something that can't be left to the market economics. It will be too late by the time we need them because of the years it takes to develop a single new drug.
Isn't this exactly what people used to say about the food supply?
Nope. It is what it is: capital-intensive research that is hard and it takes a long time to come up with a molecule that will stop an infection without killing or disabling the patient. That can't be done last minute like in the movies.
FYI: One of the last-ditch antibiotics (I forget the name) has a side-effect of permanently damaging hearing. I have to basically yell at 95 yo grandmother for her to hear me. :)
Scientists worry about the cuts to NIH funding, but the cuts to pharmaceutical research are ten times more worrying - who is going to develop the compounds to replace the current set of antibiotics when they have become useless? Wall Street is entirely unequipped to deal with this question; there are things that cannot be bought with money or at market, and scientific progress is one of them.
Pfizer got out of antibacterial R&D a few years back.
And I have to take issue with your comment "scientific progress can't be bought with money". What do you call all the new drugs that have been produced in the last century? It wasn't done by the government. Yes, basic research funded by the NIH advanced basic science, but it didn't put those pills in a bottle.
"who is going to develop the compounds to replace the current set of antibiotics when they have become useless" - Academic science. Most of the basic, foundational research in clinical medicine is done by academia, not the pharmaceutical industry.
I have long thought that humans (at least those living in the first world) had developed civilization to a point where natural selection was not really operating anymore. We can shelter ourselves, feed ourselves, and cure illnesses and injuries so well that almost all of us live to reproduce and raise our children to the point where they can take care of themselves. We haven't even had a large-scale war in the time that most of us have been alive. But on evolutionary timescales, we've really lived this way for only the blink of an eye. So maybe I'm wrong. This is a reminder that we live in a larger ecosystem that we really have a lot less control over than we might think. Nature has a way of keeping things in balance, and it's never pretty.
Yes; there are perverse disincentives built into the profit mechanism underpinning the commercial pharmaceutical industry.
Patents on antibiotics last no longer than on any other type of medicine (20 years, minus the substantial time taken to test it, jump through regulatory hoops, and bring it to market -- typically 8-14 years). The cost of meeting those regulatory prerequisites is measured in the hundreds of millions of dollars in the USA alone -- more if you want to get a product license everywhere worldwide. So you need to earn back several hundred million bucks in profit in a single-digit period of years ...
But antibiotics are unprofitable. A typical AB course lasts 5-14 days after which the patient is completely cured. Compare with antidepressants or ADHD drugs -- where you get a customer for life! Which would you invest in, if you were in that business -- a product 10% of the population will use annually for a week, or a product 10% of the population will be hooked on for life?
It's not a coincidence that research into new antibiotics ground to a halt in the 1970s around the time that the regulatory barriers to entry rose so high that small and medium scale pharmaceutical companies were frozen out of the business and the surviving operators were the large conglomerates.
I saw a documentary in which it was said that another disincentive to antibiotic research is that its very use causes its effectiveness (for the general population) to reduce, due to antibiotic resistance. So that it would eventually stop selling.
It is not so in the case of medicines for BP, diabetes etc.
We may eventually need to have a compulsory hospital stay (or something else) for antibiotic treatment so that a patient treated with an antibiotic does not have any leftover resistant pathogens to transfer to the public.
I think it's also occurring in part because of doctors who are prescribing aggressive and often unnecessary courses of antibiotics.
I expect this is at least one explanation for why (as the article notes) antibiotics are ineffective at treating more than half of urinary tract infections caused by E. Coli. One standard treatment for persistent, recurrent UTIs in women is to prescribe a prophylactic antibiotic to be taken post-coitally, which typically means that a woman takes a pill irregularly--either every time after she has sex or once a week. This can last for years, without the doctor reevaluating the necessity of the treatment. While this is completely necessary for truly severe, recurring cases, I've seen several doctors prescribe this casually to women who don't have recurring UTIs but request it anyway. This is detrimental for the community and the patient, who has a higher risk of developing drug-resistant infections.
I think one way to address this problem is making doctors more aware of the community-wide effects of aggressive courses of treatment, informing them about alternative treatments that don't involve antibiotics, and encouraging them to use aggressive courses of antibiotics (such as prophylacticly for recurrent UTIs) as a treatment of last-resort.
The other problem that exists in the US is that the "family doctor" has an incentive to pack his schedule full of as many people as he can to collect as much money as possible. If someone comes in complaining that they have had a sore throat for a day, then they are going to get a pill; regardless of whether or not the infection is viral or bacterial. It is way, way faster to send the patient out the door with a pill that they think will make them feel better than it is to educate them about the macro effects of improper prescription of antibiotics. The only thing they care about is missing another day of work because they have a big deadline and the boss is breathing down their neck.
Not necessary; even in countries where you can't get antibiotics without prescription, doctors are prescribing them to avoid liability or to shut up annoying patients. It's a simple question of short-term gain vs. long-term loss.
Is there any particular reason we can't just create new antibiotics? Is there something inherent in the current design of antibiotics that prevents creating new versions of what we have? If so, is there an 'upper limit' of how many we can create, and have we reached it already?
Most antibiotics are not created but discovered. They are often species of fungus or other microorganisms that happen to attack certain kinds of bacteria. Take any place on earth where you might find microorganisms, grow them in a culture and then test their effects until you find one with the desired properties (kills bacteria but not human cells) and then you might be able to develop a new drug from it. The problem is we're running out of places to scoop up microorganisms from and the newest drugs are being made from fungi found deep in the most inaccessible caves underground for which bacteria above ground has not developed a resistance to. It's an evolutionary arms race which we're ultimately destined to lose which is why we need to find better ways of killing bacteria.
Couldn't evolution be accelerated in the lab? If the bacteria can evolve a way to thwart a fungus' defense, wouldn't it stand to reason that the fungi could evolve a new defense as well?
Not sure why this was down voted because it's true. Only a few big pharma have R&D programs in the antibacterial space. As a reply above states, the current system penalizes new antibiotics by reserving them for only the most severe cases. With the cost of a new antibiotic approval in the hundreds of millions of dollars, companies put their R&D dollars into areas with better returns.
That being said, a few new legislative changes have happened and will happens (GAIN Act approved, DISARM Act being considered) that will change the economics of antibiotic research and have already prompted drug companies to get back into the field.
I'd go a step further - at some point, there will be NO possible new antibiotics to develop or design. At the core, the concept of antibiotics depends on bacteria having a sufficiently different metabolism than our own cells, so that some compound disrupts internal processes of bacteria without affecting the similar process of 'good' cells. We have found a couple such metabolic pathways, and have various drugs targeting them. The problem is that once bacteria become drug-resistant, i.e., mutate so that they use a bit different chemistry, most likely more similar to our cells (obtained from our own DNA?) - then you can't do that anymore.
Perhaps there are some new antibiotics to be found, perhaps there aren't; but in any case there's an end of the road somewhere. After that, only radically different mechanisms would work - vaccines, phages, nanobots, something else, but not antibiotics.
There are plenty of bacterial targets that we haven't even started to explore. Many of the current antibacterials work by interrupting cell wall synthesis. There are many different protein involved in cell wall synthesis. Stop anyone of those from working and you have a new antibiotic mechanism.
We are creating new versions of what we have already. When you hear something referred to, for example, as a "beta-lactam antibiotic", what that actually means is a more creative version of penicillin. We tack new functional groups onto antibiotics to try to outpace resistance mechanisms, but its a stalling tactic, not a solution.
New antibiotic classes are hard to find. You need to find compounds that are lethal to bacterial cells (but not our cells) that there's no pre-existing immunity to. That's an extremely tall order, and we've run out of easy sources for those compounds.
IANA*, but as I understand it there are fundamentally two forms of antibiotic - variations on penicillin, and variations on vancomycin. While varying the exact form of antibiotic works to a point, eventually you run into the problem that bugs become resistant to the basic underlying common mechanism within the family of antibiotics. Everyone accepts this process with penicillin-ish drugs, but when it starts happening to the vancomycin-ish drugs, that's when it gets scary, because there is no 3rd tier.
There are a couple dozen classes of antibiotics, of which penicillins and glycopeptides (vancomycin) are just two. Personally, I have just been through 4 classes while trying to fight cellulitis (a penicillin, 2 lincosamides, a sulfonamide, and a tetracycline). I was probably a day or two away from being hospitalized for IV glycopeptide treatment. In my case, the problem was the speed with which the infection was progressing; I had daily appointments with my orthopedist until we found the right combination. Still, there are a variety of antibiotics that can be tried, alone or in combination. There is only a fuzzy concept of "tiers". Its more about strength and side effects.
If we were a rational species, we would recognize we're at war with another species that's killing millions of us, and spend a portion of our military budget on antibiotics research, instead of leaving it all up to the private sector.
We spend tax money on defense because it's a public good and in the absence of tax dollars there's no money in it. The same applies here.
It isn't what you mean, but DARPA does fund medical research, including treatments for infection. And USAMRIID ends up doing some research into treatments.
Homeopathy offers remedies for antibiotic resistant infections. I had a relative who had severe infection post knee replacement surgery. She was operated 4 times due to this infection as the bacteria is considered antibiotic resistant. A classical homeopath treated her to recover from the infection.
This is the bacteria that caused the post surgery infection
Yip, this is definitely a serious threat, one that will affect the rich in ways that climate change won't so immediately do. Probably a good thing in terms of finding a solution ;)
I did come across (I forget where) a very interesting talk which was outlining new techniques in antibiotics. The basic idea was that instead of straight out killing them (in which some breed resistance) instead you get in the middle of their chemical signals and basically tell them to attach before they've reached the point where the immune system won't win.
Still, bacteria being bacteria they'll probably work their way around it, but maybe rewriting your messaging system is a little harder than breeding resistance.
Instead of developing more antibiotics, can we reengineer these disease bacterias with a kill switch built in? Then release them into the wild to compete with non-engineered species and eventually displace them?
You would have to also engineer an evolutionary advantage - something that would make them likelier to survive in the wild than their non-engineered counterparts. Building in a 'kill switch' by its very nature gives engineered bacteria a huge disadvantage, meaning there'd have to be something else making them more likely to reproduce.
It would probably be a better use of time engineering the bacteria to be harmless to humans, negating the need for a course of drugs to kill it off.
On a personal note, my mom is still under the weather, having stuck to three different courses of antibiotics for a simple nasal infection.
It's frightening when this becomes the norm, not the exception because we're basically running out of options by natural selection moving faster than research.
We need a crash program to develop antibiotics before it's too late.
I would like to know why wouldn't it work to simply flood hospital rooms (any time they were empty) with lethal (for bacteria) doses of non-ionizing radiation (or any kind that doesn't go through walls and don't make said walls radioactive) so that those pesky tolerant strains have a really hard time propagating
Most of the transmission of infections is from human to human contact. Yes, bacteria can reside on equipment and facilities, but we have adequate measures to deal with that.
As an interesting aside, more and more copper is being used in medical equipment as it is naturally antibacterial.
The one limit seems to be that even if we did that the bacteria will evolve to become resistant against those as well. This is a game of leap-frog, we've been ahead for a while, now we'll be behind for a while and so on.
Think of it as a very slow arms race where on the one side there is intelligence and design and on the other there is the lottery driven mechanism of evolution that rewards the solver of the newly posed problem with a very large number of offspring.
The sides are surprisingly well matched and short of total eradication this is likely going to be the game for the next foreseeable future.
The bigger challenge will be to restrain ourselves to consume much more limited amounts if and when we do find antibiotics that work again in order to lengthen the time that we're 'on top'.
That's part of it, but this is something governments have to take leadership on right now. That will only happen with direct pressure. Waiting until it's the leading cause of death will be too late, because of drug development pipeline timeframes.
You'd think the companies behind creating this technology would welcome the never-ending arms race. They get to keep releasing products while their old ones get cannibalized for them.
Stuff that kills bacteria has to also not kill people.
I saw a TV programme where scientists had a big tray of nutrient gel. They divided the tray into sections. The fist section was normal nutrient gel. The next contained a normal dose of antibiotic. The next section was 10x, the next section was 100x and the final section was 1000x a regular dose. This was far more than humans could tolerate. They stopped at 1000x because that was the limits of solubility - they couldn't disolve more antibiotic into the gel.
Scientists then dropped a bit of e.coli on the normal gel and set their time lapse cameras.
In just a few weeks the bacteria had evolved to live on all sections of the gel.
(This was a BBC 'Horizon' programme called "defeatng the superbugs")
Worth noting: the bacteria at the end are not the same as the bacteria at the start.
Antibiotic acts on a particular mechanism to kill the bacteria. In order to overcome an antibiotic threat, bacteria have to either modify or drop any functions associated with that mechanism.
If any of those functions help them to infect humans, then the bacteria at the end of the process will be generally less able to infect humans.
There are multiple kinds of antibiotics, right? Couldn’t one globally rotate the different kinds of antibiotics so that germs have a harder time adapting to it?
Not really. Resistant strains of bacterial exist everywhere. Every area in the world needs the full range of current antibacterials.
The other thing to remember is international travel. It's pretty easy for someone in North America, who has a resistant bacterial infection, to hope on a plane and spread it around Europe.
- bacteriophages (viruses that kill bacteria)
- vitamin C for some bacteria, vitamin D, other supplements like MSM. Most must be used in megadoses for this effect.
- plant AB's (onion, black pepper, curcumin, the list is enormous and probably infinite)
Apart from 'sacred rivers' the best known example is probably your mouth - viruses do kill majority bacteria there until you start to adopt non-natural cleaning systems (i.e. toothpaste) and carb overflowing you are actually making thing worse.
Bacteriophages, while fun, and something I once wanted to work in, are nowhere near as "point and click" efficacious as antibiotics are, even under the most optimistic scenarios.
Best case scenario is that we find a way to get back in front of the mutations, but even that would just be buying time before the bacteria adapted again. On a long time scale, it's hubris to think we can stay in front indefinitely. We'd be better off improving our relationship with/attitude toward death on the whole.
Sterilizing things you own is unlikely to help. You'd reduce any naturally acquired resistance, yet still remain vulnerable to getting infected from the entire world you cannot sanitize.
Perhaps I lack proper context, but drug-resistance terrifies me significantly more than global warming. Primarily, I think, because we are still speculating about the consequences of climate change - if not so much its causes. In contrast, we know what a world without antibiotics looks like, and it's pretty horrifying.