‘Superbug’ scourge spreads as U.S. fails to track rising human toll • Hacker News Board

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#71

Post by lobster_johnson » Wed, Sep 07, 2016, 6:13 PM UTC

dv_dt wrote: post #35

codezero wrote: post #5

My mother in law, a healthy 50 year old, recently died of an unspecified infection. They still don't know what it was or why antibiotics weren't helping. Ultimately, her lungs gave out after more than a week on life support. Was it a superbug? Dunno, and nothing in her medical record leaves any indication that it might have been, the world just moved on.

There was an article a few years ago about the fall of the medical autopsy rate. Because it's unclear how we fund it, and most people aren't in a position of knowledge to request it (or in a financial position to pay for it), the rates of autopsy to find a considered cause of death have been dropping precipitously.

Atul Gawande talks about this a lot in "Complications" [1]. A great book about medical procedure, and specifically about the process of learning, trial and error and the whole feedback loop of working with disease.

[1] https://www.amazon.com/Complications-Surgeons-Notes-Imperfec...

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#72

Post by pyre » Wed, Sep 07, 2016, 6:18 PM UTC

badminton1 wrote: post #23

ocschwar wrote: post #17

Bear in mind that in the US, our lovely republican party literally made it illegal to research where the superbugs are being bred. In the US, the problem is mostly pig and cattle feedlots that rely on antibiotics to keep the animals from being sickened but he crowding. Naturally, there is no proof that superbugs are coming out of the feedlots, because the feedlot owners do not allow any sort of sample collection by s…

Farmers massively administer antibiotics so they can keep animals in crowded/unsanitary conditions. If antibiotics were administered properly that would severely affect their revenue.

Farmers do this for a number of reasons:

- Constantly feeding livestock antibiotics makes them grow bigger. The mechanism for why this happens is not understood (but who cares because bigger livestock means more money).

- It is costly to deal with an animal after it gets an infection rather than just being preventative.

- Farmers are scared about diseases sweeping through their herds and causing issues where they are forced to kill the whole herd (e.g. mad cow disease -- though antibiotics don't prevent prion diseases).

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#73

Post by exDM69 » Wed, Sep 07, 2016, 6:19 PM UTC

alkonaut wrote: post #28

This is why antibiotics use in livestock should be a top question in international trade. Not only should every country stop using antibiotics in healthy livestock, all imports of meat and animals from such countries should be banned, and to take it one step further - stop importing umbrellas and calculators from those countries too, in order to apply economic pressure.

> Not only should every country stop using antibiotics in healthy livestock

Antibiotics are not used for healthy livestock in many countries. The US is a very notable exception.

It comes down to cutting costs. In the US, it's not typical to clean the facilities between batches of animals like chicken. This mean that the new batch would contract any bacteria left behind the previous animals. It's not even that big of a cost, I'd call it borderline negligence.

I agree with you, this practice should end. Giving antibiotics to livestock at all is harmful and it should never be done as a precautionary measure.

On smaller farms, isolating or just killing the sick animals would be fine but that will not work in industrial scale.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#74

Post by pg_is_a_butt » Wed, Sep 07, 2016, 6:20 PM UTC

daveloyall wrote: post #64

Hello. I work for public health. My job is to support the computer systems that allow epidemiologists to track 'superbugs' (and regular ones). Deathcerts is an interesting dataset. It's not the only one. Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked. There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent…

Hello. I read the lies published by Y Combinator. Misleading!

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#75

Post by thr0waway1239 » Wed, Sep 07, 2016, 6:21 PM UTC

daveloyall wrote: post #64

Hello. I work for public health. My job is to support the computer systems that allow epidemiologists to track 'superbugs' (and regular ones). Deathcerts is an interesting dataset. It's not the only one. Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked. There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent…

From the subhead: "government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem"

I ask as someone who is quite a novice when it comes to knowledge of what is the expected reporting requirement: That subhead is a blanket assertion, but when applied to the death-by-MRSA issue, do the public have access to accurate, up-to-date information? If not, isn't that assertion partially correct?

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#76

Post by exDM69 » Wed, Sep 07, 2016, 6:22 PM UTC

pyre wrote: post #72

badminton1 wrote: post #23

Earlier quoted context omitted.

Farmers massively administer antibiotics so they can keep animals in crowded/unsanitary conditions. If antibiotics were administered properly that would severely affect their revenue.

Farmers do this for a number of reasons: - Constantly feeding livestock antibiotics makes them grow bigger. The mechanism for why this happens is not understood (but who cares because bigger livestock means more money). - It is costly to deal with an animal after it gets an infection rather than just being preventative. - Farmers are scared about diseases sweeping through their herds and causing issues where they are…

This is not the practice everywhere worldwide. The US is particularly bad when it comes to antibiotics in livestock.

It's a harmful practice and should be outlawed. Even if it means paying more for your food.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#77

Post by [deleted] » Wed, Sep 07, 2016, 6:22 PM UTC

pyre wrote: post #72

badminton1 wrote: post #23

Earlier quoted context omitted.

Farmers massively administer antibiotics so they can keep animals in crowded/unsanitary conditions. If antibiotics were administered properly that would severely affect their revenue.

Farmers do this for a number of reasons: - Constantly feeding livestock antibiotics makes them grow bigger. The mechanism for why this happens is not understood (but who cares because bigger livestock means more money). - It is costly to deal with an animal after it gets an infection rather than just being preventative. - Farmers are scared about diseases sweeping through their herds and causing issues where they are…

[deleted]

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#78

Post by dmix » Wed, Sep 07, 2016, 6:22 PM UTC

daveloyall wrote: post #64

Hello. I work for public health. My job is to support the computer systems that allow epidemiologists to track 'superbugs' (and regular ones). Deathcerts is an interesting dataset. It's not the only one. Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked. There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent…

Strange, so that basically refutes the a pretty core point of the article (that it isn't being tracked).

The reason they said doctors don't put it on death records is because they dont always want to wait the 2-3 days it takes to get results back from the labs. So it makes way more sense that the labs record the bugs. Instead of doctors in the field.

Those are the people who are trained to detect the bugs... so they should be responsible for tracking them. I presume they could get indications from the doctors on whether the patients died as well.

Couldn't the doctors update death records after-the-fact? If they found out afterwards what the actual cause of death was, they should really being recording that.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#79

Post by codezero » Wed, Sep 07, 2016, 6:29 PM UTC

dv_dt wrote: post #35

codezero wrote: post #5

My mother in law, a healthy 50 year old, recently died of an unspecified infection. They still don't know what it was or why antibiotics weren't helping. Ultimately, her lungs gave out after more than a week on life support. Was it a superbug? Dunno, and nothing in her medical record leaves any indication that it might have been, the world just moved on.

There was an article a few years ago about the fall of the medical autopsy rate. Because it's unclear how we fund it, and most people aren't in a position of knowledge to request it (or in a financial position to pay for it), the rates of autopsy to find a considered cause of death have been dropping precipitously.

We shelled out for a private company for an autopsy, but post-mortem, lots of things happen to the body that make identifying a source of an infection really hard – basically, it didn't tell us anything new :(

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#80

Post by daxorid » Wed, Sep 07, 2016, 6:33 PM UTC

exDM69 wrote: post #73

alkonaut wrote: post #28

This is why antibiotics use in livestock should be a top question in international trade. Not only should every country stop using antibiotics in healthy livestock, all imports of meat and animals from such countries should be banned, and to take it one step further - stop importing umbrellas and calculators from those countries too, in order to apply economic pressure.

> Not only should every country stop using antibiotics in healthy livestock Antibiotics are not used for healthy livestock in many countries. The US is a very notable exception. It comes down to cutting costs. In the US, it's not typical to clean the facilities between batches of animals like chicken. This mean that the new batch would contract any bacteria left behind the previous animals. It's not even that big of…

This is not the reason antibiotics are given to livestock. A wide class of antibiotics, when delivered in subtherapeutic doses, increase feed conversion efficiency and result in larger animals for the same feed inputs.

So yes, it's about costs, but not for the reasons you cite.