Live data from Hacker News

Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

pbs.org

31–40 of 414 posts

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#31
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?

http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#32
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.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#33
post #12

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.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#34
post #24
post #15

> 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 ev…

>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…

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 ;)

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#35
post #7

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?

This is a decent, accessibly written survey article as of 2004, from Nature Biotechnology: http://seahorse.louisiana.edu/biol224/Pdfs/From%202010/Thiel...

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#36

It wasn't long ago that thread appeared about silver making antibiotics thousands of times more effective. Not sure where the thread is but the story here: http://www.nature.com/news/silver-makes-antibiotics-thousand...

I used to see, in Sky Mall magazine, a colloidal silver injector that would spray through the skin to treat dermal infections.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#37
My doctor friends have been warning about this for 15 years, and the situation has continued to worsen.

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.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#38

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…

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.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#39
post #19

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.

Re: Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”

#40

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…

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.

Post reply on HN