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

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

#51

Post by nate_meurer »

legitsource wrote: post #16
erichurkman wrote: post #11

Earlier quoted context omitted.

> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.

The return of the sanitarium and things like leper colonies could be in our futures.

And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.

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

#52

Post by nikbackm »

ramblerman wrote: post #38
AaronFriel wrote: post #6

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.

Well, none of those (if you replace Y2K with Y2038!) are down for the count yet.

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

#54

Post by robterrell »

zeteo wrote: post #49
AaronFriel wrote: post #6

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…

> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development…

I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.

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

#55

Post by freehunter »

ramblerman wrote: post #38
AaronFriel wrote: post #6

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.

Of those, though, two of the threats were real and mitigated before the impact could be realized (nuclear war and Y2K), and one of them is a fairly recent scientific theory that is still trying to be understood (climate change).

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

#56

Post by schoper »

Antibiotic resistance shows up among the unhealthiest communities first. They act as the necessary incubators that resistance needs to develop. In a person with a working immune system, the time frame of antibiotic and pathogen contact is very small compared to the time frame of antibiotic and pathogen contact in an immunocompromised patient.

To put the above into simple English: Our problem isn't that we give antibiotics out like candy, it's that we give them to the elderly, people with AIDS, the poor, etc. This massively increases the chance of antibiotic resistance developing.

What can we do about it? To start with, run the numbers, make some cost-benefit calculations, and think about the problem. There may be technical as well as social solutions.

Not thinking about the problem, making it harder for the healthiest people to get antibiotics, and pretending that you are doing something is also a viable option. It's what we're doing now.

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

#57

Post by DanBC »

I've posted this before, but some people may have missed it.

"Defeating the superbugs" (http://www.bbc.co.uk/programmes/b01ms5c6) has a segment showing bacteria developing resistance to antibiotics.

(http://v6.tinypic.com/player.swf?file=24goih4&s=6) (Sorry about the lousy host; YouTube's content sniffing detects this as BBC property and blocks it.)

They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility)

They drop a bit of bacteria on the zero antibiotic section.

A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans.

It's an excellent, scary, bit of video.

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

#58

Post by GlueChemist »

zeteo wrote: post #49
AaronFriel wrote: post #6

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…

> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development…

This is not at all how drug development works.

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

#59

Post by route66 »

nostromo wrote: post #53

80% of the antibiotics we use are given to animals.[1] That seems like a good place to cut back. [1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...

And not to cure diseases: http://www.ucsusa.org/food_and_agriculture/our-failing-food-... (slow site warning)

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

#60

Post by roc »

javajosh wrote: post #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 h…

> "Why isn't it economically feasible to create new drugs for them? "

It's not that you couldn't make a profit off them. It's that the opportunity costs can't be justified (today).

There's a finite amount of R&D funds available to any firm. And if I'm maximizing profit, I'm not going to spend my money on difficult research, seeking and developing a drug useful to a handful of patients in 4% of hospitals, that's taken for a few weeks by each patient.

Not if I can instead spend it tweaking known drugs, useful to 30-50% of the entire population, that they'll take for the rest of their lives. (e.g. blood pressure medicine)

And particularly not when CDC, WHO, et al are actively campaigning for changes to antibiotic handling/prescription/use which may well mean your potential future market for "a better antibiotic" is actually smaller than today's.

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