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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”

#141

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.

This is what I don't completely understand. Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? Or, do I not understand the vectors properly? The way I perceive these stories is that hospitals are actually extremely dirty on a microbial level (as is most of the world), it's just counter-intuitive becau…

Google for "mrsa aerosol transmission".

Yes yes make everyone wear gas masks and space suits the entire time, staff and patient alike...

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

#142

Earlier quoted context omitted.

In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection…

>We [sic] should just make it flat out illegal to... >We [sic] should also fine doctors for... Why is violence an appropriate response to these non-violent issues?

That's not violence. They're not being beaten with a crowbar.

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

#143
> Bacteria, like any living organism, want to survive.

> bacteria will always change in order to survive.

Excellent article. Everyone should read it from top to bottom twice. Forward it to your entire network. This is a serious matter.

However. I really cringe when I see scientists get loose with language like this. I know he knows perfectly well how evolution works. This is an attempt to make it simpler to swallow for those who might not be up to speed and, perhaps, come to the discussion lacking a minimal scientific background to be able to rationalize it. I get it. Among that population the misrepresentation of the driving mechanisms behind evolution can actually do more harm than good.

Taken far enough you end up with? "Oh, so you mean to say that a monkey WANTED to survive and CHANGE in order to become a human". Which makes you sound like an insane lunatic, of course.

The mechanism is dead simple: Out of a pool of organisms exposed to an environment some die and some survive. This "environment" can be anything, from an antibiotic at the bacterial level to a flood in a canyon. Of those who survived some did so due to blind chance. Others because they might possess a characteristic that helped them survive the environment. Survivors mate and reproduce. Some mutations occur. The cycle repeats with the new population. If the environmental "attack" (antibiotics, the flood, whatever) remains the same, over time populations will develop that will have better and better resistance to their particular challenges. This is the brutally simple result of the demise of those who simply could not handle whatever was dished out. Over time either the entire population is killed off and game over or those who were resistant, for whatever reason, will --without intent, goals or knowledge-- help evolve populations equipped with increased resistance to what is trying to kill them.

In evolution there is no "wanting" to do anything. There isn't even the idea of wanting to survive. There is no struggle for survival. There is no conscious desire to change or to become something else. It is brutal and simple. Some die. Some don't. Those who survive repeat the cycle. Eventually either all die or you end-up with one or more new species/variants that got past the killing spree and emerge resistant to whatever ailed them. And it goes on. Challenge after challenge.

Part of me wishes people would have a better handle on this very simple scientific fact so we could move on to more important topics. We went to see Richard Dawkins at Caltech this weekend. He mentioned that in the US some 40% of the population think the earth is 6,000 years old and reject evolution. What they reject might very well be what ends-up killing them.

This issue of bacteria evolving past our ability to concoct antibiotics is a very serious one. I've always believed we are all going to be killed-off by something microscopic that nobody is going to see coming. The potential is there for hundreds of millions of people to die over a short period of time. Airplanes will contribute to that greatly, helping take bacteria all over the world before we even realize what's happening.

That's why I don't understand why we don't get behind this --as a planet, not just a nation-- with great force. I see virtually no use for our military and that of other nations. Can't we lobby for the elimination of the horrible waste that is the maintenance of massive military forces and, instead, devote those funds to more worthy causes? Imagine if we, as a nation, devoted half our current military budget to honest medical research. I am not one for huge government programs, but there would be ways to do such a thing without having government bureaucracies devolve the thing into a cash burning furnace.

The point isn't the details but rather the idea that something like this should be priority one. We are looking at the possibility that within the next 25 to 50 years there could be a massive antibiotic resistant bacteria outbreak that takes out a huge chunk of the human race. We need to be ahead of that event, not behind it. And it is far wiser to throw billions of dollars into medical research of almost any kind rather than into making the latest wiz-bank how-to-kill-more-people-per-round machine.

Utopia. I know. Sad.

EDIT: I neglected to add how I would explain evolution to a general audience without resorting to "want" and "desire" type analogies. In other words, don't be critical without offering a solution. Well, I think it's simple, I sort of did:

When faced with challenges organisms either excel or die. Those who excel go on to reproduce. In reproduction there is mutation. Small changes to each and every new organism. Reproduction does not produce clones. Reproduction results in a population of new and distinct individuals with some of the traits of their parents and some new ones. Their offsprings, if faced with the same challenges will, just the same, survive or die. If none survive the population goes extinct. Otherwise, over time, the only organisms who will continue to survive are those who continue to carry the traits that made their ancestors survive. This repeats over time and across challenges.

That's not the elevator pitch, of course. So here is that one, applied to bacteria in particular:

When attacked by antibiotics some bacteria survive. These reproduce and produce new bacteria that might carry-on some of the traits that allowed the parents to survive. Random mutations might also make some members of the new population even more resistant to the same antibiotics. The process repeats over many generations. Over time new populations emerge with immunity to the antibiotics that killed so many of their ancestors.

The more we expose bacterial populations to wide ranges of antibiotic challenges the greater the effect can be. Over time populations will evolve that will be resistant to anything we have on the shelves to throw at them.

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

#145
post #81

Earlier quoted context omitted.

Refuse behaving like the average (ahem, mostly american) and don't ask for medicine for benign illnesses.

I think as a rule people aren't as stupid as "common knowledge" would like to pretend. My 18mo daughter has had a half dozen ear infections and two staph infections. Antibiotics each time. Would it be better to leave a staph infection untreated with antibiotics? How? Lance and clean the infection site... and then what? Or ear infections? I had frequent undiagnosed ear infections as a small child and now have reduced…

I'm not talking about infants, I'm talking about the majority of the adult population which can take good care of it's own.

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

#146

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-...

Of course, they're given to animals to keep them healthy enough so we can eat them.

If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.

I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.

http://en.wikipedia.org/wiki/Ishmael_%28novel%29

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

#147
post #56

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 antibi…

> 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.

Do you realize what you've just said? Are you arguing that we shouldn't have had given antibiotics to people that needed antibiotics?

Also, I don't know how your society is or does, but in our country the poor have a better immune system.

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

#148

Earlier quoted context omitted.

>We [sic] should just make it flat out illegal to... >We [sic] should also fine doctors for... Why is violence an appropriate response to these non-violent issues?

That's not violence. They're not being beaten with a crowbar.

It's the threat thereof that persuades compliance. If you try hard enough to do & keep doing something illegal, there is no limit which the state is unwilling to go to in coercing compliance.

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

#149

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…

> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary

Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?

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

#150

" These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic. " The profit motive is almost as blind a watchmaker as natural selection. We've built an environment which encourages bacteria to develop antibiotic resistance. Let's structure a pharmaceutical industry in which antibiotics are profitable…

I'm pretty sure an X-Prize-style $10 Billion tax free for the next antibiotic from the government[1] would probably get something done. Given our needs, the $10B would be cheap. Heck, buy the next 3 or 4 discovered.

1) assuming said government exempts the company from court claims on the approved drug

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