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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”

#241

Post by mtdewcmu »

tokenadult wrote: post #70

The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and ki…

The particular nit that I'd like to pick is blaming only misuse of antibiotics for the problem. The only way to distinguish use and misuse is in retrospect, and it's hard to say last-line antibiotics like vancomycin and meropenem have been abused.

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

#242

Post by sliverstorm »

fnordfnordfnord wrote: post #240
sliverstorm wrote: post #208

Earlier quoted context omitted.

Antibiotics in animal farms should be banned world wide. Why? The problem isn't giving antibiotics to animals. Antibiotics are useful for animals the same way they are useful for controlling disease in humans. The problem is abuse of antibiotics.

Antibiotics are routinely included in animal feed as a prophylactic.

Yes, I know.

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

#244

Post by stcredzero »

ataggart wrote: post #135
stcredzero wrote: post #63

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?

I think it's an appropriate response to life and death issues, when, on one side of the scale are the potential deaths of millions.

My ex-girlfriend's dad died of an infection, quite possibly a superbug. I was there with her and her mom the second he stopped breathing. Go and be there at the moment of death by infection of someone you know, then tell me how you feel about people who needlessly weaken antibiotics.

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

#245

Post by Fomite »

Timothee wrote: post #172
hodder wrote: post #86

The anthropomorphism of bacterial evolution makes the article hard to follow for the layman (me). Can someone familiar with bacterial evolution please explain to me how the use of antibiotics leads to superbugs? I am clearly misunderstanding something. I was under the impression that in a population of bacteria, genes express themselves in any number of random ways. If we expose the bacterial culture to antibiotics,…

That's a good question. I have no credentials or background to know the answer, but I wonder if this is something where the use of antibiotics decimates most the bacteria population so that it's easier for the resistant ones to thrive, as opposed to cohabitate and possibly be overtaken by the non-resistant ones. I'm thinking of it like Conway's Game of Life where a cell dies if surrounded by more than 3 cells. With a…

Theoretically, non-resistant bacteria should have a competitive advantage over resistant bacteria in an environment without antibiotics - they don't have to spend energy producing useless resistance enzymes, and instead can grow better.

That means, in theory, with no antibiotics, you should have very few resistant organisms.

The problem is that's all "in theory". Right now, the level of evidence for community-acquired MRSA and the competitive advantages of susceptible versus resistant S. aureus has thrown that all into question.

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

#246

Post by kodeninja »

vivin wrote: post #94
tokenadult wrote: post #70

The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and ki…

I think it's a bit pedantic to argue about his usage of "desire". Evolution is a blind watchmaker. The bacteria are reacting to selective pressures. Large populations of bacteria around the world are getting exposed to different kinds of antibiotics. It's not a matter of "if" they will acquire resistance, but "when", and we're seeing this happening right now. The fact that lines of bacteria go extinct does nothing to…

On the topic of Bacteriophages, I seem to recall reading in Biology class a long time ago, that the reason the water of the Ganges can be stored for a long time without getting spoilt is because of the presence of Bacteriophages! Certainly useful to humans!

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

#247

Post by frakkingcylons »

DanBC wrote: post #165
vidarh wrote: post #152

Earlier quoted context omitted.

Killing bacteria is easy. The trick is killing bacteria without harming ourselves. Soaps can be massively more "brutal" in terms of the mechanisms that destroy bacteria than what antibiotics can, and so the evolutionary steps that would have to occur for resistance are vastly larger, and would mean changing them in many different directions. E.g. it does not help if a bacteria can survive a soap if it is still physic…

I agree with you, but we need to be cautious with washing hands. The CDC have a nice document about "when is clean too clean?" which mentions the problems with people who have to clean their hand frequently. Damaged skin can harbour bacteria, and can make it harder to remove those bacteria. ( http://wwwnc.cdc.gov/eid/article/7/2/70-0225_article.htm ) > Skin hygiene, particularly of the hands, is a primary mechanism f…

Thanks for linking that article. The most interesting takeaway from that personally was that an alcohol-based rinse (hand sanitizer) is effective against nearly all kinds of infectious agents except for Gram-positive bacteria (which have a lipid cell envelope), without the threat of the emergence of resistance.

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

#248

Post by breischl »

dylandrop wrote: post #171
ctdonath wrote: post #148

Earlier quoted context omitted.

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.

Of course, because if we make feeding antibiotics to livestock illegal, it can only be enforced by lynch mobs. C'mon. Do you really think every food regulation is being watched by military police who will come and beat you up if you break said regulation?

It's no secret that if you defy the authorities they escalate the amount of coercion they use. You just need to follow the progression far enough to get to the violence.

They start with a polite court summons, then send a police officer to your home, and if you don't come quietly they'll physically force you. If you manage to resist that, well now you're resisting arrest so it doesn't even matter what the original summons was for. They'll escalate to tasers, nightsticks, maybe tear gas. You probably need guns on your side to resist past that point, which means the police get their guns out, and they've got more guys and more guns than you. You most likely end up dead, but definitely not resisting anymore. At no point will they say "Gee guys, this is just too much effort, guess we better let him do whatever he wants."

There is implied violence in every government directive. You don't usually see it because almost nobody has the will and the means to push it that far, but it's still there. I think people would do well to remember that when casually calling for things to be made illegal.

That said, I actually agree with the idea of banning antibiotics in agriculture. It's quite important, and a classic market failure/tragedy of the commons situation that you sadly do need government to solve.

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

#249

Post by Fomite »

joshuahedlund wrote: post #66

I've been hearing about the coming Antibiotics Apocalypse for some time now, and while it sounds very dangerous I'm wondering what signs to look for about how bad it's getting. Articles like these point to limited things like an increase in MSRA outbreaks or vague statements about increasing infections from hospitals, but it's not like average people are dying in the streets or anything. How do we tell how much we're…

Yes, average people are dying in the streets. Hospital infections, many of which are caused by resistant organisms, are a major cause of death in the United States.

Beyond that, you now have things like extensively resistant Gonorrhea, which has taken a disease that is fairly common, but easy to treat if caught and thus embarrassing without being dangerous, and turned it into a serious problem, especially for women.

The answer for "How do we tell" is that epidemiologists (like me) do a lot of surveillance for antibiotic resistance. We ask why hospital patients died, and what organism killed them - and what is was susceptible to.

And the answer is this is a rather serious problem.

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

#250

Post by stcredzero »

mistercow wrote: post #138
tokenadult wrote: post #70

The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and ki…

I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover". Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if y…

> Evolution is actually a really crappy optimization algorithm...Bacteria work on a faster time scale than animals in terms of evolution, but five orders of magnitude? Somehow, I think we'll win in the long run.

However, it's one that doesn't need an agency to implement it. It just happens. A lot. Especially in the case of bacteria. You have a slow, crappy algorithm, but it's constantly running relentlessly in parallel in many trillions of instances. It doesn't need human attention. It doesn't need investment. It doesn't need society to be aware of its importance.

On the other hand, progress in antibiotics needs all of the above. If one of those things flags a bit, bacteria gain the upper hand. This is the problem.

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