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

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

#271

Post by Fomite » Wed, Oct 23, 2013, 7:55 PM UTC

EvanKelly wrote: post #266

Fomite wrote: post #229

Earlier quoted context omitted.

I'll take a stab at this - I'm an infectious disease epidemiologist that works on hospital infections mostly. The thing with anti-bacterial soaps is not that the use of the soap is bad. The problem is the anti-bacterial part. It puts amounts of a broad spectrum antibiotic into the environment (be it your hands, your countertop, or the water system) in concentrations that aren't enough to do much, but are enough to pu…

How do you feel about Triclosan in toothpaste? I dated a heatlh care professional for a while who was pretty adament that it was causing detrimental effects in the same manner as antibacterial soap.

That one is...a little trickier. There is some evidence that it works for controlling bacterial growth leading to gingivitis - suggesting there may be some utility for it. But its ubiquity in consumer products makes me a little skittish.

So I don't know if I'd want it gone from toothpaste, but I'd like to see it gone from the many products where its useless or nearly useless, but included so someone can put 'Antibacterial' on the label.

Like soap. Soap is already antibacterial.

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

#272

Post by evanmoran » Wed, Oct 23, 2013, 7:56 PM UTC

sliverstorm wrote: post #208

kephra wrote: post #132

Earlier quoted context omitted.

Antibiotics in animal farms should be banned world wide. Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics. Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiot…

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.

The issue is any antibiotic that could be used to cure humans should be used for nothing but curing humans. Every use of it rolls the dice that the bacteria will evolve an immunity to that drug. There isn't any "safe" use. Bacteria will eventually evolve and we can only reduce the amount of evolutionary pressure being applied.

So in short, yes the problem is giving it to animals.

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

#273

Post by evanmoran » Wed, Oct 23, 2013, 7:57 PM UTC

grecy wrote: post #146

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-...

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

Choosing between vegetarianism and pandemic isn't a hard choice=).

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

#274

Post by kintamanimatt » Wed, Oct 23, 2013, 7:58 PM UTC

meepmorp wrote: post #218

kintamanimatt wrote: post #160

Earlier quoted context omitted.

Nobody's gonna beat a vet with a rubber hose because they gave a cow antibiotics.

It's your basic (American, right-) libertarian argument against the state doing anything that limits business. I think its application in a case like this nicely encapsulates the flaws in the philosophy, or at least the ability of its adherents to apply it sensibly. Edit for clarity.

What? How did you make that leap from "nobody's gonna beat a vet with a rubber hose" to assuming I'm a hardcore libertarian? I'm for the reduction of antibiotics through government regulation. I think business should be restricted when it comes to doing harm to society.

With such a leap, I can only logically assume you replied to the wrong comment.

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

#275

Post by Ergomane » Wed, Oct 23, 2013, 8:12 PM UTC

Fomite wrote: post #221

jmsduran wrote: post #126

Earlier quoted context omitted.

I have never heard of bacteriophages before. Doing some light research, I found their protein/body structures to look almost machine-like. Very fascinating stuff. From Wikipedia's Bacteriophage page: "Medical trials were carried out, but a basic lack of understanding of phages made these invalid". I seriously hope alternatives like bacteriophages are being revisited and reconsidered within the medical community, as i…

Phages have been, and are, being revisited and reconsidered. The early days of 'phage therapy' were pretty bad - because we really didn't understand what was going on, the "purified" phage solutions still had bits of bacterial cell membranes and the like in them, including endotoxins. People died. But phages were still being looked at for most of the antibiotic period, especially in countries without quite such wides…

Even purified phages are not without possible side-effects.

Several phages even encode for bacterial virulence factors such as exotoxins (stx, diphteria toxin).

Fortunately, we are much better equipped in the molecular biology department to do research.

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

#276

Post by itsybitsycoder » Wed, Oct 23, 2013, 8:15 PM UTC

ssmoot wrote: post #81

TsiCClawOfLight wrote: post #41

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 don't know much about the varieties of ear infections babies get, but if the ear infection is viral, I can't see how an antibiotic would help. I used to have a problem with ear infections and I've had a doctor tell me the infection is viral and then offer me antibiotics in the same breath.

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

#277

Post by Fomite » Wed, Oct 23, 2013, 8:17 PM UTC

Ergomane wrote: post #275

Fomite wrote: post #221

Earlier quoted context omitted.

Phages have been, and are, being revisited and reconsidered. The early days of 'phage therapy' were pretty bad - because we really didn't understand what was going on, the "purified" phage solutions still had bits of bacterial cell membranes and the like in them, including endotoxins. People died. But phages were still being looked at for most of the antibiotic period, especially in countries without quite such wides…

Even purified phages are not without possible side-effects. Several phages even encode for bacterial virulence factors such as exotoxins (stx, diphteria toxin). Fortunately, we are much better equipped in the molecular biology department to do research.

Indeed. That was just a particular method of killing people, rather than an exhaustive list of them.

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

#278

Post by uptownJimmy » Wed, Oct 23, 2013, 8:19 PM UTC

waps wrote: post #270

tokenadult wrote: post #228

Earlier quoted context omitted.

General reply to express thanks for and respond to the several replies my first comment here received. First of all, I wrote in the original reply, "his warnings should be taken seriously," so I am by no means disagreeing with the quoted CDC expert about his general policy recommendations. Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banni…

So much wrong with this post: > There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. Do a dumb test. Walk into your nearest hospital, I don't even want to…

Much of this is nonsense.

This, for instance:

"If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead."

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

#279

Post by Ergomane » Wed, Oct 23, 2013, 8:20 PM UTC

mitchty wrote: post #186

mjt0229 wrote: post #24

Earlier quoted context omitted.

>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…

There is a catch here however, any resistance a bacteria has, has implicit cost to the bacteria in the form of copying the resistances' dna into new cells. This costs the organism energy and time to copy. If it confers no benefit it will be dropped from the genome. I really recommend everyone here read Power, Sex, Suicide, mitochondria and the meaning of life. Amazon link (no affiliation/referral) http://www.amazon.c…

> Bacteria both evolve resistance quickly, they also lose it just as quick.

Alas, experiments have shown that it is possible for resistant strains to strongly reduce the cost of resistance maintenance. If there are no naive invaders, this can lead to an evolutionary stable situation where the maintenance of resistance is less costly than losing it.

See Lenski's (old) review "Bacterial evolution and the cost of antibiotic resistance"

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

#280

Post by tokenadult » Wed, Oct 23, 2013, 8:23 PM UTC

waps wrote: post #270

tokenadult wrote: post #228

Earlier quoted context omitted.

General reply to express thanks for and respond to the several replies my first comment here received. First of all, I wrote in the original reply, "his warnings should be taken seriously," so I am by no means disagreeing with the quoted CDC expert about his general policy recommendations. Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banni…

So much wrong with this post: > There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. Do a dumb test. Walk into your nearest hospital, I don't even want to…

Let me do what I hope will be a smart test here by sharing some more information and asking some follow-up questions. I invite onlookers to comment about this too.

The Centers for Disease Control and Prevention (the same organization that employs the expert quoted in the article submitted to open this thread) reports that "Although MRSA is still a major patient threat, a CDC published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011."[1] So there are responses already in place that are gaining on antibiotic-resistant bacteria in hospital settings in the United States.

I care about the spread of antibiotic-resistant bacteria. I am gravely concerned about the medical and public-health practices in India that have resulted in a massive increase in patients infected there with multiple-antibiotic-resistant tuberculosis.[2] I am 100 percent behind the idea that antibiotics have to be used cautiously and responsibly, and meanwhile we have to keep researching other means of infection control besides antibiotics.

You wrote,

We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them.

Do you really mean "we" there? Are you saying that this mechanism in any way makes it impossible for human beings to eradicate harmful microorganisms? How? Please connect the dots to back up your conclusion that

Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years

because the "all" there and the time scale you talk about both appear to be exaggerations, especially in light of the progress that has already occurred in limiting MRSA infections in the United States.

[1] http://www.cdc.gov/mrsa/healthcare/index.html

[2] http://online.wsj.com/news/articles/SB1000142405270230344420...

http://www.tbcindia.nic.in/

http://articles.economictimes.indiatimes.com/2013-06-23/news...