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”

#311

Post by Fomite » Wed, Oct 23, 2013, 9:19 PM UTC

mhb wrote: post #309

Fomite wrote: post #294

Earlier quoted context omitted.

Umm...rabies pretty much is curtains. If we miss the postexposure prophylaxis window, the fatality rate for rabies is indistinguishable from 100%

Yeah, but how did we lose that fight a decade ago? Whether or not we'd prefer something better, doesn't the treatment that worked then, still work now?

As another poster has said, we didn't really "lose" that fight. Rabies has always been that way - invariably fatal unless treated, and the only treatment (outside some insane edge cases) is the administration of the rabies vaccine shortly after (or ideally before) contact.

The very low rabies incidence and near zero fatalities of rabies in the developed world actually show that it's a very winnable fight. The issue is, we have to show up to said fight. In the developing world, we're not always good at that.

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

#312

Post by thwest » Wed, Oct 23, 2013, 9:20 PM UTC

ChuckMcM wrote: post #302

thwest wrote: post #290

Earlier quoted context omitted.

The day we're ready for that virus to mutate in the wild and target RNA it wasn't designed for?

I understand the emotion in your response, I believe (correct me if I am wrong) that it comes from being unable to calculate a risk on something we don't understand. However, the action proposed sets as a prerequisite that understanding. Consider 'fly by wire' as an analogy. There was great emotion (and still is) around taking the pilot of an aircraft out of direct control of that aircraft. First required by dynamica…

I really want to read the engineering details of what it takes to add a self destruct on bad RNA checksum feature to your bug.

(I think your analogy hides the potential impact of a mutating virus. Fly by wire only puts air travel at risk.)

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

#313

Post by Fomite » Wed, Oct 23, 2013, 9:22 PM UTC

VladRussian2 wrote: post #296

Fomite wrote: post #236

Earlier quoted context omitted.

We do. We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin. Bacteria are just bloody durable, and people are shedding new bacteria into the environment at really absurd rates.

>We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin. And the bacteria which survives all of this, i think it should look something like this: http://www.imdb.com/media/rm617979392/tt0088944?ref_=ttmi_mi...

It actually looks like this: http://upload.wikimedia.org/wikipedia/commons/0/0f/Clostridi...

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

#314

Post by cstigler » Wed, Oct 23, 2013, 9:39 PM UTC

Modal stacked above another modal when I opened the page. Neither relevant. gags

The article's cool though.

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

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Post by thenomad » Wed, Oct 23, 2013, 9:58 PM UTC

SiVal wrote: post #299

thenomad wrote: post #285

Earlier quoted context omitted.

As others have mentioned, in fact the incidence of MRSA has declined significantly over the last few years, down 50%: http://www.cdc.gov/mrsa/statistics/ (Center for Disease Control) And the numbers of infections were far lower than you're claiming here - rather than approximately 20,000 in 100,000 as claimed above, the numbers (in 2011) were 4.5 in 100,000. http://uk.reuters.com/article/2013/09/16/us-hospital-mrsa-i…

Yes, MRSA has declined, but not because of improved treatments. Now that we can no longer kill these bugs after they invade the body, hospitals have significantly ramped up their efforts to kill them before they invade. Hurray for these protocols, but that won't do all that we need. It won't be possible to scrub the whole world with poisons the way we have begun scrubbing hospital rooms. We need ways to stop infectio…

That's definitely true.

It's a very worrying situation.

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

#316

Post by robot » Wed, Oct 23, 2013, 10:06 PM UTC

I've been hearing about MRSA since 2000s. What's new? I mean, what has changed now since 2000 that this is now more important?

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

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Post by gnaritas » Wed, Oct 23, 2013, 10:14 PM UTC

FkZ wrote: post #224

baddox wrote: post #100

Earlier quoted context omitted.

Yes, the talk of desire is clearly personification that's not meant to be taken literally.

Inability to understand figurative language seems a common malady on certain parts of the internet.

It's not an inability to understand you're seeing, it's a rejection of it because it misleads people. Pendants attack such language precisely because it's misleading without cause. There's no reason to personify random processes and doing so actively misleads people.

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

#318

Post by ronaldx » Wed, Oct 23, 2013, 10:18 PM UTC

rdmcfee wrote: post #163

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…

> Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things We're giving bacteria (which reproduce rapidly and mutate quickly) the perfect natural science lab to mutate and select for antibiotic resistance. There are 10^14 bacterial cells in the human body vs only 10^13 human cells [1]. Their reproductive c…

Your take-away should really be that bacterial evolution is part of being human - without those 10^14 bacterial cells evolving over one million times faster than our own, we wouldn't be able to survive - we wouldn't be human.

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

#319

Post by ronaldx » Wed, Oct 23, 2013, 10:42 PM UTC

refurb wrote: post #223

nathan_long wrote: post #196

Earlier quoted context omitted.

My guess: before the antibiotic, the minority resistant bacteria have to compete with the majority non-resistant. After, they can proliferate freely. Repeat with the next antibiotic, and soon all the ones we see are resistant to all the antibiotics we have.

You pretty much nailed it in a very succinct manner. That's why it's so important to complete a course of antibiotics rather than stopping once you feel better. Once you've started antibiotics, you're basically enriching the population in bacteria that aren't affected by the antibiotic. This is normally a very small population, but if you stop half-way, the pressure on those bacteria from other bacteria (the ones tha…

This is an unconvincing argument to me - if antibiotic resistant bacteria survive, why would finishing the course of antibiotics make a difference?

Does it clinically happen that stopping a course of antibiotics early causes an antibiotic resistant form of the infection?

(I couldn't find evidence either way, but I did find a few articles saying typically prescribed course lengths could be safely reduced in the effort to reduce antibiotic use generally)

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

#320

Post by ronaldx » Wed, Oct 23, 2013, 10:51 PM UTC

alan_cx wrote: post #110

This is not my thing at all, so this might be a really silly question, but... Are people who have avoided prescribed antibiotics in a better position than those who haven't? Then, what is the effect on such people of the antibiotics taken in by eating meat from animals which have been give antibiotics? Have the people who have been avoiding completely wasted their time?

It's hard to know the answer to this question. Yes, antibiotic resistant bacteria pose a new threat to everyone (likely still less of a threat than non resistant bacteria did in 1950), but maybe not equally.

it's possible that antibiotic-resistant bacteria have more chance to take hold (asymptomatically/latently) in people who are regularly exposed to antibiotics.

You could be carrying around MRSA but you wouldn't observe symptoms unless/until you are otherwise in a critical state - wounded or immune-suppressed.

It's not currently obvious how antibiotic-resistance spreads in the wild and so it's still plausible that avoiding antibiotics gives you some degree of protection.