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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”

#331

Post by whitemen »

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…

>Bacteria don't desire anything, and they don't seek out anything or plan anything.

Wow. Just how autistic do you have to be...? He was speaking to the general public, and he adapted his choice of words in consequence of that. So no, he wasn't wrong.

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

#332

Post by memracom »

Technology is the answer.

All citizens will be required to carry a smartphone or other GPS tracking device that reports their location every 5 mins to a central database run by the National Security Agency. When a new infected person is discovered, National Bureau of Health agents will contact everyone who was close enough to the infected person to have possibly transmitted (given or received) the infection over the previous two months. Those people will be tested and infected people will be incarcerated in National Health Concentration Centers for healing. They will stay their for life, or until no longer infected.

Will it come to this?

What about mandatory death penalty (plus confiscation of all family assets) for anyone who gives antibiotics to an animal or who supplies antibiotics to a farmer?

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

#333

Post by schoper »

bad_user wrote: post #147
schoper wrote: 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.

I correctly described the situation. I think it's ugly too. Do you have a fix? Because that's what we need, a fix, not cheap moralizing.

Moralizing doesn't save anyone from gangrene and sepsis and a slow death. It doesn't prevent the diarrhea to dehydration to death sequence. It doesn't do an ounce of good for anyone.

Immunocompromise (poor, sick, elderly, AIDS, etc.) + long-term antibiotic use = Antibiotic resistance.

That equation is death, and we need fixes, not the crap in your comment above.

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

No doubt you live on Mars or Venus.

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

#334

Post by Houshalter »

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…

>"So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything.

You are taking this too literally. But in any case just because bacteria aren't intelligent doesn't mean their behavior is purposeless. Evolution acts as an optimization process. It's not too far from the truth to ascribe it "desires".

On the frontline episode this was from talked about how pharmaceutical companies have all stopped investing in new antibiotics. It might be possible to make better ones but I don't know how much research is actually going on at the moment.

I'm kind of skeptical. We are fighting against millions of years of evolution. The drugs we have we only got by copying things evolution already found, and they became resistant in mere decades, an extremely short time from an evolutionary perspective. Any simple way of killing bacteria would probably already have been developed by evolution. Likewise pathogens have spent millions of years evolving to defeat everything thrown in their way, and they continue to do so.

We are joining into this ancient arms race as entirely new players.

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

#335

Post by tpainton »

antibiotics do not cause resistance to form. resistance occurs due to natural mutations. these are going to occur regardless of exposure to antibiotics or not. The antibiotics simply select out the resistant organisms from the auger. It was shear panic when S. aureas developed penicillin resistance decades ago. methicillin was the solution. Now we have methicillin resistant staph aureas. This is nothing to panic over. it simply means the battle is never won and we'll require ongoing research on new antibiotics. To say we have lost is just not true. This is the way life works. he also ignores the possibility of human evolution. We can develop resistance to bacteria as well.

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

#336

Post by baak »

Fomite wrote: post #310
vacri wrote: post #308

Earlier quoted context omitted.

Rabies is a virus - antibiotics don't have any effect on viruses. Ceol may also be referring to the incubation time for rabies usually being more than a week - if you've just been infected with it and you present at day 7, then a prophylaxis will be administered.

Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.

I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.

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

#337

Post by mtdewcmu »

tokenadult wrote: post #228
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…

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…

There is a bit of hubris here borne of ignorance. If you study this problem in any depth, you start to appreciate how pernicious it is. I'm not an doctor or epidemiologist, but I learned quite a bit by reading an excellent book[1] on the subject:

> 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 banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.

Exposure to one agent can make bacteria more resistant to other agents, even ones that are unrelated. This is surprising, but confirmed through experiments. Bacteria have ways of flushing out toxins that become up-regulated, and they become more resistant to toxins in general. Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed, but the ramifications could extend to other, more critical, antibiotics used in medicine.

> As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms.

I think you're underestimating what we already know. Current antibiotics are based on the differences between eukaryotic and prokaryotic cells, and we understand a lot about the underlying biochemistry and drug targets. Lack of fundamental knowledge isn't a primary issue.

> 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.

Here you're underestimating bacteria. Bacterial lineages don't really go extinct, because they have no well-defined boundaries. Bacteria are very different from eukaryotes and they pick up genes from the environment. See horizontal gene transfer.

This is one of those vicious problems, like cancer, that resists being solved not for lack of our best efforts, but in spite of them.

[1] http://www.perseusbooksgroup.com/dacapo/book_detail.jsp?isbn...

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

#338

Post by tpainton »

This person reminds me of a lot of people I went to medical school with. Very smart, and yet, not very realistic. He outlines a scenario that is endgame.. when in fact, we are seeing cyclical events. We saw the emergence of penicillin resistence in S. Aureas, then methicillin resistance. we moved to quinalones, and sulfa and we see resisance develop there.. OF COURSE it does. The antibiotics don't cause resistance.. Natural selection is the process going on here. There are random mutations that occur regardless of antibiotic exposure. We do see antibiotics cause resistance such as in inducible extended beta lactamase resistance.. (I have a patient currently with E coli resistant to everything but Colistin) but the overwhelming process..it's still good old fashion natural selection that Darwin made us all aware of. We really don't need to panic.. we just need to keep fighting the fight..because it won't ever end, unless we give up. Relax. When I hear people claim it was wanton use of antibiotics that caused all of this.. I wonder if they ever read a word about biologic evolution. Right now, there are organisms out there that are already resistant to antibiotics that haven't been developed yet. How can we blame humans for that?

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

#339

Post by shabble »

aestra wrote: post #256
rodw wrote: post #121

Earlier quoted context omitted.

The function of antibiotics in agriculture isn't to prevent infection (or at least, not primarily to prevent infection) but to fatten the animals up for slaughter.

How exactly does antibiotics fatten animals up for slaughter?

The obvious answer is: You can't profitably slaughter diseased animals (at least for human consumption, with various complex exemptions that massively reduce value)

So treating with broad-spec antibiotic prophylaxis increases your healthy-at-slaughter-date yield, especially under cost-optimised industrial feedlots.

More incrementally, (if perhaps still somewhat controversially), normal gut bacteria accounts for some fraction of the energy intake provided by animal feed. By killing them off, it frees up nutrients for the host. Other mechanisms including reduced immune load may also be involved.

Quoting from [1]:

> According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to "help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals". Although the mechanism underpinning their action is unclear, it is believed that the antibiotics suppress sensitive populations of bacteria in the intestines. It has been estimated that as much as 6 per cent of the net energy in the pig diet could be lost due to microbial fermentation in the intestine (Jensen, 1998). If the microbial population could be better controlled, it is possible that the lost energy could be diverted to growth.

[1] http://www.fao.org/docrep/article/agrippa/555_en.htm

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

#340

Post by tpainton »

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,…

There are some situations where an organism can evolve overnight to exposure to an antibiotic. See Inducible Extended Beta lactamase resistance in E Coli. HOWEVER. Bacteria evolve just as any organism does via random genetic mutations that may or may not lead to resistance. It's Darwinism on the cellular level. The vast majority of antibiotic resistance occurred regardless of exposure. There is a segment of society that wants to blame humans for every problem it seems.
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