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”

#361

Post by kamaal » Thu, Oct 24, 2013, 5:09 AM UTC

rblatz wrote: post #76

DanBC wrote: post #57

I've posted this before, but some people may have missed it. "Defeating the superbugs" ( http://www.bbc.co.uk/programmes/b01ms5c6 ) has a segment showing bacteria developing resistance to antibiotics. ( http://v6.tinypic.com/player.swf?file=24goih4&s=6 ) (Sorry about the lousy host; YouTube's content sniffing detects this as BBC property and blocks it.) They have a slab of nutrient jelly. The jelly has sections of di…

I've always been under the impression that bacteria pay a heavy evolutionary tax for their resistance. So what would happen if you then took a sample from the 1000x section of jelly and then another sample of your initial bacteria and put them on opposite sides of nutrient jelly slab. Would the new bacteria be completely overwhelmed? Would infecting someone with a non resistant strain, letting it sit for a while and…

Its difficult to say if they've reached the end of their 'maximum optimization limit' or a local maximum.

The beauty of evolution is not to be stopped by limits, but to run near infinite instances of optimization algorithms over infinite time scales to over come the limits that exist.

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

#362

Post by j2d3 » Thu, Oct 24, 2013, 5:40 AM UTC

What seems missing from this HUGE discussion about "the end of antibiotics" is vaccination.

There is work in progress toward a MRSA vaccine[1,2,3], though it won't be easy. Nevertheless, the way I see it, vaccines are a strategic approach, while antibiotics are tactical.

Obviously we need to continue to pursue both, but I just think it's important to consider and even maybe refocus our efforts to deal with MRSA and other tricky fast evolving bacteria that become widespread and problematic in our communities by pushing hard for vaccine development.

[1] http://www.trefis.com/stock/pfe/articles/205872/pfizers-vacc...

[2] http://www.huffingtonpost.co.uk/2012/02/15/scientists-create...

[3] http://www.fiercevaccines.com/story/pfizer-glaxo-and-novadig...

(did you know there was a website called "fiercevaccines.com"???)

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

#363

Post by kamaal » Thu, Oct 24, 2013, 5:42 AM UTC

schoper wrote: post #333

bad_user wrote: post #147

Earlier quoted context omitted.

> 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 resistanc…

I don't know how that works,

God forbid say your dad is sick- Will you go and tell him- 'Dad, you better die for the sake humanity and than take these antibiotics and have you pain reduced'.

If you are poor, will you tell your kid- 'Sorry son, I have to sacrifice you for the sake of humanity, no more antibiotics for you'

The parent comment to yours is correct. Poor have better immune systems, because theirs is trained to handle such situations from their birth than yours and mine which live well sanitized environments and have never been exposed to them before.

That's at least true in a country like India. I'm not sure where you live, poor people dying out of fatal infections is one thing. But its also a fact, some that requires me or you take a sick leave doesn't even bother them.

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

#364

Post by tanzam75 » Thu, Oct 24, 2013, 5:49 AM UTC

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.

You used the wrong term. What's lethal is not "infection" with rabies -- but a full-blown case of rabies.

Rabies infection is very survivable if caught before symptoms start to show up. We have a post-infection vaccine that can be used during the incubation period. We've had a vaccine for over a hundred years, and it works very well. In fact, the original rabies vaccine was the second vaccine ever developed, after smallpox.

What's lethal is symptomatic rabies -- but even that is not 100% lethal. There have actually been a few (under a dozen) documented cases of human survival after symptomatic rabies. Look up the Milwaukee Protocol.

Problem is, the treatment lies within the realm of heroic medicine, works less than 10% of the time, and requires a long period of physical therapy afterwards. The cost easily goes into the seven figures. And we don't even know if the treatment works. Survival might simply be the luck of the genetic draw.

So, $10 million to save the life of one patient with symptomatic rabies, vs. $2000 for the vaccine. So you can see why the treatment protocol emphasizes post-infection vaccination.

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

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Post by mtdewcmu » Thu, Oct 24, 2013, 6:06 AM UTC

nate_meurer wrote: post #353

mtdewcmu wrote: post #337

Earlier quoted context omitted.

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 (esp…

Well said. However... > "Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed..." The reality is much worse. Factory meat producers will abuse any antibiotic if they are allowed, even the most powerful last-resort antibiotics. For example, many poultry producers were routinely mixing fluoroquinolones into their feed until very recently. The practice w…

Interesting.

Incidentally, I think the intuitive idea that the last resort antibiotics are the most powerful ones is a bit of a misconception. The ones used as a last resort tend to be the more toxic ones and the ones that have to be given intravenously. The reason they still work is probably because they were used sparingly while there were better alternatives available. That delayed the development of resistance.

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

#366

Post by baddox » Thu, Oct 24, 2013, 6:09 AM UTC

gnaritas wrote: post #317

FkZ wrote: post #224

Earlier quoted context omitted.

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.

Where's your evidence that people are mislead? I don't have any data either, but I suspect exactly zero people came away thinking that bacteria have conscious desires, just like zero people believe that wind actually bites or people actually get butterflies in their stomach.

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

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Post by baddox » Thu, Oct 24, 2013, 6:13 AM UTC

gnaritas wrote: post #345

enraged_camel wrote: post #327

Earlier quoted context omitted.

There is no "active misleading." On the contrary, the usage of the word "desire" in this context aids layman understanding of the subject.

That's your opinion, not mine; however it's exactly talk like this that has led to most laymen not understanding evolution. They don't get that it's being dumbed down for them and that's not their fault, it's the fault of people who casually anthropomorphize things because they wrongly think it helps to clarify; it does not. Understanding comes from truth, not casual simplifying lies.

You place a large hindrance on discussion if you require every discussion that mentions natural selection to give an entire introductory lesson on evolution. It's a ridiculous notion, especially when there is unlikely to be any misconceptions taken from this article. The purpose of the article was to explain why bacteria become resistant to antibiotics and how our use of antibiotics has led to this, and it does a fine job of that even if some uneducated people still can't describe the modern evolutnary synthesis.

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

#368

Post by mtdewcmu » Thu, Oct 24, 2013, 6:40 AM UTC

Goopplesoft wrote: post #222

mathattack wrote: post #28

Earlier quoted context omitted.

> 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 one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospit…

> This is one reason to avoid hospitals at all cost. I think generally, everyone avoids hospitals at all costs.

Good point. And hospitals themselves are very costly. In case you need another reason.

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

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Post by Shinkei » Thu, Oct 24, 2013, 6:43 AM 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…

>Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. 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. Which is exactly what we've seen happening.

This is the important point that people forget. Bacteria are experiencing an extremely accelerated time course and can evolve and exchange advantageous mutations very quickly. We have only had antibiotics for 100 years, which is 3-4 generations of man, but billions of generations of bacteria!

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

#370

Post by gsk » Thu, Oct 24, 2013, 6:55 AM UTC

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.

When you say this, aren't you are making precisely the same mistake you claim the expert was making?! I am sure Dr Arjun knows very well that evolutionary goals are local and specific to the circumstance a creature finds itself in.

>The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.

:-) how anthropomorphic! Intelligence may not be a survival trait as you seem to assume. We simply don't know that. Btw, bacteria has been a lot longer on this planet than primates. We are way out of our depth when it comes to understanding how they work (I am simply paraphrasing a friend's statement, he is doing fundamental research on biochemical pathways)