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The antimicrobial resistance crisis needs action now

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Re: The antimicrobial resistance crisis needs action now

#121

Post by midoridensha »

dmckeon wrote: post #74
retrac wrote: post #39

Earlier quoted context omitted.

Like many slow moving disasters, it doesn't feel like one while you live through it. An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective…

Also 40 years ago, 40-some years after penicillin was introduced, gonorrhea had evolved to produce an enzyme that acted specifically against it, penicillinase. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1046026/pdf/brj... No matter how many new, different, or even radical antibiotics we develop, unless we get ahead of over-prescribing and under-treating (not taking all of a prescribed treatment course) we will cont…

I think it's utterly hopeless. With billions of humans, there's no way to get everyone to agree to do the right thing, both with doctors and especially patients. You just need a small fraction doing the wrong thing for something bad to evolve: look at Covid, for instance. That simply evolved somewhere at one point in time in one place, and then spread like wildfire.

Re: The antimicrobial resistance crisis needs action now

#122

Post by midoridensha »

r3trohack3r wrote: post #54
SQueeeeeL wrote: post #28

Earlier quoted context omitted.

Not OP, but it's kinda like boiling or alcohol versus poisoning (which is essentially how most drugs work). Certain attack vectors are literally unevolvable, as they would require fundamentally different building blocks to be able to be able to handle, which is too big of a leap for evolution to make.

This was a light bulb comment for me, thank you. The challenge is: 1) finding something that kills mostly/only cells we don't want in or around our cells 2) kill them in such a ruthlessly efficient way that there are no survivors As a sibling points out, the vacuum of space does #2 quite well. Actually we have a lot of stuff that handles #2 quite well. But #1, differentiating between "good" and "bad" with our murder…

We need to create nanides: nano-scale machines that can differentiate between microbes and destroy the bad ones. Just don't piss them off with a phaser blast when they get into the ship's computer core.

Re: The antimicrobial resistance crisis needs action now

#123

Post by adolph »

An offering of ill-informed conjecture/prediction from afar: no progress in future antibiotics—things shift to understanding human biome, at least in significant parts of not whole. Antibiotics are an Industrial Age approach that got humanity across some hurdles, similar to hydrocarbons, but are a dead end.

Re: The antimicrobial resistance crisis needs action now

#124

Post by wnevets »

epicureanideal wrote: post #114
wnevets wrote: post #100

Earlier quoted context omitted.

> As the population grows there’s more and more taxes to spend for this purpose. but so does the cost to service that growing population.

Basic research scales in a way that treating specific individuals doesn’t. Treating specific individuals can be handled by insurance.

Any increase in general tax revenue generated by an increase in population is going to used for the new population. For example NASA's budget didn't increase just because of an increase in population

Re: The antimicrobial resistance crisis needs action now

#125

Post by toofy »

ChrisMarshallNY wrote: post #105
hourago wrote: post #81

Earlier quoted context omitted.

> The problem is that cost and risk of development and trials is too large for the current rewards, This kind of invesment has been traditionally done by governments. But with a reduction of taxation governments do not have animore money to do this. And for private companies it makes more sense to spend that kind of money in advertisment than in developing new products. > ensuring good prices or bounties for successf…

> Give passionate CEOs money and you get the next big scam. This has been the case for decades, yet we still seem to have not learned this. This is my observation, from having seen this happen in a couple of industries, and hearing of it happening in others. There seems to be a "sweet spot," in new money-making stuff, where real value is produced, rewards are reaped, and scamming is low. The industry starts off with…

i think you’re hitting the nail on the head emphasizing passion.

so often people entirely disregard passion for the work when theorizing that no one would be a ceo for less than $40million.

i haven’t ever seen studies done surrounding the issue, but i’d bet far more innovation comes from people doing something because they’re passionate than it does from monetary reward.

there’s a tipping point somewhere when innovation takes a backseat to greed.

often greed directly leads to a willingness to destroy a things essence or just chip away at the thing completely ignoring the passion which brought it about in the first place.

edit: forgive me if this seems a bit heavy handed—just watched Its a Wonderful Life with the family for Christmas so maybe i’m feeling a bit jaded towards greed.

Re: The antimicrobial resistance crisis needs action now

#126

Post by Gatsky »

zosima wrote: post #15

I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinica…

Not sure I agree. Take a look at recently developed antimicrobials. It’s not like there haven’t been any new ones. The problem is this: they are very expensive compared to older antimicrobials (so don’t get used at all except in wealthy healthcare systems) and they are tightly held in reserve for only the most resistant cases (so very small market). The latter point is particularly insurmountable, since widespread use will make the new antimicrobial less useful. It isn’t really worth it for a drug maker. The article talks about this, indicating that public-private partnerships are the way forward.

Re: The antimicrobial resistance crisis needs action now

#127

Post by pmalynin »

unity1001 wrote: post #113
version_five wrote: post #109

Earlier quoted context omitted.

I thought of that too. I don't know enough about it to know if it's a legit counterpoint. My view is that real competition is necessary to efficiently and effectively get to a solution, versus focusing on the bureaucratic mechanics of running the machine that's supposed to be building the solution, which is what happens when government takes things on. But the space program, and maybe the Manhattan project, actually…

> I don't know enough about it to know if it's a legit counterpoint. Its a gigantic counterpoint. A large swath of the technology used today was developed by NASA and then turned over to the private corporations for them to profit. Socializing the costs. Privatizing the profits. The Internet iself an argument. It was developed at DARPA with taxpayer money. Then turned over to the private corporations so that they cou…

With the Internet the government got their pound of flesh through taxation of all the new enterprises that sprung up because of their investments , so I wouldn’t make it sound so negative.

Re: The antimicrobial resistance crisis needs action now

#128

Post by hristov »

zosima wrote: post #15

I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinica…

What if new antimicrobials do get developed? They will once again be used in massive quantities in dirty and otherwise unsanitary livestock operations, resistant bacteria will develop again and we will be where we started again. Actually we will be at a worse place from where we started because all new antimicrobials that do get developed seem ever more dangerous with ever increasing lists of ever more serious side effects.

The large livestock operations keep their livestock in horrible unsanitary conditions to save money and they create a breeding petry dish for bacteria. They rely on antibiotics to kill the bacteria but in those conditions the bacteria have all the advantages and usually are able to create resistant stains pretty quick.

Re: The antimicrobial resistance crisis needs action now

#129

Post by hristov »

clnq wrote: post #102
nextos wrote: post #8

We need more research in bacteriophages. They can be engineered to avoid any resistance, and they can replace antibiotics in all use cases. Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.

Phage therapy is already used in Eastern Europe and Russia. I received phage therapy there myself against an antibiotic-resistant GI infection about 15 years ago. It has been effective. Of course, this is a sample size of 1. I genuinely believe that ideological and political stigma still stands in the way of phage research and use in the West as it did in the cold war when phages were considered "Soviet". More though…

Another reason why phages aren't used in western countries is that it is difficult to make money off of them. As I understand it, phages are bred uniquely for each strain which means it is difficult to patent them. The strains change all the time, therefore the phages have to change, by the time you get a patent for one, it is already likely to be ineffective.

Furthermore, the process of breeding phages for each disease is something drug companies really do not want to do. They want to manufacture pills, ship them in boxes to hospitals and get their money. Doesn't work with phages. You have to take samples at the hospital from a patient of the bacteria, breed a phage that eats that bacteria and then send that phage back to the patient.

This kind of back and forth seems way to expensive and complicated to the modern drug company. They do not want to build infrastructure around all the country's hospitals to ship contagious samples and to have labs all over the country to breed and manufacture phages.

Re: The antimicrobial resistance crisis needs action now

#130

Post by alxmng »

Brendinooo wrote: post #22

At the risk of sounding ignorant… I’ve been hearing stuff like this for twenty years now. And yet the crisis hasn’t happened. Why is that?

It has happened. My child got a resistant strain of Shigella causing severe dysentery. After a stool assay it was found only 3 kinds of IV antibiotics were effective, with only 1 being safe for children at effective dose. And it still took a week of 3x per-day IV infusion for it to clear. The doctors said only 5-10 years ago there were still oral antibiotics that worked, but now there aren't any.
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