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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”

#251

Post by refurb »

protomyth wrote: post #150
JumpCrisscross wrote: post #139

" These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic. " The profit motive is almost as blind a watchmaker as natural selection. We've built an environment which encourages bacteria to develop antibiotic resistance. Let's structure a pharmaceutical industry in which antibiotics are profitable…

I'm pretty sure an X-Prize-style $10 Billion tax free for the next antibiotic from the government[1] would probably get something done. Given our needs, the $10B would be cheap. Heck, buy the next 3 or 4 discovered. 1) assuming said government exempts the company from court claims on the approved drug

The gov't is already looking at something similar. If an antibiotic is approved by the FDA, the company would be guaranteed at least $100M in revenue per year, going up to $350M in the fifth and final year.

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

#252

Post by Fomite »

tzakrajs wrote: post #48

Do doctors over-use antibiotics to save from being sued by patients in the case of an infection?

There are a number of reasons to over-use antibiotics:

1. Patients ask for them. For a long time, the thinking went 'What's the harm?' in giving Mr. Jones some penicillin for what's probably a viral infection.

2. There is the potential for lawsuits, and the desire to have 'done something' to cover your ass, but I think this is widely exaggerated as a threat.

3. It's hard to diagnose many conditions. Like juries think all crimes get the full CSI treatment, patients often think doctors can just pop down to the lab and find out what you have, like in House. The answer is that's often hard, expensive, and failure prone. So they give antibiotics, especially broad spectrum ones, because of the subset of things you might have, antibiotics can treat some of them.

4. This is really 3b, but it's also possible, when you have no clue what your patient has, to try different antibiotics to try to get a handle on things. This...ends up using a lot of antibiotics.

5. Doctors, at their core, want to treat their patients. To make them better. They're trained to deal at the individual level - antibiotic resistance is a population level concern.

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

#253

Post by stcredzero »

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

> If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.

There are better ways of ensuring the supply of food than the abuse of antibiotics in livestock.

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

#254

Post by MaysonL »

XorNot wrote: post #103
carbocation wrote: post #77

Earlier quoted context omitted.

As you can imagine, doctors initially got into trouble with this because there is no test that you can use in clinic that says "this patient just has a viral infection". Nevertheless, there are clinical criteria that we can use to come to the same conclusion, and the tide changed years ago with regards to inappropriate antibiotic use for routine viral illnesses. It gets much dicier in-hospital when someone has a SIRS…

Resistance is a funny thing: there's nothing specifically wrong with going nuts with the antibiotics provided everything gets dead. The problem is much more with people who only take partial courses or are non-compliant, because if you don't clear the infection then round 2 is full of the slightly more resistant members of the species.

There's also, of course, all the antibiotics that go into sewers.

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

#255

Post by stcredzero »

api wrote: post #84

... and the judicious use of antibiotics requires some kind of regulatory agency or system to make sure the users follow through. This seems like another area where libertarianism is crashing against the rocks of reality-- as socialism, communism, and all other political ideologies have already done. I have a profound sense that all political ideologies are failed, and that we're entering a post-ideological age of pr…

> This seems like another area where libertarianism is crashing against the rocks of reality

Antibiotics use fits the "Tragedy of the Commons" scenario to a T.

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

#256

Post by aestra »

rodw wrote: post #121
stcredzero wrote: post #63

Earlier quoted context omitted.

In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection…

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?

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

#258

Post by [deleted] »

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…

[deleted]

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

#259

Post by g8oz »

The antibiotic overuse that caused this problem will not be solved with out action in 2 area. 1) Antibiotic overuse in poultry and livestock farming to compensate for overcrowded and stressful conditions and 2) Antibiotic overuse in the developing world.

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

#260

Post by aianus »

selmnoo wrote: post #91
robterrell wrote: post #54

Earlier quoted context omitted.

I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.

This is touched in the FRONTLINE documentary. See 33:40-40:00 here: http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmar... Basically Pfizer, one of the last companies working on antibiotics for gram-negative bacteria, pulled out due to pressure from shareholders, because there's little money to be made here. You spend billions of dollars on creating an antibiotic, and upon its release the recommended instruc…

They could patent it and charge $5000 a course to people who are suffering from resistant bacteria. It's the American way.
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