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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”

#261

Post by revelation »

resu_nimda wrote: post #197
mistercow wrote: post #138

Earlier quoted context omitted.

I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover". Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if y…

Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. It took evolution billions of years to make machines that can run 60 miles per hour. You come off as being dismissive of the power and beauty of evolution, although I don't think that's your intent. Evolution assembled the most complex system known to e…

I guess thats the curse of programming. We all have a very clear understanding of how very very simple logic gates give rise to systems of infinite complexity.

It's a recurring pattern. SAT, the NP-complete problem, is at first glance a ridiculously simple task, yet solving it means being able to solve all other problems. When designing a language or a machine, it is very very simple to accidentally make it Turing compatible, the barrier is just so low, despite the reward being.. everything.

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

#262

Post by AsymetricCom »

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…

Thanks for your useless karma whoring post that does nothing but distract from the content of the article with more "fallacious teleological language" of your own.

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

#263

Post by MaysonL »

mturmon wrote: post #188
zeteo wrote: post #65

Earlier quoted context omitted.

>you'll buy drugs for high cholesterol the rest of your life Not if you get killed by an infection first.

This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.

And it's sometimes easier to invent a chronic condition for a drug, than vice versa.

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

#264

Post by eliben »

I'm always confused by these articles. If the issue was really so serious, wouldn't governments be concerned by it at this point? What does it mean that they aren't, in fact, concerned? Does it mean that the amount of people currently affected by these bacteria is negligible? Something else? That there are opposite experts who say this is no a real problem? Lobbying?

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

#265

Post by ceejayoz »

swamp40 wrote: post #181
ceejayoz wrote: post #82

Earlier quoted context omitted.

Those examples both qualify as necessary and emergent. What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).

I'm not sure how prevalent your example is these days. I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn. They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.

Doctors are getting better about it because of better awareness of the problem. My kids' pediatrician is similarly good about it.

Last year NY state started putting out "when does my child need antibiotics?" pamphlets that they have in the exam rooms.

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

#266

Post by EvanKelly »

Fomite wrote: post #229
dsizzle wrote: post #169

Earlier quoted context omitted.

Ignoring the snark (of the parent comment), I've often wondered why it was bad to use anti-bacterial soap (and antibiotics in general), but not regular soap, since both leave some amount of bacteria behind, which presumably have genetics making them more resistant to the pressure. I think part of the answer is that its just not possible to evolve resistance to any amount of soap and hand washing, unlike resistance to…

I'll take a stab at this - I'm an infectious disease epidemiologist that works on hospital infections mostly. The thing with anti-bacterial soaps is not that the use of the soap is bad. The problem is the anti-bacterial part. It puts amounts of a broad spectrum antibiotic into the environment (be it your hands, your countertop, or the water system) in concentrations that aren't enough to do much, but are enough to pu…

How do you feel about Triclosan in toothpaste?

I dated a heatlh care professional for a while who was pretty adament that it was causing detrimental effects in the same manner as antibacterial soap.

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

#267

Post by davvolun »

vivin wrote: post #94
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…

I think it's a bit pedantic to argue about his usage of "desire". Evolution is a blind watchmaker. The bacteria are reacting to selective pressures. Large populations of bacteria around the world are getting exposed to different kinds of antibiotics. It's not a matter of "if" they will acquire resistance, but "when", and we're seeing this happening right now. The fact that lines of bacteria go extinct does nothing to…

I believe the point being made was not pedantic, but to express the difference between a blind watchmaker (as you say, evolution) and a sighted watchmaker (theoretically, the effort of humanity, science, ...). Of course, that assumes that humanity as a whole, or in part, can actually recognize the need and organize an effort compared to how quickly the blind watchmaker works. Maybe I'm reading too much into it, but I think I see what OP is getting at there.

In fact, a bacteriophage may or may not be the most promising vector, but a bacteriophage engineered to attack pneumonia or specific infections would be the work of a sighted watchmaker, not dissimilar from ideas of targeted radiation or chemotherapy that are moving forward in the area of cancer treatment. I recall an experiment (not that this is my area of expertise at all) in the recent past that was attempting to use magnetized medicine along with some sort of electrode insertion, I believe, to coerce medicine to specific areas of the body.

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

#268

Post by hershel »

carbocation wrote: post #77
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…

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…

>>there is no test that you can use in clinic that says "this patient just has a viral infection"

I believe there are some labs-on-chip that can detect multiple(even thousands) bacteria and/or viruses. I'm not sure if they are in commercial usage.

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

#269

Post by andrewparker »

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…

Good summary of human being's advantage in the war. But don't forget bacteria's key advantage: iteration speed.

Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses.

It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's are to win, I think they will need to bump up the defensive iteration time an order of magnitude or so.

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

#270

Post by waps »

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…

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 know which it is. Ask how many patients are infected with mRSA. Collect your jaw from the floor when they give you an answer that's 15% if you're lucky, 60-70% if you're unlucky. We have lost the fight with bacteria. It's over. We aren't "about to" lose it, we lost it ~1 year ago, and medicine is fast losing the ability to treat bacterial disease. We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.

We are in fact well on our way to transform hospitals into deathtraps.

> Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town.

First of all, the obvious advantage of evolution is it's running time, 3.5 billion years. Second you probably subscribe to the naive notion that evolution, in 3.5 billion years running time, somehow failed to realize that mutation + natural selection is very, very slow. It didn't. The algorithm that, today, controls evolution of pretty much any species works entirely different from what most textbooks teach you. There are very, very few species that evolve through mutation and selection. We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves).

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.

You'll also quickly realize that no matter how well-intentioned your use of bacteriophages is, it is very, very likely to make things worse, not better.

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