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”

#71

Post by gibwell » Wed, Oct 23, 2013, 4:36 PM UTC

mesaaz wrote: post #18

sailfast wrote: post #4

This resistance scares me a great deal, especially as a new dad. I'm hopeful that in the coming years we'll be able to target bacteria and viruses more specifically using nano-technology and other tools at a cost effective level (admittedly I don't have a lot of knowledge in this area but I'm hopeful.) If all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacteri…

There is reason for guarded optimism if we can eliminate, or at least drastically reduce, irresponsible use of antibiotics: The capacity to resist antibiotics extracts a small metabolic/competitive "tax" on bacteria. In the presence of antibiotics, the costs of this tax are outweighed by the obvious benefits of antibiotic resistance. In an environment without antibiotics, the costs of the tax outweigh their benefits,…

We can't discipline ourselves because there are giant vested interests in selling antibiotics and none in resisting buying them.

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

#72

Post by gibwell » Wed, Oct 23, 2013, 4:38 PM UTC

How are we going to use fewer antibiotics when they are a profit making venture?

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

#73

Post by DanBC » Wed, Oct 23, 2013, 4:38 PM UTC

humanrebar wrote: post #46

AaronFriel wrote: post #6

For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a…

I think you're going a bit too far there. I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).

People use antibiotics to treat things that are not helped by antibiotics.

Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm.

(http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm)

> Untreated gonorrhea can cause serious and permanent health problems in both women and men.

That seems like a reasonable use of an antibiotic. But maybe we should have been working out how to get people to use condoms.

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

#74

Post by tokenadult » Wed, Oct 23, 2013, 4:39 PM UTC

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…

A good illustration. Your phrasing "The bacteria has developed resistance to the antibiotic" is of course better understood as "the descendant bacterial cells have been ruthlessly selected for resistance to this antibiotic." But that is not an invariant characteristic of bacteria. It is perfectly possible to completely wipe out a population of bacteria in a particular place so that the bacteria have NO descendants.

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

#75

Post by saalweachter » Wed, Oct 23, 2013, 4:39 PM UTC

jabagonuts wrote: post #42

erichurkman wrote: post #11

Earlier quoted context omitted.

> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. 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.

I feel a lot less silly now for avoiding medical treatment unless absolutely necessary all my life.

The difficulty is avoiding treatment and not diagnostics. If your method of avoiding treatment is never going to the doctor, ie, never being diagnosed, you don't really know when your problems are life-threatening.

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

#76

Post by rblatz » Wed, Oct 23, 2013, 4:39 PM UTC

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 then hitting them with antibiotics knock the infection low enough that your immune system could wipe up the rest?

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

#77

Post by carbocation » Wed, Oct 23, 2013, 4:41 PM UTC

stcredzero wrote: post #63

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-...

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 response and you need to presumptively treat them for sepsis.

I would be curious to know: of the antibiotic resistance burden that comes from human antibiotic use (specifically in countries where abx are physician-prescribed and not available over the counter), how much of this burden comes from broad treatment of presumed serious infections, and how much comes from treatment of presumed non-serious infections or even postsurgical prophylaxis?

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

#78

Post by polarix » Wed, Oct 23, 2013, 4:41 PM UTC

swamp40 wrote: post #64

AaronFriel wrote: post #6

For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a…

> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. Really? And whose lives are you willing to play that game with? Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set? Your wife, with a bladder infection so severe it's bleeding and she has a fever? "Sorry, son - your suffering is for the betterment of mankind.…

How about the animals and hand-soap aficionados? Perhaps they could hold off for a bit?

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

#79

Post by coryrc » Wed, Oct 23, 2013, 4:44 PM UTC

swamp40 wrote: post #64

AaronFriel wrote: post #6

For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a…

> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. Really? And whose lives are you willing to play that game with? Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set? Your wife, with a bladder infection so severe it's bleeding and she has a fever? "Sorry, son - your suffering is for the betterment of mankind.…

Maybe GP didn't have the best wording, but I would classify those both as emergencies appropriate for antibiotic use -- you may only think them not because antibiotics are seen as so commonplace.

Non-emergencies:

* sore throat * lots of chickens packed in one place

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

#80

Post by criley2 » Wed, Oct 23, 2013, 4:45 PM UTC

robterrell wrote: post #54

zeteo wrote: post #49

Earlier quoted context omitted.

> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development…

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.

Remember, it takes 8-12 years and $1,000,000,000 on average to whittle 10,000 drug candidates into 1 fully tested FDA approved drug.

If a company is going to spend a decade and a billion attempting to develop a "management" antibiotic for continual profit, I'm willing to bet the profit motive exists for another company to make a normal antibiotic... that most doctors would happily prescribe over the ridiculous multi-year option...

It's a big risk and I doubt some company will attempt to make a maintenance drug out of antibiotics.

Unless you're implying that profit motive means they simply won't try because it's not insulin or something, which is ridiculous. Profit motive... there is profit to be made in a new antibiotic, there's the motive. Not every pharma company will just let money sit on the table in favor of older drugs nearing the end of patent protection.