Antifungal resistance is here

https://www.theatlantic.com/science/archive/2018/11/when-tulips-kill/574489/

by xoa • 8 years ago

138 28 8 years ago

xoa4• 8 years ago

This is a shitty, clickbait title which I'm sorry about, but the article itself is decent though verbose. And the subject matter itself seems important enough to be worth overlooking some presentation issues, and deserves public attention, even if it's not new to many here. I follow medical literature reasonably closely for a layman (I have a cousin finishing their residency soon) but while antibiotic resistance and the links to agriculture has gotten a lot of discussion and begun to reach the public at last, this is the first time I can remember hearing about this particular link to agriculture and triazole resistance. I remember reading about fungal infections a number of times over the years as a difficult class of infections, but I had assumed that no human compatible compounds were used there because they didn't boost animal size and there were hundreds of human (well probably mammal in general) bio-incompatible ones that were fine with plants.

This probably shouldn't be surprising but it's still worrisome given how few compounds there are for medical use even compared to antibiotics. At least in America for whatever reason apparently agricultural triazole use is still relatively low though increasing, so perhaps it could still be nipped in the bud so to speak.

sevensor2• 8 years ago

This is a shitty, clickbait title which I'm sorry about,

It's a really unfortunate strategy the Atlantic has taken. They do the same thing on the cover of the print magazine, choosing the most provocative thing they can come up with. It's one of the reasons I stopped renewing my subscription. The other being that they stopped accepting checks for subscriptions. I won't stand for opt-out credit card renewals on magazines. It's an abusive practice. All this makes me sad because the Atlantic's writers still produce good articles like this one, but they're running the rest of the magazine in the worst possible way.

xoa4• 8 years ago

I won't stand for opt-out credit card renewals on magazines

You are entirely morally justified in this, and even though a lot of consumer facing businesses find actual checks themselves troublesome at scale that's not excuse not to offer one-time CC transactions at least (and preferably a full range of e-payment methods). FWIW though there is a sort of hack a lot of cards offer that can be helpful for this sort of service (at least when you find it too important to be practical to just write off): virtual card numbers. They go under different branding at different places, Bank of America for example calls it "Shop Safe" or something like that IIRC. Effectively though you access the card provider's tool, put in a balance and expiration date, and it then generates a credit card number (including 'security code') that has that expiration and balance, and of course can be trivially cancelled at will. You can use it anywhere any other credit card would work. That allows creating a maximum budget payment upfront that you can then entirely forget about, it won't auto-rollover, and it can never be charged more then the balance set. I think the way most (all?) places have it set up the VCC also binds on first use, so even if it was leaked it can't be utilized anywhere else.

It's a useful tool for this sort of situation since it puts the buyer back in the driver's seat. Rather then having to fight to cancel something, it's up to them to get more money out of you since they don't actually have a real card. Can also be handy for buying online from places you're not 100% confident in, you can set a balance at just the price and at least know your loss is limited there. Regrettably I don't know of any places that make this nearly as central and easy a feature as it should be, and not all banks offer it, but it comes in handy sometimes anyway.

freyir• 8 years ago

It's a really unfortunate strategy the Atlantic has taken.

The Atlantic's title is "Killer Tulips Hiding in Plain Sight."

Or did they change it?

aklemm• 8 years ago

On the other hand, I'm glad they successfully got aggressive on the Web a few years ago or they'd probably be gone.

haaen• 8 years ago

It's also badly written, with many me's an I's, like

'I squint at the plant names that have been rendered into Dutch.'

and uninteresting facts about the appearance of the scientist, like:

'Meis is a big man, almost a foot taller than me, broad-shouldered and bullet-headed with an exuberant laugh. Eyeing the boxes, though, he looks solemn.'

ravenstine• 8 years ago

and uninteresting facts about the appearance of the scientist, like: 'Meis is a big man, almost a foot taller than me, broad-shouldered and bullet-headed with an exuberant laugh. Eyeing the boxes, though, he looks solemn.'

I'd seriously like to know how many of today's journalists were at one point creative writing majors, as it seems like every year we get more articles with this kind of narrative fluff.

Just look at the first paragraph:

The glass-walled landscaping center on the road south of Nijmegen looks like a gardener’s dream of heaven. My fingers tingle as I thread my way through stands of soaring bamboo, drifts of asters, and lanes of rhododendrons, tempted to grab a trowel and forget what I’m here for.

It was a dark and stormy night...

So much "in depth" journalism today starts out with this kind of storytelling, and I'm sure that this is rationalized as a way of "grabbing the reader's attention", but I'm not sure it's doing the actual content of the story a service. It might grab the attention of casual readers, but somehow I doubt that people actually curious about science really want to sift through a bunch of words that basically say nothing.

xoa4• 8 years ago

This has gotten replies focusing on aspects such as the "human interest angle" purple prose of the article. One of the whole problems with that style of writing really, it can end up drawing so much attention to the writing itself that it can overshadow the topic. But the topic really is a big deal! And as HN has a significant US contingent I want to reemphasize the section this paragraph starts at the end:

"Until recently, the United States was exempt from concerns about azole-resistant Aspergillus. Azole use here has historically been low, a small percentage of what happens in Europe—though the numbers that record it, kept by the U.S. Geological Survey, may be incorrect because submitting them is voluntary. Nevertheless, tebuconazole use in the United States rose five times over from 1995 to 2015; the crops that accounted for the most use were wheat and corn. Meanwhile, a Centers for Disease Control (CDC) poll of state health laboratories found no cases of resistance as recently as 2014. But last month, the CDC disclosed that 10 patients treated in the United States have been diagnosed with triazole-resistant Aspergillus bearing the mutations associated with agriculture. In a report in its weekly bulletin, the agency analyzed the records of seven of them. Four of them had never received azoles before they were diagnosed with the resistant strain. Three of the patients died."

With the discussions on antibiotic resistance softening the way, I think real action might be yet possible to forestall this becoming as entrenched an issue over here. I drafted a letter and sent it on my way home from work to my House rep and both my Senators. Seriously, this shouldn't have too many entrenched interests behind it yet, it's relatively small scale and doesn't seem to have the same sort of alternate usage and dependencies agricultural antibiotic use does. And the description of fungal tendrils growing through the lungs then sprouting in internal organs is sufficient graphic and terrifying (like, for those who don't find "100% fatality rate" worrisome by itself) and easy to understand that it could generate a real quick public interest. If a lot of people had no idea this was even a thing, don't assume your reps have it on their radar either. A quick "just use what you were using before and save the medicine for our children" ban before use can really ramp up might well be feasible. In my experience people writing to express issues are rare, such things do get read and if there is no one yet lobbying against it can be the stuff of easy political wins (and/or get slipped into omnibus bills for better and for worse).

Also if you live in the Southwest then I think "valley fever" must link into this, it's also a deadly fungal infection. Treatment is fluconazole.

brazzledazzle• 8 years ago

The amount of off-topic comments under yours about click-bait, grammar and english majors(??) is borderline obnoxious.

Mvandenbergh• 8 years ago

“Agriculture has almost 300 compounds they can use on fungi,” he tells me. “In medicine, we have four. And they use the four that we also use, because they work so well.”

They're also very safe for humans, other mammals, and other animals. Logically something that has been cleared for humans to ingest or apply to themselves in high doses deliberately is going to have a very benign safety profile when applied to non-food plants in your garden.

aurizon2• 8 years ago

This is a real menace to millions of people who get Aspergillosis. The wide us of these compounds is going to manifest in resistance to many fungal infections of many kinds.

jonathanjaeger• 8 years ago

There are a couple biotech companies working on less resistant drugs for Aspergillosis (such as Scynexis and Cidara Therapeutics). That being said, they're just in trials, and probably 2-4 years from commercialization.

aurizon2• 8 years ago

That is good, too many people are dying now

ohiovr• 8 years ago

How long till it ends up in the gardening section of lowes?

DoctorOetker• 8 years ago

it will be a real bummer the generalized pattern of harmful organism developing resistance in commercial setting as opposed to medical setting (like antifungal resistance, or antibiotic resistance) turns out to be "The Great Filter" of life in the universe. Hopefully we will learn our lesson after a couple of instances and rigorously ban non-medical use of drugs reserved for human medical use.

admax88q• 8 years ago

Nausicaa becoming more relevant.

chiefalchemist2• 8 years ago

"About a decade ago, he and some of his colleagues faced a diagnostic puzzle. Some of their patients were sicker than they ought to be, but there was no clear connection to a cause."

Odd as this might sound, disease is often a symptom. The root problem being a compromised immune system. The human immune system is robust. It's had many centuries and many generations to perfect its craft.

But modern life (with its associated chemicals and other factors that are historically abnormal) is bad - and getting worse? - for the immune system. No other species, that I'm aware of, is so willing to put itself in harm's way. Perhaps humans have out smarted evolution to the point of ending the species' reign?

Years ago there was a TV advert, something about "it's not nice to fool Mother Nature." Seems like that tongue in cheek tag line isn't so funny after all.

pighive• 8 years ago

For some reason I read it as ‘anti-frugal’ and started reason my thinking. Daah!

Antifungal resistance is here

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