Imagining the Post-Antibiotics Future

https://medium.com/editors-picks/892b57499e77

by k-mcgrady • 12 years ago

157 50 12 years ago

grlhgr4203• 12 years ago

when this was posted on metafilter last year someone posted a truly excellent comment: https://www.metafilter.com/134210/Imagining-the-Post-Antibio...

tempestn• 12 years ago

That was an extremely interesting comment. It would be helpful to mention that it's essentially an overview of bacteriophages, viruses which target bacteria. Describes their initial development, reasons why they aren't currently widely used, and links to more information about possible future development.

Chattered2• 12 years ago

who calls antibiotic resistance as serious a threat as terrorism

What an unbelievably stupid comparison. Terrorism is mass murder turned into the sort of spectacle that causes us to massively overestimate a threat to our individual lives. If antibiotic resistance is that sort of threat, then it isn't much of a threat at all, and we can all go back to worrying about normal things such as dying from regular homicide, heart disease, crossing the road, and choking on food.

conover• 12 years ago

Maybe they meant it in the sense that we should be spending the same amount of resources on antibiotic resistance as terrorism. Or maybe it's just a ridiculous comparison.

Qantourisc• 12 years ago

No it's not as serious as terrorism. Antibiotic resistance is MORE threatening then terrorism !

Chattered2• 12 years ago

The stupidity of the comparison means that I have no idea what is meant by "threatening." In terms of individual lives, regular homicide is far more threatening than terrorism, as is choking on your next meal. Even ignoring the entwining of terrorism with politics, that already makes this a meaningless comparison.

And it's not necessary, because surely we've got plenty of analogous pandemics in the field of medicine which can orientate ourselves to any looming crisis. The AIDs virus in the West is still fresh in our memory, and a far more appropriate comparison.

kitwalker12• 12 years ago

the comparison is with the 'threat level', not the idea itself

jacquesm• 12 years ago

Terrorism is rarely mass murder.

magikroundabout2• 12 years ago

I think all that is meant is that if we are lucky, the threat posed by antibiotic-resistant strains of bacteria will be negligible in spite of media hype. Just like terrorism is. A groping comparison perhaps but a fair statement.

rwallace• 12 years ago

Unfortunately, antibiotic resistance isn't that sort of threat. It's orders of magnitude greater.

swombat• 12 years ago

Dukes believes, though he has no evidence, that the bacteria in his gut became drug-resistant because he ate meat from animals raised with routine antibiotic use. That would not be difficult: most meat in the United States is grown that way. To varying degrees depending on their size and age, cattle, pigs, and chickens — and, in other countries, fish and shrimp — receive regular doses to speed their growth, increase their weight, and protect them from disease. Out of all the antibiotics sold in the United States each year, 80 percent by weight are used in agriculture, primarily to fatten animals and protect them from the conditions in which they are raised.

I really don't like to generalise in this way, but this sort of stuff makes me, as a European, pretty angry at the general laissez-faire attitude of the United States towards such things.

You may say "The US is allowed to govern itself as it wishes, no one's forcing you to live there" - but with its heavy use of antibiotics in cattle-raising (banned in the EU - even though the US has tried to use its muscle to get the EU to un-ban it), the US is basically doing a fantastic job of fucking up antibiotics for everyone. So yes, I'm angry at the United States and its corrupt political system that means that there's almost zero chance that any of this will be fixed until it's far too late.

goldfeld• 12 years ago

Hey, libertarianism is great! Down with the state!

I get actually more pissed off with libertarian cargo-culting than with current government regulation. As much as government is in bed with big corps, it's so much easier to get to an antibiotic ban with a government capable of enforcing it than with a withered state.

wooter2• 12 years ago

Drug resistant bacteria (by the articles own numbers) has killed less people per year than if you were to amortize the cost in lives of Germany's very-powerful state (and then you can add the 49-78,000,000 people killed by Mao). I, for one, am proud that Libertarians look for ways to avoid coercion and want to promote voluntary means. Bans don't work for drugs - I hope people have realized this by now...

Sorry, but I find the "its such a good idea! lets force everyone to do it!" mentality quite irritating. Most solutions come from outside government. Instead of throwing huge capital at a fruitless ban, we should instead use the money on useful research. (such as the link about bacteriophages below: http://www.metafilter.com/134210/Imagining-the-Post-Antibiot...) Or even an educational campaign.

jerf• 12 years ago

Because when I think "federal department held in thrall by the forces of small government", I think the United States Department of Agriculture, and their notorious resistance to massive subsidies and stubborn refusal to issue guidance. I mean, my goodness, the USDA's budget has shrunk every year for the last 20 years! Dastardly Libertarians!

...

Face it... this is not a shrunken, cowardly government quivering in fear of the mighty Libertarian Lobby and their massive and well-coordinated .4% of the vote. This is an already strong government showing you why you can't simply count on a strong government to give you your every whim.

Before one can criticize the actions of a "withered state", shouldn't we first have one? If you insist that the current state is withered, then it is only withered due to the actions of big government collapsing under the weight of its own contradictions because the government has been firmly under the control of Big Government types for the past 6 years at least and arguably beyond that (Bush was no small government advocate), and, well, if you want to go that route I'm game but I'm not sure you are.

(Frankly the efforts to pin blame on Libertarians, who have basically no power, whiffs of desperation.)

Update: Well, I think I can be forgiven for not being intimately familiar with the Byzantine Federal government. It appears to be the FDA that already had the power to regulate this and wasn't using it, rather than the USDA: http://www.politico.com/story/2013/12/fda-meat-antibiotics-1... The article doesn't mention anything about this requiring a new law, so it appears to be something they've had the power to do for a while... they just didn't. The FDA is also, of course, well known for being gunshy with their regulations because of the mighty power of the Libertarians.

TTPrograms• 12 years ago

Dukes believes, though he has no evidence

adventured• 12 years ago

China is in fact by far the biggest problem regarding antibiotics.

So while you're busy being angry, don't forget to spread that anger around.

"Last month, the country's Ministry of Health revealed that on average each Chinese person consumes 138 g of antibiotics per year — 10 times the amount consumed per capita in the U.S. "

For those keeping track at home, that's about 41 times the total use of antibiotics in China compared to the US due to their population size.

http://content.time.com/time/world/article/0,8599,2103733,00...

yaix2• 12 years ago

http://en.wikipedia.org/wiki/Whataboutism

logicchains• 12 years ago

I think the difference is that the problem of antibiotics overuse in US agriculture is amenable to a relatively simple regulatory situation: making a law banning or limiting antibiotics use in livestock. Addressing the issue in China, on the other hand, would require overhaul of the entire medical system, as hospitals are dependent on antibiotics sales for a significant proportion of their revenue.

I went with a friend to a hospital in Shanghai once, and the doctor ran a blood test and found that my friend had a viral infection. He then attempted to sell her antibiotics (which anyone who's done even high school biology knows are completely ineffective against viruses, only against bacteria). I called him out on it, and he just scowled at me and muttered 'westerners do things differently'.

a8da6b0c91d• 12 years ago

I will be interested to see how sexual mores develop this century. I think the "sexual revolution" will turn out to have been a flash in the pan. Resistant clap and syphilis are a growing occurrence. I expect the old order of arresting people for promiscuity to return and the new idea of privacy in the bedroom to die.

perlpimp• 12 years ago

"removing antibiotics from hog raising would force farmers to spend $4.50 more per pig, a cost that would be passed on to consumers."

one of those cases where savings of $4.50 a month cause extinction of human race.

netcan• 12 years ago

Eating a pig month would be quite an achievement.

venomsnake• 12 years ago

I really really hope that the threat of antibiotic resistance is like the one for terrorism. Almost negligible. But I really doubt it. Seems like a greater serious one ...

Udo• 12 years ago

Antibiotics are done, and they've been failing increasingly for at least two decades even though nobody cared to report it then. The speed of our transition to the "post-antibiotics era" is certainly our fault, but the phenomenon itself was always inevitable. Biology is an arms race, and it will always be one. In fact, biology overall is one of the worst substrates imaginable for hosting conscious entities, and that means this and many other problems may never be permanently solved.

However, it's not all hopeless. There are a lot of bacterial infections that will continue to be treatable with antibiotics for some time to come. So it's not like we'll lose all of our capabilities at the same rate. It just means that gradually the number of strains that are panresistant will increase.

To see what complete powerlessness over an infectious agent looks like you don't have to look further than viral infections today. The reality is we still can't do very much to treat them, so over time we'll just add significant bacterial adversaries to this list of diseases for which there is nothing else but symptomatic treatment available.

This will all change, because medicine has to change. In the future, it won't be enough to hit an unspecific infection with an unspecific antibiotic. It will be necessary to analyze individual infections and their interactions with individual patients in detail - and then very specific biochemical treatments will have to be tailored on a case-by-case basis.

The recent rise of monoclonal antibody drugs is a bridge to that future. We're still not knowledgeable enough, and we're still using these treatments with all the finesse of a 3-year old hammering huge lego toys together, but we'll get there eventually. We have to, it's the only hope against a lot of other diseases as well, including cancer.

In the mean time, there is a lot of research that needs to be done. We're also missing the actual technologies, both diagnostic and generative machines, but the most important obstacle to overcome will probably be the culture of medicine. This culture will change only when there is enough pressure for it to change. The FDA will have to change when its primary role becomes denying treatment to people who are going to die instead of keeping the population safe. Medical professionals will change when it becomes a big factor that they lack the scientific background to effectively devise and apply advanced treatments. But first, all of these disasters will probably have to actually happen, and we're already seeing the first signs of that trend.

So, there is definitely a path forward - it's not an inevitable descent into the dark ages. It's just that due to inertia and time spent waiting for basic scientific advances, there will be a period with less protection overall. Drugs may become available to plug some of these gaps, like insect-derived antibiotics, which will eventually fail too but will buy some additional time.

vim-guru• 12 years ago

I guess there's already a movie in the making of how this all turns out.

kylebrown2• 12 years ago

The recent PBS Frontline documentary on the topic was excellent.

magikroundabout2• 12 years ago

Does anyone think it might just be an idea to change the amount of meat we produce? When people start dying at the age of twenty and thirty of bacterial infections that are totally curable today, and gonorrhoea becomes incurable, will we think our current insouciance rational? Will it be seen as a price worth paying in order to have cheap meat? A tremendous proportion of the antibiotics we use are abused as growth promoters for animals reared for meat or their products. They are used pro-actively on healthy animals outside of the EU. Even within the EU, they are used routinely in a way that is driving us towards a post-antibiotics future.

It is pretty sad to reflect that we are not able to prioritize our own health above an immediate desire to consume more meat more cheaply.

bayesianhorse2• 12 years ago

One of the bright spots is that it seems hard for bacteria to evolve more than one resistance, and that resistances don't confer an evolutionary benefit in the absence of the specific antibiotics.

There are modern techniques to avoid resistance issues. For example, as most diseases can be treated by more than one drug, switching them regularly in a hospital or practice.

There are other combinations of drugs which haven't been used a lot or not even been discovered yet. It would be nice for example to trick an infection into letting go of the resistance and then attacking it with the AB.

mnw21cam• 12 years ago

One of the bright spots is that it seems hard for bacteria to evolve more than one resistance

Not sure where you got that impression. There are bacteria out there that are basically resistant to every antibiotic we have. The article even gave an example of a case where someone died because of this.

There are modern techniques to avoid resistance issues.

Yes, true, and it is right that we should implement these techniques. However, until the whole world plays along there are going to be problems. If sub-clinical or too frequent doses of antibiotics are given somewhere in the world, then antibiotic resistant strains of bacteria will develop, and can be transmitted across borders.

bayesianhorse2• 12 years ago

Yes there are multiply resistant strains. But due to chance and evolution, they are spreading slowly.

This is still a dangerous issue... just not as bad as if the multiply resistant bugs sprang up all over the place like single-resistant ones do.

GFK_of_xmaspast• 12 years ago

They call it "MRSA" because it's "Multiply Resistant".

exratione• 12 years ago

This seems like the same sort of pointless hand-wringing that attends every technology at its peak. There are any number of works in progress that could replace antibiotics. None of them have yet because they are not economically competitive. As that changes - because they either realize their potential to be much, much more effective, or because the cost of working antibiotics rises - then antibiotics will fade in favor of the next technology in line.

This is what happens to every technology. Yet people seem to forget, despite the evidence all around them, that they live in a world that changes rapidly due to the fact that many, many individuals are working on new and better ways to do everything. Periods of seeming stasis to the outside observer - such as the long use of antibiotics, which is really actually a continual hectic development of new types of the single class of item - only occur because economic conditions favor them. As soon as economic conditions favor another technology, it is developed and deployed from its prototypes pretty rapidly.

gbrhaz• 12 years ago

Can you give examples of the technologies that would replace antibiotics?

kylebrown2• 12 years ago

A comment by Udo mentions monoclonal antibody drugs.

cicero• 12 years ago

I don't think it is pointless to consider the possibility that infinite progress is not inevitable. You may have faith that science and technology will always come through, but I don't. This blind faith that things will always get better is one reason why people deny climate change. I'm not saying we give up and admit defeat, but blind optimism is foolish. Keep working on solutions, but be prepared for failure scenarios.

noir_lord• 12 years ago

I don't think it is pointless to consider the possibility that infinite progress is not inevitable.

It's an interesting thought but we don't even know what there is that we don't know, In the late 19th century many scientists thought we'd solved science (Kelvin among others said (in hindsight) hilarious things “Heavier-than-air flying machines are impossible.” and "Radio has no future" and he was the chair of the royal academy of sciences.

You may have faith that science and technology will always come through, but I don't.

I have more faith in human ingenuity than I have in anything else, human ingenuity exists and works.

This blind faith that things will always get better is one reason why people deny climate change.

I have no idea about that one, the climate change deniers I've met have broadly been deniers based on religion or because it benefits them in some way directly.

I'm not saying we give up and admit defeat, but blind optimism is foolish.

So is blind pessimism, people forget that by every measurable standard the human race is in a golden age (even including places like central Africa).

The one thing that has lifted large parts of the world out of a short nasty, disease ridden life is science (and technology but they go together).

coldcode• 12 years ago

Reading this scares the crap out of me. Unless there are incentives to drug companies (and those who research other antibiotic tech) we could go extinct before anyone creates a solution. Yet drug companies perversely invest billions on drugs that cost $1000 a month and help solve relatively minor ailments.

TheCoelacanth• 12 years ago

economists for the National Pork Producers Council estimated that removing antibiotics from hog raising would force farmers to spend $4.50 more per pig, a cost that would be passed on to consumers

That is an unbelievable. A single pig produces over 100 pounds of meat, so we are risking catastrophe for a cost savings of less than 5 cents per pound of meat.

JasonFruit2• 12 years ago

I don't understand this bit: ". . . resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat . . . "

How are different microorganisms sharing DNA with each other? Am I misunderstanding completely?

maxerickson• 12 years ago

You are reading correctly. Lots here:

http://en.wikipedia.org/wiki/Horizontal_gene_transfer

In short, one thing that happens is that they exchange small fragments of DNA (called plasmids). Those fragments can contain the information necessary for the resistance.

JasonFruit2• 12 years ago

Mind? Blown. I had no idea that happened — it sounds almost Lamarckian.

dredmorbius• 12 years ago

This problem has been known for a long time, though it's taken a while for it to fully emerge.

I first encountered it reading Isaac Asimov's essay collection Twentieth Century Discovery, which highlights a number of the most significant inventions of the 20th century as of its publication date, in 1969 (and no, I'm not that old, I read it probably ~15 years later).

http://www.amazon.com/Twentieth-Century-Discovery-Isaac-Asim...

The point being that natural selection is a very powerful force, and while antibiotics have proven useful, they've got very clear limits as well. And humans are an awfully large and well-connected biological niche to exploit at present.

Imagining the Post-Antibiotics Future

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