Imagining the Post-Antibiotic Future 453
Hugh Pickens DOT Com writes "Health authorities have been struggling to convince the public that the threat of totally drug-resistant bacteria is a crisis. Earlier this year, British chief medical officer Sally Davies described resistance to antibiotics as a 'catastrophic global threat' that should be ranked alongside terrorism. In September, Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: 'If we're not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.' Now Maryn McKenna writes that we are on the verge of entering a new era in history and asks us to imagine what our lives would be like if we really lost antibiotics to advancing drug resistance. We'll not just lose the ability to treat infectious disease; that's obvious. But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. We'll lose any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. We'd lose any major open-cavity surgery, on the heart, the lungs, the abdomen. We'd lose implantable devices: new hips, new knees, new heart valves. We'd lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We'd lose the safety of modern childbirth. We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. 'And it wouldn't be just meat. Antibiotics are used in plant agriculture as well, especially on fruit. Right now, a drug-resistant version of the bacterial disease fire blight is attacking American apple crops,' writes McKenna. 'There's currently one drug left to fight it.'"
terrorism! ha! (Score:5, Interesting)
If this is a threat that "should be ranked alongside terrorism" then I'm not even going to waste my time reading about it.
Be Afraid, be very very afraid. (Score:3, Interesting)
Re:Be Afraid, be very very afraid. (Score:5, Interesting)
Will the market save us by producing something be it at a price, or, is this too big and needs to be done by government money and research?
Antibiotics are arguably an example of a situation that (while not meeting the classic definition of 'market failure') is not a market victory.
If the price of an antibiotic is relatively low, it becomes economically viable as a growth enhancer/mortality reducer in high-density agricultural applications, likely burning through its effectiveness relatively quickly (with some help from being handed out to treat patients whining about the sniffles and being reflexively used on basically anybody admitted to a hospital; but veterinary uses are the big one). If the price is relatively high, you see a strong incentive for poorer users (especially in the 'developing' world) to try to make do by 'stretching' inadequate supplies across longer times or more patients than the supplies can provide adequate doses for. You also have more incentive for diluted and fraudulently labelled, or outright faked, versions to make it into the supply chain.
On the supply side, I don't know why it isn't working; whether biology is just being a stubborn bastard and we'd need to throw ten times as many scientists at the problem, or whether the ROI on penis pills and hair loss and pimping minor rebadges of old drugs is better than doing research; but the steady advances in increasingly resistant bacteria have not caused the invisible hand to keep pace with new drugs (particularly new drugs with novel mechanisms, which would get us further ahead in the arms race than incremental tweaks on resistance-threatened mechanisms.)
Phages will have to be a part of the answer (Score:5, Interesting)
Hopefully our biotech is starting to get to the point where we can tailor viruses to specific targets, at least some of the time. Things like this [codagenix.com] give me some hope. If we can do that, we can do at least some of that kind of tailoring.
The problem (Score:5, Interesting)
The summary says:
We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock
This the source of the problem, not the effect.
Yes, it does turn out that dosing meat animals with antibiotics even when they are not sick will increase their weight (and hence production) by about 10%, This is a small increase-- but the margin on meat production is low enough that it makes a difference in profitability, and hence if some of the farms do it, pretty much all of them follow.
So, we're losing the ability to use antibiotics because we're spraying them across the landscape, not to cure sickness, but as a fattening agent for cattle.
and protect them from the conditions in which the animals are raised.
This is actually a much smaller use of antibiotics. But, yes, the idea is that we can save money by not bothering with sanitation and health in cattle, but instead just dose them with antibiotics.
Anonymous wrote:
As ranching employs a significant number of people in some states, and agrobusiness has great clout with Congress, this just isn't going to happen. Plus, the average American is not going to accept such a sudden stop to his high meat intake.
Actually, it's a very small effect-- eliminating antibiotic use on cattle would have only a trivial effect on price. The problem is that the low margin on meat production means that if one cattle-production factory does it, everybody has to do so to keep up.
Re:Be Afraid, be very very afraid. (Score:5, Interesting)
With antibiotics in industry, it is in any individual company's best interest to have everyone else move away from it. If a company uses lots of antibiotics while others do not, not only does it make their own product cheaper and fattier, but they will get more time out of the antibiotics. So no company (outside luxury brands) has an interest in being the one or group of ones to stop the practice since all it will do is help some competitor who does not play along. Same goes in health care unfortunately.
Re:What will researchers do next (Score:4, Interesting)
Not to say that anti-biotic resistant bacteria aren't a significant problem, but 100 years ago we had poor nutrition and poor sanitation and poor hygiene. Most of the reason those scrapes and bruises and for that matter surgeries resulted in such appallingly high mortality is that people didn't clean wounds or their hands, including surgeons.
To compare those days to today is really rather ridiculous. Even if a significant number of bacteria strains became totally anti-biotic immune we'd still not have anything close to the death tolls experienced 100 years ago. It's a serious issue, but we don't have a black death coming any more than H1N1 resulted in the kind of death tolls we saw in the early 20th century.
Of course, a lot of the improvements you mention are related specifically to the introduction of antibiotics. Cleaning wounds with soap and water only goes so far and can't be down with deep wounds. MRSA is already a very real problem for hospitals, which is why they are taking such precautions already. But even in 2nd world countries where there is decent sanitation and the like, bacterial infections are a real problem because of the lack of antibiotics. It is easy to extrapolate that to 1st world countries if antibiotics became ineffective.
Even going back to the 1950s, people died from staph infections all the time. During the Korean War, wounded soldiers often had successful surgeries but died from infection. That occurred whether in a MASH or at a real hospital. Sulfa powder, while more effective than nothing wasn't very effective compared to antibiotics.
Of course if the medical profession wants to get the public to take note, just tell them that we won't be able to treat syphilis anymore. If common STDs become untreatable and declared an epidemic, then the public will take notice.
Re:terrorism! ha! (Score:4, Interesting)
> They said "if you get a scrape you could potentially die," which is a factual statement if we have no effective antibiotics.
This is factual even with antibiotics.
In fact we tend to forget the only actual fact of life: you will eventually die.
That's true but the number two cause of death from the time we created agriculture and cities until just recently was infection from cuts.
Number one was disease, killing off more than half our babies.
Antibiotics is the number one reason there are so many people alive right now in the world. Seven billion humans is an incredibly large portion of the amount of life on the planet. Losing antibiotics would put a check on the human population. A serious big check. Perhaps big enough to deal with global warming but that's not 'why' it happened.
Evolution is basic biology. In fact, there is a theory that sexual reproduction was "invented" by multicellular organisms in order to stay ahead of the much faster evolution of the single-celled bacteria that preyed on them.
That war continues today and will never stop. Only the individuals fighting on both sides stop. Always.
But the basic impetus for us is to try to stay alive at least long enough to have babies.
That's what the war is all about.
Re:Be Afraid, be very very afraid. (Score:5, Interesting)
The market is definitely causing this. True story:
I know a guy who is a MD and worked most of his career as an antibiotic researcher. His team came up with a new antibiotic that killed everything they tested it on. When he brought the research to the VPs and the CEO, the CEO told him, "You expect me to spend millions of dollars to bring this drug to market only to have the damn doctors keep it in reserve so they can use it as a last resort?"
So, yeah this is a market epic fail. ROI > life. To the morons running these companies, the equation is as simple as that.
Re:The problem (Score:4, Interesting)
They make the cow fatter because cows are not meant to eat corn, corn gives them stomach ulcers, the antibiotics make sure the ulcers do not cause them health issues, so the increased calorie density of corn feed means the cows gain weight more consistently.
Re:terrorism! ha! (Score:3, Interesting)
You aren't successful because there is no evidence to back you idea. It's been looked at, many times. Fact is, there is no scientific evidence that any antibiotic resistance is coming from give antibiotics to cows.
Yes, I know it's counter intuitive, but when you look at the data it's clearly coming from too places:
People not finishing the regime, and hospitals.
People disagreeing with you doesn't make them a shill. Shills get paid to promote an idea or activity.
" I wish /. would implement a better search algo so that we can for instance search our own past posts."
agreed, but abbreviating 'algorithm' to 'algo' make you sound like a douche.
Re:terrorism! ha! (Score:2, Interesting)
Anecdote: my bike slid on gravel and I felt lightly. Getting up I saw a cut on my elbow. Fast forward 24h and there was a red spot around the cut. Another day later and the red spot had grown halfway down my arm. I got IV antibiotics 3 times a day during 9 days with two different antibiotics to fight that infection. Without antibiotics the only recourse would have been to try an amputation.
Sure the other times I fell off my bike I didn't have to take antibiotics. But I was unlucky once, and this was a pretty minor accident. It could have cost my life in other times.
Antiserums (Score:4, Interesting)
With antibiotics becoming less effective, and molecular biology making such advances, perhaps medicine will stop relying so exclusively on antibiotics (selective poisons) and increase the use and development of antiseurms (mixes of antibodies specific to small regions of the pathogen's surface).
Indeed: When antibiotics were the new "magic bullets", some diseases still responded far better to antiserum treatment than the antibiotics the doctors switched to treating with.
In those days making antiserums was a matter of injecting the pathogen into an animal (typically a horse), then (after a few days) extracting some antibodies (to EVERY pathogen the horse had experienced) and injecting the lot into the patients.
Now we can identify the "conserved regions" that the bug can't change without becoming non-pathogenic, making human antibodies to those regions, sorting out the most effective ones, transplanting the DNA into suitable cell cultures, and making exactly the desired antibody by the bucketload.
With a library of antibiodies to test against we have automated mechanisms - based on silicon chip technology - to assay a pathogen against thousands of them and identify the effective ones within minutes.
Antiseurm the body's own, very effective, way to prevent a recurrence of a disease or infection that one has already survived. But the body's own R&D and deployment takes about three days. Like doctors giving antibiotics, it relies on more general approaches to fight off the initial infection. Giving it assistance with the better-tuned countermeasure in the early stages should be at least as effective as antibiotics were before the development of resistance.
Antibodies can be made to just about any molecular shape the bug exposes to its surroundings. (The hard part is avoiding making one that also appears on normal tissue.) The antibody works, not just by jamming up some necessary machinery in the pathogen, but also by marking the pathogen for destruction by the rest of the patient's immune system. So this approach should work on just about any bug that isn't avoiding the immune system by hiding inside cells or other places it can't reach, or has already devastated the body's clean-up crew.