Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period”
October 24, 2013 7:01 PM   Subscribe

For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question mark?” Well, now I would say you can change the title to “The end of antibiotics, period.
posted by Memo (82 comments total) 51 users marked this as a favorite
 
I hope that phage therapy gets an exponential funding bump.
posted by clockzero at 7:11 PM on October 24, 2013 [12 favorites]


God I love Frontline. This is such a great example of how you do a science interview in a mainstream media outlet: start with the real basic basics, keep questions short and simple at first and gradually expand into details by building off of each simple question with a slightly more complex/nuanced one and let an expert teach. It's like a breath of fresh air after a million awful sensationalist hack jobs.
posted by jason_steakums at 7:14 PM on October 24, 2013 [44 favorites]


At least you tasted Chicken McNuggets before it all went paws up.
posted by ChurchHatesTucker at 7:24 PM on October 24, 2013 [3 favorites]


Well, we had a good run.
posted by Ray Walston, Luck Dragon at 7:31 PM on October 24, 2013


Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. It’s a reality that many of the drug companies left this market because of financial realities that are placed on them. These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic.

Head, bash, wall, etc
posted by showbiz_liz at 7:31 PM on October 24, 2013 [5 favorites]


Curious -- what's going on in the field of phage therapy these days? I remember reading something a few years ago, but nothing since.
posted by evil otto at 7:31 PM on October 24, 2013


At least you tasted Chicken McNuggets before it all went paws up.


As I lay there, in the quarantine zone known as Detroit-that-was and I wait to die, I will think on Chicken Nuggets. I will think on Chicken Nuggets and Hot Mustard sauce.

Mmm.
posted by kbanas at 7:33 PM on October 24, 2013 [9 favorites]


Well, we had a good run.

As a species we survived thousands of years before antibiotics. There just might not be as many of us and we might not live as long.
posted by Talez at 7:34 PM on October 24, 2013 [2 favorites]


There will still be about as many of us. Antibiotics are only around 150 years old. Most people who die from infections are past their prime child bearing years. So it sucks for us but it won't impact population much.
posted by Justinian at 7:38 PM on October 24, 2013 [1 favorite]


A more innovative form of [antibiotics] stewardship is the development of therapies that do not drive resistance. For example, the infusion of monoclonal antibodies (a modern advance on serum therapy, which is more than a century old) or white cells that attack microbes holds promise for treating infections. Finally, what if we were able to treat infections without seeking to kill the microbe? Casadevall and Pirofski's damage-response framework of microbial pathogenesis underscores the concept that clinical signs, symptoms, and outcomes of infection result as much, or more, from the host response to the microbe as from a direct effect of the microbe itself.4 Thus, we should be able to treat infections by attacking host targets rather than microbial targets. Indeed, recent preclinical research demonstrates that we can successfully deploy therapies that either moderate the inflammatory response to infection or that limit microbial growth by blocking access to host resources without attempting to kill microbes. For example, an antibiotic of a novel class (LpxC inhibitors), which blocks synthesis of gram-negative lipopolysaccharide, could not kill Acinetobacter baumannii but prevented the microbe from causing disease in vivo.5 Other examples include antiinflammatory monoclonal antibodies, probiotics to compete with microbial growth, and sequestration of host nutrients (e.g., iron) to create a resource-limited environment in which microbes cannot reproduce. Such strategies require clinical validation but have the potential to reduce resistance when pursued in concert with traditional antibiotic therapy.
posted by Blazecock Pileon at 7:39 PM on October 24, 2013 [6 favorites]


Most people who die from infections are past their prime child bearing years.

Wouldn't this basically make surgery impossible, and make small cuts potentially deadly? Wouldn't it make childbirth way more dangerous, and C-sections basically unthinkable?
posted by showbiz_liz at 7:40 PM on October 24, 2013 [2 favorites]


Unless civilization comes to a crashing halt, and life sciences research along with it, we will probably come out of this okay. Perhaps with fewer tools on hand, but better and more targeted tools among what we will have at our disposal.
posted by Blazecock Pileon at 7:41 PM on October 24, 2013 [2 favorites]


Phage therapy is awesome but I'm super fascinated with meds that work on quorum sensing. That's some crazy sci-fi, out-of-the-box medicinal thinking and oh man, I love it.
posted by jason_steakums at 7:43 PM on October 24, 2013 [3 favorites]


There will still be about as many of us.

Great. So more of us will be dying painfully and it won't even incidentally serve a useful purpose. All because we now believe in the value of free markets more than the value of life itself.
posted by saulgoodman at 7:44 PM on October 24, 2013 [23 favorites]


And why wouldn't phage therapies and other options eventually bump up against the same economic realities?
posted by saulgoodman at 7:45 PM on October 24, 2013


Phage theory and quorum sensing! Looks like I've got some new things to learn about, thanks everyone.
posted by JHarris at 7:48 PM on October 24, 2013 [1 favorite]


There will still be about as many of us. Antibiotics are only around 150 years old. Most people who die from infections are past their prime child bearing years. So it sucks for us but it won't impact population much.

I always think of this as, like, evolution's dark joke. A highly advanced, sentient, brilliant species evolves and flourishes to the point that they get really good at keeping people alive throughout the child bearing years so the natural selection that they rode in on can't help them one iota anymore.
posted by jason_steakums at 7:48 PM on October 24, 2013 [5 favorites]


JHarris, check out Bonnie Bassler's TED talk about quorum sensing! So cool.
posted by jason_steakums at 7:49 PM on October 24, 2013 [5 favorites]


I find it amazing and infuriating that he managed to go through that entire interview without once using the words "evolution" or "evolve".

It's particularly disappointing because this isn't a mere matter of nomenclature, that pathogens evolve, and become resistant to antibiotics and also become more or less virulent, is all about evolution and we cannot in the long run practice medicine without approaching pathogens in that context. The field is called "evolutionary medicine" and it's ground zero for the issues discussed in this link.

For example, I find Paul Ewald's theory of virulency very convincing — in short, it's that virulency is strongly related to the infection vector. If infection is passed from host to host, then lower virulency is selected for because higher virulency means less transmission. But if infection is passed via a third agent, such as through water contamination (cholera) or an insect (malaria), then there's no selection against virulency and so the pathogen is free to become more virulent. So the common cold is not virulent at all, it doesn't debilitate us, and we're free to walk around and socialize and go about our business, spreading the pathogen far and wide. In contrast, both cholera and malaria are spread by things other than the infected people, so the pathogen can become very virulent and kill people and still be very successful.

This has great relevance with regard to iatrogenic infections (spread by health care workers, such as in hospitals). Ewald's theory about virulence predicts that pathogens can evolve to become more virulent in health care settings where the health care worker becomes the vector of transmission between different (bedridden) patients in the hospitals. So, aside from evolving resistance to the antibiotics being used in hospitals to treat these infections, these infections may be and probably are become more virulent, too.

There's a variety of health policy implications of this theory of virulence, and that's just one example of the kinds of approach to medicine that is the focus of evolutionary medicine.

This really is far more serious than people realize — we've several generations that have taken for granted that infections are usually easily treatable. People don't realize how rapidly that's now reversing.
posted by Ivan Fyodorovich at 7:51 PM on October 24, 2013 [57 favorites]


Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle.

If you use an antibiotic, then that one among the group that is resistant becomes the predominant one. So resistance is something that is an inevitable consequence of bacterial evolution. But it’s also something that we have certainly helped along the way.

RTFA
posted by dudemanlives at 7:53 PM on October 24, 2013 [5 favorites]


I did read the article and was looking for it, but missed those two instances in the entire thing. He was clearly avoiding the word.
posted by Ivan Fyodorovich at 7:55 PM on October 24, 2013 [2 favorites]


This is such a great example of how you do a science interview in a mainstream media outlet: start with the real basic basics, keep questions short and simple at first and gradually expand into details by building off of each simple question with a slightly more complex/nuanced one and let an expert teach. It's like a breath of fresh air after a million awful sensationalist hack jobs.

Really? I found the second-grade-level explanations ("Without antibiotics, we couldn't treat infections!" ) and diction ("We've fueled this fire of bacterial resistance!") hella irritating by about the second paragraph. Surely their average reader isn't all that dumb. And that kind of dreamy vagueness-- no numbers, no details, no sources, no hard words-- persisted all the way to the end, where the take-home point was... Because of $UnrelatedPublicHealthCrisis, sometimes you need to Think Big!.

I mean, I get that this is mainstream media, and their average reader probably doesn't need any statistics or sources or, you know, information. But if you're in a position where you can afford to relate to this thing on a simplistic Think Big!-type level, then let's face it, you're not in a position to do anything about it anyway, beyond carefully following the instructions on your prescription bottles. So why does it matter whether we get sensationalist hack-jobs or soothing, earnest Mr. Rogers-style patronizing? At least with the sensationalists I don't feel talked down to.
posted by Bardolph at 8:00 PM on October 24, 2013


As a species we survived thousands of years before antibiotics.

Yeah, but it mostly sucked

history I mean
posted by Ray Walston, Luck Dragon at 8:08 PM on October 24, 2013


With the sensationalists, yeah, they aren't talking down to you, but they're misleading people. (headline: "Have Scientists Finally Cracked Cancer?" article: No, not really. totally missing: Any idea that they're massively simplifying everything down to the premise of the article.) There are some real public policy repercussions when mainstream media outlets mislead the layman about science, and I'd rather have a hundred articles simplifying things Mr. Rogers-style than one straight up creating a fantasy world where cures come in magic bullets and loons get equal footing with scientists. I mean, at the very least, Dr. Srinivasan impresses upon the audience that this is real and serious business, and the interviewer doesn't get in the way with a bunch of popsci schlock.
posted by jason_steakums at 8:11 PM on October 24, 2013 [1 favorite]


Thanks for posting this, memo. I watched that Frontline last night.
posted by annsunny at 8:11 PM on October 24, 2013


I was initially annoyed that they didn't mention routine antibiotic use in livestock, but at the end of the program there's a trailer for the next episode which will go into that.

Maybe they'll also talk about quorum sensing and phage therapies.
posted by monotreme at 8:13 PM on October 24, 2013 [3 favorites]


It's physically nauseating to me that he's talking about how there's a Dramatic Call to Action and then does this little soft shoe number around Big Agriculture's near monopolistic and entirely unwarranted use of antibiotics in this country. I guess I should be impressed that they bothered to even reference it in passing.

Except I'm not.

Fuck you, Arjun. If you want to be an alarmist and be the Voice of Scientific Reason, actually address the god damn root causes of the problem rather than worry about playing politics, sniveling and scared of pissing off Big Pharm and Big Ag. Blaming doctors for not washing their hands and for over prescribing medications, yeah I'm sure that polls real well with Dr. Oz's daytime TV audience.
posted by hobo gitano de queretaro at 8:14 PM on October 24, 2013 [11 favorites]


I assume before launching off on that angry fist-shaking you ignored the bit where they're talking about that next episode?
posted by Ghostride The Whip at 8:17 PM on October 24, 2013 [1 favorite]


Without working antibiotics, I might not have survived a post-C-section infection. Without working antibiotics, organ transplants can't be done, and any surgery is a lot riskier. Welcome back, gonorrhea and syphilis. Hello, Lyme disease, kidney infections, bacterial pneumonia. And nobody's even seriously trying to do anything about the abuse of antibiotics in livestock. It's been great to live in a time when so many illnesses are curable, and we're headed back to a scarier world.
posted by theora55 at 8:18 PM on October 24, 2013 [8 favorites]


That's a good question, Ghostride.

I assume you're also not living in a world where vital public policy decisions that could herald the end of modern medicine are decided during the next installment of a show on PBS?

Correct me if I'm wrong.

There was a time in the history of this country, not so very long ago, where if you were proven to have an infectious disease someone would put you on an island and wait for you to die.

But I guess cheap hamburgers are more important.
posted by hobo gitano de queretaro at 8:40 PM on October 24, 2013 [1 favorite]


But I guess cheap hamburgers are more important.

Now with totally antibiotic resistant flesh-eating bacteria!
posted by George_Spiggott at 8:42 PM on October 24, 2013 [1 favorite]


Metafilter: Surely their average reader isn't all that dumb.
posted by dogwalker at 8:51 PM on October 24, 2013


It's physically nauseating to me that he's talking about how there's a Dramatic Call to Action and then does this little soft shoe number around Big Agriculture's near monopolistic and entirely unwarranted use of antibiotics in this country.

I was listening to Fresh Air the other day and one of the journalists working on this episode was being interviewed. At the end of the episode, Terry Gross explicitly asked about the Big Ag angle and he said that a whole new episode about just that was in the works for Frontline in the future.
posted by Hypnotic Chick at 8:53 PM on October 24, 2013 [1 favorite]


Yeah, for all they can fall into the common journalistic traps of the age (though they're much better about that than most - usually), Frontline does really good work and takes their time and gives multi-episode runs to topics that really warrant the length. Certainly in a perfect world Frontline's quality would be the baseline and we'd have a lot of even higher quality mainstream journalism, but they aren't hacks.
posted by jason_steakums at 9:01 PM on October 24, 2013 [2 favorites]


Doesn't PBS -- or at least some subset of PBS-carried programs -- get a lot of money from the Ag and Pharma sectors? Seems like I'm always seeing their plugs at the head of a show.
posted by George_Spiggott at 9:02 PM on October 24, 2013


Most people who die from infections are past their prime child bearing years. So it sucks for us but it won't impact population much.--Justinian

That may be true now, and maybe that's why you think this, but I don't think it was true 200 years ago. Life expectancy wasn't short in the 1800s because of older people dying, but because of younger people dying, especially infants.

You don't want your kids dying or losing a limb because of a scrape while playing sports. Yet that is where we are headed.

But if we don't load antibiotics into cows in crowded, filthy, bacteria strewn conditions (prime locations for growing resistant bacteria), then we don't get our cheap beef.

Apparently, most people think it is worth it (or maybe most people don't think at all).
posted by eye of newt at 9:09 PM on October 24, 2013 [4 favorites]


Doesn't PBS -- or at least some subset of PBS-carried programs -- get a lot of money from the Ag and Pharma sectors? Seems like I'm always seeing their plugs at the head of a show.

Their funding is all over the place. Business, government funding (though not a lot), viewers like you. Sometimes they buck their sponsors, sometimes stuff like this happens where it's not really clear how much pressure there is but it's suspect. It's kind of a mishmash, and a big fluid push and pull since they're in a position where they can't please one entity without pissing off another and a lot of jobs are holding on at the whims of every source of funding at member stations - seriously, it's really bad, if you ever meet a PBS member station master control worker, buy 'em a drink, because they ultimately keep the systems on the air, understaffed at low wages and with little to no cost of living increases for years, and they're the first ones on the chopping block. I made 10 cents over minimum wage when I did it for a little while a couple years back, keeping public TV on the air no matter what and coordinating fixes on a rapidly-failing multimillion dollar statewide tower system, and some of those people have been there for years doing it under those conditions because it's a good cause. And the higher-ups aren't working for outrageous sums and get super cagey when any funding hiccups threaten those low-level jobs that keep the whole duct-tape and hope system of public television running. (Seriously I wish they'd just spell the dire state of things out during pledge drives in between episodes of Red Green marathons and gaelic vocal choirs)
posted by jason_steakums at 9:39 PM on October 24, 2013 [7 favorites]


That may be true now, and maybe that's why you think this, but I don't think it was true 200 years ago. Life expectancy wasn't short in the 1800s because of older people dying, but because of younger people dying, especially infants.

But for this to be relevant you have to show that those infant mortality rates were due to bacterial infections. My understanding is that much of the higher rate of infant mortality in the past can be attributed to maternal nutrition (or lack thereof), poor feeding practices, poor general health of the mother, lack of proper modern sanitation and sanitation practices, and many diseases a lot of which cannot be treated with antibiotics.

That said it is definitely true that there were locations where local conditions meant huge numbers of infants and children would die every year from various forms of gastroenteritis. And some of those would undoubtedly be bacterial. However, that problem has been mostly eliminated not through widespread nuking with antibiotics but through better sanitation.

Infant and child mortality would not spike to the huge levels seen in the past if all the antibiotics in the world stopped working tomorrow. There would be a modest increase, sure, and that would be a bad thing. But birthrates would likely also rise if infant mortality rose. Not that I'm recommending the solution "have more babies if your other babies die" obviously.
posted by Justinian at 9:41 PM on October 24, 2013 [2 favorites]


Modern sanitation practices help prevent MRSA infections in hospitals, which is where such infections have frequently started, and it is why elderly were more often infected (they were more often in hospitals).

But that has changed. Now there are resistant bacteria that are spreading more outside of hospitals, especially among athletes. The rate of infection among non-infant kids is rising.
posted by eye of newt at 10:11 PM on October 24, 2013


Sure, it went from 1.1 to 1.7 per 100,000 per year. Which is bad if its your kid but isn't going to affect overall population numbers. It's true it could keep rising but you can't extrapolate from two data points.
posted by Justinian at 10:13 PM on October 24, 2013


"Fuck you, Arjun. If you want to be an alarmist and be the Voice of Scientific Reason, actually address the god damn root causes of the problem rather than worry about playing politics, sniveling and scared of pissing off Big Pharm and Big Ag. Blaming doctors for not washing their hands and for over prescribing medications, yeah I'm sure that polls real well with Dr. Oz's daytime TV audience."

Am I missing something? From the linked article:

"Certainly the CDC believes quite firmly, and I think there are a number of veterinary experts here and in other places who agree with the stance that we should never be using antibiotics in agriculture or in people for any other purpose than to treat infections."

Do you just want him to be more strident? As for doctors and handwashing-hospital born infections are a big deal, and many health-care practitioners don't wash as often as they should. Is that controversional?
posted by HighTechUnderpants at 10:21 PM on October 24, 2013 [5 favorites]


Do you just want him to be more strident?

HE SHOULD BE SPEAKING IN ALL CAPS!!!

Also, he should be waving his arms around. Arm waving always helps.
posted by happyroach at 10:26 PM on October 24, 2013 [3 favorites]


The article (and the Frontline program from which it derives) makes only passing mention of today's #1 multi-drug resistant bacterial threat to human health, that kills more than 2 million people annually, which is tuberculosis. But previous programs have talked about that, at some length.

The takeaway from some who study tuberculosis treatment worldwide is that health systems in some poor countries where TB is nearly endemic are really lucky to get full remissions from so called basic anti-biotic treatments (average cost of treatment of a few hundred dollars per life saved, with treatment duration of a few months), but find that second tier treatments for drug resistant strains are both less effective, and much higher cost and duration (thousands of dollars in drug costs per case, and treatment courses that stretch out over years). Although at present, only about 2% of all TB cases are either multiply drug resistant (MDR) or extensively drug resistant (XDR, meaning resistant to at least three of the most commonly used antibiotic treatment regimens), treating the most drug resistant TB strains (extensively drug resistant or XDR-TB) in U.S. treatment settings can cost more than several hundred thousand dollars a case, with courses of antibiotics that need to be individually tailored, and that still stretch out over years. And even some of those with access to such treatment levels for their XDR-TB cases die of the disease, as do millions more with just non-drug resistant strains of TB, who can't, for cost or other reasons, complete their course of antibiotic treatments.

The cost/profit curves driving corporate decisions as outlined in the Frontline piece, and the link article, are less those dictated by cold hearted corporate decision makers, and more those presented to us by the biology of microorganisms. Apparently, for the foreseeable future, we must all, still, die of something, and if we are not ready yet, as a society or as individuals, to pick and implement appropriate means at appropriate times, we'd better damn well pick our fights very carefully with those means nature provides. Dying fairly quickly from pneumonia is comparatively peaceful, against many of the horror shows the rest of microbiology can, and will, if we insist on mindless medical interventions, visit upon us.

For the gram-negative bacteria that so often colonize many of us, antibiotics have never been the panacea that they have seemed to be, to those whose lives they have saved from more virulent, but less common bacterial killers.
posted by paulsc at 10:54 PM on October 24, 2013 [2 favorites]


Antibiotics literally saved my life. I had to have emergency surgery a few months ago to remove my gallbladder that had literally started to die and rupture because of an infection (mostly e.coli), that was subsequently spreading through my system. The high strength antibiotics were what stopped it, and prevented anything else taking advantage of my weakened state post-surgery. E.coli infections can easily be fatal, even with treatment, so I consider myself lucky indeed to have survived.

All my life, antibiotics have been able to be counted on to counter infection. While there were resistant versions of some bacteria, like MRSA, tuberculosis and e.coli, there were still antibiotics that could treat them. That is now coming to an end, and we are facing the reality that in the next couple of decades we're likely to see an explosion of deaths and injuries (such as serious kidney damage, leading to life long dialysis) from diseases that have been beaten back to be more annoyances rather than life threatening. And it was but a short reprieve, when we acted like it was a miracle cure.

We got complacent. The powerful value profit over the lives of millions, and plenty of us cheered them while they did it. I survived due to antibiotics. Soon, many won't get that second chance.
And the alternative therapies, right now, are little more than interesting side projects, and no where near advanced enough to be the next weapon against disease for a long time.

Between climate change, this, and the coming fresh water crisis and energy crisis, my optimism that we're going to survive into the next century as an advanced species is reaching near zero.
posted by ArkhanJG at 12:06 AM on October 25, 2013 [2 favorites]


I'm just going to enjoy my chickinubs and wait for the end of the world. Seriously, Atwood's not even writing fiction anymore.
posted by Ghidorah at 12:07 AM on October 25, 2013 [1 favorite]


Boomers took us back to the dark ages
posted by fullerine at 12:15 AM on October 25, 2013 [3 favorites]


"Antibiotics literally saved my life. ..."
posted by ArkhanJG at 3:06 AM on October 25

Would that that were so, ArkhanJG. Antibiotics have prolonged your life, as they have mine, but in the end, you and me, and every mother's daughter and every father's son are still going to die. If tiny microbes don't come for you with benign, sleepy and mostly painless endings, their more ferocious cousins will, with less regard for your remaining self as meat, someday, presuming that accident or other biological or mechanical causes don't take you first. What future end have antibiotics preserved you to endure? What independent agency will you still have when that day comes?

I looked at the little girl in the Frontline piece, whose life was prolonged by extensive antibiotic therapy, by ECMO therapy (for weeks), and eventually by lung transplantation, and at how she's returned home, to handfuls of pills every day to manage her transplant and immunity conditions, and her history of 5 incidents of pneumonia in the last year, and at her nurse "mother," who should know, better than any layman, what all this means in the end, and I just think, for that poor 11 year old child:

When the hell is enough medicine, enough humanity?

I think the same thing for myself, now, every time I have a fever, or a cough, at 6 times her age. I wish I could recognize the friendly knock of mortality, reliably, when it comes. It would be so much easier. But if I can't, at least let me keep my agency, until my last, even if that last isn't the medically possible, or theoritical last.
posted by paulsc at 12:40 AM on October 25, 2013 [1 favorite]


I find it amazing and infuriating that he managed to go through that entire interview without once using the words "evolution" or "evolve".

For some reason, the phrase Funded in part by a grant from the David H. Koch Foundation comes to mind.

My mother graduated from nursing school well before the War -- as in World, II, so her first years in practice were well before antibiotics. She went back to nursing in the late 1960s. I once asked her what the biggest difference was between then and now at that time. She said, Well, you never see cases of mastoiditis anymore.... Which was a great relief to her, as in the old days, there were many. There are many painful ways to die from which we were spared for a few decades.
posted by y2karl at 1:23 AM on October 25, 2013 [2 favorites]


I hope I can make it to Madagascar in time.
posted by maxwelton at 3:02 AM on October 25, 2013 [7 favorites]


I think the same thing for myself, now, every time I have a fever, or a cough, at 6 times her age. I wish I could recognize the friendly knock of mortality, reliably, when it comes. It would be so much easier. But if I can't, at least let me keep my agency, until my last, even if that last isn't the medically possible, or theoritical last.

My dad has a ten inch scar on his back from where they opened him up in 1929 to drain his lungs when he was an infant. His two year old sister died the month before from the same pneumonia. My grandmother used to try and describe how it felt to leave the hospital when my dad, but she could never get past the tears. She never failed to remind me that the surgery was a last ditch hope and they never expected him to live.

My dad and I were talking about it a while ago, and he says to me "For the want of a couple of pills that weren't around then, that would have been nothing more than a bad cold."

I get the whole "when it's your time, unnecessary suffering" thing, but goddamn there are plenty of people who suffer unnecessarily for the want of a couple of pills and who would happily prolong their lives with them.

He also pointed out that that was the problem. The economics for antibiotics are poor because they work. You get an infection, take a course of antibiotics, and no more infection. There is no recurring income stream from individual patients. Drug companies see much more promise in the development of anti-psycotics, blood-pressure medicines, and the like which people might take for decades.
posted by three blind mice at 3:08 AM on October 25, 2013 [8 favorites]


I always think of this as, like, evolution's dark joke. A highly advanced, sentient, brilliant species evolves and flourishes to the point that they get really good at keeping people alive throughout the child bearing years so the natural selection that they rode in on can't help them one iota anymore.
posted by jason_steakums at 3:48 AM on October 25


In terms of the evolutionary survival of the species, surely we're doing the best thing possible by making it so that more of us can breed, with a wider variety of partners, so that we have as much diversity as possible across our population. In times of plenty, specialisation is pointless, especially when you don't know the future.
posted by dng at 4:54 AM on October 25, 2013


Something I found interesting in the piece was his insistence that there was no Great Leader in the struggle against resistance, and that there shouldn't be. The interviewer keeps pressing--surely it's a failure in leadership, surely someone needs to stand up--and he counters that this is a complex issue, with action needed at both the national and local level. Diffuse and interconnected. That's important, especially for a scientific issue that's bound up in politics, because our politics is so hero-driven, so personality-focused. Who is the person who will save us all? We keep asking, and no matter who steps up, it turns out they are flawed and incapable of solving massive worldwide problems through force of personality or ideology. So, I'm glad no one is taking charge, and that instead the problem is distributed over thousands of people who want to solve it.
posted by mittens at 5:15 AM on October 25, 2013 [2 favorites]


Further off that phages and etc. but what about nanotech?

Bogey off the rear microprop, firing protein spear.
posted by snuffleupagus at 5:59 AM on October 25, 2013 [1 favorite]


"So, I'm glad no one is taking charge, and that instead the problem is distributed over thousands of people who want to solve it."

I agree with the point that the desire to have a "czar" of something is simplistic and a kind of magical thinking; but I also think that it's true that that sort of supposed centralized oversight serves as a kind of civil statement of intent, that something is taken very seriously. That has value.

The implicit bureaucracy often creates more problems than it solves, but it also acts as a high-profile investment in the enterprise. And such a bureaucracy's self-serving desire to survive and grow can, when its function is actually very important, act to protect that function. Distributed stuff can die of a million cuts, mostly unseen.

I don't know if those are good reasons for it — clearly something needs to be done to ensure that this is a high priority for both government and the private sector.
posted by Ivan Fyodorovich at 6:16 AM on October 25, 2013 [3 favorites]


This might be have mentioned already, Norway seems to have figured out how to handle MRSA. The solution, give anti-bionics only when necessary.

http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-solution/
posted by KaizenSoze at 6:39 AM on October 25, 2013


We always thought we'd figure out how to make the Human Race immortal, turns out we were wrong and we could only made deadly bacteria live forever.
posted by blue_beetle at 7:11 AM on October 25, 2013


The solution, give anti-bionics only when necessary.

They have cybernetic drug-resistant bacteria in Norway? We're even more screwed than we thought...
posted by Strange Interlude at 7:26 AM on October 25, 2013


"They have cybernetic drug-resistant bacteria in Norway? We're even more screwed than we thought..."

Well, imagine the future when there will be a wild ecosystem of nanotech, our own bodies will have a nanotech-augmented and oriented adjunct to our immune systems, and severe nanotech infection will require antinanotech meds to control.
posted by Ivan Fyodorovich at 7:56 AM on October 25, 2013


"Every provider has to become a leader in this way. Every person who prescribes antibiotics has to do so responsibly."

The problem is many, many PCPs make conscious decisions every day to prescribe antibiotics irresponsibly every day. By that I mean they are aware of the problem but contribute to it for the profit.
In my previous career I taught basic science courses (and, of course, did research) at three different medical schools. I have helped train and known socially and professionally many physicians. I began discussing this issue with these folks back in the 80's. I have heard the same rationalization from (I would guess) the majority of practicing physicians...
When someone comes in with the flu or some other viral infection (that will likely run its course without treatment) the patient expects to get a bottle of pills or a shot of antibiotic. If one doc refuses to provide the scrip, the patient will find another one who will. "I'll lose my practice if I don't give them what they expect. Besides, the placebo effect often makes them feel better anyway."
Medicine for profit. There ya go.
posted by txmon at 8:25 AM on October 25, 2013


Perhaps a less harmful placebo should be found.
posted by soelo at 8:31 AM on October 25, 2013 [2 favorites]


This might be have mentioned already, Norway seems to have figured out how to handle MRSA. The solution, give anti-bionics only when necessary.

Well that's probably lagniappe to the generally parsimonious approach of the state run healthcare system. They only give drugs as a last resort to save money. When my wife burned her hand severely last year, the very modern Swedish hospital would not give her any pain killers. The doctor said it was not permitted, but that the liquor store (systembolaget) was still open and she should buy some booze. If I wasn't there I wouldn't have believed it. 50% tax and there's still not enough money.....
posted by three blind mice at 8:32 AM on October 25, 2013


Apparently, most people think it is worth it (or maybe most people don't think at all).

Most regular people don't really have a choice. Organically raised meat is super expensive. So, let's say I decide to swear off all meat. But then I'm not supposed to eat wheat either (because, you know, GMO's and Wheat is Poison) and, oh, by the way soy will make us infertile and give us cancer. And, again, you know it's hard to avoid the GMO.

Unless you're wealthy enough to buy only local, organic, "safe" food, or poor enough to spend your days raising your own food, you really don't have much of a choice. You think about it, and worry about it, but you can't really affect change about it.
posted by anastasiav at 8:49 AM on October 25, 2013 [1 favorite]


We can't even get doctors to reliably prescribe pills the way they should be prescribed. Anecdata: My grandma had a recalcitrant bladder infection that would kind of knock down and then, once the course of antibiotics was cleared, come roaring back. Her doc prescribed oral vancomycin pills for this. Now, vanco is one of the better antibiotics left out there and it costs accordingly, that shit be pricey. BUT vancomycin can't pass through the gut and get into the bloodstream that way. It just can't. You can do oral vanco for gut ailments and you can do IV vanco for things not-located-in-the-intestinal-system but you can't do oral vanco for non-gut ailments and expect it to do a lick of good.

We learned this because I went home (after dropping grandma off at her house) and googled the shit out of vancomycin because it was so bloody expensive and I wanted to see if it was made of gold or something that it cost so much. And I did the reading on what oral vanco was good for and what it was not good for. And then I referred my aunt (RN, BSN) to the articles and she read them. And then she took them to my grandma's doctor and was all like "Hey, is this relevant to grandma's issues?"

And the doc was all "Oops, my bad. You're totally right, those excessively pricey pills ain't gonna do shit for you." Mmm-hmm.
posted by which_chick at 8:55 AM on October 25, 2013 [3 favorites]


"When someone comes in with the flu or some other viral infection (that will likely run its course without treatment) the patient expects to get a bottle of pills or a shot of antibiotic. If one doc refuses to provide the scrip, the patient will find another one who will. 'I'll lose my practice if I don't give them what they expect. Besides, the placebo effect often makes them feel better anyway.'"

I agree this is a serious problem and is ubiquitous, but I don't think it's profit that's is the impetus. It's just what you describe — patients don't understand that they can't always get a pill that will cure any sort of infection, don't understand the difference between viral and bacterial infections, and they just plain expect to leave the doctor's office with a scrip for an antibiotic when they go in for a cough.

Sure, this arguably started with doctors just over-prescribing antibiotics just to be cautious, and a lot of docs still prescribe antiobiotics like that. If the whole profession just stopped doing this, patients would figure this out pretty quickly and their expectations would change.

Still, I don't think it's profit motive behind this. Now, it's mostly patient expectations.
posted by Ivan Fyodorovich at 9:02 AM on October 25, 2013 [1 favorite]


Ivan Fyodorovich said
For example, I find Paul Ewald's theory of virulency very convincing — in short, it's that virulency is strongly related to the infection vector. If infection is passed from host to host, then lower virulency is selected for because higher virulency means less transmission. But if infection is passed via a third agent, such as through water contamination (cholera) or an insect (malaria), then there's no selection against virulency and so the pathogen is free to become more virulent. So the common cold is not virulent at all, it doesn't debilitate us, and we're free to walk around and socialize and go about our business, spreading the pathogen far and wide. In contrast, both cholera and malaria are spread by things other than the infected people, so the pathogen can become very virulent and kill people and still be very successful.


Yes, that Ewald book was fascinating. The most interesting implication of his theory is that the virulency of diseases might be manipulated by modifying their relative success rates of their different infection vectors. Here are a couple of links where he discusses this briefly.
posted by Hubajube at 9:28 AM on October 25, 2013 [3 favorites]


There will still be about as many of us.

Because chopping off a percentage at either end of the age distribution won't affect the total? By what math is that true? Or does 'about' include enough wiggle room for any number?
posted by srboisvert at 12:07 PM on October 25, 2013


Or does 'about' include enough wiggle room for any number?

It includes enough wiggle room for the small numbers we're probably talking about. We're not talking about a quarter of the population dropping dead if antibiotics stop working.
posted by Justinian at 12:19 PM on October 25, 2013


So why are we still letting the meat industry pre-emptively dose animals full of vaccines (live organisms) that can then spread mutate and evolve hundreds of times a day in over crowded, indoors with no cirulating air, conditions? Because cheap chicken and steak is more important? Or is it the weight of money and the inability of those in power to understand what is important? And why do we aid this by always blaming civilians never the meat industry?
posted by maiamaia at 5:49 PM on October 25, 2013


Wait, what? Vaccines? Aren't we talking about antibiotics?
posted by Justinian at 6:03 PM on October 25, 2013 [1 favorite]


Let me check my list: Tokyo's set for a megaquake any day now; we're almost certainly set for another economic crash, resulting in another, perhaps worse recession or depression; the oceans are heating up and dying; the atmosphere is heating up and water is becoming scarce; and now antibiotics will stop working.

I'll be the one over in the corner, drinking and weeping.
posted by zardoz at 1:10 AM on October 26, 2013


Dropping dead isn't the only issue. Remember, bacterial infection can do all sorts of non-fatal damage to tissues. Destroyed heart valves, disfigured faces, amputated limbs; most of us may survive the failure of antibiotics, but many, many of us will be permanently changed.
posted by mittens at 6:45 AM on October 26, 2013


Bacteria-eating viruses return, this time to fight superbugs

Bacteria-eating viruses that kill the hospital superbug C. difficile have been isolated by scientists. The use of these kinds of viruses, known as phages, to tackle bacterial infection was employed before the advent of antibiotics. And now the technique is being used in the fight against superbugs that are antibiotic-resistant.
posted by Artw at 7:18 AM on October 27, 2013 [1 favorite]


The use of these kinds of viruses, known as phages, to tackle bacterial infection was employed before the advent of antibiotics.

Uh. What? Bacteriophages weren't even discovered until around the first World War. A lot of the work with phages was done by Soviet scientists.

Do they just make this stuff up or what?
posted by Justinian at 10:53 AM on October 27, 2013


Penicillin was discovered in 28.
posted by Artw at 1:45 PM on October 27, 2013


Ok, maybe I have the history wrong but I thought the Soviet work with phages was WW2 era and post WW2.
posted by Justinian at 4:23 PM on October 27, 2013


Early 20s.
posted by Artw at 4:24 PM on October 27, 2013


That early?

THE MORE YOU KNOW.
posted by Justinian at 7:15 PM on October 27, 2013


Wiki.

Interesting field. It sets off my woo sensors a little but i'm almost certain that's a false alarm.
posted by Artw at 7:37 PM on October 27, 2013


I think this is how the zombies rise up.
posted by Justinian at 12:55 AM on October 28, 2013








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