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Imagining the Post-Antibiotics Future
November 26, 2013 8:05 AM   Subscribe

Five years after my great-uncle’s death, penicillin changed medicine forever. Infections that had been death sentences—from battlefield wounds, industrial accidents, childbirth—suddenly could be cured in a few days. So when I first read the story of his death, it lit up for me what life must have been like before antibiotics started saving us. -- Lately, though, I read it differently. In Joe’s story, I see what life might become if we did not have antibiotics any more.
posted by Potomac Avenue (103 comments total) 44 users marked this as a favorite

 
Antibiotic-resitant bacteria has replaced peak oil in the category of "horrifying apocalyptic shit that keeps me up at night, staring wide-eyed into the darkness of my bedroom and wondering whether I will die in terrible misery."
posted by Sokka shot first at 8:16 AM on November 26, 2013 [23 favorites]


Yep, this and climate change are my two biggest fears.
posted by ocherdraco at 8:16 AM on November 26, 2013 [7 favorites]


Peak oil is a distant third to antibiotic-resistant bacteria and global climate change.

Towards the end of the article there's a graphic that reads "80% of all antibiotics are administered to livestock" Good. God.
posted by mcstayinskool at 8:18 AM on November 26, 2013 [14 favorites]


But the market will...oh...nevermind. We're screwed.
posted by kjs3 at 8:21 AM on November 26, 2013 [6 favorites]


It's hard to imagine anything more catastrophic to modern society than the loss of an effective means to treat infection, and it's infuriating that it's really not that complicated to slow the evolution of resistant microbes. Essentially, it boils down to: prescribe only when needed. That's too hard for us to manage though.

Christ, twenty years ago I went to the doctor to be checked out for a persistent hacking cough--I'd had it for a couple of weeks and it was interfering with work, so I thought it was worth a cautionary visit. The doctor checked me out, pronounced that it was viral, and then wrote me a prescription for antibiotics anyway, chuckling as he explained, "In Europe, a lot of doctors would think I'm a quack for writing this, but better safe than sorry!"

I was appalled. I was only in my early twenties and had barely heard of antibiotic resistance, but even then I knew what he was doing was terrible.

That kind of doctor is still really common though, and if the doctors are that bad, we know how unreasonable and short-sighted the patients will be.
posted by Ickster at 8:25 AM on November 26, 2013 [6 favorites]


So... should I lick all of the surfaces, or Purell the crap out of everything?
posted by Theta States at 8:25 AM on November 26, 2013 [11 favorites]


My kids get strep throat an average of once every year. This topic shares the shit out of me.
posted by jbickers at 8:26 AM on November 26, 2013 [1 favorite]


Oh, and no, I didn't fill that prescription.
posted by Ickster at 8:26 AM on November 26, 2013 [1 favorite]


I'm often concerned that we've been so blinded by a century or so of success solving problems that we've come to believe that we'll just keep solving them as they come up when instead, we've just been painting ourselves into a corner.
posted by Ickster at 8:30 AM on November 26, 2013 [24 favorites]


a girl know... she has all kinds of weird food allergies and gets sick really easily, much more so than she did as a kid. she's convinced it's because her mom demanded antibiotics for every little thing when she was young. she remembers talking them practically every time she had a cold or sniffle.
posted by sio42 at 8:30 AM on November 26, 2013 [1 favorite]


Looks like I am fortunate enough to live right in the hotbed of antibiotic abuse in the United States. Alabama: At Least It's Not Mississippi!™

Also, I learned recently that one significant driver of resistant strains like MRSA is frequent use of triple antibiotic creams like Neosporin for small wounds. So if you're concerned about this, just opt for some petroleum jelly on your next cut.
posted by Rhaomi at 8:32 AM on November 26, 2013 [8 favorites]


I'm not going to go and dig it out because it was awful and depressing enough to read the first time, but the other day there was an article about how in the first weeks after the storm people in the area affected by the big hurricane/typhoon in the Philippines were dying of relatively minor injuries because of a lack of antibiotics.

We've been through a couple of cycles of minor issues turning more complicated by having to cycle through a series of antibiotics to find one that works. Purely anecdotal, but I don't remember anyone in my family ever having to do that when I was growing up.

I think the best hope is someone making a discovery that supersedes the current array of antibiotics; staying on the current path of chasing resistance is not going to end well. Failing that, I can see us looping back to the days when a minor UTI or tooth abscess meant serious debility or even death.
posted by Dip Flash at 8:32 AM on November 26, 2013 [1 favorite]


This is of course also the best argument against building huge new consolidated regional hospitals like what they just built in Birmingham, UK...which already had a superbug outbreak in the hospital it replaced.

If you have to shut down or isolate a hospital it is better if it is a small hospital rather than the only provider of many services for an entire region.
posted by srboisvert at 8:35 AM on November 26, 2013 [4 favorites]


Sign up now to live inside a giant can of Lysol stationed in low orbit!

I am
[ ] a poor, but attractive, artist
[ ] a useful engineer
[ ] rich overweight person (ballast/possible food source)
[ ] other (jk do not apply)

posted by Potomac Avenue at 8:36 AM on November 26, 2013 [12 favorites]


The spread of antibiotic resistant bugs is serious and cause for concern but not apocalyptic.

1) Part of the problem is that pharma companies are less incentivized to spend on antibiotic research because it's difficult and antibiotics (which one generally takes for a brief time and then no longer needs) are less profitable than drugs to manage chronic conditions. If the antibiotic resistance becomes a big enough problem national governments will most likely step in with funding and regulation to promote antibiotic research. This is an arms race, and funding on the side of drug research could tip the balance.

2) As noted another part of the problem is the widespread use of antibiotics in livestock. Again should the problem get bad enough this practice will likely become more restrictively regulated.

3) There is some promise in other areas of research into fighting bacteria. Doubtless blasdelb will eventually drop into this thread to talk about bacteriophages.

4) There is some hope that cycling antibiotics is a possible avenue for addressing resistance. Research on this is mixed.
posted by Wretch729 at 8:36 AM on November 26, 2013 [9 favorites]


This is something I Just Don't Get. I knew about the dangers of antibiotic abuse in creating resistant strains as a kid some forty years ago - I remember discussing it with my family GP when I was sick at home - and I've also known about bacteriophages being used in the (then) Soviet Union from really not much later than that. I think I read about it in the Reader's Digest.

So if some hick kid in the sticks knew all this, then what's been happening since? I've just looked and the first proper human clinical trials in the West on phage treatments happened in 2009.

This isn't like climate change or Peak Oil or anything where the sheer momentum of industrial society means we won't fix it until a suitably large value of $disaster hits a suitably large value of $westerneconomicinterests. We could have been starting to fix this, for not very much money and in a not very disruptive way, decades ago.

Uh?
posted by Devonian at 8:37 AM on November 26, 2013 [4 favorites]


Towards the end of the article there's a graphic that reads "80% of all antibiotics are administered to livestock" Good. God.

Remember that there are good reasons for some part of that, though - for example, bovine tuberculosis can cross over into humans, so before public health efforts to establish standards for care of livestock, the way many people caught tuberculosis was by drinking milk from an infected cow.

Not that antibiotic use in farming is all good by any means, but it's not entirely equivalent to something like over-use of pesticides where it's all about maximizing yield and industrial productivity. There's at least a kernel of reason down underneath all of the use of antibiotics as a way to cut costs and permit cheaper, more crowded, disease-promoting conditions for raising animals.
posted by XMLicious at 8:42 AM on November 26, 2013 [1 favorite]


Wait a minute, aren't overuse of antibiotics, climate change and peak oil just symptoms of an even greater issue, overpopulation of humanity? It seems to me that our environment has been pretty good at culling the herd up until a couple hundred years ago when human technology made a mockery of its efforts. This antibiotic resistance might frighten the fuck out of us humans but I guarantee you the rest of the earth's inhabitants can't wait for that day to come. It's their only hope to reverse climate change.
posted by any major dude at 8:43 AM on November 26, 2013 [5 favorites]


It really boggles me that the number one response to the antibiotic problem in the US is to tell doctors not to prescribe antibiotics to patients when 80% of antibiotics are going into livestock. Sure, people should use fewer antibiotics. But fixing the 20% problem and doing nothing about the 80% problem doesn't seem like it will do that much to preserve antibiotics for medical use. Yes, great, bovine tuberculosis. The problem is we're too invested in cheap meat and are subsidizing our addiction to it by pissing away antibiotics on keeping cattle in terrible unsafe conditions.

(And as someone who's had a "go to the ER with facial swelling" allergic reaction to an antibiotic already, yes, this is on my nightmare list too.)
posted by immlass at 8:46 AM on November 26, 2013 [23 favorites]


I got a staph infection in New York last year, and was petrified it was MRSA. As a European citizen with a maximum of 4 antibiotic treatments in my life, I was profoundly worried, still.
posted by flippant at 8:47 AM on November 26, 2013


i try to buy antibiotic meat and other proteins whenever i can afford it.

I'm not sure i always trust the labeling tho. kind of how cage-free for chickens apparently doesn't mean the same thing everywhere, that it's a spectrum.
posted by sio42 at 8:51 AM on November 26, 2013


immlass: fixing the 20% problem and doing nothing about the 80% problem

This has now replaced "In God We Trust" as the US motto.
posted by Rock Steady at 8:52 AM on November 26, 2013 [15 favorites]


See Also:
- Obamacare
- Sequester
- Climate Change
- Energy Independence
- Homeland Security
posted by Rock Steady at 8:54 AM on November 26, 2013


Neither climate change, peak oil, nor antibiotic backlash are apocalypic. We just have a stupid habit of assigning big problems to either denial or apocalypse, ignoring the middle ground. We live in a system that is for practical purposes finite, and these are all artifacts of natural limits. But our culture's mythology tends to claim we're exempt from limits, and that colors our discourse.
posted by maniabug at 8:54 AM on November 26, 2013 [12 favorites]


Flippant: with a maximum of 4 antibiotic treatments in my life, I was profoundly worried, still.

That's not how antibiotic resistance works, though. Your body doesn't develop a resistance to antibiotics, the bacteria do. So it's not limited to only people who overuse antibiotics, it's something that anybody can contract, and is hard to treat regardless of how many antibiotics you've taken.
posted by KGMoney at 8:55 AM on November 26, 2013 [22 favorites]


Interesting question : If you, a nation, etc. invented an anti-biotic, and could enforce a patent or strictly control information on synthesis, what measures are appropriate to ensure it's continued effectiveness? Is it reasonable to refuse sale to countries that use anti-biotics in agriculture? Imho yes. Is it reasonable to deny sales to countries whose citizens don't follow usage instructions? etc.
posted by jeffburdges at 8:58 AM on November 26, 2013


There are a lot of things we're going to have to adjust, I think. Neti pots can reduce sinus infections. Tonsil irrigation can reduce tonsillitis and strep without the risks of removal. Things that don't necessarily reduce our exposure to the world but that do encourage the human body's ability to heal itself--they do exist. Unfortunately, a lot of them are still things that people consider "gross". And workplaces are still extremely hostile to people actually taking time off to recover from illness, another factor. Hygiene can be taken too far, but we did manage to significantly reduce infections from wounds and most-childbirth infections just by adjusting the way we did things--not to the degree we have since, but it's not like we're going back to the 1500s.

Levofloxacin is not habitually given to cattle, last I heard, and yet we're still seeing resistance. That antibiotic use is a problem, but it seems like the real issue is that people are taking this stuff for every little sniffle and then not finishing out the course and we really need to learn another way to handle minor infections so that when they are killing us we still have something left.
posted by Sequence at 8:59 AM on November 26, 2013


As a teen I took antibiotics continuously for around 6 years, for acne. The only other treatment that is proven to work is a much, much more hardcore drug called Isotretinoin.

I knew my spots were bad news; now it looks like they've contributed to trashing myself and the world.
posted by colie at 8:59 AM on November 26, 2013 [2 favorites]


I got a staph infection in New York last year, and was petrified it was MRSA. As a European citizen with a maximum of 4 antibiotic treatments in my life, I was profoundly worried, still.

It doesn't really matter how many you've had personally, though - resistance is a function of the bacteria, not the host. If you had a habit of stopping antibiotics early, of course, that could lead to resistance in the infection you were currently battling (and potentially in bacterial populations in other body sites), but part of what's so scary about this is that if you had surgery in an American hospital, your chances of getting an antibiotic-resistant infection would probably be in the same ballpark as anyone else's.

On preview, jinx, KGMoney.
posted by en forme de poire at 8:59 AM on November 26, 2013


so taking lots of antibiotics over your life does not make you more susceptible to getting infections? i thought that it both made these resistant strains and also could affect a person's immune system if overused.
posted by sio42 at 9:01 AM on November 26, 2013


so taking lots of antibiotics over your life does not make you more susceptible to getting infections? i thought that it both made these resistant strains and also could affect a person's immune system if overused.

It's theorized that antibiotic overuse makes our gut bacteria resistant to antibiotics. Thus when we perform surgery that results in the spread of this gut bacteria to the bloodstream we make our prophylactic courses less effective and can introduce untreatable cases of sepsis.
posted by Talez at 9:04 AM on November 26, 2013 [4 favorites]




I'm not surprised that 80% of antibiotics go to livestock. Most cows or chickens will refuse to leave the doctors office without a prescription for something.
posted by dr_dank at 9:05 AM on November 26, 2013 [11 favorites]


This antibiotic resistance might frighten the fuck out of us humans but I guarantee you the rest of the earth's inhabitants can't wait for that day to come. It's their only hope to reverse climate change.
This force, evolution, is not sentimental. Like the earth itself, it knows only the hard facts of life's struggle with death. All you can do is hope and trust that when you have served its needs faithfully, there may still remain some glimmer of the life you once knew.
—Dr. Mohinder Suresh
posted by XMLicious at 9:05 AM on November 26, 2013 [8 favorites]


It usually does not as long as you properly took the full course. What is scary is when someone takes half their full regimen, feels better and then stops taking it. They then transmit a resistant bacteria to others who, due to resistance, cannot take that antibiotic to fight the infection, and so on...
posted by Sophie1 at 9:05 AM on November 26, 2013 [2 favorites]


From the same author on Medium (the FERN, which sounds like a group in 12 Monkeys, so there's that): How Your Chicken Dinner is Creating a Drug Resistant Superbug
posted by Potomac Avenue at 9:06 AM on November 26, 2013


What Wretch said
posted by KokuRyu at 9:06 AM on November 26, 2013


So... should I lick all of the surfaces, or Purell the crap out of everything?

Centers For Disease Contraction Urges Americans To Suck Doorknob (note: autoplaying video)
posted by one more dead town's last parade at 9:07 AM on November 26, 2013 [2 favorites]


before public health efforts to establish standards for care of livestock, the way many people caught tuberculosis was by drinking milk from an infected cow

Was that also before pasteurization was mandatory, and before milk was ~universally stored and transported in refrigerated containers?
posted by ROU_Xenophobe at 9:14 AM on November 26, 2013


Neti pots can reduce sinus infections.

And increase brain parasites.
posted by entropicamericana at 9:18 AM on November 26, 2013 [1 favorite]


So can I start killing chicken farmers and claiming self-defense?
posted by Naberius at 9:26 AM on November 26, 2013 [1 favorite]


I talked to our local antibiotic free beef producer a while back. I asked him what he does if his cows get sick (and cows, even well treated, will get sick, just like every other animal). He said he sells the cow. Clearly, to remain to the 'antibiotic free' claim, he needs to.

But this is clearly not really the answer, either. For one thing, it just pushes the antibiotic usage to a different vendor. It does eliminate routine usage for non-sick animals, though. But really, a sick cow should be able to receive treatment.

Just like for humans, we need better guidelines for when to give livestock antibiotics, not just try to make it antibiotic free. These all or nothing approaches get in the way of sensible solutions.
posted by Bovine Love at 9:26 AM on November 26, 2013 [13 favorites]


Neti pots can reduce sinus infections.

And increase brain parasites.


So use distilled or previously boiled water, or get your tap water from somewhere less likely to have brain parasites. Not that hard.

(I'm lying, it is totally hard to get the water to the right temperature if you're not able to just mix the tap water to suit. But then I don't currently live in Louisiana.)
posted by asperity at 9:27 AM on November 26, 2013 [1 favorite]


that's interesting about how the antibiotic-free farmers do it...they pass it off. i knew there was something i didn't know.
posted by sio42 at 9:30 AM on November 26, 2013 [2 favorites]


i thought that it both made these resistant strains and also could affect a person's immune system if overused.

Yeah, as talez points out it can affect the normal flora in your body as well (not just in the gut but on the skin, where garden-variety staph is quite common). There are also indications that antibiotic use may have some impact on immunity due to the collateral damage of wiping out normal non-disease-causing bacteria - the human microbiome (the trendy word for the bacteria living in and on us) does play a role in training the immune system - but that's less immediately relevant to the spread of things like MRSA.
posted by en forme de poire at 9:32 AM on November 26, 2013 [1 favorite]


I beat a sinus infection over the last week with just a neti pot and no antibiotics. Bought a gallon of distilled water at the store, still have half of it left.
posted by any major dude at 9:33 AM on November 26, 2013


UGH we're all going to die in basically the grossest way possible. I don't like this future, I want to exchange it for a better one.
posted by elizardbits at 9:33 AM on November 26, 2013 [5 favorites]


I feel a sort of "Que sera, sera" attitude toward the problem. When the consequences of antibiotics abuse are felt by lots of people, rich and poor, a solution will be found or not. In either cases, biology is working.
posted by francesca too at 9:35 AM on November 26, 2013


I don't like this future, I want to exchange it for a better one.

Hell, at this rate I would exchange it for certain bits of the past
posted by forgetful snow at 9:39 AM on November 26, 2013 [2 favorites]


I beat a sinus infection over the last week with just a neti pot and no antibiotics.

Most sinus infections are viral.
posted by asperity at 9:45 AM on November 26, 2013 [14 favorites]


Just like for humans, we need better guidelines for when to give livestock antibiotics, not just try to make it antibiotic free. These all or nothing approaches get in the way of sensible solutions.
posted by Bovine Love at 11:26 on November 26

Bias much ?
posted by Pogo_Fuzzybutt at 9:46 AM on November 26, 2013 [8 favorites]


This is part of why I quit eating meat, and why everybody else should too--or at least cut back severely, and move to organic, grass-fed meat (or hunt it themselves). There's a symbiotic relationship between our meat consumption and the government regulations that allowed this antibiotic issue to happen, and I wanted to cut myself out of it entirely. (I also believe animals deserve to live and we shouldn't kill them, but that's a different conversation altogether)

Not only does the factory farming system force animals to live in horrible conditions without use of anesthetic or painkillers, but it freely uses antibiotics in a grossly irresponsible manner, creating superbugs and antibiotic resistance. If we support factory farmed meat, it may end up causing epidemics that are entirely due to antibiotic resistance from needless overuse in farm animals. This is a case where the government either needs to step in and remove subsidies or we need to reduce our meat consumption: factory farmed animals ~need heavy doses of antibiotics because the consumer demand for meat is so high that farms allow animals to live in their own waste in cramped quarters just to keep up production levels (also, ruminants are being fed corn, which their bodies didn't evolve to handle--they must be fed antibiotics to prevent infection from the nearly undigestible food source). The "meat market" is becoming a public health hazard. I don't know how the US meat consumption levels would have played out if the government had not subsidized both meat and corn, so there's a lot to debate with respect to free markets as well.
posted by semaphore at 9:47 AM on November 26, 2013 [2 favorites]


Neither climate change, peak oil, nor antibiotic backlash are apocalypic. We just have a stupid habit of assigning big problems to either denial or apocalypse, ignoring the middle ground. We live in a system that is for practical purposes finite, and these are all artifacts of natural limits. But our culture's mythology tends to claim we're exempt from limits, and that colors our discourse.

The other thing is that to counter the lobbying of companies, we rely on doom-scenarios. We have to find a way, because this talk encourages the "we're doomed anarchists" to just give up and do nothing. All backwards.
posted by Ironmouth at 9:58 AM on November 26, 2013 [3 favorites]


Yes, that paralysis is exactly the biggest problem caused by making a dichotomy between no problem and disaster.
posted by maniabug at 10:02 AM on November 26, 2013


So America, with its spotty healthcare, is well positioned for the coming collapse.
posted by Brandon Blatcher at 10:02 AM on November 26, 2013


It usually does not as long as you properly took the full course. What is scary is when someone takes half their full regimen, feels better and then stops taking it.

Have you met my aunt? I nearly lost my mind when I was talking to her once and she explained that she was taking antibiotics but was going to stop so she would have them for later in case she needed them. She is not dumb but still did not appreciate what a horrible idea that was. But it's okay because she volunteers at a hospital and helps old people with their errands, then watches my cousin's children.
posted by kat518 at 10:05 AM on November 26, 2013 [5 favorites]


and that's how that ties neatly back into our fucked up healthcare system.

sometimes meds are expensive and not covered by your insurance plan. or you haven't met your deductible yet. so you buy it but want it to keep it around in case you need it again and can't afford it.

it's ok to do if you don't use all the Vicodin after oral surgery, but people don't get antibiotics are different than pain killers.
posted by sio42 at 10:08 AM on November 26, 2013 [3 favorites]


Yikes. Antibiotic Mary?
posted by ocherdraco at 10:09 AM on November 26, 2013


Was that also before pasteurization was mandatory, and before milk was ~universally stored and transported in refrigerated containers?

I don't think refrigeration prevents tuberculosis from being contracted.

According to this (pdf), standard pasteurization techniques at the time livestock care was first getting regulated near the beginning of the twentieth century weren't adequate to completely eliminate all diseases that could infect humans. That improved during the century to the point that now bacillus cereus is presently the only major concern in the same category that gets past it.

But drinking milk isn't the only way that pathogens for things like tuberculosis can get from animal populations to humans; this is exactly why antibiotic-resistant pathogens developing in livestock is a problem, because there isn't any guaranteed way to completely firewall between them. So if you're trying to imply that eliminating antibiotic use in agriculture and counting on pasteurization and refrigeration to stop the subsequent epidemics from crossing over to people would be adequate, it totally wouldn't and many people would die as a result of that.

The approach that people are suggesting here, to drastically reduce the consumption of animal products, seems like what would be necessary. Antibiotic use in agriculture could be reduced substantially but as long as we're going to have livestock we can't just forget about treating their diseases or quarantining or otherwise epidemiologically controlling them.
posted by XMLicious at 10:11 AM on November 26, 2013


If the antibiotic resistance becomes a big enough problem national governments will most likely step in with funding and regulation to promote antibiotic research...As noted another part of the problem is the widespread use of antibiotics in livestock. Again should the problem get bad enough this practice will likely become more restrictively regulated.


The face that a huge part of your big program relies on government oversight and intervention from a government that has been under attack for 30+ years at an ever-increasing pitch fills me with so much confidence in the future.
posted by Steely-eyed Missile Man at 10:16 AM on November 26, 2013 [1 favorite]


What is scary is when someone takes half their full regimen, feels better and then stops taking it.

This is my parents, except that they don't stop taking it because they feel better, they stop taking it so they can stockpile half of the antibiotic for next time they feel a bit under the weather.

The last time I visited their home was in 2010. I arrived with a cold; I hadn't been in the door ten minutes before my mother is handing me a seven year old bottle of tetracycline "to clear up that cold". God help us all.
posted by Sternmeyer at 10:36 AM on November 26, 2013 [8 favorites]


from a government that has been under attack for 30+ years

Yeah but this is exactly why this sort of stuff is cyclical. When things start to get bad people suddenly remember why they wanted government in the first place. Oversimplified, but: food and drug laws were tightened in the early 20th century because significant numbers of people were dying from things like untested drugs and quack radioactive beverages. EPA was started under Nixon not because he adored big government but because of things like the Cuyahoga River literally catching on fire.
posted by Wretch729 at 10:38 AM on November 26, 2013 [5 favorites]


Both of those were things happening for the first time. How is that proof that things are "cyclical"?
posted by Steely-eyed Missile Man at 10:42 AM on November 26, 2013


Sternmeyer, there's more concern about that then just resistance:

"The breakdown products of tetracyclines are toxic and can cause Fanconi Syndrome, a potentially fatal disease affecting proximal tubular function in the nephrons of the kidney. Prescriptions of these drugs should be discarded once expired because they can cause hepatotoxicity." -wiki

Not everything simply gets less potent with expiration.
posted by Dynex at 10:49 AM on November 26, 2013 [6 favorites]


I am a human pug dog. My sinuses are ten miles of bad road, even at the best of times. The critters in my sinuses and I have a sort of Middle East tentative ceasefire thing going, and in my defense, I'm never the one who starts shit with them.

I end up taking antibiotics three or four times per year when one of my chronic sinus infections reaches the point where I'm having trouble staying awake for more than a few hours or where my face starts swelling up until I can't talk. (No, I don't know why those are my biggest sinus infection symptoms, though probably the fact that I'm always congested and thus have pressure headaches means that those aren't reliable indicators and thus I don't notice them as much.) I try not to go to the doctor until it reaches some kind of crisis point precisely because of these worries, and I am sometimes bleakly certain that I already have some sort of resistant strain that has basically colonized my nose.


(And yes, I've tried a Neti pot. I believe I mentioned ten miles of bad road? The water would go in and wouldn't come back out, so all I did was give myself even more congestion, plus the fun of randomly having several ounces of water shoot out of my nose at an unpredictable interval later in the day, perhaps onto my keyboard or my boss's hair.)
posted by Scattercat at 11:01 AM on November 26, 2013 [6 favorites]


"3) There is some promise in other areas of research into fighting bacteria. Doubtless blasdelb will eventually drop into this thread to talk about bacteriophages."
Heh, I guess I am your friendly resident phage biologist.

They are the viruses of bacteria, think herpes, influenza, smallpox, or HIV but for bacteria. This is what they  look like, and to really make sense of them the story starts with an aggressively stubborn French-Canadian microbiologist named Félix d'Herelle.

After he and his brother lost family's fortune on a doomed chocolate factory, he left for South America where he made a decent living inventing new processes for converting tropical plants such as bananas and sisal into distilled liquor for western markets. However, while he was in Mexico he noticed something interesting, after the the swarms of locusts that devastated local agriculture passed through, sick locusts could be noticed to have been left behind. It occurred to him to isolate the pathogen to see if he could use it to combat the swarms. His technique ended up working so well that in 1911 d'Herelle was invited to travel to Argentina as a microbiologist to address the locust problems there. The problem was MASSIVE, every other year locusts would create the modern equivalent of billions of dollars worth of damage to cash crops and generate famine on the extraordinarily fertile pampas. It was so bad, and Argentina was rich enough then, that plans were being drawn up to import most of the world’s silver to build massively long 4 meter high walls across the pampas to stop the plagues. Apparently they'd have done it to if they thought they could stop theft, and on top of this the Ministry of Agricultural Defense had grown to a 3,000 member strong bureaucracy dedicated to extraordinary campaigns to defeat them.

d'Herelle's plan was again to spread diseases of the locust itself ahead of the swarms to use the same terrifying scale that made farmers so helpless, against the plague. He ended up getting funding to find sick locusts, cultivate the disease though serial transfer between 100 locust cages, and thus isolate 100% virulent and contagious strains of a cocobacillus. When thousands of these carcasses were spread out ahead of a swarm they were brought to an epic halt within a few days. After two years of d'Herelle's efforts the plagues ceased to be the issue that they once were in Argentina and the Pasteur Institute sent out his cultures to Columbia where several successful trials were conducted, as well as Cyprus and Algeria where they had significant effect.

All of this must have primed him to the idea that pathogens, or at least problem species, might have their own pathogens that we could team up with for productive effects, thus perhaps contributing to one of the more brilliant examples of deductive reasoning in modern science. At one point while he was in Paris before 1917, d'Herelle noticed something odd in a lawn of dysentery bacteria he had grown on a petri dish, a glassy clear dead spot. He must have thought this was interesting and so he plucked the spot from the plate and spread it out over a new lawn of the same bacteria, which then would not grow. Presumably figuring that he had isolated a new toxin of some kind, he made serial dilutions of it to see how just how toxic it was, and it did something toxins had never been known to do before. Arranging the plates in a row from highest dilution to lowest dilution, for a toxin, one would expect to see progressively but evenly damaged growth as one went down the series. However he saw first low numbers and then high numbers of the same glassy spots that mathematically followed the series. He quickly made a leap of judgment, clear only in hindsight, that would be challenged by many of the finest minds in the word until he was proven right by one of the first electron micrographs ever taken, that this wasn't a toxin at all, but a discrete organism. The problem was that his phages were far too small to see with a light microscope, no matter how powerful, as visible light has a wavelength of around 600nm and phage are around 25-250nm (thus using light to get a sense of what phage look like is kind of like using a blunt end of a telephone pole to get a sense of what a grasshopper feels like).

His discovery of phages was long before antibiotics, when bacterial disease killed most who died eventually and in horrific ways without much anyone could do for the sick. d'Herelle instantly saw the value that this pathogen of bacteria could have for patients, just like the value his coccobacilli had for farmers. He soon found a chicken farm with chicken typhoid that he successfully treated with phage isolated from the farm itself. He then isolated bacteria from the stool of a bunch dying French cavalrymen at a military hospital, isolated phage against them, amplified those phages, purified them as best he could, drank a bunch to demonstrate safety, and then gave it to the cavalrymen who each very quickly recovered.

Phage therapy exploded quickly, the major pharmaceutical companies of the United States and Europe, including Eli Lily which is still around, pumped out cocktails as quickly as they could and marketed them aggressively. However, no one really knew what phages were, much less how they worked, and most of the commercial entities profiting from phage didn’t seem to much care. This ended up giving phage a very well deserved bad reputation among physicians who tried preparations that we now know to have been heat or acid killed, or against the wrong pathogen, or against the right pathogen but with the wrong host range, or advertised as being effective against absurd things like gallstones and herpes and understandably decided the whole thing was bullshit. Many physicians considered the question settled with a pretty damning article series published in JAMA in 1934, before antibiotics became available a few years later making the question at least seem largely irrelevant for most pathogens (Though successful phage therapy of typhoid fever continued in the US into the 50s when effective antibiotics were finally found against S. typhii, and in France until the 80’s when poorly worded AIDS related legislation killed it).

Phage therapy did, however, survive and thrive in the Soviet Union after Stalin ended up reading d’Herelle’s first two books in the early 1930s with great interest. In 1934 he invited d’Herelle to set up a phage institute in what is now the Republic of Georgia with a Georgian microbiologist, George Eliava, for the purpose of studying phage and providing the Red Army with a reliable supply. While d’Herelle is said to have been initially enamored with communism, he was soon soured on it when Eliava was suddenly kidnapped, murdered, and denounced by Beria (it likely had as much to do with Beria demonstrating that even Heroes of Soviet Science were not immune to his power as anything else, but the oral history remembered by Georgian phage biologists is that Eliava slept with an opera singer that Beria had his eye on). Despite the institute’s decapitation with the loss of Eliava and the fleeing of d’Herelle, the women they trained took over and turned it into one of the great centers of Soviet medicine. They conducted large and well-designed, particularly for the era, studies to establish phage as a standard of care and then slowly expanded that standard as new needs arose.

Over the last fifteen years or so, with the breakup of the Soviet Union and this exponentially growing crisis of antibiotic resistance, phage therapy is looking very exciting again. Unlike the ‘30s, we now have a decent understanding of phage biology as well as the infrastructure to keep phages cold until use, effective diagnostic tools for knowing what bug we're fighting, and most importantly, regulatory structures that shut out hucksters. Having failed to take off at least three times now since the 90s, depending on how you count, from fools who started to think of phage as their Microsoft and started to alienate everyone to some truly shady shit - we now finally have some industry players who are ambitious without being assholes, a healthy community of young academic PIs who can get shit done, governmental support that wants us to succeed, and a regulatory community who thankfully both understand us better than many of us would like them to and also want us to succeed.

If you'd like a good idea of the current state of the art from a medical perspective, I'd recommend these three relatively short talks from last year,
David Harper's talk at VoM Brussels in 2012 (17:05)
Regulatory and clinical challenges with respect to phage therapy

Gilbert Verbeken's talkat VoM Brussels in 2012 (16:51)
Bacteriophage therapy: analyses of specific legal hurdles in the current regulatory frames

Dan Neilson's talk at VoM Brussels in 2012 (39:37)
Talking about his phage based enzyme therapy, a good introduction to the concept.
This, a shameless self link, is at least for the moment still the best recent review from a general perspective,
Phage treatment of human infections
Phages as bactericidal agents have been employed for 90 years as a means of treating bacterial infections in humans as well as other species, a process known as phage therapy. In this review we explore both the early historical and more modern use of phages to treat human infections. We discuss in particular the little-reviewed French early work, along with the Polish, US, Georgian and Russian historical experiences. We also cover other, more modern examples of phage therapy of humans as differentiated in terms of disease. In addition, we provide discussions of phage safety, other aspects of phage therapy pharmacology, and the idea of phage use as probiotics.
While these two papers really represent the two ways forward being pursued at the moment, leaving aside the often mysterious and occasionally bullshit-full stuff happening around the military,
The role of regulated clinical trials in the development of bacteriophage therapeutics
Antibiotic resistance is now recognized as a major, global threat to human health and the need for the development of novel antibacterial therapies has become urgent. Lytic bacteriophages (phages) targeting individual bacterial pathogens have therapeutic potential as an alternative or adjunct to antibiotic use. Bacteriophage therapy has been used for decades, but clinical trials in this field are rare, leaving many questions unanswered as to its effectiveness for many infectious diseases. As a consequence bacteriophage therapy is not used or accepted in most parts of the world. The increasing need for new antimicrobial therapies is driving the development of bacteriophage therapies for a number of diseases but these require the successful completion of large-scale clinical trials in accordance with US FDA or European EMA guidelines. Bacteriophages are considered as biological agents by regulatory authorities and they are managed by biological medicinal products guidelines for European trials and guidelines of the division of vaccines and related product applications in the USA. Bacteriophage therapy is typically an ‘active’ treatment requiring multiplication in the bacterial host and therefore the factors that govern its success are different from those of conventional antibiotics. From the pharmacokinetic and pharmacodynamic points of view, time of treatment, dosage depending on the site of infection and the composition of the bacteriophage formulation (single vs multiple strains) need careful consideration when designing clinical trials. Scientific evidence regarding inflammatory effects, potential for gene transfer and phage resistance, need to be evaluated through such trials. However purity, stability and sterility of preparations for human use can be addressed through Good Manufacturing Practises to reduce many potential safety concerns. In this review we discuss the potential for the development of bacteriophage therapy in the context of critical aspects of modern, regulated clinical trials.

What is needed for phage therapy to become a reality in Western medicine?
The current status of phage therapy approaches is reviewed and possible hurdles to a practical medical application of bacteriophages in Western countries are identified as discussed at a recent EMBO meeting on “Viruses of Microbes” in Brussels. In view of the growing antibiotic resistance crisis, a coordinated effort by the public health sector is needed to evaluate the potential of phage therapy as an adjunct to antibiotics.
Unmentioned in these links, there are also Naturopaths in Oregon and Washington State using broad spectrum Georgian phage preparations against various intestinal complaints under a peculiar state law that allows Naturopaths to use medicines that are part of the standard of care in other countries, as phage are in the former Soviet Union. As well as also plans moving rapidly for the use of phage against staph in diabetic foot ulcers, likely to take place in Philadelphia.
posted by Blasdelb at 11:12 AM on November 26, 2013 [119 favorites]


Sometimes I wonder what it must be like to sit next to blasdelb on a plane when someone in the next row over coughs without covering their mouth.
posted by elizardbits at 11:26 AM on November 26, 2013 [16 favorites]


We could have been starting to fix this, for not very much money and in a not very disruptive way, decades ago.

Humans will either outgrow this, or the world will outgrow them.

She is not dumb but still did not appreciate what a horrible idea that was.

A lot of this is the perception that medication is like a pile of jelly bellies, when it is more like a Fugu fish. They put recommended treatment cycles, dosages and expiration dates on there for a reason.

It's odd, but the same person who would never eat visibly expired eggs or milk or raw organ meat will have a 20 year old bottle of Tylenol in their cabinet and just completely ignore the directives on the bottle.

They should design medicine to start stinking badly after the expiration date...
posted by smidgen at 11:27 AM on November 26, 2013


"Sometimes I wonder what it must be like to sit next to blasdelb on a plane when someone in the next row over coughs without covering their mouth."

One time someone puked in the aisle ahead of me and, when the chatty guy who kept asking poorly worded questions about what I do looked really disturbed by the smell, I showed him this paper about Norovirus transmission in an airplane and explained in great detail the exact nature of what this both-ends-tapping shit-puking disease does to you along with the near perfect beauty of its indifferently evil design. Somehow he lost his curiosity for the entire five hour duration of the rest of the flight while I happily drank my mini-scotch thing.

As metabugs once said of biologists, we can show you things that would make you ashamed to be organic.
posted by Blasdelb at 11:38 AM on November 26, 2013 [34 favorites]


This is obviously God's punishment for not teaching evolution in schools.
posted by wobh at 12:32 PM on November 26, 2013 [1 favorite]


Remember that there are good reasons for some part of that,

Yes like maximizing profit from feeding animals diets they should not have that would otherwise result in sick/dead animals.

the way many people caught tuberculosis was by drinking milk from an infected cow.

And yet that can be treated with pasturization, no?

If pasteurization addresses the issue, then why introduce antibiotics as a preventive?

(And the above contagion reason is finally a stated reason about raw milk. 10+ years I've been hearing about raw milk and no one claiming its bad has ever stated WHY.)
posted by rough ashlar at 1:04 PM on November 26, 2013


...and blasdelb does not disappoint!

missile man - I didn't mean cyclical in some sort of grand theory of historical cycles way, maybe a better term would have been cyclically responsive. I just mean there was a more obvious need for government intervention in various areas in the past, that need was filled, and once problems were ameliorated people forgot why they wanted the government intervention in the first place. The cycle will repeat again if conditions worsen enough. (I'm not saying that's an ideal or rational way to run a country but I do think that's what happens, in broad general terms.)
posted by Wretch729 at 1:10 PM on November 26, 2013 [1 favorite]


This is my parents, except that they don't stop taking it because they feel better, they stop taking it so they can stockpile half of the antibiotic for next time they feel a bit under the weather.

Have you met my aunt?


These examples are actually super common. Both stockpiling and not feeling like they need the whole regimen. In fact, after September 11, 2001, people began genuinely stockpiling for an anthrax attack. Now there's a bunch of decade old antibiotics out there in grandma's medicine cabinet or bug out bag.
posted by Sophie1 at 1:11 PM on November 26, 2013 [1 favorite]


I dunno, seems that an antibiotic resistant plague would pretty much target people who didn't believe in modern medicine to begin with. .

Boo-hoo??
posted by Renoroc at 2:21 PM on November 26, 2013


EVERYONE can get the antibiotic resistant strain.
posted by sio42 at 2:35 PM on November 26, 2013 [2 favorites]


so if you believe in modern medicine they can't treat you. which is why the people in the article died or ended up with severe life altering body impairments.
posted by sio42 at 2:36 PM on November 26, 2013 [1 favorite]


I dunno, seems that an antibiotic resistant plague would pretty much target people who didn't believe in modern medicine to begin with. .

Boo-hoo??


and their kids, who I guess are no loss either
posted by Rustic Etruscan at 2:42 PM on November 26, 2013 [2 favorites]


I dunno, seems that an antibiotic resistant plague would pretty much target people who didn't believe in modern medicine to begin with. .

No, antibiotic resistance affects everyone. Antibiotics are not a prophylactic such as immunizations.
posted by KokuRyu at 3:12 PM on November 26, 2013 [1 favorite]


And yet that can be treated with pasturization, no?

Ctrl-F "pasteurization"

To paraphrase, the entire reason that antibiotic-resistant pathogens developing through agricultural practices is a problem in the first place is because there are many ways that diseases can cross from livestock to humans. You can't just stop treating communicable diseases in dairy cattle and say "oh well, there's pasteurization" when epidemics run rampant that could spread to humans.
posted by XMLicious at 3:47 PM on November 26, 2013


Somehow he lost his curiosity for the entire five hour duration of the rest of the flight while I happily drank my mini-scotch thing.

Seanan McGuire has a great story about being seated next to one of the authors of the Canadian Disease Control pandemic preparedness plan and horrifying every other passenger around them with talks about stacking bodies in empty hockey rinks so of course I had to track it down and read it and then I couldn't have a conversation with anyone for the next few weeks without mentioning improvised field methods for infected corpse burning.
posted by The Whelk at 3:57 PM on November 26, 2013 [6 favorites]


So... should I lick all of the surfaces, or Purell the crap out of everything?

Both. Dump Purell on it, THEN lick it.

(Which brings me to one of my own pet peeves: don't give Purell to kids, FFS. They smear it on their hands AND THEN LICK IT. The antibiotic resistance doesn't bother me nearly as much as THAT KID IS LICKING RUBBING ALCOHOL. Just wash their damn hands.)
posted by sonika at 5:02 PM on November 26, 2013


I was actually going to post this CBC Ideas program as an FPP, but it is a good fit with this post, and provides some hope in the face of alarmism

Bugs 'R Us We are constantly at war with microbes -- SARS, MERS, E.coli, C.difficile -- filthy little organisms that threaten our health and safety. These pathogens can be deadly, but have we gone too far? Is eliminating our exposure to microbes actually bad for us? Microbiologist Dr. Brett Finlay (Publications) argues that we're entering a golden era in our understanding of microbes, and that new technologies are giving us unprecedented insights into health and disease.
posted by KokuRyu at 6:46 PM on November 26, 2013 [2 favorites]


>So... should I lick all of the surfaces, or Purell the crap out of everything?

Both. Dump Purell on it, THEN lick it.


My assumption was that we're susceptible to bacteria that already live - but are kept in check by a number of defenses - on our body, such as staph, which lives on the nose, and behind the ears, and above the buttocks (at the top of your ass crack).

It's when staph, for example, gets transported to a part of the body that is not prepared to deal with the bacteria that we can encounter serious infections.
posted by KokuRyu at 6:50 PM on November 26, 2013


It's when staph, for example, gets transported to a part of the body that is not prepared to deal with the bacteria that we can encounter serious infections.

Like from something as seemingly non threatening as a teeny weeny sliver. This happened to me about 15 years ago. I never noticed the sliver and woke up one morning with my hand a little stiff and a weird colored spot on the palm. I was tree planting at the time and parked way out in the bush at a camp that we had to be flown into. A couple hours later both the stiffness and the color spread to most of my hand. Once we realized that something more serious was going on I needed to be taken out. This, for a number of reasons proved to be quite the logistical plan that involved a boat, small hike, atv ride and a truck ride to the nearest hospital. By the time I left camp my hand according to my crew looked like this weird purple dead fish and what we assumed was an infection was moving up my arm in lines through my veins. It was happening fast enough to watch.

It was cleared up really easily with a couple shots and subsequent prescription. Though it was never diagnosed that doc said it was likely some sort of staph or staph like infection that got in on the sliver we found. When I asked if I could have prevented it in anyway he said that even though tree planting wasn't the cleanest of jobs it really was more like a random, crapshoot thing that the sliver happened to go in, in such a way and at a spot where it pulled just the right little nasty with it. It's not like I haven't been cut and got slivers dozens upon dozens of times in my life. It's just that this one, without antibiotics could have quite realistically killed me.

The whole thing was really sobering. I would hate to go back to a world where just the right sliver can kill.
posted by Jalliah at 7:08 PM on November 26, 2013 [4 favorites]


When I asked if I could have prevented it in anyway he said that even though tree planting wasn't the cleanest of jobs it really was more like a random, crapshoot thing that the sliver happened to go in, in such a way and at a spot where it pulled just the right little nasty with it.

When our son was born in 2002 he developed a fever a couple of days after birth. It turned out he had both bacterial and viral meningitis. It was very scary (but he survived and thrived). The doctor said it was just one of those things. A crapshoot.
posted by KokuRyu at 7:33 PM on November 26, 2013 [2 favorites]


It turned out he had both bacterial and viral meningitis. It was very scary (but he survived and thrived). The doctor said it was just one of those things. A crapshoot.

I had viral meningitis as a kid and I get asked a lot "How did you GET that?!" Well. It's a virus. And usually it gives you a cold. And it got into my spinal fluid. Total crapshoot.

There's definitely a pervasive attitude that something rare means it's also somehow preventable. Not really. It just means it doesn't happen often, not that it's being stopped from happening.
posted by sonika at 8:23 PM on November 26, 2013 [1 favorite]


To paraphrase, the entire reason that antibiotic-resistant pathogens developing through agricultural practices is a problem in the first place is because there are many ways that diseases can cross from livestock to humans.

Then additional information is needed for a better discussion as that paraphrasing misses various "reasons" antibiotics are being given in bulk.

Ethanol producers use antibiotics to keep the tanks from being contaminated with lactobacilli, bacteria that compete with the yeast and lower the ethanol yield. Contamination is common, so tanks are often inoculated as a preventive measure: penicillin, erythromycin, virginaiamycin, or tylosin are added during the distillation process, and the leftover corn mash—a waste product the industry calls DGs —is sold to cattle, dairy, swine, and poultry producers for livestock feed.

Shockingly, FDA has not restricted antibiotic use in ethanol production, but instead decided to treat the antibiotics as “food additives.”


The feedlot operations and the grain result in sick animals.

Then there is this: While some of that 80% is used to treat animal illnesses, the majority (90%) is administered through the animals’ water or feed to assist the animals’ growth and subsequent weight gain and to also preventively help the livestock survive the harsh farm and living conditions through antibiotic treatment

Arguing the issue is about keeping human disease at bay ignores an entire set of reasons to ALSO consider.
posted by rough ashlar at 3:06 AM on November 27, 2013 [3 favorites]


a hospital infection that was “pan-resistant” — that is, responsive to no antibiotics at all. He died fourteen days later. When his doctors related his case in a medical journal months afterward, they still sounded stunned. “It is a rarity for a physician in the developed world to have a patient die of an overwhelming infection for which there are no therapeutic options,” they said, calling the man’s death “the first instance in our clinical experience in which we had no effective treatment to offer.”

As approved by the Government.

IV based Vitamin C has been used in cancer and viral issues - one Doc claims "Dr. Thomas Levy sent me a case report where vitamin C was used to completely cure a case of swine flu. He says that adequately dosed vitamin C, to his knowledge, has never failed to cure an acute viral syndrome. "

Research back in 1944 by Cavallito, Buck and Suter talk about Allicin (part of Garlic) but using IV based Allicin in high dose (30mg per kg in mice - cancer research) resulted in vein necrosis.
posted by rough ashlar at 3:36 AM on November 27, 2013


That map of antibiotic prescription rates was interesting. Why are the highest rates in the south?
posted by Seymour Zamboni at 5:00 AM on November 27, 2013


The use of probiotics has been quite effective in Finland for reducing the need for antibiotics in poultry production. Here (pdf) are statistics from The Association for Animal Disease Prevention (ETT) for antibiotics use in chicken and turkey production between 2007-2012 (Google translate version). No antibiotics were administered for the production flocks of chicken for the past three years.
posted by baueri at 5:41 AM on November 27, 2013


I just came here to say what rough ashlar said: most of the antibiotics used in in agriculture aren't to prevent disease, they're to increase yields. In my view, this leaves farmers and pharmaceutical manufacturers to balance their desire for a healthy bottom line with the public's need for effective antibiotics. Why is Regulation a bad thing, again?
posted by sneebler at 6:38 AM on November 27, 2013


I think a lot of people simply feel entitled to high yields and low prices. The political will for regulation would have to come from a more coherent place. Do we have it in us to put forth a real critique of that entitlement? It does open up a can of worms.
posted by maniabug at 8:00 AM on November 27, 2013 [1 favorite]


one Doc claims "Dr. Thomas Levy sent me a case report where vitamin C was used to completely cure a case of swine flu. He says that adequately dosed vitamin C, to his knowledge, has never failed to cure an acute viral syndrome. "

nope:
It is interesting to note that Thomas E Levy, who trained as a medical doctor in the 70’s and then qualified as a lawyer in the mid 90’s, states on his CV, which is available to download on his website, that he is currently an Associate Professor at Capital University of Integrative Medicine (CUIM). Turns out that CUIM was founded by a convicted fraudster and closed its operations over five years ago. Furthermore, it was what is known in the industry as a ‘diploma mill’, offering degrees that were not recognised by official educational accrediting bodies. Despite ‘15 years of research’ Dr Levy has not published a single peer-reviewed article on the link between vitamin C and disease.
Vitamin C megadosing is also unproven for cancer.

The answer to diminishing effectiveness of antibiotics is to shepherd the use of the ones we have better and to develop new ones (including non-small-molecule therapies), not to resort to placebos.
posted by en forme de poire at 11:54 AM on November 27, 2013


Also, viral infections have absolutely nothing to do with antibiotics. Failure to recognize this difference is one reason for increased rates of antibiotic resistance, as Sternmeyer illustrated above.
posted by en forme de poire at 11:55 AM on November 27, 2013 [1 favorite]


Vitamin C megadosing is also unproven for cancer.

1) "Managing" dis-ease is far more profitable than a cure.
2) "cancer" is used to cover a very broad range of things. Some caused by virus, some by mutigens like heavy metals, some by more complex chemical chains that are in-organic, some by toxins of molds, on and on. Knowing what is "simple" to treat and guessing how deep your pocket is a speciality of some "cancer centers" as "cancer" is a scary word.

Cuba under Castro had a goal to educate and send out to other nations doctors along with trying to figure out how to "do medicine" with a "shoestring budget". If there is test data on the efficacy of things like Vitamin C I'd look to what the Cubans have data on. Cuba not under a Castro may have a different "economic model" and who knows what kind of direction their nation will take.

I think a lot of people simply feel entitled to high yields and low prices.

Feel? That was the policy change under Earl Butz during the reign of Nixon.

I remember reading 30% of income was traditionally housing, 30% food. The US had been at 10% food for a couple of decades per that same source.

If 50% of your income goes to taxes in various forms and 30% is housing - what does one do if food goes from 10% to 30%? Who in "that picture" is gonna "starve"?

Why are the highest rates in the south?

Food Bacteria-Spice Survey Shows Why Some Cultures Like It Hot might lead you to sit and think about what one can add to your diet to help the body to fight off things like bacteria or "cancer". "Culture" is the "easy" answer to your high rates in the south but without a comparison with nations that have a large temperature differential it may be as simple as hotter leads to more bacterial "action" and more "action" means more antibiotics. Odds are someone has PHD dissertations someplace on that topic and if not - well, there's your PHD paper.
posted by rough ashlar at 3:59 PM on November 27, 2013 [2 favorites]


to develop new ones

Plastic 'ninjas' take on deadly bacteria

But what would be simpler is to stop using antibiotics for non human uses like adding weight gains to animals. But I don't see many suggesting less profit other than The Pope.

not to resort to placebos.

VS what, develop a drug, find out it does work and then market it anyway?

Do feel free to explain how, in a money-driven system how therapeutic modalities can be fully examined that could cut into the profitability of the money driven system.

A question gets asked along this line: It is surprising how little we still know about vitamin C metabolism and pharmacokinetics more than sixty years after Szent-Györgyi received the Nobel Prize for his discoveries of vitamin C's biological oxidation processes. I'll put forth the answer is in ones face - no massive private profit can be made.

(and also dear readers note the way the negative "placebo" was framed. Rather than point out where and HOW Levy is wrong the framing was to just declare Levy is wrong by tying the negative "placebo" and mention how the proposed method doesn't work for something it was never claimed it worked for in this FPP. )
posted by rough ashlar at 9:31 AM on November 28, 2013 [1 favorite]


If you're going to argue that Vitamin C is a panacea you are going to need to find someone more credible to cite. At the very least, someone who doesn't make nonsensical claims like "a toxin, infection or anything that causes a medical symptom in the body is a result of oxidative stress or due to a lack of electrons.” (from)

Since you apparently seem to believe that only research performed in communist countries is valid (you should really google Lysenko - capitalism hardly has a monopoly on scientific malfeasance) I'm pretty sure you have successfully immunized your argument against most of the evidence anyone is likely to cite. Nevertheless, if vitamin C infusion was actually some kind of panacea against all known viral infections, you would expect there to be a major literature supporting that treatment, as funding for this type of research comes largely from the public sector, not from Big Pharma. (If you're going to argue that all of pharma is tainted because it's in their interest to prefer partial, long-term treatments, consider that the government spends quite a lot of money on health care and it is actually in their interest to prefer cheaper cures.) The fact that there isn't such a literature is telling.

Anyway, you were the one who brought up cancer and viruses in a thread about antibiotic resistance, but you're correct that it has nothing to do with the FPP.
posted by en forme de poire at 12:56 PM on November 28, 2013 [2 favorites]


Your response to:
Do feel free to explain how, in a money-driven system how therapeutic modalities can be fully examined that could cut into the profitability of the money driven system.
is:
Since you apparently seem to believe that only research performed in communist countries is valid

Way to dodge the request for an explanation.

I'm pretty sure you have successfully immunized your argument against most of the evidence anyone is likely to cite.

Or, gosh, you could go ahead and actually cite things.

As for citations you make this statement:
At the very least, someone who doesn't make nonsensical claims like "a toxin, infection or anything that causes a medical symptom in the body is a result of oxidative stress or due to a lack of electrons.”

The very least you could have done was note anything that causes a medical symptom in the body and point out how, say, a broken bone causes a medical symptom and is not a result of oxidative stress or due to a lack of electrons. Feel free to show in other ways the blanket statement made is wrong VS just saying "nonsensical".

Not to mention the article puts the above in quote marks indicating this was said by Levy. I see no reference to an actual citation as something Levy said somewhere at sometime. Dr. Levy may have very well said it, but as you pointed out in your 1st sentence you like citations.

Anyway, you were the one who brought up cancer and viruses in a thread about antibiotic resistance

You are right, I did. Because like you citing the above absolute statement I had heard about IV based asorbic acid and IV based allicin being used in place of an IV based antibiotic. So rather than just repeat I looked and found both tales lacking citations for IV and bacteria.

The fact that there isn't such a literature is telling.

So you claim. But I did ask you to explain
how, in a money-driven system how therapeutic modalities can be fully examined that could cut into the profitability of the money driven system.

If your answer is this:
funding for this type of research comes largely from the public sector, not from Big Pharma.

You've not shown any ratios of funding or provided anything beyond a prima facia handwave case.

On a web site where one can find on a weekly basis commentary about the gutting of public funding for the public good.
posted by rough ashlar at 6:54 AM on November 29, 2013


The NIH spends about $30b/y on basic science, translational studies and clinical trials, awarded by study sections which are a form of grant peer review. $3b/year is spent on clinical trials. More to the point, a lot of the science funded by the NIH is in vivo in model systems like mice, where you could for example give mice staph infections and then challenge with IV ascorbate or allicin or whatever. The process of publishing these results does not need to involve any money from industry at all.

You appear to have been able to come up with examples yourself about how not every medical symptom is a result of oxidative stress. Of course, there are a variety of processes that can cause unpleasant symptoms. Influenza virus, for instance, causes cell damage by a variety of mechanisms, including triggering apoptosis (the cell's self-destruct mechanism). Exocrine tumors cause symptoms by flooding the body with inappropriate levels of hormones. Etc. I thought that statement was pretty plainly ridiculous without my having to explain it further, and you appear to agree so I'm not sure why you're being so hostile about it.

If you knew that allicin and ascorbate weren't viable options for treating bacterial infections, then why post about them as examples of viable treatments that are not "approved by the Government"? My point is that they are not approved by the government because they have not demonstrated any efficacy. Here, for example, are two recent open access studies testing IV ascorbate as an adjunctive therapy in cancer. They do not describe any effect on tumor size, cancer progression, or patient survival, focusing instead on the fact that ascorbate appears to reduce inflammation. This isn't worthless, though it is a pretty small effect - and if it indeed turns out to significantly improve outcomes in the future, you can bet that it will be published very quickly and doctors will adopt it. But right now, it is like any other hypothetical, unproven treatment. There is no conspiracy to keep viable treatments out of the hands of doctors and patients.

I think this is my last comment on this since it's really not the subject of the thread.
posted by en forme de poire at 12:02 PM on November 29, 2013 [1 favorite]


More to the point, a lot of the science funded by the NIH is in vivo

So that is the 'acceptable standard'?

In vitro mechanism of inhibition of bacterial cell growth by allicin. Over 100 others cite that late 1980's work.

The NIH spends ... clinical trials,

So trying the material is an 'acceptable standard'?

via Avian Diseases 43:656-663, 1999 "The effects of Asorbic Acid on In Virto Heterophil Function"
"SUMMARY. As a feed additive, asorbic acid has been shown to have a protective effect against bacterial and viral diseases and to reduce determertral stress in chickens."

(Oh look - Vit C might actually work like the low level antibiotics in feed. Now, where are the tests to show the effectiveness/cost between the 2 binary choices?)

If you knew that allicin and ascorbate weren't viable options for treating bacterial infections,

Not what was said or cited - for IV based control....based on the citations. And now you have citations that meet a stated level of "credibility".

As one can see from oral applications and in an in vitro model an effect has been shown. I will explicitly stake out that as the ways for drug makers to make obscene profits the testing to obtain government certification won't happen for things like Allicin, Asorbic Acid, the mushrooms listed, or even Tumeric. I'll go further - that if part of the cited $30 billion was spent to test such effectiveness testing various Congress-things would be contacted by "constituents" explaining how money on such should not be spent on such efforts.

I've asked for someone show "how, in a money-driven system how therapeutic modalities can be fully examined that could cut into the profitability of the money driven system. " and thus this has not happened.
posted by rough ashlar at 8:20 AM on November 30, 2013


yes, you have won the thread and indeed the entire internets

well done indeed, very special
posted by elizardbits at 10:02 AM on November 30, 2013 [3 favorites]


"I will explicitly stake out that as the ways for drug makers to make obscene profits the testing to obtain government certification won't happen for things like Allicin, Asorbic Acid, the mushrooms listed, or even Tumeric. I'll go further - that if part of the cited $30 billion was spent to test such effectiveness testing various Congress-things would be contacted by "constituents" explaining how money on such should not be spent on such efforts."

So far more than $20 billion dollars of our money has been spent on researching Complimentary and Alternative medicine by Senator Tom Harkin using the NCCAM, producing an amount of useful knowledge and products with proven efficacy that can be pretty accurately be summarized as diddlyshit. It has produced no real discoveries, a pathetic publication record, and nothing of value to an industry that doesn't care it its shit works anyway.

There would be money for the whole nine yards of phase I-III trials for all the shit you just named if there was any reason to think they would produce useful fruit. Bitter experience with shit like this has shown otherwise.
posted by Blasdelb at 1:18 PM on December 2, 2013 [2 favorites]




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