6 ms·

Rising Threat of Infections Unfazed by Antibiotics

16 points by cromulent 17y ago

Mz 17y ago
This is the part of the article I most like: “You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.” Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.” Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection. Of course, I'm highly biased in that regard. :-)
- ledger123 17y ago
  "Of course, I'm highly biased in that regard." This prompted me to look at your info and now reading your website (http://www.healthgazelle.com/ http://www.healthgazelle.com/) and I am pleased, to say the least. I added my comment above (or below where ever it appears) without reading your website.
  - Mz 17y ago
    I suppose that answers your closing question of "Any ideas?". ;-)
jrockway 17y ago
At least the pharmaceutical companies are hard at work finding new drugs to make your eyelashes grow longer.
- Mz 17y ago
  I'm just waiting for people to start reporting ghastly unexpected side effects. (My eyelashes seem to be getting longer as a consequence of getting myself healthier. But I can't imagine anyone wanting me to say "Just spend 10 years working on your basic health instead of using this stuff". It's really not hip to be square.)
  - 0wned 17y ago
    Give it 20 years and we'll know for certain.
- alaithea 17y ago
  That's actually a drug originally developed for glaucoma. The eyelash-growing part was a side-effect.
- anamax 17y ago
  While the eyebrow example is wrong, let's assume that the gist was correct. In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong? You want more drugs that save peoples lives? Great! So do I. Here's how we do it. Make it possible for folks to get rich on drugs that save people's lives. Note - cost controls won't do it (unless we're talking about controlling regulatory costs).
  - rsheridan6 17y ago
    Here's another way - socialize medical research funding, at least for antibiotics. Antibiotics are inherently less profitable than other drugs because doctors try to avoid using new ones so that the bugs don't develop resistance to them. By the time they're freely used, the patent might have expired, as patents of the kidney-killing drugs mentioned in this article have decades ago. I don't really see a good market-based solution here.
    - gort 17y ago
      And even if they do get used they heal the patient; whereas the most profitable drugs are the ones requiring continued use.
  - camccann 17y ago
    In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong? Because having individuals with limited resources independently pursuing their own goals doesn't necessarily maximize overall utility, or even any actual individual's utility. It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same. Since it's difficult to ensure wide-scale cooperation, it doesn't happen and the result is that everyone is worse off. I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.
btilly 17y ago
This is a disaster in slow motion. It is a few years old, but Betrayal of Trust is still an excellent overview of the problem: http://www.amazon.com/gp/product/0786884401?ie=UTF8&tag=randomobser0b-20 http://www.amazon.com/gp/product/0786884401?ie=UTF8&tag=...
- billswift 17y ago
  I haven't read that one, but I read Garrett's earlier one, "The Coming Plague" - it was an hysterical, anti-Western, fear-mongering eco-nut screed. In the decade and a half since she wrote it, not a single one of the "plagues" she claimed were about to break out across the world has shown any signs of getting worse, much less becoming the sort of widespread "disaster" she claimed was imminent.
ledger123 17y ago
This article is scary. To me it seems that we are just creating more powerful strains of various bacteria with our use of anti-biotics. May be it is time we need to look at alternate ways to enhance our immunity so that we are not that much susceptible to bacterial (or virus) infection. May be alternative medicine or Michael Pollan way of eating. Any ideas?
- tokenadult 17y ago
  we need to look at alternate ways to enhance our immunity Vaccines suit this description. But natural selection will favor bacteria that beat your immunity, however your immunity is enhanced. The bacteria for which we have effective defenses, of whatever kind, we forget about, but the few kinds of bacteria that can harm human beings continue to be surprising. That's the arms race of natural selection.
  - camccann 17y ago
    I've heard it proposed that we could try and work with this instead of against it, by "domesticating" diseases. Take some harmful bacteria, breed a strain that's mostly benign and moderately contagious, then let it loose to displace the more harmful strains while carefully avoiding doing too much to kill it. In other words, create selection pressures that favor mild strains.
- carbocation 17y ago
  Multidrug therapy will become the mainstay. It works for HIV (HAART) because despite the high mutation rate of HIV, it is exceedingly rare for the virus to sustain the ~3 different mutations required to confer resistance to 3 different drugs simultaneously. I imagine that this will, in fact, be how we end up applying our targeted cancer therapies as well. Let me put it this way: each base of the genome of a {cancer, bacterium, virus} has some chance of mutation at each replication step. If you target just one protein, then you may need as little as one mutation to confer resistance. In a normal human genome, you would expect this to happen to the nucleotide of interest once every hundred thousand cell divisions. Obviously a cancer has a higher error rate and millions of rapidly dividing cells, so this would occur quickly. If you target two proteins, you would expect both mutations to co-occur once every (100,000 x 100,000) cell divisions. If you target three proteins... Now you are getting somewhere. Certainly it is not quite this simple. If variants with one mutation are more fit than those without it, then resistance to one drug in the cocktail will be selected for. But with HAART, we have seen that the multidrug approach is fairly - perhaps surprisingly - robust to that possibility.
tumult 17y ago
I know someone who contracted MRSA after randomly scraping his knee. Almost killed him, and it came out of nowhere. Some hospitals have MRSA fatality rates over 20%. Scary as shit! Antibiotics abuse has screwed us, I guess, along with the sloppiness of many healthcare providers.
- carbocation 17y ago
  Patients are equally sloppy. When they feel better, many discontinue antibiotic use. Providers too readily prescribe antibiotics to try to appease patients with, say, an obvious viral respiratory infection, but these are most often less valuable antibiotics such as first generation penicillins anyways. Judicious antibiotic use is important, both for patient and provider, but there is a more pernicious problem lurking: the use of late-generation antibiotics - still critical for hospital use - in feed to produce larger livestock more cheaply.
  - tumult 17y ago
    Yep. In general, we too often use our powerful weapons with disregard, and it's coming back to bite us in the ass.
- electromagnetic 17y ago
  MRSA lives in the community just as much, if not more, than it lives in the hospitals. From what I know of the area, some hospitals had up to 80% community-acquired infections as opposed to hospital-acquired infections, this meant that the majority of these patients were being killed by their families. I know many ICU's in the UK have full out bans on any family members entering, because if anyone in an ICU catches MRSA they're gone. It's easy to blame the healthcare providers, and I'm sure in many cases it is the healthcare providers' fault. However, if they simply flat-out banned people from visiting in the hospital MRSA infection rates (in good hospitals) would drop like a rock. I wouldn't be surprised if hospitals with MRSA fatality rates over 20% allow visitors in the ICU and don't have well established visitor protocols in the regular hospital. I know some wards in the UK (I have friends and family who work in hospitals) will escort you out if they see you go between patients' beds; essentially they allow you to visit 1 person per day, and they frequently have visiting hours only a couple hours long so they can actively enforce this. My advice to anyone visiting a friend in hospital, don't touch them. No handshakes, especially no hugs. This seems extreme, but patients have died from MRSA infection in key-hole surgery incisions.
cwan 17y ago
Despite the on-again off-again media hysteria, it would seem that there is some promising research on the horizon. Check out the TED talk by Kary Mullis: http://www.ted.com/talks/lang/eng/kary_mullis_next_gen_cure_for_killer_infections.html http://www.ted.com/talks/lang/eng/kary_mullis_next_gen_cure_... "Drug-resistant bacteria kills, even in top hospitals. But now tough infections like staph and anthrax may be in for a surprise. Nobel-winning chemist Kary Mullis, who watched a friend die when powerful antibiotics failed, unveils a radical new cure that shows extraordinary promise."

16 points by cromulent 17y ago

Mz 17y ago

This is the part of the article I most like: “You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.” Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.” Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection. Of course, I'm highly biased in that regard. :-)

ledger123 17y ago
"Of course, I'm highly biased in that regard." This prompted me to look at your info and now reading your website (http://www.healthgazelle.com/ http://www.healthgazelle.com/) and I am pleased, to say the least. I added my comment above (or below where ever it appears) without reading your website.
- Mz 17y ago
  I suppose that answers your closing question of "Any ideas?". ;-)

jrockway 17y ago

At least the pharmaceutical companies are hard at work finding new drugs to make your eyelashes grow longer.

Mz 17y ago
I'm just waiting for people to start reporting ghastly unexpected side effects. (My eyelashes seem to be getting longer as a consequence of getting myself healthier. But I can't imagine anyone wanting me to say "Just spend 10 years working on your basic health instead of using this stuff". It's really not hip to be square.)
- 0wned 17y ago
  Give it 20 years and we'll know for certain.
alaithea 17y ago
That's actually a drug originally developed for glaucoma. The eyelash-growing part was a side-effect.
anamax 17y ago
While the eyebrow example is wrong, let's assume that the gist was correct. In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong? You want more drugs that save peoples lives? Great! So do I. Here's how we do it. Make it possible for folks to get rich on drugs that save people's lives. Note - cost controls won't do it (unless we're talking about controlling regulatory costs).
- rsheridan6 17y ago
  Here's another way - socialize medical research funding, at least for antibiotics. Antibiotics are inherently less profitable than other drugs because doctors try to avoid using new ones so that the bugs don't develop resistance to them. By the time they're freely used, the patent might have expired, as patents of the kidney-killing drugs mentioned in this article have decades ago. I don't really see a good market-based solution here.
  - gort 17y ago
    And even if they do get used they heal the patient; whereas the most profitable drugs are the ones requiring continued use.
- camccann 17y ago
  In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong? Because having individuals with limited resources independently pursuing their own goals doesn't necessarily maximize overall utility, or even any actual individual's utility. It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same. Since it's difficult to ensure wide-scale cooperation, it doesn't happen and the result is that everyone is worse off. I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.

btilly 17y ago

This is a disaster in slow motion. It is a few years old, but Betrayal of Trust is still an excellent overview of the problem: http://www.amazon.com/gp/product/0786884401?ie=UTF8&tag=randomobser0b-20 http://www.amazon.com/gp/product/0786884401?ie=UTF8&tag=...

billswift 17y ago
I haven't read that one, but I read Garrett's earlier one, "The Coming Plague" - it was an hysterical, anti-Western, fear-mongering eco-nut screed. In the decade and a half since she wrote it, not a single one of the "plagues" she claimed were about to break out across the world has shown any signs of getting worse, much less becoming the sort of widespread "disaster" she claimed was imminent.

ledger123 17y ago

This article is scary. To me it seems that we are just creating more powerful strains of various bacteria with our use of anti-biotics. May be it is time we need to look at alternate ways to enhance our immunity so that we are not that much susceptible to bacterial (or virus) infection. May be alternative medicine or Michael Pollan way of eating. Any ideas?

tokenadult 17y ago
we need to look at alternate ways to enhance our immunity Vaccines suit this description. But natural selection will favor bacteria that beat your immunity, however your immunity is enhanced. The bacteria for which we have effective defenses, of whatever kind, we forget about, but the few kinds of bacteria that can harm human beings continue to be surprising. That's the arms race of natural selection.
- camccann 17y ago
  I've heard it proposed that we could try and work with this instead of against it, by "domesticating" diseases. Take some harmful bacteria, breed a strain that's mostly benign and moderately contagious, then let it loose to displace the more harmful strains while carefully avoiding doing too much to kill it. In other words, create selection pressures that favor mild strains.
carbocation 17y ago
Multidrug therapy will become the mainstay. It works for HIV (HAART) because despite the high mutation rate of HIV, it is exceedingly rare for the virus to sustain the ~3 different mutations required to confer resistance to 3 different drugs simultaneously. I imagine that this will, in fact, be how we end up applying our targeted cancer therapies as well. Let me put it this way: each base of the genome of a {cancer, bacterium, virus} has some chance of mutation at each replication step. If you target just one protein, then you may need as little as one mutation to confer resistance. In a normal human genome, you would expect this to happen to the nucleotide of interest once every hundred thousand cell divisions. Obviously a cancer has a higher error rate and millions of rapidly dividing cells, so this would occur quickly. If you target two proteins, you would expect both mutations to co-occur once every (100,000 x 100,000) cell divisions. If you target three proteins... Now you are getting somewhere. Certainly it is not quite this simple. If variants with one mutation are more fit than those without it, then resistance to one drug in the cocktail will be selected for. But with HAART, we have seen that the multidrug approach is fairly - perhaps surprisingly - robust to that possibility.

tumult 17y ago

I know someone who contracted MRSA after randomly scraping his knee. Almost killed him, and it came out of nowhere. Some hospitals have MRSA fatality rates over 20%. Scary as shit! Antibiotics abuse has screwed us, I guess, along with the sloppiness of many healthcare providers.

carbocation 17y ago
Patients are equally sloppy. When they feel better, many discontinue antibiotic use. Providers too readily prescribe antibiotics to try to appease patients with, say, an obvious viral respiratory infection, but these are most often less valuable antibiotics such as first generation penicillins anyways. Judicious antibiotic use is important, both for patient and provider, but there is a more pernicious problem lurking: the use of late-generation antibiotics - still critical for hospital use - in feed to produce larger livestock more cheaply.
- tumult 17y ago
  Yep. In general, we too often use our powerful weapons with disregard, and it's coming back to bite us in the ass.
electromagnetic 17y ago
MRSA lives in the community just as much, if not more, than it lives in the hospitals. From what I know of the area, some hospitals had up to 80% community-acquired infections as opposed to hospital-acquired infections, this meant that the majority of these patients were being killed by their families. I know many ICU's in the UK have full out bans on any family members entering, because if anyone in an ICU catches MRSA they're gone. It's easy to blame the healthcare providers, and I'm sure in many cases it is the healthcare providers' fault. However, if they simply flat-out banned people from visiting in the hospital MRSA infection rates (in good hospitals) would drop like a rock. I wouldn't be surprised if hospitals with MRSA fatality rates over 20% allow visitors in the ICU and don't have well established visitor protocols in the regular hospital. I know some wards in the UK (I have friends and family who work in hospitals) will escort you out if they see you go between patients' beds; essentially they allow you to visit 1 person per day, and they frequently have visiting hours only a couple hours long so they can actively enforce this. My advice to anyone visiting a friend in hospital, don't touch them. No handshakes, especially no hugs. This seems extreme, but patients have died from MRSA infection in key-hole surgery incisions.

cwan 17y ago

Despite the on-again off-again media hysteria, it would seem that there is some promising research on the horizon. Check out the TED talk by Kary Mullis: http://www.ted.com/talks/lang/eng/kary_mullis_next_gen_cure_for_killer_infections.html http://www.ted.com/talks/lang/eng/kary_mullis_next_gen_cure_... "Drug-resistant bacteria kills, even in top hospitals. But now tough infections like staph and anthrax may be in for a surprise. Nobel-winning chemist Kary Mullis, who watched a friend die when powerful antibiotics failed, unveils a radical new cure that shows extraordinary promise."