16 ms·

A 'slow catastrophe' unfolds as the golden age of antibiotics comes to an end

139 points by Mz 10y ago

notadoc 10y ago
This is a public health crisis that needs urgent attention. Governments should step in with huge funding to NIH and pharma to accelerate R&D, and offer incentives to invest heavily in antibiotic development (extended patent terms for antibiotics, tax-free repatriation for antibiotic R&D funds, whatever it takes). The current free market approach is completely failing this. It's not particularly profitable to invest many years in a drug people only need to take once to cure a disease when compared to developing a drug people need to take for 5-10+ years to manage a disease. Phage therapy should be further developed as well, which has been proven to work against some resistant strains.
- savanaly 10y ago
  >The current free market approach is completely failing this. It's not particularly profitable to invest many years in a drug people only need to take once to cure a disease when compared to developing a drug people need to take for 5-10+ years to manage a disease. Why couldn't their payment scheme be identical even if it's a one time dose? Instead of $1000 per year for a drug you need to buy every year for ten years, make it so it has an up front cost of $12,000 or whatever with a ten year payment plan available for people who don't have that kind of cash on hand. This suggestion obviously inspired by the real world good that is a one time purchase that people make all the time: houses.
  - xg15 10y ago
    Martin Shkreli approves. But to elaborate, aside from the obvious ethical implications, there are also practical differences. You are usually not forced out-of-the-blue to buy a house, no matter if you can afford it or have just bought a house last month. Also, houses can be sold, so people have ways to back out of a purchase when they realize they cannot pay back the loan. None of this works for drugs. Trying to apply the same logic to drugs would make the the debt problem of medical bills even worse than it already is. It would also lead to a strong inequality in medical care.
    - savanaly 10y ago
      Isn't Martin Shkreli notorious for hiking prices on drugs, not for pioneering new payment models for drugs? My post was about how if a company had a drug which it had development cost $X for, it could recoup X + p from the consumer even if the drug is a one time dose rather than an ongoing treatment. How much p profit they make is a separate question and anyways is sort of orthogonal to the question of whether they pay per month or once.
  - refurb 10y ago
    This is what should happen. If you price a drug based on the value it offers, antibiotics should cost a lot more than they do now. You're talking about a single treatment regimen that often saves the patients lives. The problem with that approach is the way that hospitals are reimbursed for antibiotics in the US. There is no room for those prices. I know Congress is trying to change that by making antibiotics separately reimbursed. [Source: I worked at a biotech firm that has a number of antibiotics in development]
praptak 10y ago
"Researchers haven’t identified a new class of antibiotic medication since 1987." Teixobactin is 2015 and is probably a member of a new class of antibiotics.
- nanofortnight 10y ago
  Teixobactin unfortunately isn't helpful to us. We really really need something that works against gram negatives at the moment. Also note that retrospective studies have shown that first observed resistance to an antibiotic appears about six months after it is introduced. We are producing new antibiotic families far slower than this rate.
yourkin 10y ago
Articles like this urge me to stop reading pop science journalism altogether. What is not mentioned is a new class of antibiotics discovered in 2015 (https://en.wikipedia.org/wiki/Teixobactin https://en.wikipedia.org/wiki/Teixobactin) which is a big deal in that it can be used instead of antibiotics resistance to which has been acquired by bacteria during this "golden age" and as microbes evolve extremely fast, within an observable timeframe they will lose resistance to the old classes allowing those to be used again. So effectively shelving will work. Another point is that other new methods of searching for new drugs are being researched (http://www.theverge.com/2016/5/18/11686268/new-antibiotic-drug-candidates-resistance-harvard-macrolide http://www.theverge.com/2016/5/18/11686268/new-antibiotic-dr...) and the future is not at all gloomy.
- drzaiusapelord 10y ago
  Its incredible that so far there's no evidence of resistance development with Teixobactin. It prevents cells from building cell walls. There may not be an evolutionary path for bacteria to stop this kind of thing or if there is, its a very slow path that might mean decades before resistance begins to show instead of the standard few years. Still, its limited scope. Works well with staph, but does nothing for other infections like e.coli, salmonella, and h.pylori. The funding purse is open for antibiotic research and I find it hard to believe its a dry well. I think we'll see more discoveries like these in our lifetime.
  - folli 10y ago
    It's probably more a case of "not looking hard enough", especially since this antibiotic class was discovered only ~1 year ago
- folli 10y ago
  Any references detailing the shelving method? I'm genuinely interested, especially about the necessary timescale etc. I absolutely agree that it won't be as gloomy as outlined in the article. The search for novel antibiotics has been pretty much neglected (Teixobactin is more of an exception to the rule) because the currently employed drugs work quite well. As this is changing, the possible market for novel antibiotics will increase and thus funding will shift into this direction.
exabrial 10y ago
Seems like this is time to research how antibiotic resistance is jumping species. I feel like we could take advantage of unauthenticated exchange of information and inject weaknesses instead.
- Mz 10y ago
  Basically, when bacteria discover a gene that works, they share it with others. As far as I know, this does not readily lend itself to a human counterattack of some similar approach. The solution will likely come from some other avenue.
  - eggie 10y ago
    They don't find it works then share. They are randomly sharing, and sometimes it works. Bacterial sex.
    - Mz 10y ago
      You have to live to share. So, the distinction is essentially immaterial. They find something that works, they live, they share randomly for kicks with other bacteria they picked up at the bar, those bacteria become resistant, rinse and repeat.
  - AnimalMuppet 10y ago
    How about we "share" something with the bacteria? We create a package, and they pick it up, and it turns out to either kill them outright or leave them vulnerable to some simple treatment. Might be a bit rough on gut bacteria, though...
    - Mz 10y ago
      Sounds like a (bad) plan! (Your gut is about 70 percent of your immune system.) From what I have read and experienced firsthand, you are far better off strengthening your gut flora, not undermining them.
- outworlder 10y ago
eggie 10y ago
Microorganisms have been able to cope with each other for damn near a billion years using toxin-antitoxin systems. People are exploring these as negative selection systems. Traditionally, antibiotics are used. http://nar.oxfordjournals.org/content/early/2015/03/23/nar.gkv248.short http://nar.oxfordjournals.org/content/early/2015/03/23/nar.g... There is probably a huge array of such things out there. They are unlikely to be as broad-spectrum as traditional antibiotics, but with research we should be able to find ones to apply to the right situations. At the same time as this crisis unfolds, our ability to know exactly what someone is infected with improves. Soon sequencing of bacterial infections will be the first step in patient triage. This will help us apply precisely the right toxin to rid the body of the problematic type(s) of bacteria.
carapace 10y ago
Bacteriophage therapy? https://en.wikipedia.org/wiki/Phage_therapy https://en.wikipedia.org/wiki/Phage_therapy
- abrookewood 10y ago
  I always wonder why this is never mentioned in these articles. If I recall correctly, this approach is quite popular in Russia.
  - Fomite 10y ago
    There are considerable problems with it. It's popular in Russia because they didn't have access to antibiotics in large quantities.
    - abrookewood 10y ago
      Can you elaborate on what the problems are? I haven't read much on it, but it sounded very promising.
- quakeguy 10y ago
  This seems to be an alternative approach of tackling said infections, sadly research in the EU has been blocked by Big Pharma for years, at least in Germany very successfully to be precise, noone with a slight of reputation is going to touch this topic. I wonder why. It does work under the conditions described as far as i can understand. The Georgian Institute that does most of this research is well underfunded too.
- Fomite 10y ago
  Phage therapy is neat, it really is, but there are a couple major issues: - There is no such thing as a "broad spectrum" phage. You can't do empirical treatment using phages, and there's not really "off the shelf" phage therapy - it tends to be a bespoke creation for a particular infection. - There's some serious regulatory problems, similar to those experienced by fecal transplant treatments. We're not yet really equipped to think about handling evolving, custom microbes as a treatment. - Because of the first, it's going to require a considerable amount more lab capacity than most clinical settings currently have, and considerable delays until treatment. - There's also some biosafety issues around phage prep, but those are easily solvable. It's a great way to treat particularly resistant or hard to treat infections, but it's not a particularly great general solution. There's a reason it was abandoned in countries with easy access to antibiotics - they're just roundly superior in basically every respect.
RcouF1uZ4gsC 10y ago
This is to be expected. The big issue is that it is not worth it for a pharmaceutical company to develop new antibiotics. The initial cost is high. Then, if it is successful, the antibiotic will only be given as a last resort, thus reducing the number of doses. In addition, unlike chronic conditions such as diabetes or high blood pressure, severe bacterial infection is usually time limited - the patient will either get better or they will die. In either case, they do not continue to need the antibiotic. Thus, to recoup costs, the pharmaceutical company will have to sell it at low volume/high prices. Of course, if they do that, the press starts blaming them for the high cost of the medication and it is a PR disaster (see Sovaldi) even though everyone is strictly better off due to their selling the antibiotic even at a higher price. In the end, it is better for their reputation and their bottom line not to develop these antibiotics. Thus, mainly because we do not have aggressive new development of antibiotics for these severe infections, we have these articles claiming the end of the antibiotic age.
- ansible 10y ago
  And in response to that, the pharmaceutical companies will sell the antibiotic in high volumes to the livestock industry. Thus increasing profits... forever!
  - loup-vaillant 10y ago
    With the nice side effect that this will spur more resistances, hence more reasons to develop new drugs, that they can sell at higher prices, driving profits even upper. It's nice to get paid to solve a problem you created in the first place.
  - refurb 10y ago
    Ummm... human and animal health are usually separate companies. I know Pfizer had an animal health unit, but it was spun off. Those are two different groups of companies you're talking about.
christkv 10y ago
When an organism develops resistance it usually makes an evolutionary trade-off. This ironically might make them susceptible to older style antibiotics who have been phased out. However retesting these antibiotics are not really being done extensively due to there being little financial benefit. http://jac.oxfordjournals.org/content/70/8/2177.full http://jac.oxfordjournals.org/content/70/8/2177.full My experience with kids is that here in Spain they are using older antibiotics now to preserve the newer ones for serious infections trying to limit evolutionary pressure on the bacteria.
mkriss 10y ago
Antibiotics resistance is getting stronger, probably because people eat a lot of meat which is full of antibiotics. Because they feed animals with antibiotics to grow faster and bigger. People should really think what food they put in their body and less about some magic pill.
KaiserPro 10y ago
So there are two issues that are touched on here, which are not really expanded enough. 1) farmers everywhere are allowed to use last line/new antibiotics routinely in food production. This is utterly fucking stupid. Whats more brain dead is that its not just china its US and canada. (possibly the EU.) It could be stopped by the FDA withdrawing the license. but no. Too much money. 2) over subscription in private health. I once listened to a co-worker phone up the Doctor and ask to have "the same antibiotics I had last time for that cold" and get it[1]. She had the fucking snuffles. No consultation, not even bothering to figure out if its even got a hint of bacterial infection. A placebo would have been more effective. It wouldn't have given her the shits either. Paracetamol is what was needed, as its the only thing that would have made her feel better. Seriously. yes I know that the customer is always right, but don't fucking dish out drugs like sweets. My old age, and my children's health are dependent on those drugs. [1] yes this was in the USA, santa monica to be precise. Yes I'm british. However the prevalence of prescription medication abuse and deaths is a massive fucking warning. Something is horridly wrong with the US's health care system. What surprises me is with the levels of litigation against doctors, this hasn't seemed to trigger any change in behaviour. Disclosure: I live with a doctor.
- stcredzero 10y ago
  1) farmers everywhere are allowed to use last line/new antibiotics routinely in food production. This is utterly fucking stupid. Basically, it's exactly the worst thing you can possibly do, with regards to what the theory of evolution by natural selection tells us. Then add in what we know about bacteria exchanging genetic material, and it's like we're trying to inactivate all of our antibiotics on purpose.
  - trhway 10y ago
    >Basically, it's exactly the worst thing you can possibly do, with regards to what the theory of evolution by natural selection tells us. from the half-full glass POV we are just speeding up the natural selection of bacteria resistant humans (it has been going for millenia and got, probably only temporary, delayed for the last 80 years). Also, as a side effect, it can help solve (at least temporarily) the overpopulation issue until the much more smart (wrt. health and Earth resources usage) humans evolve. Basic dialectics at work.
a3n 10y ago
Are we using the older meds much, like penicillin? I wonder if bacteria eventually lose their resistance to older meds with lack of exposure.
- JunkDNA 10y ago
  In general antibiotic resistance is lost when it doesn't confer an advantage. In some cases resistance to antibiotics costs cells energy they'd much rather be spending on other things. When the antibiotic is gone, cells without the energy tax can outcompete ones that do and divide quicker. The population then reverts to sensitive cells again. Even in a hypothetical case where a random enzyme mutation confers resistance with no real obvious cost or side effect to the cell, unless there is specific environmental pressure to keep that mutation, it can easily revert in subsequent generations.
- Fomite 10y ago
  Bacteria aren't resistant to a drug. They're resistant to a mechanism of action. For example, bacteria develop beta-lactamase based resistance, which can make them resistant to all beta-lactam antibiotics, which is any antibiotic with -illin in the name. You'd potentially have to take whole classes of antibiotics out of circulation, for a long time. And even then, some of them will maintain resistance genes because these compounds are present in the environment.
a3n 10y ago
> The economics of drug development are partly to blame. > To offset the millions of dollars they pour into research, clinical trials and the FDA approval process, pharmaceutical companies aim to develop blockbuster drugs, said Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases. An ideal candidate would be used by millions of people every day for the rest of their lives, like pills to keep cholesterol or blood pressure in check. > Antibiotics won’t pay the freight. They should be prescribed sparingly and only used for about a week. Hmmm. Natural selection of humans, in an environment partly controlled by Pharma. Pharma needs lots of patients that consume a drug every day for life. (I take three of them, plus an arguable fourth.) People who take one or more of these drugs are valuable. Such people who live longer lives are more valuable. By not discovering low revenue new antibiotics and making them available, what we're left with is people who take daily drugs for life, and somehow survive or avoid bacterial infection. I want to believe that no one in Pharma has thought of this.

139 points by Mz 10y ago

This is a public health crisis that needs urgent attention. Governments should step in with huge funding to NIH and pharma to accelerate R&D, and offer incentives to invest heavily in antibiotic development (extended patent terms for antibiotics, tax-free repatriation for antibiotic R&D funds, whatever it takes). The current free market approach is completely failing this. It's not particularly profitable to invest many years in a drug people only need to take once to cure a disease when compared to developing a drug people need to take for 5-10+ years to manage a disease. Phage therapy should be further developed as well, which has been proven to work against some resistant strains.

savanaly 10y ago
>The current free market approach is completely failing this. It's not particularly profitable to invest many years in a drug people only need to take once to cure a disease when compared to developing a drug people need to take for 5-10+ years to manage a disease. Why couldn't their payment scheme be identical even if it's a one time dose? Instead of $1000 per year for a drug you need to buy every year for ten years, make it so it has an up front cost of $12,000 or whatever with a ten year payment plan available for people who don't have that kind of cash on hand. This suggestion obviously inspired by the real world good that is a one time purchase that people make all the time: houses.
- xg15 10y ago
  Martin Shkreli approves. But to elaborate, aside from the obvious ethical implications, there are also practical differences. You are usually not forced out-of-the-blue to buy a house, no matter if you can afford it or have just bought a house last month. Also, houses can be sold, so people have ways to back out of a purchase when they realize they cannot pay back the loan. None of this works for drugs. Trying to apply the same logic to drugs would make the the debt problem of medical bills even worse than it already is. It would also lead to a strong inequality in medical care.
  - savanaly 10y ago
    Isn't Martin Shkreli notorious for hiking prices on drugs, not for pioneering new payment models for drugs? My post was about how if a company had a drug which it had development cost $X for, it could recoup X + p from the consumer even if the drug is a one time dose rather than an ongoing treatment. How much p profit they make is a separate question and anyways is sort of orthogonal to the question of whether they pay per month or once.
- refurb 10y ago
  This is what should happen. If you price a drug based on the value it offers, antibiotics should cost a lot more than they do now. You're talking about a single treatment regimen that often saves the patients lives. The problem with that approach is the way that hospitals are reimbursed for antibiotics in the US. There is no room for those prices. I know Congress is trying to change that by making antibiotics separately reimbursed. [Source: I worked at a biotech firm that has a number of antibiotics in development]

praptak 10y ago

"Researchers haven’t identified a new class of antibiotic medication since 1987." Teixobactin is 2015 and is probably a member of a new class of antibiotics.

nanofortnight 10y ago
Teixobactin unfortunately isn't helpful to us. We really really need something that works against gram negatives at the moment. Also note that retrospective studies have shown that first observed resistance to an antibiotic appears about six months after it is introduced. We are producing new antibiotic families far slower than this rate.

yourkin 10y ago

Articles like this urge me to stop reading pop science journalism altogether. What is not mentioned is a new class of antibiotics discovered in 2015 (https://en.wikipedia.org/wiki/Teixobactin https://en.wikipedia.org/wiki/Teixobactin) which is a big deal in that it can be used instead of antibiotics resistance to which has been acquired by bacteria during this "golden age" and as microbes evolve extremely fast, within an observable timeframe they will lose resistance to the old classes allowing those to be used again. So effectively shelving will work. Another point is that other new methods of searching for new drugs are being researched (http://www.theverge.com/2016/5/18/11686268/new-antibiotic-drug-candidates-resistance-harvard-macrolide http://www.theverge.com/2016/5/18/11686268/new-antibiotic-dr...) and the future is not at all gloomy.

drzaiusapelord 10y ago
Its incredible that so far there's no evidence of resistance development with Teixobactin. It prevents cells from building cell walls. There may not be an evolutionary path for bacteria to stop this kind of thing or if there is, its a very slow path that might mean decades before resistance begins to show instead of the standard few years. Still, its limited scope. Works well with staph, but does nothing for other infections like e.coli, salmonella, and h.pylori. The funding purse is open for antibiotic research and I find it hard to believe its a dry well. I think we'll see more discoveries like these in our lifetime.
- folli 10y ago
  It's probably more a case of "not looking hard enough", especially since this antibiotic class was discovered only ~1 year ago
folli 10y ago
Any references detailing the shelving method? I'm genuinely interested, especially about the necessary timescale etc. I absolutely agree that it won't be as gloomy as outlined in the article. The search for novel antibiotics has been pretty much neglected (Teixobactin is more of an exception to the rule) because the currently employed drugs work quite well. As this is changing, the possible market for novel antibiotics will increase and thus funding will shift into this direction.

exabrial 10y ago

Seems like this is time to research how antibiotic resistance is jumping species. I feel like we could take advantage of unauthenticated exchange of information and inject weaknesses instead.

Mz 10y ago
Basically, when bacteria discover a gene that works, they share it with others. As far as I know, this does not readily lend itself to a human counterattack of some similar approach. The solution will likely come from some other avenue.
- eggie 10y ago
  They don't find it works then share. They are randomly sharing, and sometimes it works. Bacterial sex.
  - Mz 10y ago
    You have to live to share. So, the distinction is essentially immaterial. They find something that works, they live, they share randomly for kicks with other bacteria they picked up at the bar, those bacteria become resistant, rinse and repeat.
- AnimalMuppet 10y ago
  How about we "share" something with the bacteria? We create a package, and they pick it up, and it turns out to either kill them outright or leave them vulnerable to some simple treatment. Might be a bit rough on gut bacteria, though...
  - Mz 10y ago
    Sounds like a (bad) plan! (Your gut is about 70 percent of your immune system.) From what I have read and experienced firsthand, you are far better off strengthening your gut flora, not undermining them.
outworlder 10y ago

eggie 10y ago

Microorganisms have been able to cope with each other for damn near a billion years using toxin-antitoxin systems. People are exploring these as negative selection systems. Traditionally, antibiotics are used. http://nar.oxfordjournals.org/content/early/2015/03/23/nar.gkv248.short http://nar.oxfordjournals.org/content/early/2015/03/23/nar.g... There is probably a huge array of such things out there. They are unlikely to be as broad-spectrum as traditional antibiotics, but with research we should be able to find ones to apply to the right situations. At the same time as this crisis unfolds, our ability to know exactly what someone is infected with improves. Soon sequencing of bacterial infections will be the first step in patient triage. This will help us apply precisely the right toxin to rid the body of the problematic type(s) of bacteria.

carapace 10y ago

Bacteriophage therapy? https://en.wikipedia.org/wiki/Phage_therapy https://en.wikipedia.org/wiki/Phage_therapy

abrookewood 10y ago
I always wonder why this is never mentioned in these articles. If I recall correctly, this approach is quite popular in Russia.
- Fomite 10y ago
  There are considerable problems with it. It's popular in Russia because they didn't have access to antibiotics in large quantities.
  - abrookewood 10y ago
    Can you elaborate on what the problems are? I haven't read much on it, but it sounded very promising.
quakeguy 10y ago
This seems to be an alternative approach of tackling said infections, sadly research in the EU has been blocked by Big Pharma for years, at least in Germany very successfully to be precise, noone with a slight of reputation is going to touch this topic. I wonder why. It does work under the conditions described as far as i can understand. The Georgian Institute that does most of this research is well underfunded too.
Fomite 10y ago
Phage therapy is neat, it really is, but there are a couple major issues: - There is no such thing as a "broad spectrum" phage. You can't do empirical treatment using phages, and there's not really "off the shelf" phage therapy - it tends to be a bespoke creation for a particular infection. - There's some serious regulatory problems, similar to those experienced by fecal transplant treatments. We're not yet really equipped to think about handling evolving, custom microbes as a treatment. - Because of the first, it's going to require a considerable amount more lab capacity than most clinical settings currently have, and considerable delays until treatment. - There's also some biosafety issues around phage prep, but those are easily solvable. It's a great way to treat particularly resistant or hard to treat infections, but it's not a particularly great general solution. There's a reason it was abandoned in countries with easy access to antibiotics - they're just roundly superior in basically every respect.

RcouF1uZ4gsC 10y ago

This is to be expected. The big issue is that it is not worth it for a pharmaceutical company to develop new antibiotics. The initial cost is high. Then, if it is successful, the antibiotic will only be given as a last resort, thus reducing the number of doses. In addition, unlike chronic conditions such as diabetes or high blood pressure, severe bacterial infection is usually time limited - the patient will either get better or they will die. In either case, they do not continue to need the antibiotic. Thus, to recoup costs, the pharmaceutical company will have to sell it at low volume/high prices. Of course, if they do that, the press starts blaming them for the high cost of the medication and it is a PR disaster (see Sovaldi) even though everyone is strictly better off due to their selling the antibiotic even at a higher price. In the end, it is better for their reputation and their bottom line not to develop these antibiotics. Thus, mainly because we do not have aggressive new development of antibiotics for these severe infections, we have these articles claiming the end of the antibiotic age.

ansible 10y ago
And in response to that, the pharmaceutical companies will sell the antibiotic in high volumes to the livestock industry. Thus increasing profits... forever!
- loup-vaillant 10y ago
  With the nice side effect that this will spur more resistances, hence more reasons to develop new drugs, that they can sell at higher prices, driving profits even upper. It's nice to get paid to solve a problem you created in the first place.
- refurb 10y ago
  Ummm... human and animal health are usually separate companies. I know Pfizer had an animal health unit, but it was spun off. Those are two different groups of companies you're talking about.

christkv 10y ago

When an organism develops resistance it usually makes an evolutionary trade-off. This ironically might make them susceptible to older style antibiotics who have been phased out. However retesting these antibiotics are not really being done extensively due to there being little financial benefit. http://jac.oxfordjournals.org/content/70/8/2177.full http://jac.oxfordjournals.org/content/70/8/2177.full My experience with kids is that here in Spain they are using older antibiotics now to preserve the newer ones for serious infections trying to limit evolutionary pressure on the bacteria.

mkriss 10y ago

Antibiotics resistance is getting stronger, probably because people eat a lot of meat which is full of antibiotics. Because they feed animals with antibiotics to grow faster and bigger. People should really think what food they put in their body and less about some magic pill.

KaiserPro 10y ago

So there are two issues that are touched on here, which are not really expanded enough. 1) farmers everywhere are allowed to use last line/new antibiotics routinely in food production. This is utterly fucking stupid. Whats more brain dead is that its not just china its US and canada. (possibly the EU.) It could be stopped by the FDA withdrawing the license. but no. Too much money. 2) over subscription in private health. I once listened to a co-worker phone up the Doctor and ask to have "the same antibiotics I had last time for that cold" and get it[1]. She had the fucking snuffles. No consultation, not even bothering to figure out if its even got a hint of bacterial infection. A placebo would have been more effective. It wouldn't have given her the shits either. Paracetamol is what was needed, as its the only thing that would have made her feel better. Seriously. yes I know that the customer is always right, but don't fucking dish out drugs like sweets. My old age, and my children's health are dependent on those drugs. [1] yes this was in the USA, santa monica to be precise. Yes I'm british. However the prevalence of prescription medication abuse and deaths is a massive fucking warning. Something is horridly wrong with the US's health care system. What surprises me is with the levels of litigation against doctors, this hasn't seemed to trigger any change in behaviour. Disclosure: I live with a doctor.

stcredzero 10y ago
1) farmers everywhere are allowed to use last line/new antibiotics routinely in food production. This is utterly fucking stupid. Basically, it's exactly the worst thing you can possibly do, with regards to what the theory of evolution by natural selection tells us. Then add in what we know about bacteria exchanging genetic material, and it's like we're trying to inactivate all of our antibiotics on purpose.
- trhway 10y ago
  >Basically, it's exactly the worst thing you can possibly do, with regards to what the theory of evolution by natural selection tells us. from the half-full glass POV we are just speeding up the natural selection of bacteria resistant humans (it has been going for millenia and got, probably only temporary, delayed for the last 80 years). Also, as a side effect, it can help solve (at least temporarily) the overpopulation issue until the much more smart (wrt. health and Earth resources usage) humans evolve. Basic dialectics at work.

a3n 10y ago

Are we using the older meds much, like penicillin? I wonder if bacteria eventually lose their resistance to older meds with lack of exposure.

JunkDNA 10y ago
In general antibiotic resistance is lost when it doesn't confer an advantage. In some cases resistance to antibiotics costs cells energy they'd much rather be spending on other things. When the antibiotic is gone, cells without the energy tax can outcompete ones that do and divide quicker. The population then reverts to sensitive cells again. Even in a hypothetical case where a random enzyme mutation confers resistance with no real obvious cost or side effect to the cell, unless there is specific environmental pressure to keep that mutation, it can easily revert in subsequent generations.
Fomite 10y ago
Bacteria aren't resistant to a drug. They're resistant to a mechanism of action. For example, bacteria develop beta-lactamase based resistance, which can make them resistant to all beta-lactam antibiotics, which is any antibiotic with -illin in the name. You'd potentially have to take whole classes of antibiotics out of circulation, for a long time. And even then, some of them will maintain resistance genes because these compounds are present in the environment.

a3n 10y ago

> The economics of drug development are partly to blame. > To offset the millions of dollars they pour into research, clinical trials and the FDA approval process, pharmaceutical companies aim to develop blockbuster drugs, said Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases. An ideal candidate would be used by millions of people every day for the rest of their lives, like pills to keep cholesterol or blood pressure in check. > Antibiotics won’t pay the freight. They should be prescribed sparingly and only used for about a week. Hmmm. Natural selection of humans, in an environment partly controlled by Pharma. Pharma needs lots of patients that consume a drug every day for life. (I take three of them, plus an arguable fourth.) People who take one or more of these drugs are valuable. Such people who live longer lives are more valuable. By not discovering low revenue new antibiotics and making them available, what we're left with is people who take daily drugs for life, and somehow survive or avoid bacterial infection. I want to believe that no one in Pharma has thought of this.