6 ms·

From the article, "Public measures designed to incentivize development of new antibiotics are woefully inadequate." This is the issue. Relying on private entit

by jdkee 7y ago

From the article, "Public measures designed to incentivize development of new antibiotics are woefully inadequate." This is the issue. Relying on private entities to provide (R&D, clinical trials) for what are ostensibly public goods (antibiotic resistant bugs puts every person at risk) brings the real risk of market failure. The NIH is making some progress on this front. https://aspe.hhs.gov/system/files/pdf/258516/ProgressYears1and2CARBNationalActionPlan.pdf https://aspe.hhs.gov/system/files/pdf/258516/ProgressYears1a... It appears that overprescribing existing antibiotics to people and livestock is a leading cause of rising drug resistance, both of which can be addressed by policy changes.

mark-r 7y ago
> It appears that overprescribing existing antibiotics to people and livestock is a leading cause of rising drug resistance, both of which can be addressed by policy changes. I worry that any changes in that area will be too little too late.
iambateman 7y ago
It seems like overprescribing to a cow is such low hanging fruit. I understand that if my 5-day-old child marginally needs antibiotics, that the doctor may prescribe to appear active. But couldn’t sensible legislation end over-prescription to livestock overnight? Is this really an issue of beating the cow lobby?
- dv_dt 7y ago
  The "cow lobby" is large multinational corporations... so yes it's an issue beating their lobbyists. Also, a side effect of antibiotics is weight gain in livestock - so even legislation that ostensibly outlaws use for the direct purpose of directly adding to profits, language in regulation is generally kept for medical purposes of "reducing disease" among herds. Disease that is at a high rate because of high density feedlot practices...
  - yabadabadoes 7y ago
    I think a weight loss factor could be added to legal antibiotics to remove the benefits of their overuse.. Caffeinated cows on a rampage might correct the industry.
  - killjoywashere 7y ago
    > a side effect of antibiotics is weight gain in livestock Original article in Nature: https://www.nature.com/articles/nature11400 https://www.nature.com/articles/nature11400
    - dv_dt 7y ago
      There have been quantitative calculations for antibiotics taught for years in ag departments, and known among industry practitioners. Farming is a highly quantitative industry, and any agent of growth promotion is tracked carefully along with feed energy & cost inputs. Today you may have to go back to older documents to see talk about it in a more open manner though. Here's a more industrial type of analysis paper (2003) https://www.cambridge.org/core/journals/journal-of-agricultural-and-applied-economics/article/productivity-and-economic-effects-of-antibiotics-used-for-growth-promotion-in-us-pork-production/63959BF885FCE4C2E8C55BBFF566F8F5 https://www.cambridge.org/core/journals/journal-of-agricultu...
- thomasmeeks 7y ago
  Overprescribing antibiotics to animals helps keep meat cheap. Politicians have a hard time with the headwinds caused by ads like “Evil big-government libs are raising the price of your steak!!” So it doesn’t happen. You’d probably be surprised how cheap some feed antibiotics are — Tylan powder being a good example. In short, yes, it is beating lobbyists and opportunistic political opponents. Even if this issue is important to you, political capital is not limitless, so it has to be weighed against a whole host of other issues.
- deleted 7y ago
  [deleted]
heavyset_go 7y ago
> It appears that overprescribing existing antibiotics to people and livestock is a leading cause of rising drug resistance, both of which can be addressed by policy changes. About 80% of antibiotics sold in the US are used in agriculture[1], where they are given to animals not to treat infections, but to prevent them and to stimulate growth. Over 60% of infectious disease in humans are spread from animals, and 75% of new diseases in humans are spread from animals[2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/ [2] https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html
- refurb 7y ago
  Back in 2017, the FDA banned the use of medicinally important antibiotics in livestock. https://www.cdc.gov/drugresistance/food.html https://www.cdc.gov/drugresistance/food.html
  - heavyset_go 7y ago
    That's good to know, thanks for the link. However, up until recently, you could buy 55-gallon drums of antibiotics without a license on sites like Alibaba.
  - dv_dt 7y ago
    This line item for allowed uses from that link: * Prevent disease in animals that are at risk for becoming sick Is pretty much a giant loophole.
    - refurb 7y ago
      If those animals are treated, they then need to be pulled out of the food supply until the antibiotic washes out. It’s not in a farmers best interest to use an antibiotic in those circumstances unless the animal needs it.
      - Retric 7y ago
pmontra 7y ago
I've seen this in sports and games. Sometimes everybody know they should make a move to catch up with the current leader but if they do they probably spend too many resources and lose from the others close to them. So they wait for somebody else to self sacrifice and the leader eventually wins. The leader here are the superbugs and I'm afraid that no normal market rules can make us win this race.
killjoywashere 7y ago
There is a tragedy of the commons problem as well: from massive over-use of the same antibiotics in farm animals. Antibiotic susceptibility is a asset of the commons. And there are farmers who are incentivized to ruin it for everyone else. I would interpret this as roughly equivalent to the biomedical industry telling Congress they need to put the meat industry in its place. Stopping use of antibiotics in animal husbandry will raise the price of meats, decreasing the market for them. It seems that Congress is, by neglect, accepting some human deaths in exchange for cheap meat and a few animal husbandry jobs.
Fomite 7y ago
I work in this area, and a couple notes: - The free market is actually doing a really good job driving down antibiotic use in livestock. - There's not a huge amount of evidence that livestock use of antibiotics has as big an impact on human resistance patterns we see. Overuse in human populations is a big enough problem on its own. Medicine has, in some ways, been really eager to abdicate its own role in developing resistance by pointing at veterinary use. - There are a number of policy changes already in effect, but all they can do is kick the can down the road a little. Bacteria will develop resistance to antibiotics - it's what they do. Some more easily, some less easily. This is a treadmill you can never get off - all stewardship does is control the speed. Even with good stewardship programs, we'll still need new classes of antibiotics.

by jdkee 7y ago

mark-r 7y ago

> It appears that overprescribing existing antibiotics to people and livestock is a leading cause of rising drug resistance, both of which can be addressed by policy changes. I worry that any changes in that area will be too little too late.

iambateman 7y ago

It seems like overprescribing to a cow is such low hanging fruit. I understand that if my 5-day-old child marginally needs antibiotics, that the doctor may prescribe to appear active. But couldn’t sensible legislation end over-prescription to livestock overnight? Is this really an issue of beating the cow lobby?

dv_dt 7y ago
The "cow lobby" is large multinational corporations... so yes it's an issue beating their lobbyists. Also, a side effect of antibiotics is weight gain in livestock - so even legislation that ostensibly outlaws use for the direct purpose of directly adding to profits, language in regulation is generally kept for medical purposes of "reducing disease" among herds. Disease that is at a high rate because of high density feedlot practices...
- yabadabadoes 7y ago
  I think a weight loss factor could be added to legal antibiotics to remove the benefits of their overuse.. Caffeinated cows on a rampage might correct the industry.
- killjoywashere 7y ago
  > a side effect of antibiotics is weight gain in livestock Original article in Nature: https://www.nature.com/articles/nature11400 https://www.nature.com/articles/nature11400
  - dv_dt 7y ago
    There have been quantitative calculations for antibiotics taught for years in ag departments, and known among industry practitioners. Farming is a highly quantitative industry, and any agent of growth promotion is tracked carefully along with feed energy & cost inputs. Today you may have to go back to older documents to see talk about it in a more open manner though. Here's a more industrial type of analysis paper (2003) https://www.cambridge.org/core/journals/journal-of-agricultural-and-applied-economics/article/productivity-and-economic-effects-of-antibiotics-used-for-growth-promotion-in-us-pork-production/63959BF885FCE4C2E8C55BBFF566F8F5 https://www.cambridge.org/core/journals/journal-of-agricultu...
thomasmeeks 7y ago
Overprescribing antibiotics to animals helps keep meat cheap. Politicians have a hard time with the headwinds caused by ads like “Evil big-government libs are raising the price of your steak!!” So it doesn’t happen. You’d probably be surprised how cheap some feed antibiotics are — Tylan powder being a good example. In short, yes, it is beating lobbyists and opportunistic political opponents. Even if this issue is important to you, political capital is not limitless, so it has to be weighed against a whole host of other issues.
deleted 7y ago
[deleted]

heavyset_go 7y ago

> It appears that overprescribing existing antibiotics to people and livestock is a leading cause of rising drug resistance, both of which can be addressed by policy changes. About 80% of antibiotics sold in the US are used in agriculture[1], where they are given to animals not to treat infections, but to prevent them and to stimulate growth. Over 60% of infectious disease in humans are spread from animals, and 75% of new diseases in humans are spread from animals[2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/ [2] https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html

refurb 7y ago
Back in 2017, the FDA banned the use of medicinally important antibiotics in livestock. https://www.cdc.gov/drugresistance/food.html https://www.cdc.gov/drugresistance/food.html
- heavyset_go 7y ago
  That's good to know, thanks for the link. However, up until recently, you could buy 55-gallon drums of antibiotics without a license on sites like Alibaba.
- dv_dt 7y ago
  This line item for allowed uses from that link: * Prevent disease in animals that are at risk for becoming sick Is pretty much a giant loophole.
  - refurb 7y ago
    If those animals are treated, they then need to be pulled out of the food supply until the antibiotic washes out. It’s not in a farmers best interest to use an antibiotic in those circumstances unless the animal needs it.
    - Retric 7y ago

pmontra 7y ago

I've seen this in sports and games. Sometimes everybody know they should make a move to catch up with the current leader but if they do they probably spend too many resources and lose from the others close to them. So they wait for somebody else to self sacrifice and the leader eventually wins. The leader here are the superbugs and I'm afraid that no normal market rules can make us win this race.

killjoywashere 7y ago

There is a tragedy of the commons problem as well: from massive over-use of the same antibiotics in farm animals. Antibiotic susceptibility is a asset of the commons. And there are farmers who are incentivized to ruin it for everyone else. I would interpret this as roughly equivalent to the biomedical industry telling Congress they need to put the meat industry in its place. Stopping use of antibiotics in animal husbandry will raise the price of meats, decreasing the market for them. It seems that Congress is, by neglect, accepting some human deaths in exchange for cheap meat and a few animal husbandry jobs.

Fomite 7y ago

I work in this area, and a couple notes: - The free market is actually doing a really good job driving down antibiotic use in livestock. - There's not a huge amount of evidence that livestock use of antibiotics has as big an impact on human resistance patterns we see. Overuse in human populations is a big enough problem on its own. Medicine has, in some ways, been really eager to abdicate its own role in developing resistance by pointing at veterinary use. - There are a number of policy changes already in effect, but all they can do is kick the can down the road a little. Bacteria will develop resistance to antibiotics - it's what they do. Some more easily, some less easily. This is a treadmill you can never get off - all stewardship does is control the speed. Even with good stewardship programs, we'll still need new classes of antibiotics.