12 ms·

Antibiotic resistance 'a time-bomb'

119 points by clicks 14y ago

michaelochurch 14y ago
Antibiotic resistance is scarier than terrorism. A once-in-a-century terrorist attack killed 3000 people. TB still carries off more than a million people per year, and used to be incurable. Drug-resistant bacteria sounds like a paranoid tinfoil fear, but hospitals already deal with the problem. Doctors do not want to hear the words "drug-resistant MRSA", ever. Probably the worst culprit is the abuse of antibiotics in factory farming. The animals live in disgusting conditions that require antibiotics to keep them viable. (As a side effect, the drugs also make them fatter, producing more meat per head.) This is a huge contributor to the problem.
- carbocation 14y ago
  I'm with you on basically all points. For a good time, take a look at carbapenem-resistant enterobacteriaciae [1] and totally resistant TB [2]. Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger, and it may well not have anything to do with poor living conditions. It seems to work in humans, too, and these results were discovered as early as the 1940s [citation needed]. But those are just quibbles; on the key points, I'm with you. [1] http://www.cdc.gov/hai/organisms/cre/index.html http://www.cdc.gov/hai/organisms/cre/index.html [2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
  - dmiladinov 14y ago
    > Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger I think the explanation that I heard which sounds plausible is that the antibiotics free up a certain amount of energy in the organism that would have gone to fighting micro-organisms that can instead be applied to growth.
    - eru 14y ago
      Be very cautious with easy and intuitive explanations in biology.
  - ericb 14y ago
    Do antibiotics make people taller, fatter, or both?
  - arvin 14y ago
    > Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger From the 'Germs Are Us' article: "In August, Ilseung Cho, of the New York University School of Medicine, published a study showing that antibiotics eradicated bacteria, commonly found in the digestive system of mice, that help the animals metabolize calories efficiently; without the microbes, the mice absorbed more calories from the same amount of food and rapidly became obese." http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter?currentPage=all http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_...
- deleted 14y ago
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  - carbocation 14y ago
    While your criticism is technically correct, when michaelochurch says "drug resistant MRSA", he's probably thinking of VISA/VRSA [1], which is more extensively (but not completely) resistant to the pharmacological armamentarium. [1] http://www.cdc.gov/HAI/organisms/visa_vrsa/visa_vrsa.html http://www.cdc.gov/HAI/organisms/visa_vrsa/visa_vrsa.html
  - michaelochurch 14y ago
    Good call. Thanks.
- nodata 14y ago
  But what do we do about it, when it seems that nobody at all cares?
  - carbocation 14y ago
    People care a ton about this, enough so that the FDA has released guidance on it and even industry magazines are talking about it [1]. This is a huge issue with major visibility in the health professions. [1] http://nationalhogfarmer.com/health/be-ready-antibiotic-restrictions http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...
  - michaelochurch 14y ago
    Factory farming should be outlawed for a number of reasons. It's inhumane, devastating to the environment, and bad in a million other ways. It's not even efficient, except in jurisdictions that allow the farms to (freely) dump their effluent-- an externalized cost. Factory farms are literally putting huge quantities of shit into their local water tables. That would be a start. Then we put a ban on the sale, for human consumption, of animals that were treated with antibiotics. If you want to save your pet cat's life-- or your pig's-- that's fine. Just don't sell it as food. That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that. People in the developed world eat too much meat for their own health anyway. What remains is educating people about antibiotics so they stop asking for them when they get colds and flus (they don't do a damn bit of good for a viral infection). Doctors in the US tend to be over-liberal with the drugs, even knowing that they have no effect on viruses.
    - alvarosm 14y ago
      It's funny how everyone has solutions for our eating up the planet. But it's never the obvious: stop having children like there's no tomorrow. If you think you have the right to have 90 children if you feel so inclined, then you'll have to acknowledge the planet must turn into a massive farm.
      - dwiel 14y ago
- DanBC 14y ago
  MRSA is already drug resistant. That's what the MR bit is - methicillin resistant. > Probably the worst culprit is the abuse of antibiotics in factory farming. That's certainly a problem, but misuse of antibiotics in humans is still a big big problem. Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds. In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.
  - Smudge 14y ago
    > In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford. I wish I could say this was limited to developing nations.
  - carbocation 14y ago
    > In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford. This brings up an important topic in infectious diseases right now: in many cases, long courses of antibiotics increase selective pressure and favor the antibiotic-resistant bacteria. One strategy to reduce drug resistance is to (rationally) minimize duration of treatment [1]. This isn't to say that medication nonadherence is good, but it is to say that the field is moving towards a shorter duration of treatment for many infections. [1] http://cid.oxfordjournals.org/content/46/4/491.short http://cid.oxfordjournals.org/content/46/4/491.short
    - grhino 14y ago
      Yeah, I've always been suspicious of the phrase "until the bacteria are all killed". It sounds like a pleasant rationalization than an elegant simplification of the argument.
  - 14y ago
- jpdoctor 14y ago
  > "drug-resistant MRSA" Also antibiotic resistant c-diff. I have heard about klebsiella pneumoniae, but don't know any cases personally. Eventually, advanced societies will realize that immune systems need to be exercised just like the rest of the body, but good luck telling helicopter moms that Jr shouldn't have antibiotics for his ear ache.
- InclinedPlane 14y ago
  A point of correction: 9/11 may be an outlier but it's unfair to characterize it as a super unique event. Terrorist attacks routinely kill dozens and even hundreds of people, and this continues even today. Though such attacks are for the moment much less common in the developed world.
- enraged_camel 14y ago
  Factory farming is insanity, not just in its contribution to antibiotic resistance but also because of its devastating impacts on the environment. An article was published in December 2006 that described how Smithfield, America's largest pork meat producer, manages all the excrement from the 27 million hogs it slaughters every year. The article at the end is worth a read, but I'll give you a summary: 27 million hogs produce an unbelievable amount of shit. This shit is collected in what Smithfield calls "holding ponds" - which are actually lagoons - that can run 30 feet deep. These ponds contain many extremely toxic substances in addition to good old pig shit. Even light rains can cause them to overflow. And the stuff is so vicious that people are often overcome by the fumes and are hospitalized. And if someone falls into the stuff, they die. How does this stuff affect humans? Well, gravity causes the toxic material in the lagoons to seep down into the groundwater supplies. From there it arrives in people's sinks, showers, and drinking water. http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-s-top-hog-producer-is-also-one-of-america-s-worst-polluters/13479 http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-...
  - 10098 14y ago
    time to become a vegetarian
    - aethertap 14y ago
      Or switch to sustainably raised meat (that's the focus on my farm). No medication of any kind, animals live on managed pasture that requires no inputs other than sun, air, and water. Switching away from meat will certainly help to address the development of resistant microbes, but if you can make a switch instead to meat that was raised with regenerative pasture management practices, you can additionally have a large positive impact on many other environmental factors. Look for terms like "high-density grazing," "holistic grazing," "holistic management," or "management-intensive grazing (MIG)." This TED talk [1] covers some of the information, for more you can google around for the above terms (sorry I don't have a good link handy). Correctly managing grazing livestock can actually reverse desertification and trap tons of carbon per year per acre in the soil. Of course, doing it wrong can have the opposite effect, so if you go this route it's important to know whether your farmer is running his operation with land restoration in mind. Conventional vegetable production also comes with a slew of its own problems (breeding of herbicide-resistant weeds [2] being something closely related to the topic at hand). Eating in a way that doesn't cause harm is a tricky thing these days. [1] - http://www.ted.com/talks/allan_savory_how_to_green_the_world_s_deserts_and_reverse_climate_change.html http://www.ted.com/talks/allan_savory_how_to_green_the_world... [2] - http://www.sciencedaily.com/releases/2012/10/121002092839.htm http://www.sciencedaily.com/releases/2012/10/121002092839.ht... *edited for formatting
- adventured 14y ago
  I agree, although the real once-in-a-century attack that obviously concerns people for the next century is a nuclear attack, or a biological attack, that kills hundreds of thousands or millions (not to mention killing technology that is likely to exist in the next century that we can't imagine today). The prior century was extremely limiting for terrorists by comparison to what the next century is likely to make possible.
DanBC 14y ago
(http://v6.tinypic.com/player.swf?file=24goih4&s=6 http://v6.tinypic.com/player.swf?file=24goih4&s=6) Here's a short snippet from a BBC Television programme (Horizon - 'defeating the superbugs'). It shows E.Coli developing anti-biotic resistance. There's a tray of nutrient jelly. The jelly is divided into sections. It starts with no antibiotic. Then there's a normal dose. Then there's a 10x dose, followed by 100x dose, followed by 1000x dose. They reach the limits of solubility. They cannot dissolve any more antibiotic into the jelly. Then they drop E.Coli onto the normal jelly, and use a time lapse camera to show the growth. After just two weeks the bacteria is able to live on the 1000x dosed jelly. It's pretty impressive demonstration. (Apologies for the suboptimal hosting site. YouTube's contentID blocks this video worldwide.)
- jacquesm 14y ago
  That's scarier than any horror movie that I've ever seen. It also makes perfect sense. You're providing nature with an evolutionary pressure and it adopts by breeding the most resistant strains until they are undefeatable.
  - sbirchall 14y ago
    Exactly why industrial scale monoculture is the single greatest threat to humanity. We rely almost entirely on a few dozen animals, vegetable plants, grasses and a handful of other organisms that have all have their comfort zones artificially inflated and their genetic variance severely compromised by human intervention. We've essentially created vast plateaus within the evolutionary landscape and these are beginning to be occupied by pioneer species that will quickly take the advantage to adapt. Scary stuff indeed.
  - kragen 14y ago
    It might help you feel better to know that E. coli is harmless, perhaps actually healthy, and competes in your intestines with other bacteria that might make you sick. (Except for some recent strains of E. coli that produce toxins.) The usual reason people get worried about E. coli contamination of food is not that the E. coli itself is dangerous, but rather that it's a reliable and easily-detectable indicator of fecal contamination.
alvarosm 14y ago
Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock. Nobody is interested reducing pharmaceuticals' revenue either. On a side note, take into account we didn't have antibiotics centuries ago, and people just lived. Endure whatever comes, just live. And don't look so shocked, we have democracy and we're surrounded by morons, the shocking thing is that there's still any prosperity at all.
- andor 14y ago
  Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock This is also a problem in North America. Try buying a simple disinfectant (e.g. for small cuts) that doesn't contain antibiotics.
  - jrmg 14y ago
    I think you're thinking of antiseptics or disinfectants, not antibiotics. Resistance to these is not such a problem, and many work on a level that it would be very hard for a microorganism to develop resistance to (for example, by physically destroy the organism). http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Disinfectant http://en.wikipedia.org/wiki/Disinfectant
    - tsotha 14y ago
      Sadly, he's probably not thinking of antiseptics or disinfectants. Manufacturers have started putting antibiotics in consumer products (especially soaps) because there are a lot of consumers who don't know any better.
      - maxerickson 14y ago
        Or ggp is talking about Neosporin (and other triple antibiotic ointments). But peroxide and iodine and rubbing alcohol are all also available, and plain petroleum jelly is available. And then most small cuts should probably just be washed with soapy water and left open to the air. (also, the Wikipedia roundup on triclosan suggests it isn't a problem yet: http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns Not that it is particularly useful to put it in soap)
btipling 14y ago
The comments here are a little over the top "antibiotic resistance is worse than terrorism!" Drug resistance is a problem, but check a reasonable source: http://www.cdc.gov/drugresistance/about.html http://www.cdc.gov/drugresistance/about.html and don't gravitate toward panic and fear. Fear is the path to the dark side.
- carbocation 14y ago
  People shouldn't be afraid of antibiotic resistance so much as they should be outraged, diligent, and cautious. According to the World Health Organization, tuberculosis antibiotic resistance kills 150,000 people per year [1], so I believe your statements on this topic are much too sanguine. [1] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/
  - btipling 14y ago
    There is no shortage of outrage on Hacker News, there seems to be an infinite supply every other day so you've tapped a good market.
- lgleason 14y ago
  Not really, the number of deaths from it are much higher.
- misnome 14y ago
  Slightly ironic that you are warning against fear and panic to retort against statements that this is worse than terrorism, considering that the "Threat of Terrorism" is almost entirely fear and panic. Antibiotic resistance is a real threat, that will only get worse. It's just harder to sensationalize than the latest middle-eastern bogeyman.
  - btipling 14y ago
    Well in that case I hope you are able to achieve the requisite amount of panic and fear you think is warranted.
lgleason 14y ago
A year ago my mother went in for back surgery, a week after she had a sharp pain, and ended up with MRSA which had turned into sepsis. It damaged her heart and in the end, after a two month fight led the ARDS and took her life. The hell this put her through was extremely real. Between the lack of solid contact precautions, doctors who think they are above them, the over-use of antibiotics which lead to this etc. this is a huge problem. The number of instances of MRSA are growing every year which is the scariest part of this. I can vividly remember my mother reading and recommending a book about the coming superbugs back in the 90's when MRSA was rare. It was quite ironic that this ended up killing her.
- harshreality 14y ago
  My condolences. Can someone explain, even if there are resistant pathogenic bacterial strains floating around, where the entrypoint for infection is? Operating rooms are cleanrooms, and after that, with good dressings on the wounds, bacteria should be prevented from entering. "Flesh eating bacteria" due to scratching is one thing; bacteria that gain a foothold through the GI tract is another; I understand how those infections get started. However, internal infections caused somehow by surgical wounds? Are surgical suite clean rooms not a low enough class and therefore not sterile enough? Is wound aftercare not good enough? Are surgical tools getting contaminated after sterilization but before the surgery? Maybe hospitals should be turned into high-class[1] (lower-effectiveness) cleanrooms. I realize laminar flow in such a chaotic environment is impossible, and of limited effectiveness if people are not gowned and so shed contamination all the time, but there could at least be an attempt to push some of the contamination to vents on the floor. How much would that increase costs? It wouldn't have to be entire hospitals, only the recovery wards. Other than that, a major initiative to clean up hospitals could be undertaken. Surfaces and floors and everything else commonly touched should be sterilized more often, to start with. Any area that sees a lot of patient turn-over is going to be heavily contaminated. Anyone who goes from room to room (doctors, nurses) should wear gloves before entering a room to avoid cross-contamination. Donning new gloves once in a room is not good enough; doorknobs, clipboards, light switches, etc. are all still subject to cross-contamination. Recent studies on hotel rooms made me never want to check into one again: http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-dirty-hotels.html http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-d... http://www.scientificamerican.com/podcast/episode.cfm?id=hotel-rooms-house-bountiful-bacteri-12-06-19 http://www.scientificamerican.com/podcast/episode.cfm?id=hot... [1] http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classifications http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...
deleted 14y ago
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AaronBBrown 14y ago
I had a "minor" bought with MRSA a few years back that put me in the hospital for 2 days. Several weeks after getting a tiny little scratch near my elbow my entire forearm swelled up a couple inches. I went through several oral antibiotic treatments before they had to stick me in the hospital to give me the crazy IV stuff. The one that ended up solving the infection was vancomycin, which has been historically the "drug of last resort." During that little incident, I developed an allergy to two different antibiotics, so on top of bacterial resistance, now I have to be concerned with my own body's inability to deal with particular antibiotics. Also, let me tell you, IV Benadryl is some good shit...
nathan_long 14y ago
To help, spread this message: you often don't want an antibiotic. If you have a viral infection, taking an antibiotic is like setting mousetraps to kill mosquitos. Meanwhile, your unnecessary antibiotic 1) has side effects, 2) costs money, 3) helps breed superbugs. Many patients feel that "if I waited 2 hours to see the doctor, he/she had better give me something." Many doctors cave to these demands. We need to stop both.
- tomjen3 14y ago
  What we really need is something that can do to viruses what penicillin did to bacteria. And we need some serious work on bacteriophages. Those little buggers are _awesome_ and have a faster evolution than bacteria.
  - tsotha 14y ago
    That evolution part is the problem. There's a chance we'll breed superviruses in our effort to stop supergerms. As a practical matter, it's nearly impossible to breed therapeutic quantities of a virus without having a wide range of mutations present. We'll probably end up using phages because we won't have any other choice. But they won't be as safe as antibiotics.
ams6110 14y ago
A bit of a tangent, but... from the posted link: Routine operations such as hip replacements could become deadly in just 20 years time if we lose the ability to fight infection I would never encourage anyone to think of a hip replacement as "routine." It is majorly invasive surgery, and any number of things can go wrong. Post op infections are not uncommon. And just being under deep anasthesia for that long is not without suspected long-term side effects.
- to3m 14y ago
  Better yet, the daily mail quotes the uk chief medical adviser describing organ transplants in the same terms! http://www.dailymail.co.uk/health/article-2291314/Superbugs-send-health-service-19th-century-Even-routine-surgery-deadly-warns-medical-adviser.html?ito=feeds-newsxml http://www.dailymail.co.uk/health/article-2291314/Superbugs-...
boas 14y ago
I've worked in a US hospital for a few years, and I've never seen a bacteria that was resistant to all antibiotics, but I have seen people die from bacterial infections. So I think the media focus on drug-resistant bacteria is oversimplified. Why would someone die from a bacterial infection while receiving appropriate antibiotics? One reason is that the antibiotics can't reach the bacteria -- for example if the bacteria are organized into an abscess or biofilm. Another reason is that the body can overreact to the infection, and the patient can die from their immune response rather than the infection itself -- this is called sepsis. Other problems with antibiotics: culture results (which tell you which antibiotic to use) can take a few days, antibiotics frequently have side effects, and it's frequently unclear when the infection is fully treated and the antibiotics can be stopped. I felt a need to respond because a politician reading articles in the popular media will get a distorted view of what is actually needed in hospitals, potentially leading to inappropriate research funding priorities.
- ZoFreX 14y ago
  > So I think the media focus on drug-resistant bacteria is oversimplified. This article is from the UK. Our media's focus on drug-resistant bacteria isn't oversimplified, it's FUD. The whole nation is scared stiff of MRSA because the papers all used "the lab that gets results" - aka some dude in his shed who had no idea what he was doing. They used this lab because it repeatedly confirmed that large numbers of journalists samples (taken from various areas in hospitals) did indeed contain MRSA. Not that there isn't a problem, and it merits attention, but the hysteria they whipped up was unwarranted. I'd be less angry, but despite all this antibiotic fear, people still keep taking them for colds. Grr.
stephengillie 14y ago
Antibiotic resistance, giant mosquitos [1], mutant rats [2]. Pests are evolving to continue living despite our pesticides. We aren't going to make the Earth too hot to live on, or block out the sun with pollution. We're going to be forced off of the planet by evolved pests and predators. Like species which were forced out of the water, onto dry land, because they were out-competed -- one of our evolutionary advantages is that we can survive in space. [1] http://www.gainesville.com/article/20130305/ARTICLES/130309802/-1/news?Title=State-prone-for-mosquito-season-ripe-with-painful-behemoth&tc=ar http://www.gainesville.com/article/20130305/ARTICLES/1303098... [2] http://www.thenational.ae/news/world/middle-east/iran-deploys-sniper-teams-in-tehran-to-battle-mutant-rats http://www.thenational.ae/news/world/middle-east/iran-deploy...
- lysol 14y ago
  We can survive, for short periods of time. But we can't thrive yet.
- crusso 14y ago
  We're going to be forced off of the planet by evolved pests and predators. Doubtful. They may impact our growth or even trim back our numbers, but we're numerous and have lots of mutations too. If technology doesn't save us, it's likely that we'll experience some sort of evolution that allows us to adapt. Even back before modern medicine, the Plague only managed to wipe out 2/3 of the population. one of our evolutionary advantages is that we can survive in space I doubt we'll be getting many humans out into space any time before some sort of Singularity beyond which we're all just guessing anyway.
- hugoc 14y ago
  I think you just spoiled the plot for After Earth
jsherry 14y ago
The ROI on antibiotics is much lower than that of a "lifetime drug" such as an anti-depressant that a patient will take for years and years. Pharmaceuticals are mostly privatized and that's not changing, so the government is going to have to find some ways to incentivize innovation in the antibiotics market. Counting on government isn't a popular option these days, but this is the perfect role for them actually.
jballanc 14y ago
I think this Wikipedia page does the best job of succinctly summarizing the severity of the issue: http://en.wikipedia.org/wiki/Timeline_of_antibiotics http://en.wikipedia.org/wiki/Timeline_of_antibiotics
jbhernan 14y ago
What about how most of the soap you can buy in stores these days is antibacterial soap? I would think the huge use of antibacterial soap might play a part as well. Antibacterial soap probably is not necessary for most people yet it has become the default soap for most, and you have to go out of your way to buy non antibacterial soap.

119 points by clicks 14y ago

Antibiotic resistance is scarier than terrorism. A once-in-a-century terrorist attack killed 3000 people. TB still carries off more than a million people per year, and used to be incurable. Drug-resistant bacteria sounds like a paranoid tinfoil fear, but hospitals already deal with the problem. Doctors do not want to hear the words "drug-resistant MRSA", ever. Probably the worst culprit is the abuse of antibiotics in factory farming. The animals live in disgusting conditions that require antibiotics to keep them viable. (As a side effect, the drugs also make them fatter, producing more meat per head.) This is a huge contributor to the problem.

carbocation 14y ago
I'm with you on basically all points. For a good time, take a look at carbapenem-resistant enterobacteriaciae [1] and totally resistant TB [2]. Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger, and it may well not have anything to do with poor living conditions. It seems to work in humans, too, and these results were discovered as early as the 1940s [citation needed]. But those are just quibbles; on the key points, I'm with you. [1] http://www.cdc.gov/hai/organisms/cre/index.html http://www.cdc.gov/hai/organisms/cre/index.html [2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
- dmiladinov 14y ago
  > Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger I think the explanation that I heard which sounds plausible is that the antibiotics free up a certain amount of energy in the organism that would have gone to fighting micro-organisms that can instead be applied to growth.
  - eru 14y ago
    Be very cautious with easy and intuitive explanations in biology.
- ericb 14y ago
  Do antibiotics make people taller, fatter, or both?
- arvin 14y ago
  > Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger From the 'Germs Are Us' article: "In August, Ilseung Cho, of the New York University School of Medicine, published a study showing that antibiotics eradicated bacteria, commonly found in the digestive system of mice, that help the animals metabolize calories efficiently; without the microbes, the mice absorbed more calories from the same amount of food and rapidly became obese." http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter?currentPage=all http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_...
deleted 14y ago
[deleted]
- carbocation 14y ago
  While your criticism is technically correct, when michaelochurch says "drug resistant MRSA", he's probably thinking of VISA/VRSA [1], which is more extensively (but not completely) resistant to the pharmacological armamentarium. [1] http://www.cdc.gov/HAI/organisms/visa_vrsa/visa_vrsa.html http://www.cdc.gov/HAI/organisms/visa_vrsa/visa_vrsa.html
- michaelochurch 14y ago
  Good call. Thanks.
nodata 14y ago
But what do we do about it, when it seems that nobody at all cares?
- carbocation 14y ago
  People care a ton about this, enough so that the FDA has released guidance on it and even industry magazines are talking about it [1]. This is a huge issue with major visibility in the health professions. [1] http://nationalhogfarmer.com/health/be-ready-antibiotic-restrictions http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...
- michaelochurch 14y ago
  Factory farming should be outlawed for a number of reasons. It's inhumane, devastating to the environment, and bad in a million other ways. It's not even efficient, except in jurisdictions that allow the farms to (freely) dump their effluent-- an externalized cost. Factory farms are literally putting huge quantities of shit into their local water tables. That would be a start. Then we put a ban on the sale, for human consumption, of animals that were treated with antibiotics. If you want to save your pet cat's life-- or your pig's-- that's fine. Just don't sell it as food. That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that. People in the developed world eat too much meat for their own health anyway. What remains is educating people about antibiotics so they stop asking for them when they get colds and flus (they don't do a damn bit of good for a viral infection). Doctors in the US tend to be over-liberal with the drugs, even knowing that they have no effect on viruses.
  - alvarosm 14y ago
    It's funny how everyone has solutions for our eating up the planet. But it's never the obvious: stop having children like there's no tomorrow. If you think you have the right to have 90 children if you feel so inclined, then you'll have to acknowledge the planet must turn into a massive farm.
    - dwiel 14y ago
DanBC 14y ago
MRSA is already drug resistant. That's what the MR bit is - methicillin resistant. > Probably the worst culprit is the abuse of antibiotics in factory farming. That's certainly a problem, but misuse of antibiotics in humans is still a big big problem. Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds. In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.
- Smudge 14y ago
  > In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford. I wish I could say this was limited to developing nations.
- carbocation 14y ago
  > In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford. This brings up an important topic in infectious diseases right now: in many cases, long courses of antibiotics increase selective pressure and favor the antibiotic-resistant bacteria. One strategy to reduce drug resistance is to (rationally) minimize duration of treatment [1]. This isn't to say that medication nonadherence is good, but it is to say that the field is moving towards a shorter duration of treatment for many infections. [1] http://cid.oxfordjournals.org/content/46/4/491.short http://cid.oxfordjournals.org/content/46/4/491.short
  - grhino 14y ago
    Yeah, I've always been suspicious of the phrase "until the bacteria are all killed". It sounds like a pleasant rationalization than an elegant simplification of the argument.
- 14y ago
jpdoctor 14y ago
> "drug-resistant MRSA" Also antibiotic resistant c-diff. I have heard about klebsiella pneumoniae, but don't know any cases personally. Eventually, advanced societies will realize that immune systems need to be exercised just like the rest of the body, but good luck telling helicopter moms that Jr shouldn't have antibiotics for his ear ache.
InclinedPlane 14y ago
A point of correction: 9/11 may be an outlier but it's unfair to characterize it as a super unique event. Terrorist attacks routinely kill dozens and even hundreds of people, and this continues even today. Though such attacks are for the moment much less common in the developed world.
enraged_camel 14y ago
Factory farming is insanity, not just in its contribution to antibiotic resistance but also because of its devastating impacts on the environment. An article was published in December 2006 that described how Smithfield, America's largest pork meat producer, manages all the excrement from the 27 million hogs it slaughters every year. The article at the end is worth a read, but I'll give you a summary: 27 million hogs produce an unbelievable amount of shit. This shit is collected in what Smithfield calls "holding ponds" - which are actually lagoons - that can run 30 feet deep. These ponds contain many extremely toxic substances in addition to good old pig shit. Even light rains can cause them to overflow. And the stuff is so vicious that people are often overcome by the fumes and are hospitalized. And if someone falls into the stuff, they die. How does this stuff affect humans? Well, gravity causes the toxic material in the lagoons to seep down into the groundwater supplies. From there it arrives in people's sinks, showers, and drinking water. http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-s-top-hog-producer-is-also-one-of-america-s-worst-polluters/13479 http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-...
- 10098 14y ago
  time to become a vegetarian
  - aethertap 14y ago
    Or switch to sustainably raised meat (that's the focus on my farm). No medication of any kind, animals live on managed pasture that requires no inputs other than sun, air, and water. Switching away from meat will certainly help to address the development of resistant microbes, but if you can make a switch instead to meat that was raised with regenerative pasture management practices, you can additionally have a large positive impact on many other environmental factors. Look for terms like "high-density grazing," "holistic grazing," "holistic management," or "management-intensive grazing (MIG)." This TED talk [1] covers some of the information, for more you can google around for the above terms (sorry I don't have a good link handy). Correctly managing grazing livestock can actually reverse desertification and trap tons of carbon per year per acre in the soil. Of course, doing it wrong can have the opposite effect, so if you go this route it's important to know whether your farmer is running his operation with land restoration in mind. Conventional vegetable production also comes with a slew of its own problems (breeding of herbicide-resistant weeds [2] being something closely related to the topic at hand). Eating in a way that doesn't cause harm is a tricky thing these days. [1] - http://www.ted.com/talks/allan_savory_how_to_green_the_world_s_deserts_and_reverse_climate_change.html http://www.ted.com/talks/allan_savory_how_to_green_the_world... [2] - http://www.sciencedaily.com/releases/2012/10/121002092839.htm http://www.sciencedaily.com/releases/2012/10/121002092839.ht... *edited for formatting
adventured 14y ago
I agree, although the real once-in-a-century attack that obviously concerns people for the next century is a nuclear attack, or a biological attack, that kills hundreds of thousands or millions (not to mention killing technology that is likely to exist in the next century that we can't imagine today). The prior century was extremely limiting for terrorists by comparison to what the next century is likely to make possible.

DanBC 14y ago

(http://v6.tinypic.com/player.swf?file=24goih4&s=6 http://v6.tinypic.com/player.swf?file=24goih4&s=6) Here's a short snippet from a BBC Television programme (Horizon - 'defeating the superbugs'). It shows E.Coli developing anti-biotic resistance. There's a tray of nutrient jelly. The jelly is divided into sections. It starts with no antibiotic. Then there's a normal dose. Then there's a 10x dose, followed by 100x dose, followed by 1000x dose. They reach the limits of solubility. They cannot dissolve any more antibiotic into the jelly. Then they drop E.Coli onto the normal jelly, and use a time lapse camera to show the growth. After just two weeks the bacteria is able to live on the 1000x dosed jelly. It's pretty impressive demonstration. (Apologies for the suboptimal hosting site. YouTube's contentID blocks this video worldwide.)

jacquesm 14y ago
That's scarier than any horror movie that I've ever seen. It also makes perfect sense. You're providing nature with an evolutionary pressure and it adopts by breeding the most resistant strains until they are undefeatable.
- sbirchall 14y ago
  Exactly why industrial scale monoculture is the single greatest threat to humanity. We rely almost entirely on a few dozen animals, vegetable plants, grasses and a handful of other organisms that have all have their comfort zones artificially inflated and their genetic variance severely compromised by human intervention. We've essentially created vast plateaus within the evolutionary landscape and these are beginning to be occupied by pioneer species that will quickly take the advantage to adapt. Scary stuff indeed.
- kragen 14y ago
  It might help you feel better to know that E. coli is harmless, perhaps actually healthy, and competes in your intestines with other bacteria that might make you sick. (Except for some recent strains of E. coli that produce toxins.) The usual reason people get worried about E. coli contamination of food is not that the E. coli itself is dangerous, but rather that it's a reliable and easily-detectable indicator of fecal contamination.

alvarosm 14y ago

Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock. Nobody is interested reducing pharmaceuticals' revenue either. On a side note, take into account we didn't have antibiotics centuries ago, and people just lived. Endure whatever comes, just live. And don't look so shocked, we have democracy and we're surrounded by morons, the shocking thing is that there's still any prosperity at all.

andor 14y ago
Yeah, well, good luck convincing, say, chinese farmers not to give tons of antibiotics to their livestock This is also a problem in North America. Try buying a simple disinfectant (e.g. for small cuts) that doesn't contain antibiotics.
- jrmg 14y ago
  I think you're thinking of antiseptics or disinfectants, not antibiotics. Resistance to these is not such a problem, and many work on a level that it would be very hard for a microorganism to develop resistance to (for example, by physically destroy the organism). http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Disinfectant http://en.wikipedia.org/wiki/Disinfectant
  - tsotha 14y ago
    Sadly, he's probably not thinking of antiseptics or disinfectants. Manufacturers have started putting antibiotics in consumer products (especially soaps) because there are a lot of consumers who don't know any better.
    - maxerickson 14y ago
      Or ggp is talking about Neosporin (and other triple antibiotic ointments). But peroxide and iodine and rubbing alcohol are all also available, and plain petroleum jelly is available. And then most small cuts should probably just be washed with soapy water and left open to the air. (also, the Wikipedia roundup on triclosan suggests it isn't a problem yet: http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns http://en.wikipedia.org/wiki/Triclosan#Resistance_concerns Not that it is particularly useful to put it in soap)

btipling 14y ago

The comments here are a little over the top "antibiotic resistance is worse than terrorism!" Drug resistance is a problem, but check a reasonable source: http://www.cdc.gov/drugresistance/about.html http://www.cdc.gov/drugresistance/about.html and don't gravitate toward panic and fear. Fear is the path to the dark side.

carbocation 14y ago
People shouldn't be afraid of antibiotic resistance so much as they should be outraged, diligent, and cautious. According to the World Health Organization, tuberculosis antibiotic resistance kills 150,000 people per year [1], so I believe your statements on this topic are much too sanguine. [1] http://www.who.int/mediacentre/factsheets/fs194/en/ http://www.who.int/mediacentre/factsheets/fs194/en/
- btipling 14y ago
  There is no shortage of outrage on Hacker News, there seems to be an infinite supply every other day so you've tapped a good market.
lgleason 14y ago
Not really, the number of deaths from it are much higher.
misnome 14y ago
Slightly ironic that you are warning against fear and panic to retort against statements that this is worse than terrorism, considering that the "Threat of Terrorism" is almost entirely fear and panic. Antibiotic resistance is a real threat, that will only get worse. It's just harder to sensationalize than the latest middle-eastern bogeyman.
- btipling 14y ago
  Well in that case I hope you are able to achieve the requisite amount of panic and fear you think is warranted.

lgleason 14y ago

A year ago my mother went in for back surgery, a week after she had a sharp pain, and ended up with MRSA which had turned into sepsis. It damaged her heart and in the end, after a two month fight led the ARDS and took her life. The hell this put her through was extremely real. Between the lack of solid contact precautions, doctors who think they are above them, the over-use of antibiotics which lead to this etc. this is a huge problem. The number of instances of MRSA are growing every year which is the scariest part of this. I can vividly remember my mother reading and recommending a book about the coming superbugs back in the 90's when MRSA was rare. It was quite ironic that this ended up killing her.

harshreality 14y ago
My condolences. Can someone explain, even if there are resistant pathogenic bacterial strains floating around, where the entrypoint for infection is? Operating rooms are cleanrooms, and after that, with good dressings on the wounds, bacteria should be prevented from entering. "Flesh eating bacteria" due to scratching is one thing; bacteria that gain a foothold through the GI tract is another; I understand how those infections get started. However, internal infections caused somehow by surgical wounds? Are surgical suite clean rooms not a low enough class and therefore not sterile enough? Is wound aftercare not good enough? Are surgical tools getting contaminated after sterilization but before the surgery? Maybe hospitals should be turned into high-class[1] (lower-effectiveness) cleanrooms. I realize laminar flow in such a chaotic environment is impossible, and of limited effectiveness if people are not gowned and so shed contamination all the time, but there could at least be an attempt to push some of the contamination to vents on the floor. How much would that increase costs? It wouldn't have to be entire hospitals, only the recovery wards. Other than that, a major initiative to clean up hospitals could be undertaken. Surfaces and floors and everything else commonly touched should be sterilized more often, to start with. Any area that sees a lot of patient turn-over is going to be heavily contaminated. Anyone who goes from room to room (doctors, nurses) should wear gloves before entering a room to avoid cross-contamination. Donning new gloves once in a room is not good enough; doorknobs, clipboards, light switches, etc. are all still subject to cross-contamination. Recent studies on hotel rooms made me never want to check into one again: http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-dirty-hotels.html http://www.cbc.ca/news/canada/story/2012/11/07/marketplace-d... http://www.scientificamerican.com/podcast/episode.cfm?id=hotel-rooms-house-bountiful-bacteri-12-06-19 http://www.scientificamerican.com/podcast/episode.cfm?id=hot... [1] http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classifications http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...

deleted 14y ago

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AaronBBrown 14y ago

I had a "minor" bought with MRSA a few years back that put me in the hospital for 2 days. Several weeks after getting a tiny little scratch near my elbow my entire forearm swelled up a couple inches. I went through several oral antibiotic treatments before they had to stick me in the hospital to give me the crazy IV stuff. The one that ended up solving the infection was vancomycin, which has been historically the "drug of last resort." During that little incident, I developed an allergy to two different antibiotics, so on top of bacterial resistance, now I have to be concerned with my own body's inability to deal with particular antibiotics. Also, let me tell you, IV Benadryl is some good shit...

nathan_long 14y ago

To help, spread this message: you often don't want an antibiotic. If you have a viral infection, taking an antibiotic is like setting mousetraps to kill mosquitos. Meanwhile, your unnecessary antibiotic 1) has side effects, 2) costs money, 3) helps breed superbugs. Many patients feel that "if I waited 2 hours to see the doctor, he/she had better give me something." Many doctors cave to these demands. We need to stop both.

tomjen3 14y ago
What we really need is something that can do to viruses what penicillin did to bacteria. And we need some serious work on bacteriophages. Those little buggers are _awesome_ and have a faster evolution than bacteria.
- tsotha 14y ago
  That evolution part is the problem. There's a chance we'll breed superviruses in our effort to stop supergerms. As a practical matter, it's nearly impossible to breed therapeutic quantities of a virus without having a wide range of mutations present. We'll probably end up using phages because we won't have any other choice. But they won't be as safe as antibiotics.

ams6110 14y ago

A bit of a tangent, but... from the posted link: Routine operations such as hip replacements could become deadly in just 20 years time if we lose the ability to fight infection I would never encourage anyone to think of a hip replacement as "routine." It is majorly invasive surgery, and any number of things can go wrong. Post op infections are not uncommon. And just being under deep anasthesia for that long is not without suspected long-term side effects.

to3m 14y ago
Better yet, the daily mail quotes the uk chief medical adviser describing organ transplants in the same terms! http://www.dailymail.co.uk/health/article-2291314/Superbugs-send-health-service-19th-century-Even-routine-surgery-deadly-warns-medical-adviser.html?ito=feeds-newsxml http://www.dailymail.co.uk/health/article-2291314/Superbugs-...

boas 14y ago

I've worked in a US hospital for a few years, and I've never seen a bacteria that was resistant to all antibiotics, but I have seen people die from bacterial infections. So I think the media focus on drug-resistant bacteria is oversimplified. Why would someone die from a bacterial infection while receiving appropriate antibiotics? One reason is that the antibiotics can't reach the bacteria -- for example if the bacteria are organized into an abscess or biofilm. Another reason is that the body can overreact to the infection, and the patient can die from their immune response rather than the infection itself -- this is called sepsis. Other problems with antibiotics: culture results (which tell you which antibiotic to use) can take a few days, antibiotics frequently have side effects, and it's frequently unclear when the infection is fully treated and the antibiotics can be stopped. I felt a need to respond because a politician reading articles in the popular media will get a distorted view of what is actually needed in hospitals, potentially leading to inappropriate research funding priorities.

ZoFreX 14y ago
> So I think the media focus on drug-resistant bacteria is oversimplified. This article is from the UK. Our media's focus on drug-resistant bacteria isn't oversimplified, it's FUD. The whole nation is scared stiff of MRSA because the papers all used "the lab that gets results" - aka some dude in his shed who had no idea what he was doing. They used this lab because it repeatedly confirmed that large numbers of journalists samples (taken from various areas in hospitals) did indeed contain MRSA. Not that there isn't a problem, and it merits attention, but the hysteria they whipped up was unwarranted. I'd be less angry, but despite all this antibiotic fear, people still keep taking them for colds. Grr.

stephengillie 14y ago

Antibiotic resistance, giant mosquitos [1], mutant rats [2]. Pests are evolving to continue living despite our pesticides. We aren't going to make the Earth too hot to live on, or block out the sun with pollution. We're going to be forced off of the planet by evolved pests and predators. Like species which were forced out of the water, onto dry land, because they were out-competed -- one of our evolutionary advantages is that we can survive in space. [1] http://www.gainesville.com/article/20130305/ARTICLES/130309802/-1/news?Title=State-prone-for-mosquito-season-ripe-with-painful-behemoth&tc=ar http://www.gainesville.com/article/20130305/ARTICLES/1303098... [2] http://www.thenational.ae/news/world/middle-east/iran-deploys-sniper-teams-in-tehran-to-battle-mutant-rats http://www.thenational.ae/news/world/middle-east/iran-deploy...

lysol 14y ago
We can survive, for short periods of time. But we can't thrive yet.
crusso 14y ago
We're going to be forced off of the planet by evolved pests and predators. Doubtful. They may impact our growth or even trim back our numbers, but we're numerous and have lots of mutations too. If technology doesn't save us, it's likely that we'll experience some sort of evolution that allows us to adapt. Even back before modern medicine, the Plague only managed to wipe out 2/3 of the population. one of our evolutionary advantages is that we can survive in space I doubt we'll be getting many humans out into space any time before some sort of Singularity beyond which we're all just guessing anyway.
hugoc 14y ago
I think you just spoiled the plot for After Earth

jsherry 14y ago

The ROI on antibiotics is much lower than that of a "lifetime drug" such as an anti-depressant that a patient will take for years and years. Pharmaceuticals are mostly privatized and that's not changing, so the government is going to have to find some ways to incentivize innovation in the antibiotics market. Counting on government isn't a popular option these days, but this is the perfect role for them actually.

jballanc 14y ago

I think this Wikipedia page does the best job of succinctly summarizing the severity of the issue: http://en.wikipedia.org/wiki/Timeline_of_antibiotics http://en.wikipedia.org/wiki/Timeline_of_antibiotics

jbhernan 14y ago

What about how most of the soap you can buy in stores these days is antibacterial soap? I would think the huge use of antibacterial soap might play a part as well. Antibacterial soap probably is not necessary for most people yet it has become the default soap for most, and you have to go out of your way to buy non antibacterial soap.