13 ms·

For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies,

For the past half century, we should have been treating our antibiotics like weapons of mass destruction - tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. The industry and the doctors responded: antibiotics were too profitable and the risk seemed too distant. Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. For the first time in the memory of anyone alive today, we're going to see medical science step backwards. We're going to be more vulnerable tomorrow than we are today, and we did it to ourselves.

erichurkman 13y ago
> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.
- legitsource 13y ago
  The return of the sanitarium and things like leper colonies could be in our futures.
  - nate_meurer 13y ago
    And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.
- w4 13y ago
  This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
  - saalweachter 13y ago
    Fun fact: modern plastic surgery -- including purely cosmetic, non-normative surgery -- predates both antibiotics and anesthetics.
    - evacuationdrill 13y ago
      That's not too surprising. People sometimes have ugly face moles and stuff, and it's not too hard to cut it off.
- mathattack 13y ago
  > Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease. This is one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospital trip where someone didn't catch something new at the hospital.
  - Goopplesoft 13y ago
    > This is one reason to avoid hospitals at all cost. I think generally, everyone avoids hospitals at all costs.
    - mtdewcmu 13y ago
      Good point. And hospitals themselves are very costly. In case you need another reason.
- jabagonuts 13y ago
  I feel a lot less silly now for avoiding medical treatment unless absolutely necessary all my life.
  - saalweachter 13y ago
    The difficulty is avoiding treatment and not diagnostics. If your method of avoiding treatment is never going to the doctor, ie, never being diagnosed, you don't really know when your problems are life-threatening.
  - Fomite 13y ago
    So this would be a bad time to start talking about rates of community acquisition of MRSA and C. difficile, wouldn't it?
- snake_plissken 13y ago
  This is what I don't completely understand. Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? Or, do I not understand the vectors properly? The way I perceive these stories is that hospitals are actually extremely dirty on a microbial level (as is most of the world), it's just counter-intuitive because I think a lot of people take for granted that a hospital is imagined to be a super sterile place. MRSAs could potentially reside on every surface; an act as simple as touching a bed railing could get you infected. You then have patients in recovery with healing wounds/depressed immune systems, which need antibiotic treatment of some kind when they have an infection. But it's not like you cannot become infected by a MRSA outside of a hospital, you can, and the same antibiotics won't work effectively for you just as they don't work effectively in the hospital. So the first step in my mind is making sure the hospital is 'clean'.
  - VLM 13y ago
    Google for "mrsa aerosol transmission". Yes yes make everyone wear gas masks and space suits the entire time, staff and patient alike...
  - stonemetal 13y ago
    > Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? We have robots that do that now. http://loyolamedicine.org/newswire/news/uv-light-robots-kill-999-percent-germs-including-superbugs-loyola-and-gottlieb http://loyolamedicine.org/newswire/news/uv-light-robots-kill...
  - Fomite 13y ago
    We do. We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin. Bacteria are just bloody durable, and people are shedding new bacteria into the environment at really absurd rates.
    - VladRussian2 13y ago
- marcosdumay 13y ago
  Maybe the solution is to have the procedure in a place that is a hospital. You'd want some environemnt that isn't shared by other sic people, and is only sporadically sterilized. Yep, I have no idea how to actualy do that. There are all kinds of issues, but I'd guess that you can solve nearly all of them with tech.
  - evacuationdrill 13y ago
    Like a surgery center? They do have those. I worked at a hospital for awhile, and one of the things I found interesting, though, is that the departments balance each other out. For example, our hospital did obstetrics more as a service to the community, since other hospitals were much further, but they always lost money on it. So maybe the reason we don't see surgery centers or things like that as often is that medical institutions are more stable providing a broader range of services.
ramblerman 13y ago
It's not an impossible scenario but have the decency not to wrap this 'End of the world fantasy' as a fact or certainty. There have been plenty of those before you and there will be plenty more to come. Y2K, Nuclear War, Swine Flu, Global Warming, Apocalypse, take your pick.
- nikbackm 13y ago
  Well, none of those (if you replace Y2K with Y2038!) are down for the count yet.
  - TillE 13y ago
    Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union, which isn't to say that such conditions could never arise again. And of course the risk of a smaller scale nuclear war is still very real. In each of these cases there seems to be a tendency to think that just because total disaster has not yet occurred, that the risks are nonexistent.
    - VLM 13y ago
      "Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union" Why? Did the weapons magically disappear? That outcome is much more likely in the 2010s than the 1980s, for example.
- freehunter 13y ago
  Of those, though, two of the threats were real and mitigated before the impact could be realized (nuclear war and Y2K), and one of them is a fairly recent scientific theory that is still trying to be understood (climate change).
  - jacobquick 13y ago
    In the 80s we acted faster on freon/CFCs than we have on climate change in the ensuing 30 years, with less danger to human life and less evidence. The only thing that's new about climate change as a scientific theory is the annual increase in the pile of evidence that it's happening and we're the cause of it.
cliveowen 13y ago
I think it's too easy to say that overuse of antibiotics is what brought us here. In the article it says that companies stopped developing new antibiotics when development costs became too high to justify given the narrow market. Now, if doctors were to use antibiotics only for very serious infections, a last resort method, then pharmaceutical companies wouldn't have had the incentive to develop even the drugs that we now take for granted, because the market would have been so incredibly small to not give them enough reason to invest in development. I think we would've ended up in this very same position anyway, it was just a matter of time.
- UnFleshedOne 13y ago
  Kinda brings the free market idea into a different light, isn't it?
- swalkergibson 13y ago
  At least we have Viagra!
humanrebar 13y ago
I think you're going a bit too far there. I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).
- DanBC 13y ago
  People use antibiotics to treat things that are not helped by antibiotics. Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm. (http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm) > Untreated gonorrhea can cause serious and permanent health problems in both women and men. That seems like a reasonable use of an antibiotic. But maybe we should have been working out how to get people to use condoms.
  - humanrebar 13y ago
    Obviously unnecessary use of antibiotics is unnecessary (a fact I alluded to), but that's not what I was responding to. You're putting words in my mouth there. I said the call for "emergencies only!" antibiotics was overkill. If I took your point differently than you intended, maybe you would like to rephrase.
zeteo 13y ago
> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.
- robterrell 13y ago
  I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.
  - zeteo 13y ago
    >you'll buy drugs for high cholesterol the rest of your life Not if you get killed by an infection first.
    - bad_user 13y ago
      Also many chronic diseases are autoimmune diseases, like asthma or type 1 diabetes. In such patients the immune system gets weaker when in crisis, leaving them vulnerable to infections.
    - mturmon 13y ago
      This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.
      - MaysonL 13y ago
        And it's sometimes easier to invent a chronic condition for a drug, than vice versa.
swamp40 13y ago
> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. Really? And whose lives are you willing to play that game with? Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set? Your wife, with a bladder infection so severe it's bleeding and she has a fever? "Sorry, son - your suffering is for the betterment of mankind. I'm pretty sure you'll survive." "Sorry, honey - let's just see if you can make it another week or two."
- polarix 13y ago
  How about the animals and hand-soap aficionados? Perhaps they could hold off for a bit?
- coryrc 13y ago
  Maybe GP didn't have the best wording, but I would classify those both as emergencies appropriate for antibiotic use -- you may only think them not because antibiotics are seen as so commonplace. Non-emergencies: * sore throat * lots of chickens packed in one place
- ceejayoz 13y ago
  Those examples both qualify as necessary and emergent. What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).
  - bad_user 13y ago
    Exactly. And not even for more severe colds either, like when having fever or a red throat, but rather for freaking runny noses.
  - swamp40 13y ago
    I'm not sure how prevalent your example is these days. I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn. They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.
yetanotherphd 13y ago
I think it would be more accurate to characterize antibiotics as effective, not just profitable. You are completely ignoring the actual benefit of antibiotics and acting like they created profits without actually benefiting the patient
tieTYT 13y ago
> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?
timthimmaiah 13y ago
Being somewhat pessimistic here. As someone who actively hacks DNA, I believe that we can address this problem responsibly with the development of new and novel antibiotics for antibiotic-resistant bacteria. There are significant challenges in the biology but there is technology being developed that will significantly reduce the cost and time needed to develop new antibodies. For example, my company TeselaGen (http://teselagen.com http://teselagen.com) has developed a cloud based platform for biologists to design, build, and test a large combinatorial set of DNA constructs. Some of our customers use our software today to easily and effectively test an incredible number of DNA devices for identifying and developing useful antibodies.If you have an understanding of genetics and cloning you can try out the software yourself.

erichurkman 13y ago

> Now we have no weapons; we're helpless and the world is again going to be a scary place where a cut or a scrape can land you in a hospital or in a mortuary. Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease.

legitsource 13y ago
The return of the sanitarium and things like leper colonies could be in our futures.
- nate_meurer 13y ago
  And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.
w4 13y ago
This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
- saalweachter 13y ago
  Fun fact: modern plastic surgery -- including purely cosmetic, non-normative surgery -- predates both antibiotics and anesthetics.
  - evacuationdrill 13y ago
    That's not too surprising. People sometimes have ugly face moles and stuff, and it's not too hard to cut it off.
mathattack 13y ago
> Perhaps most terrifying is that the mere act of hospitalization will likely be the highest vector of transmission of nearly untreatable infections. Go in for a routine procedure and end up in the isolation ward due to some highly infectious, deadly disease. This is one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospital trip where someone didn't catch something new at the hospital.
- Goopplesoft 13y ago
  > This is one reason to avoid hospitals at all cost. I think generally, everyone avoids hospitals at all costs.
  - mtdewcmu 13y ago
    Good point. And hospitals themselves are very costly. In case you need another reason.
jabagonuts 13y ago
I feel a lot less silly now for avoiding medical treatment unless absolutely necessary all my life.
- saalweachter 13y ago
  The difficulty is avoiding treatment and not diagnostics. If your method of avoiding treatment is never going to the doctor, ie, never being diagnosed, you don't really know when your problems are life-threatening.
- Fomite 13y ago
  So this would be a bad time to start talking about rates of community acquisition of MRSA and C. difficile, wouldn't it?
snake_plissken 13y ago
This is what I don't completely understand. Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? Or, do I not understand the vectors properly? The way I perceive these stories is that hospitals are actually extremely dirty on a microbial level (as is most of the world), it's just counter-intuitive because I think a lot of people take for granted that a hospital is imagined to be a super sterile place. MRSAs could potentially reside on every surface; an act as simple as touching a bed railing could get you infected. You then have patients in recovery with healing wounds/depressed immune systems, which need antibiotic treatment of some kind when they have an infection. But it's not like you cannot become infected by a MRSA outside of a hospital, you can, and the same antibiotics won't work effectively for you just as they don't work effectively in the hospital. So the first step in my mind is making sure the hospital is 'clean'.
- VLM 13y ago
  Google for "mrsa aerosol transmission". Yes yes make everyone wear gas masks and space suits the entire time, staff and patient alike...
- stonemetal 13y ago
  > Why has no one developed a disinfectant spray that hospitals can apply ad-nauseum (pun intended, the smell ideally wouldn't make people nauseous) all over the hospital? We have robots that do that now. http://loyolamedicine.org/newswire/news/uv-light-robots-kill-999-percent-germs-including-superbugs-loyola-and-gottlieb http://loyolamedicine.org/newswire/news/uv-light-robots-kill...
- Fomite 13y ago
  We do. We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by Cylon looking robots, and surfaces made of copper and patterned after shark skin. Bacteria are just bloody durable, and people are shedding new bacteria into the environment at really absurd rates.
  - VladRussian2 13y ago
marcosdumay 13y ago
Maybe the solution is to have the procedure in a place that is a hospital. You'd want some environemnt that isn't shared by other sic people, and is only sporadically sterilized. Yep, I have no idea how to actualy do that. There are all kinds of issues, but I'd guess that you can solve nearly all of them with tech.
- evacuationdrill 13y ago
  Like a surgery center? They do have those. I worked at a hospital for awhile, and one of the things I found interesting, though, is that the departments balance each other out. For example, our hospital did obstetrics more as a service to the community, since other hospitals were much further, but they always lost money on it. So maybe the reason we don't see surgery centers or things like that as often is that medical institutions are more stable providing a broader range of services.

ramblerman 13y ago

It's not an impossible scenario but have the decency not to wrap this 'End of the world fantasy' as a fact or certainty. There have been plenty of those before you and there will be plenty more to come. Y2K, Nuclear War, Swine Flu, Global Warming, Apocalypse, take your pick.

nikbackm 13y ago
Well, none of those (if you replace Y2K with Y2038!) are down for the count yet.
- TillE 13y ago
  Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union, which isn't to say that such conditions could never arise again. And of course the risk of a smaller scale nuclear war is still very real. In each of these cases there seems to be a tendency to think that just because total disaster has not yet occurred, that the risks are nonexistent.
  - VLM 13y ago
    "Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union" Why? Did the weapons magically disappear? That outcome is much more likely in the 2010s than the 1980s, for example.
freehunter 13y ago
Of those, though, two of the threats were real and mitigated before the impact could be realized (nuclear war and Y2K), and one of them is a fairly recent scientific theory that is still trying to be understood (climate change).
- jacobquick 13y ago
  In the 80s we acted faster on freon/CFCs than we have on climate change in the ensuing 30 years, with less danger to human life and less evidence. The only thing that's new about climate change as a scientific theory is the annual increase in the pile of evidence that it's happening and we're the cause of it.

cliveowen 13y ago

I think it's too easy to say that overuse of antibiotics is what brought us here. In the article it says that companies stopped developing new antibiotics when development costs became too high to justify given the narrow market. Now, if doctors were to use antibiotics only for very serious infections, a last resort method, then pharmaceutical companies wouldn't have had the incentive to develop even the drugs that we now take for granted, because the market would have been so incredibly small to not give them enough reason to invest in development. I think we would've ended up in this very same position anyway, it was just a matter of time.

UnFleshedOne 13y ago
Kinda brings the free market idea into a different light, isn't it?
swalkergibson 13y ago
At least we have Viagra!

humanrebar 13y ago

I think you're going a bit too far there. I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).

DanBC 13y ago
People use antibiotics to treat things that are not helped by antibiotics. Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm. (http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm) > Untreated gonorrhea can cause serious and permanent health problems in both women and men. That seems like a reasonable use of an antibiotic. But maybe we should have been working out how to get people to use condoms.
- humanrebar 13y ago
  Obviously unnecessary use of antibiotics is unnecessary (a fact I alluded to), but that's not what I was responding to. You're putting words in my mouth there. I said the call for "emergencies only!" antibiotics was overkill. If I took your point differently than you intended, maybe you would like to rephrase.

zeteo 13y ago

> we're helpless and the world is again going to be a scary place Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective: >Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic. When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.

robterrell 13y ago
I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.
- zeteo 13y ago
  >you'll buy drugs for high cholesterol the rest of your life Not if you get killed by an infection first.
  - bad_user 13y ago
    Also many chronic diseases are autoimmune diseases, like asthma or type 1 diabetes. In such patients the immune system gets weaker when in crisis, leaving them vulnerable to infections.
  - mturmon 13y ago
    This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.
    - MaysonL 13y ago
      And it's sometimes easier to invent a chronic condition for a drug, than vice versa.

swamp40 13y ago

> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary. Really? And whose lives are you willing to play that game with? Your 8 y.o son, who just broke his arm and has new swelling three days after the arm has been set? Your wife, with a bladder infection so severe it's bleeding and she has a fever? "Sorry, son - your suffering is for the betterment of mankind. I'm pretty sure you'll survive." "Sorry, honey - let's just see if you can make it another week or two."

polarix 13y ago
How about the animals and hand-soap aficionados? Perhaps they could hold off for a bit?
coryrc 13y ago
Maybe GP didn't have the best wording, but I would classify those both as emergencies appropriate for antibiotic use -- you may only think them not because antibiotics are seen as so commonplace. Non-emergencies: * sore throat * lots of chickens packed in one place
ceejayoz 13y ago
Those examples both qualify as necessary and emergent. What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).
- bad_user 13y ago
  Exactly. And not even for more severe colds either, like when having fever or a red throat, but rather for freaking runny noses.
- swamp40 13y ago
  I'm not sure how prevalent your example is these days. I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn. They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.

yetanotherphd 13y ago

I think it would be more accurate to characterize antibiotics as effective, not just profitable. You are completely ignoring the actual benefit of antibiotics and acting like they created profits without actually benefiting the patient

tieTYT 13y ago

> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?

timthimmaiah 13y ago

Being somewhat pessimistic here. As someone who actively hacks DNA, I believe that we can address this problem responsibly with the development of new and novel antibiotics for antibiotic-resistant bacteria. There are significant challenges in the biology but there is technology being developed that will significantly reduce the cost and time needed to develop new antibodies. For example, my company TeselaGen (http://teselagen.com http://teselagen.com) has developed a cloud based platform for biologists to design, build, and test a large combinatorial set of DNA constructs. Some of our customers use our software today to easily and effectively test an incredible number of DNA devices for identifying and developing useful antibodies.If you have an understanding of genetics and cloning you can try out the software yourself.