Antibiotic resistance 'a time-bomb'(belfasttelegraph.co.uk)
belfasttelegraph.co.uk
Antibiotic resistance 'a time-bomb'
http://www.belfasttelegraph.co.uk/news/local-national/uk/antibiotic-resistance-a-timebomb-29121193.html
14 comments
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.
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.
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.
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.
Awesome. Thanks for that. Do you know if there are any examples showing the opposite approach? If they force the bacteria to go directly from no antibiotics to the maximum concentration, with no stepping stones, I wonder if that just slows down their mutation or if it actually makes it completely impossible.
The antibiotics will probably diffuse in the gel to a degree, so a step-function concentration might be difficult to establish.
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.
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.
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-d...
http://www.scientificamerican.com/podcast/episode.cfm?id=hot...
[1] http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...
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-d...
http://www.scientificamerican.com/podcast/episode.cfm?id=hot...
[1] http://en.wikipedia.org/wiki/Cleanroom#Cleanroom_classificat...
Hospitals really can be that bad. People get sloppy if they aren't constantly reminded that they need to be vigilant. I have personally witnessed doctors open doors with bloody gloves and then interact with patients.
http://thechart.blogs.cnn.com/2011/04/08/hospital-checklist-...
http://thechart.blogs.cnn.com/2011/04/08/hospital-checklist-...
The funny thing is (if by funny you mean absolutely horrific), some doctors and hospitals really dislike the idea of checklists. For a variety of reasons, but one suspects that the motivating concern is that it assumes it's possible for doctors to be utterly incompetent.
As I said in a different comment, doctors can be exceedingly sloppy. There are no consequences. There's no clear evidentiary trail pointing back to the doctor (there could be -- but hospitals have no interest in that). And the worst thing is that we have a culture of sheep who treat doctors as if they are a kind of God. They aren't. Some of them are heroes, but some are worse than the average car mechanic.
If a doctor didn't follow proper procedures and ended up spreading MSRA to your mother, then in effect that was negligent homicide. I think this happens all the time. I've seen it happen myself, where a doctor touches an open wound without having washed his hands first.
But how often are doctors prosecuted for this kind of negligence? Something is very wrong with our medical system and it's worse than MSRA.
But how often are doctors prosecuted for this kind of negligence? Something is very wrong with our medical system and it's worse than MSRA.
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...
Also, let me tell you, IV Benadryl is some good shit...
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.
> 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.
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.
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.
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.
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-...
http://www.dailymail.co.uk/health/article-2291314/Superbugs-...
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.
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.
This is also a problem in North America. Try buying a simple disinfectant (e.g. for small cuts) that doesn't contain antibiotics.
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/Disinfectant
http://en.wikipedia.org/wiki/Antiseptic http://en.wikipedia.org/wiki/Disinfectant
He was most likely referring to one of the many products that ineffectively use antibiotics instead of antiseptics. One such example is Neosporin.
http://en.wikipedia.org/wiki/Neosporin#Efficacy
http://en.wikipedia.org/wiki/Neosporin#Efficacy
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.
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
Not that it is particularly useful to put it in soap)
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
Not that it is particularly useful to put it in soap)
Wow, I didn't actually realtors that's what Neosporin was. I'm from he UK, where antibiotics are heavily controlled and, though I lived for a fair amount of time in the USA, I guess my bias made me not even consider that could be the case. Crazy.
Having said that, even with what ie now learned, I think it's still the case that _most_ disinfectants and antiseptics, even in the USA, are not antibiotics.
Thanks for the correction, I certainly learned something.
Having said that, even with what ie now learned, I think it's still the case that _most_ disinfectants and antiseptics, even in the USA, are not antibiotics.
Thanks for the correction, I certainly learned something.
A lot of people just died without antibiotics.
Nobody is saying this will destroy the human race or anything like that. Clearly, as a species, we don't need this stuff. But it will be a huge negative change for individuals.
Nobody is saying this will destroy the human race or anything like that. Clearly, as a species, we don't need this stuff. But it will be a huge negative change for individuals.
> take into account we didn't have antibiotics centuries ago, and people just lived
For some values of "lived", including "often died of things that today are trivial".
For some values of "lived", including "often died of things that today are trivial".
Hey! We have improved quality of life and expected lifespan quite a bit since then, and antibiotics were a big part of that change.
> On a side note, take into account we didn't have antibiotics centuries ago, and people just lived.
Yeah, but you could die from a small wound in the leg or something.
Yeah, but you could die from a small wound in the leg or something.
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.
[deleted]
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/1303098...
[2] http://www.thenational.ae/news/world/middle-east/iran-deploy...
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/1303098...
[2] http://www.thenational.ae/news/world/middle-east/iran-deploy...
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.
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.
I think you just spoiled the plot for After Earth
We can survive, for short periods of time. But we can't thrive yet.
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.
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.
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.
And we need some serious work on bacteriophages. Those little buggers are _awesome_ and have a faster evolution than bacteria.
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.
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.
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 and don't gravitate toward panic and fear. Fear is the path to the dark side.
Comparing antibiotic-resistant bacteria to terrorism gives terrorism far too much credit. Non-state terrorism is only a distraction from things that actually matter.
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/
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/
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.
Not really, the number of deaths from it are much higher.
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.
Antibiotic resistance is a real threat, that will only get worse. It's just harder to sensationalize than the latest middle-eastern bogeyman.
Well in that case I hope you are able to achieve the requisite amount of panic and fear you think is warranted.
>The problem is a "ticking time-bomb" and should be put on the Government's National Risk Register - which also includes "catastrophic terrorist attacks" and other civil emergencies, Professor Dame Sally Davies said.
Dame Sally Claire Davies, DBE (born 24 November 1949) is the Chief Medical Officer for England, and previously Director General of Research and Development and Chief Scientific Adviser for the Department of Health and National Health Service in the United Kingdom.
Yeah, she sure sounds like a quack to me...
Dame Sally Claire Davies, DBE (born 24 November 1949) is the Chief Medical Officer for England, and previously Director General of Research and Development and Chief Scientific Adviser for the Department of Health and National Health Service in the United Kingdom.
Yeah, she sure sounds like a quack to me...
> Drug resistance is a problem, but check a reasonable source: http://www.cdc.gov/drugresistance/about.html
Did you read your reasonable source? That page links to:
http://www.cdc.gov/getsmart/antibiotic-use/antibiotic-resist...
"Antibiotic resistance has been called one of the world's most pressing public health problems... antibiotic resistance is among CDC's top concerns."
Did you read your reasonable source? That page links to:
http://www.cdc.gov/getsmart/antibiotic-use/antibiotic-resist...
"Antibiotic resistance has been called one of the world's most pressing public health problems... antibiotic resistance is among CDC's top concerns."
There's a difference between "top concerns" and the tone on this ridiculous HN thread. You'd think the world was ending. I hope all the downvotes help these people find relief from their vexing anxiety.
The tone here is "this is a big problem", which is the correct tone according to the CDC. Terrorism kills small numbers of people. Antibiotic resistant bacteria already kill more, and that's only going to go up if solutions aren't found.
"Worse than terrorism" is an extremely low bar. It's hard to see how saying that antibiotic resistance could not be worse than terrorism, since terrorism is an extremely minor problem.
Indeed, it gets pretty tricky to think of something that fails to pass that hurdle.
Swimming pools: worse than terrorism. Check.
Driving: worse than terrorism. Check.
The common cold: worse than terrorism. Check.
Sitting at a desk for 40 hours a week: worse than terrorism. Check.
Terrorism is a useful cudgel for tyranny because it hits the convenient sweet spot of high profile incidents to rally around, nationalist xenophobia, and maximally invading the civil liberties of otherwise thoughtful citizens.
Swimming pools: worse than terrorism. Check.
Driving: worse than terrorism. Check.
The common cold: worse than terrorism. Check.
Sitting at a desk for 40 hours a week: worse than terrorism. Check.
Terrorism is a useful cudgel for tyranny because it hits the convenient sweet spot of high profile incidents to rally around, nationalist xenophobia, and maximally invading the civil liberties of otherwise thoughtful citizens.
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.
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
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.
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.
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.
> 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.
> 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
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
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.
> 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.
I wish I could say this was limited to developing nations.
>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.
On the contrary, I would like to point out that its not limited to developing nations. When I first arrived in the US, one of the advice that my US settled relatives gave me was that American doctors routinely prescribe antibiotics even for the simplest illness. This fact was confirmed when I took my Mum to a doctor when she felt unwell when visiting me: light fever, and the prescription was some very potent antibiotics. My mother refused to take them and got better on her own after a few days. There seems to be a reluctance to take antibiotics in my family.
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.
On the contrary, I would like to point out that its not limited to developing nations. When I first arrived in the US, one of the advice that my US settled relatives gave me was that American doctors routinely prescribe antibiotics even for the simplest illness. This fact was confirmed when I took my Mum to a doctor when she felt unwell when visiting me: light fever, and the prescription was some very potent antibiotics. My mother refused to take them and got better on her own after a few days. There seems to be a reluctance to take antibiotics in my family.
[deleted]
Yes, I worded my post poorly.
What I meant to say was something like "Another misuse of antibiotics is caused by poor people not being able to afford a complete course".
What I meant to say was something like "Another misuse of antibiotics is caused by poor people not being able to afford a complete course".
I think another huge trend worth noting is the use of anti-bacterial products. They do nothing other than killing a large portion of both good and bad bacteria indiscriminately and leaving a small, drug-resistant strain, which then does not have to compete for resources with all the non-resistant bacteria and reproduces freely to ultimately make people sick.
I think most of those products are anti-bacterial by virtue of things like extremely high alcohol content. I could be wrong, but I don't expect bacteria to develop a resistance to 93% ethyl alcohol any more than I expect bleach- or hydrochloric- resistant bacteria.
IIRC most of these anti-bacterial soaps contain this stuff: https://en.wikipedia.org/wiki/Triclosan
It doesn't seem to lead to resistance either, but that doesn't make using those products any more sensible.
It doesn't seem to lead to resistance either, but that doesn't make using those products any more sensible.
Yes, the big problem with triclosan is that it's a water pollutant. This is why I've stopped using it.
That said, I think the concerns about antibacterial hand soaps leading to resistance are overblown. The bacteria on your hands are not an isolated population; you're exchanging bacteria with the environment all the time. Applying intermittent selection pressure to a tiny fraction of a population at a time causes little if any genetic drift in the entire population.
Say you wash your hands with triclosan soap, and all but a few bacteria are killed. When those bacteria are transferred to a doorknob, say, they have no advantage against the other bacteria that are already there; indeed, whatever mutation allowed them to survive the triclosan probably puts them at a disadvantage in a triclosan-free environment. Even the ones that stay on your hands don't have a competitive advantage against newcomers until the next time you wash.
Conversely, the bacteria in your body are an isolated population. When you subject them to strong selection pressure by taking an antibiotic, if any manage to develop a little resistance, they continue to have an advantage as long as you're taking it. If you don't take enough to kill them despite their resistance, you'll wind up with a pretty pure population that has this new level of resistance. Pass that to a few other people, and repeat the process a few thousand times, and you have a problem.
That said, I think the concerns about antibacterial hand soaps leading to resistance are overblown. The bacteria on your hands are not an isolated population; you're exchanging bacteria with the environment all the time. Applying intermittent selection pressure to a tiny fraction of a population at a time causes little if any genetic drift in the entire population.
Say you wash your hands with triclosan soap, and all but a few bacteria are killed. When those bacteria are transferred to a doorknob, say, they have no advantage against the other bacteria that are already there; indeed, whatever mutation allowed them to survive the triclosan probably puts them at a disadvantage in a triclosan-free environment. Even the ones that stay on your hands don't have a competitive advantage against newcomers until the next time you wash.
Conversely, the bacteria in your body are an isolated population. When you subject them to strong selection pressure by taking an antibiotic, if any manage to develop a little resistance, they continue to have an advantage as long as you're taking it. If you don't take enough to kill them despite their resistance, you'll wind up with a pretty pure population that has this new level of resistance. Pass that to a few other people, and repeat the process a few thousand times, and you have a problem.
Though less prevalent, even people in developed countries do this (short course). Slightly off-topic, but with the "complete" and "short" courses now available (e.g., a complete lasts only 2-3 days), how is resistance affected? Is it better, worse, or the same? Better, since people are more likely to complete a course?
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-...
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-...
time to become a vegetarian
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...
[2] - http://www.sciencedaily.com/releases/2012/10/121002092839.ht...
*edited for formatting
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...
[2] - http://www.sciencedaily.com/releases/2012/10/121002092839.ht...
*edited for formatting
What do you do when your animals get sick?
I'm not trying to be inflammatory, I'm just curious.
I'm not trying to be inflammatory, I'm just curious.
It's a natural question. Sick animals are culled from the herd. They may be either processed or sold to another producer who is willing to medicate, but my program is focused on building resistant genetics. You can look into "South poll cattle" [1] for an example of this type of breeding program. I don't raise cattle at this time, but I will be soon, and I'll be using an aggressive culling system like what was used for that breed with good results. For more information about this methodology, check out the Lasater Philosophy of Cattle Raising [2]. In my case, I try to apply the same basic ideas to sheep (and eventually cattle).
[1] http://www.southpoll.com/History.html
[2] http://www.amazon.com/The-Lasater-Philosophy-Cattle-Raising/...
[1] http://www.southpoll.com/History.html
[2] http://www.amazon.com/The-Lasater-Philosophy-Cattle-Raising/...
Just wanted to add two notes: First, I'm relatively new to raising animals, so I'm speaking from a position of some experience, but primarily learning from others' work. Second, sickness in general is rare for animals raised in this manner (long rest rotational mob grazing), so it's not an issue that really crops up very often.
Factory farming extends to vegetables.
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
[2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
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
[2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
> 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_...
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_...
Do antibiotics make people taller, fatter, or both?
> 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.
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.
Be very cautious with easy and intuitive explanations in biology.
But what do we do about it, when it seems that nobody at all cares?
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-rest...
[1] http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...
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.
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.
> 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.
This is an interesting proposal I haven't heard before, and it sounds like a good idea. I think it's going to be difficult to convince ranchers that they have to suck up the loss of a $5000 steer to a bacterial infection that could have been cured with $10 of antibiotics.
This is an interesting proposal I haven't heard before, and it sounds like a good idea. I think it's going to be difficult to convince ranchers that they have to suck up the loss of a $5000 steer to a bacterial infection that could have been cured with $10 of antibiotics.
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.
Do you mean to imply that the only thing we need to do is "stop having children like there's no tomorrow?" michaelochurch didn't say that outlawing factory farming was the only thing we should do like you seem to imply.
Also it's been done.
Western fertility rates are on average ~2. Development and education in poorer nations - especially for women - also results in declining birthrates.
Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!
Western fertility rates are on average ~2. Development and education in poorer nations - especially for women - also results in declining birthrates.
Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!
>Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!
Side-note is incorrect. It's a probability game. Going from (hypothetically) 1000 CAFOs to 10 would drop the rate of production by 100x.
Side-note is incorrect. It's a probability game. Going from (hypothetically) 1000 CAFOs to 10 would drop the rate of production by 100x.
Which doesn't matter, because it only has to happen once.
Literally nothing about reducing the population density of an area addresses the horrific practices of the meat industry. They would still be a bad idea if there was exactly 1 next to a town of 1000 people, because that town would still be wiped out by drug-resistant bacteria.
We don't need current meat production practices - they're about corporate profit, not long-term efficiency.
Literally nothing about reducing the population density of an area addresses the horrific practices of the meat industry. They would still be a bad idea if there was exactly 1 next to a town of 1000 people, because that town would still be wiped out by drug-resistant bacteria.
We don't need current meat production practices - they're about corporate profit, not long-term efficiency.
No, you're incorrect. Reducing the human population density would decrease meat consumption, which would decrease cattle population density, which would decrease anti-bacterial consumption.
There's a known method to get reproductive rates down currently being applied across the globe: affluence. There's no need to mandate it, people are getting there on their own.
Of course, affluence is where most of the problem lies. The difference in environmental impact between a rich human and a poor human is much greater than between a poor human and no human.
Which leads to a more accurate description of the problem: how do you make not destroying the planet more appealing than destroying the planet on an individual level?
Of course, affluence is where most of the problem lies. The difference in environmental impact between a rich human and a poor human is much greater than between a poor human and no human.
Which leads to a more accurate description of the problem: how do you make not destroying the planet more appealing than destroying the planet on an individual level?
Who exactly is having children like there's no tomorrow? If not for immigration, the US population would be declining already. Educate people (esp women) and suddenly your major western nation can't maintain population replacement levels of births.
http://www.slate.com/articles/technology/future_tense/2013/0...
http://www.slate.com/articles/technology/future_tense/2013/0...
You know those people still have children regardless of which country they're in, right?
No, actually I didn't.
In my experience, "those people" are indistinguishable from "people who have the same skin colour as me" after a generation or two.
Oh, and here a some studies with, you know, numbers and statistics that bear that out:
Migrant birthrates falling in Germany, study finds -- http://www.thelocal.de/society/20100811-29073.html
"Fertility rates among foreign-born women start to decline relatively soon after they arrive in Canada, and eventually reach those of women who were born in Canada" --http://www.statcan.gc.ca/daily-quotidien/031222/dq031222c-en...
In my experience, "those people" are indistinguishable from "people who have the same skin colour as me" after a generation or two.
Oh, and here a some studies with, you know, numbers and statistics that bear that out:
Migrant birthrates falling in Germany, study finds -- http://www.thelocal.de/society/20100811-29073.html
"Fertility rates among foreign-born women start to decline relatively soon after they arrive in Canada, and eventually reach those of women who were born in Canada" --http://www.statcan.gc.ca/daily-quotidien/031222/dq031222c-en...
Citation needed. Even if true, once they're here, their children are likely to be better educated and have access to birth control.
In areas home to CAFOs (Concentrated Animal Feedlot Operations) there are lagoons of liquified pig or cattle waste.
Lagoons of shit. Literally.
Lagoons of shit. Literally.
>>That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that.
You may be okay with that, but there are a large number of low-income people who are not.
I'm not disagreeing with you - I think factory farming and antibiotic usage for farm animals should be banned. I just think it's worth keeping a broad perspective so that we can appreciate that these problems are in fact very difficult to solve.
You may be okay with that, but there are a large number of low-income people who are not.
I'm not disagreeing with you - I think factory farming and antibiotic usage for farm animals should be banned. I just think it's worth keeping a broad perspective so that we can appreciate that these problems are in fact very difficult to solve.
Maybe these low-income people could make a decent living out of tending to farm animals if it was more of a concern to the industry than it is now.
... or we could all deal with the fact that meat isn't a human right, and the lack of it would be a slight inconvenience compared to the implications of antibiotic resistance.
So yeah, low-hanging fruit.
... or we could all deal with the fact that meat isn't a human right, and the lack of it would be a slight inconvenience compared to the implications of antibiotic resistance.
So yeah, low-hanging fruit.
> or we could all deal with the fact that meat isn't a human right
Neither is food, if you really want to go that route. The point of civilization is that we try to provide for ourselves things that are not just our rights, but our desires.
(Show me where nature will automatically provide food for humans.)
Neither is food, if you really want to go that route. The point of civilization is that we try to provide for ourselves things that are not just our rights, but our desires.
(Show me where nature will automatically provide food for humans.)
I think GP was saying that access to meat is not a survival requirement, or even a requirement to be happy. I know people who would miss steak and ribs in a nostalgic sense, but anyone who hasn't found tasty vegan food hasn't looked very hard.
Access to basic nutrition is a de facto human right, in the modern civic sense. Nature doesn't guarantee that humans are fed, but many governments try to, with welfare and food stamps.
Access to basic nutrition is a de facto human right, in the modern civic sense. Nature doesn't guarantee that humans are fed, but many governments try to, with welfare and food stamps.
> access to meat is not a survival requirement, or even a requirement to be happy
It is for some people. Or is their culture wrong to you?
It is for some people. Or is their culture wrong to you?
Erm, pre-agriculture, that's all nature did. Hunter gatherers today still literally walk up to their food and pick it up (or pull it from bushes, etc.). Or run it to exhaustion. Sure, it takes a minimal amount of effort (and took a lot less when there weren't 6 billion people crowding out natural food supplies), but the state of nature provides plenty of food for a small population. What you're saying is essentially that there's no natural right to free speech, because nature doesn't provide you with language (it takes other humans teaching you how to speak before you can access your right to free speech).
> pre-agriculture, that's all nature did
Not in the slightest, and I wonder where you've lived that that's ever been the case. Not on Earth, certainly.
The only things Nature provides free are sunlight, weather, and parasites.
Not in the slightest, and I wonder where you've lived that that's ever been the case. Not on Earth, certainly.
The only things Nature provides free are sunlight, weather, and parasites.
By the universal declaration of human rights, every person has the right to life. I'm sure you can figure out a way that wouldn't entail food.
I'm not sure how nature automatically providing food has anything to do with it. The point of human rights is to provide for ourselves things that are not just facts of nature, but satisfy our ethical beliefs.
I'm not sure how nature automatically providing food has anything to do with it. The point of human rights is to provide for ourselves things that are not just facts of nature, but satisfy our ethical beliefs.
> "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.
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.
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.
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.
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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.)