June 25, 2015
On Threshold Of Post Antibiotic Era
Watch this: Maryn McKenna: What do we do when antibiotics donít work any more?
50,000 people per year in the United States and 700,000 per year globally are dying from infections which can resist all antibiotics.
We'll lose surgery because opening the body will let in resistant bacteria. Giving birth will become much more risky. Injuries will become a lot more dangerous. Strep throat will cause heart damage. Says McKenna:
How did we get to this point where what we have to look forward to is those terrifying numbers? The difficult answer is, we did it to ourselves. Resistance is an inevitable biological process, but we bear the responsibility for accelerating it. We did this by squandering antibiotics with a heedlessness that now seems shocking. Penicillin was sold over the counter until the 1950s. In much of the developing world, most antibiotics still are. In the United States, 50 percent of the antibiotics given in hospitals are unnecessary. Forty-five percent of the prescriptions written in doctor's offices are for conditions that antibiotics cannot help. And that's just in healthcare. On much of the planet, most meat animals get antibiotics every day of their lives, not to cure illnesses, but to fatten them up and to protect them against the factory farm conditions they are raised in. In the United States, possibly 80 percent of the antibiotics sold every year go to farm animals, not to humans, creating resistant bacteria that move off the farm in water, in dust, in the meat the animals become. Aquaculture depends on antibiotics too, particularly in Asia, and fruit growing relies on antibiotics to protect apples, pears, citrus, against disease. And because bacteria can pass their DNA to each other like a traveler handing off a suitcase at an airport, once we have encouraged that resistance into existence, there is no knowing where it will spread.
We ought to ban antibiotic use in livestock. Antibiotic usage in medicine ought to be cut in half.
What else should we do? My guess: Develop ways to make our immune systems much stronger. For starters, develop lots of vaccines against assorted bacteria species. When drugs can't help you are on your own. Your own immune system needs to become much stronger. We also need immune system strengthening by other means. We differ greatly in the effectiveness of our immune systems. We need to discover the genetic variants that make some immune systems stronger and develop cell therapies and gene therapies that will strengthen our immune systems.
Policies of governments around the world with regard to antibiotic usage have been retarded for decades. Time to stop being so stupid.
Randall Parker, 2015 June 25 08:47 PM
Any use of antibiotics that is clinically effective creates a selective pressure that induces resistance in the target organism. That is simple Bio 101, and doctors used to know it. So, eventually widespread resistance to penicillin would have occurred in even the best of worlds. We did accelerate the process, but we didn't create it, it's just Natural Selection.
There is a solution. First, antibiotics that have induced significant resistance should be withdrawn from the market. Organisms lose characters when the selective pressure that induced them is removed. So, we can expect that after a while the bacteria that are resistant to penicillin or whatever will lose that resistance, and some day, decades or so in the future, penicillin or whatever can be reintroduced. And the cycle would be repeated indefinitely.
Second, there has to be a vigorous research program the develops and continually introduces new antibiotics to replace those withdrawn. For economic reasons, this will have to be a government project.
The policy should be that antibiotics are continually introduced and removed when resistance appears, and then reintroduced when the resistance disappears. This requires vigorous government supervision and international agreements.
Maryn McKenna is every bit as ignorant of elementary biology as the people she justly criticizes, and she is typical of our maleducated, brainwashed Ruling Class. However, that same Ruling Class will not take the obvious steps. The entirely unncecessary loss of antibiotics in general could be avoided but likely won't be.
For starters, develop lots of vaccines against assorted bacteria species.
Cue Jenny McCarthy freakout in 3, 2, 1...
I would just like to point out that, while the medical profession doesn't like to admit it, they bear a lot of responsibility for this.
A lot of antibiotic prescription practices don't make sense, and it isn't the patients doing the prescribing. But worse, hospitals have become factories for manufacturing multiply resistant strains, because of cross-infection between patients.
Haven't we known since Lister how to prevent cross-infection?
Doctors are just going to have to relearn something called "sterile procedure". Washing your hands between patients, UV lights in the hallways, surfaces that can be sterilized.
And we can bring antibiotics back, you know. Antibiotic resistance comes at a metabolic cost, or else the bacteria would have had it from the beginning, antibiotics being present naturally in the environment. We just need to lower the ambient level of antibiotics enough that the bacteria lose that resistance in the wild, AND re-institute sterile procedure in medical settings. A few things like that. Bacteria have fast generations, antibiotics will be useful again as soon as we reform their use, and interrupt the transmission of antibiotic resistance.
I wouldn't be so certain. As I recall, at least one major resistance gene initially had a high fitness cost, but a second mutation radically reduced that cost. There won't be any reversions to the original type along the same path because of that very fitness cost; the change is locked in, and only replacement by the wild type can get rid of it. Further, as long as the resistance allele is present in a population it will rapidly dominate as soon as antibiotics are present again.
That requires evolutionary engineering. The resistance gene being known, you need to introduce something to the environment that makes having that particular gene costly. Maybe something that *becomes* toxic when the bacteria with that gene ingest it.
But we also need to put a lot more work into phages.
Phages, molecules which gum up the antibiotic-pumps, a host of things.
Neither new antibiotics nor other major new treatments to replace them are going to happen. No technological fix is possible. Alas. Because:
(1) No private party, profit or non-profit, can invest in them massively, because the purchasers of medical treatments will all be stingy national monopsonies, now even in the United States, so costs cannot come close to being recovered.
(2) No public agency is going to invest in them (massively, wisely, and with intelligent management), because (a) that's not what government does, and (b) the payoff to the investment comes after the incumbent politicians are re-elected (or not)--likely after they're retired or dead.
To fix this problem would require--and it would have to be in the United States, alas--fixing the regulation, tax, tort, and intellectual property systems (for instance, *knowledge* must be patentable) and (because those systems can all be re-broken in a demagogic hot flash) also the Constitution, putting those things beyond the reach of the political branches (yes, all three political branches). Never going to happen.
"What do we do when antibiotics donít work any more?"
If penicillin were invented today, could it get US-FDA approval and to market for under 4 billion dollars in development and testing costs?
Phages will be the future. Think Phages + bioinformstics + the Compounding pharmacy model + amazon.com distro model.
before antibiotics were technically feasible we had phages and hyper-serum, that is viruses that attack specific bacteria, and bacteria-specific antibodies from non-human sources. Technology has now improved both radically, phages mutate just as rapidly as bacteria do and can be tailored to the exact strain infecting a patient. We now have transgenic animals capable of producing fully human anti-bodies, eliminating the risks of serum sickness which were a problem in the past. All that is stopping these two solutions to bacterial infections is the FDA which insists on treating customized biologicals as unique drugs requiring billion dollar trails . This is not only financially impossible but absolutely impossible because each treatment is customized for each patient, making a trial with multiple patients impossible. Whether the FDA will die before the human race is an open question, since humans , especially the politically inclined are amazingly stupid.
1. TED talks are, on balance, designed to give the illusion of having read broadly and thought deeply on a subject about which both the speaker and the audience are, essentially, ignorant.
2. Maryn McKenna has a decided preference in her reporting for doom-and-gloom stories about antibiotic resistance. She rarely, if ever, mentions or covers positive developments.
3. One such positive development on which, according to Google, Maryn McKenna is silent: http://www.northeastern.edu/news/2015/01/kim-lewis-teixobactin-nature-paper/
4. Another new line of attack is to target the resistance mechanisms themselves. This allows a sort of one-two punch by administering one compound to attack the resistance mechanism and then defeating the now non-resistant bacteria with a previously ineffective anitbiotic. http://phys.org/news/2014-09-persister-cells-responsible-bacteria-resistant.html
5. There are two main problems barring discovery at the moment: a drug approval process that is broken and simple math. The cost to bring new drugs to market in the U.S is so great that drug companies are adverse to the sorts of green fields development needed to solve the problem. Basic research funding from the government, which is scarce, will only become more scarce because we all want our free government lunch and we want someone else to pay for it. This means we will witness a slow degradation of the services and benefits we expect from the government as politicians and bureaucrats gradually hollow out the remaining research and infrastructure budgets in order to avoid an honest reckoning of our debts and assets.
There are any number of ways we might solve this problem but the problem ain't the bugs, it's math.