In Denmark, they prevent infections in chicken houses by thoroughly cleaning them, then using techniques developed for clean rooms to prevent infections. In the US, we let them wade in their own filth and pump them full of antibiotics. We should just make it flat out illegal to use antibiotics across entire herds of livestock. We should also fine doctors for prescribing antibiotics to patients with a viral infection and no sign of bacteria in their systems, unless they are severely immune compromised.
There's a bill introduced in the Senate that would restrict antibiotics that are approved in humans from being used in agricultural in a prophylactic way.[1] A similar bill has been introduced in the House[2] by Rep. Louise Slaughter who has degrees in microbiology and public health.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
Antibiotics in animal farms should be banned world wide.
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiotic free meat.
Of course, they're given to animals to keep them healthy enough so we can eat them.
If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.
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.
> 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.
> 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.
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.
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.
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).
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) 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.
> 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?
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
> Eventually bacteria will evolve, and they’ll adapt ways around that to overcome that obstacle.
I am more optimistic than that.
Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will.
But, this will come with a genetic cost to the bacteria.
The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us.
Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time).
This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances.
>The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do not necessarily evolve optimally all of the time. It is possible that an evolutionary step towards resistance might also improve the fitness of the germ overall (for example, by further optimizing the efficiency of a metabolic pathway). That evolutionary step might have been inevitable, but required additional selective pressure or the presence of a more active mutagen to actually occur.
Your claim is sort of assuming that each bug is already optimal for its environment, and any change must therefore be deleterious in some regard, but I hold that neither fact is necessarily true.
This makes the assumption that evolution results in a perfect organism, which it does not. Instead, it results in a "good enough" organism.
The definition of "good enough" for bacteria has changed over the last 50 years, so these changes are occurring now. It doesn't necessarily require a cost, or at least not a cost that matters to humans.
It's an insane world we live in where all the measures that should be used to control the distribution of antibiotics exist, but they are used instead for opiates.
I'm not saying opiates addiction isn't a genuine problem, but it's a largely individual one. There's no widespread negative externalities to prescribing opiates to a patient. Antibiotics on the other hand, present a classic limited pool resource allocation problem (the same species of problem as the tragedy of the commons).
It's antibiotics that should require a three part pad, with one copy sent off to the federal government and investigations into over-prescribers -- not painkillers. It's antibiotics that should be subject to intentional treaties governing their distribution and use -- not painkillers. It's antibioatics that should have criminal penalties for misuse -- not painkillers.
They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility)
They drop a bit of bacteria on the zero antibiotic section.
A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans.
One thing I learned from watching this episode of Frontline was that we aren't doing a lot of research into new antibiotics. Companies like Pfizer (the original makers of penicillin) would rather create drugs like Lipitor or Prozac, things that customers will take everyday for the rest of their lives. Antibiotics are intended to be used as sparingly as possible, which doesn't leave room for a lot of profit. Even the National Institute of Health has but antibiotic research on the back burner to pursue more pressing concerns.
The other big problem we face is that certain antibiotics are like steroids for farm animals. I believe that they kill the bacteria in the gut of a cow or big that signals when they should stop eating, resulting in larger stock (or something like that). This increases the exposure of bacteria to the antibiotics, making things less safe for all of us.
But drug companies and farmers aren't to blame for our antibiotic situation. Capitalism encourages profit and doesn't ask questions about how it's made. Corporations have a fiduciary responsibility. And doctors can't be faulted for overprrscribing antibiotics either. A sick person is the ultimate debugging task and most doctors will try anything that could help the patient. I don't know if this problem has a good solution.
If we research new antibiotics then bacteria will eventually evolve to resist them (kicking the can down the road). If we stop using antibiotics then more people will suffer, potentially unnecessarily (destroying the village to save the village). Trying to fight evolution is a losing game. I am, however, confident that someone somewhere will come up with a break through in the next few decades that will allow us to temporarily solve this problem once again.
The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything. Moreover, it is perfectly possible for lineages of bacteria to go completely extinct, and that has undoubtedly happened more times than human beings are aware.
Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings.
And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
General reply to express thanks for and respond to the several replies my first comment here received. First of all, I wrote in the original reply, "his warnings should be taken seriously," so I am by no means disagreeing with the quoted CDC expert about his general policy recommendations. Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.
I respectfully note the disagreement of several participants here have with me. They disagree with my disagreement with the interviewed expert's casual language about thoughtful agency by bacteria. Noting your statements that this is just everyday conversational usage, I stand by my objection to that fallacious manner of speaking. Most people in the English-speaking world think erroneously about biological evolution and especially about the implications of evolution for human medicine. I am not alone in thinking that popular thinking about biology needs to be improved by rejecting the idea of organismal agency in evolution,[2] although it is remarkably hard to find this kind of careful thinking by a Google search amid the flood of webpages that specifically assert a purpose or intention to evolution by natural selection. Ernst Mayr, mentioned in one reply to my first comment here, is indeed a rare example of a reliable author on that issue. Human beings have a cognitive bias of attributing agency to inanimate objects,[3] and the reactions to my first comment suggest how deep-seated that cognitive bias is.
The entire revised introduction to the thirtieth anniversary edition of Richard Dawkins's book The Selfish Gene[4] appears to be available for free online reading, and Dawkins writes explicitly about what level of analysis can be useful when pretending that genes have intentions and goals while thinking about problems in evolutionary theory. The University of California Berkeley website about evolution has a good page about antibiotics[5] that makes helpful medical practice and public policy suggestions with more cautious language.
There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. The precautionary principle suggests that we follow the quoted expert's policy recommendations, but meanwhile conduct research for a deeper understanding of the biochemistry of harmful microorganisms and their ecology.
Two other comments at this level express the nub of the argument:
I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover".
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town.
That is very well put, and deserves your upvote.
At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
A good question. It is an empirical question about the future, so it has no definite answer yet, but that is the general research direction to follow to get around the legitimate problem mentioned in the article kindly submitted here.
I think it's a bit pedantic to argue about his usage of "desire". Evolution is a blind watchmaker. The bacteria are reacting to selective pressures. Large populations of bacteria around the world are getting exposed to different kinds of antibiotics. It's not a matter of "if" they will acquire resistance, but "when", and we're seeing this happening right now.
The fact that lines of bacteria go extinct does nothing to disprove the fact that bacteria are developing resistance to antibiotics. Is it possible that there are antibiotics out there that can stop the newly-resistant bacteria? Of course. But it's getting harder and harder to find newer and more-powerful antibiotics.
A promising alternative appears to be bacteriophages.
You are completely right in that bacteria don't have the ability to "want" things since they don't have any kind of brain. However, desire is a useful way for the general public to understand what is happening. It's like saying "Water wants to flow to the lowest point of a room" or "The arrow wants to follow the path of least air resistance"
I share your distaste of when evolution is personified or otherwise represented to be anything other than a powerful but passive process.
That being said, I have no problem with the statement that bacteria want to survive. They most certainly have mechanisms that are engaged actively in order to increase chances of survival. Horizontal gene transfer (http://en.wikipedia.org/wiki/Horizontal_gene_transfer) allows bacteria to evolve in means other than traditional reproduction.
To add to my pedantic argument, it's not a conscious desire of theirs, but I'd argue that the basic things that humans do to survive (eat, drink, sleep, and have sex) are not conscious desires either. I'd argue that sexual reproduction is a mechanism that directly represents the biological success of greater genetic diversity and sharing of genes between organisms. We desire sex, and we desire sex with the best genetic candidates, and it's all a biological process encoded into our DNA that represents our desire for survival, so in that sense, bacteria desire survival as well.
And what does desire even mean? Does desire require consciousness and the ability to choose? It's a horribly imprecise term if you stare too long at it, so what I'm saying is that I don't think it's useful to pick on the doctor for his choice of words in this case.
Anyway, you have great points otherwise, but that first paragraph is not a point worth tripping over.
I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover".
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. It took evolution billions of years to make machines that can run 60 miles per hour. It took humans a few thousand years to create machines that run about 12 times that fast.
Bacteria work on a faster time scale than animals in terms of evolution, but five orders of magnitude? Somehow, I think we'll win in the long run.
Is there any indication that the organisms we have "stolen" antibiotic molecules from might become themselves suffer disruption from bacteria that they can no longer kill? Fungi are involved in many symbiotic relationships that we indirectly depend on, for example the fixation of nitrogen for plant growth.
One imagines a future in which we have a dwindling supply of biodiversity to 'sacrifice' in order to keep ourselves safe from bacterial onslaught.
Not unlike oil -- millions of years to produce, but destroyed in a few generations of exponential human growth.
> we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists
This is the stuff of the Nobel prizes of yore, and it is the mechanistic basis for how antibiotics kill bacteria and not humans. Penicillins destroy the cell wall as it is remodeled (humans don't have a cell wall); lincosamides block protein synthesis at the ribosome (humans have a different ribosomal structure); amphotericin binds ergosterol and forms ion channels in fungal membranes (humans lack ergosterol).
As we continue to explore biochemistry, we will continue to understand (and perhaps even discover) new antimicrobials, though I suspect most of the future advances will come from large-scale screens of discovered or synthesized compounds without taking much biology into account until secondary stages (to increase potency or reduce toxicity).
Evolution doesn't work the same way in bacteria as in other organisms due to horizontal gene transfer[1]. Bacteria can't be split into well-defined lines, because they share a common pool of genetic information.
[2] is a good book to get a perspective on antibiotic resistance.
In his book 'Toward a New Philosophy of Biology" there is a chapter on this very topic - how teleonomy has pervaded almost all of Biological science and how teleological statements, which are just plain incorrect, are the major way in which Biological processes are explained. I think this has only increased in severity and effect as we have consolidated our systems level view of the world and I've often been in awe of the general ignorance toward fundamental principals such as this.
My own personal take on the situation?
I think it is a very dangerous and ignorant thing for our species to continue with it's genetic hegemony of our ecosystems, creating vast evolutionary plateaus where the slightest advantage can run amok and adapt into something that could wipe out entire species. There is _probably_ enough genetic diversity in humans to avoid this, but I doubt so amongst our crops and livestock.
But I share your optimism/pragmatism in that I feel our human ingenuity will overcome, and if so then the prizes are great indeed. From new drug delivery systems and entirely new ways of treating illnesses, to a more mature approach to our interactions with the biological inheritance we have here on Earth 1.0 - I would like to see our crops and livestock diversified, farming practices overhauled to focus on the long term and most importantly more serious study devoted to analysing and utilising the solutions evolution has put in front of us for the taking.
Not only are these things (IMHO) essential to the prolonged survival of our species, they are also achievable. The organic farming movement took only a generation to go from grass roots to industry standard (and I know there is all sorts of controversy surrounding it but the point is that the industry IS open to disruption), here in the UK there is a debate simmering under the surface of the popular media that could end in more wild deer providing venison for the pot, Canadian geese too, and everyone knows of the whole insect protein debate, and the practical applications of bio-tech and nano-tech are only getting more interesting as the fields begin to find their feet.
Good summary of human being's advantage in the war. But don't forget bacteria's key advantage: iteration speed.
Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses.
It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's are to win, I think they will need to bump up the defensive iteration time an order of magnitude or so.
Right. We could lose the utility of all naturally-occurring antibiotics and still be OK because we synthesize new ones.
However, right now the first part is happening and the second part isn't, so until medical science and technology advance sufficiently far -- if indeed they ever do, and specifically if they ever do before a devastating plague hits -- we're in trouble.
Thinking about the ideas you bring up.. it seems we humans have been playing on the same level as the bacteria upto now. Greedy algorithm vs greedy algorithm. Could we perhaps use certain antibiotics that will force bacteria to evolve in a way that opens up a certain weak spot which we will then allow to spread through their population before we step in and wipe them out using this forced back-door? This simple 1-2 plan seems enough to really cause evolution a problem if humans can coordinate enough to pull it off (and a plausible plan appears, details..).
One of the best ways to combat the problem is to speed-up detection speeds of bacteria. Lots of companies are tackling this problem. One of them I've been following has made enormous progress in reducing these detection times.
They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24 hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours. Etc.
"These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic."
The profit motive is almost as blind a watchmaker as natural selection. We've built an environment which encourages bacteria to develop antibiotic resistance. Let's structure a pharmaceutical industry in which antibiotics are profitable.
The problem appears to be myopia. Antibiotics make money for a few weeks, chronic diseases for a lifetime. Fortunately, finance long ago solved the temporal shifting of incentives and payoffs. We need smooth the lumpy, often in-the-future, demand for antibiotics.
The government could tax the pharmaceutical industry, medical insureres, or the public. The proceeds would fund tax credits for the developers and/or producers of antibiotics. Alternatively, a more elaborate system by which health and life insurers incentivise antibiotic research, perhaps by issuing credit default swaps on pools of their reinsurance liabilities to antibiotic developers, could be structured.
It turns out there is a whole sub-field of interaction between medicine and finance devoted to the economics of drug discovery. You can google it, but here's one example:
I attended a talk by an economist (whose name I don't recall, alas) who discussed establishing a futures market for drugs, with portfolios which would smooth out variabilities in what works and does not. It's pretty much the same as what you described.
I'm pretty sure an X-Prize-style $10 Billion tax free for the next antibiotic from the government[1] would probably get something done. Given our needs, the $10B would be cheap. Heck, buy the next 3 or 4 discovered.
1) assuming said government exempts the company from court claims on the approved drug
This is very serious. But consider the worst-case outcome:
No more anti-biotics, for anyone.
That is, we go back to the era before anti-biotics, life in the 1920's. Maybe mortality rates will go back to that era, and maybe higher. But thankfully we aren't talking about a plague. At least not yet.
Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics, but (unknown to him) I didn't take them. I healed fine. And so it was in the 20's and before that. Plenty of people survived and thrived before anti-biotics. And life will go on when we don't have them anymore.
No doubt these super bugs have had to give up certain advantages to attain what is (for their species) a very specialized survival mechanism. Which means that if we ease off of the drugs for a while, the bacterial populations will compete, and the less drug resistant ones will thrive. Then we can use our drugs again. Or that's the idea.
What I'd really like to see are the internal assessments of big pharma of these gram neg bugs. Why isn't it economically feasible to create new drugs for them? This article makes it sound like there is a large and growing market of suffering people who'd be more than willing to spend every last cent for a pill to make the pain go away. And if the prospect of people willingly bankrupting themselves for drugs doesn't perk big pharma's interest, I don't know what would.
The anthropomorphism of bacterial evolution makes the article hard to follow for the layman (me). Can someone familiar with bacterial evolution please explain to me how the use of antibiotics leads to superbugs? I am clearly misunderstanding something.
I was under the impression that in a population of bacteria, genes express themselves in any number of random ways. If we expose the bacterial culture to antibiotics, the bacteria susceptible to the antibiotic dies, while the resistant bacteria lives on free to reproduce, leaving the descendant bacteria with resistive characteristics...
My question to the HN scientists is, doesn't this just destroy some subset of bacteria? Is new genetic information produced that did not exist before? Taking this trimming tree down the line, wouldn't the "superbug" antibiotic resistant bacteria have been created/survived and thrived anway? Or does the antibiotic exposure actually cause, "the bacteria to want to survive", in the sense that exposing them to antibiotics leads to more rapid mutation of descendants? Why wouldnt the antibiotic resistant bacteria be created with or without overuse of antibiotics? Isn't the spectrum of the genetic tree just trimmed?
I remember hearing about Soviet research into phage therapy, where bacteriophages are cultured to consume particular strains of bacteria. I believe the treatment is only in use in a couple ex-Soviet states. Is this a reasonable avenue once we're essentially dealing with only MRSA-like infections?
This resistance scares me a great deal, especially as a new dad. I'm hopeful that in the coming years we'll be able to target bacteria and viruses more specifically using nano-technology and other tools at a cost effective level (admittedly I don't have a lot of knowledge in this area but I'm hopeful.)
If all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacterials every 50 years or so depending on the resistance trends we see crop up and hope we don't lose too many humans in the process. At any rate, I'm glad lots of smart people are working on this problem.
I know the article tries to explain things in a way a layman can understand, but the wording when it comes to evolution is quite poorly chosen IMO. Saying thinks like 'Bacteria, like any living organism, want to survive' and 'bacteria will always change in order to survive', are just incorrect and will result in big misconceptions.
To my knowledge, bacteria don't have an agenda, they don't want to survive and they certainly don't change in order to survive. Instead, they change at random, which sometimes helps an individual to survive and sometimes not.
> Another reality is there’s not much money to be made in making new antibiotics, so we saw a lot of drug companies who left the field of antibiotic development because of this combination of factors, that it was getting really hard to discover, to develop new antibiotics, and you don’t make a lot of money in selling these drugs, so the market really wasn’t there.
To me this seems like the big problem here. Antibiotic resistance is an inevitability regardless of our usage rates - there's too much selective pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have to constantly be developing new antibiotics just to keep pace.
I suspect this problem will self-correct eventually, with the unfortunate side-effect that the cost of effective antibiotics will skyrocket for awhile.
That being said, we're obviously not doing ourselves any favors by dispensing them like candy, especially to the agricultural industry. It definitely encourages cycles - Effective antibiotics are rare and therefore profitable so tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes down because there's so many options/patents expire -> Overuse -> Resistance develops quickly and we're left with few effective options.
I'd like to know what this will do for bacteriophage therapy. Georgia has been the center of phage research since the 20s and has a massive bank of phages for all sorts of infections. Can someone more knowledgeable of this topic explain why the end of antibiotics is such a problem if there's already a decent alternative? What are the downsides to phage therapy?
I wish he mentioned the massive dumping of antibiotics into our food supply via feedlots, et cetera. You think the fact that all the meat we eat is swimming in antibiotics for its entire life has something to do with this antibiotic resistant bacteria in our stomachs? It'd be a damn shame to undo one of the miracles of the twentieth century so your chicken sandwich is fifty cents cheaper.
Meanwhile tons of antibiotics are used in factory farming. I'm not sure why it has ever been legal to use massive amounts of antibiotics on animals that aren't sick yet.
[+] [-] nostromo|12 years ago|reply
[1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...
[+] [-] stcredzero|12 years ago|reply
[+] [-] bradleyjg|12 years ago|reply
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
[1] Preventing Antibiotic Resistance Act of 2013 -- http://thomas.loc.gov/cgi-bin/query/z?c113:S.1256.IS:/
[2] Preservation of Antibiotics for Medical Treatment Act of 2013 -- http://thomas.loc.gov/cgi-bin/bdquery/z?d113:H.R.1150:@@@L
[+] [-] kephra|12 years ago|reply
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiotic free meat.
[+] [-] route66|12 years ago|reply
[+] [-] grecy|12 years ago|reply
If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.
http://en.wikipedia.org/wiki/Ishmael_%28novel%29
[+] [-] AaronFriel|12 years ago|reply
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|12 years ago|reply
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.
[+] [-] zeteo|12 years ago|reply
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.
[+] [-] ramblerman|12 years ago|reply
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.
[+] [-] swamp40|12 years ago|reply
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."
[+] [-] cliveowen|12 years ago|reply
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.
[+] [-] humanrebar|12 years ago|reply
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).
[+] [-] timthimmaiah|12 years ago|reply
For example, my company TeselaGen (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.
[+] [-] tieTYT|12 years ago|reply
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?
[+] [-] yetanotherphd|12 years ago|reply
[+] [-] ronaldx|12 years ago|reply
I am more optimistic than that.
Sure: as long as antibiotic resistance is crucial for bacterial survival, bacteria have a natural need to evolve it. And, they will.
But, this will come with a genetic cost to the bacteria.
The reason that antibiotics work is because they are attacking some function that has deliberately evolved, through natural selection, to be like that. Antibiotic resistance must literally cost bacteria some efficiency in some of their other functions.
This cost was originally such that the bacteria would die. Fantastic. But note: we wouldn't actually benefit from all bacteria dying at the mention of the word antibiotic, and some bacterial resistance is good for us.
Under normal circumstances, bacteria that don't need to carry around antibiotic resistance with them will most likely have a lower genetic cost and thrive better. This may be why we have seen MRSA predominantly in hospitals and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would be MR all the time).
This gives me some hope - that antibiotic resistance is balanced, genetically forcing bacteria to be less effective in other ways and less competitive in other circumstances.
We humans are not out yet.
[+] [-] mjt0229|12 years ago|reply
I'm not convinced that there must be a cost; furthermore, I think it's unlikely that if there is a cost, it is high enough to be significant. Bugs evolve, but they do not necessarily evolve optimally all of the time. It is possible that an evolutionary step towards resistance might also improve the fitness of the germ overall (for example, by further optimizing the efficiency of a metabolic pathway). That evolutionary step might have been inevitable, but required additional selective pressure or the presence of a more active mutagen to actually occur.
Your claim is sort of assuming that each bug is already optimal for its environment, and any change must therefore be deleterious in some regard, but I hold that neither fact is necessarily true.
[+] [-] falcolas|12 years ago|reply
The definition of "good enough" for bacteria has changed over the last 50 years, so these changes are occurring now. It doesn't necessarily require a cost, or at least not a cost that matters to humans.
[+] [-] bradleyjg|12 years ago|reply
I'm not saying opiates addiction isn't a genuine problem, but it's a largely individual one. There's no widespread negative externalities to prescribing opiates to a patient. Antibiotics on the other hand, present a classic limited pool resource allocation problem (the same species of problem as the tragedy of the commons).
It's antibiotics that should require a three part pad, with one copy sent off to the federal government and investigations into over-prescribers -- not painkillers. It's antibiotics that should be subject to intentional treaties governing their distribution and use -- not painkillers. It's antibioatics that should have criminal penalties for misuse -- not painkillers.
[+] [-] DanBC|12 years ago|reply
"Defeating the superbugs" (http://www.bbc.co.uk/programmes/b01ms5c6) has a segment showing bacteria developing resistance to antibiotics.
(http://v6.tinypic.com/player.swf?file=24goih4&s=6) (Sorry about the lousy host; YouTube's content sniffing detects this as BBC property and blocks it.)
They have a slab of nutrient jelly. The jelly has sections of differing strength of antibiotic. There's a section with no antibiotic, then 10x, then 100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at that point, they've reached the limits of solubility)
They drop a bit of bacteria on the zero antibiotic section.
A time lapse camera shows the bacteria growing, and developing resistance to each section. After two weeks the entire slab, all sections, are covered. The bacteria has developed resistance to the antibiotic, and is resistant to antibiotics at a strength that could not be used in humans.
It's an excellent, scary, bit of video.
[+] [-] hooande|12 years ago|reply
The other big problem we face is that certain antibiotics are like steroids for farm animals. I believe that they kill the bacteria in the gut of a cow or big that signals when they should stop eating, resulting in larger stock (or something like that). This increases the exposure of bacteria to the antibiotics, making things less safe for all of us.
But drug companies and farmers aren't to blame for our antibiotic situation. Capitalism encourages profit and doesn't ask questions about how it's made. Corporations have a fiduciary responsibility. And doctors can't be faulted for overprrscribing antibiotics either. A sick person is the ultimate debugging task and most doctors will try anything that could help the patient. I don't know if this problem has a good solution.
If we research new antibiotics then bacteria will eventually evolve to resist them (kicking the can down the road). If we stop using antibiotics then more people will suffer, potentially unnecessarily (destroying the village to save the village). Trying to fight evolution is a losing game. I am, however, confident that someone somewhere will come up with a break through in the next few decades that will allow us to temporarily solve this problem once again.
[+] [-] tokenadult|12 years ago|reply
Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings.
And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
[1] http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html
http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolu...
[+] [-] tokenadult|12 years ago|reply
I respectfully note the disagreement of several participants here have with me. They disagree with my disagreement with the interviewed expert's casual language about thoughtful agency by bacteria. Noting your statements that this is just everyday conversational usage, I stand by my objection to that fallacious manner of speaking. Most people in the English-speaking world think erroneously about biological evolution and especially about the implications of evolution for human medicine. I am not alone in thinking that popular thinking about biology needs to be improved by rejecting the idea of organismal agency in evolution,[2] although it is remarkably hard to find this kind of careful thinking by a Google search amid the flood of webpages that specifically assert a purpose or intention to evolution by natural selection. Ernst Mayr, mentioned in one reply to my first comment here, is indeed a rare example of a reliable author on that issue. Human beings have a cognitive bias of attributing agency to inanimate objects,[3] and the reactions to my first comment suggest how deep-seated that cognitive bias is.
The entire revised introduction to the thirtieth anniversary edition of Richard Dawkins's book The Selfish Gene[4] appears to be available for free online reading, and Dawkins writes explicitly about what level of analysis can be useful when pretending that genes have intentions and goals while thinking about problems in evolutionary theory. The University of California Berkeley website about evolution has a good page about antibiotics[5] that makes helpful medical practice and public policy suggestions with more cautious language.
There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. The precautionary principle suggests that we follow the quoted expert's policy recommendations, but meanwhile conduct research for a deeper understanding of the biochemistry of harmful microorganisms and their ecology.
[1] https://news.ycombinator.com/item?id=5674781
[2] http://whyevolutionistrue.wordpress.com/2011/02/21/natural-s...
[3] http://cogsci.stackexchange.com/questions/3951/is-there-a-co...
[4] http://books.google.com/books?id=koaD_Aod_V0C&printsec=front...
[5] http://evolution.berkeley.edu/evolibrary/article/medicine_03
Two other comments at this level express the nub of the argument:
I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover".
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town.
That is very well put, and deserves your upvote.
At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
A good question. It is an empirical question about the future, so it has no definite answer yet, but that is the general research direction to follow to get around the legitimate problem mentioned in the article kindly submitted here.
[+] [-] vivin|12 years ago|reply
The fact that lines of bacteria go extinct does nothing to disprove the fact that bacteria are developing resistance to antibiotics. Is it possible that there are antibiotics out there that can stop the newly-resistant bacteria? Of course. But it's getting harder and harder to find newer and more-powerful antibiotics.
A promising alternative appears to be bacteriophages.
[+] [-] jasonshen|12 years ago|reply
[+] [-] skunkworks|12 years ago|reply
That being said, I have no problem with the statement that bacteria want to survive. They most certainly have mechanisms that are engaged actively in order to increase chances of survival. Horizontal gene transfer (http://en.wikipedia.org/wiki/Horizontal_gene_transfer) allows bacteria to evolve in means other than traditional reproduction.
To add to my pedantic argument, it's not a conscious desire of theirs, but I'd argue that the basic things that humans do to survive (eat, drink, sleep, and have sex) are not conscious desires either. I'd argue that sexual reproduction is a mechanism that directly represents the biological success of greater genetic diversity and sharing of genes between organisms. We desire sex, and we desire sex with the best genetic candidates, and it's all a biological process encoded into our DNA that represents our desire for survival, so in that sense, bacteria desire survival as well.
And what does desire even mean? Does desire require consciousness and the ability to choose? It's a horribly imprecise term if you stare too long at it, so what I'm saying is that I don't think it's useful to pick on the doctor for his choice of words in this case.
Anyway, you have great points otherwise, but that first paragraph is not a point worth tripping over.
[+] [-] mistercow|12 years ago|reply
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. It took evolution billions of years to make machines that can run 60 miles per hour. It took humans a few thousand years to create machines that run about 12 times that fast.
Bacteria work on a faster time scale than animals in terms of evolution, but five orders of magnitude? Somehow, I think we'll win in the long run.
[+] [-] taliesinb|12 years ago|reply
One imagines a future in which we have a dwindling supply of biodiversity to 'sacrifice' in order to keep ourselves safe from bacterial onslaught.
Not unlike oil -- millions of years to produce, but destroyed in a few generations of exponential human growth.
[+] [-] carbocation|12 years ago|reply
This is the stuff of the Nobel prizes of yore, and it is the mechanistic basis for how antibiotics kill bacteria and not humans. Penicillins destroy the cell wall as it is remodeled (humans don't have a cell wall); lincosamides block protein synthesis at the ribosome (humans have a different ribosomal structure); amphotericin binds ergosterol and forms ion channels in fungal membranes (humans lack ergosterol).
As we continue to explore biochemistry, we will continue to understand (and perhaps even discover) new antimicrobials, though I suspect most of the future advances will come from large-scale screens of discovered or synthesized compounds without taking much biology into account until secondary stages (to increase potency or reduce toxicity).
[+] [-] mtdewcmu|12 years ago|reply
[2] is a good book to get a perspective on antibiotic resistance.
[1] http://en.wikipedia.org/wiki/Horizontal_gene_transfer [2] http://www.perseusbooksgroup.com/dacapo/book_detail.jsp?isbn...
[+] [-] sbirchall|12 years ago|reply
In his book 'Toward a New Philosophy of Biology" there is a chapter on this very topic - how teleonomy has pervaded almost all of Biological science and how teleological statements, which are just plain incorrect, are the major way in which Biological processes are explained. I think this has only increased in severity and effect as we have consolidated our systems level view of the world and I've often been in awe of the general ignorance toward fundamental principals such as this.
My own personal take on the situation?
I think it is a very dangerous and ignorant thing for our species to continue with it's genetic hegemony of our ecosystems, creating vast evolutionary plateaus where the slightest advantage can run amok and adapt into something that could wipe out entire species. There is _probably_ enough genetic diversity in humans to avoid this, but I doubt so amongst our crops and livestock.
But I share your optimism/pragmatism in that I feel our human ingenuity will overcome, and if so then the prizes are great indeed. From new drug delivery systems and entirely new ways of treating illnesses, to a more mature approach to our interactions with the biological inheritance we have here on Earth 1.0 - I would like to see our crops and livestock diversified, farming practices overhauled to focus on the long term and most importantly more serious study devoted to analysing and utilising the solutions evolution has put in front of us for the taking.
Not only are these things (IMHO) essential to the prolonged survival of our species, they are also achievable. The organic farming movement took only a generation to go from grass roots to industry standard (and I know there is all sorts of controversy surrounding it but the point is that the industry IS open to disruption), here in the UK there is a debate simmering under the surface of the popular media that could end in more wild deer providing venison for the pot, Canadian geese too, and everyone knows of the whole insect protein debate, and the practical applications of bio-tech and nano-tech are only getting more interesting as the fields begin to find their feet.
[1: http://en.wikipedia.org/wiki/Ernst_Mayr]
[+] [-] andrewparker|12 years ago|reply
Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses.
It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's are to win, I think they will need to bump up the defensive iteration time an order of magnitude or so.
[+] [-] CurtMonash|12 years ago|reply
However, right now the first part is happening and the second part isn't, so until medical science and technology advance sufficiently far -- if indeed they ever do, and specifically if they ever do before a devastating plague hits -- we're in trouble.
[+] [-] alexandros|12 years ago|reply
[+] [-] uptown|12 years ago|reply
They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24 hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours. Etc.
http://nanologix.com/test_results.html
Stopping these problems before they get the chance to spread is how I believe these infections will be slowed, as antibiotics become less effective.
[+] [-] JumpCrisscross|12 years ago|reply
The profit motive is almost as blind a watchmaker as natural selection. We've built an environment which encourages bacteria to develop antibiotic resistance. Let's structure a pharmaceutical industry in which antibiotics are profitable.
The problem appears to be myopia. Antibiotics make money for a few weeks, chronic diseases for a lifetime. Fortunately, finance long ago solved the temporal shifting of incentives and payoffs. We need smooth the lumpy, often in-the-future, demand for antibiotics.
The government could tax the pharmaceutical industry, medical insureres, or the public. The proceeds would fund tax credits for the developers and/or producers of antibiotics. Alternatively, a more elaborate system by which health and life insurers incentivise antibiotic research, perhaps by issuing credit default swaps on pools of their reinsurance liabilities to antibiotic developers, could be structured.
[+] [-] mturmon|12 years ago|reply
http://www.nature.com/clpt/journal/v87/n3/pdf/clpt2009298a.p...
I attended a talk by an economist (whose name I don't recall, alas) who discussed establishing a futures market for drugs, with portfolios which would smooth out variabilities in what works and does not. It's pretty much the same as what you described.
[+] [-] protomyth|12 years ago|reply
1) assuming said government exempts the company from court claims on the approved drug
[+] [-] javajosh|12 years ago|reply
Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics, but (unknown to him) I didn't take them. I healed fine. And so it was in the 20's and before that. Plenty of people survived and thrived before anti-biotics. And life will go on when we don't have them anymore.
No doubt these super bugs have had to give up certain advantages to attain what is (for their species) a very specialized survival mechanism. Which means that if we ease off of the drugs for a while, the bacterial populations will compete, and the less drug resistant ones will thrive. Then we can use our drugs again. Or that's the idea.
What I'd really like to see are the internal assessments of big pharma of these gram neg bugs. Why isn't it economically feasible to create new drugs for them? This article makes it sound like there is a large and growing market of suffering people who'd be more than willing to spend every last cent for a pill to make the pain go away. And if the prospect of people willingly bankrupting themselves for drugs doesn't perk big pharma's interest, I don't know what would.
[+] [-] hodder|12 years ago|reply
I was under the impression that in a population of bacteria, genes express themselves in any number of random ways. If we expose the bacterial culture to antibiotics, the bacteria susceptible to the antibiotic dies, while the resistant bacteria lives on free to reproduce, leaving the descendant bacteria with resistive characteristics...
My question to the HN scientists is, doesn't this just destroy some subset of bacteria? Is new genetic information produced that did not exist before? Taking this trimming tree down the line, wouldn't the "superbug" antibiotic resistant bacteria have been created/survived and thrived anway? Or does the antibiotic exposure actually cause, "the bacteria to want to survive", in the sense that exposing them to antibiotics leads to more rapid mutation of descendants? Why wouldnt the antibiotic resistant bacteria be created with or without overuse of antibiotics? Isn't the spectrum of the genetic tree just trimmed?
[+] [-] selmnoo|12 years ago|reply
[+] [-] mmoche|12 years ago|reply
[+] [-] sailfast|12 years ago|reply
If all else fails, I guess we'll depend on the cycles of nature's adaptations and break out a new set of antibacterials every 50 years or so depending on the resistance trends we see crop up and hope we don't lose too many humans in the process. At any rate, I'm glad lots of smart people are working on this problem.
[+] [-] felxh|12 years ago|reply
To my knowledge, bacteria don't have an agenda, they don't want to survive and they certainly don't change in order to survive. Instead, they change at random, which sometimes helps an individual to survive and sometimes not.
[+] [-] bronbron|12 years ago|reply
To me this seems like the big problem here. Antibiotic resistance is an inevitability regardless of our usage rates - there's too much selective pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have to constantly be developing new antibiotics just to keep pace.
I suspect this problem will self-correct eventually, with the unfortunate side-effect that the cost of effective antibiotics will skyrocket for awhile.
That being said, we're obviously not doing ourselves any favors by dispensing them like candy, especially to the agricultural industry. It definitely encourages cycles - Effective antibiotics are rare and therefore profitable so tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes down because there's so many options/patents expire -> Overuse -> Resistance develops quickly and we're left with few effective options.
[+] [-] tezza|12 years ago|reply
MRSA was a bit of a wakeup here in the UK, but the main 'solution' was concentration on cleaning hospitals rather than developing new anitbiotics.
It is my opinion that unfortunately it will require high profile people to start dying before support is galvanised.
It would seem from the outside that HIV/AIDs started to be addressed when superstars like Freddie Mercury started succumbing.
[+] [-] DonPellegrino|12 years ago|reply
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
[+] [-] warcher|12 years ago|reply
[+] [-] darkarmani|12 years ago|reply