
CDC Threat Report: ‘We Will Soon Be in a Post-Antibiotic Era’ - colmvp
http://www.wired.com/wiredscience/2013/09/cdc-amr-rpt1/
======
jacquesm
Antibiotics are now so widespread in use that you can detect them in the
ground water and in the oceans.

[http://sustainability.formas.se/en/Issues/Issue-3-November-2...](http://sustainability.formas.se/en/Issues/Issue-3-November-2012/Content/Focus-
articles/Residues-from-antibiotics-in-the-ocean-affect-the-whole-food-chain/)

[http://www.sciencedaily.com/releases/2007/08/070821153926.ht...](http://www.sciencedaily.com/releases/2007/08/070821153926.htm)

MRSA is just one small example of what the future holds if we don't manage
this carefully, we're actually exerting evolutionary pressure on the one
adversary that holds a serious trump card over us, an 8 hour reproductive
cycle.

~~~
jessriedel
> Antibiotics are now so widespread in use that you can detect them in the
> ground water and in the oceans.

"Detectability" is a silly metric which tells you nothing about this issue.
Molecules are really, really, ridiculously small. Most of the breaths you take
contain atoms from Caesar's last gasp, but that doesn't tell you anything
useful about the prevalence of Caesar.

~~~
MartinCron
It's the same kind if silly metric that is sticky, resonant, and evocative. If
you want people to care about what you have to say, it's a smart strategy,
especially if you back it up with meaningful analysis.

~~~
jessriedel
I use to come to HN because people argued intelligently. Now people want to
justify dumb pandering comments. What a bummer.

------
stephnexus
Agree that antibiotics need to be withheld from livestock unless they are
actually sick. Our conventional food system practices are a disgusting joke.

On the innovative side, I wish more research were ongoing with regard to
bacteriophages:

[http://en.wikipedia.org/wiki/Phage_therapy](http://en.wikipedia.org/wiki/Phage_therapy)

This therapy pre-dates antibiotics but is harder to target to the pathogen.
Russia has been using phages for decades.

Other options include natural antibiotics, like manuka honey, which is already
being used (as "MediHoney") by hospitals in the U.S. when other antibiotics
fail. My main question is: Why is this end-of-line therapy, when it has few to
no side effects and it's more difficult for bacteria to develop resistance to
it (since it's a multifaceted natural compound, instead of a single-strategy
synthetic compound)?

Answer: profit. But it's time for us to evolve. And evolution in this case
doesn't necessarily mean more high-tech -- we're low-tech organisms, it's
quite possible that the solution is also low-tech.

~~~
haldujai
Actually you're quite mistaken. The reason no one uses phage therapy is
because for it to be effective it has to be given in a cocktail, i.e. you're
given 20 different phages at a time. The FDA/CDC strongly discourage cocktail
usage as it promotes the development of resistance more than antibiotic abuse.

MediHoney is used mainly as a wound dressing to prevent infection, not to
treat current infections (maybe infections at the wound site). The answer is
not profit as you may believe.

~~~
Blahah
That's not the only reason no-one uses phage therapy - there's also a strong
cultural resistance in the west. I've worked on phage targeting various
Salmonella serovars, and while you do require cocktails for the most effective
treatment, but phage evolve along with the pathogen. There's no inherent limit
on the availability of phage like there is with our current suite of
antibiotics.

With extensive sequencing-based environmental monitoring, as we're starting to
see in many western countries, we can detect the evolution of new bacterial
and phage strains in near real-time and isolate the phage to treat the
pathogens. We can keep up with pathogen evolution. There's no equivalent
system for generating new antibiotics. I reckon this kind of tech is only a
few years away - all the pieces are coming into place.

~~~
j_baker
_but phage evolve along with the pathogen._

How do you prevent the phage from evolving to target the human cells?

~~~
haldujai
(Bacterio)phages target bacteria only by nature, there are several mechanisms
that prevent them from targeting human cells. They recognize bacterial
membranes and not human, their replication mechanisms don't work in human
cells and our cells have defenses against them. In short it would take a great
amount of evolution to make them target human cells in the order of thousands
of years at least due to the several existing barriers.

See:
[https://en.wikipedia.org/wiki/Bacteriophage](https://en.wikipedia.org/wiki/Bacteriophage)

Edit: Just in case someone calls me out on this 'thousands of years' is an
educated guess on my part from studying evolution not something I've actually
read.

~~~
tedunangst
How long did bacteria and penicillin coexist? Thousands of years? Then
practically overnight the bacteria decided they needed to evolve...

I don't think evolution always works according to the popular "and then the
next giraffe's neck was 1mm longer than its parents'" gradual change model.

~~~
lutusp
> How long did bacteria and penicillin coexist?

In different places, not an issue. It's only when penicillin is directly
applied to a bacterial colony is there any chance for bacterial evolution to
take place.

> Then practically overnight the bacteria decided they needed to evolve

You mean, when humans applied penicillin to bacteria on a large scale for the
first time? That changed the bacteria's environment, most died, except those
naturally resistant. It's classic natural selection.

> I don't think evolution always works according to the popular "and then the
> next giraffe's neck was 1mm longer than its parents'" gradual change model.

But one can argue that evolution almost never works, on the ground that the
vast majority of mutations aren't adaptive. But the argument misses the point
that some tiny fraction of the mutations become the entire future species
because of increased reproductive fitness.

Also, the "gradual change" you describe normally arises because of the odd
beneficial mutation, which, apart from being very improbable, might require
many thousands of years to manifest itself.

------
aluhut
I grew up in a former East Block country. Back then we had medical centers. If
you were sick, you went there and they gave you something. Most of the time
the solution was: Antibiotics. Because I was sick quite often, I can say I
grew up on Antibiotics. When we moved to West Europe my mother made the
mistake of chosing a doctor from our country (so she could uderstand what she
says). So I continued to get antibiotics until I got an bronchitis. Two weeks
had passed until the doctor decided it was a bronchitis and not "just" one of
my usual sick-phases (that she also treated with antibiotics). I spend
additional two weeks getting more of the same antibiotic. It got worse. Finaly
she decided that it may be useful to make an radiographic examination. Lucily
the doctor there realised that I had pneumonia and changed my medication.

I have not been to a doctor for over 20 years since. I did not take anything
besides some aspirine when I hit my head skiing 8 years ago. I don't know how
this is possible after my very hard childhood but I just don't get sick
anymore.

I am very sure that I'll not make the same mistake of letting the doctors
solve everything with the hammer when my children get sick.

~~~
swombat
_I don 't know how this is possible after my very hard childhood but I just
don't get sick anymore._

Sounds like whatever your doctors did worked miracles. No serious illness for
20 years? If this experiment could be repeated at scale, and proved to apply
to others, everyone should receive the same antibiotics treatment you had!

~~~
VLM
Perhaps his parents smoked. Mine did. All kinds of respiratory problems as a
kid, mysterious miracle cure at 19 when I moved out.

~~~
aluhut
No my parents never smoke.

I did though.

------
velodrome
People need stop using antibiotics for everything and use it only when
necessary.

When Drugs Stop Working-Norway's Answer:
[http://www.cbsnews.com/2100-205_162-6014559.html](http://www.cbsnews.com/2100-205_162-6014559.html)

~~~
r0h1n
> Norwegians are sanguine about their coughs and colds, toughing it out
> through low-grade infections.

> "We don't throw antibiotics at every person with a fever. We tell them to
> hang on, wait and see, and we give them a Tylenol to feel better," says
> Haug.

I wish more of us would follow this approach and learn to accept being 'sick'
for a few days (or even a week) every now and then.

~~~
rdtsc
What I noticed in US is that people are very touchy about being uncomfortable.
Doctors are supposed to "fix" problems and make things "comfortable". This
usually means "give me antibiotics to kill this infections as fast as
possible" and "give me more pain pills, I don't want to feel any slight
discomfort". If doctor tells them to drink some hot tea and lay in bed instead
they might just switch doctors who will give them antibiotics. Or say a doctor
decides that well you can get opiates for your pain but you might become
dependent so take some aspirin and tough it out -- that won't work with many.

I know I am painting with a broad brush and with a sample of 30 or so
acquaintances from both sides of the "pond" here, but it was my impression so
far.

~~~
astrodust
It's ironic this attitude comes from the same country that tells you to "man
up and walk it off" for just about anything.

~~~
gtaylor
I think this is probably more of a TV/movie thing than much based in reality.
We're no tougher than anyone else, but I could see how you may think we see
ourselves as such if you just watch our movies/shows.

~~~
astrodust
You'd think that's true, but then again, look at how badly veterans are
treated, especially those with deep psychological problems like PTSD.

------
alan_cx
Why is it that some apocalyptic scientific predictions are accepted, while
others gain a culture of denial?

Strikes me that one could construct a counter argument against this prediction
which is as strong as the arguments, for example, climate change deniers use.
Yet, no one has done so.

I'm struggling to imagine why. Is there profit for the current big players in
solving this issue, where as climate change solutions are not so good for
current energy supplier? Or something like that?

~~~
anon1385
If you speak to farmers or others in the meat industry you will find plenty of
strong denial about antibiotics in farming being a risk. You will find all the
usual arguments: it's impossible for bacteria in animals to ever affect
humans, they use different kinds of antibiotics, we will find newer
antibiotics to solve the problem Once And For All etc etc.

For the most part the lack of widespread public denial is because the public
are not talking about this issue so there is little need to modify public
opinion. There hasn't been any serious attempt to limit the use of antibiotics
in industrial farming in the USA yet[1]. If governments do get serious about
that then the denier dollars will start flowing and Heartland and Cato will
find shills to write articles about how the economic cost of stopping
antibiotic use (here is where they claim it is a total ban when it isn't) in
farming outweighs the cost of global pandemics because the people that die
will mostly be the economically unproductive old and poor or some similar FUD.

[1] [http://www.motherjones.com/tom-philpott/2012/04/fda-
factory-...](http://www.motherjones.com/tom-philpott/2012/04/fda-factory-
farms-antibiotics)

~~~
jacquesm
> it's impossible for bacteria in animals to ever affect humans

Those farmers should read the book 'spillover'. According to some papers 60%
of all pathogens has in recent times jumped from some other species to
humanity, and depending on how rigidly you define species you can add the
other 40% too.

~~~
haldujai
Their logic is that the meat will be cooked killing all bacteria and
denaturing and DNA remnants. What spillover discusses is referred to as
zoonosis, and that's when the animal is alive (or carries a vector that is).

~~~
jacquesm
To cook it you have to be in contact with it first.

------
ktd
Terrible, sensationalist title. The actual quote from the article is "If we
are not careful, we will soon be in a post-antibiotic era," which paints a
very different picture.

~~~
rurounijones
Given the fact that the "If we are careful" bit is not going to happen
(Without some drastic societal changes around the globe) I think we can pretty
much ignore that part of the sentence.

~~~
droopyEyelids
Yep. I'd like to see a detailed analysis of how the future will develop
regarding this.

America and most European countries already exercise care with antibiotics.
However, South American countries and India etc sell almost all of them OTC
where they can be incorporated into folklore style medicine.

Will drug resistant diseases stay within the boarders of the countries that
incubate them? Or will the cases that slip across borders be enough to negate
any benefit more careful countries cultivate?

~~~
rurounijones
> America and most European countries already exercise care with antibiotics

Warning: Generalisations ahead

And even in the countries you include as exercising care, we still have a
significant number of people who do not finish their antibiotic courses.

Tis a bit of a quandry, people tend not to be altruistic if they cannot
observe the effect of their altruism.

------
jtheory
Evolution is such an important concept for people in general to understand.
Bacteria evolve based on environmental factors (like varying levels of
antibiotics), and that's eventually a very bad thing.

Viruses evolve as well, and the nasty viruses that we _could_ eradicate
entirely if we had good global vaccination coverage instead -- for a host of
often-silly reasons -- get to explode in numbers in various outbreaks.

Even if a measles outbreak kills _no one_ , it is still a huge increase in the
amount of virus in the wild, and that means faster evolution.

I hate to imagine a parent who has been against vaccines (due to being duped
by the anti-vaxxers) finding that their own local outbreak was the source for
the super-measles virus, which isn't reliably stopped by vaccines and spreads
like wildfire, or is more deadly than current strains.

~~~
route66
Careful though, antibiotics are not directed against viruses but bacteria.
These in turn are not being "preempted" by vaccination, to use a threading
term for a threat.

[http://health.howstuffworks.com/medicine/medication/question...](http://health.howstuffworks.com/medicine/medication/question88.htm)

~~~
throwaway812
GP made no claims about antibiotics and viruses. (S)he was simply going on a
tangent about the problems with the anti-vaxx folks.

------
colmvp
Has there been any research to indicate that antibiotics in livestock gets
passed to humans (and if so, to what degree)?

I know that there was testimony by Dr. Lance B. Price to the House Committee
for greater transparency on "why, how and in what animals these vital drugs
are used."

[http://democrats.energycommerce.house.gov/sites/default/file...](http://democrats.energycommerce.house.gov/sites/default/files/documents/Testimony-
Price-Health-ADUFA-AGDUFA-2013-4-9.pdf)

~~~
route66
As a challenge a Dutch research:
[http://www.vwa.nl/onderwerpen/risicobeoordelingen/bestand/22...](http://www.vwa.nl/onderwerpen/risicobeoordelingen/bestand/2200068/antibioticaresistentie-
effect-van-antibiotica-versleping-via-diervoeder)

From the abstract (freely translated): "... guessed is that a third to half of
resistance encountered in germs within humans is of agricultural origin."

Important is that not the antibiotics are transferred from animals to humans
but the already resistant bacteria.

A short summary is here:
[http://www.upi.com/Science_News/2012/08/31/Antibiotic-
resist...](http://www.upi.com/Science_News/2012/08/31/Antibiotic-resistance-
seen-growing-in-soil/UPI-35091346452976/?spt=hs&or=sn)

~~~
colmvp
Awesome, thank you.

------
Tichy
Is the problem really hospitals, or is it industrial animal farming? Because I
suspect it is mostly the latter. It is of course more convenient to rant
against sick people than to give up the daily junk food burger.

------
rurounijones
while post anti-biotic sucks for humans directly. What about post-antibiotic
for livestock which forms our food sources.

If we can no longer raise as many cattle, pigs, sheep etc. then what are the
global implications.

~~~
smackay
Quite simple: healthier humans and more sustainable agriculture.

From Yahoo Answers: it takes 17 kilos of corn, beans, grains, etc, to produce
one kilo of beef in feedlot cattle.

Having a large proportion of meat in one's diet is not the most efficient use
of the available (limited) resources we have.

~~~
rurounijones
That is the simple answer in a perfect world.

I was more thinking of the political and economic effects, especially if there
is a post-antibiotic problem which quickly decimates existing stocks.

~~~
smackay
Unless there is some kind of apocalypse (rinderpest making it to the USA due
to global warming) then the decline in meat production might be (relatively)
gradual. The main use of antibiotics in agriculture (AFAIK) is simply to aid
fattening animals as they are sick for fewer days of the year and so can put
on more weight. Reduce antibiotic use and the market weight of animals will
decline and either prices will have to rise or demand will fall as people move
to other sources of protein - assuming there are reasonable/viable
alternatives.

I'm not sure there will be many political effects - unless of course people
are going hungry, however the economic effects might be interesting. If
intensive meat production stopped then perhaps there would be more free-range
or extensive meat available (certainly at a higher price). Environmentally
this might not be a bad thing, for example, the integrated olive/chestnut,
goat/pig agriculture we have here in Portugal is pretty good for wildlife.
More animals wandering over a wider area would be good for vultures as well
(which are in rapid decline globally). Admittedly this is probably a limited
scenario but it illustrates that there are desirable alternatives to highly
intensive agriculture.

Aside: The economics of meat production seem pretty crazy to me. I can go to
my local supermarket and purchase several meals worth of fatty pork for less
than the price of a couple of heads of broccoli and and few carrots. Given it
takes a lot more resources to produce the pork that suggests that the system
we have is seriously out of whack.

Caveat: Off course, we might not be able to carpet the globe in goats to make
this all work. It's just not going to be possible (or at least very difficult)
to do this with a population well in excess of 10 billion.

~~~
claudius
Regarding your aside: Cattle are usually not fed broccoli and carrots, and I
am fairly certain you can get loads of _their_ food for the price of some
fatty pork. Even one of the higher-quality cereals, wheat, is sufficiently
cheap that the price you pay for bread is almost entirely in manufacturing the
bread and the various ingredients with less mass.

------
cantankerous
Since new anti-biotic development is so critical, I don't get why the feds
don't in-source it to the CDC or provide massive incentives already. This is
an infuriating problem that should've been dealt with decades ago on the
R&D-funding front.

~~~
snowwrestler
As I understand it, the problem is more fundamental than that.

Antibiotics were originally discovered accidentally, and a lot of subsequent
antibiotics were discovered/created by investigating and extending the
mechanisms of the original discoveries.

We're now running out of those implications to chase down. To get the "next
breakthrough" in antibiotics will require another surprise discovery, or some
other fundamental breakthrough in basic biological understanding.

~~~
bbatchelder
Last I heard, the next breakthrough is expected to be the exploitation of
quorum sensing. Tricking the bacteria into thinking there are already more
than enough of them so they at least stop reproducing.

~~~
DerpObvious
Another use of interfering with quorum sensing is keeping bacteria docile,
even when they've multiplied to levels where they could be threatening to the
host.

------
NovemberWest
Yay. This is what our current healthcare system is giving us. And it is
impossible to talk about alternatives. You morons are going to die of hubris.
Basically.

------
coldcode
Once we all die, then people will change. Which makes as much sense as giving
pigs antibiotics.

------
jackgavigan
I, for one, welcome our new antibiotic-resistant bacterial overlords.

<mutter>Might finally put a stop to rampant population growth...</mutter>

