
World on cusp of 'post-antibiotic era' - pmoriarty
http://www.bbc.co.uk/news/health-34857015
======
cryoshon
"Bacteria becoming completely resistant to treatment - also known as the
antibiotic apocalypse - could plunge medicine back into the dark ages."

Probably not, for a number of reasons. The arms-race strategy of antibiotics
vs drug resistance was doomed to fail from the start, as many know. The
solution is counter intuitive: stop the arms race of stronger and stronger
antibiotics completely, and the bacterial resistance to weaker antibiotics
will be reduced over time. It's expensive for bacteria to keep antimicrobial
genes around, and once the selective pressure of an antibiotic environment
decreases, they'll lose the traits that confer resistance. It may even be
possible to phase out one drug resistance trait at a time in multiple-drug-
resistant populations. The horizontal gene transfer that the article mentions
is really cool, but ultimately a non-sequitor when it comes to population-
level infection control.

This solution means temporarily accepting uncontrolled drug-resistant bacteria
in some narrow cases, which is unpalatable, but this strat works in the petri
dish.

~~~
mooreds
Does "this strat" work when your father/mother/son/daughter is in the
hospital?

Or are you (and I include in "you" any human being with the choice) going to
want every antibiotic available for your loved one?

Maybe I miss the point of your comment, but if not, I doubt it is a viable
strategy.

~~~
zasz
This is one of the few fairly clear cases in real life where you could make a
utilitarian argument, though. Sacrifice a few lives now to save more in the
long run. I wouldn't want to be the government that has to dictate this
policy, though. The guilt would be too much.

~~~
cryoshon
Yep, that's my angle. Utilitarianism is king in epidemiology. We can pretend
otherwise, but frequently our hand will be forced anyway.

I don't know if we're going to need to "sacrifice" people who have poly-drug
resistant bacteria, but I'm guessing it won't be in our control anyway, if the
option is between doing nothing and the patients dying versus doing everything
we can and still having the patient die. Damage control is critical, and
sentimentality can't get in the way.

FWIW, I wrote an in depth report on controlling poly drug resistant
tuberculosis in poor countries when I was in college... the conclusion was
that quarantine was not only necessary, it was the only effective course of
action for people with full spectrum drug resistant TB. Of course, TB is far
more infectious and lethal than garden variety "bacteria".

------
zeveb
> They identified bacteria able to shrug off the drug of last resort -
> colistin - in patients and livestock in China.

…

> It is likely resistance emerged after colistin was overused in farm animals.

What the heck? Shouldn't the antibiotic of last resort be used only as … a
last resort? I can't believe that any farm animal would be worth the use of
such a drug (although I suppose it's possible, were it the last of its breed
or something).

~~~
fredsted
It seems like antibiotics like Colistin are uncontrolled in China, and perhaps
very cheap? It seems like madness to use these last resort drugs on farm
animals.

~~~
mikeash
The whole problem here (as with many other things) is that actions which are
"madness" when looking at the big picture come from perfectly rational actions
by individuals.

~~~
liamconnell
Nah I hate that kind of thinking. Someone or some group of people have to be
deemed responsible. Here's my thought process with this:

So in China, and every country there are a few relevant players. Farmers, farm
owners, politicians, and scientists.

Farmers (laborers) have to survive and most work wages so they arent
accountable. Farm owners have to compete and if they dont they go out of
business and someone will take their place so they're not really accountable.
But its the law that makes the rules of the game and so it is the
responsibility of the political class to avoid designing "tragedy of the
commons" scenarios.

There are at least SOME good-willed politicians who dont want things like
antibiotic-apocolypse. The problem is that they have a ton of scientists
whispering different things in their ears so they dont know what issues are
big threats and which are scientists trying to get funding into their own
field of study. Its therefore also the responsibility of the scientific
community to effectively communicate with the political class.

See? At least some people out there arent perfectly rational!

~~~
lotyrin
No, it's a closed loop of externalized costs. Workers have to try to eat,
businesses have to try to compete, voters have to promote their economic
interests, politicians have to stay elected. Climate change and antibiotic
resistance et al don't cost any of these people anything -- individually. If
nobody has to pay for them, and everybody has to compete to take advantage of
whatever they can to live and prosper, the rational thing is to fuck
everything up. It's a massive scale prisoner's dilemma with high stakes.

Government is ostensibly the system that prevents external costs, and imposes
rules that skew what's rational for individuals today to be closer to what's
rational for society tomorrow, but in practice it fails to do so much of the
time.

~~~
TeMPOraL
Exactly.

Also, per tradition, let me post a handy reference on coordination problems:

[http://slatestarcodex.com/2014/07/30/meditations-on-
moloch/](http://slatestarcodex.com/2014/07/30/meditations-on-moloch/)

------
iamthepieman
I wonder what this will do to the short term evolution of our species.

It's terribly morbid and I really don't think it will come to this but if many
people start dying due to once easily treatable infections then it could
rapidly (within a dozen generations or so) change how our immune system works.

A mass dieoff of a species due to a single catastrophic event is unlikely to
intensely select for certain traits.

A flood amonsgst a non-swimming species is as likely to select for resillience
or sleeping late in your tree or some other unpredicable attribute as it is
for the "swimming" gene

But constant intense pressure could easily single out favorable attributes and
I wonder what those will be and what the side effects or emergent traits of
those genes will be.

Of course we are evolving via technology and society more rapidly than
genetically so that could change everything.

~~~
mrestko
You mean a return to the wold before antiobiotics? The world that existed when
my grandparents were born? I doubt the few generations of people born during
the "antibiotic era" have any meaningful genetic traits connected with the use
of antibiotics

~~~
lucaspiller
Just to put things into perspective, the world population was around 2 billion
when penicillin was discovered in 1928. Even without antibiotics we still know
about things like sanitation and the importance of clean drinking water, so
it's not exactly going back to the dark ages as the article suggests.

~~~
DanBC
It's going to be pretty bad.

[https://publichealthmatters.blog.gov.uk/2015/11/02/i-need-
an...](https://publichealthmatters.blog.gov.uk/2015/11/02/i-need-antibiotics-
that-work-7-health-profs-share-their-antibiotic-resistance-fears/)

> If we can’t stop the infection, however, we can’t stop the sepsis. A world
> without effective antibiotics will mean that every one of the 100,000 people
> who develop sepsis each year in the UK - every one of the 18 million people
> with sepsis each year worldwide - could certainly die from simple infections
> like chest and water infections. A human could die from infection every
> second.

> When I started treating people with bacterial infections it was rare that I
> didn’t have tablet antibiotics that I could treat them with; rare that I
> needed to keep people in hospital to treat their infections. Now every week,
> I treat young women with last resort antibiotics for urinary tract
> infections. Rather than given them a simple 7-day tablet course, they have
> to stay in hospital for a week or more, or come to the hospital every day
> for an injection.

[https://publichealthmatters.blog.gov.uk/2014/11/18/10-reason...](https://publichealthmatters.blog.gov.uk/2014/11/18/10-reasons-
you-should-be-worried-about-antibiotic-resistance)

> When we discuss antibiotic resistance we talk about a frightening future and
> rightly ask for action to stop the problem from getting worse. But this
> doesn't mean it's all just an issue for future generations. It’s estimated
> that 25,000 people already die every year in Europe because of infections
> resistant to antibiotics and in the USA the figure is 23,000 people, every
> year.

[https://publichealthmatters.blog.gov.uk/2015/11/18/7-more-
re...](https://publichealthmatters.blog.gov.uk/2015/11/18/7-more-reasons-you-
should-be-worried-about-antibiotic-resistance/)

> In 2013 there were 480,000 recorded cases of multi drug-resistant TB (TB
> that can’t be treated by our usual medicines). TB is a bacterial infection
> that can spread through the lymph nodes and blood stream to any organ in
> your body. It commonly affects the lungs and while a lot of people might not
> consider it to be an issue in the UK, or think it couldn’t affect them, this
> isn’t true. 37 million lives worldwide have been saved by antibiotic
> treatment for TB since 2000. In some countries, it is becoming increasingly
> difficult to treat MDR-TB. Treatment options are limited, recommended
> medicines are not always available, and patients experience many adverse
> effects from the drugs.

------
jarmitage
Radiolab did a great podcast on this recently

[http://www.radiolab.org/story/best-
medicine/](http://www.radiolab.org/story/best-medicine/)

------
DamnYuppie
While this does sound terrifying I believe the next step in combating these
viruses will be precision immunotherapeutics. What I mean by this is that we
do have the ability to create custom antibodies for a specific person for a
specific virus or bodily activity. There are several companies working on this
and are having great results using this to treat cancer, first among them is
Imagen Biopharma, Inc.

~~~
vox_mollis
Cancer kills in months; sepsis kills in days. Do these techniques work on
those timescales?

~~~
DamnYuppie
My understanding is that it would be use as an immunization ahead of time.

~~~
ceejayoz
That doesn't really fit with "custom antibodies for a specific person for a
specific virus or bodily activity".

~~~
AnimalMuppet
Well, try this: You go to the doctor's office. They take a blood sample or a
throat swab or whatever. They DNA sequence the bacteria they find. Then they
give you antibiotics that will kill what _you_ have.

------
stank345
Isn't it possible for us to invent/discover new antibiotics?

~~~
adventured
The value of which skyrockets as each older antibiotic becomes increasingly
useless. That's being entirely ignored, seemingly in every article that talks
about this problem.

A recent example of a new antibiotic:

[http://www.smithsonianmag.com/science-nature/new-
antibiotic-...](http://www.smithsonianmag.com/science-nature/new-antibiotic-
dirt-soil-can-kill-drug-resistant-bacteria-180953828/)

Or how about this: a break-through that goes beyond classic antibiotics.
Something that hasn't been thought of yet. Not like humans have a history of
accomplishing such feats, right? Not like the entire last century of medicine
falls into that category.

I can't think of a single example in modern history, in which our species has
failed to think its way out of a major problem. X Y Z bad thing was supposed
to take us down, or impede our progress, and we thought our way out of it.
We'll continue to do that, and the overly dramatic forecasters of doom will
continue to be wrong as they always are.

~~~
brianlweiner
One problem is bacteria develop resistance to the new drugs very quickly.
Usually within 2-3 years.

It's difficult to recoup your investment costs for a drug that has an
effective use window that small.

~~~
noir_lord
I think if you have a disease that is curable with an antibiotic that gets
really out of control you will find that government funding will become much
more of a factor.

Been the government that threw a few billion bucks and saved thousands of
(electorate) lives is a good vote winner.

The cost of developing antibiotics is large (in the billions) but US defence
spending is 600bn dollars, UK defence spending is 60-odd bn dollars.

Governments should already be funding this stuff (imo) since the defence of
the realm is theoretically their first goal.

------
halviti
There is a natural way to kill every single bacteria out there. They are
called phages.

For every bacteria, there is a phage that will kill it.

Back in the Soviet Union they used this medical technology extensively to cure
all sorts of things, and the hospitals in Georgia and surrounding areas would
be sprayed down with phage to kill bacteria within the hospital corridors and
rooms to prevent the hospitals themselves from becoming breeding grounds for
bacteria.

If you're interested in learning more I would recommend the 1997 BBC four
documentary called 'The Virus that Cures'

~~~
gue5t
Quack flags: "natural", silver bullet, forgotten techniques from the past,
citation is a documentary

~~~
iamthepieman
Agreed about the flags. However in this case it may be a false positive.

[http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(...](http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736\(05\)66759-1.pdf)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400130/pdf/fmi...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400130/pdf/fmicb-03-00238.pdf)

[http://aac.asm.org/content/51/6/2156.long](http://aac.asm.org/content/51/6/2156.long)

~~~
mbrock
A long comment on MetaFilter by someone doing their Ph.D. research on phage
biology.

[http://metatalk.metafilter.com/21925/Interesting-
Profiles#10...](http://metatalk.metafilter.com/21925/Interesting-
Profiles#1012599)

Excerpt:

> _Over the last fifteen years or so, with the breakup of the Soviet Union and
> the exponentially growing crisis of antibiotic resistance, phage therapy is
> looking very exciting again. Unlike the ‘30s, we now have a decent
> understanding of phage biology as well as the infrastructure to keep phages
> cold until use, effective diagnostic tools, and most importantly, regulatory
> structures that shut out hucksters. The need is also dire, for example
> multi-drug resistant Staph infections kill more people in the United States
> than AIDS does._

> _Basic phage biology has also been undergoing a resurgence as we discover
> just how important phages are to the global ecosystem, they are indeed the
> dominant organism on Earth outnumbering anything else by two orders of
> magnitude. Indeed, despite being just ~125 nm tall (check this out for
> scale), if one were to stack the 1031 phages on the planet end to end you
> would get a tower that would stand 200 million lightyears tall. Our oceans
> are remarkably free of cellular life and the reason is phages, as well as
> the other the viruses of microbes. For example the growth and death of algae
> blooms are centrally mediated by viral dynamics. Meta-genomics studies of
> the oceans pull out more predicted phage proteins than anything else without
> some fancy filtering, and even then they get a bunch. Phages are also
> teaching us a lot about the primordial origins of life, they are after all
> proto-cellular organisms._

> _These days are exciting times to be interested in phages._

------
jcfrei
I wonder: The arms race between bacteria and other organisms has gone on for a
long long time, is there a defense mechanism against every bacteria? Because
otherwise bacteria would be the only organism to inhabit this planet? Or is
the only thing that historically prevented world domination by bacteria the
lack of transportation to remote places? If that's the case then has the
proliferation of mass transport ultimately shifted the odds in favor of
bacteria?

And are antibiotics a catalyst for the evolution of bacteria or its demise?

~~~
Retric
In terms of Biomass Bacteria are the dominate life form on the earth. The
average person has over 1lb of Bacteria living in there body and vastly more
bacterial cells than human cells.

------
raziel2701
This might be the influence of playing too much metal gear solid, but how far
ahead is nanomachine research? I know some people use nanowires coated with
certain human-compatible proteins to make them more appealing to osteosarcoma
(bone cancer cells) so the cancer cells take in these nanowires. However
implementation of a mechanism to target something like a bacterial infection
is not something I've heard of.

~~~
TeMPOraL
The thing you want to look at is biotech. Life is nothing but nanotechnology
that we didn't build and we can't control _yet_.

The hottest thing right now in fighting bacteria seems to be
bacteriophages[0]. I've heard Russians had some success in R&D there, but I
don't know much more. Maybe some knowledgable HNer could elaborate.

[0] -
[https://en.wikipedia.org/wiki/Bacteriophage](https://en.wikipedia.org/wiki/Bacteriophage)

------
akkartik
Anybody know if there's any progress with ADEP4?
[http://phenomena.nationalgeographic.com/2013/11/13/killing-s...](http://phenomena.nationalgeographic.com/2013/11/13/killing-
sleeper-cells-and-superbugs-with-assassin-janitors)

