
World without antibiotics - fern12
http://www.publicbooks.org/world-without-antibiotics/
======
moppl
There exists an alternative to antibiotics since it's very beginnings. It is
the bacteriophages therapy:

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

It is practiced since the 20ies in Tiblisi Georgia. TED talk about it:

[https://www.youtube.com/watch?v=sjH6m5VuR6I](https://www.youtube.com/watch?v=sjH6m5VuR6I)

So it is not all doomsday.

~~~
QAPereo
There are serious limitations to the current application of phage therapy, not
the least of which is the need to positively identify a given strain you want
to attack.

[https://en.m.wikipedia.org/wiki/Phage_therapy#Obstacles](https://en.m.wikipedia.org/wiki/Phage_therapy#Obstacles)

~~~
JoshTko
Isn't this potentially a feature? In that you won't be promoting resistance in
non target bacteria? Seems that this would force much less over-prescription.

~~~
keevie
That does seem like an advantage, but the downside is that people who don't
have access to fancy diagnostic equipment potentially just die of things that
could be cured with some antibiotics....

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pmontra
An order of magnitudes less important consequence of the end of antibiotics
would be the end of professional sports and possibly also amateur sports.

Probably not a big impact on baseball or cricket (but I don't know much about
them), but any contact sport, bicycle races, motor sport, climbing, etc has a
good chance of generating large scratches and injuries (broken bones, torn
tendons, etc) that result in surgical treatment. How many football players
(both the American and the rest of the world varieties) would survive a full
career, from childhood to mid 30s? And there is some crash at almost every
single pro bicycle race, with broken collarbones and/or patches of skin peeled
off by sliding on the tarmac. Again, how may of them would make it into the
40s without antibiotics? Amateurs go cycling for fun on Sunday morning. They
also crash. A broken collarbone is bad, but risking the life for a scratch is
much worse.

~~~
King-Aaron
Anecdotally, I've crashed my rally car a couple of times, fallen off my road
bike many more times, and wrecked myself pretty hard surfing a couple of times
- though I can't recall being fed antibiotics for any of those situations.

Anecdote aside, I have the feeling that you'd find more people succumbing to
lifestyle ailments than not if you were to (hypothetically) ban all kinds of
physical activity.

~~~
King-Aaron
Ironically, only a few days after making this comment, I'm on a course of
extremely potent AB's following being attacked by a large dog. Go me!

------
Angostura
There was an interesting piece on BBC radio 4 a few months ago looking at the
problems with the market when it comes to developing new antibiotics and I
suspect government intervention will be needed to help the market along.

The usual model of drug development is

Spot opportunity > spend lots on R&D > Go into production > maximise sales >
recoup money as soon as possible > Profit!

However, with new antibiotics we, as society absolutely do _not_ want them to
maximise sales. Ideally we don't want any production at all. At worst, we'd
like it to be used in a handful of cases for 5, 10 or 20 years, keeping it as
a treatment of last resource.

In such circumstances you can see the problem for the pharmaceuticals.
Personally, I think there needs to be some kind of prize fund that can let the
companies recoup (and make a decent profit) from antibiotic discoveries.
Either that or public-sector research.

~~~
adrianN
I feel like a lot more drug research should be state funded. Increasingly
often we hear about some miraculous new drug that costs an arm and a leg and
literally bankrupts people who need it. I understand that pharma corporations
need to recoup the massive R&D costs, but it seems morally reprehensible to
restrict treatment to the rich.

~~~
hashmymustache
The alternative to a $50k drug can be a $100k stay in the ICU.

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manmal
There are surely alternatives/augmentations to antibiotics. One that comes to
mind is that exposure to certain blue light wavelengths kills germs (as
recently discovered by the anti-acne industry). They could irradiate the
operated tissue with intense blue light (plus maybe red light to lessen
inflammation) before sewing up. And near infrared therapy (LLLT or even LED)
would deal with a lot of inflammation post-op. A quite cheap option actually..
it would of course not prevent all infections, but sure a lot of them.

ADDED

Since people seem to have trouble with the antibacterial claim, here is an
article:
[https://www.ncbi.nlm.nih.gov/m/pubmed/23009190/](https://www.ncbi.nlm.nih.gov/m/pubmed/23009190/)

Just google “pubmed blue light antimicrobial”.

~~~
adrianN
I'm pretty sure that if it were as simple as shining some light on tissue we
wouldn't use antibiotics, since they come with pretty strong side-effects.

Even supposing that the light really kills germs, the light won't reach all
spots in the wound and it wouldn't reach the bacteria that already entered the
bloodstream.

~~~
manmal
Some light wavelengths do kill germs, this is well established (EDIT: And I
don't even mean UV light, but other, visible wavelengths). Just google it up,
there's lots of papers. And big cos like Neutrogena offer inexpensive devices
that effectively kill bacteria responsible for acne - that's no proof, but for
me an indicator that this has arrived in the mainstream.

You are right that light might only kill bacteria on tissue surface. But this
is exactly where surgeons need it! My grandfather died of complications caused
by a resistant strain infection after hip surgery. What happened is that
bacteria from the environment entered the wound before it was sealed. Sure,
you won't remotely kill all germs, but you might make an otherwise deadly
infection manageable.

Just because it's not yet done, does not mean it's BS.

~~~
KaiserPro
You are confusing anti-septic with antibiotic.

Cleaning things _before_ you operate is relativly easy.
Iodine/bleach/listerene/arsenic/ozone will all kill bacteria on surfaces.

Why antibiotics are great is that they can be taken orally and they kill
bacteria _inside_, but not your body.

UV/blue light is indescriminate, you can swallow a blue light pill and expect
it to descriminate between your body and non-local bacteria

~~~
tremon
_Why antibiotics are great is that they can be taken orally and they kill
bacteria _inside_, but not your body._

FCVO "your body". Antibiotics definitely do kill gut bacteria, which many
consider to be part of our bodies.

~~~
KaiserPro
yes, it does, which is a side effect, however unlike anti septic it doesn't
total the intestine wall, and anything else behind it.

For example Arsenic is a brilliant antibiotic, its just it kills you _and_ the
infection. what we call antibiotics are far more diserning.

~~~
thfuran
Which really is a shame. I think the terminology ought to be the other way
around.

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MollyR
A world without antibiotics is also a world with very limited surgeries.

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vt100
Maybe we should stop randomly giving antibiotics to chickens in order to make
them bigger

~~~
wolco
When is this going to stop?

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sebringj
This was on TED where it demonstrated using Ultraviolet wavelengths at a
particular frequency that didn't cause skin cancer but only killed surface
bacteria.
[https://www.ted.com/talks/david_brenner_a_new_weapon_in_the_...](https://www.ted.com/talks/david_brenner_a_new_weapon_in_the_fight_against_superbugs)
we good

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tzahola
Bacteriophages!

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staticelf
This always scares me and I think it isn't covered in mainstream media enough.
When you say this to people, often they don't believe you.

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cageface
Makes you wonder why we allow the animal agriculture industry to jack up their
profits with wildly excessive overuse of antibiotics and externalize the cost
onto the rest of us, not only in terms of dollars but in terms of loss of
access to fundamental and essential medical procedures.

~~~
jopsen
Yeah, we won't need rationing for humans if we just stop overuse in
agriculture.

Credits to the EU for regulation this aggressively.. I even think the US is
doing something:
[https://en.m.wikipedia.org/wiki/Antibiotic_use_in_livestock](https://en.m.wikipedia.org/wiki/Antibiotic_use_in_livestock)

As with climate change, this is probably going to hit emerging economies the
hardest.. due to lack of regulation and less ability to deal with cost of
workarounds.

~~~
hycaria
Wow wow wow, are you kidding ? You must be one of those regulators that
constantly press breeders and veterinarians over lowering antibiotics usage in
livestock, yet risible efforts in comparison are made in human medicine. Let's
use latest generation antibiotics for the smallest procedures ! Who cares ?!

Literally everyone is doing something about it in animal care (in the EU we
lost availability of many specialties, or some are now usable only after
antibiograms), yet it doesn't get better because MDs don't do shit. And what
can they do after all, people can just go and find another practitioner. I
just hope that with such reasoning you're ready to have your animal protein
have its price tripled then or see your dog die of pneumonia, because that's
what we're coming to.

Or maybe everyone needs to brace themselves and endure having a cold for 2
more days and not resort to antibiotics for every little thing, or we will
soon leave our YOPI (young, old, pregnant, immunosuppressed) to dying with no
available care. By our current state of overpopulation, it's not a big deal
after all.

~~~
alkonaut
What's your point? That the EU banning antibiotics in healthy livestock is a
bad thing, because it drives up meat prices? I'm completely happy with meat
prices where I live and our ban on antibiotics for growth (i.e. in health
animals) predates the EU regulation.

> Or maybe everyone needs to brace themselves and endure having a cold for 2
> more days and not resort to antibiotics for every little thing

The reduction in antibiotic use here by doctors is also pretty noticable. I
certainly don't get antibiotics prescribed for every little thing. Also, it's
important to remember that while doctors might seem like they throw
antibiotics at every patient, they typically prescribe the same very narrow
antibiotics for everyone and use broad spectrum ones more restrictively (which
is a good thing). It would be terrible if people could buy broad spectrum
antibiotics over the counter.

~~~
hycaria
Not everyone is prepared for higher animal protein prices (I don't think it's
a bad thing, and I don't consume them anyways). But the people most prone to
ask for radical measures are often the least aware of situations and their
consequences.

>our ban on antibiotics for growth

Which were the only approved use of antibiotics in animals in your country
without a doubt.

>I certainly don't get antibiotics prescribed for every little thing

Yeah me neither yet the spectacular decrease we should see is not there yet.
Maybe there are other, more exigent patients then ?!

>they typically prescribe the same very narrow antibiotics for everyone and
use broad spectrum ones more restrictively (which is a good thing). It would
be terrible if people could buy broad spectrum antibiotics over the counter.

Well luckily some are only available in hospitals or such. But when I hear war
stories from a veterinarian friend who switched to human medicine and sees
lastest quinolones used systematically no matter the health status of the
person for benign procedures, we just facepalm. They don't want to take the 5%
risk that someone will need aftercare I guess. But MRSA and nosocomial
infections are the real, growing threat...

~~~
alkonaut
> Which were the only approved use of antibiotics in animals in your country
> without a doubt.

You mean countries had (or has) laws that _prohibited_ antibiotics for its
proper use (to treat infection) but _allowed_ antibiotics in livestock for
growth stimulation? Which countries were that? And what would be the reasoning
behind that?

As I understood it, the "bad" countries allow antibiotics for both purposes,
whereas the "good" countries started restricting antibiotics for growth, and
eventually banned it completely. Have I completely misunderstood you mean?

~~~
cageface
Antibiotics are still used in massive quantities in the US solely to promote
growth and also to allow animals to be confined in increasingly smaller and
less hygienic environments and to compensate for increasingly dirtier and more
dangerous slaughterhouse conditions. None of this is necessary. From what I
understand this is less the case in the EU.

80% of the antibiotics used in the US are given to animals, not people:

[http://www.sciencemag.org/news/2017/09/are-antibiotics-
turni...](http://www.sciencemag.org/news/2017/09/are-antibiotics-turning-
livestock-superbug-factories)

~~~
alkonaut
While I'm sure the situation isn't improving as fast as the ambitions are, the
last regulation in the US which bans the use of subtherapeutic antibiotics in
feed, was effective as late as jan 1st 2017. So the regulation at least seems
to be catching up, whether realtity is following is another question.

~~~
cageface
Any progress in this direction welcome, of course. We have a long way to go.

