
Could Ancient Remedies Hold the Answer to the Looming Antibiotics Crisis? - hunglee2
http://www.nytimes.com/2016/09/18/magazine/could-ancient-remedies-hold-the-answer-to-the-looming-antibiotics-crisis.html
======
reasonattlm
Plants are a poor resource to mine in comparison to bacteria. There are way
more bacteria, they evolve much more rapidly, and they spend much of their
time trying to kill each other.

The historical problem with mining the bacterial world has been that only
about 1% of all bacterial species can be cultured in the laboratory. That was
solved a couple of years ago with an ingenious low-tech approach called the
Ichip. The people who solved it went on an ad-hoc, short fishing expedition
and found a new viable antibiotic candidate the first time they tried. [1]

The future of antibiotics, like the future of a large chunk of drug
development, is thus going to involve mining bacteria for the weapons they use
on one another and the tools they use to eat things. We'll never run out of
those, and we'll have more candidates than we know what to do with once people
make a serious go of using the new methods of culturing bacteria. [2]

[1]: [http://www.the-
scientist.com/?articles.view/articleNo/41850/...](http://www.the-
scientist.com/?articles.view/articleNo/41850/title/New-Antibiotic-from-Soil-
Bacteria/)

[2]: [https://www.edge.org/response-
detail/26701](https://www.edge.org/response-detail/26701)

------
hprotagonist
looking for biologics in plants is really nothing new. Done intelligently,
you're exploiting 4.5 billion years worth of pre-optimization. Done poorly,
you're selling herbal supplement snake oil with no oversight or meaningful
regulation.

The last big hit was about a half-century ago, too, so it's no magic bullet.
[1,2] >natural products aren’t dead, by any means. But they aren’t an
untouched gold mine, either.

You'll get interesting hits, but the overall success rate for developing a
reasonable drug out of them is still about 2% overall.

Sometimes (see: tramadol[0]), you can also confuse reuptake with production,
and wind up concluding the wrong thing.

[0]:
[https://en.wikipedia.org/wiki/Tramadol#Pin_cushion_tree](https://en.wikipedia.org/wiki/Tramadol#Pin_cushion_tree)
[1]:
[http://blogs.sciencemag.org/pipeline/archives/2016/04/19/gri...](http://blogs.sciencemag.org/pipeline/archives/2016/04/19/grinding-
up-the-leaves-and-roots) [2]:
[http://blogs.sciencemag.org/pipeline/archives/2008/01/04/pla...](http://blogs.sciencemag.org/pipeline/archives/2008/01/04/plants_for_cancer)

~~~
Alex3917
> Done poorly, you're selling herbal supplement snake oil with no oversight or
> meaningful regulation.

For obvious reasons though, the plants and mushrooms with the longest
histories of antibiotic use tend to be the easiest to identify. I find it
generally really difficult to learn new species from field guides, but most of
the stuff with antibiotic properties is pretty trivial to identify even
without joining your local mycological association or native plant society.

E.g. plantago, one of the plants they are making a big deal about in the
article, is almost certainly growing within a hundred yards of wherever you
happen to be if you're anywhere in North America, Europe, or Asia. So yeah,
while it's completely criminal that big box retailers are allowed to sell fake
herbal medicines with impunity, I also think that people generally have a
moral obligation to learn something about their local plants and fungi anyway.

~~~
avn2109
>> "...almost certainly growing within a hundred yards of wherever you happen
to be if you're anywhere in North America..."

That's intriguing. Still true in downtown Manhattan?

~~~
Alex3917
> Still true in downtown Manhattan?

Absolutely. Just look in the grass of any park, or in any vacant lot, or even
near the base of many street trees. Basically it's impossible to go anywhere
with disturbed soil or grass without finding them.

------
hackbinary
There is also phage therapy.

[https://en.wikipedia.org/wiki/Phage_therapy](https://en.wikipedia.org/wiki/Phage_therapy)
[http://www.bbc.co.uk/programmes/articles/yGJ6MtYrP2S0gjssltQ...](http://www.bbc.co.uk/programmes/articles/yGJ6MtYrP2S0gjssltQBS2/could-
viruses-called-bacteriophages-be-the-answer-to-the-antibiotic-crisis)

~~~
FreeFull
One problem with phage therapy is that your immune system will still seek out
and destroy phages, even though they aren't capable of infecting your cells.

------
adekok
Related:

[http://www.sciencealert.com/1-000-year-old-onion-and-
garlic-...](http://www.sciencealert.com/1-000-year-old-onion-and-garlic-
remedy-kills-antibiotic-resistant-bugs)

People 1000 years ago were smart, and understood "scientific" practices such
as trial and error, running multiple experiments, etc. Since they had little
way to communicate with peers, the scientific revolution had to wait another
800 or so years.

------
blacksqr
Increasing antibiotic resistance isn't inevitable. Norway has placed strict
limits on antibiotic usage, and as a result, effectiveness of drugs like
penicillin is coming back [1].

All we have to do to solve our problems is behave sensibly.

[1] [http://www.cbsnews.com/news/when-drugs-stop-working-
norways-...](http://www.cbsnews.com/news/when-drugs-stop-working-norways-
answer/)

------
JoeAltmaier
Strange: after describing all the roadblocks to development (money,
indifference by pharmaceutical companies; government requirements; resistance
by regulators to anything labeled 'traditional') they mentioned how they'd
_added their own obstacle_ : the new international Convention on Biological
Diversity that requires companies to negotiate with traditional healers for
compensation.

------
dharma1
Wonderful article, thanks for posting.

It seems like a race against time, with much of the wisdom accumulated over
centuries lost as people move into cities, and with a lot of biodiversity
being destroyed.

Would be great if the proven natural remedies were compiled into a clean,
peer-reviewed database, free to use. I also wonder if it's possible to
automate the discovery and testing much further than currently

~~~
smallnamespace
> Would be great if the proven natural remedies were compiled into a clean,
> peer-reviewed database, free to use

'Proven' in this context means 'FDA-approved', but regulation in the US
basically _only_ encourages development of novel, patentable pharmaceutical
compounds at the expense of everything else.

Because only _novel_ compounds and formulations can be patented, there is zero
incentive for any company to do research on plant medicinals: they wouldn't be
able to recoup the cost of the research (people can just go buy the actual
plant supplement, even if the company patented a different formulation).

Because only deep-pocketed pharma companies seek FDA approval for drugs, the
regulatory apparatus has over time gotten more and more expensive and rigid. I
believe even getting a drug to Stage 3 trials is in the tens of millions of
dollars. This very high barrier to entry further forces pharmaceutical
companies to only invest in drugs that will be highly profitable
('blockbusters'). ([http://www.forbes.com/sites/theapothecary/2012/04/25/how-
the...](http://www.forbes.com/sites/theapothecary/2012/04/25/how-the-fda-
stifles-new-cures-part-ii-90-of-clinical-trial-costs-are-incurred-in-phase-
iii/#65af6acb41e8))

Because of the close relationship between pharmaceutical companies and
doctors, it's often a large professional risk for a doctor to prescribe a
supplement to a patient. If something goes wrong, the local medical board can
and will go after doctors for not going with FDA approved guidelines for
treatment. That's why to even see a doctor who will prescribe supplements, in
the US you often have to look for a 'naturopath'.

TL;DR: regulation that favors new compounds -> no profit incentive to look at
plant compounds -> no group that will lobby for change -> regulation that
favors new compounds

Just as a counterpoint, herbal medicines in China are widely available, very
cheap, and there is a large amount of government-funded research into which
plants have what compounds and what they do. Doctors are also allowed to
prescribe them and routinely do. Obviously, it helped that there was a
developed system of medicine in China before Western medicine arrived.

This is somewhat similar to the status of Kampo medicine in Japan ('Kampo'
literally means 'Han prescription'), except Kampo medicine isn't under as
active development.

By no means is the system in China is perfect -- there's probably under-
regulation of the 'patent medicine' system and a lot of low quality crap sold
to the public. But at the end of the day, a large class of pharmaceutically
active and relevant medicinal compounds aren't simply excluded because they
don't mesh well with the basic assumptions of the regulatory apparatus.

~~~
dharma1
Yeah. I don't think FDA-approved will ever happen for a majority of the
substances, since it's too expensive.

Perhaps "proven" could just be several independent studies showing something
works in a certain way. Even if most doctors were not able to use the database
initially in their daily work, it would still be valuable to researchers.

TCM - I'm not overly familiar with it, but I think an ideal system today would
need to be subject to much more rigorous scientific examination in terms of
what works and what doesn't. Traditional medicine and folklore can greatly
reduce the search space of plant compounds, but probably isn't enough on it's
own.

------
Mz
I got as far as the paragraph where they are hoping to _create new drugs_ from
these plants as their brilliant solution to the fact that drugs are our new
problem. I stopped there.

 _We cannot solve our problems with the same thinking we used when we created
them._

\- Albert Einstein

------
dorfsmay
What about phage therapy(1)? Why does it seem to be completely ignored in the
west?

1:
[https://en.wikipedia.org/wiki/Bacteriophage#Phage_therapy](https://en.wikipedia.org/wiki/Bacteriophage#Phage_therapy)

~~~
smallnamespace
At least in the US, the regulatory framework and medical system is heavily
biased towards mass-produced pharmaceuticals.

Biological agents like phages have a much higher regulatory hurdle to clear
(you need to show that they won't develop virulence), and they have also been
traditionally harder to administer than drugs (e.g. phage therapy ideally
requires a sample of the infectious agent and individualized identification of
phage species).

Basically once we discovered penicillin, it was so cheap, effective, and easy
to distribute, that we built a medical system premised on developing new
drugs, and dropped most alternatives. It's very hard to turn back the clock.

FYI, one reason phage therapy continued to be developed in Eastern Europe was
less widespread availability of antibiotics at the time.

~~~
dorfsmay
This makes a lot of sense but with superbug bacteria that are resistant to
antibiotics, wouldn't phage be a solution?

It looks as though we're not even considering them, while people are of MRSA
etc...

~~~
smallnamespace
We don't know that phages are a solution until a whole bunch of money has been
spent trying it, but the system currently discourages the research.

