
How to Avoid a Post-Antibiotic World - jseliger
https://www.nytimes.com/2017/01/18/opinion/how-to-avoid-a-post-antibiotic-world.html
======
lbarrett
The overuse of antibiotics in large-scale animal farming is particularly
terrible; many are given low doses of antibiotics as part of their food [1].
This gives bacteria lots of time and selective breeding to become resistant,
and it's probably the worst thing we could do for the long-term health of
humanity.

[1]
[https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock#Un...](https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock#United_States)

~~~
eeZah7Ux
Interesting to notice how europe banned antibiotics while China and US are
doing nothing about it:

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

~~~
maxerickson
The US has banned the use of medically important antibiotics as feed
additives:

[https://www.statnews.com/2017/01/03/fda-livestock-
antibiotic...](https://www.statnews.com/2017/01/03/fda-livestock-antibiotics/)

It's not a particularly aggressive action but it probably clears the 'nothing'
bar.

~~~
Fomite
It's the most direct "there is no good reason to use this" ban.

There's really three reasons to use antibiotics in livestock:

1\. Growth promotion 2\. Prophylaxis 3\. Treating disease.

The ban hits #1. #3 really doesn't deserve to be banned - it's a legitimate
use of antibiotics in veterinary medicine. #2 is where there's still a
problem, because the use of antibiotics as a preventative runs the gamut from
a perfectly legitimate veterinary intervention to an egregious misuse of
antibiotics depending on the circumstance.

------
milesf
From this website:
[http://seqclinic.com/chinese_medicine.html](http://seqclinic.com/chinese_medicine.html)

    
    
        Historically, a Chinese Medicine doctor was paid a
        retainer to keep their patients healthy. If a patient 
        became sick, the doctor would not be paid until the 
        patient’s health returned. In a similar vein, a doctor 
        that resorted to surgery was considered an inferior 
        doctor. If he/she did their job correctly and helped
        their clients stay healthy, there would be no need to
        perform surgery.
    

Perhaps the current incentive for drug companies is the problem. They don't
care if we stay healthy (which is what we all want), they only treat illness.
In fact you could argue it's in the best interest of drug companies to keep us
sick!

Maybe there's an alternative way to fund them, or an alternative way to deal
with infections in the first place.

~~~
abalone
_> If he/she did their job correctly and helped their clients stay healthy,
there would be no need to perform surgery._

Sheer nonsense. This assumes that all surgeries are a result of poor
preventative care which is trivially false.

Why does it seem like the folks criticizing the profit motive of
pharmaceutical companies see no such perverse motive in those selling holistic
treatments? I don't suppose that "alternative way of dealing with infections"
happens to involve spending money regularly on herbs and acupuncture...

~~~
Asooka
Yes, you're right in that adopting verbatim the philosophy of ancient China
isn't a perfect fit for our modern world. But the sentiment - that doctors
should make more money when we're healthy vs not is one worth thinking about.
Currently the entire medical field is reactive - you get sick, you get
treated. I've never heard of doctors administering preventative care. We don't
have a profession that fills the niche of "I'm feeling fine now, but I want to
take the steps necessary to prevent things that might ail me in the near
future".

~~~
DanBC
> I've never heard of doctors administering preventative care.

"Making every contact count", a UK initiative to make sure that doctors[1] use
every opportunity to promote smoking cessation, alcohol use reduction, weight
loss, and other lifestyle adjustments.

[http://makingeverycontactcount.co.uk/](http://makingeverycontactcount.co.uk/)

~~~
claudius
Though note that the NHS to some extend does incorporate that idea, namely
that doctors are paid by the state and _not_ by individual sick patients.
Hence, doctors don’t have an incentive to ‘keep their patients sick, but
alive’, which could be argued to be the case in systems such as Germany or the
US, where doctors are paid for each individual visit by each individual
patient.

~~~
andy_ppp
This assumes doctors are capitalists; some are sure, but most of those
_people_ went into banking...

------
csl
Alexander Fleming gave the following warning, way back in his 1945 Nobel
speech:

    
    
      It is not difficult to make microbes resistant to
      penicillin in the laboratory by exposing them to
      concentrations not sufficient to kill them, and the
      same thing has occasionally happened in the body.
    

From page 93 in
[https://www.nobelprize.org/nobel_prizes/medicine/laureates/1...](https://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-
lecture.pdf)

BBC did a very good radio segment about the penicillin discovery in their "50
Things That Made the Modern Economy" radio series:
[http://www.bbc.co.uk/programmes/p04pfn2z](http://www.bbc.co.uk/programmes/p04pfn2z)

------
jakobegger
A few important points about antibiotic resistance (as far as understood by a
lay person that likes to read articles on the topic):

1) Resistance is inevitable. It doesn't matter if everyone finishes their
prescribed treatment or not, bacteria will develop resistance to antibiotics
one way or another.

2) Antibiotic resistance comes at a cost to the bacteria. In the absence of
antibiotics, bacteria will lose their resistance. It is pretty unlikely that
you will get infected with antibiotic-resistant bacteria when you bruise your
knee in the dirt.

3) Multi-resistant bacterial infections mostly occur in a clinical setting,
where people are especially vulnerable to infections (people on a respirator,
people with a central venous line). You can prevent multi-resistant infections
just like you prevent normal infections: Use sterile gloves, isolate people,
follow procedure protocols precisely, etc.

Multi-resistant pathogens are a problem, but it's far from the doomsday
scenario painted in those "it's the end of antibiotics" articles.

~~~
morsch
Points 1 and 2 seem contradictory.

~~~
edem
It is not. Basically it says: "bacteria will get resistant with prolonged
exposure, but lose resistance when they are no longer exposed."

~~~
piratelax40
be very careful about semantics, the statement is:

bacteria will become resistant overtime when exposed to antibotics at
concentrations insufficient to kill all of them, however when removing the
selective pressure of antibiotics, they will "lose" resistance as that
selective pressure is no longer applied.

As the poster above mentioned, energetically, resistance to antibiotics is
costly, as bacteria will do things like increase the number of efflux pumps in
their cell membranes pumping out antibiotics. When there are plenty of
nutrients available as other strains have died, this is an acceptable
tradeoff, however without that pressure, the strains with less defense
mechanisms, but also need less nutrients to survive, will again outcompete and
become dominant.

Finally, just to reiterate, it is exposure at levels not high enough to kill
all strains that causes resistance development. If you maintain concentrations
so high that no strains can survive, resistance will never develop.
Unfortunately, this is virtually impossible in practice, as adverse safety
events would also occur too frequently at those 'scorched earth' levels.

------
gleb
We could use a solution from electricity markets.

Electricity generation companies are paid not just for the electricity they
produce, but also for reserve capacity. Because that's the only way to keep
the lights on reliably.

Seems like this would work for antibiotics and snake antivenoms.

[http://www.theenergycollective.com/adamjames/237496/energy-n...](http://www.theenergycollective.com/adamjames/237496/energy-
nerd-lunch-break-how-capacity-market-works-and-why-it-matters)

~~~
rtkwe
An electric company doesn't have to invent a new plant design or even build an
entirely new plant to have reserves but with antibiotics you do. Building
reserve antibiotics isn't simple and even holding back a known antibiotic
doesn't guarantee it'll work when you need it. We kind of already do that with
carbapenems which are supposed the be the antibiotic of last resort.

~~~
kpil
Yes, but I think I see the analogy.

The problem is the commercial model for funding and research, as a new
antibiotic is guaranteed to be a commercial failure, and the risks are high.

If EU, US and maybe the Chinese funded research - both universities but also
in some way that it would be economically interesting for commercial entities,
there would be new drugs.

~~~
Fomite
> a new antibiotic is guaranteed to be a commercial failure

This is not axiomatically true.

~~~
aembleton
If you develop a new antibiotic then it won't be used, it will be held in
reserve for when current antibiotics no longer work. We don't want to expose
bacteria to new antibiotics until we have to. This is why it would be a
commercial failure.

A change to the model where the government(s) develop their own antibiotics so
that they can sit on them might be in order. It's not much of a vote winner
but is as essential as defence.

~~~
Fomite
Except new antibiotics _are_ in use. Fidaxomicin is currently on the market,
and is not being held back just because Vancomycin still works.

------
cstejerean
Time to stimulate research into phage therapy instead of granting longer
patents to antibiotics. The field seems promising with a long history in
Russia but mostly ignored in the west until recently.
[https://en.m.wikipedia.org/wiki/Phage_therapy](https://en.m.wikipedia.org/wiki/Phage_therapy)

~~~
Fomite
Phages are being researched. This literally comes up in every single HN thread
on antibiotics, so once more, posting my "Why Phages Aren't the Answer"
shortlist. Note that I love phage therapy - this is the problems as seen by
someone who doesn't think it's a dead end.

Phage therapy is neat, it really is, but there are a couple major issues:

\- There is no such thing as a "broad spectrum" phage. You can't do empirical
treatment using phages, and there's not really "off the shelf" phage therapy -
it tends to be a bespoke creation for a particular infection.

\- There's some serious regulatory problems, similar to those experienced by
fecal transplant treatments. We're not yet really equipped to think about
handling evolving, custom microbes as a treatment. - Because of the first,
it's going to require a considerable amount more lab capacity than most
clinical settings currently have, and considerable delays until treatment.

\- There's also some biosafety issues around phage prep, but those are easily
solvable. It's a great way to treat particularly resistant or hard to treat
infections, but it's not a particularly great general solution. There's a
reason it was abandoned in countries with easy access to antibiotics - they're
just roundly superior in basically every respect.

~~~
danieltillett
As someone who used to work in the phage area there are in fact "broad
spectrum" phages. The problem is the methods used by most groups to isolated
phages selects for narrow host range phages. My group isolated hundred of
broad host range phages by using a better protocol.

You are right that phage therapy is very challenging under current
regulations. If we want phage treatments we are going to need to change how
drugs are licensed.

~~~
Fomite
Do you have a link to a paper on that protocol? I'd be interested in reading
more about it, because I've never encountered a phage-prep technique intended
for clinical use that wasn't targeted.

~~~
danieltillett
I didn’t think the protocol was that amazing so it is just described in
passing in our papers (see [1] for an example).

The basic idea is really simple. Phages come as both generalists and
specialists (and all grades in between). The specialists grow on a limited
range of bacterial strains, while the generalists can grow on a wide range of
bacteria (even different genera). The specialist phages grow faster than the
generalists in a single bacterial strain as they are better adapted to their
specific host. The problem is that when most groups isolate phages from the
environment they only use one bacterial strain at a time so they end up
isolating specialists rather than the generalists; the generalists are just
too slow to form visible plaques in the presence of specialists.

The solution to isolating broad host range phages is to use multiple bacterial
strains in the enrichment and isolation process (we used up to 50 at a time).
Under these conditions the generalists grow faster since they have more hosts
they can infect (i.e. the specialist can only reproduce in one bacterial
strain, while the generalists can reproduce in multiple). This tips the
isolation process towards pulling out generalists phages that have a broad
host range. I have to say when I entered the field I thought that this was the
way everyone isolated phages as it is so obvious, but I was wrong.

1\.
[http://aem.asm.org/content/77/4/1389](http://aem.asm.org/content/77/4/1389)

------
halestock
In its apparent desire to blame Congress for the end of antibiotics, this
article misses a big reason companies aren't developing new antibiotics
anymore: they just don't work like they used to. Every new generation of
antibiotic is effective for a shorter period than the previous.

~~~
melling
They should be blaming doctors and people for using them incorrectly. Doctors
used to give them to people because they had a cold, for example. People
insisted on being given some sort of medicine.

In India, you can still buy antibiotics over the counter.

[http://www.npr.org/sections/goatsandsoda/2015/09/17/44114639...](http://www.npr.org/sections/goatsandsoda/2015/09/17/441146398/why-
india-is-a-hotbed-of-antibiotic-resistance-and-sweden-is-not)

~~~
douche
Unfortunately, that does work in most cases. I'm curious what the success
rates would be if all zithromax (?) prescriptions were replaced with sugar
pills. I've gotten that drug many times for what may or may not have been
strep or bronchitis.

~~~
rscho
The "success" rate would still be very high, as most people would surmount the
infection. However, the "failure" rate (people dying) would be much higher as
well... I am sure you can see that would be an ethical and practical problem.
Where would you put the "safety" cutoff of not giving zithromax?

~~~
douche
Really, what are the rates on people dying from tier 1 infections like that

~~~
rscho
[https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm](https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm)

That kind of rates.

In the 1918 influenza pandemics for example, many people died of a bacterial
pneumonia following the flu infection. So you see, the impact of "1-tier"
infections is very real without antibiotics.

EDIT: by all means, downvoters, make your point explicit!

------
sengork
For those that would like to visualise how the bacteria vs anitbiotics evolve
in an experiment over 11 days, have a look at this video from Harvard:

[https://www.youtube.com/watch?v=plVk4NVIUh8](https://www.youtube.com/watch?v=plVk4NVIUh8)

------
Animats
The parent article is by two lawyers. Here's a better introductory article by
a biochemist.[1] A key point is that there are a finite number of small
molecules which can potentially be used as antibiotics. Throwing money at
finding them may not work against a depleting resource.

[1]
[http://fire.biol.wwu.edu/cmoyer/zztemp_fire/biol345_F10/pape...](http://fire.biol.wwu.edu/cmoyer/zztemp_fire/biol345_F10/papers/Davies_evol_anti_rest_mmbr10.pdf)

------
nradov
In evolving resistance to multiple antibiotics do bacteria tend to become
weaker or less fit in other ways? I would think there must be some trade offs
involved if they can no longer use certain molecules in their cell walls or
metabolic pathways. Or to put it another way, if there are resistant and non-
resistant bacteria in a particular environment will the non-resistant
population tend to out compete the resistant population in the absence of
antibiotics?

~~~
Fomite
The conventional assumption is that antibiotic resistance comes at a
substantial fitness cost, so in the _absence_ of selective pressure,
susceptible bacteria will out compete them.

This is a nice, clear, elegant theory.

It hasn't worked in practice. Community-acquired MRSA rates have risen, even
as the selective pressure from antibiotics has declined, and the general
observation is that the fitness cost is nowhere _near_ as big as we assumed it
would be.

~~~
jakobegger
Interesting. I didn't know about Community-acquired MRSA. From some googling,
it sounds like its spread is currently still limited to at-risk communities
(athletes that share equipment, kids in daycare).

There still has to be a substantial selective cost, otherwise the resistant
strain would quickly spread through the whole population, right?

~~~
Fomite
We honestly don't have a _great_ handle on it's prevalence.

It would only spread quickly through the population of there was also a lot of
selective pressure from antibiotics in the community. There's definitely
_some_ selective cost to multi-drug resistance, but it's proving to not be
nearly as big a hurdle as conventional wisdom suggested it would be.

------
whack
The article seems to have thrown in the towel with regard to existing
antibiotics, which seems like a waste since there's so much more we could do.
Restrict antibiotics the same way we restrict morphines. Censure doctors who
over prescribe antibiotics, when they aren't needed. Do not allow them to be
used in animal feed for any reason. We're talking about a vital resource that
can save millions of lives. Allowing this resource to be depleted by frivolous
use, is downright criminal.

~~~
cdmckay
The issue is that it needs to be a global solution. Just changing the rules in
the US won't prevent them from being abused in other countries.

~~~
adventured
China for example is by far the world's largest abuser of antibiotics [1]. The
average person in China is taking ten times the amount of antibiotics annually
that the average person in the US takes (and when you consider the number of
people in question, it's that much more staggering). You're spot on, in that
it's a dramatic challenge, figuring out how to convince a nation like China to
tamp down on that given the scale involved (eg a billion people being commonly
prescribed antibiotics for a normal cold).

[1]
[http://content.time.com/time/world/article/0,8599,2103733,00...](http://content.time.com/time/world/article/0,8599,2103733,00.html)

------
lunchladydoris
At the individual level, I've always thought of antibiotic misuse as (at least
in some part) a symptom of our resistance to authority. People end their
antibiotic course early (and then usually use the remaining pills another
time) because, of course, they know better. I've run into people like this
many times.

Now, perhaps doctors should take part of the blame for not explaining why you
should finish your course of antibiotics, but users should take some of the
responsibility too.

~~~
rwallace
To play devil's advocate, since this doesn't seem to get mentioned often:

1\. People ending their antibiotic course early is a drop in the ocean
compared to the abuse of antibiotics in agriculture.

2\. The advice to finish the course was coined back when GPs did house calls.
Now, if you use up all your current supply, what do you do next time you get
sick? By the time you know you need an antibiotic, you're not going to be well
enough to hump your arse across town to petition a doctor for a prescription.
The official answer might be to call an ambulance, but the ambulances and
hospitals are hopelessly overloaded already, and that's nevermind the
situation in the US where a hospital visit can bankrupt you even if you have
insurance.

~~~
DanBC
Don't play devil's advocate. Only advocate positions you believe in.

2) is countered by the fact that antibiotics are not needed by most of those
people; and antibiotics don't reduce the severity or duration of the disease
by much.

See for example conjunctivitis. Most people attend their doctors and expect to
be given antibiotics. This is the case even though doctors find it hard to
tell the difference between bacterial and viral conjunctivitis; and that
antibiotics don't reduce the severity of the illness, and only reduce duration
by one third of one day.

[http://bjgp.org/content/early/2016/07/05/bjgp16X686125](http://bjgp.org/content/early/2016/07/05/bjgp16X686125)

~~~
ZenoArrow
>"Don't play devil's advocate. Only advocate positions you believe in."

That's terrible advice. The main reason for playing Devil's advocate is to try
to see things from a different perspective to build a fuller understanding.
This is frequently useful.

~~~
DanBC
> This is frequently useful.

Not on HN it isn't.

~~~
ZenoArrow
Why not?

------
botexpert
It's such a shame we used them all on livestock. We raise around 60 billion
land animals every year and probably more than 90% is being given last-line-
of-defense antibiotics for faster growth. Perfect pool for some unbelievable
evolution of antibiotic resistant bacteria, and yet we want to ban
antibacterial soaps and other minor things.

But, at least the stakes and muttons and whatevz can be enjoyed.

~~~
nickhalfasleep
Another reason to grow laboratory meat in rooms so clean they do not need
antibiotics. _Do not need antibiotics.

_ Less water to consume.

 _Less energy to produce.

_ Can be situated closer to populations who consume it.

*Cruelty free.

------
toodlebunions
This is a global health crisis waiting to happen. Incentives need to be
created for pharma to create many new broad spectrum antibiotics. Longer
patents, financial or tax incentives, even subsidies, whatever it takes.

~~~
adventured
The solution is already rapidly inbound, few are talking about it for some
reason though. Within three or so years, everyone will be talking about the
obvious solution to it. You'll see dozens upon dozens of articles pop up in
that time, talking about the same thing...

For less than $20,000 you can start experimenting with new attacks on
infection and resistance, in your kitchen (so to speak; I'd suggest a real
lab), using CRISPR. You can order the bacterial samples you need very
inexpensively, and just begin working on it. Based on the current legal
position of Broad and Berkeley, You can also do any work you want around Cas9
or Cpf1 in the US, without concerns for licensing/patents (until or less you
plan to commercialize).

Only a few interesting things are out there about it now, that'll change
_very_ soon:

[https://www.ncbi.nlm.nih.gov/pubmed/26502735](https://www.ncbi.nlm.nih.gov/pubmed/26502735)

[https://www.geneticliteracyproject.org/2016/08/22/crispr-
gen...](https://www.geneticliteracyproject.org/2016/08/22/crispr-genome-
editing-game-changer-war-antibiotic-resistance/)

------
Ericson2314
Honestly drug bounties seems so much better than patents across the board.
Patents are better when you're inventing the market too, but even then are no
panacea as it may take a long time to build the market after the initial
invention, eating into the patterns lifespan. True innovative is often
bewildered.

Here not only is the market clear cut, but this benefits new entrents as the
immediate windfall allows for more risk-taking. It's liquidity for innovation.

Finally, the costs for patients / emergencies can be dirt-cheap, which is good
because just as one should have insurance to cover future emergencies, so
should society budge the R&D up-front.

------
umberway
There may be a lot of antibiotics present in the soil which haven't been
exploited yet because it's hard to grow in the lab the organisms which produce
them. However techniques are being developed to circumvent this problem and
here's an early discovery:

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

Hopefully other and fundamentally newer ways to fight infection will be found.
In the mean time getting fit and healthy now seems like a slightly wiser
choice than it already was.

~~~
candiodari
I don't think this is true. When we initially found out about antibiotics, in
about 15 years we got to about 5 working general purpose antibiotics (general
= works against pretty much every pathogen). Since then we've found 1 more, in
over 70 years.

Even if this new drug turns out to be a total success, counting on finding new
drugs in the near future seems to be an extremely long shot. It's not going to
happen. Rates of discovery predict availability of future drugs.

Furthermore the rate at which bacteria adapt to drugs has also increased.
Adaptation happens faster and faster. While I don't know how that applies to
this particular drug, a naive extrapolation would seem to indicate it won't
last half a decade.

~~~
guftagu
That is completely false. Just a Google search will reveal to you that dozens
of new antibiotics have been found since but they didn't last long. BTW,
Penicillin also lasted less than a year before bacteria developed resistance
to it.

~~~
candiodari
Well it's not false once you consider that those "dozens" are tiny variations
of the existing ones.

------
amorphid
It'll be interesting to see if/when a non-antibiotic solution to killing
bacteria comes along. I read about an approach a novel approach a couple
months ago that uses a polymer to destroy bacteria.[1] I'm not qualified to
comment on the merits of the science.

[1] [http://inhabitat.com/student-discovers-a-way-to-destroy-
supe...](http://inhabitat.com/student-discovers-a-way-to-destroy-superbug-
bacteria-without-antibiotics/)

~~~
sengork
There are a few of those non-antibiotic based approaches discussed in the
following BBC Horizon programme:

[http://www.bbc.co.uk/programmes/b01ms5c6](http://www.bbc.co.uk/programmes/b01ms5c6)

------
jahbrewski
Okay, I've read enough articles on superbugs to be seriously frightened. My
question: is there anything I, personally, can do to help?

~~~
lunchladydoris
There are two small things you can do:

1\. Always finish your course of antibiotics. Even if you're feeling better.
The course is as long as it is for a reason. 2\. If for some reason you choose
not to do (1) above, do not ever give someone what is left over from your
course.

~~~
askvictor
There is little evidence behind the length of the antibiotic course[1].
Depending on the type of infection, coming off antibiotics early may be better
for you (OTOH, this can lead to a bad outcome for you too).

[1] [https://www.mja.com.au/journal/2015/202/3/knowing-when-
stop-...](https://www.mja.com.au/journal/2015/202/3/knowing-when-stop-
antibiotic-therapy)

------
adventured
This premise is going to turn out to be entirely incorrect.

There's a wave of therapeutic approaches to antibiotic resistance coming in
the next 10-15 years, courtesy of CRISPR (gene editing broadly). We're going
to end up having hundreds of new experimental angles of attack at resistance
and infection. In fact, by far the bigger problem, is going to be narrowing
down the vast array of options of attack that CRISPR is going to unleash.

These articles repeating the same hyped up fear, are missing what's right
around the corner (which usually happens with such statements of doom, ala the
world running out of food claims from decades ago). And best of all it's going
to be inexpensive, relatively speaking, and extremely fast paced, to make
progress in that direction. Cas9 and its superior alternatives such as Cpf1
arrived just in time.

~~~
Fomite
I sincerely hope this is true, but 10-15 years ago high throughput
computational screening was going to usher in a new wave of targets and
molecules that acted against them, and we were going to unlock who new
families of antimicrobials.

------
grahamm
The problem is anti-biotics are no longer being developed. They could be
developed but it is not finicially worth a large pharma to do so.

Consider this, development takes years (>10) and costs billions due to failed
attempts (over 9 in 10 fail), testing, etc. They then go to market and no
government will buy them because the price is high to recoup the billions
spent developing over ten drugs which only one made to market. In the end the
governments force the companies to sell them at a loss should there be an
epidemic. Then to cap it all some company in another part of the world where
IP is not honoured rips off the drug and floods the most needed places with a
cheap knock off.

Where is the incentive for a pharma to go through this.

~~~
d33
How could the costs be driven down? Perhaps it's because FDA is overly
cautious?

~~~
grahamm
And before the FDA is over cautious the pharma is cautious. If they pushed a
drug through that didn't work or caused serious side effects there would be
legal implications that would wipe out some or all financial gains from the
drug. Back to having no incentive.

------
jvanderbot
[https://www.hhs.gov/about/news/2016/07/28/hhs-forges-
unprece...](https://www.hhs.gov/about/news/2016/07/28/hhs-forges-
unprecedented-partnership-combat-antimicrobial-resistance.html)

HHS has a joint initiative with UK-based research foundations.

I really wish an easy non-profit foundation existed that I could throw some
change at.

Here's some more information: [http://www.openphilanthropy.org/research/cause-
reports/antib...](http://www.openphilanthropy.org/research/cause-
reports/antibiotic-resistance)

------
necessity
The woman died because the antibiotic that could save her life was not
approved in the US by the FDA, not because there was no anti-biotic that could
possibly save her.

[https://www.theatlantic.com/health/archive/2017/01/a-superbu...](https://www.theatlantic.com/health/archive/2017/01/a-superbug-
resistant-to-26-antibiotics-killed-a-woman-itll-happen-again/513050/)

------
vivekd
>Although the patent system is good at producing new blood-pressure
medications and cardiovascular drugs, it’s not the right fit for antibiotics.

I don't know if I want to get into an arms race with microbes where we keep
trying to discover new antibodies only to have them develop resistance. Maybe
the better solution is to limit antibiotics only to life threatening
situations and let people build up their natural resistance.

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marktuff1
Doesn't it strike anyone that perhaps of constantly trying to kill everything
in sight that perhaps we should figure out a way to add super pro-biotics to
our micro-biome to create little beneficial bacteria armies to fight the war
against bugs instead of nuking our whole flora which then results in zero
immunity and ability to fight anything off.

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chrisgd
How are we able to create vaccines against bacteria and why couldn't we do it
for more strains i.e.,MRSA?

My son spent some time in the hospital fighting a pneumonia. Now his doctors
are looking into why his body didn't get immunity from the pneumococcal
vaccine (Prevnar13). I was always under the impression only viruses could be
immunized against.

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ivanceras
Wait until enough people are sick or dying at the same time to impact the
economy or some high ranking politician finds his dicks rotting away from an
untreatable STD and they'll soon plough money into the problem.

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thephyber
This was the subject of this week's "50 Things that Made the Modern Economy",
a BBC podcast:

[http://www.bbc.co.uk/programmes/p04pfn2z](http://www.bbc.co.uk/programmes/p04pfn2z)

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diminoten
I've never really bought these doomsday scenario claims, if only because I
feel like innovation is constantly taking place, and these projections
necessarily assume no new innovations (how could they predict innovation,
after all?).

~~~
Hondor
I agree. Furthermore, now that people are accustomed to not dieing all the
time, even with no new technology, we would probably tolerate more serious
measures to maintain this safety. Even if it came to draconian quarantine and
hygene laws, or just wearing a face mask every day.

Remember how Ebola didn't cause an epidemic in any moderately developed
country despite being one of the easiest diseases to transmit?

~~~
manarth

      Ebola didn't cause an epidemic in any moderately developed country
      despite being one of the easiest diseases to transmit?
    

Ebola isn't airborne, and an infected person isn't contagious until they start
to present symptoms. Although it's a very serious disease, its presentation
makes an outbreak relatively easy to recognise and control.

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mtdewcmu
An even more direct way for the government to push discovery of new
antibiotics would be for the government to do the R&D itself. Of course, that
would offend certain ideologues.

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known
Can we use a virus that eats/kills that bacteria and later we'll kill that
virus.

