
Imagining the Post-Antibiotics Future - k-mcgrady
https://medium.com/editors-picks/892b57499e77
======
swombat
> _Dukes believes, though he has no evidence, that the bacteria in his gut
> became drug-resistant because he ate meat from animals raised with routine
> antibiotic use. That would not be difficult: most meat in the United States
> is grown that way. To varying degrees depending on their size and age,
> cattle, pigs, and chickens — and, in other countries, fish and shrimp —
> receive regular doses to speed their growth, increase their weight, and
> protect them from disease. Out of all the antibiotics sold in the United
> States each year, 80 percent by weight are used in agriculture, primarily to
> fatten animals and protect them from the conditions in which they are
> raised._

I really don't like to generalise in this way, but this sort of stuff makes
me, as a European, pretty angry at the general laissez-faire attitude of the
United States towards such things.

You may say "The US is allowed to govern itself as it wishes, no one's forcing
you to live there" \- but with its heavy use of antibiotics in cattle-raising
(banned in the EU - even though the US has tried to use its muscle to get the
EU to un-ban it), the US is basically doing a fantastic job of fucking up
antibiotics _for everyone_. So yes, I'm angry at the United States and its
corrupt political system that means that there's almost zero chance that any
of this will be fixed until it's far too late.

~~~
adventured
China is in fact by far the biggest problem regarding antibiotics.

So while you're busy being angry, don't forget to spread that anger around.

"Last month, the country's Ministry of Health revealed that on average each
Chinese person consumes 138 g of antibiotics per year — 10 times the amount
consumed per capita in the U.S. "

For those keeping track at home, that's about 41 times the total use of
antibiotics in China compared to the US due to their population size.

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

~~~
yaix
[http://en.wikipedia.org/wiki/Whataboutism](http://en.wikipedia.org/wiki/Whataboutism)

~~~
comicjk
The above argument is not whataboutism. The statement "the US is basically
doing a fantastic job of fucking up antibiotics for everyone" is false because
no policy change in the US will significantly affect the rate at which
resistant strains appear worldwide, US antibiotics consumption being less than
3% of China's. This refutes the original argument by bringing in additional
information, whereas whataboutism is defined as changing the subject "without
directly refuting or disproving the opponent's initial argument."

------
grlhgr420
when this was posted on metafilter last year someone posted a truly excellent
comment: [https://www.metafilter.com/134210/Imagining-the-Post-
Antibio...](https://www.metafilter.com/134210/Imagining-the-Post-Antibiotics-
Future#5305117)

~~~
tempestn
That was an extremely interesting comment. It would be helpful to mention that
it's essentially an overview of bacteriophages, viruses which target bacteria.
Describes their initial development, reasons why they aren't currently widely
used, and links to more information about possible future development.

------
Chattered
> who calls antibiotic resistance as serious a threat as terrorism

What an unbelievably stupid comparison. Terrorism is mass murder turned into
the sort of spectacle that causes us to massively _overestimate_ a threat to
our individual lives. If antibiotic resistance is that sort of threat, then it
isn't much of a threat at all, and we can all go back to worrying about normal
things such as dying from regular homicide, heart disease, crossing the road,
and choking on food.

~~~
Qantourisc
No it's not as serious as terrorism. Antibiotic resistance is MORE threatening
then terrorism !

~~~
Chattered
The stupidity of the comparison means that I have no idea what is meant by
"threatening." In terms of individual lives, regular homicide is far more
threatening than terrorism, as is choking on your next meal. Even ignoring the
entwining of terrorism with politics, that already makes this a meaningless
comparison.

And it's not necessary, because surely we've got plenty of analogous pandemics
in the field of medicine which can orientate ourselves to any looming crisis.
The AIDs virus in the West is still fresh in our memory, and a far more
appropriate comparison.

------
TheCoelacanth
> economists for the National Pork Producers Council estimated that removing
> antibiotics from hog raising would force farmers to spend $4.50 more per
> pig, a cost that would be passed on to consumers

That is an unbelievable. A single pig produces over 100 pounds of meat, so we
are risking catastrophe for a cost savings of less than 5 cents per pound of
meat.

------
exratione
This seems like the same sort of pointless hand-wringing that attends every
technology at its peak. There are any number of works in progress that could
replace antibiotics. None of them have yet because they are not economically
competitive. As that changes - because they either realize their potential to
be much, much more effective, or because the cost of working antibiotics rises
- then antibiotics will fade in favor of the next technology in line.

This is what happens to every technology. Yet people seem to forget, despite
the evidence all around them, that they live in a world that changes rapidly
due to the fact that many, many individuals are working on new and better ways
to do everything. Periods of seeming stasis to the outside observer - such as
the long use of antibiotics, which is really actually a continual hectic
development of new types of the single class of item - only occur because
economic conditions favor them. As soon as economic conditions favor another
technology, it is developed and deployed from its prototypes pretty rapidly.

~~~
cicero
I don't think it is pointless to consider the possibility that infinite
progress is not inevitable. You may have faith that science and technology
will always come through, but I don't. This blind faith that things will
always get better is one reason why people deny climate change. I'm not saying
we give up and admit defeat, but blind optimism is foolish. Keep working on
solutions, but be prepared for failure scenarios.

~~~
noir_lord
> I don't think it is pointless to consider the possibility that infinite
> progress is not inevitable.

It's an interesting thought but we don't even know what there is that we don't
know, In the late 19th century many scientists thought we'd solved science
(Kelvin among others said (in hindsight) hilarious things “Heavier-than-air
flying machines are impossible.” and "Radio has no future" and he was the
chair of the royal academy of sciences.

> You may have faith that science and technology will always come through, but
> I don't.

I have more faith in human ingenuity than I have in anything else, human
ingenuity exists _and_ works.

> This blind faith that things will always get better is one reason why people
> deny climate change.

I have no idea about that one, the climate change deniers I've met have
broadly been deniers based on religion or because it benefits them in some way
directly.

> I'm not saying we give up and admit defeat, but blind optimism is foolish.

So is blind pessimism, people forget that by every measurable standard the
human race is in a golden age (even including places like central Africa).

The one thing that has lifted large parts of the world out of a short nasty,
disease ridden life is science (and technology but they go together).

------
magikroundabout
Does anyone think it might just be an idea to change the amount of meat we
produce? When people start dying at the age of twenty and thirty of bacterial
infections that are totally curable today, and gonorrhoea becomes incurable,
will we think our current insouciance rational? Will it be seen as a price
worth paying in order to have cheap meat? A tremendous proportion of the
antibiotics we use are abused as growth promoters for animals reared for meat
or their products. They are used pro-actively on healthy animals outside of
the EU. Even within the EU, they are used routinely in a way that is driving
us towards a post-antibiotics future.

It is pretty sad to reflect that we are not able to prioritize our own health
above an immediate desire to consume more meat more cheaply.

------
dredmorbius
This problem has been known for a long time, though it's taken a while for it
to fully emerge.

I first encountered it reading Isaac Asimov's essay collection _Twentieth
Century Discovery_ , which highlights a number of the most significant
inventions of the 20th century as of its publication date, in 1969 (and no,
I'm not _that_ old, I read it probably ~15 years later).

[http://www.amazon.com/Twentieth-Century-Discovery-Isaac-
Asim...](http://www.amazon.com/Twentieth-Century-Discovery-Isaac-
Asimov/dp/B0027WR3JU/)

The point being that natural selection is a very powerful force, and while
antibiotics have proven useful, they've got very clear limits as well. And
humans are an awfully large and well-connected biological niche to exploit at
present.

------
bayesianhorse
One of the bright spots is that it seems hard for bacteria to evolve more than
one resistance, and that resistances don't confer an evolutionary benefit in
the absence of the specific antibiotics.

There are modern techniques to avoid resistance issues. For example, as most
diseases can be treated by more than one drug, switching them regularly in a
hospital or practice.

There are other combinations of drugs which haven't been used a lot or not
even been discovered yet. It would be nice for example to trick an infection
into letting go of the resistance and then attacking it with the AB.

~~~
mnw21cam
> One of the bright spots is that it seems hard for bacteria to evolve more
> than one resistance

Not sure where you got that impression. There are bacteria out there that are
basically resistant to every antibiotic we have. The article even gave an
example of a case where someone died because of this.

> There are modern techniques to avoid resistance issues.

Yes, true, and it is right that we should implement these techniques. However,
until the whole world plays along there are going to be problems. If sub-
clinical or too frequent doses of antibiotics are given somewhere in the
world, then antibiotic resistant strains of bacteria will develop, and can be
transmitted across borders.

~~~
bayesianhorse
Yes there are multiply resistant strains. But due to chance and evolution,
they are spreading slowly.

This is still a dangerous issue... just not as bad as if the multiply
resistant bugs sprang up all over the place like single-resistant ones do.

------
perlpimp
"removing antibiotics from hog raising would force farmers to spend $4.50 more
per pig, a cost that would be passed on to consumers."

one of those cases where savings of $4.50 a month cause extinction of human
race.

~~~
netcan
Eating a pig month would be quite an achievement.

------
venomsnake
I really really hope that the threat of antibiotic resistance is like the one
for terrorism. Almost negligible. But I really doubt it. Seems like a greater
serious one ...

------
Udo
Antibiotics are done, and they've been failing increasingly for at least two
decades even though nobody cared to report it then. The speed of our
transition to the "post-antibiotics era" is certainly our fault, but the
phenomenon itself was always inevitable. Biology is an arms race, and it will
always be one. In fact, biology overall is one of the worst substrates
imaginable for hosting conscious entities, and that means this and many other
problems may never be permanently solved.

However, it's not all hopeless. There are a lot of bacterial infections that
will continue to be treatable with antibiotics for some time to come. So it's
not like we'll lose all of our capabilities at the same rate. It just means
that gradually the number of strains that are panresistant will increase.

To see what complete powerlessness over an infectious agent looks like you
don't have to look further than viral infections today. The reality is we
still can't do very much to treat them, so over time we'll just add
significant bacterial adversaries to this list of diseases for which there is
nothing else but symptomatic treatment available.

This will all change, because medicine has to change. In the future, it won't
be enough to hit an unspecific infection with an unspecific antibiotic. It
will be necessary to analyze individual infections and their interactions with
individual patients in detail - and then very specific biochemical treatments
will have to be tailored on a case-by-case basis.

The recent rise of monoclonal antibody drugs is a bridge to that future. We're
still not knowledgeable enough, and we're still using these treatments with
all the finesse of a 3-year old hammering huge lego toys together, but we'll
get there eventually. We have to, it's the only hope against a lot of other
diseases as well, including cancer.

In the mean time, there is a lot of research that needs to be done. We're also
missing the actual technologies, both diagnostic and generative machines, but
the most important obstacle to overcome will probably be the culture of
medicine. This culture will change only when there is enough pressure for it
to change. The FDA will have to change when its primary role becomes denying
treatment to people who are going to die instead of keeping the population
safe. Medical professionals will change when it becomes a big factor that they
lack the scientific background to effectively devise and apply advanced
treatments. But first, all of these disasters will probably have to actually
happen, and we're already seeing the first signs of that trend.

So, there is definitely a path forward - it's not an inevitable descent into
the dark ages. It's just that due to inertia and time spent waiting for basic
scientific advances, there will be a period with less protection overall.
Drugs may become available to plug some of these gaps, like insect-derived
antibiotics, which will eventually fail too but will buy some additional time.

------
coldcode
Reading this scares the crap out of me. Unless there are incentives to drug
companies (and those who research other antibiotic tech) we could go extinct
before anyone creates a solution. Yet drug companies perversely invest
billions on drugs that cost $1000 a month and help solve relatively minor
ailments.

------
JasonFruit
I don't understand this bit: ". . . resistant bugs have grown more numerous
and by sharing DNA with each other, have become even tougher to treat . . . "

How are different microorganisms sharing DNA with each other? Am I
misunderstanding completely?

~~~
maxerickson
You are reading correctly. Lots here:

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

In short, one thing that happens is that they exchange small fragments of DNA
(called plasmids). Those fragments can contain the information necessary for
the resistance.

~~~
JasonFruit
Mind? Blown. I had no idea that happened — it sounds almost Lamarckian.

------
vim-guru
I guess there's already a movie in the making of how this all turns out.

~~~
kylebrown
The recent PBS Frontline documentary on the topic was excellent.

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a8da6b0c91d
I will be interested to see how sexual mores develop this century. I think the
"sexual revolution" will turn out to have been a flash in the pan. Resistant
clap and syphilis are a growing occurrence. I expect the old order of
arresting people for promiscuity to return and the new idea of privacy in the
bedroom to die.

