
Doctors Battle Drug-Resistant Typhoid Outbreak - GW150914
https://www.nytimes.com/2018/04/13/health/drug-resistant-typhoid-epidemic.html
======
rectang
Meanwhile, entrenched agricultural sub-therapeutic usage continues. It's a
classic tragedy of the commons scenario.

We can see the train bearing down on a crowd of people packed upon the tracks,
but real action won't happen until it plows through them. If then.

~~~
campground
I have felt, increasingly, like the only way to deal with this and many
similar problems (global warming, growing wealth inequality) is a legitimate
global government with real authority. Unfortunately, it feels like the public
appetite for institutions like that has never been lower, and all the smart
people seem to be obsessed with decentralization.

~~~
hackermailman
In my naive opinion, the least shitty modern political theory I've found so
far is Murray Bookchin's scheme for municipalism, where it's an Athenian
style, decentralized democracy with horizontal instead of vertical power
structures. The best part of this scheme is it can implemented within a state
like Pakistan so these peasants can organize their own affairs with each other
on a community basis for things like clean water or agriculture trading.

People are hesitant to usher in a global power because nobody in the elite
circles of such a power would bother listening to the concerns of the far
removed people affected by their laws, it's more likely they would just
implement ideology they think is best and become a prince ruling over a
colony.

If anybody knows of any universities with an active political theorist
department or journal that isn't recycling 20th century ideology I'd be
interested.

~~~
StavrosK
I've had an idea for a while, where you basically build a government as a
service. The way you do it is this:

1) You create a non-profit organization and hire a few people.

2) You create a website where every law proposal that goes through
parliament/congress/whatever is displayed on the website, and you give each
citizen one vote on this website on each proposal.

3) Your people run for members of parliament in the next election.

4) Here's the kicker: You promise that all of your elected members of
parliament will unanimously vote on each decision whatever the vote on the
website was. If a majority of citizens voted yes on a law, your people will
also all vote yes and (hopefully) pass it.

5) Citizens are incentivized to elect your MPs because they are basically
direct democracy, transparent and accountable.

6) You explain each proposal in layman's terms, and how it will affect people,
so they're more informed on how they vote.

The good thing about this is that it's backwards-compatible with democracy and
it's in the people's best interests to vote for your people. They do need to
trust that you'll do what you say, but standard checks and balances apply
there (you won't be elected next term if you don't). You also need to solve
the electronic voting problem, which is hard, but this protocol is probably
better than the one we have now where MPs vote based on lobbyists.

~~~
rectang
My proposal: Our shiny new aircraft carrier shall be christened "Boaty
McBoatface".

~~~
StavrosK
And our president shall be Donald Trump!

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sho
Just wait until this happens to something airborne, not via contaminated
water.

~~~
maxerickson
It basically already has with Tuberculosis.

[https://en.wikipedia.org/wiki/Extensively_drug-
resistant_tub...](https://en.wikipedia.org/wiki/Extensively_drug-
resistant_tuberculosis)

------
DoreenMichele
From the article:

 _If vaccination campaigns and modern sanitation systems don’t outpace the
pathogen, they anticipate a return to the pre-antibiotic era when mortality
rates soared.

“This isn’t just about typhoid,” ...“Antibiotic resistance is a threat to all
of modern medicine — and the scary part is, we’re out of options.”

Typhoid is endemic to Pakistan, where poor infrastructure, low vaccination
rates and overpopulated city dwellings persist.

Experts are also reinforcing hygiene habits for prevention: washing hands
frequently, boiling drinking water and eating well-cooked foods. In the longer
term, modern sanitation infrastructure is needed._

\---

We aren't _out of options._ The article itself provides options: Fix the
infrastructure problems. Make sure people stop living in filth and have access
to clean water and modern sanitation.

This is handwringing and it also amounts to justifying not fixing the
infrastructure problems, which I frankly find not only disingenuous but also
disgusting.

Furthermore, in the pre-antibiotic era, people went to "the baths" \-- usually
located at a natural hot spring -- where they took hot and cold treatments.
It's harder to kill infection that way and it really helps to have access to
modern water infrastructure, but it is possible to kill infection that way.

There are other options for treating infection beyond that, such as herbal
remedies. For decades, antibiotics have been the slam dunk, sure fire answer
that is convenient because you can pop a pill and head off for your job while
recuperating, but they aren't the only means we have to kill infection.

There is also research on reversing antibiotic resistance. But those studies
get largely ignored while the public focuses on these kinds of dramatic
stories because, in the minds of most people, _news_ means _bad news,_ a point
I have made many times before and don't feel like harping on by giving my same
tired examples involving Y2K and the Kuwaiti oil well fires.

There are myriad other options. We just don't really like hearing that for
various reasons.

I would much rather see the world focus on how to get the infrastructure built
and how to come up with effective solutions rather than more dystopian fiction
indulging macabre fantasies of a future without antibiotics where we can't
really be arsed to solve it because we are such drama llamas.

~~~
maxerickson
Yeah, improving infrastructure is likely to be the most effective step.

There's ~ _400_ reported cases of Typhoid per year in the US, out of 12.5
million globally. Access to clean water makes a big difference.

There's also cheap, effective vaccines. Just need to build/rebuild the trust
needed to get them to the people they would really help.

~~~
DoreenMichele
The article says this is happening in Pakistan. This probably means a
wealthier, more developed nation -- or non profit from such -- needs to step
up and work on this as an act of enlightened self interest. Because letting
third world countries live in filth is threatening to export antibiotic
resistant infections to the rest of the world. This _not my problem_ attitude
is going to make it our problem and it's dumb.

~~~
wbl
Pakistan has nuclear weapons and a large army. They don't need aid they need
better leaders.

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jlg23
Side note: I only got a vaccination in Germany 3 years ago because I was going
to a high risk area for several months. "It is treatable, so we do not
vaccinate for a mere 2 week holiday." There was an actual shortage of vaccine
because it was simply almost never administered.

~~~
djsumdog
Back in 1998 I got a Typhoid vaccination because I was going to Indian for a
month. I got them as pills.

I'm confused though. I thought Typhoid was viral, but it looks like it's
bacterial. How do bacterial vaccines work? The wikipedia page for it is pretty
sparse.

~~~
maxerickson
They work like viral vaccines, by exposing the immune system to the pathogen
(or something similar enough to activate it against the pathogen).

The oral vaccine is live typhus that has been manipulated to not be harmful:

[https://en.wikipedia.org/wiki/Ty21a](https://en.wikipedia.org/wiki/Ty21a)

------
candiodari
One should note that this would have happened >10 years ago if we hadn't
gotten the lucky stroke of the century. After 40 years of zero active
antibiotic discoveries we found a few new types. Currently, they work.

The previous types lasted 60 years. The new set lasted ~6 years, or 10 years
if you count until we found diseases resistant to both the new and all old
types. They're resistant, so the antibiotics still help, but they only slow it
down, they don't actually cure anymore. We probably have months until they're
fully immune all types.

The issue is that bacteria regularly exchange genes outside of their
particular species, so given historical data we have ~2 years time before
there are outbreaks of every known disease which fully ignore all types of
antibiotics.

This means that (assuming it is verified, and if it isn't, some other outbreak
will be verified soon) at this point it is utterly too late for any attempt at
restricting antibiotics (which governments are only doing to save money
anyway, which is why it is only restricted for human patients and not or very
little for agriculture. Besides, it doesn't matter unless every government
does it). Worse: at this point restricting antibiotics is counterproductive:
we should immediately switch to a different regimen, to maximize the remaining
utility. When a patient gets infected with an unknown disease, and there's
even slight reasons to suspect resistant strains, they should immediately get
a cocktail. A high dose of the 5 known general antibiotics. Especially
children.

We all know it won't be done. Firstly, governments move slowly, and never
admit mistakes or failure (although you have to appreciate just how slow:
outpaced by evolution. I mean ... seriously ?). Admitting failure will be the
bigger problem no doubt.

Secondly, it is slightly expensive. It will save many lives, maximize the
remaining utility and prevent outbreaks, but it will be somewhat more
expensive.

Result will, inevitably, be that in 2 years, half a dozen (common) diseases
will require extremely expensive "long-tail" medicines. In a decade, every
disease will require it. We need to get started on developing hundreds, and
then thousands of individual medications, requiring much more money for
medical research than is currently being spent.

And we all know we won't do that. First victim will be sex. Why ? Because when
a disease gets called "sexually transmitted" that mostly means only sexually
transmitted (the only more restrictive form is blood-transmitted. Only gets
transmitted from mother to child or through blood transfusions). Sex will
transmit pretty much every disease known with only a few exceptions. When we
have 5 common incurable diseases, sex with many partners becomes Russian
roulette. When we have 50 ...

~~~
StavrosK
Is this true? Are we basically fucked in two years?

------
cfadvan
_“There are multiple worst-case scenarios,” said Dr. Klemm. “One is that this
strain spreads to other regions through migration. But the other is that it
pops up elsewhere on its own — plasmids with drug resistance are everywhere.”_

This is a terrifying statement, and implies that whatever we do to combat this
will not be enough. It would be so stupid if it took a global pandemic of XDR
Typhoid to start changing things around abuse or antibiotics in livestock and
humans. Actually, I wonder if that would actually lead to change? I would have
thought so when I was younger, but now I think deaths might not move the kinds
of people pumping livestock with drugs we need to live.

It’s just so frustrating! Life without antibiotics would be a nightmare,
hospitals would become charnel houses again, and we’d have to be terrified of
every cut and scrape. All for cheap dairy, eggs, and milk?

~~~
sho
> a global pandemic of XDR Typhoid

Well, it's not going to happen in developed countries; typhoid is spread by
contaminated water, like sewers getting into water mains. There's a reason
you've probably never heard of anyone getting typhoid, or cholera.

If it was TB though - that could be a legitimate global disaster for everyone.
Hell, some countries curtailed air travel for SARS, and that _was_ treatable!

edit: duh, flu is not a bacteria. Replaced with TB

~~~
cfadvan
It could hit South/Central America, And Mexico, chunks of Eastern Europe,
China, it could devastate India, and while the US and Western Europe might not
suffer much directly, that would still be a global pandemic. Even if you dont
care about people with bad plumbing, you’d still care about the economic
impacts. All told, this is bad news, and kind of like finding all of the
canaries dead in the mine

Incidentally while I agree that another pandemic, lethal,influenza strain
would be terrible, it’s a totally different and unrelated issue. Influenza is
a virus, so antibiotic resistance isn’t a factor. It is true that some
agricultural practices do contribute to mutations and spread of influenza, but
ironically not the ones most associated with abuse of antibiotics.

~~~
sho
Would probably be India or Indonesia with the highest body count. That's 1.5
billion people! Didn't mean to imply I don't care about people with bad
plumbing.

Yep I meant tuberculosis. Thanks for the correction. Time for bed..

