
Dr. Arjun Srinivasan: We’ve Reached “The End of Antibiotics, Period” - selmnoo
http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/
======
nostromo
80% of the antibiotics we use are given to animals.[1] That seems like a good
place to cut back.

[1] [http://www.nytimes.com/2012/09/04/health/use-of-
antibiotics-...](http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-
in-animals-raised-for-food-defies-scrutiny.html)

~~~
stcredzero
In Denmark, they prevent infections in chicken houses by thoroughly cleaning
them, then using techniques developed for clean rooms to prevent infections.
In the US, we let them wade in their own filth and pump them full of
antibiotics. We should just make it flat out illegal to use antibiotics across
entire herds of livestock. We should also fine doctors for prescribing
antibiotics to patients with a viral infection and no sign of bacteria in
their systems, unless they are severely immune compromised.

~~~
ataggart
>We [sic] should just make it flat out illegal to...

>We [sic] should also fine doctors for...

Why is violence an appropriate response to these non-violent issues?

~~~
kintamanimatt
That's not violence. They're not being beaten with a crowbar.

~~~
ctdonath
It's the threat thereof that persuades compliance. If you try hard enough to
do & keep doing something illegal, there is no limit which the state is
unwilling to go to in coercing compliance.

~~~
dylandrop
Of course, because if we make feeding antibiotics to livestock illegal, it can
only be enforced by lynch mobs.

C'mon. Do you really think every food regulation is being watched by military
police who will come and beat you up if you break said regulation?

~~~
breischl
It's no secret that if you defy the authorities they escalate the amount of
coercion they use. You just need to follow the progression far enough to get
to the violence.

They start with a polite court summons, then send a police officer to your
home, and if you don't come quietly they'll physically force you. If you
manage to resist that, well now you're resisting arrest so it doesn't even
matter what the original summons was for. They'll escalate to tasers,
nightsticks, maybe tear gas. You probably need guns on your side to resist
past that point, which means the police get their guns out, and they've got
more guys and more guns than you. You most likely end up dead, but definitely
not resisting anymore. At no point will they say "Gee guys, this is just too
much effort, guess we better let him do whatever he wants."

There is implied violence in every government directive. You don't usually see
it because almost nobody has the will and the means to push it that far, but
it's still there. I think people would do well to remember that when casually
calling for things to be made illegal.

That said, I actually agree with the idea of banning antibiotics in
agriculture. It's quite important, and a classic market failure/tragedy of the
commons situation that you sadly do need government to solve.

~~~
vacri
I think it'd funny that the libertarian definition of violence includes
everything the government does, but it doesn't include their own 'social
contract' stuff. "The right to swing your fist ends at my nose" \- this
requirement, for example, sounds nice and fluffily individualistic, but what
happens if you violate it? You are taken to court, and if you continue to not
comply, you go through the usual escalation of things. So using the same
standards of proof, "don't hit me" is an act of violence.

The same goes for the requirements for a free market - which involves perfect
information on the part of the purchaser. If you withhold information, you've
violated the requirements... and if you continue to not comply, the system
requires escalation, and libertarianism in particular relies heavily on the
courts to fix things post facto, and of course, courts need to be able to
enforce their dictates. So not providing perfect information to the market is
an act of violence, using these flawed "chain-of-events-that-end-in-foo-are-
literally-foo" terms.

The libertarian redefinition of 'violence' really needs to be abandoned.

------
AaronFriel
For the past half century, we should have been treating our antibiotics like
weapons of mass destruction - tools of last resort only to be used in
emergencies, with great hesitation, and only when absolutely necessary. The
industry and the doctors responded: antibiotics were too profitable and the
risk seemed too distant. Now we have no weapons; we're helpless and the world
is again going to be a scary place where a cut or a scrape can land you in a
hospital or in a mortuary.

For the first time in the memory of anyone alive today, we're going to see
medical science step backwards. We're going to be more vulnerable tomorrow
than we are today, and we did it to ourselves.

~~~
erichurkman
> Now we have no weapons; we're helpless and the world is again going to be a
> scary place where a cut or a scrape can land you in a hospital or in a
> mortuary.

Perhaps most terrifying is that the mere act of hospitalization will likely be
the highest vector of transmission of nearly untreatable infections. Go in for
a routine procedure and end up in the isolation ward due to some highly
infectious, deadly disease.

~~~
snake_plissken
This is what I don't completely understand. Why has no one developed a
disinfectant spray that hospitals can apply ad-nauseum (pun intended, the
smell ideally wouldn't make people nauseous) all over the hospital? Or, do I
not understand the vectors properly?

The way I perceive these stories is that hospitals are actually extremely
dirty on a microbial level (as is most of the world), it's just counter-
intuitive because I think a lot of people take for granted that a hospital is
imagined to be a super sterile place. MRSAs could potentially reside on every
surface; an act as simple as touching a bed railing could get you infected.
You then have patients in recovery with healing wounds/depressed immune
systems, which need antibiotic treatment of some kind when they have an
infection. But it's not like you cannot become infected by a MRSA outside of a
hospital, you can, and the same antibiotics won't work effectively for you
just as they don't work effectively in the hospital. So the first step in my
mind is making sure the hospital is 'clean'.

~~~
Fomite
We do. We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot
by Cylon looking robots, and surfaces made of copper and patterned after shark
skin.

Bacteria are just bloody durable, and people are shedding new bacteria into
the environment at really absurd rates.

~~~
VladRussian2
>We have disinfectant sprays, chlorhexidine, bleach, UV radiation shot by
Cylon looking robots, and surfaces made of copper and patterned after shark
skin.

And the bacteria which survives all of this, i think it should look something
like this:

[http://www.imdb.com/media/rm617979392/tt0088944?ref_=ttmi_mi...](http://www.imdb.com/media/rm617979392/tt0088944?ref_=ttmi_mi_all_prd_21)

~~~
Fomite
It actually looks like this:
[http://upload.wikimedia.org/wikipedia/commons/0/0f/Clostridi...](http://upload.wikimedia.org/wikipedia/commons/0/0f/Clostridium_difficile_01.jpg)

------
ronaldx
> Eventually bacteria will evolve, and they’ll adapt ways around that to
> overcome that obstacle.

I am more optimistic than that.

Sure: as long as antibiotic resistance is crucial for bacterial survival,
bacteria have a natural need to evolve it. And, they will.

But, this will come with a genetic cost to the bacteria.

The reason that antibiotics work is because they are attacking some function
that has deliberately evolved, through natural selection, to be like that.
Antibiotic resistance must literally cost bacteria some efficiency in some of
their other functions.

This cost was originally such that the bacteria would die. Fantastic. But
note: we wouldn't actually benefit from all bacteria dying at the mention of
the word antibiotic, and some bacterial resistance is good for us.

Under normal circumstances, bacteria that don't need to carry around
antibiotic resistance with them will most likely have a lower genetic cost and
thrive better. This may be why we have seen MRSA predominantly in hospitals
and rarely in the 'wild'. (If MRSA was necessary or not costly, all SA would
be MR all the time).

This gives me some hope - that antibiotic resistance is balanced, genetically
forcing bacteria to be less effective in other ways and less competitive in
other circumstances.

We humans are not out yet.

~~~
mjt0229
>The reason that antibiotics work is because they are attacking some function
that has deliberately evolved, through natural selection, to be like that.
Antibiotic resistance must literally cost bacteria some efficiency in some of
their other functions.

I'm not convinced that there must be a cost; furthermore, I think it's
unlikely that if there is a cost, it is high enough to be significant. Bugs
evolve, but they do not necessarily evolve optimally all of the time. It is
possible that an evolutionary step towards resistance might also improve the
fitness of the germ overall (for example, by further optimizing the efficiency
of a metabolic pathway). That evolutionary step might have been inevitable,
but required additional selective pressure or the presence of a more active
mutagen to actually occur.

Your claim is sort of assuming that each bug is already optimal for its
environment, and any change must therefore be deleterious in some regard, but
I hold that neither fact is necessarily true.

~~~
coolsunglasses
[http://en.wikipedia.org/wiki/Plasmid](http://en.wikipedia.org/wiki/Plasmid)

"In nature, plasmids carry genes that may benefit survival of the organism
(e.g. antibiotic resistance),"

Plasmids cost energy, they are dropped in the course of natural selection if
they stop conferring an advantage.

More quickly than you might think, too.

If we stop using antibiotics, the bacteria will become less resistant.

~~~
selectodude
Norway did just that, and it seems to have worked rather well.

[http://www.cbsnews.com/2100-205_162-6014559.html](http://www.cbsnews.com/2100-205_162-6014559.html)

------
bradleyjg
It's an insane world we live in where all the measures that should be used to
control the distribution of antibiotics exist, but they are used instead for
opiates.

I'm not saying opiates addiction isn't a genuine problem, but it's a largely
individual one. There's no widespread negative externalities to prescribing
opiates to a patient. Antibiotics on the other hand, present a classic limited
pool resource allocation problem (the same species of problem as the tragedy
of the commons).

It's antibiotics that should require a three part pad, with one copy sent off
to the federal government and investigations into over-prescribers -- not
painkillers. It's antibiotics that should be subject to intentional treaties
governing their distribution and use -- not painkillers. It's antibioatics
that should have criminal penalties for misuse -- not painkillers.

~~~
Timothee
_Antibiotics on the other hand, present a classic limited pool resource
allocation problem_

While reading the article, that's what I was thinking: even if _I_ limit my
antibiotics use, it won't help me since this affects everyone, not just people
who abuse antibiotics…

------
DanBC
I've posted this before, but some people may have missed it.

"Defeating the superbugs"
([http://www.bbc.co.uk/programmes/b01ms5c6](http://www.bbc.co.uk/programmes/b01ms5c6))
has a segment showing bacteria developing resistance to antibiotics.

([http://v6.tinypic.com/player.swf?file=24goih4&s=6](http://v6.tinypic.com/player.swf?file=24goih4&s=6))
(Sorry about the lousy host; YouTube's content sniffing detects this as BBC
property and blocks it.)

They have a slab of nutrient jelly. The jelly has sections of differing
strength of antibiotic. There's a section with no antibiotic, then 10x, then
100x then 1000x. (They cannot dissolve any more antibiotic into the jelly at
that point, they've reached the limits of solubility)

They drop a bit of bacteria on the zero antibiotic section.

A time lapse camera shows the bacteria growing, and developing resistance to
each section. After two weeks the entire slab, all sections, are covered. The
bacteria has developed resistance to the antibiotic, and is resistant to
antibiotics at a strength that could not be used in humans.

It's an excellent, scary, bit of video.

~~~
rblatz
I've always been under the impression that bacteria pay a heavy evolutionary
tax for their resistance. So what would happen if you then took a sample from
the 1000x section of jelly and then another sample of your initial bacteria
and put them on opposite sides of nutrient jelly slab. Would the new bacteria
be completely overwhelmed?

Would infecting someone with a non resistant strain, letting it sit for a
while and then hitting them with antibiotics knock the infection low enough
that your immune system could wipe up the rest?

~~~
XorNot
The problem is in situations where you want to use antibiotics, time is not on
your side. There has been some work done on this idea, though I cannot recall
the specifics.

------
hooande
One thing I learned from watching this episode of Frontline was that we aren't
doing a lot of research into new antibiotics. Companies like Pfizer (the
original makers of penicillin) would rather create drugs like Lipitor or
Prozac, things that customers will take everyday for the rest of their lives.
Antibiotics are intended to be used as sparingly as possible, which doesn't
leave room for a lot of profit. Even the National Institute of Health has but
antibiotic research on the back burner to pursue more pressing concerns.

The other big problem we face is that certain antibiotics are like steroids
for farm animals. I believe that they kill the bacteria in the gut of a cow or
big that signals when they should stop eating, resulting in larger stock (or
something like that). This increases the exposure of bacteria to the
antibiotics, making things less safe for all of us.

But drug companies and farmers aren't to blame for our antibiotic situation.
Capitalism encourages profit and doesn't ask questions about how it's made.
Corporations have a fiduciary responsibility. And doctors can't be faulted for
overprrscribing antibiotics either. A sick person is the ultimate debugging
task and most doctors will try anything that could help the patient. I don't
know if this problem has a good solution.

If we research new antibiotics then bacteria will eventually evolve to resist
them (kicking the can down the road). If we stop using antibiotics then more
people will suffer, potentially unnecessarily (destroying the village to save
the village). Trying to fight evolution is a losing game. I am, however,
confident that someone somewhere will come up with a break through in the next
few decades that will allow us to temporarily solve this problem once again.

~~~
j_baker
It makes me think that the government will have to take some of the
responsibility from the drug companies. If capitalism isn't working (which
frequently happens in medical fields), we need another mechanism to make new
antibiotics available.

~~~
refurb
It's not capitalism that's the problem, it's the current regulations
surrounding drug research. The FDA has set out hurdles for drug approval that
make it very unattractive to discover new antibiotics. They are currently
changing the way these drugs are reviewed to try and alleviate that (new
endpoints, etc).

------
tokenadult
The interviewed expert has very good credentials and clinical experience to be
talking about what he is talking about, and his warnings should be taken
seriously. But even at that, the fallacious teleological language he uses
about biological evolution by natural selection suggests a way out of this
problem. When he says, "Bacteria, like any living organism, want to survive,"
and "So anything that we do to try and kill bacteria, or anything the
environment does to try and kill bacteria, bacteria will eventually discover
ways or find ways around those" he is making factual statements that are
plainly incorrect on their face. Bacteria don't desire anything, and they
don't seek out anything or plan anything. Moreover, it is perfectly possible
for lineages of bacteria to go completely extinct, and that has undoubtedly
happened more times than human beings are aware.

Current antiobiotics are themselves mostly derived from "natural" chemicals
emitted by microorganisms so that those microorganisms survive natural
selection to go on reproducing in a world full of bacteria. Many of the early
antiobiotics, for example penicillin, are derived from mycotoxins produced by
fungi. Human medicine can use chemicals from fungi for protection against
bacteria because human beings and all animals are more closely related to
fungi than either fungi or animals are related to bacteria,[1] so fungi have a
biochemical similarity to animals that makes it likely (although not certain)
that a mycotoxin that is lethal to bacteria will be relatively harmless to
human beings.

And this is the way forward to developing new antibiotics. As we reach a
deeper biochemical understanding of the basis of all life, we will eventually
understand the differences, which are biochemical differences at bottom,
between human beings and bacteria, between human beings and protists, between
human beings and fungi (yes, there are some systematic differences between
animals and fungi) and between human beings and all other harmful
microorganisms. Only human beings have science labs and clinical research
studies to come up with new defenses against the thoughtless, largely immobile
threats from other living things. We can form hypotheses, test those
hypotheses rigorously, and perhaps make some lineages of harmful
microorganisms as extinct in the wild as the smallpox virus and rinderpest
virus now are. The intelligence that the hominid lineage has evolved gives
human beings advantages that bacteria will never possess.

[1]
[http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html](http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html)

[http://www.nytimes.com/1993/04/16/us/animals-and-fungi-
evolu...](http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolutionary-
tie.html)

~~~
mistercow
I'm slightly bugged by "desire" type language because it does actually cause
problems in how laymen think about evolution. It's not uncommon to hear them
make the mistake of thinking evolution will "think ahead". But the bigger
problem I have with it is the "anything we do ... bacteria will eventually
discover".

Some problems are just very difficult to evolve around, and it's hard to
predict what they'll be even if you have a complete working knowledge of an
organism's genome and biological workings. If the problem space doesn't
contain a solution that can be climbed toward without sacrificing fitness in
the short term, it is unlikely that it will ever be found by evolution.

Evolution is actually a really crappy optimization algorithm. The reason it
has worked so well is not that it is so effective, but because it's the only
game in town. It took evolution billions of years to make machines that can
run 60 miles per hour. It took humans a few thousand years to create machines
that run about 12 times that fast.

Bacteria work on a faster time scale than animals in terms of evolution, but
five orders of magnitude? Somehow, I think we'll win in the long run.

~~~
resu_nimda
_Evolution is actually a really crappy optimization algorithm. The reason it
has worked so well is not that it is so effective, but because it 's the only
game in town. It took evolution billions of years to make machines that can
run 60 miles per hour._

You come off as being dismissive of the power and beauty of evolution,
although I don't think that's your intent. Evolution assembled the most
complex system known to exist, starting from a handful of molecules, without
any "thought" or "reasoning." The entire concept/illusion of life and
consciousness was fabricated out of simple natural elements and physical
processes. Amazing. Sure, once all of that has been put in place, it's trivial
to expand upon. I'm sure you agree, I just like to take any opportunity to
point this out. :)

~~~
mistercow
Sure, but the main power and beauty of evolution is a direct result of the
fact that it is _an_ optimization algorithm. The fact that such an algorithm
could just _happen_ is astounding (although possibly inevitable, if universes
are common and varied).

If I come across as cynical about this, it's a response to the way evolution
as a process has been fetishized by people who don't understand it. People
look at the application of evolutionary algorithms to solving difficult
problems and conclude that evolution is smarter than humans. But evolution's
power really comes from its dumbness. It works without understanding the
problem, and so it can be used to solve problems we don't understand very
well. But when we learn how to model a problem intelligently, we're generally
able to crush the results of evolution.

------
uptown
One of the best ways to combat the problem is to speed-up detection speeds of
bacteria. Lots of companies are tackling this problem. One of them I've been
following has made enormous progress in reducing these detection times.

They've reduced MRSA from 18-24 hours down to 6 hours. Salmonella from 24
hours to a 30 minutes. Mycobacterium tuberculosis from 21 days to 1.5 hours.
Etc.

[http://nanologix.com/test_results.html](http://nanologix.com/test_results.html)

Stopping these problems before they get the chance to spread is how I believe
these infections will be slowed, as antibiotics become less effective.

------
JumpCrisscross
" _These are companies that are for-profit companies, and like you said, they
have to answer to people. They have to develop drugs that will make money, and
that’s not an antibiotic._ "

The profit motive is almost as blind a watchmaker as natural selection. We've
built an environment which encourages bacteria to develop antibiotic
resistance. Let's structure a pharmaceutical industry in which antibiotics are
profitable.

The problem appears to be myopia. Antibiotics make money for a few weeks,
chronic diseases for a lifetime. Fortunately, finance long ago solved the
temporal shifting of incentives and payoffs. We need smooth the lumpy, often
in-the-future, demand for antibiotics.

The government could tax the pharmaceutical industry, medical insureres, or
the public. The proceeds would fund tax credits for the developers and/or
producers of antibiotics. Alternatively, a more elaborate system by which
health and life insurers incentivise antibiotic research, perhaps by issuing
credit default swaps on pools of their reinsurance liabilities to antibiotic
developers, could be structured.

~~~
protomyth
I'm pretty sure an X-Prize-style $10 Billion tax free for the next antibiotic
from the government[1] would probably get something done. Given our needs, the
$10B would be cheap. Heck, buy the next 3 or 4 discovered.

1) assuming said government exempts the company from court claims on the
approved drug

~~~
refurb
The gov't is already looking at something similar. If an antibiotic is
approved by the FDA, the company would be guaranteed at least $100M in revenue
per year, going up to $350M in the fifth and final year.

~~~
protomyth
The big one would be the immunity from court action. Look at all the crap
going on with the Lyme Disease Vaccine and flu shots.

------
javajosh
This is very serious. But consider the worst-case outcome:

    
    
      No more anti-biotics, for anyone.
    

That is, we go back to the era before anti-biotics, life in the 1920's. Maybe
mortality rates will go back to that era, and maybe higher. But thankfully we
aren't talking about a plague. At least not yet.

Recently I had a wisdom tooth extracted. The dentist prescribed anti-biotics,
but (unknown to him) I didn't take them. I healed fine. And so it was in the
20's and before that. Plenty of people survived and thrived before anti-
biotics. And life will go on when we don't have them anymore.

No doubt these super bugs have had to give up certain advantages to attain
what is (for their species) a very specialized survival mechanism. Which means
that if we ease off of the drugs for a while, the bacterial populations will
compete, and the less drug resistant ones will thrive. Then we can use our
drugs again. Or that's the idea.

What I'd really like to see are the internal assessments of big pharma of
these gram neg bugs. Why _isn 't_ it economically feasible to create new drugs
for them? This article makes it sound like there is a large and growing market
of suffering people who'd be more than willing to spend every last cent for a
pill to make the pain go away. And if the prospect of people willingly
bankrupting themselves for drugs doesn't perk big pharma's interest, I don't
know what would.

~~~
roc
> _" Why isn't it economically feasible to create new drugs for them? "_

It's not that you _couldn 't_ make a profit off them. It's that the
opportunity costs can't be justified (today).

There's a finite amount of R&D funds available to any firm. And if I'm
maximizing profit, I'm not going to spend my money on difficult research,
seeking and developing a drug useful to a handful of patients in 4% of
hospitals, that's taken for a few weeks by each patient.

Not if I can instead spend it tweaking known drugs, useful to 30-50% of the
entire population, that they'll take for the rest of their lives. (e.g. blood
pressure medicine)

And particularly not when CDC, WHO, et al are actively campaigning for changes
to antibiotic handling/prescription/use which may well mean your potential
future market for "a better antibiotic" is actually _smaller_ than today's.

------
hodder
The anthropomorphism of bacterial evolution makes the article hard to follow
for the layman (me). Can someone familiar with bacterial evolution please
explain to me how the use of antibiotics leads to superbugs? I am clearly
misunderstanding something.

I was under the impression that in a population of bacteria, genes express
themselves in any number of random ways. If we expose the bacterial culture to
antibiotics, the bacteria susceptible to the antibiotic dies, while the
resistant bacteria lives on free to reproduce, leaving the descendant bacteria
with resistive characteristics...

My question to the HN scientists is, doesn't this just destroy some subset of
bacteria? Is new genetic information produced that did not exist before?
Taking this trimming tree down the line, wouldn't the "superbug" antibiotic
resistant bacteria have been created/survived and thrived anway? Or does the
antibiotic exposure actually cause, "the bacteria to want to survive", in the
sense that exposing them to antibiotics leads to more rapid mutation of
descendants? Why wouldnt the antibiotic resistant bacteria be created with or
without overuse of antibiotics? Isn't the spectrum of the genetic tree just
trimmed?

~~~
nathan_long
My guess: before the antibiotic, the minority resistant bacteria have to
compete with the majority non-resistant. After, they can proliferate freely.
Repeat with the next antibiotic, and soon all the ones we see are resistant to
all the antibiotics we have.

~~~
refurb
You pretty much nailed it in a very succinct manner.

That's why it's so important to complete a course of antibiotics rather than
stopping once you feel better. Once you've started antibiotics, you're
basically enriching the population in bacteria that aren't affected by the
antibiotic. This is normally a very small population, but if you stop half-
way, the pressure on those bacteria from other bacteria (the ones that died)
is lower, allowing the resistant population to flourish.

If you finish a course of antibiotics, you not only kill the susceptible
bacteria, but you also give your own immune system a chance to take down the
few remaining bacteria that are resistant.

~~~
ronaldx
This is an unconvincing argument to me - if antibiotic resistant bacteria
survive, why would finishing the course of antibiotics make a difference?

Does it clinically happen that stopping a course of antibiotics early causes
an antibiotic resistant form of the infection?

(I couldn't find evidence either way, but I did find a few articles saying
typically prescribed course lengths could be safely reduced in the effort to
reduce antibiotic use generally)

~~~
refurb
This gives a much better summary of the theory...

[http://blog.oup.com/2011/11/antibiotics/](http://blog.oup.com/2011/11/antibiotics/)

~~~
ronaldx
Yes, I get the theory, but I think it's probably false. No clinical evidence
is offered.

~~~
refurb
Care to share it?

~~~
ronaldx
Just to be clear:

I can't share because that's exactly my point - as far as I can find, _there
isn 't a single clinical example_ of stopping antibiotics early causing any
problem of antibiotic resistance.

------
selmnoo
Watch the full FRONTLINE documentary here:
[http://www.pbs.org/wgbh/pages/frontline/hunting-the-
nightmar...](http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmare-
bacteria/)

------
mmoche
I remember hearing about Soviet research into phage therapy, where
bacteriophages are cultured to consume particular strains of bacteria. I
believe the treatment is only in use in a couple ex-Soviet states. Is this a
reasonable avenue once we're essentially dealing with only MRSA-like
infections?

~~~
frakkingcylons
I believe the MRSA-like infections you're thinking of are the Gram-negative
bacteria [1] mentioned in the article. Based on the Wikipedia page for phage
therapy [2], it should be an effective treatment option where the bacteria
have polysacharride layer in the cell envelope, which most antibiotics cannot
penetrate. There's more in the treatment section [3], which doesn't mention
phage therapy however.

[1]: [http://en.wikipedia.org/wiki/Gram-
negative_bacteria](http://en.wikipedia.org/wiki/Gram-negative_bacteria) [2]:
[http://en.wikipedia.org/wiki/Phage_therapy](http://en.wikipedia.org/wiki/Phage_therapy)
[3]: [http://en.wikipedia.org/wiki/Gram-
negative_bacteria#Medical_...](http://en.wikipedia.org/wiki/Gram-
negative_bacteria#Medical_treatment)

------
sailfast
This resistance scares me a great deal, especially as a new dad. I'm hopeful
that in the coming years we'll be able to target bacteria and viruses more
specifically using nano-technology and other tools at a cost effective level
(admittedly I don't have a lot of knowledge in this area but I'm hopeful.)

If all else fails, I guess we'll depend on the cycles of nature's adaptations
and break out a new set of antibacterials every 50 years or so depending on
the resistance trends we see crop up and hope we don't lose too many humans in
the process. At any rate, I'm glad lots of smart people are working on this
problem.

~~~
mesaaz
There is reason for guarded optimism if we can eliminate, or at least
drastically reduce, irresponsible use of antibiotics:

The capacity to resist antibiotics extracts a small metabolic/competitive
"tax" on bacteria. In the presence of antibiotics, the costs of this tax are
outweighed by the obvious benefits of antibiotic resistance.

In an environment without antibiotics, the costs of the tax outweigh their
benefits, so these antibiotic-resistant bacteria will eventually be outgrown
by "normal" bacteria.

If we can discipline ourselves to use antibiotics only when necessary,
gradually antibiotic-resistant bacteria should become less common.
Unfortunately, I doubt this will happen until the antibiotic-resistance
problem becomes much more serious.

~~~
gibwell
We can't discipline ourselves because there are giant vested interests in
selling antibiotics and none in resisting buying them.

~~~
penguindev
I don't know why you were down voted; you had a logical argument. There's no
greed like short term greed.

------
felxh
I know the article tries to explain things in a way a layman can understand,
but the wording when it comes to evolution is quite poorly chosen IMO. Saying
thinks like 'Bacteria, like any living organism, want to survive' and
'bacteria will always change in order to survive', are just incorrect and will
result in big misconceptions.

To my knowledge, bacteria don't have an agenda, they don't _want_ to survive
and they certainly don't change _in order to_ survive. Instead, they change at
random, which sometimes helps an individual to survive and sometimes not.

~~~
leephillips
I wouldn't be so hard on him. Teaching physics, we often find ourselves saying
things like "the ball wants to roll down the hill". It seems to be natural to
talk in terms of agency when trying to make concepts intelligible to the
relative layman.

~~~
flatline
Yes, but the ball rolling down the hill is not very contentious, whereas
evolution is (at least in the US), and wrongness explaining it makes
dismissing it easier.

------
bronbron
> Another reality is there’s not much money to be made in making new
> antibiotics, so we saw a lot of drug companies who left the field of
> antibiotic development because of this combination of factors, that it was
> getting really hard to discover, to develop new antibiotics, and you don’t
> make a lot of money in selling these drugs, so the market really wasn’t
> there.

To me this seems like the big problem here. Antibiotic resistance is an
inevitability regardless of our usage rates - there's too much selective
pressure for it not to. To co-opt the Red Queen hypothesis slightly, we have
to constantly be developing new antibiotics just to keep pace.

I suspect this problem will self-correct eventually, with the unfortunate
side-effect that the cost of effective antibiotics will skyrocket for awhile.

That being said, we're obviously not doing ourselves any favors by dispensing
them like candy, especially to the agricultural industry. It definitely
encourages cycles - Effective antibiotics are rare and therefore profitable so
tons of $$ goes into R&D -> Lots of new antibiotics are created -> price goes
down because there's so many options/patents expire -> Overuse -> Resistance
develops quickly and we're left with few effective options.

------
tezza
My doctor friends have been warning about this for 15 years, and the situation
has continued to worsen.

MRSA was a bit of a wakeup here in the UK, but the main 'solution' was
concentration on cleaning hospitals rather than developing new anitbiotics.

It is my opinion that unfortunately it will require high profile people to
start dying before support is galvanised.

It would seem from the outside that HIV/AIDs started to be addressed when
superstars like Freddie Mercury started succumbing.

------
DonPellegrino
I'd like to know what this will do for bacteriophage therapy. Georgia has been
the center of phage research since the 20s and has a massive bank of phages
for all sorts of infections. Can someone more knowledgeable of this topic
explain why the end of antibiotics is such a problem if there's already a
decent alternative? What are the downsides to phage therapy?

[http://www.thelancet.com/journals/lancet/article/PIIS0140-67...](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2966759-1/fulltext)

------
warcher
I wish he mentioned the massive dumping of antibiotics into our food supply
via feedlots, et cetera. You think the fact that all the meat we eat is
swimming in antibiotics for its entire life has something to do with this
antibiotic resistant bacteria in our stomachs? It'd be a damn shame to undo
one of the miracles of the twentieth century so your chicken sandwich is fifty
cents cheaper.

~~~
bronbron
There's an entire section on the use of antibiotics in agriculture.

------
darkarmani
Meanwhile tons of antibiotics are used in factory farming. I'm not sure why it
has ever been legal to use massive amounts of antibiotics on animals that
aren't sick yet.

~~~
sliverstorm
A thought occurs to me- do we know it to be true, that a constant life-long
supply of antibiotics results in the development of greater numbers of
resistant strains of bacteria?

Think about it. We always say humans who don't finish their prescription are
allowing some of the most resistant strains to survive, when taking the full
prescription would generally finish off everything (even the moderately
resistant strains) preventing selection. Farm animals that never _stop_ taking
antibiotics never provide that window of opportunity for unresistant strains
to take hold and then undergo selection due to antibiotic regimes that are
ended too soon.

Maybe I've got the wrong idea here, but is this particularly different from,
say, a petri dish full of sulfuric acid, and a petri dish that periodically
has some acid introduced for a short period of time? Drop a culture in the
first dish, and they all die. Drop a culture in the second dish, and they have
time to develop resistance.

------
alan_cx
This is not my thing at all, so this might be a really silly question, but...

Are people who have avoided prescribed antibiotics in a better position than
those who haven't? Then, what is the effect on such people of the antibiotics
taken in by eating meat from animals which have been give antibiotics? Have
the people who have been avoiding completely wasted their time?

~~~
ronaldx
It's hard to know the answer to this question. Yes, antibiotic resistant
bacteria pose a new threat to everyone (likely still less of a threat than non
resistant bacteria did in 1950), but maybe not equally.

it's possible that antibiotic-resistant bacteria have more chance to take hold
(asymptomatically/latently) in people who are regularly exposed to
antibiotics.

You could be carrying around MRSA but you wouldn't observe symptoms
unless/until you are otherwise in a critical state - wounded or immune-
suppressed.

It's not currently obvious how antibiotic-resistance spreads in the wild and
so it's still plausible that avoiding antibiotics gives you some degree of
protection.

------
j2d3
What seems missing from this HUGE discussion about "the end of antibiotics" is
vaccination.

There is work in progress toward a MRSA vaccine[1,2,3], though it won't be
easy. Nevertheless, the way I see it, vaccines are a strategic approach, while
antibiotics are tactical.

Obviously we need to continue to pursue both, but I just think it's important
to consider and even maybe refocus our efforts to deal with MRSA and other
tricky fast evolving bacteria that become widespread and problematic in our
communities by pushing hard for vaccine development.

[1] [http://www.trefis.com/stock/pfe/articles/205872/pfizers-
vacc...](http://www.trefis.com/stock/pfe/articles/205872/pfizers-vaccination-
business-antibiotic-resistant-staph-mrsa-opportunity/2013-09-17)

[2] [http://www.huffingtonpost.co.uk/2012/02/15/scientists-
create...](http://www.huffingtonpost.co.uk/2012/02/15/scientists-create-mrsa-
vaccine_n_1279160.html)

[3] [http://www.fiercevaccines.com/story/pfizer-glaxo-and-
novadig...](http://www.fiercevaccines.com/story/pfizer-glaxo-and-novadigm-
race-develop-mrsa-vaccine/2012-09-17)

(did you know there was a website called "fiercevaccines.com"???)

------
jasonkolb
Well let's start doing something about this. I created a whitehouse.gov
petition, let's start spreading it around:
[https://petitions.whitehouse.gov/petition/make-antibiotic-
us...](https://petitions.whitehouse.gov/petition/make-antibiotic-use-illegal-
except-treating-bacterial-infections-humans/gtGrwQ6K)

Hopefully we'll be able to create some alternatives, but let's stop the
bleeding if we can.

------
dekhn
I'm not going to watch the documentary to see the full quote, but taken on its
face, this is a false statement. There continue to be many infections which
will still be treatable by antibiotics for the foreseeable future.

~~~
refurb
I have to agree. There are many antibiotics in the pipeline right now as well.
The recent GAIN legislation and other FDA initiatives have spurred the
development of new antibiotics.

Antibiotic resistance will continue to be a problem (obviously), but we're
going to have effective antibiotics available to us for the coming decades.

------
Tjmac73
This is a really big deal, and should be getting more visibility. I think the
good news here is it opens the door for a more targeted approach. Current
antibiotics are a nuclear option, they wipe out the good with the bad. Thats
very bad when a majority of the cells in our body are good bacteria that play
a role in our immunity and health. You can see how this leads to a reliance on
the nuclear option.

If this is the end of the Age of Antibiotics, I hope its the beginning of the
Age of Probiotics. Working with the good bacteria and developing more targeted
strategies of taking out the bad. Snipers, not nukes. (Im no scientist but
perhaps learning from how good bacteria fight off bad bacteria is a good place
to start)
[http://www.sciencedaily.com/releases/2010/03/100324094717.ht...](http://www.sciencedaily.com/releases/2010/03/100324094717.htm)

------
joshuahedlund
I've been hearing about the coming Antibiotics Apocalypse for some time now,
and while it sounds very dangerous I'm wondering what signs to look for about
how bad it's getting. Articles like these point to limited things like an
increase in MSRA outbreaks or vague statements about increasing infections
from hospitals, but it's not like average people are dying in the streets or
anything. How do we tell how much we're moving on the long continuum from here
to there while keeping isolated stories in the larger context of overall
antibiotic resistance?

~~~
Fomite
Yes, average people are dying in the streets. Hospital infections, many of
which are caused by resistant organisms, are a major cause of death in the
United States.

Beyond that, you now have things like extensively resistant Gonorrhea, which
has taken a disease that is fairly common, but easy to treat if caught and
thus embarrassing without being dangerous, and turned it into a serious
problem, especially for women.

The answer for "How do we tell" is that epidemiologists (like me) do a lot of
surveillance for antibiotic resistance. We ask why hospital patients died, and
what organism killed them - and what is was susceptible to.

And the answer is this is a rather serious problem.

------
tpainton
This person reminds me of a lot of people I went to medical school with. Very
smart, and yet, not very realistic. He outlines a scenario that is endgame..
when in fact, we are seeing cyclical events. We saw the emergence of
penicillin resistence in S. Aureas, then methicillin resistance. we moved to
quinalones, and sulfa and we see resisance develop there.. OF COURSE it does.
The antibiotics don't cause resistance.. Natural selection is the process
going on here. There are random mutations that occur regardless of antibiotic
exposure. We do see antibiotics cause resistance such as in inducible extended
beta lactamase resistance.. (I have a patient currently with E coli resistant
to everything but Colistin) but the overwhelming process..it's still good old
fashion natural selection that Darwin made us all aware of. We really don't
need to panic.. we just need to keep fighting the fight..because it won't ever
end, unless we give up. Relax. When I hear people claim it was wanton use of
antibiotics that caused all of this.. I wonder if they ever read a word about
biologic evolution. Right now, there are organisms out there that are already
resistant to antibiotics that haven't been developed yet. How can we blame
humans for that?

~~~
shabble
> * We saw the emergence of penicillin resistence in S. Aureas, then
> methicillin resistance. we moved to quinalones, and sulfa and we see
> resisance develop there.. OF COURSE it does. The antibiotics don't cause
> resistance.. Natural selection is the process going on here.*

[...]

> _When I hear people claim it was wanton use of antibiotics that caused all
> of this.. I wonder if they ever read a word about biologic evolution_

Natural selection describes the shift in characteristics of a population due
to some environmental pressure which favours individuals with specific
characteristics. How they acquire those characteristics is largely immaterial,
be it through random mutation, sexual reproduction, viral transduction, etc.

So yes, natural selection is the process by which the resistant bacteria
outcompete the vulnerable ones, and thus become the dominant population. But
the reason that occurs in the first place is because of the environmental
pressure induced by the antibiotic.

Or am I missing something here?

------
tocomment
I heard the author on NPR yesterday. I think it's all very true, but it seem
disingenuous to blame antibacterial soaps. I haven't ever heard of human
antibiotics being added to soaps. And I don't think a triclosan resistant
bacteria would be of much risk to us.

The only argument I can think of against antibacterial cleaning products would
be that our bodies get less exposure or "practice" against ordinary bacteria?

------
sphericalgames
It wasn't long ago that thread appeared about silver making antibiotics
thousands of times more effective.

Not sure where the thread is but the story here:
[http://www.nature.com/news/silver-makes-antibiotics-
thousand...](http://www.nature.com/news/silver-makes-antibiotics-thousands-of-
times-more-effective-1.13232)

~~~
euroclydon
I used to see, in Sky Mall magazine, a colloidal silver injector that would
spray through the skin to treat dermal infections.

------
schoper
Antibiotic resistance shows up among the unhealthiest communities first. They
act as the necessary incubators that resistance needs to develop. In a person
with a working immune system, the time frame of antibiotic and pathogen
contact is very small compared to the time frame of antibiotic and pathogen
contact in an immunocompromised patient.

To put the above into simple English: Our problem isn't that we give
antibiotics out like candy, it's that we give them to the elderly, people with
AIDS, the poor, etc. This massively increases the chance of antibiotic
resistance developing.

What can we do about it? To start with, run the numbers, make some cost-
benefit calculations, and think about the problem. There may be technical as
well as social solutions.

Not thinking about the problem, making it harder for the healthiest people to
get antibiotics, and pretending that you are doing something is also a viable
option. It's what we're doing now.

~~~
bad_user
> _Our problem isn 't that we give antibiotics out like candy, it's that we
> give them to the elderly, people with AIDS, the poor, etc._

Do you realize what you've just said? Are you arguing that we shouldn't have
had given antibiotics to people that needed antibiotics?

Also, I don't know how your society is or does, but in our country the poor
have a better immune system.

~~~
schoper
I correctly described the situation. I think it's ugly too. Do you have a fix?
Because that's what we need, a fix, not cheap moralizing.

Moralizing doesn't save anyone from gangrene and sepsis and a slow death. It
doesn't prevent the diarrhea to dehydration to death sequence. It doesn't do
an ounce of good for anyone.

Immunocompromise (poor, sick, elderly, AIDS, etc.) + long-term antibiotic use
= Antibiotic resistance.

That equation is death, and we need fixes, not the crap in your comment above.

"Also, I don't know how your society is or does, but in our country the poor
have a better immune system."

No doubt you live on Mars or Venus.

~~~
kamaal
I don't know how that works,

God forbid say your dad is sick- Will you go and tell him- 'Dad, you better
die for the sake humanity and than take these antibiotics and have you pain
reduced'.

If you are poor, will you tell your kid- 'Sorry son, I have to sacrifice you
for the sake of humanity, no more antibiotics for you'

The parent comment to yours is correct. Poor have better immune systems,
because theirs is trained to handle such situations from their birth than
yours and mine which live well sanitized environments and have never been
exposed to them before.

That's at least true in a country like India. I'm not sure where you live,
poor people dying out of fatal infections is one thing. But its also a fact,
some that requires me or you take a sick leave doesn't even bother them.

------
dsschnau
Okay, I'm sold, as a citizen, that this is an issue I and my child's
generation will have to face. How can I help?

~~~
TsiCClawOfLight
Refuse behaving like the average (ahem, mostly american) and don't ask for
medicine for benign illnesses.

~~~
ssmoot
I think as a rule people aren't as stupid as "common knowledge" would like to
pretend.

My 18mo daughter has had a half dozen ear infections and two staph infections.
Antibiotics each time.

Would it be better to leave a staph infection untreated with antibiotics? How?
Lance and clean the infection site... and then what?

Or ear infections? I had frequent undiagnosed ear infections as a small child
and now have reduced hearing to thank for it. My entire life I've had people
annoyed with me asking them to repeat themselves. Some ear infections may
clear up on their own. The ENT has told us this is unlikely in 12mo or younger
ages since cranial structures aren't in place that allows excess fluid to
drain. We can let her have a fever for a day or two, and give Tylenol, but all
that's going to do is delay the necessary antibiotics. We could also have
tubes inserted in her ears, but it's not like those are without risks or
downsides either.

Since people don't have to play the lottery with their hearing or their lives
anymore because they have access to antibiotics now sure, maybe that has some
scary consequences. But it's not like people are popping them for a headache
or skinned knee. And insulting people may make some feel superior, but it
doesn't actually solve anything or even hint at a possible solution. You don't
just "ride these things (staph) out" and hope for the best. There are
consequences to going all granola "nature will take care of itself".

~~~
TsiCClawOfLight
I'm not talking about infants, I'm talking about the majority of the adult
population which can take good care of it's own.

~~~
ssmoot
Yeah, it's still a superiority insult.

I think I've been prescribed antibiotics for an obviously viral infection one
time in my adult life. I can count the number of times (in my late 30s) that
I've been prescribed antibiotics as an adult on one hand.

When you factor in that people just don't go to Dr's all that often in the US,
especially the poor, I'd need to see some actual data before I believe this is
a grossly American problem. Because given other factors, you'd be forgiven for
thinking something doesn't add up with that characterization.

I would for example, imagine it's much more of an issue in the UK with people
having cheap convenient access to the NHS.

In the US I'd have to find a Dr, and if I'm uninsured that means spending a
half-day at the ER, and then I'd have to take that Rx to a Pharmacy, who's
going to offer me a generic at an uninsured price that's probably somewhere
around my grocery budget.

If it's an issue at all (comparable to countries with socialized medicine) in
the US it would almost have to be an exclusively middle to upper class
behavior.

That's a good deal of the population that just doesn't play the game.

Honestly, framing this as a Stupid Fat American problem reads like "Are
Antibiotics Going to Kill Your Children?!? Find out tonight on XYZ News at
6PM!!!". Those stories are definitely out there and pretty pervasive. It would
be pretty ironic if Geeks with Superiority Complexes were being feed their
dogma by "common knowledge" based on soundbites from the nightly news...

Not to dismiss this as a problem. But insulting people (even comparably low
quality-of-life Americans) doesn't get us any closer to a solution. And
blaming those people, already stretched thin by work hours, insurance costs
(if they even have it), day care, trying to ensure they get to sit down for a
family dinner, go to work sick so they can afford the time off for a family
vacation that they're the problem because they're just dumb Americans is...
It's to express in words how petty and mean spirited that comes off as.

~~~
selectodude
[http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm...](http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm=a&Drug=AMOXICILLIN)

30 pills - $5.90. So a normal cycle would be about 3 dollars. In the United
States. Antibiotics are so inexpensive.

~~~
ssmoot
Amoxicillin hasn't been prescribed by our Dr after it failed to do anything
for the first ear infection. The Pharmacy isn't just going to substitute
different antibiotics for you either.

Here's what my daughter was prescribed:
[http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm...](http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm=b&Drug=BACITRACIN)

So $230 for the course. So sure. Amoxicillin is cheap. So is Tylenol. What's
your point? After the Dr's visit you're still likely out _at least_ $100, not
to mention time off work, and that's if the "cheap stuff" even works. You
can't get this stuff OTC.

I stand by my statement: Without data I think it's a lot easier to believe
that places with socialized medicine and generous labor laws for things like
sick time are much more likely to see abuse.

~~~
desas
In the UK both Amoxicillin and BACITRACIN will cost £0 for a child, the over
60s and pregnant women, or £7.85 for everyone else.

You do need to get a prescription though, which doctors don't dole out with a
smile. Companies don't have to pay to advertise drugs though.

------
benmarks
Really don't like the anthropomorphism.

~~~
jmcgough
Same - he's trying to dumb it down but really misrepresenting some things by
doing so (like how evolution works).

~~~
kubiiii
Dumbing it down on purpose might be the key to political action.

------
Futurebot
Norway came up with their own solution to this issue, and it has apparently
been working very well for them:

[http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-
so...](http://www.spokesman.com/stories/2010/jan/03/norways-mrsa-solution/)

------
memracom
Technology is the answer.

All citizens will be required to carry a smartphone or other GPS tracking
device that reports their location every 5 mins to a central database run by
the National Security Agency. When a new infected person is discovered,
National Bureau of Health agents will contact everyone who was close enough to
the infected person to have possibly transmitted (given or received) the
infection over the previous two months. Those people will be tested and
infected people will be incarcerated in National Health Concentration Centers
for healing. They will stay their for life, or until no longer infected.

Will it come to this?

What about mandatory death penalty (plus confiscation of all family assets)
for anyone who gives antibiotics to an animal or who supplies antibiotics to a
farmer?

------
triplesec
Can anybody outline what possible justification there is for the continued use
of antibiotics not as disease cure, but as prophylaxis and growth promoters in
intensive farming? I heard about the stupidity of this as a child, from
competent medical professionals, and decades on, nothing has changed. Rather
than such socially rapacious short-sighted practices, we ought to be
legislating better farming practices and tighter controls on these precious
medicines.

I believe this is quite likely a worse issue than the other problem: the
blatant overprescription of antibiotics by weak and obsequious family doctors
looking to defend themselves from lawsuits and approbation from wealthy and
stupid patients with colds and coughs, which has also accelerated resistance.

------
robomartin
I'm out of my depth here, but it seems to me one idea could be to help
bacteria evolve rather than aim to kill them all. What I mean by this is that
perhaps using bacteria against themselves could be an interesting approach.
Much like over decades people bred dogs to encourage certain traits perhaps we
can coax bacteria into developing traits that help us rather than help them
when they come into our bodies. Maybe your run a fever for five or ten days
and feel crummy but rather than have bacteria trying to destroy you they are,
effectively, fighting and destroying themselves.

In other words, Aikido not Karate. Use their own energy against them.

Just a thought. Probably nonsense. Not a biologist.

------
api
... and the judicious use of antibiotics requires some kind of regulatory
agency or system to make sure the users follow through.

This seems like another area where libertarianism is crashing against the
rocks of reality-- as socialism, communism, and all other political ideologies
have already done. I have a profound sense that all political ideologies are
failed, and that we're entering a post-ideological age of pragmatism driven by
either populism, oligarchy, or technocracy... take your pick.

~~~
stcredzero
_> This seems like another area where libertarianism is crashing against the
rocks of reality_

Antibiotics use fits the "Tragedy of the Commons" scenario to a T.

------
elangoc
I'm genuinely interested to know whether garlic can be safe and effective
replacement. I ask in all seriousness since garlic is said to have
antibacterial properties (and was used topically as an antiseptic for wounds
in WW 1 & WW 2). The thing about garlic is that our body never develops a
tolerance for it. Is it true that bacteria can never develop resistance to the
active compounds in garlic (ex: allicin) ?

------
moocowduckquack
With the development of generic anti-virals like DRACO ^1 -
[http://web.mit.edu/newsoffice/2011/antiviral-0810.html](http://web.mit.edu/newsoffice/2011/antiviral-0810.html)
\- I wonder if we might see viruses become largely treatable even while
bacterial infections are becoming less so.

^1 _who names these things and are they purposely trolling conspiracy
theorists?_

------
eliben
I'm always confused by these articles. If the issue was really so serious,
wouldn't governments be concerned by it at this point? What does it mean that
they aren't, in fact, concerned? Does it mean that the amount of people
currently affected by these bacteria is negligible? Something else? That there
are opposite experts who say this is no a real problem? Lobbying?

------
ericb
I wonder if we should have been prescribing 3 antibiotics at a time. This
would be for the same reason we use redundant disk drives--the odds of one
disk write failing might be one in 100. But the odds of 3 disk writes failing
simultaneously should be 1 / million. If some bugs need to survive to develop
resistance, this seems like it would reduce the chances.

------
patrickg_zill
While most view colloidal silver as quackery, the fact is that using silver in
colloidal form along with other medicine administered at the same time, was
standard practice 80 years ago.

Perhaps silver in nanoparticle form will make a comeback, as bacteria don't
seem to be as able to survive the cell wall disruption that silver can cause.

~~~
TaffeyLewis
There are actually studies being done around implementing exactly that with
antibiotics... However there is also the fun danger of your skin turning
incurably silvery blue thanks to the silver component in the antibiotics... No
really.

------
the_watcher
I'm hopeful this leads to new default treatments, since I have had allergic
reactions to the last 3 antibiotics I have been prescribed. They do a great
job fighting what they were designed to fight (for me), but then I get a week
of a really itchy rash, cortisone shots, and cortico steroids.

------
gurtwo
I wonder, what should we do as individuals? Shall we refuse to take prescribed
antibiotics for "minor" things, and let the body heal itself at the cost of
some extra discomfort? Would that make any difference in the long run? Does
the resistance apply to any kind of antibiotics?

------
kubiiii
I was wondering if resistant bacterial strain would drop resistances against
one antibiotic if we stop using it for long enough. Maintaining a resistance
comes at a cost for a living organism (synthesizing an enzyme), so the
bacteria that would drop it would be promoted.

~~~
roc
It seems like a plausible approach, _if_ you could coordinate antibiotic use.
But if we were capable of coordinating antibiotic use, we could correct the
practices that got us to this point in the first place.

------
tpainton
antibiotics do not cause resistance to form. resistance occurs due to natural
mutations. these are going to occur regardless of exposure to antibiotics or
not. The antibiotics simply select out the resistant organisms from the auger.
It was shear panic when S. aureas developed penicillin resistance decades ago.
methicillin was the solution. Now we have methicillin resistant staph aureas.
This is nothing to panic over. it simply means the battle is never won and
we'll require ongoing research on new antibiotics. To say we have lost is just
not true. This is the way life works. he also ignores the possibility of human
evolution. We can develop resistance to bacteria as well.

------
tzakrajs
Do doctors over-use antibiotics to save from being sued by patients in the
case of an infection?

~~~
Fomite
There are a number of reasons to over-use antibiotics:

1\. Patients ask for them. For a long time, the thinking went 'What's the
harm?' in giving Mr. Jones some penicillin for what's probably a viral
infection.

2\. There is the potential for lawsuits, and the desire to have 'done
something' to cover your ass, but I think this is widely exaggerated as a
threat.

3\. It's hard to diagnose many conditions. Like juries think all crimes get
the full CSI treatment, patients often think doctors can just pop down to the
lab and find out what you have, like in House. The answer is that's often
hard, expensive, and failure prone. So they give antibiotics, especially broad
spectrum ones, because of the subset of things you _might_ have, antibiotics
can treat some of them.

4\. This is really 3b, but it's also possible, when you have no clue what your
patient has, to try different antibiotics to try to get a handle on things.
This...ends up using a lot of antibiotics.

5\. Doctors, at their core, want to treat their patients. To make them better.
They're trained to deal at the individual level - antibiotic resistance is a
population level concern.

------
g8oz
The antibiotic overuse that caused this problem will not be solved with out
action in 2 area. 1) Antibiotic overuse in poultry and livestock farming to
compensate for overcrowded and stressful conditions and 2) Antibiotic overuse
in the developing world.

------
tocomment
I submitted this a few days ago about future alternatives to antibiotics.
Maybe it's more interesting now?

[https://news.ycombinator.com/item?id=6559134](https://news.ycombinator.com/item?id=6559134)

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tocomment
Wow, harsh downvote. Sorry for submitting something related to antibiotics I
thought you guys would find interesting.

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lgleason
My mother died from a MRSA infection. This is VERY serious stuff.

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thewarrior
Reading this really scared me. Is there any hope against this.

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_pmf_
Aw, shucks! At least some people made a quick buck fattening up animals to
fatten up Westerners. That surely justifies a few million deaths in the
future.

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eranation
What about Linezolid?
[http://en.wikipedia.org/wiki/Linezolid](http://en.wikipedia.org/wiki/Linezolid)

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w4
The Wiki article you linked specifically mentions Linezolid isn't necessarily
effective against many Gram-negatives (the resistant bacteria):

 _Linezolid has no clinically significant effect on most Gram-negative
bacteria. Pseudomonas and the Enterobacteriaceae, for instance, are not
susceptible.[90] In vitro, it is active against Pasteurella multocida,[2][91]
Fusobacterium, Moraxella catarrhalis, Legionella, Bordetella, and
Elizabethkingia meningoseptica, and moderately active (having a minimum
inhibitory concentration for 90% of strains of 8 mg /L) against Haemophilus
influenzae.[87][90] It has also been used to great effect as a second-line
treatment for Capnocytophaga infections.[43][92]_

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eranation
Oh, thanks, missed that.

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dailo10
Interesting that in a non-antibiotic environment, the antibiotic resistant
bacteria are actually less fit because that resistance comes at a cost.

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robot
I've been hearing about MRSA since 2000s. What's new? I mean, what has changed
now since 2000 that this is now more important?

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Fomite
It's more prevalent, and has gone from a weird bug mostly in hospitals to
something you can pick up in the community.

Beyond that, it's no longer just MRSA. There's all manner of resistance
mechanisms, for a very, very wide set of diseases, including some dirt common
ones.

"Resistant" isn't an on/off switch. _How_ resistant? _Where_ are the resistant
bugs? _How many of them_ are there compared to non-resistant competitors, etc.

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polskibus
What about chemiotics? Do the usual warnings about antibiotics abuse refer to
chemiotics in the same way?

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cstigler
Modal stacked above another modal when I opened the page. Neither relevant.
_gags_

The article's cool though.

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rrtyyyy
Evolution always wins

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T3RMINATED
Sounds like the guy from the Patent Office that said they should shut it down
everything has been invented.

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gibwell
How are we going to use fewer antibiotics when they are a profit making
venture?

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robomartin
> Bacteria, like any living organism, want to survive.

> bacteria will always change in order to survive.

Excellent article. Everyone should read it from top to bottom twice. Forward
it to your entire network. This is a serious matter.

However. I really cringe when I see scientists get loose with language like
this. I know he knows perfectly well how evolution works. This is an attempt
to make it simpler to swallow for those who might not be up to speed and,
perhaps, come to the discussion lacking a minimal scientific background to be
able to rationalize it. I get it. Among that population the misrepresentation
of the driving mechanisms behind evolution can actually do more harm than
good.

Taken far enough you end up with? "Oh, so you mean to say that a monkey WANTED
to survive and CHANGE in order to become a human". Which makes you sound like
an insane lunatic, of course.

The mechanism is dead simple: Out of a pool of organisms exposed to an
environment some die and some survive. This "environment" can be anything,
from an antibiotic at the bacterial level to a flood in a canyon. Of those who
survived some did so due to blind chance. Others because they might possess a
characteristic that helped them survive the environment. Survivors mate and
reproduce. Some mutations occur. The cycle repeats with the new population. If
the environmental "attack" (antibiotics, the flood, whatever) remains the
same, over time populations will develop that will have better and better
resistance to their particular challenges. This is the brutally simple result
of the demise of those who simply could not handle whatever was dished out.
Over time either the entire population is killed off and game over or those
who were resistant, for whatever reason, will --without intent, goals or
knowledge-- help evolve populations equipped with increased resistance to what
is trying to kill them.

In evolution there is no "wanting" to do anything. There isn't even the idea
of wanting to survive. There is no struggle for survival. There is no
conscious desire to change or to become something else. It is brutal and
simple. Some die. Some don't. Those who survive repeat the cycle. Eventually
either all die or you end-up with one or more new species/variants that got
past the killing spree and emerge resistant to whatever ailed them. And it
goes on. Challenge after challenge.

Part of me wishes people would have a better handle on this very simple
scientific fact so we could move on to more important topics. We went to see
Richard Dawkins at Caltech this weekend. He mentioned that in the US some 40%
of the population think the earth is 6,000 years old and reject evolution.
What they reject might very well be what ends-up killing them.

This issue of bacteria evolving past our ability to concoct antibiotics is a
very serious one. I've always believed we are all going to be killed-off by
something microscopic that nobody is going to see coming. The potential is
there for hundreds of millions of people to die over a short period of time.
Airplanes will contribute to that greatly, helping take bacteria all over the
world before we even realize what's happening.

That's why I don't understand why we don't get behind this --as a planet, not
just a nation-- with great force. I see virtually no use for our military and
that of other nations. Can't we lobby for the elimination of the horrible
waste that is the maintenance of massive military forces and, instead, devote
those funds to more worthy causes? Imagine if we, as a nation, devoted half
our current military budget to honest medical research. I am not one for huge
government programs, but there would be ways to do such a thing without having
government bureaucracies devolve the thing into a cash burning furnace.

The point isn't the details but rather the idea that something like this
should be priority one. We are looking at the possibility that within the next
25 to 50 years there could be a massive antibiotic resistant bacteria outbreak
that takes out a huge chunk of the human race. We need to be ahead of that
event, not behind it. And it is far wiser to throw billions of dollars into
medical research of almost any kind rather than into making the latest wiz-
bank how-to-kill-more-people-per-round machine.

Utopia. I know. Sad.

EDIT: I neglected to add how I would explain evolution to a general audience
without resorting to "want" and "desire" type analogies. In other words, don't
be critical without offering a solution. Well, I think it's simple, I sort of
did:

When faced with challenges organisms either excel or die. Those who excel go
on to reproduce. In reproduction there is mutation. Small changes to each and
every new organism. Reproduction does not produce clones. Reproduction results
in a population of new and distinct individuals with some of the traits of
their parents and some new ones. Their offsprings, if faced with the same
challenges will, just the same, survive or die. If none survive the population
goes extinct. Otherwise, over time, the only organisms who will continue to
survive are those who continue to carry the traits that made their ancestors
survive. This repeats over time and across challenges.

That's not the elevator pitch, of course. So here is that one, applied to
bacteria in particular:

When attacked by antibiotics some bacteria survive. These reproduce and
produce new bacteria that might carry-on some of the traits that allowed the
parents to survive. Random mutations might also make some members of the new
population even more resistant to the same antibiotics. The process repeats
over many generations. Over time new populations emerge with immunity to the
antibiotics that killed so many of their ancestors.

The more we expose bacterial populations to wide ranges of antibiotic
challenges the greater the effect can be. Over time populations will evolve
that will be resistant to anything we have on the shelves to throw at them.

