I live in India and despite some improvements, the level of antibiotic abuse here is shocking. They're available over the counter and people self-medicate with antibiotics all the time. The attitude is, "if my sore throat doesn't go away in a couple of days, its time to take antibiotics. No point in going to the doc coz they'll prescribe antibiotics too and this way I save money."
India is actually the free world's final exam. Biggest democracy in the world, a population that will soon surpass China, yet it is poor, uneducated, the government is highly dysfunctional.
Every year that we fail to help India reach the superpower status hints at chinese-style authoritarianism being a superior model. I wish we would spend more time and effort helping them.
I'd imagine it's not much different in Central and South America based on my travels. You can walk into any pharmacy and show them the word "amoxicillin" and they'll give you a 2 week course.
It used to be like that in Brazil, but in recent years Anvisa (the Brazilian equivalent of the FDA) tightened policy on this and now people can only buy antibiotics with a prescription.
BTW, in my experience Brazilian doctors prescribe antibiotics a lot less than American doctors.
So this is the way it works in India. Most people who know a little english remember the brand name of the drug.
Others just walk to the pharmacy store and narrate the symptoms to the pharmacist. Typically: Sore throat, a little fever etc. Then they state their budget(10-20 rupees), the pharmacist gives two tablets of Azithromycin.
A country that allows humans to buy antibiotics over the counter OR allows antibiotic use in healthy livestock needs to be heavily sanctioned very quickly. Sanctions from the international community can include ceasing aid, adding visa requirements or other travel restrictions, food import bans, or whatever.
I don't understand why other countries (and the international community as a whole) still accept this behavior.
"Approximately 80 percent of the antibiotics sold in the United States are used in meat and poultry production.2 The vast majority is used on healthy animals to promote growth, or prevent disease in crowded or unsanitary conditions."
Exactly. It happens almost everywhere. I claim moral superiority coming from a place where there are no over-the-counter antibiotics and none used in healthy livestock :)
Its like "I seem to have sore throat, let me take this anti-biotic right now, so that it doesn't escalate to something big later"
And they are right too. Most doctors write down the same regimen of antibiotics every single time.
Either way most doctors in India care about nothing apart from money and their immediate interests. Many realize they will never do a MD, so there are a lot of small time clinics, with rudimentary testing labs for blood work. They only care about maximizing per visit consultation fees and commission they get from the pharmacy store next door.
Its a huge mess, and there are no ways to fix it given the population scale.
It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.
- ALEXANDER FLEMING, Nobel Lecture, December 11, 1945
This is an amazing video[1] from Harvard Medical School released couple of days ago showing evolution of bacteria that evolve in 10 days to become resistant to antibiotics.
It is amazing. They've been doing that experiment for a while now, so I hope the video makes people realise how serious it is.
Here's a clip with a bit more information from the BBC Horizon popular science programme. http://v6.tinypic.com/player.swf?file=24goih4&s=6 (Sorry for the sub-optimal hosting, but YouTube's contentID blocks this clip.)
One of the things they don't mention in that video is what the safe human dose of that antibiotic is. I'm not sure where on that slab the dose of antibiotics starts killing humans.
Question that comes to mind is how easy would it be to take the bacteria that make it to the center, and put them on a new plate with a different antibiotic in the same configuration, and then repeat until you've gone through all available antibiotics, then scoop that last batch up and do something really nasty with it?
It must be harder than it seems, because otherwise why do terrorists and the like even bother with (seemingly much harder to obtain, though admittedly flashier) chemical and nuclear weapons?
The problem is bacteria are generally not that dangerous. You might need antibiotics a few times in your life. But, people regularly lived to 70+ without them.
Thus post attack the deaths would take a long time to add up and be hard to trace back to some attack.
PS: I had a foot of my intestines removed without being prescribed antibiotics or getting an infection.
Bioweapons are hard to deploy in a targeted fashion. Also, development of an antibiotic resistant bacteria that would be truly dangerous to a population requires great care during development not to kill those doing the development themselves. Also, I think we tend to overestimate the resources available to terrorists.
Fair point! I suppose I should reword it to say something like "why aren't we more concerned with this, at least as concerned as we are about chemical and nuclear weapons," but I guess "they're actually not that acutely dangerous that other comments have pointed to is the reason.
I spoke to an MD/biochemist friend of mine about this issue recently, and was told that this really isn't that big a deal. Specifically that antibiotic resistance is usually a self-limiting trait, so bacteria that evolve that capability will quickly lose it when no longer in a hostile environment. So these 'superbugs' can be an issue in particular settings, like hospitals, but are unlikely to ever produce major global catastrophes, or spread much beyond those limited environments.
Can anyone else with more knowledge of this confirm/refute this perspective?
EDIT: I should point out he wasn't saying it was a total non-issue. Just that some of the fear-mongering about global pandemics and such was completely unfounded.
I work in biomedical informatics, genetics background, and your friend is technically correct and MONSTROUSLY WRONG.
Bacterial populations that develop these resistances are certainly self limiting to a small extent - the resistance makes them less fit, less survivable and powerful, than other bacteria that lack the resistance trait - this means that bacteria WITHOUT the resistance out-compete bacteria WITH it -
That, in turn, means that when we take away antibiotics from the bacterial growth environment, the population with the resistance dwindles greatly or even disappears -
BUT
And this is a GIGANTIC BUT!
- often the mechanism that causes bacteria to stop expressing the resistance trait doesn't actually remove the genetic material from the individual bacterium, and even more, doesn't remove the trait entirely from the population. The end result of this is that you have a bacterial population that isn't DIRECTLY resistant to a given antibiotic NOW, but that if you introduce an antibiotic, you will almost immediately have a bacterial population resistant to that antibiotic. Through mechanisms like turning resistance genes back 'on' that were previously 'off', genetic material communication (essentially just bacteria passing genes back and forth amongst themselves, many bacteria are frighteningly efficient at this!) - we get the end result that's the functional equivalent of a a town full of regular folk who can go to a bunker in the event of an emergency and immediately transform into the hyper-militia from hell. Like a population full of terrorist sleeper cells, only with far more destructive capability than any terrorist group!
Not from a medical background, but I spent some time writing hospital infection surveillance software so can share a few anecdotes.
What he's saying isn't inaccurate. The idea is antibiotic resistance generally carries some metabolic cost -- the bacteria disable or find some other way around whatever pathway is being targeted by the antibiotic. This means they operate "less efficiently" than their non-resistant peers. When the antibiotic disappears from the environment, the resistance no longer offers an advantage, so they get out-competed by their non-resistant "more-efficient" peers.
This is in fact one of the ways hospitals fight outbreaks of resistant bacteria -- they cycle antibiotics. More subtleties of course, but basically the head infection surveillance person says "alright docs, this month we're blacklisting these antibiotics, next month we're blacklisting these." (This is one of the interventions our infection software helped with.)
On the other hand, there are places where the widespread use of antibiotics extends far beyond the reaches of a hospital building. Commercial agriculture is infamous for overusing antibiotics (basically mixing them into the lot's feedstock so every cow gets it). Outbreaks like SARS and avian flu weren't antibiotic-resistance outbreaks, but they WERE caused by sizable quantities of people working in close proximity with livestock and then spreading the disease through their normal travel and social interaction vectors.
India is known for having antibiotics widely available over-the-counter for people. There are stories of people coming back from India with an infection resistant to literally everything (there's only about 50 antibiotics out there) -- when that happens, it's like the outbreak movies where the CDC comes in with plastic sheets and wearing bunny suits to quarantine the room.
So will the lower-metabolic-efficiency attribute of antibiotic resistance be self-limiting enough to prevent it from turning into another 1918 spanish flu global pandemic? Maybe. But as long as there are large city-scale pockets of heavy antibiotic over-use with people traveling in-and-out, there are going to be constant transmission vectors that will still kill people in largely preventable ways.
I am in the medical field and can relate an anecdote, I'm sure which happens regularly across the US.
Patient visiting from India comes in with sepsis from urinary tract infection, and she has a history of multiple ones. ER doctor calls me to admit her. I come down and review her paper chart that the family brought with her and see where her last E coli UTI was resistant to everything except meropenem, and possibly gentamicin although I don't recall.
Until I had looked over this, the patient wasn't in any contact precautions (meaning disposable gloves or gowns for staff) and the ER doctor had given her the usual treatment for a UTI which in her case was going to do nothing.
I work in hospital epidemiology. It should be noted that even cycling has some serious problems. Many pathogens, such as community-acquired MRSA are causing a problem because our assumptions about the fitness costs taking care of things - and how swiftly that will occur - are not working nearly as well as some had hoped.
A great many things have changed in recent decades that create a situation that never before existed. We have an unprecedented level of human population. For the first time in the history of the human race, more people live in cities than in rural settings, which means increased density and increased exposure. We use antibiotics on livestock and most humans take them fairly routinely.
When antibiotics were introduced, it was heralded as the end of disease. Now, not that many decades later, we are dealing with super bugs.
I have read research on how to effectively reverse antibiotic resistance. I think this is a problem we can find solutions for in terms of societal level changes to reduce this issue. But, for the time being, you are screwed if you get one of these and my big concern is that this may be solved by having enough billions of people die so as to serve as a natural means to reduce population densities and interrupt the path we are on currently. This would majorly suck, even if you are one of the lucky survivors, because it would destroy a lot of things we currently take for granted, among other things.
It's absolutely a big issue. The main site of antibiotic treatment is hospitals (in the developed world) and if people come to hospital with a treatable or partially treatable infection and then we treat with antibiotics of last resort, and then they aren't treatable anymore because transfection of resistant plasmids happens in hospital, that person dies
I've seen very little discussion of this. Is antibiotic resistant (proof?) TB in 2016 deadlier than TB without antibiotics in 1916? That seems extremely unlikely, but pop news coverage basically makes it sound like we're all going to die.
In fact, in western countries, if we discover infection we treat.
If you have TB, your risk of becoming symptomatic is only about 1% per year, however you are potentially contagious the entire time. So in the health community we conduct TB screening, and most migrants are required to either show evidence of BCG status, or a series of chest x-rays often combined with the results of a Mantoux test.
A friend of mine, an emergency trainee, recently changed hospitals and had to have another Mantoux test. He lived in shanghai as a kid and would have been exposed in some manner, even though his body either cleared it or it is long dormant (his CXRs are clear). NSW health policy is that he needs 6 months of a course of antibiotics to ensure it is not latent in him.
The same approach is taken to would be migrants.
So you see, with tb the issue is not so much virulence, but our ability to control its spread in the community and prevent a potential pandemic of XDR TB, which all of a sudden would have TB as big of a public health threat as it was 50 years ago
The presence of antibiotics creates what's called a selective pressure in favor of bacteria with antibiotic resistance. Removing that selective pressure (i.e. the antibiotics) can potentially lead to the growth of non-resistant bacteria like your friend points out. But that doesn't mean antibiotic resistant bacteria just 'goes away.' There was a recent paper[0] published by the ASM that suggests antibiotic resistant genes can persist even in the absence of selective pressure. While I only skimmed over it, and it's certainly not definitive, it's very much an alarming conclusion. So while I understand his general point, I wouldn't bet the farm on it.
Already, we're seeing some pretty scary bugs with CRE (carbapenem-resistant enterobacteriaceae) and XDR-TB (extensively drug-resistant tuberculosis) and others. Festering in hospitals, where patients are at a much higher risk almost by definition, can create a real nightmare scenario that spreads outward from there. Even if that's avoided, antibiotics are almost a fundamental aspect of modern medicine. When they first came out, they were quickly perceived as an almost magical cure-all by the general public. Most people aren't able to imagine a world without them, let alone support the necessary steps to fight such a scenario. Medicine pre-penicillin was a scary thing, and no one really wants to think about the possibility of returning to it.
The body count--figuratively, literally, and economically--will likely be higher than a feared superbug as a result of surgical complications, the impact on organ transplants (if they're even feasible at that point), and a host of other problems brought about by common antibiotic resistance under the worst case scenarios. It's not a scary picture, and it's already here with thousands of deaths annually.
Unless some of the many ideas already being explored start to pan out, along with the discovery of new antibiotics in the interim, we're looking at a major step backwards to the 1930s. But that's going to require a lot of public funding and support. Personally, my nightmare scenario isn't a pandemic or a drastic decrease in survival rates for routine procedures. It's that we'll wind up having to experience one or both of those before the public starts to understand the problem and change their behavior. Maybe I'm being too pessimistic, but then I look at how antibiotics are treated in foreign countries and in livestock management, and I start to wonder if I'm not being pessimistic enough.
The Nature article hints that the main barrier to adoption is that it's difficult to for pharmaceutical companies to make a profit out of phage therapy: the cure is entirely natural, bacteriophage are the most common organisms on the planet, they reproduce very quickly, and evolve to overcome bacterial resistance.
Each bacteriophage typically targets just one or at most few types of bacteria. The targeted treatment in many ways is an advantage because a phage treatment to target a pathogen wouldn't also wipe out the symbiotic bacteria that we are increasing finding act as part of our natural defense mechanism against pathogens.
The challenge for drug companies is that they would need to isolate and get regulatory approval for each pathogenic bacteria that they wanted to treat. Today one of the challenges that drug companies face with developing new antibiotics is that the profit models for antibiotics are poor compared to drugs that treat chronic conditions. With an antibiotic you sell one course of treatment per patient but with a diabetes drug , for example, you're selling a lifetime supply. With a phage your taking the already small pool of money for antibiotic treatment and dividing it by a hundred or a thousand.
The other challenge is that using phages as part of a treatment protocol the diagnosing physician would need to culture and identify the pathogenic bacteria and then order a specific phage for treatment which would increase the cost of diagnosis. One possibility would be creating cocktails of phages that would target many different strains of phages but that would require complex revenue sharing agreements unless all the phages were developed by one drug company.
And while phages work great in vitro the don't always work as well in vivo because they are ... viruses ... which the immune system will attempt to identify and destroy them. Phage therapy for a sore throat, for example, requires gargling a phages in liquid. Not as simple as popping a pill to treat a blood infection.
Other than the last paragraph, the problems you mention are a market failure, which can be dealt with by having all aspects of phage therapy carried out within a government-owned health service, rather than by privately owned pharmaceutical companies.
It's worth noting that phage therapy was successfully used in the Soviet Union, and is still used in Georgia where the phage was "farmed", and that attempts to commercialize it have (as far as I know) invariably failed.
The clinical problems in administration of phage therapy to patients you mention are well-known and limit their use somewhat. But phage therapy could still be a valuable addition in the fight against pathogenic bacteria, rather than a replacement for antibiotics, which are more convenient, and work very well most of the time.
Phage therapy comes mostly out of Russia because they had much more limited access to antibiotics once the Cold War kicked off, so established some of the best research groups for other alternatives.
This was also why Germany, during the 2nd World War, were probably the world's experts in Sulfa.
That's not the only problem. Every time phage therapy comes up, I end up posting my thoughts on it (and this is from someone who loves, and wanted to work in, phage therapeutics):
Phage therapy is neat, it really is, but there are a couple major issues:
- There is no such thing as a "broad spectrum" phage. You can't do empirical treatment using phages, and there's not really "off the shelf" phage therapy - it tends to be a bespoke creation for a particular infection.
- There's some serious regulatory problems, similar to those experienced by fecal transplant treatments. We're not yet really equipped to think about handling evolving, custom microbes as a treatment.
- Because of the first, it's going to require a considerable amount more lab capacity than most clinical settings currently have, and considerable delays until treatment.
- There's also some biosafety issues around phage prep, but those are easily solvable.
It's a great way to treat particularly resistant or hard to treat infections, but it's not a particularly great general solution. There's a reason it was abandoned in countries with easy access to antibiotics - they're just roundly superior in basically every respect.
I think the problem with making profit out of it is that it's very time consuming(read - expensive) process, which has to be tailored to every person individually. In theory, a phage therapy could save someone who doesn't react to any other antibiotics, but the therapy would need to be prepared specifically for that one person. At least that's what I read about this.
Phages are easier to manufacture, and more expensive to deliver, than antibiotics.
They target very specific bacteria. Instead of identifying the bacterial strain (which if I'm not mistaken is done using phages), a cocktail of phages would be administered. Even if that doesn't work, finding a strain of bacteriophage from the environment which does kill the bacteria would still be quicker than developing a new antibiotic.
You used the word "evolve" - I don't think this means what you think it means. Evolving means that positive mutations are occurring that assist these organisms; what is really happening is Natural Selection; where already present genetic capabilities are being favored and those populations are thus surviving.
Mutations occur in bacteriophage. Those mutant bacteriophage which can attack previously resistant bacteria are then selected for and become more prevalent.
The article focus, and my focus, is a about how or if there is actual evolution occurring within DNA. It is separate and apart from the organism in question. My point is that almost everybody these days mixes up evolution and natural selection when they are two very distinct things.
All forms of selection that differ from the current equilibrium cause evolution in a group that is either sufficiently diverse group (assuming HGT or sexual reproduction) or has a sufficiently high mutation rate.
We got a scare a couple of years back when our teenage son got an eye infection - the doctors and eye hospital went through five different antibiotics before finally finding something that fixed it, which was quite stressful.
NB When you are warned not to wear contact lenses in swimming pools - take it seriously! We're almost certain that's how he got the problem.
That sounds really scary. I have gradually given up on contacts and gone back to glasses over the years - partly because of comfort, and partly because of hearing nasty stories of infections and complications caused by keeping them in too long.
If you wear contacts and follow all the rules exactly (like always taking them out before swimming/water sports, taking them out after X hours of wear each day, etc), I feel like they lose a lot of the convenience that made them so appealing in the first place.
You really want to just stick them in your eyes first thing in the morning and then forget about your crappy eyesight until bedtime, but it never seems to quite work out like that. (At least not for me, I have friends who wear them day in, day out with no apparent issues).
"“It doesn’t matter if it’s fresh water or a chlorinated pool,” Gibbons said. “There are bugs and pathogens that chlorine doesn’t kill, which could potentially cause damage to the cornea, infection or ulcers.”
They can't really become resistant to high concentrations of cleaning products like chlorine bleach because they just physically ruin the organism - the best explanation I've heard is that that would be "like a human becoming resistant to lava." Not gonna happen.
But in really low concentrations like in a pool, perhaps they could resist the oxidation effects...
Swimming pools are far from sterile. The chlorine and other additives serve to inhibit the growth of organisms, but with so many contaminating bodies in it, they are far from sterile. Some public pools, not assiduously managed, at the end of the day, take on more than the aroma of chlorine; but even those that don't are not free of bacteria and other interesting life.
Well I specifically didn't say "sterile" but rather "fairly sterile" compared to other water sources.
Edit: As a note to the pedants, of course sterile" is a binary, I used that casually to mean "less microbrial than a lot of the places where our eyes go." ;) <- right eye unfortunately hit the unsterile waters of a chlorinated pool.
> As a former boss used to say, there is no "fairly sterile" just as there is no "fairly pregnant".
This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything.
This is measured in multiple ways, depending on field: sterility assurance level[0] is one, similar to the way the USDA specifies cooking temperatures to hit 6- or 7-log reduction in bacteria populations. This is also why we crash probes like Cassini into Saturn to not risk contaminating any possible niches that could support life even though the probes have been built in a clean room, cleaned, and irradiated.
> This (and mrob's post) is definitely incorrect. It's the opposite, in fact, there is no "sterile" in the absolute sense. You'll never kill everything.
I suspect that there's some level of heat at which you've done exactly that. What organic molecule is going to survive a bath in liquid tungsten? ~6100F
Sure, but usually the problem is the thing you're trying to sterilize won't survive either :)
There's also flaws in procedure -- was it at the required temperature long enough -- and, of course, the real world that your target is going to be exposed to when it leaves the tungsten bath -- clean rooms aren't all that clean.
There is no "fairly sterile" -- things are either sterile or they're not. "Sterile" means zero viable microbes. It might be fairly sanitary compared to other water sources but any water treatment that's actually sterile is going to kill the swimmers.
It seems like a lot of these warnings relate to reusable lenses. I use daily disposables, and I really can't see how, say, getting tap water on them when I'm wearing them can be any more dangerous than splashing tap water in my eye.
I don't think that's true at all. I think the issue with contacts (even dailies) is that they can trap pathogens on the surface of the eye and give them a place to breed, allowing an infection to take hold. This could happen within a day while you have your lenses on.
I think dailies are somewhat safer, because you're starting each day with a sterile pair. But splashing any non-sterile water onto them is a mistake.
I think that one source of infection is dirty storage pots. That's what NHS Choices says, and they tend to be evidence based (although we can argue about the evidence they use).
That seems plausible. But I was once told that ideally you shouldn't even take a shower in contacts (Not that I always followed that advice). Maybe I just had an over-cautious optometrist.
It's definitely the standard advice, I just wonder how much evidence there is to support it. I guess it does make sense that the lens might make it easier for the bacteria to breed.
If any microorganism gets in your eye, it will usually be washed out of the eye by your tears and the sweep of the eyelid. If you're wearing contacts, it can get trapped in the film of liquid between the contact lens and the cornea, or in the film around the edge, and the tears and eyelid sweep will not be able to eliminate it. It's then in an environment where it's free to multiply and cause problems.
They were single use daily soft lenses - which I've used for a few years.
He had only been using them for a week or so and wasn't that good at getting them out so I suspect he must have scratched his eye while getting them out after swimming.
easy solution is to just heavily tax dairy, livestock and other industries that produce hundreds of billions of bacteria testing grounds (animals) per year at the same time using last-resport antibiotics to spur growth and reap profits.
or give extreme tax benefits to those that don't use antibiotics.
> First, a lot of antibiotic resistance appears to be driven by the agricultural use of antibiotics as growth enhancers. Thus, we can be savvy consumers and support and be willing to absorb the costs of the efforts to get antibiotics out of the meat industry.
It's a well known problem, not some esoteric trivia. It is also the biggest cause of selective pressure, not antibacterial soaps or human medicine misuse of antibiotics.
Cool, thanks! I did some looking into it, and it appears that as of 1 Jan 2017, in the US such uses of medically important antibiotics will be banned in the US (http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/uc...). The EU has had a ban since 2006. China and some other countries may still be a problem. Not sure how much meet the US/EU imports from those countries.
With these bans in place, it doesn't seem necessary to implement a tax on their use. Perhaps a ban on importing meat that was produced using antibiotics for growth.
You think paying more for your food will make bacteria stop reacting to selective pressure?
Or do you think we can stop relying on 'organic' food?(in the biochemical sense, not the hippie meaning)
I can understand what he meant:
Heavy use of antibiotics in diary and poultry industry is a significant factor contributing to drug resistant bacteria.
In other words, these industries are actively providing the selection pressure you referring here.
Well the selection environment is a requirement to not getting sick from eating the products. You can't just have a nice chat with the microbe unions and ask them to behave and stay off the meat...
> is a requirement to not getting sick from eating the products
one gives antibiotics to one's thousands of chickens to spur growth (body growth - gaining mass), not to protect the consumer from disease.
giving antibiotics to poultry extremely increases mass gains. post-slaughter processes add chemicals that keep meat from rotting, eradicating some of those living harmful bacteria that just so happen to turn flesh into unwanted dark piece of s+=t.
I entirely agree on your opinion of the antibiotic situation regarding large scale farming.
The problem is that we could not substitute another method to produce enough food to me(e|a)t demand. If we want to keep eating we must have safe food, and to keep food safe in frankly hostile environments we need to treat it. Until we can do without what passes for modern industrialised food growing and processing, we'll need treatments and colorants so we can pretend this is 'regular' food.
Antibiotics are not given to livestock to reduce loss. They are given to increase mass.
Farming without prophylactic antibiotics--where antibiotics are only used to treat sick animals, as they are in humans--could meet the demand for food easily.
There is no need to meet the current demand for meat. If meat was our only food source, then perhaps this syllogism you've drawn would be true.
But in reality, meat is an inefficient form of producing food, with complements humans can easily shift to. So the way you get less antibiotic use in livestock in a capitalist decision market is by reducing the demand for livestock. Taxes do a great job at reducing demand.
Maybe my pun about meet/meat confused you but the problem definitely isn't limited to meat production. You should see the quantites of pesticides/fertilisers/treatment agents used in the extensive culture of plants.
The question holds, if you don't intend to back current production levels that are only possible through over intensive exploitation to the detriment of the product and it's growing medium, what alternatives are there to meet current demand for food in general?
Use of pesticides in plant agriculture is mostly driven by huge demand of meat/dairy industry for feed. GMOs also aren't exactly necessary if you don't have 90 billion mouths to feed every day.
There are some vegetables that are easily grown in unsuitable areas with GM, and some people do use pesticides and GMOs to "defeat" the market but if international logistics weren't so hard it would be easier to just import the stuff.
Similar industry, completely plant driven, is cotton agriculture for clothes - to ensure proper demand you need GMO or pesticides.
When it comes to beans, lentils, soybean for humans (although most of it is for fish farms, poultry and livestock), wheat, corn, rice, all sorts of fruits, pesticides come in hand, but there's more than enough if space was taken from dairy/meat and given to those.
It's just 7 billion people, while you have to raise 50 billion chickens, 1 billion cows, -- about 150 billion animals yearly just to get them from baby form to somewhat of an adult form. That requires a lot of food, way more than 7 billion avg. 150 pound humans.
edit: realistically, this problem is unsolvable, just like US and China and others won't really struggle lowering their CO2 footprint, so will not Brazil, USA, India, Australia, Denmark and others when it comes to reduction of their meat/dairy output. If we were some nice unified Humanity maybe things would be different.
I would not be so pessimistic. Lots of things that many people thought certain would never happen or would take a very long time have happened in relatively short order.
Things like the fall of the Soviet Union, desegregation in the US, man on the moon, etc. Even things that required great international cooperation have happened. Like the eradication of smallpox and polio, the creation of the United Nations, etc.
But the reduction of meat consumption and reliance on factory farming need not be done on a global level to be worthwhile. It can happen one country at a time. Even one person or one animal at a time will be helpful, even if it won't solve everything. It doesn't have to be all or nothing.
We could meet food demand with quite a bit less production if we ate lower on the food chain, improved transportation infrastructure and reduced waste. People don't go hungry because farmers don't produce enough food, not today; people go hungry because some people don't get enough allocation of resources and/or transportation infrastructure is crappy.
I spy with my little eye someone who'd die early, in a world without antibiotics.
Some contaminations can't be washed or cooked away (Staphylococcus aureus, some Clostridiums...). And there are a lot of ways to mess up and contaminate an otherwise perfectly fine sample.
If the animal is sick enough to make you sick when you eat it, it would have died long before it reached the slaughterhouse. What you'd see without agricultural prophylactic antibiotics, at worst, would be occasional mass die-offs and spikes in meat prices. So instead of chicken always being $5/lb, it would be $5/lb most of the time and $50/lb when the die-offs happen.
The cheap option is antibiotics, that's why we have this problem in hte first place! If you want the best of both worlds (limiting bacteria proliferation AND antibiotic use) the current methods for providing food at scale are impractical for many cost-related reasons.
If meat is expensive you can go on to a largely vegetable and plant based diet. Meat is already more expensive than tofu and beans and lentils. And thanks to the Internet, it's now easy to pick up recipes and change ones diet with food from multiple cultures that don't use extensive amounts of meat.
Yup. I am an avid meat eater, love BBQ, all of the food I cook has meat in it- but I am absolutely aware that it is a luxury. I do my absolute best to buy higher quality meat as close to pasture raised as I can get... but I don't make that final leap to source out local farmers and buy directly from them to ensure that I know exactly how the meat I'm eating is raised.
But at the end of the day, not everyone can afford organic pasture raised eggs at $7/dozen. And the problem is that we've all gotten so used to eggs at $0.50/dozen or chicken at $1/pound that I don't think society as a whole could deal with the cost of meat equalizing to reflect the true cost of non-factory farmed production.
I think limiting the means for gaining resistance should have been considered more seriously. For now, things are taken seriously only "when the shit hits the fan" and that in itself is a weakness that seemingly still affects us as species despite the numerous lessons that should have taught us the importance of prevention.
Seriously though, we can forget about getting 7 billion people to use antibiotics safely. Really- forget about it. Not even education helps- after all it's doctors and pharmacists who are primarily responsible for this mess we're in [1].
Our only chance is to find some other way to deal with bacteria -perhaps that phage therapy thing- otherwise we may as well just accept that X million people will die every year because of bacterial infections. Not to mention, of all the conditions that might be safe to treat given antibiotics, but not without them (you know, open heart surgery, brain surgery, that sort of thing).
[1] Here's a childhood memory: my family doctor telling me I have a viral infection ... and prescribing antibiotics. Almost every year until I was 18 and stopped taking the damn things on my own, for entirely irrelevant reasons (I thought they were making me worse) (I got better).
The antidote to overprescription of antibiotics is to be able to get accurate test results to determine what to treat rather than throwing antibiotics at every problem. This company is working on products which dramatically decrease testing times to the degree that you can have actionable information before prescribing antibiotics:
Among some of the advancements:
* Group B Strep results under one hour (traditionally 48-72 hours)
* Salmonella results in 30 minutes (traditionally 24 hours)
There's a pretty good Frontline about this...I didn't see this fact listed in the article, but another huge problem is that it's generally not profitable for big medicine corporations to research new antibiotics, which means that for the time-being, we're stuck with our current regime.
I find this implausible. Surely pharmaceutical companies are as aware as anyone of the growing antibiotic-resistance problem and know that there will likely be a return on their investments in new antibiotic research. Sure, these companies sometimes exhibit a bias towards short-term gains, but they also aren't run by morons. And if they are run by morons, I see some great start-up opportunities...
The reason they are not profitable is because generally antibiotics are only taken for short time periods. Additionally, it is almost certain that new antibiotics will be obsoleted by the emergence of resistance. Spending hundreds of millions of dollars on bringing a drug to market is already a risky proposition, even more so when your drug will be consumed in low quantities and may be useless before the patent even expires.
Merck followed the purchase with firing a large chunk of Cubist's researchers. It's more likely that they purchased Cubist for Dapto, a proven winner and billion dollar drug, and maybe for their pipeline. I wouldn't hold my breath for Merck to follow through on the research beyond trawling through whatever Cubist had in development already.
"Merck bought a company for their already successful antibiotic and the others they had in the pipeline" hardly undermines the notion that there's still money in antibiotic development.
And they're still funding studies for Fidaxomicin.
Very naive question: won't bacteria lose their resistance after a while? What if we cycle certain antibiotics on an annual basis? When we reintroduce them, they'll be more powerful. Right?
> won't bacteria lose their resistance after a while?
DNA is good at accumulating, and relatively poor at editing out. Some bacteria will lose resistance, just like your ancestors lost the ability to make Vitamin C. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145266/ but you only need one single bacteria to have not lost the ability.
> What if we cycle certain antibiotics on an annual basis?
it helps. We can also stack them, and use multiple attacks at the same time. which also helps. But it just delays the inevitable.
> When we reintroduce them, they'll be more powerful. Right?
the bacteria, yes. because they'll have accumulated defense mechanisms.
Ultimately, I think we win this race, because we can intelligently and actively edit DNA.
True. Unused traits that are not maintained with selection pressure begin accumulating random mutations. The eventual outcome is the complete disappearance of said trait.
The downside to this is that the process of losing a trait is much more slower than gaining a trait. Think about it: Natural selection is a targeted process where by favored traits are directly selected and built up. Thus each generation gets a step closer towards a final selected outcome.
On the other hand, losing a trait involves one waiting for random mutations to basically destroy the trait by random chance, no direct selection is involved. By probability the complete destruction of a trait not maintained under selection pressure will eventually occur given enough time.
It is however basically comparing a blind folded dart game with a dart game that isn't blind folded. Hitting the center of the board in the blind folded game will take much longer than the other game but the center of the board will always eventually be hit given enough turns.
We have seen experiments (and the recent amazing video) of bacteria evolving resistance to antibiotics. Does anyone know of any research that studies the length of time it takes for these bacteria to lose a trait?
If you can get the entire human race to match in lockstep with rotating antibiotics in and out, AND the array of antibiotics is large enough, then yes, that's exactly what would happen.
The second part is in the works, constantly. The first part, however, is proving difficult.
I was chatting to doctor friend recently who has a masters in this area and he said that in theory yes but it would likely require the bacteria to have a reason to loose the mutation that caused the resistance in the first place so there is no guarantee.
Your doctor friend is incorrect. Unused traits will be lost eventually through the accumulation of random mutations. In order for a trait to form and be stable in an organism, selection pressure must not just be applied... it must be maintained.
This backwards process is actually observable. Many fish living in underground caves have lost their eyes through evolution. While eyes don't aid a fish in surviving in the dark, they certainly don't hinder the fish from surviving either... Yet cave fish have lost their eyes despite the lack of negative selection pressure.
> Many fish living in underground caves have lost their eyes through evolution.
some have, yes. but in order to get the antibiotic benefit we're looking for, you'd need to have ALL fish having lost their eyes. That's a much higher bar. ( https://en.wikipedia.org/wiki/Blind_fish seems to be a reasonably comprhensive list ). We also need the antibiotics to be viable again in a reasonable timespan ( a decade or two?), in order to be useful -- not on the timescale that was involved in cavefish eye degeneration.
Bacteria mutate much quicker than fish. Generations of bacteria form within minutes. There is significant possibility in the viability of cycling antibiotics as bacteria lose resistance.
I'm not sure, but that sounds like it might work. The real problem is: good luck getting all hospitals in the world to agree on a rotated schedule of which antibiotics to use / not use and when.
We are not enforcing a rotating schedule but hospitals are already naturally rotating antibiotics in response to resistance. Once penicillin was lost we switched to another antibiotic. The problem is that we don't have enough classes of antibiotics restart the cycle. It takes way longer for bacteria to lose resistance than for bacteria to gain resistance.
Antibiotics are used as growth factor in chicken. Many are growthfactors in humans also. There could be some way to fight antibiotic resistance considering this fact.
Hospitals give a wide range of antibiotics to people once they're admitted. Since after admitting someone they're legally responsible for their health.
Worst case scenario we end up with no working antibiotics. This is no worse than the pre-penicillin era. We haven't hurt ourselves by developing antibiotics.
People self-medicating on antibiotics end up taking an incomplete dose without fully understanding the implications. This has lead to the rise of superbugs like https://en.wikipedia.org/wiki/New_Delhi_metallo-beta-lactama...