When We Lose Antibiotics, Here’s Everything Else We’ll Lose Too

[KamaAina]

http://www.wired.com/wiredscience/2013/11/end-abx/

If we really lost antibiotics to advancing drug resistance — and trust me, we’re not far off — here’s what we would lose. Not just the ability to treat infectious disease; that’s obvious.

But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. Any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. Any major open-cavity surgery, on the heart, the lungs, the abdomen. Any surgery on a part of the body that already harbors a population of bacteria: the guts, the bladder, the genitals. Implantable devices: new hips, new knees, new heart valves. Cosmetic plastic surgery. Liposuction. Tattoos.

We’d lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We’d lose the safety of modern childbirth: Before the antibiotic era, 5 women died out of every 1,000 who gave birth. One out of every nine skin infections killed. Three out of every 10 people who got pneumonia died from it.

And we’d lose, as well, a good portion of our cheap modern food supply. Most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. Without the drugs that keep livestock healthy in concentrated agriculture, we’d lose the ability to raise them that way. Either animals would sicken, or farmers would have to change their raising practices, spending more money when their margins are thin. Either way, meat — and fish and seafood, also raised with abundant antibiotics in the fish farms of Asia — would become much more expensive.

[grilled onions]

1. As if the pain,suffering and premature deaths are not enough...

surgeons will be forced to sit on the side line watching patients fail,knowing if that "coach" called antibiotics allowed him to go in the patient could have thrived...the nurses who thought they could give their care to patients,surgical teams,wound care specialists will be under employed. Farmers too will suffer at the hands of over use and the constant use of antibiotics to everything that breathes.
Diseases that we thought were done for may perk up and the younger generations who never had many of the childhood maladies of 50 years ago may experience them.
It is frightening to think what the possibilities can be.

[Rex]

2. We are fighting against evolution.

MRSA...ie...Super Staph is already here and probably in your local hospital somewhere on the floor or a cabinet top.

[KamaAina]

3. Evolution?

We don't cotton to that kind of commie talk 'round these parts!

[Rex]

4. We are fighting against Satan.

Also his lesser known brother, Stan.

[loli phabay]

26. i thought it was his dyslexic brother santa.

[mother earth]

5. If antibiotics weren't prescribed so freely when NOT needed, and they weren't fed routinely to

livestock to FATTEN for profit motives, thereby lessening nutritional value & making a hormonal mess of what goes to market, we wouldn't be in this mess.

EVERY hot mess our country is in is thanks to profiteering motives, to hell with what's right, what's best, if it doesn't make profits rise - its of no value to the corporate mindset.

Yes, indeed, be very afraid because it's all going to hit the fan sooner or later. What a mess we've made of it all.

[Egnever]

7. Well said

I had to LOL when they lamented the ability to raise animals in putrid conditions without antibiotics.

I had to laugh to keep from crying.

[mother earth]

13. Those raising the animals should be subjected to the same treatment, maybe then they

might understand...maybe not, seems you just cannot fix stupid or greedy.

[Avalux]

9. Yes we would. Those factors contribute -

however bacteria adapt to their environment and will eventually become resistant even without taking them when not needed and giving them to animals (it just might take a little longer).

We need an initiative to develop NEW antibiotics that bacteria haven't seen before. That hasn't happened for decades.

[magical thyme]

19. Not exactly. If you stop using antibiotics, the resistant populations lose their survival advantage

over non-resistant populations and eventually die out. This is because the resistant populations have to divert their resources to synthesizing the resistance mechanisms, which leaves them less robust than non-resistant populations. The non-resistant populations have more resources available to generate reproduction and population growth, and eventually crowd out the resistant bacteria.

So we could reduce resistance overall by very careful and judicious use of antibiotics, periodically rotating certain classes out of use temporarily. It would mean no more factory farming, and much more expensive meat (which is not necessarily a bad thing). And it would mean only using antibiotics when they are really called for.

This principal is currently being applied in the horse world, not to antibiotics but to deworming programs. Veterinarians used to recommend a rotation program of de-worming every 2 months with a different de-wormer each time. However, worms have become increasingly resistant to the milder dewormers necessitating high dosages. (For example, we were using just a single dose of strongid when I rescued my elderly gelding. His last couple years, I had to increase it to a triple dose to effectively de-worm him.).

Now, the vets I know are taking an entirely different approach. We did a fecal on each of my 2 horses in the spring and determined they were clean, which meant their immune systems were effectively keeping the worm population in check. Instead of de-worming 6 times/year, we de-worm just twice using 2 different wormers that the worms have not yet developed resistance to. The other de-wormers are off limits for now. In theory, at least, over time the non-resistant worms will out-compete the resistant worms for the same reasons as I described above with bacteria. They are more robust and can devote more of their resources to reproduction and population growth.

[Boudica the Lyoness]

31. I also worm twice a year now.

After the first hard frost in the winter and then in the Spring.

[mother earth]

20. Why aren't we studying and promoting natural antibiotics, natural antimicrobials? Big pharma can't

patent them, that's why...NO BIG MONEY seduction...that's where our mindset is set...fuck what's right, what's best.

[Silent3]

28. Um, like natural organisms wouldn't adapt to natural antibiotics?

As if the billions of years of evolution before humans came along weren't a long story of natural organisms adapting to natural threats their survival?

This sounds a lot like a knee jerk "natural = good, artificial = bad" reaction, without any real consideration of the issues involved. "Natural" just has to be better!

[mother earth]

33. I'm not sure you understand naturopathy, and obviously you don't understand that the only reason

pharmaceuticals are used is because these same natural substances are changed up to put a patent on them, FOR PROFIT.
There are physicians who incorporate naturopathy in their practices, are they wrong to do so? I think not.

You are the one with the knee jerk reaction, and YES when possible natural is better.

The human body is an incredible machine when it's fueled with the right substances. GMO's and antibiotic resistance issues are forcing all of us to use our brains and rethink the BS we've all been taught, that there's a pill for everything that ails you. You are living in a fool's paradise if you ignore nature - the controversy about marijuana - a natural substance that has def. therapeutic properties, when you are considering "real issues" don't rule out mother nature...and if you use antibiotics, make sure you use probiotics, you know that good "natural" substance in yogurt...it just might be of benefit after you've killed off all bacteria from that round of antibiotics, bacteria is not all bad, some are quite good.

Never doubt natural science, oil of oregano, olive leaf, garlic, and so many natural substances (extracts, vitamins, minerals) too numerous to name would be studied far more if it meant huge profits, but don't doubt that the aforementioned are indeed natural antibiotics, antimicrobials and anti-inflamatories and they DON'T cause resistance when used. I could go on and on, my friend.

[Silent3]

34. Back when everything we consumed was "all natural" because we hadn't invented...

... the artificial stuff yet, human life spans were much shorter on average than they are now, and often plagued by many infirmities.

Yes, simple things like improved sanitation and an abundance of food in developed countries are a big part of longer lives and better health. I'm hardly suggesting we're living longer because of Xanax and cheese puffs.

On the other hand, the sum total of artificial drugs and processed food can't be, on the whole, so very, very terrible as some people make it out to be, or it would override and largely cancel out those other gains.

I don't doubt that there are some, maybe even many natural substances that could be equal to or better for people than many profit-making artificial alternatives. But each needs to be proven on a case-by-case basis. Deciding that "natural = good, artificial = bad" is a gross oversimplification that does not serve well us as a strictly followed issue of faith.

If I were forced to oversimplify with one rule, I'd probably favor natural over artificial -- so long as we kept improved sanitation and a productive, abundant food supply. But I'm not forced into such ridiculous oversimplification, and neither is anyone else.

Living a long and healthy life, free from diseases and parasites, is actually one of the most artificial, unnatural things one can hope for.

[Avalux]

35. Do you know how antibiotic drugs are made?

Antibiotics are chemical agents produced by one organism (bacteria or fungi) that inhibits or kills another organism. Daptomycin, the last new antibiotic approved a decade ago, is a compound derived from a soil bacteria (streptomyces roseosporus specifically). Penicillin is made from the mold Penicillium. They are naturally occurring compounds that need help through chemistry so they can be made into a drug that is delivered either topically or systemically to eradicate infection.

So essentially - compounds from bacteria and fungi are used to kill other competing bacteria and fungi. That's how it works.

I understand the claim that oregano oil, grapefruit seed extract and colloidal silver (for example) have antimicrobial activity, but there is zero clinical evidence of their effectiveness; and ingesting colloidal silver may even be harmful.

We absolutely need antibiotics to combat bugs like MRSA, VRE, CRE, and pan-resistant bacteria. Unfortunately, the process for getting them into a form that will help people is handled by big pharma, for profit. I wish that wasn't the case.

[mother earth]

36. I never said traditional medicine was of no value or should be abandoned. I do believe naturopathy

can be and is quite successfully incorporated into traditional practice. Dr. Atkins is one famous physician who did so and wrote books about it, he is not alone.

I'm not getting into a contest with any of you arguing points on traditional vs. alternative, that could go on endlessly. There are many doctors using these methods, they work, they are based on science, not voodoo.

We've got a problem with antibiotics that is man-made, the basis of which I have already commented on. You can spit on natural medicine all you want. I'm not bent on convincing you of its value. I don't have to, its value is not in question, there's plenty of documented proof, books, etc.

I never said anything about colloidal silver and have no knowledge of its effectiveness.

Antibiotics are valuable, BUT they have been and are abused, for profit, which is why the OP is being discussed.

My contested comment is that we need MORE research and promotion of natural medicine, there is much to be gained from
doing so, because traditional medicine fails us at times, and this issue with resistance is a prime example.

[Avalux]

39. I am not spitting on natural medicine, it has its place on a broad scale.

But back to microbial infections specifically - there is nothing to replace antibiotics, they are essential to combat deadly bacteria. What happened prior to the discovery of penicillin? Lots and lots of people died including those using natural remedies.

[mother earth]

41. There is nothing, because further study and research is only done on patentable solutions. nt

[Aristus]

12. The cattle I can't do anything about.

but I'm reducing antibiotic abuse in clinical medical practice one patient at a time. I am very, if you will, conservative, when prescribing antibiotics. I never prescribe them for viral illnesses (and neither should any other medical provider), and I educate my patients about the consequences of overprescribing antimicrobials.

When a patient comes to me and asks: "Can you just give me some antibiotics? I've got a little cold", I educate him or her very quickly.

I don't hold with the apocalyptic scenario; I think we'll solve this problem. It will take time and effort, that's all. We have less and less of the former all the time, and too little desire to make the latter.

[Avalux]

18. Thank you.

I am happy to hear you take the time to educate your patients and don't give in to them.

[mother earth]

21. Aristus, have you ever studied the benefits of natural remedies, there's an abundance of natural

antibiotics and antimicrobials, but it's simply not a factor in medical practices today. We have an abundance of alternatives that gets zero recognition.

Dr. Atkins (for one) practiced medicine using naturopathic solutions, why is there so little predisposition to using these?

[Aristus]

22. I haven't studied them very closely.

But one of my classmates from PA School is a licensed naturopath. I have a great deal of respect for naturopathic medicine. When my patients request natural remedies, I refer them to naturopaths. I also spend time explaining to skeptical patients the difference between naturopathic medicine, and homeopathic 'medicine', and that naturopathic medicine is a science, just like clinical medicine; and that homeopathic medicine is not.

[mother earth]

32. Yes, naturopathic medicine is not homeopathic, it's a shame it is not first course of action...

it does seem that the only good to come from GMO's and antibiotic resistance issues is that those inclined to do so are becoming much more aware and self-sustaining. Thanks for your reply.

[First Speaker]

24. Thanks...

...both for the obvious thought and care you provide to your patients, and for your relative optimism that we *can* solve this. Reading DU has given me a considerable respect for your judgment... ...this makes me feel a little better.

[Aristus]

25. That's very kind, thank you.

I am optimistic about our ability to solve problems when we have the will and the resources.

But I'm also confident about the ways in which certain seemingly intractable problems can solve themselves.

For example, a few years ago, I read an article which detailed how former member of the Mafia who were in the witness protection program were coming out of hiding, and suffering no deadly consequences. The Mob, which once seemed so powerful and pervasive, was shrinking, and no longer had the power or the resources to chase down snitches.

Similarly, organized white supremacy is dying out. No matter how loud and ubiquitous they seem now. More and more kids are growing up in the Facebook generation, and seeing the similarities between themselves and other kids their age of different ethnicities.

And more to the point of the OP, antibiotic medications that have fallen out of use due to resistance will make a comeback someday as the resistant strains die out, and new generations of susceptible organisms develop.

[countryjake]

6. Did you see this?

If not, you can watch it at PBS online now.

Frontline: Hunting the Nightmare Bacteria

http://video.pbs.org/video/2365104403/

[Avalux]

8. Big Pharma doesn't give a crap about antibiotic research.

Most of my career was spent in infectious diseases research, and there's very little money in developing novel new antibiotics. Most of the 'new' stuff are just cousins of those we already have. There's no money in antibiotics. ID docs are well-read and know their stuff, marketing doesn't really work with them. Also, antibiotics aren't given long term, like the designer drugs that rake in the profits.

My colleagues have been talking about the upcoming crisis for a long time, we all know it's going to happen. We can't depend on for profit corporations to solve this. There should be a government-funded and ideally, a global initiative for the development of new antibiotics. I'm not going to hold my breath though.

Bacteria are living organisms and survive by adapting to their environment. Only an idiot would think our current drug arsenal will continue to be effective.

[KamaAina]

10. The same author mentions that in another piece.

https://medium.com/p/892b57499e77

With antibiotics losing usefulness so quickly — and thus not making back the estimated $1 billion per drug it costs to create them — the pharmaceutical industry lost enthusiasm for making more. In 2004, there were only five new antibiotics in development, compared to more than 500 chronic-disease drugs for which resistance is not an issue — and which, unlike antibiotics, are taken for years, not days. Since then, resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat with the few drugs that remain. In 2009, and again this year, researchers in Europe and the United States sounded the alarm over an ominous form of resistance known as CRE, for which only one antibiotic still works.

Here's a thought: Evul soshulist big gummint could make them.

[Avalux]

14. There are scientists and clinicians in academia who need funding to do the work and can't get it.

Developing new drugs takes a lot of time and money - when done, most of them fall out in early stages of development. There is no quick fix to this, even if an initiative is started now it would take decades.

A couple of my pet peeves....

Internal medicine physicians prescribing broad spectrum (big gun) antibiotics for infections where a targeted antibiotic would be effective. We need to protect the powerful ones and only use them for really bad bugs, but that isn't happening. There is a finesse to prescribing antibiotics that is often neglected.

Viral vs. Bacterial. Often a hysterical mother will take her sick child to the doctor and instead of being told she has to wait it out because the infection is viral, it's easier for a physician to prescribe an antibiotic (that won't help in any way) just to make the mother feel better. It happens all the time.

[jberryhill]

15. Are countries with national health systems unable to?

[Avalux]

17. It needs to be bigger than that, I think. Here's a good article:

Sustainable Global System Might Avert Antibiotic Resistance

The entire structure of healthcare delivery for effective antibiotics, including research and development, distribution, and rational use, must be reengineered to avert the looming global threat of antibiotic resistance, according to a Lancet Infectious Diseases Commission report published online November 17 in the Lancet Infectious Diseases.

The report, authored by 26 experts from around the world, offers a comprehensive global overview of the growing problem of antibiotic resistance, leading causes and repercussions, and critical areas needing urgent action. Release of the report immediately precedes European Antibiotic Awareness Day and the Centers for Disease Control and Prevention's (CDC's) Get Smart About Antibiotics Week, which begins November 18.

"The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world," lead author Professor Otto Cars, MD, from Uppsala University in Sweden and ReAct Action on Antibiotic Resistance, said in a news release. "Within just a few years, we might be faced with unimaginable setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions to improve surveillance and transform the way antibiotics are regulated and developed are taken immediately."

http://www.medscape.com/viewarticle/814567

[Aristus]

23. Even in some of the ones that do, antibiotic abuse is rampant.

Russia, for example.

When I was in my family medicine rotation, I evaluated and treated the three kids of a recent Russian immigrant. They all had viral illnesses, and I prescribed appropriate symptomatic treatment for them until they got better on their own. I was charting my report when the nurse came back to me and said that the mother was complaining because I didn't treat her children for their illnesses. I replied of course I did.

Then my mentor took me aside and said: "It's common among Russians to expect antibiotics at a clinical visit. In Russia, they just throw antibiotics at their patients, without regard for resistance, or proper treatment of viral illnesses.

The mother had been expecting me to prescribe antibiotics for her kids. It wasn't a medical visit to her unless they got antibiotics.

Despite this cultural expectation in medicine, I have no idea what, if anything, the Russians are doing to fix the problem.

[mother earth]

37. Isn't the fact it's fed to livestock routinely to fatten them up & then gets into the food supply

to wreak havoc the more problematic part of the resistance issue? We are being fed antibiotics almost on a daily basis through our food.

[Avalux]

40. 70% are given to livestock to keep them from getting sick -

and yes, it does contribute to the resistance problem. It's one of the reason's I don't eat meat.

[KamaAina]

11. Not mentioned: residential segregation

There's a reason those who could used to move to the fringes of crowded cities. Bye-bye, urban renaissance.

[malaise]

16. Lots of women died during childbirth while WWII raged

because antibiotics were not available.

[CFLDem]

27. I think it would be a severe but temporary pandemic.

It's gameover for any germ/virus once nanobots become advanced enough to fight infections.

[pnwmom]

29. We don't need them and should eliminate them from our food supply.

We especially SHOULDN'T be using them to fatten up our farm animals, which exposes us all to antibiotics with no important gain.

If it costs more to produce meat without it, then so be it.

[cui bono]

30. Using them in our food supply is a large part of the reason antibiotics are losing their

effectiveness.

We shouldn't eat animal products that have antibiotics in them, we should eat less of them and raise them in a more humane and hygienic and safe fashion.

[mother earth]

38. Absolutely. nt