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Scotty

A world where anti-biotics don't work is coming soon

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A disturbing story today on the emergence of a new super bug which is immune to all antibiotics. When you think of how often we use antibiotics to combat various infections the implications are staggering and the death toll from previous, easy to treat infections could be enormous. Hundreds of thousands a year already die due to antibiotic resistant bugs. That number could easily grow to tens of millions.

Bacteria becoming completely resistant to treatment - also known as the antibiotic apocalypse - could plunge medicine back into the dark ages. Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.

http://www.bbc.com/news/health-34857015

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The market on its own cannot deal with this challenge. What should governments do?

1. Pay companies to develop and stockpile new antibiotics.

2. Change the profit model from sales volume to utility of the product.

3. Incentivise doctors to use antibiotics as judiciously as possible. Some serious infections will thereby go untreated but this is a necessary cost.

4. Monitor antibiotic resistance more closely at provincial, federal and international level.

5. Subsidize new technologies to make hospitals safer e.g. cleaning agents, robotic cleaners, paints, room design.

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The market on its own cannot deal with this challenge. What should governments do?

1. Pay companies to develop and stockpile new antibiotics.

2. Change the profit model from sales volume to utility of the product.

3. Incentivise doctors to use antibiotics as judiciously as possible. Some serious infections will thereby go untreated but this is a necessary cost.

4. Monitor antibiotic resistance more closely at provincial, federal and international level.

5. Subsidize new technologies to make hospitals safer e.g. cleaning agents, robotic cleaners, paints, room design.

You forgot the biggest problem. We have GROSSLY abused anti-biotics. Doctors have prescribed them for all kinds of things which they are ineffective against. We use them as broad spectrum protection for herds of animals. We use them in cleaning formulas for sprays and wipes. All of that should be made illegal. Use soap to clean your damned hands or kitchen counter, and make doctors only use them for infections which can't be combatted in other ways.

We also need a crash program to develop new anti-bacterial agents but that won't help if we continue to spray these things around hither and yon wherever we feel they might be useful. If we have no antibiotics then common infections will start killing people, not just old and inform people but young and healthy people, and in much greater numbers.

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You forgot the biggest problem. We have GROSSLY abused anti-biotics. Doctors have prescribed them for all kinds of things which they are ineffective against. We use them as broad spectrum protection for herds of animals. We use them in cleaning formulas for sprays and wipes. All of that should be made illegal. Use soap to clean your damned hands or kitchen counter, and make doctors only use them for infections which can't be combatted in other ways.

We also need a crash program to develop new anti-bacterial agents but that won't help if we continue to spray these things around hither and yon wherever we feel they might be useful. If we have no antibiotics then common infections will start killing people, not just old and inform people but young and healthy people, and in much greater numbers.

The challenge is how to change prescribing, which is a complex business. Patients expect antibiotics and will go to doctors who will give them out. There needs to be a cultural shift in expectations as well as various sticks and carrots to move doctors in the necessary direction. Doctors also need to be protected from lawsuits if a patient presents with signs of a viral illness, is refused antibiotics, and turns out to have a serious bacterial infection.

I'm not sure how we can best move to a completely different way of behaving with antibiotics. Perhaps a country could negotiate a licence to use particularly important antibiotic for, say, three years and then try to restrict its use only to appropriate cases. One problem would be the black market.

The debate about antibiotic usage in animals is something I have seen waged elsewhere. There are proponents for both sides. I would certainly prefer to see it minimized.

Washing hands - certainly, a good idea.

Edited by SpankyMcFarland

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It's just a good thing for us there's such spirit of cooperation and shared cause around the world otherwise we'd be hard-pressed to do much if anything about the real issues facing the world.

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There was an excellent episode of Radiolab about this a few weeks ago ("Staph Retreat"). Antibiotic resistance is not a new thing. Since the first discovery of penicillin, we have always had to develop new antibiotics as the old ones became less effective. One of the reasons it's a bigger issue these days is big pharma isn't finding it profitable to keep up the pace of antibiotic development, the resistance is being allowed to get ahead of the science. One interesting thing is, they are finding that the further back you go to the oldest antibiotics, the more you find those ones actually working again. The "resistance" appears to fade over time. Also, there are really old antimicrobial recipes that are not at all approved for human use (think witch doctor level stuff), and have never gone through trials, that recent testing appears to show killing off otherwise resistant bacterial strains very effectively.

http://www.radiolab.org/story/best-medicine/

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Seems beyond stupid that anyone would use colistin ("the drug of last resort") as a blanket drug continuously applied to herds of pigs. These antibiotics should be controlled substances and should be strictly forbidden for any use except medical treatment in humans and for scientific purposes, period. We should have an international protocol on this, and countries that fail to comply should be compelled to do so, through military force if need be, cause honestly they pose a far greater danger to the world than the cave men with guns who we wage war against the rest of the time.

And any doctor who prescribes an antibiotic because they feel pressured by the patient to do so, when the doctor knows that an antibiotic is not applicable to the problem the patient is having, should be banned from the profession for life, cause they obviously don't have the character to be a doctor.

Also, not completing your prescribed course of antibiotics should be a criminal offense (unless you have a valid medical reason).

Edited by Bonam

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Seems beyond stupid that anyone would use colistin ("the drug of last resort") as a blanket drug continuously applied to herds of pigs.

What else do you expect from a country with no ability or willingness to enforce laws restricting the actions of people with the right connections to the party.

Also, not completing your prescribed course of antibiotics should be a criminal offense (unless you have a valid medical reason).

A hard law to enforce if people can barely afford the drugs in the first place.

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Seems beyond stupid that anyone would use colistin ("the drug of last resort") as a blanket drug continuously applied to herds of pigs. These antibiotics should be controlled substances and should be strictly forbidden for any use except medical treatment in humans and for scientific purposes, period.

I would go further by saying it should only be used in hospitals. Because as noted, people often stop taking antibiotics when they feel better, which allows remnants of the infection within them to often survive and develop immunity to the drugs used against it.

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The challenge is how to change prescribing, which is a complex business. Patients expect antibiotics and will go to doctors who will give them out.

I don't think we see much doctor shopping in Canada since it's hard to get a family doctor in the first place. I doubt yous ee it much in Europe or the rest of the world either. The US might be the only place for it.

Definitely doctors have to be told that giving out unneeded antibiotics is malpractice.

As an aside, I am coincidentally on antibiotics right now. I somehow developed an infection in my colon, which, if untreated, would get progressively worse and eat through my intestine walls. I went to ER last week and was told this isn't even all that rare, but not to worry because it was easily treated with antibiotics.

One more day and I'm done the required ten days. I've felt fine for several days, though, and could have stopped taking them, but I know better. If you're told to take them for ten days you take the damn pills for ten days. People not doing so are a major problem.

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I don't think we see much doctor shopping in Canada since it's hard to get a family doctor in the first place. I doubt yous ee it much in Europe or the rest of the world either. The US might be the only place for it.

Definitely doctors have to be told that giving out unneeded antibiotics is malpractice..

Most of us agree on what should be done. The question is how to get there. Anyone who wants an antibiotic badly enough can get it one way or the other, on the Net if all else fails. Many patients still expect antibiotics for what are probably viral illnesses and that expectation has to be changed.

Doctors are getting better advice from labs these days about which drugs to use, partly to keep drugs effective. Such advice is by no means always followed.

The biggest problem is that capitalism and human nature are fighting against what needs to be done. The current market model encourages maximum volume of drug use, which will increase resistance. What may benefit an individual may not be in the interests of the community.

Edited by SpankyMcFarland

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One other thing that can be done:

Promote vaccinations.

Vaccines work differently than antibiotics (working to prepare the body's defenses, rather than trying to attack the bacteria itself). Now, many of the diseases we use vaccines for are viral (i.e. antibiotics wouldn't work on them anyways).... however, sometimes one illness (e.g influenza, measles) can indirectly cause complications involving secondary infections (e.g. bacterial pneumonia). Stop the first disease, and you don't have to worry about using antibiotics for the secondary diseases.

Plus, you reduce the number of people in hospitals and doctor's offices. (One less patient in the hospital being treated for the measles means one less person who can be exposed to people carrying bacteria in the hospitals.)

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What else do you expect from a country with no ability or willingness to enforce laws restricting the actions of people with the right connections to the party.

Trade deals and more deregulation.

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Here are some recent proposals to fight this growing problem, potentially a new 'dark age' in medicine:

http://www.theguardian.com/society/2016/may/19/no-antibiotics-without-a-test-says-report-on-rising-antimicrobial-resistance

http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf

I think governments are going to have to invest substantially in this area. We must respect our opponent. Bacteria have been in the resistance business for something like 3 billion years, and they are ready to resist antibiotics they have not even been exposed to. For example, Clostridium species isolated from the bowel of a Franklin expedition member, frozen in the ice for 120 years, were found to be resistant to antibitiotics developed in the twentieth century.

https://news.google.com/newspapers?nid=1980&dat=19881026&id=YYUiAAAAIBAJ&sjid=9akFAAAAIBAJ&pg=4063,4308629&hl=en

Edited by SpankyMcFarland

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