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.
As you can imagine, doctors initially got into trouble with this because there is no test that you can use in clinic that says "this patient just has a viral infection". Nevertheless, there are clinical criteria that we can use to come to the same conclusion, and the tide changed years ago with regards to inappropriate antibiotic use for routine viral illnesses.
It gets much dicier in-hospital when someone has a SIRS response and you need to presumptively treat them for sepsis.
I would be curious to know: of the antibiotic resistance burden that comes from human antibiotic use (specifically in countries where abx are physician-prescribed and not available over the counter), how much of this burden comes from broad treatment of presumed serious infections, and how much comes from treatment of presumed non-serious infections or even postsurgical prophylaxis?
Resistance is a funny thing: there's nothing specifically wrong with going nuts with the antibiotics provided everything gets dead.
The problem is much more with people who only take partial courses or are non-compliant, because if you don't clear the infection then round 2 is full of the slightly more resistant members of the species.
Sure, but my question is about epidemiology. Rather than assuming that most resistance comes from "bad"/noncompliant/non-adherent/choose-your-euphemism patients, it would be interesting to know what the current burden of resistance can actually be attributed to (separating out resistance due to livestock antibiosis, countries where people can just buy antibiotics over the counter, etc).
The function of antibiotics in agriculture isn't to prevent infection (or at least, not primarily to prevent infection) but to fatten the animals up for slaughter.
I'm just pointing out that the antibiotics aren't strictly being used for disease-prevention (hence better hygiene alone might not eliminate their use).
The obvious answer is: You can't profitably slaughter diseased animals (at least for human consumption, with various complex exemptions that massively reduce value)
So treating with broad-spec antibiotic prophylaxis increases your healthy-at-slaughter-date yield, especially under cost-optimised industrial feedlots.
More incrementally, (if perhaps still somewhat controversially), normal gut bacteria accounts for some fraction of the energy intake provided by animal feed. By killing them off, it frees up nutrients for the host. Other mechanisms including reduced immune load may also be involved.
Quoting from [1]:
> According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to "help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals". Although the mechanism underpinning their action is unclear, it is believed that the antibiotics suppress sensitive populations of bacteria in the intestines. It has been estimated that as much as 6 per cent of the net energy in the pig diet could be lost due to microbial fermentation in the intestine (Jensen, 1998). If the microbial population could be better controlled, it is possible that the lost energy could be diverted to growth.
User shabble has some ideas (in a sibling comment to this one), but reading that gives me the impression that this is a little bit of a theoretical concept. It's not. It's very widely practiced, with the explicit intent of "promoting growth".
E.g., a search like [1] calls up a large number of references to it.
I think it's an appropriate response to life and death issues, when, on one side of the scale are the potential deaths of millions.
My ex-girlfriend's dad died of an infection, quite possibly a superbug. I was there with her and her mom the second he stopped breathing. Go and be there at the moment of death by infection of someone you know, then tell me how you feel about people who needlessly weaken antibiotics.
If someone is going to put a single bullet in his gun, spin the cylinder, point it at someone and fire then I think I would subsequently be quite justified in restraining them even if the gun didn't happen to go off that time. Likewise if the person was doing something that had a 1 in 60 chance of killing 10 people, and likewise if what they were doing had an tiny chance of killing millions of people.
So if it had been "making it illegal for corporations to spill contaminants in local water supplies", this would also be considered violence, in your eyes?
I, for one, think we should pass laws that prevent people from doing harmful things to society..
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.
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.
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.
Yes, so we're talking about someone who would be committed enough to resisting authority to provoke violence. This is different than saying "if you break a law, it will result in violence" or even the more extreme "instituting a law is a violent act", which is what the original comment in this tree suggested. I realize what you're saying, but I think at this point it's argument just for argument's sake.
Also, in this case, the individual dosing livestock with antibiotics is actually harming society, in which case I think it would be okay to physically detain him/her from doing so, rather than just saying "this is just too much effort, guess we better let him do whatever he wants". In most scenarios though, I don't think this would be necessary.
If I go to an Apple store and decide I can pick up an iPad and get out, because I've been nice to everybody and I deserve it, similar things will happen, starting with "Excuse me sir," verbal arguments, guards, armed guards, and (if I decide to defend my right to my iPad with armed force) eventually a shoot-out match.
So, we could equally say that there is implied violence in every transaction. (Well, yes sometimes the violence is leased from the government, which will happen if I bring my armed thugs to raid an Apple store. And I'd consider that a good use of the government's resource.)
It's your basic (American, right-) libertarian argument against the state doing anything that limits business. I think its application in a case like this nicely encapsulates the flaws in the philosophy, or at least the ability of its adherents to apply it sensibly.
What? How did you make that leap from "nobody's gonna beat a vet with a rubber hose" to assuming I'm a hardcore libertarian? I'm for the reduction of antibiotics through government regulation. I think business should be restricted when it comes to doing harm to society.
With such a leap, I can only logically assume you replied to the wrong comment.
No, I was responding to you with an observation about the comment above yours. There's nothing about your post that indicates adherence to libertarianism.
If it's outlawed (as suggested above), he refuses to pay the fine, persists in doing it, and goes to great lengths to refuse subsequent incarceration, then yes he will face something akin to getting beaten with a rubber hose.
Nonsense. Jaywalking is illegal, I do it every day, and have done for most of my 40 years on this planet. The state hasn't yet seen fit to bother coercing my legal compliance in this matter. It's hardly going to unlimited lengths to stop this illegal activity.
I didn't say it would go that far, I said there was no limit to how far it might should it choose to. There are plenty of horror stories regarding jaywalking prohibition enforcement. In some places, the state does indeed go to remarkable lengths to stop that activity.
If you're arguing it that way, then giving livestock antibiotics or dumping polluted waste is also violence by your definition: by these actions, they're coercing others to die without their permission.
There's a bill introduced in the Senate that would restrict antibiotics that are approved in humans from being used in agricultural in a prophylactic way.[1] A similar bill has been introduced in the House[2] by Rep. Louise Slaughter who has degrees in microbiology and public health.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
Given the pernicious and undemocratic over-representation of rural interests embodied in the structure of the Senate, I don't expect them to go anywhere.
I'm sure the rural interests have the same thing to say about urban interests & the House. Which, really, means things are working as intended.
As intended is rather irrelevant to the question of whether or not it's a good system. Unless you think that the so-called founding fathers were infallible?
A system which gives representation to rocks and cows rather than to people is undemocratic. That's not just my opinion man, it's a statement of fact. The House doesn't over-represent urban interests it represents them in the proportion that people of the country live there.
Your post smacks of the fallacy of the golden mean fallacy, which is unfortunately a serious problem in the United States today. There aren't two sides to every issue. Often some people are just wrong.
Of course it is undemocratic. This country wasn't built to be a perfect democracy. Allowing urban voters to dictate policy affecting rural voters under the name of democracy just because there are more urban voters could turn out to be a very bad idea, because urban voters are not necessarily well-informed on issues that apply to rural America. This in turn be bad for everyone, as the urban voters depend on rural America to produce food.
The debate over firearms is a simple example. Urban voters do not see why rural voters cannot simply depend on the police to maintain law and order. Rural voters on the other hand do not see why urban voters think the police can respond in time. The difference is their context. Urban voters are probably right- in the context of a city.
(I am not arguing about firearms, I just thought the debate was an easy illustrative example of how your context matters)
There aren't two sides to every issue. Often some people are just wrong.
I'm sure you are conveniently always on the side that is right? :)
Antibiotics in animal farms should be banned world wide.
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
Consumers might have a choice, if they are wealthy enough to afford it. If you are a beef consumer, eat beef from Namibia, where antibiotics for animals are banned, and avoid US or South Africa. Ask you butcher, if he can offer antibiotic free meat.
Unfortunate the only nation who has the power to convince others joining this ban, is one of the worst abusers of antibiotics.
I'm curious as to just exactly how you think the US is going to convince China, Russia, India, etc to ban antibiotics? The US could obviously afford to do so, as the incremental cost in the price of animal protein (due to smaller yields) could be absorbed by modifications to eating habits or redistribution models (i.e. food stamps).
I'm not sure the same could be said in some of the countries that are much larger and have huge difficulties with food production/distribution already.
Antibiotics in animal farms should be banned world wide.
Why? The problem isn't giving antibiotics to animals. Antibiotics are useful for animals the same way they are useful for controlling disease in humans. The problem is abuse of antibiotics.
The issue is any antibiotic that could be used to cure humans should be used for nothing but curing humans. Every use of it rolls the dice that the bacteria will evolve an immunity to that drug. There isn't any "safe" use. Bacteria will eventually evolve and we can only reduce the amount of evolutionary pressure being applied.
So in short, yes the problem is giving it to animals.
But we derive real utility from using antibiotics with animals. First in preventing blights in our food supply (which has been the downfall of many nations of antiquity) and second in controlling diseases that can jump to humans.
If there is no safe use, then what matters is risk vs. reward, right? There is real utility (reward) to using antibiotics on animals, and I don't see how we can simply blanket rule it out.
Of course, they're given to animals to keep them healthy enough so we can eat them.
If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
I recently re-read the fantastic Ishmael[1] which does a fantastic job of explaining the crazy things we've done to increase our food supply in the last 10,000 years.
> If you cut back on keeping them healthy, you're cutting the amount of food available for human consumption.
You are cutting the amount of meat and dairy available for human consumption, not food. Eating animal products is not a terribly efficient way of getting nutrients.
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.
> 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.
> 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.
This is one reason to avoid hospitals at all cost. It's also why hospitals are terrible as a first treatment option for the poor. I can't recall a family hospital trip where someone didn't catch something new at the hospital.
This, right here, is the biggest issue. Routine, minor surgery? No longer a risk free proposition. This sort of antibiotic resistance will have, and is having, enormously deleterious effects on the kind of basic health care and medical science we take for granted.
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'.
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.
>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:
> 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?
That kind of solution is part of the problem. Resistent bacteria are normaly outcompeted by non-resistant ones, except when there is antibiotics on the enviroment. As a consequence, the mere act of keeping something always sterilized (as well as possible) helps the resitent bacteria growth.
But, of course, you can't avoid keeping a hospital sterilized.
And they'll be absolutely necessary. The infrastructure exists now. As an example, if you contract XDR tuberculosis you will be quarantined under orders from the CDC, by force if necessary, until the infection is cleared, which can currently be done reliably only with surgery.
Maybe the solution is to have the procedure in a place that is a hospital. You'd want some environemnt that isn't shared by other sic people, and is only sporadically sterilized.
Yep, I have no idea how to actualy do that. There are all kinds of issues, but I'd guess that you can solve nearly all of them with tech.
I worked at a hospital for awhile, and one of the things I found interesting, though, is that the departments balance each other out. For example, our hospital did obstetrics more as a service to the community, since other hospitals were much further, but they always lost money on it. So maybe the reason we don't see surgery centers or things like that as often is that medical institutions are more stable providing a broader range of services.
The difficulty is avoiding treatment and not diagnostics. If your method of avoiding treatment is never going to the doctor, ie, never being diagnosed, you don't really know when your problems are life-threatening.
> we're helpless and the world is again going to be a scary place
Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective:
>Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic.
When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.
I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.
Basically Pfizer, one of the last companies working on antibiotics for gram-negative bacteria, pulled out due to pressure from shareholders, because there's little money to be made here. You spend billions of dollars on creating an antibiotic, and upon its release the recommended instruction is to "use it as less as possible"? -- there's no money in that obviously, there's more money in cholesterol drugs, ADHD drugs, and other drugs you'll continue taking for a long long time.
I feel bad to steer the discussion this way -- but this it, this perfectly underscores one of the scary faults of capitalism. Everyone wants to see a nice smooth growth curve. Growth is prioritized higher than long-term stability of society. We need to fundamentally re-think this.
Having read this and the article on autonomous corporations, I suddenly understand that the future of capitalism is extinct humans and very financially well-off computers.
Keep in mind that Pfizer's strategy is in response to the incentives offered by the marketplace including regulations set forth by the FDA and patent office. It's not a free market that sense.
It's not hard for the FDA to streamline approval process so that development costs are lowered or for them to offer extended periods of market exclusivity so that costs can be recouped over a longer period of time.
The FDA has already moved on the regulatory aspect and companies have responded. Antibacterials is a much more attractive market now than it was 5 years ago.
I worked for Pfizer, for 2 years in clinical trials to get Linezolid on the market. This was for treating MRSA infections. I was in close contact with nurses & doctors who seemed to think it worked well. Back then (around 10 yrs ago), there was almost no MRSA resistance, unheard of from what I remember.
Then I left and lost track of it all. Wikipedia now says it's 100USD / pill.
If there's really a lot of resistance to Linezolid, that would be quite shocking.
In my project there was a lot more MRSA in "poorer" parts of the country, in hospitals with lower hygiene standards. Hospitals also refused to report their MRSA stats ("it doesn't exist here", not wanting to be known as a place where it's found since it is related to hygiene).
No we don't - this is just where we need to fund government laboratories to research drugs in areas which drug companies do not presently find profitable.
If that's what's necessary for the company to develop such an antibiotic, why not? State-of-the-art cancer drugs can cost that ore more.
I'd rather pay $5k and live, to not being able to do anything.
Remember, it takes 8-12 years and $1,000,000,000 on average to whittle 10,000 drug candidates into 1 fully tested FDA approved drug.
If a company is going to spend a decade and a billion attempting to develop a "management" antibiotic for continual profit, I'm willing to bet the profit motive exists for another company to make a normal antibiotic... that most doctors would happily prescribe over the ridiculous multi-year option...
It's a big risk and I doubt some company will attempt to make a maintenance drug out of antibiotics.
Unless you're implying that profit motive means they simply won't try because it's not insulin or something, which is ridiculous. Profit motive... there is profit to be made in a new antibiotic, there's the motive. Not every pharma company will just let money sit on the table in favor of older drugs nearing the end of patent protection.
This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.
Also many chronic diseases are autoimmune diseases, like asthma or type 1 diabetes. In such patients the immune system gets weaker when in crisis, leaving them vulnerable to infections.
I suppose that's true, but it seems like a perverse incentive to me. Drug companies have a financial incentive to wait for people to die rather than taking action that will prevent people from dying.
Really? The most profitable drug ever is Lipitor which is entirely based on reducing the threat of future health problems. High cholesterol does nothing to you in a short timeframe, but will greatly increase your likelihood of death 20-30 years from now.
It's not an impossible scenario but have the decency not to wrap this 'End of the world fantasy' as a fact or certainty.
There have been plenty of those before you and there will be plenty more to come. Y2K, Nuclear War, Swine Flu, Global Warming, Apocalypse, take your pick.
Of those, though, two of the threats were real and mitigated before the impact could be realized (nuclear war and Y2K), and one of them is a fairly recent scientific theory that is still trying to be understood (climate change).
In the 80s we acted faster on freon/CFCs than we have on climate change in the ensuing 30 years, with less danger to human life and less evidence. The only thing that's new about climate change as a scientific theory is the annual increase in the pile of evidence that it's happening and we're the cause of it.
Absolutely horrible example because .com owns .gov and the primary patent for CFC production expired in 1979, obviously lots of money is going to be poured into encouraging the use of patented CFC replacements, such as making the use of CFCs illegal. I'm not questioning the science of it, I'm explaining why .com and .gov worked together really hard on banning CFCs in the early/mid 80s, because HCFCs and HFCs are more profitable. The historical about-face is documented and hilarious how .com strongly denied CFCs could have any effect therefore .gov wouldn't ban them until the patent expired, then suddenly everyone agrees we need to use the more expensive HFCs and HCFCs.
I'm quite sure around the time HFC and HCFC patents expire we'll all have to suffer thru very well industry funded explanations of how R-141b causes excessive pr0n browsing or some such nonsense, so for the children, we'll all have to switch a new, ever more expensive refrigerant.
I'm sure if the patent for CFC production expired in 2020 we'd still be pumping the classic stuff out, along with an industry funded denial movement and probably an alignment on political party lines to prevent any progress, etc.
Bringing it back on the original topic the best way to get .com (and since the merger, .gov) to fund antibiotic research in the modern real world would be to genetically engineer bacteria genome to contain an encoded .avi of the SuperBowl or an encoded Miley Cyrus .mp3 or something like that. Maybe glycophosphate resistant MRSA would get some attention from the usual suspects.
If someone could figure out how to patent global warming or global cooling we'd be on to something...
This is nonsense. Some large portion of industry would be happy enough to not pay royalties.
There are also at least several countries with little regard for patents and significant industrial bases that none the less signed on to treaties to limit and cease the production of CFCs...
But sure, Dupont made the US government strong arm India and China into paying for their new refrigerants. And Russia too.
Exactly. Those are two specific things that needed to be eliminated. Climate change deals with a lot of bad actors, and a very broad category of changes.
Tne real threat of a Dr. Strangelovian nuclear apocalypse certainly died with the Soviet Union, which isn't to say that such conditions could never arise again. And of course the risk of a smaller scale nuclear war is still very real.
In each of these cases there seems to be a tendency to think that just because total disaster has not yet occurred, that the risks are nonexistent.
Those examples both qualify as necessary and emergent.
What's been happening for decades is things like kids getting a cold and doctors wanting to appease panicked parents by prescribing an antibiotic (that's obviously going to do nothing to a virus).
I'm not sure how prevalent your example is these days.
I have plenty of recent experience bringing kids to pediatricians, and they do not hand out antibiotics like popcorn.
They do lots of rapid in-office tests that detect strep, flu, swine flu, fungus etc. within minutes - so the diagnoses are much more accurate than in the past.
What I'm saying is that we should have treated antibiotics, as a worldwide community, like a stockpile with a finite lifespan and only a limited availability. As few uses as possible, with the goal of saving lives, not making people "feel better".
What I'm imagining is something like the Department of Energy, or even the CDC here, regulating the ability to prescribe antibiotics and establishing rules that must be followed for their use. Antibiotics would not be a privately exchanged commodity, but a highly regulated resource managed for the public good.
So, would this hypothetical future involve antibiotics for your hypothetical cases? Probably? Possibly? If doctors discerned that the cause of the swelling was bacterial infection, if the bladder infection was threatening to the wife's future well-being? Then I'd suppose so.
But you wouldn't get antibiotics just for being alive like you do now. They practically hand them out like candy at doctor's offices.
Oh, you have a cough? Have a z-pak. Doesn't matter if it's a viral infection going around, who cares if giving you this drug just ensures that some day in the future we won't be able to treat someone who is actually dying with azithromycin. What's important is that taking these pills will make you feel like we're doing something to help.
Maybe GP didn't have the best wording, but I would classify those both as emergencies appropriate for antibiotic use -- you may only think them not because antibiotics are seen as so commonplace.
Non-emergencies:
* sore throat
* lots of chickens packed in one place
I think it's too easy to say that overuse of antibiotics is what brought us here. In the article it says that companies stopped developing new antibiotics when development costs became too high to justify given the narrow market.
Now, if doctors were to use antibiotics only for very serious infections, a last resort method, then pharmaceutical companies wouldn't have had the incentive to develop even the drugs that we now take for granted, because the market would have been so incredibly small to not give them enough reason to invest in development.
I think we would've ended up in this very same position anyway, it was just a matter of time.
I could agree (or at least agree to disagree) if you were talking solely about agricultural use of antibiotics or just-in-case prescriptions, but it's a bit tone deaf to complain about people using antibiotics to treat non-emergency diseases (like strep throat and gonorrhea).
People use antibiotics to treat things that are not helped by antibiotics.
Antibiotics were routinely used for ear infection even though there's no evidence of benefit. Antibiotics were routinely used for viral illness where there's no possibility of benefit, and possibility of harm.
Obviously unnecessary use of antibiotics is unnecessary (a fact I alluded to), but that's not what I was responding to. You're putting words in my mouth there. I said the call for "emergencies only!" antibiotics was overkill. If I took your point differently than you intended, maybe you would like to rephrase.
Being somewhat pessimistic here. As someone who actively hacks DNA, I believe that we can address this problem responsibly with the development of new and novel antibiotics for antibiotic-resistant bacteria. There are significant challenges in the biology but there is technology being developed that will significantly reduce the cost and time needed to develop new antibodies.
For example, my company TeselaGen (http://teselagen.com) has developed a cloud based platform for biologists to design, build, and test a large combinatorial set of DNA constructs. Some of our customers use our software today to easily and effectively test an incredible number of DNA devices for identifying and developing useful antibodies.If you have an understanding of genetics and cloning you can try out the software yourself.
> tools of last resort only to be used in emergencies, with great hesitation, and only when absolutely necessary
Does that exclude post surgery recovery to prevent infection? Or are you saying that people should get the infection first then it should be treated after?
I think it would be more accurate to characterize antibiotics as effective, not just profitable. You are completely ignoring the actual benefit of antibiotics and acting like they created profits without actually benefiting the patient
> 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.
>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.
I appreciate your point and I don't disagree with you (+1). However, the issue is complicated and I wanted to present another side to the original post.
I think it's likely that those two claims are mostly true in bacteria. Since bacteria evolve quickly and have experienced a lot of evolution, I believe they are likely near-optimum and therefore the second claim (IMHO) follows from that: changes would typically be deleterious.
On the other hand, even allowing for that, it's possible we could be allowing them to escape a local maximum and reach a more-optimal state.
And, there is a more significant criticism you could make:
Even if I am right on both points, a population that evolved to be heterogeneous (with some small percentage of wildtype being resistant) could likely have the best of both worlds ;)
There is a catch here however, any resistance a bacteria has, has implicit cost to the bacteria in the form of copying the resistances' dna into new cells. This costs the organism energy and time to copy. If it confers no benefit it will be dropped from the genome.
Bacteria both evolve resistance quickly, they also lose it just as quick. Because unless it directly is needed in the here and now, the bacteria that remove it and survive without it outcompete the rest of the bacteria.
This is my understanding at least, a real bacteriologist can comment what I inevitably got wrong. But the recent study that used existing antibiotics in a certain way to kill bacteria is a great demonstration of bacteria not being able to select for all simultaneously and retain the old resistance in the future.
I'm not overly concerned about bacterial resistance given there are ways we can work around it.
> Bacteria both evolve resistance quickly, they also lose it just as quick.
Alas, experiments have shown that it is possible for resistant strains to strongly reduce the cost of resistance maintenance. If there are no naive invaders, this can lead to an evolutionary stable situation where the maintenance of resistance is less costly than losing it.
See Lenski's (old) review "Bacterial evolution and the cost of antibiotic resistance"
Plasmids are only one of the ways that bacteria adapt.
Adapting antibiotic resistance can take as little as a single nucleotide mutation in the right part of a bacterial genome. Many of the known antibiotic resistance mechanisms involve small mutations to critical proteins.
This makes the assumption that evolution results in a perfect organism, which it does not. Instead, it results in a "good enough" organism.
The definition of "good enough" for bacteria has changed over the last 50 years, so these changes are occurring now. It doesn't necessarily require a cost, or at least not a cost that matters to humans.
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.
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…
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.
A good illustration. Your phrasing "The bacteria has developed resistance to the antibiotic" is of course better understood as "the descendant bacterial cells have been ruthlessly selected for resistance to this antibiotic." But that is not an invariant characteristic of bacteria. It is perfectly possible to completely wipe out a population of bacteria in a particular place so that the bacteria have NO descendants.
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?
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.
Its difficult to say if they've reached the end of their 'maximum optimization limit' or a local maximum.
The beauty of evolution is not to be stopped by limits, but to run near infinite instances of optimization algorithms over infinite time scales to over come the limits that exist.
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.
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.
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).
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.
I think it's a bit pedantic to argue about his usage of "desire". Evolution is a blind watchmaker. The bacteria are reacting to selective pressures. Large populations of bacteria around the world are getting exposed to different kinds of antibiotics. It's not a matter of "if" they will acquire resistance, but "when", and we're seeing this happening right now.
The fact that lines of bacteria go extinct does nothing to disprove the fact that bacteria are developing resistance to antibiotics. Is it possible that there are antibiotics out there that can stop the newly-resistant bacteria? Of course. But it's getting harder and harder to find newer and more-powerful antibiotics.
A promising alternative appears to be bacteriophages.
I have never heard of bacteriophages before. Doing some light research, I found their protein/body structures to look almost machine-like. Very fascinating stuff.
From Wikipedia's Bacteriophage page: "Medical trials were carried out, but a basic lack of understanding of phages made these invalid".
I seriously hope alternatives like bacteriophages are being revisited and reconsidered within the medical community, as it's obvious that conventional antibiotics are increasingly becoming less effective each year.
Phages have been, and are, being revisited and reconsidered.
The early days of 'phage therapy' were pretty bad - because we really didn't understand what was going on, the "purified" phage solutions still had bits of bacterial cell membranes and the like in them, including endotoxins. People died.
But phages were still being looked at for most of the antibiotic period, especially in countries without quite such widespread access to antibiotics. The Soviet Union had a very active program in Georgia, which was ongoing before the trouble there a few years back, I don't know the status of it now.
It's a promising avenue, and there's some decisive advantages phages have over antibiotics. But it's also quite hard, and right now we lack a generalizable form of phage therapy - it tends to be a bespoke solution to specific intractable cases. But the incentives might increase as antibiotics become less and less effective.
For awhile I wanted to work on phage research before I realized wet-lab Biology was not my forte.
Bacteriophages are very much the answer to the titular problem. Instead of finding tiny little lethal molecules, we will likely end up actually designing machine-like phages to kill the causes of our illnesses. They're easy to select for, quite good at what they do, and are some of the most approachable objects in synthetic biology, currently. And they are much more amenable to continued use than the 3 or 4 scaffoldings of antibiotics (small molecules) that we know of today.
The biggest problem with phages is they can be quite specific. Antibiotics put phage research out to pasture because a single, easy to mass produce small molecules were capable of wiping out enormous varieties of bacteria.
With phages you'd need a large library to counter different bacteria, you'd have to successfully identify the bacteria which is causing the problem which may require culturing. If you wanted to maintain phage effectiveness in a heavily selected environment you'd also need to design phage "reactors" where the phages can be continually evolved against current bacterial populations.
Which in the long run is a far more elegant solution. Rather than "Kill All The Things!" (including your target), it's "Kill the Bad Guy!" - but you have to know who he was.
I believe the point being made was not pedantic, but to express the difference between a blind watchmaker (as you say, evolution) and a sighted watchmaker (theoretically, the effort of humanity, science, ...). Of course, that assumes that humanity as a whole, or in part, can actually recognize the need and organize an effort compared to how quickly the blind watchmaker works. Maybe I'm reading too much into it, but I think I see what OP is getting at there.
In fact, a bacteriophage may or may not be the most promising vector, but a bacteriophage engineered to attack pneumonia or specific infections would be the work of a sighted watchmaker, not dissimilar from ideas of targeted radiation or chemotherapy that are moving forward in the area of cancer treatment. I recall an experiment (not that this is my area of expertise at all) in the recent past that was attempting to use magnetized medicine along with some sort of electrode insertion, I believe, to coerce medicine to specific areas of the body.
On the topic of Bacteriophages, I seem to recall reading in Biology class a long time ago, that the reason the water of the Ganges can be stored for a long time without getting spoilt is because of the presence of Bacteriophages! Certainly useful to humans!
You are completely right in that bacteria don't have the ability to "want" things since they don't have any kind of brain. However, desire is a useful way for the general public to understand what is happening. It's like saying "Water wants to flow to the lowest point of a room" or "The arrow wants to follow the path of least air resistance"
It's not an inability to understand you're seeing, it's a rejection of it because it misleads people. Pendants attack such language precisely because it's misleading without cause. There's no reason to personify random processes and doing so actively misleads people.
Where's your evidence that people are mislead? I don't have any data either, but I suspect exactly zero people came away thinking that bacteria have conscious desires, just like zero people believe that wind actually bites or people actually get butterflies in their stomach.
Yea, like zero people believe water has memory or zero people believe the earth is 6000 years old. Open your eyes, people believe shit they hear that's absurd constantly and in my anecdotal experience maybe 1 in 8 people I've met understood evolution. But maybe you don't live in a red state.
That's your opinion, not mine; however it's exactly talk like this that has led to most laymen not understanding evolution. They don't get that it's being dumbed down for them and that's not their fault, it's the fault of people who casually anthropomorphize things because they wrongly think it helps to clarify; it does not.
Understanding comes from truth, not casual simplifying lies.
You place a large hindrance on discussion if you require every discussion that mentions natural selection to give an entire introductory lesson on evolution. It's a ridiculous notion, especially when there is unlikely to be any misconceptions taken from this article. The purpose of the article was to explain why bacteria become resistant to antibiotics and how our use of antibiotics has led to this, and it does a fine job of that even if some uneducated people still can't describe the modern evolutnary synthesis.
I require no such thing, it is possible to have the same discussion without the unnecessary personification of bacterial wants. It adds nothing to the conversation to say bacteria wants rather than the fit survive.
"Desire" implies that the bacteria is acting purposefully and planning ahead. This isn't what's happening unless you attribute the bacteria's activity to some sort of intelligence.
On the contrary, we eliminated smallpox which was one of the most devastating diseases in history so this fatalism is basically disproved. More depressingly, we've also made extinct thousands of species who have not evolved to resist us.
That comment digressed to discuss whether or not evolution plans ahead and "eventually discovers ways to overcome" as implied by the OP. Keep up with the topic :)
The bacteria is acting purposefully I guess in the same sense that a hammer acts purposefully to drive down a nail. I don't know if that's a correct usage of language or not but it's essentially the same thing. But it is correct to say the hammer's purpose is to drive down the nail, and the bacteria's purpose is to survive and reproduce successfully.
So what if a species goes extinct? That doesn't mean it can't evolve, only that it didn't adapt quickly enough.
> However, desire is a useful way for the general public to understand what is happening.
No it isn't, it's misleading.
> It's like saying "Water wants to flow to the lowest point of a room"
Equally unnecessarily misleading. Water doesn't want anything, and before you claim people understand that let me tell you, they don't. It's a common belief that water has memory, there's an entire industry based on the concept and people fall for it. Walk into any grocery store and there are shelves of very expensive little bottles of water (homeopathy) being sold as cures for all kinds of things, it's disgusting.
> or "The arrow wants to follow the path of least air resistance"
Also unnecessarily misleading. Such talk may be fine among experts who "get" that's it's not accurate, but when talking to general public one should speak accurately, not loosely and "hope" they get it because the reality is many if not most don't and take what you say quite literally.
Bacteria don't 'want' anything in a purely technical sense. But they will eventually develop/are developing resistance to antibiotics anyway. You seem to be stuck in debating about the right sentences to describe that.
Semantics matter, communication is not possible without agreement on the meaning of words. And the OP made the argument, not me, I'm simply agreeing with his point that's it's wrong to personify evolution, it's why so many people don't understand it.
It's far worse than that. Not on;y is it not possible to have semantic communication without a general agreement on the meaning of words, but at the same time perfect agreement is impossible. This is generally understood (and has been understood for a hundred years) to be one of the causes of linguistic drift.
No they aren't, which is why it's even more important to make sure we're actually talking about the same things. Semantics matter. I tire of people insisting that I know what they mean when what it's not what they said. I don't read minds, I hear words; the words you choose have meanings and those meanings matter if you want to convey your ideas to me.
> which is why it's even more important to make sure we're actually talking about the same things.
To some extent, but it is also impossible to do so perfectly.
> Semantics matter.
Semantic agreement is limited to the actual parties to the communication, and by location, place, time, and social context. You wouldn't explain something to a 5 year old the way you would a 25 year old and the same basic problems occur when you cross cultural or temporal boundaries.
When linguists discuss language, they usually start by pointing out that human language is defined by usage, not by prescriptions regarding definitions or grammar. This is a critical difference between natural languages and computer languages. Computer languages rigidly conform to specifications. Natural languages only approximate the rules we use to describe them.
So I think you are expecting too much from human communications.
I share your distaste of when evolution is personified or otherwise represented to be anything other than a powerful but passive process.
That being said, I have no problem with the statement that bacteria want to survive. They most certainly have mechanisms that are engaged actively in order to increase chances of survival. Horizontal gene transfer (http://en.wikipedia.org/wiki/Horizontal_gene_transfer) allows bacteria to evolve in means other than traditional reproduction.
To add to my pedantic argument, it's not a conscious desire of theirs, but I'd argue that the basic things that humans do to survive (eat, drink, sleep, and have sex) are not conscious desires either. I'd argue that sexual reproduction is a mechanism that directly represents the biological success of greater genetic diversity and sharing of genes between organisms. We desire sex, and we desire sex with the best genetic candidates, and it's all a biological process encoded into our DNA that represents our desire for survival, so in that sense, bacteria desire survival as well.
And what does desire even mean? Does desire require consciousness and the ability to choose? It's a horribly imprecise term if you stare too long at it, so what I'm saying is that I don't think it's useful to pick on the doctor for his choice of words in this case.
Anyway, you have great points otherwise, but that first paragraph is not a point worth tripping over.
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.
"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."
This is a stunning visual - thank you. I see a multi-dimensional space of possible organism "configurations". Each dimension is a set of related alleles, spaced by the amount of energy it would take to shift from one to the other, i.e. the likelihood of switching that allele independently. Angles between dimensions indicate correlation, or more fundamentally the cost of holding similarly positioned alleles simultaneously. Each organism is a point in that space with a species being a cloud.
When one shines a "light", i.e. an antibiotic, on the space it lights up with warmer colours signifying configurations which take less energy for the organism to survive as (are more favourable) and cooler colours denoting deadlier configurations.
Thus, antibiotics become a game of chess. Humans try to box the organism into coolly coloured regions. That way, the amount of energy it would take to "tunnel" through the wall would be high. The organism, on the other hand, is trying to find warm "tunnels" by which to escape regions which are being boxed in. Advantage to the organism is it can build new dimensions.
> Evolution is actually a really crappy optimization algorithm...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.
However, it's one that doesn't need an agency to implement it. It just happens. A lot. Especially in the case of bacteria. You have a slow, crappy algorithm, but it's constantly running relentlessly in parallel in many trillions of instances. It doesn't need human attention. It doesn't need investment. It doesn't need society to be aware of its importance.
On the other hand, progress in antibiotics needs all of the above. If one of those things flags a bit, bacteria gain the upper hand. This is the problem.
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.
It took evolution billions of years to make machines that could make machines that run about 700 miles per hours.
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. :)
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.
I guess thats the curse of programming. We all have a very clear understanding of how very very simple logic gates give rise to systems of infinite complexity.
It's a recurring pattern. SAT, the NP-complete problem, is at first glance a ridiculously simple task, yet solving it means being able to solve all other problems. When designing a language or a machine, it is very very simple to accidentally make it Turing compatible, the barrier is just so low, despite the reward being.. everything.
> Evolution assembled the most complex system known to exist, starting from a handful of molecules, without any "thought" or "reasoning."
There may have been a lot more complexity early on than that statement assumes. Static systems, after all, pretty much by definition can't evolve (and this is why a reductionistic assessment of evolution as biochemistry doesn't work).
The beauty behind evolution is the same beauty behind Feynman integrals in quantum physics. You take the integral over all possible paths and something is likely to work. Many paths will end or cancel eachother out.
It's still an incredibly stupid process. Sure it made it's way to the complex life forms we have today, but only after unfathomably huge amounts of time, and trillions and trillions of attempts.
>>but only after unfathomably huge amounts of time, and trillions and trillions of attempts.
What's really huge and what no is really a limit and perception of our brains, no?
For a evolutionary process that has started at the earliest stars after the Big Bang. Those species are currently so powerful, that we are very likely to them the same as bacteria are to us. Might as well perceive that to be a very reasonably efficient process.
Evolution is a very generalized but very slow optimization algorithm, actually, and it's velocity is sort of inherently connected to the population size and lifespan, meaning it has to make trade-offs, it is limited. But because it's generic that means it can evolve faster mechanisms. I like to think of intelligence as this faster mechanism -- it came about because for living beings with a large lifespan evolving through natural barriers takes too long, so that this more time-localized procedure is needed.
Or to put it a different way: extinction happens all the time. Entire branches of evolution are lost to its inability to adjust to rapid change. That bacteria evolve doesn't mean we can't beat them.
Is there any indication that the organisms we have "stolen" antibiotic molecules from might become themselves suffer disruption from bacteria that they can no longer kill? Fungi are involved in many symbiotic relationships that we indirectly depend on, for example the fixation of nitrogen for plant growth.
One imagines a future in which we have a dwindling supply of biodiversity to 'sacrifice' in order to keep ourselves safe from bacterial onslaught.
Not unlike oil -- millions of years to produce, but destroyed in a few generations of exponential human growth.
I've wondered about that. But the antibiotics we use medically are only a small fraction of the antibiotics in nature, because the others are toxic or otherwise unsuitable to use as drugs. So the fungi probably have backups.
It might make sense to speak of an antibiotic peak, like we speak of peak oil. I wonder if you could draw the same kind of curve.
We're using only a subset of antibiotics that doesn't kill people as well - I'm not a biologist, but the cells are different enought that there should be many chemicals that are safe for fungi, kill bacteria, but aren't usable for people.
> we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists
This is the stuff of the Nobel prizes of yore, and it is the mechanistic basis for how antibiotics kill bacteria and not humans. Penicillins destroy the cell wall as it is remodeled (humans don't have a cell wall); lincosamides block protein synthesis at the ribosome (humans have a different ribosomal structure); amphotericin binds ergosterol and forms ion channels in fungal membranes (humans lack ergosterol).
As we continue to explore biochemistry, we will continue to understand (and perhaps even discover) new antimicrobials, though I suspect most of the future advances will come from large-scale screens of discovered or synthesized compounds without taking much biology into account until secondary stages (to increase potency or reduce toxicity).
Evolution doesn't work the same way in bacteria as in other organisms due to horizontal gene transfer[1]. Bacteria can't be split into well-defined lines, because they share a common pool of genetic information.
[2] is a good book to get a perspective on antibiotic resistance.
Good summary of human being's advantage in the war. But don't forget bacteria's key advantage: iteration speed.
Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses.
It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's are to win, I think they will need to bump up the defensive iteration time an order of magnitude or so.
Yes, that was the background idea in the talk. Among the ideas explicitly said was that our iteration for antibacterial defenses is low and slowing, and that we actively contributed to the increase of bacterial mutation opportunity. The solution mentioned include corrections for both these.
Right. We could lose the utility of all naturally-occurring antibiotics and still be OK because we synthesize new ones.
However, right now the first part is happening and the second part isn't, so until medical science and technology advance sufficiently far -- if indeed they ever do, and specifically if they ever do before a devastating plague hits -- we're in trouble.
Thinking about the ideas you bring up.. it seems we humans have been playing on the same level as the bacteria upto now. Greedy algorithm vs greedy algorithm. Could we perhaps use certain antibiotics that will force bacteria to evolve in a way that opens up a certain weak spot which we will then allow to spread through their population before we step in and wipe them out using this forced back-door? This simple 1-2 plan seems enough to really cause evolution a problem if humans can coordinate enough to pull it off (and a plausible plan appears, details..).
I think the problem with this kind of idea is that there are so many bacteria all over the world and you'll never reach all of them.
Recall the very mechanism that makes bacteria resistant over time: an antibiotic is deployed over a population of bacteria that have largely the same genotype but there are lots of mutations thrown in because they divide so fast. If any of the bacteria are resistant to the antibiotic, they survive and create a new population, again with largely the same genotype with lots of mutations thrown in, but this new population is entirely resistant to that antibiotic.
Now you've probably been visualizing a human body or a petri dish when I talk about "a population of bacteria", but consider the entire Earth. You'll never deploy an antibiotic across all the nooks and crannies of the entire Earth, and even if you were to, you'd just get an ~evenly spread population of bacteria, resistant to that antibiotic.
I guess you could _try_, if you were a supervillain or something.
Good luck trying to convince people to accept the inherent sacrifice required in the short term. On the other hand, pugilists do understand the need for setups and combinations.
I don't get the sense from this comment that you totally know what you're talking about (neither is it my area of expertise). On the one hand, you're right that many humans are actively working on this problem. On the other hand, the data suggests to me that you might be overly optimistic. Only 2 new classes of antibiotics (oxazolidinones and cyclic lipopeptides) have been developed in the last 40 years. The rate of new antibiotic drugs reaching the market has decreased significantly as well. There are a finite number of biological mechanisms for antibiotics to disrupt, and the methods that bacteria use to develop resistance are quite general.
In his book 'Toward a New Philosophy of Biology" there is a chapter on this very topic - how teleonomy has pervaded almost all of Biological science and how teleological statements, which are just plain incorrect, are the major way in which Biological processes are explained. I think this has only increased in severity and effect as we have consolidated our systems level view of the world and I've often been in awe of the general ignorance toward fundamental principals such as this.
My own personal take on the situation?
I think it is a very dangerous and ignorant thing for our species to continue with it's genetic hegemony of our ecosystems, creating vast evolutionary plateaus where the slightest advantage can run amok and adapt into something that could wipe out entire species. There is _probably_ enough genetic diversity in humans to avoid this, but I doubt so amongst our crops and livestock.
But I share your optimism/pragmatism in that I feel our human ingenuity will overcome, and if so then the prizes are great indeed. From new drug delivery systems and entirely new ways of treating illnesses, to a more mature approach to our interactions with the biological inheritance we have here on Earth 1.0 - I would like to see our crops and livestock diversified, farming practices overhauled to focus on the long term and most importantly more serious study devoted to analysing and utilising the solutions evolution has put in front of us for the taking.
Not only are these things (IMHO) essential to the prolonged survival of our species, they are also achievable. The organic farming movement took only a generation to go from grass roots to industry standard (and I know there is all sorts of controversy surrounding it but the point is that the industry IS open to disruption), here in the UK there is a debate simmering under the surface of the popular media that could end in more wild deer providing venison for the pot, Canadian geese too, and everyone knows of the whole insect protein debate, and the practical applications of bio-tech and nano-tech are only getting more interesting as the fields begin to find their feet.
General reply to express thanks for and respond to the several replies my first comment here received. First of all, I wrote in the original reply, "his warnings should be taken seriously," so I am by no means disagreeing with the quoted CDC expert about his general policy recommendations. Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.
I respectfully note the disagreement of several participants here have with me. They disagree with my disagreement with the interviewed expert's casual language about thoughtful agency by bacteria. Noting your statements that this is just everyday conversational usage, I stand by my objection to that fallacious manner of speaking. Most people in the English-speaking world think erroneously about biological evolution and especially about the implications of evolution for human medicine. I am not alone in thinking that popular thinking about biology needs to be improved by rejecting the idea of organismal agency in evolution,[2] although it is remarkably hard to find this kind of careful thinking by a Google search amid the flood of webpages that specifically assert a purpose or intention to evolution by natural selection. Ernst Mayr, mentioned in one reply to my first comment here, is indeed a rare example of a reliable author on that issue. Human beings have a cognitive bias of attributing agency to inanimate objects,[3] and the reactions to my first comment suggest how deep-seated that cognitive bias is.
The entire revised introduction to the thirtieth anniversary edition of Richard Dawkins's book The Selfish Gene[4] appears to be available for free online reading, and Dawkins writes explicitly about what level of analysis can be useful when pretending that genes have intentions and goals while thinking about problems in evolutionary theory. The University of California Berkeley website about evolution has a good page about antibiotics[5] that makes helpful medical practice and public policy suggestions with more cautious language.
There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. The precautionary principle suggests that we follow the quoted expert's policy recommendations, but meanwhile conduct research for a deeper understanding of the biochemistry of harmful microorganisms and their ecology.
Two other comments at this level express the nub of the argument:
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.
That is very well put, and deserves your upvote.
At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
A good question. It is an empirical question about the future, so it has no definite answer yet, but that is the general research direction to follow to get around the legitimate problem mentioned in the article kindly submitted here.
There is a bit of hubris here borne of ignorance. If you study this problem in any depth, you start to appreciate how pernicious it is. I'm not an doctor or epidemiologist, but I learned quite a bit by reading an excellent book[1] on the subject:
> Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.
Exposure to one agent can make bacteria more resistant to other agents, even ones that are unrelated. This is surprising, but confirmed through experiments. Bacteria have ways of flushing out toxins that become up-regulated, and they become more resistant to toxins in general. Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed, but the ramifications could extend to other, more critical, antibiotics used in medicine.
> 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.
I think you're underestimating what we already know. Current antibiotics are based on the differences between eukaryotic and prokaryotic cells, and we understand a lot about the underlying biochemistry and drug targets. Lack of fundamental knowledge isn't a primary issue.
> I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine.
Here you're underestimating bacteria. Bacterial lineages don't really go extinct, because they have no well-defined boundaries. Bacteria are very different from eukaryotes and they pick up genes from the environment. See horizontal gene transfer.
This is one of those vicious problems, like cancer, that resists being solved not for lack of our best efforts, but in spite of them.
> "Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed..."
The reality is much worse. Factory meat producers will abuse any antibiotic if they are allowed, even the most powerful last-resort antibiotics. For example, many poultry producers were routinely mixing fluoroquinolones into their feed until very recently. The practice was outlawed in 2005, but there is good evidence that some poultry producers continue to do it in violation of the law:
Incidentally, I think the intuitive idea that the last resort antibiotics are the most powerful ones is a bit of a misconception. The ones used as a last resort tend to be the more toxic ones and the ones that have to be given intravenously. The reason they still work is probably because they were used sparingly while there were better alternatives available. That delayed the development of resistance.
> There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine.
Do a dumb test. Walk into your nearest hospital, I don't even want to know which it is. Ask how many patients are infected with mRSA. Collect your jaw from the floor when they give you an answer that's 15% if you're lucky, 60-70% if you're unlucky. We have lost the fight with bacteria. It's over. We aren't "about to" lose it, we lost it ~1 year ago, and medicine is fast losing the ability to treat bacterial disease. We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
We are in fact well on our way to transform hospitals into deathtraps.
> 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.
First of all, the obvious advantage of evolution is it's running time, 3.5 billion years. Second you probably subscribe to the naive notion that evolution, in 3.5 billion years running time, somehow failed to realize that mutation + natural selection is very, very slow. It didn't. The algorithm that, today, controls evolution of pretty much any species works entirely different from what most textbooks teach you. There are very, very few species that evolve through mutation and selection. We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves).
Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening.
You'll also quickly realize that no matter how well-intentioned your use of bacteriophages is, it is very, very likely to make things worse, not better.
And the numbers of infections were far lower than you're claiming here - rather than approximately 20,000 in 100,000 as claimed above, the numbers (in 2011) were 4.5 in 100,000.
Yes, MRSA has declined, but not because of improved treatments. Now that we can no longer kill these bugs after they invade the body, hospitals have significantly ramped up their efforts to kill them before they invade.
Hurray for these protocols, but that won't do all that we need. It won't be possible to scrub the whole world with poisons the way we have begun scrubbing hospital rooms. We need ways to stop infections that we can't prevent.
While you're in that hospital, ask what their procedure is if you've been infected with rabies within the past week. It's most certainly not "curtains and sedation."
Just that bit of factual nonsense leads me to believe you are speaking far out of your area of expertise.
Yeah, but after that window closes, our treatment options for rabies are essentially Hail Mary, "Well, it's not like it can get any worse..." level treatments.
That's not a big deal in the U.S. because rabies is quite rare, but in the developing world it's still a thing.
Rabies is a virus - antibiotics don't have any effect on viruses.
Ceol may also be referring to the incubation time for rabies usually being more than a week - if you've just been infected with it and you present at day 7, then a prophylaxis will be administered.
Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
You used the wrong term. What's lethal is not "infection" with rabies -- but a full-blown case of rabies.
Rabies infection is very survivable if caught before symptoms start to show up. We have a post-infection vaccine that can be used during the incubation period. We've had a vaccine for over a hundred years, and it works very well. In fact, the original rabies vaccine was the second vaccine ever developed, after smallpox.
What's lethal is symptomatic rabies -- but even that is not 100% lethal. There have actually been a few (under a dozen) documented cases of human survival after symptomatic rabies. Look up the Milwaukee Protocol.
Problem is, the treatment lies within the realm of heroic medicine, works less than 10% of the time, and requires a long period of physical therapy afterwards. The cost easily goes into the seven figures. And we don't even know if the treatment works. Survival might simply be the luck of the genetic draw.
So, $10 million to save the life of one patient with symptomatic rabies, vs. $2000 for the vaccine. So you can see why the treatment protocol emphasizes post-infection vaccination.
When I suggested that there are some "Hail Mary" treatments once the post-exposure prophylaxis window closes, I was talking about the Milwaukee Protocol. Or the, I believe, single reported case of someone surviving a untreated rabies infection with no clear treatment.
As for whether or not I used the right term, I'd actually suggest that "infection" is kind of a fussy term to begin with. But I also never used it in my post, so I'm curious as to how I could have used it wrongly.
I stated that after the treatment window closes for PEP, we're in the realm of very difficult treatments that are really only workable in the developed world. I don't see anywhere that your post and mine are contradictory.
I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.
Firstly, there's a real difference between rates of MRSA colonisation and rates of MRSA infection, which implies a pathological process at work.
Secondly, what on earth do you mean when you say we lost the fight against viruses a decade ago'?
We have only got better at treating viruses; we had almost no treatment for viruses a decade ago and we have some treatments now; for example we are now much better at treating chronic hepatitis c infection which is a leading cause of liver failure and cancer; we have good HIV drugs which can lead to long term management without significant comorbidities (although many of the pieces were in place a decade ago), and your illustrated case, rabies, has long been a problem child like many significant viral illnesses that are discovered close to the end of their course, has caused so much pathology by tr time they present that the course is terminal.
But there have only been a handful of cases of fulminant rabies in the developed world in the last decade, so it's hardly a thing that we are getting experience in treating.
All the generic virus drugs we had have been eliminted : pretty much all existing viruses are eliminated and we have lost the ability to heal, for example, heal elderly or children infected with the flue (the groups at risk of dying from the disease).
We do not have any drug against any retrovirus (ie. a family of viruses) to which viruses do not show at least partial resistance.
As for the AIDS case, prevention of AIDS has pretty much failed in Africa and the middle east, as well as in significant parts of Asia. It is a matter of a decade or so until ~80% of those populations are HIV positive and the rest of the world will follow in the next few decades. All currently know anti-AIDS drugs will cease being effective in 5 years or less, and the rate of adaptation that the virus exhibits is still accelerating (we wouldn't be able to keep up with the current rate, so sadly, that doesn't even matter).
This is of course assuming we don't have another pandemic like the Spanish flue. We have had several near-pandemic panics in the past decade and all incidents have one thing in common : we failed spectacularly at containment. If, for example, bird flue had been ~6% more infectious than it was, it would have killed ~20% of the world's population (at least), and would have reaped >90% of it's death toll before a vaccine would become available. Absolutely nothing would have stopped it. Bird flue itself was only one of 5 incidents that could have exploded into a pandemic. The big message of these incidents: yes, they stopped, hurray. Sadly it wasn't us who stopped it (but rather small flaws in the virus' design).
There is a staggering amount wrong with this statement. Staggering.
- The prevention of HIV in developing countries is hampered not by the ineffectiveness of drugs, but the expense and difficulty administering them. HIV in the developed world is, in many cases, now essentially a chronic disease. Indeed, it is the use of HAART drugs to prevent transmission in discordant couples that is providing a glimmer of hope for reducing the burden of HIV without a vaccine.
- While serious, prevalence of HIV is nowhere near 80%. Also, increasing prevalence is a function of disease duration, so better treatments will, mathematically, cause prevalence to rise.
- I'd contest rather strongly that we failed spectacularly at containment for several recent outbreaks.
- Antiviral drugs are not our only means of fighting viruses. If "Anti-X drugs" were the solution, we'd have eliminated many bacterial diseases - we haven't. The key to fighting viruses is vaccination, and we've wiped two viruses off the face of the earth, and are largely facing political/social problems, rather than scientific ones, with adding two more to that tally.
>We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
What? We never had effective antivirals. We have a few useful drugs (oseltamivir, protease inhibitors, etc) for particular viruses, but there has never been a point in human history when rabies was a treatable disease. The Milwaukee protocol, which is the only effective[1] non-vaccine treatment for rabies, isn't even drug-based!
You may of course be confused. The major antiviral used in replications of the Giese case, amantadine, was also an anti-flu drug, resistance to which is now widespread in influenza (see http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse ). However, I do not believe amantadine resistance has ever been described in rabies, which in any case is usually treated with vaccination -- the challenge is to get the immune system to respond to the virus before the host dies! Giese herself was treated with both amantadine and ribavirin. In any case, your claim is confusing at best, misleading at worst.
Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves
Breathing? Where are the bacteria in the gas-exchange process? And 'metabolism' is a catch-all term that refers to so many different chemical reactions, plenty of which are conducted within the human cells themselves.
He probably confused cellular respiration with physiological respiration, and thus incorrectly conflated the primary purpose of the mitochondria with the physical act of breathing.
"If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead."
Yeah, but how did we lose that fight a decade ago? Whether or not we'd prefer something better, doesn't the treatment that worked then, still work now?
As another poster has said, we didn't really "lose" that fight. Rabies has always been that way - invariably fatal unless treated, and the only treatment (outside some insane edge cases) is the administration of the rabies vaccine shortly after (or ideally before) contact.
The very low rabies incidence and near zero fatalities of rabies in the developed world actually show that it's a very winnable fight. The issue is, we have to show up to said fight. In the developing world, we're not always good at that.
I hadn't seen the newer revision of the protocol, only the original 2 out of 25 number. "Indistinguishable from 100%" was perhaps a little severe, but 90% survival is still pretty long odds.
> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
The fight we have not yet one is the fight against poverty.
Not many wealthy people die of rabies.
AIDS which was once fatal, is no longer, provided you can afford the treatment.
Honestly, at this point HAART treatments for HIV are giving folks a near natural lifespan, and the major threats to their health are becoming diseases of old age - cancer and the like. And the years they have are fully functional.
Compared to a chronic, wasting disease that will take years of opportunistic infections before you die, that's damned good.
Magic Johnson and Andrew Sullivan have had HIV for over 20 years and seem to be handling it fairly well. Certainly a harder life than most, but that's not stopping them from living a full life.
Let me do what I hope will be a smart test here by sharing some more information and asking some follow-up questions. I invite onlookers to comment about this too.
The Centers for Disease Control and Prevention (the same organization that employs the expert quoted in the article submitted to open this thread) reports that "Although MRSA is still a major patient threat, a CDC published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011."[1] So there are responses already in place that are gaining on antibiotic-resistant bacteria in hospital settings in the United States.
I care about the spread of antibiotic-resistant bacteria. I am gravely concerned about the medical and public-health practices in India that have resulted in a massive increase in patients infected there with multiple-antibiotic-resistant tuberculosis.[2] I am 100 percent behind the idea that antibiotics have to be used cautiously and responsibly, and meanwhile we have to keep researching other means of infection control besides antibiotics.
You wrote,
We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them.
Do you really mean "we" there? Are you saying that this mechanism in any way makes it impossible for human beings to eradicate harmful microorganisms? How? Please connect the dots to back up your conclusion that
Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years
because the "all" there and the time scale you talk about both appear to be exaggerations, especially in light of the progress that has already occurred in limiting MRSA infections in the United States.
>Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening.
This is the important point that people forget. Bacteria are experiencing an extremely accelerated time course and can evolve and exchange advantageous mutations very quickly. We have only had antibiotics for 100 years, which is 3-4 generations of man, but billions of generations of bacteria!
I am not actually sure that it takes as long as people think. The fact is it isn't just individual genes, but selection for combinations of them. If you look at random mutations, I think that is likely dwarfed by random permutations. This is why the resistance bell curve shifts over time. You aren't just selecting for a single gene, but for a function, which could be carried out any number of different ways, and which any number of different gene combinations could do it.
Richard Dawkin's book "The Selfish Gene" uses the same language, but, to his credit, he pauses regularly to remind the reader that genes are not really "selfish" and that they don't have "wants" and "desires," but that he is using that language to make it easier to understand the concepts. I understand your complaint, but it's a necessary communication technique when dealing with the general public.
> 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're giving bacteria (which reproduce rapidly and mutate quickly) the perfect natural science lab to mutate and select for antibiotic resistance. There are 10^14 bacterial cells in the human body vs only 10^13 human cells [1]. Their reproductive cycle is over one million times faster than ours.
We're creating the perfect conditions for rapid evolution of these organisms. This system is executed by billions of billions of bacteria continuously and we're trying to combat that evolution with a few thousand humans in labs.
It seems to me that the take-away here is we need better engineering of our own solutions and we need to find a way stop enabling this rapid evolution of bacteria.
Your take-away should really be that bacterial evolution is part of being human - without those 10^14 bacterial cells evolving over one million times faster than our own, we wouldn't be able to survive - we wouldn't be human.
There's also inputs into their environment that influence whether they move via random tumbling, or directed movement, allowing them to move toward something.
While they might not desire anything, they do definitely seek out things.
>Bacteria don't desire anything, and they don't seek out anything or plan anything.
When you say this, aren't you are making precisely the same mistake you claim the expert was making?! I am sure Dr Arjun knows very well that evolutionary goals are local and specific to the circumstance a creature finds itself in.
>The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
:-) how anthropomorphic! Intelligence may not be a survival trait as you seem to assume. We simply don't know that. Btw, bacteria has been a lot longer on this planet than primates. We are way out of our depth when it comes to understanding how they work (I am simply paraphrasing a friend's statement, he is doing fundamental research on biochemical pathways)
For someone who opens complaining of teleology, your third paragraph relies heavily on the assumption that science will march forward. Where is the skepticism aimed at the assumption that we will be able to surgically genocide _all harmful bacteria_ faster than they can evolve?
The particular nit that I'd like to pick is blaming only misuse of antibiotics for the problem. The only way to distinguish use and misuse is in retrospect, and it's hard to say last-line antibiotics like vancomycin and meropenem have been abused.
I think you're using the term "desire" in a far too literal manner.
The organism of the bacterium doesn't have desire the way humans do, but the idea of a virus or manifestation of bacteria can have a figurative desire to evolve and grow.
Killing bacteria is easy. The trick is killing bacteria without harming ourselves. Soaps can be massively more "brutal" in terms of the mechanisms that destroy bacteria than what antibiotics can, and so the evolutionary steps that would have to occur for resistance are vastly larger, and would mean changing them in many different directions.
E.g. it does not help if a bacteria can survive a soap if it is still physically flushed away.
We also have a massive escalation ladder for external detergents beyond basic soaps that include a near infinite number of substances of increasing brutality than our arsenal of antibiotics. Essentially anything that will not harm us much with relatively limited exposure, yet will physically disrupt small organism. We can wash our hands in bleach. Or various acids. Or any of numerous agents that are massively disruptive on biological organisms through basic chemistry or even by being physically abrasive.
We don't even particularly need to care if we kill off a fairly substantial number of our own skin cells in the process.
If we had the same arsenal available for fighting bacteria internally as what we can safely apply externally, we'd be in a fantastic position.
I agree with you, but we need to be cautious with washing hands. The CDC have a nice document about "when is clean too clean?" which mentions the problems with people who have to clean their hand frequently. Damaged skin can harbour bacteria, and can make it harder to remove those bacteria.
> Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices.
Thanks for linking that article. The most interesting takeaway from that personally was that an alcohol-based rinse (hand sanitizer) is effective against nearly all kinds of infectious agents except for Gram-positive bacteria (which have a lipid cell envelope), without the threat of the emergence of resistance.
Handwashing with soap doesn't actually kill bacteria, it mechanically dislodges the oils and debris that bacteria are embedded in on your skin and rinses them down the drain. So bacteria have no defense.
The ability to burrow in between cells and to have more adhesive surfaces seem like two possible defenses bacteria already vary in and could evolve better. (Surely handwashing doesn't remove 100% of bacteria.) One reason this doesn't pose problems similar to antibiotic resistance is that this defense doesn't become a useful strategy inside the body, where infections are problematic for humans.
You don't directly address the resistance question, but I think that issue comes down to the "escalation ladder", which you do bring up. You can increase the effective of handwashing (or ultraviolet or whatever) in a way that just isn't possible with antibiotics.
You've been voted down but there is actually a school of thought that excess use of antibacterials and generally going "overboard" (whatever that means exactly) with preventing children from being exposed to natural flora can potentially result in weakened immune systems. There's a lot of pseudo-science in these claims but that doesn't mean there's absolutely no truth to them. It would probably be hard to do a study though and it's not clear who would fund such a thing.
Ignoring the snark (of the parent comment), I've often wondered why it was bad to use anti-bacterial soap (and antibiotics in general), but not regular soap, since both leave some amount of bacteria behind, which presumably have genetics making them more resistant to the pressure. I think part of the answer is that its just not possible to evolve resistance to any amount of soap and hand washing, unlike resistance to the targeted mechanisms of an antibacterial compound.
I'll take a stab at this - I'm an infectious disease epidemiologist that works on hospital infections mostly.
The thing with anti-bacterial soaps is not that the use of the soap is bad. The problem is the anti-bacterial part. It puts amounts of a broad spectrum antibiotic into the environment (be it your hands, your countertop, or the water system) in concentrations that aren't enough to do much, but are enough to put a little bit of selective pressure on the organisms and promote resistance.
It's also not particularly effective - soap and water, through a combination of both mechanical action and how soap disrupts cell membranes, works swimmingly. So there's a cost, and no benefit.
The answer to 'why isn't there a resistance to soap' is that soap, as a chemical, is absurd overkill. It's hellish on lipids of all sorts (tough on grease...and lipid cell membranes), and there's nothing to evolve a resistance to. Not expressing a particular protein, or expressing an enzyme that does a number on an antibiotic compound is effective - to evolve a resistance to soap, you'd somehow have to develop an entirely new type of compound to build cell membranes out of.
And while evolution is rather magnificent, that's asking a little much.
Bacteria evolving to secrete a soap-resistant compound doesn't sound far-fetched at all. Such compounds clearly exist already (e.g. pigments that don't wash off).
Thinking about this more, I suspect there already has been some selection in this direction, but that it has little to no public health impact, as this defense is not useful in places where infections are typically a problem. Indeed, our body is teeming with bacteria (mainly in the guy) that are in fact beneficial, and they've presumably managed some resistance to shear stress and extreme chemical environments (e.g. high acid).
I dated a heatlh care professional for a while who was pretty adament that it was causing detrimental effects in the same manner as antibacterial soap.
That one is...a little trickier. There is some evidence that it works for controlling bacterial growth leading to gingivitis - suggesting there may be some utility for it. But its ubiquity in consumer products makes me a little skittish.
So I don't know if I'd want it gone from toothpaste, but I'd like to see it gone from the many products where its useless or nearly useless, but included so someone can put 'Antibacterial' on the label.
It obviously is possible to evolve resistance to soap and hand washing: It doesn't kill us.
But the gap from a bacteria to something that can withstand the physical barrage of a thorough wash is huge in comparison to the relatively tiny changes to overcome some antibiotics. E.g. an antibiotic might disrupt a single process of the bacteria that is beneficial (for them) but that have a multitude of similar alternatives that are different enough for the antibiotic to fail. Compare that to even just being able to strongly enough attach to the skin to not be flushed away by sheer force from a wash.
There are many reasons that tends to be given for being careful about stronger measures: 1) it is not necessary. It's a matter of being cautious - by using the least effective means that is effective enough, we exert the minimum pressure necessary, leaving us with a larger arsenal of (to us) gentle alternatives to step up to. 2) the stronger methods, the more we kill off beneficial or neutral bacteria too, and by doing so we may make conditions better for bacteria that are nasty for us if we happen to pick them up.
3) we reduce our immune systems exposure to relatively harmless amounts of bacteria and some believe this may be sufficient to actually reduce our overall immune defence.
As DanBC pointed out in response to one of my other comments, there's also the issue of physical damage. While we can bring the heavy artillery and effectively kill anything that lives on our skin, we can as collateral damage cause damage to our skin that creates additional places to hide - effectively a worse variation of washing away good/neutral baceteria - not only may we be removing the competition, but we may be opening cracks and folds that'll be excellent hiding places.
Interesting, was going to say basically the same thing. At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
I understand the emotion in your response, I believe (correct me if I am wrong) that it comes from being unable to calculate a risk on something we don't understand. However, the action proposed sets as a prerequisite that understanding.
Consider 'fly by wire' as an analogy. There was great emotion (and still is) around taking the pilot of an aircraft out of direct control of that aircraft. First required by dynamically unstable aircraft (the F-117) this is now a standard feature on large passenger aircraft. The problems are still the same though, one bad line of code (or perhaps a few bad lines) and the plane flies into the ground killing everyone.
Similarly with engineered RNA. We actually do this a lot these days (very interesting bio hacking going on) and with DNA printers you can pretty much design your own bug, print it out, load it into a waiting husk of an E. Coli bacterium and boom, new bug.) Understanding isn't quite there yet but it will be. And knowing the risks of a particular DNA pattern will be just as understandable as a knowing the risks of a piece of flight software.
I don't doubt that if we devote enough attention, we can solve this problem. What I am afraid of, is that we will wait until it becomes a real and immediate threat before we dedicate any effort.
The black death bubonic plague killed around a hundred million people, almost half of Europe's population. World war 2 got close to that number of deaths, but the black plague bacterium remains the most efficient killer of humanity on record.
Something that terrible sometimes has to be personified, just to make it comprehensible.
>"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.
You are taking this too literally. But in any case just because bacteria aren't intelligent doesn't mean their behavior is purposeless. Evolution acts as an optimization process. It's not too far from the truth to ascribe it "desires".
On the frontline episode this was from talked about how pharmaceutical companies have all stopped investing in new antibiotics. It might be possible to make better ones but I don't know how much research is actually going on at the moment.
I'm kind of skeptical. We are fighting against millions of years of evolution. The drugs we have we only got by copying things evolution already found, and they became resistant in mere decades, an extremely short time from an evolutionary perspective. Any simple way of killing bacteria would probably already have been developed by evolution. Likewise pathogens have spent millions of years evolving to defeat everything thrown in their way, and they continue to do so.
We are joining into this ancient arms race as entirely new players.
Agency description language is easier for humans to understand than the passive language required to describe the actual occurrences.
Yes, it's inaccurate, but it is what often happens when you want to get across the message and can live with a bit of inaccuracy at the expense of message reach.
Haha, I had the same thought, basically that evolution is not directed to overcome particular threats, and can certainly fail to do so. I kind of assume that he knows that, and decided to simplify (a poor choice for a lengthy and detailed interview imo).
I'm not sure I understand your point though, beyond "with more knowledge we will get better at this." What is the timeline? Is there any current research that may lead to this breakthrough, whereby we no longer have to borrow evolved tools from other life forms and can actually develop a precise and resistance-immune treatment?
Thanks for your useless karma whoring post that does nothing but distract from the content of the article with more "fallacious teleological language" of your own.
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.
"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.
It turns out there is a whole sub-field of interaction between medicine and finance devoted to the economics of drug discovery. You can google it, but here's one example:
I attended a talk by an economist (whose name I don't recall, alas) who discussed establishing a futures market for drugs, with portfolios which would smooth out variabilities in what works and does not. It's pretty much the same as what you described.
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
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.
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.
> "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.
I think you seriously underestimate just how many lives antibiotics save. Sure, for your tooth extraction they were completely unnecessary and your doctor is either a bit of an idiot or there were other compelling reasons to suspect that antibiotics might be beneficial. But healthcare-wise I would not want to go back to the 1920, no sir. Without antibiotics, medical routine procedures will become life-threatening again (that said, I don’t share the article’s pessimism; yes, it’s bad – but there will be solutions).
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?
Let's suppose that in an antibiotic-resistant future some, very small, number of people develop a mutation that produces 2 effects: antibiotic resistance and VERY ugly nose warts. Since other people live for 25 years and the uglies for 100 years, I suppose they would be desirable mates with lots of offspring despite the ugliness. In a few centuries, they would be the majority.
Now, if there weren't the antibiotic resistance, do such mutations have the same chance to appear? Yes, but they'd have hard trouble finding mates. Their mutation has only drawbacks, and no advantages. As soon as the advantage appears, the mutation has more chance to spread through offspring.
The same with bacteria. It is not necessary that they mutate more, it is just that those mutations that help the bacteria survive spread quickly. But if the danger is not present, the mutation is not significant.
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.
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.
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)
>> if antibiotic resistant bacteria survive, why would finishing the course of antibiotics make a difference?
I can only speculate, but here's how I imagine it.
Your body can kill a certain number of bacteria on its own. Antibiotics help reduce the infection to the point where your body can do the rest.
If the resistant bacteria are a small minority, taking antibiotics long enough to kill most of the non-resistant ones will let your body kill the remaining resistant ones.
If you stop too early, the battle tide has not yet turned. Instead, by killing, say, half the non-resistant ones, you've made the resistant ones a larger proportion of the whole infection. Then both groups continue to multiply.
If you repeat this several times, starting and stopping the antibiotics depending on how you feel, the resistant bacteria could go from being 1% of your infection to 50%.
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.
I have no credentials or background to know the answer, but I wonder if this is something where the use of antibiotics decimates most the bacteria population so that it's easier for the resistant ones to thrive, as opposed to cohabitate and possibly be overtaken by the non-resistant ones. I'm thinking of it like Conway's Game of Life where a cell dies if surrounded by more than 3 cells. With antibiotics, you limit the number of living cells around and are more likely to keep others living.
Or maybe the non-resistant ones would have another trait that make them thrive more than the resistant ones if both are mixed?
Theoretically, non-resistant bacteria should have a competitive advantage over resistant bacteria in an environment without antibiotics - they don't have to spend energy producing useless resistance enzymes, and instead can grow better.
That means, in theory, with no antibiotics, you should have very few resistant organisms.
The problem is that's all "in theory". Right now, the level of evidence for community-acquired MRSA and the competitive advantages of susceptible versus resistant S. aureus has thrown that all into question.
There are some situations where an organism can evolve overnight to exposure to an antibiotic. See Inducible Extended Beta lactamase resistance in E Coli. HOWEVER. Bacteria evolve just as any organism does via random genetic mutations that may or may not lead to resistance. It's Darwinism on the cellular level. The vast majority of antibiotic resistance occurred regardless of exposure. There is a segment of society that wants to blame humans for every problem it seems.
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?
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.
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.
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.
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.
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.
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.
It's very hard to get the phrasing right. There's always a certain amount of random mutation going on, which can lead to better fitness (or not). However individuals with better fitness end up reproducing more, so mutations that lead to such better outcomes end up surviving.
This coupled with multiple ways that bacterias can use to protect themselves against antibiotics, like enzymes, better shielding, or even pumping the antibiotics out, also increases the chance for successful mutations. And they've also developed this mechanism for spreading their DNA around to other bacterias.
The result is almost the same as if bacterias would have an agenda. Although it can happen for mutations to lead to worse fitness in contact with older and forgotten antibiotics. And it can also happen for these random mutations to drive a whole population to extinction. But these two outcomes have a much lower probability than bacterias becoming highly resistant to all antibiotics.
I don't see why we can apply these words and ideas to humans but not to bacteria.
Our feelings (wants) and actions are a result of evolution just the same as bacterial action.
We may choose not to ascribe feelings to bacteria, but the origin of the motivation is precisely the same as it is in humans - the motivation to survive and reproduce is universal to organisms.
> 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.
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?
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.
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.
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.
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?
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.
Even if you've never taken antibiotics, you're in the same boat as everyone else. The resistant bacteria are in the environment.
If your immune system works fine, there's less to worry about. The most urgent danger is to the very young, old, or immunocompromised because of illness or therapy. (That said, MRSA infections do happen in otherwise healthy people from time to time)
If you've been avoiding meat raised with antibiotics, you're part of the solution, because you're pushing the market away from the cheap short-term fix (antibiotics) towards more sustainable solutions without the societal consequences.
The problem as I understand it is not with human immunity, but rather that we will not be able to kill or control the bacteria when it's bad enough to warrant treatment. I'm not a biologist, but I'd wager the answer is that they are not any better off.
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.
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.
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.
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...
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?
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.
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?
> * 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.
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?
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.
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.
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.
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".
The thing with Tragedy of the Commons -- which is exactly what the antibiotic situation is -- is that the decisions which are optimum for each individual actor in isolation are suboptimal on the whole.
I don't know much about the varieties of ear infections babies get, but if the ear infection is viral, I can't see how an antibiotic would help. I used to have a problem with ear infections and I've had a doctor tell me the infection is viral and then offer me antibiotics in the same breath.
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.
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.
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.
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?
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.
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.
... 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.
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) ?
With the development of generic anti-virals like DRACO ^1 - 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?
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?
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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]
You basically have polymixins (colistin) and, depending on resistance profile, fosfomycin and tigecycline. Colistin is avoided if possible because of nephrotoxicity, but as usual, medicine is a field heavily involved in balancing risks and benefits.
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.
> 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.
[1] http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-...