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Comment by DoreenMichele | Hacker News Reader

...in mice.

It would be nice if we spent as much time, money and attention on figuring out prevention. Inadequate hygiene infrastructure (like toilets) in developing areas is part of the problem here.

But addressing that isn't as exciting to people as finding a cure for a super bug. If we really want to fix this, that needs to change.

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Super bugs are a mostly first world problem, rampant in top tier hospitals providing cutting edge treatments, despite following safety precautions meant to deter secondary bacterial infections during or post hospitalization

Super bugs are a mostly first world problem

Not true at all. There are several known resistant strains that have come out of developing countries.

Why? Antibiotic use can be rampant - in many countries you can buy them without a prescription.

I heard someone (in the correct area of expertise) describing how he had visited a developing country and tested the water in a river downstream of an antibiotic manufacturing plant, and found the concentration of a particular antibiotic to be approximately the same as what you would typically want to achieve in the blood of a patient.

If that isn't going to drive resistance to that particular antibiotic, I don't know what will.

People say things like this, but how many antibiotic compounds are in the soil naturally? Living creatures exist in an environment with countless bacteria and evolve to survive, and some of the compounds they produce are turned into human drugs. So I feel like there's something missing in the ordinary narrative about antibiotic resistance. Where did penicillin come from again?

Most developing countries don't actually keep adequate data on super bugs. So we don't really know that.

In 2014, the WHO released the first report on antimicrobial resistance, in which the WHO collected national data on nine bacterial infections/antibiotic combinations of greatest concern for global health.[5] The data revealed that out of 194 countries, only 129 provided data, of which only 22 had data on all nine infection-antibiotic resistance combinations deemed to be emerging global threats.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380099/

Anyway, this is sort of off topic because I know the article was submitted to HN for the cool factor of using artificial intelligence or machine learning or whatever, not because people are really deeply concerned about antibiotic resistant infections. So idly saying "I feel like they are barking up the wrong tree and focusing on the wrong things if they want to solve this." isn't at all welcome as part of the conversation, as evidenced by the downvotes for a really mild, brief remark.

I wasn't trying to derail the discussion. I just read up some on things like antibiotic resistance because of my medical situation, so I happen to know a bit about the topic.

But I'm planning on stepping away from this discussion because it seems like a pointless waste of time that's just inviting negativity from a crowd that doesn't see my comments as anything intelligent or interesting.

We do.

I can't think of the last time I saw a headline on the front page of HN about the importance of solving open defecation. I see headlines about creating new treatments for super bugs pretty regularly.

Open defecation costs $US260b globally

https://www.news.com.au/world/breaking-news/open-defecation-...

Price to pay: Antibiotic-resistant infections cost $2 billion a year

http://www.cidrap.umn.edu/news-perspective/2018/03/price-pay...

We basically know how to solve open defecation: build toilets and sewage systems.

I think we could largely solve open defecation in five years if we really wanted to. But we aren't throwing resources at it like crazy because it isn't a "sexy" issue and because first world wealthy people don't see it as directly relevant to their lives. They see it as "being nice to poor people in developing nations," not as an urgent global priority because it's fueling the creation of antibiotic resistant infections which can be exported within 24 hours to their country by someone jumping on a plane before they are symptomatic.

And I really can't recall ever seeing a headline explicitly linking the two things. But they are linked.

http://resistancecontrol.info/2017/prevention-first-tackling...

That's probably because Bill & Melinda issued their grants a few years back. You can see a list of all of the high-tech outhouse makers here [0]. Many of the designs are out in the field for long-term testing.

[0]https://stepsforsanitation.org/innovation-center/

I come from a country with serious sewage issues. Most of it is government operated sewage works that are just not maintained and were due for upgrade 10-20 years ago. The issue is also an order of magnitude worse in some areas than in others.

The Gates Foundation is not relevant here, in that problem field, in any meaningful way. It is an issue about operational structure and unit cost structure. Tax money gets spent on black Mercedes cars instead of what it is supposed to be spent on.

Also, it is not a technological issue at all. In terms of tech for sewage treatment, the path forward is clear. In terms of politics it is not.

It is my (albeit limited) understanding that the Gates grants are focused on providing toilets to areas where there previously were none and not on replacing crumbling infrastructure. They're trying to get facilities to the millions of people who have to poop in the bushes because that's all there is.

That's not the issue. The issue is that there are sewage systems that dump raw sewage into rivers. Toilets are more of a nod to human decency than environmental issues.

But if Bill would like to phone me, then I would explain to him that while decency does score high in my books, you can have perfect golden toilets that dump sewage into rivers. In that case I would rather take a veldtie in the bushes.

Or maybe it's because you don't see articles about open defecation posted here all that much.

I can find two. One from two years ago and one from six years ago.

https://hn.algolia.com/?q=open+defecation

If you search on toilet, there's a lot more articles that come up, but at first glance, most don't appear to be about solving open defecation, though there is one on the front page of the search about the Gates foundation funding toilet research.

https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...

In contrast, you can put in antibiotic resistant and limit it to the past year and get pages of hits. Granted, they won't all be about the latest sexy research methods.

https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=tru...

There's one more. https://news.ycombinator.com/item?id=20730146 from six months ago is titled "California’s Biggest Cities Confront a ‘Defecation Crisis’" and deals with "excrement on the sidewalks of San Francisco".

It has 159 comments, probably because of how it affects "first world wealthy people".

Bill Gates did a lot of funding for developing low cost toilets for developing countries. There is a documentary called "Bill Gates Mind" on Netflix that talks about it.

I think those links look interesting, can't speak for the rest of HN. If you don't want to post them, can I? (specifically that last one?)

Have at it.

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