What was the Golden Age of Antibiotics, and how can we spark a new one?
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Even if you discover a groundbreaking new antibiotic under current incentives it's going to get fed to pigs in China until it's useless.
Arguably the kinds of antibiotics we need the most are ones with significant side effects; effective enough that they can save humans but with side effects that are severe enough that they are not over-prescribed or fed to livestock.
I don’t think there can be a better example of perverse incentives than this.
Do Chinese farms do it more / worse?
What? Absolutely not. The patients would have a very strong incentive to not finish the whole course of treatment.
So I wouldn't worry about that. Healthcare is not nearly as expensive as US providers make it. Single payer systems aren't perfect either but from my perspective having lived with one my entire life it works fine. I have always gotten the help I need in reasonable time. I also have private options if I want to spend money, and they're far cheaper than private options in the US. But so far I haven't felt any need for it. A colleague was recently diagnosed with testicular cancer, he was admitted for surgery within a few days and back to work in a few weeks. Didn't cost him anything.
And just to reiterate - this is cheaper per capita, just comparing tax costs, than the US system and that's ignoring insurance premiums and copays etc.
How do you think about the nationalisation of generics of existing drugs being detrimental to new drugs' development?
Firstly, while pharma collectively spends a lot of money (many, many billions) on drug discovery and development, in the grand scheme of collective global governmental spending, it’s not so very much. If the (e.g.) 20 richest nations got together and shared out the cost according GDP it wouldn’t be too much for them to bear at all.
Secondly, as a race we’re currently very bad at ‘global’ cooperation, especially if it requires ’vision’. Even when there’s a strong incentive to cooperate across borders (like, say, an immediate threat from a global pandemic) we mostly sucked. And even relative success stories coming out of the pandemic, like the development of mRNA vaccines spectacularly quickly, had less to do with global coordination and cooperation than might have been the case. It would be wonderful to start to address this broad topic, and the constant threat from antibiotic resistance would seem like a great place to start, before we get to the stage that any operation brings the threat of death by untreatable infection with it.
We also have pharmacists who act as doctors in a pinch and reccomend drugs.
Honestly this is a very granular problem I think, simply because doctors are so expensive in quite a few locations. Wherever doctors are affordable or accessible, I've never seen a pharmacist play doctor and push their medication. Kerala, Himachal, Goa, places with good accessible govt clinics and hospitals, etc.
I've heard that it lives on in Georgia.
As the other post says, it's effective but cost prohibitive at scale, and biologics are a pain. It'll get here, but we need way better tools to lower the costs.
Can you very, very briefly tell me what the biologics are in the case - cultures?
Antibiotics as 'consolation prizes' is definitely a thing.
Better education on health and healthcare would help, but certainly not come anywhere near eliminating the incentives to over prescribe versus under prescribe antibiotics and medications. Perhaps more placebo medications could help, but that has its own litany of problems in making people believe they are receiving a medication when they are not, and numerous patients might view it as being scammed even if a placebo is the best thing that could be given to them.
They still suck on just taking a swab and culture.
This hasn't been true for most of my life and it remains a serious concern.
Not to mention antibiotics often come with seriously nasty side effects of their own, so you as the patient even wanting the best outcome shouldn't even necessarily want antibiotics.
It is a massive, massive issue in some very large countries.
I can afford to go to a nice doctor who will prioritize my comfort and who will literally tell me what to say to meet the criteria but anyone with less choice will have to fight.
If your doctor is giving you antibiotics for clearly viral illnesses they are doing a disservice to you, it isn’t actually nice. It’s not like I’ve ever seen some systemic withholding of antibiotics when they are clearly indicated - quite the opposite, some of the worst areas for resistance are the poorest. They aren’t without other side effects, resistance being only one.
Also you have it backwards, the racist thing to do is to just prescribe the antibiotics, since they are dirt cheap, cost me (the provider) nothing, and makes the person whose skin color I possibly don’t like get out of my office faster (if not racism, pragmatism to see too many patients). Racism alone is not necessarily the only explanation, but antibiotic over prescription/use tends to be associated with poverty.
Well run antibiotic stewardship is a conceit of the most affluent health systems.
You're trying to shoehorn an unfounded accusation of racism into a discussion about antibiotics. This sh*t is tiresome.
This is the reality of medical care right now in the US what are you talking about?
https://www.hopkinsmedicine.org/news/articles/2021/06/physic...
The existing bias in the medical system along with policy that asks doctors to doubt more patients has a pretty damn predictable outcome.
Some countries are very restrictive on prescribing antibiotics (almost too strict) and it feels like it falls flat as you can get it over the counter in a lot of places.
In Hungary, on the other hand, they hand them out like candies.
So yes, the solution was to import them from Hungary. :-)
Yes that’s exactly how it should be. They are not at all benign misprescribed.
> Even when I had a lung issue for 2 weeks I had to beg to get antibiotics.
Was there any evidence of a bacterial infection or did they just give in? 2 weeks is not a long time for a viral respiratory illness either.
They could have done some more tests or whatever, as it was maybe the worst lung issue I've had and I was really miserable. I knew that antibiotics would help, and they did. I sourced them myself.
You could say lucky guess, but after I complained to my health insurer about the bad doctor's visit, they covered the cost fully without any dispute, so they must have agreed with me with at least about maybe running some more tests...
This is a real posibility and is a real problem to test how useful the medicines are. So all serious studies use a control group [2] to compare the rate of spontanous healing with the rate of healing with the antibiotic.
[1] Some virus are very nasty and can kill you. People confuse the common cold andd the flu, but usualy the flu is much worse.
[2] Preferabely a preregistered double blind randomized control group, becuse there are a lot of other problem that can cause a false result.
For external infections, observation by visible inspection is still evidence, a sign, not a symptom. So, not sure what your point is. Erysipelas is invariably diagnosed by signs, not symptoms. Very rarely are bacterial infections diagnosed by symptoms alone.
When you go to multiple doctors and they're in agreement it's a bad idea, the correct response likely isn't to self-medicate in your addled state.
If they actually do, they'll probably not give you antibiotics, which are associated with many undesirable short and long-term health outcomes.
Taking antibiotics for mere "comfort" in the hopes they do anything is not a good idea. Even if you were absolutely sure they will help it may still not be worth it.
As an example, [0] is of the best reviews available on the contribution of non-therapeutic antibiotic usage in animal feeds to AMR. Despite the large amount of evidence cited, the authors can't conclude that a ban on animal use of antibiotic class X would lead to Y more years before resistance to X emerges/spreads.
It seems well established that banning use of certain antibiotics as a feed additive would slow the emergence of resistance, but that magnitude of that effect seems totally unknown. There is perhaps a strong precautionary principle argument to be made for banning use of medically important antibiotics as feed additives, but we should be cautious in making any firm conclusions about how much that would impact the medically useful lifetime of existing or new antibiotics.
In a similar vein, the idea that commercial prospects for antibiotic development are limited because agricultural use would cause fast emergence is not supported from what I can find. A very good recent paper [1] discussing failures of antibiotic development in the US in the last 20 years highlights trial, regulatory, and commercial hurdles as key roadblocks to successful commercialization of antibiotics.
[0] https://journals.asm.org/doi/full/10.1128/cmr.00002-11 [1] https://www.nature.com/articles/s41599-024-03452-0
The same rules would have to apply to all.
It's in nerd hands now ...
https://pmc.ncbi.nlm.nih.gov/articles/PMC4242550/
I think cocktails will be used (if they are not already in use) to attack the bacteria from different angles at the same time reducing the likelihood of developing resistance.
Another thing is better protocols. More quick testing before prescription so you use more targeted antibiotics and reduce the use of wide spectrum antibiotics.
I'm not making this up. A medical provider up-thread made this point.
Now we just wreck havoc of absolutely anything which is a bacteria, it would be nice to be able to select the typology.
Especially in agricultural animals...