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Comment by michaelochurch | Hacker News Reader

Antibiotic resistance is scarier than terrorism. A once-in-a-century terrorist attack killed 3000 people. TB still carries off more than a million people per year, and used to be incurable.

Drug-resistant bacteria sounds like a paranoid tinfoil fear, but hospitals already deal with the problem. Doctors do not want to hear the words "drug-resistant MRSA", ever.

Probably the worst culprit is the abuse of antibiotics in factory farming. The animals live in disgusting conditions that require antibiotics to keep them viable. (As a side effect, the drugs also make them fatter, producing more meat per head.) This is a huge contributor to the problem.

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MRSA is already drug resistant. That's what the MR bit is - methicillin resistant.

> Probably the worst culprit is the abuse of antibiotics in factory farming.

That's certainly a problem, but misuse of antibiotics in humans is still a big big problem.

Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds.

In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.

> In developing nations people often use antibiotics in the worst way - a short course until they feel better, not a long course until the bacteria are all killed. This is partly because they don't know any better and partly because they buy what they can afford.

I wish I could say this was limited to developing nations.

This brings up an important topic in infectious diseases right now: in many cases, long courses of antibiotics increase selective pressure and favor the antibiotic-resistant bacteria. One strategy to reduce drug resistance is to (rationally) minimize duration of treatment [1]. This isn't to say that medication nonadherence is good, but it is to say that the field is moving towards a shorter duration of treatment for many infections.

[1] http://cid.oxfordjournals.org/content/46/4/491.short

Yeah, I've always been suspicious of the phrase "until the bacteria are all killed". It sounds like a pleasant rationalization than an elegant simplification of the argument.

>Antibiotics were routinely used for illnesses where they shouldn't have been - ear infections, viral coughs and colds.

On the contrary, I would like to point out that its not limited to developing nations. When I first arrived in the US, one of the advice that my US settled relatives gave me was that American doctors routinely prescribe antibiotics even for the simplest illness. This fact was confirmed when I took my Mum to a doctor when she felt unwell when visiting me: light fever, and the prescription was some very potent antibiotics. My mother refused to take them and got better on her own after a few days. There seems to be a reluctance to take antibiotics in my family.

Yes, I worded my post poorly.

What I meant to say was something like "Another misuse of antibiotics is caused by poor people not being able to afford a complete course".

I think another huge trend worth noting is the use of anti-bacterial products. They do nothing other than killing a large portion of both good and bad bacteria indiscriminately and leaving a small, drug-resistant strain, which then does not have to compete for resources with all the non-resistant bacteria and reproduces freely to ultimately make people sick.

I think most of those products are anti-bacterial by virtue of things like extremely high alcohol content. I could be wrong, but I don't expect bacteria to develop a resistance to 93% ethyl alcohol any more than I expect bleach- or hydrochloric- resistant bacteria.

IIRC most of these anti-bacterial soaps contain this stuff: https://en.wikipedia.org/wiki/Triclosan

It doesn't seem to lead to resistance either, but that doesn't make using those products any more sensible.

Yes, the big problem with triclosan is that it's a water pollutant. This is why I've stopped using it.

That said, I think the concerns about antibacterial hand soaps leading to resistance are overblown. The bacteria on your hands are not an isolated population; you're exchanging bacteria with the environment all the time. Applying intermittent selection pressure to a tiny fraction of a population at a time causes little if any genetic drift in the entire population.

Say you wash your hands with triclosan soap, and all but a few bacteria are killed. When those bacteria are transferred to a doorknob, say, they have no advantage against the other bacteria that are already there; indeed, whatever mutation allowed them to survive the triclosan probably puts them at a disadvantage in a triclosan-free environment. Even the ones that stay on your hands don't have a competitive advantage against newcomers until the next time you wash.

Conversely, the bacteria in your body are an isolated population. When you subject them to strong selection pressure by taking an antibiotic, if any manage to develop a little resistance, they continue to have an advantage as long as you're taking it. If you don't take enough to kill them despite their resistance, you'll wind up with a pretty pure population that has this new level of resistance. Pass that to a few other people, and repeat the process a few thousand times, and you have a problem.

Though less prevalent, even people in developed countries do this (short course). Slightly off-topic, but with the "complete" and "short" courses now available (e.g., a complete lasts only 2-3 days), how is resistance affected? Is it better, worse, or the same? Better, since people are more likely to complete a course?

Factory farming is insanity, not just in its contribution to antibiotic resistance but also because of its devastating impacts on the environment.

An article was published in December 2006 that described how Smithfield, America's largest pork meat producer, manages all the excrement from the 27 million hogs it slaughters every year. The article at the end is worth a read, but I'll give you a summary: 27 million hogs produce an unbelievable amount of shit. This shit is collected in what Smithfield calls "holding ponds" - which are actually lagoons - that can run 30 feet deep. These ponds contain many extremely toxic substances in addition to good old pig shit. Even light rains can cause them to overflow. And the stuff is so vicious that people are often overcome by the fumes and are hospitalized. And if someone falls into the stuff, they die.

How does this stuff affect humans? Well, gravity causes the toxic material in the lagoons to seep down into the groundwater supplies. From there it arrives in people's sinks, showers, and drinking water.

http://www.globalresearch.ca/pork-s-dirty-secret-the-nation-...

time to become a vegetarian

Or switch to sustainably raised meat (that's the focus on my farm). No medication of any kind, animals live on managed pasture that requires no inputs other than sun, air, and water.

Switching away from meat will certainly help to address the development of resistant microbes, but if you can make a switch instead to meat that was raised with regenerative pasture management practices, you can additionally have a large positive impact on many other environmental factors. Look for terms like "high-density grazing," "holistic grazing," "holistic management," or "management-intensive grazing (MIG)."

This TED talk [1] covers some of the information, for more you can google around for the above terms (sorry I don't have a good link handy). Correctly managing grazing livestock can actually reverse desertification and trap tons of carbon per year per acre in the soil. Of course, doing it wrong can have the opposite effect, so if you go this route it's important to know whether your farmer is running his operation with land restoration in mind.

Conventional vegetable production also comes with a slew of its own problems (breeding of herbicide-resistant weeds [2] being something closely related to the topic at hand). Eating in a way that doesn't cause harm is a tricky thing these days.

[1] - http://www.ted.com/talks/allan_savory_how_to_green_the_world...

[2] - http://www.sciencedaily.com/releases/2012/10/121002092839.ht...

*edited for formatting

What do you do when your animals get sick?

I'm not trying to be inflammatory, I'm just curious.

It's a natural question. Sick animals are culled from the herd. They may be either processed or sold to another producer who is willing to medicate, but my program is focused on building resistant genetics. You can look into "South poll cattle" [1] for an example of this type of breeding program. I don't raise cattle at this time, but I will be soon, and I'll be using an aggressive culling system like what was used for that breed with good results. For more information about this methodology, check out the Lasater Philosophy of Cattle Raising [2]. In my case, I try to apply the same basic ideas to sheep (and eventually cattle).

[1] http://www.southpoll.com/History.html

[2] http://www.amazon.com/The-Lasater-Philosophy-Cattle-Raising/...

Just wanted to add two notes: First, I'm relatively new to raising animals, so I'm speaking from a position of some experience, but primarily learning from others' work. Second, sickness in general is rare for animals raised in this manner (long rest rotational mob grazing), so it's not an issue that really crops up very often.

Factory farming extends to vegetables.

I'm with you on basically all points. For a good time, take a look at carbapenem-resistant enterobacteriaciae [1] and totally resistant TB [2].

Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger, and it may well not have anything to do with poor living conditions. It seems to work in humans, too, and these results were discovered as early as the 1940s [citation needed].

But those are just quibbles; on the key points, I'm with you.

[1] http://www.cdc.gov/hai/organisms/cre/index.html

[2] http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html

> Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger

I think the explanation that I heard which sounds plausible is that the antibiotics free up a certain amount of energy in the organism that would have gone to fighting micro-organisms that can instead be applied to growth.

Be very cautious with easy and intuitive explanations in biology.

Do antibiotics make people taller, fatter, or both?

> Regarding the antibiotics, it's not completely clear why giving them to animals makes them bigger

From the 'Germs Are Us' article:

"In August, Ilseung Cho, of the New York University School of Medicine, published a study showing that antibiotics eradicated bacteria, commonly found in the digestive system of mice, that help the animals metabolize calories efficiently; without the microbes, the mice absorbed more calories from the same amount of food and rapidly became obese."

http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_...

But what do we do about it, when it seems that nobody at all cares?

People care a ton about this, enough so that the FDA has released guidance on it and even industry magazines are talking about it [1]. This is a huge issue with major visibility in the health professions.

[1] http://nationalhogfarmer.com/health/be-ready-antibiotic-rest...

Factory farming should be outlawed for a number of reasons. It's inhumane, devastating to the environment, and bad in a million other ways. It's not even efficient, except in jurisdictions that allow the farms to (freely) dump their effluent-- an externalized cost. Factory farms are literally putting huge quantities of shit into their local water tables.

That would be a start. Then we put a ban on the sale, for human consumption, of animals that were treated with antibiotics. If you want to save your pet cat's life-- or your pig's-- that's fine. Just don't sell it as food.

That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that. People in the developed world eat too much meat for their own health anyway.

What remains is educating people about antibiotics so they stop asking for them when they get colds and flus (they don't do a damn bit of good for a viral infection). Doctors in the US tend to be over-liberal with the drugs, even knowing that they have no effect on viruses.

It's funny how everyone has solutions for our eating up the planet. But it's never the obvious: stop having children like there's no tomorrow. If you think you have the right to have 90 children if you feel so inclined, then you'll have to acknowledge the planet must turn into a massive farm.

Do you mean to imply that the only thing we need to do is "stop having children like there's no tomorrow?" michaelochurch didn't say that outlawing factory farming was the only thing we should do like you seem to imply.

Also it's been done.

Western fertility rates are on average ~2. Development and education in poorer nations - especially for women - also results in declining birthrates.

Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!

>Interesting side point though: reduced birthrates don't result in any benefits to drug-resistant bacteria though, since a small population can still run high density feedlots which promote them!

Side-note is incorrect. It's a probability game. Going from (hypothetically) 1000 CAFOs to 10 would drop the rate of production by 100x.

Which doesn't matter, because it only has to happen once.

Literally nothing about reducing the population density of an area addresses the horrific practices of the meat industry. They would still be a bad idea if there was exactly 1 next to a town of 1000 people, because that town would still be wiped out by drug-resistant bacteria.

We don't need current meat production practices - they're about corporate profit, not long-term efficiency.

No, you're incorrect. Reducing the human population density would decrease meat consumption, which would decrease cattle population density, which would decrease anti-bacterial consumption.

Who exactly is having children like there's no tomorrow? If not for immigration, the US population would be declining already. Educate people (esp women) and suddenly your major western nation can't maintain population replacement levels of births.

http://www.slate.com/articles/technology/future_tense/2013/0...

You know those people still have children regardless of which country they're in, right?

No, actually I didn't.

In my experience, "those people" are indistinguishable from "people who have the same skin colour as me" after a generation or two.

Oh, and here a some studies with, you know, numbers and statistics that bear that out:

Migrant birthrates falling in Germany, study finds -- http://www.thelocal.de/society/20100811-29073.html

"Fertility rates among foreign-born women start to decline relatively soon after they arrive in Canada, and eventually reach those of women who were born in Canada" --http://www.statcan.gc.ca/daily-quotidien/031222/dq031222c-en...

Citation needed. Even if true, once they're here, their children are likely to be better educated and have access to birth control.

There's a known method to get reproductive rates down currently being applied across the globe: affluence. There's no need to mandate it, people are getting there on their own.

Of course, affluence is where most of the problem lies. The difference in environmental impact between a rich human and a poor human is much greater than between a poor human and no human.

Which leads to a more accurate description of the problem: how do you make not destroying the planet more appealing than destroying the planet on an individual level?

In areas home to CAFOs (Concentrated Animal Feedlot Operations) there are lagoons of liquified pig or cattle waste.

Lagoons of shit. Literally.

>>That's the low-hanging fruit. It will make meat slightly more expensive, but I'm okay with that.

You may be okay with that, but there are a large number of low-income people who are not.

I'm not disagreeing with you - I think factory farming and antibiotic usage for farm animals should be banned. I just think it's worth keeping a broad perspective so that we can appreciate that these problems are in fact very difficult to solve.

Maybe these low-income people could make a decent living out of tending to farm animals if it was more of a concern to the industry than it is now.

... or we could all deal with the fact that meat isn't a human right, and the lack of it would be a slight inconvenience compared to the implications of antibiotic resistance.

So yeah, low-hanging fruit.

> or we could all deal with the fact that meat isn't a human right

Neither is food, if you really want to go that route. The point of civilization is that we try to provide for ourselves things that are not just our rights, but our desires.

(Show me where nature will automatically provide food for humans.)

I think GP was saying that access to meat is not a survival requirement, or even a requirement to be happy. I know people who would miss steak and ribs in a nostalgic sense, but anyone who hasn't found tasty vegan food hasn't looked very hard.

Access to basic nutrition is a de facto human right, in the modern civic sense. Nature doesn't guarantee that humans are fed, but many governments try to, with welfare and food stamps.

> access to meat is not a survival requirement, or even a requirement to be happy

It is for some people. Or is their culture wrong to you?

Erm, pre-agriculture, that's all nature did. Hunter gatherers today still literally walk up to their food and pick it up (or pull it from bushes, etc.). Or run it to exhaustion. Sure, it takes a minimal amount of effort (and took a lot less when there weren't 6 billion people crowding out natural food supplies), but the state of nature provides plenty of food for a small population. What you're saying is essentially that there's no natural right to free speech, because nature doesn't provide you with language (it takes other humans teaching you how to speak before you can access your right to free speech).

> pre-agriculture, that's all nature did

Not in the slightest, and I wonder where you've lived that that's ever been the case. Not on Earth, certainly.

The only things Nature provides free are sunlight, weather, and parasites.

By the universal declaration of human rights, every person has the right to life. I'm sure you can figure out a way that wouldn't entail food.

I'm not sure how nature automatically providing food has anything to do with it. The point of human rights is to provide for ourselves things that are not just facts of nature, but satisfy our ethical beliefs.

> Then we put a ban on the sale, for human consumption, of animals that were treated with antibiotics. If you want to save your pet cat's life-- or your pig's-- that's fine. Just don't sell it as food.

This is an interesting proposal I haven't heard before, and it sounds like a good idea. I think it's going to be difficult to convince ranchers that they have to suck up the loss of a $5000 steer to a bacterial infection that could have been cured with $10 of antibiotics.

> "drug-resistant MRSA"

Also antibiotic resistant c-diff. I have heard about klebsiella pneumoniae, but don't know any cases personally.

Eventually, advanced societies will realize that immune systems need to be exercised just like the rest of the body, but good luck telling helicopter moms that Jr shouldn't have antibiotics for his ear ache.

I agree, although the real once-in-a-century attack that obviously concerns people for the next century is a nuclear attack, or a biological attack, that kills hundreds of thousands or millions (not to mention killing technology that is likely to exist in the next century that we can't imagine today). The prior century was extremely limiting for terrorists by comparison to what the next century is likely to make possible.

A point of correction: 9/11 may be an outlier but it's unfair to characterize it as a super unique event. Terrorist attacks routinely kill dozens and even hundreds of people, and this continues even today. Though such attacks are for the moment much less common in the developed world.

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