Imagining the Post-Antibiotics Future

> Dukes believes, though he has no evidence, that the bacteria in his gut became drug-resistant because he ate meat from animals raised with routine antibiotic use. That would not be difficult: most meat in the United States is grown that way. To varying degrees depending on their size and age, cattle, pigs, and chickens — and, in other countries, fish and shrimp — receive regular doses to speed their growth, increase their weight, and protect them from disease. Out of all the antibiotics sold in the United States each year, 80 percent by weight are used in agriculture, primarily to fatten animals and protect them from the conditions in which they are raised.

I really don't like to generalise in this way, but this sort of stuff makes me, as a European, pretty angry at the general laissez-faire attitude of the United States towards such things.

You may say "The US is allowed to govern itself as it wishes, no one's forcing you to live there" - but with its heavy use of antibiotics in cattle-raising (banned in the EU - even though the US has tried to use its muscle to get the EU to un-ban it), the US is basically doing a fantastic job of fucking up antibiotics for everyone. So yes, I'm angry at the United States and its corrupt political system that means that there's almost zero chance that any of this will be fixed until it's far too late.

when this was posted on metafilter last year someone posted a truly excellent comment: https://www.metafilter.com/134210/Imagining-the-Post-Antibio...

> who calls antibiotic resistance as serious a threat as terrorism

What an unbelievably stupid comparison. Terrorism is mass murder turned into the sort of spectacle that causes us to massively overestimate a threat to our individual lives. If antibiotic resistance is that sort of threat, then it isn't much of a threat at all, and we can all go back to worrying about normal things such as dying from regular homicide, heart disease, crossing the road, and choking on food.

> economists for the National Pork Producers Council estimated that removing antibiotics from hog raising would force farmers to spend $4.50 more per pig, a cost that would be passed on to consumers

That is an unbelievable. A single pig produces over 100 pounds of meat, so we are risking catastrophe for a cost savings of less than 5 cents per pound of meat.

This seems like the same sort of pointless hand-wringing that attends every technology at its peak. There are any number of works in progress that could replace antibiotics. None of them have yet because they are not economically competitive. As that changes - because they either realize their potential to be much, much more effective, or because the cost of working antibiotics rises - then antibiotics will fade in favor of the next technology in line.

This is what happens to every technology. Yet people seem to forget, despite the evidence all around them, that they live in a world that changes rapidly due to the fact that many, many individuals are working on new and better ways to do everything. Periods of seeming stasis to the outside observer - such as the long use of antibiotics, which is really actually a continual hectic development of new types of the single class of item - only occur because economic conditions favor them. As soon as economic conditions favor another technology, it is developed and deployed from its prototypes pretty rapidly.

Does anyone think it might just be an idea to change the amount of meat we produce? When people start dying at the age of twenty and thirty of bacterial infections that are totally curable today, and gonorrhoea becomes incurable, will we think our current insouciance rational? Will it be seen as a price worth paying in order to have cheap meat? A tremendous proportion of the antibiotics we use are abused as growth promoters for animals reared for meat or their products. They are used pro-actively on healthy animals outside of the EU. Even within the EU, they are used routinely in a way that is driving us towards a post-antibiotics future.

It is pretty sad to reflect that we are not able to prioritize our own health above an immediate desire to consume more meat more cheaply.

This problem has been known for a long time, though it's taken a while for it to fully emerge.

I first encountered it reading Isaac Asimov's essay collection Twentieth Century Discovery, which highlights a number of the most significant inventions of the 20th century as of its publication date, in 1969 (and no, I'm not that old, I read it probably ~15 years later).

http://www.amazon.com/Twentieth-Century-Discovery-Isaac-Asim...

The point being that natural selection is a very powerful force, and while antibiotics have proven useful, they've got very clear limits as well. And humans are an awfully large and well-connected biological niche to exploit at present.

One of the bright spots is that it seems hard for bacteria to evolve more than one resistance, and that resistances don't confer an evolutionary benefit in the absence of the specific antibiotics.

There are modern techniques to avoid resistance issues. For example, as most diseases can be treated by more than one drug, switching them regularly in a hospital or practice.

There are other combinations of drugs which haven't been used a lot or not even been discovered yet. It would be nice for example to trick an infection into letting go of the resistance and then attacking it with the AB.

"removing antibiotics from hog raising would force farmers to spend $4.50 more per pig, a cost that would be passed on to consumers."

one of those cases where savings of $4.50 a month cause extinction of human race.

I really really hope that the threat of antibiotic resistance is like the one for terrorism. Almost negligible. But I really doubt it. Seems like a greater serious one ...

Antibiotics are done, and they've been failing increasingly for at least two decades even though nobody cared to report it then. The speed of our transition to the "post-antibiotics era" is certainly our fault, but the phenomenon itself was always inevitable. Biology is an arms race, and it will always be one. In fact, biology overall is one of the worst substrates imaginable for hosting conscious entities, and that means this and many other problems may never be permanently solved.

However, it's not all hopeless. There are a lot of bacterial infections that will continue to be treatable with antibiotics for some time to come. So it's not like we'll lose all of our capabilities at the same rate. It just means that gradually the number of strains that are panresistant will increase.

To see what complete powerlessness over an infectious agent looks like you don't have to look further than viral infections today. The reality is we still can't do very much to treat them, so over time we'll just add significant bacterial adversaries to this list of diseases for which there is nothing else but symptomatic treatment available.

This will all change, because medicine has to change. In the future, it won't be enough to hit an unspecific infection with an unspecific antibiotic. It will be necessary to analyze individual infections and their interactions with individual patients in detail - and then very specific biochemical treatments will have to be tailored on a case-by-case basis.

The recent rise of monoclonal antibody drugs is a bridge to that future. We're still not knowledgeable enough, and we're still using these treatments with all the finesse of a 3-year old hammering huge lego toys together, but we'll get there eventually. We have to, it's the only hope against a lot of other diseases as well, including cancer.

In the mean time, there is a lot of research that needs to be done. We're also missing the actual technologies, both diagnostic and generative machines, but the most important obstacle to overcome will probably be the culture of medicine. This culture will change only when there is enough pressure for it to change. The FDA will have to change when its primary role becomes denying treatment to people who are going to die instead of keeping the population safe. Medical professionals will change when it becomes a big factor that they lack the scientific background to effectively devise and apply advanced treatments. But first, all of these disasters will probably have to actually happen, and we're already seeing the first signs of that trend.

So, there is definitely a path forward - it's not an inevitable descent into the dark ages. It's just that due to inertia and time spent waiting for basic scientific advances, there will be a period with less protection overall. Drugs may become available to plug some of these gaps, like insect-derived antibiotics, which will eventually fail too but will buy some additional time.

Reading this scares the crap out of me. Unless there are incentives to drug companies (and those who research other antibiotic tech) we could go extinct before anyone creates a solution. Yet drug companies perversely invest billions on drugs that cost $1000 a month and help solve relatively minor ailments.

I don't understand this bit: ". . . resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat . . . "

How are different microorganisms sharing DNA with each other? Am I misunderstanding completely?

I guess there's already a movie in the making of how this all turns out.

I will be interested to see how sexual mores develop this century. I think the "sexual revolution" will turn out to have been a flash in the pan. Resistant clap and syphilis are a growing occurrence. I expect the old order of arresting people for promiscuity to return and the new idea of privacy in the bedroom to die.