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View Diary: The looming antibiotic crisis can't be solved by the free market (248 comments)

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  •  Selman Waksman (19+ / 0-)

    THE pioneer, as I understand it, was Selman Waksman,  a Ukrainian immigrant working under the aegis of Rutgers University.  He invented the very word antibiotic,  and got a Nobel in 1952.

    As a wee child I was informed of this because we often drove by the Institute of Microbiology and my Mom told me about it.  Prolly about 1955 or so.

    Years later,  as a hippie,   it was part of the lore that excessive antibiotic use would lead to bacterial resistance, which is why we attempted to learn the old herbal remedies and save the big gun for when it was actually life-threatening, rather than merely convenient.

    Ultimately,  immune systems have to be used to be effective,   and an antibiotic short-circuits the process of immune development.

    But the shareholders don't make no dough if people tough it out.

    don't always believe what you think

    by claude on Wed Mar 13, 2013 at 05:36:45 AM PDT

    [ Parent ]

    •  Claude, hate to disillusion you but pre- (26+ / 0-)

      antibiotics, people didn't tough out lots of infections, they died from them.  

      Many infections, left untreated by antibiotics, do become life-threatening.

      I know many, many people who believe in the "have to exercise my immune system so don't do antibiotics, don't do vaccines" myth.  But I'm afraid it is just that, a myth.

      The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

      by helfenburg on Wed Mar 13, 2013 at 05:49:21 AM PDT

      [ Parent ]

      •  Claude did include this (9+ / 0-)
        save the big gun for when it was actually life-threatening, rather than merely convenient.

        "No one life is more important than another. No one voice is more valid than another. Each life is a treasure. Each voice deserves to be heard." Patriot Daily News Clearinghouse & Onomastic

        by Catte Nappe on Wed Mar 13, 2013 at 08:01:07 AM PDT

        [ Parent ]

        •  It was always life-threatening. Why do you think (0+ / 0-)

          smth like 80% of kids died before reaching adulthood?

          •  I think I need a source for that 80% figure. -eom- (1+ / 0-)
            Recommended by:
            mamamedusa

            The road to Hell is paved with pragmatism.

            by TheOrchid on Wed Mar 13, 2013 at 08:14:33 AM PDT

            [ Parent ]

          •  Not always life threatening (5+ / 0-)

            You don't really appreciate how incredibly wonderful antibiotics are... but also how overused they are... until you find yourself in a situation where you cannot take them safely any longer.

            But for sure, an inexpensive 10 day prescription that we so take for granted saves a lot of lives.

            Fry, don't be a hero! It's not covered by our health plan!

            by elfling on Wed Mar 13, 2013 at 08:15:30 AM PDT

            [ Parent ]

            •  Certainly, they are overused. And vaccination (3+ / 0-)
              Recommended by:
              Eddie L, Bluehawk, JerryNA

              was a much more important factor in decreasing mortality from infectious diseases. But still, infectious diseases were a huge problem before 19th century or so.

              •  Prevention is now even more important (12+ / 0-)

                Good point about vaccination.  Antibiotics are needed if vaccination fails. Vaccination leads to herd immunity, making it hard for infection to spread.  Sadly, an anti-vaccination movement has sprung up, largely started by a fraudster trying to sell his own vaccine by claiming others were toxic.  And nutcases like Jenny McCarthy spread the poisonous meme, getting lots of TV time because, frankly, she has big boobs.  Then the newage types decided that vaccines were bad, so the haut-bourgeois suburbs are hotbeds of preventable disease.

                And of course other preventative measures, like good sanitation in hospitals (not antibacterials at home!), are critical.

                •  Vaccination / Antibiotics in livestock. (19+ / 0-)

                  Vaccination is mostly against viral infections, not bacterial infections. There are of course very important exceptions, like meningococcal vaccine that prevents a deadly form of meningitis, and pertussis (whooping cough), which are both caused by bacteria. But the vast majority of vaccine preventable diseases, at least in the U.S., are caused by viruses: measles, mumps, smallpox, chicken pox, HPV, polio, hepatitis (A and B), and of course, influenza.

                  One vitally important point made by the diarist, which cannot be emphasized too much, and which gets widely ignored (especially in Congress), is the huge damage being done by wanton use of antibiotics in livestock:

                  Industrial farms have been adding antibiotics to livestock feed since 1946, when studies showed that antibiotics caused animals to grow faster and put on weight more efficiently, increasing meat producers' profits. Between 1985 and 2001, the use of antibiotics in feed for industrial livestock production rose a startling 50%. Today, antibiotics are routinely fed to livestock, poultry, and fish on industrial farms to promote faster growth and to compensate for the unsanitary conditions in which they are raised. According to a new report by the FDA, approximately 80 percent of all antibiotics used in the United States are fed to farm animals. This means that in the United States only 20 percent of antibiotics, which were originally developed to protect human health, are actually used to treat infections in people.
                  There is no better example of the limits of the free market to solve problems than this. The free market only cares about short-term profit. It is absolutely agnostic about public health and public good. And this is where Ayn Rand disciples like Paul Ryan are intellectually and morally bankrupt.

                  Excellent diary -- thank you. Should be on the Rec list.

                  The only entitlement that needs reforming is the inbred belief of the 0.1% that they are entitled to 99.9% of the wealth and 100% of the power.

                  by flitedocnm on Wed Mar 13, 2013 at 09:15:31 AM PDT

                  [ Parent ]

            •  Penicillin saved my life as a child... (4+ / 0-)

              This past Saturday, mid-day - my husband got bitten by a neighbors cat.  The wound on his hand "looked" clean.  By Mon evening his hand was pink and swollen to twice normal.  

              We were LUCKY to get to a Dr. THAT NIGHT who gave him a tetanus shot and antibiotics - it appears to be slowly fading this morning.

              Called the Vet who told me 2 of their techs ended up in ICU with an antibiotic drip due to cat bites.  I asked how long it took for the infection to take hold - one unfortunate persons entire arm was swollen like a balloon - the next morning!

              Due to the current overuse of antibiotics - what my husband was given was NOT guaranteed to work.  He has a followup Th night.

              Sad days.  EPA and our govt. appears to work for the corporate financial good to keep paying off pols - leaving the rest of us who PAY THEM for the "privilege"... out of luck.

              Perhaps we could start by taking FLUORIDE out of the water supply - to stop dumbing down the population much?

              Change must come from the people.
              Politicians are too paid off to care when they reach capitol hill.
            •  The problem is that people take them when they (3+ / 0-)
              Recommended by:
              JerryNA, RoCali, mamamedusa

              don't have bacterial infections.  I know many people who will get an antibiotic prescription if they go to the doctor for a cold.  That's the problem.  Doctors want to be perceived as doing something - don't have the balls to tell the person to go home, rest, take aspirin, drink plenty of fluids and you'll be better in a couple of days.

              The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

              by helfenburg on Wed Mar 13, 2013 at 12:28:51 PM PDT

              [ Parent ]

              •  even worse, cows take them when they don't need (2+ / 0-)
                Recommended by:
                crose, Carol in San Antonio

                them.

                THe practice of feeding antibiotics to feed animals ought to be a crime against humanity, punishable by a life sentence in the Hague to atone for the milllions of preventable deaths food company CEOs will cause in order to be more profitable.

                Capitalism will be the death of us.  Anyone who thinks it is an unbridled good is either not paying attention or dumber than most bricks.

                Hay hombres que luchan un dia, y son buenos Hay otros que luchan un año, y son mejores Hay quienes luchan muchos años, y son muy buenos. Pero hay los que luchan toda la vida. Esos son los imprescendibles.

                by Mindful Nature on Wed Mar 13, 2013 at 10:02:55 PM PDT

                [ Parent ]

          •  It is not always life threatening (4+ / 0-)
            Recommended by:
            claude, tacet, helfenburg, mamamedusa

            That is the problem with overuse. People use them when they aren't necessary, and for things anitbiotics cannot help with at all, like viruses.

            "No one life is more important than another. No one voice is more valid than another. Each life is a treasure. Each voice deserves to be heard." Patriot Daily News Clearinghouse & Onomastic

            by Catte Nappe on Wed Mar 13, 2013 at 08:42:14 AM PDT

            [ Parent ]

          •  80% figure doubtful, dynamic described real... (0+ / 0-)

            My maternal grandparents' generation is a good example, in particular my grandfather, born around 1890.  Eleven children; eight survived until adulthood.  My grandmother; four children, three survived until adulthood.  Although I cannot recall the particulars of decades-ago discussions of collateral family branches, I do recall it being rare for all the children of any family to survive to adulthood, usually because of some infectious disease.

          •  Antibiotics get more credit than they deserve for (13+ / 0-)

            reducing mortality in many cases.  One of the most profound increases in public health in the early 1900s came as a result of water treatment, modern plumbing, and dedicated sewer/sanitation systems.  Cholera stopped being a huge killer because of that, not because we developed antibiotics.

            An interesting related note; in the wake of the Rwandan genocide there were massive refuge camps on the border with large cholera outbreaks.  The UN told the world to stop sending drugs, and instead send water treatment equipment and port-a-johns. They were right.

            Gentlemen, you can't fight in here! This is the War Room!

            by bigtimecynic on Wed Mar 13, 2013 at 10:18:25 AM PDT

            [ Parent ]

      •  that is an overgeneralization (8+ / 0-)

        of causes of childhood mortality before antibiotics,  not everything is actually life threatening, not everything improved only because of antibiotics.  Simple hygiene advances made a huge difference, everything from more regular bathing, to clean running water, septic/sewer improvements, etc.

        If anything, recent research indicates we have cleaned out too many forms of bacteria with overuse of antibiotics and antiseptics, and even with the antibiotic resistant superbugs excluded from the equation of antibiotic misuse and overuse, we would be healthier with more bacteria in our systems.

      •  As an herbalist (11+ / 0-)

        of forty years experience AND an administrative assistant with twenty-five years in medical research, I've got to say that this isn't an either-or situation.  You DO have to exercise your immune system for it to work, and overuse of antibiotics on problems that the immune system can handle by itself only accelerates the development of microbial resistance.  OTOH if you wait until the point where an infection is life-threatening, it will take much more drug and time to subdue it, it could cause permanent damage, and you could still die.  So balancing between competing objectives takes skill and common sense, which neither patients nor time-stressed doctors tend to exercise.  One or the other usually wants a "quick fix" without effort and nobody likes to think, work, or suffer if they don't have to.  In addition we are dealing with a workplace which no longer tolerates extended absences for dealing with illness in an intelligent manner.  Instead, workers are fired for taking time off for the common cold if they don't drag themselves out to sit in an uncomfortable office full of sick people for hours in order to get a doctor's note verifying what anyone with eyes could see without it, and probably a drug which will do little good except to a drug company's bottom line.

        Prevention remains the best idea, and while vaccines are a nice silver bullet, their efficacy and safety are overhyped and their prices often ridiculous for the uninsured.  The best prevention for illness remains eating lots of fruits and veggies, getting a good night's sleep EVERY night, and avoiding drugs which are known to suppress the immune system if you can possibly do without them.  The best cure for the common cold remains a toddy of hot lemonade full of brandy, because it will convince you to remain in bed where you belong.

      •  YMMV (3+ / 0-)
        Recommended by:
        jabney, elfling, ladybug53

        I can only speak of my own experience.  Maybe it's all just a crap shoot, how one does in the genetic lottery.  There are folks who obsess about diet and health and try to do everything right,  and still they succumb to illness early,  while others live utterly without health consciousness,  do all the wrong things,  and are never sick.

        don't always believe what you think

        by claude on Wed Mar 13, 2013 at 11:25:57 AM PDT

        [ Parent ]

      •  Pretty broad brush you've got there (2+ / 0-)
        Recommended by:
        Sunspots, mamamedusa
        I know many, many people who believe in the "have to exercise my immune system so don't do antibiotics, don't do vaccines" myth.  But I'm afraid it is just that, a myth.
        But if your 2-year-old develops a middle ear infection and you take her to the doctor, you may well leave the office without a prescription for antibiotics, because practice guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians state that unless the illness is severe, the child's immune system is likely to take care of the infection without antibiotics.

        Likewise, with acute sinusitis, doctors now will often wait a week or so before prescribing antibiotics, because in most cases the immune system will clear the infection without them.

        As for vaccines, one of their downsides is that in some cases the protection they provide will fade unless you get booster shots, whereas if you get the disease, your immune system will provide far more long-lasting protection. Given a choice between chickenpox and chickenpox vaccine, I'd go with chickenpox. (Given a choice between tetanus and tetanus shots, though, I go with the shots.)

        So I'd have been much happier with your statement if you'd done it this way:

        I know many, many people who believe in the "have to exercise my immune system so don't do antibiotics, don't do vaccines" idea. But I'm afraid it depends on the circumstances.
        •  So if the antibiotics are so useless, why are we (0+ / 0-)

          worrying about the fact that they are going to disappear?

          Surely our immune systems will benefit and we'll all become immortal gods of strengthened immunity.

          The elevation of appearance over substance, of celebrity over character, of short term gains over lasting achievement displays a poverty of ambition. It distracts you from what's truly important. - Barack Obama

          by helfenburg on Wed Mar 13, 2013 at 12:32:26 PM PDT

          [ Parent ]

          •  You certainly gave that straw man a death blow (2+ / 0-)
            Recommended by:
            Mindful Nature, mamamedusa

            Here's your starting premise: "if antibiotics are so useless". But my comment very carefully emphasizes that antibiotics are not needed in some situations. (Did you miss the part where I specified that "it depends on the circumstances"?).

            Does "not needed in some situations" mean "completely useless" to you?

            •  love that line (0+ / 0-)

              "gave that straw man a death blow"  Perfect.

              Of course, he's reacting to the new agey anti-vaxers types, who are just as anti-science as the anti-evolution types and the climate change deniers.

              I think modern biology would in fact counsel judicious use, given what we know about evolution

              Hay hombres que luchan un dia, y son buenos Hay otros que luchan un año, y son mejores Hay quienes luchan muchos años, y son muy buenos. Pero hay los que luchan toda la vida. Esos son los imprescendibles.

              by Mindful Nature on Wed Mar 13, 2013 at 10:04:42 PM PDT

              [ Parent ]

        •  good start, but bad conclusion (2+ / 0-)
          Recommended by:
          high uintas, RoCali

          tacet,
          You started okay but your conclusion is awful.  Chicken pox is somewhat dangerous by itself, but it may not clear from your system.  Instead, it can go dormant and come back as shingles much later in life.  Shingles causes blisters and neuropathy (nerve damage) with major pain.  It is no joke.  Chickenpox vaccine is much preferable to the disease.  This is true for most diseases for which we have vaccines.
          Other bacterial and viral infections are similarly bad, but people today (like you) are not familiar with the major pain and death they can cause.  When you give advice about toughing it out, have the decency to know what you are talking about.  You do not.

          •  I would love to get the shingles vaccine (1+ / 0-)
            Recommended by:
            crose

            My ins. won't pay for it unless it's given in a Dr.'s office and we don't have a doctor in our system who will do it. It would cost me $500 to get it at my local pharmacy. Why? No clue.

            "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

            by high uintas on Wed Mar 13, 2013 at 04:45:58 PM PDT

            [ Parent ]

            •  A friend of mine (1+ / 0-)
              Recommended by:
              high uintas

              has had mutiple doses of the shingles vaccine, and her shingles returns every late fall right before first sememster finals--she is a college teacher. First she gets the Cold Sore That Ate Milwaukee and then shingles develops. For some reason the vaccine doesn't work for her or for several members of her family.

        •  I just vaccinate for diseases that can kill (0+ / 0-)

          both livestock and myself.  And I'm nevertheless wondering if maybe I'm overdoing it.  

          A strong immune system is still the all-around protection, since microbes evolve a whole lot faster than we do, and they can share the genes that provide resistance.  

        •  Not exactly correct, but close... (2+ / 0-)
          Recommended by:
          mamamedusa, crose

          ... When WarriorGirl got an ear-infection at age 3, we called it in and asked if we could wait and see what developed, which is what the doctor wanted to do as well.  The next morning she screamed and her ear started bleeding, so right into the office (Saturday am) and a shot of antibiotics.  Which according to her pediatrician was their office practice; if pus or bleeding indicating perforation, antibiotics.  Otherwise, wait, with OTC fever reducers.  Their experience is about half go away without a shot.  WarriorGirl healed up fine (her hearing is great).  And she's fully vaccinated for the next 5 years (until Gardasil).

          Our adult PCP practice has a similar policy on sinus infections; they don't prescribe until you've been producing green-goo for more than 48 hours.  I went in at day three and they took one look and said, yep, that's not going away by itself; took a look at my ears, and said "ooh, it's spreading to your ears" and gave me a scrip.  

          Disease immunity fades as well immunization.  I had Rubella at 2 years old; they couldn't find antibodies when I was 19 (during an outbreak at uni) and was vaccinated with the then "new" MMR.

          Then when I got married I tested negative again for Rubella antibodies, and had to be vaccinated once more.  Our PCPs are actually re-vaccinating several old shots (I got the new DTP or whatever the adult variant is, it hurt like hell) because of fading immunity.

      •  Malnutrition has a lot to do with high death rates (1+ / 0-)
        Recommended by:
        crose

        in the past and around the world now, too.  

        Crowded unsanitary conditions, people pushing into new areas and hunting new animals because they are crowded or displaced and need food, for instance ebola or HIV...

        •  Don't confuse malnutrition with disease morbidity. (0+ / 0-)

          Sunspots, you are mixing up three different problems.  
          1. People moving into new areas for whatever reason, for food, water, climate, or whatever, can mean they are exposed to new diseases.  The food itself can be the disease vector (chimpanzee meat for HIV, pork for trichinosis, etc.).  
          2. Unsanitary conditions spread diseases like cholera.
          3. Malnutrition can increase the death rate of diseases, but good nutrition cannot reduce the death rate below a floor.  In the case of ebola, the average death rate is about 65%.  Other dangerous diseases in the same region do not kill people so quickly or effectively, so you cannot blame malnutrition.  In the case of untreated HIV, after 5 years death ranges from 95-98%.  No amount of good nutrition or sanitation will stop hemorrhagic fever or help restore a destroyed immune system.

    •  Well, let's not forget Alexander Fleming (5+ / 0-)
      Recommended by:
      Paul1a, whenwego, FG, Bluehawk, 714day

      And Florey and Chain.  Fleming discovered penicillin and Florey and Chain turned it into something useful, just in time for WWII.

      "Don't be defeatist, dear. It's very middle class." - Violet Crawley

      by nightsweat on Wed Mar 13, 2013 at 06:46:38 AM PDT

      [ Parent ]

    •  demon under the microscope (1+ / 0-)
      Recommended by:
      ladybug53

      this man may be considered the inventor of the first antibiotic (maybe?).

      great book.

      oh and the comedy: during his nobel acceptance speech, he warned of the dangers of resistance.

      this is not a new problem, just as greed and stupidity are not new problems.

      big badda boom : GRB 090423

      by squarewheel on Wed Mar 13, 2013 at 09:06:18 AM PDT

      [ Parent ]

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