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Most of us alive today do not remember life before antibiotics.  I would have had one more uncle had penicillin been available a year earlier; up through the first half of the twentieth century, many now-minor diseases were fatal.  Antibiotics were the original miracle drugs, curing a range of bacterial diseases.

But the antibiotic era may be ending.  Antibiotics contain the seeds of their own destruction:  A few bacteria occasionally have mutations that lead to resistance, and those quickly multiply.  Thus an antibiotic's useful life span is limited.  In the 1960s, I used to take Penicillin G for various things.  It has been out of general use for decades.  A range of other members of that beta-lactam antibiotic family have been developed since then, each one chasing after the newly-resistant strains of bacteria that kept emerging.  And other antibiotic families chased after other types of bacteria, or served those with a common allergy to penicillin and its relatives.  For a few decades, the pharmaceutical industry kept up with the threat.

But now the bacteria are winning.  And we're not doing anything about it.  This is the microbiological cousin of global warming, a public health crisis that capitalism can't solve.

The problem is not just that we can't keep creating new antibiotics.  It's more systemic than that.  We no longer even try.  The medical and pharmaceutical industry structure has no room for antibiotic research and development.

Developing a new drug is costly.  It begins with a lot of candidate compounds.  Some are simply lab-developed molecules that look like they might attack bacteria (viruses are not attacked by antibiotics; anti-viral drugs are even rarer).  Some are natural compounds, often alkaloids extracted from plants.  Tropical rain forests are a wonderful source of exotic chemicals; with all of those life-forms in balance, the chemistry between them is a great place to look.  But rain forest destruction isn't even the biggest problem.

Lots of compounds are tested in the lab to see if they have a useful effect.  Those that look promising are then subjected to another range of tests, to see for instance if they're poisonous themselves.  Finding something that is both safe and effective is a real needle in the haystack search.  It takes time and money.  Once a promising compound is found, it is given more in vitro testing and then animal testing before human testing begins.  It is tested for toxicity and tested for effectiveness, usually with double-blind testing with real patients.

This process is largely the same regardless of a drug's commercial potential.  Big pharma has figured this out, and they now focus primarily on drugs for chronic conditions.  If you need Lipitor or another statin for your cholesterol, you take it daily.  Prozac or another psy-med is taken daily.  Glaucoma drops are taken daily.  Go down the list -- the hot-selling drugs are the ones where the prescription gets refilled, not the ones that are used for ten days until the infection is cured.

And the high cost of prescription drugs in the US is not mostly being spent on R&D, no matter what they want you to think.  The brand-name drug companies spend more on marketing and advertising than on new-drug development.  And a lot of drug development is for copycat drugs, those that are very similar to another one, but different enough to have their own patent.   So there are a bunch of statins on the market.  And the d-isomers of drugs that came out in achiral (d+l) form, like Nexium, the d-isomer of Prilosec.  No biological difference, but a much higher price for the sucker who demands it.  Or their insurance carrier.

So antibiotics, where success means you only need a few doses, are a lousy business to invest in.  But it gets even worse than that.  If an antibiotic turns out to be successful against resistant bugs, then the best thing to do from the public health perspective is to not use it unless it is absolutely necessary.  The more an antibiotic is used, the sooner resistance will appear, so once the arrow is in the medical quiver, it should only be fired rarely, so long as alternatives exist.  But how does that make for a business?  Especially when the high profits to the drug's developer only accrue during the term of the patent, before generics come out at a lower price.  Manufacturers want to sell as much as they can during the patent term.  That is exactly what should not be done with new antibiotics!

(And let's not forget about the fact that most antibiotics are fed to farm animals, as part of their daily feed, where they breed resistance.  That practice should be banned.)

In the meantime, drug-resistant bacteria are spreading. They typically spread in hospitals and nursing homes.  In a decade or two, we could end up with epidemics as bad as before antibiotics hit the market.

So what can we do about it?  The problem is that nobody in power wants to deal with the problem.  American civil religion preaches that the market solves all problems, but antibiotics defy the market, since the goal is to have a small demand and to not use it more than necessary.  Thus big pharma simply isn't developing them any more.  Nobody is. And the usual solutions make no sense.  The old "orphan drug" rule allows even stricter patent protection, so the drug can be retailed for a more ridiculous price.  (Some drugs now sell for around $1000/day. Their manufacturers simply assume that the insurance companies will pay.) And even that leads to only limited development.

Antibiotics, properly regulated, are a public good.  So their development should be funded as a public good.  Raytheon doesn't have to advertise its missiles on TV; Lockheed-Martin doesn't advertise its warplanes.  If we can spend hundreds of billions of public dollars on weapons of war designed to fight the Soviets and other no-longer-existent enemies, why can't we spend public money to develop medicine?  It needn't all be done by big pharma, either; universities are well-positioned to do the basic research.  Then the drugs can be patented by the government, as the funding agency, and made available at a reasonable cost, manufactured like generics.  This would help lower overall health care bills too, compared to the purely-capitalist model of pharma funding we now have.

It takes a long time to develop a really new antibiotic -- an unpredictable time, since you never know when you'll find a good one.  Research should have started yesterday.  It would be a very good investment of public funds, not wasteful spending.  Congress' refusal to consider it shows how it is still beholden to private interests, regardless of the public good.

Originally posted to Frenzy. Illusion. Shadow. Fiction. on Tue Mar 12, 2013 at 08:00 PM PDT.

Also republished by Community Spotlight.


Should Congress fund a multi-billion dollar NIH program to develop multiple new antibiotics?

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  •  Tip Jar (269+ / 0-)
    Recommended by:
    asilomar, wayoutinthestix, Gooserock, JeffW, bgblcklab1, radical simplicity, devis1, VaBreeze, onanthebarbarian, myboo, ontheleftcoast, Zinman, pimutant, edrie, Deward Hastings, FG, YucatanMan, Regina in a Sears Kit House, Rosaura, cordgrass, snoopydawg, magnetics, chantedor, Hayate Yagami, dotsright, 2dot, camlbacker, TerribleTom, riverlover, vadasz, jgnyc, basquebob, native, Eric K, fallina7, northsylvania, journeyman, HarpboyAK, Mentatmark, joynow, WI Deadhead, praenomen, 207wickedgood, checkerspot, KJG52, dRefractor, bloomer 101, Pluto, rivamer, irate, ovals49, Habitat Vic, SaraBeth, Ian S, some other george, SteelerGrrl, coldwynn, Chi, Mark Wallace, Dobber, gramofsam1, asym, Cat Whisperer, evelette, caryltoo, marleycat, DRo, Steven D, marsanges, chira2, Tinfoil Hat, Ian H, jcrit, eagleray, nuclear winter solstice, lotlizard, claude, Roadbed Guy, concernedamerican, LEP, terabytes, NYmom, sodalis, DvCM, jamess, Kristina40, Skennet Boch, oortdust, EclecticCrafter, copymark, nsfbr, mconvente, One Pissed Off Liberal, kurious, Les Common, Old Surgeon, mr crabby, donaurora, Heart of the Rockies, fiddler crabby, blue aardvark, entrelac, fisheye, flowerfarmer, Powered Grace, pixxer, stlsophos, Gowrie Gal, tonyahky, hazzcon, jnhobbs, CayceP, SeaTurtle, cotterperson, nzanne, Williston Barrett, zaynabou, Robynhood too, Paul1a, belinda ridgewood, Odysseus, hlsmlane, AZ Sphinx Moth, hubcap, JamieG from Md, emmasnacker, NYC Sophia, maryabein, elfling, livingthedream, Marihilda, zerelda, tle, whenwego, kenwards, Debs2, Cassandra Waites, roses, enufisenuf, sillia, GeorgeXVIII, leeleedee, Ice Blue, Catte Nappe, MA Liberal, Sylv, Sun Tzu, bleeding blue, Brooke In Seattle, Janine7, PhilJD, jfromga, Luma, Anthony Page aka SecondComing, chimpy, leonard145b, JohnnySacks, countwebb, kevinpdx, beth meacham, science nerd, Ekaterin, DavidHeart, slapshoe, exNYinTX, flitedocnm, fumie, squarewheel, la motocycliste, ChemBob, Emerson, qofdisks, mkfarkus, LillithMc, Involuntary Exile, cynndara, karmsy, Blue Bell Bookworm, pvasileff, the fan man, 714day, Thutmose V, Bluehawk, turn blue, eru, lgmcp, punkin4, wader, illegal smile, texasmom, Glacial Erratic, Tirge Caps, Homer177, ThirtyFiveUp, Aaa T Tudeattack, 3goldens, citisven, ewmorr, LamontCranston, wasatch, Russ Jarmusch, tacet, Born in NOLA, Gay CA Democrat, mn humanist, Loudoun County Dem, Jbearlaw, Mistral Wind, bfitzinAR, TexDem, Mr Robert, arendt, SanFernandoValleyMom, jediwashuu, StrayCat, blackjackal, Lily O Lady, ClickerMel, 2thanks, samddobermann, grumpyolddonkey, helpImdrowning, Chaddiwicker, rapala, schnecke21, Jollie Ollie Orange, Laughing Vergil, docmidwest, ladybug53, Teiresias70, DrSocMama, old wobbly, rodentrancher, pat bunny, WheninRome, Sunspots, Bernie68, fiercefilms, wildweasels, gmats, lu3, tofumagoo, petulans, greenotron, freesia, turdraker, FlyingToaster, poliwrangler, ipaman, SueM1121, mamamedusa, crose, Sandino, pragmaticidealist, FogCityJohn, Oaktown Girl, Avila, Jeffersonian Democrat, citylights, grollen, Pat K California, bluesheep, Linda1961, Carol in San Antonio, rchipevans, profh, Ironic Chef, mofembot, splashy
  •  But It Was Never Industry Doing Basic Research (64+ / 0-)

    and discovery was it? I thought they only came in after government (university etc) research had proven a concept, their "research" being how to make it practical and marketable.

    I think the problem is the increasing corporatization of public sector research which gives them the incentive to turn away from basic research to the later profit-driven development.

    I have 2 ties to this topic; one, I was once a grunt support staff worker in university research administration, the unit that legally worked between donors and researchers; and the other, I've spent the last 5 years trying to get past the digestive side effects of antibiotics prescribed for head related issues, which may well involve at this point resistant bugs.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Tue Mar 12, 2013 at 08:08:21 PM PDT

    •  At this point there isn't much academic research (17+ / 0-)

      going on new antibiotics. It's mostly development done in industry.

      •  The original antibiotics were developed at least (20+ / 0-)

        in part by academic researchers.  But let's face it, the free market does not solve all human problems.  How silly to believe that.   Many of the most valuable things don't generate a profit.

        Two names - Jonas Salk, Albert Sabin.  Yes, I know, vaccines, not antibiotics, but still.

        Isn't it possible that there are physical limits to our ability to generate antibiotic compounds?

        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 03:45:27 AM PDT

        [ Parent ]

        •  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:

                  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


                      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

                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:

                  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:

              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:

            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 ]

        •  There is an issue of a horse race. New antibiotics (1+ / 0-)
          Recommended by:

          are created, bugs develop immunity to them. It used to take 5-10 years, now it takes 2-3. It is a well known problem and people in both academia and industry are looking for solutions. In all likelihood, some solution will e found.

          •  New Antibiotic targets mec Bacterial resistance. (5+ / 0-)

            Just to interject a little reality, bacteria acquire resistance by swapping DNA circles that contain the instructions for resistance (plasmids) with each other, which they do like crazy whenever they come under stress from heat, cold, changes in gas pressure, chemicals, starvation, everything is a cue for a hot bacterial swapfest (conjugation).
                   I remember in 2008 the FDA withheld approval from  an antibiotic that specifically blocked the ability of the bacteria to grow the structures used in the plasmid swapping process.  The comment was that there were irregularities in the testing process.
            I remember looking into it further and finding that there had been some recording errors at something like 4 or 5 sites out of more than 500.  It looked like none  of the recording errors bore on the safety or effectiveness of the compound. The side effects reported were the same as the plecebo.

            It really appeared as if the FDA had denied approval because they were waiting for the little bio-tech company that had developed the drug to be sold to a bigger drug company.
            But this drug can prevent the development of resistance to other drugs.  
            Now if I could only remember its name.

            To Goldman Sachs in according to their desires, From us in accordance with the IRS.

            by Bluehawk on Wed Mar 13, 2013 at 10:24:22 AM PDT

            [ Parent ]

        •  If defense contractors can devise 10,000 way to (1+ / 0-)
          Recommended by:

          kill people, you'd think we could devise a larger number of ways to kill bacteria.  It's all about funding, planning, and motivation.

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

          by bigtimecynic on Wed Mar 13, 2013 at 10:13:47 AM PDT

          [ Parent ]

        •  No, animals and plants are evolving (1+ / 0-)
          Recommended by:

          all the time against the things that attack them, big and little. It's an arms race.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Wed Mar 13, 2013 at 02:16:36 PM PDT

          [ Parent ]

    •  Sure, academia does most of the basic (7+ / 0-)

      research - and uncovers (fairly cheaply) initial leads that then are developed by industry (which is damn expensive).

      That's a bit misleading insofar as overall the "basic science" aspect is not cheap in the aggregate.

      For example, there are 2 or 3 new drugs each year (or maybe 10 in a very good year) with their genesis in NIH sponsored research).  These come out of 2 or 3 million dollar grants (out of about 30,000 total sponsored by the NIH).

      Thus, it only costs $1,000,000 for "discovering" a drug in an academic lab - then industry has to step in and spend 100 to 1000 that much to commercialize the drug and bring it to the clinic.  If you look at things that way - for any particular drug, private industry spent WAY more than the public to make it a viable therapeutic to be used clinically.

      But, another way to look at it is in any given year, 10,000 grants (representing $10 billion investment of public money) don't directly lead to a drug for any one that dose.   But maybe all that money * should * be counted towards the cost of developing the few drugs that make it - in this case the public investment in drugs does dwarf the contributions of industry.

      •  the sad reality of university research (5+ / 0-)
        Recommended by:
        wasatch, tacet, JerryNA, Sunspots, Roadbed Guy

        Maybe it’s different in other places than ones I am familiar with, but pure, for lack of a better word, research is increasingly a luxury pursuit even at so-called research universities. The research institutes and academic departments are under a lot of pressure to develop marketable compounds that can be patented, sold or spun off into revenue-generating businesses. In many cases, peoples’ jobs depend on it because their salaries are funded by research grants or patent income, and not the university itself.

        One might assume that innovations produced at public universities and funded by tax dollars are in some way owned by the public. That’s usually not the case. At best, the innovations are monetized and used by the university to fund itself. It’s unfortunate but also understandable in a way, considering how dramatically state funding has fallen over the past 10-15 years.  

        Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

        by Joe Bob on Wed Mar 13, 2013 at 09:15:49 AM PDT

        [ Parent ]

        •  of course, without that "pure" basic research (6+ / 0-)

          you won't get many marketable applications. This is a personal hobby horse of mine, having worked in research labs and loving science. I've made similar posts here many times.

          I prefer basic research, so I'm biased that way, but it's absolutely true that basic research is the necessary foundation for useful applications. How do you develop a solution for something unless you understand in detail how it works? That's in addition to serendipitous discoveries, like that of penicillin itself. I wish that was more widely understood, by politicians and the public.

          •  Yes, like the green fluorescent protein (1+ / 0-)
            Recommended by:

            which (along with different colored mutants) has become  hugely important important in biomedical research.

            But it all started out with some investigator's curiosity about why   jelly fish were glowing brightly - I guess 25 years ago it was possible to get research $$s to look into that although it did not have any clear relevance to human health.

            Good luck with that today!!

    •  You're right, Gooserock. (8+ / 0-)

      In terms of time and actual research labor, the bulk is done at research universities.  Methods to synthesize and separate the drug happen here.  See the diary on student loan debt....

      However, developing the commercial process (including production, marketing, and delivery), along with human trials is done at the commercial level.

      What's been pointed out in the diary is related to the problem with healthcare in general.  Effective treatments are expensive, and most sick people are broke.  For-profit industry is only effective when costs can be made low and the end-pool of customers has access to abundant cash.  Doesn't work for long in healthcare world.

      I appreciate your low standards ;)

      by Cameron Hoppe on Wed Mar 13, 2013 at 06:44:28 AM PDT

      [ Parent ]

    •  Fecal transplant (3+ / 0-)
      Recommended by:
      elfling, blackjackal, Sunspots

      As gross as it sounds, there are promising reports of people having great success with fecal transplants to heal gut related injury from resistant bugs.  

    •  If you're talking c. diff (2+ / 0-)
      Recommended by:
      Paul1a, Sunspots

      My sympathies. Nasty nasty stuff. But it does seem like some of the crazy stuff people have tried (like the fecal transplants) is panning out.

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

      by elfling on Wed Mar 13, 2013 at 08:17:52 AM PDT

      [ Parent ]

    •  The vast majority of drug research is (2+ / 0-)
      Recommended by:
      wasatch, Avila

      done by industry. My significant other works for a large pharma. They have hundreds and hundreds of chemists synthesizing molecules trying to develop one which will be able to be metabolized and which might be effective.

      A senior chemist, with whom she is working on a new molecule, told her that he has never in over 35 years of research found a molecule that became an FDA approved drug. He said that statistically it takes 50 chemists each working for forty years to develop one viable molecule.

      There is a connection between academic and commercial research, but the information flow moves both ways. My partner spends a fair amount of time doing presentations to academic and government researchers on the molecules she is developing. In fact, I was quite surprised at the extent to which competing pharmas share information about early stage drug development.

      Here's my take on it - the revolution will not be blogged, it has to be slogged. - Deoliver47

      by OIL GUY on Wed Mar 13, 2013 at 09:21:10 AM PDT

      [ Parent ]

      •  I should qualify my first sentence. (2+ / 0-)
        Recommended by:
        wasatch, Avila

        There is a huge investment by the government in funding basic medical research. Almost none of this is focused directly at new drug development per se, but it does reveal mechanisms in the body for introducing a potentially beneficial molecule.

        To the extent that academia gets involved in human trials, which is more and more common, they are financed by a particular pharma that has developed a molecule for testing. Most major universities have associations with 'contract research organizations'. These CRO's are groups of physicians who run trial for the large pharmas.

        These entities are themselves commercial entities which compete with one another for the billions of dollars pharmas invest in drug trials.. A single large-scale human trial, can cost a billion dollars and would typically involve dozens of hospitals around the world. To get to that stage, the molecule would have undergone years of testing, yet still it is common for these big phase 3 trials to fail than succeed.

        Here's my take on it - the revolution will not be blogged, it has to be slogged. - Deoliver47

        by OIL GUY on Wed Mar 13, 2013 at 09:37:37 AM PDT

        [ Parent ]

    •  You are correct. (1+ / 0-)
      Recommended by:

      The Federal Government used to fund most of the basic research in academia.

      But after decades of neocon restructuring, most of the basic research in academia is now funded by private corporations.

      In the Fox News Christian Nation, public schools won't teach sex education and evolution; instead they'll have an NRA sponsored Shots for Tots: Gunz in Schoolz program.

      by xynz on Wed Mar 13, 2013 at 01:08:27 PM PDT

      [ Parent ]

      •  It's more nuanced than that (0+ / 0-)

        I work in academia and know where most researchers get their money-and that is through the NIH or NSF, not private corporations. The most significant funding sources outside of government are Howard Hughes and the Gates Foundation, with less amounts by American Heart Assn, American Cancer Soc, and several other small foundations. Trying to run a research program with money from these is very difficult--Howard Hughes simply picks who they fund (you can't send in an application), and funding by others are, as with government funding, extremely competitive and usually only provide limited amounts of money.

        The NIH provides funds for 4 years for meritorious grants, and it is enough to cover your salary, a grad student, a post-doc, and supplies and research costs. But it has now become so competitive (only 1 in 18 proposals are funded during any cycle) that many excellent grants don't make it. It is so bad that many young scientists cannot envision themselves in a research career, having to work so hard to get money to do the research. Sequester has made it even worse. I don't know the answer, but right now if feels broken.

  •  I think the people in power (50+ / 0-)

    are parents who shouldn't be demanding that their kids get an antibiotic for every single cough, ear ache, etc.  The other people in power or the doctors who should tell the Pharma company reps to fuck off when they provide incentives to prescribe antibiotics.  The other people in charge should be people listening to idiotic drug commercials -- more than half of which are telling you how you will die from taking their drugs.

    Folks should stop buying goddammed anti-microbial soaps and let their little darlings play in the dirt and occasionally stick stuff in their mouths.  They should let them be exposed to pets.

    Ok, I'm finished.  I grew up when practically no kid had an allergy to anything other than a bee sting.  We didn't go to the doctors unless something was broken or spurting blood.  I still use home remedies.

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Tue Mar 12, 2013 at 08:08:37 PM PDT

    •  Antibacterials are a bad idea too (28+ / 0-)

      I agree that we should not use antibacterial soap or other crap -- I never buy them.  They also lead to resistance, at least to themselves.  But the "hygiene hypothesis" for allergies is not getting much support from the evidence.  Allergies are getting stronger in other countries too, where they don't keep the little darlings in hermetically-sealed anti-bacterial playroom bubbles.  This story, The Allergy Buster, in Sunday's NYTimes magazine, about multi-food allergy desensitization, mentions that fact, which I've also heard elsewhere.

      •  I grew up in the 1960s. I don't remember ever (15+ / 0-)

        having a kid in my class with peanut allergies. Now it seems like there are more than just a few in any school.

      •  Here's the thing-- back in the 50s and 60s, when (22+ / 0-)

        I grew up, there weren't as many environmental complicating or triggering factors that might lead to food allergies.  It's not just some new allergen or bacteria creating more infections and allergies now; it's that now we live with so much unchecked pollution, chemical runoff, food engineering, hormones, etc. that course through our bodies in the air we breathe, the rain that falls on us, the soil we walk on, the food we eat.

        Yes, there are tons more allergies now than there were back in the day.  Hell, I never had any allergies when I was a kid, and now I have them at age 51.  But I also live in the state with the most air pollution (Ohio) and after 20 years of living here, the poor quality of our air, along with the effects of pollution in rainwater runoff, soil, etc. are, I am sure, conspiring to produce allergies.  

        We need research into antibiotics that will take into account the exacerbating and triggering effects of environmental pollutants and chemicals.

        That's one more thing to add to my long list of small problems. --my son, age 10

        by concernedamerican on Wed Mar 13, 2013 at 05:10:51 AM PDT

        [ Parent ]

        •  And even for people who would have had an allergy (4+ / 0-)

          to a food even back then, thanks to processed food factories getting larger and companies making ever greater varieties of products under the same roof, that one thing someone knows they are allergic to can end up in a LOT more stuff simply because it's in the factories so it can be used in a completely different product as an intended ingredient.

          And thanks to processed food, even intended ingredients can be awfully hard to figure out - I've got an acquired sensitivity to a not uncommon but not common cheese variety, and oh the trouble sometimes trying to figure out if a frozen pizza's 'deluxe'-ness comes from adding something that is not usually pizza cheese on there... At least in a restaurant I have a chance to try asking and "If you feed me this, I will know and feel ill before you ask me if I want to order dessert and definitely before we figure out the tip" means I have a decent chance of getting an honest answer. And when it comes to in-family cooking, we just don't keep the stuff around.

          Prayers and best wishes to those in Japan.

          by Cassandra Waites on Wed Mar 13, 2013 at 07:59:01 AM PDT

          [ Parent ]

        •  Another likely culprit (7+ / 0-)

          in increasing food allergies may be the 'extra' large proteins produced by GE food cultivars, which are ubiquitous in our food supply these days. Monsanto's GE soy was found by FDA to produce several of these large-molecule 'extras', proteins that were not intended by the genetic manipulations. Child allergies to soy in the UK more than doubled in the year following the introduction of GE soy in the UK, as documented by the UK's universal health care system.

          Soy and soy lecithin are in pretty much ALL processed foods, and soy is quite closely related to peanuts. GE corn is also ubiquitous, if not as an identified corn ingredient then as the corn used to produce the HFCS that food processors add to almost everything. Remember the Starlink corn fiasco? The FDA/USDA did not approve that cultivar for human consumption due to potentially allergenic 'extra' large-molecule proteins - it was allowed solely for animal feed. But it got into the human supply anyway (and inevitably), leading to a short-term increase in allergic reactions requiring medical intervention.

          Then, of course, there are the bacterial toxins engineered into food crops, to which humans have never been directly exposed but are now expressed in every cell of the plant cultivar. The long-term consequences of that remain unknown, as no long-term feeding trials were ever conducted for any of the toxins. Or rather, the public are the guinea pigs for the ongoing long-term feeding trials. In this country GMO foods and additives are not required to be labeled as such. So even if the trial goes very badly, the cause-effect relationship could not be traced.

          Lucky us...

          •  Where can one shop, and buy food, to minimize (1+ / 0-)
            Recommended by:

            one's exposure to these things?

            Any national or mail-order chains in the US?

            That's one more thing to add to my long list of small problems. --my son, age 10

            by concernedamerican on Wed Mar 13, 2013 at 10:44:13 AM PDT

            [ Parent ]

            •  I am lucky enough (3+ / 0-)

              to live in one of those "hip enclave" areas, where customer lobbying some years ago got most big area grocery chains to label their produce for country/state of origin, carry nice selections of locally grown fruits and veggies, local raw honeys, locally produced value-addeds (honey, condiments, jams and jellies, fried and dried veggie chips, etc.), and dedicate whole sections to certified organic produce. They also carry organic label canned and box goods, right there amongst the regular selections in the aisles. There are also many local and regional farmer's markets large and small, I can find one almost any day of the week for nine months a year.

              Without that, I'd advise shopping at markets that advertise organics, and seek out organic selections at your regular grocery store, quite a few are offering these days because people are willing to pay a few cents more - they fly off the shelves. There are several association labels out there for organically grown, non-GMO products from farmers who have chosen not to jump through USDA's hoops for certification. Monsanto's been busy-busy trying hard to subvert the whole enterprise since the beginning, and they've succeeded on some levels. I obtain grain from local producers in the valley who have more land than I do and a tractor to work it with. Wheat, barley, corn and oats. I can grind at home, but if I want rolled multi-grains for hot cereal and breads I buy in bulk from EarthFare or Amazing Savings (great organic collections). Also grow herbs, veggies and fruit (peaches, cherries, apples, pears and grapes - muscadine, concord and zinfandel) on my homestead, and make wine, wine and balsamic vinegars, dried fruit mixes, pickles, veggie-herb table salts, powdered soup stocks, etc.

              A trip twice a month to the regional farmer's market can be fun. Take the kids (some have enclosures with miniature horses and goats and such), maybe a couple of neighbors, friends or relatives and share the experience. If you aren't sure of something, just ask the vender point-blank. I have never had one lie to me about how the food was grown or if it's a GMO cultivar. Most keep those well separate at their spaces so they can get that premium for organics when the right customer comes along. Think about joining a local CSA [Community Supported Agriculture], usually one or several small farms that specialize in certain crops/products, for which you purchase a 'share' early in the year to help them buy seeds and do the work. You get a nice box or bag of fresh food once a week, whatever's coming in at the time.

              •  somebody gave me a grain mill a few years ago (1+ / 0-)
                Recommended by:

                and I have never used it.

                Perhaps I should?  I could buy bulk grain at the local organic market, and grind it into my own flour?

                How would one make the equivalent of "white flour" if one grinds grain at home?  Which grains, do you know?


                That's one more thing to add to my long list of small problems. --my son, age 10

                by concernedamerican on Wed Mar 13, 2013 at 02:55:20 PM PDT

                [ Parent ]

                •  I grind red wheat (1+ / 0-)
                  Recommended by:

                  as I need it, haven't used white flour for years. Since the germ is removed as well as the bran from white flour, I don't know how you'd get it at home. But you can set your mill to grind coarse or fine, and if you run it through 'fine' more than once, it's good for pastry or cakes.

                  Mostly I use my mill for corn. Grow Indian and blue corn. Which so far isn't GMO but any big lot may contain transgene contamination. Corn pollen can travel on the wind for miles and contaminate fields. I still can't believe they were allowed to create these and turn them loose on the world indiscriminately. Transgenes are promiscuous - are DESIGNED to be promiscuous - and do get around.

                  •  Wheat, or wheat berries? How does it come at (1+ / 0-)
                    Recommended by:

                    the health food store?  (No other way to get it where I live.)  I'll have to find out.


                    That's one more thing to add to my long list of small problems. --my son, age 10

                    by concernedamerican on Thu Mar 14, 2013 at 09:11:20 AM PDT

                    [ Parent ]

                    •  Comes already threshed, (1+ / 0-)
                      Recommended by:

                      as berries. You'll get germ in your flour, but little to no bran. You can order whole organic grains over the internet, there are lots of dealers and a range of prices. But then you've got to pay shipping, which can make it much cheaper at the health food store in small amounts.

                      My region has several buying cooperatives for hard staple items. That's a group of people who get together and order enough bulk to get the volume discount and free shipping. Getting that volume takes awhile, so you shouldn't be in a hurry.

                      If there's a Co-Op near you, members can sometimes add a bushel to the outlet's order for grain and get it at a significant discount plus Co-Op overhead. Wheat's averaging $6 to $8+ a bushel on the commodities market, and a bushel of wheat is 60 pounds. Average price of wheat berries retail is more than a dollar a pound from organic outlets (sometimes double that), so $20-$30 for 60 pounds is a very good price.

                      But for many it's just more convenient to buy already ground grain. Bob's Red Mill and King Arthur both have certified organic lines available in most good-sized grocery stores. If you put the stuff in jars and store in the freezer, it'll keep well for as long as it lasts.

            •  It's not easy to eliminate GMO's ... (1+ / 0-)
              Recommended by:

              If you want to eliminate GMO's completely, you need to do a lot of research and hook up with your local Whole Foods staff or your local CSA.  Check out the movie "Genetic Roulette".

              Some GMO crops are corn, soy, cotton, canola, sugar (beets) and potatoes.  So, you might want to make sure you are buying organic when you buy products made with them.  Also, corn syrup is made with GMO corn and is in lots of stuff, like just about anything sweet that you drink.  I agree that I don't want to eat anything that comes from a Round Up Ready seed.  I used to use that s**t on my brick walkway because it kills just about everything.

              I was not happy to find out that billions of tons of it is going into our food supply.  This is not something that one can wash off of their produce.

      •  If you do a PubMed search on (13+ / 0-)

        "hygiene hypothesis" - which turns up something like 1589 peer reviewed papers (many of them very recent) - it is clear that

        1) it has major caveats and cannot explain everthing

        2) it has NOT been debunked / discredited

        3) remains a very active research area.

        The problem probably comes in when people try to use it to explain too much with overly broad blanket statements:  Here's typical information:

        Curr Opin Pediatr. 2012 Feb;24(1):98-102. doi: 10.1097/MOP.0b013e32834ee57c.

        The hygiene hypothesis revisited: does exposure to infectious agents protect us from allergy?

        Fishbein AB, Fuleihan RL.
        SourceDivision of Allergy and Immunology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.


        PURPOSE OF REVIEW: The increase in incidence and prevalence of allergic disease remains a mystery and cannot be explained solely by genetic factors. The hygiene hypothesis provides the strongest epidemiological explanation for the rise in allergic disease. This review evaluates the recent epidemiological and mechanistic research in the role of infectious agents in the pathogenesis of or protection from allergic disease.

        RECENT FINDINGS: Recent literature has extended the epidemiological findings of the protective effect of being born and reared in a farm environment and associates an increased diversity of organisms in house-dust samples with protection from allergic disease. Furthermore, human and animal studies provide increasing evidence for the role of both the innate and adaptive immune systems, including regulatory cells, as mediators of this protective effect.

        SUMMARY: There is evidence that exposure to some infectious organisms can protect from atopy, whereas other infections appear to promote allergic diseases. The timing of exposure to infection and the properties of the infectious agent, in addition to the genetic susceptibility of the host, play an important role in the future development of allergic disease.

        PMID: 22227779 [PubMed - indexed for MEDLINE]

        Note that the "recent findings" section of this paper stresses accumulating evidence for this hypothesis.

        And that the "summary" takes care to point out that certain infectious agents actually have the opposite effect . .. .  probably a pretty big caveat for any parent who decides to purposefully expose their kid to pathogens to prevent allergies!

        •  There's a difference between food and (1+ / 0-)
          Recommended by:

          environmental allergies in this - apparently food allergies are not well explained by the hygiene hypothesis, but environmental allergies are. Where people do NOT keep their children hermetically sealed through childhood, environmental allergies like ours are much lower, but they are getting food allergies.  

          We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
          Julian Castro, DNC 4 Sept 2012

          by pixxer on Wed Mar 13, 2013 at 07:02:09 AM PDT

          [ Parent ]

      •  It's not obvious to me why rampant sales (4+ / 0-)
        Recommended by:
        entrelac, Steve Masover, Paul1a, JerryNA

        of "antibacterial" soaps are even legal, since they increase the likelihood of antibiotic resistance developing. That ought to be something the US government has an interest in as a public health issue, and so could regulate. What on Earth department would handle it I don't know.

        We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
        Julian Castro, DNC 4 Sept 2012

        by pixxer on Wed Mar 13, 2013 at 06:23:06 AM PDT

        [ Parent ]

        •  Anti bacterial agents are not antibiotics (13+ / 0-)

          The use of anti bacterial soaps and other surface disinfectants should not be conflated with the use of antibiotics.  they are very different chemistry with very different biological actions.  Biological resistance to the disinfecting agents used in some soaps may well occur (indeed it is highly likely to so do) however that does not indicate any increase in the likely resistance to antibiotics.  in reality the mechanical action of washing has a greater log reduction than the anti-bacterial agent in the soap, the exception being alcohol based hand gels used in hospitals.

          Disinfectant chemistry is relatively simple with most molecules focused on disruption of the cellular membrane operation.  the antibiotic chemistry we use involves complex organic molecules that are typically derived through biological processes in fungi or plants, there multiple modes of action some very focused some broader spectrum.  The biggest problem is that as the number and type of pasmids present in the environment to be collected and incorporated by organisms is increasing and has provided resistance characteristics to species that would not otherwise exhibit those attributes.

          there is only one reality, republicans just forget at times

          by Bloke on Wed Mar 13, 2013 at 06:58:11 AM PDT

          [ Parent ]

          •  I'll admit to just parroting public health (0+ / 0-)

            organizations on the soap thing, without looking up the chemistry myself. But public health organizations have indeed decried the widespread use of "antibacterials" in soaps etc. I always assumed that the action in hand gels must be to disrupt the lipid bilayer, which would be pretty hard to develop resistance to. You're saying that the "antibacterial" soaps are also just working on the membrane? [OK, I can look this up, really :) ] Thanks.

            We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
            Julian Castro, DNC 4 Sept 2012

            by pixxer on Wed Mar 13, 2013 at 07:12:53 AM PDT

            [ Parent ]

          •  OK, I learned something about Triclosan (2+ / 0-)
            Recommended by:
            JerryNA, Sunspots

            and it is indeed something bacteria could easily become resistant to, given all it does is act to inhibit an enzyme involved in FA biosynthesis. Search obviously a quickie at this point, but here is something from a peer-reviewed journal (Clinical Infectious Diseases), anyway:

            Results. Soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%–0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria.

            Conclusions. The lack of an additional health benefit associated with the use of triclosan-containing consumer soaps over regular soap, coupled with laboratory data demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by governmental regulators regarding antibacterial product claims and advertising. Further studies of this issue are encouraged.

            So, as you importantly point out, this does not have to do with resistance to the antibiotics we buy from the pharmacist. However, the potential for creating bacteria resistant to this compound that could indeed be of use in the future (and evidently is not so in hand soaps) should mean that the compound should be removed from the popular market.

            I also liked this popular article, though I read it pretty quickly. It's from the USC magazine "illumin."

            We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
            Julian Castro, DNC 4 Sept 2012

            by pixxer on Wed Mar 13, 2013 at 07:33:02 AM PDT

            [ Parent ]

            •  There are lots of surface disinfectants (1+ / 0-)
              Recommended by:

              Triclosan is not particularly effective, and many of the claims made are exaggerated.  I really do not worry about that aspect, I believe that the challenge associated with producing effective antibiotics is far greater than the challenge/cost associated with producing surface disinfectants.  
              Once we have a resistant organism eradication from the environment such as a hospital is relatively expensive but is possible, getting it out of the community is a bigger issue. eradicating those pathogens from people is a real challenge.  Many of us are colonized with MDROs but asymptomatic, a drop in immune status may change that relationship, as does the impact of certain antibiotics (check out the prime cause of Clostridium difficile associated disease)
              the whole subject is a lot more complex than simply banning a biocides in hand soaps.

              there is only one reality, republicans just forget at times

              by Bloke on Wed Mar 13, 2013 at 03:39:13 PM PDT

              [ Parent ]

      •  You're right, they're stupid. (1+ / 0-)
        Recommended by:

        All soap is anti-bacterial.  There is no need to add extra antibacterials to soap.  

      •  Most antibacterials are things that are difficult (0+ / 0-)

        to develop resistance to.

        How does a cell develop resistance to the equivalent of a human stab wound to the chest?

        We don't want our country back, we want our country FORWARD. --Eclectablog

        by Samer on Wed Mar 13, 2013 at 10:35:01 AM PDT

        [ Parent ]

        •  See comment above about Triclosan (0+ / 0-)

          Samer, you're wrong.  While bacteria may not become resistant to ethanol, they are becoming resistant to Triclosan, and cross-resistant to other antibiotics.  

          •  OK, I might be wrong about the "most," but my (0+ / 0-)

            basic point is that many of them have a mechanical basis, rather than a biochemical basis, that are difficult to evolve resistance to. Triclosan is an example of the latter.

            And I didn't say "impossible" because there are organisms that can survive in near vacuum (like Deinococcus radiodurans).

            We don't want our country back, we want our country FORWARD. --Eclectablog

            by Samer on Wed Mar 13, 2013 at 03:14:40 PM PDT

            [ Parent ]

    •  I was a kid in the 50s (24+ / 0-)

      and, like you, my parents didn't drag me off to the doctor at the first sign of a sniffle.  I played in the dirt, I ran around outside barefoot, and I spent a lot of time around a river that flowed through the family ranch mucking about in pools trying to catch polliwogs and minnows and what-not.  And I was hardly ever sick.  About the only time I remember being truly ill was when I had the red measles and my fever went up to 104, which scared my parents enough to call the doc to make a house call, which they still did do back in those days.  I think I was given sulfa for that, though I could be wrong.  As for antibiotics, about the only ones I remember hearing about were penicillin and Teremycin (sp?).  I did develop an allergy to grain dust and fire weed pollen, but I grew out of that.

      I remember when I had a cold, my mother would rub my neck and chest with camphorated oil or Vicks Vapo-Rub (I hated the smell!!) and wrap a wool flannel scarf around.  With an upset stomach, I got weak, black tea with honey and lemon.  Cuts, unless an artery seemed to be involved, were dealt with with methiolate or Mecurochrome and a band aid or bandage.  Why go to a doctor when it could be avoided seemed to be my parents' attitude.  And I survived quite well, thank you very much.  

      Even today, in my advancing dotage, I still am skeptical of all the junk they try to stuff down my throat or inject into me.  As for antibiotics, they've always worked on me, but I've always been meticulous about how I take them.  Someone I knew died of an overdose on one of them when we were both just teenagers, and I've been damned careful of them ever since.  

      -7.13 / -6.97 "The people never give up their liberties but under some delusion." -- Edmund Burke

      by GulfExpat on Wed Mar 13, 2013 at 03:28:26 AM PDT

      [ Parent ]

      •  Antibiotics work TOO well (0+ / 0-)

        on some people (like me). The standard prescribed course of antibiotics for an infection is quite high, which is made necessary due to the notable overuse of antibiotics in the daily feed of food animals. Cattle, hogs, chickens, farmed fish, etc. Which means that people who eat meat are getting a constant low-level dose of antibiotics with every meal.

        Those of us who don't eat meat are not getting that chronic low-level dose of antibiotics in the food we eat. So your basic prescribed dose of antibiotics works so well that by the time it's over the 'friendly' bacteria inhabiting our digestive systems are decimated, not being resistant as are the symbiotic bacteria in meat eaters' systems.

        Neither doctors nor drug manufacturers recognize (or maybe even know about) this significant difference among patients. A doctor has never asked me if I eat meat when prescribing an antibiotic, and manufacturers make no adjustments to recommended dosage to account for the less resistant patient.

        •  I'm skeptical (2+ / 0-)
          Recommended by:
          Joieau, Sunspots

          that a vegetarian diet makes a big difference. Meat-eaters certainly can and do get c. diff. Whether you're regularly around livestock or hospitals are probably bigger risk factors. Another factor seems to be having antibiotic courses close together, and also I understand that new mothers have a larger risk.

          But I think that practically nothing is understood about intestinal flora, and I think it is much much more important than anyone appreciates.

          I am fascinated by the stat that 90% of the cells associated with your body aren't actually human cells.

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

          by elfling on Wed Mar 13, 2013 at 12:40:22 PM PDT

          [ Parent ]

          •  I find that fascinating too. (0+ / 0-)

            I do know that every time I've taken a course of antibiotics, I go through stomach and intestinal issues. My husband, daughter and grandson have the same problem, none of us eat meat. Takes awhile to get the system up and running smoothly again, and I've been told by several nurse friends that the antibiotics do kill indiscriminately and that causes these problems. We need our endogenous fauna - without them we simply cannot properly digest food or absorb nutrients.

            The meat eaters I know do not seem to suffer the same problems. I've long thought that may have something to do with them being constantly exposed to antibiotics in their diet. Could be wrong about that, of course.

            BTW, I am around livestock every day - hub's pet Pekin ducks, from which we get 2-4 eggs a day. They do not get antibiotics in their food or water, and are robustly healthy on their supplemental diet of grubs, slugs, worms, assorted bug-bugs and green shoots. Do have to pay attention to keeping their night quarters, food and water containers clean. So far so good, and the eggs are delicious!

            •  The issue with being around livestock (1+ / 0-)
              Recommended by:

              is that they also tend to carry C. difficile spores, which will sit around doing nothing (in them and in you) if the appropriate intestinal colony is present, maintaining the proper pH. It is not about them being fed antibiotics - horses are known as a risk factor for example, and they can also get sick with it.

              Doctors don't usually ask about any of this. Maybe if they're especially progressive they might suggest you eat some yogurt.

              If you make your way to a c. diff support group, you'll find it's mostly populated with meat eaters. ;-)

              Ducks are awesome. Messy, but awesome. :-) A wet duck is a happy duck.

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

              by elfling on Wed Mar 13, 2013 at 02:42:06 PM PDT

              [ Parent ]

            •  There's no question though (2+ / 0-)
              Recommended by:
              Sunspots, Joieau

              that for certain whole foods, you need the right colony designed to digest them for you, and that antibiotics take them out.

              I have been learning about nutrition in horses and sheep lately. I had thought they had native enzymes for digesting grasses (lignin and cellulose) but in fact they don't; they rely on fermentation by bacteria to break those down and create absorbable molecules out of them. Sheep have a rumen for it, which is a big vat of sloshy fermenting goodness, and horses have a happening colony in their large intestine doing the work.

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

              by elfling on Wed Mar 13, 2013 at 02:50:28 PM PDT

              [ Parent ]

            •  Yogurt helps or fermented foods - real sauerkraut (1+ / 0-)
              Recommended by:

              or kim chi, not the canned dead vinegared stuff, but real fermented veggies with all the live complicated assortment of microbes.  If you can't find a source of them, you can make it yourself pretty easily in just a couple of days.  This is a great website:

              Yogurt with live cultures always worked for me if I had to take antibiotics, before I discovered fermented veggies.  But if you don't eat any dairy, the fermented foods may actually have a more balanced and complete assortment of good bugs.  They can be pretty tasty, almost addictive, too.

    •  AND (14+ / 0-)

      Doctors need to stop GIVING IN to the demands of their patients. THEY have the power of the prescription pad! THEY understand that antibiotics do nothing for viral illnesses (colds and flu), which is what most people have when they come into the office with those symptoms.

      Rather than taking the time to explain the difference and standing their ground (or risk losing  a patient)....its easier to pull out a script.

      •  A couple of counterpoints (5+ / 0-)

        The  physician often doesn't know for sure whether it's a virus or not (how could they when the average healthy kid has 1,000 types of viruses at any one time and the more sickly kids have 10,000?)

        And even if an illness if viral in origin, which most are, being sick with a virus increases the chance of bacterial infection.

        so, to be safe, they tend to over-prescribe antibiotics.

        Which I agree is a HUGE problem - but still, there is a small (at least statistical) benefit for over-prescribing.

      •  AND (2+ / 0-)
        Recommended by:
        jabney, JerryNA

        Parents need to enforce the prescription regimen.  Just because little Geoffrey feels better doesn't mean mommy or daddy can forget about finishing the prescription.

        Call me a pragmatic pessimist, but I think the current Social Security funding cluster fuck is a waste of time in light of the probability of a looming biological disaster.

      •  They also may not prescribe enough when needed (0+ / 0-)

        because they have a brief course drilled into them and often don't really listen to patients.

        When you do need an antibiotic and don't get enough to knock the infection down, what's left are the resistant bugs, and when they multiply and make you sicker again, the old one doesn't work and you need another -  that's the classic recipe for developing resistance.

    •  a huge "AMEN" to that, gchaucer2 (1+ / 0-)
      Recommended by:

      don't always believe what you think

      by claude on Wed Mar 13, 2013 at 05:40:20 AM PDT

      [ Parent ]

    •  Hey... it's the free market... (1+ / 0-)
      Recommended by:

      Right?... right?

      It's the other half of the diarist's gripe - the free market has got us into this mess in the first place.

      Freedom isn't free. So quit whining and pay your taxes.

      by walk2live on Wed Mar 13, 2013 at 08:59:56 AM PDT

      [ Parent ]

    •  Cousin grew up on a farm... died of lockjaw. (1+ / 0-)
      Recommended by:

      Was just 1.5 years old as his little body froze up and shut down.  Tetanus shot would have saved him.

      It's NOT the antibiotic - it's the overuse.  WHO is going to stop greedy corporations who don't care if they have SHIT in our beef... just keep feeding it to people... covered in antibiotics, of course!  

      Hide it like the oily companies did with corexit chemical in the gulf, which was already BANNED in Europe.  EPA appears to be owned by corporations.

      If you don't "see" it, corporations don't pay - but we sure do!

      •    America was supposed to be a free country,
       not a corporative state.
      •  Overuse and underuse (0+ / 0-)

        A lot of the problem with feeding it to livestock is that it's fed as a constant low dose -  that's selecting for resistance.

        If you have a sick animal, it should get enough to deal with the problem, and then no more.  And you should of course raise the animals in conditions that don't make them sick.

        I've read recently that pigs and chickens are being fed beta blockers, too.  Sounds like an attempt to deal with the stress of raising them in horrible conditions.  God knows what the beta blocker residues are doing to people who eat the meat.

    •  In part, yes (25+ / 0-)

      Overuse leads to faster resistance.  Careful, limited use eventually leads to some resistance, but it takes longer.

      The problem now is that we have a lot of resistance to existing antibiotics, and any new ones that are developed commercially are likely to be overused as well, since that's what capitalism preaches:  Good stuff sells more.  How do you have good stuff and make it sell less without overpricing it from those who need it?  That's the market failure.

      •  The problem is overuse (4+ / 0-)
        Recommended by:
        chira2, Ian H, Paul1a, cynndara

        somewhere. Diseases like coronaviruses and noroviruses travel the world at a tremendous rate. If in one country, doctors prescribe antibiotics for a disease and the occasional patient doesn't take the whole course, it enables resistant strains to develop. Someone carrying that strain then flies abroad or goes on a cruise and a bunch of people from around the world get exposed to that strain.
        The doctors of Britain are very careful about prescribing antibiotics, but we still get the same resistant strains everyone else does because lots of people come here to visit, and people here like to visit other places.

        "We are monkeys with money and guns". Tom Waits

        by northsylvania on Wed Mar 13, 2013 at 01:51:20 AM PDT

        [ Parent ]

        •  Norovirus and coronavirus are viruses (16+ / 0-)

          and viruses don't respond to antibacterials.  There are some antiviral medications available - such as acyclovir for herpes zoster but in general we don't have many antiviral medications and nothing for noroviruses and coronaviruses.

          The problem with noroviruses and ships is due to the persistent nature of these viruses on surfaces such as doornobs.  They can be eradicated with soap and water.  Cleansers like Purel are good for bacterial - such as mRSA - methicillin resistant strep aureus but are useless for norovirus.

          The problem of antibacterial resistance is a real and present danger.  We saw how MRSA moved out of hospitals and nursing homes into the community.  These new resistant organisms are still in the hospital-nursing home stage.

          •  You got a point there. (0+ / 0-)

            Sorry, bad examples. MRSA and clostridium difficile would be better, thanks.

            "We are monkeys with money and guns". Tom Waits

            by northsylvania on Wed Mar 13, 2013 at 04:49:23 AM PDT

            [ Parent ]

            •  c. difficile is a different problem (3+ / 0-)
              Recommended by:
              northsylvania, JerryNA, bogieshadow

              It has a spore form which is not vulnerable to any antibiotic and never has been. Thus, it is very difficult to eradicate with medications and it is not killed by alcohol or hand sanitizers.

              There are only two antibiotics with any effectiveness against it, the inexpensive but problematic metronidozole and the expensive and more effective and better tolerated vancomyacin which is the antibiotic of last resort for many infections.

              There is evidence that it is developing resistance to both of these, but it can be a little hard to tease out because of the spore issue.

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

              by elfling on Wed Mar 13, 2013 at 08:23:52 AM PDT

              [ Parent ]

              •  Now that is interesting. (0+ / 0-)

                I will have to read up on that.

                "We are monkeys with money and guns". Tom Waits

                by northsylvania on Wed Mar 13, 2013 at 10:25:27 AM PDT

                [ Parent ]

              •  A new approach to C difficile (2+ / 0-)
                Recommended by:
                elfling, JerryNA

                Since C difficile doesn't cause illness unless the spores germinate, researchers have tried using agents that keep the spores from germinating. In mice, at least, a particular bile salt analog has proved very effective for that. You can read the study abstract here

                •  Nice. (2+ / 0-)
                  Recommended by:
                  JerryNA, Sunspots

                  It seems that it's pretty common to have C. difficile spores in one's colon, but that the pH and existing flora of a healthy intestinal tract keep it from doing all that much. It's like having a field... as long as there's healthy grass, seeds that blow over it don't have much foothold. But if you just remove all the grass and leave unexposed dirt, you'll have a plot full of weeds in no time.

                  Something like that salt might be helpful to administer along with antibiotics, especially in at-risk patients.

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

                  by elfling on Wed Mar 13, 2013 at 12:52:47 PM PDT

                  [ Parent ]

      •  CDC calls this ‘nightmare bacteria’ (21+ / 0-)

        Describes the Triple threat

        First, the bacteria are resistant to all or nearly all antibiotics, even those of last resort, he said. Second, they kill up to half of patients who get bloodstream infections from them. And third, the bacteria can transfer their antibiotic resistance to other bacteria within the family, potentially making other bacteria untreatable, as well.
        This comes from Thomas Frieden, director of the Centers for Disease Control and Prevention
        In an interview he said treatment might be a decade away.

        We can blame everything we are blaming
        but being right is no consolation if someone we love is infected... which could lead to many we love being infected.

        Stopping the quick spread is  an evidently rare and difficult procedure... medical staff washing their hands.

        It is a BFD

      •  Thanks 4 diary! In MENA, Dr's overprescribe. (3+ / 0-)
        Recommended by:
        elfling, the fan man, JerryNA

        Probably elsewhere, too. Here in Middle East, if you visit the doctor for almost anything, they will prescribe antibiotics routinely. And I bet a large % of patients don't complete the course -- hastening resistance.


        How about topical antibiotic ointments, like using Neosporin on all cuts?

        There is also significant concern that use of Neosporin contributes to the emergence of antibiotic resistant bacteria. In the US, the only large market for Neosporin, the ointment has been shown to promote the prevalence of MRSA bacteria, specifically the highly lethal ST8:USA300 strain.
    •  Well, it was, but now the horses are out of (5+ / 0-)
      Recommended by:
      2dot, chira2, pixxer, Cassandra Waites, JerryNA

      the barn, so the problem is getting new antibiotics and then not allowing them to be overused.

      Ideally, antibiotics would be found which cannot be adapted to by the bacteria, but that may be a pipe dream.  

      Still there is a lot of novel research underway for viral drugs which may turn out to be useful - combating the physical attributes of the virus rather than the biological functions or immune response (vaccines).

      "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

      by YucatanMan on Tue Mar 12, 2013 at 11:15:03 PM PDT

      [ Parent ]

      •  It's often the case that organisms that thrive (2+ / 0-)
        Recommended by:
        YucatanMan, JerryNA

        in a certain environment are actually less fit when the environment changes. It's possible that, if we now significantly curtail the (mis)use of antibiotics, and if antibiotic resistant bacteria are less fit than their non-resistant cousins in an antibiotic-free environment, that "normal" bacteria could come to predominate again. However, given the way that resistance is commonly transferred among bacteria (on little DNA circles called plasmids, that are separate from the chromosome) it's awfully easy for resistance to be spread back into the bacterial "community" even if it were to die down significantly.

        We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
        Julian Castro, DNC 4 Sept 2012

        by pixxer on Wed Mar 13, 2013 at 07:07:26 AM PDT

        [ Parent ]

        •  Very good point. Just because we've done the (1+ / 0-)
          Recommended by:

          wrong thing in the past is no reason not to stop and have good practices going forward.

          "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

          by YucatanMan on Wed Mar 13, 2013 at 10:43:30 AM PDT

          [ Parent ]

    •  This is a major problem. (30+ / 0-)

      The first imperative step is to ban the use of antibiotics in animal feed on factory farms.

      No arguments, no ifs ands and buts, no maybe we need to study it more.  No penny tax or bubblegum wrappers.  Just an immediate ban.

      Sign me

      Elmer Ph(u)d

      The hungry judges soon the sentence sign, And wretches hang, that jurymen may dine.

      by magnetics on Tue Mar 12, 2013 at 11:36:41 PM PDT

      [ Parent ]

      •  Amen to that. A serious public health menace! nt (2+ / 0-)
        Recommended by:
        magnetics, JerryNA

        We all understand that freedom isn't free. What Romney and Ryan don't understand is that neither is opportunity. We have to invest in it.
        Julian Castro, DNC 4 Sept 2012

        by pixxer on Wed Mar 13, 2013 at 07:08:13 AM PDT

        [ Parent ]

      •  Yes. (4+ / 0-)
        Recommended by:
        magnetics, entrelac, JerryNA, Sunspots

        The only reason they need antibiotics in the first place is that they try to make their operations so "efficient" by cramming unbelievable numbers of animals together in tiny spaces without adequate ventilation or exercise.  Denying them the cheap fix at the public expense would force them to treat the animals better so that they could be healthy without all the drugs.  Believe it or not, animals originally evolved to survive without antibiotics, just like we did.

        •  Yes and no (2+ / 0-)
          Recommended by:
          JerryNA, Sunspots

          Preventing disease isn't the only reason; the antibiotics also promote the animals' growth (see Antibiotic Growth-Promoters in Food Animals). So in free-market terms, they're irresistable: the financial benefits go to the corporation, while the public health costs get paid by society at large.

          •  That's why the state must intervene. (1+ / 0-)
            Recommended by:

            It's also rather unclear how antibiotics function in subclinical doses, to promote growth in factory-farmed animals.

            Has anyone done comparative studies with free range animals?

            The hungry judges soon the sentence sign, And wretches hang, that jurymen may dine.

            by magnetics on Wed Mar 13, 2013 at 07:47:27 PM PDT

            [ Parent ]

            •  Hypotheses (1+ / 0-)
              Recommended by:

              From the link in my first comment:

              According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to "help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals". Although the mechanism underpinning their action is unclear, it is believed that the antibiotics suppress sensitive populations of bacteria in the intestines. It has been estimated that as much as 6 per cent of the net energy in the pig diet could be lost due to microbial fermentation in the intestine (Jensen, 1998). If the microbial population could be better controlled, it is possible that the lost energy could be diverted to growth.

              Thomke & Elwinger (1998) hypothesize that cytokines released during the immune response may also stimulate the release of catabolic hormones, which would reduce muscle mass. Therefore a reduction in gastrointestinal infections would result in the subsequent increase in muscle weight. Whatever the mechanism of action, the result of the use of growth promoters is an improvement in daily growth rates between 1 and 10 per cent resulting in meat of a better quality, with less fat and increased protein content. There can be no doubt that growth promoters are effective; Prescott & Baggot (1993), however, showed that the effects of growth promoters were much more noticeable in sick animals and those housed in cramped, unhygienic conditions.

              Note that last sentence: these drugs minimize the financial drawbacks of the animal concentration camps known as CAFOs.
    •  Very much so (3+ / 0-)
      Recommended by:
      Miggles, hester, Sunspots

      This is a LARGE part of the problem. I only buy meat raised without antibiotics and pressure restaurant chains to buy meat raised without antibiotics.

      FREEDOM ISN'T FREE: That's why we pay taxes. NYC's Progressive/Reform Blog

      by mole333 on Wed Mar 13, 2013 at 04:41:33 AM PDT

      [ Parent ]

  •  Another major factor where the free market (48+ / 0-)

    backfired was using antibotics to promote animal growth. This was done on a massive scale with cows, chickens, etc. which only hastened the speed at which restristant strains came to prominence. With antibiotics being relatively cheap to produce adding pennies of them to food for a dollar of increased value was considered "a smart business decision" (boy, there's a phrase that's seldom correct) But there's still another factor -- Americans make up <5% of the world population. Unless every country joins together in tackling these resistant strains they will eventually hop borders and all the research money in the world will be useless when the next bubonic plague sweeps the globe.

    You can't assassinate the character of any of modern conservative. You'd have to find where it was buried, dig it up, resurrect it, then kill it. And killing a zombie isn't really assassination, is it?

    by ontheleftcoast on Tue Mar 12, 2013 at 10:14:37 PM PDT

  •  thank you for this - excellent diary! (11+ / 0-)

    and an excellent read...  this is the dk of old at its finest!

    EdriesShop Is it kind? is it true? is it necessary?

    by edrie on Tue Mar 12, 2013 at 10:55:56 PM PDT

  •  Completely agree on usage of antibiotics in farm (15+ / 0-)

    animals. Insane practice.

    Some universities are doing this type of work (Scripps Florida comes to mind). But drug development has traditionally been done in industry and many universities are not equipped for it. Also, laws don't generally allow the government to get IP on the drug even if its development is funded by the government grant. The only exception is if the drug is developed at one of NIH institutes. Of course, laws can be changed but it's unlikely to happen.

    •  Well, (0+ / 0-)

      the laws certainly won't change as long as the only people lobbying about it are the corporate interests that benefit from the status quo.

      I am constantly amazed at how few people in this country understand that laws are completely and totally artificial.  They are NOT LAWS OF NATURE.  They are made by our government, and if our government is failing, it is because it is unwilling or unable to make sensible laws.  The historical fix for this is to change the government.

  •  It is time that Big Pharma was whittled down (11+ / 0-)

    to size.

    Most of advances in research come from government (or govt funded) research, which is then "licensed" to Big Pharma companies at far less than the market value.  They are then free to charge, literally, whatever they want ($16000 per dose for cancer-fighting drugs which cost $10 to mfr?) and literally steal from the very most vulnerable people in America.

    Frankly, they are scum. If not for the Tea Party, they could be brought to heel. If they haven't already bought enough D's too.

    "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

    by YucatanMan on Tue Mar 12, 2013 at 11:12:25 PM PDT

    •  I don't know, but I think big pharma is one of the (1+ / 0-)
      Recommended by:
      Roadbed Guy

      few industries that keeps the American economy alive at all.  Everything involved in manufacturing and production is long gone.  What do we have left?  Big pharma, Silicon Valley, Microsoft, Hollywood, a much reduced auto industry and even that Repubs would be happy to let die.  What else is there?

      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 03:51:25 AM PDT

      [ Parent ]

    •  That's not what the data says (3+ / 0-)
      Recommended by:
      terrypinder, sfsteach, elfling

      I'm afraid the paper itself is paywalled, but Derek Lowe at In the Pipeline discusses a 2010 paper that looks at all drugs approved by the FDA from 1998 to 2007.

      The simplest breakdown is:
      58% from pharmaceutical companies.
      18% from biotech companies..
      16% from universities, transferred to biotech.
      8% from universities, transferred to pharma.

      Making drugs is hard. And just because you have a potential target because you made 50 mg of material and screened it doesn't mean you're anywhere close to a drug. You're looking at years of work. Lead optimization, assay screening, early safety studies, eventually clinical testing, and of course the development of the knowledge of how to actually make the active ingredient on large scales with control so that you have enough material for all your testing and eventual manufacture.

      •  agreed. (1+ / 0-)
        Recommended by:

        I work for a neurology non-profit research and education center and we have been involved in just about every drug trial for MS over the past 20 years. The time these studies take is considerable, plus we have to have medical staff to oversee the studies and see patients. If the MD wasn't such a research geek, our expenses would probably put us out of the business, but he donates a ton of time to make sure it all gets done.

        “Reason must be our last judge and guide in everything.”~John Locke

        by sfsteach on Wed Mar 13, 2013 at 07:31:18 AM PDT

        [ Parent ]

      •  And the market doesn't do it for antibiotics (0+ / 0-)

        It is clear that the universities today are mostly doing just the first stages; the rest belongs to pharma.  That's the system we have.  I'm not sure that universities are the right place to move farther up the ladder, though I could see their involvement in more clinical testing and the like.  The problem is that we have a gap in the food chain. Big pharma would rather invest where its shareholders get more return, largely on chronic-disease drugs.  

        So maybe we need some other mechanism -- maybe drug companies could be paid by the government, for instance, to do those other jobs, not for profit but on a cost-plus basis, the way military contracts are done. That's not super-efficient either but at least it is a model for getting something done.  I think flu vaccine is already funded that way.

      •  Making drugs is easy. (2+ / 0-)
        Recommended by:
        Teiresias70, Sunspots

        I worked for years in a lab where they did it all the time.

        Getting them tested, approved, FUNDED, CAPITALIZED, tested again and marketed, now that takes some work.  But at least 50% of the effort is caused by the inefficiencies of the public-private tug of war.  If we instituted a "Manhattan Project" type operation to develop ANY drug currently in the initial stages, it could be in hospitals within 18 months, fully tested.  It's the layers and layers of evaluation by both bureaucrats and capitalists for its economic (profit) potential that costs most of the money.  Actual attention from high-level managers is expensive.

      •  Good Points (0+ / 0-)

        I actually do drug development of anti-infectives at a large research University, and the first part (coming up with candidates) is relatively inexpensive. We received a grant from the NIH to take a drug up to the IND proposal (Investigative New Drug) stage, and it provides a fair amount of money ($500,000 per year split between three investigators) to get this done. The government also helps to fund Phase I trials (through BARDA) and has SBIR grants for small spinoff companies. So the government does contribute, and they certainly realize the importance of getting new antimicrobials.

        The problem is that once you get to clinical trials (particularly Phase II and Phase III), the amount of money required is so high, there is no way that the NIH could continue to fund it, so one must find a partner to go forward. These most often are big (or medium size) pharma, and if they don't see large profit margins on the drug that experience says will have a small chance to get through the clinical trials (safety and efficacy) without failing, they won't do it. I think that is the major hurdle for any new antibiotic approval.

  •  Of course. (0+ / 0-)

    But they all have fears -

       of what others will say,

       of handling possible arguments,

       of scary words they've been told - that they don't know the meaning of but some smart people must because they say them with scorn: "deficit" "inflation" "debt"

    Boehner Just Wants Wife To Listen, Not Come Up With Alternative Debt-Reduction Ideas

    by dov12348 on Wed Mar 13, 2013 at 01:28:48 AM PDT

  •  The idea that 'the free market" (14+ / 0-)

    is capable of effectively addressing fundamentnal issues that are vital to the very survival of life on this planet, is best described in one word: Idiotic.

    There never has been such a thing as "the free market". That is an illusion, a sort of ideal, created by greedy profiteers who equate virtue with wealth. Markets of whatever sort have always been controlled to some degree, and manipulated to favor certain interests. More often than not, they have been anything but equitable.

    Now our so-called "free market" has resulted in obscenely vast agglomerations of capital, and power, in collusion with revered governmental institutions whose primary purpose has devolved into serving and aggrandizing purely acquisitive goals. Greedy and oppressive goals that are willfully blind to the human and environmental damage they cause.

    The "free market" has no direction, no purpose, no ethics, and hardly any intelligence. It is blind, brutal, ignorant, and immensely energetic. But somehow "profitable" to a select few. Given free rein it will stupidly trample and destroy the very ground that gives it, and all of us sustenance.

    This much is clear. What's not clear is how, or if it can be stopped, or even curtailed.

    •  I see it very simply -- the economy is supposed to (11+ / 0-)

      serve human kind, but somehow we've been persuaded to believe that we should serve it.  We are simply the "human resources".  

      That's the essential fallacy of the "free market" 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 03:53:18 AM PDT

      [ Parent ]

      •  If I could rec this a hundred times (3+ / 0-)
        Recommended by:
        IowaBiologist, cynndara, Sunspots

        I would.

      •  Sure it's a fallacy, and sure it's a myth, (0+ / 0-)

        but what do we have to replace it with? The capitalistic engines of growth for the sake of growth are so powerful that they have encompassed us all. We are trapped within these machines designed for making money while ignoring all else. Not just our government, but we ourselves are subservient to the process of producing ever more things, ever more possessions, ever more symbols to affirm our status.

        The "status symbol" is alive and well - from Donald Trump's latest Vegas extravaganza to Bono's $300 shades, it's all about putting oneself in a higher, or more exclusive category than the average Joe. And that costs money. When was the last time you saw a politician wearing grubby Sally Anne clothes? I wear them myself, but that's neither here nor there. I am not a politician.

        We all -- you, me, and everybody -- we all use money as an evaluative tool. Let's be honest, if you ain't got the do-re-me, you ain't gonna be worth much, in the eyes of society.

        But is this a bad thing? Is there a better way to structure a social hierarchy than money? And does human society require a hierarchical structure at all, or is it better expressed by communitarian systems?

        I confess that I do not know.

  •  That's the nature of tragedies of the commons (3+ / 0-)
    Recommended by:
    geemah, cynndara, Sunspots

    The free market sucks at them.  In fact, the free market is what tightens the thumbscrews right down on them in the first place.

    That's what the concepts of commonwealth and government are for.

  •  Actually, Raytheon and Lockheed-Martin advertise.. (6+ / 0-)

    ..all the time. They place warm 'n fuzzy 'patriotic' ads in military themed magazines, spiffy videos of streaking jet fighters that sometimes run during football games...

    Your tax dollars at work.

  •  Medicine should not be for profit (4+ / 0-)
    Recommended by:
    ovals49, cynndara, bluezen, Sunspots

    This does not mean it should be for free.

    Profit means "costs + pay + paying the investors," and that's not right in medicine.

    What's more, the "deregulation" of allowing direct advertising of medicines has produced multiple bad effects and no good effects that I can see. However, there the real problem is the underlying assumption of the American voter that "free markets" are democracy.

    The free market reacts. It reacts to abuses, and it reacts to opportunities, and it reacts to needs. It foresees nothing. It has to allow a thousand bleeding wounds before the Cox-2 inhibitors stop being advertized for Warfarin-taking patients, because FDA took the company's research and was too understaffed to ask for a study on such patients. It has to wait for a MRSA epidemic to come up with a new antibiotic to charge extra for.

    NIH and CDC were supposed to check this impulse, but, of course, if they get starved of money and forbidden from drug development. . . .

    Everyone is innocent of some crime.

    by The Geogre on Wed Mar 13, 2013 at 04:10:55 AM PDT

    •  it shouldn't be forgotten that Big Pharma (3+ / 0-)
      Recommended by:
      tacet, The Geogre, Sunspots

      and the CDC/NIH have the same revolving door problem as the financial sector, defense sector.

      "Understaffing". Right.

      •  They do and don't (2+ / 0-)
        Recommended by:
        protectspice, Sunspots

        Pharma/NIH is not revolving door. It's PhARMA and the FDA that has a revolving door, and NIH administration to "industry" revolve. The various NIH lab chiefs are rarely sucked up or spit from "industry," but the political appointees frequently are.

        PhARMA simply gets no pay-off from soiling itself with bench science. It's better to allow the government to pay for basic science and then swoop in with a grant in exchange for all patent rights when the science pans out. Thus, it's in their interest that NIH and NSF grants be too low, be underfunded, so that their grants can be too sweet to ignore for a researcher.

        Next thing you know, your wife's genes are patented, and her cells are immortalized and sold again and again, without her knowledge or remuneration.

        Everyone is innocent of some crime.

        by The Geogre on Wed Mar 13, 2013 at 01:45:59 PM PDT

        [ Parent ]

        •  I've got to disagree (1+ / 0-)
          Recommended by:
          The Geogre

          there are many examples even in the past decade alone of NIH/pharma revolving door.

          The most recent being the NIH chief going to work for Merck's vaccine unit, but there are many more examples which can be easily googled. It's all quid pro quo like the financial sector. And ultimately it is the people suffer in this arrangement, as well.

          •  Then let me say this, (0+ / 0-)

            Basic science NIH doesn't seem to share/bleed with PhARMA. It may well be that clinical and applied do, because that's where the bucks already are.

            A genetic researcher looking for a new knock-out mouse will probably fail. Her university pays a salary, and there is an NSF grant, but there's no caviar. When the mouse makes it, Monsanto wants it to be the Monsanto Clean Spec Mouse with Added Mutagenesis at the Fox-2, so they offer her a grant to improve the lab process. Their scientists are now eager to work with her, and she gets a big grant, and she's happy, and Monsanto gets the patent, and she gets some personal consideration.

            On the other hand, the head of diabetes (I knew the guy that was the guy for a while) is enormously powerful, because he can nod and every prescription pad will change. I can see that PhARMA wants him or her. The more basic (and real) the science, the less the corporate world cares to support it, if they can steal it later.

            Everyone is innocent of some crime.

            by The Geogre on Wed Mar 13, 2013 at 03:37:42 PM PDT

            [ Parent ]

  •  and... the definition of "solved" matters... (4+ / 0-)
    Recommended by:
    claude, kareylou, cynndara, tacet

    the free market types sort of go with the way the Black death was "solved"

    ... by allowing the free market of people's immune systems... the genetic, social and environmental lottery to merely "reward" the survivors... by the bald fact that they were still alive... plus also supplying them with overpriced drugs or remedies that may or may not work. The key elements are: can Doctors be encouraged to prescribe them and can people be persuaded to buy them... whether they work or not and buyer beware etc. Ruling class rules and the Bottom line rules overall. Judge only by the quarterly results.

    So of course we'd be proactive in a Randian paradise... but only when the price was right. And the price would be right after some mega deaths sharpened up the demand enough to gouge the anxious, still not dead.

    So yes, the "problem" of resistant microbes would be solved. We would weed out a few hundred million humans with immune system failures and reward the surviving "winners" who win via a mix of blind luck and the market bothering to develop new antibiotics after removing all the annoying government restrictions on testing, quality, effectiveness etc. And of course any restrictions on overuse breeding up a new round of resistant pathogens making the new drugs ineffective sooner and paving the way for new patented drugs to kill the newer germs...

    So lets not be too hard on the Free marketers way of solving things just because it tends to mean "solved" the same way that WWII "solved" the excess prime military age overpopulation, surplus very young and very old too plus surplus of older infrastructure and structures on prime real estate... so it is one actual way of "solving" a problem. Disaster capitalism worked well then and would work astonishingly well for a super plague of resistant germs... for the "winners" that is... and by that I mean not the survivors but the wise investors who waited for the best time to invest in and then monopolize a key market...

    Pogo & Murphy's Law, every time. Also "Trust but verify" - St. Ronnie (hah...)

    by IreGyre on Wed Mar 13, 2013 at 04:11:58 AM PDT

  •  scary (1+ / 0-)
    Recommended by:

    I have a genetic immune deficiency that increases my risk of infection a good deal. In addition, I have a mild version of brittle bone disease, so my risk of fractures requiring surgery is super high. I've already had a partial shoulder replacement due to a compound fracture, and knee surgery due to a fracture.  I end up needing antibiotics more than I'd like and, on occasion, have tried prophylactic antibiotics, about which I have very mixed feelings because of the whole antibiotic resistance thing.  I read stuff like this and I feel like I can just about predict how I'm going to die - from some hospital acquired infection post-surgery for a fracture.  And there's nothing I can do to prevent that potential outcome other than lock myself up in a padded bubble.  

  •  Unfortunately our government serves the interests (4+ / 0-)
    Recommended by:
    claude, DrTerwilliker, cynndara, Sunspots

    of the oligarchs first. The interests of the people are served as an afterthought, if at all, and even then only when it happens that it will also be in the interest of the oligarchs.  

    There is nothing benign about unbridled capitalism, it serves it own interests. Period.  The greed which powers capitalism may be a powerful engine for economic growth, but it clearly becomes a maleficent force absent the brakes and a steering wheel which could, theoretically, be applied by by our government.  

    why can't we spend public money to develop medicine?
    Because our "public money" is currently far more likely to be spent in the service of profit than of humanity.

    It has always seemed strange to me...The things we admire in men, kindness and generosity, openness, honesty, understanding and feeling, are the concomitants of failure in our system. - John Steinbeck, Cannery Row

    by ovals49 on Wed Mar 13, 2013 at 04:33:26 AM PDT

  •  I am currently taking Zithromax for a bad sinus (2+ / 0-)
    Recommended by:
    Roadbed Guy, high uintas

    infection.  I just noticed this morning that on the box it says "Made in India."

    Normally when I would take Zithromax, by day 3 I'd feel a little better.  But today I feel as though nothing is changed, and this is day 3.  My impulse is to say "crappy pharmaceuticals with no quality control from India.  Why the hell isn't this stuff made in Europe or the USA or Canada or some country with standards?"  

    So I see that a problem compounding our antibiotics resistance, and the emergence of new bacteria, is that we have outsourced our R & D, our manufacturing, our science.  We have outsourced our interest in raising generations of scientists, tech workers and manufacturers, to foreign countries--- most of which have no stake in seeing Americans stay healthy, live long lives, and heal.

    That's one more thing to add to my long list of small problems. --my son, age 10

    by concernedamerican on Wed Mar 13, 2013 at 05:04:33 AM PDT

    •  P.S. got the prescription filled at CVS n/t (1+ / 0-)
      Recommended by:
      high uintas

      That's one more thing to add to my long list of small problems. --my son, age 10

      by concernedamerican on Wed Mar 13, 2013 at 05:14:32 AM PDT

      [ Parent ]

    •  My doctor no longer prescribes Z packs (3+ / 0-)
      Recommended by:
      cynndara, skod, Sunspots

      and hasn't for about 4 years. He said that he's found that they just don't work anymore.

    •  What do you expect when people (0+ / 0-)

      don't want to (or can't) pay more than $4?

      Thanks WalMart!!

    •  It may be you have a different infection (3+ / 0-)
      Recommended by:
      elfling, entrelac, Sunspots

      than the ones that Zith seemed to cure in the past. So a different antibiotic might be needed. Sinuses are notoriously hard to treat (I suffered from sinus infections for years...)

      I agree that we should be manufacturing drugs right here, however I don't think that made in India is necessarily a bad thing--they are a much more modern country than people realize, with modern medicine and manufacturing. I would trust their quality control much more than say, China.

      Anyway, I hope you know about saline rinsing to help kick your sinus infection? My ENT got me started on this after my sinus surgery and it has made a huge difference.

      I love it that Obama's channeling Harry Truman: "I don't give 'em hell; I just tell the truth and they think it's hell!"

      by sillia on Wed Mar 13, 2013 at 08:08:21 AM PDT

      [ Parent ]

      •  I will second the advice to use a saline rinse (3+ / 0-)
        Recommended by:
        squarewheel, sillia, bluezen

        That has been a huge help with my recurring sinus issues.

        •  use distilled water. (1+ / 0-)
          Recommended by:

          if you live in a warm climate there is an extremely remote chance you might incur an infection from a particularly nasty amoeba which likes to eat the neurons in your brain.

          very remote, but distilled water eliminates the possibility.

          also chlorine in tap water - very uncomfortable.

          big badda boom : GRB 090423

          by squarewheel on Wed Mar 13, 2013 at 09:17:48 AM PDT

          [ Parent ]

          •  ...or a very good filter (0+ / 0-)

            we are on well water so no chlorine or other chemicals in it. I use a good quality double-stage filter for drinking water; no bacteria can get through that.

            If you're going to be doing the saline rinse every day (makes sense for allergies or chronic problems) it would pay to get an excellent water filter rather than constantly buying distilled, which sits in plastic anyway.

          •  This is exactly why (0+ / 0-)

            I only use the prepackaged rinses. I saw one news story about someone contracting an amoeba using a Neti Pot and got a little paranoid.

    •  Feel for you (0+ / 0-)

      mr.u gets lots of sinus infections and has had two surgeries. He is addicted to his Netti Pot and it has helped, but he still can get one now and then. He has to take his antibiotic longer, two doses instead of one and sometimes it's hit or miss.

      "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 05:04:20 PM PDT

      [ Parent ]

    •  It never touched sinus infections for me at all (0+ / 0-)

      It took the second- or third-line antibiotics to make any difference.  They prescribe Zithromax for everything, so a lot of bugs have to have developed resistance by now.

      One problem with the other drugs is that you will probably have to insist on them, and may have to research them yourself, which is wearing when you're sick.

      Another problem is that they tend to have side effects.  The fluoroquinolines worked but may screw up your tendons, among other things.  Tetracycline and doxicycline worked, but they're broad spectrum and you have to be careful to keep eating live-culture yogurt or sauerkraut/kim chee.

      Zithromax has just been implicated in heart rhythm irregularities, too.

  •  The antibiotic crisis (3+ / 0-)
    Recommended by:
    Roadbed Guy, cynndara, Sunspots

    First off this was on ABC news so was total hype.

    Some thoughts on this ‘crisis’.  Many ‘new’ antibiotics could be made very quickly by pharma – big, small and generic.  That is because many antibiotics are relatively simple compounds.  And there is the problem.  They are easy to recreate and to make and cheap to make.  For example one of the Big Pharma companies that I worked for was able to produce a product that their cost was about $1.50 per treatment and sold for between $15 & $30 retail, profit for us of about $3.  Small market, only a moderate profit and tied up one manufacturing line.  Generic company took product, changed just a few things and got approval, cutting into our profit, so we dropped the product.  Their cost by the way was $0.18 and sold for same price, made in Puerto Rico .  Pharma is spoiled!  Big Pharma likes the complex products that are hard to recreate, expensive to make and have a huge market because those products are the money makers.  FYI some antibiotics are those type of drugs – complex, expensive & huge market.

    So what is the solution?  For now cover regular antibiotics under the Orphan Drug Act.

    My background – over 18 years in research and quality control in the pharmaceutical industry for firms big and small.

    •  I didn't see the ABC News story (2+ / 0-)
      Recommended by:
      elfling, Sunspots

      I did hear one on NPR, and saw one in the Times.  The NPR story got me thinking, which led to this.

      The key issue, though, was not that there is a crisis.  The key issue which the NPR story missed, and I'm sure that the Mouse News story also missed, is that there's no good market mechanism to fix it.  The Orphan Drug Act comes up, of course, as the standard fix. It is not really a market solution, since patents by definition are a distortion of the market, but we accept "intellectual property" as a valid distortion of the market.

      But even an orphan drug is worth more to its patent owner when overprescribed.  And that's really counterproductive with antibiotics.

      I am also suspicious of a law that made Botox an orphan drug, but then allowed it to be mass-marketed off-label for a ridiculous cosmetic usage.  Bad enough that non-orphan drugs get recycled as cosmetics, like Latisse.

  •  What????????? (1+ / 0-)
    Recommended by:

    Haven't you heard? According to Ron and Rand, Paul Ryan, and Alan Greenspan, the market is ALWAYS a perfect, self-regulating, balanced system that ALWAYS delivers a perfect result. Those guys are really smart so I believe them.

    Here in Pleasantville, we never worry about germs, climate change, stock market crashes, poverty, or unemployment because these things don't really exist.  Or if they do, it's because some communist meany has been talking about them and as we all know the best way to have these things not exist is to pretend they don't.

    So there; let's just forget about all those yucky germs and have a perfect day.  Mom's making mac & cheese for dinner, and we all know how good THAT is.

    Labor was the first price paid for all things. It was not by money, but by labour, that all wealth of the world was originally purchased. - Adam Smith

    by boatwright on Wed Mar 13, 2013 at 05:44:06 AM PDT

    •  Even Greenspan knows that's ridiculous (0+ / 0-)

      But, being a vain and greedy megalomaniac, he lied his way to fame and power. Paul Ryan, though, is just a creepy moron on the make.

      "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

      by kovie on Wed Mar 13, 2013 at 06:11:57 AM PDT

      [ Parent ]

  •  Actually weapons manufacturers do advertise (1+ / 0-)
    Recommended by:
    Catte Nappe

    especially on radio, but occasionally on cable and tv

    here in the DC metro area

    where the target is the electeds in Congress and the decision makers (uniformed and civilian) in the Pentagon

    "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

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

    •  I hear those commercials on local (1+ / 0-)
      Recommended by:

      news radio in the DC area.  I was floored the first time a heard a missile weapons system being advertised.  It seems to have become prevalent in the last year or so.

      “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

      by musiclady on Wed Mar 13, 2013 at 08:13:43 AM PDT

      [ Parent ]

  •  But it was only a no-brainer (0+ / 0-)

    after you explained it.

    Very clear and well-argued diary.  Thank you.

  •  Since no one will be immune to the superbugs... (2+ / 0-)
    Recommended by:
    tmservo433, Sunspots

    ...the funding of research and development of new antibiotics would be a "no brainer".  Unfortunately, it seems that far too many of our "leaders" indeed have no brains.

  •  Drug resistant tuberculosis, one coming nightmare (8+ / 0-)

    Original recipe TB is the undisputed all-time super killer: Over a billion fatalities. Millions die EVERY YEAR from this disease.

    Like the ancient terror of plague, sometimes the disease kills quickly, sometimes not at all  - and most often slowly and horribly.

    It's not an especially contagious malady compared to viral infections like flu but it doesn't have to be, because it's everywhere.

    More than two billion people are TB carriers, a vast number enabled by rapid population growth in the Third World.  In non-HIV cases 5% become symptomatic. Of these, one in 100 will die in a given year. In HIV+ persons, 30% become symptomatic.

    The pre-antiobiotic annualized TB fatality rate is at least 10 times higher than present. In the 1800s, a whopping one quarter of ALL deaths in Europe came from TB.

    Let's put it another way: Enter drug-resistant TB, a de facto return to the untreatable era when the poet Keats sojourned in Italy and died well-versed and horribly.

    Presently, in our modern medical miracle world, MERELY 30% not 80%  are TB+. In our time, 10% tops ever become symptomatic as opposed to 30%. Overall, 1 in 100 of these persons die each opposed to 1 in 10.

    And that situation produces 1.5 million fatalities a year. Rephrase: We keep the number as low as we do because up until now, the antibiotics work.

    What if they stop working? In that case the annual number of fatalities could top 100 million a year in a world without any TB safety net.

    Let's walk this nightmare scenario back: A replacement of all TB cases with drug resistant ones, in a situation of global complete breakdown in care is an outlier. Let's cut that back, a lot, to 10 million additional deaths a year to keep talking round numbers.

    This one drug resistant malady, plus known slowdown in global fertility rates, would lead to first a stall in human population growth then gradual decline. Presumably natural resistance would arise in time, newer coping strategies and the world would go on with a smaller, scarred and smarter human population.

    Yet TB is not the only killer with drug resistant strains. And it will not take much more additional mortality, on top of emergent TB drug resistance  to generate a severe population loss event in the human population.

    Some may say: good. Such persons are probably speaking from relative affluence and imaginary safety. Like the revelers from Poe's "The Masque of the Red Death", only less fun and more unbearable.

    I happen to think human extinction would be an unqualified bad even if one's ethos is guided by maximization of nonhuman species diversity and conservation of pristine habitat.

    Because no one can fix our mess but us. And if we're all dead, no one can fix a thing. And trusting our absence to eventually clean up after us is as immoral as willfully and gleefully destroying habitat and species for its own sake.

    Because it's an easy and cowardly way out that kills just as many species and destroys just as much habitat, while feeling superior. Just like Poe's revelers.

    •  Wouldn't cause extinction. (2+ / 0-)
      Recommended by:
      cskendrick, tacet

      The mere fact that much smaller populations of humans co-existed with mycobacterium tuberculosis for thousands of years without antibiotics or extinction indicates that the human genome has some defenses.  I'm not saying it's GOOD or that there wouldn't be incredible suffering and losses, but alone, it wouldn't drive the entire species off the planet.

      One problem, of course, is that it spreads much more efficiently the more densely-packed the population is, which used to make it a disease of urbanism.   Another is that after a hundred years of antibiotic use, four or five generations have grown up without exposure, and large numbers who would have succumbed have repeatedly reproduced.  That leaves our populations full of individuals who would never have been born in prior eras due to lack of TB resistance, and who would succumb quickly as they lack that particular genetic trait.  It's not a pretty situation.  But look on the bright side.  We really, REALLY need to pull the plug on exploding human populations.  There are far too many of us on this planet; the life-support systems can't handle it and we've yet to find anywhere to offload some of the excess.


      •  If it were just one disease, yep. (0+ / 0-)

        If it were just drug-resistant diseases, yep.

        But it's disease. Habitat loss. War. Breakdown in supply chains supporting an advanced civilization. Depletion of key resources.

        If the population goes into collapse it might not stop at a sustainable level from the OTHER extreme.

        We might not survive the equivalent of another Taupo-level dieback.

  •  Understanding evolution would help (8+ / 0-)

    but one major American party has decided evolution is fake and made a religious creation myth part of its party platform, so...welp.

  •  Capitalism can only serve some of society's needs (1+ / 0-)
    Recommended by:

    Mainly, the steady, unavoidable, fundamental needs, be they for food, clothing, housing, entertainment (yes, we need that, be it "high" or "low"), toothpaste, etc. It doesn't always meet these needs with the highest quality, best value solutions, which is why we need regulations, standards and oversight, but it does, for the most part, meet them. But as this article shows, it doesn't meet certain kinds of needs, and that's where government needs to step in and fill the void (and, also, individuals, acting on their own or in groups, as NGOs).

    We need to get back to the public-private mix, where the private sector does what it does best--with government oversight--and government does what it does best, and away from this privatize everything, free market nonsense.

    It's literally killing us.

    "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

    by kovie on Wed Mar 13, 2013 at 06:07:21 AM PDT

  •  Very well stated (1+ / 0-)
    Recommended by:


    Economics is a social *science*. Can we base future economic decisions on math?

    by blue aardvark on Wed Mar 13, 2013 at 06:08:20 AM PDT

  •  I've just spent two weeks sick thinking on this (2+ / 0-)
    Recommended by:
    entrelac, Sunspots

    I started out with a minor cold type thing; but it turned into lung infection.. and it got.. bad.   Until last week where I went on an injectible Antibiotic (Rocephin) then sent home with Levoquin, I just felt like I was going to die.

    It's only about 4 days later I feel like life is back to normal.   The reality is antibiotics, and effective ones are crucial in the way we treat illness.   But you're right, monetarily it's hard to back as a big pharma.

    And, FYI, my at home run of Levoquin, prior to insurance: $140.   Not chump change.

    Gandhi's Seven Sins: Wealth without work; Pleasure without conscience; Knowledge without character; Commerce without morality; Science without humanity; Worship without sacrifice; Politics without principle

    by Chris Reeves on Wed Mar 13, 2013 at 06:12:02 AM PDT

  •  Big Pharma will respond to every emergency by (4+ / 0-)

    developing six new types of Viagra.

    Also, by charging higher and higher prices. Why? Because they can. And the system is built to encourage it.

    And God said, "Let there be light"; and with a Big Bang, there was light. And God said "Ow! Ow My eyes!" and in a flash God separated light from darkness. "Whew! Now that's better. Now where was I. Oh yea . . ."

    by Pale Jenova on Wed Mar 13, 2013 at 06:35:50 AM PDT

  •  I was born before WWII, and lived in (1+ / 0-)
    Recommended by:
    Catte Nappe

    a small Texas town in the middle of nowhere. The doctor in our town somehow became deeply involved in the treatment of soldiers who were sent to the Army hospitals in San Antonio. Our doctor had a small plane that he flew himself back and forth to San Antonio. I became very ill with an infection of some kind and was hospitalized in the little hospital that our doctor had built out of his own pocket. I got worse, then my aunt, one of the nurses at the hospital, came in with a really big syringe. I got shots in my butt and the needle was so big you could see the places where I had been injected with this new medicine that our doctor brought back from San Antonio. I was told that it was penicillin. I recovered but was a sickly child. A few years later I became ill again and was hospitalized for six straight weeks. Nothing seemed to help and I gradually wasted away. But then another miracle drug appeared and I took it orally in chocolate milk. It tasted pretty bad, but I got better. I was told that it was Aureomycin, but I am really not sure. Anyhow I got better fast. A couple of weeks after I got out I attended a birthday party for one of my classmates. I still have a group photo of seven of us little boys. I was much smaller than the others. My two younger brothers, seven and twelve years younger, did not have such problems and they are both much larger than me. One is six inches taller and the other is four inches. I think my size and my lack of stamina had a lot to do with those infections and the lack of an effective cure. I am very lucky to be alive.

    Might and Right are always fighting, in our youth it seems exciting. Right is always nearly winning, Might can hardly keep from grinning. -- Clarence Day

    by hestal on Wed Mar 13, 2013 at 06:49:17 AM PDT

  •  For a good alternative, try Osha Root (1+ / 0-)
    Recommended by:

      I have used Osha Root to cure almost everything that has ailed me for 30 years now.  It is antiviral, antibacterial, antitumor and more.  
      I am no doctor but I eat a couple of teaspoon of the ground root powder at the first sign of a dry throat, unexpected tiredness, runny nose or just feeling "off".
      Your milage may vary but I would try Osha Root at your next opportunity.
      The whole root powder is best although turpentiny tasting.  Tinctures or teas are less effective but easier for some folks to get down.

  •  The correct poll answer is "Of course they should, (2+ / 0-)
    Recommended by:
    entrelac, Lily O Lady

    its a no brainer. So they wont. Because dis iz America."

  •  Up to 70% of new drugs are "copycat" drugs (0+ / 0-)

    It's analogous to reality television, in a way. One company comes up with a "blockbuster" and everybody else wants in on the share so they come up with their own version. I'm all for free competition, but there needs to be incentives again for "new" drug development, believe me, there are plenty of opportunities to do so. We are so close to "major" breakthroughs in so many areas especially cholesterol and genetic conditions.

    “The problem with the world is that the intelligent people are full of doubts, while the stupid ones are full of confidence.” ― Charles Bukowski

    by macleme on Wed Mar 13, 2013 at 07:07:48 AM PDT

  •  It's insurance, isn't it? (0+ / 0-)

    I wonder whether the key point in this post was put in parentheses:

    (Some drugs now sell for around $1000/day. Their manufacturers simply assume that the insurance companies will pay.)
    Perhaps it's only single-payer insurance that would 'rationalize' the health care 'market' to align it to social priorities and reasonably-undistorted economic capacity.

    If the Obamacare-hysterics called out "death panels" in response to the ACA, imagine the seizures we'd see over One Big Government-Run Insurance Pool refusing to pay Big Pharma its ransoms.

    The death panels will more likely be staffed by microorganisms that won't be subject to legislation or lobbying.

    Great diary, thanks for writing ...

    •  Just because it was a bit off topic (0+ / 0-)

      I parenthesized it because those drugs aren't antibiotics.  And I didn't want to get bogged down with a digression into cancer drugs, or whether I was mistakenly confusing the price of cancer drugs with the price of antibiotics.  Those are worthy of discussion but in their own threads.

      •  Fair enough on editorial choice...but my point was (0+ / 0-)

        ... that cutting the legs out from under Big Pharma's infatuation with $1000/day drugs may be the only way to move the "industry" into a public-health orientation (as opposed to Big Profit orientation) ... which is the only frame within which focus on the "little" drugs (antibiotics) is likely to regain traction.

  •  totally agree, but found a few nitpicks (3+ / 0-)
    Recommended by:
    entrelac, kareylou, Catte Nappe
    Antibiotics contain the seeds of their own destruction:  A few bacteria occasionally have mutations that lead to resistance, and those quickly multiply.
    the only time/reason a bacterium ever develops resistance to an antibiotic is through exposure to it; otherwise, there would be nothing impelling the mutation.
    So antibiotics, where success means you only need a few doses, are a lousy business to invest in.
    this ties in to what i said above:  i can think of just about NO infections that only need a "few" doses to achieve success.  most antibiotic courses are a good week long.

    part of this problem is people who would get their script, take it home, take a day or two's worth and start feeling better.  so they stop taking the antibiotic, thinking those are good to have around.  

    except instead of wiping out one's infection, you just knocked it back and gave it a chance to rally back with resistance.

    Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

    by Cedwyn on Wed Mar 13, 2013 at 07:21:18 AM PDT

    •  I think the point was "few" compared to (1+ / 0-)
      Recommended by:

      a statin or a new diabetes drug that has to be taken every day for life.

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

      by elfling on Wed Mar 13, 2013 at 08:29:41 AM PDT

      [ Parent ]

    •  "Few" is relative (0+ / 0-)

      Azithromycin became popular because it needed five days' treatment, vs. ten for common alternatives.  To me those are a "few" doses, taken only when needed.  Contrast with daily meds, 365 days a year.

      But it is true that they should be taken for the full course -- incomplete coursing is a serious risk, which our for-profit medical system doesn't deal with well.  Not that I'm sure any system could deal with human behavior of that sort.

    •  Also worth noting (1+ / 0-)
      Recommended by:

      ... is their use post op.  In the majority of surgeries, infection is a serious concern.  This is the major reason that multi-drug resistant strains used to only be hospital acquired, due to the high usage of antibiotics in hospital settings.  The more resent development has been the emergence of non-hospital acquired resistant strains.

  •  Agreed (3+ / 0-)
    Recommended by:
    elfling, entrelac, Roadbed Guy

    I used to work in biotech, where we were researching monoclonal antibody drugs to combat chronic conditions such as autoimmune disorders. We had a couple of lines of cancer research, but I specifically remember that we were trying to get the American Cancer Society or some kind of non-profit to partner with us; when we couldn't, we either sold off or gave up on that line of research. Non-profits, obviously, get tax breaks from the government, as well as grants.

    Even the drugs you hear about have more government involvement than you might think.

    We really don't spend enough on public research. And a lot of the people doing that research aren't even paid well. Post doc researchers often make less than 45k full time at universities.

    As for that company I worked for - after many years, many studies, and enormous amounts of effort, we ended up with only one very blunt drug that is used to nuke the immune systems of transplant patients, and one of the patents used by Avastin, the cancer drug (which we didn't directly develop). Everything else was unsuccessful. One of our autoimmune drugs looked promising, but the side effects turned out to be too much. Of 700 employees, only 10 are still there, acting as accountants for the patent holding company that remains.

    The factory (valued at over 100 million dollars) was sold to a Dutch pharma company, who used it for their own MAB studies, but last week I drove by and their sign had been taken off the building.

    If there's one thing that experience taught me, it's the enormous effort required to map out even one area of research in biotech, and the sheer probability of failure. The incentive to stick to relatively "safe" and high-profit research areas is huge. Thus ten flavors of SSRIs, the same for statins, viagras, etc.

  •  Now I understand the push to lower (0+ / 0-)

    the blood glucose threshold for a diabetes diagnosis from 126 mg/dL to 106 mg/dL. No clinical or outcomes benefit. Just more customers for diabetic meds and supplies and more profits for pharma!

    Everybody loves free speech until they hear some of it.

    by dobleremolque on Wed Mar 13, 2013 at 08:21:58 AM PDT

  •  Minor quibbles (2+ / 0-)
    Recommended by:
    elfling, Roadbed Guy
    Raytheon doesn't have to advertise its missiles on TV; Lockheed-Martin doesn't advertise its warplanes...
    Ah, but they do.  Ride around the DC Metro area sometime and I guarantee you will see at least 4-5 Lockheed ads with big pictures of the F35 on buses, Metro billboards, etc...

    I thought your post was very well done, but one major thing I felt was missing is that you failed to mention that Big Pharma is in fact conducting new antibiotic development, but that their R&D focus/practices have shifted.

    Back in the early days of antibiotics, discovery was mainly focused on screening environmental compound libraries.  In the age of genetics, there was a shift to trying to identify specific, molecular targets in the lab, and then to custom design an antibiotic around that knowledge.  Within the last 10 years, potentially due to the low productivity of the more genetic approaches, pharma companies have been transitioning back to natural compound screening.  This is actually coinciding with the transfer of their R&D facilities out of the US to places like China within the last 10 years or so.

  •  Actually (1+ / 0-)
    Recommended by:

    The free market WILL solve the problem (obviously not humanely), because there's more money in letting people die these days than saving them. That's why the Republican policy positions on healthcare are what they are.

    The GOP jobs plan is to manufacture outrage.

    by Doug in SF on Wed Mar 13, 2013 at 08:48:11 AM PDT

  •  I think you skipped half the story... (1+ / 0-)
    Recommended by:

    Not only is "the free market" unable to finance the development of new antibiotics (at least until bodies start piling up and people are willing to pay any price).

    It was "the free market" that's caused this problem in the first place. It's the unregulated use of antibiotics that has required development of new ones. If antibiotics had been used more sparingly (instead of at every turn that can make some an extra $), we wouldn't be in the mess we're in, and no more lives would have been lost.

    It kills me when I hear free market evangelists skip over stuff like this... they'll say that the market will eventually figure it out. Trouble is that in the meantime, people die. And if enough of them die, "the market" will die with them.

    Freedom isn't free. So quit whining and pay your taxes.

    by walk2live on Wed Mar 13, 2013 at 08:57:49 AM PDT

    •  You are right (0+ / 0-)

      The studies have already been done.  I believe it was England that banned the use of broad spectrum antibiotics in animal feed a decade or so ago and has since seen a remarkable drop in multi-drug resistant bacterial infections since.  I'll try and find the study and link it elsewhere in the comment section.

  •  See Monday's episode of Dr. Oz show (0+ / 0-)

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Wed Mar 13, 2013 at 09:08:09 AM PDT

  •  Some Antibiotics aren't available in US (4+ / 0-)

    In November of 2011 I fell sick with a septic infection. I was so sick, they were using 10 different antibiotics trying to kill off the infection. Since I was in a coma at the time, my wife was the one talking to the Doctors and the Infection Specialist said there was a antibiotic in India that would have killed it off inside of a week, instead of the 6 weeks it took. When my wife asked why we couldn't use it here, the answer was simple, no drug company would get it approved by the FDA for use because there was no profit in it for them.

    Stupid Is As Republican Does

    by VinBacchus on Wed Mar 13, 2013 at 09:35:05 AM PDT

  •  Academia & the military have always led... (1+ / 0-)
    Recommended by:
    Bluehawk r&d and incentives in drug development. The use of ground forces relies on the ability to withstand various local diseases and survive bouts of illness. The gov't should partner with academia and communities to build the people, processes and products for the future in health, which, as you say, is not  free market. Clearly educating the youth to rise above the petty politics and fight corruption may be in the critical path. Also, this is an area that becomes richer by a globalized framework so today's resources and diversity are new abundant assets.

  •  I've mention this before, but it is still relevent (4+ / 0-)

    When I was in high school, back around 1967, I had a job as a lab assistant to a Molecular Biologist doing some of the original research on "Infectious Drug Resistance"

    (aside) "Infectious Drug Resistance" is the process where a resistant bacterium can pass a DNA fragment (a plasmid) encoding the resistance to another bacterium, even one from a different species. Your gut typically contains a variety of resistant bacteria, and in the presence of an antibiotic they start passing these plasmids around like party favors.

    At the time (and remember, this was almost half a century ago), it was obvious to everyone in the field that over-prescription of antibiotics -- and worse yet the use of antibiotics in animal feed -- was a disaster waiting to happen. The alarm was sounded, but everybody ignored it. (Where have we heard this before?)

  •  You should update and cross-link to another diary (3+ / 0-)
    Recommended by:
    schnecke21, julesrules39, Sunspots

    on the rec list about how the meat industry accounts for massive amounts of anti-biotic use. So should new antibiotics be developed as you suggest? Absolutely.  But it won't do any good if massive factory farms keep destroying the viability of these new drugs faster than we can develop them. We need a multi-faceted solution.

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

    by bigtimecynic on Wed Mar 13, 2013 at 10:12:12 AM PDT

  •  This is something that has been (0+ / 0-)

    worrying me for some time because I lost a beloved relative to a hospital nasty infection.  (?Nasty hospital?)

    United Citizens beat Citizens United

    by ThirtyFiveUp on Wed Mar 13, 2013 at 10:21:43 AM PDT

  •  I might write a diary in response to this one (1+ / 0-)
    Recommended by:
    Roadbed Guy

    because there are at least a couple of points here that are
    well off the mark.

    First off: a big part of the problem is the rather perverse IP situation, since pharmaceuticals and medical devices are regulated more than almost any other type of invention.

    Second: there are very sound reasons for converting racemic mixtures to pure chiral ones, even if they don't "work better."

    Please note, though, that I am not strictly defending Big Pharma here; some of the inaccuracies paint them in a somewhat more positive light, I think, than is deserved.

    We don't want our country back, we want our country FORWARD. --Eclectablog

    by Samer on Wed Mar 13, 2013 at 10:29:25 AM PDT

  •  Shortage of current antibiotics (4+ / 0-)

    Old mainstay Doxycyline is in short supply with subsequent price gauging. I have heard of ten day courses of #20 pills going for $200. This is crazy -- this is a "$4" drug.

    If the drug manufacturers can't even supply us with old "stand-by" antibiotics it is time for the government to produce them. It is not rocket science.

    It is not just doxycycline -- the FDA reports on many, many antibiotics and medications that are in short supply in the nation.

    Let the government make these basic meds if the private pharmaceuticals can't get their act together.  

    While they are at it, set up national labs to do the most basic testing and save our country BILLIONS in health care costs.

    •  doxycycline is in a ridiculous state (2+ / 0-)
      Recommended by:
      roonie, Sunspots

      It's a really important drug in veterinary medicine for treating actual infections, simple and straightforward to make as drugs go, used to be very inexpensive, and now it's completely unavailable.

      We have to figure out how to solve this.

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

      by elfling on Wed Mar 13, 2013 at 12:46:33 PM PDT

      [ Parent ]

  •  The free market offers a solution (0+ / 0-)

    but as with everything else it is a bad solution.

  •  Phage (1+ / 0-)
    Recommended by:
    Roadbed Guy

    Promising early research on phage (short for bacteriophage, viruses that target bacteria) was cut short in the 1930s with the advent of broad spectrum antibiotics.

    The phage are still there, and with more advanced abilities to quickly identify the species of bacteria causing illness, and the (private enterprise largely) efforts to collect, categorize, and identify bacterial targets of thousands of phage species, there is real hope for a healthful post antibiotic era.

    Just to be is a blessing; just to live is holy -- Abraham J. Heschel

    by jotter on Wed Mar 13, 2013 at 12:02:01 PM PDT

    •  The Russians have been looking at this for years (1+ / 0-)
      Recommended by:

      ... through the 60-70s and as late as the last decade or so.
      There is a reason that small molecule inhibitors won out over phages though.

      The problem is that phages and bacteria have existed in biological warfare for the better part of the existence of life on this planet.  Phages are generally highly specific and bacteria acquire resistance to them on the order of 100-1000 times faster then to small molecule inhibitors (ie antibiotics).  There mechanisms of activity are generally similar, such as the activity of lysozyme and B-lactam based antibiotics both targeting bacterial peptidoglycan biosynthesis.

      I'm sure if phage were at all a superior method of killing infectous bacteria, the Russians would be running the antibacterial business right now.

    •  Or maggots (1+ / 0-)
      Recommended by:

      which are FDA approved medical devices!

      From Wikipedia:

      While at Johns Hopkins University in 1929, Dr. Baer introduced maggots into 21 patients with intractable chronic osteomyelitis. He observed rapid debridement, reductions in the number of pathogenic organisms, reduced odor levels, alkalinization of wound beds, and ideal rates of healing. All 21 patients' open lesions were completely healed and they were released from the hospital after two months of maggot therapy.

      After the publication of Dr. Baer's results in 1931,[6] maggot therapy for wound care became very common, particularly in the United States. The Lederle pharmaceutical company commercially produced "Surgical Maggots", larvae of the green bottle fly, which primarily feed on the necrotic tissue of the living host without attacking living tissue. Between 1930 and 1940, more than 100 medical papers were published on maggot therapy. Medical literature of this time contains many references to the successful use of maggots in chronic or infected wounds including osteomyelitis, abscesses, burns, sub-acute mastoiditis,[7][8] and chronic empyema.[9]

      More than 300 American hospitals employed maggot therapy during the 1940s. The extensive use of maggot therapy prior to World War II was curtailed when the discovery and growing use of penicillin caused it to be deemed outdated. Due to the lack of conventional medicines, maggot therapy was used by Allied military medical staff in Japanese prisoner of war camps in the Far East throughout World War II.[10]

  •  thank you for this diary... (0+ / 0-)

    I wish it could be permanently on the Rec List.  

    There are many problems that the not-so-free market does not do well attacking.  I believe its been close to 30 years since we've come up with a new antibiotic.  

    Climate Problem, Population problem, natural disasters, and soon Pestilence.  Our children have so much to look forward too!  

  •  May I Point Out Sharklet (0+ / 0-)

    Sharklet works against bacteria by acting as a poor host. Along with the use of sterling silver dinnerware, probably the safest way to prevent bacteria from invading ones space. And totally avoiding the danger of creating superbugs at the same time.



    Strange that a harp of thousand strings should keep in tune so long

    by jabney on Wed Mar 13, 2013 at 12:32:36 PM PDT

  •  Good thing choice #1 is a "no-brainer" because (0+ / 0-)

    few in Congress have any brains.

    "The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

    by Lily O Lady on Wed Mar 13, 2013 at 12:50:41 PM PDT

  •  This is the Genius of Capitalism...... (0+ / 0-)

    .......inventing newer and more innovative refutations of the Gospel according to the True Believers in the Holy Free Market.

    In the Fox News Christian Nation, public schools won't teach sex education and evolution; instead they'll have an NRA sponsored Shots for Tots: Gunz in Schoolz program.

    by xynz on Wed Mar 13, 2013 at 01:00:09 PM PDT

  •  There needs to be a long term strategy. (0+ / 0-)

    That would mean we probably have to understand better how resistance develops and the long term evolution of resistance in bacteria.  Just developing new antibiotics will probably have diminishing returns without some understanding and strategy to deal with resistance.  We might have to have a very long term rotation of antibiotics (50 years?, 100?, 500 years?).

    Of course, such a long term strategy would require long term world wide cooperation to be effective.  But that is true of so many other problems.  The record so far of world wide cooperation is not very good.  The conservative movement in this country, and similar impulses in most other countries, are a serious obstacle to such cooperation.

    "The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt." Bertrand Russell

    by Thutmose V on Wed Mar 13, 2013 at 01:34:47 PM PDT

  •  Antibiotics - No money in them (1+ / 0-)
    Recommended by:

    Drug companies want to develop maintenance drugs, something your take every day forever like blood pressure medicines. Antibiotics are taken for a releatively short period. No money in them for big Pharma. Big government will have to do the lifting for antibiotics.

  •  Do not EVEN go there (1+ / 0-)
    Recommended by:

    I'm having sinus surgery a week from tomorrow for something nasty in my ethmoid sinus.  They aren't sure what it is - drug resistant infection, fungus - but I'm sure that it's all I can smell or taste.

    I've been on Augmentin, zithromyxin, avalox and doxycycline, with a course of prednisone, between now and November.  No reaction at all.

    So they're going to go in and take it out and culture it.  I keep thinking there ought to be a better way.

    "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

    by escapee on Wed Mar 13, 2013 at 02:27:32 PM PDT

  •  We only need to get through the next ~30 years (0+ / 0-)

    And then global warming will have decimated civilization, so no drugs for anyone who can't make them themselves.  

  •  Let me tell you a, um, amusing(?) story about... (4+ / 0-)

    ...a totally new class of antibiotic, the oxazolidine moiety we now know as linezolid.

    The antibiotic was developed at the company that was (then) known as Pharmacia (Upjohn) and everybody was excited because:

    1)  It was a totally new structural class.

    2)  It was active against Vancomyocin Resistant Enterococci (VRE) and...

    3) Methocillin Resistant Staphlococcus Aureus.  (MRSA).

    So, um, Pharmacia was able to rush it to market and expected huge success, except...


    Physicians heard all about these wonderful properties and decided not to write prescriptions for it because they might induce resistance to linezolid and other moieties that might be developed in its class, so they saved it for "last resort."   That is they used it only when a VRE or MRSA were encountered, which was happily, not often.  Otherwise they started with common antibiotics, worked their way up to either methocillin or vancomyicin or both and if they failed, wrote a linezolid script.

    Thus the sales of the wonder drug were crappy.

    Pharmacia was financially weakened and was acquired and destroyed by Pfizer, which um, has a way of doing that to pharmaceutical companies that actually know how to discover drugs, rather than market them.

    Pfizer's marketing people began to push the drug in a completely different marketing strategy, which included the claim that linezolid - marketed as Zyvox - was actually superior to all applications of vancomyicin, which was not true except in the case of VRE's.    Pfizer paid a $2.3 billion fine for marketing practices including, but not limited to Zyvox marketing.

    The Pfizer strategy was effective at increasing sales, by the way, with the consequence being that there are now linezolid resistant bacteria because of over use of the drug.

    But the takeaway is pretty much what you correctly described, the fact that a novel antibiotic that treats the newly untreatable diseases will be a financial dog, of which the legitimate use of linezolid is an example.

    Thanks for an important diary.   Please accept a recommend and a tip.

  •  Remember when (0+ / 0-)

    they used to teach us in schools that America was superior because we had a "mixed economy"?

      Since the 80's we've been superior because we haven't (so they say).

    ¡Cállate o despertarás la izquierda! - protest sign in Spain

    by gjohnsit on Wed Mar 13, 2013 at 04:56:08 PM PDT

  •  R u suggesting that the government give BigPharm (0+ / 0-)

    more subsidies and tax breaks?  Given that most of those companies already don't pay taxes by sheltering profits overseas, the suggestion seems ludicrous.  Big Pharm, Big Ag (especially the chemical companies and meat producers) are some of the biggest spenders on Capital Hill to ensure their tax loopholes and corporate subsidies in the next Farm Bill are continued or increased.

    80% of antibiotics in the US are used on animals, almost wholly for U.S. MEAT PRODUCTION.  Even if you don't eat meat, you are paying for them with your tax dollars.

    People should stop buying so much CAFO meat (beef, pork and chicken raised in Concentrated Animal Feeding Operations).  Americans eat twice as much meat as Europeans and four times as much as the rest of the world, on average.

    Eating CAFO meat supports industrialized farming practices which input billions of tons of herbicides, pesticides, fertilizers, hormones and antibiotics into our food supply as well as pulluting our soil, water, air and health.  Instead, we should be encouraging our representatives in Washington to move subsidies to farmers practicing sustainable practices which safeguard our at risk resources, biodiversity and our health.

    •  No, that's not what I was suggesting (0+ / 0-)

      What I was suggesting, however, smacks of that "s-word" that teabaggers confuse with everything they want us to be afraid of.  Subsidies and tax breaks are the answers that get proposed by those who demand that all public goods also create more private wealth for the very wealthy class.

  •  Some inaccuracies about resistance. (0+ / 0-)

    It is true that there is more money now in erectile dysfunction drugs than antibiotics, and no new antibiotic families are being developed as far as I know. But drugs like penicillin G are still quite effective and are used as primary treatments in Scandinavian countries for gram positive cocci. The difference is the dose is 5X higher now than 30 or 40 years ago.
    In the US, we are giving fancy cephalosporins instead. It makes much more sense to reduce the different antibiotics and move to higher doses.

    "You can die for Freedom, you just can't exercise it"

    by shmuelman on Wed Mar 13, 2013 at 05:53:44 PM PDT

    •  Actually, I just came of course of penicillin V (1+ / 0-)
      Recommended by:

      for strep throat just ten days ago. Worked like a charm. Actually, the whole family had strep, and the kids got amoxicillin since penicillin apparently tastes gross when given as a suspension. Still, amoxicillin is almost as old of a standby as penicillin.

      Then, my wife's infection returned, and this time they put her on a cephalosporin. Hopefully that will do the trick.

      In any case, at least our doctors here in Virginia still use penicillins, so not all US doctors have given up on them.

      "A government that robs Peter to pay Paul can always depend on the support of Paul." - George Bernard Shaw

      by Drobin on Wed Mar 13, 2013 at 06:44:42 PM PDT

      [ Parent ]

      •  Just be careful when they prescribe (0+ / 0-)

        levoquin for persistent strep. Read up on it because it is a very toxic drug. It is given in 10 d. course, but should be discontinued after 5 days if you are better. I am not a doctor but am developing software for antibiotic management in the hospital ICU, where we are hoping to cut antibiotic use by 10 - 20% (we believe about 50% of antibiotic use is excessive / misprescribed).

        "You can die for Freedom, you just can't exercise it"

        by shmuelman on Thu Mar 14, 2013 at 08:19:41 AM PDT

        [ Parent ]

  •  Who really pays (1+ / 0-)
    Recommended by:

    We do.  Government has always paid for the bulk of Pharmacy research. Just as the government pays for most so-called religious charity.  They administer at our expense the distribution of our money.  
    Then, they reap the credit, profits and good will.  Every prescription should list how much government money went into it.

  •  Great diary (0+ / 0-)

    Tiny quibble:

    Raytheon doesn't have to advertise its missiles on TV; Lockheed-Martin doesn't advertise its warplanes.
    I dunno about TV but military contractors sure do advertise this kind of wares in the subway stations of the Washington, D.C., area and in publications perused by politicians, appointees, high-level military and their staffs.

    This has absolutely no bearing on your main point, though.

    •  Others have pointed that out about Washington (0+ / 0-)

      Raytheon is headquartered right up the road from me; they're one of the biggest if not the biggest private employer in Massachusetts.  But they don't advertise here.  I suppose they and other military contractors are advertising in Washington as a way of improving their chances in Congress.  But they're not advertising to get individuals to specify their products.

      But big pharma advertises on national TV.  Some cable networks seem to be primarily supported by prescription-drug ads.

  •  I don't know much about antibiotics ... (0+ / 0-)

    (well, that's not true, I know a lot about antibiotics, as well as MRSA, but that's not the point of this clever little comment) ... but I do know that the only thing that can be solved by the free market is the problem of sociopaths not having as much of the money supply as they would like.

    To put the torture behind us is, inevitably, to put it in front of us.

    by UntimelyRippd on Wed Mar 13, 2013 at 06:59:45 PM PDT

  •  saw a comment in the last (1+ / 0-)
    Recommended by:

    couple of days (and alas cannot remember just where) that the commercial meat industry uses four-fifths of the antibiotics produced in this country.

    Maybe we need fewer drugs, less use of them, and more reliance on preventive health care. But, of course, there's no profit for insurance companies in prevention, so there's that.

    Life is extremely cheap to the right-wing until a decision about it is either in the hands of a pregnant women or a Democratic president. -- Lia Matera

    by Mnemosyne on Wed Mar 13, 2013 at 07:12:42 PM PDT

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