[HN Gopher] Why do antibiotics exist?
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Why do antibiotics exist?
Author : maxerickson
Score : 56 points
Date : 2021-12-08 19:13 UTC (3 hours ago)
(HTM) web link (journals.asm.org)
(TXT) w3m dump (journals.asm.org)
| DantesKite wrote:
| What's interesting is that the same principle doesn't seem to
| apply for viral infections.
|
| The smallpox vaccine is just as effective today as it was a
| couple decades ago.
|
| Then again the flu is constantly mutating so maybe it's just
| contingent on the type of disease.
| not2b wrote:
| Depends on which virus. Flu shots have to be changed every
| year, but measles shots appear to give lifetime immunity.
| roywiggins wrote:
| Flu doesn't evolve to resist each vaccine, it's just a
| different strain becoming prevalent each year. I'm not sure
| what the mechanism behind that is, but it was happening
| before the flu vaccine existed.
| bink wrote:
| Is there much difference conceptually between a virus
| mutating in a body and then finding ready hosts amongst the
| vaccinated if there is a large vaccinated population and a
| bacteria that has a resistance to an antibiotic spreading
| in a host that is receiving that antibiotic?
|
| Sorry for probably not using the right terminology here but
| they seem closely related to me.
| Gunax wrote:
| Does antibiotic overuse really contribute a large portion of
| antibiotic use?
|
| I ask because it seems like misuse is blamed for antibiotic
| resistance: but it seems to me that bacteria don't care whether
| youre using it legitimately or not: either way has a chance of
| contributing to resistance.
| tshaddox wrote:
| I don't think people are claiming that bacteria care how you're
| using the antibiotics. It's just that using less antibiotics is
| better if possible, and it makes more sense to cut out the
| least important usages first. I mean, if it's between throwing
| 100 doses of antibiotics into a river or depriving 100 sick
| people of their dose of antibiotics, it seems pretty clear
| which choice to make.
| Fomite wrote:
| It definitely is - both in the developed and developing world
| there is a staggering amount of overuse of antibiotics.
| xmprt wrote:
| Coming from India, it's crazy what you can get over the
| counter. I think that medicine should be more available and
| cheaper but the fact that you can get so many antibiotics
| without a prescription is definitely a contributing factor.
| droopyEyelids wrote:
| From what I've read, it's not even human misuse in India
| driving the change, rather pharmaceutical factories dispose
| of their antibiotic-laden wastewater into local rivers,
| driving an ecosystem level race for resistance.
| Fomite wrote:
| It's more of a "yes and..." problem. There's also a
| sanitation aspect to things.
| jurassic wrote:
| One thing I hear cited often is the way antibiotics are widely
| used in animal agriculture to boost margins by helping keep
| more animals alive in the lowest cost living conditions (often
| squalid and unhealthy for the animal). This is antibiotic abuse
| on a massive scale, for the profit of private individuals.
| :facepalm:
| vkk8 wrote:
| This feels like a pretty low hanging fruit to regulate away.
| Ban antibiotics use in agriculture in civilized countries and
| ban importing antibiotics grown meat from the others (I would
| guess it's easy to test).
| nradov wrote:
| The FDA has already been working to reduce antibiotic use
| in agriculture.
|
| https://www.fda.gov/animal-veterinary/safety-
| health/antimicr...
| culi wrote:
| I wouldn't call it low-hanging fruit considering just how
| dependent large-scale animal agriculture is dependent on
| antibiotics
| mdavis6890 wrote:
| This would mean either that we would have a lot less food,
| or we would have to divert a lot of effort from other
| productive activities to make it up. Maybe that's okay, but
| still this idea is not free, and not low-hanging fruit.
| throwoutway wrote:
| From conversations with medical professionals: Antibiotic
| "misuse" is one of the most frustrating things in the field.
| They're taught about antibiotic resistance in school, but then
| contribute to the problem by overprescribing it. The y describe
| the circumstances that patients (and parents) just want "a pill"
| to solve "a problem", and that while the doctors know that it's a
| viral infection, they still prescribe the antibiotics to placate
| the patient/parent. Further compounding the problem.
|
| They'd be better just prescribing placebos or "drink some ginger
| garlic tea and rest"
| cogman10 wrote:
| I have to wonder, though, if it's human prescribed antibiotics
| that source these super-bugs.
|
| It's pretty common practice in the cattle industry, for
| example, to just pump cows with antibiotics because studies
| have shown cows constantly on antibiotics grow fatter than cows
| not on antibiotics. (Likely, because they don't ever really get
| sick). [1]
|
| That makes me wonder how many of our super bugs have origins in
| the livestock industries where common practice is literally a
| recipe to bread superbugs.
|
| [1] https://www.cidrap.umn.edu/news-
| perspective/2020/06/report-s...
| Fomite wrote:
| It's been funny working at the intersection of human and
| animal health. The medical types all want to blame
| agriculture. The agriculture types all respond that they're
| not using major frontline human antibiotics (outside some
| stuff for companion animals).
|
| It's sort of a complex mix - there's a lot of bulk use in
| agriculture, but the drug-microorganism pairings in human
| medicine are somewhat more acute.
| hyperman1 wrote:
| This is one of the contentious points in trade between the
| USA and the EU: The EU does not allow preventive antibiotic
| use, but the USA does. Same for growth hormones. As a result,
| USA meat can not be imported in the EU. USA claims this is
| foul play, protectionism, against WTO rules.
|
| Now the EU does allow curative antibiotic usage on animals,
| so I wonder if this is actually such a big difference. If a
| vet prescribes antibiotics for the slightest reason, there
| might not be much changed in reality.
| Fomite wrote:
| This is certainly a problem when banning antibiotics for
| growth promotion, but allowing the prophylactic use of
| antibiotics.
|
| Any animal in the type of farm looking for growth promotion
| is at risk for a bacterial infection basically all the
| time.
| fennecfoxen wrote:
| Well, that's not covered by my health plan!
| snarf21 wrote:
| Of course, but the US fee-for-service model is aligned
| elsewhere. I think a lot of them think that as long as they are
| not prescribing a z-pack every month, it won't be that big of a
| deal. Also, customer acquisition is hard. Patients will just
| find another primary or go to an urgent care and get the meds
| there. For primary care, being seen as "not helpful" won't just
| lose one patient, but a whole household of them. As you quote
| above, people want a quick fix. The person consuming 3000
| calories of carbs per day wants a magic pill to fix their type
| 2 diabetes _without_ them having to make any changes. I don 't
| envy them.
| nradov wrote:
| SGLT2 inhibitors pretty much are magic pills for type 2
| diabetes.
|
| https://www.fda.gov/drugs/postmarket-drug-safety-
| information...
|
| But of course it's better to prevent the condition in the
| first place.
| MaxBarraclough wrote:
| It seems odd to me that doctors are even allowed to prescribe
| antibiotics when they know they aren't necessary. Why shouldn't
| that be grounds for disciplinary action?
| [deleted]
| cycomanic wrote:
| That's one of the interesting experiences when moving to
| Sweden. One is highly unlikely to be prescribed antibiotics
| here, and one gets prescribed very "old" antibiotics, that my
| partner who was trained in France said are hardly used
| anymore in France due to resistances. When she started
| working as a GP here she found out that it's very hard for
| doctors to prescribe antibiotics, i.e. the conditions under
| which doctors are allowed to prescribe them are very strict.
|
| There's a lot of things that are frustrating about the
| medical system here, but the restrictions on antibiotics is
| one of the very good things.
| MaxBarraclough wrote:
| Sounds sensible, but I imagine it won't do much good if
| it's just Sweden doing it.
| beached_whale wrote:
| There was talk to the placebos on SBM at one point, the gist of
| it being that it would be far worse for them to do so for a few
| reasons. It erodes trust is the big point. But, I assume, there
| would be issues with informed consent too. How does one
| prescribe a placebo where the user can lookup the drug by name
| online.
|
| Not a medical professional, but I think the issue comes down to
| doctors saying no as a group and being ok if they shop another
| doctor. If enough do that, the issue goes away.
| cortesoft wrote:
| Isn't this paper actually debunking that argument (That overuse
| of antibiotics has increased antibiotic resistance)? The paper
| says that resistance didn't diminish when antibiotic use was
| decreased. It seems that our common understanding of how
| resistance develops was incorrect, at least partially.
| commiefornian wrote:
| If there is selective pressure to increase resistance,
| resistance increases over time.
|
| If there is not selective pressure to increase resistance...
| nothing. There is no pressure to change anything relating to
| resistance. It could increase. It could decrease. It could
| stay the same. There is no reason to expect anything in
| particular about it.
| avgDev wrote:
| I do not understand why there is a huge gap between scientific
| knowledge and physicians.
|
| I had a problem with an allergic reaction to an antibiotic.
| This resulted in me actually paying attention to drug labels,
| side effects and what a drug is being prescribed for. It has
| quite literally ruined my trust in doctors.
|
| Last year I had stomach pain, I thought it was appendix. So, I
| went to an urgent care because my physician could not see me.
| They had access to my medical records. Quickly, I receive a
| diagnosis of "Diverticulitis". 2 minutes later I'm given a
| prescription for Cipro, which I'm deadly allergic to. New
| guidelines suggest not using antibiotics in uncomplicated
| diverticulitis. I didn't take the meds, and I'm pretty sure I
| just pulled an abdomen muscle as it healed over the next few
| weeks.
|
| I have many stories from sports injuries and doctors offering
| steroid injections as first line treatment, which is no longer
| recommended.
|
| NSAIDs are also not recommended for tendon injuries and it is
| the first thing the doctor will offer.
|
| I don't get it. The information is easily available. Saying I
| read a study or a updated recommendation gets most doctors
| visibly upset. Not sure if it is the long working hours and
| trying to move as many patients as possible or just lack of
| giving a fuck.
| bserge wrote:
| It's both. On the one hand, I hate the fuckers who don't give
| a shit, I've met way too many of them.
|
| On the other hand, too many times they are overworked and/or
| underpaid. At some point anyone will stop giving a fuck.
|
| Surgeons, dentists, EMTs deserve respect though. Yeah they
| fuck up, but nowhere near as often or bad as those
| responsible for gatekeeping useful medicine.
| peakaboo wrote:
| It's about money and they just want to get rid of you,
| because they are understaffed, overworked and not happy
| people.
| nradov wrote:
| I don't have the citation handy but the Institute of Medicine
| researched this and found it takes about 17 years in average
| to get all physicians to adopt new clinical practice
| guidelines. For physicians with a wide scope of practice it's
| just tough to keep up with all the chances. There might be
| some opportunities to use technology in clinical decision
| support systems that warn about potentially inappropriate
| treatments, but those have to be handled carefully so as to
| not slow down patient care unnecessarily.
| PeterWhittaker wrote:
| It isn't so much a knowledge gap as misalignment between
| patient and doctor interest: there is pretty much zero
| incentive for doctors to follow a non pharmacological path,
| limited incentive for them to follow a more difficult
| pharmacological path, and low to no cost to them for
| following that easiest pharmacological path.
|
| Doctors are highly trained technicians who are well rewarded
| for processing patients quickly and are well protected
| (insured) against the inevitable occasional error, assuming
| such thing can be a) detected and b) proved.
|
| We are better protected from our lawyers and bankers than we
| are from our doctors.
| echelon wrote:
| Warning: anecdotal evidence from a limited perspective.
|
| I did a biochem undergrad and was surrounded by premed
| students. Every single one of them was a North Face-wearing,
| click-y, "there to get the grade" student. They didn't
| display the same kind of awe for the amazing biological
| processes we were learning about, and they certainly didn't
| put in any legwork into undergrad research projects. They
| weren't nerds. They wanted a job with prestige and money.
| Several of them were bullies that talked bad about us and
| were not fun to be around.
|
| I spent my time thinking about human regenerative cloning,
| transfecting biochemical synthesis pathways into things, the
| metabolome, connectome, etc. They used flash cards and
| socialized and would quickly change the subject when talking
| about biology topics. The material didn't matter one bit to
| them.
|
| Complex things were gamed even more. They spent their time
| memorizing o-chem reactions rather than following the
| electrons.
|
| My experience led me to believe that there are doctors that
| are only after the title and wage. They're not domain
| material geeks like us. I just question how many are actually
| like that, because my school was loaded to the brim with
| these people.
| tralarpa wrote:
| That's funny because something similar happened to a friend
| of mine. He was the only biochemist in a class that was
| mandatory for med students. It was about drugs and their
| (side) effects. The professor was so happy that there was
| at least one student in the room who could answer his
| (mostly rhetoric) "why" questions, while the other students
| were just memorizing.
| ianmcgowan wrote:
| "like us". It seems like the developer field has its share
| of Brogrammers and other non-traditionally nerdy types.
| Speaking as a super-nerdy science geek, it's probably not
| all bad that the field has widened - along with the bro's
| you get more women, non-compsci, and people-of-color
| entering the field, if some of the gate-keeping is relaxed.
|
| There are MD/PhD doctors out there at the cutting edge, but
| most docs are more like PC repair techs - swap things out
| until the problem goes away, have a basic understanding of
| the underlying tech. You don't have to be a chip designer
| to swap a motherboard, or follow the electrons to prescribe
| some meds :-)
| vkk8 wrote:
| Exactly what I also wrote. The only people who are really
| good at any complex topic are huge geeks with some level of
| obsession for it. I've met plenty of programmers,
| mathematicians and even some finance people (those people
| work in trading) who are like that, but never a doctor.
| jonshariat wrote:
| Ditto. While I'm sure they get patients who read random stuff
| on the internet, its frustrating that I can often get better
| information searching the internet with a basic understanding
| of how to determine the validity and how damn often thats
| better than my doctors recommendation and understanding and
| how often it changes the treatment path that would have been
| taken.
|
| You absolutely need to be your own advocate because most
| doctors just follow a playbook and/or don't have time to
| think deeply on your issue, and/or don't spend time keeping
| their knowledge up to date.
| cosmojg wrote:
| This is a huge problem, and something really ought to be done
| about it. I'm not sure what that would look like from a top-
| down, structural or regulatory perspective (loosen
| regulations and make it easier to become a doctor so that we
| have more doctors with more time?), but I have some bottom-
| up, individual-level ideas that I described in a comment on
| another post[1]:
|
| ---
|
| > We briefly discussed my anxiety, but his immediate solution
| was the anti-anxiety drug. I made it clear that I was worried
| about the procedure and wanted to know more details about it.
| He didn't want to explain the procedure beyond "we'll inject
| medication that will help preserve your vision", and he
| avoided answering repeated questions. Maybe he tried to
| shield me from the details and not confirm my worst fears.
|
| Based on stories I've heard from emotionally immature doctor
| friends and my own experience being a little more
| confrontational with my doctors, he most likely didn't know
| the answers to your questions and was too proud to say, "I
| don't know."
|
| It seems many forget that, at the end of the day, doctors are
| people, too, with just as many flaws and emotions as the rest
| of us. It's unfortunate that this affects quality of care,
| but it's a fact of life in every industry.
|
| The best thing you can do for yourself in such a situation is
| to prepare yourself before appointments and remember the
| humanity of doctors during appointments. If your doctor is
| being dodgy about answering questions, let them know that
| it's okay if they don't know and that you won't think
| anything less of them for it. If it's an urgent matter,
| suggest looking it up together so that your doctor can
| provide context for whatever research you manage to find.
|
| A doctor is like a contractor you've hired to inspect and
| maintain your body. As with any contractor, if you want them
| to do a good job, you have to work with them, as a team.
|
| ---
|
| And, as a child comment pointed out, if you really don't like
| your contractor, you can always fire them and find a new one,
| and in fact, you should. Don't reward people for bad
| behavior, vote with your wallet, etc. etc.
|
| [0] https://news.ycombinator.com/item?id=29109114
| vkk8 wrote:
| Possible explanation: People who become physicians do so for
| wrong reasons. Medicine is highly paid, high status field and
| thus attracts people who are reasonably smart and just want
| to have a good life, but are, in the end, not very internally
| motivated to keep studying their field. Better system would
| select for people who are more geeky and like to read the new
| antibiotic studies for fun, much like many developers do
| stuff like write their own compilers and file systems for
| fun.
| nradov wrote:
| Have you ever talked to real physicians? Except for a few
| small specialties the pay isn't that great once you factor
| in educational expenses, unpaid overtime, and liability
| insurance. Very few are really in it primarily for the
| money.
|
| We already have a shortage of primary care physicians.
| Imposing additional selection criteria based on some
| arbitrary, subjective measure of geekiness would be
| completely stupid and counterproductive.
| jebronie wrote:
| I know people who got into the medical field because the
| like "Grey's Anatomy". Incompetence and lack of internal
| motivation is everywhere. I think most people are just not
| good at their job.
| getoj wrote:
| To add another anecdote from the perspective of living in two
| countries - the recommendations we get from doctors in each
| country are often polar opposites of each other. Drugs
| available over the counter in one country are outlawed in the
| other, and vice versa. Information from a trustworthy source
| in one language is called pseudoscience in the other, and
| vice versa. Meanwhile, the health outcomes do not seem to be
| significantly different in either place. I am less and less
| convinced by anything my doctor says, in any language.
| nradov wrote:
| At the population level, outcomes are driven mostly by
| public health measures (clean water, food safety,
| vaccination) and cultural factors (obesity, substance
| abuse). Individual healthcare interventions barely move the
| needle.
| darkerside wrote:
| Urgent care doctors in particular are basically glorified
| pharmacists. I will never go to an urgent care unless I know
| what it is and how to fix it, and I just need their
| signature.
|
| If you need real help, go to an emergency room or wait for a
| specialist.
| nostromo wrote:
| I don't buy that the primary issue is with human antibiotic
| use.
|
| Doctors have become increasingly stingy with antibiotics,
| sometimes at the expense of human well-being -- meanwhile 80%
| of antibiotics are used in livestock production.
|
| We could reduce the need for antibiotics in livestock if we
| treated animals better. Giving animals a bit of breathing room
| and fresh air would reduce the need to jack them up on
| antibiotics from day one.
|
| Reducing use in humans seems like banning straws to take on
| plastic waste -- a feel good policy that won't actually fix
| much.
| sattoshi wrote:
| > In reaction to the antibiotic resistance problem and with
| treatment options dwindling, public health officials attempted to
| control antibiotic usage as a means of controlling resistance
| (20). The expectation was that rates of resistance would diminish
| as antibiotic usage dropped. However, resistance persisted even
| in the face of such drug management practices on both small and
| large scales (20-23).
|
| This makes perfect sense to me. Why did this not work? The
| article continues with an explanation of "the ecological fallacy"
| but I don't understand how the two are supposed to be connected.
| rudyfink wrote:
| From "The Demon Under the Microscope" by Hager--an interesting
| read on the history of Sulfonamides (the drug that kicks off
| the "golden age of antibiotics on the chart)--usage was
| entirely uncontrolled and people did not complete drug regimes.
| Generally (and I'll probably get this very wrong), that
| antibiotic worked by blocking uptake of external energy
| sources.
|
| The drug was tremendously effective and widespread. The book
| made it sound like all of the strains that did not evolve a
| solution to that antibiotic were completely wiped out by the
| evolutionary pressure of the antibiotic.
|
| I'd imagine (just guessing) that even if the antibiotic was
| stopped, the organisms would not have anything like the
| evolutionary pressure to change back (and the consequence of
| getting wiped out by the drug if they did). They probably get
| along "good enough" or the drift back is slow. In other words,
| the pressure to change was one of, essentially, absolute
| survival, while the change back is one of risky convenience.
| christkv wrote:
| There are so many exiting old antibiotics that might be
| possible to repurpose however no money or willingness to
| qualify them
| https://www.sciencedirect.com/science/article/pii/S1198743X1...
|
| I guess there is no money in requalifying an out of patent
| antibiotic.
| Fomite wrote:
| The problem is that there was a very compelling "just so" story
| that antibiotic-resistant bacteria are inherently at a
| competitive disadvantage vs. susceptible bacteria absent
| selective pressure.
|
| Take the antibiotics away, and the resistant bacteria will
| follow.
|
| Unfortunately, microbial ecology is much more complex than
| that, and it hasn't panned out that way. Often because
| resistance plasmids _also_ carry other helpful genes. For
| example, I 'm currently working on a study where there's high
| levels of antibiotic resistance to an antibiotic that _isn 't
| used_ in that population because there's other things hanging
| out on the same plasmid.
|
| Also note: That's not what most people mean when they say
| "ecological fallacy", which is a statistics term.
| jessriedel wrote:
| Not all proposed evolutionary mechaniams that turn out to be
| false, much less merely incomplete, are just-so stories. The
| fact that the hypothesis was simple makes it _more_
| reasonable.
| Fomite wrote:
| Yeah, but this was _very much_ a just so story.
| wonnage wrote:
| The hypothesis was that resistance mutations would negatively
| impact fitness (as mutations usually do), so natural selection
| would prefer no-resistance once the antibiotics are stopped.
| But instead it looks like once resistance has evolved it
| doesn't go away, suggesting that it comes at no cost to
| reproductive fitness.
| brazzy wrote:
| Not necessarily at _no_ cost - but not at a cost greater than
| the advantage of having the resistance, which is still
| massive since the use of antibiotics is not in fact stopped,
| just reduced.
| User23 wrote:
| I'm a little disappointed that this isn't an article about how
| fungi became the world heavyweight champions of cellular level
| biological warfare.
|
| I've often wondered if we could let the fungi do the work for us,
| and maintain colonies that are periodically challenged with
| organisms of interest, such as ones that have broad resistance,
| and see what they come up with as a way to create new
| antibiotics.
| alan-crowe wrote:
| The article makes much of the pairing of antibiotic production
| genes and antibiotic resistance genes. They often occur on a
| single plasmid and are passed around together.
|
| But there must be different facets to antibiotic resistance
| genes, because a bacterium that is producing an antibiotic needs
| to avoid being poisoned by it. Perhaps some genes produce
| antibiotic resistance by coding for proteins that metabolize the
| antibiotic. Such genes are not helpful when paired with
| antibiotic production because they are destroying the antibiotic
| as fast as the other genes produce it.
|
| By contrast, some antibiotics work by destroying the cell walls
| of bacteria. Presumably some antibiotic resistance genes work by
| coding for resistant cell walls. And a bacterium that is
| producing such an antibiotic had better have such resistance
| genes or it will end up destroying its own cell walls.
|
| The article is silent on the differences between antibiotic
| resistance genes that a producer needs, to survive its own
| antibiotics, and antibiotic resistance genes that a producer
| mustn't have, to avoid sabotaging its own production.
|
| The article raises the issue of mutualism between different
| species of bacteria, with shared resistance and production genes
| letting the diverse community resist outsiders. Perhaps that is
| already a complicated story without adding in different kinds of
| resistance genes.
| mrtweetyhack wrote:
| for the same reason biotics exists
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