[HN Gopher] What was the Golden Age of Antibiotics, and how can ...
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What was the Golden Age of Antibiotics, and how can we spark a new
one?
Author : surprisetalk
Score : 39 points
Date : 2024-12-23 15:24 UTC (2 days ago)
(HTM) web link (ourworldindata.org)
(TXT) w3m dump (ourworldindata.org)
| chiph wrote:
| Stop administering them whenever anyone gets a sniffle so they
| stay effective longer. Also firmly separate veterinary antibiotic
| classes from human antibiotics so that the ones intended for
| humans stay effective longer.
| Spivak wrote:
| The problem with a policy like this is that in practice rich
| people will get antibiotics whenever they (we? hn is well off
| enough to cont as rich for this perk) want and everyone else
| suffers. It will for sure also summon the racist underbelly of
| the US where doctors will believe white sympathetic patients
| when they say how long they've been sick and question everyone
| else. This will deal double damage if you try to enforce any
| kind of quota.
|
| I can afford to go to a nice doctor who will prioritize my
| comfort and who will literally tell me what to say to meet the
| criteria but anyone with less choice will have to fight.
| whatshisface wrote:
| Judging the need for antibiotics is not some kind of
| personality quiz, bacteria can be cultured. (I'm not sure why
| they don't usually do it.)
| queuep wrote:
| Sure, but on a global scale the rich are a small percentage
| of the world population.
|
| Some countries are very restrictive on prescribing
| antibiotics (almost too strict) and it feels like it falls
| flat as you can get it over the counter in a lot of places.
| _zoltan_ wrote:
| In Switzerland it's tough to get antibiotics unless you
| absolutely need them. Even when I had a lung issue for 2
| weeks I had to beg to get antibiotics. Weird. And they are
| not available over the counter.
|
| In Hungary, on the other hand, they hand them out like
| candies.
|
| So yes, the solution was to import them from Hungary. :-)
| epcoa wrote:
| > get antibiotics unless you absolutely need them.
|
| Yes that's exactly how it should be. They are not at all
| benign misprescribed.
|
| > Even when I had a lung issue for 2 weeks I had to beg
| to get antibiotics.
|
| Was there any evidence of a bacterial infection or did
| they just give in? 2 weeks is not a long time for a viral
| respiratory illness either.
| _zoltan_ wrote:
| they didn't give in, but I actually checked hospital
| internal guidelines for doctors, and it states 3 weeks.
|
| They could have done some more tests or whatever, as it
| was maybe the worst lung issue I've had and I was really
| miserable. I knew that antibiotics would help, and they
| did. I sourced them myself.
|
| You could say lucky guess, but after I complained to my
| health insurer about the bad doctor's visit, they covered
| the cost fully without any dispute, so they must have
| agreed with me with at least about maybe running some
| more tests...
| gus_massa wrote:
| If it was "only" [1] a viral disease, it should dissapear
| even without antibiotics after a week or two. So perhaps
| your body solved the problem alone, while you took
| antibiotics that had no effect.
|
| This is a real posibility and is a real problem to test
| how useful the medicines are. So all serious studies use
| a control group [2] to compare the rate of spontanous
| healing with the rate of healing with the antibiotic.
|
| [1] Some virus are very nasty and can kill you. People
| confuse the common cold andd the flu, but usualy the flu
| is much worse.
|
| [2] Preferabely a preregistered double blind randomized
| control group, becuse there are a lot of other problem
| that can cause a false result.
| dillydogg wrote:
| I find this is so frustrating to describe to patients.
| There really is a limited scope of appropriate outpatient
| antibiotic use.
| epcoa wrote:
| > I can afford to go to a nice doctor
|
| If your doctor is giving you antibiotics for clearly viral
| illnesses they are doing a disservice to you, it isn't
| actually nice. It's not like I've ever seen some systemic
| withholding of antibiotics when they are clearly indicated -
| quite the opposite, some of the worst areas for resistance
| are the poorest. They aren't without other side effects,
| resistance being only one.
|
| Also you have it backwards, the racist thing to do is to just
| prescribe the antibiotics, since they are dirt cheap, cost me
| (the provider) nothing, and makes the person whose skin color
| I possibly don't like get out of my office faster (if not
| racism, pragmatism to see too many patients). Racism alone is
| not necessarily the only explanation, but antibiotic over
| prescription/use tends to be associated with poverty.
|
| Well run antibiotic stewardship is a conceit of the most
| affluent health systems.
| PessimalDecimal wrote:
| > It will for sure also summon the racist underbelly of the
| US where doctors will believe white sympathetic patients when
| they say how long they've been sick and question everyone
| else.
|
| You're trying to shoehorn an unfounded accusation of racism
| into a discussion about antibiotics. This sh*t is tiresome.
| PittleyDunkin wrote:
| > Stop administering them whenever anyone gets a sniffle
|
| This hasn't been true for most of my life and it remains a
| serious concern.
|
| Not to mention antibiotics often come with seriously nasty side
| effects of their own, so you as the patient even wanting the
| best outcome shouldn't even necessarily want antibiotics.
| foobiekr wrote:
| It is not an issue in the US.
|
| It is a massive, massive issue in some very large countries.
| PittleyDunkin wrote:
| Ahh yes, very fair.
| ipaddr wrote:
| It is still a big issue in the US even if it is more
| massive elsewhere plus we use it in the meat industry to
| the point where certain types of antibiotics cannot be used
| anymore.
| fnordpiglet wrote:
| In most of the world, by population, the regulatory structure
| of society is so weak that there is no way to achieve this.
| Antibiotics are available without prescription, licensed
| doctors of skill are rare, and patients are insistent on
| antibiotics for everything. In most developed countries doctors
| are already parsimonious with antibiotics and generally won't
| prescribe them unless an infection is observable. But in most
| of the developing world it's prevalent to over administer
| antibiotics either through clinics are directly at the
| unregulated pharmacies.
| AyyEye wrote:
| > In most developed countries doctors are already
| parsimonious with antibiotics and generally won't prescribe
| them unless an infection is observable.
|
| Antibiotics as 'consolation prizes' is definitely a thing.
| PessimalDecimal wrote:
| Overuse and misuse of antiobiotics isn't really a US thing.
| https://resistancemap.onehealthtrust.org/AntibioticResistanc...
| is a nice, interactive map showing where the majority of the
| resistant strains are found. Any effort to curtail the emergence
| of antibiotic resistant bacteria will require coordinated global
| action, which means it's highly unlikely to happen.
| api wrote:
| Agricultural overuse is also a major vector.
| nimish wrote:
| Do we need one? Quarantine them from the countries that can't or
| won't enforce discipline on prescription and the problem solves
| itself.
| bigmadshoe wrote:
| Insane take. What about the people with life threatening
| infections in those countries? Just collateral damage?
| voidfunc wrote:
| Sucks to be them?
| old_king_log wrote:
| This poster has +2551 karma. Stay classy HN.
| aurizon wrote:
| Doctors and their 'fee for service' mentality are, in part, at
| the roof of this. They know an antibiotic is a waste of $$ for a
| viral disease, but the money meter ticks upwards.
| fnordpiglet wrote:
| I think the UN or governments themselves should get into the
| business of bad business medicine. The fact drug companies are
| prioritizing research of chronic medications is an obvious
| outcome of our current structure. The government or quasi
| governmental organization can continue to subsidize industry
| research and buy licenses for discoveries they then productionize
| at cost. This wouldn't directly compete with industry and it
| would incentivize public private research across large areas of
| otherwise unprofitable areas of medicine such as this.
| evrimoztamur wrote:
| This is what the Turkish government has been up to and it has
| driven drug costs, and therefore overall costs of healthcare
| provision and insurance, down. More countries should
| nationalise production of generics, it works.
| xyzzy123 wrote:
| We also need regulation (and effective enforcement) as much as
| research.
|
| Even if you discover a groundbreaking new antibiotic under
| current incentives it's going to get fed to pigs in China until
| it's useless.
|
| Arguably the kinds of antibiotics we need the most are ones
| with significant side effects; effective enough that they can
| save humans but with side effects that are severe enough that
| they are not over-prescribed or fed to livestock.
| dartos wrote:
| > Arguably the kinds of antibiotics we need the most are ones
| with significant side effects
|
| I don't think there can be a better example of perverse
| incentives than this.
| johnea wrote:
| #1 thing that could be done in the US would be to stop using so
| many of them.
|
| Especially in agricultural animals...
| Faaak wrote:
| Sad that the article is not talking about bacteriophages[1].
| Basically viruses that infect other bacteria. The world is full
| of them (and even virophages: viruses that infect other viruses).
| The soviet union started experimenting them, and they seem to be
| used to treat hard-to-cure infections like Staphylococcus aureus,
| but I guess it died down somehow?
|
| [1]: https://en.wikipedia.org/wiki/Bacteriophage
| MoreMoore wrote:
| From the bits and pieces I've heard, the problem is one of
| scaling. Bacteriophages had to be made bespoke for a specific
| patient.
| pazimzadeh wrote:
| Most new antibiotics come from soil bacteria. We got all the low
| hanging fruits, now you need to dig through tons of soil to find
| something new., Better culture methods would make it easier to
| run experiments instead of relying on genome rather than relying
| on /cloning/expression in E. coli.
| vouaobrasil wrote:
| Is there a danger that with more sophisticated antibiotics, we
| could eventually eradicate too much good bacteria?
| xandrius wrote:
| More sophisticated, I'd expect more precision not just more of
| the same (and bad) old.
|
| Now we just wreck havoc of absolutely anything which is a
| bacteria, it would be nice to be able to select the typology.
| cyberax wrote:
| This article misses several new antibiotic classes that are
| emerging: macrocyclic peptides, and a bunch of compounds from
| unculturable soil bacteria (clovibactin, teixobactin, etc.)
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