Antibiotic-resistant bacteria (now on your junk)

Speaking of Superbugs, it looks like we're on our way to incurable, antibiotic-resistant gonorrhea. This article also brings up a point I didn't mention in the book review yesterday: Part of the problem is that nobody is developing new antibiotics. Once an old drug becomes ineffective, there's nothing to replace it with. New drugs could be made, but the work (as with any brand new drug development) is expensive, and pharmaceutical companies aren't inclined to invest in products with a limited effective life, that patients only use for short periods of time.

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

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Glindie

I wouldn’t place all the blame on GPs. I’m sure many of them feel their hands are tied–patients *want* to be prescribed antibiotics–they want to get better; that’s why they’re at the doctor, after all. They don’t want to hear “come back in a week and if you’re still sick, then we’ll see”. *Especially* if their child is sick. It’s one hell of a catch-22. It’s easy for us to rail against the “evil” GPs and their over-prescription of antibiotics, but the general “we” is just as much to blame as they are. GPs need to put food on the table just as much as the rest of us.

You could say “but they should know better”! Maybe *now*, yeah. *Maybe*. I’m not sure my nurse practitioner at the free clinic in The-middle-of-nowhere, Arkansas which I have to go to b/c of my insurance has any idea of the implications of over-prescribing antibiotics. *shrug* And I *know* that when antibiotics were first invented, and for a long time afterward, doctors had no idea that they would lead to the “super-infections” we’re seeing today. I stand by my idea that most nurse practitioners/GPs *still* don’t know that.

As for the pharmaceutical companies? They’re out to make money. That’s what they *do*. The capitalist/political scientific climate of the United States makes what they do possible. *shrug* It irritates me to no end that the people providing substances necessary to save people’s lives are also corporations out to make as much money as possible (i.e. a company, ;) ), but that’s the way it is, and I have to live with it.
DrPretto

For people interested in nanotechnology and bacteriophage (which I wrote about on my post #9)
Nanotechnology: Artificial Pore Created
http://www.sciencedaily.com/releases/2009/09/090928131020.htm
How Viruses Destroy Bacteria:
http://www.sciencedaily.com/releases/2009/11/091118143221.htm
http://en.wikipedia.org/wiki/Phage_therapy
http://www.phagetherapycenter.com/pii/PatientServlet?command=static_home
Anonymous

Please don’t start the viruses/virii war here. I will explain why you shouldn’t, and then please let us never mention it again,

“Viruses” is correct for pluralizing the kind of virus that infects your mammalian physical body. There is ZERO disagreement here among English grammarians, unless someone is stupid enough to start it.

“Virii” used to be the plural for the kind of virus that infects your computer software. Then in 1999 Tom Christiansen wrote a retarded epistle that claimed that because it’s not proper latin (neither is “viruses”) nobody should ever use the term virii. Because Tom is a perl Ghod, the perl groupies picked it up, and some obsessive personalities on Wikipedia got infected with the meme, and now it’s a decade-long flame war that serves no purpose except to eradicate a functional distinction that once made it easy for people like me to use search engines intelligently. You see, I need to know about both kinds, and I don’t have time to read every single link on google to find out which is which. Having separate terms was useful and forcing the use of the same term for two similar things is just being a pedantic dick. That sort of dickishness is why we can never have a semantic web!

To Tom’s credit, he has pulled his essay from the web. It’s easy to find copies of it, though.
GetItOffMe

This is scary, but unsurprising news. I live in Bangkok and the clap is utterly rife. Because it’s largely asymptomatic in women sex workers are a major infection vector. One can buy most classes of antibiotics over the counter here so the place is a hotbed of resistant strains.

The normal size of a condom here is 52mm (girth, thanks) and, not to brag, but they break all the time when used by those of us of a non-Asian background. Pretty much a recipe for disaster, not to mention awkwardness.
OrcOnTheEndOfMyFork

#33, allow me to show you how big a condom can get. I think you really need to see this… you’ll understand why.
http://www.youtube.com/watch?v=As3pRa9O1VM
NeonCat

What if in addition to improved antibiotics, we also developed fast and effective field tests for STDs? If you could swab each others’ genitals & mouths and get an indication from a cheap test on what, if anything, you have, you could take extra precautions as well as know that you need (or still need) treatment.

I will grant there would be widespread objections to this, from religious/moral zealots who have no problem with their being wages of sin to the lawsuit happy who will sue over false positives/negatives to abusive parents who will test their children to see if they are sexual active.

There would also be spin-offs to other bacterial diseases, too, I suspect.
diorio

So is BoingBoing now promoting longer patent rights for pharma companies? That last sentence made me think I was at another site!
- Lobster
  
  Sometimes it’s OK to believe facts you don’t like.
- Maggie Koerth-Baker
  
  Um, then you need to read it again.
  
  Effective life has nothing to do with patents and everything to do with bacterial evolution. Some antibiotics start being resisted less than a year out of the gate. And you don’t really know which ones will last and which won’t.
- Chevan
  
  I don’t think patent rights come into the issue at all. The problem is that because of our treatment habits the drugs themselves have a limited time in which they remain effective, not that there is a limited time in which the drug turns a profit for a company before becoming generic.
Anonymous

Your problem isn’t just over-prescribing by doctors.

Perhaps you already know: someone’s already mentioned feedlots and ‘growth promoters’.

We’ll never know if the exact cause of all those deaths by Vancomycin-resistant bacteria was the misuse of ‘Virginamycin’ and ‘Avoparcin’ down on the farm: but the first patients to die when Vancomycin, the ‘antibiotic of last resort’ didn’t save them were clustered around large-scale intensive pig farms… Where continuous doses of low-cost agricultural-grade congeners of Vancomycin were used to give a small but profitable boost to the conversion of feed into bacon.

The inevitable result was (and still is, because the process is continuing) the evolution of resistant bacteria.

The antibiotics we’ve got left aren’t as good, and many of them have toxic effects on the kidney and on the nervous system – I know a girl who had the nerves that control her bladder damaged by one of the drugs we now use *routinely* for postoperative treatment in penicillin-sensitive patients; and she has, at the age of 16, a problem that is the death of a teenage girl’s social life and whatever she had hoped would be a sex life… But the life she’s got is way better than having your kidneys destroyed. Or being dead.

You hear cases like that – and, sooner or later, ‘you’ will mean YOU – and it gets personal.

European countries have banned the use of ‘growth promoters’ on the farm. You can treat a sick animal, but you can’t administer a pervasive low dose to healthy ones for commercial gain. A difficult decision, given the political power of the farming lobby, and Britain isn’t the only EC country where ‘regulatory capture’ means the regulations aren’t always enforced.

But we took he step. Can you? I believe that there is absolutely no way that the corrupted polity of the United States of America can enact and enforce such a law against as influential a voting bloc as the farmers, and their superbly-organised lobbyists.

You can disagree with that assertion as politely as you please, or as rudely. But this has been a known public-health issue for twenty years and, as your fellow-commenters well know, growth promoters are still in widespread use in the feedlots.

Whatever your opinions on the political process, you’ll take it personally when someone you know comes up against resistant bacteria.

…Or viruses. Did you ever pin down that story from China, about a chicken farm using Tamiflu in low doses as a growth promoter during the H5N1 scare? If the farm was a work unit of the Peoples’ Liberation Army, they were (and are) by definition above the law. The only reason your nearest chicken farm isn’t feeding the flock pervasive low doses of antivirals is economics: there’s no cheap and readily-available agricultural-grade congener of the medical antivirals currently in use.

But there will be: and the destruction of at least one antibiotic’s medical utility – and profitability! – is associated with the greed and stupidity of marketing and selling a related ‘growth promoter’ from the agricultural products division of the same drug’s manufacturer.
Glindie

I have nothing important to add to the discussion. I just stopped by to say: this headline made my day. :)
Nobody Special

Why would pharma companies pass up development of a high-profit drug merely because the volume of sales consists of a higher number of patients for a shorter time, rather than a lower number of patients for a longer time?
- Maggie Koerth-Baker
  
  They aren’t.
  
  They’re passing up “brand new development, high number of patients, short time periods and who knows how long the drug will be effective” for “cheaper re-formulating, high number of patients, long amount of time”.
  
  Maryn McKenna’s example: Would you, from a purely monetary standpoint, rather be investing in a “new” Viagra-style drug that healthy men take regularly for decades, or a from-the-beginning creation of a new antibacterial?
professor

I agree we need a new method to fight bacterial infections… nano-copies of the ACTA agreement injected into the bloodstream perhaps? That should scare the little buggers away!
Anonymous

This was one of the good things in the soviet regime.
They diverted a lot of funds to research and education, particulary in the medical field, for the benefit of the people and not for financial gain. (For instance the heavy focus on alternative medicine as a substitue to the conventional one…)
Of course most of the universities do perform researches like that, but not in the same scope, direction, availbility and education of the public…
Anonymous

I don’t know if keeping unsafe drugs from the market is such a bad thing…
Sure it puts aditional cost on the companies but overpricing is usually depends on percentage of revenue. And if the drug fail the tests…well than its good that it isn’t on the shelves.
The only thing is, if what you are saing is true, than the FDA needs to be consistant and not screw up someones business model in the middle of its execution. Drug companies should be able to calculate more accurately their expenses (although reasearch business can’t be that accurate, you cant always tell when your research will be finished).
wetzel

You could turn an old antibiotic into a new antibiotic by taking one off the market for a decade. When you bring it back the bacteria populations will have lost resistance. Resistance plasmids are expensive to hold onto and without selective pressure the bacteria revert to being non-resistant. Such a program like would require extensive study and cooperation among manufacturers though.
- HerkyDerky
  
  I can’t site this (I read it a long time ago) but your assumption is not 100% true. Some plasmids make the bacteria stronger in other ways, and selective pressure keeps them around despite taking the drugs off the market.
JulianR

Nobody is developing new antibiotics? The university of Jena, Germany, is! http://tinyurl.com/3437q8d
Reverend Loki

#1: That’s the thing – if you are going to restrict the length of pharma patents and reduce the motivation for pharma companies to R&D new ones, it needs to be accompanied by increased R&D budget for University and Hospital research. Of course, the idea being that patents for those results belong to the public trust. I don’t think we’ve seen much of the second half of that equation.

#2: Shortening the term of the patent doesn’t by any means imply that the volume of sales during that term will increase.
DrPretto

Yes, this is a really BIG problem, we physicians are facing many bacteria that in the past were sensible to common antibiotics like penicillin, and now are resistant.
But I am sure the next step will be using genetics to create virus that destroy bacterias (bacteriophagus) or nanotechnology, nanobots that do the same. Until then we are still locked on antibiotics.
- Stefan Jones
  
  Of course, Mexican pharmacies will then start selling nanotech drugs over the counter, and feedlots will start dosing cattle with them, and we’ll end up with nanotech resistant bacteria that shoot bullets and infect people through Facebook.
- donniebnyc
  
  Shouldn’t a doctor know:
  
  - Sensible is not the same as susceptible.
  
  - Virii is the plural of virus.
  
  - Bacteria is already a plural; no “s” is needed.
  
  DrPretto: I’m not really a doctor, but I play one on the interwebs.
  - DrPretto
    
    Yes I am a medical doctor, and please excuse my bad english, I was born and live in a third world country called Panama in Central America, and here we speak spanish and I learnt english almost by myself.
    - donniebnyc
      
      I stand corrected, and I apologize.
      - DrPretto
        
        No problem my friend.
  - DrPretto
    
    As a clinical physician we use sensible and suceptible as synonyms. When we receive the Bacteriogram report from the lab, Bacteria are classifieed as:
    S = SENSIBLE
    R = RESISTANT
    I = INTERMEDIATE
    For sure we only use the antibiotics for which that bacteria is sensible, if the infection is severe (sepsis) we do not wait for the lab results, we start the treatment empirically.
  - kc0bbq
    
    “Virii is the plural of virus.”
    
    No, it’s not. It’s viruses. If it was virii, it would have to be virius. That’s assuming it, also, followed the Latin.
    
    Though, I think Virius is a name.
  - TooGoodToCheck
    
    Christ dude. DrPretto’s first language isn’t English. Being an anglophone should not be a prerequisite for being taken seriously.
    
    so. . . please don’t be a dick. thanks!
    - DrPretto
      
      Thanks, my friend.
      I know the nanobots and nanotechnology sounds futuristic, but I really think we wont be using antibiotics forever, bacteria already is winning antibiotics war.
theultramusicgeek

I personally think that we need more push into alternate methods of removing infection or disease. I’ve done some research into bacteriophage/virophage therapy, and it seems to work really well when you know what you’re dealing with. The problem is that microorganisms like bacteria and viruses mutate and evolve incredibly fast- within a few months or even weeks. Once we start a treatment type, the agents will just evolve to match. These things were built to survive and will do so at any expense. But, if you have something that can destroy them easily and near-universally (things that eat them, for example), then we have a chance.
Anonymous

So what this article is saying is “don’t swallow”?

Love the captcha I got btw, “lifestyle”(s). This captcha brought to you by Trojan brand condoms.
Anonymous

The FDA is squarely to blame here. They put out these statements that, ‘oh yes, please, develop new antibiotics’ then when a company does (c.f. Replidyne), the agency changes the goalposts, requires them to do yet another mind-boggingly expensive trial (around $40M a pop, and oh yeah, you have to do TWO!). Whoops. Company goes bankrupt, can’t raise another round and is forced into a merger with some medical device company. This story has been repeated over and over the past decade. We’ll develop new anti-biotics when, and only when, the FDA makes up its mind as to what is “acceptable” to them. Until then, yes, it’s a heck of a lot easier to make a “new” drug with a proven mechanism, like another Cialis, Lipitor, etc etc.
Orpheus84

What’s the point in creating a new antibiotic? The ones we have are failing to work now through overuse by GPs who are prescribing them for viral infections/colds, for which they are useless, but it’s a lot easier to get a patient to go away by giving them something to take instead of saying ‘wait a week and it’ll go away on its own’. As a kicker, the antibiotic will probably work wonders as a placebo.

As an idea, if the patent life on a new, working antibiotic was extended, the pharmaceuticals could charge a bit more for them (than the generic companies) for longer and maybe the doctors would be less inclined to dish them out, and the NHS wouldn’t buy it. So maybe it would take longer for bacteria to become resistant to it. /Pure speculation based on nothing other than the contents of my head/

Not that I’m saying that the pharmaceutical companies are blameless, going after the diseases which are big moneyspinners (I’d say as a consequence of being in a capitalist system). I’m just saying that they’re not the ONLY ones to blame.
Anonymous

I don’t think the blame for the lack of new antibiotics lies solely with greedy pharmaceutical companies. The legal and regulatory climate in which they operate is very different, and much more hostile to new development, than it was decades ago when the current crop of antibiotics were developed. The safety and testing regimes that new medicines must undergo are very expensive and time-consuming, and even if the company complies with all the regulations needed to get approval, it doesn’t shield them from a lawsuit from someone who thinks the medicine caused them harm. Given the high up-front costs and the risk of massive judgments in a lawsuit, it’s not surprising that the development of new pharmaceuticals has slowed down so much.
Anonymous

Nobody Special â€¢ #2 â€¢ 10:07 on Thu, Apr.29 â€¢ Reply

“Why would pharma companies pass up development of a high-profit drug merely because the volume of sales consists of a higher number of patients for a shorter time, rather than a lower number of patients for a longer time?”

Yes, because with the way things are going, they’ll be accused of acting “unfairly” by charging a lot and get regulated out of their product and/or weâ€™ll allow reimportation from Canada (where they regularly threaten to nullify patents in the name of consumer â€˜protectionâ€™).
Anonymous

Snig â€¢ #27 â€¢ 13:44 on Thu, Apr.29 â€¢ Reply
We don’t need to create patented drugs. It’s our current system, but we can directly invest in resarch. It’s how chemotherapy was initially developed.
http://en.wikipedia.org/wiki/History_of_cancer_chemotherapy
Yes, it’s harder to get approval these days, partly for good reason, but we wouldn’t have to spend money on marketing.

“In the future, archeologists of the next civilization will wonder why we all died of a plague, despite having the resources and technology to to fight the disease. We were somehow beholden to this strange professional class called “pharmaceutical lobbyists” and they would not allow us to develop drugs without them, but the laws of their craft would not allow them to develop the drugs the civilization needed.”

No, itâ€™s that the government has ruined most of the vaccine makers by virtue of being their biggest customer and not paying real fair market values (ah, [almost] single payer….)…. and the FDA’s rules not making it practical to do work with things like phage therapy.
Snig

We don’t need to create patented drugs. It’s our current system, but we can directly invest in resarch. It’s how chemotherapy was initially developed.
http://en.wikipedia.org/wiki/History_of_cancer_chemotherapy
Yes, it’s harder to get approval these days, partly for good reason, but we wouldn’t have to spend money on marketing.

In the future, archeologists of the next civilization will wonder why we all died of a plague, despite having the resources and technology to to fight the disease. We were somehow beholden to this strange professional class called “pharmaceutical lobbyists” and they would not allow us to develop drugs without them, but the laws of their craft would not allow them to develop the drugs the civilization needed.

I’m not for breaking a system that isn’t broken, but this process is broken, and wating for this to be somehow profitable for drug companies seems a ridiculous strategy.

There are other work arounds, using both public health measures and new technology, but it’d still be helpful to develop new classes and types of drugs.