Running out of anti-biotics really a major threat?

I know anti-biotics are over used and there is a real concern that we should be aware of. But is it realistic that “the germs will win” and we’ll be back to a scenario like we were 100 years ago where people regularly die of infections from minor wounds?

Seems to me science will stay ahead of the germs. We have alternatives to anti-biotics, phage viruses and we seem to be almost at the stage where we could genetically engineer a virus to target specific bacteria. Of course we’re also much much better at supportive care, so even if we can’t directly kill an infection, you can put someone on an IV and provide whatever else is needed to give the bodies immune system the best chance to fight it off.

Barring a civilisational crash (in which case we have other problems), I just don’t see the germs getting ahead again. What say the dope, am I putting too much faith in Science?

Last year a lot of people were close to panic due to the Ebola virus. Predicting the imminent destruction of human civilisation everywhere. For some reason some people just have it best if the end is nigh.

There’s a lot of work being done on antibiotic development at the moment. While superbugs are, obviously, a serious medical concern, I think a lot of the “antibiotic apocalypse” hype is just that; hype.

Pew Trusts - Antibiotics Currently in Clinical Development.

Would we have made the progress if we weren’t frightened? Kinda like global warming. If we get lucky and smart both, and make major advances in sustainable energy, cheap green energy everywhere…and then we find out that global warming was bogus…what, we give the knowledge back? Tear it all down because we did it for the wrong reason?

Monkey-boys are usually stupid when they are scared, but sometimes it can provide focus and concentration.

The traditional antibiotics are very cheap. The new super drugs are very expensive. A large proportion of the world’s population will be priced out of the market for these new drugs.

Except that India and Brazil have both shown they have no problem with ignoring patents and making cheap generic versions of drugs when its in the public interest.

Why do you believe that? It sounds like wishful thinking to me, albeit thinking that I share.

Ok imagine what can be done if a multiple resistant antibiotic strain of staph becomes rampant. If a “manhattan project” style unlimited budget focus gets put on this with barriers removed from quick approval from clinical trials then I’m sure we can new medicines out quickly. Worse case scenario millions of people would die before we have new meds but that wouldn’t be the end of the world. See the 1918 flu pandemic for an example.

And Phage Therapy seems very promising as a alternative to anti-biotics.

Someone correct me if I’m wrong…

Ok. Millions dying until a massive project with an “unlimited budget” achieves results doesn’t sound quite like “staying ahead” to me, though.

It all depends on how many years it takes until we catch up again. And yes I guess I admit thats a matter of faith in science. But so far I have no reason to believe we won’t catch up again.

Phage therapy is exciting (and not new, but rather older than antibiotics!), to be sure, but the news isn’t doing a great job of explaining their biggest drawback: they are so, so specific. They can only be used against one single bacteria strain. To use it therapeutically, you have to take a culture of the wound and grow the infection causing bacteria, which can take months. Lots of people will be dead of their sepsis before you’ve gotten the correct phage produced.

You know how they have to retool the flu vaccine every year because the virus mutates so much? You’re talking about a therapy that requires you to make the medicine match each case.

Please show that some authoritative source–not doomsday preppers or fundamentalist apocalypse fanatics–predicted “the imminent destruction of human civilization everywhere”. There was legitimate concern that the Ebola outbreak in Guinea and Sierra Leone could become unconfined, and in fact, that happened as the outbreak spread to Europe and the United States. Since Ebola is not treatable and palliative care has little effectiveness on mortality rates, an outbreak is of genuine concern. However, ebola can only be spread by transmission of bodily fluids; while it can aerosolize, it doesn’t survive long in the ambient environment outside of the tropics. The more virulent strains have a mortality of around 50%; the strain of the 2013 to 2016 outbreak was less than 30%. The danger out Ebola and other highly contagious virulent diseases isn’t that they’ll kill off the world population or any such nonsense; it is that the efforts taken in trying to contain the spread will have substantial economic and logistical impacts which can interfere with trade and prevent critical aid from getting to people in need, resulting in a large number of secondary deaths.

It is also the case that when it is necessary to develop a new ‘superdrug’ to combat an antibiotic resistant bacterial infection, there is delay as the new drug has to be demonstrated to work without causing deleterious side effects. Or, as many pharmaceutical companies are wont to do, go test the drug on some developing world population and see whether people start dying. The notion that we can some how “scan” a disease-causing organism and concoct a tailored bacteriophage is simply not reflective of the state of the art. Current development of phage therapy modifies existing bacteriophages which are specific to the bacteria in question to prevent replication or function of the bacteria. Bacteria can become resistant to phages just as they can to antibiotics. By the time a strain-specific bacteriophage has been developed and tested, the strain in the wild may have evolved into resistant forms.

As for “But is it realistic that “the germs will win” and we’ll be back to a scenario like we were 100 years ago where people regularly die of infections,” this is already the case. There are nearly an estimated 10 million cases of tuberculosis in the world with nearly 1.5 million deaths last year; most are not HIV-positive so it isn’t just an issue of compromised immune response. Because of an aggressive campaign by the World Health Organization incidence of TB is dropping rapidly and is mostly incident in Africa and Southeast Asia, but it remains a scourge, and a significantly resistant strain could result in a resurgence without careful containment. Effectively combatting and eradicating disease is as much about basic hygiene, clean sources of water and food, and containing the spread of an outbreak as it is about pharmaceutical treatment.


The price issue is an interesting one, and one I hadn’t fully considered until I saw a documentary on this subject a few months back. We’re very used to antibiotics being trivially cheap. We don’t blink (much, anyway) at the idea of spending thousands and thousands of dollars on drugs to fight cancer or AIDS, but we still feel that killing a bacterial infection, which is potentially just as deadly, should be basically free. Developing new antibiotic drugs is just as difficult and just as expensive as developing those chemotheraputic drugs, but pharmaceutical companies know that we’re not going to be willing to pay for them, so it doesn’t make financial sense to focus on them. The drug pipeline is all but empty at this point, apart from a few small groups working on the problem out of a sense of duty rather than any expectation of profit. It’s a tricky conundrum. One potential solution would be for the government to fund the research into new drugs for the good of all of us, but government funding for scientific research is so pathetically reduced right now that that’s never going to happen.

Anyone following TPP (The Trans-Pacific Partnership) and similar trade treaties? While it is too complicated for me my impression is that a primary goal was to guarantee the pharmaceutical companies would no longer have the problem of countries like India and Brazil ignoring patents and making cheap generics (although neither of those two are members of TPP so TPP wouldn’t apply to them I expect similar trade agreements among other countries in the future).

Yes the TPP and TTIP are disgusting corporate power grabs in my opinion. As you say so far India and Brazil have not signed onto them and India in particular I think is very unlikely to agree to anything that stops them making cheap generics. Them doing so would effectively be signing death warrants for tens of millions of their own population that would die from otherwise treatable diseases. They’ll tell big pharma to suck it up and keep rolling out the generics.

Countries like Brazil, India, Indonesia and Pakistan have large populations in addition to big Pharmaceutical industries.

That means that they can make generics and the size of the market means that the large companies cannot ignore them without taking hits; in essence they can tell big Pharma to go pound sand.

Yes, thats pretty much what I said. Thanks for agreeing with me :wink:

It’s a real threat, but not an insurmountable one.

Yes, we probably can make new antibiotics, via a wide variety of methods, including plenty that we haven’t thought of. But there’s no guarantee that we’ll be able to. At some point, we may hit some real barriers. In the 60s, everyone thought that we’d all have our own private jet planes by now, but it turns out that there were physical and economic barriers to that sort of progress, so we don’t. It’s hard to predict what kinds of barriers we’ll run into that will slow or halt development of new antibiotics.

The additional wrinkle is that many of the problems with antibiotic use and resistance are cultural, economic, and systemic, rather than medical in nature. These are classic tragedy of the commons issues. Antibiotics are overused because each individual actor has an incentive to use more, even though the net effects of everyone using more are worse. Farmers have an incentive to use antibiotics on their animals because they result in higher weight animals and more money. And if they don’t use them, their animals might all get sick (and some competitor who did use them will drive them out of business). Doctors and patients have incentive to take them because, even if they’re pretty sure that it’s something viral, a small chance of dying right now isn’t worth hypothetical future use. Pharmaceutical companies have more financial incentives to invest in things other than antibiotics both because (1) new antibiotics are generally held back as much as possible to avoid resistance to them spreading, which means that they don’t get paid as much and (2) there’s lots of social and governmental pressure to price actual life-saving treatments closer to marginal costs. No tearfully distraught woman is going to get a bunch of TV time cradling her poor husband’s pale head because they couldn’t afford a new baldness cure; the mother of a kid who died because the antibiotics were too dear will play very well.

Some of these things can be fixed or helped by better regulation and market making (prizes instead of patents for new antibiotics, perhaps). But (maybe you’ve noticed), our governments aren’t very good at working with each other (or with themselves). And our public health resources have their attention split between new treatments for illnesses and convincing people to actually use preventative treatments we figured out were effective 150 years ago.

The bright side is that we have disciplines like genetics and computing that will potentially allow us to leap so far ahead of evolved resistance that we can waltz circles around it. The speed of evolutionary adaptation in microbes is fast (they reproduce really quickly), but relatively fixed. The speed of our computers and DNA sequencers and protein folding models keeps increasing. If we can actually maintain that increase, we should get to the point where new drug discovery can outpace evolution, and then say goodbye to microbial diseases for good.