Antibiotic resistance

52 thoughts on “Antibiotic resistance”

1. In Libertaria, insurance companies would be completely deregulated, and could act in concert. (They would also pay every valid claim on time, with no hassle.) They would therefore have an incentive to pay off the just the right number of farmers just the right amount of money to optimize the use of antibiotics on livestock. Their square-jawed market calculations and hard-headed bargaining would be far more efficient than anything concocted by a pinhead bureaucrat.

   It only took me a dozen joints to arrive at this state of libertarian satori. It usually takes me at least 20 to believe that Randy Barnett makes any sense.

2. Libertarian here. This is a collective action problem. (Each individual actor pursuing their own self-interest would lead to a decidedly sub-optimal outcome for all of us.) Government regulation–a ban on the routine use of anti-biotics on non-sick animals–is completely justified.

   I am in 100% agreement with Professor Kleiman here. I’m a little unsure why he feels the need to preemptively taunt me.

   (Also–isn’t the regulatory capture of the Ag Dept. a big part of the problem here?)

   1. This isn’t about the Ag department, as it’s not their remit to prevent the emergence of antibiotic resistance bacteria, so long as they’re not actually in your food. The problem is, I’m not sure it’s anyone else’s job, either.

   2. Libertarians know the theory, but don’t seem to vote that way when it comes to nut cutting time.
      (painting with a very broad brush here, so my apologies to you and other exceptions.)

   3. I’m glad we agree. Now work on your fellow libertarians.

3. 1. Torts
   2. Private Courts
   3. Spontaneous, Emergent Order*
   4. Collective action problem solved!

   *This is the libertarian’s replacement for “?????”

   1. Is this satire?

      1. It would appear so, and a pretty good one at that, IMHO. Nice twist on the profit meme.

      2. I’m not sure; I didn’t even intend to write it. It’s just a spontaneously emergent order of words, numbers, and punctuation.

         1. OK. I was dense.

4. “Libertarian” = “out of touch with the realities of 21st Century human society”. Why again is it that we should be fascinated by the alleged philosophy of self-described libertarians?

   1. “Libertarian” = “out of touch with the realities of human society since feudalism.”

      1. “Libertarian” = “out of touch with the realities of hunting and gathering societies”.

         (Our ancestors threw them out of the tribe for not sharing long ago. Forced them to go Galt with zest. And that was basically a death sentence. As one human being in the wilderness is as worthless as one ant or one bee. This means wealth redistribution genes have been heavily selected for many generations.)

5. i read a few chem/pharma blogs. here’s a posting about the interview on frontline for an insiders perspective on the situation–

   http://pipeline.corante.com/archives/2013/11/12/leaving_antibiotics_an_interview.php

   this blog is worth following and the tag “things i won’t work with” is hilarious.

   1. that was me. i’m using my mother’s computer and it takes a great deal of force to get the v key to work.

6. I also think regulation is completely justified, but it was surprisingly hard to get experts I interviewed to commit to the notion that this was a major factor in antibiotic resistance. Apparently they tend to use antibiotics that aren’t safe in humans, for one reason or another.

   1. Next step: getting primary-care docs to stop prescribing antibiotics for the common cold.

      1. Does this happen? I was aware of similar practices by pharmacists in the developing world, but not in the USA.

         1. It does, though not as much as it used to; they’ve really gotten serious about this in the last decade. Biggest problem is hospitals; antibiotics permit lousy infection control. That’s here, anyway; each country has its own particular issues.

            1. This is not just a U.S. problem. I had two relatives in Germany die of MRSA infections (contracted in the hospital) within the past 5 years.

      2. I would say the next step is getting hospitals to (re)institute sufficient sterile procedures to stop cross-infection between patients. After all, over (And under!) use of antibiotics outside the medical profession can contribute to the creation of strains resistant to this or that, but hospitals and clinics are a major site where the resistant strains get together to share their resistance.

         We’ve known since Lister how to keep this from happening, there’s no excuse for people catching things in hospitals that they didn’t suffer from when they entered.

         Besides this, I think I’ve already shared the story of how me and my wife keep getting identical antibiotic prescriptions despite differing in weight by a factor of 3, leading to her getting ill from the overdose, and me not being quite over the infection before the prescription runs out. As near as I can tell, this happens because it’s considered too inconvenient to stock the antibiotic in more than one sized dose.

         The bottom line would appear to be, that a large number of medical decisions are being made for reasons unrelated to medical efficacy, and this isn’t just the case outside the medical profession.

         On libertarianism, libertarians don’t deny the existance and importance of third party effects. We simply think they should be minimized, instead of deliberately increased so as to provide an excuse to regulate third parties.

         1. It may be inconvenient for the pharmacy to stock more than one size pill, but it would be easy to prescribe your wife a dose of 1/2 pill every six hours and you a dose of 1.5 pills every six hours, and then multiply that number by 28 and give each of you a bottle containing a one-week course.

            1. But “Z packs” are not prescribed in bottles: They consist of a blister pack of pills with instructions, (Two the first day, one each day thereafter, until they run out.) And if they’re available in different sizes, more than one doctor I’ve encountered is unaware of it.

         2. Brett Bellmore says:

            “I would say the next step is getting hospitals to (re)institute sufficient sterile procedures to stop cross-infection between patients. After all, over (And under!) use of antibiotics outside the medical profession can contribute to the creation of strains resistant to this or that, but hospitals and clinics are a major site where the resistant strains get together to share their resistance.

            We’ve known since Lister how to keep this from happening, there’s no excuse for people catching things in hospitals that they didn’t suffer from when they entered.”

            God save us from engineers – Brett, read up a bit on it; it’s really, really, *really* hard to keep infections from spreading. This happened a lot in the pre-antibiotic era.

            1. Barry, take a walk through a hospital some time. (I used to do it a lot, before my elderly mother died.) People with unrelated illnesses sharing rooms. Utterly impossible to sterilize carpet on the floors. Doctors and nurses going from patient to patient without cleaning inbetween. People walking in off the street coughing, walking past the open doors of rooms of immune compromised patients.

               They can buy multi-million dollar scanners, but not install air filtration and UV lights?

               No, antibiotics made the medical profession lazy about basic sterile procedure, and they still haven’t relearned what they forgot.

            2. maybe it’s just the hospital in our area or maybe it’s the one in yours but when my wife had a double knee replacement the doctors and nurses used a medical grade hand sanitizer every time they entered or left the room and did a hand wash any time they did anything that required handling either her wounds or her intravenous port. as far as the floors, there were no carpets in any public area or any patient room.

               as far as azithromycin, it is available in other dosings but it’s mostly used for someone who is very large, like myself. the regular z pack, iirc, is based on a person with an 80kg body mass which is half mine.

   2. Is that because of a lack of evidence, so they don’t want to speculate? Or have there been good studies that gave rise to conflicting conclusions?

   3. Megan, you’ve got a track record of reading one or two articles and not even keeping those right, as well as making claims later admitted to be ‘hypotheticals’. And that’s not counting the many, many times you’ve made convenient arithmetic errors to your benefit.

      1. (sorry, that was me, courtesy of software which can’t remember names)

7. Well, there may be new strategies. But, in general agreement with naarro’s link, I have heard from a reliable source that Merck discontinued within the last 3-4 years their program to develop antibiotics using novel approaches (still proprietary according to my source, who supervised the work). They bought the technology and then decided not to go through with it, more or less…Anyway, MRSA can kill or disfigure you. And your kids. And your parents. Stay out of locker rooms and hospitals.

   Aside from the issue of antibiotic resistance in human pathogens, which may well have come primarily from the overuse of the drugs by physicians starting in the 1950s, spiking animal feed with antibiotics makes possible the inhumane industrial production of meat in CAFOs. If you haven’t done so, visit a hog CAFO one day; be sure to walk through the sanitizing foot bath going in and out. You might get the stench out of your nose in a week to ten days. Or not.

   1. We raised hogs “organically” when I was growing up. No antibiotics in their food, but there was a visit or two from a veterinarian bearing hypodermics. Hogs are mean, nasty, filthy, smelly, extremely powerful, and very dangerous. They will eat anything, including humans. They are extremely hard to herd — you can beat them anywhere on their bodies with a 2×4 as hard as you can, and they don’t seem to feel a thing. You need to keep them in pens. Our hog pen wasn’t much less dense than modern CAFO operations, once they reached full size. After the slaughter my brothers and I had the unenviable chore of cleaning out the hog pen. It took all day to remove dozens of wheelbarrow loads of mud and pig poop, and the pen didn’t look (or smell) much different afterwards. Forty years later, I’m not sure I’ve ever completely gotten rid of the stench in my nose from that.

      Wanna know what was even worse? The chickenhouse. And though we had a “free-range” chicken pen with lots of room to roam outdoors, I’ll never get rid of that stench.

      If you like to eat, thank a farmer. It’s hard, nasty work raising the food you put on the table.

      1. Holy crap. (Sorry, when it comes to puns I’m like a molester at the Chuck E. Cheese.)

         I seriously thought that it was corporate malfeasance that made sh*t smell bad. Effin’ vegans fooled me again!

      2. Hogs, given enough open space, are pretty clean animals. They will pick an area to defecate that they don’t otherwise use.

8. It might be possible to reverse some of the spread of resistance if we really clamped down on the use of antibiotics for all but essential cases. That type of omni-resistance comes at a “fitness” cost for the bacteria in question, so cutting back on the amounts used might could lead to them being outbred by vulnerable bacteria.

9. As long as we are on the topic, we should be looking into being “pro”-biotic as well as “anti”-biotic. There are only a few bad acting bacteria, and we are killing off the good ones. Stop using anti-microbial soap. Stop using the wipes at the grocery store. Michael Pollen’s latest book “Cooked” is a great read, and if you don’t have time for that, please read http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html?_r=0

   We should all be cultivating good bacteria. For the children, please!

10. Meanwhile, liberals and progressives celebrate the fact the FDA has ruled that even information regarding your own DNA needs to be cleared by the federal government.

    http://www.bloomberg.com/news/2013-11-25/fda-tells-google-backed-23andme-to-halt-dna-test-service.html#disqus_thread

    Got that? Genetic tests – that you voluntarily approved of and paid for – are forthwith to be prohibited because you might make unreasonable medical decisions as a consequence of them.

    1. Please to be substantiating your first phrase, or alternatively just admit you were trolling.

       1. Please refute my first phrase.

          The FDA can willy-nilly exceed its mandate and we’re supposed to accept that somehow its regulatory decrees are in abidance with its statutory mandate, even when its not. Senator Obama worked to pass legislation regulating genetic testing and failed, but somehow we’re supposed to accept that the fact that Congress failed to pass any bill on the matter shouldn’t impede the FDA from unilaterally deciding to regulate it anyway.

          This shouldn’t even be an ideological issue. Bleeding heart liberals and progressives who want to bend the health care cost curve should be at the forefront of defending cheap direct-to-consumer genetic testing.

          1. If you are going to use the phrase “liberals and progressives celebrate”, the onus is on you to provide some evidence that liberals and progressives are celebrating. I’m certainly not. And if paul below is right, you should check the rest of your facts, too.

       2. What the order actually required is that the tests in question be vetted (by someone other than the company’s own staff) to make sure that the results are what the company says they are.

          1. (from a casually reading of an article on this) the FDA had meeting after meeting after meeting with the company, trying to explain things like diagnostic accuracy, and the company’s people keep not understanding it.

    2. As someone who is liberal only in the “classical liberal” sense, I can’t get too worked up about this.

       23AndMe does a nice little regulatory tap dance in pretending not to sell a health product in the small print, but in practice advertises a health product (“Genetic testing for Health, Disease, and Ancestry”, “Reports on 240+ health conditions and traits”) . So, yeah, I’m not surprised that the FDA doesn’t like this.

       This has nothing to do with information regarding your DNA being “cleared by the federal government”. It’s the FDA saying, “please have a scientific basis for the clinical validity of your health claims”. It’s not about knowing the particular order of As, Cs, Gs, and Ts or that your genes are 2.3% Neanderthal, but saying stuff like, “hey, you may be afflicted with a lethal condition”.

       Or, in short: “please don’t peddle snake oil”.

       1. The FDA is afraid that DNA test results will scare people into DIY mastectomies.

11. I agree with this, as phrased, but it shouldn’t be confused with the marketing term “probiotic”, which is essentially meaningless. The evidence is utterly lacking that ingesting products marketed as “probiotic” will alter the composition of your gut flora for the better.

    1. This was written as a reply to KT’s 8:08. I must’ve used the wrong comment box.

12. Progressive: “So you do think the government has some roles in addressing certain kinds of externality problems?”

    Libertarian: “Of course! I’m not an anarchist or sop for big business!”

    Progressive: “So…regulating antibiotic use on factory farms?”

    Libertarian: “THE MARKET WILL SOLVE FOR THAT! HAYEK!”

13. Farming’s use of antibiotics should have been regulated a decade ago. Many advocated for it.
    The failure to do so is another example of regulatory capture.
    That this is the talk of the town now is another example of American democracy locking the barn after the steed has been vaccinated.

    The larger issue here is highly educated medical professionals being lazy or stupid.
    We’ve had doctors prescribing antibiotics by the cart-full to people with viral infections.
    This human action, more than any other, has killed drug efficacy.

    This seems to be another example of why choosing our doctors by the number of A’s that get in high school…
    Or by the fact that there daddies can afford tuition at a Medical school…
    Is really a amateurish way to choose those that would heal us.

14. Our daughter recently had a viral infection that gave her a nasty enough earache for my wife to take her to the ER (on a weekend, so her regular dr’s office was closed). In the ER, they said “it’s probably viral, but the standard of care is to prescribe antibiotics for ear infections”. This was after my wife expressed skepticism about the need for anything stronger than Tylenol. My daughter ended up on Zithromax for a week. So it’s not just that doctors are being cavalier: it’s that the medical profession as a whole (at least in the US) has outdated practices that encourage the development of antibiotic resistance.

    1. “Outdated” has it exactly backwards, I think. They used to care if it was viral or bacterial, and if the latter, what sort of bacteria. They used to do things like take throat swabs, and culture them, so that they’d figure out whether what they’d prescribed would actually work before you came back even sicker.

       The last time I offered to save some of the gunk I was coughing up so that the doctor could actually look at it, they looked at me like I was from Mars.

       “Outdated” would be an improvement, the care and detail with which they deal with infections has gotten worse over time, not better.

    2. This is more likely defensive medicine than an outdated practice.

15. We could declare that everyone who eats farm animals that were raised on antibiotics to be part of the problem and then make war against them. Then allow the police to selectively determine which consumers they want to arrest. Also, we should probably punish consumers of chickens raised with antibiotics more harshly… maybe 18 times more harshly?

    You did say liberal approach right??

    1. We could declare that everyone who eats farm animals that were raised on antibiotics to be part of the problem and then make war against them.

       Seems a bit easier to me to use science and our brains to figure out what antibiotics the farming industry can and can’t use. And then being flexible to tighten or loosen the rules as time goes on.

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