“But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in underdosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.”
Edit: Fleming's full Nobel lecture: http://www.nobelprize.org/nobel_prizes/medicine/laureates/19...
Stern warnings with no information about possible consequences is heavily lambasted in movies, yet we repeat this behavior with medicine and expect different results.
If you tell someone not to do something and don't tell them why not, and the consequences aren't otherwise clear, expect them to do what you said not to do.
My mother was a nurse so she always reminded me of the critical missing reason why, and I've always dutifully finished all antibiotics prescriptions as a result.
But that was a simple thing the doctors writing the prescription should have been doing themselves, and an apparent systemic failure of the medical profession to account for messy human psychology in a critical procedure.
Gone are the days where a doctor should be taken at his judgment 100% as if medicine is a black box enigma. The average HNer would be wise to google about their conditions and drugs they consume. A doctor can only remember so much - they are primarily valuable for their experience in hueristic diagnosis -- not for knowing everything medical and everything pharmacutical. It is wise to relinquish some responsibility to a professional but not all.
Most of medicine aside from surgical methods can be understood by a mildly intelligent person who cares enough, because of wikipedia and google, everything except actual experience is very accessible.
I dont see how your astonishment is anything other than misinformed hyperbole.
[1] https://upload.wikimedia.org/wikipedia/commons/8/87/Antibiot...
For the most part, of course. Cultural evolution does occur, however it's unpredictable and not something that can be easily forced.
Stepping down off a high dosage in halves is the exact same strategy used to ease people out of addiction.
As a kid, I thought anti-biotics were this far-out medicine, so strong and hazardous that coming down off them was something you had to do carefully.
I got strep throat a few times as a kid. I don't have perfect recall about the details of what I had to take and when or why, though. But I do remember having to vary dosage.
Given an instruction when you don't understand the "why" is highly ineffective. As seen by your experience with your doctor.
There is also a further problem in that antibiotics treat not just you, but prevent infection in the wider population. People in general find it hard to think about the wider impact, which is something we see every day with regards to the world wide population's regards to the impact of their own pollution. It's why we recycle but then drive SUVs.
"Take all of the prescribed medication" : "They're just greedy and want to make me buy more"
vs.
"Take all or you'll breed antibiotic-resistant bacteria that cannot be treated and you will die and kill the human race" : "I better follow this prescription"
Both of them are wrong, btw. Pharma companies are greedy and they do everything they can to make you spend more. Doctors are influenced by them, often very subtly. That is a fact, not a conspiracy. But the fact also is, that doctors save lives and most have noble intentions (despite the meat grinder medical career is). One needs to learn what information belongs more to "greedy companies" category, and what belongs to "life saving science" category. It's no surprise people get confused about this - and that's why you absolutely need to explain to them why they need to finish antibiotics treatments.
It's from Friedrich Nietzsche's "Twilight of the Idols": "What does not kill me, makes me stronger."
Also, most people don't know that either. Today it's just a saying, that's been repeated by people for decades.
I'm ashamed to admit that the big part of my adult life I didn't know the reason behind that, and always assumed that to be of a kind "you must eat your whole meal" constantly told by grandma. I'm sure I'm not the only one..
I agree with the observation that telling people to do something without explaining why is stupid and will only lead to disappointment.
Understanding the process that leads to antibacterial resistance requires understanding evolution. So it's no surprise that much of the world fails to understand it.
Turned out this was a major point of the anti-evolution stance at his church. I've since encountered the same viewpoint from a number of other people, all going to primarily small, ostensibly non-denominational, churches.
I am happy to base my work on the currently best working scientific models.
My faith is also based on "best practices": what worked well for my parents, grandparents and me and which also happened to help create the western culture we enjoy today.
"Render therefore to Caesar the things which are Caesar's; and to God the things that are God's."
Probably the opposite, if you look at any conflicts they were involved in, or what social advances were blocked.
I am, to a certain degree, that evidence. (Edit: this holds true to some degree even if you look at it from a purely techical POV which makes me smile : )
> Probably the opposite, if you look at any conflicts they were involved in, or what social advances were blocked.
This is meaningless unless you also take into account the advances brought forward because of it.
And, FWIW, you have to cast your net wide and far to find anything real horrific.
This is not to say we are better people than other, but trying to say our faith made us worse than the alternative (warrior tribes as they existed some hundred years ago) seems very wrong.
The point of Creationism (the non-laughable variety, at least) is that some transcendental being designed this Universe with all its fundamental laws and specific constants, including Evolution, with the express intent to have us here, now, in the exact shape we are.
It is not something that can be easily refuted, BTW, nor proven. Which is why it's a matter belonging to faith and not science, for now.
This is a strawman, as it's quite explicitly not what's being discussed in the parent comment, which specified "created....thousands of years ago" (I assume that kind of creationism is what you're referring to as "laughable").
Today's religion is different in many ways. The ones that say that bible is the 100% correct source of truth are the crazy ones.
There are a lot of atheist scientists that are perfect bayesian reasoners while doing research, but when they step out of the lab they suddenly get as irrational as the rest of the general population. People are way too good at compartmentalizing beliefs.
Furthermore in Hospitals you make people wash their hands (as in you post security gaurds at the hand washing stations and none shall pass a station without washing) and you have separate wards for those with MRSA and those without MRSA.
If you need an antibiotic that is not in rotation, you are hospitalized while everyone makes sure you take your full course.
Doing these things eliminates about 90% of the problem.
There are third world countries that don't care and will not follow any of those rules. Also foreign prison systems, particularly in Russia, which breed TB.
Then there are people that are prescribed low doses of antibiotics for things like acne. I imagine that's a huge risk more than all the other things, taking it every single day.
And, as others have mentioned, agriculture uses about 50% of the world's supply of antibiotics IIRC, and that's not really safe.
It's much easier to make antibiotics prescription only. Which we have. For humans at least.
I don't think the decision has been conscious.
More importantly the costs and benefits haven't been amortised over the life (and impact) of those decisions. Or, if you will, it hasn't been worth it yet. Unfortunately at the point where we can properly assess the enormous cost of these decisions, the opportunity will be long gone.
When I see something like this I start to question our governing system. Its way to slow and sluggish to react to these kind of events that requires immediate attention.
Each of these events would cost a few (hundreds of?) billions to address or mitigate. It requires a super human intelligence to separate the chaff from the wheat. And this is hard to know what is scaremongering, and what is really dangerous.
Indeed. Also there are increasing evidence that many scientific studies aren't reproducable.
We need a better System to identify 'useful signals' among noises. But in our current socio-economic structure, this topic never comes up as the most important issue. Abraham Lincoln founded National Science Foundation that laid out a solid ground work for this movement, but nobody(correct me if I am wrong) picked it up where he left of and pushed Scientific inquiry as one of our top agenda.
Farmers use antibiotics basically by default and in large doses to avoid bacterial problems with their cattle.
I remember reading a stat that said 93% of all anti-biotics use is in agriculture.
On the one had it is as you said, as a preventative measure to head off infection (which is obviously very bad), but it's worse than that - industrial farmers use antibiotics so they don't have to inspect and treat each animal. Just dump antibiotics into their food and if they are injured somewhere along the way it will hopefully heal on its own. Inspecting and treating each animal individually would be a lot more expensive.
The other reason antibiotics are given to livestock is to cause weight gain. If the antibiotics cost less than the value of the extra meat produced, then you make more money.
It's a fucked up practice that we'll be all pay for in a few decades.
Note the wiki page is an ok source, but is in need of some attention from someone outside the industry.
At some point, it will become obvious enough that victims' estates will start winning lawsuits :)
I see some great opportunities in technology for streamlining processes behind fair and high-quality agricultural products.
If we were serious about humanity's future, antibiotics would only be given in hospitals and all of your bodily waste would be incinerated until it no longer tests positive for antibiotics. You'd leave the hospital with a shaved head too, since hair may come to contain the antibiotics as it grows.
This is a case where government just needs to step in and ban the practice.
The reader and the software are going to be a few hundred dollars or maybe a couple thousand. But it's a one time investment, plus ongoing implants as the herd changes over time.
I suspect the main selling point is going to be the one-time capital investment aspects and the fact that antibiotics are being painted as an undesirable additive in meat and dairy. When the general public starts to dislike a substance, suppliers scramble to distinguish their products, e.g. "No added growth hormones" and the like.
Maybe the startup could manage to do it for a cost that's less than organic meat?
Example: almost all turkey meat that's so in fashion today comes from farmers that use antibiotics as preventative measure. I personally source meat from small family run farms that adhere to biological agriculture principles, (there only ill animals get antibiotics and those aren't butchered and sold later as meat).
Better example is doctors writing prescriptions for common cold infections that are viral anyway so they can appease patients by "doing something."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/
Your condition is the reason that I find myself prescribing courses of amox even when chances of chronic strep colonization are much more likely than true acute infection. It's a real diagnostic quandary.
They really don't seem to understand the concept of antibiotic resistance. They're all engineers too, they really should know better.
And he completely understood the concept of antibiotic resistance. He just gave a sheepish grin when I confronted him like "Aw, shucks, ain't I a scamp". He was a really nice guy, except for this case where he was a sociopathic asshole.
Some studies suggest though that 90% of cases can be resolved with less antibiotics.
It is a famous and time-honored rationalization that sidesteps doing the right thing because the wrong thing is certain to occur anyway. The logic is faulty and self-serving, of course. Sometimes someone else won't do it. The soldiers asked to fire on their own people when the Iron Curtain governments were crumbling all refused, one after another. Sometimes someone else does it, but the impact of the refusal leads to a good result anyway. When Elliot Richardson was ordered by Richard Nixon to fire Watergate Special Prosecutor Archibald Cox, he refused and resigned. Cox ended up being fired anyway, but Richardson's protest helped turn public opinion against the White House. Even if neither of these are the final result, the individual's determination to do right is always desirable in itself. The Futility Illusion is just a sad alternative to courage.
Do you have any scientific evidence to back up your theory? Or, said another way, where is this science you speak of documented and tested?
As far as evidence against your theory, evolution (e.g. bacteria becoming resistant to antibiotics) is the result of mutation and selective pressure. If antibiotics are never used, then there is no selective pressure. Significant percentages of a bacterial species do not just decide to become immune to some antibiotic that doesn't exist or is never used.
When the selective pressure of an antibiotic is present, however, those mutations that provide immunity to the antibiotic are selected (as the others die) and become a larger percentage of the total population of the species.
This is also why you take the full dosage of an antibiotic. Otherwise, you leave the most resistant alive (those more vulnerable to the antibiotic die first, in theory).
Also why farms are considered to be the leading cause of antibiotic resistance. By constantly administering antibiotics when they are not needed, you are providing a constant selective pressure, forcing adaptation to occur.
Bleach is vastly more effective at sterilization than any known antibiotic. Their only advantage is inside an organism by nocking things back immune systems can win. However, for example in imunocompromized people they have minimal effect.
It's well known that bacteria live and reproduce outside the human body. Many strains, like listeria or salmonella, can live in food, outside of any human or animal host. Cholera lives in sewage. Also, animals are reservoirs for a large number of bacterial species. Unless we're going to dose all humans, all animals, and the environment as well, then we're not going to succeed.
Further, 80% or so of most antibiotics get excreted right out of the body in urine within a matter of hours. This means that the environment is going to get dosed with a low level of antibiotics, just the perfect environment for breeding immunity.
Finally, bacteria can exchange plasmids inter-species, so if some innocuous bacterium in the environment develops immunity, it can transfer that to a virulent species at a later time.
I think however it's not enough to conclude that consciously avoiding using antibiotics provides a net gain.
It, in my mind, becomes a bit of an economics question if you consider the trade-offs. Not dosing cattle could to food poisoning which could lead to higher human consumption of antibiotics.
I also have a fear of this becoming a panic, much like the anti-vaccine panic which leads people away from getting proper medical treatment.
And that's how antibiotic resistance happens.