hi doctor person or soon to be doctor,
im interested in antimicrobial resistance but dont want to make a thread so thought id ask a communist on a forum about what the response is in the medical profession of w/ever country u are in to the current state of AMR and the thought of some sort of post-antibiotic age - also in relation to how healthcare is provided (insurance/nhs/magic/etc).
Also if you have any thoughts on class analysis of who anti-biotic resitence most affects, who is most vulnerable, how this may develop in the future - will we reach a stage where rich people get treated in their fortified compounds and only poor people go to hospitals (or is it already like that?!) that would be v. dope
This is something of great interest to me so any time u might spend replying to this appreciated,
ur pal tears
hi tears,
to be clear i'm not a doctor or med student, i'm a nurse but eventually i'm trying to become a nurse practitioner inshallah.
antimicrobial resistance is really fucking scary for reasons that i'm sure you're all familiar with. here in the US a lot has changed in the past 15-20 years wrt antibiotic (ab)use, and most if not all physicians are pretty wary of indiscriminate prescribing of abx. a lot of improvements have been made. but there's still a lot of problematic use, especially by family practitioners. shit is far from perfect and our armamentarium is getting eroded every day.
still, we're all in a pretty serious bind as we are doing battle with fundamental evolutionary forces here. total eradication of a given pathogenic organism in a patient is extremely difficult. in a patient being treated for, say, a systemic S. aureus infection, a certain number of bacteria will survive even after the patient fully recovers and symptoms end-- even if we adhere perfectly to the prescribing guidelines for antibiotics. this is the perfect definition of selection pressure: bacteria and viruses replicate and mutate so quickly that they will, over time, inevitably develop traits that give them partial or full resistance to antimicrobial agents-- the question is only how quickly it happens. changes in antibiotic use have slowed this process, but mistakes always happen and even if we were absolutely perfect in how we use abx we'd still face emerging resistance eventually. keeping resistance at bay is a dialectical relationship between selection pressures and the development of new drugs.
another problem is that "correct" use of abx is really far from a cut-and-dried set of rules. doctors will, when presented with a case that forces them to choose between 1) using antibiotics in a way that may engender resistance, or 2) risking harm to a patient due to excessive caution, they will ALWAYS go with option 1. that's human nature, and that's how our ethical-legal framework for patient care is structured. Here's an example: say we have a patient that's going into the early stages of sepsis, they have bacteria growing unchecked in their bloodstream and their immune system can't fight it off. this puts tremendous strain on their cardiovascular system--they could go into shock and potentially die at any time. in an ideal world, we'd take a blood sample, do a culture and sensitivity test, identify the causative pathogen and select an appropriately selective antimicrobial agent to treat it. in the real world, that almost never happens because C&S testing sometimes takes days to get a definitive result. by that time, the patient might already be dead. so we use broad-spectrum antibiotics and hope for the best. no doc is gonna risk their license over possibly killing a patient because they were leery of prescribing IV vancomycin for someone who was going septic due to an unknown pathogen because it *might* have caused antibiotic resistance. that sort of thing happens all the time in hospitals. and there's the rub, because yeah, that's the only moral choice in our current understanding of how to provide medical care, but it does create resistance over time.
an aside: really, resistance due to medical misuse is only one part of the puzzle: agricultural overuse of antibiotics is rampant due to how our industrial food system is structured. we bathe cattle and pigs (organisms with immune systems fairly similar to our own) in ridiculous levels of antibiotics all the damn time, potentially creating a massive pool of resistant organisms that could cross to the human population really quickly. this is a standard best practice in the meat industry and very little is being done to curb it.
where do we go from here? i expect to see more government resources devoted to R&D into new antimicrobials in the coming years-- obama is pushing to get an additional $1.6 billion in the FY2016 budget devoted to NSF grants to fund research on new antibiotics. (of course anything that comes out of that process will be in the hands of pharmaceutical companies and sold at a profit, more public investment in private gain.) but it's too little, too late and very little short of the expropriation and nationalization of drug companies will change the fact that there's little economic incentive for pharma to invest in new antimicrobials-- hospitals won't pay for them if they're too expensive, and what's the point of investing X millions on a new antibiotic if the clock just starts ticking till the next resistant bug comes along and they have to start over? better to keep cranking out dick pills and antidepressants.
new drugs will get developed eventually, but that doesn't change the fact that we're already pretty fucked. i won't go into it here, just google "antibiotic resistance" "XDR-Tb" or "MRSA" to get an idea. of course the third world is going to face the brunt of it: multidrug-resistant tuberculosis is going to start fucking romping on humanity in the next few decades if nothing changes, just in time for the climate to implode, hooray.
in the first world, we're going to see a lot more use of nasty third or fourth generation abx with really miserable side effects as the benign drugs become less useful. when MRSA becomes totally prevalent (it will, soon) we're going to see a steady increase in the rate of postoperative infections-- elective procedures will become a lot less common. we'll have to reconsider what procedures should be just clean and which need to be aseptic. and a lot more people will die. and, i think this will really cut across class lines-- VRE doesn't give a shit if it's infecting a millionaire getting a hip replacement or a prole getting their appendix out. unless the super-rich start developing their own private stock of elite-level antibiotics, that is.
