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.
Edited by drwhat ()
I've been reading about holistic medicine, and a lot of the commonly used herbs, and food recipes are supposed to help to build your immune system.
Are there any changes in common habits and routines that the average person should adjust to in order to keep relatively healthy?
(add some paragraphs and edit a little and then frontpage this shit this is awesome)
littlegreenpills posted:people should probably wash their hands a lot more often. how come handwashing and bleach don't cause microbial antisoap and antibleach resistance though. hmm
there is resistance to triclosan out there, which is the active ingredient in most antibacterial soaps.
bleach and the like are a little different. we don't really see resistance to bleach or hydrogen peroxide because they attack bacteria and viruses on so many fronts by destroying cell membranes and denaturing any proteins that they touch. that's why we don't use bleach as an antibiotic, it does the same thing to our body's cells. that's the main challenge in developing new antibiotics: it's pretty easy to kill bacteria. the problem is that bacterial cells and human cells on a functional metabolic level are fairly similar and what kills one will pretty handily kill the other. finding a chemical that kills bacteria but leaves human cells intact is tricky and is one reason why many antibiotics have nasty side effects
interesting u mention 3rd and 4th gen antiobiotics being much less pleasent - would u say that the easy antibiotics at the beginning of the curve were easy to find and had few side effects, but each new antibiotic is harder to discover/invent and has worse side effects (a somewhat exponential curve)
and that whats really called for is a revolution in infection treatment post actual revolution away from looking for further "crude" antibiotic treatments based on the single molecule "drug" approach to treating infection. Revolution not reform
tears posted:antibiotic resistance, superbug proliferation, animal-human transmission, continuing soil erosion, ocean acidification, coral reef die-offs, continued deforestation, tropical peat incineration, rising atmospheric nitrogen levels, marine mollusc dissolution, continued atmospheric methane rises, continued atmospheric carbon dioxide rises, peak phosphorous, fertiliser shortages, seed shortages, water pollution, air pollution, soil pollution, strip-mined fisheries, oceanic mean trophic level crashes, species range changes, pollinator collapse, species extinctions, soil organic content reductions, tropical disease spread, parasite proliferation, increased pathogen overwintering success, anoxic ocean dead zone proliferation, increasing oceanic red tide frequency, glacier retreat, snowpack reduction, increased river seasonality, reduced river flow, permafrost thaw, all year wildfire seasons, diminishing crop yields, amazonian wildfires, seasonality predictability reductions, unprecedented storm strength, infrastructure damage, distribution chain breakdown, sea level rise, aquifer salinisation, sanitation system failures, rapidly changing rainfall patterns, unprecedented flooding, an ice free arctic, globally reduced albedo, abrupt methane clathrate releases, aquifer depletion, land subsidence, shrinking inland seas, desertification, toxic dust storms, oceanic eutrophication, abrupt climate change, fertile delta erosion, hydropower failure, coastal abandonment, unliveable wet bulb temperatures, deadly heat waves, equatorial abandonment, megadroughts, water wars, land wars, starvation gigadeaths, backfired geo-engineering projects, wholesale refugee murder, abandonment of millions of people, nuclear war, death is certain
and Putin is the bad guy?
tsinava posted:In anticipation of this imminent myriad of epidemics, what can the individual do to keep healthy?
I've been reading about holistic medicine, and a lot of the commonly used herbs, and food recipes are supposed to help to build your immune system.
Are there any changes in common habits and routines that the average person should adjust to in order to keep relatively healthy?
imo there's a lot of promise in a re-apprasal of herbal medicine. there are many antimicrobial remedies out there that are well documented and researched (usnea comes to mind ) but aren't really feasible for large-scale production for a variety of reasons. of course that doesn't help the bulk of humanity who don't have access to these compounds.
as far as prevention, yeah health maintenance is really important. if you're eating well and are physically fit, you aren't going to get sick as much. that's one thing that lay people don't really realize about MDR diseases: they aren't necessarily more virulent or fatal than their drug-susceptible cousins. the pathologies and symptoms are pretty much the same, it's just that we suddenly have lost one of the main treatments for them. people get mild staph infections all the time, anytime you get an infected cut it's probably due to S. aureus, possibly a drug resistant strain. but you were otherwise healthy and your immune system was able to fight it off. white cells don't care if a bacteria is drug resistant.
but then again, TB doesn't really care how healthy you are when it takes up residence in your lungs.
tears posted:Dank_xiao, thanks for answering my question
interesting u mention 3rd and 4th gen antiobiotics being much less pleasent - would u say that the easy antibiotics at the beginning of the curve were easy to find and had few side effects, but each new antibiotic is harder to discover/invent and has worse side effects (a somewhat exponential curve)
and that whats really called for is a revolution in infection treatment post actual revolution away from looking for further "crude" antibiotic treatments based on the single molecule "drug" approach to treating infection. Revolution not reform
to clarify, i meant that in the future we will be forced to use a lot more of the drugs that are currently avoided because of their undesirable side effects, not that new drugs will somehow be more nasty.
honestly, i have no idea about what new drugs will be like. yeah, we've found a lot of the low-hanging fruit, but i don't think that means that newer drugs have to be harder on our bodies. pharmacology is extremely complex and new drugs often are a lot more benign than their predecessors. plenty of the first-gen abx are pretty terrible (doxycicline gives you terrible acid reflux, can destroy your hearing, makes you extremely susceptible to sunburn, turns children's teeth black, causes diarrhea, etc.)
Edited by dank_xiaopeng ()
dank_xiaopeng posted:bablu feel free to chime in here, seeing as you're Actually Gonna Be A Doctor and i'm just an ass wiper. also let me take this opportunity to ask for a moment of silence for gwap/peezlebub, the fallen third member of the Loley Catheter's
i wish i had more to add but i'm only in preclinical. pathology is next year, infectious diseases unit is in fourth year. i'm not rlly better informed than the avg guy now. a little knowledge is a dangerous thing. promise i'll make effortposts when i'm not ignorant though, so in like 2021
i do like listening to mark crislip's puscast where he reviews current infectious diseases literature. he always emphasizes we're gunna eventually lose the arms race against antimicrobial resistance and really all we can do is use antibiotics conscientiously to increase the period where they're effective
dank_xiaopeng posted:finding a chemical that kills bacteria but leaves human cells intact is tricky and is one reason why many antibiotics have nasty side effects
i was reading some interesting stuff about how the human immune system works in a way that doesnt generate resistance in the same way. the conclusion that they reached was that there are some important differences in the cell walls of prokaryotic vs eukaryotic cells that allow certain elements of the human immune system to be effective (i dont remember what exactly it was). the specific difference that they were suggesting was that for prokaryotic membranes it is possible to generate regions of high (negative?) curvature so that they were easier to create pores.
You are technically correct in that MRSA doesn't care whose hemorrhoid it ends up in, but beyond that, every other aspect of the american health care system massively favors the wealthy. TB is primarily a homeless disease at this point in most regions, I think. Yeah the odd business/vacation traveler brings it home from overseas sometimes but that's far outnumbered by the cases in alleys and tent cities and shelters.
I'm not a doc or a nurse, but I was a hospital engineer for several years, and worked with some good and bad infection control departments. Even leaving aside differences in treatment and staffing, just from a physical facilities perspective I can't even count all the ways that a more moneyed hospital or higher end clinic would outclass a public hospital catering to the poor.
MarxUltor posted:I must respectfully disagree with the comrade nurse about the class neutrality of drug resistant illness. At least in the US, I believe antibiotic resistant bacteria is very much a class problem.
You are technically correct in that MRSA doesn't care whose hemorrhoid it ends up in, but beyond that, every other aspect of the american health care system massively favors the wealthy. TB is primarily a homeless disease at this point in most regions, I think. Yeah the odd business/vacation traveler brings it home from overseas sometimes but that's far outnumbered by the cases in alleys and tent cities and shelters.
I'm not a doc or a nurse, but I was a hospital engineer for several years, and worked with some good and bad infection control departments. Even leaving aside differences in treatment and staffing, just from a physical facilities perspective I can't even count all the ways that a more moneyed hospital or higher end clinic would outclass a public hospital catering to the poor.
yeah, this is completely true. it's something that i can easily overlook because i live/work in an area where the high-level critical care, elective procedures, and charity care are all provided by the same university hospital. in areas where private hospitals predominate, what you said is absolutely the case. especially regarding "premium" clinics, which we will probably see a lot more of in the coming years.
that's in the near term, though. you're correct inasmuch as most of the scary MDR bugs out there are predominantly hospital-associated, and that hospitals that cater to the elite will be able to maintain much more strict infection control procedures. my point was, with time, the drug resistant organisms that are currently only endemic to hospitals are going to make their way into the general population and will become part of our normal flora. that's already happening with MRSA, we'll see it with pneumonias in a few decades, and C. difficile is on its way, too. when that happens i think we'll see a levelling in mortality across class lines, as no amount of strict infection control or expensive equipment will be able to prevent colonization. but the ultra-rich will always be able to afford treatments and procedures that we won't.
XDR-TB is really in a category all of its own, and probably deserves its own thread.
drwhat posted:I'd like to front page this, op, would you like it to go up unedited (wrt shift key, paragraphs), would you like me to do that, or would you like to? I'm cool with it going up however you prefer & would be happy to do whatever to get it there
give me a few days to fix it up and add some stuff that i've talked about since the first post. i'll make it a little less stream of consciousness. ty!
as a farmy aside: It seems disgusting that its now common practice to just feed livestock antibiotics like magic pills in the US, and surely they most be seeing rising antibiotic resistince in livestock, although of course the way livestock live and move and interact is much differnt to how people do the same so obviously inter-herd/flock/drove transmission of abx resistant bacteria is going to be much lower because they dont all hang out at the hospital
tears posted:antibiotic resistance, superbug proliferation, animal-human transmission, continuing soil erosion, ocean acidification, coral reef die-offs, continued deforestation, tropical peat incineration, rising atmospheric nitrogen levels, marine mollusc dissolution, continued atmospheric methane rises, continued atmospheric carbon dioxide rises, peak phosphorous, fertiliser shortages, seed shortages, water pollution, air pollution, soil pollution, strip-mined fisheries, oceanic mean trophic level crashes, species range changes, pollinator collapse, species extinctions, soil organic content reductions, tropical disease spread, parasite proliferation, increased pathogen overwintering success, anoxic ocean dead zone proliferation, increasing oceanic red tide frequency, gglacier retreat, snowpack reduction, increased river seasonality, reduced river flow, permafrost thaw, all year wildfire seasons, diminishing crop yields, amazonian wildfires, seasonality predictability reductions, unprecedented storm strength, infrastructure damage, distribution chain breakdown, sea level rise, aquifer salinisation, sanitation system failures, rapidly changing rainfall patterns, unprecedented flooding, an ice free arctic, globally reduced albedo, abrupt methane clathrate releases, aquifer depletion, land subsidence, shrinking inland seas, desertification, toxic dust storms, oceanic eutrophication, abrupt climate change, fertile delta erosion, hydropower failure, coastal abandonment, unliveable wet bulb temperatures, deadly heat waves, equatorial abandonment, megadroughts, water wars, land wars, starvation gigadeaths, backfired geo-engineering projects, wholesale refugee murder, abandonment of millions of people, nuclear war, death is certain
vote trump
Gssh posted:You might solve a lot of problems by burning down hospitals every once in a while.
unfortunately hospitals and their equipment are really expensive 
although some pretty crazy new disinfection procedures are being invented like using basically bigass hydrogen peroxide foggers to douse rooms in sanitizing solutions or just blasting everything with highpowered UV
Gssh posted:You might solve a lot of problems by burning down hospitals every once in a while.
Is this what Obama is doing all the drones for?
dank_xiaopeng posted:although some pretty crazy new disinfection procedures are being invented like using basically bigass hydrogen peroxide foggers to douse rooms in sanitizing solutions or just blasting everything with highpowered UV
There was a really interesting anecdote my Prof. of Microbial Pathogenicity told me once, about the local hospital being re-fitted in the sixties. Originally, all the door handles and wash basins were made out of copper or copper alloys. All stuff that was installed when the hospital opened up in the 19th Century. And the department decided to upgrade the facilities. All shiny new stainless steel and chrome.
Infection rates skyrocketed because bugs are able to hang around on stainless steel touch surfaces for practically weeks, but the ionic nature of the copper zaps populations in about 1 or 2 hours tops. Unfortunately, this wasn't something anyone knew/thought about at the time.
https://www.washingtonpost.com/news/to-your-health/wp/2016/05/26/the-superbug-that-doctors-have-been-dreading-just-reached-the-u-s/?postshare=3471464289168129&tid=ss_tw
For the first time, researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could mean “the end of the road” for antibiotics.
The antibiotic-resistant strain was found last month in the urine of a 49-year-old Pennsylvania woman. Defense Department researchers determined that she carried a strain of E. coli resistant to the antibiotic colistin, according to a study published Thursday in Antimicrobial Agents and Chemotherapy, a publication of the American Society for Microbiology. The authors wrote that the discovery “heralds the emergence of a truly pan-drug resistant bacteria.”
aaaaaaaand it probably jumped to humans from pigs treated with antibiotics!
It’s the first time this colistin-resistant strain has been found in a person in the United States. In November, public health officials worldwide reacted with alarm when Chinese and British researchers reported finding the colistin-resistant strain in pigs and raw pork and in a small number of people in China. The deadly strain was later discovered in Europe and elsewhere.
dank_xiaopeng posted:hey cat admin, it turns out i've been extremely busy at work, and not at work. so i haven't had time to rework this into a more coherent essay, if you're desperate for Content go ahead and clean it up. i give you permission to use broad and despotic editorial powers. feel free to edit in some of the stuff i elaborated on later itt. or don't, i don't care.
ok i just edited it to remove the lines referencing PMs and now it looks like an article i guess. good enough for me.
congratulations, this is first in the dr dank xiaopeng's mailbox series! (it's ok if this is the only entry in the series, i just felt like it)
tears posted:antibiotic resistance, superbug proliferation, animal-human transmission, continuing soil erosion, ocean acidification, coral reef die-offs, continued deforestation, tropical peat incineration, rising atmospheric nitrogen levels, marine mollusc dissolution, continued atmospheric methane rises, continued atmospheric carbon dioxide rises, peak phosphorous, fertiliser shortages, seed shortages, water pollution, air pollution, soil pollution, strip-mined fisheries, oceanic mean trophic level crashes, species range changes, pollinator collapse, species extinctions, soil organic content reductions, tropical disease spread, parasite proliferation, increased pathogen overwintering success, anoxic ocean dead zone proliferation, increasing oceanic red tide frequency, glacier retreat, snowpack reduction, increased river seasonality, reduced river flow, permafrost thaw, all year wildfire seasons, diminishing crop yields, amazonian wildfires, seasonality predictability reductions, unprecedented storm strength, infrastructure damage, distribution chain breakdown, sea level rise, aquifer salinisation, sanitation system failures, rapidly changing rainfall patterns, unprecedented flooding, an ice free arctic, globally reduced albedo, abrupt methane clathrate releases, aquifer depletion, land subsidence, shrinking inland seas, desertification, toxic dust storms, oceanic eutrophication, abrupt climate change, fertile delta erosion, hydropower failure, coastal abandonment, unliveable wet bulb temperatures, deadly heat waves, equatorial abandonment, megadroughts, water wars, land wars, starvation gigadeaths, backfired geo-engineering projects, wholesale refugee murder, abandonment of millions of people, nuclear war, death is certain