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Actually the same reasoning applies to poverty disease control and eradication: You cannot control/eliminate/eradicate if you do not have a environment conductive to that: Try eliminate whatever-disease when there is a war going on. Or when people simply have other issues at hand like getting food for the day.

You first have to fix society at large, before you can do some things.

In any case the whole resistance issue poses some very interesting moral questions:

  1. Delay treatment now to (maybe) save the efficacy later?

  2. Should we risk mass treatment (to eradicate) incurring the risk of spread of resistance if we fail?

I am mostly interested in point 2: It is a case where excess optimism can be deadly.
by cagatacos on Sun Apr 15th, 2012 at 05:33:40 AM EST
[ Parent ]
Ah... there are even researchers proposing under-treatment (not me, I published against it), in this case another moral question arises:

Can we risk treating a person insufficiently (and thus risk her health) to delay the spread of resistance?

This would be though questions even in a sane environment: without financial interests and with intelligent people.

by cagatacos on Sun Apr 15th, 2012 at 05:36:19 AM EST
[ Parent ]
The corollary is obvious.

If you think of financials station as a decision-making process, and if you examine the claim that only financialisation can create 'progress', the objective reality is that financialisation makes a species stupid.

by ThatBritGuy (thatbritguy (at) googlemail.com) on Sun Apr 15th, 2012 at 05:57:32 AM EST
[ Parent ]
('financialisation' - damn you, iPhone autocorrect)
by ThatBritGuy (thatbritguy (at) googlemail.com) on Sun Apr 15th, 2012 at 06:17:53 AM EST
[ Parent ]
Wouldn't under-treatment promote resistance? Or do you mean not using certain antibiotics at all?
by Colman (colman at eurotrib.com) on Sun Apr 15th, 2012 at 10:45:35 AM EST
[ Parent ]
Wouldn't under-treatment promote resistance?

That is the orthodox view (to which I fully subscribe).

In the case of malaria there is a general consensus that under-treatment (in the 50s, Thai-Cambodian border) was the cause for resistance emergence (actually not under-treatment, but presumptive treatment - chloroquine (CQ) in small doses in salt). This was a policy recommended by the WHO (I traced the first suggestion to a paper written in 1953).

There are people trying to introduce treatment with doses below clearance. Their rationale is based on mouse models. Problem is: mouse and lab models have a tradition of not being transportable to human field reality. For instance (and this is interesting in economic terms):

Lab models predicted that CQ resistance would be maintained because CQ-resistant parasite multiply faster than CQ-sensitive parasites. We now know that this is not true (CQ-resistance falls if CQ if removed). NOTE THE UNDERLYING (wrong in this case) REASONING: something that grows faster is more fit that something that grows slower (growth, growth, growth baby). It never crossed peoples minds that faster growth might mean, for instance, killing the host before transmission is possible.

But it is interesting to see that the "growth is always good" meme goes well beyond economics....

by cagatacos on Sun Apr 15th, 2012 at 12:06:07 PM EST
[ Parent ]
But significant portions of Multiply Drug Resistant bacteria are generated in the watersheds downstream from factory farms and the intended exposure to antibiotics was made to animals to increase production of meat and of revenue to pharma. But bacterial plasmids are well capable of transferring resistance between bacteria populations. And while odor alone would ward of most from 'nature' in the vicinity of the facility, creeks and streams carry the resistance through parks, towns and cities.

As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Sun Apr 15th, 2012 at 10:52:23 AM EST
[ Parent ]
Minor: Just to note that Plasmodium is not a bacteria, therefore there should be no horizontal gene transfer (HGT).

Bacteria, virus and protozoans might require very different approaches and it is not clear that one can transfer reasoning from one to the other.

HGT is probably the cause for multi-resistant bacteria. In malaria it is probably recombination of resistant genotypes (save one exception, through mitochondrial mutation)

by cagatacos on Sun Apr 15th, 2012 at 12:15:52 PM EST
[ Parent ]
I was not referring to malaria, but rather to drug resistance in bacteria, which has become a major problem in hospitals and other health care facilities. Whole watersheds from Texas and Oklahoma up through Nebraska have been shown to have antibiotic resistant bacteria as the predominant genotype, This has been the case for more than ten years and probably for almost as many years as big pharma has been pushing antibiotics to feed lot operators and poultry farms.

Denying antibiotics to humans on account of the danger of building resistance seems bogus when industry is allowed to turn entire landscapes anti-biotic resistant. It is just that it is easier to let medical professionals harangue their patients than to confront big pharma and eleminate a practice that is sold as adding 1-3% growth to meat animals. If I get some chickens I will have my choice of medicated or non-medicated feed.

As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."

by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Sun Apr 15th, 2012 at 03:48:14 PM EST
[ Parent ]
Food for thought (Portuguese situation):

  1. Common cold is routinely treated with antibiotics (and I don't mean only self-prescription)

  2. Helicobacter pylori is not treated

[The UK seems to do the opposite, at least it seems. Interestingly antibiotic use seems high in both places but for completely different reasons]

Not giving an opinion here... just food for thought, really.

by cagatacos on Sun Apr 15th, 2012 at 06:35:10 PM EST
[ Parent ]
Amoxicillin is prescribed in Spain like candy. It's probably entirely useless by now, due to resistance.

guaranteed to evoke a violent reaction from police is to challenge their right to "define the situation." --- David Graeber citing Marc Cooper
by Migeru (migeru at eurotrib dot com) on Sun Apr 15th, 2012 at 07:43:03 PM EST
[ Parent ]
cagatacos:
Actually the same reasoning applies to poverty disease control and eradication: You cannot control/eliminate/eradicate if you do not have a environment conductive to that: Try eliminate whatever-disease when there is a war going on. Or when people simply have other issues at hand like getting food for the day.

You first have to fix society at large, before you can do some things.

So the eradication of European malaria was possible due to a high level of organisation in Europe?

I am reminded of the US based organisations that tried to fix things in China in the 20ies and 30ies - agriculture, energy, stopping female feet binding - only to run into problems relating to there being a civil war going on.

A vote for PES is a vote for EPP! A vote for EPP is a vote for PES! Support the coalition, vote EPP-PES in 2009!

by A swedish kind of death on Sun Apr 15th, 2012 at 03:08:42 PM EST
[ Parent ]
My personal view (and my knowledge of eradication in Europe is limited) is what you suggest: it worked mostly because society was stable. People would argue that insecticide resistance was non-existent at that time and that helped a lot. DDT spaying et al. But take this with a grain of salt.

Interestingly I submitted a grant proposal to study the genetic basis of insecticide resistance (trying to move from parasites to vectors).

by cagatacos on Sun Apr 15th, 2012 at 06:43:20 PM EST
[ Parent ]
Actually the same reasoning applies to poverty disease control and eradication: You cannot control/eliminate/eradicate if you do not have a environment conductive to that: Try eliminate whatever-disease when there is a war going on. Or when people simply have other issues at hand like getting food for the day.
------
I totally agree with this. And yes it is poverty that definitely makes people ill but it is also "culture" or so called "way of life". It's bad enough what we are actually eating and drinking and with "fast food culture" it is just way worse...We already see statistics that next generation will live shorter than previous one...Add stress that they are living with each and every day and you don't need to ask why...
by vbo on Mon Apr 16th, 2012 at 05:16:58 AM EST
[ Parent ]

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