I'm not really all that mysterious

Antibiotic Resistance

Antibiotic resistance isn’t so much about humans vs. bacteria as it is about humans vs. laissez-faire capitalism, specifically Big Ag, but also the health insurance/for-profit health care industrial complex.

In the U.S. alone, 70 percent of antibiotics that are medically useful to humans are given to animals instead, and not just for treating disease but for promoting growth or compensating for poor farming practices.

It also argues for restrictions or bans on the agricultural use of any drug that’s a last-line defense for humans. And it suggests that meat should be transparently labeled so consumers can make informed choices.

Of the 40 million people who get antibiotics in the U.S. every year, only 13 million actually need them; the rest have viral infections that can’t be treated with these drugs. One solution is to develop better, faster, cheaper diagnostic tools, so doctors don’t have to assess vague symptoms, or rely on slow, expensive tests based on centuries-old technology.

The Plan to Avert Our Post-Antibiotic Apocalypse • 2016 May 19 • Ed Yong • The Atlantic

With regards to better diagnostic testing, the problem isn’t availability, it’s the way incentives are lined up.

For example, with the rapid Strep test, if it turns out negative, you’re going to have to send out a throat culture anyway.

Strep throat in general is fairly rare (most cases of acute pharyngitis are due to viruses) so you’re going to have a lot of negative tests.

So HMOs and IPAs will tend to towards just doing the throat culture and skipping the rapid Strep test in order to cut costs and maximize profit.

Unfortunately, while rapid Strep tests only take 15 minutes to run, the throat culture requires a minimum of 48 hours, meaning that the patient will have to wait for treatment. Even though the risks of delaying treatment include increased likelihood of peritonsillar abscesses, post-Strep glomerulonephritis, acute rheumatic fever, and death from necrotizing fasciitis due to Group A Strep, these are exceedingly rare and are still cheaper to deal with than doing a rapid Strep test on everyone.

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