The interviewed expert has very good credentials and clinical experience to be talking about what he is talking about, and his warnings should be taken seriously. But even at that, the fallacious teleological language he uses about biological evolution by natural selection suggests a way out of this problem. When he says, "Bacteria, like any living organism, want to survive," and "So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything. Moreover, it is perfectly possible for lineages of bacteria to go completely extinct, and that has undoubtedly happened more times than human beings are aware.
Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings.
And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
I think it's a bit pedantic to argue about his usage of "desire". Evolution is a blind watchmaker. The bacteria are reacting to selective pressures. Large populations of bacteria around the world are getting exposed to different kinds of antibiotics. It's not a matter of "if" they will acquire resistance, but "when", and we're seeing this happening right now.
The fact that lines of bacteria go extinct does nothing to disprove the fact that bacteria are developing resistance to antibiotics. Is it possible that there are antibiotics out there that can stop the newly-resistant bacteria? Of course. But it's getting harder and harder to find newer and more-powerful antibiotics.
A promising alternative appears to be bacteriophages.
I have never heard of bacteriophages before. Doing some light research, I found their protein/body structures to look almost machine-like. Very fascinating stuff.
From Wikipedia's Bacteriophage page: "Medical trials were carried out, but a basic lack of understanding of phages made these invalid".
I seriously hope alternatives like bacteriophages are being revisited and reconsidered within the medical community, as it's obvious that conventional antibiotics are increasingly becoming less effective each year.
Phages have been, and are, being revisited and reconsidered.
The early days of 'phage therapy' were pretty bad - because we really didn't understand what was going on, the "purified" phage solutions still had bits of bacterial cell membranes and the like in them, including endotoxins. People died.
But phages were still being looked at for most of the antibiotic period, especially in countries without quite such widespread access to antibiotics. The Soviet Union had a very active program in Georgia, which was ongoing before the trouble there a few years back, I don't know the status of it now.
It's a promising avenue, and there's some decisive advantages phages have over antibiotics. But it's also quite hard, and right now we lack a generalizable form of phage therapy - it tends to be a bespoke solution to specific intractable cases. But the incentives might increase as antibiotics become less and less effective.
For awhile I wanted to work on phage research before I realized wet-lab Biology was not my forte.
Bacteriophages are very much the answer to the titular problem. Instead of finding tiny little lethal molecules, we will likely end up actually designing machine-like phages to kill the causes of our illnesses. They're easy to select for, quite good at what they do, and are some of the most approachable objects in synthetic biology, currently. And they are much more amenable to continued use than the 3 or 4 scaffoldings of antibiotics (small molecules) that we know of today.
The biggest problem with phages is they can be quite specific. Antibiotics put phage research out to pasture because a single, easy to mass produce small molecules were capable of wiping out enormous varieties of bacteria.
With phages you'd need a large library to counter different bacteria, you'd have to successfully identify the bacteria which is causing the problem which may require culturing. If you wanted to maintain phage effectiveness in a heavily selected environment you'd also need to design phage "reactors" where the phages can be continually evolved against current bacterial populations.
Which in the long run is a far more elegant solution. Rather than "Kill All The Things!" (including your target), it's "Kill the Bad Guy!" - but you have to know who he was.
I believe the point being made was not pedantic, but to express the difference between a blind watchmaker (as you say, evolution) and a sighted watchmaker (theoretically, the effort of humanity, science, ...). Of course, that assumes that humanity as a whole, or in part, can actually recognize the need and organize an effort compared to how quickly the blind watchmaker works. Maybe I'm reading too much into it, but I think I see what OP is getting at there.
In fact, a bacteriophage may or may not be the most promising vector, but a bacteriophage engineered to attack pneumonia or specific infections would be the work of a sighted watchmaker, not dissimilar from ideas of targeted radiation or chemotherapy that are moving forward in the area of cancer treatment. I recall an experiment (not that this is my area of expertise at all) in the recent past that was attempting to use magnetized medicine along with some sort of electrode insertion, I believe, to coerce medicine to specific areas of the body.
On the topic of Bacteriophages, I seem to recall reading in Biology class a long time ago, that the reason the water of the Ganges can be stored for a long time without getting spoilt is because of the presence of Bacteriophages! Certainly useful to humans!
You are completely right in that bacteria don't have the ability to "want" things since they don't have any kind of brain. However, desire is a useful way for the general public to understand what is happening. It's like saying "Water wants to flow to the lowest point of a room" or "The arrow wants to follow the path of least air resistance"
It's not an inability to understand you're seeing, it's a rejection of it because it misleads people. Pendants attack such language precisely because it's misleading without cause. There's no reason to personify random processes and doing so actively misleads people.
Where's your evidence that people are mislead? I don't have any data either, but I suspect exactly zero people came away thinking that bacteria have conscious desires, just like zero people believe that wind actually bites or people actually get butterflies in their stomach.
Yea, like zero people believe water has memory or zero people believe the earth is 6000 years old. Open your eyes, people believe shit they hear that's absurd constantly and in my anecdotal experience maybe 1 in 8 people I've met understood evolution. But maybe you don't live in a red state.
That's your opinion, not mine; however it's exactly talk like this that has led to most laymen not understanding evolution. They don't get that it's being dumbed down for them and that's not their fault, it's the fault of people who casually anthropomorphize things because they wrongly think it helps to clarify; it does not.
Understanding comes from truth, not casual simplifying lies.
You place a large hindrance on discussion if you require every discussion that mentions natural selection to give an entire introductory lesson on evolution. It's a ridiculous notion, especially when there is unlikely to be any misconceptions taken from this article. The purpose of the article was to explain why bacteria become resistant to antibiotics and how our use of antibiotics has led to this, and it does a fine job of that even if some uneducated people still can't describe the modern evolutnary synthesis.
I require no such thing, it is possible to have the same discussion without the unnecessary personification of bacterial wants. It adds nothing to the conversation to say bacteria wants rather than the fit survive.
"Desire" implies that the bacteria is acting purposefully and planning ahead. This isn't what's happening unless you attribute the bacteria's activity to some sort of intelligence.
On the contrary, we eliminated smallpox which was one of the most devastating diseases in history so this fatalism is basically disproved. More depressingly, we've also made extinct thousands of species who have not evolved to resist us.
That comment digressed to discuss whether or not evolution plans ahead and "eventually discovers ways to overcome" as implied by the OP. Keep up with the topic :)
The bacteria is acting purposefully I guess in the same sense that a hammer acts purposefully to drive down a nail. I don't know if that's a correct usage of language or not but it's essentially the same thing. But it is correct to say the hammer's purpose is to drive down the nail, and the bacteria's purpose is to survive and reproduce successfully.
So what if a species goes extinct? That doesn't mean it can't evolve, only that it didn't adapt quickly enough.
> However, desire is a useful way for the general public to understand what is happening.
No it isn't, it's misleading.
> It's like saying "Water wants to flow to the lowest point of a room"
Equally unnecessarily misleading. Water doesn't want anything, and before you claim people understand that let me tell you, they don't. It's a common belief that water has memory, there's an entire industry based on the concept and people fall for it. Walk into any grocery store and there are shelves of very expensive little bottles of water (homeopathy) being sold as cures for all kinds of things, it's disgusting.
> or "The arrow wants to follow the path of least air resistance"
Also unnecessarily misleading. Such talk may be fine among experts who "get" that's it's not accurate, but when talking to general public one should speak accurately, not loosely and "hope" they get it because the reality is many if not most don't and take what you say quite literally.
Bacteria don't 'want' anything in a purely technical sense. But they will eventually develop/are developing resistance to antibiotics anyway. You seem to be stuck in debating about the right sentences to describe that.
Semantics matter, communication is not possible without agreement on the meaning of words. And the OP made the argument, not me, I'm simply agreeing with his point that's it's wrong to personify evolution, it's why so many people don't understand it.
It's far worse than that. Not on;y is it not possible to have semantic communication without a general agreement on the meaning of words, but at the same time perfect agreement is impossible. This is generally understood (and has been understood for a hundred years) to be one of the causes of linguistic drift.
No they aren't, which is why it's even more important to make sure we're actually talking about the same things. Semantics matter. I tire of people insisting that I know what they mean when what it's not what they said. I don't read minds, I hear words; the words you choose have meanings and those meanings matter if you want to convey your ideas to me.
> which is why it's even more important to make sure we're actually talking about the same things.
To some extent, but it is also impossible to do so perfectly.
> Semantics matter.
Semantic agreement is limited to the actual parties to the communication, and by location, place, time, and social context. You wouldn't explain something to a 5 year old the way you would a 25 year old and the same basic problems occur when you cross cultural or temporal boundaries.
When linguists discuss language, they usually start by pointing out that human language is defined by usage, not by prescriptions regarding definitions or grammar. This is a critical difference between natural languages and computer languages. Computer languages rigidly conform to specifications. Natural languages only approximate the rules we use to describe them.
So I think you are expecting too much from human communications.
I share your distaste of when evolution is personified or otherwise represented to be anything other than a powerful but passive process.
That being said, I have no problem with the statement that bacteria want to survive. They most certainly have mechanisms that are engaged actively in order to increase chances of survival. Horizontal gene transfer (http://en.wikipedia.org/wiki/Horizontal_gene_transfer) allows bacteria to evolve in means other than traditional reproduction.
To add to my pedantic argument, it's not a conscious desire of theirs, but I'd argue that the basic things that humans do to survive (eat, drink, sleep, and have sex) are not conscious desires either. I'd argue that sexual reproduction is a mechanism that directly represents the biological success of greater genetic diversity and sharing of genes between organisms. We desire sex, and we desire sex with the best genetic candidates, and it's all a biological process encoded into our DNA that represents our desire for survival, so in that sense, bacteria desire survival as well.
And what does desire even mean? Does desire require consciousness and the ability to choose? It's a horribly imprecise term if you stare too long at it, so what I'm saying is that I don't think it's useful to pick on the doctor for his choice of words in this case.
Anyway, you have great points otherwise, but that first paragraph is not a point worth tripping over.
I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover".
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. It took evolution billions of years to make machines that can run 60 miles per hour. It took humans a few thousand years to create machines that run about 12 times that fast.
Bacteria work on a faster time scale than animals in terms of evolution, but five orders of magnitude? Somehow, I think we'll win in the long run.
"If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution."
This is a stunning visual - thank you. I see a multi-dimensional space of possible organism "configurations". Each dimension is a set of related alleles, spaced by the amount of energy it would take to shift from one to the other, i.e. the likelihood of switching that allele independently. Angles between dimensions indicate correlation, or more fundamentally the cost of holding similarly positioned alleles simultaneously. Each organism is a point in that space with a species being a cloud.
When one shines a "light", i.e. an antibiotic, on the space it lights up with warmer colours signifying configurations which take less energy for the organism to survive as (are more favourable) and cooler colours denoting deadlier configurations.
Thus, antibiotics become a game of chess. Humans try to box the organism into coolly coloured regions. That way, the amount of energy it would take to "tunnel" through the wall would be high. The organism, on the other hand, is trying to find warm "tunnels" by which to escape regions which are being boxed in. Advantage to the organism is it can build new dimensions.
> Evolution is actually a really crappy optimization algorithm...Bacteria work on a faster time scale than animals in terms of evolution, but five orders of magnitude? Somehow, I think we'll win in the long run.
However, it's one that doesn't need an agency to implement it. It just happens. A lot. Especially in the case of bacteria. You have a slow, crappy algorithm, but it's constantly running relentlessly in parallel in many trillions of instances. It doesn't need human attention. It doesn't need investment. It doesn't need society to be aware of its importance.
On the other hand, progress in antibiotics needs all of the above. If one of those things flags a bit, bacteria gain the upper hand. This is the problem.
It took evolution billions of years to make machines that can run 60 miles per hour. It took humans a few thousand years to create machines that run about 12 times that fast.
It took evolution billions of years to make machines that could make machines that run about 700 miles per hours.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. It took evolution billions of years to make machines that can run 60 miles per hour.
You come off as being dismissive of the power and beauty of evolution, although I don't think that's your intent. Evolution assembled the most complex system known to exist, starting from a handful of molecules, without any "thought" or "reasoning." The entire concept/illusion of life and consciousness was fabricated out of simple natural elements and physical processes. Amazing. Sure, once all of that has been put in place, it's trivial to expand upon. I'm sure you agree, I just like to take any opportunity to point this out. :)
Sure, but the main power and beauty of evolution is a direct result of the fact that it is an optimization algorithm. The fact that such an algorithm could just happen is astounding (although possibly inevitable, if universes are common and varied).
If I come across as cynical about this, it's a response to the way evolution as a process has been fetishized by people who don't understand it. People look at the application of evolutionary algorithms to solving difficult problems and conclude that evolution is smarter than humans. But evolution's power really comes from its dumbness. It works without understanding the problem, and so it can be used to solve problems we don't understand very well. But when we learn how to model a problem intelligently, we're generally able to crush the results of evolution.
I guess thats the curse of programming. We all have a very clear understanding of how very very simple logic gates give rise to systems of infinite complexity.
It's a recurring pattern. SAT, the NP-complete problem, is at first glance a ridiculously simple task, yet solving it means being able to solve all other problems. When designing a language or a machine, it is very very simple to accidentally make it Turing compatible, the barrier is just so low, despite the reward being.. everything.
> Evolution assembled the most complex system known to exist, starting from a handful of molecules, without any "thought" or "reasoning."
There may have been a lot more complexity early on than that statement assumes. Static systems, after all, pretty much by definition can't evolve (and this is why a reductionistic assessment of evolution as biochemistry doesn't work).
The beauty behind evolution is the same beauty behind Feynman integrals in quantum physics. You take the integral over all possible paths and something is likely to work. Many paths will end or cancel eachother out.
It's still an incredibly stupid process. Sure it made it's way to the complex life forms we have today, but only after unfathomably huge amounts of time, and trillions and trillions of attempts.
>>but only after unfathomably huge amounts of time, and trillions and trillions of attempts.
What's really huge and what no is really a limit and perception of our brains, no?
For a evolutionary process that has started at the earliest stars after the Big Bang. Those species are currently so powerful, that we are very likely to them the same as bacteria are to us. Might as well perceive that to be a very reasonably efficient process.
Evolution is a very generalized but very slow optimization algorithm, actually, and it's velocity is sort of inherently connected to the population size and lifespan, meaning it has to make trade-offs, it is limited. But because it's generic that means it can evolve faster mechanisms. I like to think of intelligence as this faster mechanism -- it came about because for living beings with a large lifespan evolving through natural barriers takes too long, so that this more time-localized procedure is needed.
Or to put it a different way: extinction happens all the time. Entire branches of evolution are lost to its inability to adjust to rapid change. That bacteria evolve doesn't mean we can't beat them.
Is there any indication that the organisms we have "stolen" antibiotic molecules from might become themselves suffer disruption from bacteria that they can no longer kill? Fungi are involved in many symbiotic relationships that we indirectly depend on, for example the fixation of nitrogen for plant growth.
One imagines a future in which we have a dwindling supply of biodiversity to 'sacrifice' in order to keep ourselves safe from bacterial onslaught.
Not unlike oil -- millions of years to produce, but destroyed in a few generations of exponential human growth.
I've wondered about that. But the antibiotics we use medically are only a small fraction of the antibiotics in nature, because the others are toxic or otherwise unsuitable to use as drugs. So the fungi probably have backups.
It might make sense to speak of an antibiotic peak, like we speak of peak oil. I wonder if you could draw the same kind of curve.
We're using only a subset of antibiotics that doesn't kill people as well - I'm not a biologist, but the cells are different enought that there should be many chemicals that are safe for fungi, kill bacteria, but aren't usable for people.
> we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists
This is the stuff of the Nobel prizes of yore, and it is the mechanistic basis for how antibiotics kill bacteria and not humans. Penicillins destroy the cell wall as it is remodeled (humans don't have a cell wall); lincosamides block protein synthesis at the ribosome (humans have a different ribosomal structure); amphotericin binds ergosterol and forms ion channels in fungal membranes (humans lack ergosterol).
As we continue to explore biochemistry, we will continue to understand (and perhaps even discover) new antimicrobials, though I suspect most of the future advances will come from large-scale screens of discovered or synthesized compounds without taking much biology into account until secondary stages (to increase potency or reduce toxicity).
Evolution doesn't work the same way in bacteria as in other organisms due to horizontal gene transfer[1]. Bacteria can't be split into well-defined lines, because they share a common pool of genetic information.
[2] is a good book to get a perspective on antibiotic resistance.
Good summary of human being's advantage in the war. But don't forget bacteria's key advantage: iteration speed.
Bacteria may be blind and and random in their micro-level behavior. But the speed at which they replicate is multiple orders of magnitude faster than the speed at which we can test and iterate new defenses.
It's a race of blindingly fast random iterations VS top-down snail-paced logical defense. If human's are to win, I think they will need to bump up the defensive iteration time an order of magnitude or so.
Yes, that was the background idea in the talk. Among the ideas explicitly said was that our iteration for antibacterial defenses is low and slowing, and that we actively contributed to the increase of bacterial mutation opportunity. The solution mentioned include corrections for both these.
Right. We could lose the utility of all naturally-occurring antibiotics and still be OK because we synthesize new ones.
However, right now the first part is happening and the second part isn't, so until medical science and technology advance sufficiently far -- if indeed they ever do, and specifically if they ever do before a devastating plague hits -- we're in trouble.
Thinking about the ideas you bring up.. it seems we humans have been playing on the same level as the bacteria upto now. Greedy algorithm vs greedy algorithm. Could we perhaps use certain antibiotics that will force bacteria to evolve in a way that opens up a certain weak spot which we will then allow to spread through their population before we step in and wipe them out using this forced back-door? This simple 1-2 plan seems enough to really cause evolution a problem if humans can coordinate enough to pull it off (and a plausible plan appears, details..).
I think the problem with this kind of idea is that there are so many bacteria all over the world and you'll never reach all of them.
Recall the very mechanism that makes bacteria resistant over time: an antibiotic is deployed over a population of bacteria that have largely the same genotype but there are lots of mutations thrown in because they divide so fast. If any of the bacteria are resistant to the antibiotic, they survive and create a new population, again with largely the same genotype with lots of mutations thrown in, but this new population is entirely resistant to that antibiotic.
Now you've probably been visualizing a human body or a petri dish when I talk about "a population of bacteria", but consider the entire Earth. You'll never deploy an antibiotic across all the nooks and crannies of the entire Earth, and even if you were to, you'd just get an ~evenly spread population of bacteria, resistant to that antibiotic.
I guess you could _try_, if you were a supervillain or something.
Good luck trying to convince people to accept the inherent sacrifice required in the short term. On the other hand, pugilists do understand the need for setups and combinations.
I don't get the sense from this comment that you totally know what you're talking about (neither is it my area of expertise). On the one hand, you're right that many humans are actively working on this problem. On the other hand, the data suggests to me that you might be overly optimistic. Only 2 new classes of antibiotics (oxazolidinones and cyclic lipopeptides) have been developed in the last 40 years. The rate of new antibiotic drugs reaching the market has decreased significantly as well. There are a finite number of biological mechanisms for antibiotics to disrupt, and the methods that bacteria use to develop resistance are quite general.
In his book 'Toward a New Philosophy of Biology" there is a chapter on this very topic - how teleonomy has pervaded almost all of Biological science and how teleological statements, which are just plain incorrect, are the major way in which Biological processes are explained. I think this has only increased in severity and effect as we have consolidated our systems level view of the world and I've often been in awe of the general ignorance toward fundamental principals such as this.
My own personal take on the situation?
I think it is a very dangerous and ignorant thing for our species to continue with it's genetic hegemony of our ecosystems, creating vast evolutionary plateaus where the slightest advantage can run amok and adapt into something that could wipe out entire species. There is _probably_ enough genetic diversity in humans to avoid this, but I doubt so amongst our crops and livestock.
But I share your optimism/pragmatism in that I feel our human ingenuity will overcome, and if so then the prizes are great indeed. From new drug delivery systems and entirely new ways of treating illnesses, to a more mature approach to our interactions with the biological inheritance we have here on Earth 1.0 - I would like to see our crops and livestock diversified, farming practices overhauled to focus on the long term and most importantly more serious study devoted to analysing and utilising the solutions evolution has put in front of us for the taking.
Not only are these things (IMHO) essential to the prolonged survival of our species, they are also achievable. The organic farming movement took only a generation to go from grass roots to industry standard (and I know there is all sorts of controversy surrounding it but the point is that the industry IS open to disruption), here in the UK there is a debate simmering under the surface of the popular media that could end in more wild deer providing venison for the pot, Canadian geese too, and everyone knows of the whole insect protein debate, and the practical applications of bio-tech and nano-tech are only getting more interesting as the fields begin to find their feet.
General reply to express thanks for and respond to the several replies my first comment here received. First of all, I wrote in the original reply, "his warnings should be taken seriously," so I am by no means disagreeing with the quoted CDC expert about his general policy recommendations. Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.
I respectfully note the disagreement of several participants here have with me. They disagree with my disagreement with the interviewed expert's casual language about thoughtful agency by bacteria. Noting your statements that this is just everyday conversational usage, I stand by my objection to that fallacious manner of speaking. Most people in the English-speaking world think erroneously about biological evolution and especially about the implications of evolution for human medicine. I am not alone in thinking that popular thinking about biology needs to be improved by rejecting the idea of organismal agency in evolution,[2] although it is remarkably hard to find this kind of careful thinking by a Google search amid the flood of webpages that specifically assert a purpose or intention to evolution by natural selection. Ernst Mayr, mentioned in one reply to my first comment here, is indeed a rare example of a reliable author on that issue. Human beings have a cognitive bias of attributing agency to inanimate objects,[3] and the reactions to my first comment suggest how deep-seated that cognitive bias is.
The entire revised introduction to the thirtieth anniversary edition of Richard Dawkins's book The Selfish Gene[4] appears to be available for free online reading, and Dawkins writes explicitly about what level of analysis can be useful when pretending that genes have intentions and goals while thinking about problems in evolutionary theory. The University of California Berkeley website about evolution has a good page about antibiotics[5] that makes helpful medical practice and public policy suggestions with more cautious language.
There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. The precautionary principle suggests that we follow the quoted expert's policy recommendations, but meanwhile conduct research for a deeper understanding of the biochemistry of harmful microorganisms and their ecology.
Two other comments at this level express the nub of the argument:
I'm slightly bugged by "desire" type language because it does actually cause problems in how laymen think about evolution. It's not uncommon to hear them make the mistake of thinking evolution will "think ahead". But the bigger problem I have with it is the "anything we do ... bacteria will eventually discover".
Some problems are just very difficult to evolve around, and it's hard to predict what they'll be even if you have a complete working knowledge of an organism's genome and biological workings. If the problem space doesn't contain a solution that can be climbed toward without sacrificing fitness in the short term, it is unlikely that it will ever be found by evolution.
Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town.
That is very well put, and deserves your upvote.
At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
A good question. It is an empirical question about the future, so it has no definite answer yet, but that is the general research direction to follow to get around the legitimate problem mentioned in the article kindly submitted here.
There is a bit of hubris here borne of ignorance. If you study this problem in any depth, you start to appreciate how pernicious it is. I'm not an doctor or epidemiologist, but I learned quite a bit by reading an excellent book[1] on the subject:
> Indeed, I am on record here on HN[1] saying that I'd like to see the United States follow the lead of the EU immediately in banning antibiotics used in human medicine (especially last-line antibiotics used for antibiotic-resistant human disease) from use on farms. That seems like a sensible way to segregate the ecosystems in which microorganisms develop antibiotic resistance by haphazard evolution through natural selection.
Exposure to one agent can make bacteria more resistant to other agents, even ones that are unrelated. This is surprising, but confirmed through experiments. Bacteria have ways of flushing out toxins that become up-regulated, and they become more resistant to toxins in general. Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed, but the ramifications could extend to other, more critical, antibiotics used in medicine.
> As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms.
I think you're underestimating what we already know. Current antibiotics are based on the differences between eukaryotic and prokaryotic cells, and we understand a lot about the underlying biochemistry and drug targets. Lack of fundamental knowledge isn't a primary issue.
> I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine.
Here you're underestimating bacteria. Bacterial lineages don't really go extinct, because they have no well-defined boundaries. Bacteria are very different from eukaryotes and they pick up genes from the environment. See horizontal gene transfer.
This is one of those vicious problems, like cancer, that resists being solved not for lack of our best efforts, but in spite of them.
> "Agriculture only uses a few antibiotics, ones that are cheap in bulk, nontoxic to livestock, and can be mixed with feed..."
The reality is much worse. Factory meat producers will abuse any antibiotic if they are allowed, even the most powerful last-resort antibiotics. For example, many poultry producers were routinely mixing fluoroquinolones into their feed until very recently. The practice was outlawed in 2005, but there is good evidence that some poultry producers continue to do it in violation of the law:
Incidentally, I think the intuitive idea that the last resort antibiotics are the most powerful ones is a bit of a misconception. The ones used as a last resort tend to be the more toxic ones and the ones that have to be given intravenously. The reason they still work is probably because they were used sparingly while there were better alternatives available. That delayed the development of resistance.
> There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine.
Do a dumb test. Walk into your nearest hospital, I don't even want to know which it is. Ask how many patients are infected with mRSA. Collect your jaw from the floor when they give you an answer that's 15% if you're lucky, 60-70% if you're unlucky. We have lost the fight with bacteria. It's over. We aren't "about to" lose it, we lost it ~1 year ago, and medicine is fast losing the ability to treat bacterial disease. We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
We are in fact well on our way to transform hospitals into deathtraps.
> Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town.
First of all, the obvious advantage of evolution is it's running time, 3.5 billion years. Second you probably subscribe to the naive notion that evolution, in 3.5 billion years running time, somehow failed to realize that mutation + natural selection is very, very slow. It didn't. The algorithm that, today, controls evolution of pretty much any species works entirely different from what most textbooks teach you. There are very, very few species that evolve through mutation and selection. We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves).
Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening.
You'll also quickly realize that no matter how well-intentioned your use of bacteriophages is, it is very, very likely to make things worse, not better.
And the numbers of infections were far lower than you're claiming here - rather than approximately 20,000 in 100,000 as claimed above, the numbers (in 2011) were 4.5 in 100,000.
Yes, MRSA has declined, but not because of improved treatments. Now that we can no longer kill these bugs after they invade the body, hospitals have significantly ramped up their efforts to kill them before they invade.
Hurray for these protocols, but that won't do all that we need. It won't be possible to scrub the whole world with poisons the way we have begun scrubbing hospital rooms. We need ways to stop infections that we can't prevent.
While you're in that hospital, ask what their procedure is if you've been infected with rabies within the past week. It's most certainly not "curtains and sedation."
Just that bit of factual nonsense leads me to believe you are speaking far out of your area of expertise.
Yeah, but after that window closes, our treatment options for rabies are essentially Hail Mary, "Well, it's not like it can get any worse..." level treatments.
That's not a big deal in the U.S. because rabies is quite rare, but in the developing world it's still a thing.
Rabies is a virus - antibiotics don't have any effect on viruses.
Ceol may also be referring to the incubation time for rabies usually being more than a week - if you've just been infected with it and you present at day 7, then a prophylaxis will be administered.
Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
You used the wrong term. What's lethal is not "infection" with rabies -- but a full-blown case of rabies.
Rabies infection is very survivable if caught before symptoms start to show up. We have a post-infection vaccine that can be used during the incubation period. We've had a vaccine for over a hundred years, and it works very well. In fact, the original rabies vaccine was the second vaccine ever developed, after smallpox.
What's lethal is symptomatic rabies -- but even that is not 100% lethal. There have actually been a few (under a dozen) documented cases of human survival after symptomatic rabies. Look up the Milwaukee Protocol.
Problem is, the treatment lies within the realm of heroic medicine, works less than 10% of the time, and requires a long period of physical therapy afterwards. The cost easily goes into the seven figures. And we don't even know if the treatment works. Survival might simply be the luck of the genetic draw.
So, $10 million to save the life of one patient with symptomatic rabies, vs. $2000 for the vaccine. So you can see why the treatment protocol emphasizes post-infection vaccination.
When I suggested that there are some "Hail Mary" treatments once the post-exposure prophylaxis window closes, I was talking about the Milwaukee Protocol. Or the, I believe, single reported case of someone surviving a untreated rabies infection with no clear treatment.
As for whether or not I used the right term, I'd actually suggest that "infection" is kind of a fussy term to begin with. But I also never used it in my post, so I'm curious as to how I could have used it wrongly.
I stated that after the treatment window closes for PEP, we're in the realm of very difficult treatments that are really only workable in the developed world. I don't see anywhere that your post and mine are contradictory.
I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.
Firstly, there's a real difference between rates of MRSA colonisation and rates of MRSA infection, which implies a pathological process at work.
Secondly, what on earth do you mean when you say we lost the fight against viruses a decade ago'?
We have only got better at treating viruses; we had almost no treatment for viruses a decade ago and we have some treatments now; for example we are now much better at treating chronic hepatitis c infection which is a leading cause of liver failure and cancer; we have good HIV drugs which can lead to long term management without significant comorbidities (although many of the pieces were in place a decade ago), and your illustrated case, rabies, has long been a problem child like many significant viral illnesses that are discovered close to the end of their course, has caused so much pathology by tr time they present that the course is terminal.
But there have only been a handful of cases of fulminant rabies in the developed world in the last decade, so it's hardly a thing that we are getting experience in treating.
All the generic virus drugs we had have been eliminted : pretty much all existing viruses are eliminated and we have lost the ability to heal, for example, heal elderly or children infected with the flue (the groups at risk of dying from the disease).
We do not have any drug against any retrovirus (ie. a family of viruses) to which viruses do not show at least partial resistance.
As for the AIDS case, prevention of AIDS has pretty much failed in Africa and the middle east, as well as in significant parts of Asia. It is a matter of a decade or so until ~80% of those populations are HIV positive and the rest of the world will follow in the next few decades. All currently know anti-AIDS drugs will cease being effective in 5 years or less, and the rate of adaptation that the virus exhibits is still accelerating (we wouldn't be able to keep up with the current rate, so sadly, that doesn't even matter).
This is of course assuming we don't have another pandemic like the Spanish flue. We have had several near-pandemic panics in the past decade and all incidents have one thing in common : we failed spectacularly at containment. If, for example, bird flue had been ~6% more infectious than it was, it would have killed ~20% of the world's population (at least), and would have reaped >90% of it's death toll before a vaccine would become available. Absolutely nothing would have stopped it. Bird flue itself was only one of 5 incidents that could have exploded into a pandemic. The big message of these incidents: yes, they stopped, hurray. Sadly it wasn't us who stopped it (but rather small flaws in the virus' design).
There is a staggering amount wrong with this statement. Staggering.
- The prevention of HIV in developing countries is hampered not by the ineffectiveness of drugs, but the expense and difficulty administering them. HIV in the developed world is, in many cases, now essentially a chronic disease. Indeed, it is the use of HAART drugs to prevent transmission in discordant couples that is providing a glimmer of hope for reducing the burden of HIV without a vaccine.
- While serious, prevalence of HIV is nowhere near 80%. Also, increasing prevalence is a function of disease duration, so better treatments will, mathematically, cause prevalence to rise.
- I'd contest rather strongly that we failed spectacularly at containment for several recent outbreaks.
- Antiviral drugs are not our only means of fighting viruses. If "Anti-X drugs" were the solution, we'd have eliminated many bacterial diseases - we haven't. The key to fighting viruses is vaccination, and we've wiped two viruses off the face of the earth, and are largely facing political/social problems, rather than scientific ones, with adding two more to that tally.
>We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
What? We never had effective antivirals. We have a few useful drugs (oseltamivir, protease inhibitors, etc) for particular viruses, but there has never been a point in human history when rabies was a treatable disease. The Milwaukee protocol, which is the only effective[1] non-vaccine treatment for rabies, isn't even drug-based!
You may of course be confused. The major antiviral used in replications of the Giese case, amantadine, was also an anti-flu drug, resistance to which is now widespread in influenza (see http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse ). However, I do not believe amantadine resistance has ever been described in rabies, which in any case is usually treated with vaccination -- the challenge is to get the immune system to respond to the virus before the host dies! Giese herself was treated with both amantadine and ribavirin. In any case, your claim is confusing at best, misleading at worst.
Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves
Breathing? Where are the bacteria in the gas-exchange process? And 'metabolism' is a catch-all term that refers to so many different chemical reactions, plenty of which are conducted within the human cells themselves.
He probably confused cellular respiration with physiological respiration, and thus incorrectly conflated the primary purpose of the mitochondria with the physical act of breathing.
"If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead."
Yeah, but how did we lose that fight a decade ago? Whether or not we'd prefer something better, doesn't the treatment that worked then, still work now?
As another poster has said, we didn't really "lose" that fight. Rabies has always been that way - invariably fatal unless treated, and the only treatment (outside some insane edge cases) is the administration of the rabies vaccine shortly after (or ideally before) contact.
The very low rabies incidence and near zero fatalities of rabies in the developed world actually show that it's a very winnable fight. The issue is, we have to show up to said fight. In the developing world, we're not always good at that.
I hadn't seen the newer revision of the protocol, only the original 2 out of 25 number. "Indistinguishable from 100%" was perhaps a little severe, but 90% survival is still pretty long odds.
> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead.
The fight we have not yet one is the fight against poverty.
Not many wealthy people die of rabies.
AIDS which was once fatal, is no longer, provided you can afford the treatment.
Honestly, at this point HAART treatments for HIV are giving folks a near natural lifespan, and the major threats to their health are becoming diseases of old age - cancer and the like. And the years they have are fully functional.
Compared to a chronic, wasting disease that will take years of opportunistic infections before you die, that's damned good.
Magic Johnson and Andrew Sullivan have had HIV for over 20 years and seem to be handling it fairly well. Certainly a harder life than most, but that's not stopping them from living a full life.
Let me do what I hope will be a smart test here by sharing some more information and asking some follow-up questions. I invite onlookers to comment about this too.
The Centers for Disease Control and Prevention (the same organization that employs the expert quoted in the article submitted to open this thread) reports that "Although MRSA is still a major patient threat, a CDC published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011."[1] So there are responses already in place that are gaining on antibiotic-resistant bacteria in hospital settings in the United States.
I care about the spread of antibiotic-resistant bacteria. I am gravely concerned about the medical and public-health practices in India that have resulted in a massive increase in patients infected there with multiple-antibiotic-resistant tuberculosis.[2] I am 100 percent behind the idea that antibiotics have to be used cautiously and responsibly, and meanwhile we have to keep researching other means of infection control besides antibiotics.
You wrote,
We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them.
Do you really mean "we" there? Are you saying that this mechanism in any way makes it impossible for human beings to eradicate harmful microorganisms? How? Please connect the dots to back up your conclusion that
Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years
because the "all" there and the time scale you talk about both appear to be exaggerations, especially in light of the progress that has already occurred in limiting MRSA infections in the United States.
>Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening.
This is the important point that people forget. Bacteria are experiencing an extremely accelerated time course and can evolve and exchange advantageous mutations very quickly. We have only had antibiotics for 100 years, which is 3-4 generations of man, but billions of generations of bacteria!
I am not actually sure that it takes as long as people think. The fact is it isn't just individual genes, but selection for combinations of them. If you look at random mutations, I think that is likely dwarfed by random permutations. This is why the resistance bell curve shifts over time. You aren't just selecting for a single gene, but for a function, which could be carried out any number of different ways, and which any number of different gene combinations could do it.
Richard Dawkin's book "The Selfish Gene" uses the same language, but, to his credit, he pauses regularly to remind the reader that genes are not really "selfish" and that they don't have "wants" and "desires," but that he is using that language to make it easier to understand the concepts. I understand your complaint, but it's a necessary communication technique when dealing with the general public.
> Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things
We're giving bacteria (which reproduce rapidly and mutate quickly) the perfect natural science lab to mutate and select for antibiotic resistance. There are 10^14 bacterial cells in the human body vs only 10^13 human cells [1]. Their reproductive cycle is over one million times faster than ours.
We're creating the perfect conditions for rapid evolution of these organisms. This system is executed by billions of billions of bacteria continuously and we're trying to combat that evolution with a few thousand humans in labs.
It seems to me that the take-away here is we need better engineering of our own solutions and we need to find a way stop enabling this rapid evolution of bacteria.
Your take-away should really be that bacterial evolution is part of being human - without those 10^14 bacterial cells evolving over one million times faster than our own, we wouldn't be able to survive - we wouldn't be human.
There's also inputs into their environment that influence whether they move via random tumbling, or directed movement, allowing them to move toward something.
While they might not desire anything, they do definitely seek out things.
>Bacteria don't desire anything, and they don't seek out anything or plan anything.
When you say this, aren't you are making precisely the same mistake you claim the expert was making?! I am sure Dr Arjun knows very well that evolutionary goals are local and specific to the circumstance a creature finds itself in.
>The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
:-) how anthropomorphic! Intelligence may not be a survival trait as you seem to assume. We simply don't know that. Btw, bacteria has been a lot longer on this planet than primates. We are way out of our depth when it comes to understanding how they work (I am simply paraphrasing a friend's statement, he is doing fundamental research on biochemical pathways)
For someone who opens complaining of teleology, your third paragraph relies heavily on the assumption that science will march forward. Where is the skepticism aimed at the assumption that we will be able to surgically genocide _all harmful bacteria_ faster than they can evolve?
The particular nit that I'd like to pick is blaming only misuse of antibiotics for the problem. The only way to distinguish use and misuse is in retrospect, and it's hard to say last-line antibiotics like vancomycin and meropenem have been abused.
I think you're using the term "desire" in a far too literal manner.
The organism of the bacterium doesn't have desire the way humans do, but the idea of a virus or manifestation of bacteria can have a figurative desire to evolve and grow.
Killing bacteria is easy. The trick is killing bacteria without harming ourselves. Soaps can be massively more "brutal" in terms of the mechanisms that destroy bacteria than what antibiotics can, and so the evolutionary steps that would have to occur for resistance are vastly larger, and would mean changing them in many different directions.
E.g. it does not help if a bacteria can survive a soap if it is still physically flushed away.
We also have a massive escalation ladder for external detergents beyond basic soaps that include a near infinite number of substances of increasing brutality than our arsenal of antibiotics. Essentially anything that will not harm us much with relatively limited exposure, yet will physically disrupt small organism. We can wash our hands in bleach. Or various acids. Or any of numerous agents that are massively disruptive on biological organisms through basic chemistry or even by being physically abrasive.
We don't even particularly need to care if we kill off a fairly substantial number of our own skin cells in the process.
If we had the same arsenal available for fighting bacteria internally as what we can safely apply externally, we'd be in a fantastic position.
I agree with you, but we need to be cautious with washing hands. The CDC have a nice document about "when is clean too clean?" which mentions the problems with people who have to clean their hand frequently. Damaged skin can harbour bacteria, and can make it harder to remove those bacteria.
> Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices.
Thanks for linking that article. The most interesting takeaway from that personally was that an alcohol-based rinse (hand sanitizer) is effective against nearly all kinds of infectious agents except for Gram-positive bacteria (which have a lipid cell envelope), without the threat of the emergence of resistance.
Handwashing with soap doesn't actually kill bacteria, it mechanically dislodges the oils and debris that bacteria are embedded in on your skin and rinses them down the drain. So bacteria have no defense.
The ability to burrow in between cells and to have more adhesive surfaces seem like two possible defenses bacteria already vary in and could evolve better. (Surely handwashing doesn't remove 100% of bacteria.) One reason this doesn't pose problems similar to antibiotic resistance is that this defense doesn't become a useful strategy inside the body, where infections are problematic for humans.
You don't directly address the resistance question, but I think that issue comes down to the "escalation ladder", which you do bring up. You can increase the effective of handwashing (or ultraviolet or whatever) in a way that just isn't possible with antibiotics.
You've been voted down but there is actually a school of thought that excess use of antibacterials and generally going "overboard" (whatever that means exactly) with preventing children from being exposed to natural flora can potentially result in weakened immune systems. There's a lot of pseudo-science in these claims but that doesn't mean there's absolutely no truth to them. It would probably be hard to do a study though and it's not clear who would fund such a thing.
Ignoring the snark (of the parent comment), I've often wondered why it was bad to use anti-bacterial soap (and antibiotics in general), but not regular soap, since both leave some amount of bacteria behind, which presumably have genetics making them more resistant to the pressure. I think part of the answer is that its just not possible to evolve resistance to any amount of soap and hand washing, unlike resistance to the targeted mechanisms of an antibacterial compound.
I'll take a stab at this - I'm an infectious disease epidemiologist that works on hospital infections mostly.
The thing with anti-bacterial soaps is not that the use of the soap is bad. The problem is the anti-bacterial part. It puts amounts of a broad spectrum antibiotic into the environment (be it your hands, your countertop, or the water system) in concentrations that aren't enough to do much, but are enough to put a little bit of selective pressure on the organisms and promote resistance.
It's also not particularly effective - soap and water, through a combination of both mechanical action and how soap disrupts cell membranes, works swimmingly. So there's a cost, and no benefit.
The answer to 'why isn't there a resistance to soap' is that soap, as a chemical, is absurd overkill. It's hellish on lipids of all sorts (tough on grease...and lipid cell membranes), and there's nothing to evolve a resistance to. Not expressing a particular protein, or expressing an enzyme that does a number on an antibiotic compound is effective - to evolve a resistance to soap, you'd somehow have to develop an entirely new type of compound to build cell membranes out of.
And while evolution is rather magnificent, that's asking a little much.
Bacteria evolving to secrete a soap-resistant compound doesn't sound far-fetched at all. Such compounds clearly exist already (e.g. pigments that don't wash off).
Thinking about this more, I suspect there already has been some selection in this direction, but that it has little to no public health impact, as this defense is not useful in places where infections are typically a problem. Indeed, our body is teeming with bacteria (mainly in the guy) that are in fact beneficial, and they've presumably managed some resistance to shear stress and extreme chemical environments (e.g. high acid).
I dated a heatlh care professional for a while who was pretty adament that it was causing detrimental effects in the same manner as antibacterial soap.
That one is...a little trickier. There is some evidence that it works for controlling bacterial growth leading to gingivitis - suggesting there may be some utility for it. But its ubiquity in consumer products makes me a little skittish.
So I don't know if I'd want it gone from toothpaste, but I'd like to see it gone from the many products where its useless or nearly useless, but included so someone can put 'Antibacterial' on the label.
It obviously is possible to evolve resistance to soap and hand washing: It doesn't kill us.
But the gap from a bacteria to something that can withstand the physical barrage of a thorough wash is huge in comparison to the relatively tiny changes to overcome some antibiotics. E.g. an antibiotic might disrupt a single process of the bacteria that is beneficial (for them) but that have a multitude of similar alternatives that are different enough for the antibiotic to fail. Compare that to even just being able to strongly enough attach to the skin to not be flushed away by sheer force from a wash.
There are many reasons that tends to be given for being careful about stronger measures: 1) it is not necessary. It's a matter of being cautious - by using the least effective means that is effective enough, we exert the minimum pressure necessary, leaving us with a larger arsenal of (to us) gentle alternatives to step up to. 2) the stronger methods, the more we kill off beneficial or neutral bacteria too, and by doing so we may make conditions better for bacteria that are nasty for us if we happen to pick them up.
3) we reduce our immune systems exposure to relatively harmless amounts of bacteria and some believe this may be sufficient to actually reduce our overall immune defence.
As DanBC pointed out in response to one of my other comments, there's also the issue of physical damage. While we can bring the heavy artillery and effectively kill anything that lives on our skin, we can as collateral damage cause damage to our skin that creates additional places to hide - effectively a worse variation of washing away good/neutral baceteria - not only may we be removing the competition, but we may be opening cracks and folds that'll be excellent hiding places.
Interesting, was going to say basically the same thing. At what point do we start designing RNA with a delivery mechanism that attaches itself to a specific bacterial type and eliminates it?
I understand the emotion in your response, I believe (correct me if I am wrong) that it comes from being unable to calculate a risk on something we don't understand. However, the action proposed sets as a prerequisite that understanding.
Consider 'fly by wire' as an analogy. There was great emotion (and still is) around taking the pilot of an aircraft out of direct control of that aircraft. First required by dynamically unstable aircraft (the F-117) this is now a standard feature on large passenger aircraft. The problems are still the same though, one bad line of code (or perhaps a few bad lines) and the plane flies into the ground killing everyone.
Similarly with engineered RNA. We actually do this a lot these days (very interesting bio hacking going on) and with DNA printers you can pretty much design your own bug, print it out, load it into a waiting husk of an E. Coli bacterium and boom, new bug.) Understanding isn't quite there yet but it will be. And knowing the risks of a particular DNA pattern will be just as understandable as a knowing the risks of a piece of flight software.
I don't doubt that if we devote enough attention, we can solve this problem. What I am afraid of, is that we will wait until it becomes a real and immediate threat before we dedicate any effort.
The black death bubonic plague killed around a hundred million people, almost half of Europe's population. World war 2 got close to that number of deaths, but the black plague bacterium remains the most efficient killer of humanity on record.
Something that terrible sometimes has to be personified, just to make it comprehensible.
>"So anything that we do to try and kill bacteria, or anything the environment does to try and kill bacteria, bacteria will eventually discover ways or find ways around those" he is making factual statements that are plainly incorrect on their face. Bacteria don't desire anything, and they don't seek out anything or plan anything.
You are taking this too literally. But in any case just because bacteria aren't intelligent doesn't mean their behavior is purposeless. Evolution acts as an optimization process. It's not too far from the truth to ascribe it "desires".
On the frontline episode this was from talked about how pharmaceutical companies have all stopped investing in new antibiotics. It might be possible to make better ones but I don't know how much research is actually going on at the moment.
I'm kind of skeptical. We are fighting against millions of years of evolution. The drugs we have we only got by copying things evolution already found, and they became resistant in mere decades, an extremely short time from an evolutionary perspective. Any simple way of killing bacteria would probably already have been developed by evolution. Likewise pathogens have spent millions of years evolving to defeat everything thrown in their way, and they continue to do so.
We are joining into this ancient arms race as entirely new players.
Agency description language is easier for humans to understand than the passive language required to describe the actual occurrences.
Yes, it's inaccurate, but it is what often happens when you want to get across the message and can live with a bit of inaccuracy at the expense of message reach.
Haha, I had the same thought, basically that evolution is not directed to overcome particular threats, and can certainly fail to do so. I kind of assume that he knows that, and decided to simplify (a poor choice for a lengthy and detailed interview imo).
I'm not sure I understand your point though, beyond "with more knowledge we will get better at this." What is the timeline? Is there any current research that may lead to this breakthrough, whereby we no longer have to borrow evolved tools from other life forms and can actually develop a precise and resistance-immune treatment?
Thanks for your useless karma whoring post that does nothing but distract from the content of the article with more "fallacious teleological language" of your own.
Current antiobiotics are themselves mostly derived from "natural" chemicals emitted by microorganisms so that those microorganisms survive natural selection to go on reproducing in a world full of bacteria. Many of the early antiobiotics, for example penicillin, are derived from mycotoxins produced by fungi. Human medicine can use chemicals from fungi for protection against bacteria because human beings and all animals are more closely related to fungi than either fungi or animals are related to bacteria,[1] so fungi have a biochemical similarity to animals that makes it likely (although not certain) that a mycotoxin that is lethal to bacteria will be relatively harmless to human beings.
And this is the way forward to developing new antibiotics. As we reach a deeper biochemical understanding of the basis of all life, we will eventually understand the differences, which are biochemical differences at bottom, between human beings and bacteria, between human beings and protists, between human beings and fungi (yes, there are some systematic differences between animals and fungi) and between human beings and all other harmful microorganisms. Only human beings have science labs and clinical research studies to come up with new defenses against the thoughtless, largely immobile threats from other living things. We can form hypotheses, test those hypotheses rigorously, and perhaps make some lineages of harmful microorganisms as extinct in the wild as the smallpox virus and rinderpest virus now are. The intelligence that the hominid lineage has evolved gives human beings advantages that bacteria will never possess.
[1] http://ucjeps.berkeley.edu/DeepGreen/NYTimes.html
http://www.nytimes.com/1993/04/16/us/animals-and-fungi-evolu...