Biology rants for the day

There's a PBS show on now about infectious disease. It's called "Rx for World Health." They are currently discussing an issue that I agree is of the utmost concern - the explosion of antibiotic-resistant bacteria.



The current approach is to find new chemicals that kill bacteria. Penicillin was an amazing discovery, but our lack of understanding and later misuse of it have led us deep into problems. You know what happens when you pick up someone's weapon and use it against enemies that have already been fighting those weapons? The enemy can fight back...and is working hard to develop better shields and better weapons. Yes, it's concerning that there have been so few drugs developed recently to treat infections. Yes, it's concerning that many pharmaceutical companies don't profit from antibiotics and so don't choose to pursue treatments. Yes, it's an issue that we don't have a good sense of the identities of most of the microbial life around us - the good, the bad, the invisible.

Here's the idea that became crystal clear to me during my class on the evolution of infectious disease: don't f*cking up the ante if you don't want to increase the risk of loss. I don't care how many new drugs are developed to kill - they *all* are on a trajectory favoring evolution of resistance. And no, the answer isn't easy here, even if the evolutionary theory is clear...what we need to do is to change the game we're playing. We need to disarm the infectious agents, not kill them. Make it profitable for them to stop killing us.

I can't remember the sources offhand, but there were some papers that I read in my class that offered an intriguing plan: design drugs that disable the weapons used by bugs. This is particularly relevant for bacteria - if you give patients a drug that binds to toxin, then the toxin stops making them sick, but doesn't kill the bacteria. Bacterial genomes have a deletional bias, which makes it easier to lose non-essential genes. It's unclear whether small genomes are favored by natural selection (or, if so, why), but there may well be a cost to carrying genes that don't make life better. Those genes should then fall out of favor with the community - and the hope is that we'd eventually see people who carry harmless bacterial infections where they would once have been sick. Granted, it's a tough game to play, given the complications of biology and evolution, but it's worth a try, right?

No, this doesn't eliminate all virulence - there will still be bugs that are new to us, that will still take us out quickly. (This is the whole idea behind avian influenza - we know that there are variants of the two major surface proteins of the virus out there, but since no humans have experienced them, nobody has "natural" resistance. And we can't predict which viral flavors are going to make the jump. We can barely predict which variants already circulating among humans are going to peak during each flu season!)

And yet...what can we do? It would take so long to make things work in an intelligent manner, and we may not have the time to get them working before we all get taken out. One of the proposals, in fact, is that anyone who gets a little bit sick should stay home. Doing so means that it's more beneficial for the bug to hurt you less - that's the only way it makes it to your workplace, your grocery store, your loved ones. If you're already miserable and really sick by the time you stay home, the bug has already "been told" that being virulent gets it around (after all, it gets around better when you're coughing your lungs out over your desk). Try telling that to the average corporate manager. Hell, it's been too much of a battle for parental leave for birth! How would we ever convince employers that workers should get more days off if they need them? Or that employees should be able to telecommute when feeling just a bit under the weather, while clearly infected?

Argh. It's so frustrating. And it's that much worse because people have been publishing on this for years, but none of the popular press seem to have heard it. All you hear about are the amazing breakthrough drugs. (Which leads me to a rant topic I won't indulge here, except to say that it sometimes pisses me off that there are multiple drugs that help men get and keep erections...while we lack drugs to treat infectious diseases that kill hundreds to millions of people each year. Not that I want to deprive any patients of tools to live full, healthy, happy lives...just seems like profits have had an undue effect on priorities.)

Okay, rant over. I'll go back to being a good little grad student who tries to change the world a few students at a time. But please - keep these ideas in the back of your head. I know you're all educated enough to know all of this, but I feel this desperate need to say it again: don't pressure doctors for antibiotics, don't violate the directions of your prescriptions, and avoid antibacterial products that use "low level drugs" - but wash your hands often. (Honestly, the "violence" of scrubbing dislodges germs from your skin, and plain old soap will make cellular invaders explode. You've probably experienced times when washing your hands too often with soap makes them get dry and crackly...my understanding is that the soap just destroys your protective layers of oil and cells. Please correct me if I'm wrong, though. What I do know is that we use detergents as the first step of DNA extraction - it's the primary ingredient of our mix to bust open cells.) Vaccinate your children and clean/cook your food.

Alright, I'm really done now. :-)