New Antibiotics

Healthcare has always been ultimately futile because we will eventually die not matter what. This is no reason to ignore the field completely. A new and effective antibiotic would save millions, perhaps billions of lives; not forever, but saved nonetheless. I don't see that as "futile".

I don't think we need to give up on our approach just yet, because it isn't as bad as you might think. Medical progress has, I believe, the capacity to out pace evolution. Allow me some ridiculous analogies to back this up:Suppose we are frontiersmen plagued by wolves which are eating our livestock. They can hide quite well and require some pretty tough work to hunt, and it isn't really practical to "clear" an area of wolves since they will either remain undetected or simply return after a hunt. We make a windfall discovery though; by putting on polarized sunglasses 90% of wolves will appear to have hot pink fur.Needless to say this technology makes it easy to spot and kill those wolves, but what of the remaining 10% that can still hide? Eventually all wolves will end up being the non-pink kind but will this prevent their eventual extinction? What if we come up with a second windfall that kills 90% of those remaining wolves, and we get this windfall within 2 months of the first?Back to reality: Wiping out large swaths of the bacterial population has benefits beyond the individual cases, even if we assume that the overall population size remains constant. The remaining scraps of resistant bacteria are lacking in the genetic diversity of the original population, and genetic diversity takes time to develop. The next method of bacterial death we develop will likely apply to a larger swath of the remaining population; ultimately the goal being to find an antibiotic effective against all of the remaining handful of strains.20% of bacteria might be resistant to Med A.
20% of bacteria might be resistant to Med B.
How many are resistant to both Med A and Med B? Much fewer.. maybe 5% overall.
How about Med C, specifically targeting that remaining 5%? Due to the specialization of the few strains, it gets all but 10% (.5% overall).
How about Med D, nearly useless on the original population since it only takes out 1% overall? On the other hand it completely obliterates every last strain that was resistant to A, B, and C.Evolution is powerful yet slow. Humans are the poster child of overcoming the evolutionary race: Wolves ate humans (among other things). Humans ran away, and got pretty good at it. Wolves got better at running. Humans got good at hiding. Wolves got good at finding. Humans banded together for protection. And humans made tools, such as spears. And guns, and trucks, and houses, and fences, and helicopters, and poisons, and traps, and... well, if not for our efforts to avoid it there wouldn't be any wolves left at all. There *are* still wolves out there now, but they are hardly a problem.

Yes, each patient is a microcosm of their own. We still go into the fight with all guns blazing though, we don't have to start medical science over every time. Oftentimes the patient's infections can be completely wiped out by our medicine and they never develop a resistant strain at all. You might do the same to the next, and the next. When I suggest that 99% of the world's population of the pathogen could be killed by antibiotics I obviously don't mean *instantly*, you obviously have to do it per-patient. Absolutely, I don't claim that wolves are perfectly analogous to bacteria. I don't think it is proper to say that bacteria necessarily develop resistances to drugs out of whole cloth, rather that selective pressures tend to make those most resistant to our drugs the most "fit" for the environment. Medicine is getting faster, but it does not *need* to get that fast if we can back infections into a corner through limiting their genetic diversity. Who knows, one day we might even have all the bases covered and be able to treat every possible avenue of infection, but until then what we are doing helps. Surely you are not suggesting that we should eliminate that open field by allowing it to be packed with competition?! "Good lord, this man is being ravaged by malaria! Don't worry though, we can limit its damage by simultaneously infecting him with some bubonic plague and various types of flu!" If we can treat 95% of the ailment we SHOULD! We are guaranteed for that treatment to be better than doing nothing, and the worst case scenario of an infection immune to everything we have would still be functionally equivalent to your original proposal. Sure we have, fire works pretty well. Of course we don't want to kill *everything*, we just want to kill very specific things. When we kill those things we often come up with new things we want to kill too, that require new methods. This does not mean that we shouldn't have killed those first things though.Applying evolutionary theory to medical and pharmaceutical research is well and good, but avoiding the use of antibiotic research is not the answer. By doing so we would give up our most powerful evolutionary advantage, our intellect. Basically it would be declaring bacteria the winners for all time, rather than the usual state of things where we are the winners except for a few isolated cases.It may be a legitimate concern that by continuing this arms race at the limit of both our capacities we are unlikely to win absolutely, and instead we would eventually be faced with a similar status quo as now, perhaps a little better, but that without medicine an infection would utterly destroy our immune system. I would counter this by saying that we are there already in other aspects of our lives; we need the advances of clothing and tools to be able to properly compete with the wildlife around us, so adding medicine to those "crutches" like fire and thumbs isn't the end of the world.

This seems like it would actually place evolutionary pressure on increasing virulence since the window of infection becomes smaller. All he has managed to do is reduce the number of vectors without needing to produce a new pesticide. A better Band-Aid.Instead if we wanted to actually reduce their virulence we should place an evolutionary advantage on infecting something other than humans. We could do this by, say, destroying every human malaria case that we can find thus making human-infecting malaria strains less fit as they are less likely to reproduce. Logically then evolution would point them away from infecting humans.

Virulence does not mean lethality. Malaria could increase its virulence by infecting more mosquitoes, becoming more likely to infect through an infected mosquito, or even by completing its incubation faster. I don't recall anything about malaria being detrimental to the life cycle of mosquitoes so any of those would have no particular impact on the vector. Sure, reducing vectors is wonderful. If we could kill all infected mosquitoes within 10 days of their infection then malaria would be dead right there. I don't agree that the eradication of the disease isn't going to happen, at least within human hosts. We have eradicated diseases before so there is no reason to think it cannot happen again. I am certainly not arguing against the attack of vectors, I am arguing against the attack of vectors *instead* of direct attacks on the organism. I disagree with your statement that those attacks are not helpful, in the sense of evolutionary theory, at reducing their impact on humans. I mean by developing medicines and treatments that can finish off a malaria case within a human before it has a chance to spread. Human infection is a stage in the life of human strains, and if they don't survive it the cycle of life does not go on. If we can consistently cure a large majority of human cases before they manage to reproduce and spread then that is strong evolutionary pressure for being unfit for the environment.