May 30, 2007 5
Time for a New Medical Doctrine? (Updated)
After reading the New York Times article “TB Patient is Isolated After Taking Two Airline Flights,” I have come to believe that we are beginning to lose the war against bacteria. The article mentions a strand of extreme drug resistant TB that is mostly untreatable. Unfortunately, drug resistant bacteria are becoming more and more common with each passing day. The problem, I believe, is not that our rate of technological innovation is too slow, it is that the ‘Doctrine*‘ we use in applying our technology is antiquated.
We need to improve our tactics in order to prevent and reverse the trend of drug resistant disease. Currently, doctors tell their patients to complete the required dose of a certain antibiotic, with the hope of eliminating the infection quickly. We then cross our fingers and hope that the disease does not evolve any defense. No global effort is coordinated**. We really need to use evolution against bacteria. Since bacteria is always evolving through random mutations, if a particular drug type is not used, resistance to this drug will erode. This is similar to why animals that live entirely in caves have no vision. The idea is that we rotate different drugs in cycles. If we resist using a particular drug that has become generally ineffective, like penicillin was for a while, when we reintroduce it, it will once again act like a ‘miracle’ drug. Consider that penicillin has become more effective as people have stopped using it. If we entirely stop the use of a particular drug, this will happen much faster***. Of course, this would require world wide coordination, but in the long run it has the potential to save many lives.
* Consider that in World War II, the French army was nearly as well equipped as the German army. However, Germany had invented a combined tactics approach to warfare that became known as Blitzkrieg. Using this superior Doctrine, French resistance was effectively defeated in just a few weeks.
** This is akin to having an army made up entirely of platoons, with little or no higher authority to organize it.
*** I have done some research into evolutionary adaptations, mostly through computer simulation. What I have found is that once an adaptation is in place, even slight positive evloutionary pressures will maintain or improve that adaption despite genetic drift. That is why the wholesale prohibition on certain drugs would drastically increase the rate at which bacteria lost resistance to them. Actual research should be done, but I would guess rotating drugs in 10-20 year cycles would be very beneficial.