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.
May 30th, 2007 at 9:07 pm
Grey Swan: We now commonly see methicillin resistant staph aureus. It is resistant to all the commonly used anti staph drugs, but it is sensitive to septra and doxycycline. In the past, i would never have treated a staph infection as it was recognized that these two drugs were generally ineffecgtive against staph. Instead I used Keflex or oxacillin, or Augmentin. The MRSA staph is now resistant to these drugs. Years ago the drug clindamycin was commonly used to treat all sorts of infections, but people developed side effects to it and its use was severely curtailed. Now it is effective against most MRSA infections and it is the drug I reach for when I suspect resistant staph. The drug was uncommonly used for over 20 years. barry
May 31st, 2007 at 7:27 am
To say that the equipment of the Germans were rougly the same than
of the French is true quantity wise but not quality wise. The Luftwaffe was clearly superior and one Panther could face easily more than ten French tanks. In fact, Sherman’s were crap too, and without clear air superiority the Panthers and Tigers would have easily thrown the allies back into the atlantic. Only the soviets had a comparable tank to the Panther.
May 31st, 2007 at 10:34 am
Let’s get back to using sulfa drugs too. They used them before antibiotics and in WW2. Thy’ve got their issues, like all drugs do, but they seemed pretty effective. Any doctors out there ant to chime in?
May 31st, 2007 at 10:40 am
Let’s get back to using sulfa drugs too. They used them before antibiotics and in WW2. Thy’ve got their issues, like all drugs do, but they seemed pretty effective. Any doctors out there want to chime in?
Gannon, the main reason the Sherman was effective was sheer numbers. I remember reading some great panzer commander who has probably dozens of tank kills to his record was finally ambushed by about 10 Sherman tanks and blown to pieces in the ensuing fight. And some German said something to the effect of, “A German panzer can defeat 10 Shermans, but unfortunately there are 11 Shermans.”
June 8th, 2007 at 9:19 am
I think the phrase was, “One of our tanks could defeat ten of theirs, but those damn Americans always had an eleventh.”
The currently used sulfa drug, Bactrim, has lots of nasty side effects. It can damage your bone marrow, liver, kidneys, and skin. People are also often allergic to sulfa drugs. It may see use now that the bugs are resistant to lots of other things. We’re using things like polymyxin that used to only be used on the skin because of their toxicity.