"If We Were Half As Good As Bacteria At Evolving..., We'd Probably Now Rule The Universe"

[Hissyspit]

http://www.huffingtonpost.com/deborah-blum/tb-and-the-question-of-ev_b_50123.html

"It's impossible to overstate the evidence for evolution at work in this dilemma. If we were half as good as bacteria at evolving to meet challenges, we'd probably now rule the universe."

Deborah Blum| BIO
TB and the Question of Evolution

I recently attended a national meeting of biologists, gathered in dismay over the way we teach medicine in the United States, at least regarding basics of biology. At the top of their list was the failure of medical schools to adequately teach principles of evolution. They blamed such ignorance for what we all face now -- an unwanted and dangerous experiment in microbe evolution.

I'm talking, of course, about the rise of antibiotic resistant bacteria. The "superbugs" are once again in the news following this week's travel fiasco, involving a Georgia man, who against the advice of his doctors, decided to fly to Europe for his honeymoon, although he was infected with tuberculosis. In fact, by the time he arrived in Italy, doctors realized that he was carrying a worst-case form of the disease called XDR TB, which is highly infectious, usually fatal, and resistant to almost all available treatment.

- snip -

It would be easy enough to speculate at this point about human stupidity and its causes. But I don't want to dwell on the passenger in question. I want to dwell on the mycobacterium responsible for tuberculosis and why it shape-shifted into a form so potentially deadly that CDC issued its first quarantine order since 1963. (That order involved a suspected case of smallpox.)

And that, of course, brings us back to medical schools and the question of evolution. Today most doctors prescribe antibiotics sparingly but, even 10 years ago, medications were given for
infection the way water is given for thirst. The result was to create a richly antibiotic-laced world, one that presented bacteria with a challenging new environment. And microbes responded by adapting, evolving to meet its pressure. The problem (for us) was not the bacteria that died, but the ones that contained mutations that allowed them to survive. The survivors reproduced. Challenged by another drug, they died back except for a few resistant to both chemical agents. And that scenario repeated itself to create our current problem. To use TB as an example, there are now more than half a million people infected with multiple-drug resistant tuberculosis.

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[WinkyDink]

1. Something ELSE rules the Universe?

[Hissyspit]

4. She didn't say that!

:P

[Mr_Jefferson_24]

2. Yeah, but we'd really smell bad.

[sicksicksick_N_tired]

3. I'm no scientist or doctor but I always avoided antibiotics until my own body,...

,...was losing the fight. I sincerely figured my body would be stronger by fighting, on its own,...and it is. Same with my kid. We've taken antibiotics twice, at most, in the last ten years.

With respect to the humanity evolving,...I've often wondered if we're not DEvolving and becoming more stupid by the minute. *shrug* Dunno' for sure.

[necso]

5. Here's a WHO link:

http://www.who.int/mediacentre/news/notes/2006/np23/en/index.html

MDR (Multidrug Resistant) and XDR (Extensive/Extreme Drug Resistant; I like "extensive" better) are terms used to describe the extent to which a disease strain has evolved resistance to different families of drugs (that otherwise could typically be used to successfully treat it). (Although the precise details of how these terms are defined (and how disastrous these strains might be) can vary across diseases -- and how wide a range of treatments are available.) Moreover, multiple strains of a disease can be MDR\XDR (XDR implies MDR), so the term doesn't identify a strain, rather just characterizes it (says something important about its nature).

I have also seen the term extreme-XDR used, with the meaning "resistant to all families of drugs" (that otherwise could be used to treat it) or sometimes "almost all" (potentially a huge difference).

(In many things it's important to maintain fine distinctions, but that's another discussion.)

As a disease strain becomes resistant to more families of drugs, the less options there are to treat it. And if a disease strain becomes resistant to all it's treatment-drugs, then there are no drug-options left. This could essentially catapult us back into the bad-old-days before antibiotics (etc), at least as far the particular disease strain is concerned.

TB is a real problem because of its capacity to spread, its potential lethality and because it can take a long time to cure, even when it responds to treatment (which makes mistreatment more likely, and perhaps thereby encourages new resistance).

And those with weak immune systems will be especially vulnerable.

We are creating (have created) a fairly sucky world for ourselves, because of our poor-focus, selfishness and greed (apathy, inertia, etc).

Basic selection will catch up with us sooner or later.

[FloridaJudy]

6. Rachel Maddow

Was talking about this case on Olbermann the other night. This whole thing was a monumental f&*k-up on the part of the medical authorities: there was no plan to deal with a contagious, lethal, multi-drug resistant disease. Considering the amount of money diverted from the public health system to cope with "bio-terrorism", this amounts to criminal negligence.

Another little-known case occurred at the height of the bio-terrorism scare, when the government was trying to get all health care workers immunized against small-pox. A man showed up in the ER of a mid-Western hospital with what - to all appearances - could actually have been small-pox: I saw the man's pictures, and I'm old enough to remember what small-pox looks like. If I had been one of those hospital employees I'd have been frightened out of my wits. The ER did the right thing: rushed the guy into strict isolation, carefully collected specimens, put them in leak-proof, tamper-proof containers and sterilized the outside of the containers. From then on, the case was a massive balls-up. Nobody at the CDC seemed to know where to advise the docs to send the specimens, and when they did decide where they should go, no one could be found to transport them. Every single airline refused to touch them, even though they were securely locked in a sterilized container. In all it took over two days to get the specimens where they needed to go, when it should have taken mere hours.

It turned out the man was an AIDS patient with a very nasty and atypical case of herpes. Horrible for him, of course, but not a threat to the general public. But the point was made: for all our lip-service of protecting the people from biological threats, when it comes to actual cases, our public health system fails miserably. That's unbelievably sad, because I worked for the public health department for over 20 years, and it's staffed with bright, dedicated people. What we need are clear plans for dealing with unexpected - or for that matter expected - threats, and this administration has failed us miserably. It's a natural consequence of putting uneducated ideologues in charge of programs that are supposed to benefit the public.

[kineneb]

7. Laurie Garrett warned about these problems

in two of her books:

The Comming Plague and Betrayal of Trust.

Both are weighty tomes that will scare the crap out of anyone who reads them...and we all should.

[kikiek]

11. I have read The Coming Plague. That is a good book. Anyone doubting evolution only needs to look at

bacteria for ongoing proof. Of course if the hardcore creationists controlled our government we would be dying from the lack of treatment. Wouldn't have funded the science needed to fight the ever changing bugs since it would disprove their creationism only theory.

[Evoman]

8. No matter what we do, they will beat us.

They are always one step ahead, those bacteria. The only thing we can do is extend the time that specific antibiotics remain effective....and giving EVERYBODY antibiotics for EVERYTHING is not the way to do it. And doctors need to own up to the fact that they have made this problem worse with irresponsible prescription dispensing.

Not to mention current farming practices, with over-feeding of livestock with antibiotics is causing the evolution of drug-resistant bugs.

[frustrated_lefty]

9. Transmission rate vs mortality

The occurrence of MDR strains is a serious concern, but it's not the cataclysm some seem to expect.

To drag a virus into the discussion, consider Ebola. There is no medication to treat it, it causes a hideous death. Why hasn't it, or one of the other hemmorhagic fever inducing viruses wiped us all out? The answer is it has a high transmission rate and rapid mortality rate. Basically, the people infected with it don't live long enough for it to spread very far.

HIV is scarier, in some ways, because of its latency period. If it takes 10-30 years to spread before it causes death, it spreads a LOT farther.

Bacterial infections GENERALLY tend to kill quickly, although they spread more easily. There are exceptions to that rule, but those also aren't the bacteria you routinely hear concern about. Staph kills in days to weeks. Strep pyogenes, the same. Pathogenic strains of E. coli, days. Acinetobacter, the latest gift in the Middle East, weeks.

Don't get me wrong, these are all horrible things, but we're not looking at the "End Times."

[Vidar]

10. And it's a good thing for the universe that we don't.