Putting the life back in science fiction

High tech, no antibiotics: a thought experiment
September 24, 2016, 8:39 pm
Filed under: futurism, science fiction, Speculation, Uncategorized | Tags: , ,

First off, I wanted to share a neat video from Bad Astronomy, showing just how, and how fast, bacteria evolve.  Yes, this is evolution in action, captured on a video.  Share it with your creationist frenemies.  Isn’t the 21st Century awesome?

And now, a thought experiment: normally, when we think of a science fictional future, it contains antibiotics, either explicitly or more generally, implicitly.  Antibiotics are routine, not just for treating infections, but more importantly for treating wounds such as you would get from surgery.  Anything involving a transplant, a replacement, or even opening up the body goes much better if there’s a course of antibiotics afterwards to clear up whatever bacteria got into the wounds that the surgeons made.

It’s not news that antibiotics are ephemeral products, and that the more we use them, the faster they become ineffective.  They knew that when they commercialized penicillin.  My question is, what would an antibiotic-free future look like?  Especially one that is high-tech?It’s not something I’ve spent a huge amount of time thinking about, so I’m posing it as a thought experiment. What do you think?

Obviously there are substitutes, like bacteriophage viruses, that can partially take the place of antibiotics.  The problem is that they’re more complicated to use.  Bacteriophages are used in hospitals now, but to have them replace broad-spectrum antibiotics, you not only need a lot more of them, you need both an active phage-industrial complex to grow them and keep creating new phages to deal with the rapidly evolving bacteria (see the video above), and you also need much more sophisticated (and rapid) diagnostic tests so that you know which phage cocktail to dose a patient with so that the viruses can kill the bacteria.  It’s worth realizing that the CRISPR technology is based on a bacterial defense against viruses, so all we’re doing with phage therapies is interfering in a 4 billion year-old war to favor the viruses over the bacteria for a short time on a particular evolutionary battlefield, otherwise known as the patient’s body.

In any case, I don’t think bacteriophages will exactly substitute for antibiotics, any more than I think electric cars will exactly substitute for gas guzzlers.  Life will change if antibiotics go away.  What will an antibiotic free society look like?  For one, we can kiss any idea of cyberpunk goodbye (you want to wire a cell phone to your brain without antibiotics?).  What else?   Will this affect issues around sustainability, that other semi-mythical future we’re all hoping will happen?


10 Comments so far
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There are a number of promising avenues that will make existing antibiotics effective as well as creating new classes of antibiotics. The problem isn’t really the bogey of bacterial resistance due to overuse, especially on farms, but rather the disinclination of Big Pharma to invest in drug research for acute conditions, due to the high cost to get to market.

I think we can solve the monetary problem in a number of ways if we don’t assume that the unregulated, unfettered “free market” solves economic production and distribution optimally.

Comment by alexandertolley

>Isn’t the 21st Century awesome?


Comment by a scruffian

Phages have various problems. One of them is that people develop immune responses to them, up to and including anaphylactic shock.

An advanced understanding of immunology will probably help some. It won’t help much for people who show up with some kind of infection. The human immune response will probably identify threats and respond to them as fast as artificial labs can. But for epidemics, we can identify the threat and spread the response to many people faster than they could each do it from scratch.

Also we might develop cell lines that have a minimal number of markers that people can react against, and use them to carry immunological knowledge to people who are about to be exposed to new threats.

Antibiotics could still be useful if we use them a lot less. Generally, bacteria that are resistant to an antibiotic have a disadvantage from it. If they make an enzyme that degrades the antibiotic, they have to make an extra enzyme which is otherwise useless to them, and that will slow their growth some when the speed that they make useful proteins is the limiting factor.

Bacteria that don’t need antibiotic resistance will have some tendency to lose it. And then the antibiotics can have an effect. we have to be careful not to over-use them. It might also make sense to do things like collect the patients’ urine and de-activate whatever antibiotics might be there, so we avoid selecting bacteria that are resistant to small amounts of antibiotic wherever the sewage goes. Similarly with wastes from antibiotic factories.

There’s room for a collection of new technologies we don’t have yet. Antibiotics are just for bacteria anyway, and we might get things that work against viruses and cancers etc.

Here’s a generality I can’t provide specifics for — we tend to get more virulent diseases when we select for virulence. Lots of naive hosts mixing in large numbers, so the version that becomes infectious quickest has plenty of people to spread to. Hosts that are already weakened by malnutrition etc so they are likely to die pretty quick even with a less-lethal pathogen, so being infectious for longer is not much advantage compared to being infectious sooner.

If we could manipulate the circumstances well enough, we might find ways to breed diseases that are less virulent. Of course we might prefer to kill them off entirely. But breeding them to be not as bad could save a lot of lives.

Comment by J Thomas

Antibiotic resistance will only be reliably selected for in bacteria that spread human to human or at least spend a reasonable fraction of their generations on humans. Environmental opportunistic infections from, say, soil not taking sewage runoff will remain relatively resistance free. Hospitals, and all obligate pathogens, are another matter.

Ive read accounts from 80 year old nurses saying they are shocked and appalled by the low hygene standards in modern hospitals. Apparently in the past dust was the devil and many surfaces were daiky wiped down with dilute bleach, and carpet or plush furniture were anathema because they coukd not be wiped down. One can expect more impermiable surfaces in medical contexts, especially copper and brass with their natural antimiirobial properties.

Comment by Tony

Indeed. A couple of years ago, during the Ebola outbreak, I had a relative in a nearby hospital. He had a fairly resistant and common bacterium, so he was in partial quarantine. We all grumbled about how careless the staff was about the quarantine. His comment, which I think was accurate, was that if Ebola got to that hospital, he’d be dead along with most of the staff, and he was angry, not frightened. Fortunately, they didn’t have to deal with Ebola, so they could keep on being careless. Personally, I hope I never have to go to that hospital as a patient.

Most of the hospitals I’ve seen are relatively impermeable, relatively being the key word, because they rely on plastics and chromed metals. The problem, at least in the US, is that most of the staff don’t really understand sterile procedure at all well. I get it a little better, because I’ve done some fungal culturing, and when you screw that up, you contaminate your culture, so you learn quickly. As you note, in a hospital this is about dusting, but it’s also about being serious about not transferring pathogens. \

Comment by Heteromeles

@JThomas – I think you mean collect patient’s stools. Urine will be sterile unless the person has a UTI or their kidneys are severely damaged.

@All. Hospital sterility cannot be maintained. What is perhaps worrying is that routine swab cultures of equipment can even track particular strains when sequenced. Sometimes it turns out that a particular staff member is the source of contamination. Hospitals are awful places to be if you don’t want to catch a resistant bug. And don’t ever go into an ER during flu season!

Hi-tech hospitals may end up with enclosed bed modules like you see in Sci-Fi movies, keeping the patient isolated from the outside. What that will do for the patient’s psychological welfare is anybody’s guess. Alternatively, when equipment becomes cheap, it might just be best to treat the patient at home, rather than in a place that concentrates infections and increases transfer risks.

Comment by alexandertolley

“I think you mean collect patient’s stools. Urine will be sterile unless the person has a UTI or their kidneys are severely damaged.”

Antibiotics which are not degraded inside a human being, eventually get excreted. Then they are present in low concentrations wherever they wind up, where they do something toward creating resistant strains. Anywhere there is enough antibiotic to slow down the growth of the old-type bacteria by 1% can breed resistance.

SImilarly, wastes from antibiotics factories tend to kill off unprepared sewage treatment plants. They contain too much antibiotic which was lost in the purification procedure. But within a reasonable time the sewage treatment plant is occupied entirely by resistant strains. Is this something we want?

Someday when we understand the infective process better, when an epidemic disease gets started, we will quick analyze it and create a new version which can infect and can spread, but which is not very virulent. Then we spread around the weakened disease as a sort of firebreak. The mild version spreads and gives people resistant to the deadly kind. Much less organization required than vaccinating many millions of people.

Comment by J Thomas

I see. You weren’t concerned with bugs that became resistant in your body, but the excreted antibiotic that then goes into the environment which subsequently may cause resistance. (You also need to worry about the drugs being flushed down the toilet too.) Since animal outbreaks seem to come from farms, my sense is that the immediate resistance is the problem, as there are new hosts for the resistant bugs to infect.

Comment by alexandertolley

Bacteria do become resistant in your body, of course, as the video implies. Take a dose that isn’t high enough to kill all of them, give the survivors time to multiply, take another small dose, that’s the method that creates resistance, only spread out in time rather than space.

Out in the world, bacteria get sophisticated mechanisms to deal with antibiotics, and package them onto plasmids where they can spread fairly easily from one kind to another. The resistance they get from simple mutation inside a single host is primitive by comparison. You might have only a few billion cells causing the disease, but there can be quintillions of them out in the world, ready to share genes. It could be a circuitous route from a sewage treatment plant back to a virulent bacterium that infects people, but there are a very large number of those circuitous routes available.

So I figure we’re better off if we don’t encourage those sophisticated defenses against antibiotics to spread more than we have to.

If you give antibiotics to a lot of farm animals with the belief that this will improve growth, and the antibiotics don’t degrade inside the animal, then they will wind up in the animal’s environment in low doses. They will provide a setting for the first stage in the video, the .1% or 0.01% concentraion that all the bacteria in the area easily become immune to.

Comment by J Thomas

And another new solution to antibiotic resistance.

Comment by Alex Tolley

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