Today more than 600,000 Americans die of evolution every year – overwhelmed by infections or cancers that have evolved to resist drugs. While discovering new drugs is mind-bogglingly expensive, it’s actually relatively easy science. The challenge is maintaining the effectiveness of new drugs in the face of relentless evolution of the life forms they target.
Thus, the problem we face is an ecological problem, not a biochemical one.
What we need is a solid understanding of “evolutionary management” when it comes to diseases that allows us to know things we can only guess at today. This means knowing the properties of drugs that can best combat the evolution of viruses, bacteria, and cancer, and how best to combine drugs to slow or stop their evolution entirely. It also means knowing how best to use drugs. We need to learn when we should use overwhelming chemical firepower and when that just makes resistance worse.
To achieve this knowledge and how best to use it, we need to move beyond our focus on “eminence” – practices based on experience and expert consensus – and move to a focus on evidence, measuring the forces that drive the evolution that kills. Most importantly, we must fund research to develop a rigorous experimental science of resistance management, testing strategies and measuring the resulting evolution, or lack thereof.
The ultimate fruit of this research will be the development of “evolution-proof” drugs.
We will be using compounds not even categorized as drugs today; some of those compounds will slowly starve cells while others will trick resistant cells into making themselves more vulnerable to other drugs. We will know how to drive target cells into evolutionary dead ends.
For infections, we will have properly determined where resistance originates: agriculture, our microbiomes, other people, or the environment. When we know the relative importance of the major evolutionary drivers, we can change the future for the better.
Today, HIV is no longer the death sentence it once was, as physicians now know how to stop the virus from evolving resistance. I look forward to the day when science shows us how to do that for the vast diversity of other viruses, bacteria, protozoa, fungi, worms and cancer that cause so much human misery.
But for that day to come, continued public support for the research we need is critical.
Dr. Andrew Read is the Evan Pugh Professor of Biology & Entomology, Eberly Professor of Biotechnology, and Director of the Center for Infectious Disease Dynamics at Penn State University. His research focuses on the ecology and evolutionary genetics of infectious disease. He is the principal investigator for multiple awards from the National Institutes of Health, including the National Institute of Allergy and Infectious Diseases and the National Institute for General Medical Sciences.
This piece appears courtesy of Science2034, where an earlier version of this piece was first published.