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Counterpoint: A recent Kurzgesagt video suggests that we may be able to deploy bacteriophages (bacteria-attacking viruses) to combat superbugs. https://www.yout

Counterpoint: A recent Kurzgesagt video suggests that we may be able to deploy bacteriophages (bacteria-attacking viruses) to combat superbugs. https://www.youtube.com/watch?v=YI3tsmFsrOg https://www.youtube.com/watch?v=YI3tsmFsrOg Note: I'm not a doctor/biologist/etc., so I cannot comment on the details of this claim (e.g. how far away we are from a widely deployed phage-based treatment).

DonaldFisk 8y ago
Bacteriophages were used instead of antibiotics in the Soviet Union, and are still used today in Georgia.
- smaddox 8y ago
  My extremely limited understanding is that a given bacteriophage only attacks a very specific strain, and thus that you would need to constantly evolve them to fight new strains. While perhaps not useless, that doesn't sound like a replacement for antibiotics.
  - ManFromUranus 8y ago
    Well not an easy replacement anyway, but something that is always useful forever.
  - DonaldFisk 8y ago
    In the Soviet Union, they used cocktails of bacteriophage in much the same way as broad-spectrum antibiotics are used, whenever it was impractical to identify the bacterial strain. Bacteriophage evolve of their own accord, so phage resistance is temporary. Often the bacteriophage strain you need already exists and you just have to find it. This is much less effort than developing a new antibiotic.
    - AstralStorm 8y ago
      The general problem is that bacteria co-evolve with phages making outdated stains as worthless as last year's flu vaccine most of the time.
  - JulianMorrison 8y ago
    Possibly with CRISPR patching of their innards, you can tailor-and-deploy them automatically?
    - aaronblohowiak 8y ago
      The other parts of the process are still quite onerous
  - JulianMorrison 8y ago
    Also bear in mind that as far as new strains in one patient go, unlike antibiotics they will evolve themselves to chase the new strain down, and that's useful.
    - AstralStorm 8y ago
      And sometimes not. Please provide serious efficacy numbers compared to antibiotics.
  - balls187 8y ago
    Given how medicine works in the US, that's not a problem, but an opportunity. US Medicine is for profit, and the money is in reoccuring treatment, not cures. So a never ending battle of cat-and-mouse is the type of R&D phramas would love. A potential future scenario: Keep going to your doctor to get a Rx for the latest strain or pay a monthly fee to a Bacteriophage-As-A-Service SV tech company to get the latest delivered right to your door you use in conjunction with a smartphone app. The latter of which would have operated illegally until sufficiently large enough to hire insider DC lobbyists to gut the FDA.
    - DonaldFisk 8y ago
      And yet phage therapy's been successfully used under communism but not capitalism. This is because it's cheap, low tech, and there are no economic barriers to market entry.
      - AstralStorm 8y ago
        You forgot to mention the scale. It does not easily scale as the required laboratory space to handle even a few hundred phage strains is enormous. Please provide numbers of patients treated with phages, time to treat one and efficacy numbers.
  - sdabdoub 8y ago
    You are correct, however with new sequencing technologies like the MinION[1] we have access to real-time sequencing in something roughly the size of a cell phone. They are still in development and there are some technical hurdles, but before too long cheap, fast, and accurate strain typing should be ubiquitous. The next issue is then creating the specific phages, but the first stage is pretty close at hand. [1] https://nanoporetech.com/products/minion https://nanoporetech.com/products/minion
    - AstralStorm 8y ago
      And the final issue will be actually getting this in the field for non laboratory personnel. Where a GP can fashion a phage in their office and/or order one as easily as the right antibiotic. Good luck trying to even get the bacterial sample to do it for quite a few kinds of infections. Lungs and other organs would need a good biopsy or at least really well done aspiration, handling of samples is very messy. It is a good method to use in hospital settings perhaps where you want to sample anyway.
acjohnson55 8y ago
Reading the Wikipedia article, it sounds like we're nowhere close to being able to deploy phage therapy on a large scale, due to practical, economic, and regulatory challenges. https://en.wikipedia.org/wiki/Phage_therapy https://en.wikipedia.org/wiki/Phage_therapy
- DonaldFisk 8y ago
  They were deployed on a large scale in the Soviet Union. They're not patentable, so it's difficult for private companies to make money out of them. Phage therapy could still be developed by a government-owned and run health service.
  - ceejayoz 8y ago
    Why wouldn't phage therapy be patentable? A quick Google reveals a number of them.
    - WalterSear 8y ago
      Constant evolution.
    - tim333 8y ago
      The phages are found in nature so you cant really patent them. Using them to treat patients has been done for a century or so so it's hard to patent that. The FDA could help by letting anyone provide phage therapy without further testing given it's been proven over the decades and is pretty harmless to humans. At the moment I think you'd be blocked by regulations, unnecessary ones in my opinion.
    - DonaldFisk 8y ago
      Because they're natural organisms. You can't patent them any more than you could patent a breed of dog. You might be able to patent genetically engineered ones, or a novel process involving them.
  - acjohnson55 8y ago
searine 8y ago
Phage therapy is as effective as antibiotics but it is not as convenient as chemotherapy. One of the problems with phage therapy is precision. You have to know roughly what kind of bacteria is causing the infection. To know that it takes tests, and time, which cost money. Antibiotics on the other hand are broadspectrum and can be deployed without much prior knowledge (which is cheap, but also a problem that causes resistance). The other problem is production and regulation. Antibiotics are chemical, phages are biological. It is much harder to produce a consistent safe product with a biologic compared. We don't have the infrastructure (yet) to mass produce viral phages for consumers.
- AstralStorm 8y ago
  Even if we did, the sampling itself would be onerous. Unless you could somehow guess the phage based on immune response or metabolic products as in blood sample. Which is extremely hard to pull off and still much harder than guessing the right antibiotic in most cases.

DonaldFisk 8y ago

Bacteriophages were used instead of antibiotics in the Soviet Union, and are still used today in Georgia.

smaddox 8y ago
My extremely limited understanding is that a given bacteriophage only attacks a very specific strain, and thus that you would need to constantly evolve them to fight new strains. While perhaps not useless, that doesn't sound like a replacement for antibiotics.
- ManFromUranus 8y ago
  Well not an easy replacement anyway, but something that is always useful forever.
- DonaldFisk 8y ago
  In the Soviet Union, they used cocktails of bacteriophage in much the same way as broad-spectrum antibiotics are used, whenever it was impractical to identify the bacterial strain. Bacteriophage evolve of their own accord, so phage resistance is temporary. Often the bacteriophage strain you need already exists and you just have to find it. This is much less effort than developing a new antibiotic.
  - AstralStorm 8y ago
    The general problem is that bacteria co-evolve with phages making outdated stains as worthless as last year's flu vaccine most of the time.
- JulianMorrison 8y ago
  Possibly with CRISPR patching of their innards, you can tailor-and-deploy them automatically?
  - aaronblohowiak 8y ago
    The other parts of the process are still quite onerous
- JulianMorrison 8y ago
  Also bear in mind that as far as new strains in one patient go, unlike antibiotics they will evolve themselves to chase the new strain down, and that's useful.
  - AstralStorm 8y ago
    And sometimes not. Please provide serious efficacy numbers compared to antibiotics.
- balls187 8y ago
  Given how medicine works in the US, that's not a problem, but an opportunity. US Medicine is for profit, and the money is in reoccuring treatment, not cures. So a never ending battle of cat-and-mouse is the type of R&D phramas would love. A potential future scenario: Keep going to your doctor to get a Rx for the latest strain or pay a monthly fee to a Bacteriophage-As-A-Service SV tech company to get the latest delivered right to your door you use in conjunction with a smartphone app. The latter of which would have operated illegally until sufficiently large enough to hire insider DC lobbyists to gut the FDA.
  - DonaldFisk 8y ago
    And yet phage therapy's been successfully used under communism but not capitalism. This is because it's cheap, low tech, and there are no economic barriers to market entry.
    - AstralStorm 8y ago
      You forgot to mention the scale. It does not easily scale as the required laboratory space to handle even a few hundred phage strains is enormous. Please provide numbers of patients treated with phages, time to treat one and efficacy numbers.
- sdabdoub 8y ago
  You are correct, however with new sequencing technologies like the MinION[1] we have access to real-time sequencing in something roughly the size of a cell phone. They are still in development and there are some technical hurdles, but before too long cheap, fast, and accurate strain typing should be ubiquitous. The next issue is then creating the specific phages, but the first stage is pretty close at hand. [1] https://nanoporetech.com/products/minion https://nanoporetech.com/products/minion
  - AstralStorm 8y ago
    And the final issue will be actually getting this in the field for non laboratory personnel. Where a GP can fashion a phage in their office and/or order one as easily as the right antibiotic. Good luck trying to even get the bacterial sample to do it for quite a few kinds of infections. Lungs and other organs would need a good biopsy or at least really well done aspiration, handling of samples is very messy. It is a good method to use in hospital settings perhaps where you want to sample anyway.

acjohnson55 8y ago

Reading the Wikipedia article, it sounds like we're nowhere close to being able to deploy phage therapy on a large scale, due to practical, economic, and regulatory challenges. https://en.wikipedia.org/wiki/Phage_therapy https://en.wikipedia.org/wiki/Phage_therapy

DonaldFisk 8y ago
They were deployed on a large scale in the Soviet Union. They're not patentable, so it's difficult for private companies to make money out of them. Phage therapy could still be developed by a government-owned and run health service.
- ceejayoz 8y ago
  Why wouldn't phage therapy be patentable? A quick Google reveals a number of them.
  - WalterSear 8y ago
    Constant evolution.
  - tim333 8y ago
    The phages are found in nature so you cant really patent them. Using them to treat patients has been done for a century or so so it's hard to patent that. The FDA could help by letting anyone provide phage therapy without further testing given it's been proven over the decades and is pretty harmless to humans. At the moment I think you'd be blocked by regulations, unnecessary ones in my opinion.
  - DonaldFisk 8y ago
    Because they're natural organisms. You can't patent them any more than you could patent a breed of dog. You might be able to patent genetically engineered ones, or a novel process involving them.
- acjohnson55 8y ago

searine 8y ago

Phage therapy is as effective as antibiotics but it is not as convenient as chemotherapy. One of the problems with phage therapy is precision. You have to know roughly what kind of bacteria is causing the infection. To know that it takes tests, and time, which cost money. Antibiotics on the other hand are broadspectrum and can be deployed without much prior knowledge (which is cheap, but also a problem that causes resistance). The other problem is production and regulation. Antibiotics are chemical, phages are biological. It is much harder to produce a consistent safe product with a biologic compared. We don't have the infrastructure (yet) to mass produce viral phages for consumers.

AstralStorm 8y ago
Even if we did, the sampling itself would be onerous. Unless you could somehow guess the phage based on immune response or metabolic products as in blood sample. Which is extremely hard to pull off and still much harder than guessing the right antibiotic in most cases.