7 ms·

So much wrong with this post: > There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confiden

by waps 13y ago

So much wrong with this post: > There is a testable prediction here of course: either bacteria outrun human antibiotic development or they do not. I'm confident that more bacterial lineages will be wiped out before human medicine is seriously compromised by natural selection of bacteria that are resistant to most antibiotics used in human medicine. Do a dumb test. Walk into your nearest hospital, I don't even want to know which it is. Ask how many patients are infected with mRSA. Collect your jaw from the floor when they give you an answer that's 15% if you're lucky, 60-70% if you're unlucky. We have lost the fight with bacteria. It's over. We aren't "about to" lose it, we lost it ~1 year ago, and medicine is fast losing the ability to treat bacterial disease. We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. We are in fact well on our way to transform hospitals into deathtraps. > Evolution is actually a really crappy optimization algorithm. The reason it has worked so well is not that it is so effective, but because it's the only game in town. First of all, the obvious advantage of evolution is it's running time, 3.5 billion years. Second you probably subscribe to the naive notion that evolution, in 3.5 billion years running time, somehow failed to realize that mutation + natural selection is very, very slow. It didn't. The algorithm that, today, controls evolution of pretty much any species works entirely different from what most textbooks teach you. There are very, very few species that evolve through mutation and selection. We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves). Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening. You'll also quickly realize that no matter how well-intentioned your use of bacteriophages is, it is very, very likely to make things worse, not better.

uptownJimmy 13y ago
Much of this is nonsense. This, for instance: "If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead."
- Fomite 13y ago
  Umm...rabies pretty much is curtains. If we miss the postexposure prophylaxis window, the fatality rate for rabies is indistinguishable from 100%
  - caseydurfee 13y ago
    That's not a new development, though. OP makes it sound like it is. Rabies has always been that way.
  - mhb 13y ago
    Yeah, but how did we lose that fight a decade ago? Whether or not we'd prefer something better, doesn't the treatment that worked then, still work now?
    - Fomite 13y ago
      As another poster has said, we didn't really "lose" that fight. Rabies has always been that way - invariably fatal unless treated, and the only treatment (outside some insane edge cases) is the administration of the rabies vaccine shortly after (or ideally before) contact. The very low rabies incidence and near zero fatalities of rabies in the developed world actually show that it's a very winnable fight. The issue is, we have to show up to said fight. In the developing world, we're not always good at that.
  - brazzy 13y ago
    Actually, there are experimental treatments that involve an induced coma and seem to produce survival rates of over 10%: https://en.wikipedia.org/wiki/Milwaukee_protocol https://en.wikipedia.org/wiki/Milwaukee_protocol
tokenadult 13y ago
Let me do what I hope will be a smart test here by sharing some more information and asking some follow-up questions. I invite onlookers to comment about this too. The Centers for Disease Control and Prevention (the same organization that employs the expert quoted in the article submitted to open this thread) reports that "Although MRSA is still a major patient threat, a CDC published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011."[1] So there are responses already in place that are gaining on antibiotic-resistant bacteria in hospital settings in the United States. I care about the spread of antibiotic-resistant bacteria. I am gravely concerned about the medical and public-health practices in India that have resulted in a massive increase in patients infected there with multiple-antibiotic-resistant tuberculosis.[2] I am 100 percent behind the idea that antibiotics have to be used cautiously and responsibly, and meanwhile we have to keep researching other means of infection control besides antibiotics. You wrote, We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Do you really mean "we" there? Are you saying that this mechanism in any way makes it impossible for human beings to eradicate harmful microorganisms? How? Please connect the dots to back up your conclusion that Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years because the "all" there and the time scale you talk about both appear to be exaggerations, especially in light of the progress that has already occurred in limiting MRSA infections in the United States. [1] http://www.cdc.gov/mrsa/healthcare/index.html http://www.cdc.gov/mrsa/healthcare/index.html [2] http://online.wsj.com/news/articles/SB10001424052702303444204577460734274201756 http://online.wsj.com/news/articles/SB1000142405270230344420... http://www.tbcindia.nic.in/ http://www.tbcindia.nic.in/ http://articles.economictimes.indiatimes.com/2013-06-23/news/40134749_1_stop-tb-department-mario-raviglione-jmm-meeting http://articles.economictimes.indiatimes.com/2013-06-23/news...
ceol 13y ago
While you're in that hospital, ask what their procedure is if you've been infected with rabies within the past week. It's most certainly not "curtains and sedation." Just that bit of factual nonsense leads me to believe you are speaking far out of your area of expertise.
- Fomite 13y ago
  Yeah, but after that window closes, our treatment options for rabies are essentially Hail Mary, "Well, it's not like it can get any worse..." level treatments. That's not a big deal in the U.S. because rabies is quite rare, but in the developing world it's still a thing.
  - vacri 13y ago
    Rabies is a virus - antibiotics don't have any effect on viruses. Ceol may also be referring to the incubation time for rabies usually being more than a week - if you've just been infected with it and you present at day 7, then a prophylaxis will be administered.
    - Fomite 13y ago
      Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
      - baak 13y ago
        I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.
        Fomite 13y ago
thenomad 13y ago
As others have mentioned, in fact the incidence of MRSA has declined significantly over the last few years, down 50%: http://www.cdc.gov/mrsa/statistics/ http://www.cdc.gov/mrsa/statistics/ (Center for Disease Control) And the numbers of infections were far lower than you're claiming here - rather than approximately 20,000 in 100,000 as claimed above, the numbers (in 2011) were 4.5 in 100,000. http://uk.reuters.com/article/2013/09/16/us-hospital-mrsa-idUKBRE98F0X920130916 http://uk.reuters.com/article/2013/09/16/us-hospital-mrsa-id... (Reuters quoting numbers from a JAMA / CDC study). As for rabies, according to Wikipedia quoting Sherris Medical Microbiology (4th ed.), "Treatment after exposure is highly successful in preventing the disease if administered promptly, in general within 10 days of infection." There's more information here: http://en.wikipedia.org/wiki/Rabies#Treatment http://en.wikipedia.org/wiki/Rabies#Treatment (Wikipedia)
- SiVal 13y ago
  Yes, MRSA has declined, but not because of improved treatments. Now that we can no longer kill these bugs after they invade the body, hospitals have significantly ramped up their efforts to kill them before they invade. Hurray for these protocols, but that won't do all that we need. It won't be possible to scrub the whole world with poisons the way we have begun scrubbing hospital rooms. We need ways to stop infections that we can't prevent.
  - thenomad 13y ago
    That's definitely true. It's a very worrying situation.
vacri 13y ago
Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves Breathing? Where are the bacteria in the gas-exchange process? And 'metabolism' is a catch-all term that refers to so many different chemical reactions, plenty of which are conducted within the human cells themselves.
- quasque 13y ago
  He probably confused cellular respiration with physiological respiration, and thus incorrectly conflated the primary purpose of the mitochondria with the physical act of breathing.
artsrc 13y ago
> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. The fight we have not yet one is the fight against poverty. Not many wealthy people die of rabies. AIDS which was once fatal, is no longer, provided you can afford the treatment.
- kamaal 13y ago
  Keeping you alive is not the same as living. A few would like to stay in situation where you can't do 99% of the things other humans do. Its very common in a lot of of places in the world to ask for euthanasia in case of such diseases.
  - parasubvert 13y ago
    Magic Johnson and Andrew Sullivan have had HIV for over 20 years and seem to be handling it fairly well. Certainly a harder life than most, but that's not stopping them from living a full life.
  - Fomite 13y ago
    Honestly, at this point HAART treatments for HIV are giving folks a near natural lifespan, and the major threats to their health are becoming diseases of old age - cancer and the like. And the years they have are fully functional. Compared to a chronic, wasting disease that will take years of opportunistic infections before you die, that's damned good.
scythe 13y ago
>We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. What? We never had effective antivirals. We have a few useful drugs (oseltamivir, protease inhibitors, etc) for particular viruses, but there has never been a point in human history when rabies was a treatable disease. The Milwaukee protocol, which is the only effective[1] non-vaccine treatment for rabies, isn't even drug-based! You may of course be confused. The major antiviral used in replications of the Giese case, amantadine, was also an anti-flu drug, resistance to which is now widespread in influenza (see http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse ). However, I do not believe amantadine resistance has ever been described in rabies, which in any case is usually treated with vaccination -- the challenge is to get the immune system to respond to the virus before the host dies! Giese herself was treated with both amantadine and ribavirin. In any case, your claim is confusing at best, misleading at worst. [1]: controversial, see http://www.medscape.com/viewarticle/712839_7 http://www.medscape.com/viewarticle/712839_7
robbiep 13y ago
Firstly, there's a real difference between rates of MRSA colonisation and rates of MRSA infection, which implies a pathological process at work. Secondly, what on earth do you mean when you say we lost the fight against viruses a decade ago'? We have only got better at treating viruses; we had almost no treatment for viruses a decade ago and we have some treatments now; for example we are now much better at treating chronic hepatitis c infection which is a leading cause of liver failure and cancer; we have good HIV drugs which can lead to long term management without significant comorbidities (although many of the pieces were in place a decade ago), and your illustrated case, rabies, has long been a problem child like many significant viral illnesses that are discovered close to the end of their course, has caused so much pathology by tr time they present that the course is terminal. But there have only been a handful of cases of fulminant rabies in the developed world in the last decade, so it's hardly a thing that we are getting experience in treating.
- Fomite 13y ago
  I'm also curious as to how any period where we "Lost the fight against viruses" also includes the elimination of Rinderpest.
  - waps 13y ago
    All the generic virus drugs we had have been eliminted : pretty much all existing viruses are eliminated and we have lost the ability to heal, for example, heal elderly or children infected with the flue (the groups at risk of dying from the disease). We do not have any drug against any retrovirus (ie. a family of viruses) to which viruses do not show at least partial resistance. As for the AIDS case, prevention of AIDS has pretty much failed in Africa and the middle east, as well as in significant parts of Asia. It is a matter of a decade or so until ~80% of those populations are HIV positive and the rest of the world will follow in the next few decades. All currently know anti-AIDS drugs will cease being effective in 5 years or less, and the rate of adaptation that the virus exhibits is still accelerating (we wouldn't be able to keep up with the current rate, so sadly, that doesn't even matter). This is of course assuming we don't have another pandemic like the Spanish flue. We have had several near-pandemic panics in the past decade and all incidents have one thing in common : we failed spectacularly at containment. If, for example, bird flue had been ~6% more infectious than it was, it would have killed ~20% of the world's population (at least), and would have reaped >90% of it's death toll before a vaccine would become available. Absolutely nothing would have stopped it. Bird flue itself was only one of 5 incidents that could have exploded into a pandemic. The big message of these incidents: yes, they stopped, hurray. Sadly it wasn't us who stopped it (but rather small flaws in the virus' design).
Shinkei 13y ago
>Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening. This is the important point that people forget. Bacteria are experiencing an extremely accelerated time course and can evolve and exchange advantageous mutations very quickly. We have only had antibiotics for 100 years, which is 3-4 generations of man, but billions of generations of bacteria!
- einhverfr 13y ago
  I am not actually sure that it takes as long as people think. The fact is it isn't just individual genes, but selection for combinations of them. If you look at random mutations, I think that is likely dwarfed by random permutations. This is why the resistance bell curve shifts over time. You aren't just selecting for a single gene, but for a function, which could be carried out any number of different ways, and which any number of different gene combinations could do it.

by waps 13y ago

uptownJimmy 13y ago

Much of this is nonsense. This, for instance: "If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead."

Fomite 13y ago
Umm...rabies pretty much is curtains. If we miss the postexposure prophylaxis window, the fatality rate for rabies is indistinguishable from 100%
- caseydurfee 13y ago
  That's not a new development, though. OP makes it sound like it is. Rabies has always been that way.
- mhb 13y ago
  Yeah, but how did we lose that fight a decade ago? Whether or not we'd prefer something better, doesn't the treatment that worked then, still work now?
  - Fomite 13y ago
    As another poster has said, we didn't really "lose" that fight. Rabies has always been that way - invariably fatal unless treated, and the only treatment (outside some insane edge cases) is the administration of the rabies vaccine shortly after (or ideally before) contact. The very low rabies incidence and near zero fatalities of rabies in the developed world actually show that it's a very winnable fight. The issue is, we have to show up to said fight. In the developing world, we're not always good at that.
- brazzy 13y ago
  Actually, there are experimental treatments that involve an induced coma and seem to produce survival rates of over 10%: https://en.wikipedia.org/wiki/Milwaukee_protocol https://en.wikipedia.org/wiki/Milwaukee_protocol

tokenadult 13y ago

Let me do what I hope will be a smart test here by sharing some more information and asking some follow-up questions. I invite onlookers to comment about this too. The Centers for Disease Control and Prevention (the same organization that employs the expert quoted in the article submitted to open this thread) reports that "Although MRSA is still a major patient threat, a CDC published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011."[1] So there are responses already in place that are gaining on antibiotic-resistant bacteria in hospital settings in the United States. I care about the spread of antibiotic-resistant bacteria. I am gravely concerned about the medical and public-health practices in India that have resulted in a massive increase in patients infected there with multiple-antibiotic-resistant tuberculosis.[2] I am 100 percent behind the idea that antibiotics have to be used cautiously and responsibly, and meanwhile we have to keep researching other means of infection control besides antibiotics. You wrote, We evolve through copying of other's genes, simulation and symbiosis (yes, genes can simulate the effect other genes will have on them. Do you really mean "we" there? Are you saying that this mechanism in any way makes it impossible for human beings to eradicate harmful microorganisms? How? Please connect the dots to back up your conclusion that Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years because the "all" there and the time scale you talk about both appear to be exaggerations, especially in light of the progress that has already occurred in limiting MRSA infections in the United States. [1] http://www.cdc.gov/mrsa/healthcare/index.html http://www.cdc.gov/mrsa/healthcare/index.html [2] http://online.wsj.com/news/articles/SB10001424052702303444204577460734274201756 http://online.wsj.com/news/articles/SB1000142405270230344420... http://www.tbcindia.nic.in/ http://www.tbcindia.nic.in/ http://articles.economictimes.indiatimes.com/2013-06-23/news/40134749_1_stop-tb-department-mario-raviglione-jmm-meeting http://articles.economictimes.indiatimes.com/2013-06-23/news...

ceol 13y ago

While you're in that hospital, ask what their procedure is if you've been infected with rabies within the past week. It's most certainly not "curtains and sedation." Just that bit of factual nonsense leads me to believe you are speaking far out of your area of expertise.

Fomite 13y ago
Yeah, but after that window closes, our treatment options for rabies are essentially Hail Mary, "Well, it's not like it can get any worse..." level treatments. That's not a big deal in the U.S. because rabies is quite rare, but in the developing world it's still a thing.
- vacri 13y ago
  Rabies is a virus - antibiotics don't have any effect on viruses. Ceol may also be referring to the incubation time for rabies usually being more than a week - if you've just been infected with it and you present at day 7, then a prophylaxis will be administered.
  - Fomite 13y ago
    Of which I am well aware, and has absolutely zero to do with the content of my post. Someone disputed that a rabies infection is "curtains" - I posed the circumstances where it is.
    - baak 13y ago
      I realize you're probably playing devil's advocate, but there are more issues with the original statement anyway. He implied this was new. Rabies has always been a 100% mortality rate past a certain point in the infection. In addition, he implied that if you're infected, it's game over. It's definitely not. As you've said, there is a window in which you'll most likely be fine with treatment.
      - Fomite 13y ago

thenomad 13y ago

As others have mentioned, in fact the incidence of MRSA has declined significantly over the last few years, down 50%: http://www.cdc.gov/mrsa/statistics/ http://www.cdc.gov/mrsa/statistics/ (Center for Disease Control) And the numbers of infections were far lower than you're claiming here - rather than approximately 20,000 in 100,000 as claimed above, the numbers (in 2011) were 4.5 in 100,000. http://uk.reuters.com/article/2013/09/16/us-hospital-mrsa-idUKBRE98F0X920130916 http://uk.reuters.com/article/2013/09/16/us-hospital-mrsa-id... (Reuters quoting numbers from a JAMA / CDC study). As for rabies, according to Wikipedia quoting Sherris Medical Microbiology (4th ed.), "Treatment after exposure is highly successful in preventing the disease if administered promptly, in general within 10 days of infection." There's more information here: http://en.wikipedia.org/wiki/Rabies#Treatment http://en.wikipedia.org/wiki/Rabies#Treatment (Wikipedia)

SiVal 13y ago
Yes, MRSA has declined, but not because of improved treatments. Now that we can no longer kill these bugs after they invade the body, hospitals have significantly ramped up their efforts to kill them before they invade. Hurray for these protocols, but that won't do all that we need. It won't be possible to scrub the whole world with poisons the way we have begun scrubbing hospital rooms. We need ways to stop infections that we can't prevent.
- thenomad 13y ago
  That's definitely true. It's a very worrying situation.

vacri 13y ago

Also, most "life" functions of a human body, like breathing, metabolism, ... are actually performed by symbiotic bacteria on our behalf. Human cells can't actually do it themselves Breathing? Where are the bacteria in the gas-exchange process? And 'metabolism' is a catch-all term that refers to so many different chemical reactions, plenty of which are conducted within the human cells themselves.

quasque 13y ago
He probably confused cellular respiration with physiological respiration, and thus incorrectly conflated the primary purpose of the mitochondria with the physical act of breathing.

artsrc 13y ago

> We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. The fight we have not yet one is the fight against poverty. Not many wealthy people die of rabies. AIDS which was once fatal, is no longer, provided you can afford the treatment.

kamaal 13y ago
Keeping you alive is not the same as living. A few would like to stay in situation where you can't do 99% of the things other humans do. Its very common in a lot of of places in the world to ask for euthanasia in case of such diseases.
- parasubvert 13y ago
  Magic Johnson and Andrew Sullivan have had HIV for over 20 years and seem to be handling it fairly well. Certainly a harder life than most, but that's not stopping them from living a full life.
- Fomite 13y ago
  Honestly, at this point HAART treatments for HIV are giving folks a near natural lifespan, and the major threats to their health are becoming diseases of old age - cancer and the like. And the years they have are fully functional. Compared to a chronic, wasting disease that will take years of opportunistic infections before you die, that's damned good.

scythe 13y ago

>We lost the fight with viruses a decade ago. If you get infected with a deadly viral disease, like rabies, it's curtains. There's nothing any hospital can do for you except sedate you until you're dead. What? We never had effective antivirals. We have a few useful drugs (oseltamivir, protease inhibitors, etc) for particular viruses, but there has never been a point in human history when rabies was a treatable disease. The Milwaukee protocol, which is the only effective[1] non-vaccine treatment for rabies, isn't even drug-based! You may of course be confused. The major antiviral used in replications of the Giese case, amantadine, was also an anti-flu drug, resistance to which is now widespread in influenza (see http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse http://en.wikipedia.org/wiki/Amantadine#Veterinary_misuse ). However, I do not believe amantadine resistance has ever been described in rabies, which in any case is usually treated with vaccination -- the challenge is to get the immune system to respond to the virus before the host dies! Giese herself was treated with both amantadine and ribavirin. In any case, your claim is confusing at best, misleading at worst. [1]: controversial, see http://www.medscape.com/viewarticle/712839_7 http://www.medscape.com/viewarticle/712839_7

robbiep 13y ago

Firstly, there's a real difference between rates of MRSA colonisation and rates of MRSA infection, which implies a pathological process at work. Secondly, what on earth do you mean when you say we lost the fight against viruses a decade ago'? We have only got better at treating viruses; we had almost no treatment for viruses a decade ago and we have some treatments now; for example we are now much better at treating chronic hepatitis c infection which is a leading cause of liver failure and cancer; we have good HIV drugs which can lead to long term management without significant comorbidities (although many of the pieces were in place a decade ago), and your illustrated case, rabies, has long been a problem child like many significant viral illnesses that are discovered close to the end of their course, has caused so much pathology by tr time they present that the course is terminal. But there have only been a handful of cases of fulminant rabies in the developed world in the last decade, so it's hardly a thing that we are getting experience in treating.

Fomite 13y ago
I'm also curious as to how any period where we "Lost the fight against viruses" also includes the elimination of Rinderpest.
- waps 13y ago
  All the generic virus drugs we had have been eliminted : pretty much all existing viruses are eliminated and we have lost the ability to heal, for example, heal elderly or children infected with the flue (the groups at risk of dying from the disease). We do not have any drug against any retrovirus (ie. a family of viruses) to which viruses do not show at least partial resistance. As for the AIDS case, prevention of AIDS has pretty much failed in Africa and the middle east, as well as in significant parts of Asia. It is a matter of a decade or so until ~80% of those populations are HIV positive and the rest of the world will follow in the next few decades. All currently know anti-AIDS drugs will cease being effective in 5 years or less, and the rate of adaptation that the virus exhibits is still accelerating (we wouldn't be able to keep up with the current rate, so sadly, that doesn't even matter). This is of course assuming we don't have another pandemic like the Spanish flue. We have had several near-pandemic panics in the past decade and all incidents have one thing in common : we failed spectacularly at containment. If, for example, bird flue had been ~6% more infectious than it was, it would have killed ~20% of the world's population (at least), and would have reaped >90% of it's death toll before a vaccine would become available. Absolutely nothing would have stopped it. Bird flue itself was only one of 5 incidents that could have exploded into a pandemic. The big message of these incidents: yes, they stopped, hurray. Sadly it wasn't us who stopped it (but rather small flaws in the virus' design).

Shinkei 13y ago

>Unfortunately, if you study how evolution actually works you'll realize what it means for resistant bacteria. Once a fully resistant bacterial strain evolves, a process that takes between decades and centuries, all other species of bacteria will quickly copy the resistance, in a matter of months to years. Which is exactly what we've seen happening. This is the important point that people forget. Bacteria are experiencing an extremely accelerated time course and can evolve and exchange advantageous mutations very quickly. We have only had antibiotics for 100 years, which is 3-4 generations of man, but billions of generations of bacteria!

einhverfr 13y ago
I am not actually sure that it takes as long as people think. The fact is it isn't just individual genes, but selection for combinations of them. If you look at random mutations, I think that is likely dwarfed by random permutations. This is why the resistance bell curve shifts over time. You aren't just selecting for a single gene, but for a function, which could be carried out any number of different ways, and which any number of different gene combinations could do it.