by Andrew Read, Ph.D., Penn State University
In 2034, science will have delivered evolution-proof drugs.
Today over 600,000 Americans die of evolution – overwhelmed by infections or cancers that have evolved to resist drugs. Discovering new drugs is a mind-bogglingly expensive, but relatively easy science. The challenge is maintaining the effectiveness of new drugs in the face of relentless evolution of the life forms they target.
I believe that by 2034 we will have a solid understanding of evolutionary management that will allow us to know things we guess at today. We will know the properties of drugs that best combat the evolution of viruses, bacteria, and cancer, and how best to combine drugs to slow or stop their evolution entirely. 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.
By 2034, we will also have figured out how best to use drugs. We will have learned when we should use overwhelming chemical firepower and when that just makes resistance worse. For infections, we will have properly determined where resistance originates: agriculture, our microbiomes, other people, or the environment. Until we know the relative importance of the major evolutionary drivers, we can’t change the future for the better.
We are currently faced with an ecological problem, not a biochemical one. To achieve the aforementioned knowledge and how best to use it, we need to move beyond our focus on eminence 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.
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.
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.
PHOTO: Patrick Mansell/Penn State