A lot (but not nearly enough) has been talked about the growing problem of antibiotic resistance; and the issue is compounded by the fact that we’re not doing a very good job at developing new antibacterial medication. And indeed there’s a lot of room for improvement in research methodology, corporate priorities, research incentives, etc.
But I often get the feeling that people talk about those issues like they’re the only thing preventing us from “winning” the war against bacteria; that the threat of a bacterial apocalypse hangs over us because we’re too dumb to fight them back properly. This seems to ignore a simple, basic fact:
Bacteria are nasty
If those microscopic, crazy hairy submarines don’t scare you, I don’t know what will.
Because seriously, they are. We are not at war against ourselves here – it’s a war against bacteria, and bacteria are breed for war, really. They are independent, free-ranged organisms, that are constantly fighting against every single other thing in their ecosystem – including themselves. They are nature’s self-replicating army of attack submarines.
Dealing with cancer cells is though, but even tumors – for all their crazy, uncontrolled growth and resistance – are still pretty lazy dudes, which still rely on the host organism to provide then with nutrition. They still expect to have food delivery (and garbage taken) by the bloodstream, and that’s why preventing formation of new blood vessels (angiogenesis) is a promising oncology strategy. But bacteria? They have to hunt down their own food while competing with every single other bacterium in the area. They communicate with each other, react to threats, learn quickly, and reproduce like crazy.
Developing new medical compounds is hard. Often you devise a compound that does what you want but you just can’t get it into the target cells, even thought those same cells happily allow a similar compound thru their membranes. This is a frustrating waste of resources and that often happens quite late into research. Bacteria, however, have cell walls like you wouldn’t believe. Getting a gram-negative bacteria to swallow whatever protein compound you’re trying to develop is nothing short of a miracle; a miracle that hasn’t been happening very often.
Where are all the drugs?
This further emphasizes how our strategies must rely on learning how to work better with what we have, instead of hoping for new miracle drugs.
We need more antibacterial drugs. We need to get better at researching them, and bringing them to market, and learn to use them sparingly, and there are a lot of things wrong with how the research industry works.
But in the end the real reason why we have so little antibacterial discoveries is that finding them is despairingly hard, and bacteria are ready and willing to fight back when we do. We must not expect this to be an easy fight.