The world is running out of effective antibiotics. To address the crisis, scientists need to unify and play off each other's strengths.
This is an editorial for Issue 10 by Lateral editor-in-chief Jack Scanlan. He used to not be able to swallow pills, but now he can, because he's a big grown-up boy.
It’s tempting to assume that, since Alexander Fleming discovered penicillin in 1928, humanity has been steadily winning the war against disease-causing bacteria, that the discovery and/or development of new and improved antibiotics is beating back pathogens all around the world, and the number of deaths from bacterial infections is falling to zero.
But unfortunately, this never quite took place. Many bacteria are now resistant to the most commonly used antibiotics, and some extremely dangerous species are only vulnerable to a select few drugs, which must now be prescribed to patients sparingly in an attempt to extend their useful lifespan. Rubbing salt into the wound, the development of novel antibiotics has slowed to a crawl since the 1960s. This widespread resistance to antibiotics is shaping up to be one of the major challenges to public and private health in the 21st century: without effective antibiotics, global bacterial pandemics could become a reality, but on a personal scale, even routine surgeries could become incredibly dangerous.
This is a troubling situation, to say the least. There are a number of crises on the same sort of level; the one that springs to mind most readily is probably climate change. But climate change, as much as it is ignored by segments of the public, is at least regularly discussed in the media. By comparison, antibiotic resistance is hiding the shadows, biding its time.
Of course, this issue is important, which is reason enough to write about it. But antibiotic resistance also highlights a critical fact about how science can and should progress, and it’s something that I believe has been largely overlooked: bringing every style of science together.
Science is often delineated into two broad camps: ‘pure’ or ‘blue sky’ research, which pursues knowledge about the world for its own sake, and ‘applied’ or ‘practical’ research, which explicitly works towards goals (technological, medical or otherwise) to produce stuff that impacts humanity. There’s a reasonable amount of tension between these camps — some blue sky researchers get jealous of the money poured into applied research, while some applied researchers get annoyed that blue sky researchers get any money at all.
Is it worthwhile to do science for the sake of curiosity, without an application in mind? That’s not a question I’m going to attempt to answer here. But if we want to address the crisis of antibiotic resistance, blue sky and applied researchers will need to get along, or else no significant progress will be made, I can guarantee you that much.
Applied research is great at producing useful knowledge, but it rests on an oft-neglected foundation of blue sky research. Work into the structure of DNA, once considered blue sky, eventually lead to modern biomedical advances and cutting-edge therapies. Research on 'boring' model organisms, like thale cress and fruit flies, has bolstered the planet's agriculture, even under the strain of a rising global population. Your mobile phone wouldn't exist without centuries of curiosity-driven physics.
But antibiotic resistance is a particularly illuminating case. Basic research into the biology of bacteria has taught us how they work — and therefore how they can be killed. The mechanisms by which antibiotic resistance evolve relate to important proteins and structures inside bacterial cells, which we only started studying because past generations of scientists thought they were interesting.
The environmental and ecological pathways to resistance also rest on over a century of refinement to Charles Darwin's original ideas about evolution and natural selection. We now know, thanks to blue sky researchers, that bacteria defy the laws of sex and swap genes freely between unrelated species, which can provide passage to resistance genes from harmless bacteria to exceptionally nasty ones. Resistance can truly come from anywhere.
Developing new classes of antibiotics is difficult, but blue sky research helps out here too. Many species of fungi, as well as fellow bacteria, naturally synthesise incredibly potent antibiotic chemicals, which they use to keep a tight grip on their own ecological niches. Unknown soil bacteria have been cultivated to discover promising new antibiotics to replace our failing ones, while obscure fungi can also be exploited in a similar way. Usually only blue sky bacteriologists and mycologists have the knowledge to work with these new species and point biomedical researchers in the right direction.
Once new candidate molecules have been discovered, they can be passed to medicinal chemists and pharmacologists for refinement and to make sure they're safe and effective at treating infections in humans. A pipeline, from basic, 'pure' knowledge about microbes to applied work in medical models, will be crucial to beat back the bacteria that encroach on our bodies and our lives.
Science communication, of course, has a big role here too. While new antibiotics are being discovered and refined, experts say the public needs to be aware of how to minimise developing resistance through their own actions — take your full course of prescribed antibiotics (except if you feel better before you finish) and avoid using non-alcoholic hand sanitisers! Doctors, too, sometimes need to be prompted in the right direction too — don't prescribe antibiotics as placebos! It's all well and good to produce a new range of antibiotics, but if the actions of the community don't change, soon resistance will develop against them too, and the research community's efforts will have been for nothing. Communicating ideas outside this insular bubble of scientists can be tough though, and the problem deserves attention.
In the end, on some level, the divide between blue sky and applied science is artificial. Every piece of knowledge we gain about the world has the potential to be useful, even if we don't see it right away. That it takes global problems to bring these two halves of the research community together, however, shouldn't be a huge surprise. We just need to foster the relationship — because then everybody benefits.
Antibiotics, however, aren't the only drugs science has been experimenting with — read the rest of Issue 10 of Lateral to discover a whole lot more.