the modern prometheus
TRANSCRIPT
20 August 2011 | NewScientist | 3
EDITORIAL
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WE’VE all been there. You get a sore throat or a hacking cough and you begin to feel bad, so you visit your doctor. The doctor says maybe it’s a bacterial infection, and gives you a course of antibiotics. Or, maybe it’s a virus, so here’s a decongestant, drink lots of fluids and have some antibiotics anyway, just to be on the safe side.
Some doctors think certain symptoms distinguish the two types of infection, but this is not a reliable method. Your symptoms reflect your immune system’s response to respiratory infection, regardless of the exact cause, so they tend to look similar. Astonishingly, in the 21st century, there is no quick way for your doctor to distinguish a bacterial from a viral infection.
This may not matter if you get better quickly. But if you don’t, you could be in serious trouble. And if you were given antibiotics, they might simply have bred antibiotic-resistant bacteria as your doctor tried different drugs until one worked – diagnosis by treatment.
We can do so much better. There are new technologies, mainly based on advances in analysing
DNA, that can enable a hospital lab to diagnose what’s eating you in hours (see page 44). Affordable, accurate versions could be a boon to family doctors, yet they are reaching even hospital clinics at a needlessly glacial pace, if at all.
One hurdle is a mistrust among some doctors of tests that seem to replace their judgement. But infectious diseases are caused by specific agents, so it makes sense to make testing more objective to allow treatment to
be as specific as possible. Of course a doctor’s judgement will always be central, but just as standardised medicines replaced physicians’ 19th-century nostrums, reliable tests for pathogens can surely be worked into the financial, legal and cultural institutions of medicine.
The second block is more exasperating. Regulatory agencies have not yet figured out an efficient way to approve these technologies. Obviously tests
must be shown definitively to do what they say they do. Yet this seems to require more imagination than these agencies have been able to muster. Caution seems excessive at the US Food and Drug Administration, for example, which recently approved one automated test for only nine different viruses affecting the respiratory tract, when the same test has been approved in the European Union for 19, along with 15 gut pathogens.
The regulators need to be pushed into action. Doctors should be screaming for change. Besides helping patients, routine, automated diagnosis of the agent behind every infection will show us the ebb and flow of the microbial sea we inhabit; one pilot trial has already done it. Who knows what that could tell us about which bugs cause which unsuspected diseases, or how infections interact with each other.
Although germs are an ancient foe, we have yet to learn the lessons of The Art of War, one of the oldest and most influential books on military strategy. To mount an effective attack, you first have to know your enemy. n
Medicine: the diagnosisLet’s speed the transfer of innovative tests from the lab to the clinic
THE debate about how far we should manipulate life to pursue our desire for knowledge has raged for centuries.
Mary Shelley captured Victorian anxiety about the subject with her Gothic tale of Frankenstein and Michael Crichton’s 1990 bestseller Jurassic Park showed this concern continues, arising from such techniques as genetic modification, animal cloning and now a plan to manipulate a
chicken embryo to awaken the dinosaur within.
Unease about the latter idea will grow as evidence mounts to show that rewinding evolution may not be that difficult (see page 6). The secret is not to find viable dinosaur DNA, which is highly unlikely, but in making major shifts in anatomy with relatively minor genetic changes.
But though these experiments are in effect creating a “monster”,
they can bring important advances too. They can help pinpoint the sources of birth defects. The work also shows we can alter development by changing the way genes are programmed, sidestepping the need for gene therapy.
As a bonus, this research undermines creationist arguments about the impossibility of large-scale evolutionary changes. Who could possibly argue with that? n
Let Prometheus be unbound
“routine diagnosis will show us in real time the ebb and flow of the microbial sea we inhabit”