Andrew Read and Robert Woods recently published a case study of bacterial resistance evolution in EMPH ( Click here for our coverage of this article, and here for PNAS coverage). Below they offer a commentary about deep implications of this study for the application of evolutionary theory to medical practice and for the teaching of evolution to students and medical scientists. Their commentary is reproduced in full below.
Their suggestions for developing education resources are perfectly aligned with the soon-to-be-released new version of EvMedEd. Do get in touch with them.
When evolution kills. A teachable moment.
By Andrew Read and Robert Woods
We recently published a case report of a patient who died from overwhelming evolution. She had a chronic bacterial infection, and the evolution of antibiotic resistance became the key threat to the quality and quantity of her life. When she died, we could not but feel it was a failure of evolutionary science. The modern treatment of HIV shows that resistance evolution can be headed off. It should be possible to do the same for bacteria. For the most part, it is not. We hope that our description of this individual tragedy spurs research aimed at predicting, controlling and redirecting life-threatening bacterial evolution in clinical settings.
We have also come to hope that from this tragedy emerges a useful teaching tool. In our experience, students respond powerfully to narratives, particularly of individual patients. The case illustrates how many clinical decisions should be informed by evolutionary principles. We also describe the realities impacting clinical decisions (uncertainty, risk, side effects); the tension between these considerations and evolutionary principles is ripe for classroom debate. Our long list of research questions (Box 1, the Box of Ignorance) provides ample fodder for active learning exercises. The case also provides a hook for discussion of non-chemotherapeutic options (hygiene/infection control, vaccines, phage therapy). It could also motivate student-driven investigations of broader research questions. For instance, are evolution-proof drug combinations as practical for bacterial infections as they are for HIV? Are microbiomes evolutionary risk factors?
We are very keen to help make the most of these pedagogical opportunities. We are considering making a short (2-3 minute) video of the case, and we would be happy to co-develop other teaching materials that could help. Problem sets? Further clinical details? Primers on the evolutionary principles involved? Different materials are likely needed for school students, pre-meds, med students, and graduate students. We continue to work on this case (we are currently analyzing full genome sequences from key time points) and would love to describe our progress to students; we are available for live skype discussions. Evolutionary science promises to make a very real difference to medical outcomes. Those of you in classrooms are major players in realizing that promise. We would love to help you.
Robert J Woods MD PhD
Department of Infectious Diseases, University of Michigan Health System
[email protected]
Andrew F Read PhD
Center for Infectious Disease Dynamics, Penn State
[email protected]
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