AHC: Phage therapy used throughout the world.

http://en.wikipedia.org/wiki/Phage_therapy

Currently, only two countries use Phage therapy: Russia and Georgia.

Challenge: Have Phage therapy be used widely throughout the world.

Either nobody discovers antibiotics, or antibiotic resistance spreads to such an extent that the disadvantages of phage therapy are outweighed by the fact that it might actually work.

Going a future history route, if current research into manufactured viruses proceeds well, it may be possible to manufacture phages capable of infecting particular bacteria. Couple that with the ability to isolate and sequence bacterial DNA from a sample of blood or other tissue, and it becomes possible that seeking treatment for an infection could involve giving a sample, having it analysed on the spot, then waiting around for a prescription of freeze-dried phage capsules to be prepared. Not feasible today, but I suspect it could be in 10-20 years time, if anyone thinks there might be sufficient profit in it.
 
Either nobody discovers antibiotics, or antibiotic resistance spreads to such an extent that the disadvantages of phage therapy are outweighed by the fact that it might actually work.

Going a future history route, if current research into manufactured viruses proceeds well, it may be possible to manufacture phages capable of infecting particular bacteria. Couple that with the ability to isolate and sequence bacterial DNA from a sample of blood or other tissue, and it becomes possible that seeking treatment for an infection could involve giving a sample, having it analysed on the spot, then waiting around for a prescription of freeze-dried phage capsules to be prepared. Not feasible today, but I suspect it could be in 10-20 years time, if anyone thinks there might be sufficient profit in it.
Yeah, if antibiotic resistance gets worse I could see that becoming a thing.
 
Have antibiotic resistance become a thing earlier, so phage therapy becomes more effective relative to antibiotics.

You could also have phage therapy be developed in Western labs instead of Soviet labs, so it isn't abandoned with the end of the Cold War.
 
Antibiotics not being discovered looks like the best route as POD. AIUI, that was a bit accidental.

I also really like the idea of "designer viri".:cool: (That does have some disturbing implications for biowarfare & bioterrorism, tho.:eek:)
 
One of the big obstacles to phage therapy, at least in the US, is regulatory: phages are specific to particular species of bacteria, and each phage is considered a separate "drug molecule" requiring its own long-running and expensive clinical trials for safety and effectiveness. In addition, the FDA has been skeptical of the concept of a self-replicating and mutating organism as a drug, and could interpret each mutation as a separate drug molecule as well.

If the laws were written differently and phage therapy could be regulated as a procedure or a device rather than as a drug, or if broad categories of phages could be approved in a single round of clinical trials, adoption becomes a lot more likely.
 
Maniakes said:
One of the big obstacles to phage therapy, at least in the US, is regulatory
That means adoption might depend on when phage therapy is adopted, no? If it can be in place before the Pure Food & Drugs Act (1906?). Is that remotely credible?
 
That means adoption might depend on when phage therapy is adopted, no? If it can be in place before the Pure Food & Drugs Act (1906?). Is that remotely credible?

Possibly. The official discovery of bacteriophages was 1915, but their existence was inferred as early as 1896 (some river water in India was observed to kill cholera bacteria, and whatever it was in the water was still there after a pass through an extremely fine filter). Phage therapy followed extremely quickly after the discovery of bacteriophages (early 1920s) even though research efforts were disrupted by WW1, so if the discovery of phages is bumped up a decade or two, phage therapy probably would be, too.

The key question is whether there's a key prerequisite to the identification and culture of phages that was missing in the 1890s, or if people just weren't looking hard enough. I can't think of one off the top of my head, but I could be wrong.
 
Oh, it will. Evolution will demand it.
That and the fact that ever stronger antiobiotics might have more serious side effects on humans. On the bright side, if we leave the bacteria alone long enough, they should theoretically revert to their non-resistant states as the alternative biological pathways that resistant individuals use may be slightly less efficient.
Have antibiotic resistance become a thing earlier, so phage therapy becomes more effective relative to antibiotics.


You could also have phage therapy be developed in Western labs instead of Soviet labs, so it isn't abandoned with the end of the Cold War.
Resistance began to show up almost immediately in some species (though for some reason, others have yet to figure out how deal with plain old penicillin) hence the constant introduction of new drugs and classes of drug.
Antibiotics not being discovered looks like the best route as POD. AIUI, that was a bit accidental.

I also really like the idea of "designer viri".:cool: (That does have some disturbing implications for biowarfare & bioterrorism, tho.:eek:)
Perhaps antiobiotics would have been discovered later but there was certainly going to be an active search for chemicals that could selectively destroy bacteria. In fact, IIRC sulfonamides actually predate penicillin. Nevertheless, I suppose that slow antiobiotic development (which was just so successful) could at least let phage therapy research get its foot in the door.

I do like the idea of unleashing a virus against bacteria. I certainly see no reason the two could not be used in conjunction with one another.
 
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You could also have phage therapy be developed in Western labs instead of Soviet labs, so it isn't abandoned with the end of the Cold War.

That and maybe have antibiotics be primarily developed in Soviet labs. After the end of the cold war, with antibiotics associated with communism and the Soviet Union, and with the side effects of antibiotics well known (resistance, etc...), most of the Western world decides to abandon the use of antibiotics.
 
I taught about that problem for my timeline as well. The short version of the conclusion I came to is that firms rushed to commercialize phages without understanding them giving them a bad press. Once they were understood antibiotics were the "better" alternative since they could be patented (were thus profitable) and they didn't require to establish a whole complex network to utilize phages properly. If the discovery of antibiotics is delayed enough and the Soviets actually invest in the technology, (as opposed to kill its inventor in a moment of "romantic" envy) than something might come out of it.
 
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Phage therapies look great in 2013 for two reasons- we're a lot more aware of antibiotic resistance and thanks to several quantum leaps in molecular biology, we can identify target organisms and custom-culture phages in ways the original developers never dreamed of.

It's also a neat strategy- one course and you not only kill the current infection but have immunity granted by sleeper phages remaining against nasties like MRTB or flesh-eating strep.

The problem is that producers needed to bill it as a vaccine, not strictly as a cure. Vaccines got a huge groundswell of public support from 1930-1970 b/c they reduced scourges like smallpox, polio, and typhoid to mere irriitants. Using viruses to tackle bacterial scourges seemed counter-intuitive but it could have worked.

Now here's the fun part- getting MDs to see it as complementary therapy.
Antibiotics are far easier to use. You don't need a precise identification of infecting organism beyond ruling out viral and fungal or protozoan infections that antibiotics won't touch.
Write a scrip for a broad-spectrum antibiotic and for a couple of bucks,
(barring allergic reaction or kidney/liver damage) patient recovers.

Phages are pretty cheap to make but you gotta be 100% sure you're giving the right phage to kill the strain.
Another cute possibility is all those lysogenic phages hanging around might cause cancer decades down the road or lupus or some other immune problem in some patients.

However, if I've got MRTB or flesh-eating strep and 99% sure I'll be dead in a week, give me phages and I might be able to deal with the sequelae.
LSS- phages needed specificity that wasn't possible 'til ca 2000. I mean you could culture phages that'd go after certain classes of bacteria before, but not be assured they'd be effective.
 
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