Some things we basically understand: building bridges and skyscrapers, treating and preventing infections, satellites and GPS, cars and ships, oil wells and gas pipelines and power plants, cell networks and databases and websites.
If we understand basically understand building bridges, then why are we building so few new bridges and those that we build end up being so expensive? The fact that building bridges with the advanced technology we have today isn’t cheaper but more expensive then building bridges 100 years ago suggests to me that we don’t understand the subject well.
As far as treating and preventing infections goes we are actually understanding the topic better then hundred years ago but we still don’t understand it well enough to prevent people from getting new infections in world-class hospitals, partly even treatment-resistentant ones.
The fact that we have existing paradigms for approaching both of those issues doesn’t limit us to think of new paradigms to approach them better.
Your last sentence is true and important. I think John’s focusing on a different problem. One could use “general” skills to turn existing paradigms, though for a student that will be hard.
Actually building bridges and Actually preventing infections requires not only improvements in applied science, but also human coordination. In the former we’ve improved, in the latter we’ve stagnated.
Actually building bridges and Actually preventing infections requires not only improvements in applied science, but also human coordination. In the former we’ve improved, in the latter we’ve stagnated.
+1 to this. The difficulties we have today with bridges and infections do not seem to me to have anything to do with the physical systems involved; they are all about incentives and coordination problems.
(Yes, I know lots of doctors talk about how we’re overly trigger-happy with antibiotics, but I’m pretty sure that hospital infection rates have a lot more to do with things like doctors not consistently washing their hands than with antibiotic-resistant bacteria. In order for antibiotic resistance to be relevant, you have to get infected in the first place, and if hospitals were consistent about sterilization then they wouldn’t have infection rates any higher than any other buildings.)
I do agree that some kinds of technical paradigm shifts could plaster over social problems (at least partially), but let’s not mistake that for a lack of understanding of the physical systems. The thing-we-don’t-understand here is mechanism design and coordination.
In order for antibiotic resistance to be relevant, you have to get infected in the first place, and if hospitals were consistent about sterilization then they wouldn’t have infection rates any higher than any other buildings.
It’s the sterilization that creates the niche in which those bacteria thrive because they face less competition then they would face in other normal buildings which are populated by diverse bacteria. No matter how much you sterilize you are not going to go to zero bacteria in a space occupied by humans and when human are a primary vector of moving bacteria around in the space you select for bacteria’s that actually interact with humans.
Where is the selection effect coming from? You’d think that the human body is large enough to host a range of different bacteria, so unless they have some way of competing within the body, sterilization would just remove some bacterial populations rather than select for those resistant to antibiotics.
I’m not talking about sterilization of the human body but sterilization of the hospital enviroment. It leads to selection effects for bacteria that are adapted to the hospital enviroment.
If you have plants in a room then part of the room is filled with bacteria that interact with plants and that creates a more diverse microbial enviroment. Having plants in a room makes it more likely that a random bacteria in the room is a plant pathogen compared to a human pathogen.
I would expect that in 50 years you will have plants with microbiomes in hospitals that are selected for hosting a microbiome that increases the surrounding microbial diversity and not hosting human pathogens. Hospitals will move from the paradigm of “everything should be sterile” to the paradigm of “there should be a lot of microbial diversity without human pathogens”.
The will regularly test what bacteria are around and when there are problems use a mix of adding new bacteria to the enviroment that contribute to healthy microbial diversity and phage therapy against those bacteria that are unwelcome.
Having cheap ways to measure the microbial enviroment via cheaper gene sequencing will lead there but there will be a lot about how to have a good microbial enviroment that we have very little understanding of today.
I unfortunately know very little about building bridges, so I can’t really tell how a new paradigm might improve the status quo. It might be possible to switch the composition of a bridge in a way where it can be created in a more automated fashion then it’s currently created.
When it comes to actually preventing infections I do think there’s room for a new paradigm that replaces “let’s kill all bacteria” with “let’s see that we have an ecosystem of bacteria without those that are problematic”.
Moving to that new paradigm for infections has similar problems to improving on cancer treatment and prevention.
If we understand basically understand building bridges, then why are we building so few new bridges and those that we build end up being so expensive? The fact that building bridges with the advanced technology we have today isn’t cheaper but more expensive then building bridges 100 years ago suggests to me that we don’t understand the subject well.
As far as treating and preventing infections goes we are actually understanding the topic better then hundred years ago but we still don’t understand it well enough to prevent people from getting new infections in world-class hospitals, partly even treatment-resistentant ones.
The fact that we have existing paradigms for approaching both of those issues doesn’t limit us to think of new paradigms to approach them better.
Your last sentence is true and important. I think John’s focusing on a different problem. One could use “general” skills to turn existing paradigms, though for a student that will be hard.
Actually building bridges and Actually preventing infections requires not only improvements in applied science, but also human coordination. In the former we’ve improved, in the latter we’ve stagnated.
+1 to this. The difficulties we have today with bridges and infections do not seem to me to have anything to do with the physical systems involved; they are all about incentives and coordination problems.
(Yes, I know lots of doctors talk about how we’re overly trigger-happy with antibiotics, but I’m pretty sure that hospital infection rates have a lot more to do with things like doctors not consistently washing their hands than with antibiotic-resistant bacteria. In order for antibiotic resistance to be relevant, you have to get infected in the first place, and if hospitals were consistent about sterilization then they wouldn’t have infection rates any higher than any other buildings.)
I do agree that some kinds of technical paradigm shifts could plaster over social problems (at least partially), but let’s not mistake that for a lack of understanding of the physical systems. The thing-we-don’t-understand here is mechanism design and coordination.
It’s the sterilization that creates the niche in which those bacteria thrive because they face less competition then they would face in other normal buildings which are populated by diverse bacteria. No matter how much you sterilize you are not going to go to zero bacteria in a space occupied by humans and when human are a primary vector of moving bacteria around in the space you select for bacteria’s that actually interact with humans.
Where is the selection effect coming from? You’d think that the human body is large enough to host a range of different bacteria, so unless they have some way of competing within the body, sterilization would just remove some bacterial populations rather than select for those resistant to antibiotics.
I’m not talking about sterilization of the human body but sterilization of the hospital enviroment. It leads to selection effects for bacteria that are adapted to the hospital enviroment.
If you have plants in a room then part of the room is filled with bacteria that interact with plants and that creates a more diverse microbial enviroment. Having plants in a room makes it more likely that a random bacteria in the room is a plant pathogen compared to a human pathogen.
https://www.frontiersin.org/articles/10.3389/fmicb.2014.00491/full#B7 is a paper that for example argues for maintaining microbial diversity in the different environments as an important issue to avoid pathogen outbreaks.
I would expect that in 50 years you will have plants with microbiomes in hospitals that are selected for hosting a microbiome that increases the surrounding microbial diversity and not hosting human pathogens. Hospitals will move from the paradigm of “everything should be sterile” to the paradigm of “there should be a lot of microbial diversity without human pathogens”.
The will regularly test what bacteria are around and when there are problems use a mix of adding new bacteria to the enviroment that contribute to healthy microbial diversity and phage therapy against those bacteria that are unwelcome.
Having cheap ways to measure the microbial enviroment via cheaper gene sequencing will lead there but there will be a lot about how to have a good microbial enviroment that we have very little understanding of today.
I unfortunately know very little about building bridges, so I can’t really tell how a new paradigm might improve the status quo. It might be possible to switch the composition of a bridge in a way where it can be created in a more automated fashion then it’s currently created.
When it comes to actually preventing infections I do think there’s room for a new paradigm that replaces “let’s kill all bacteria” with “let’s see that we have an ecosystem of bacteria without those that are problematic”.
Moving to that new paradigm for infections has similar problems to improving on cancer treatment and prevention.