Phage comes up a lot here - it seems to be on of HN's favorite biology topics.
I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):
1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.
2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.
3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it.
There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.
> it seems to be on of HN's favorite biology topics
Yeah, it seems HN knows more about phages than physicians, which is pretty bloody damning. Why TF don't physicians know about this?
"First, Strathdee found an obscure treatment that offered a glimmer of hope -- fighting superbugs with phages, viruses created by nature to eat bacteria."
According to TFA, Strathdee is also an infectious disease epidemiologist, and she didn't find out about phages until her husband had almost karked it, after several months of fighting an antibiotic-resistant infection.
There was a similar story on HN three years ago about a teenager in the UK with cystic fibrosis and an antibiotic-resistant infection after a lung transplant. The physicians treating her didn't know about phages, and her mother had to suggest it.
[https://news.ycombinator.com/item?id=19863445]
So that's at least two cases of people dying slowly from antibiotic-resistant infection until someone suggested phages, which were then successfully used to save their lives. Are the treating physicians incompetent?
It's not a standard therapy - she had to go to extremely specific specialists, including USAMRID. I've seen her talk multiple times, and am a great admirer of hers, but phage as they are are very much last ditch, bespoke treatments.
Specialist ID physicians know - there's whole sessions about it at major infectious disease conferences. But there's a huge gap between "Knowing" and "Have the capability to use this in practice".
Also, because I had a sneaking suspicion - Strathdee was an HIV researcher. In fairness, most of infectious disease epidemiology is HIV research.
It's entirely reasonable she wouldn't have necessarily heard of a fairly niche therapy in another area - phage is basically a non-starter for global health (where her work was), and hospital epidemiology is a very niche field.
That is not a good excuse for not knowing something infectious-disease-related that the average user on a software engineering forum seems to know. It's like MDs talking about a programmer and saying something like 'It's entirely reasonable that, as a Python dev, he wouldn't have heard of compilers. He doesn't need them for his work, and compiler developmentn is a very niche field'. That's simply not a good excuse.
If phages are so extremely niche as you suggest, then how come that they seem to be common knowledge among software engineers?
And you're making an inconsistent comparison: it's not about being an expert, not even about having read a wikipedia article on the topic, it's merely about having heard of that thing existing. A Python dev who has never even heard of Rust or can't even guess what HPC might stand for would be strange indeed. And the same goes for medical professionals who haven't even heard about a whole class of treatment options for a serious global disease problem (and, as a corollary, cannot recommend consulting a specialist).
Of course we learn about bacteriophages in medical school and university. I’m a radiologist and even I know about it. It’s just not FDA approved treatment. You’re talking about inoculating someone with a virus intentionally
Thanks for your insights here — is there any innovation going currently wrt phages either in academia or the startup world that looks significant from a practical point of view? I've also seen people claim that phages were never researched as much in the West because they were popular with the Soviets and therefore had a kind of tainted PR image, is there any truth to this or was their lack of prevalence primarily due to more serious issues?
Phages were used in the west prior to the advent of antibiotics. They had a repetitional issue then, because our purification methods weren't always great, so phage preparations had both phage and potentially bits of the cell wall of the bacteria they had killed. Bacterial cell walls contain endotoxins, which are potentially quite dangerous.
They were largely abandoned in the West because with the advent of antibiotics, a wildly more effective solution to bacterial infections was present. The Cold War meant the Soviet Union had less access, and so needed to continue working on phage research more intensively.
There's a lot of work on phages going on in academia - I don't know about the startup world, TBH. I think some of the most promising leads are in combination therapy. It appears that treating with phage can push bacteria back into susceptibility (basically, two selective pressures at the same time), which is a cool idea. But the gap phage has to jump from "Interesting bespoke one-time treatments" to a generalizable treatment is a pretty big one. My expectation at least in the medium term is they'll be supplemental treatments for a few well known conditions where you can maintain phage libraries for them.
A library is potentially quite large - essentially, you need a phage that's for that particular organism. Potentially a large number of each species, given that phage and bacteria are in an evolutionary arms race.
The trickier part is you have to keep them active and functional over long periods. That's not something most hospital labs are equipped to deal with.
I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):
1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.
2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.
3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it.
There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.