Nathan and Cars wrote a perspective piece on antibiotic resistance published 4 days ago in the New England Journal of Medicine. On about the same day, I gave a lecture to UNM emergency medicine residents on using evolution to mitigate antibiotic resistance and how to reduce the unintended consequences of selection on the microbiome.

I did a quick search of the recent NEJM article: amazingly, there is no mention of evolution. This omission perpetuates the misguided notion that evolution in unimportant in medicine. Most egregiously, the article made no mention of novel strategies for the prevention of resistance evolution. These include antibiotic cycling by Miriam Barlow, ways to reduce drug selection pressure by Andrew Read, and evolving bacteriophages to kill bacterial pathogens by Michael Hochberg.

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Joe Alcock

Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine