The chameleon and the Rubik’s cube
Superbugs, multidrug resistance and MRSA have been popular buzzwords for a couple of decades now.
Fears that we will run out of antibiotics have grown and are widely publicised. While at a congress last year, I attended a distressing lecture about the rising tide of resistant fungi in our hospitals.
2020 has abruptly shifted our focus to a much scarier and underestimated foe — the virus.
The fact that HIV is under relative control and is mostly prevalent in far-off countries and continents has lulled the western world’s pharmaceutical giants into a slumber.
Focus has been mostly on the more lucrative lifestyle disease market like obesity, diabetes, cholesterol, hypertension and erectile dysfunction.
The cost of developing a new drug and bringing it to market is estimated at between $314m and $2.6bn.
Thus the best investment is into either a chronic condition, a widespread disease or a disease common in developed countries .
A successful vaccination can be lucrative but they are researched and scrutinised much more closely and for longer periods of time as they are often given en masse to the young and the healthy.
Long-term effects need to be studied. Time to market and financial returns are thus much longer.
There is now a feverish rush to find effective antivirals in the short term and ultimately a vaccine for the coronavirus.
Let’s focus on the short term for now. Antivirals such as those used against HIV are drugs made to target specific enzymes in the virus’s structure .
This prevents the virus from replicating and it is thus suppressed and prevented from spreading, but it is not cured.
But why do we use three drugs together to treat HIV?
This approach has been the most successful to tackle the development of drug resistance.
Unfortunately, this leads to more potential side-effects or drug interactions and ultimately non-compliance —and non-compliance again leads to resistance .
Let’s think of antivirals as people trying to solve a Rubik’s cube.
I’m terrible at this and must confess that as a child I once removed all the coloured stickers and rearranged them in the correct order!
But we have all seen those contestants on America’s Got Talent and similar shows solving it in seconds (with one hand behind their back).
These gifted outliers would be the perfect antivirals. Only this Rubik’s cube is the spawn of the union between and mommy Rubik and a chameleon.
Each time you think you have it solved, the colours rearrange and you have to start over.
The solution is within your grasp but remains forever elusive.
The virus does this trick through regular and unpredictable mutations of its genetic material.
Viruses are much more adept at developing resistance than their larger bacterial and fungal compatriots.
This is why viruses can at best be controlled by drugs but only cured or prevented by immunisations.
It took four years from discovering HIV to approving the first antiretroviral (AZT ) in 1987 but it took us to the 2000s to really start achieving control over it.
So what advice do I have after this rather sobering read?
It’s definitely time to take control of your own and your family’s health. Put into practice the social changes we have been taught.
We can use this opportunity to change our lifestyle for the good. Eat a balanced diet, maybe start exercising and find a healthy way to relax. Or you can always buy a Rubik’s cube and start practising.
Dr Daniel Truter, a Port Elizabeth-based doctor, is Weekend Post’s new resident health expert and will be writing weekly columns. He will write under the Dr T moniker.
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