ArticleProceedings of the National Academy of Sciences of the United States of America2011
The evolution of drug resistance and the curious orthodoxy of aggressive chemotherapy.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 149 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
149 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interventions for the prevention of recurrent erysipelas and cellulitis.The Cochrane database of systematic reviews · 2017Pooled it
- Modelling the role of the microbiome in antimicrobial resistance across scales.Nature microbiology · 2026Review
- The Evolution of Knockdown Resistance: Genotypic and Phenotypic Insights IntoEvolutionary applications · 2026Article
- Adaptive and sequential cancer therapies emerge from treatment schedule optimization.Research square · 2026Article
- Phage Therapy Beyond Static Pharmaceuticals: A Framework for Controlled Evolutionary Platforms.Viruses · 2026Review
- Competitive suppression and release in artemisinin-resistantEvolution, medicine, and public health · 2026Article
- The speed of vaccination rollout and the risk of pathogen adaptation.Journal of the Royal Society, Interface · 2025Article
- Microbial Primer: Challenges and opportunities in the treatment of chronic polymicrobial infections ‒ an eco-evolutionary perspective.Microbiology (Reading, England) · 2025Review
- Artificial intelligence in drug resistance management.3 Biotech · 2025Review
- A mathematical framework for comparison of intermittent versus continuous adaptive chemotherapy dosing in cancer.NPJ systems biology and applications · 2024Article
- Resistance Management for Cancer: Lessons from Farmers.Cancer research · 2024Review
- Article
- Design and synthesis of novel rigid dibenzo[Journal of enzyme inhibition and medicinal chemistry · 2023Article
- Steering and controlling evolution - from bioengineering to fighting pathogens.Nature reviews. Genetics · 2023Review
- The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance.Nature communications · 2023Review
- A stochastic analysis of the interplay between antibiotic dose, mode of action, and bacterial competition in the evolution of antibiotic resistance.PLoS computational biology · 2023Article
- Dynamics of parasite growth in genetically diverse Plasmodium falciparum isolates.Molecular and biochemical parasitology · 2023Article
- Review
- The future of evolutionary medicine: sparking innovation in biomedicine and public health.Frontiers in science · 2023Article
- Targeting malaria parasites inside mosquitoes: ecoevolutionary consequences.Trends in parasitology · 2022Review
89 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
The evolution of drug-resistant pathogens is a major challenge for 21st century medicine. Drug use practices vigorously advocated as resistance management tools by professional bodies, public health agencies, and medical schools represent some of humankind's largest attempts to manage evolution. It is our contention that these practices have poor theoretical and empirical justification for a broad spectrum of diseases. For instance, rapid elimination of pathogens can reduce the probability that de novo resistance mutations occur. This idea often motivates the medical orthodoxy that patients should complete drug courses even when they no longer feel sick. Yet "radical pathogen cure" maximizes the evolutionary advantage of any resistant pathogens that are present. It could promote the very evolution it is intended to retard. The guiding principle should be to impose no more selection than is absolutely necessary. We illustrate these arguments in the context of malaria; they likely apply to a wide range of infections as well as cancer and public health insecticides. Intuition is unreliable even in simple evolutionary contexts; in a social milieu where in-host competition can radically alter the fitness costs and benefits of resistance, expert opinion will be insufficient. An evidence-based approach to resistance management is required.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.