delphi_ote
Philosopher
- Joined
- Jan 18, 2005
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GIVE MOBYSEVEN TRINKET[derail]Joobz: I know I've seen your sig somewhere before, and my head is going to go all Scanners on me if I don't figure this out. Where is it from???[/derail]
GIVE MOBYSEVEN TRINKET[derail]Joobz: I know I've seen your sig somewhere before, and my head is going to go all Scanners on me if I don't figure this out. Where is it from???[/derail]
How did you make that connection? The Wikipedia description of fitness landscape gives a precise description of why multiple selection pressures slows evolution.
You cannot get ye Flask.[derail]Joobz: I know I've seen your sig somewhere before, and my head is going to go all Scanners on me if I don't figure this out. Where is it from???[/derail]
Kleinman said:[...]Whoops, you can’t describe how ribose could be created in the primordial RNA world[...]mijopaalmc said:I am going to assume that, given that this thread has gone on for 3492 posts, anything that I have to say will not make kleinmann suddenly renounce his denial of evolution. However, I couldn't pass up an opportunity to pass up how utterly incorrect this statement is. I will not try to summarize the vast corpus on pre-biotic chemistry because it has already been done for me by Leslie Orgel in a masterful
Kleinman said:mijopaalmc said:review published in 2004. Suffice it to say, if kleimann deigns to read it, it should answer many of his questions of how many of the simple biological molecules could have been formed from the formation of sugars by the condensation of formaldehyde in the formose reaction to the formation of nitrogenous bases by the condensation of hydrogen cyanide with itself and various other simpler nitrogenous compounds to a proposal of a simpler system than RNA (i.e, threose nucleic acid [TNA]) as a stepping stone from the formose reaction and the various HCN condensations to RNA. This review is meant to be a supplement to the oft mentioned Miller-Urey experiment because the main focus on these forums seems to on the creation of amino acid, but here we also have another explanation of the formation of nucleotides.
Are you talking about those code fragments you posted earlier? That’s a good example of an evolutionist idea of a proof. Put those code fragments into ev and see what kind of numbers you generate.Kleinman said:The Wikipedia description of fitness landscape gives a precise description of why multiple selection pressures slows evolution.Delphi ote said:Even though I explicity wrote two fitness functions in Java-like code that demonstrate precisely the opposite? What you're saying here is a blunder equivalent to "the more integers you add, the bigger the result."
Delphi, you have worked on the concept of mutation and selection and you still have difficulty understanding the mathematics of this phenomena. Since you have difficulty grasping what ev is showing and you have difficulty comprehending why triple therapy is used for the treatment of HIV, let’s try another important clinical medical example.Delphi ote said:I'm really trying to spoon feed you here. Help me help you. How can I mathematically represent calculations on strings in a way you'll understand?
Well, if you read this thread carefully, A) you would find reference to my PhD thesis which is a computer simulation of a biological system, the results of which have been published. I have also published another computer simulation which pertained to the solution of a non-linear partial differential equation. I have also been paid for commercial work using and writing computer simulations and have taught at the university level both undergraduate and graduate level thermodynamics and heat transfer. Included in this teaching was the instruction of the writing and use of computer simulations. B) Are you sure it is not you who has had half of his gray matter disabled by a rust age theory.Level said:Hey! I said that over 4 months ago:Mr Scott said:I know, but Dr. Kleinman doesn't seem to get it. Why, I'm not sure, but I think it's A) He's not educated in computer models and simulations, and B) a bronze age holy book has disabled half of his gray matter.
Mr Scott, it does not matter what the mechanism of mutation is, it is the multiple selection conditions which interfere with evolution. This is the mathematical and real fact you have yet to come to grips with. No mechanism of mutation will change this fact.Mr Scott said:If there are, for example, 10 processes that enable evolution, and a computer simulation models 8 of them, then it's not valid to draw a conclusion like "evolution is too slow" unless the other two are also modeled. Ev does not model gene duplication, and the concensus is it's a critical process in "speeding up" evolution compared to evolution without duplication.
Your 8-cylinder car has 5 flat tires (spare tire included), no fuel and your destination is beyond the ends of the observable universe. Multiple selection processes interfere with evolution. The more selection conditions you have the slower the evolution. The fundamental mechanism of mutation and selection which you allege drives the theory of evolution does not work this way. This is shown mathematically and by real examples of the phenomena. No mutation mechanism will change this basic mathematics.Mr Scott said:It's as if Kleinman is saying that, because a 4-cylinder car is shown to not be able to reach a destination in time, it's proven an 8-cylinder car couldn't. Real world evolution runs on many more cylinders than Ev models, and we are still discovering more as science continues to penetrate the beautiful, open-ended clockwork of evolution.
Denial does not constitute a valid scientific argument. If you deny the results of ev, put whatever mutation mechanism you want in the model and see whether it will overcome the effect of multiple selection conditions. This I will continue to repeat. This is one of the fatal errors in the theory of evolution. Another fatal error is you have no selection process that can evolve a gene from the beginning.Mr Scott said:This is the fatal error in Dr. Kleinman's reasoning. He has not refuted it, so it's necessary to repeat it.
What ev does is maintain a stable unchanging set of selection pressures with no possibility of extinction. Even under these simple, stable conditions the evolution process is profoundly slow. Changing the selection conditions will slow evolution further.Kleinman said:Ev represents a best case scenario for the theory of evolution. All creatures are affected equally and there is no extinction.Ichneumonwasp said:How is that a best case scenario for evolution? That looks to me like an equilibrium scenario -- all creatures affected equally over space and time. That isn't how evolution works.
Certainly, I’ll repost the entry.Kleinman said:How did you make that connection? The Wikipedia description of fitness landscape gives a precise description of why multiple selection pressures slows evolution.joobz said:Can you post again what part of the wiki entry you think states this? Feel free to include some sentence diagrams to show this.
andWikipedia said:Fitness landscapes are often conceived of as ranges of mountains. There exist local peaks (points from which all paths are downhill, i.e. to lower fitness) and valleys (regions from which most paths lead uphill). A fitness landscape with many local peaks surrounded by deep valleys is called rugged.
Wikipedia said:Apart from the field of evolutionary biology, the concept of a fitness landscape has also gained importance in evolutionary optimization methods such as genetic algorithms or evolutionary strategies. In evolutionary optimization, one tries to solve real-world problems (e.g., engineering or logistics problems) by imitating the dynamics of biological evolution. For example, a delivery truck with a number of destination addresses can take a large variety of different routes, but only very few will result in a short driving time. In order to use evolutionary optimization, one has to define for every possible solution s to the problem of interest (i.e., every possible route in the case of the delivery truck) how 'good' it is. This is done by introducing a scalar-valued function f(s) (scalar valued means that f(s) is a simple number, such as 0.3, while s can be a more complicated object, for example a list of destination addresses in the case of the delivery truck), which is called the fitness function or fitness landscape. A high f(s) implies that s is a good solution. In the case of the delivery truck, f(s) could be the number of deliveries per hour on route s. The best, or at least a very good, solution is then found in the following way. Initially, a population of random solutions is created. Then, the solutions are mutated and selected for those with higher fitness, until a satisfying solution has been found.
Wikipedia said:Evolutionary optimization techniques are particularly useful in situations in which it is easy to determine the quality of a single solution, but hard to go through all possible solutions one by one (it is easy to determine the driving time for a particular route of the delivery truck, but it is almost impossible to check all possible routes once the number of destinations grows to more than a handful).
Half truth - typical.This is how mutation and selection works. Multiple selection pressures do not speed up evolution, they interfere with each other and prevent evolution. This is what the mathematics shows, this is what the real world shows.
I believe your reading comprehension is lacking. A good thing to try is to stop thinking of ways to lie and pay attention to what is written.Certainly, I’ll repost the entry.
[....cut for brevity...]wiki said:Evolutionary optimization techniques are particularly useful in situations in which it is easy to determine the quality of a single solution, but hard to go through all possible solutions one by one (it is easy to determine the driving time for a particular route of the delivery truck, but it is almost impossible to check all possible routes once the number of destinations grows to more than a handful).
Joobz, pay attention in particular to the last paragraph of the above quote from Wikipedia. Ev is an evolutionary optimization scheme. Convergence of ev occurs when three selection conditions are satisfied. The three selection conditions are 1) binding sites are located where they should be, 2) no spurious binding in the gene region and 3) no spurious binding sites in the non-gene region of the genome. It is the requirement that all three selection conditions be satisfied simultaneously that causes evolution to be profoundly slow. If you require that only a single selection condition be satisfied at a give time, ev converges very rapidly. Ev is showing exactly what that last paragraph of the post from Wikipedia is saying. Multiple selection conditions profoundly slow down the evolutionary process. This is also seen in reality.
Kleinman said:This is how mutation and selection works. Multiple selection pressures do not speed up evolution, they interfere with each other and prevent evolution. This is what the mathematics shows, this is what the real world shows.fishbob said:Half truth - typical.
Kleinman said:fishbob said:Multiple selection pressures can interfere to diminish or intensify.
This is what the real world really shows.
What ev does is maintain a stable unchanging set of selection pressures with no possibility of extinction.
Even under these simple, stable conditions the evolution process is profoundly slow.
Changing the selection conditions will slow evolution further.
If you can point me to a way of mathematically representing fitness landscapes for you, I will show you that you're wrong. In some cases, selection pressures can reenforce one another (as in the example code I posted.) In some cases, they have no impact on each other. In some cases, they interefere with each other.Multiple selection pressures do not speed up evolution, they interfere with each other and prevent evolution.
Wikipedia said:Evolutionary optimization techniques are particularly useful in situations in which it is easy to determine the quality of a single solution, but hard to go through all possible solutions one by one (it is easy to determine the driving time for a particular route of the delivery truck, but it is almost impossible to check all possible routes once the number of destinations grows to more than a handful).
A grammatically challenged alchemical engineer now thinks he can lecture on reading comprehension.joobz said:I believe your reading comprehension is lacking. A good thing to try is to stop thinking of ways to lie and pay attention to what is written.
Ev can’t figure it out, you can’t figure it out, no evolutionist can figure it out but you think it is scientifically true? Is this the kind of slop you teach in your alchemical engineering classes? Make sure you remain anonymous.joobz said:The Ev. Opt technique is useful when understand each baby step, but can't figure out a priori the total response, which is the sum of the baby steps.
How does modeling of the dynamics of water molecules have anything to do with the acquisition of information by mutation and selection? You must have just finished a hearty meal at kjkent1’s table, red herring, string cheese and whine.joobz said:We know and can model how a simple water molecule moves in isolation. But time it takes to run a simulation of 1ml of water is extrememly long. Does this mean that 1 ml of water doesn't exist?
You better check Wikipedia for the definition of equilibrium.Kleinman said:What ev does is maintain a stable unchanging set of selection pressures with no possibility of extinction.Ichneumonwasp said:Yes, equilibrium.
You don’t understand your own theory of evolution so why should I think you understand the meaning of equilibrium.Kleinman said:Even under these simple, stable conditions the evolution process is profoundly slow.Ichneumonwasp said:Yes, equilibrium conditions. Slow change, the theory predicts this.
Choose any case you want in ev, allow information to accumulate than turn off selection and watch the information disappear. Your own example demonstrates this, drug resistant TB occurs more readily when you reduce the number of selective pressures. Why do you think multiple drugs are used to treat TB? Use a single drug and resistance to that drug rapidly appears. Take multiple drugs and maintain the multiple selective pressures and resistant strains are much slower to appear. It doesn’t take long for poor compliance (eliminating the multiple selection pressures) with treatment to yield resistant strains.Kleinman said:Changing the selection conditions will slow evolution further.Ichneumonwasp said:How's that? Based on what data? We have great data with HIV and triple therapy (your own pet example). Multiple weak selection pressures with certain forms of triple therapy and no change in conditions (good compliance) -- resistance develops. Strong selection pressure with other forms of triple therapy and good compliance -- no resistance develops (over the short course). Strong selection pressure with that same form of triple therapy with poor compliance -- taking med, stopping, taking med again, stopping, taking med again, etc. -- resistance develops. Same thing with TB treatments -- the single best predictor of resistance development is por patient compliance -- changing selection conditions over time.
Ev is mathematically representing a fitness landscape. Have Paul put your code into ev and see whether you can speed up evolution. What is so nonsensical about your concept is that you think the mathematics will proceed more quickly the more complex you make the selection conditions. You are proposing the exact opposite of your Wikipedia link to fitness landscape. There are no fitness landscapes that become easier to optimize by adding more selection conditions to satisfy.Kleinman said:Multiple selection pressures do not speed up evolution, they interfere with each other and prevent evolution.Delphi ote said:If you can point me to a way of mathematically representing fitness landscapes for you, I will show you that you're wrong. In some cases, selection pressures can reenforce one another (as in the example code I posted.) In some cases, they have no impact on each other. In some cases, they interefere with each other.
Delphi, the only way you are going to represent any real fitness landscape is by functional notation. You can map the surface by generating data points with a computer model like ev. Somehow you are under the delusion that adding more selection conditions will make it easier to find an optimum on this surface. If you think this is true, define multiple selection conditions that converge rapidly and have Paul put them in ev and demonstrate your argument.Delphi ote said:I'd be more than happy to show you what this looks like in a mathematical context, but you don't seem to understand what I type. If you'd care to point me to a way I can explain this to you, I'll do my best. If, on the other hand, you'd rather continue this discussion by flagrantly repeating this false statement, fine. Just please stop being so very proud of your ignorance.
Kleinman said:Choose any case you want in ev, allow information to accumulate than turn off selection and watch the information disappear.
Your own example demonstrates this, drug resistant TB occurs more readily when you reduce the number of selective pressures.
Take multiple drugs and maintain the multiple selective pressures and resistant strains are much slower to appear.
It doesn’t take long for poor compliance (eliminating the multiple selection pressures) with treatment to yield resistant strains.
Ev can’t figure it out, you can’t figure it out, no evolutionist can figure it out but you think it is scientifically true? Is this the kind of slop you teach in your alchemical engineering classes? Make sure you remain anonymous.
Simple. Molecular dynamics is a method of simulating a system by appling simple force rules over and over again. It looks at each interaction and adjusts the setting as a function of time. It is quite similar in function to ev. the exact mechanics differ, but the idea of optimization is the same.How does modeling of the dynamics of water molecules have anything to do with the acquisition of information by mutation and selection?
Ok, that’s an interesting challenge. Are you proposing exposure to single or multiple selection pressures? The example you give with developing drug resistant TB occurs when taking only one or two medications rather than the three or four that is recommended, this same affect is seen with HIV and poor compliance with treatment.Kleinman said:Choose any case you want in ev, allow information to accumulate than turn off selection and watch the information disappear.Ichneumonwasp said:That's not the analogy. Exposure, remove, exposure, remove, exposure, remove, rinse, repeat.
If you look at what happens with compliance with multi-drug therapy is that patient’s often time won’t take particular drugs because of adverse reactions to those medications. In addition, taking multiple medications, multiple times a day often times leads to confusion on a patient’s part. They often forget to take medications. The mathematics dictates that drug resistance occurs quickly when taking only single medications. This is why public health departments have gotten involved in the treatment of TB. Patients must be witnessed taking their medications to insure they take all their medications.Kleinman said:Your own example demonstrates this, drug resistant TB occurs more readily when you reduce the number of selective pressures.Ichneumonwasp said:No, wrong. No drug exposure, no drug resistance. Resistance develops when people take the drug, then stop, then take the drug, then stop, then take the drug, then stop, rinse, repeat. This is not an example of reducing the number of selection pressures in some bland way. It is an example of multiple exposures and periods of remission for a given strong selection pressure(s). There is a big difference. You've not modelled this at all, so can make no comment about it. We know what happens without the selection pressure being placed -- no drug resistance. And with good patient compliance -- limited to no drug resistance. It is repeated exposures, followed by remission with a chance for the population to grow with new varieties, repeat exposure, etc. that results in drug resistance.
Come on, this phenomenon is very well known and well studied. Don't pretend that placing a selection pressure and removing it in any way mimics what I am talking about.
I missed your link. Post it again with appropriate quotes posted that you think makes your point.Kleinman said:Take multiple drugs and maintain the multiple selective pressures and resistant strains are much slower to appear.Ichneumonwasp said:Nope, not always. You did check the link I provide above regarding the situation with HIV. It is, in fact, compliance with the drug regimen that causes drug resistance, even with multiple drugs in the regimen if the selection pressure of the multiple drugs is not high enough.
You are incorrect. What ev shows, with a single selection condition, that condition quickly evolves. When people take single drug therapy for HIV and TB, resistance to that drug rapidly appears. The problem of patient compliance with multi-drug treatment regimens is not getting them to take one drug; it is getting them to take all the medications consistently. Then you slow evolution of the drug resistant strains. If the selection pressure is strong enough, you can cause the microbe to go extinct (at least with respects to that person).Kleinman said:It doesn’t take long for poor compliance (eliminating the multiple selection pressures) with treatment to yield resistant strains.Ichneumonwasp said:If you take a drug and stop it (one instance of each), no resistance arises. That is the analogy you are providing with ev -- place selection pressure and then remove it. Resistance only arises when people take drugs in a sporadic fashion.
Kleinman said:Ev can’t figure it out, you can’t figure it out, no evolutionist can figure it out but you think it is scientifically true? Is this the kind of slop you teach in your alchemical engineering classes? Make sure you remain anonymous.joobz said:ahh your back to gibberish
Kleinman said:joobz said:
Kleinman method:
Dismiss a clearly explained concept by quoting random words from said concept in a contemptable manner.
The problem with this silly analogy is that ev does compute a rate of information acquisition that is profoundly slow. The reason it is slow is the multiple selection conditions. This effect becomes apparent before you reach a genome length of 100,000. The simulation of the molecular dynamics of a gram of water requires tracking 3E+22 particles each with at least 6 degrees of freedom for each particle. That is why this computation is so slow. Your scientific analogies are as incoherent as your grammar.Kleinman said:How does modeling of the dynamics of water molecules have anything to do with the acquisition of information by mutation and selection?joobz said:Simple. Molecular dynamics is a method of simulating a system by appling simple force rules over and over again. It looks at each interaction and adjusts the setting as a function of time. It is quite similar in function to ev. the exact mechanics differ, but the idea of optimization is the same.
Kleinman said:The example you give with developing drug resistant TB occurs when taking only one or two medications rather than the three or four that is recommended, this same affect is seen with HIV and poor compliance with treatment.
Are you proposing exposure to single or multiple selection pressures?
If you look at what happens with compliance with multi-drug therapy is that patient’s often time won’t take particular drugs because of adverse reactions to those medications. In addition, taking multiple medications, multiple times a day often times leads to confusion on a patient’s part. They often forget to take medications. The mathematics dictates that drug resistance occurs quickly when taking only single medications. This is why public health departments have gotten involved in the treatment of TB. Patients must be witnessed taking their medications to insure they take all their medications.
Whether you can speed up evolution by turning on and off all selection conditions will not work in ev. This can be easily shown by turning selection on and off in the middle of a run. You also have the problem of how do you extend this concept to macroevolution. Turning off selection for a particular condition stops selection for beneficial mutations for that condition. This will slow evolution. The purpose of having selection is that increases the frequency of beneficial genetic sequences in the population. Any time you turn off selection you are losing this effect. But feel free to propose your idea to Paul and see whether your mathematics will work out.
Three weak selection pressures may not be adequate to cause extinction but they do slow the evolution of triple resistant strains. Give the drugs serially and you will get triple resistant strains much more quickly than if you give the drugs simultaneously.
What ev shows, with a single selection condition, that condition quickly evolves. When people take single drug therapy for HIV and TB, resistance to that drug rapidly appears.
The problem of patient compliance with multi-drug treatment regimens is not getting them to take one drug; it is getting them to take all the medications consistently.
Then you slow evolution of the drug resistant strains. If the selection pressure is strong enough, you can cause the microbe to go extinct (at least with respects to that person).
The widely accepted premise that non-adherence breeds resistance is now being challenged, at least as it pertains to anti-HIV therapy. Recent data from cohorts of individuals with well-characterized measures of adherence suggest that resistance to both protease and nucleoside reverse transcriptase inhibitors occurs primarily in highly adherent patients.9 In separate studies, Walsh et al.19 and Howard et al.20 demonstrated linear and direct associations between adherence and the number of drug resistance mutations. Gallego et al.21 found protease inhibitor resistance was limited to those individuals reporting more than 90% adherence.
This is an interesting post Dr Richard and I took a particular portion of the quote and reposted it above. The reason I took this particular portion of the quote is because it describes what must be done to navigate a fitness landscape.From Dr Richard’s qoute said:Several single substitutions were lethal and led the master sequence to drop down the peak. However, at other positions, single substitutions sent the master sequence to a new local optimum or peak, suggesting that the master sequence may walk through the quasispecies fitness landscape by single mutational steps without being trapped at suboptimal alleles (34, 56, 61).
You still don’t understand the mathematics of mutation and selection and how population affects the rate of evolution. Doubling the population does not double the probability that a particular mutation will hit at a particular loci. For small populations, you can approximate population as having an additive affect on this probability but as your populations get larger and larger, this effect is much less than additive. I have run a series with a population of 10^6 and the effect of increasing population is becoming very small. Paul is supposed to be running another population series and you will see this effect once again.Dr Richard said:1. The sheer number of HIV virions in a single patient: 10^9 PER DAY. Again, makes Kleinmans population of erm... 64 seem a tad conservative.
How did this individual get so many varieties of the HIV virus? Did this individual receive three antiretroviral medicines consistently or was he treated with monotherapy?Dr Richard said:2. The existence of many, many varieties of HIV within a single individual, creating the landscape as mapped.
Certainly, different antiretroviral medicines (selection pressures) should lead to different genetic sequences in the viruses. However, a given antiretroviral medication should lead to particular genetic sequence that confers resistance to that medication. I’ve heard infectious disease lectures on the topic and particular mutations and given loci confirm the particular drug resistance.Dr Richard said:3. The fact that each fitness landscape is different in each individual, due to different selection pressures
If drugs which target other enzymes are in virus are introduced, it only makes it more difficult for the virus to evolve.Dr Richard said:4. The fact that each landscape as mapped is for the protease only.
Again, from the infectious disease lectures I have heard, the drug resistant strains of HIV are less fit than the wild strain of the virus. Drug resistant viruses can not reproduce as quickly as the wild virus. The least fit of the viruses that are still able to reproduce will be the ones with the most drug resistance.Dr Richard said:5. The fact that small populations of less fit virions are kept "in reserve" in case a new selection pressure manifests.
Of course there is more diversity if there are more selection pressures. If there are no selection pressures, the virus (and it’s corresponding genome) that reproduces most rapidly will quickly take over the population. Each selection pressure added to that virus slows the reproduction of that genome and allows other variants genetic sequences to appear. If you have sufficient selection pressure, you stop the reproduction of the virus completely. So Dr Richard, are you arguing that monotherapy should be used to treat HIV? If not, why? You are arguing that multiple selection pressures accelerate the evolution of the virus so physicians should use few drugs, not more drugs.Dr Richard said:In summary, this paper demonstrates that multiple different selection pressures in fact increase the genetic diversity of the population and therefore accelerate evolution.
Far from refuting my theory, your paper supports my theory; see the quote I took from your post. Again, I ask you, does this paper support the use of monotherapy or triple antiviral agents for the treatment of HIV? You have alleged that multiple selective pressures increase the variants of the virus. By your logic, monotherapy should be used.Dr Richard said:Thank you Kleinman for coming up with the example of HIV - the evolution present within one infected person is sufficient to refute your theory by providing many, many selection pressures and a massive population. You can turn off your PC now...
Dr Richard said:P.S. the Wiki article on Fitness Landscapes also links to a paper on HIV fitness landscapes modelling >3 loci
Dr Richard said:http://arxiv.org/PS_cache/q-bio/pdf/0603/0603034v2.pdf. I it is a bit more complex than Kleinman seems to think...
Ichneumonwasp said:Here is the link regarding resistance in HIV
It isn't all that long. The important issues are that while resistance clearly develops in single drug therapies, it may also develop in multi-drug therapies that are not as good at suppressing the viral load. There are many other studies demonstrating that poor compliance to the commonly used and much better triple therapy programs is a result of poor compliance. For one teaser that does not include the multi-drug users.........
This is why I asked you if you can obtain drug resistance without using the drug. You can’t. If you don’t have fatal selection pressures against the virus, given enough time you will evolve drug resistant strains to that medication. If you administer the drug as monotherapy, that resistance comes about more quickly. If administered in combination with other medications, that resistance comes about more slowly because the virus has a more complex walk in the fitness landscape in order to develop the drug resistance.Ichneumonwasp’s quote said:The widely accepted premise that non-adherence breeds resistance is now being challenged, at least as it pertains to anti-HIV therapy. Recent data from cohorts of individuals with well-characterized measures of adherence suggest that resistance to both protease and nucleoside reverse transcriptase inhibitors occurs primarily in highly adherent patients.9 In separate studies, Walsh et al.19 and Howard et al.20 demonstrated linear and direct associations between adherence and the number of drug resistance mutations. Gallego et al.21 found protease inhibitor resistance was limited to those individuals reporting more than 90% adherence.
Kleinman said:This article was published in 2004 meaning the data are at least a couple years older. I have attended CME lectures on the topic within the last year and triple therapy with monitoring and sequencing of the virus for drug resistant strains is the standard of care. The reason this is done is so the virus can not easily walk the fitness landscape and evolve new resistant strains.
This is what the mathematics of mutation and selection shows and this is what the clinical response to these types of therapies show. Multiple selection pressures when applied simultaneously slow evolution.
If administered in combination with other medications, that resistance comes about more slowly because the virus has a more complex walk in the fitness landscape in order to develop the drug resistance.
Standard of care uses three drugs with monitoring for signs of resistance to any of the drugs. As soon as resistance to any one of the drugs is detected an attempt is made to substitute to a new drug.
There is no fact (in my opinion) that you could possibly present which would cause kleinman to reject his belief system.OK, I think I get it now. You completely misregard any information with which you cannot deal and pretend that you are answering a challenge by posting competely unrelated material.
Welcome to the Kleinman method:OK, I think I get it now. You completely misregard any information with which you cannot deal and pretend that you are answering a challenge by posting competely unrelated material.