When Antibiotics Don't Work (full documentary) | FRONTLINE

00:53:16
https://www.youtube.com/watch?v=EkyAuG9RSSU

Summary

TLDRThe video details the rise of antibiotic-resistant bacteria, focusing on three cases illustrating the global health crisis. It begins with Addie Rerecich in Tucson, whose staph infection became untreatable, leading to a desperate fight for survival with a lung transplant as the only option. The narrative then shifts to David Ricci in India, who suffered an amputation after contracting NDM-1, a gene making bacteria resistant to most antibiotics. Lastly, it highlights a superbug outbreak in a prestigious U.S. hospital and the struggle to contain it despite rigorous efforts. The video underscores the critical importance of developing new antibiotics, highlighting the economic challenges, and stresses the urgent need for global cooperation to combat these threats as predictions suggest that by 2050, superbugs could claim more lives annually than cancer.

Takeaways

  • 🔬 Antibiotic-resistant bacteria pose a global health crisis.
  • ⚠️ Overuse of antibiotics accelerates resistance development.
  • 🌍 Superbugs can spread through global travel and poor sanitation.
  • 💊 Drug companies face economic challenges in antibiotic development.
  • 🔍 Hospitals struggle to manage and contain superbug outbreaks.
  • 🚨 Predictions indicate superbugs could surpass cancer in mortality by 2050.
  • 🤝 International cooperation is crucial to combat resistance.
  • 🧬 Genetic exchanges enable rapid spread of resistance genes.
  • 💡 New antibiotics are urgently needed to tackle resistant strains.
  • 🔄 Resistance makes once treatable infections deadly and widespread.

Timeline

  • 00:00:00 - 00:05:00

    The emergence of untreatable superbugs is a global threat, infecting millions annually and defying antibiotics. Researchers and healthcare systems are grappling with these drug-resistant bacteria, raising alarms and questioning economic frameworks dependent on pharmaceutical profits in public health crises.

  • 00:05:00 - 00:10:00

    The narrative begins with the personal story of Addie, an 11-year-old from Tucson, who fell victim to a bacterial infection resistant to treatment. This highlights the rapid onset of severe illnesses and the dread of insufficient medical options in combating such resistant strains.

  • 00:10:00 - 00:15:00

    Addie's condition worsens, displaying early signs of pneumonia. She undergoes extensive treatments and diagnostics that unveil the infection's unique nature—a resistant strain posing a formidable challenge to medical conventionalism.

  • 00:15:00 - 00:20:00

    Despite medical interventions, the infection grows resistant, becoming pan-resistant and leaving no effective medical options. Medical ethics about resource allocation and potential recovery are explored as Addie battles for survival amid a bleak prognosis.

  • 00:20:00 - 00:25:00

    The story shifts to David Ricci in India, who faces another drug-resistant infection after a severe accident. The narrative expands to include the global spread and severe impact of these resistant strains in various environments.

  • 00:25:00 - 00:30:00

    Ricci confronts the ramifications of global bacterial resistance firsthand. Discovered with the NDM-1 superbug, his prognosis reflects the broader crisis, illustrating consequences of the widespread travel of these resistant genes and the challenge they pose to public health.

  • 00:30:00 - 00:35:00

    The spread of superbugs reaches the US, with experiences documented in New York and the NIH, demonstrating hospital vulnerabilities and the challenge of maintaining sterile environments against resilient bacteria like KPC.

  • 00:35:00 - 00:40:00

    A detailed breakdown of an outbreak in NIH shows aggressive containment efforts, revealing the complexity of tracing bacterial spread in hospitals and the high stakes of healthcare responses to resistant organisms.

  • 00:40:00 - 00:45:00

    Scientific investigations spotlight bacterial genomic tracking as a method to reveal transmission paths and critical gaps in infection control, marking a crucial step in addressing resistant bacteria spread.

  • 00:45:00 - 00:53:16

    The documentary underscores the grim reality of antibiotic resistance's persistent advance, exploring failure points within pharmaceutical-economic systems, public health policies, and the ongoing race against evolving drug-resilient pathogens.

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Mind Map

Video Q&A

  • What is causing the rise of antibiotic-resistant bacteria?

    Overuse and misuse of antibiotics in both humans and agriculture, along with the lack of new antibiotic development, are major factors.

  • How do bacteria become resistant to antibiotics?

    Bacteria can mutate and acquire resistance genes, which they can spread to other bacteria.

  • What is NDM-1 and why is it significant?

    NDM-1 is a gene that makes bacteria resistant to most antibiotics. It can spread between different bacteria, making infections hard to treat.

  • How was Addie's infection unique?

    Addie contracted a superbug that was resistant to all available antibiotics, illustrating the severity of antibiotic resistance.

  • What challenges do hospitals face with superbugs?

    Hospitals struggle to contain infections due to bacteria spreading silently among patients, and limited effective antibiotics.

  • Why are pharmaceutical companies reluctant to develop new antibiotics?

    Developing antibiotics is costly and offers lower returns compared to other drugs that treat chronic conditions, reducing incentive.

  • What measures can combat antibiotic resistance?

    Minimizing antibiotic use, improving sanitation, investing in new drug research, and international cooperation are crucial steps.

  • What is the impact of superbugs compared to cancer?

    Superbugs are predicted to kill more people than cancer by 2050, highlighting the severity of the resistance issue.

  • How do superbugs spread globally?

    Global travel and inadequate sanitation in various regions contribute to the spread of antibiotic-resistant bacteria.

  • What were the economic implications of antibiotic resistance discussed in the video?

    There is an inherent tension between the cost of developing new antibiotics and the necessary stewardship to limit their use.

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  • 00:00:00
    [Music]
  • 00:00:05
    we are seeing now the emergence globally
  • 00:00:07
    of some forms of bacteria that are
  • 00:00:09
    effectively untreatable each year at
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    least 2 million people are infected with
  • 00:00:14
    drug resistant super bugs they had asked
  • 00:00:16
    me to sign the papers to let her go and
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    I did and at least 23,000 die from them
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    he had some bugs that they had never
  • 00:00:25
    seen before we immediately went on high
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    alert the equivalent of Defcon
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    no matter what we did the bacteria was
  • 00:00:32
    still spreading Frontline continues its
  • 00:00:34
    reporting on how we got here then
  • 00:00:36
    overusing these antibiotics we have set
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    ourselves up for the scenario that we
  • 00:00:41
    find ourselves in now we're running out
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    of antibiotics the newest threats where
  • 00:00:46
    did it come from we don't know exactly
  • 00:00:48
    where this bacteria came from the
  • 00:00:50
    economic realities there is an
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    increasing recognition that antibiotics
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    are not a good thing to run off a pure
  • 00:00:58
    capitalistic market and what happens now
  • 00:01:01
    a lot of what we're doing requires
  • 00:01:03
    resources if there is less money there
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    are tough choices that have to be made
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    it could happen to your next door
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    neighbor could happen to your child
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    could happen to anybody those bacteria
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    are out
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    there hunting the nightmare
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    [Music]
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    bacteria this is the story of three
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    seemingly disconnected events beginning
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    at the same time
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    what they each have in common is a type
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    of infection that is becoming impossible
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    to
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    treat a type of infection that has
  • 00:01:39
    triggered deadly outbreaks even at one
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    of our most prestigious
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    hospitals it is a crisis that is
  • 00:01:45
    spreading alarmingly
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    fast threatening everyone even the
  • 00:01:53
    healthy
  • 00:01:55
    [Music]
  • 00:02:00
    our first story starts in Tucson Arizona
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    in May
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    2011 when I think about that time I
  • 00:02:09
    think about
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    spring
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    and just how you know how busy it was
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    and how beautiful she
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    was she was 11 and 1/2 years old and
  • 00:02:24
    just physically perfect beautiful from
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    head to
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    toe Slim
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    you know white blonde hair from being
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    out in the
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    sun a little bit of freckles across her
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    nose bright blue eyes paying attention
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    to what her clothes looked like and her
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    hair never stopped talking talked a mile
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    a
  • 00:02:46
    minute that was Addie at that just you
  • 00:02:50
    know in the month before she got
  • 00:02:52
    [Music]
  • 00:02:53
    sick journalist David Hoffman started
  • 00:02:56
    reporting on the threat of super bugs
  • 00:02:58
    for Frontline more than 4 years ago
  • 00:03:01
    there's a warning from the CDC new and
  • 00:03:02
    extremely dangerous covering what
  • 00:03:05
    government officials have called a
  • 00:03:06
    nightmare it's a deadly nightmare
  • 00:03:09
    bacteria but the CDC has called it a
  • 00:03:11
    nightmare a kind of dangerous bacteria
  • 00:03:15
    that is increasingly resistant to the
  • 00:03:17
    strongest antibiotics morning hi I'm DAV
  • 00:03:20
    that's what brought us to Tucson Arizona
  • 00:03:21
    in 2013 to find out what happened to
  • 00:03:24
    Addie rasich after she complained to her
  • 00:03:27
    mother about a pain in her hip
  • 00:03:31
    I thought well you know she's just
  • 00:03:33
    finishing up softball she had been to
  • 00:03:36
    the track meet you know it all kind of
  • 00:03:39
    well it could have been an
  • 00:03:41
    injury I gave her some ibuprofen as the
  • 00:03:44
    night wore on her pain got worse she
  • 00:03:46
    didn't sleep much that night woke me up
  • 00:03:49
    a couple of times asking if she could
  • 00:03:50
    take a hot bath or have another
  • 00:03:55
    ibuprofen the next day Tanya rasich a
  • 00:03:58
    nurse for 16 years
  • 00:04:00
    took Addie to a local hospital where
  • 00:04:02
    they said she had symptoms of a
  • 00:04:05
    virus but over the next few days the
  • 00:04:08
    pain spread and the fever got worse I
  • 00:04:11
    was afraid at that point I remember
  • 00:04:14
    being very
  • 00:04:15
    afraid and so I packed a bag and we went
  • 00:04:18
    to another hospital that had um
  • 00:04:20
    specialized in children's
  • 00:04:23
    care I remember
  • 00:04:26
    thinking she looks bad this is bad
  • 00:04:29
    something's really really
  • 00:04:32
    wrong they put her on antibiotics they
  • 00:04:34
    were her blood pressure was dropping
  • 00:04:37
    they you know we're making space in the
  • 00:04:39
    ICU for
  • 00:04:42
    her the next morning cheating at oxygen
  • 00:04:45
    via
  • 00:04:46
    mask they looked at part of her lungs
  • 00:04:49
    and diagnosed her with
  • 00:04:52
    pneumonia I remember sitting there
  • 00:04:54
    watching the sun come up and
  • 00:04:57
    thinking how did she get so
  • 00:05:00
    sick how did this happen so
  • 00:05:06
    fast I met Addie in a hospital bed in
  • 00:05:09
    the Intensive Care Unit she was lying
  • 00:05:12
    there breathing quickly she was scared
  • 00:05:15
    um she had uh little infected boils all
  • 00:05:19
    over her body what really looked most
  • 00:05:21
    likely when I saw her was a staff
  • 00:05:24
    bacteria causing septic shock and Addie
  • 00:05:28
    fit a pattern that I recognized with
  • 00:05:30
    Community Associated Mera when you say
  • 00:05:32
    community I mean this is what you mean
  • 00:05:34
    that a kid picks it up in a playground
  • 00:05:36
    with a scrape to the knee right
  • 00:05:39
    correct a spread of Mera a staff
  • 00:05:42
    bacteria that causes infections
  • 00:05:44
    resistant to many antibiotics has long
  • 00:05:46
    been a big problem inside hospitals but
  • 00:05:49
    over the last two decades it's also been
  • 00:05:51
    found outside in the community in
  • 00:05:55
    Addie's case she was a skin picker she
  • 00:05:57
    she as do many kids picked at her little
  • 00:05:59
    scabs um and that was likely what
  • 00:06:01
    introduced the staff
  • 00:06:05
    infection but the staff was just a start
  • 00:06:07
    of Addie's
  • 00:06:09
    troubles she already had evidence of an
  • 00:06:11
    early pneumonia and it looked like she
  • 00:06:15
    was about to get a lot sicker I asked
  • 00:06:17
    him what were the odds of her making it
  • 00:06:21
    getting well what did he say he said 30%
  • 00:06:26
    but he had to think about it for a
  • 00:06:27
    minute and I knew he was lying to me
  • 00:06:31
    I Knew by the time your blood has
  • 00:06:33
    bacteria in it you're in real
  • 00:06:37
    trouble the staff infection had so
  • 00:06:39
    damaged her lungs the doctors had no
  • 00:06:42
    choice to save her life they put her on
  • 00:06:45
    a long bypass machine called
  • 00:06:49
    emmo I remember
  • 00:06:52
    saying emmo with a squeaky voice like no
  • 00:06:56
    really you're not really talking about
  • 00:06:58
    emmo
  • 00:07:00
    this was total life support it's got
  • 00:07:03
    huge tubes that are put into an artery
  • 00:07:07
    in a
  • 00:07:08
    vein
  • 00:07:09
    and the patient's blood comes out of
  • 00:07:14
    their body runs through the machine and
  • 00:07:16
    the Machine does what your lung
  • 00:07:18
    does the tubes presented a whole new set
  • 00:07:21
    of dangers those tubes can Harbor
  • 00:07:25
    bacteria and one of the dilemmas of
  • 00:07:27
    modern medicine good J
  • 00:07:31
    the interventions that can save you can
  • 00:07:33
    also put you at serious risk you did
  • 00:07:37
    great any patient we put on ECMO has a
  • 00:07:40
    much higher risk of having additional
  • 00:07:42
    infections that's just the nature of the
  • 00:07:44
    Beast is that what happened here correct
  • 00:07:47
    and she got a particularly nasty one
  • 00:07:49
    what was it called
  • 00:07:51
    stenotrophomonas stenotrophomonas is an
  • 00:07:53
    entirely different kind of bacteria from
  • 00:07:55
    staff
  • 00:08:01
    found in hospitals it can live inside
  • 00:08:03
    breathing tubes and it's extremely
  • 00:08:05
    difficult to
  • 00:08:07
    treat the problem with stonis is even at
  • 00:08:10
    the outset it's already a very resistant
  • 00:08:13
    bacteria there are only four or maybe
  • 00:08:17
    five antibiotics normally that are able
  • 00:08:19
    to treat that particular
  • 00:08:22
    bacteria Addie was confronting the
  • 00:08:24
    frightening new face of antibiotic
  • 00:08:27
    resistance a group of bacteria called
  • 00:08:29
    called gram negatives so can you explain
  • 00:08:32
    to me why these gram negatives are so
  • 00:08:35
    stubbornly nasty gr negative bacteria um
  • 00:08:39
    it's a medical term and it really
  • 00:08:41
    references the armor that surrounds the
  • 00:08:44
    gr negative bacteria that armor makes it
  • 00:08:47
    very difficult for normal antibiotics to
  • 00:08:49
    get into the bacteria and to kill
  • 00:08:53
    it so catonis is incredibly difficult to
  • 00:08:57
    treat uh because it has that that
  • 00:09:00
    serious body armor surrounding it are
  • 00:09:02
    you guys going to come out and go that
  • 00:09:04
    way okay the ability of gram negatives
  • 00:09:07
    to aggressively fight off antibiotics
  • 00:09:09
    was now playing out in Addie hold theone
  • 00:09:14
    she was first put on one antibiotic
  • 00:09:17
    that's good for
  • 00:09:18
    stenotrophomonas and it worked for a
  • 00:09:20
    while and then guess what the antibiotic
  • 00:09:24
    doesn't work anymore let's give her a
  • 00:09:26
    different one well and then it would you
  • 00:09:28
    know work
  • 00:09:30
    a couple weeks three weeks and then the
  • 00:09:33
    stenram monus would sort of like Bloom
  • 00:09:37
    back up rear its ugly head so to speak
  • 00:09:40
    and you're doing great you are finally
  • 00:09:43
    one day they said something I never
  • 00:09:46
    thought I would
  • 00:09:49
    hear the stenotrophomonas is pan
  • 00:09:53
    resistant pan meaning resistant to
  • 00:09:57
    everything like a pan
  • 00:10:01
    Pama Addie and her mother had entered
  • 00:10:03
    the postantibiotic
  • 00:10:05
    era I had to go to her and say I I don't
  • 00:10:09
    have I don't have options based in
  • 00:10:11
    medical science I've run out of options
  • 00:10:13
    I don't see a way out of this I remember
  • 00:10:15
    a long weekend went by
  • 00:10:18
    and they had asked me to sign the papers
  • 00:10:21
    to let her go and I
  • 00:10:25
    did there was only one hope left of
  • 00:10:28
    saving Addie's life
  • 00:10:30
    to surgically remove the infection I
  • 00:10:33
    remember asking the doctors then about
  • 00:10:35
    long
  • 00:10:36
    transplant they said no that it couldn't
  • 00:10:39
    be done that it would be too dangerous
  • 00:10:42
    the problem was that she was too sick to
  • 00:10:44
    be transplanted that sounds a bit
  • 00:10:45
    strange because you think of a
  • 00:10:46
    transplant as the final life-saving
  • 00:10:48
    thing you've got um but because of that
  • 00:10:51
    resistant
  • 00:10:53
    stenotrophomonas the expected survival
  • 00:10:56
    of transplanting her uh was
  • 00:10:59
    not good in fact he might say close to
  • 00:11:02
    zero you're not going to blow
  • 00:11:04
    bubbles doctors faced a question of
  • 00:11:07
    medical ethics whether to risk such a
  • 00:11:10
    valuable Resource as a young set of
  • 00:11:11
    lungs when add's chances of survival
  • 00:11:14
    were so low what tipped the
  • 00:11:18
    balance I think it was Addie's mom Tanya
  • 00:11:23
    who was such a strong Advocate um and
  • 00:11:25
    didn't give
  • 00:11:27
    upy birthday to
  • 00:11:30
    you and it was also the fact that this
  • 00:11:32
    was not an
  • 00:11:33
    unresponsive body lying in the table
  • 00:11:36
    this was a young girl who was
  • 00:11:39
    communicating with us and had temper
  • 00:11:43
    tantrums and Sparks of Life which we
  • 00:11:45
    could all see on the ECMO apparatus I
  • 00:11:48
    mean the how how can you say no to this
  • 00:11:51
    you know living alive human being who's
  • 00:11:54
    communicating with you I need a high
  • 00:11:57
    five that's awesome
  • 00:12:00
    but Addie would still have to wait in
  • 00:12:02
    the Intensive Care Unit hoping to get a
  • 00:12:05
    new set of
  • 00:12:13
    lungs as Addie was fighting for her life
  • 00:12:17
    a 19-year-old American named David REI
  • 00:12:19
    was about to face another threat on the
  • 00:12:22
    streets of
  • 00:12:23
    India so after 30 hours on a train
  • 00:12:30
    we finally ended up in
  • 00:12:34
    kataa here gram negatives were spreading
  • 00:12:36
    in frightening ways and coming from
  • 00:12:39
    unexpected
  • 00:12:41
    places I wanted
  • 00:12:43
    to uh experience another
  • 00:12:46
    culture and put myself in an environment
  • 00:12:49
    where I was serving where I was helping
  • 00:12:54
    people I think uh India ended up
  • 00:12:58
    changing me a lot more than than I could
  • 00:13:00
    have ever changed
  • 00:13:04
    India he had come here with a mission
  • 00:13:06
    group to work in
  • 00:13:12
    [Music]
  • 00:13:16
    orphanages one morning the group headed
  • 00:13:18
    off to work at one of those orphanages a
  • 00:13:21
    Mother Teresa home it was in the slums
  • 00:13:23
    of the slums really where this orphanage
  • 00:13:25
    was so we had to walk through all of
  • 00:13:28
    these these narrow streets that I'd
  • 00:13:30
    never walked through before and we
  • 00:13:32
    basically uh took a shortcut through the
  • 00:13:34
    train station so you crossed over the
  • 00:13:36
    tracks and then we were walking adjacent
  • 00:13:39
    to the train
  • 00:13:41
    tracks and as we were going under an
  • 00:13:44
    overpass I was in the very
  • 00:13:47
    back walking and uh all of the sudden
  • 00:13:50
    you know out of nowhere a train went by
  • 00:13:52
    and I noticed I just remember thinking
  • 00:13:55
    in my head that it went by wow that went
  • 00:13:57
    by really quickly the momentum the speed
  • 00:13:59
    hooked my sleeve and ran me over and
  • 00:14:03
    dragged me underneath the Train the
  • 00:14:05
    wheel ran over my leg and I started
  • 00:14:07
    losing a ton of blood I just start
  • 00:14:08
    bleeding
  • 00:14:09
    everywhere REI was pulled from under the
  • 00:14:12
    train lucky to be alive he was rushed to
  • 00:14:15
    a local hospital a doctor came in he
  • 00:14:19
    reached up on on the top shelf and he
  • 00:14:21
    pulls out this this leather bundle and
  • 00:14:23
    then you know he takes out a big knife
  • 00:14:26
    you know big machete type looking so
  • 00:14:30
    knife and uh and they he just starts
  • 00:14:34
    telling all you know the nurses to hold
  • 00:14:35
    me down to hold me Steady and then he
  • 00:14:38
    just
  • 00:14:39
    started cutting my leg off just hacking
  • 00:14:41
    it off we were standing outside and we
  • 00:14:43
    could hear him screaming the whole
  • 00:14:47
    time and then I passed
  • 00:14:52
    out within 24 hours Richi was moved to
  • 00:14:55
    another hospital and his condition
  • 00:14:58
    deteriorated
  • 00:15:00
    quickly hey everybody I talked to the
  • 00:15:04
    doctors they said I don't have that much
  • 00:15:08
    longer
  • 00:15:11
    but I'll put in a good word for you
  • 00:15:15
    Richie was barely hanging on miss you
  • 00:15:18
    all and by the time his family reached
  • 00:15:21
    India there were new complications they
  • 00:15:24
    were just telling us we need to take
  • 00:15:25
    them back in for another surgery another
  • 00:15:28
    surgery and we didn't understand
  • 00:15:32
    why um he he almost had a surgery every
  • 00:15:35
    day and they they said um you know we've
  • 00:15:39
    got to clean up the infection and and so
  • 00:15:43
    you know I just thought it's just an
  • 00:15:45
    infection you know um I I really didn't
  • 00:15:48
    realize what they meant by
  • 00:15:53
    infection what Richi and his family
  • 00:15:55
    didn't know was that they were on the
  • 00:15:57
    front lines of a superbug crisis that
  • 00:16:00
    was just beginning to
  • 00:16:04
    unfold the study which found the NDM one
  • 00:16:07
    super buug in delhi's water samples is
  • 00:16:09
    making the Indian Health establishment
  • 00:16:11
    see red researchers had discovered a new
  • 00:16:14
    danger bacteria carrying the gene that
  • 00:16:16
    produces this ndm-1 enzyme are resistant
  • 00:16:19
    to very powerful antibiotics it
  • 00:16:22
    absolutely was a bombshell it was it was
  • 00:16:24
    unexpected the Lancet infectious
  • 00:16:26
    diseases Journal found that n M1 enzyme
  • 00:16:29
    in 11 different types of
  • 00:16:33
    bacteria ndm-1 isn't
  • 00:16:36
    bacteria it's actually a resistance Gene
  • 00:16:39
    that can turn bacteria into Super
  • 00:16:42
    bugs ndm-1 is resistant to almost all
  • 00:16:46
    antibiotics even more frightening it is
  • 00:16:49
    promiscuous the resistance Gene can jump
  • 00:16:52
    from bacteria to bacteria making
  • 00:16:55
    treatable infections suddenly
  • 00:16:57
    untreatable
  • 00:17:00
    but there was more ndm-1 wasn't just in
  • 00:17:05
    hospitals to everyone's surprise it was
  • 00:17:09
    found out in the environment too first
  • 00:17:12
    from a scientific standpoint we didn't
  • 00:17:14
    realize that this could be done quite so
  • 00:17:15
    easily it meant that in places where
  • 00:17:18
    water and sanitation was poured where
  • 00:17:20
    there was going to be lots of bacteria
  • 00:17:22
    sitting next to each other that you
  • 00:17:24
    could have very rapid spread of
  • 00:17:25
    resistance information across unrelated
  • 00:17:28
    bacteria uh just out there in the
  • 00:17:30
    environment which is a hugely greater
  • 00:17:32
    risk than if it were only to happen
  • 00:17:34
    within the bodies of patients who had um
  • 00:17:37
    these infections so you're saying that
  • 00:17:40
    the bacteria were uh swapping this
  • 00:17:42
    information just out there on the street
  • 00:17:44
    without being in a person that's correct
  • 00:17:46
    so they could transfer resistance genes
  • 00:17:48
    uh even when they were in the same
  • 00:17:50
    puddle of
  • 00:17:54
    water with the spread of ndm-1 a much
  • 00:17:58
    wider popul po ation is put at
  • 00:18:01
    risk and what has Health officials
  • 00:18:03
    around the world especially worried is
  • 00:18:05
    that ndm-1 is
  • 00:18:08
    hearty and it
  • 00:18:11
    [Applause]
  • 00:18:14
    travels after 2 weeks in an Indian
  • 00:18:16
    Hospital David Richi was flown home to
  • 00:18:18
    Seattle and taken to the trauma unit at
  • 00:18:21
    Harborview Medical
  • 00:18:26
    Center I first heard about David's C in
  • 00:18:29
    July of 2011 I was sitting in my office
  • 00:18:32
    uh doing some work and one of my
  • 00:18:33
    colleagues an orthopedic surgeon Dr Doug
  • 00:18:36
    Smith gave me a call and ask me if I had
  • 00:18:38
    known about a patient up on one of our Q
  • 00:18:40
    care floors with a number of drug
  • 00:18:42
    resistant pathogens I brought up as
  • 00:18:44
    medical record and saw a huge amount of
  • 00:18:47
    drug resistance drug resistance we don't
  • 00:18:48
    typically see all these RS mean that the
  • 00:18:52
    bacteria is resistant to that
  • 00:18:54
    antibiotic knowing that David had come
  • 00:18:56
    from India I was immediately concerned
  • 00:18:59
    even before seeing David about bacteria
  • 00:19:02
    in the wound containing this new type of
  • 00:19:05
    drug
  • 00:19:06
    resistance lab results confirmed Lynch's
  • 00:19:09
    worst fears Richi had brought ndm-1 into
  • 00:19:13
    the United States it was one of the
  • 00:19:16
    first cases to ever be identified here
  • 00:19:19
    and Lynch had little to go on there's
  • 00:19:21
    not a lot of clinical experience with
  • 00:19:23
    treating these bacteria anywhere in the
  • 00:19:25
    literature there's no books there's no
  • 00:19:27
    things on it so we have had to figure
  • 00:19:29
    out what to do for David right then and
  • 00:19:31
    there I get this knock on my on my door
  • 00:19:34
    and they open up the door and there's
  • 00:19:36
    these doctors they tell me we need to
  • 00:19:39
    isolate you we need to put you on your
  • 00:19:41
    own and quarantine you making sense to
  • 00:19:43
    you REI was in the throws of the NDM one
  • 00:19:48
    nightmare the gene was spreading
  • 00:19:50
    resistance to other infections in his
  • 00:19:54
    leg they showed us um the list of them
  • 00:19:57
    there were about five bu
  • 00:19:59
    and they said all these infections are
  • 00:20:02
    resistant to
  • 00:20:04
    antibiotics and and when they said that
  • 00:20:07
    that's what worried me because I'm I'm
  • 00:20:09
    like how's he going to get rid of
  • 00:20:11
    them Lynch tried several powerful
  • 00:20:14
    antibiotics but they didn't work have
  • 00:20:17
    you done any the and rampin combinations
  • 00:20:20
    he had only one option left a 1940s
  • 00:20:23
    antibiotic called kistin we went away
  • 00:20:26
    from it because of his toxicity and the
  • 00:20:27
    ability to use antibiotics the problem
  • 00:20:30
    now is we don't have a lot of new
  • 00:20:32
    options and we're going back to some of
  • 00:20:34
    our older antibiotics the hardest part
  • 00:20:36
    was watching to see what the antibiotics
  • 00:20:39
    did to him started to eat away at my
  • 00:20:41
    organs on the inside you know I I could
  • 00:20:43
    just feel it just just this poison
  • 00:20:47
    rushing through my
  • 00:20:49
    blood the treatment was too toxic we had
  • 00:20:52
    to stop the only drug we had left to
  • 00:20:54
    treat the grab negative rods they were
  • 00:20:56
    uh in his wounds you're telling me he
  • 00:20:59
    had these bugs and you had nothing left
  • 00:21:01
    to treat him with at this point we had
  • 00:21:02
    nothing left to treat him with I just
  • 00:21:04
    couldn't believe that there wasn't an
  • 00:21:06
    antibiotic that would fix it to tell you
  • 00:21:09
    the
  • 00:21:10
    truth they would have to cut out more of
  • 00:21:12
    the infection by cutting off more of
  • 00:21:14
    Richie's
  • 00:21:17
    leg but it would be months before they
  • 00:21:19
    knew whether all of the ndm-1 was gone
  • 00:21:23
    [Music]
  • 00:21:33
    a decade ago hospitals in the New York
  • 00:21:36
    City area became the epicenter of
  • 00:21:38
    another highly resistant and deadly type
  • 00:21:40
    of gram negative
  • 00:21:43
    bacteria this superbug didn't come from
  • 00:21:46
    overseas this one was
  • 00:21:52
    homegrown it lives in the digestive
  • 00:21:55
    system and like ndm-1 it's a gene
  • 00:21:59
    that can spread its resistance to other
  • 00:22:02
    bacteria it's called
  • 00:22:05
    KPC no one knows exactly how many
  • 00:22:08
    patients in the New York City area have
  • 00:22:10
    been infected with
  • 00:22:12
    KPC or how many have died from
  • 00:22:15
    it nationally most hospitals aren't
  • 00:22:18
    required to report outbreaks to the
  • 00:22:20
    government and most won't talk publicly
  • 00:22:23
    about
  • 00:22:25
    them but as part of frontline's
  • 00:22:27
    Investigation one of the nation's most
  • 00:22:29
    prestigious hospitals the clinical
  • 00:22:31
    Center at the National Institutes of
  • 00:22:33
    Health the NIH agreed to recount how it
  • 00:22:37
    dealt with a major KPC
  • 00:22:43
    outbreak it began in the summer of 2011
  • 00:22:46
    when a woman carrying KPC was
  • 00:22:49
    transferred from a New York City
  • 00:22:50
    Hospital here to the NIH in Bethesda
  • 00:22:56
    Maryland talking about Hospital
  • 00:22:59
    infections is really difficult for a
  • 00:23:03
    hospital because what you are saying is
  • 00:23:06
    that we all know that when you come to
  • 00:23:09
    the hospital there are certain risks but
  • 00:23:11
    we've now laid bare what are those
  • 00:23:14
    [Music]
  • 00:23:16
    risks the NIH had never treated a case
  • 00:23:19
    of KPC
  • 00:23:21
    before and as the patient was brought
  • 00:23:23
    into the ICU the staff was determined to
  • 00:23:27
    keep the KPC from spreading to other
  • 00:23:30
    patients we immediately went on high
  • 00:23:33
    alert the equivalent of uh Hospital
  • 00:23:36
    epidemiology DEFCON 5 tried to implement
  • 00:23:39
    as many things as we could think of uh
  • 00:23:42
    at the time uh to prevent any further
  • 00:23:44
    spread of the organism in the hospital
  • 00:23:46
    they called it
  • 00:23:48
    KPC and so we learned later that was
  • 00:23:51
    KSAL and pneumonia carbon penes and
  • 00:23:54
    that's a
  • 00:23:55
    mouthful but we really didn't know what
  • 00:23:57
    that meant
  • 00:24:00
    the patient was placed in what we call
  • 00:24:02
    enhanced contact isolation which means
  • 00:24:05
    everybody who went in the room including
  • 00:24:07
    visitors had to wear gloves and
  • 00:24:09
    gowns the room was at the end of the
  • 00:24:12
    hall separate from other patients let me
  • 00:24:14
    just check your blood sugar okay but
  • 00:24:17
    this was the Intensive Care Unit where
  • 00:24:19
    patients are very sick and highly
  • 00:24:21
    vulnerable and that presented heightened
  • 00:24:24
    risks it's a kind of place where the
  • 00:24:25
    bacteria can spread with ease people are
  • 00:24:28
    very busy and there are a lot of things
  • 00:24:30
    going on patients get very sick very
  • 00:24:31
    quickly and require intervention the
  • 00:24:34
    bacteria can be spread on the hands they
  • 00:24:37
    can be spread on pieces of equipment uh
  • 00:24:40
    that might go from Patient to Patient so
  • 00:24:41
    you have to be really
  • 00:24:43
    cautious their efforts to contain the
  • 00:24:45
    KPC appeared to work when other ICU
  • 00:24:49
    patients were tested for KPC we found
  • 00:24:53
    nothing so at that point we thought that
  • 00:24:56
    there had not been spread of the
  • 00:24:59
    bacteria the New York patient ultimately
  • 00:25:02
    recovered and was discharged after 4
  • 00:25:04
    weeks in the hospital we really felt
  • 00:25:07
    like we had dodged a
  • 00:25:09
    bullet but
  • 00:25:11
    then a big
  • 00:25:14
    surprise 5 Weeks Later unexpectedly
  • 00:25:17
    could you do me a favor could you get me
  • 00:25:18
    a just a a tube fixator for out of the
  • 00:25:20
    RT closet a KC bacteria turned up in a
  • 00:25:24
    respiratory
  • 00:25:27
    culture and and with it a mystery how
  • 00:25:31
    this could have spread from the first
  • 00:25:33
    patient to the second patient they were
  • 00:25:36
    not in the ICU at the same time they
  • 00:25:38
    didn't have the same caregivers they
  • 00:25:39
    didn't have the same equipment so
  • 00:25:40
    initially we thought that it might be
  • 00:25:42
    possible that this was a second
  • 00:25:44
    introduction of yet another KPC
  • 00:25:47
    organism I was extremely concerned
  • 00:25:50
    because the infections with these
  • 00:25:52
    bacteria had a high mortality
  • 00:25:54
    rate as they began to investigate search
  • 00:25:58
    ing for KPC on equipment and testing the
  • 00:26:01
    patients yet
  • 00:26:02
    again they realized the problem was much
  • 00:26:04
    bigger we started finding other patients
  • 00:26:07
    in the Intensive Care Unit to whom the
  • 00:26:10
    bacteria had
  • 00:26:12
    spread they had an
  • 00:26:15
    outbreak the KPC was
  • 00:26:18
    spreading the patients were getting
  • 00:26:21
    sicker and antibiotics weren't
  • 00:26:26
    working and we tried combinations of
  • 00:26:30
    five six antibiotics we
  • 00:26:33
    tried making oral antibiotics into
  • 00:26:36
    intervenous antibiotics we even got an
  • 00:26:40
    investigational antibiotic from a
  • 00:26:42
    pharmaceutical company an experimental
  • 00:26:43
    one a test one an experimental
  • 00:26:45
    antibiotic and that also did not
  • 00:26:48
    work desperate to contain the outbreak
  • 00:26:51
    the hospital took unprecedented
  • 00:26:54
    steps they created a separate ICU for
  • 00:26:57
    KPC patients
  • 00:26:59
    brought in robots to disinfect empty
  • 00:27:01
    rooms had monitors here reminding us to
  • 00:27:03
    wash our hands built a whole wall up in
  • 00:27:07
    in the other side we moved every patient
  • 00:27:09
    in the ICU completely cleaned it moved
  • 00:27:12
    patients back in um and no matter what
  • 00:27:15
    we did the bacteria was still it was
  • 00:27:18
    still spreading we didn't know what was
  • 00:27:21
    going
  • 00:27:22
    on okay so with the hospital in crisis
  • 00:27:26
    genetic researchers in building 49 next
  • 00:27:28
    door were scrambling to figure out how
  • 00:27:31
    the KPC was spreading we had now gotten
  • 00:27:34
    to the point where they were identifying
  • 00:27:37
    a patient a week and it was not clear
  • 00:27:42
    how these patients might be related to
  • 00:27:44
    each other Julie segr and her colleague
  • 00:27:47
    Evan snitkin started to compare the DNA
  • 00:27:50
    samples of the KPC taken from the
  • 00:27:52
    patients are these all the DN then yeah
  • 00:27:54
    these are all the DNA each patient had a
  • 00:27:56
    number so this shows you based the DNA
  • 00:27:58
    sequences how we think the bacteria
  • 00:28:00
    spread throughout the hospital by
  • 00:28:02
    matching the DNA they discovered
  • 00:28:04
    something none of them knew 3 four and8
  • 00:28:08
    were all silent carriers and what's
  • 00:28:10
    scary about that is they can be
  • 00:28:11
    transmitting to other patients without
  • 00:28:13
    anyone knowing that they even have the
  • 00:28:15
    bacteria themselves so this this
  • 00:28:17
    bacteria seemed to have been all over
  • 00:28:18
    the hospital before um they had come up
  • 00:28:22
    positive and the hospital didn't know
  • 00:28:23
    that they didn't know because this this
  • 00:28:25
    bacteria has the capacity to live in the
  • 00:28:28
    stomach of patients without causing
  • 00:28:31
    infections for me the data were stunning
  • 00:28:34
    why why was it stunning because the it
  • 00:28:36
    became very clear that we had missed the
  • 00:28:39
    transmission sequence the high-tech
  • 00:28:41
    genomics revealed a disturbing truth the
  • 00:28:45
    outbreak would be much more difficult to
  • 00:28:48
    contain and to stop it they needed to
  • 00:28:51
    figure out exactly how the KPC was
  • 00:28:53
    moving through the hospital was it on
  • 00:28:55
    the hands of workers or visitor
  • 00:28:58
    or on hospital
  • 00:29:00
    equipment and then as they urgently
  • 00:29:03
    searched for silent carriers throughout
  • 00:29:05
    the rest of the hospital their worst
  • 00:29:07
    nightmare came true the outbreak had
  • 00:29:10
    spread beyond the ICU that's a very
  • 00:29:13
    scary moment suddenly it's in the
  • 00:29:16
    general patient population I'm going to
  • 00:29:18
    go ahead and turn it off the staff was
  • 00:29:20
    in a panic as they looked on helplessly
  • 00:29:24
    patients began to die
  • 00:29:27
    [Music]
  • 00:29:30
    we felt responsible for we are
  • 00:29:32
    responsible for the patients you go into
  • 00:29:34
    a room and maybe there's a hole in your
  • 00:29:37
    glove very complex environment alarms
  • 00:29:40
    are ringing did you miss something did
  • 00:29:42
    you forget to tell the doctor something
  • 00:29:44
    did I forget to wash my hands between Mr
  • 00:29:47
    X and Mrs Y is that why Mrs y got
  • 00:29:53
    KPC there were few options
  • 00:29:56
    left Dr gallon asked me if uh we needed
  • 00:29:59
    to close the hospital or if we needed to
  • 00:30:01
    close the hospital to
  • 00:30:03
    admissions ultimately we decided not to
  • 00:30:06
    close the hospital uh but it was a
  • 00:30:08
    possibility
  • 00:30:10
    absolutely instead they expanded testing
  • 00:30:13
    Hospital wide and isolated all those
  • 00:30:16
    found with
  • 00:30:19
    KPC finally 6 months after patient one
  • 00:30:22
    first arrived the outbreak subsided
  • 00:30:25
    almost as suddenly as it had begun
  • 00:30:30
    by then 18 patients had been infected
  • 00:30:33
    with
  • 00:30:33
    KPC and the ultimate tragedy six people
  • 00:30:37
    had died from
  • 00:30:39
    it many inside NIH continued to be
  • 00:30:43
    concerned you think KPC is now gone from
  • 00:30:48
    your hospital oh no absolutely not I
  • 00:30:50
    think that that we have to be extremely
  • 00:30:54
    Vigilant in the the coming years um
  • 00:30:58
    because of the increasing rise the
  • 00:31:00
    increasing prevalence of kpcs in the
  • 00:31:02
    United
  • 00:31:06
    States the increasing prevalence of
  • 00:31:09
    threats like KPC became the focus of a
  • 00:31:12
    5-year study at the world's largest
  • 00:31:14
    Medical Center in
  • 00:31:16
    Houston using cuttingedge
  • 00:31:19
    genomics researchers analyzed infections
  • 00:31:22
    from nearly 1,800 patients and in May
  • 00:31:25
    2017 announced a startling
  • 00:31:28
    Discovery we were
  • 00:31:31
    surprised uh greatly surprised when we
  • 00:31:34
    found a new type bacterium that had
  • 00:31:36
    never been described in great abundance
  • 00:31:40
    anywhere in the
  • 00:31:42
    world this new type is called kbella CG
  • 00:31:47
    307 and it can be deadly has it killed
  • 00:31:50
    people people die with this organism
  • 00:31:52
    sometimes yes excuse me the rare
  • 00:31:55
    superbug was found in a third of the
  • 00:31:57
    samples Tak from patients now the
  • 00:31:59
    question that we don't know the answer
  • 00:32:01
    to Is Why is it abundant but it's
  • 00:32:04
    clearly been abundant here and
  • 00:32:07
    undoubtedly in other Houston hospitals
  • 00:32:09
    as
  • 00:32:10
    well and there was a more troubling
  • 00:32:13
    mystery where did it come from we don't
  • 00:32:15
    know exactly where this bacteria came
  • 00:32:19
    from but probably many patients brought
  • 00:32:23
    it into the hospital and we now know
  • 00:32:25
    that this is a common organ ISM in our
  • 00:32:31
    community the Houston study brings it
  • 00:32:34
    clear and it puts it there in black and
  • 00:32:35
    white the threat of antibiotic
  • 00:32:37
    resistance is dynamic and ever
  • 00:32:39
    evolving not only at stake are people's
  • 00:32:42
    lives but as more resistance
  • 00:32:47
    occurs and I mean nationally not just in
  • 00:32:50
    our Hospital there's more of a
  • 00:32:51
    probability of creating an organism that
  • 00:32:54
    is now resistant to every antibiotic
  • 00:33:02
    the prospect of life without antibiotics
  • 00:33:04
    is barely imaginable for a world that
  • 00:33:07
    has had a cheap and plentiful supply of
  • 00:33:09
    them since the end of World War
  • 00:33:11
    II they are a staple of modern medicine
  • 00:33:14
    it's hard to recall a time without them
  • 00:33:17
    when an infected cut could kill a
  • 00:33:19
    healthy young person in a matter of
  • 00:33:22
    days but it's now clear that we are
  • 00:33:24
    heading back in that direction that the
  • 00:33:27
    miracle of these drugs is slipping
  • 00:33:30
    away antibiotics are unique
  • 00:33:33
    drugs they're not like any other class
  • 00:33:36
    of
  • 00:33:37
    drugs 50 years from today the
  • 00:33:40
    cholesterol drugs we have now will work
  • 00:33:42
    just as well as they work today the
  • 00:33:43
    Cancer drugs we have now will work just
  • 00:33:45
    as well as they do today that's true of
  • 00:33:47
    all the other drug classes antibiotics
  • 00:33:49
    are the only class of drugs that the
  • 00:33:51
    more we use the more rapidly we lose
  • 00:33:55
    when you use it it becomes less
  • 00:33:57
    effective for me and vice
  • 00:33:59
    versa that is the essence of antibiotic
  • 00:34:02
    resistance the more you expose a
  • 00:34:05
    bacteria to an antibiotic the greater
  • 00:34:07
    the likelihood that the uh resistance to
  • 00:34:11
    that antibiotic is going to develop so
  • 00:34:13
    the more antibiotics we put into people
  • 00:34:16
    we put into the environment the more
  • 00:34:18
    opportunities we create create for these
  • 00:34:20
    bacteria to become
  • 00:34:23
    resistant but people forgot about the
  • 00:34:26
    danger of resistance because the drugs
  • 00:34:28
    were so
  • 00:34:29
    effective and what they had forgotten
  • 00:34:32
    was the warning that Alexander Fleming
  • 00:34:34
    himself the man who discovered
  • 00:34:35
    penicillin gave us in 1945 that
  • 00:34:38
    resistance was already being seen and
  • 00:34:40
    the more we wasted penicillin the more
  • 00:34:42
    people were going to die of penicillin
  • 00:34:44
    resistant
  • 00:34:45
    infections bacterial resistance is
  • 00:34:48
    largely inevitable but it's also
  • 00:34:50
    something that we uh have certainly
  • 00:34:52
    helped along the way we have fueled this
  • 00:34:54
    fire of bacterial resistance um these
  • 00:34:58
    drugs are Miracle drugs these
  • 00:34:59
    antibiotics that we have but we haven't
  • 00:35:02
    taken good care of
  • 00:35:04
    them Public Health officials estimate
  • 00:35:07
    that onethird of all antibiotic use in
  • 00:35:09
    the US is either unnecessary or
  • 00:35:13
    inappropriate and in overusing these
  • 00:35:16
    antibiotics we have set ourselves up for
  • 00:35:18
    the scenario that we find ourselves in
  • 00:35:21
    now where we're running out of
  • 00:35:24
    antibiotics but the growing scarcity of
  • 00:35:26
    effective antibi biotics isn't just a
  • 00:35:29
    problem of
  • 00:35:30
    overuse it's also been driven by what's
  • 00:35:33
    happening inside the drug industry
  • 00:35:36
    itself the place where it started to
  • 00:35:38
    turn really challenging I'd say would be
  • 00:35:40
    in the 80s and the 90s when we began to
  • 00:35:42
    see occasional bacteria that were very
  • 00:35:45
    hard to
  • 00:35:46
    treat and it would became less obvious
  • 00:35:49
    that you were able to invent new
  • 00:35:51
    antibiotics and the brand new things
  • 00:35:54
    just weren't coming at the same pace and
  • 00:35:56
    then in the '90s in the first part of
  • 00:35:58
    this Century we began to see resistant
  • 00:36:01
    bacteria for which we really didn't have
  • 00:36:03
    very much or anything at all and we had
  • 00:36:05
    nothing coming to treat
  • 00:36:09
    them that's because most major drug
  • 00:36:12
    companies were pulling out of the
  • 00:36:13
    antibiotic research field just as the
  • 00:36:16
    gram negative threat was
  • 00:36:18
    worsening one of the last companies to
  • 00:36:21
    stay was fiser which had made its name
  • 00:36:23
    on
  • 00:36:25
    antibiotics by the mid 2000s it had set
  • 00:36:28
    its sight squarely on the gram negative
  • 00:36:31
    problem we thought there was medical
  • 00:36:33
    need that's really matters um and we
  • 00:36:35
    thought that given our history in being
  • 00:36:38
    able to develop uh penicillin the
  • 00:36:41
    antifungals um you know antibiotics that
  • 00:36:44
    in fact if we put our minds to it um
  • 00:36:48
    that uh we we would succeed but this is
  • 00:36:50
    a highly risky and unpredictable
  • 00:36:53
    Enterprise despite the risk fizer built
  • 00:36:56
    a worldclass research team in Grotton
  • 00:36:58
    Connecticut and brought in a veteran in
  • 00:37:01
    Graham negative research John Quinn in
  • 00:37:04
    1983 when I finished my training almost
  • 00:37:07
    every pharmaceutical company had an
  • 00:37:09
    antibiotic development team and by the
  • 00:37:12
    time I landed at fiser in 2008 we were
  • 00:37:15
    really down to three big guys and some
  • 00:37:18
    smaller companies biotechs and so on and
  • 00:37:20
    I think all of us felt that you know we
  • 00:37:23
    had a moral obligation to continue to
  • 00:37:26
    work in this area there was a a pressing
  • 00:37:28
    clinical need most companies had
  • 00:37:30
    abandoned the field and we were still in
  • 00:37:32
    the game we were proud to still be in
  • 00:37:34
    the game Quinn and his team believed
  • 00:37:36
    they were on to something big several
  • 00:37:39
    different compounds to treat gram
  • 00:37:41
    negatives the potential breakthroughs
  • 00:37:43
    got the attention of the company's
  • 00:37:45
    science advisers including Brad spelberg
  • 00:37:47
    I felt that their pipeline was probably
  • 00:37:51
    the most comprehensive and important
  • 00:37:53
    antibacterial pipeline in the world
  • 00:37:56
    focusing on
  • 00:37:57
    the types of bacteria that we're really
  • 00:38:00
    having severe problems with right now
  • 00:38:02
    which are the the the highly resistant
  • 00:38:04
    gram negative bacteria these would have
  • 00:38:07
    solved problems and saved lives had they
  • 00:38:11
    been successfully
  • 00:38:13
    developed but bringing these drugs to
  • 00:38:15
    Market faced the economic Paradox of
  • 00:38:18
    antibiotics if you need an antibiotic
  • 00:38:20
    you need it only briefly indeed that's
  • 00:38:22
    the that's the correct way to use an
  • 00:38:23
    antibio we use it only briefly and from
  • 00:38:25
    an economic standpoint of a developer
  • 00:38:27
    that means you're not you're not getting
  • 00:38:29
    the return on the Investments you've
  • 00:38:31
    made because you've spent between 600
  • 00:38:33
    million and a billion dollars to bring
  • 00:38:35
    that new antibiotic to Market wait you
  • 00:38:36
    mean it cost up to a billion dollars to
  • 00:38:38
    bring a new drug to Market it can easily
  • 00:38:40
    cost up to a billion dollars to bring a
  • 00:38:42
    new drug to the market and the initial
  • 00:38:44
    reaction to it is that's great and we're
  • 00:38:47
    let's not use it let's use it as little
  • 00:38:49
    as possible so here's a large company
  • 00:38:52
    saying I have I can make billions off
  • 00:38:55
    cholesterol drugs blood pressure drugs
  • 00:38:57
    drugs arthritis drugs dementia things
  • 00:39:00
    that I know patients are going to have
  • 00:39:01
    to take every day for the rest of their
  • 00:39:03
    lives why would I put my R&D dollar into
  • 00:39:06
    the antibiotic division that isn't going
  • 00:39:08
    to make me any money when I can put it
  • 00:39:10
    over here so here's the deal that's
  • 00:39:13
    going to make a lot of money for the
  • 00:39:14
    company I answered his
  • 00:39:16
    shareholders that was the problem facing
  • 00:39:19
    fizer in 2011 don't kid yourself talk to
  • 00:39:22
    your it stock had plummeted on Wall
  • 00:39:24
    Street and its Blockbuster cholesterol
  • 00:39:27
    drug lipor was about to lose its patent
  • 00:39:30
    I received an email on my BlackBerry
  • 00:39:33
    that there was a mandatory emergency
  • 00:39:35
    meeting in two hours can't be good so I
  • 00:39:38
    called in for the meeting and was told
  • 00:39:41
    that the announcement had been made that
  • 00:39:43
    the gron facility was going to be closed
  • 00:39:45
    the company ended 70 years of leadership
  • 00:39:48
    in antibiotic development leaving its
  • 00:39:50
    search for a gram negative cure
  • 00:39:53
    unfinished the external people who I
  • 00:39:55
    spoke to many of whom are personal
  • 00:39:57
    friends said to me well fizer's just
  • 00:40:01
    doing what other companies have done
  • 00:40:03
    there's nothing particularly wrong with
  • 00:40:04
    that it's not immoral we are a
  • 00:40:07
    capitalist
  • 00:40:08
    Society in 2013 we asked fizer to
  • 00:40:12
    explain the decision I get the sense
  • 00:40:15
    that you have to make some very ruthless
  • 00:40:17
    decisions about where to put the
  • 00:40:19
    company's Capital about where to invest
  • 00:40:21
    where to put your emphasis and when you
  • 00:40:23
    pulled out of gram negative research
  • 00:40:25
    like that and shifted to vaccines um do
  • 00:40:27
    you look back on that and say you know
  • 00:40:30
    we learned something about this these
  • 00:40:32
    are not ruthless decisions these are you
  • 00:40:35
    know portfolio decisions about how we
  • 00:40:38
    can serve medical need in the best way
  • 00:40:40
    we want to stay you know in the business
  • 00:40:44
    of providing new Therapeutics for the
  • 00:40:46
    future our investors require that of us
  • 00:40:48
    I think Society wants um a fiser to be
  • 00:40:52
    uh doing what we do in 20 years we make
  • 00:40:55
    portfolio management decisions
  • 00:40:58
    in 2016 fiser decided to re-enter the
  • 00:41:02
    antibiotic market and bought several
  • 00:41:04
    drugs under development like other large
  • 00:41:07
    Pharmaceuticals though it is still not
  • 00:41:09
    investing in research there is an
  • 00:41:12
    increasing recognition that antibiotics
  • 00:41:15
    are not a good thing to run off a pure
  • 00:41:18
    capitalistic Market okay we need to
  • 00:41:21
    switch from an entrepreneurial business
  • 00:41:24
    model where you maximize sales to other
  • 00:41:27
    pay mechanisms where the goal is society
  • 00:41:29
    can say we want these kinds of
  • 00:41:31
    antibiotics developed and we're going to
  • 00:41:33
    help you out we're going to decrease
  • 00:41:34
    your cost and risk in return on the back
  • 00:41:37
    end we're going to have some say in how
  • 00:41:39
    it's used so it doesn't get
  • 00:41:44
    abused in Washington the federal
  • 00:41:46
    government has been ramping up its
  • 00:41:48
    involvement in the superbug Fight 2
  • 00:41:51
    years ago the Obama Administration
  • 00:41:53
    unveiled a national plan coordinated by
  • 00:41:55
    the Department of Health and Human
  • 00:41:57
    Services the point person for the effort
  • 00:42:00
    now is Christopher Jones under the
  • 00:42:02
    national action plan for combating
  • 00:42:04
    antibotic resistant bacteria which was
  • 00:42:06
    released in 2015 we now have an
  • 00:42:08
    overarching framework and structure for
  • 00:42:11
    addressing this issue across the federal
  • 00:42:13
    government we have a plan we have a plan
  • 00:42:15
    that has specific actions that are being
  • 00:42:18
    worked on every single day and I think
  • 00:42:20
    it's reflective of the Investments we've
  • 00:42:22
    been making um around surveillance
  • 00:42:25
    stewardship developing new products
  • 00:42:27
    developing new Diagnostics and
  • 00:42:29
    increasing International collaboration
  • 00:42:31
    on the issue for a long time people have
  • 00:42:33
    been warning that the pipeline of new
  • 00:42:35
    antibiotics is running dry how's that
  • 00:42:38
    going we're investing $250 million over
  • 00:42:42
    five years for the early stage
  • 00:42:44
    development of antimicrobials I think
  • 00:42:46
    the next phase as we start to think
  • 00:42:48
    about products that really show promise
  • 00:42:50
    in early phases is how do we continue to
  • 00:42:53
    support their development and I don't
  • 00:42:54
    think we've fully landed on what that
  • 00:42:56
    strategy looks like but we do have to
  • 00:42:58
    rethink how we reward companies and
  • 00:43:01
    that's again ongoing
  • 00:43:03
    conversations but some say the
  • 00:43:05
    government should be playing a larger
  • 00:43:07
    role is there more that needs to be done
  • 00:43:10
    where we need to focus on now is using
  • 00:43:12
    less antibiotics we need to create
  • 00:43:15
    policies and
  • 00:43:18
    regulations if we publicly reported
  • 00:43:20
    antibiotic use attach requirements to
  • 00:43:23
    hospitals you have to report that public
  • 00:43:26
    shaming effect
  • 00:43:27
    will drive antibiotic use down and these
  • 00:43:29
    are all the
  • 00:43:30
    m28 yes sir even as the government's
  • 00:43:33
    strategy is taking shape the Trump
  • 00:43:35
    Administration has proposed funding cuts
  • 00:43:37
    of up to 20% to programs and agencies
  • 00:43:40
    that combat antibiotic resistance what
  • 00:43:42
    would be the significance and the impact
  • 00:43:45
    of new budget reductions in antibiotic
  • 00:43:47
    resistance to your point yes a lot of
  • 00:43:50
    what we're doing uh requires Investments
  • 00:43:53
    it requires resources if there is less
  • 00:43:55
    money to spend there are tough choices
  • 00:43:57
    that have to be made things that can't
  • 00:43:59
    be
  • 00:44:00
    done I'm very concerned about it and I
  • 00:44:02
    think we all should be I think the gains
  • 00:44:04
    that we have made have been largely
  • 00:44:07
    because of investment and uh if we cut
  • 00:44:12
    back you're going to see an even faster
  • 00:44:15
    evolution of resistance and spread of
  • 00:44:17
    resistance and way fewer counter
  • 00:44:19
    measures being developed to combat
  • 00:44:22
    it last year the warnings became even
  • 00:44:26
    more dire
  • 00:44:27
    drug resistant bacterial infections are
  • 00:44:30
    on track to kill more people than cancer
  • 00:44:33
    One International report predicted by
  • 00:44:36
    2050 super bugs could kill 10 million
  • 00:44:39
    people a year now we are seeing bacteria
  • 00:44:43
    that are resistant to the absolute Last
  • 00:44:45
    Stop on the train kisten and so for
  • 00:44:48
    those patients there are no options left
  • 00:44:51
    so those patients are truly have gone
  • 00:44:53
    back in time they are back in the
  • 00:44:55
    pre-antibiotic IC era and they will
  • 00:44:58
    recover from those infections or will
  • 00:45:02
    die from those infections and there's
  • 00:45:03
    nothing we can do for
  • 00:45:08
    them as we reported in 2013 NIH never
  • 00:45:12
    did fully rid itself of the deadly
  • 00:45:14
    superbug
  • 00:45:16
    KPC a year after the outbreak a young
  • 00:45:19
    man came to the hospital because of
  • 00:45:21
    complications from a bone marrow
  • 00:45:24
    transplant while he was there he
  • 00:45:26
    contracted KPC and died the seventh
  • 00:45:30
    victim of the
  • 00:45:32
    outbreak I guess if I if I had a major
  • 00:45:34
    message it would be that it's never
  • 00:45:36
    going to end so this organism and
  • 00:45:39
    organisms like this are going to be with
  • 00:45:41
    us till the cows come
  • 00:45:45
    home and we have to learn how to deal
  • 00:45:47
    with them we have to change our culture
  • 00:45:50
    in the
  • 00:45:51
    hospital KPC has been found in hospitals
  • 00:45:54
    in all but two states and that's just
  • 00:45:57
    the hospitals that are voluntarily
  • 00:45:59
    reporting
  • 00:46:05
    [Music]
  • 00:46:10
    it as for David
  • 00:46:13
    REI it took three surgeries and another
  • 00:46:16
    round of Highly toxic antibiotics before
  • 00:46:19
    doctors believed they had removed all
  • 00:46:21
    the ndm-1 from his leg
  • 00:46:26
    [Music]
  • 00:46:30
    you know there's there's no muscle left
  • 00:46:31
    on it and uh I only got about 6 in left
  • 00:46:35
    and and the bone stops there
  • 00:46:37
    and so far REI has remained healthy
  • 00:46:41
    though not entirely free from the fear
  • 00:46:43
    of
  • 00:46:45
    ndm-1 you know my doctors were pretty
  • 00:46:47
    straightforward with me they were very
  • 00:46:49
    honest and said you know there is a good
  • 00:46:50
    chance that this infection might not go
  • 00:46:52
    away might not ever go away yeah yeah
  • 00:46:54
    they said you know we we don't have
  • 00:46:57
    enough experience to know what's going
  • 00:46:58
    to
  • 00:47:04
    happen ndm-1 has now spread to at least
  • 00:47:08
    70
  • 00:47:10
    countries and here in the US more than
  • 00:47:13
    200 cases have been
  • 00:47:16
    reported so David was actually sort of a
  • 00:47:18
    harbinger of something to come David
  • 00:47:22
    was an example of something that's
  • 00:47:24
    already here so there are entire
  • 00:47:28
    continents that have this major problem
  • 00:47:32
    Health public health problem already
  • 00:47:34
    David was simply a sample of that
  • 00:47:36
    population in New to us and that's key
  • 00:47:39
    because hospitals in uh any city in the
  • 00:47:42
    country are going to have patients from
  • 00:47:44
    all over the world that that
  • 00:47:45
    globalization that Mobility is going on
  • 00:47:48
    now this is already
  • 00:47:53
    here all right Addie let their be light
  • 00:47:58
    this is the day that the Lord has made
  • 00:48:00
    Addie rasich was finally able to return
  • 00:48:02
    home yeah but it's like not fun let
  • 00:48:06
    there be no light
  • 00:48:09
    whatsoever she received the double lung
  • 00:48:11
    transplant she'd been waiting
  • 00:48:15
    for it was like bringing home a
  • 00:48:17
    premature baby yeah we brought home
  • 00:48:20
    monitors and she couldn't do anything
  • 00:48:22
    for herself um she couldn't even turn
  • 00:48:25
    over in the bed she couldn't turn side
  • 00:48:26
    decide that's how weak and contracted
  • 00:48:29
    and debilitated she was so how are you
  • 00:48:33
    doing
  • 00:48:34
    now um basically I'm fine uh nothing
  • 00:48:39
    seems out of whack right now I seem
  • 00:48:42
    pretty I feel pretty good I um I look
  • 00:48:46
    pretty much like I did before I have all
  • 00:48:48
    my friends back did you understand what
  • 00:48:50
    was happening to you or mm-m no did
  • 00:48:53
    anybody talk about infection and what
  • 00:48:55
    that what infection
  • 00:48:58
    no basically what I was told is I'd say
  • 00:49:01
    I want to go
  • 00:49:02
    home and she'd say
  • 00:49:06
    um she'd say I couldn't make the drive
  • 00:49:09
    home ever like I was too sick to go
  • 00:49:16
    home okay everything's hard for Addie
  • 00:49:19
    now everything's a
  • 00:49:20
    battle um prescriptions she has to take
  • 00:49:26
    a handful of pills twice a
  • 00:49:31
    day we have to worry constantly about
  • 00:49:34
    you know picking up a bacteria or a
  • 00:49:37
    virus she's said pneumonia five times
  • 00:49:40
    bacterial pneumonia that had to be
  • 00:49:43
    treated with antibiotics and every time
  • 00:49:46
    I wonder is this the time that we're
  • 00:49:49
    going to come up against the bacteria
  • 00:49:51
    that they don't have anything to treat
  • 00:49:54
    it with
  • 00:49:59
    [Applause]
  • 00:50:02
    I think for lung transplants the
  • 00:50:03
    survival rate about
  • 00:50:05
    80% make it a year and about 50% make it
  • 00:50:09
    5 years and every year after that the
  • 00:50:13
    risks just go up let's bow our head
  • 00:50:18
    PR but people might say the story of
  • 00:50:21
    Addie is horrible but that won't happen
  • 00:50:23
    to my daughter is this could this happen
  • 00:50:25
    to anybody
  • 00:50:27
    it happened to Addie she was healthy it
  • 00:50:30
    could happen to anybody could happen to
  • 00:50:32
    your nextd door neighbor it could happen
  • 00:50:33
    to your child it could happen to anybody
  • 00:50:36
    now I'm not here to practice doomsday
  • 00:50:38
    thinking but those bacteria are out
  • 00:50:41
    there and they're out there in healthy
  • 00:50:43
    people in the community you don't mind
  • 00:50:44
    standing up you can walk around please
  • 00:50:47
    each other any
  • 00:50:49
    price the average person thinks oh I
  • 00:50:52
    have an infection I take an antibiotic I
  • 00:50:54
    get better yeah it's not that simple
  • 00:50:56
    anymore morning Caleb how you doing
  • 00:50:59
    sweetheart I'm good thank you Addie
  • 00:51:02
    didn't get better did you no she never
  • 00:51:05
    did get better really she didn't she had
  • 00:51:09
    to have surgery and take the infection
  • 00:51:12
    out
  • 00:51:15
    but may have saved her life mhm for
  • 00:51:21
    now B her
  • 00:51:24
    time that's what happened we bought her
  • 00:51:27
    some time and I am grateful for every
  • 00:51:30
    minute of
  • 00:51:35
    it nice to meet
  • 00:51:39
    you hi I'm Addie I don't think we ever
  • 00:51:42
    met I remember you I know I've seen you
  • 00:51:45
    somewhere before yeah me
  • 00:51:48
    too were you my nurse
  • 00:51:54
    [Music]
  • 00:52:24
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Tags
  • Antibiotic Resistance
  • Superbugs
  • Healthcare Crisis
  • NDM-1
  • Infections
  • Hospitals
  • Global Health
  • Drug Development
  • Public Health
  • Economic Impact