Antibiotic Apocalypse

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Hey, wait, you're listening to radio lab from WNYC. Hi everybody. Thank you for coming out tonight. Welcome to our home station WNYC. Hey, I'm Latte of Nasser here with our executive editor, Sorn and Wheeler.

“The only one with the key to the executive bathroom, radial labs executive bathroom.”

I've never been in there myself, but the reason I've pulled Sorn out of the executive

bathroom here onto the mic is because a little while back, here in New York City. Welcome to our home turf at the green space here. Have you gone on stage to do a little live show? I did. It's true.

We are doing a live taping of a thing that we didn't play around with lately. This was the latest in a series of shows that we've been doing with our favorite and only ER doctor, reporter of your meetup. Right. You may have heard the one I was on stage with him for about CPR, or the one Lulu did with

him about breast milk. Right.

Like everyone's in a while, he's nice to give you some air to air you out a little bit.

Let me out of the closet. Yeah, that's right. And because tonight is a live taping, we will be keeping it loose. We will have some audience interaction. We will have some live guests who can come up with it.

And part of the reason it was so fun this one was because you're an editor and you were just editing him in real time, like tweaking, adjusting, you're dialing it in, you're like, okay, we're done with this. Let's move on. Yeah.

This funny, like you can hear, this is what Sorin does behind the scenes. Anyway, I mean, we were actually trying to keep it loose, you know, like not dialing it in too much and a little bit of a seat of the pants kind of thing, but also, you know, the show with show was about was antibiotic resistance, which sexiest topic. It was, the funny thing about that is it was something that I sort of knew about quite

a bit.

“You know, like we get pictures about it, we've done shows about it, you know, I think more”

generally, all of us sort of like catch some passing news bit about it here or there once every couple of years and then move on with our lives. But a viewer in his position as a doctor, he was able to make it so much more visceral and honestly a little bit more terrifying, but at the same time, because he reported it out and looked in all these places and tried to figure out what was going on, he also, I think

by the end, gave me, for sure, and hopefully all of us, like a sort of a different and maybe even hopeful way of looking at it. Well, let's play it. Okay. Here you go.

So, help me welcome out, Doctor of the Armitra. Hey, hey, thank you. Thank you, guys. Wow. Not a few people.

I love that. I got to say that every story you've ever brought me, I feel like starts at your job, like some somebody walks through your doors at the ER, I don't know, injury or disease or what have you. That is what today's kind of about, but as I was thinking about it, I kind of realized it

goes back even further than that, goes back to 2006, this thing that happened with my dad, actually. Your dad is a doctor, right? Yeah. Yeah, he's a doctor, my mom's a doctor, my grandma's a doctor, but at the time I didn't want

to be a doctor, I just wanted to be like a rock star, that was my dream. You went to a med school, then you decided you don't want to be in med school, you want to be a musician and being an old practical man as I knew that's not going to work. I told you a thousand times that the difference between the large pizza and a musician, which

Bull, to let this rub laugh at you like that, like I said. So I go to therapy, it's a fair share.

“But the point is, like at this time in my life, you know, I was going every day to ban”

practice, hanging out with my buddies, staying up till five in the morning. Meanwhile, my dad is waking up early, he's going to work at a hospital, and he was seeing this sort of interesting change take place. We have been seeing infected hand patients, hand infection patients, coming all the time to us with various reasons, it could be a small scratch, it could be a pin puncture, and

we were treating them basically with a 48 hours worth of antibiotic, IV antibiotic or pure

antibiotic, and it is to get resolved easily. And then suddenly we started to see these patients were not really getting better within that short period of time, so we said that doesn't make any sense, why is it so that we're seeing so many patients, and we started doing some culture for each and every patient who came into the emergency room on a routine basis.

So he's doing this at work, and he sort of comes up with this idea, like, let's do a research project about this. Let's see what's going on. So he turns to me, because, you know, English isn't his first language, he doesn't know how to use a computer, I'm a pretty smart kid.

So he's like, "Why don't I get you to help me write this paper?"

“You are the only person who has absolutely nothing going on at that stage with a music”

et cetera. Instead of sitting idle, I thought if I keep you busy doing some medical papers, later on, if you ever plan to reapply, this papers might help the guys who are looking at your application saying, "He's not a complete derelict." Well, I wasn't sitting idle because I was doing this again.

It's a derelict in the sense you're doing me. I do feel like I should step in and let you all know if your was a little bit of a legit rock star. I mean, you had a record. You were on Conan O'Brien.

That's true. But this was later, right? At the time, I was broke, I was living in the basement, and it was not a good look. I get it. But anyway, back to the topic, what we found in this paper is that these patients were

coming in with infections, the bacteria was mursa. Oh, sure, I feel like mursa is the late '90s news super hospital bug. Yeah, mursa was a typical bacteria that had become resistant, and it was a thing that had already existed. But it was the type of bug, the type of infection you could get, if you were super sick,

you're in the hospital for months, and you're getting all these meds, but what this

paper found is that people were coming in off the street who had never been in a hospital.

Kid falls off his skateboard. Cut. He's got mursa. What we found is that actually this bacteria that lived in one place, it's sort of like escape.

It doesn't stay limited to that patient or that limited to that facility. It essentially escapes, and then it becomes a risk factor for the general population. So yeah, you know, I had that experience, I wrote up this paper and didn't think much of it because I was like, whatever, in a band. But eventually, you know, I go to med school, now 10 years go by, and now I'm actually

showing up in the ER as a resident, and at this point, you know, mursa is just like a common thing. Probably three or four of you have mursa here. It's like just a thing that people have. But I wasn't worried about it because we had a drug called Venka Mison, which can treat

mursa. So it's not like incurable. So now I'm working in the ER a year goes by, and then it's weird. All of a sudden I start seeing patients who have resistance to Venka Mison. So now the Venka Mison isn't working.

And it's like, okay, so at least we have a class of antibiotics called carbopenums, a little bit more rare, but I can use those drugs for those patients. So you have a backup. Yeah, I have that backup. I can use it.

But then another year goes by, and then I'm starting to see patients that are resistant to the carbopenums. That's not working anymore. And so then at that point, I have to go to this drug, colistin, which is like, just this crazy old drug that like, I don't even want to use.

It's got a bunch of side effects.

And basically, I feel like I'm being backed into a corner all of a sudden, and just this

simple infection. And now it's like, I have to do all this stuff, and I have no choice. I gotta say, like, as we've been talking about this, like, obviously I've known about antibiotic resistance.

“And I'm sure many of us here have, but like, how long have you been a doctor?”

10 years? 10 years? It's like, I'm not that that's not a lot, but it's not a lot. And I feel like, you know, in that short time, you have been sitting there literally watching drugs that you could use slip away.

I mean, it's sort of like the pace of it. Like, while we've all been distracted by presidential politics or maybe a, you know, an pandemic, like, this has been happening right in front of your eyes. Yeah. No, it honestly is terrifying to like go to work and see this happen.

I don't know. It's just scary because it's like, if we don't have antibiotics, like, we're not really doctors.

You can't get a c-section, like, you're basically useless without these drugs, you know?

“And that's why I kind of start to have these nightmares where it's like, am I just everything”

I know about medicine? Is it just this, like, little bubble that we're living in? What do you mean by, like, little bubble? What I mean is like, okay, let's zoom way, way out. All right, for hundreds of thousands of years, we've been human beings and we've been fighting

bacteria. But for, like, most of that time, we have been losing, like, just think about it. Like, back in the day, you get a little simple UTI, like, you die. Have sex with a wrong person, you get disfigured for life. You catch a little cold, turns into pneumonia.

I mean, basically, we've got to move somewhere like Arizona, try your best or if you probably just die.

Like, that is the way the world has always been.

Until not that long ago, like less than a hundred years ago, Alexander Fleming, he basically just observed that fungi were producing a chemical that was killing bacteria. So he basically just isolated that chemical in it. So that's penecine, right? That's penecine.

And, like, everything we've done since then has been a variation on that theme. We tweak it a little bit here, find a different fungus there. But it's the same idea, and it's basically this idea that is allowed, like, civilization as I guess we all know it to exist, like, that's how we've won wars, that's how we live in a city.

“That's how we're all in this room together, and like, people aren't dying, you know?”

Everything we do is just based on kind of this idea. And that is the bubble that you feel like is bursting. That's the like, hundred year bubble.

I mean, does that mean that you actually feel like, what are we looking at in the five

ten years that there are bugs out there that no drug works on? Well, maybe I can, like, share a story. Yeah. All right. As your editor, I recommend you do.

All right. I got it. No. Can't just me be me neither. Let's move.

All right. All right. So this is Stephanie Stratty. She's an infectious disease epidemiologist at the University of California, San Diego. But here, she's just going on vacation with her husband, Tom, to Egypt.

We ended up going at a time when there had been a terrorist attack in Charmel Shaker a couple of weeks prior. So all of the people from the West had canceled. And we were the only one on this cruise ship. So it was really kind of a ghostly experience.

I remember standing at the front of the boat doing one of those Titanic things. Like, then we had this lovely seafood tower for dinner and we're looking at the stars. It was really romantic. And then all of a sudden, Tom started to turn a bit green. And he was losing his stomach contents all night.

So I called a doctor to the ship and the doctor first gave him an interview in a sandy

biotic and some fluids and said, oh, he'll be right as rain by dinner. And he wasn't. He was worse. So they get off the ship at this point. They go to a clinic in Egypt where they're trying some other medicines, it's not working.

So they actually ship him to a bigger hospital in Germany. Well, he was in an ICU in Frankfurt where they have some of the best gastroenterologists in the world. But when the culture came back, the doctor said, I've got some terrible news. This is the worst bacteria on the planet.

It's ascene to back to Bombani, I. And I went, what? And when he said it again, I realized, wait a second. This was an organism that I used to plate on my petri dishes back at the University of Toronto when I was a student in the 1980s.

And all we needed was the lab coat and gloves back then. How can this be the worst bacteria on the planet? So despite all this treatment, he's getting all these antibiotics. He's getting worse and worse at this point. He's on a breathing machine.

He's getting sicker. So they package him up and send him back home to the University of California, San Diego. The ICU there. I have a chart of all the different antibiotics that it was resistant to right off the top.

And I call those the gorilla sylons that are the heavy duty antibiotics that have to be infused into the patient and then have a lot of toxic side effects. He was on all of those, and in a cocktail, but there was no other alternative. In fact, we didn't even know if these antibiotics were going to do anything. When I pointed to a whole bunch of them on the wall, and the doctor said, you know, there's

nothing that will kill this thing.

“I said, well, then why are we treating him with all of these antibiotics?”

And they said, because we don't know what else to do. This is probably a dumb question, but emotionally, what are you going through at this time? Well, I felt like it was God's cruel jokes that here I am, an infectious disease epidemiologist. And I had no idea that any microbial resistance had gotten this bad over the last few decades

that an organism, a whimpy bacteria is one of the doctors called it, that has acquired

Like, how can this be, how can an infection that you acquire on vacation to a guy who's, you know, so healthy that he was crawling backwards down into a pyramid one day, and then two days later, he's fighting for his life, like, this just doesn't happen, does it? I mean, yeah, it's crazy just to think about, like what she said, that this was a bacteria that she was plating with just gloves, and then it's become the thing that we can do

nothing about. Yeah. Yeah, it's scary, man. I mean, like, look, and this was 10 years ago that this happened. I'm showing up to work, and I'm seeing cases like this where no antibiotic works, I got

a mix and mingle different antibiotics to try our best, and I don't know, it's just scary

feeling, because I feel like I'm watching a world war that's happening basically right

under our noses, and we're not really paying attention to it, and somehow I'm at the front lines of this, and I'm like, how did this happen to me?

“Like, why am I here? I guess that's why I wanted to come here and talk today, because I wanted”

to sort of zoom out and take a big picture of, like, okay, there's this global war, like, what is really going on here? Well, so now that we've got you, it's sort of like a little bit out of Dr. Mode, and into maybe reporter or investigative looker mode, like, back me up a little bit, because you talked about it as a world war, like, give me the layout of, you know, unpack that metaphor

for me a bit, like, what's the battlefield, who are the combatants, okay? Walk me up to it. Yeah, so we could start with sort of who is this battle between, right, because you got us in humans, and on the one side, or us and bacteria, I mean, yes, yes, I was human. Us, team us, I promise I'm human, we're on this side, think about what we have, right?

Like we're composed of trillions of cells, we have, like, huge brains, we have all these

muscles, we have fancy degrees, we have chat, GPT, we have everything, and on the other side, we have bacteria that are, like, single-celled organisms, they don't go to school, they don't know how to read, they don't have brains, they don't even have a single neuron, they don't have any muscles, like, they, you know, just put them in the air and they'll probably just die.

“I got to say it raised as a question, which is sort of, like, how are we losing?”

No, I know, that's exactly what I think about, and yet I'm sitting at work and watching us lose it, and that's where I get to thinking, and I don't know, I've grown to have a respect for these guys because I'm, like, I actually fundamentally think that they're, like, better than us, I really do, and what, like, I mean, sure, we have all this stuff, you know, but they can actually just evolve better than we can at a very fundamental level.

Well, explain how something can evolve, like, because they got, like, they've, the faster lifespan, they mutate easy year, like, what, how do you evolve better?

I could describe it, but I'd rather kind of just show you.

Yeah, let's do it. But you guys have to be involved, all right, let's some crowd participation, all right, I'm going to set up a hypothetical scenario here where we're going to watch evolution happen, let's pretend you guys are all humans, and me, Dr. Mead, I'm going to try to kill everyone in this room.

The way I'm doing it is, by the way, not a typical public radio. Right. Right. It's an aggressive donation request, or else. Yeah.

No. Okay. All the way out, if you don't, no. I'm going to seal all the windows, everything, and just suck all the oxygen out of the room.

So you all are going to suffocate to death. I'm sorry. I know some of you guys. I apologize. But, and I need a volunteer, I need one volunteer, ideally a single person, all right, what's

your name? Danielle. Danielle. Not all the oxygen in the room. Everybody dying.

We got that. But, Danielle, she didn't even know that she has a random mutation where she can hold her breath for 20 minutes. So while everybody else dies, you're going to live. So let's think about, like, from an evolutionary perspective, if we want this trait,

“ability to hold your breath to spread, how's that going to happen?”

Well, Danielle has to go on some dates, meet someone that she's into. We don't need a doctor to tell us what has to happen. We get the idea. Then maybe that special miracle of birth will happen. Yeah, so that's human evolution.

We got to wait a while, but that's just human evolution. That's evolution. But it's a specific type of evolution, really. It's called vertical gene transfer. Vertical like, like, down in the generation.

Last down to the children and grandchildren, they go down the generational tree. So while Danielle has to have sex, bacteria have a sex pillus. So at this point, the show of your put up a picture right behind this on stage, and had these, like, two gray blobs, kind of a grainy picture.

the other one on the other side. It's a different thing.

“This doesn't look like Danielle at all, actually.”

No. But it turns out. It's like a date. Yeah, no. Exactly.

About a billion years ago, bacteria evolved this crazy trick where they're able to just

generate a tube out of their bodies and just suck into the bacteria next to them. It doesn't even have to be the same species. They can just create a tube and connect to the person next to them. And they're shooting genes, I assume, like that's where we make this tube. And then they can make copy of some of their genes and just send them over to the person

next to them. Wow. It's pretty cool. That's the sex pillus. And so I kind of want to use this now as an example.

Okay. So we're going to try the same scenario again. Instead of you guys being humans, now you're all bacteria. Okay. You all have a sex pillus.

So I need to pick someone in the audience. I'm going to pick what's your name? Rich. Rich the bacteria. You have a special mutation.

Let me explain.

“This scenario, all you need to live is light.”

Okay. That's what you need as bacteria. So let's go ahead and turn all the house lights down. And as these are turning down, you guys are all slowly dying. This is getting weird.

But Rich the bacteria has a special mutation. He didn't even know he had it. He has the ability to make his own light. So Rich, please tell me that you have a little glow stick. Just to explain, by the way, we'd actually handed out glow sticks to everybody in the audience

since they came in the door. But only Rich, the special bacteria, you can go ahead and turn on that glow stick for us. And hold it up. Yeah, I cannot wave it around. Let's see it.

All right. So using the sex pillus, just here, it's like no one's ever been to a ray of eye guess. This is it. All right.

So Rich, anyone you tap on the shoulder can then turn on their glow stick. Don't do it. I don't do it at all. We're going to time. Okay.

And then once you get tapped, you can turn on your glow stick and you get tapped people around you. And you get tapped also spread the tap. And let's see how long it takes for this trait to spread everywhere. Okay.

On my count. Ready three, two, one. Go. Okay. Hold them up so we can see it.

Let's see this happening. Don't turn on. So a viewer and I are standing on stage in the dark. And it was actually pretty cool to watch this happen. You can sort of see Rich's light spread to the next person and then next.

And at first, it was actually pretty slow and sort of halting.

You guys are still dying over here. No, it's wrong. But then it started to like spread pretty quickly. It took a little while to get like over to different sections. This is a VIP section is all dying.

But really once it got going, it went fast. Amazing. And suddenly the whole theater was sort of like a sea of little wiggling lights. All right. Nice.

Let's bring the house lights up. Here yourselves a round of applause. That was actually really cool. That was amazing. That was great.

That was really amazing. That was really amazing. It's a great bacteria. Yeah. That was so good.

Everybody give yourself a round of applause. So what you just witnessed is actually horizontal gene transfer. So while humans have to pass genes down, you guys can pass genes horizontally. You could just pass them to each other.

“Meanwhile, I think Danielle is still like trying to find that date and where you're going”

to go. Right. She's not so sure about the last day she went on. She's going to make some time. I want you to take your time.

But. Right. Exactly. So you know, you've got to think about that. That's spread.

And now you're taking the count that for every single human being on Earth, there are 30 trillion bacteria. Okay. Per person. Per person.

So that's me, 30 trillion. You, 30 trillion, 30 trillion. 30 trillion. Exactly. It's just unbelievable.

There's universes of bacteria for every single human being. And all it takes is for like one mutation to happen in one of those bacteria. And then that trait is going to spread like wildfire. So what we're up against is like terrifying numbers of blazingly fast and nimble, tiny little enemies.

Exactly. It really is like our brains versus their sex pillists. And their sex pillists is winning basically. Well, but okay. But this is actually where I was hoping that our brains might come back in because okay,

sex pillists and trait tricks, and we do a drug, they figure out a way around it. But then we come up with a new drug. Well, that's the idea, problem is like we haven't really been coming up with new antibiotics. We sort of fell off a cliff. Like we haven't come up with a new antibiotic, a significant one since like 1980.

No. We just don't, we just don't anymore. Why, why is there not, there's zero new antibiotics since 19, whatever that is. Why? Yeah.

I's mostly like an economic issue, you know, you think about how much money it costs

to do all these trials to invent a drug, that's going to cost you like a billion

dollars. So that's a lot if we all have to chip in on that. And you know, and you're going to do all this to make a drug, it might work. And if it does bacteria just in a matter of like two, three years, they're going to

So it's, it's just kind of like a money losing proposition for pharmaceutical companies. So there's not going to do it. All right. So that means that you then are literally just sitting around using the same drugs over an overgrin meanwhile, every time you use one, the bacteria has a chance to train up on it

and figure a way around it. Yeah.

“And that's how like a little trickle of bacterial resistance that's always been around.”

It's like turning into an avalanche. It's scary. I talked to the WHO. There's a whole chapter of the WHO dedicated to this and they told me that currently as of today, one in six infections is resistant to the antibiotic that used to work for it.

Like you have to use something else.

And currently today, a million people a year are dying from infections that they used

to survive like a couple of years ago. And obviously that number is about to get a lot bigger. Do you remember when you were pitching me this story? And I said, well, you can't just leave these people depressed and destitute. No, I know.

And you remember I said, like, there's somewhere there's going to have to be a ray of hope. And I'm thinking, now I had this. Okay. Okay.

“So with some prodding of your did eventually talk about how they're dealing with the rise”

of antibiotic resistance in hospitals. We have committees that are filled with annoying people that will email me if I do something wrong or they pull me into a Zoom meeting or there's like, all these protocols we got to follow.

Basically, making sure that they don't use antibiotics in a way that give the bacteria a chance

to evolve or resist the drug and then pass that resistance along. You know, we want to treat things only if there's really an infection and then really kill everything. Like, you know, we don't want there to be like any survivors that can live to tell the tale of what happened.

But, you did have a little bit more darkness that you wanted to stare at. Although, I promise it does eventually lead us to a more hopeful space eventually. And that all come right after this quick break, stick around. On this week's on the media, the New York Times sued the Pentagon to get its reporters back in the building and won. The Pentagon said, "Not so fast."

A spokesman said yesterday, an area of the building known as Correspondence Corridor, which reporters have used for decades to cover the DOD, will close immediate. Don't miss this week's on the media from WNYC. Find on the media wherever you get your podcasts. This is Ray Elab, I'm Storm Wheeler, and we are back on stage with Dr. of Your Metra,

who is giving us his frontline view of what he calls a "world war" between us and bacteria. And at this point in the show, of your told us that as he was reporting all of this out, he realized it wasn't just a problem with him giving antibiotics to a patient in the hospital. Like, we also give them to animals.

I don't know why that never occurred to me.

But if I had to ask you, of all the antibiotics given in the U.S., what percentage would you say go to humans versus animals? I don't know. I feel like one of those things aren't supposed to get bigger than I would think, but I don't have no idea.

Half. I don't know. It's reasonable, but actually 70 percent of all the antibiotics given are given to animals. Another way of putting that is that every year here in the U.S., we humans take about seven pounds of antibiotics, whereas farm animals are given 30 million pounds every year.

So basically, cows and pigs and chickens are getting four times the amount of antibiotics that we humans are getting. Yeah. I had no idea. They're basically just mixing their food with antibiotics.

They mix the water. They're drinking water with antibiotics. They spray it on the ground, they inject them with antibiotics. It's just over the ocean. So this is not like just if they get sick.

No, no, no. This isn't just if they get sick, it's just very willing nearly. In many cases, these are the same antibiotics that we use, treating like the same infections that we get. So a viewer ended up talking to a scientist, a guy named Lance Price.

He's a founding director of the antibiotic resistance action center at George Washington University. But before he was that, he was researching this exact problem, the use of antibiotics and farms. And the thing that he was specifically trying to figure out was, what effect could the use

“of all these antibiotics and farm animals have on us?”

So he designs a study and like all good studies that involves poop, it's like a common theme in reader lab. I feel like we soak them up a lot. So he designs a study, all right. So what he does, he decides to study the poop of chicken catchers.

The person who goes around the chicken farm and picks up the chickens by their next with

basically. So they're touching a lot of chickens.

“So what he does is he measures the bacteria in the poop of these chicken catchers versus”

the bacteria in the poop of like regular people like, you know, you and I. So we cultured all this poo and then we analyze the data and the one thing that popped out like really strong was gentimizing resistance. And so it turned out that the chicken catchers had 32 times the risk for carrying gentimizing resistance in Ecoli as their peers.

So basically these chickens before they even hatch, they would poke a hole in the egg and

inject that egg with gentimizing. Then the chickens would grow up, they're being fed gentimizing like left, right, center. And so the Ecoli that live in the gentimizing were eventually learning from this, becoming resistant to the gentimizing, those bacteria were jumping from the chickens onto the hands of the chicken catchers, into the mouths of the chicken catchers, enough to the degree where

they're literally shading out of resistant bacteria. And look, if you're an epidemiologist and you get three times the difference. You're doing cartwheels down the hall, right? So you're like, I found something, look at this, it's miraculous.

“But this was 32 times and I just said we've got to be doing something wrong, right?”

So we looked at the numbers over and over and it was, it was clean. So the person handling a chicken is 32 times more likely to have a resistant form of Ecoli

in their bodies than someone who's not handling a chicken.

Yeah, exactly. And then they find out that, okay, these chicken catchers are going home, that resistant bacteria is getting into their children. And they find that those bacteria are spreading through the schools of the children. They later find out that if you're driving behind that chicken truck, carrying chickens,

those bacteria are getting off of the truck into your air vents and landing in the cars behind them onto the people behind it. It's like, it's truly insane. And then when you really just sit back and think about it, like, then these chickens go die, they get packaged up with the bacteria in them, and they get sent to like all of our

houses. Really?

“Do you remember when like 10 minutes ago I was like, can we like, do you need to turn”

to hope thing? No, I know. I know, but like, look, this is to me, this is exciting. This is good because like, I'm spending my whole life in the ER, like, trying to be super anal.

No, you're not getting into this from my sin, like, not giving you a Z pack, but really, like, this is where the real battle is happening. I've been on the wrong battle front the whole time. Well, but so then what, I mean, okay, what's your next move? Like, you're going to call up big chicken?

Well, I did the radio lab thing, yes, so that's actually exactly what I started emailing people I was doing. I was trying to do the radio lab thing, so I emailed Tyson chicken, and they weren't into me. I kept looking, I kept looking, eventually I was able to find one guy who is a higher

up at a chicken company, a big deal guy, and he actually agreed to talk to me. Great. So let's bring him up, this is Bruce Steward Brown. He's the chief medical officer I've heard you chicken. Bruce.

Nice to see everybody. Thank you for coming. Thank you for agreeing to talk about this. I want to just break it and say that I actually had figured that this was going to be the point in his reporting where a viewer would hit a wall.

And so it really felt like a sort of strange, but very cool opportunity to sit down and talk to somebody who's on the inside of one of the biggest chicken producers in the country. Yeah, so I'm a veterinarian, and I started it Purdue in 1998 as a field veterinarian, and just kind of getting used to how commercial chicken was raised and the process of being a veterinarian specifically for chickens.

And in 2002, we got in a room together and talked about the fact that concerns around antibiotic use had hit the radar for us. And that means that people were calling in or writing and saying, look, I heard you guys use a lot of antibiotics in chickens and they wondered why.

And in this meeting, Jim used Jim Purdue's a third generation CEO of chairman of the company

at the time. And Jim is going, first of all, tell me why we use all those antibiotics in then second. Tell me how we can not use all those antibiotics. Let's make it a project and start now. Let me ask you at that moment in time when the big cheese has showed up and said, we're

going to do this. What's your reaction? I'm going, oh my man, we have, we have got to change everything. If you just pulled out the antibiotics, you're likely going to have to treat quite a few

That's not a great thing. So what are you end up doing to make up if you're going to take the antibiotics out?

“What do you have to do to make up for that?”

First thing is you have to redefine clean. You have to decide, in our case, that we thought this egg was clean, it's got to be cleaner. So there's four ways a chicken companies were using antibiotics, including us. One is it was going in every egg, as if you were... Like it's injected into the egg with a vaccine to keep the vaccine clean as you...

You have this tremendous opportunity to check and to vaccinate the embryo.

It's amazing, honestly, that you can get the vaccine started in an embryo.

But you do poke a hole in the egg. And the egg did come out of the rear end of a hint, which is the same place, you know, manure comes out of it. So it can be dirty and the idea was to keep it clean with the antibiotic. Okay, that's for cleaning chicken cloaca, is step number one.

Yeah, well, but the other parts were, there was antibiotics in the feed, every bite of feed from day old had an antibiotic in it in those days. And though they weren't sick, just in case they might be, and it helps their gut stay healthy through all the challenges. So we were putting antibiotics in the feed for that.

Then when I went down to the farm, I was seeing that the things they used to feed these birds were other animal parts. And so that gives them gastrointestinal illnesses, because it's like, you know, kind of

gross food, and so then they got to use antibiotics, so then they decide to change the

feed. Yeah, we had to change. We had to look at the feed a whole new way. You take the antibiotics out, take the animal byproducts out, because those are irritants. Put in probiotics, good bacteria, things that help the digest, the digestive track of

a chicken operate optimally. Same thing, you know, you probably all familiar with the good bug thing, it's really big. So is this all like, is it, you're going along? Is it working? Is it seem like you're getting somewhere?

I don't know, maybe there's some other things you had to do too. But yeah, well, we did have to work on the chicken house, and the change in feed, the change in approach to feed was a big deal, the cleaner eggs was a big deal. But changing the way you care for chickens became the thing. So raise these chickens in a way that even if nobody cared, you used antibiotics, you wouldn't

use them.

The whole thing became about caring for chickens in a way that you'd never let a chicken

be a chicken. Put things in the chicken house so they can get up off the floor. Let them exercise, put some windows in the chicken house, back in the chicken house. The traditional industrial chicken house has zero windows, and it's all artificial light. Put some windows back in, expand the floor space to something above the floor.

Chickens like to do three things. They like to climb, they like to perch, and they like to hide. And in a traditional chicken house, they don't get to do much any of that. And so get that back in there. Take the stressors away from the way you raise chickens as much as you can and learn all

the time.

“Can I get you like, I mean, over how long did this take, and maybe where did you land?”

Where? Where are we at now? 2016, we were done. Wait, this done means what? All the antibiotics were out of the feed, out of the eggs.

Would you like to use an any antibiotics for anything other than treat and sick flocks? Yeah. Thank you for the chicken, and thank you for coming up here and talking to us in the case. All right, everybody. That, I mean, it is actually imagining, imagining the chicken leaving its well lit coop

to go out to a little sort of playground exercise area with maybe a like probiotic, parfae, and hand. Yeah. So, other than the fact that we are eventually going to slaughter and eat them. Right, right.

And I'm going to say, you know, like also to take in consideration just what like to overall

“the animal industry is doing, should we be doing it?”

The climate, of course. Yeah. Yeah, yeah, exactly. It's like there, you know, there's a lot of problems with eating meat in general. You could think about climate change, you could think about ethics, and this doesn't solve

all of that. But certainly in just a proof of concept, you know, to mean it's interesting like the antibiotics for sort of masking, cruel treatment towards these animals. Like you can treat them however you want. But if you pump them with enough antibiotics, they live.

And once you remove those antibiotics, all of a sudden you're sort of seeing the truth of what you're doing. If you treat them better, their healthier, your healthier, what we do to them comes back to us. I don't know.

It's kind of an interesting proof of concept.

Yeah. I guess I'm just like back thinking about the war because like let's say that everybody went full Bruce, and there's maybe a cow Bruce, and a pig Bruce, and but even turkey Bruce. Like yeah, like given the way you've described what's going on globally, I mean, is

“even that any kind of decisive move on our part or are we?”

The way I see it, everything that Bruce is doing, that's sort of playing great defense, right? Like let's stop training these guys to get better. But I agree, you know, at some point we have to go on offense. Any good war. And so I do have one more story I want to share with you guys that kind of takes us there.

And honestly, I think this is the part that gives me really the most hope, the most excitement. All right, good. But to get there, we're going to have to go back to like a dark place in the theme of the night. But we got to go back to Stephanie, Stratty.

Who went with her husband Tom and the Tom gets sick and, you know, exactly. So one day, the doctors came to me and said, you know, Stratty realized that Tom's on life are supported, right, his, he's on a ventilator to keep his lungs working. He's on three medications called pressers to keep his heart working. And now his kidneys are blanking on and off.

So that's the trifecta where we stop talking about organs that are having problems working. We're talking about whole systems, whole body systems. I'm like, okay, okay, like, speak to me and they said, well, do you want to start kidney dialysis?

“And so what they were really asking me, is, do I want to pull the plug?”

And that moment was just like, I can't believe this is happening, you know, when you have your advanced directives, you know, you sit down with your partner and you're right a will. And, you know, he had said to me, hey, you know, if I'm ever like brain dad, please, like, you know, pull the plug.

But this situation, it was, is brain that was alive. It was his body that was dying and I had no idea what he would want me to do. So the doctors are looking at means and they're saying, okay, you know, what do you want to do? And I said, okay, I think we should ask Tom what he wants to do.

And then he said, well, he's in a coma stuff. Like, how's he going to communicate as well? You know, let's see, let's just see.

So I had this conversation with Tom that you just never think that you're going to have

to have with somebody. And I said, hey, honey, I am. I know you're, you're fighting really hard and you have to be really tired, but I need to know if you want to live. And if you want to live, I need you to tell me by squeezing my hand.

And I will leave no stone unturned.

“And I remember that moment like it was just yesterday, I still got chills just talking”

about it. I waited for a whole minute and I thought, my God, he's not going to squeeze my hand. And then all of a sudden, he squeezed really hard. And I thought, oh, yeah, like, you know, I pumped my little blue-gloved fist in the air. And then I thought, oh crap, like, what am I going to do now?

I'm a little bit doctor. I mean, the question in the room here, for me, at least, is what did she do next? Yeah, well, we can ask her. [audience cheering] We'll get Steph's story and what happens to her and Tom Next right after this quick break.

[upbeat music] This week on the New Yorker Radio Hour, I'll talk with the actor, John Lisco, who's on Broadway playing the author, Roll Dahl, who's anti-Semitic statements caused an international scandal. His anti-Semitism is obvious, like a leaky car battery. It's just in between the lines and some cases, just explicit.

John Lisco joins me next time on the New Yorker Radio Hour for WNYC. Listen, wherever you get your podcasts. [upbeat music] Hey, it's Ray Alab, I'm Storm Wheeler, back on stage with a beer metra. And we'd been hearing the story of Stephanie Stratty and her husband who was suffering from a bacterial infection

that no antibiotic drugs seemed to be able to treat. And at this point in the show, we actually got Stephanie up on stage to share with all of us what exactly she had to do next. [audience applauding] Hey, everybody, I can't believe I'm our real lab, I need to keep you going.

Thank you for coming. I'm going to just go in with the first one, the big question that I

were all left with, I think, what do you do next? Well, I was terrified. I mean, some of the top infectious disease positions are at University California, San Diego. They were our colleagues, caring for Tom. But, you know, I was his wife, and I wanted him to live. And I thought, okay, if he

and I've learned as an AIDS researcher that there are experimental treatments that got studied while we were doing clinical trials. And there should be some experimental treatments that we could use to save Tom. So, I hit the research. I went on PubMed, which is a search engine that the National Library of Medicine makes it freely available. And I entered the keywords, asked me to back to Bamania. I have a super bug that was killing them. Alternative

treatments, and uppops something called bacteria-faged therapy, or phage therapy for short.

“To date, and what is bacteria-faged, or what's a phage?”

Bacteria-faged are viruses that have naturally evolved to attack bacteria. The oldest, most populist organism on the planet, and they kill bacteria. So, you're saying just like how, like, I can catch a cold, like a bacteria can catch its own cold type of thing. Yeah.

Well, what was weird is that I learned about bacteria-faged when I was the student at the

University of Toronto, back in 1986. Like, it was just mentioned in class, but I never knew

that they had ever been used to treat bacterial infections. But they were discovered before penicillin. It's just that they had been, you know, popularized in the former Soviet Union. And that was seen as kind of Russian medicine, and fell out of favor in the West. Okay, so the idea then is that you're going to put a virus into Tom to fight the bacteria. And are there, is it like, oh, when you're doing the PubMed Googling, it's like, here's

“the one, to you, like, what are you coming up with?”

Yeah, well, that was the other problem. Well, first, I got my colleagues at the University California San Diego said, wow, what an interesting and intriguing idea. If you can find phage that are a match for Tom's bacterial isolate, we'll call the FDA and see if they'll give us permission to give it to him on a compassionate basis because he's going to die.

But turns out, there's like 10 million trillion trillion phages on the planet. Like, that's,

that's more than all the stars in the sky. So that was even more daunting. And luckily, I was able to find researchers that agreed to help with the help of Dr. Chip schoolie. They had an infectious disease at the time at the University of California San Diego. You know, we, we found people and even the U.S. Navy who had been sourcing phages from the villages of ships around the world. From, like, the inside of the underneath the ship,

yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah. But, but, you know, the best place to actually go for phage is where there's a lot of bacteria. And you know where there's a lot of bacteria. So like this is going back to poop. It's going back to poop. So it turns out that sewage and barnyard waste and duck pond raised that kind of stuff. The stuff from, like, like, the farm was the first was talking about, that's a perfect place to source

phage. So within a couple of weeks from my first email asking total strangers for help to the day that we treated Tom with these viruses that attacked bacteria, it was only three weeks. Three weeks of people tripping through the sewers and scraping the bottom of an avi-boats and like sending, like, some of these already samples that were in labs. But literally, yeah, you know, so, you know, I couldn't believe that we were doing this, but, you know,

like, Tom's in a coma, I said, you don't believe, like, we're going to be, like, pump and, like, you know, like, purified shit into you to see if we're going to live. Like, it's just, like, I can't believe this is my life. But that's essentially what we did. And that was, then, did you say three weeks later? Three weeks, that's all it took. Like, compare that to an antibiotic

that takes 10 to 15 years to develop in a price tag of a billion dollars or more.

“Yeah. But yeah. Okay. So, so that's what we did. It was, it was the scariest day of my life,”

but me and Tom's two daughters said, okay. Let's do it. He's, you know, and is ascended in, in an injection and IV-dursuit. First, we put it, them in the catheters and his abdomen because that was the closest to the source of the infection, which was in his gut. And then we injected them. And it was a billion pages per dose, every two hours. And two to three days later, he, like, he was, like, within hours of dying, I was told.

He lifted his head off the pillow, opened his eyes and kissed his daughter's hand. Carly was on shift at that day. And, um, everybody in the ICU freaked out. There were, like, people cheering, there were people crying. I was crying too. What is that? Was the happiest day of our lives? Wow. How much do you know about, like, I mean, the device goes in an attacks of bacteria, but like, how do you, how much do you know about how why this is so effective or what's actually

happening in there or, or how this is going down? Like, what, what's actually going on inside the body?

because a couple of the fages were synergistic with one of the antibiotics.

But that mean how does it, okay, let me, let me explain this. Okay, so you're a bacteria, okay? Okay. And I'm a phage, and, and a beer is the antibiotic, okay? And we're both trying to kill you, okay? Okay. Now, people will get you now. No, you're a bacteria. You do not have a brain in this example, okay? Like, I don't know about

“regular life. But you have to make a genetic decision about who he would rather face,”

him or me, and I'm scarier than he is, okay? You do not want how to deal with phage. So you decide to take off your shirt. Now, okay. Okay. This is not that point of show, but, but your shirt is, is, is your slimy biofilm layer. Okay. That's your superpowers. It's his resistance basis, right? But that's where the receptor for the phage is this on your shirt. Okay. So if I get rid of my

biofilm shirt, or the receptor, you can't attach. That's right. And so I, I die. But in doing so, you have made yourself susceptible to a veer's antibiotic. Okay, that was nothing more than a shirtless. So he goes. Yes, you go. So it's one, two punch. That's right. So at the same time,

“even if you want to start to work, you can, so, but does that mean that like, when you use phage,”

therapy, not only do you have a new way of getting at this bug, you've unresistinsoned it. Like, you've dialed back the resistance that it developed over the years of water. And now, now a bacteria can actually be newly susceptible to a drug that it was. So, you know, phage therapy is now going through clinical trials all around the world. It's phages all the rage people. But she's not going to say this, but actually, she is the one like setting up all these clinics all over the nose. Yes, she is. Yes, she is.

At the University of California, San Diego, we do have what became the first dedicated phage therapy

center called the Center for Innovative phage applications and therapeutics or iPads. So we do provide phage therapy to see what I said that have no. But, but there's many, many around the world now. And, of course, I didn't do this all by myself. I mean, I hear a lot happening, but I also have to wonder a little bit like, why, like, I didn't know more about this already, why a fear wasn't already thinking about this as something he might have to use. Something like, why isn't this already happening

everywhere? Yeah. Well, you know, when COVID came on the scene, everybody, you know, felt it right away, right? It was a pandemic that hit hard, hit fast with any microbial resistance. It's a slow burn. So, you don't really know or feel it, unless it hits you in your personal life, like, you're a viewer, you're an emergency room doctor, or you're his dad, and, you know, you're seeing patients that used to be treatable that aren't treatable anymore, or you're me,

like, whose husband is suddenly dying. And, you know, we have kind of let this creep up on us.

“But, you know, also with COVID, we had four vaccines or five vaccines developed within a year, right?”

And so, if we had the political will to move phage therapy forward, we could be doing a lot more than we are. So, those trials are getting done now, but if the pace is not fast enough to overcome the pace at which resistance is spreading. Can I ask you the sort of like and very singly typical question that a radio lab person might ask? I'm sure sure, don't I? Yeah. So, in the moment, the Tom came back, like, I don't know, talked to me about how that felt. I mean, I feel like there's

relief I heard joy, but there is their pride, like, I don't know, give me a little bit on that. Well, I think that Tom deserves a lot of credit in this too, because that man had so much resilience to bounce back. And, you know, he had been in the hospital nine months. He'd lost a hundred pounds. He lost all of his muscle mouth. He had to learn how to walk, how to talk, how to do everything all over again.

And now he's the face of evidence-based hope. Yeah. You know? That's an amazing thought.

Thank you, Stephanie. Thank you for sharing your story with us. Thank you for having me, everybody. So cool. Wow. All right, of you. So we've been through a lot together. Starting from coming on this sort of journey of trauma, we see that. But I, but I, you know, like starting from a place of sort of like seeing this happen in front of your eyes, dealing with it on a day-to-day

the research thing and finding all what you've found and sharing all that with us. I guess I, I'm,

“I am a little bit curious just like, where you're at now. Like, are you still in therapy or”

yeah, definitely. I mean, you know, I still, I still have a shift tomorrow. So I still got to go to work. You know, I still got to see this stuff. So it's still there. But I guess I don't know. I mean, thinking about all this stuff makes me think about the whole thing a little bit differently.

Found so. I mean, okay, let's think about it. Like, when when I was first thinking about it,

I'm thinking, it's humans versus bacteria, you know, and I'm at the middle of this. It's all about me and like that kind of thing. And as I'm thinking about it more, it's like, it's not really. It's humans, bacteria. There's animals. Animals probably playing a bigger role than humans.

“And then if you think about it some more, it's like, wow, all our antibiotics, our whole”

weaponry comes from fungi because they've been battling bacteria for longer than we've even been around

and now listening to Stephanie, it's like, oh, there's this whole class of viruses that's been

fighting bacteria for longer than the fungi have been around. So I don't know. I guess I'm just looking at the shape of this a little bit differently. It's like, there's a lot of players here and if anything, we're just like the newest kid on the block. But it does also then feel so much more. It feels like maybe overwhelmingly complex. Yes, it is, but I don't know. I guess in a weird way, like, I'm realizing we're so young. As a species, there's so much we don't know. There's so much left

to learn. And I don't know. I just think there's hope in that. Yeah, I can see that.

Well, I guess before we go, I just wanted to play one more quote because I feel like the show can't end without hearing this. I did talk to Tom and I just wanted you guys to hear him. I asked him if he remembered by any chance that moment where Stephanie squeezed his hand and asked him if he wanted to live. And this is he's in a coma and she right at this time he's in a coma. He's completely out of it. He's on the verge of death and Stephanie asked him. Do you want to live? At that moment,

I thought I was a snake in a canyon curled up under a bush and there is a wooden platform that visitors could come and view me from. And they would look down and I would look up and I could see people through this haze of my milky eyes. It would be hot sometimes. Sometimes it was cold. When the night came, I was really alone, disintegrating molecule by molecule. You know, just kind of sinking down bit by bit. My vision because it was blurred by the milkyness over my eyes,

I couldn't see her, but I could hear her in the distance. She said, "I know you've been through a

“lot and I know that it's hard and if you want to let go, it's okay. You can go."”

There was kind of a pause that I had and I realized I was a snake. I tried to figure out how to squeeze her in because I was desperate to squeeze her in, but I didn't know how without hands. So I thought and thought and then I thought, "Well, I'm a snake. I can wrap my body around her hand in squeeze." So that's what I did.

Thank you very much. Thank you guys. Of course, also a big thanks to Lance and Tom, who gave us their time and talked to us, and a beer's dad for being willing to throw shade as his son. Well, thank you, Sornin, for being on stage, helping out a beer, pushing him around,

Obviously, I had a lot of fun doing it. A couple of quick thanks.

“Thanks to Tom Philpott, Steven Roach, Kate Shaw, Carrie McCliman, Alex Wong, and Marin McKinnon.”

This episode was reported by a beer meet-ra, was produced by Jessica Jung, and fact checked by Natalie Middleton. The live show itself took place at WNWC's Green Space Performance Center, and thank you, of course, to the staff there who make those kinds of events work. Also, the folks on the radio lab team who helped us make it happen,

“Sarah Sambac, Natalia Ramirez, Anita Vietza, David Gable, Tanya Chaolin, Harry Fortuna,”

and Jeremy Bloom. I also want to mention that we actually did a first run of this show down

in Little Rock, Arkansas, a Little Rock Public Radio, the Public Radio Station down there, invited us down to the part of their annual celebration, and it was a ton of fun. So thanks a bunch to Little Rock Public Radio, and in particular to Grace Sufasi, Jonathan Seaborn,

“and Sarah Buford. And that's it, so we will just go out as we do with most of our live shows,”

by letting one of the listeners from the audience come up and read the Radio Lab credits.

Hi, I'm AJ. I'm from Jersey, and here are the staff credits. Radio Lab is hosted by Lulu Miller, and Latif Nasser. Sorin Wheeler is our executive editor. Sarah Sambac is our executive director, her managing editor is Pat Walters. Dylan Keith is our director of Sound Design. Our staff includes Jeremy Bloom, W Harry Fortuna, David Gable, Maria Paz Gutierrez, Sendo Niannaz-Sanwanda, Matt Kielty, Mona Madgavkar, Annie McEwan, Alex Neeson, Sarah Terry, Anisa Vietz,

Ariana Wack, Molly Webster, and Jessica Young, with help from Rebecca Rand. Hi, I'm Daniel from Madrid. Leadership support from Radio Lab Science Programming is provided by the Simon Foundation and the John Turpent Foundation. Fundational support from Radio Lab was provided by the Alfred B. Islam Foundation. Whether it's news from around the world or the latest from your neighborhood, New Yorkers engage with WNYC studios for the information and connection

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