[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.60,0:00:04.16,Default,,0000,0000,0000,,The first patient to ever be \Ntreated with an antibiotic
Dialogue: 0,0:00:04.16,0:00:05.69,Default,,0000,0000,0000,,was a policeman in Oxford.
Dialogue: 0,0:00:05.69,0:00:07.80,Default,,0000,0000,0000,,On his day off from work,
Dialogue: 0,0:00:07.80,0:00:11.17,Default,,0000,0000,0000,,he was scratched by a rose thorn\Nwhile working in the garden.
Dialogue: 0,0:00:11.17,0:00:14.85,Default,,0000,0000,0000,,That small scratch became infected.
Dialogue: 0,0:00:14.85,0:00:17.16,Default,,0000,0000,0000,,Over the next few days, \Nhis head was swollen
Dialogue: 0,0:00:17.16,0:00:18.88,Default,,0000,0000,0000,,with abscesses,
Dialogue: 0,0:00:18.88,0:00:21.17,Default,,0000,0000,0000,,and in fact his eye was so infected
Dialogue: 0,0:00:21.17,0:00:23.07,Default,,0000,0000,0000,,that they had to take it out,
Dialogue: 0,0:00:23.07,0:00:26.05,Default,,0000,0000,0000,,and by February of 1941,
Dialogue: 0,0:00:26.05,0:00:28.49,Default,,0000,0000,0000,,this poor man was on the verge of dying.
Dialogue: 0,0:00:28.49,0:00:31.68,Default,,0000,0000,0000,,He was at Radcliffe Infirmary in Oxford,
Dialogue: 0,0:00:31.68,0:00:33.99,Default,,0000,0000,0000,,and fortunately for him,
Dialogue: 0,0:00:33.99,0:00:35.04,Default,,0000,0000,0000,,a small team of doctors
Dialogue: 0,0:00:35.04,0:00:36.93,Default,,0000,0000,0000,,led by a Dr. Howard Florey
Dialogue: 0,0:00:36.93,0:00:38.100,Default,,0000,0000,0000,,had managed to synthesize
Dialogue: 0,0:00:38.100,0:00:41.82,Default,,0000,0000,0000,,a very small amount of penicillin,
Dialogue: 0,0:00:41.82,0:00:43.90,Default,,0000,0000,0000,,a drug that had been discovered
Dialogue: 0,0:00:43.90,0:00:46.22,Default,,0000,0000,0000,,12 years before by Alexander Fleming
Dialogue: 0,0:00:46.22,0:00:49.93,Default,,0000,0000,0000,,but had never actually been \Nused to treat a human,
Dialogue: 0,0:00:49.93,0:00:52.34,Default,,0000,0000,0000,,and indeed no one even \Nknew if the drug would work,
Dialogue: 0,0:00:52.34,0:00:55.98,Default,,0000,0000,0000,,if it was full of impurities \Nthat would kill the patient,
Dialogue: 0,0:00:55.98,0:00:57.89,Default,,0000,0000,0000,,but Florey and his team figured
Dialogue: 0,0:00:57.89,0:00:59.62,Default,,0000,0000,0000,,if they had to use it, \Nthey might as well use it
Dialogue: 0,0:00:59.62,0:01:02.18,Default,,0000,0000,0000,,on someone who was going to die anyway.
Dialogue: 0,0:01:02.18,0:01:05.84,Default,,0000,0000,0000,,So they gave Albert Alexander,
Dialogue: 0,0:01:05.84,0:01:08.72,Default,,0000,0000,0000,,this Oxford policeman, the drug,
Dialogue: 0,0:01:08.72,0:01:11.13,Default,,0000,0000,0000,,and within 24 hours,
Dialogue: 0,0:01:11.13,0:01:13.39,Default,,0000,0000,0000,,he started getting better.
Dialogue: 0,0:01:13.39,0:01:17.37,Default,,0000,0000,0000,,His fever went down, \Nhis appetite came back.
Dialogue: 0,0:01:17.37,0:01:19.68,Default,,0000,0000,0000,,Second day, he was doing much better.
Dialogue: 0,0:01:19.68,0:01:21.92,Default,,0000,0000,0000,,They were starting to \Nrun out of penicillin,
Dialogue: 0,0:01:21.92,0:01:23.98,Default,,0000,0000,0000,,so what they would do \Nwas run with his urine
Dialogue: 0,0:01:23.98,0:01:26.83,Default,,0000,0000,0000,,across the road to re-synthesize \Nthe penicillin from his urine
Dialogue: 0,0:01:26.83,0:01:28.77,Default,,0000,0000,0000,,and give it back to him,
Dialogue: 0,0:01:28.77,0:01:30.02,Default,,0000,0000,0000,,and that worked.
Dialogue: 0,0:01:30.02,0:01:32.50,Default,,0000,0000,0000,,Day four, well on the way to recovery.
Dialogue: 0,0:01:32.50,0:01:34.13,Default,,0000,0000,0000,,This was a miracle.
Dialogue: 0,0:01:34.13,0:01:38.37,Default,,0000,0000,0000,,Day five, they ran out of penicillin,
Dialogue: 0,0:01:38.37,0:01:40.64,Default,,0000,0000,0000,,and the poor man died.
Dialogue: 0,0:01:40.64,0:01:43.35,Default,,0000,0000,0000,,So that story didn't end that well,
Dialogue: 0,0:01:43.35,0:01:47.70,Default,,0000,0000,0000,,but fortunately for \Nmillions of other people,
Dialogue: 0,0:01:47.70,0:01:50.71,Default,,0000,0000,0000,,like this child who was treated \Nagain in the early 1940s,
Dialogue: 0,0:01:50.71,0:01:53.74,Default,,0000,0000,0000,,who was again dying of a sepsis,
Dialogue: 0,0:01:53.74,0:01:56.89,Default,,0000,0000,0000,,and within just six days, you can see,
Dialogue: 0,0:01:56.89,0:02:00.24,Default,,0000,0000,0000,,recovered thanks to this \Nwonder drug, penicillin.
Dialogue: 0,0:02:00.24,0:02:02.20,Default,,0000,0000,0000,,Millions have lived,
Dialogue: 0,0:02:02.20,0:02:05.78,Default,,0000,0000,0000,,and global health has been transformed.
Dialogue: 0,0:02:05.78,0:02:08.58,Default,,0000,0000,0000,,Now, antibiotics have been used
Dialogue: 0,0:02:08.58,0:02:11.70,Default,,0000,0000,0000,,for patients like this,
Dialogue: 0,0:02:11.70,0:02:13.84,Default,,0000,0000,0000,,but they've also been \Nused rather frivolously
Dialogue: 0,0:02:13.84,0:02:15.59,Default,,0000,0000,0000,,in some instances,
Dialogue: 0,0:02:15.59,0:02:17.95,Default,,0000,0000,0000,,for treating someone \Nwith just a cold or the flu,
Dialogue: 0,0:02:17.95,0:02:20.42,Default,,0000,0000,0000,,which they might not have \Nresponded to an antibiotic,
Dialogue: 0,0:02:20.42,0:02:24.16,Default,,0000,0000,0000,,and they've also been \Nused in large quantities
Dialogue: 0,0:02:24.16,0:02:27.80,Default,,0000,0000,0000,,sub-therapeutically, which\Nmeans in small concentrations,
Dialogue: 0,0:02:27.80,0:02:30.99,Default,,0000,0000,0000,,to make chicken and hogs grow faster.
Dialogue: 0,0:02:30.99,0:02:34.55,Default,,0000,0000,0000,,Just to save a few pennies\Non the price of meat,
Dialogue: 0,0:02:34.55,0:02:37.25,Default,,0000,0000,0000,,we've spent a lot of \Nantibiotics on animals,
Dialogue: 0,0:02:37.25,0:02:39.61,Default,,0000,0000,0000,,not for treatment, not for sick animals,
Dialogue: 0,0:02:39.61,0:02:42.73,Default,,0000,0000,0000,,but primarily for growth promotion.
Dialogue: 0,0:02:42.73,0:02:45.59,Default,,0000,0000,0000,,Now, what did that lead us to?
Dialogue: 0,0:02:45.59,0:02:48.30,Default,,0000,0000,0000,,Basically, the massive use of antibiotics
Dialogue: 0,0:02:48.30,0:02:49.78,Default,,0000,0000,0000,,around the world
Dialogue: 0,0:02:49.78,0:02:53.59,Default,,0000,0000,0000,,has imposed such large\Nselection pressure on bacteria
Dialogue: 0,0:02:53.59,0:02:56.24,Default,,0000,0000,0000,,that resistance is now a problem,
Dialogue: 0,0:02:56.24,0:02:58.01,Default,,0000,0000,0000,,because we've now selected for just
Dialogue: 0,0:02:58.01,0:02:59.98,Default,,0000,0000,0000,,the resistant bacteria.
Dialogue: 0,0:02:59.98,0:03:02.82,Default,,0000,0000,0000,,And I'm sure you've all read\Nabout this in the newspapers,
Dialogue: 0,0:03:02.82,0:03:04.63,Default,,0000,0000,0000,,you've seen this in every magazine
Dialogue: 0,0:03:04.63,0:03:06.53,Default,,0000,0000,0000,,that you come across,
Dialogue: 0,0:03:06.53,0:03:08.33,Default,,0000,0000,0000,,but I really want you to appreciate
Dialogue: 0,0:03:08.33,0:03:10.50,Default,,0000,0000,0000,,the significance of this problem.
Dialogue: 0,0:03:10.50,0:03:11.95,Default,,0000,0000,0000,,This is serious.
Dialogue: 0,0:03:11.95,0:03:16.77,Default,,0000,0000,0000,,The next slide I'm about to show you is \Nof carbapenem resistance in acinetobacter.
Dialogue: 0,0:03:16.77,0:03:19.15,Default,,0000,0000,0000,,Acinetobacter is a nasty hospital bug,
Dialogue: 0,0:03:19.15,0:03:20.49,Default,,0000,0000,0000,,and carbapenem is pretty much
Dialogue: 0,0:03:20.49,0:03:22.26,Default,,0000,0000,0000,,the strongest class of antibiotics
Dialogue: 0,0:03:22.26,0:03:24.72,Default,,0000,0000,0000,,that we can throw at this bug.
Dialogue: 0,0:03:24.72,0:03:27.99,Default,,0000,0000,0000,,And you can see in 1999
Dialogue: 0,0:03:27.99,0:03:30.18,Default,,0000,0000,0000,,this is the pattern of resistance,
Dialogue: 0,0:03:30.18,0:03:33.22,Default,,0000,0000,0000,,mostly under about 10 percent\Nacross the United States.
Dialogue: 0,0:03:33.22,0:03:37.22,Default,,0000,0000,0000,,Now watch what happens \Nwhen we play the video.
Dialogue: 0,0:03:46.46,0:03:48.52,Default,,0000,0000,0000,,So I don't know where you live,
Dialogue: 0,0:03:48.52,0:03:51.42,Default,,0000,0000,0000,,but wherever it is, it certainly is a lot worse now
Dialogue: 0,0:03:51.42,0:03:53.92,Default,,0000,0000,0000,,than it was in 1999,
Dialogue: 0,0:03:53.92,0:03:57.89,Default,,0000,0000,0000,,and that is the problem of antibiotic resistance.
Dialogue: 0,0:03:57.89,0:03:59.57,Default,,0000,0000,0000,,It's a global issue
Dialogue: 0,0:03:59.57,0:04:02.00,Default,,0000,0000,0000,,affecting both rich and poor countries,
Dialogue: 0,0:04:02.00,0:04:04.24,Default,,0000,0000,0000,,and at the heart of it, \Nyou might say, well,
Dialogue: 0,0:04:04.24,0:04:06.17,Default,,0000,0000,0000,,isn't this really just a medical issue?
Dialogue: 0,0:04:06.17,0:04:08.73,Default,,0000,0000,0000,,If we taught doctors how not \Nto use antibiotics as much,
Dialogue: 0,0:04:08.73,0:04:11.68,Default,,0000,0000,0000,,if we taught patients how \Nnot to demand antibiotics,
Dialogue: 0,0:04:11.68,0:04:13.13,Default,,0000,0000,0000,,perhaps this really wouldn't be an issue,
Dialogue: 0,0:04:13.13,0:04:15.12,Default,,0000,0000,0000,,and maybe the pharmaceutical companies
Dialogue: 0,0:04:15.12,0:04:16.88,Default,,0000,0000,0000,,should be working harder to develop
Dialogue: 0,0:04:16.88,0:04:18.51,Default,,0000,0000,0000,,more antibiotics.
Dialogue: 0,0:04:18.51,0:04:21.89,Default,,0000,0000,0000,,Now, it turns out that there's something \Nfundamental about antibiotics
Dialogue: 0,0:04:21.89,0:04:23.67,Default,,0000,0000,0000,,which makes it different from other drugs,
Dialogue: 0,0:04:23.67,0:04:25.69,Default,,0000,0000,0000,,which is that if I misuse antibiotics
Dialogue: 0,0:04:25.69,0:04:27.43,Default,,0000,0000,0000,,or I use antibiotics,
Dialogue: 0,0:04:27.43,0:04:31.29,Default,,0000,0000,0000,,not only am I affected but \Nothers are affected as well,
Dialogue: 0,0:04:31.29,0:04:33.63,Default,,0000,0000,0000,,in the same way as if I \Nchoose to drive to work
Dialogue: 0,0:04:33.63,0:04:36.27,Default,,0000,0000,0000,,or take a plane to go somewhere,
Dialogue: 0,0:04:36.27,0:04:38.24,Default,,0000,0000,0000,,that the costs I impose on others
Dialogue: 0,0:04:38.24,0:04:40.68,Default,,0000,0000,0000,,through global climate change go everywhere,
Dialogue: 0,0:04:40.68,0:04:43.46,Default,,0000,0000,0000,,and I don't necessarily take\Nthese costs into consideration.
Dialogue: 0,0:04:43.46,0:04:46.33,Default,,0000,0000,0000,,This is what economists might \Ncall a problem of the commons,
Dialogue: 0,0:04:46.33,0:04:48.31,Default,,0000,0000,0000,,and the problem of the commons is exactly
Dialogue: 0,0:04:48.31,0:04:50.74,Default,,0000,0000,0000,,what we face in the case \Nof antibiotics as well:
Dialogue: 0,0:04:50.74,0:04:52.89,Default,,0000,0000,0000,,that we don't consider —
Dialogue: 0,0:04:52.89,0:04:55.89,Default,,0000,0000,0000,,and we, including individuals, patients,
Dialogue: 0,0:04:55.89,0:04:59.05,Default,,0000,0000,0000,,hospitals, entire health systems —
Dialogue: 0,0:04:59.05,0:05:01.20,Default,,0000,0000,0000,,do not consider the costs \Nthat they impose on others
Dialogue: 0,0:05:01.20,0:05:03.55,Default,,0000,0000,0000,,by the way antibiotics are actually used.
Dialogue: 0,0:05:03.55,0:05:05.96,Default,,0000,0000,0000,,Now, that's a problem that's similar
Dialogue: 0,0:05:05.96,0:05:07.94,Default,,0000,0000,0000,,to another area that we all know about,
Dialogue: 0,0:05:07.94,0:05:09.87,Default,,0000,0000,0000,,which is of fuel use and energy,
Dialogue: 0,0:05:09.87,0:05:11.37,Default,,0000,0000,0000,,and of course energy use
Dialogue: 0,0:05:11.37,0:05:14.45,Default,,0000,0000,0000,,both depletes energy as well as
Dialogue: 0,0:05:14.45,0:05:17.71,Default,,0000,0000,0000,,leads to local pollution \Nand climate change.
Dialogue: 0,0:05:17.71,0:05:19.52,Default,,0000,0000,0000,,And typically, in the case of energy,
Dialogue: 0,0:05:19.52,0:05:21.83,Default,,0000,0000,0000,,there are two ways in which\Nyou can deal with the problem.
Dialogue: 0,0:05:21.83,0:05:25.58,Default,,0000,0000,0000,,One is, we can make better\Nuse of the oil that we have,
Dialogue: 0,0:05:25.58,0:05:27.69,Default,,0000,0000,0000,,and that's analogous to making better use
Dialogue: 0,0:05:27.69,0:05:29.24,Default,,0000,0000,0000,,of existing antibiotics,
Dialogue: 0,0:05:29.24,0:05:30.93,Default,,0000,0000,0000,,and we can do this in a number of ways
Dialogue: 0,0:05:30.93,0:05:33.16,Default,,0000,0000,0000,,that we'll talk about in a second,
Dialogue: 0,0:05:33.16,0:05:36.85,Default,,0000,0000,0000,,but the other option is the \N"drill, baby, drill" option,
Dialogue: 0,0:05:36.85,0:05:41.04,Default,,0000,0000,0000,,which in the case of antibiotics \Nis to go find new antibiotics.
Dialogue: 0,0:05:41.05,0:05:43.10,Default,,0000,0000,0000,,Now, these are not separate.
Dialogue: 0,0:05:43.10,0:05:46.52,Default,,0000,0000,0000,,They're related, because if we invest heavily
Dialogue: 0,0:05:46.52,0:05:48.81,Default,,0000,0000,0000,,in new oil wells,
Dialogue: 0,0:05:48.81,0:05:51.76,Default,,0000,0000,0000,,we reduce the incentives \Nfor conservation of oil
Dialogue: 0,0:05:51.76,0:05:54.29,Default,,0000,0000,0000,,in the same way that's going \Nto happen for antibiotics.
Dialogue: 0,0:05:54.29,0:05:56.45,Default,,0000,0000,0000,,The reverse is also going \Nto happen, which is that
Dialogue: 0,0:05:56.45,0:05:58.79,Default,,0000,0000,0000,,if we use our antibiotics appropriately,
Dialogue: 0,0:05:58.79,0:06:01.57,Default,,0000,0000,0000,,we don't necessarily have \Nto make the investments
Dialogue: 0,0:06:01.57,0:06:03.75,Default,,0000,0000,0000,,in new drug development.
Dialogue: 0,0:06:03.75,0:06:06.47,Default,,0000,0000,0000,,And if you thought that these two were entirely,
Dialogue: 0,0:06:06.47,0:06:08.29,Default,,0000,0000,0000,,fully balanced between these two options,
Dialogue: 0,0:06:08.29,0:06:10.47,Default,,0000,0000,0000,,you might consider the fact that
Dialogue: 0,0:06:10.47,0:06:12.74,Default,,0000,0000,0000,,this is really a game that we're playing.
Dialogue: 0,0:06:12.74,0:06:15.18,Default,,0000,0000,0000,,The game is really one of coevolution,
Dialogue: 0,0:06:15.18,0:06:18.12,Default,,0000,0000,0000,,and coevolution is, in \Nthis particular picture,
Dialogue: 0,0:06:18.12,0:06:20.47,Default,,0000,0000,0000,,between cheetahs and gazelles.
Dialogue: 0,0:06:20.47,0:06:22.09,Default,,0000,0000,0000,,Cheetahs have evolved to run faster,
Dialogue: 0,0:06:22.09,0:06:23.67,Default,,0000,0000,0000,,because if they didn't run faster,
Dialogue: 0,0:06:23.67,0:06:25.61,Default,,0000,0000,0000,,they wouldn't get any lunch.
Dialogue: 0,0:06:25.61,0:06:28.30,Default,,0000,0000,0000,,Gazelles have evolved to run faster because
Dialogue: 0,0:06:28.30,0:06:31.51,Default,,0000,0000,0000,,if they don't run faster, they would be lunch.
Dialogue: 0,0:06:31.51,0:06:34.40,Default,,0000,0000,0000,,Now, this is the game we're\Nplaying against the bacteria,
Dialogue: 0,0:06:34.40,0:06:36.45,Default,,0000,0000,0000,,except we're not the cheetahs,
Dialogue: 0,0:06:36.45,0:06:37.93,Default,,0000,0000,0000,,we're the gazelles,
Dialogue: 0,0:06:37.93,0:06:40.72,Default,,0000,0000,0000,,and the bacteria would,
Dialogue: 0,0:06:40.72,0:06:42.55,Default,,0000,0000,0000,,just in the course of this little talk,
Dialogue: 0,0:06:42.55,0:06:43.98,Default,,0000,0000,0000,,would have had kids and grandkids
Dialogue: 0,0:06:43.98,0:06:46.36,Default,,0000,0000,0000,,and figured out how to be resistant
Dialogue: 0,0:06:46.36,0:06:48.83,Default,,0000,0000,0000,,just by selection and trial and error,
Dialogue: 0,0:06:48.83,0:06:50.75,Default,,0000,0000,0000,,trying it over and over again.
Dialogue: 0,0:06:50.75,0:06:54.52,Default,,0000,0000,0000,,Whereas how do we stay \Nahead of the bacteria?
Dialogue: 0,0:06:54.52,0:06:56.57,Default,,0000,0000,0000,,We have drug discovery processes,
Dialogue: 0,0:06:56.57,0:06:58.20,Default,,0000,0000,0000,,screening molecules,
Dialogue: 0,0:06:58.20,0:06:59.93,Default,,0000,0000,0000,,we have clinical trials,
Dialogue: 0,0:06:59.93,0:07:02.08,Default,,0000,0000,0000,,and then, when we think we have a drug,
Dialogue: 0,0:07:02.08,0:07:05.82,Default,,0000,0000,0000,,then we have the FDA regulatory process.
Dialogue: 0,0:07:05.82,0:07:08.00,Default,,0000,0000,0000,,And once we go through all of that,
Dialogue: 0,0:07:08.00,0:07:10.27,Default,,0000,0000,0000,,then we try to stay one step ahead
Dialogue: 0,0:07:10.27,0:07:12.56,Default,,0000,0000,0000,,of the bacteria.
Dialogue: 0,0:07:12.56,0:07:15.34,Default,,0000,0000,0000,,Now, this is clearly not a \Ngame that can be sustained,
Dialogue: 0,0:07:15.34,0:07:16.48,Default,,0000,0000,0000,,or one that we can win
Dialogue: 0,0:07:16.48,0:07:18.31,Default,,0000,0000,0000,,by simply innovating to stay ahead.
Dialogue: 0,0:07:18.31,0:07:21.62,Default,,0000,0000,0000,,We've got to slow the pace of coevolution down,
Dialogue: 0,0:07:21.62,0:07:25.30,Default,,0000,0000,0000,,and there are ideas that we \Ncan borrow from energy
Dialogue: 0,0:07:25.30,0:07:27.07,Default,,0000,0000,0000,,that are helpful in thinking about
Dialogue: 0,0:07:27.07,0:07:28.61,Default,,0000,0000,0000,,how we might want to do this in the case
Dialogue: 0,0:07:28.61,0:07:30.15,Default,,0000,0000,0000,,of antibiotics as well.
Dialogue: 0,0:07:30.15,0:07:32.39,Default,,0000,0000,0000,,Now, if you think about how we deal with
Dialogue: 0,0:07:32.39,0:07:33.82,Default,,0000,0000,0000,,energy pricing, for instance,
Dialogue: 0,0:07:33.82,0:07:35.66,Default,,0000,0000,0000,,we consider emissions taxes,
Dialogue: 0,0:07:35.66,0:07:38.25,Default,,0000,0000,0000,,which means we're imposing \Nthe costs of pollution
Dialogue: 0,0:07:38.25,0:07:41.08,Default,,0000,0000,0000,,on people who actually use that energy.
Dialogue: 0,0:07:41.08,0:07:44.06,Default,,0000,0000,0000,,We might consider doing that for antibiotics as well,
Dialogue: 0,0:07:44.06,0:07:46.77,Default,,0000,0000,0000,,and perhaps that would make sure that antibiotics
Dialogue: 0,0:07:46.77,0:07:49.17,Default,,0000,0000,0000,,actually get used appropriately.
Dialogue: 0,0:07:49.17,0:07:51.20,Default,,0000,0000,0000,,There are clean energy subsidies,
Dialogue: 0,0:07:51.20,0:07:54.26,Default,,0000,0000,0000,,which are to switch to fuels\Nwhich don't pollute as much
Dialogue: 0,0:07:54.26,0:07:57.10,Default,,0000,0000,0000,,or perhaps don't need fossil fuels.
Dialogue: 0,0:07:57.10,0:07:59.96,Default,,0000,0000,0000,,Now, the analogy here is, perhaps we need
Dialogue: 0,0:07:59.96,0:08:02.22,Default,,0000,0000,0000,,to move away from using antibiotics,
Dialogue: 0,0:08:02.22,0:08:05.94,Default,,0000,0000,0000,,and if you think about it, what are \Ngood substitutes for antibiotics?
Dialogue: 0,0:08:05.94,0:08:08.10,Default,,0000,0000,0000,,Well, turns out that anything that reduces
Dialogue: 0,0:08:08.10,0:08:10.34,Default,,0000,0000,0000,,the need for the antibiotic would really work,
Dialogue: 0,0:08:10.34,0:08:13.48,Default,,0000,0000,0000,,so that could include improving\Nhospital infection control
Dialogue: 0,0:08:13.48,0:08:16.38,Default,,0000,0000,0000,,or vaccinating people,
Dialogue: 0,0:08:16.38,0:08:18.68,Default,,0000,0000,0000,,particularly against \Nthe seasonal influenza.
Dialogue: 0,0:08:18.68,0:08:21.21,Default,,0000,0000,0000,,And the seasonal flu is probably
Dialogue: 0,0:08:21.21,0:08:24.21,Default,,0000,0000,0000,,the biggest driver of antibiotic use,
Dialogue: 0,0:08:24.21,0:08:27.13,Default,,0000,0000,0000,,both in this country as well\Nas in many other countries,
Dialogue: 0,0:08:27.13,0:08:29.15,Default,,0000,0000,0000,,and that could really help.
Dialogue: 0,0:08:29.15,0:08:33.25,Default,,0000,0000,0000,,A third option might include\Nsomething like tradeable permits.
Dialogue: 0,0:08:33.25,0:08:37.50,Default,,0000,0000,0000,,And these seem like faraway scenarios,
Dialogue: 0,0:08:37.50,0:08:39.93,Default,,0000,0000,0000,,but if you consider the \Nfact that we might not
Dialogue: 0,0:08:39.93,0:08:43.31,Default,,0000,0000,0000,,have antibiotics for many \Npeople who have infections,
Dialogue: 0,0:08:43.31,0:08:45.55,Default,,0000,0000,0000,,we might consider the fact that we might
Dialogue: 0,0:08:45.55,0:08:47.86,Default,,0000,0000,0000,,want to allocate who actually gets to use
Dialogue: 0,0:08:47.86,0:08:50.57,Default,,0000,0000,0000,,some of these antibiotics over others,
Dialogue: 0,0:08:50.57,0:08:53.90,Default,,0000,0000,0000,,and some of these might have to\Nbe on the basis of clinical need,
Dialogue: 0,0:08:53.90,0:08:55.83,Default,,0000,0000,0000,,but also on the basis of pricing.
Dialogue: 0,0:08:55.83,0:08:57.74,Default,,0000,0000,0000,,And certainly consumer education works.
Dialogue: 0,0:08:57.74,0:09:00.34,Default,,0000,0000,0000,,Very often, people overuse antibiotics
Dialogue: 0,0:09:00.34,0:09:02.62,Default,,0000,0000,0000,,or prescribe too much without necessarily
Dialogue: 0,0:09:02.62,0:09:04.23,Default,,0000,0000,0000,,knowing that they do so,
Dialogue: 0,0:09:04.23,0:09:05.66,Default,,0000,0000,0000,,and feedback mechanisms
Dialogue: 0,0:09:05.66,0:09:07.56,Default,,0000,0000,0000,,have been found to be useful,
Dialogue: 0,0:09:07.56,0:09:09.49,Default,,0000,0000,0000,,both on energy —
Dialogue: 0,0:09:09.49,0:09:11.03,Default,,0000,0000,0000,,When you tell someone that they're using
Dialogue: 0,0:09:11.03,0:09:12.95,Default,,0000,0000,0000,,a lot of energy during peak hour,
Dialogue: 0,0:09:12.95,0:09:14.42,Default,,0000,0000,0000,,they tend to cut back,
Dialogue: 0,0:09:14.42,0:09:16.18,Default,,0000,0000,0000,,and the same sort of example has been performed
Dialogue: 0,0:09:16.18,0:09:17.99,Default,,0000,0000,0000,,even in the case of antibiotics.
Dialogue: 0,0:09:17.99,0:09:19.97,Default,,0000,0000,0000,,A hospital in St. Louis basically would put up
Dialogue: 0,0:09:19.97,0:09:24.17,Default,,0000,0000,0000,,on a chart the names of surgeons
Dialogue: 0,0:09:24.17,0:09:26.38,Default,,0000,0000,0000,,in the ordering of how much antibiotics they'd used
Dialogue: 0,0:09:26.38,0:09:28.33,Default,,0000,0000,0000,,in the previous month,
Dialogue: 0,0:09:28.33,0:09:30.67,Default,,0000,0000,0000,,and this was purely an \Ninformational feedback,
Dialogue: 0,0:09:30.67,0:09:31.85,Default,,0000,0000,0000,,there was no shaming,
Dialogue: 0,0:09:31.85,0:09:33.99,Default,,0000,0000,0000,,but essentially that provided \Nsome information back
Dialogue: 0,0:09:33.99,0:09:35.94,Default,,0000,0000,0000,,to surgeons that maybe they could rethink
Dialogue: 0,0:09:35.94,0:09:38.17,Default,,0000,0000,0000,,how they were using antibiotics.
Dialogue: 0,0:09:38.17,0:09:40.19,Default,,0000,0000,0000,,Now, there's a lot that can be done
Dialogue: 0,0:09:40.19,0:09:42.34,Default,,0000,0000,0000,,on the supply side as well.
Dialogue: 0,0:09:42.34,0:09:44.11,Default,,0000,0000,0000,,If you look at the price of penicillin,
Dialogue: 0,0:09:44.11,0:09:45.76,Default,,0000,0000,0000,,the cost per day is about 10 cents.
Dialogue: 0,0:09:45.76,0:09:47.52,Default,,0000,0000,0000,,It's a fairly cheap drug.
Dialogue: 0,0:09:47.52,0:09:49.66,Default,,0000,0000,0000,,If you take drugs that have\Nbeen introduced since then —
Dialogue: 0,0:09:49.66,0:09:52.30,Default,,0000,0000,0000,,linezolid or daptomycin —
Dialogue: 0,0:09:52.30,0:09:54.18,Default,,0000,0000,0000,,those are significantly more expensive,
Dialogue: 0,0:09:54.18,0:09:59.63,Default,,0000,0000,0000,,so to a world that has been used to\Npaying 10 cents a day for antibiotics,
Dialogue: 0,0:09:59.63,0:10:02.16,Default,,0000,0000,0000,,the idea of paying 180 dollars per day
Dialogue: 0,0:10:02.16,0:10:03.73,Default,,0000,0000,0000,,seems like a lot.
Dialogue: 0,0:10:03.73,0:10:05.72,Default,,0000,0000,0000,,But what is that really telling us?
Dialogue: 0,0:10:05.72,0:10:07.68,Default,,0000,0000,0000,,That price is telling us
Dialogue: 0,0:10:07.68,0:10:09.58,Default,,0000,0000,0000,,that we should no longer
Dialogue: 0,0:10:09.58,0:10:13.70,Default,,0000,0000,0000,,take cheap, effective \Nantibiotics as a given
Dialogue: 0,0:10:13.70,0:10:15.46,Default,,0000,0000,0000,,into the foreseeable future,
Dialogue: 0,0:10:15.46,0:10:17.99,Default,,0000,0000,0000,,and that price is a signal to us
Dialogue: 0,0:10:17.99,0:10:19.60,Default,,0000,0000,0000,,that perhaps we need to be paying
Dialogue: 0,0:10:19.60,0:10:22.16,Default,,0000,0000,0000,,much more attention to conservation.
Dialogue: 0,0:10:22.16,0:10:24.86,Default,,0000,0000,0000,,That price is also a signal
Dialogue: 0,0:10:24.86,0:10:27.74,Default,,0000,0000,0000,,that maybe we need to start\Nlooking at other technologies,
Dialogue: 0,0:10:27.74,0:10:30.39,Default,,0000,0000,0000,,in the same way that \Ngasoline prices are a signal
Dialogue: 0,0:10:30.39,0:10:32.98,Default,,0000,0000,0000,,and an impetus, to, say,
Dialogue: 0,0:10:32.98,0:10:34.84,Default,,0000,0000,0000,,the development of electric cars.
Dialogue: 0,0:10:34.84,0:10:36.62,Default,,0000,0000,0000,,Prices are important signals
Dialogue: 0,0:10:36.62,0:10:38.21,Default,,0000,0000,0000,,and we need to pay attention,
Dialogue: 0,0:10:38.21,0:10:40.66,Default,,0000,0000,0000,,but we also need to consider the fact that
Dialogue: 0,0:10:40.66,0:10:44.91,Default,,0000,0000,0000,,although these high prices\Nseem unusual for antibiotics,
Dialogue: 0,0:10:44.91,0:10:47.15,Default,,0000,0000,0000,,they're nothing compared to the price per day
Dialogue: 0,0:10:47.15,0:10:48.54,Default,,0000,0000,0000,,of some cancer drugs,
Dialogue: 0,0:10:48.54,0:10:51.90,Default,,0000,0000,0000,,which might save a patient's life only\Nfor a few months or perhaps a year,
Dialogue: 0,0:10:51.90,0:10:53.68,Default,,0000,0000,0000,,whereas antibiotics would potentially
Dialogue: 0,0:10:53.68,0:10:55.50,Default,,0000,0000,0000,,save a patient's life forever.
Dialogue: 0,0:10:55.50,0:10:56.82,Default,,0000,0000,0000,,So this is going to involve
Dialogue: 0,0:10:56.82,0:10:58.78,Default,,0000,0000,0000,,a whole new paradigm shift,
Dialogue: 0,0:10:58.78,0:11:00.64,Default,,0000,0000,0000,,and it's also a scary shift because
Dialogue: 0,0:11:00.64,0:11:02.97,Default,,0000,0000,0000,,in many parts of this country,
Dialogue: 0,0:11:02.97,0:11:04.71,Default,,0000,0000,0000,,in many parts of the world,
Dialogue: 0,0:11:04.71,0:11:06.78,Default,,0000,0000,0000,,the idea of paying 200 dollars
Dialogue: 0,0:11:06.78,0:11:09.67,Default,,0000,0000,0000,,for a day of antibiotic treatment
Dialogue: 0,0:11:09.67,0:11:12.21,Default,,0000,0000,0000,,is simply unimaginable.
Dialogue: 0,0:11:12.21,0:11:13.95,Default,,0000,0000,0000,,So we need to think about that.
Dialogue: 0,0:11:13.95,0:11:15.76,Default,,0000,0000,0000,,Now, there are backstop options,
Dialogue: 0,0:11:15.76,0:11:18.44,Default,,0000,0000,0000,,which is other alternative technologies
Dialogue: 0,0:11:18.44,0:11:19.63,Default,,0000,0000,0000,,that people are working on.
Dialogue: 0,0:11:19.63,0:11:22.28,Default,,0000,0000,0000,,It includes bacteriophages, probiotics,
Dialogue: 0,0:11:22.28,0:11:26.33,Default,,0000,0000,0000,,quorum sensing, synbiotics.
Dialogue: 0,0:11:26.33,0:11:29.37,Default,,0000,0000,0000,,Now, all of these are useful avenues to pursue,
Dialogue: 0,0:11:29.37,0:11:31.98,Default,,0000,0000,0000,,and they will become even more lucrative
Dialogue: 0,0:11:31.98,0:11:35.06,Default,,0000,0000,0000,,when the price of new \Nantibiotics starts going higher,
Dialogue: 0,0:11:35.06,0:11:37.96,Default,,0000,0000,0000,,and we've seen that the\Nmarket does actually respond,
Dialogue: 0,0:11:37.96,0:11:39.96,Default,,0000,0000,0000,,and the government is now considering
Dialogue: 0,0:11:39.96,0:11:43.73,Default,,0000,0000,0000,,ways of subsidizing new \Nantibiotics and development.
Dialogue: 0,0:11:43.73,0:11:45.46,Default,,0000,0000,0000,,But there are challenges here.
Dialogue: 0,0:11:45.46,0:11:47.03,Default,,0000,0000,0000,,We don't want to just throw money at a problem.
Dialogue: 0,0:11:47.03,0:11:48.55,Default,,0000,0000,0000,,What we want to be able to do
Dialogue: 0,0:11:48.55,0:11:50.83,Default,,0000,0000,0000,,is invest in new antibiotics
Dialogue: 0,0:11:50.83,0:11:53.80,Default,,0000,0000,0000,,in ways that actually encourage
Dialogue: 0,0:11:53.80,0:11:56.82,Default,,0000,0000,0000,,appropriate use and sales of those antibiotics,
Dialogue: 0,0:11:56.82,0:11:59.29,Default,,0000,0000,0000,,and that really is the challenge here.
Dialogue: 0,0:11:59.29,0:12:01.62,Default,,0000,0000,0000,,Now, going back to these technologies,
Dialogue: 0,0:12:01.62,0:12:03.98,Default,,0000,0000,0000,,you all remember the line from that famous
Dialogue: 0,0:12:03.98,0:12:06.20,Default,,0000,0000,0000,,dinosaur film, "Nature will find a way."
Dialogue: 0,0:12:06.20,0:12:09.52,Default,,0000,0000,0000,,So it's not as if these are \Npermanent solutions.
Dialogue: 0,0:12:09.52,0:12:13.61,Default,,0000,0000,0000,,We really have to remember that,\Nwhatever the technology might be,
Dialogue: 0,0:12:13.61,0:12:16.49,Default,,0000,0000,0000,,that nature will find some \Nway to work around it.
Dialogue: 0,0:12:16.49,0:12:18.56,Default,,0000,0000,0000,,You might think, well, \Nthis is just a problem
Dialogue: 0,0:12:18.56,0:12:21.30,Default,,0000,0000,0000,,just with antibiotics and with bacteria,
Dialogue: 0,0:12:21.30,0:12:23.25,Default,,0000,0000,0000,,but it turns out that we \Nhave the exact same
Dialogue: 0,0:12:23.25,0:12:25.98,Default,,0000,0000,0000,,identical problem in \Nmany other fields as well,
Dialogue: 0,0:12:25.98,0:12:28.93,Default,,0000,0000,0000,,with multidrug-resistant tuberculosis,
Dialogue: 0,0:12:28.93,0:12:32.50,Default,,0000,0000,0000,,which is a serious problem \Nin India and South Africa.
Dialogue: 0,0:12:32.50,0:12:34.28,Default,,0000,0000,0000,,Thousands of patients are dying because
Dialogue: 0,0:12:34.28,0:12:36.12,Default,,0000,0000,0000,,the second-line drugs are so expensive,
Dialogue: 0,0:12:36.12,0:12:38.34,Default,,0000,0000,0000,,and in some instances, even those don't work
Dialogue: 0,0:12:38.34,0:12:40.41,Default,,0000,0000,0000,,and you have XDR TB.
Dialogue: 0,0:12:40.41,0:12:42.22,Default,,0000,0000,0000,,Viruses are becoming resistant.
Dialogue: 0,0:12:42.22,0:12:45.39,Default,,0000,0000,0000,,Agricultural pests. Malaria parasites.
Dialogue: 0,0:12:45.39,0:12:47.17,Default,,0000,0000,0000,,Right now, much of the world depends on
Dialogue: 0,0:12:47.17,0:12:50.87,Default,,0000,0000,0000,,one drug, artemisinin drugs,
Dialogue: 0,0:12:50.87,0:12:52.83,Default,,0000,0000,0000,,essentially to treat malaria.
Dialogue: 0,0:12:52.83,0:12:55.41,Default,,0000,0000,0000,,Resistance to artemisinin has already emerged,
Dialogue: 0,0:12:55.41,0:12:57.77,Default,,0000,0000,0000,,and if this were to become widespread,
Dialogue: 0,0:12:57.77,0:12:59.12,Default,,0000,0000,0000,,that puts at risk
Dialogue: 0,0:12:59.12,0:13:02.01,Default,,0000,0000,0000,,the single drug that we have to \Ntreat malaria around the world
Dialogue: 0,0:13:02.01,0:13:05.22,Default,,0000,0000,0000,,in a way that's currently \Nsafe and efficacious.
Dialogue: 0,0:13:05.22,0:13:07.02,Default,,0000,0000,0000,,Mosquitos develop resistance.
Dialogue: 0,0:13:07.02,0:13:09.26,Default,,0000,0000,0000,,If you have kids, you probably \Nknow about head lice,
Dialogue: 0,0:13:09.26,0:13:10.97,Default,,0000,0000,0000,,and if you're from New York City,
Dialogue: 0,0:13:10.97,0:13:13.70,Default,,0000,0000,0000,,I understand that the \Nspecialty there is bedbugs.
Dialogue: 0,0:13:13.70,0:13:15.96,Default,,0000,0000,0000,,So those are also resistant.
Dialogue: 0,0:13:15.96,0:13:18.84,Default,,0000,0000,0000,,And we have to bring an\Nexample from across the pond.
Dialogue: 0,0:13:18.84,0:13:21.19,Default,,0000,0000,0000,,Turns out that rats are \Nalso resistant to poisons.
Dialogue: 0,0:13:21.19,0:13:23.89,Default,,0000,0000,0000,,Now, what's common \Nto all of these things is
Dialogue: 0,0:13:23.89,0:13:26.60,Default,,0000,0000,0000,,the idea that we've had these technologies
Dialogue: 0,0:13:26.60,0:13:31.22,Default,,0000,0000,0000,,to control nature only for \Nthe last 70, 80 or 100 years
Dialogue: 0,0:13:31.22,0:13:34.25,Default,,0000,0000,0000,,and essentially in a blink,
Dialogue: 0,0:13:34.25,0:13:36.80,Default,,0000,0000,0000,,we have squandered our ability to control,
Dialogue: 0,0:13:36.80,0:13:39.29,Default,,0000,0000,0000,,because we have not recognized
Dialogue: 0,0:13:39.29,0:13:42.10,Default,,0000,0000,0000,,that natural selection and \Nevolution was going to find
Dialogue: 0,0:13:42.10,0:13:43.27,Default,,0000,0000,0000,,a way to get back,
Dialogue: 0,0:13:43.27,0:13:45.32,Default,,0000,0000,0000,,and we need to completely rethink
Dialogue: 0,0:13:45.32,0:13:47.67,Default,,0000,0000,0000,,how we're going to use
Dialogue: 0,0:13:47.67,0:13:50.76,Default,,0000,0000,0000,,measures to control biological organisms,
Dialogue: 0,0:13:50.76,0:13:54.22,Default,,0000,0000,0000,,and rethink how we incentivize
Dialogue: 0,0:13:54.22,0:13:56.45,Default,,0000,0000,0000,,the development, introduction,
Dialogue: 0,0:13:56.45,0:13:59.12,Default,,0000,0000,0000,,in the case of antibiotics prescription,
Dialogue: 0,0:13:59.12,0:14:02.89,Default,,0000,0000,0000,,and use of these valuable resources.
Dialogue: 0,0:14:02.89,0:14:05.27,Default,,0000,0000,0000,,And we really now need to \Nstart thinking about them
Dialogue: 0,0:14:05.27,0:14:07.23,Default,,0000,0000,0000,,as natural resources.
Dialogue: 0,0:14:07.23,0:14:09.47,Default,,0000,0000,0000,,And so we stand at a crossroads.
Dialogue: 0,0:14:09.47,0:14:12.62,Default,,0000,0000,0000,,An option is to go through that rethinking
Dialogue: 0,0:14:12.62,0:14:14.44,Default,,0000,0000,0000,,and carefully consider incentives
Dialogue: 0,0:14:14.44,0:14:16.99,Default,,0000,0000,0000,,to change how we do business.
Dialogue: 0,0:14:16.99,0:14:19.25,Default,,0000,0000,0000,,The alternative is
Dialogue: 0,0:14:19.25,0:14:22.34,Default,,0000,0000,0000,,a world in which even a blade of grass
Dialogue: 0,0:14:22.34,0:14:24.76,Default,,0000,0000,0000,,is a potentially lethal weapon.
Dialogue: 0,0:14:24.76,0:14:26.56,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:14:26.56,0:14:29.30,Default,,0000,0000,0000,,(Applause)