WEBVTT 00:00:00.921 --> 00:00:02.918 This is my great uncle, 00:00:02.918 --> 00:00:05.936 my father's father's younger brother. 00:00:05.936 --> 00:00:07.902 His name was Joe McKenna. 00:00:08.142 --> 00:00:13.089 He was a young husband and a semi-pro basketball player 00:00:13.089 --> 00:00:16.417 and a fireman in New York City. 00:00:17.407 --> 00:00:20.007 Family history says he loved being a fireman, 00:00:20.007 --> 00:00:23.542 and so in 1938, on one of his days off, 00:00:23.542 --> 00:00:26.319 he elected to hang out at the firehouse. 00:00:27.019 --> 00:00:31.218 To make himself useful that day, he started polishing all the brass, 00:00:31.218 --> 00:00:34.612 the railings on the fire truck, the fittings on the walls, 00:00:34.612 --> 00:00:36.957 and one of the fire hose nozzles, 00:00:36.957 --> 00:00:39.465 a giant, heavy piece of metal, 00:00:39.465 --> 00:00:43.074 toppled off a shelf and hit him. 00:00:43.574 --> 00:00:47.382 A few days later, his shoulder started to hurt. 00:00:47.382 --> 00:00:50.656 Two days after that, he spiked a fever. 00:00:50.656 --> 00:00:53.141 The fever climbed and climbed. 00:00:53.141 --> 00:00:55.091 His wife was taking care of him, 00:00:55.091 --> 00:00:59.393 but nothing she did made a difference, and when they got the local doctor in, 00:00:59.393 --> 00:01:01.679 nothing he did mattered either. NOTE Paragraph 00:01:02.149 --> 00:01:05.460 They flagged down a cab and took him to the hospital. 00:01:05.911 --> 00:01:09.905 The nurses there recognized right away that he had an infection, 00:01:09.905 --> 00:01:14.061 what at the time they would have called "blood poisoning," 00:01:14.061 --> 00:01:16.174 and though they probably didn't say it, 00:01:16.174 --> 00:01:18.031 they would have known right away 00:01:18.031 --> 00:01:21.430 that there was nothing they could do. NOTE Paragraph 00:01:21.770 --> 00:01:24.788 There was nothing they could do because the things we use now 00:01:24.788 --> 00:01:27.437 to cure infections didn't exist yet. 00:01:27.737 --> 00:01:31.173 The first test of penicillin, the first antibiotic, 00:01:31.173 --> 00:01:33.843 was three years in the future. 00:01:33.843 --> 00:01:38.547 People who got infections either recovered, if they were lucky, 00:01:38.547 --> 00:01:40.042 or they died. 00:01:40.322 --> 00:01:42.411 My great uncle was not lucky. 00:01:42.411 --> 00:01:45.708 He was in the hospital for a week, shaking with chills, 00:01:45.708 --> 00:01:47.566 dehydrated and delirious, 00:01:47.566 --> 00:01:50.468 sinking into a coma as his organs failed. 00:01:50.468 --> 00:01:52.604 His condition grew so desperate 00:01:52.604 --> 00:01:57.234 that the people from his firehouse lined up to give him transfusions 00:01:57.234 --> 00:02:01.097 hoping to dilute the infection surging through his blood. NOTE Paragraph 00:02:01.497 --> 00:02:04.603 Nothing worked. He died. 00:02:05.143 --> 00:02:07.705 He was 30 years old. NOTE Paragraph 00:02:08.115 --> 00:02:10.088 If you look back through history, 00:02:10.088 --> 00:02:13.362 most people died the way my great uncle died. 00:02:13.362 --> 00:02:16.032 Most people didn't die of cancer or heart disease, 00:02:16.032 --> 00:02:20.120 the lifestyle diseases that afflict us in the West today. 00:02:20.490 --> 00:02:24.229 They didn't die of those diseases because they didn't live long enough 00:02:24.229 --> 00:02:26.225 to develop them. 00:02:26.225 --> 00:02:28.338 They died of injuries -- 00:02:28.338 --> 00:02:30.823 being gored by an ox, 00:02:30.823 --> 00:02:32.727 shot on a battlefield, 00:02:32.727 --> 00:02:36.465 crushed in one of the new factories of the Industrial Revolution -- 00:02:36.465 --> 00:02:39.846 and most of the time from infection, 00:02:39.846 --> 00:02:43.352 which finished what those injuries began. NOTE Paragraph 00:02:44.492 --> 00:02:48.024 All of that changed when antibiotics arrived. 00:02:48.599 --> 00:02:52.198 Suddenly, infections that had been a death sentence 00:02:52.198 --> 00:02:55.588 became something you recovered from in days. 00:02:55.588 --> 00:02:58.630 It seemed like a miracle, 00:02:58.630 --> 00:03:04.954 and ever since, we have been living inside the golden epoch of the miracle drugs. NOTE Paragraph 00:03:05.294 --> 00:03:09.241 And now, we are coming to an end of it. 00:03:09.241 --> 00:03:14.303 My great uncle died in the last days of the pre-antibiotic era. 00:03:14.303 --> 00:03:19.457 We stand today on the threshold of the post-antibiotic era, 00:03:19.457 --> 00:03:23.219 in the earliest days of a time when simple infections 00:03:23.219 --> 00:03:27.928 such as the one Joe had will kill people once again. NOTE Paragraph 00:03:28.884 --> 00:03:32.015 In fact, they already are. 00:03:32.785 --> 00:03:35.618 People are dying of infections again because of a phenomenon 00:03:35.618 --> 00:03:37.961 called antibiotic resistance. 00:03:38.381 --> 00:03:40.119 Briefly, it works like this. 00:03:40.119 --> 00:03:45.091 Bacteria compete against each other for resources, for food, 00:03:45.091 --> 00:03:49.758 by manufacturing lethal compounds that they direct against each other. 00:03:49.758 --> 00:03:52.103 Other bacteria, to protect themselves, 00:03:52.103 --> 00:03:55.354 evolve defenses against that chemical attack. 00:03:55.354 --> 00:03:57.676 When we first made antibiotics, 00:03:57.676 --> 00:04:01.878 we took those compounds into the lab and made our own versions of them, 00:04:01.878 --> 00:04:06.336 and bacteria responded to our attack the way they always had. NOTE Paragraph 00:04:07.674 --> 00:04:09.898 Here is what happened next: 00:04:10.098 --> 00:04:13.488 Penicillin was distributed in 1943, 00:04:13.488 --> 00:04:18.619 and widespread penicillin resistance arrived by 1945. 00:04:18.619 --> 00:04:21.568 Vancomycin arrived in 1972, 00:04:21.568 --> 00:04:24.668 vancomycin resistance in 1988. 00:04:25.028 --> 00:04:27.150 Imipenem in 1985, 00:04:27.150 --> 00:04:29.922 and resistance to in 1998. 00:04:30.192 --> 00:04:33.860 Daptomycin, one of the most recent drugs, in 2003, 00:04:33.860 --> 00:04:38.225 and resistance to it just a year later in 2004. NOTE Paragraph 00:04:38.575 --> 00:04:42.335 For 70 years, we played a game of leapfrog -- 00:04:42.335 --> 00:04:45.261 our drug and their resistance, 00:04:45.261 --> 00:04:48.906 and then another drug, and then resistance again -- 00:04:48.906 --> 00:04:51.217 and now the game is ending. 00:04:51.437 --> 00:04:55.477 Bacteria develop resistance so quickly that pharmaceutical companies 00:04:55.477 --> 00:04:59.842 have decided making antibiotics is not in their best interest, 00:04:59.842 --> 00:05:02.652 so there are infections moving across the world 00:05:02.652 --> 00:05:06.111 for which, out of the more than 100 antibiotics 00:05:06.111 --> 00:05:08.340 available on the market, 00:05:08.340 --> 00:05:11.754 two drugs might work with side effects, 00:05:11.754 --> 00:05:14.238 or one drug, 00:05:14.238 --> 00:05:15.646 or none. NOTE Paragraph 00:05:16.096 --> 00:05:17.668 This is what that looks like. 00:05:18.278 --> 00:05:22.458 In 2000, the Centers for Disease Control and Prevention, the CDC, 00:05:22.458 --> 00:05:24.501 identified a single case 00:05:24.501 --> 00:05:26.753 in a hospital in North Carolina 00:05:26.753 --> 00:05:30.486 of an infection resistant to all but two drugs. 00:05:30.886 --> 00:05:35.205 Today, that infection, known as KPC, 00:05:35.205 --> 00:05:37.805 has spread to every state but three, 00:05:37.805 --> 00:05:40.150 and to South America, Europe 00:05:40.150 --> 00:05:42.357 and the Middle East. 00:05:42.867 --> 00:05:45.189 In 2008, doctors in Sweden 00:05:45.189 --> 00:05:47.975 diagnosed a man from India with a different infection 00:05:47.975 --> 00:05:51.690 resistant to all but one drug that time. 00:05:51.690 --> 00:05:53.919 The gene that creates that resistance, 00:05:53.919 --> 00:06:00.444 known as NDM, has now spread from India into China, Asia, Africa, 00:06:00.444 --> 00:06:04.809 Europe and Canada, and the United States. NOTE Paragraph 00:06:05.129 --> 00:06:07.688 It would be natural to hope 00:06:07.688 --> 00:06:11.287 that these infections are extraordinary cases, 00:06:11.287 --> 00:06:13.145 but in fact, 00:06:13.145 --> 00:06:15.606 in the United States and Europe, 00:06:15.606 --> 00:06:18.322 50,000 people a year 00:06:18.322 --> 00:06:22.446 die of infections which no drugs can help. 00:06:22.966 --> 00:06:26.008 A project chartered by the British government 00:06:26.008 --> 00:06:29.746 known as the Review on Antimicrobial Resistance 00:06:29.746 --> 00:06:37.118 estimates that the worldwide toll right now is 700,000 deaths a year. NOTE Paragraph 00:06:38.291 --> 00:06:42.655 That is a lot of deaths, 00:06:42.655 --> 00:06:45.767 and yet, the chances are good that you don't feel at risk, 00:06:45.767 --> 00:06:48.995 that you imagine these people were hospital patients 00:06:48.995 --> 00:06:50.713 in intensive care units 00:06:50.713 --> 00:06:54.660 or nursing home residents near the ends of their lives, 00:06:54.660 --> 00:06:57.841 people whose infections are remote from us, 00:06:57.841 --> 00:07:01.045 in situations we can't identify with. NOTE Paragraph 00:07:02.455 --> 00:07:05.852 What you didn't think about, none of us do, 00:07:05.852 --> 00:07:10.818 is that antibiotics support almost all of modern life. NOTE Paragraph 00:07:11.721 --> 00:07:13.932 If we lost antibiotics, 00:07:13.932 --> 00:07:15.386 here's what else we'd lose: 00:07:15.836 --> 00:07:20.015 First, any protection for people with weakened immune systems -- 00:07:20.015 --> 00:07:23.475 cancer patients, AIDS patients, 00:07:23.475 --> 00:07:27.979 transplant recipients, premature babies. NOTE Paragraph 00:07:27.979 --> 00:07:32.391 Next, any treatment that installs foreign objects in the body: 00:07:32.391 --> 00:07:36.269 stents for stroke, pumps for diabetes, 00:07:36.269 --> 00:07:40.193 dialysis, joint replacements. 00:07:40.193 --> 00:07:43.908 How many athletic baby boomers need new hips and knees? 00:07:43.908 --> 00:07:46.717 A recent study estimates that without antibiotics, 00:07:46.717 --> 00:07:50.234 one out of ever six would die. NOTE Paragraph 00:07:50.664 --> 00:07:53.869 Next, we'd probably lose surgery. 00:07:53.869 --> 00:07:56.191 Many operations are preceded 00:07:56.191 --> 00:07:59.139 by prophylactic doses of antibiotics. 00:07:59.139 --> 00:08:00.811 Without that protection, 00:08:00.811 --> 00:08:05.015 we'd lose the ability to open the hidden spaces of the body. 00:08:05.015 --> 00:08:07.848 So no heart operations, 00:08:07.848 --> 00:08:10.680 no prostate biopsies, 00:08:10.680 --> 00:08:13.382 no Cesarean sections. 00:08:13.792 --> 00:08:18.444 We'd have to learn to fear infections that now seem minor. 00:08:18.784 --> 00:08:22.592 Strep throat used to cause heart failure. 00:08:22.592 --> 00:08:25.239 Skin infections led to amputations. 00:08:25.819 --> 00:08:28.722 Giving birth killed, in the cleanest hospitals, 00:08:28.722 --> 00:08:31.397 almost one woman out of every 100. 00:08:31.717 --> 00:08:36.550 Pneumonia took three children out of every 10. NOTE Paragraph 00:08:37.220 --> 00:08:39.333 More than anything else, 00:08:39.333 --> 00:08:43.708 we'd lose the confident way we live our everyday lives. 00:08:44.836 --> 00:08:49.043 If you knew that any injury could kill you, 00:08:49.043 --> 00:08:52.289 would you ride a motorcycle, 00:08:52.289 --> 00:08:55.500 bomb down a ski slope, 00:08:55.500 --> 00:08:58.976 climb a ladder to hang your Christmas lights, 00:08:58.976 --> 00:09:02.643 let your kid slide into home plate? 00:09:03.573 --> 00:09:06.638 After all, the first person to receive penicillin, 00:09:06.638 --> 00:09:10.516 a British policeman named Albert Alexander, 00:09:10.516 --> 00:09:14.858 who was so ravaged by infection that his scalp oozed pus 00:09:14.858 --> 00:09:17.783 and doctors had to take out an eye, 00:09:17.783 --> 00:09:21.162 was infected by doing something very simple. 00:09:22.172 --> 00:09:26.988 He walked into his garden and scratched his face on a thorn. 00:09:28.831 --> 00:09:32.481 That British project I mentioned which estimates that the worldwide toll 00:09:32.481 --> 00:09:36.358 right now is 700,000 deaths a year 00:09:36.358 --> 00:09:42.535 also predicts that if we can't get this under control by 2050, 00:09:42.535 --> 00:09:50.127 not long, the worldwide toll will be 10 million deaths a year. NOTE Paragraph 00:09:50.127 --> 00:09:52.829 How did we get to this point 00:09:52.829 --> 00:09:54.864 where what we have to look forward to 00:09:54.864 --> 00:09:58.347 is those terrifying numbers? 00:09:58.347 --> 00:10:02.535 The difficult answer is, we did it to ourselves. 00:10:02.875 --> 00:10:05.847 Resistance is an inevitable biological process, 00:10:05.847 --> 00:10:09.900 but we bear the responsibility for accelerating it. 00:10:10.490 --> 00:10:14.043 We did this by squandering antibiotics 00:10:14.043 --> 00:10:18.131 with a heedlessness that now seems shocking. 00:10:19.408 --> 00:10:23.494 Penicillin was sold over the counter until the 1950s. 00:10:23.494 --> 00:10:26.829 In much of the developing world, most antibiotics still are. 00:10:27.209 --> 00:10:30.971 In the United States, 50 percent 00:10:30.971 --> 00:10:34.663 of the antibiotics given in hospitals are unnecessary. 00:10:34.663 --> 00:10:39.037 Forty-five percent of the prescriptions written in doctor's offices 00:10:39.037 --> 00:10:43.010 are for conditions that antibiotics cannot help. 00:10:44.577 --> 00:10:47.247 And that's just in healthcare. 00:10:47.247 --> 00:10:52.100 On much of the planet, most meat animals get antibiotics every day of their lives, 00:10:52.100 --> 00:10:54.376 not to cure illnesses, 00:10:54.376 --> 00:10:57.835 but to fatten them up and to protect them against 00:10:57.835 --> 00:11:01.806 the factory farm conditions they are raised in. 00:11:01.806 --> 00:11:04.824 In the United States, possibly 80 percent 00:11:04.824 --> 00:11:11.527 of the antibiotics sold every year go to farm animals, not to humans, 00:11:11.527 --> 00:11:15.203 creating resistant bacteria that move off the farm 00:11:15.203 --> 00:11:17.827 in water, in dust, 00:11:17.827 --> 00:11:20.695 in the meat the animals become. 00:11:20.985 --> 00:11:23.910 Aquaculture depends on antibiotics too, 00:11:23.910 --> 00:11:25.559 particularly in Asia, 00:11:25.559 --> 00:11:28.902 and fruit growing relies on antibiotics 00:11:28.902 --> 00:11:33.801 to protect apples, pears, citrus, against disease. 00:11:34.491 --> 00:11:40.117 And because bacteria can pass their DNA to each other 00:11:40.117 --> 00:11:44.552 like a traveler handing off a suitcase at an airport, 00:11:44.552 --> 00:11:49.360 once we have encouraged that resistance into existence, 00:11:49.360 --> 00:11:51.587 there is no knowing where it will spread. NOTE Paragraph 00:11:53.723 --> 00:11:55.294 This was predictable. 00:11:55.674 --> 00:11:58.506 In fact, it was predicted 00:11:58.506 --> 00:12:02.941 by Alexander Fleming, the man who discovered penicillin. 00:12:02.941 --> 00:12:06.935 He was given the Nobel Prize in 1945 in recognition, 00:12:06.935 --> 00:12:11.282 and in an interview shortly after, this is what he said: NOTE Paragraph 00:12:11.282 --> 00:12:15.549 "The thoughtless person playing with penicillin treatment 00:12:15.549 --> 00:12:18.823 is morally responsible for the death of a man 00:12:18.823 --> 00:12:21.147 who succumbs to infection 00:12:21.147 --> 00:12:24.050 with a pencillin-resistant organism." 00:12:24.050 --> 00:12:28.335 He added, "I hope this evil can be averted." NOTE Paragraph 00:12:28.986 --> 00:12:31.842 Can we avert it? 00:12:31.842 --> 00:12:35.510 There are companies working on novel antibiotics, 00:12:35.510 --> 00:12:39.086 things the superbugs have never seen before. 00:12:39.086 --> 00:12:41.803 We need those new drugs badly, 00:12:41.803 --> 00:12:44.055 and we need incentives: 00:12:44.055 --> 00:12:46.586 discovery grants, extended patents, 00:12:46.586 --> 00:12:53.343 prizes, to lure other companies into making antibiotics again. NOTE Paragraph 00:12:53.343 --> 00:12:55.709 But that probably won't be enough. 00:12:56.059 --> 00:13:00.163 Here's why: Evolution always wins. 00:13:00.703 --> 00:13:04.627 Bacteria birth a new generation every 20 minutes. 00:13:04.627 --> 00:13:09.410 It takes pharmaceutical chemistry 10 years to derive a new drug. 00:13:09.410 --> 00:13:12.266 Every time we use an antibiotic, 00:13:12.266 --> 00:13:15.540 we give the bacteria billions of chances 00:13:15.540 --> 00:13:17.281 to crack the codes 00:13:17.281 --> 00:13:20.486 of the defenses we've constructed. 00:13:20.486 --> 00:13:22.877 There has never yet been a drug 00:13:22.877 --> 00:13:25.431 they could not defeat. NOTE Paragraph 00:13:25.431 --> 00:13:28.961 This is asymmetric warfare, 00:13:28.961 --> 00:13:32.969 but we can change the outcome. 00:13:33.929 --> 00:13:40.334 We could build systems to harvest data to tell us automatically and specifically 00:13:40.334 --> 00:13:43.263 how antibiotics are being used. 00:13:43.263 --> 00:13:46.096 We could build gatekeeping into drug order systems 00:13:46.096 --> 00:13:49.811 so that every prescription gets a second look. 00:13:49.811 --> 00:13:55.920 We could require agriculture to give up antibiotic use. 00:13:56.243 --> 00:13:59.275 We could build surveillance systems 00:13:59.275 --> 00:14:03.501 to tell us where resistance is emerging next. NOTE Paragraph 00:14:03.501 --> 00:14:05.814 Those are the tech solutions. 00:14:06.264 --> 00:14:08.888 They probably aren't enough either, 00:14:08.888 --> 00:14:12.117 unless we help. 00:14:15.785 --> 00:14:18.099 Antibiotic resistance is a habit. 00:14:18.479 --> 00:14:21.567 We all know how hard it is to change a habit. 00:14:21.567 --> 00:14:26.097 But as a society, we've done that in the past. 00:14:26.397 --> 00:14:29.972 People used to toss litter into the streets, 00:14:29.972 --> 00:14:31.737 used to not wear seatbelts, 00:14:31.737 --> 00:14:35.994 used to smoke inside public buildings. 00:14:36.404 --> 00:14:38.624 We don't do those things anymore. 00:14:39.144 --> 00:14:41.466 We don't trash the environment 00:14:41.466 --> 00:14:44.623 or court devastating accidents 00:14:44.623 --> 00:14:47.595 or expose others to the possibility of cancer, 00:14:47.595 --> 00:14:51.102 because we decided those things were expensive, 00:14:51.102 --> 00:14:55.175 destructive, not in our best interest. 00:14:55.815 --> 00:14:58.715 We changed social norms. 00:14:59.135 --> 00:15:03.279 We could change social norms around antibiotic use too. NOTE Paragraph 00:15:05.499 --> 00:15:07.774 I know that the scale of antibiotic resistance 00:15:07.774 --> 00:15:09.678 seems overwhelming, 00:15:09.678 --> 00:15:13.138 but if you've ever bought a fluorescent lightbulb 00:15:13.138 --> 00:15:15.854 because you were concerned about climate change, 00:15:15.854 --> 00:15:18.989 or read the label on a box of crackers 00:15:18.989 --> 00:15:23.470 because you think about the deforestation from palm oil, 00:15:23.470 --> 00:15:26.349 you already know what it feels like 00:15:26.349 --> 00:15:31.349 to take a tiny step to address an overwhelming problem. 00:15:31.829 --> 00:15:36.310 We could take those kinds of steps for antibiotic use too. 00:15:36.310 --> 00:15:43.947 We could forgo giving an antibiotic if we're not sure it's the right one. 00:15:44.251 --> 00:15:50.564 We could stop insisting on a prescription for our kid's ear infection 00:15:50.564 --> 00:15:52.462 before we're sure what caused it. 00:15:53.678 --> 00:15:57.045 We could ask every restaurant, 00:15:57.045 --> 00:15:58.856 every supermarket, 00:15:58.856 --> 00:16:00.476 where their meat comes from. 00:16:00.806 --> 00:16:02.640 We could promise each other 00:16:02.640 --> 00:16:06.745 never again to buy chicken or shrimp or fruit 00:16:06.745 --> 00:16:09.629 raised with routine antibiotic use, 00:16:09.629 --> 00:16:12.323 and if we did those things, 00:16:12.323 --> 00:16:16.815 we could slow down the arrival of the post-antibiotic world. NOTE Paragraph 00:16:17.547 --> 00:16:21.680 But we have to do it soon. 00:16:21.680 --> 00:16:26.185 Penicillin began the antibiotic era in 1943. 00:16:26.185 --> 00:16:31.891 In just 70 years, we walked ourselves up to the edge of disaster. 00:16:32.291 --> 00:16:34.613 We won't get 70 years 00:16:34.613 --> 00:16:38.339 to find our way back out again. NOTE Paragraph 00:16:38.769 --> 00:16:40.279 Thank you very much. NOTE Paragraph 00:16:40.789 --> 00:16:46.640 (Applause)