-
This is my great uncle,
-
my father's father's younger brother.
-
His name was Joe McKenna.
-
He was a young husband
and a semi-pro basketball player
-
and a fireman in New York City.
-
Family history says
he loved being a fireman,
-
and so in 1938, on one of his days off,
-
he elected to hang out at the firehouse.
-
To make himself useful that day,
he started polishing all the brass,
-
the railings on the fire truck,
the fittings on the walls,
-
and one of the fire hose nozzles,
-
a giant, heavy piece of metal,
-
toppled off a shelf and hit him.
-
A few days later,
his shoulder started to hurt.
-
Two days after that, he spiked a fever.
-
The fever climbed and climbed.
-
His wife was taking care of him,
-
but nothing she did made a difference,
and when they got the local doctor in,
-
nothing he did mattered either.
-
They flagged down a cab
and took him to the hospital.
-
The nurses there recognized right away
that he had an infection,
-
what at the time they would
have called "blood poisoning,"
-
and though they probably didn't say it,
-
they would have known right away
-
that there was nothing they could do.
-
There was nothing they could do
because the things we use now
-
to cure infections didn't exist yet.
-
The first test of penicillin,
the first antibiotic,
-
was three years in the future.
-
People who got infections
either recovered, if they were lucky,
-
or they died.
-
My great uncle was not lucky.
-
He was in the hospital for a week,
shaking with chills,
-
dehydrated and delirious,
-
sinking into a coma as his organs failed.
-
His condition grew so desperate
-
that the people from his firehouse
lined up to give him transfusions
-
hoping to dilute the infection
surging through his blood.
-
Nothing worked. He died.
-
He was 30 years old.
-
If you look back through history,
-
most people died the way
my great uncle died.
-
Most people didn't die
of cancer or heart disease,
-
the lifestyle diseases that afflict us
in the West today.
-
They didn't die of those diseases
because they didn't live long enough
-
to develop them.
-
They died of injuries --
-
being gored by an ox,
-
shot on a battlefield,
-
crushed in one of the new factories
of the Industrial Revolution --
-
and most of the time from infection,
-
which finished what those injuries began.
-
All of that changed
when antibiotics arrived.
-
Suddenly, infections that had
been a death sentence
-
became something
you recovered from in days.
-
It seemed like a miracle,
-
and ever since, we have been living inside
the golden epoch of the miracle drugs.
-
And now, we are coming to an end of it.
-
My great uncle died in the last days
of the pre-antibiotic era.
-
We stand today on the threshold
of the post-antibiotic era,
-
in the earliest days of a time
when simple infections
-
such as the one Joe had
will kill people once again.
-
In fact, they already are.
-
People are dying of infections again
because of a phenomenon
-
called antibiotic resistance.
-
Briefly, it works like this.
-
Bacteria compete against each other
for resources, for food,
-
by manufacturing lethal compounds
that they direct against each other.
-
Other bacteria, to protect themselves,
-
evolve defenses against
that chemical attack.
-
When we first made antibiotics,
-
we took those compounds into the lab
and made our own versions of them,
-
and bacteria responded to our attack
the way they always had.
-
Here is what happened next:
-
Penicillin was distributed in 1943,
-
and widespread penicillin resistance
arrived by 1945.
-
Vancomycin arrived in 1972,
-
vancomycin resistance in 1988.
-
Imipenem in 1985,
-
and resistance to in 1998.
-
Daptomycin, one of
the most recent drugs, in 2003,
-
and resistance to it
just a year later in 2004.
-
For 70 years, we played
a game of leapfrog --
-
our drug and their resistance,
-
and then another drug,
and then resistance again --
-
and now the game is ending.
-
Bacteria develop resistance so quickly
that pharmaceutical companies
-
have decided making antibiotics
is not in their best interest,
-
so there are infections
moving across the world
-
for which, out of the more
than 100 antibiotics
-
available on the market,
-
two drugs might work with side effects,
-
or one drug,
-
or none.
-
This is what that looks like.
-
In 2000, the Centers for Disease
Control and Prevention, the CDC,
-
identified a single case
-
in a hospital in North Carolina
-
of an infection resistant
to all but two drugs.
-
Today, that infection, known as KPC,
-
has spread to every state but three,
-
and to South America, Europe
-
and the Middle East.
-
In 2008, doctors in Sweden
-
diagnosed a man from India
with a different infection
-
resistant to all but one drug that time.
-
The gene that creates that resistance,
-
known as NDM, has now spread
from India into China, Asia, Africa,
-
Europe and Canada, and the United States.
-
It would be natural to hope
-
that these infections
are extraordinary cases,
-
but in fact,
-
in the United States and Europe,
-
50,000 people a year
-
die of infections which no drugs can help.
-
A project chartered
by the British government
-
known as the Review
on Antimicrobial Resistance
-
estimates that the worldwide toll
right now is 700,000 deaths a year.
-
That is a lot of deaths,
-
and yet, the chances are good
that you don't feel at risk,
-
that you imagine these people
were hospital patients
-
in intensive care units
-
or nursing home residents
near the ends of their lives,
-
people whose infections
are remote from us,
-
in situations we can't identify with.
-
What you didn't think about,
none of us do,
-
is that antibiotics support
almost all of modern life.
-
If we lost antibiotics,
-
here's what else we'd lose:
-
First, any protection for people
with weakened immune systems --
-
cancer patients, AIDS patients,
-
transplant recipients, premature babies.
-
Next, any treatment that installs
foreign objects in the body:
-
stents for stroke, pumps for diabetes,
-
dialysis, joint replacements.
-
How many athletic baby boomers
need new hips and knees?
-
A recent study estimates
that without antibiotics,
-
one out of ever six would die.
-
Next, we'd probably lose surgery.
-
Many operations are preceded
-
by prophylactic doses of antibiotics.
-
Without that protection,
-
we'd lose the ability to open
the hidden spaces of the body.
-
So no heart operations,
-
no prostate biopsies,
-
no Cesarean sections.
-
We'd have to learn to fear infections
that now seem minor.
-
Strep throat used to cause heart failure.
-
Skin infections led to amputations.
-
Giving birth killed,
in the cleanest hospitals,
-
almost one woman out of every 100.
-
Pneumonia took three children
out of every 10.
-
More than anything else,
-
we'd lose the confident way
we live our everyday lives.
-
If you knew that any injury
could kill you,
-
would you ride a motorcycle,
-
bomb down a ski slope,
-
climb a ladder to hang
your Christmas lights,
-
let your kid slide into home plate?
-
After all, the first person
to receive penicillin,
-
a British policeman named
Albert Alexander,
-
who was so ravaged by infection
that his scalp oozed pus
-
and doctors had to take out an eye,
-
was infected by doing
something very simple.
-
He walked into his garden
and scratched his face on a thorn.
-
That British project I mentioned
which estimates that the worldwide toll
-
right now is 700,000 deaths a year
-
also predicts that if we can't
get this under control by 2050,
-
not long, the worldwide toll
will be 10 million deaths a year.
-
How did we get to this point
-
where what we have to look forward to
-
is those terrifying numbers?
-
The difficult answer is,
we did it to ourselves.
-
Resistance is an inevitable
biological process,
-
but we bear the responsibility
for accelerating it.
-
We did this by squandering antibiotics
-
with a heedlessness
that now seems shocking.
-
Penicillin was sold
over the counter until the 1950s.
-
In much of the developing world,
most antibiotics still are.
-
In the United States, 50 percent
-
of the antibiotics given
in hospitals are unnecessary.
-
Forty-five percent of the prescriptions
written in doctor's offices
-
are for conditions
that antibiotics cannot help.
-
And that's just in healthcare.
-
On much of the planet, most meat animals
get antibiotics every day of their lives,
-
not to cure illnesses,
-
but to fatten them up
and to protect them against
-
the factory farm conditions
they are raised in.
-
In the United States, possibly 80 percent
-
of the antibiotics sold every year
go to farm animals, not to humans,
-
creating resistant bacteria
that move off the farm
-
in water, in dust,
-
in the meat the animals become.
-
Aquaculture depends on antibiotics too,
-
particularly in Asia,
-
and fruit growing relies on antibiotics
-
to protect apples, pears,
citrus, against disease.
-
And because bacteria can pass
their DNA to each other
-
like a traveler handing off
a suitcase at an airport,
-
once we have encouraged
that resistance into existence,
-
there is no knowing where it will spread.
-
This was predictable.
-
In fact, it was predicted
-
by Alexander Fleming,
the man who discovered penicillin.
-
He was given the Nobel Prize
in 1945 in recognition,
-
and in an interview shortly after,
this is what he said:
-
"The thoughtless person playing
with penicillin treatment
-
is morally responsible
for the death of a man
-
who succumbs to infection
-
with a pencillin-resistant organism."
-
He added, "I hope this evil
can be averted."
-
Can we avert it?
-
There are companies working
on novel antibiotics,
-
things the superbugs
have never seen before.
-
We need those new drugs badly,
-
and we need incentives:
-
discovery grants, extended patents,
-
prizes, to lure other companies
into making antibiotics again.
-
But that probably won't be enough.
-
Here's why: Evolution always wins.
-
Bacteria birth a new generation
every 20 minutes.
-
It takes pharmaceutical chemistry
10 years to derive a new drug.
-
Every time we use an antibiotic,
-
we give the bacteria billions of chances
-
to crack the codes
-
of the defenses we've constructed.
-
There has never yet been a drug
-
they could not defeat.
-
This is asymmetric warfare,
-
but we can change the outcome.
-
We could build systems to harvest data
to tell us automatically and specifically
-
how antibiotics are being used.
-
We could build gatekeeping
into drug order systems
-
so that every prescription
gets a second look.
-
We could require agriculture
to give up antibiotic use.
-
We could build surveillance systems
-
to tell us where resistance
is emerging next.
-
Those are the tech solutions.
-
They probably aren't enough either,
-
unless we help.
-
Antibiotic resistance is a habit.
-
We all know how hard it is
to change a habit.
-
But as a society,
we've done that in the past.
-
People used to toss litter
into the streets,
-
used to not wear seatbelts,
-
used to smoke inside public buildings.
-
We don't do those things anymore.
-
We don't trash the environment
-
or court devastating accidents
-
or expose others
to the possibility of cancer,
-
because we decided those things
were expensive,
-
destructive, not in our best interest.
-
We changed social norms.
-
We could change social norms
around antibiotic use too.
-
I know that the scale
of antibiotic resistance
-
seems overwhelming,
-
but if you've ever bought
a fluorescent lightbulb
-
because you were concerned
about climate change,
-
or read the label on a box of crackers
-
because you think about
the deforestation from palm oil,
-
you already know what it feels like
-
to take a tiny step to address
an overwhelming problem.
-
We could take those kinds of steps
for antibiotic use too.
-
We could forgo giving an antibiotic
if we're not sure it's the right one.
-
We could stop insisting on a prescription
for our kid's ear infection
-
before we're sure what caused it.
-
We could ask every restaurant,
-
every supermarket,
-
where their meat comes from.
-
We could promise each other
-
never again to buy chicken
or shrimp or fruit
-
raised with routine antibiotic use,
-
and if we did those things,
-
we could slow down the arrival
of the post-antibiotic world.
-
But we have to do it soon.
-
Penicillin began
the antibiotic era in 1943.
-
In just 70 years, we walked ourselves
up to the edge of disaster.
-
We won't get 70 years
-
to find our way back out again.
-
Thank you very much.
-
(Applause)