1 00:00:06,841 --> 00:00:11,865 Antibiotics: behind the scenes, they enable much of modern medicine. 2 00:00:11,865 --> 00:00:14,485 We use them to cure infectious diseases, 3 00:00:14,485 --> 00:00:19,607 but also to safely facilitate everything from surgery to chemotherapy 4 00:00:19,607 --> 00:00:21,607 to organ transplants. 5 00:00:21,607 --> 00:00:23,170 Without antibiotics, 6 00:00:23,170 --> 00:00:27,858 even routine medical procedures can lead to life-threatening infections. 7 00:00:27,858 --> 00:00:30,788 And we’re at risk of losing them. 8 00:00:30,788 --> 00:00:34,950 Antibiotics are chemicals that prevent the growth of bacteria. 9 00:00:34,950 --> 00:00:38,871 Unfortunately, some bacteria have become resistant 10 00:00:38,871 --> 00:00:42,270 to all currently available antibiotics. 11 00:00:42,270 --> 00:00:46,280 At the same time, we’ve stopped discovering new ones. 12 00:00:46,280 --> 00:00:49,673 Still, there’s hope that we can get ahead of the problem. 13 00:00:49,673 --> 00:00:53,160 But first, how did we get into this situation? 14 00:00:53,160 --> 00:00:56,534 The first widely used antibiotic was penicillin, 15 00:00:56,534 --> 00:01:00,210 discovered in 1928 by Alexander Fleming. 16 00:01:00,210 --> 00:01:03,994 In his 1945 Nobel Prize acceptance speech, 17 00:01:03,994 --> 00:01:08,707 Fleming warned that bacterial resistance had the potential to ruin 18 00:01:08,707 --> 00:01:10,987 the miracle of antibiotics. 19 00:01:10,987 --> 00:01:13,994 He was right: in the 1940s and 50s, 20 00:01:13,994 --> 00:01:17,904 resistant bacteria already began to appear. 21 00:01:17,904 --> 00:01:20,234 From then until the 1980s, 22 00:01:20,234 --> 00:01:23,746 pharmaceutical companies countered the problem of resistance 23 00:01:23,746 --> 00:01:26,744 by discovering many new antibiotics. 24 00:01:26,744 --> 00:01:32,232 At first this was a highly successful— and highly profitable— enterprise. 25 00:01:32,232 --> 00:01:35,092 Over time, a couple things changed. 26 00:01:35,092 --> 00:01:38,582 Newly discovered antibiotics were often only effective 27 00:01:38,582 --> 00:01:41,492 for a narrow spectrum of infections, 28 00:01:41,492 --> 00:01:44,838 whereas the first ones had been broadly applicable. 29 00:01:44,838 --> 00:01:46,812 This isn’t a problem in itself, 30 00:01:46,812 --> 00:01:51,072 but it does mean that fewer doses of these drugs could be sold— 31 00:01:51,072 --> 00:01:53,486 making them less profitable. 32 00:01:53,486 --> 00:01:57,452 In the early days, antibiotics were heavily overprescribed, 33 00:01:57,452 --> 00:02:01,262 including for viral infections they had no effect on. 34 00:02:01,262 --> 00:02:06,751 Scrutiny around prescriptions increased, which is good, but also lowered sales. 35 00:02:06,751 --> 00:02:10,381 At the same time, companies began to develop more drugs 36 00:02:10,381 --> 00:02:12,966 that are taken over a patient’s lifetime, 37 00:02:12,966 --> 00:02:15,626 like blood pressure and cholesterol medications, 38 00:02:15,626 --> 00:02:20,146 and later anti-depressants and anti-anxiety medications. 39 00:02:20,146 --> 00:02:24,942 Because they are taken indefinitely, these drugs more profitable. 40 00:02:24,942 --> 00:02:30,789 By the mid-1980s, no new chemical classes of antibiotics were discovered. 41 00:02:30,789 --> 00:02:35,169 But bacteria continued to acquire resistance and pass it along 42 00:02:35,169 --> 00:02:39,310 by sharing genetic information between individual bacteria 43 00:02:39,310 --> 00:02:41,726 and even across species. 44 00:02:41,726 --> 00:02:46,216 Now bacteria that are resistant to many antibiotics are common, 45 00:02:46,216 --> 00:02:51,954 and increasingly some strains are resistant to all our current drugs. 46 00:02:51,954 --> 00:02:54,334 So, what can we do about this? 47 00:02:54,334 --> 00:02:58,791 We need to control the use of existing antibiotics, create new ones, 48 00:02:58,791 --> 00:03:02,143 combat resistance to new and existing drugs, 49 00:03:02,143 --> 00:03:06,081 and find new ways to fight bacterial infections. 50 00:03:06,081 --> 00:03:10,021 The largest consumer of antibiotics is agriculture, 51 00:03:10,021 --> 00:03:13,401 which uses antibiotics not only to treat infections 52 00:03:13,401 --> 00:03:16,411 but to promote the growth of food animals. 53 00:03:16,411 --> 00:03:18,981 Using large volumes of antibiotics 54 00:03:18,981 --> 00:03:22,481 increases the bacteria’s exposure to the antibiotics 55 00:03:22,481 --> 00:03:26,851 and therefore their opportunity to develop resistance. 56 00:03:26,851 --> 00:03:32,336 Many bacteria that are common in animals, like salmonella, can also infect humans, 57 00:03:32,336 --> 00:03:36,913 and drug-resistant versions can pass to us through the food chain 58 00:03:36,913 --> 00:03:41,456 and spread through international trade and travel networks. 59 00:03:41,456 --> 00:03:44,186 In terms of finding new antibiotics, 60 00:03:44,186 --> 00:03:47,455 nature offers the most promising new compounds. 61 00:03:47,455 --> 00:03:52,431 Organisms like other microbes and fungi have evolved over millions of years 62 00:03:52,431 --> 00:03:54,661 to live in competitive environments— 63 00:03:54,661 --> 00:03:58,065 meaning they often contain antibiotic compounds 64 00:03:58,065 --> 00:04:02,285 to give them a survival advantage over certain bacteria. 65 00:04:02,285 --> 00:04:07,378 We can also package antibiotics with molecules that inhibit resistance. 66 00:04:07,378 --> 00:04:12,005 One way bacteria develop resistance is through proteins of their own 67 00:04:12,005 --> 00:04:13,745 that degrade the drug. 68 00:04:13,745 --> 00:04:18,275 By packaging the antibiotic with molecules that block the degraders, 69 00:04:18,275 --> 00:04:21,187 the antibiotic can do its job. 70 00:04:21,187 --> 00:04:25,615 Phages, viruses that attack bacteria but don’t affect humans, 71 00:04:25,615 --> 00:04:29,965 are one promising new avenue to combat bacterial infections. 72 00:04:29,965 --> 00:04:33,158 Developing vaccines for common infections, meanwhile, 73 00:04:33,158 --> 00:04:36,595 can help prevent disease in the first place. 74 00:04:36,595 --> 00:04:40,255 The biggest challenge to all these approaches is funding, 75 00:04:40,255 --> 00:04:43,625 which is woefully inadequate across the globe. 76 00:04:43,625 --> 00:04:48,490 Antibiotics are so unprofitable that many large pharmaceutical companies 77 00:04:48,490 --> 00:04:50,870 have stopped trying to develop them. 78 00:04:50,870 --> 00:04:54,645 Meanwhile, smaller companies that successfully bring new antibiotics 79 00:04:54,645 --> 00:05:00,347 to market often still go bankrupt, like the American start up Achaogen. 80 00:05:00,347 --> 00:05:04,077 New therapeutic techniques like phages and vaccines 81 00:05:04,077 --> 00:05:08,135 face the same fundamental problem as traditional antibiotics: 82 00:05:08,135 --> 00:05:11,445 if they’re working well, they’re used just once, 83 00:05:11,445 --> 00:05:13,675 which makes it difficult to make money. 84 00:05:13,675 --> 00:05:17,075 And to successfully counteract resistance in the long term, 85 00:05:17,075 --> 00:05:20,595 we’ll need to use new antibiotics sparingly— 86 00:05:20,595 --> 00:05:24,495 lowering the profits for their creators even further. 87 00:05:24,495 --> 00:05:30,706 One possible solution is to shift profits away from the volume of antibiotics sold. 88 00:05:30,706 --> 00:05:33,906 For example, the United Kingdom is testing a model 89 00:05:33,906 --> 00:05:38,024 where healthcare providers purchase antibiotic subscriptions. 90 00:05:38,024 --> 00:05:42,164 While governments are looking for ways to incentivize antibiotic development, 91 00:05:42,164 --> 00:05:45,104 these programs are still in the early stages. 92 00:05:45,104 --> 00:05:48,414 Countries around the world will need to do much more— 93 00:05:48,414 --> 00:05:51,964 but with enough investment in antibiotic development 94 00:05:51,964 --> 00:05:54,604 and controlled use of our current drugs, 95 00:05:54,604 --> 00:05:57,254 we can still get ahead of resistance.