WEBVTT 00:00:06.841 --> 00:00:11.865 Antibiotics: behind the scenes, they enable much of modern medicine. 00:00:11.865 --> 00:00:14.485 We use them to cure infectious diseases, 00:00:14.485 --> 00:00:19.607 but also to safely facilitate everything from surgery to chemotherapy 00:00:19.607 --> 00:00:21.607 to organ transplants. 00:00:21.607 --> 00:00:23.170 Without antibiotics, 00:00:23.170 --> 00:00:27.858 even routine medical procedures can lead to life-threatening infections. 00:00:27.858 --> 00:00:30.788 And we’re at risk of losing them. NOTE Paragraph 00:00:30.788 --> 00:00:34.950 Antibiotics are chemicals that prevent the growth of bacteria. 00:00:34.950 --> 00:00:38.871 Unfortunately, some bacteria have become resistant 00:00:38.871 --> 00:00:42.270 to all currently available antibiotics. 00:00:42.270 --> 00:00:46.280 At the same time, we’ve stopped discovering new ones. 00:00:46.280 --> 00:00:49.673 Still, there’s hope that we can get ahead of the problem. NOTE Paragraph 00:00:49.673 --> 00:00:53.160 But first, how did we get into this situation? 00:00:53.160 --> 00:00:56.534 The first widely used antibiotic was penicillin, 00:00:56.534 --> 00:01:00.210 discovered in 1928 by Alexander Fleming. 00:01:00.210 --> 00:01:03.994 In his 1945 Nobel Prize acceptance speech, 00:01:03.994 --> 00:01:08.707 Fleming warned that bacterial resistance had the potential to ruin 00:01:08.707 --> 00:01:10.987 the miracle of antibiotics. 00:01:10.987 --> 00:01:13.994 He was right: in the 1940s and 50s, 00:01:13.994 --> 00:01:17.904 resistant bacteria already began to appear. NOTE Paragraph 00:01:17.904 --> 00:01:20.234 From then until the 1980s, 00:01:20.234 --> 00:01:23.746 pharmaceutical companies countered the problem of resistance 00:01:23.746 --> 00:01:26.744 by discovering many new antibiotics. 00:01:26.744 --> 00:01:32.232 At first this was a highly successful— and highly profitable— enterprise. NOTE Paragraph 00:01:32.232 --> 00:01:35.092 Over time, a couple things changed. 00:01:35.092 --> 00:01:38.582 Newly discovered antibiotics were often only effective 00:01:38.582 --> 00:01:41.492 for a narrow spectrum of infections, 00:01:41.492 --> 00:01:44.838 whereas the first ones had been broadly applicable. 00:01:44.838 --> 00:01:46.812 This isn’t a problem in itself, 00:01:46.812 --> 00:01:51.072 but it does mean that fewer doses of these drugs could be sold— 00:01:51.072 --> 00:01:53.486 making them less profitable. 00:01:53.486 --> 00:01:57.452 In the early days, antibiotics were heavily overprescribed, 00:01:57.452 --> 00:02:01.262 including for viral infections they had no effect on. 00:02:01.262 --> 00:02:06.751 Scrutiny around prescriptions increased, which is good, but also lowered sales. 00:02:06.751 --> 00:02:10.381 At the same time, companies began to develop more drugs 00:02:10.381 --> 00:02:12.966 that are taken over a patient’s lifetime, 00:02:12.966 --> 00:02:15.626 like blood pressure and cholesterol medications, 00:02:15.626 --> 00:02:20.146 and later anti-depressants and anti-anxiety medications. 00:02:20.146 --> 00:02:24.942 Because they are taken indefinitely, these drugs more profitable. NOTE Paragraph 00:02:24.942 --> 00:02:30.789 By the mid-1980s, no new chemical classes of antibiotics were discovered. 00:02:30.789 --> 00:02:35.169 But bacteria continued to acquire resistance and pass it along 00:02:35.169 --> 00:02:39.310 by sharing genetic information between individual bacteria 00:02:39.310 --> 00:02:41.726 and even across species. 00:02:41.726 --> 00:02:46.216 Now bacteria that are resistant to many antibiotics are common, 00:02:46.216 --> 00:02:51.954 and increasingly some strains are resistant to all our current drugs. NOTE Paragraph 00:02:51.954 --> 00:02:54.334 So, what can we do about this? 00:02:54.334 --> 00:02:58.791 We need to control the use of existing antibiotics, create new ones, 00:02:58.791 --> 00:03:02.143 combat resistance to new and existing drugs, 00:03:02.143 --> 00:03:06.081 and find new ways to fight bacterial infections. 00:03:06.081 --> 00:03:10.021 The largest consumer of antibiotics is agriculture, 00:03:10.021 --> 00:03:13.401 which uses antibiotics not only to treat infections 00:03:13.401 --> 00:03:16.411 but to promote the growth of food animals. 00:03:16.411 --> 00:03:18.981 Using large volumes of antibiotics 00:03:18.981 --> 00:03:22.481 increases the bacteria’s exposure to the antibiotics 00:03:22.481 --> 00:03:26.851 and therefore their opportunity to develop resistance. 00:03:26.851 --> 00:03:32.336 Many bacteria that are common in animals, like salmonella, can also infect humans, 00:03:32.336 --> 00:03:36.913 and drug-resistant versions can pass to us through the food chain 00:03:36.913 --> 00:03:41.456 and spread through international trade and travel networks. NOTE Paragraph 00:03:41.456 --> 00:03:44.186 In terms of finding new antibiotics, 00:03:44.186 --> 00:03:47.455 nature offers the most promising new compounds. 00:03:47.455 --> 00:03:52.431 Organisms like other microbes and fungi have evolved over millions of years 00:03:52.431 --> 00:03:54.661 to live in competitive environments— 00:03:54.661 --> 00:03:58.065 meaning they often contain antibiotic compounds 00:03:58.065 --> 00:04:02.285 to give them a survival advantage over certain bacteria. NOTE Paragraph 00:04:02.285 --> 00:04:07.378 We can also package antibiotics with molecules that inhibit resistance. 00:04:07.378 --> 00:04:12.005 One way bacteria develop resistance is through proteins of their own 00:04:12.005 --> 00:04:13.745 that degrade the drug. 00:04:13.745 --> 00:04:18.275 By packaging the antibiotic with molecules that block the degraders, 00:04:18.275 --> 00:04:21.187 the antibiotic can do its job. NOTE Paragraph 00:04:21.187 --> 00:04:25.615 Phages, viruses that attack bacteria but don’t affect humans, 00:04:25.615 --> 00:04:29.965 are one promising new avenue to combat bacterial infections. 00:04:29.965 --> 00:04:33.158 Developing vaccines for common infections, meanwhile, 00:04:33.158 --> 00:04:36.595 can help prevent disease in the first place. NOTE Paragraph 00:04:36.595 --> 00:04:40.255 The biggest challenge to all these approaches is funding, 00:04:40.255 --> 00:04:43.625 which is woefully inadequate across the globe. 00:04:43.625 --> 00:04:48.490 Antibiotics are so unprofitable that many large pharmaceutical companies 00:04:48.490 --> 00:04:50.870 have stopped trying to develop them. 00:04:50.870 --> 00:04:54.645 Meanwhile, smaller companies that successfully bring new antibiotics 00:04:54.645 --> 00:05:00.347 to market often still go bankrupt, like the American start up Achaogen. 00:05:00.347 --> 00:05:04.077 New therapeutic techniques like phages and vaccines 00:05:04.077 --> 00:05:08.135 face the same fundamental problem as traditional antibiotics: 00:05:08.135 --> 00:05:11.445 if they’re working well, they’re used just once, 00:05:11.445 --> 00:05:13.675 which makes it difficult to make money. 00:05:13.675 --> 00:05:17.075 And to successfully counteract resistance in the long term, 00:05:17.075 --> 00:05:20.595 we’ll need to use new antibiotics sparingly— 00:05:20.595 --> 00:05:24.495 lowering the profits for their creators even further. NOTE Paragraph 00:05:24.495 --> 00:05:30.706 One possible solution is to shift profits away from the volume of antibiotics sold. 00:05:30.706 --> 00:05:33.906 For example, the United Kingdom is testing a model 00:05:33.906 --> 00:05:38.024 where healthcare providers purchase antibiotic subscriptions. 00:05:38.024 --> 00:05:42.164 While governments are looking for ways to incentivize antibiotic development, 00:05:42.164 --> 00:05:45.104 these programs are still in the early stages. 00:05:45.104 --> 00:05:48.414 Countries around the world will need to do much more— 00:05:48.414 --> 00:05:51.964 but with enough investment in antibiotic development 00:05:51.964 --> 00:05:54.604 and controlled use of our current drugs, 00:05:54.604 --> 00:05:57.254 we can still get ahead of resistance.