0:00:21.654,0:00:25.904
Antibiotics were the wonder drugs[br]of the 20th century.

0:00:25.904,0:00:29.158
Now, amazingly antibiotics are responsible

0:00:29.158,0:00:33.346
for extending the average human life[br]about ten years.

0:00:33.914,0:00:37.960
But we are currently in the middle[br]of a global crisis where

0:00:37.960,0:00:40.640
antibiotics are loosing their effectiveness

0:00:40.640,0:00:42.579
against infectious diseases.

0:00:43.532,0:00:46.717
The headlines, if you can see them,[br]are very alarming.

0:00:48.783,0:00:51.079
Bacteria are rapidly becoming resistant

0:00:51.079,0:00:53.963
to all of the antibiotics that we currently use.

0:00:53.963,0:00:57.320
Now, in order to understand[br]the nature of this problem,

0:00:57.320,0:00:59.249
you have to understand bacteria.

0:01:00.787,0:01:04.076
We live in a world filled with bacteria.

0:01:04.430,0:01:06.558
Bacteria are everywhere.

0:01:06.558,0:01:09.064
Everything that you look at,

0:01:09.064,0:01:10.194
everything you touch,

0:01:10.194,0:01:12.076
everything you put in your mouth,

0:01:12.076,0:01:14.232
everything you sit on

0:01:14.232,0:01:18.104
is covered with millions and millions of bacteria.

0:01:18.688,0:01:20.012
They're so small

0:01:20.012,0:01:22.757
that you can't see them[br]without a microscope.

0:01:22.757,0:01:25.646
But they're there.[br]And they are literally everywhere.

0:01:25.652,0:01:28.890
You can find them at the bottom[br]of the deepest part of the ocean.

0:01:28.890,0:01:31.011
You can find them[br]at the top of the tallest mountain.

0:01:31.011,0:01:33.288
You can even find them[br]in the polar ice caps.

0:01:33.672,0:01:37.022
They can live in places[br]where there is no sunlight,

0:01:37.035,0:01:39.906
no oxygen, no food.

0:01:39.926,0:01:43.129
They can grow in radioactive waste,

0:01:43.129,0:01:44.742
and in toxic chemicals,

0:01:44.742,0:01:48.548
and in boiling hot springs.

0:01:49.609,0:01:52.872
When bacteria find a place[br]where they can survive,

0:01:52.872,0:01:56.114
they'll multiply fast to very high numbers.

0:01:56.207,0:01:59.423
Now, one of the places[br]that bacteria like to call home

0:01:59.423,0:02:01.338
is the human body.

0:02:01.477,0:02:03.947
A recent survey by microbiologists

0:02:03.947,0:02:07.483
identified over ten thousand different microbes

0:02:07.483,0:02:10.319
that live on, or in the human body.

0:02:10.319,0:02:14.255
In fact, there are more bacterial cells in you

0:02:14.255,0:02:15.658
than there are human cells.

0:02:15.658,0:02:17.926
And there are more bacteria genes in you

0:02:17.926,0:02:19.295
than human genes.

0:02:19.295,0:02:21.998
So you can argue that each one of you

0:02:21.998,0:02:24.953
is actually more bacterium[br]than you are human.

0:02:25.383,0:02:26.503
(Laughter)

0:02:26.503,0:02:29.332
So, now we have established that

0:02:29.332,0:02:31.200
I am talking to a room full of bacteria --

0:02:31.200,0:02:32.234
(Laughter)

0:02:32.234,0:02:34.149
-- I'm going to flatter the audience[br]here a little bit

0:02:34.149,0:02:38.291
and tell you that bacteria[br]are amazing organisms.

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And one of the things[br]that makes them so amazing

0:02:41.795,0:02:44.546
is their ability to share genes[br]with each other.

0:02:45.316,0:02:47.564
Now, I need to describe this a little bit more.

0:02:47.564,0:02:50.246
Because this lies at the heart of how

0:02:50.246,0:02:53.100
bacteria become resistant to antibiotics.

0:02:55.007,0:02:56.402
And I don't have any slides,

0:02:56.402,0:02:58.377
so I'll have to describe it to you.

0:03:00.239,0:03:02.105
As you probably know:

0:03:02.105,0:03:04.854
Who you are lies in your genes.

0:03:04.854,0:03:07.688
So, for example,[br]if you're tall or you have blue eyes

0:03:07.688,0:03:09.694
is because you have genes[br]that make you tall

0:03:09.694,0:03:11.526
or that give you blue eyes.

0:03:11.526,0:03:14.930
And likewise bacteria that can live[br]in Antarctica

0:03:14.930,0:03:16.805
have genes that make them resistant[br]to the cold.

0:03:16.805,0:03:19.970
And bacteria that are not killed by penicillin

0:03:19.970,0:03:23.237
have genes that make them resistant[br]to penicillin.

0:03:24.421,0:03:26.053
So where did these genes come from?

0:03:26.053,0:03:28.579
Well, you are familiar with humans,

0:03:28.579,0:03:31.220
who are born with a set of genes,

0:03:31.220,0:03:32.816
that they inherit from their parents.

0:03:32.816,0:03:34.985
And they keep the same genes[br]until the day that they die.

0:03:34.985,0:03:38.688
So, for example, if you're born[br]with brown eyes,

0:03:38.688,0:03:41.220
even if you wish that you have blue eyes,

0:03:41.220,0:03:44.161
your eyes will remain brown[br]until the day that you die.

0:03:44.161,0:03:46.805
Because these were the genes[br]that you born with.

0:03:47.405,0:03:49.393
But this is not true for bacteria,

0:03:49.409,0:03:52.090
who are in a habit of sharing[br]genes with each other

0:03:52.090,0:03:54.719
in some pretty incredible ways.

0:03:54.719,0:03:56.497
And one of the ways

0:03:56.497,0:03:59.435
the bacteria will share genes[br]with each other,

0:03:59.435,0:04:02.743
is through picking genes up[br]from their surroundings.

0:04:03.389,0:04:05.984
And they usually do this after[br]one of their neighbors has died.

0:04:05.984,0:04:10.040
So we're going to refer to this technique[br]as the funeral grab.

0:04:10.040,0:04:12.790
OK, bacteria Number 1 dies

0:04:12.790,0:04:15.516
and releases it's genes[br]into the surroundings,

0:04:15.516,0:04:18.549
and now bacteria Number 2[br]will pick up some of these genes

0:04:18.549,0:04:20.056
and pull them in.

0:04:20.056,0:04:23.801
So now bacteria Number 2[br]can do something

0:04:23.801,0:04:26.330
that previously[br]only bacteria Number 1 could do.

0:04:26.330,0:04:29.176
So this is equivalent[br]of you going to the funeral

0:04:29.176,0:04:31.706
of someone who had blue eyes,

0:04:31.706,0:04:33.907
taking a piece of their body out of the casket

0:04:33.907,0:04:35.321
and eating it.

0:04:35.321,0:04:37.686
And hey! You have blue eyes too.

0:04:37.686,0:04:39.869
But now imagine that instead of blue eyes,

0:04:39.869,0:04:42.507
you now are resistant to tetracycline.

0:04:43.706,0:04:45.675
Another way that bacteria have

0:04:45.675,0:04:47.813
to share genes is through viruses.

0:04:48.474,0:04:51.746
So, yes, bacteria get[br]their version of the flu too.

0:04:51.792,0:04:54.751
And there are a lot of viruses[br]that will infect bacteria.

0:04:54.751,0:04:58.549
So, we're going to call this technique:[br]the viral pass.

0:04:58.949,0:05:01.368
A virus will infect bacteria Number 1

0:05:01.368,0:05:03.127
and pick up some of its genes,

0:05:03.127,0:05:05.998
and then inject these genes[br]into bacteria Number 2.

0:05:05.998,0:05:08.734
Now bacteria Number 2[br]can do something

0:05:08.734,0:05:11.434
that previously only bacteria Number 1[br]could do.

0:05:11.434,0:05:13.873
So this is the equivalent[br]of you catching the flu

0:05:13.873,0:05:15.465
from someone who has blue eyes.

0:05:15.465,0:05:18.384
And after catch the flu,[br]your eyes turn blue too.

0:05:19.046,0:05:21.117
But, now imagine that instead of blue eyes,

0:05:21.117,0:05:23.469
you're now resistant to methacycline.

0:05:24.516,0:05:28.220
And the third way that bacteria share genes[br]is through sex.

0:05:28.220,0:05:30.131
So, yes, bacteria have sex too.

0:05:30.131,0:05:31.992
And they're actually pretty promiscuous.

0:05:31.992,0:05:34.947
So, we're going to refer to this technique

0:05:34.947,0:05:36.510
as makin' whoopee.[br](Laughter)

0:05:36.510,0:05:38.799
So bacteria Number 1, the donor,

0:05:38.799,0:05:42.270
builds a bridge to bacteria Number 2,[br]the recipient,

0:05:42.270,0:05:43.732
through which genes are passed

0:05:43.732,0:05:45.683
from the donor to the recipient -

0:05:45.683,0:05:48.299
much like sexual activity you're familiar with.

0:05:48.299,0:05:50.620
But at the end of this sexual activity,

0:05:50.620,0:05:52.854
bacteria Number 2[br]can now do something,

0:05:52.854,0:05:56.316
that previously only bacteria Number 1[br]could do before sex.

0:05:56.592,0:05:59.496
So this is the equivalent of having sex[br]with the blue-eyed partner.

0:05:59.496,0:06:02.312
And after sex, you eyes turn blue too.

0:06:02.312,0:06:03.720
(Laughter)

0:06:03.720,0:06:06.036
But now imagine instead of blue eyes,

0:06:06.036,0:06:08.787
now you are resistant to vancomycin.

0:06:08.787,0:06:09.779
(Laughter)

0:06:09.779,0:06:11.894
So you see bacteria have lots of ways

0:06:11.894,0:06:13.362
to share genes among each other.

0:06:13.362,0:06:16.963
And with over ten thousand[br]different types of bacteria

0:06:16.963,0:06:18.581
in the human body alone,

0:06:18.581,0:06:22.014
not to mention the millions[br]of bacteria everywhere that you look,

0:06:22.014,0:06:24.066
this is a huge community

0:06:24.066,0:06:27.504
that's sharing antibiotic-resistant genes[br]with each other.

0:06:28.119,0:06:31.345
So, now in order to understand[br]antibiotic resistence,

0:06:31.345,0:06:34.314
you have to understand[br]how antibiotics actually work.

0:06:34.667,0:06:40.922
So, in many ways bacteria[br]are very different than humans.

0:06:40.922,0:06:43.549
And what this means is they have[br]a lot of components

0:06:43.549,0:06:45.633
that can be target by specific chemicals.

0:06:45.633,0:06:48.381
So antibiotics are fantastic drugs.

0:06:48.381,0:06:51.831
Because they can kill bacterium[br]without harming the human

0:06:52.107,0:06:55.522
by recognizing something very specific[br]in the bacterium

0:06:55.522,0:06:57.141
and not the human.

0:06:57.141,0:06:59.250
They work like a key and a lock,

0:06:59.250,0:07:02.150
very specifically finding and binding their target

0:07:02.150,0:07:04.671
which leads to inactivation of the bacterium.

0:07:05.825,0:07:07.335
But bacteria have evolved a number

0:07:07.335,0:07:09.342
of different defensive maneuvers

0:07:09.342,0:07:11.282
to avoid being killed by antibiotics.

0:07:11.282,0:07:13.090
So we're going to talk about three ways

0:07:13.090,0:07:14.862
that bacteria can become resistant.

0:07:15.000,0:07:17.806
And the first way[br]we are going to call the "up-chuck".

0:07:18.006,0:07:21.035
The antibiotic targets something specific

0:07:21.035,0:07:23.157
inside the bacterial cell.

0:07:23.157,0:07:25.407
But as soon as the antibiotic gets inside,

0:07:25.407,0:07:27.241
the bacterium barfs it right back out.

0:07:27.241,0:07:29.483
Preventing it from finding its target.

0:07:29.514,0:07:31.944
This is a technique that bacteria use

0:07:31.944,0:07:33.996
to be resistant to tetracycline.

0:07:34.380,0:07:37.018
Another way we're going to call[br]the "stealth mode".

0:07:37.018,0:07:42.055
So the antibiotic recognizes something[br]specifically again in the bacterial cell.

0:07:42.362,0:07:45.808
So the bacterium changes[br]the target just enough,

0:07:45.823,0:07:48.490
so that the antibiotic no longer recognizes it.

0:07:48.490,0:07:50.030
The target is in stealth mode.

0:07:50.030,0:07:51.929
The antibiotic has no effect.

0:07:51.929,0:07:54.100
And the bacterium is resistant.

0:07:54.253,0:07:56.966
This is a technique that bacteria use

0:07:56.966,0:07:59.674
to be resistant to streptomycin.

0:07:59.766,0:08:03.906
And the third way we're going to call[br]"the ballistic missile defense".

0:08:03.906,0:08:05.845
The bacteria makes a type of weapon

0:08:05.845,0:08:07.773
that goes out and finds the antibiotic

0:08:07.773,0:08:10.281
before the antibiotic can find its target.

0:08:10.758,0:08:13.553
The bacterium sends out waves of this missiles

0:08:13.553,0:08:14.878
that breakdown the antibiotic

0:08:14.878,0:08:16.460
and allow the bacterium to survive.

0:08:16.460,0:08:19.023
So this is a technique that bacteria actually use

0:08:19.023,0:08:21.232
to be resistant to penicillin.

0:08:21.570,0:08:23.198
So you can see that the bacteria have

0:08:23.198,0:08:24.641
lots of simple and effective ways

0:08:24.641,0:08:27.034
to avoid being killed by antibiotics,

0:08:27.034,0:08:30.729
that include things like:[br]upchucks, stealth modes

0:08:30.772,0:08:32.440
and ballistic missiles.

0:08:32.440,0:08:34.802
And the genes for these[br]antibiotic resistant mechanisms

0:08:34.802,0:08:36.940
are shared among the bacteria.

0:08:36.940,0:08:41.026
Through funeral grabs, viral passes,[br]and makin' whoopee.

0:08:41.026,0:08:44.686
So remember the important atributes[br]of bacteria:

0:08:44.686,0:08:46.039
they are small,

0:08:46.039,0:08:49.307
they multiply fast,[br]and they share genes.

0:08:49.308,0:08:52.025
Your body is chock-full

0:08:52.025,0:08:55.141
of millions of good, innocent bacteria,

0:08:55.141,0:08:56.630
that cause you no harm,

0:08:56.630,0:09:00.853
they live in a peaceful[br]gated community inside of you.

0:09:00.853,0:09:02.142
(Laughter)

0:09:02.142,0:09:04.079
But now let's imagine that

0:09:04.079,0:09:06.062
some bad bugs[br]move into this neighborhood,

0:09:06.062,0:09:08.805
and start causing trouble,[br]being obnoxious,

0:09:08.805,0:09:11.473
playing loud music,[br]trashing the neighborhood.

0:09:11.490,0:09:12.988
You feel sick.

0:09:12.988,0:09:14.289
You go to the doctor.

0:09:14.289,0:09:16.644
You get some antibiotics,[br]and you take them.

0:09:16.659,0:09:19.461
The antibiotics kill off[br]most of the bad bugs

0:09:19.461,0:09:21.875
and a lot of good bugs as well.

0:09:21.907,0:09:23.664
So now you're feeling better,

0:09:23.664,0:09:27.627
so you stop taking the antibiotics[br]before the doctor prescribed.

0:09:27.627,0:09:29.465
So what happens next?

0:09:29.465,0:09:33.331
Well, let's say that one of the good bacteria[br]was already resistant.

0:09:33.331,0:09:35.936
So when half of the neighborhood dies off

0:09:35.936,0:09:37.974
from this antibiotic armageddon,

0:09:37.974,0:09:41.078
it multiplies fast to occupy[br]all the empty houses.

0:09:41.078,0:09:44.147
As in any war, in order to win,

0:09:44.470,0:09:47.521
we need to develop new[br]and more powerful weapons

0:09:47.521,0:09:49.973
to fight and defeat them.

0:09:50.220,0:09:52.807
And the time to invest[br]in new antibiotic is now,

0:09:52.807,0:09:55.310
before we're completely out of weapons.

0:09:55.341,0:09:58.103
This needs to be a continuous,[br]sustained effort.

0:09:58.103,0:10:00.358
One that really should be considered

0:10:00.358,0:10:02.542
a global health arms race.

0:10:02.574,0:10:05.410
With funding support,

0:10:05.410,0:10:07.811
new antibiotic[br]can be developed continuously,

0:10:07.811,0:10:10.010
and released continuously into the market.

0:10:10.010,0:10:11.549
As you can now appreciate,

0:10:11.549,0:10:16.042
it is inevitable bacteria will eventually[br]become resistant to the next antibiotic.

0:10:16.042,0:10:19.535
But by this time,[br]the next antibiotic will be ready.

0:10:19.536,0:10:21.225
A sobering thought is that

0:10:21.225,0:10:23.061
a number of people in this room

0:10:23.061,0:10:24.467
are only here today,

0:10:24.467,0:10:26.496
because antibiotics saved your lives

0:10:26.496,0:10:28.487
at some point in the past.

0:10:28.487,0:10:32.327
We need to avoid returning[br]to the pre-antibiotic era,

0:10:32.332,0:10:34.466
where common bacterial infections,

0:10:34.466,0:10:36.855
resulting from things like a cut,[br]or a scratch,

0:10:36.861,0:10:38.399
or a struck throat,

0:10:38.399,0:10:41.038
could sometimes be a death sentence.

0:10:41.038,0:10:44.258
In this manner, with new antibiotics,

0:10:44.258,0:10:46.377
we can maintain the upper hand

0:10:46.377,0:10:49.112
against the rise of the superbugs.

0:10:49.112,0:10:50.360
Thank you.

0:10:50.360,0:10:52.483
(Applause)