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[music playing]
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>> We have a very skewed
sense of our relationship with
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microorganisms in general
and bacteria specifically.
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>> They collectively outweigh
human beings by 100 million
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times.
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They can replicate 500,000
times faster than we can.
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And they've been doing
this for 1,000 times
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longer than our
species has existed.
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>> We've just touched the corner
of understanding the diversity
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of the microbes
that are out there.
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We've barely
scratched the surface.
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And we need to understand
this because, again, they
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make plants functional.
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They affect the movement
of methane, and hydrogen,
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and nitrogen, and phosphorus.
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They affect the carbon fixation
and the plankton in the oceans.
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Viewing them as
important players
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in our ecosystem in
the same way people
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have viewed forests and
grasslands would probably
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make us treat the
world in a better way.
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[chatter]
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>> My name is Robert Beam.
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I'm Jesse's father.
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[chatter]
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>> I'm Christy Beam.
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I'm Jesse's stepmom.
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[chatter]
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>> And then just step
out for a second.
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And we'll pull this up.
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>> We were actually
at cross country camp.
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>> See how tall you are.
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>> And I think it
was the second day,
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he started developing a fever.
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The following day we came
back here to Kentucky.
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>> Now you can step away.
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>> And he was really--
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getting dramatic with him.
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Jesse Beam does not
do sick very well.
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So he was kind of--
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I thought he was playing it.
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And he was kind of
moping around the house
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and crawling at one
point out of his bedroom.
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And I told him to get up.
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And he did.
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So you think he's playing it.
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Next day while
I'm at the office,
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he calls me wanting
to go to the hospital.
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So I call his pediatrician.
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And she said, get him
in here right now.
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Finally got us a room.
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Got an X-ray.
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They found pneumonia
in his right lung.
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Figured that was what
we were dealing with.
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So I called Christy and told
her we're in the hospital.
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He's got pneumonia.
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She's trying to calm me down.
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Told me not to worry about it.
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You know, kids get pneumonia.
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They'll be fine.
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He'll probably stay in the
hospital for a day or two.
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All night long he just kept
getting worse and worse.
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His temperature would
get pretty high.
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Or, at least his body
temperature was high.
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But his oral temperature was
never really spiking real high.
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He started hallucinating around
4:00, 5:00 in the morning.
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And that's when I--
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I went to help him
go to the bathroom.
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And when we stood him up,
his front was really clammy.
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And his back would
almost burn your hands.
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And I told the nurse that.
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So she came in.
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And they had to do a
rectal temperature.
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And his internal temperature
at that point was 105.9.
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She called in the
critical care team.
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His pediatrician showed up, who
made the call that he needed
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to be at a pediatric hospital.
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Again, I'm still
thinking pneumonia.
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So I told Jesse I was
going run to the house,
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get him some clean
clothes, get him his games.
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And I'd be down
there to Vanderbilt.
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In about-- I don't know
how much longer it was.
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But I was about Goodlettsville
when they called me and told me
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that they were there.
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They'd made it.
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Jesse made the flight well.
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But his body was
doing a lot of work.
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[music playing]
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That's when they told me
they put him in a coma.
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[music playing]
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[beeping]
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[music playing]
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We started with daptomycin.
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And then we went to clindamycin.
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We went to vancomycin, which
he finished off vanc upstairs.
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>> Yeah, and he was on
all three at one time.
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And that's whenever
they told us that, look,
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he's on all three medicines.
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We've done everything we can do.
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You know--
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>> If the bacteria
doesn't stop growing now,
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then there's nothing else.
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>> There's nothing
else we can do.
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We've got nothing
else to pull from.
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[beeping]
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[music playing]
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>> Antibiotics are basically
poisons that kill bacteria
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and don't kill us.
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[music playing]
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They often have some effects
on the human body as well.
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But for infections, it's
going to do one of two things
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to a bacteria.
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It either kills it or
it makes it stronger.
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[music playing]
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>> But what we do
with antibiotics--
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because we give the wrong
doses of antibiotics to people,
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or we give the right doses, but
people end up dosing themselves
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incorrectly because they don't
take a full prescription,
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or because we give antibiotics
to healthy farm animals,
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what we do in all
those situations
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is we set up a sort of
Darwinian battleground
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within the body of the
human or the animal who's
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getting the antibiotics, in
which the weak susceptible
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bacteria are knocked
out by the drug.
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But the strong survive.
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>> And it unfortunately occurs
more rapidly than you might
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think.
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[music playing]
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Because they go so quickly
as a community of organisms,
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if there's a way to become
resistant, they can find it.
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[music playing]
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>> About three quarters of
the way through my fellowship,
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we began to see just an
explosion of highly resistant
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infections.
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And that was concordant
with it happening all
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over the country and the world.
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There's nothing unique
about our setting.
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And I remember the
first patient that I
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took care of who had an
untreatable infection.
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Could not be treated.
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And it was a woman in her 20s,
who had two small kids, who
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had leukemia.
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[clears throat]
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Sorry.
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[coughs]
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[clears throat]
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And she developed an
infection in her blood
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by an acinetobacter.
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So we started treating
it with the drug
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that we had left
at the time, which
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was a drug called imipenem.
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That was the big gun.
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That was the last ditch.
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And she looked like she was
getting better at first.
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But then the
infection came back.
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And it was resistant
to the imipenem.
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It developed resistance in the
middle of a course of therapy.
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And when it came back, I have
this just vivid recollection
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of looking at the
computer screen.
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[music playing]
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And you just see a printout
on the computer screen
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of all the antibiotics that
the bacteria is resistant to--
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resistant, resistant,
resistant, resistant, resistant.
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There was nothing.
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It was resistant to everything.
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And I couldn't fathom
how in the 21st century
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an infectious disease specialist
would run out of stuff.
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I mean this is--
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since penicillin, we've
expected that we're
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going to have relatively
inexpensive, safe, tremendously
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effective drugs to
treat infections.
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And this woman had
returned to 1935.
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She had returned to
the pre-antibiotic era.
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And she died.
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There was nothing to do.
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>> Antibiotics were the only
thing we ever had in all
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of human history that really
stopped infectious diseases.
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And we took that just
miraculous, precious substance,
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and we completely squandered it.
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And it astonishes me sometimes
that we don't ask ourselves,
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how is it that we
squandered this?
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And why can't we stop?
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[waves crashing]
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[cheering]
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00:10:07,607 --> 00:10:10,978
[waves crashing]
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>> I came home from
work one afternoon.
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I'd been working under
a boat all day painting.
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And I was extra stiff.
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My back hurt.
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So I thought, well, maybe
I'll get in the bathtub.
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We have a Jacuzzi tub.
191
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So I filled it up with
hot water and got in it.
192
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And that's pretty much
the last thing I remember.
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>> But I remember.
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>> Glad she remembers.
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00:10:44,077 --> 00:10:48,148
>> We also thought that we
might be sore because we were
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training really hard for the
Molokai to Oahu Outrigger Canoe
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Race, which is pretty
intense workouts.
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And my back hurt.
199
00:11:01,194 --> 00:11:03,697
So I called to make
an appointment for him
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00:11:03,797 --> 00:11:05,799
to see his regular doctor.
201
00:11:05,899 --> 00:11:09,669
And from there, he went
for CAT scans and tests.
202
00:11:09,770 --> 00:11:13,206
And the CAT scan showed that
he had lesions on his spine.
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They had discovered it was
Methicillin-resistant staph.
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So he was on vancomycin.
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00:11:21,815 --> 00:11:23,784
And it was an
emergency situation
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to open him up and
clean those out.
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00:11:27,788 --> 00:11:31,158
>> Apparently, I'd picked
up this staff either from
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00:11:31,258 --> 00:11:34,895
the water in the marina or
surfing next door at Doheny,
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00:11:34,995 --> 00:11:36,596
which is right
adjacent to the marina.
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00:11:40,667 --> 00:11:42,635
Between the sepsis
and the surgery,
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I've lost use of my legs.
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00:11:44,004 --> 00:11:45,372
>> Let's tie your shoelaces.
213
00:11:49,042 --> 00:11:49,743
[groan]
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00:11:51,311 --> 00:11:53,646
OK.
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00:11:53,747 --> 00:11:56,449
>> You know, I haven't really
taken the time to grieve about
216
00:11:56,549 --> 00:11:58,986
it too much because
just too much to grieve.
217
00:12:14,434 --> 00:12:16,303
Do this without my
pants falling off.
218
00:12:21,875 --> 00:12:24,177
I've always been able
to bait my own hook.
219
00:12:24,277 --> 00:12:27,747
And I can't do that anymore.
220
00:12:30,683 --> 00:12:31,384
It's hard.
221
00:12:31,484 --> 00:12:32,252
It's really hard.
222
00:12:32,352 --> 00:12:35,122
>>
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This is a man who
was surfing one day
224
00:12:39,059 --> 00:12:43,196
and had his spine opened the
next day from a resistant
225
00:12:43,296 --> 00:12:44,497
infection.
226
00:12:44,597 --> 00:12:47,400
And I think the thing
that's come home to me
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is it can happen to
anybody, anytime, anywhere.
228
00:12:52,739 --> 00:12:53,640
Nobody is safe.
229
00:13:00,313 --> 00:13:01,448
Don't get me wrong.
230
00:13:01,548 --> 00:13:04,351
Antibiotics saved my life.
231
00:13:04,451 --> 00:13:05,953
I'm really grateful for them.
232
00:13:06,053 --> 00:13:10,290
But I do feel that the
likelihood of me getting this
233
00:13:10,390 --> 00:13:14,427
was probably because of our sort
of rampant use of antibiotics
234
00:13:14,527 --> 00:13:15,228
in the first place.
235
00:13:21,268 --> 00:13:22,169
[cheering]
236
00:13:22,269 --> 00:13:25,605
[chatter]
237
00:13:30,677 --> 00:13:34,347
>> It's clear that people don't
quite understand the extent
238
00:13:34,447 --> 00:13:39,019
of usage of antibiotics
in our everyday life.
239
00:13:39,119 --> 00:13:41,889
We know that they're
used on farm animals.
240
00:13:41,989 --> 00:13:45,959
Do we know that they're put into
household products, sanitation
241
00:13:46,059 --> 00:13:47,294
products?
242
00:13:47,394 --> 00:13:50,097
Do we know that some
300,000 pounds are
243
00:13:50,197 --> 00:13:51,999
sprayed on fruit trees--
244
00:13:52,099 --> 00:13:54,534
>> --on kitchen counters,
in our wall materials,
245
00:13:54,634 --> 00:13:57,537
school cafeteria
trays, on everything--
246
00:13:57,637 --> 00:14:01,808
>> --to supposedly improve
their antibacterial activity?
247
00:14:01,909 --> 00:14:02,642
But for what?
248
00:14:07,948 --> 00:14:11,651
>> Virtually all the antibiotics
that I've ever been used have
249
00:14:11,751 --> 00:14:16,189
come from organisms that are in
the world around us from soil
250
00:14:16,289 --> 00:14:20,560
fungi, or from something
growing on bread,
251
00:14:20,660 --> 00:14:23,663
or other organisms
that are out there.
252
00:14:23,763 --> 00:14:27,134
And they've been in a
struggle for existence
253
00:14:27,234 --> 00:14:28,835
for billions of years.
254
00:14:28,936 --> 00:14:32,739
And we have just come in at this
last minute basically and said,
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00:14:32,839 --> 00:14:34,241
we're going to take
those chemicals
256
00:14:34,341 --> 00:14:37,244
and spray them into
the world around us
257
00:14:37,344 --> 00:14:39,379
in these massive doses.
258
00:14:39,479 --> 00:14:42,882
And what happens is is
that most of the microbes
259
00:14:42,983 --> 00:14:46,219
will in fact be killed by
some of those chemicals.
260
00:14:46,319 --> 00:14:49,089
And the ones that
survive now will
261
00:14:49,189 --> 00:14:52,259
be resistant to the chemical
that you're threw at it.
262
00:14:52,359 --> 00:14:54,694
So you throw another
chemical at those microbes.
263
00:14:55,728 --> 00:14:57,430
And most of them
are killed again.
264
00:14:57,530 --> 00:14:58,932
And some survive.
265
00:14:59,032 --> 00:15:01,501
And they will now be resistant
to both of the chemicals
266
00:15:01,601 --> 00:15:03,103
that you've thrown at them.
267
00:15:03,203 --> 00:15:05,638
And if we keep going
down this path,
268
00:15:05,738 --> 00:15:07,074
the microbes in
the world around us
269
00:15:07,174 --> 00:15:09,342
will be resistant to
most of the chemicals
270
00:15:09,442 --> 00:15:11,144
that we can throw at them.
271
00:15:11,244 --> 00:15:16,349
And now if one of those microbes
also happens to cause disease,
272
00:15:16,449 --> 00:15:18,351
then we have nothing
left in our arsenal
273
00:15:18,451 --> 00:15:22,956
to throw at it because we've
wasted all of these tools
274
00:15:23,056 --> 00:15:23,756
at everything.
275
00:15:23,856 --> 00:15:26,994
[music playing]
276
00:15:45,812 --> 00:15:49,282
>> People talk about antibiotic
resistance taking us back
277
00:15:49,382 --> 00:15:51,484
to a pre-antibiotic era.
278
00:15:51,584 --> 00:15:53,853
And what I think
they are envisioning
279
00:15:53,953 --> 00:15:56,323
when they say that
is the way things
280
00:15:56,423 --> 00:15:59,392
were in the 19th century,
the 18th century, or earliest
281
00:15:59,492 --> 00:16:02,329
when people died of
infections because they
282
00:16:02,429 --> 00:16:04,697
tripped and fell in
front of the plow
283
00:16:04,797 --> 00:16:06,099
that their oxen were dragging.
284
00:16:06,199 --> 00:16:09,669
Or, they fell into the works of
the factories of the Industrial
285
00:16:09,769 --> 00:16:10,703
Revolution.
286
00:16:10,803 --> 00:16:12,672
And people say to
themselves, well, we
287
00:16:12,772 --> 00:16:14,374
don't have that anymore.
288
00:16:14,474 --> 00:16:16,243
We don't farm with
oxen and plows.
289
00:16:16,343 --> 00:16:18,811
We don't have huge filthy
factories like that.
290
00:16:18,911 --> 00:16:20,047
So we're not really at risk.
291
00:16:24,851 --> 00:16:26,753
But what they don't
think about is
292
00:16:26,853 --> 00:16:30,123
that most of the structure
of modern medicine
293
00:16:30,223 --> 00:16:33,026
relies on the deployment
of antibiotics.
294
00:16:33,126 --> 00:16:37,030
If we didn't have antibiotics
anymore, if we went to a pre
295
00:16:37,130 --> 00:16:41,201
or post antibiotic era, there
would be no transplants.
296
00:16:41,301 --> 00:16:44,371
Heart infections might
kill 50% of people again.
297
00:16:44,471 --> 00:16:46,673
Childbirth might be
much more dangerous.
298
00:16:46,773 --> 00:16:49,109
To take antibiotics out
of the medical system
299
00:16:49,209 --> 00:16:51,511
is to shut down a good
part of the medical system.
300
00:16:58,851 --> 00:17:01,788
>> Penicillin was our
first real antibiotic.
301
00:17:01,888 --> 00:17:05,758
That is a substance made by
another biologic creature,
302
00:17:05,858 --> 00:17:08,027
which is able to
inhibit the growth
303
00:17:08,127 --> 00:17:10,363
or kill another
biologic creature.
304
00:17:11,830 --> 00:17:15,768
>> 1928-- Alexander Fleming
leaves a window open in his
305
00:17:15,867 --> 00:17:16,736
laboratory.
306
00:17:16,836 --> 00:17:18,671
And something blows
into the window
307
00:17:18,771 --> 00:17:20,507
and contaminates
his culture plates.
308
00:17:20,607 --> 00:17:22,541
And when he looks at
them two weeks later,
309
00:17:22,642 --> 00:17:26,445
he can see that there's
little dead zones in the staph
310
00:17:26,546 --> 00:17:29,149
and the mold at the
center of the dead zones.
311
00:17:29,249 --> 00:17:34,221
Turns out to be the
source of the penicillin.
312
00:17:34,321 --> 00:17:38,825
>> While he surmised that
this was an important finding,
313
00:17:38,925 --> 00:17:41,228
he could not see it
as a therapeutic.
314
00:17:44,631 --> 00:17:48,335
>> Then two other British
scientists, Dr. Florey and Dr.
315
00:17:48,435 --> 00:17:51,471
Chain, began developing
its usefulness for fighting
316
00:17:51,571 --> 00:17:53,740
infection inside the human body.
317
00:17:59,879 --> 00:18:01,714
>> So during the
First World War,
318
00:18:01,814 --> 00:18:04,851
many more people died of
infectious disease than died
319
00:18:04,951 --> 00:18:08,188
of actual battle wound injury.
320
00:18:08,288 --> 00:18:10,257
During the Second
World War, antibiotics
321
00:18:10,357 --> 00:18:11,791
had just been introduced.
322
00:18:11,891 --> 00:18:15,195
But then scaling up production
to a mass scale, which
323
00:18:15,295 --> 00:18:18,265
would allow many soldiers
to be saved by these drugs,
324
00:18:18,365 --> 00:18:20,300
required someone to figure
out how to make these.
325
00:18:22,969 --> 00:18:25,438
>> Dr. Florey and an
assistant, Dr. Heatley,
326
00:18:25,538 --> 00:18:28,775
came to the United States to
start a search for new sources
327
00:18:28,875 --> 00:18:31,644
of penicillin.
328
00:18:31,744 --> 00:18:33,646
Agents from the
Department of Agriculture
329
00:18:33,746 --> 00:18:36,183
were instructed to
send moldy foodstuffs
330
00:18:36,283 --> 00:18:37,750
from every part of the country.
331
00:18:40,453 --> 00:18:43,556
One day it led to
a moldy cantaloupe.
332
00:18:43,656 --> 00:18:47,694
The mold from this melon gave
200 times more penicillin
333
00:18:47,794 --> 00:18:49,629
than any that had
been tested before.
334
00:18:51,231 --> 00:18:52,799
This was the turning point.
335
00:18:52,899 --> 00:18:54,601
[music playing]
336
00:18:54,701 --> 00:18:56,736
[MUSIC - BO CARTER, "BANANA IN
YOUR FRUIT BASKET"]
337
00:18:56,836 --> 00:18:59,506
>> Penicillin was tried
in different environments,
338
00:18:59,606 --> 00:19:01,574
in different places
during the war.
339
00:19:01,674 --> 00:19:04,611
And a need from the
military was to have
340
00:19:04,711 --> 00:19:07,947
some of this wonder drug
for venereal disease, which
341
00:19:08,047 --> 00:19:10,350
was rampant among
the military groups.
342
00:19:12,985 --> 00:19:15,655
>> We average 30 venereal
disease cases each year out
343
00:19:15,755 --> 00:19:17,957
of every 1,000 men in uniform.
344
00:19:18,057 --> 00:19:20,560
That means 300,000 men put
out of action each year
345
00:19:20,660 --> 00:19:22,229
in a 10 million man army.
346
00:19:22,329 --> 00:19:23,896
And every one of those
men is a casualty
347
00:19:23,996 --> 00:19:25,465
as far as combat is concerned.
348
00:19:25,565 --> 00:19:26,266
[laughing]
349
00:19:26,366 --> 00:19:27,334
Figure that.
350
00:19:27,434 --> 00:19:29,902
300,000 casualties
without even a battle.
351
00:19:30,002 --> 00:19:31,971
Well, I'm sorry to have
to run out on you Colonel.
352
00:19:32,071 --> 00:19:33,306
But I'm swamped with work.
353
00:19:33,406 --> 00:19:33,973
>> Let me put my--
354
00:19:34,073 --> 00:19:34,674
>> Thank you, Major.
355
00:19:34,774 --> 00:19:35,208
>> --banana in your--
356
00:19:35,308 --> 00:19:35,742
>> Goodbye.
357
00:19:35,842 --> 00:19:36,309
>> Goodbye.
358
00:19:36,409 --> 00:19:37,009
--fruit basket.
359
00:19:37,109 --> 00:19:39,011
Then I'll be satisfied.
360
00:19:39,111 --> 00:19:42,749
>> The question was at a time
when you have a miracle drug
361
00:19:42,849 --> 00:19:46,486
that's saving lives in
hospitals in London,
362
00:19:46,586 --> 00:19:52,559
can we really allow it to be
used for the results of playing
363
00:19:52,659 --> 00:19:55,595
around in the military?
364
00:19:55,695 --> 00:19:58,765
And the story goes
that Winston Churchill
365
00:19:58,865 --> 00:20:01,200
was involved in that decision.
366
00:20:01,301 --> 00:20:02,769
And while it wasn't
direct, there
367
00:20:02,869 --> 00:20:06,406
was a little notation on
the side of the request.
368
00:20:06,506 --> 00:20:11,478
And that was Churchill's
sign that, yes, yes,
369
00:20:11,578 --> 00:20:13,246
save our military.
370
00:20:13,346 --> 00:20:15,982
But let's not make a big
announcement about it.
371
00:20:16,082 --> 00:20:18,985
>> Let me put my banana
in your fruit basket.
372
00:20:19,085 --> 00:20:20,720
Then I'll be satisfied.
373
00:20:30,663 --> 00:20:32,532
>> So penicillin arrives.
374
00:20:32,632 --> 00:20:34,334
And it's a miracle drug.
375
00:20:34,434 --> 00:20:36,769
People who would have died of
things like blood poisoning
376
00:20:36,869 --> 00:20:38,671
are now cured in 48 hours.
377
00:20:38,771 --> 00:20:42,575
The problem is we almost
immediately overuse it.
378
00:20:46,613 --> 00:20:48,515
>> When I first got
interested in resistance,
379
00:20:48,615 --> 00:20:52,619
it was because of penicillin
resistance in gonorrhea.
380
00:20:52,719 --> 00:20:55,355
And turns out that the
origins of penicillin
381
00:20:55,455 --> 00:21:00,560
resistant in gonorrhea were
from brothels in Vietnam
382
00:21:00,660 --> 00:21:04,230
where the US Army had
given out penicillin
383
00:21:04,331 --> 00:21:06,633
to all the sex workers.
384
00:21:06,733 --> 00:21:09,469
>> Not to treat, but to
prevent venereal disease
385
00:21:09,569 --> 00:21:11,037
in the soldiers.
386
00:21:11,137 --> 00:21:14,040
>> This indiscriminate use
of the antibiotic drug has
387
00:21:14,140 --> 00:21:16,676
contributed to the appearance
of a strain of gonorrhea
388
00:21:16,776 --> 00:21:19,278
completely resistant
to penicillin.
389
00:21:19,379 --> 00:21:21,448
The new strain was first
detected in this country
390
00:21:21,548 --> 00:21:24,517
last year in infected
military personnel returning
391
00:21:24,617 --> 00:21:25,752
from the Orient.
392
00:21:25,852 --> 00:21:32,792
>> So it was in fact
someone's decision to protect
393
00:21:32,892 --> 00:21:37,830
the military from getting the
disease that led to a strain
394
00:21:37,930 --> 00:21:42,802
and eventually a whole number
of strains of the bacterium,
395
00:21:42,902 --> 00:21:48,307
which were no longer controlled,
killed by penicillin.
396
00:21:48,408 --> 00:21:50,677
>> And as a result now,
penicillin doesn't work
397
00:21:50,777 --> 00:21:52,144
for gonorrhea for the most part.
398
00:22:09,629 --> 00:22:12,999
>> Alexander Fleming, the man
who discovered penicillin,
399
00:22:13,099 --> 00:22:15,468
warned the medical community
in the New York Times interview
400
00:22:15,568 --> 00:22:19,906
in 1945 that physicians
were wasting penicillin.
401
00:22:20,006 --> 00:22:22,709
We need to understand why
is it that physicians over
402
00:22:22,809 --> 00:22:24,877
prescribe antibiotics.
403
00:22:24,977 --> 00:22:26,546
Because if you're
going to fix that,
404
00:22:26,646 --> 00:22:29,115
you need to understand
the root cause.
405
00:22:29,215 --> 00:22:33,352
The reason docs overprescribe
antibiotics is fear.
406
00:22:33,453 --> 00:22:35,187
It's not so much
fear of being sued.
407
00:22:35,287 --> 00:22:37,056
It's fear of being wrong.
408
00:22:37,156 --> 00:22:39,058
It's fear of I have a
patient in front of me.
409
00:22:39,158 --> 00:22:42,228
There's a 95% chance that
this patient has a virus.
410
00:22:42,328 --> 00:22:44,196
There's still a 5% chance
that it's a bacteria.
411
00:22:44,296 --> 00:22:45,865
And they have exactly
the same symptoms.
412
00:22:45,965 --> 00:22:49,335
I can't distinguish with
any certainty beyond that.
413
00:22:49,436 --> 00:22:52,038
Well, it's just this--
one prescription
414
00:22:52,138 --> 00:22:53,172
isn't going to ruin things.
415
00:22:53,272 --> 00:22:54,907
And what if I'm wrong
about this patient?
416
00:22:55,007 --> 00:22:58,711
It could really hurt her
or him if it's not a virus.
417
00:22:58,811 --> 00:22:59,879
And I don't give an antibi--
418
00:22:59,979 --> 00:23:02,048
I'm just going to
give the script
419
00:23:02,148 --> 00:23:04,350
and give them the
antibiotic just to be sure.
420
00:23:04,451 --> 00:23:06,886
If you don't address
that fear that
421
00:23:06,986 --> 00:23:10,322
occurs at that moment when
that patient is the physician's
422
00:23:10,423 --> 00:23:13,292
responsibility, not
society at large,
423
00:23:13,392 --> 00:23:14,461
then it's not going to work.
424
00:23:17,029 --> 00:23:19,298
>> Where that gets really
challenging for us as providers
425
00:23:19,398 --> 00:23:23,169
is that when we see patients
who have cough, and fever,
426
00:23:23,269 --> 00:23:26,072
and are missing school
or missing work,
427
00:23:26,172 --> 00:23:30,276
we feel a need to be able to
intervene to be able to cut
428
00:23:30,376 --> 00:23:33,580
those symptoms short and
get people back to health.
429
00:23:33,680 --> 00:23:35,548
Since we don't have good
therapies for viruses,
430
00:23:35,648 --> 00:23:38,518
we tend to focus a lot on
those bacterial infections
431
00:23:38,618 --> 00:23:40,587
that we do have antibiotics for.
432
00:23:40,687 --> 00:23:43,389
The problem is is that for
every patient that we treat
433
00:23:43,490 --> 00:23:47,226
with antibiotics we're breeding
a certain sense of resistance
434
00:23:47,326 --> 00:23:50,830
in the community, that's fine
for infections that absolutely
435
00:23:50,930 --> 00:23:52,431
require antibiotics.
436
00:23:52,532 --> 00:23:54,266
But where we really
get into trouble
437
00:23:54,366 --> 00:23:57,704
is that we prescribe antibiotics
for maybe five people.
438
00:23:57,804 --> 00:24:00,707
Maybe only two or three of
them actually need antibiotics.
439
00:24:00,807 --> 00:24:03,242
And only two or three of them
will those antibiotics actually
440
00:24:03,342 --> 00:24:04,410
make them better faster.
441
00:24:04,511 --> 00:24:07,346
>> And we need things like
rapid diagnostic tests.
442
00:24:07,446 --> 00:24:10,983
So when this patient is
in my office, I run a test
443
00:24:11,083 --> 00:24:12,118
and a printout comes out.
444
00:24:12,218 --> 00:24:14,353
And it says, oh, this
patient has a virus.
445
00:24:14,453 --> 00:24:16,523
Now I have no more fear.
446
00:24:16,623 --> 00:24:18,958
Now I'm comfortable
explaining to the patient
447
00:24:19,058 --> 00:24:19,959
you have a virus.
448
00:24:20,059 --> 00:24:20,993
We don't have any
treatment for it.
449
00:24:21,093 --> 00:24:22,294
But it's just going to go away.
450
00:24:22,394 --> 00:24:25,498
You don't need an antibiotic.
451
00:24:25,598 --> 00:24:32,138
>> If you have a cold,
stay home, stay in bed.
452
00:24:32,238 --> 00:24:34,607
This is the prescription
which common sense
453
00:24:34,707 --> 00:24:39,011
and medical science recommend.
454
00:24:39,111 --> 00:24:40,880
>> And that feeling
of being ineffective,
455
00:24:40,980 --> 00:24:45,885
that feeling of not being able
to cure all ills is sometimes
456
00:24:45,985 --> 00:24:47,386
really tough.
457
00:24:47,486 --> 00:24:49,556
I've taken care of
several teenagers
458
00:24:49,656 --> 00:24:51,758
over the past few years
that have suffered
459
00:24:51,858 --> 00:24:54,226
from community acquired
methicillin-resistant staph
460
00:24:54,326 --> 00:24:55,628
aureus infections.
461
00:24:55,728 --> 00:24:57,396
In all of those
situations, I remember
462
00:24:57,496 --> 00:25:01,467
at least one moment where I
had to tell the family that I
463
00:25:01,568 --> 00:25:03,770
didn't think their child
was going to survive
464
00:25:03,870 --> 00:25:05,938
this devastating infection.
465
00:25:06,038 --> 00:25:08,174
And that's typically done
in an environment where
466
00:25:08,274 --> 00:25:10,109
the child's on a ventilator.
467
00:25:10,209 --> 00:25:13,345
They may be on a cardiac bypass
unit called ECMO, where we're
468
00:25:13,445 --> 00:25:17,216
doing all of the work for them,
doing the work of the kidneys,
469
00:25:17,316 --> 00:25:19,151
and the heart, and the lungs.
470
00:25:19,251 --> 00:25:21,320
It's usually after
a very grueling week
471
00:25:21,420 --> 00:25:25,658
or maybe two weeks of antibiotic
use that is not effective.
472
00:25:25,758 --> 00:25:27,326
And it's usually in
the setting where
473
00:25:27,426 --> 00:25:28,861
I have the
conversation that we've
474
00:25:28,961 --> 00:25:32,732
been able to have some
victory over the bacteria.
475
00:25:32,832 --> 00:25:35,234
But because the bacteria
was there for so long
476
00:25:35,334 --> 00:25:37,469
and because the
inflammatory response
477
00:25:37,570 --> 00:25:41,373
was so great, that things aren't
going the way they need to be.
478
00:25:41,473 --> 00:25:42,174
[beeping]
479
00:25:42,274 --> 00:25:45,612
[hammering]
480
00:25:50,617 --> 00:25:53,953
[hammering]
481
00:25:56,022 --> 00:25:58,490
>> It was within a day that they
had come back and told us it
482
00:25:58,591 --> 00:26:00,026
was MRSA blood infection.
483
00:26:03,963 --> 00:26:06,032
>> They think it
was in his nose.
484
00:26:06,132 --> 00:26:07,399
And that it just
started floating
485
00:26:07,499 --> 00:26:09,969
through his bloodstream and
found a weak spot to attack,
486
00:26:10,069 --> 00:26:11,804
which ended up being his knee.
487
00:26:11,904 --> 00:26:13,640
Then it attacked his lungs.
488
00:26:13,740 --> 00:26:15,074
And then it just
eventually started
489
00:26:15,174 --> 00:26:17,109
taking all of his organs.
490
00:26:17,209 --> 00:26:20,079
[beeping]
491
00:26:20,179 --> 00:26:22,381
He'll probably need
other surgeries.
492
00:26:22,481 --> 00:26:24,684
[beeping]
493
00:26:24,784 --> 00:26:29,922
>> And the growth plate on his
thigh bone and his femur is
494
00:26:30,022 --> 00:26:31,023
involved in all this.
495
00:26:31,123 --> 00:26:32,258
So it's not growing.
496
00:26:32,358 --> 00:26:34,060
So this leg is
shorter than this leg.
497
00:26:34,160 --> 00:26:39,031
So probably down the
road we'll do something
498
00:26:39,131 --> 00:26:40,499
to equal the two out.
499
00:26:40,599 --> 00:26:42,001
[beeping]
500
00:26:42,101 --> 00:26:43,002
All right.
501
00:26:43,102 --> 00:26:44,971
>> Want me to get a couple more.
502
00:26:45,071 --> 00:26:46,472
>> I think this
will do it, Susan.
503
00:26:46,572 --> 00:26:47,273
>> OK.
504
00:26:47,373 --> 00:26:50,142
[beeping]
505
00:26:51,310 --> 00:26:53,445
>> Could you put family
in a room, please?
506
00:26:53,545 --> 00:26:55,314
[beeping]
507
00:27:04,523 --> 00:27:08,127
>> The hardest part I think
was walking in there that first
508
00:27:08,227 --> 00:27:12,598
time and seeing your child
laying there with medicine all
509
00:27:12,699 --> 00:27:13,399
behind him--
510
00:27:13,499 --> 00:27:14,767
>> Oh, Lord.
511
00:27:14,867 --> 00:27:16,468
>> --and wires, and machines,
and only enough room for you
512
00:27:16,568 --> 00:27:18,204
to walk by his feet.
513
00:27:18,304 --> 00:27:20,072
And you can't do anything.
514
00:27:20,172 --> 00:27:22,541
And we just felt helpless.
515
00:27:31,784 --> 00:27:33,686
>> I don't know.
516
00:27:33,786 --> 00:27:40,192
Because I mean nobody
wants to think about death.
517
00:27:40,292 --> 00:27:41,127
You don't want to die.
518
00:27:49,601 --> 00:27:51,771
I just knew like it was
getting to the point--
519
00:27:51,871 --> 00:27:54,440
I mean, I knew it
had to be serious.
520
00:27:54,540 --> 00:27:57,376
They wouldn't just fly me
down there for no reason.
521
00:27:57,476 --> 00:28:00,913
And I just--
522
00:28:01,013 --> 00:28:01,914
I don't know.
523
00:28:02,014 --> 00:28:03,215
I kind of gave up, I guess.
524
00:28:03,315 --> 00:28:06,052
[music playing]
525
00:28:06,152 --> 00:28:07,019
>> 20 more.
526
00:28:07,119 --> 00:28:10,823
[chatter]
527
00:28:10,923 --> 00:28:14,961
>> Like the stuff I still take
for granted I'd say is school.
528
00:28:15,061 --> 00:28:18,965
But things I don't take
for granted that I used to
529
00:28:19,065 --> 00:28:20,867
is like--
530
00:28:20,967 --> 00:28:23,702
before all this happened,
like taking a shower.
531
00:28:27,539 --> 00:28:30,042
The first time I got back in
the shower I was in hospital.
532
00:28:30,142 --> 00:28:31,177
And my dad was helping me.
533
00:28:31,277 --> 00:28:33,012
And I cried because that
was first time I felt
534
00:28:33,112 --> 00:28:34,280
the water hit me on the feet.
535
00:28:34,380 --> 00:28:37,683
[chatter]
536
00:28:42,488 --> 00:28:46,558
>> This has affected
his life and long term.
537
00:28:46,658 --> 00:28:47,960
He keeps thinking.
538
00:28:48,060 --> 00:28:50,797
I'm going to be better in a
month, or two months, or three
539
00:28:50,897 --> 00:28:52,198
months.
540
00:28:52,298 --> 00:28:55,167
And it's hard for him to try to
wrap his brain around the fact
541
00:28:55,267 --> 00:29:01,774
that he's got plates, and
screws, and pins in his leg.
542
00:29:01,874 --> 00:29:03,309
And his lung is--
543
00:29:03,409 --> 00:29:04,243
>> [inaudible]
544
00:29:04,343 --> 00:29:06,678
>> --shrunken
545
00:29:06,779 --> 00:29:08,080
>> Does that hurt?
546
00:29:08,180 --> 00:29:10,282
>> There's always going to be
that fear of what happens if.
547
00:29:10,382 --> 00:29:12,819
What happens if
he's 20 years old
548
00:29:12,919 --> 00:29:15,721
and something starts going wrong
with the sutures in his lung?
549
00:29:15,822 --> 00:29:19,225
What happens if he
breaks that leg again,
550
00:29:19,325 --> 00:29:21,794
and it's chronic osteomyelitis,
and it never heals, and it's
551
00:29:21,894 --> 00:29:22,862
always going to be broken?
552
00:29:22,962 --> 00:29:24,663
[music playing]
553
00:29:24,763 --> 00:29:29,501
But I think overall I want him
to get the most out of life.
554
00:29:29,601 --> 00:29:30,436
[beeping]
555
00:29:30,536 --> 00:29:32,738
[music playing]
556
00:29:32,839 --> 00:29:33,973
There's something out there.
557
00:29:34,073 --> 00:29:38,144
There's some reason this
kid was not allowed to go.
558
00:29:38,244 --> 00:29:39,711
And I can't wait
to see what it is.
559
00:29:39,812 --> 00:29:42,614
[beeping]
560
00:29:42,714 --> 00:29:46,052
[music playing]
561
00:29:59,265 --> 00:30:01,200
>> To make a difference
to antibiotic resistance,
562
00:30:01,300 --> 00:30:05,071
the thing that we have to do is
to stop misusing antibiotics.
563
00:30:05,171 --> 00:30:07,806
We have to stop misusing them
or using them inappropriately
564
00:30:07,907 --> 00:30:09,008
in human medicine.
565
00:30:09,108 --> 00:30:10,877
And we have to stop
misusing them and using them
566
00:30:10,977 --> 00:30:12,945
inappropriately in agriculture.
567
00:30:13,045 --> 00:30:14,847
Why do those two
things keep going on?
568
00:30:14,947 --> 00:30:17,316
I think it's really two
different situations.
569
00:30:17,416 --> 00:30:20,853
I think in the case of medicine,
it's mostly just inertia.
570
00:30:20,953 --> 00:30:24,023
That medicine is a big,
complicated enterprise.
571
00:30:24,123 --> 00:30:27,927
And it's hard to get new
best practices, I guess
572
00:30:28,027 --> 00:30:31,630
they would say, into
the hands of hospitals
573
00:30:31,730 --> 00:30:34,166
and to convince everyone
of what has to happen.
574
00:30:34,266 --> 00:30:37,336
But in agriculture, it's
a different situation.
575
00:30:37,436 --> 00:30:39,505
You hear over and over
again in agriculture,
576
00:30:39,605 --> 00:30:42,441
we're not really sure if
the use of antibiotics
577
00:30:42,541 --> 00:30:43,809
is contributing to resistance.
578
00:30:43,910 --> 00:30:45,811
[music playing]
579
00:30:45,912 --> 00:30:46,879
Yes, it is.
580
00:30:46,979 --> 00:30:48,580
It's not a scientific
question any more.
581
00:30:48,680 --> 00:30:49,982
It's a question of politics.
582
00:30:50,082 --> 00:30:52,451
And it's a question
of economics.
583
00:30:52,551 --> 00:30:54,086
But it's really not
a science question.
584
00:30:54,186 --> 00:30:57,523
[music playing]
585
00:31:00,559 --> 00:31:03,595
[clucking]
586
00:31:04,496 --> 00:31:07,333
[buzzing]
587
00:31:07,433 --> 00:31:10,769
[pigs grunting]
588
00:31:13,305 --> 00:31:18,144
>> The agriculture believed
that with antibiotics they could
589
00:31:18,244 --> 00:31:21,180
grow healthier, fatter
animals quicker.
590
00:31:21,280 --> 00:31:23,149
And then it evolved
the fact that they
591
00:31:23,249 --> 00:31:25,217
found that they could keep
animals in some pretty
592
00:31:25,317 --> 00:31:26,919
deplorable conditions--
593
00:31:27,019 --> 00:31:29,121
unsanitary, unhealthy.
594
00:31:29,221 --> 00:31:32,058
But if they put some antibiotic
in their food every day,
595
00:31:32,158 --> 00:31:37,129
they felt that they were
stopping the animal illness.
596
00:31:37,229 --> 00:31:38,597
And that's about
the same as trying
597
00:31:38,697 --> 00:31:40,967
to sprinkle antibiotic
on your children's cereal
598
00:31:41,067 --> 00:31:41,867
every morning.
599
00:31:41,968 --> 00:31:43,235
It makes about as much sense.
600
00:31:56,748 --> 00:32:01,120
>> Today, agriculture is going
far beyond nature to produce
601
00:32:01,220 --> 00:32:05,224
new miracles for an even
better, more abundant life.
602
00:32:07,493 --> 00:32:09,962
>> Well, we produce 9 billion
food animals in the United
603
00:32:10,062 --> 00:32:11,063
States every year.
604
00:32:11,163 --> 00:32:13,299
So those are animals
that we raise for meat.
605
00:32:13,399 --> 00:32:16,268
And those 9 billion
animals-- most of those
606
00:32:16,368 --> 00:32:17,970
are raised in Concentrated
Animal Feeding
607
00:32:18,070 --> 00:32:22,541
Operations, or CAFOs, and given
regular doses of antibiotics.
608
00:32:22,641 --> 00:32:26,012
And what we know is that
about 80% of those antibiotics
609
00:32:26,112 --> 00:32:27,879
are used non-therapeutically.
610
00:32:27,980 --> 00:32:30,649
And they're used to make
the animals grow faster
611
00:32:30,749 --> 00:32:32,184
and to prevent
diseases that may just
612
00:32:32,284 --> 00:32:34,320
be occurring because of
the way we're raising them.
613
00:32:34,420 --> 00:32:37,456
[music playing]
614
00:32:39,058 --> 00:32:42,428
[engine roaring]
615
00:33:04,550 --> 00:33:08,387
>> It's as if someone said, what
would be the best way to come
616
00:33:08,487 --> 00:33:12,124
up with a novel pathogen
that we can't control?
617
00:33:12,224 --> 00:33:15,294
Hmm, let's get a bunch
of creatures together.
618
00:33:15,394 --> 00:33:17,596
Let's put them together
in close quarters.
619
00:33:17,696 --> 00:33:20,699
Let's put them literally
over their own manure.
620
00:33:20,799 --> 00:33:23,202
Let's feed them the same thing.
621
00:33:23,302 --> 00:33:26,072
And let's just to sort
of ramp it up one-- let's
622
00:33:26,172 --> 00:33:29,208
put daily small
doses of antibiotics.
623
00:33:29,308 --> 00:33:33,212
So we're making sure to select
for bacterial strains that
624
00:33:33,312 --> 00:33:35,747
can survive these antibiotics.
625
00:33:35,847 --> 00:33:36,582
Let's do that.
626
00:33:39,318 --> 00:33:42,288
>> He's got a support your
local farmer sign there.
627
00:33:46,392 --> 00:33:50,929
He just does that
because he can.
628
00:33:51,029 --> 00:33:52,264
He knows he's not a farmer.
629
00:33:52,364 --> 00:33:54,700
He's an industrial pig producer.
630
00:33:58,237 --> 00:34:00,672
They're still working on that
glass building back there.
631
00:34:00,772 --> 00:34:04,076
Like I said, there's a 600 head,
a 1,200 head, an 1,800 head,
632
00:34:04,176 --> 00:34:06,745
and now another
1,200 head facility.
633
00:34:06,845 --> 00:34:09,114
But if you looked
in the building,
634
00:34:09,215 --> 00:34:12,484
you'll find somewhere
between 1,100 and 1,500 head
635
00:34:12,583 --> 00:34:17,289
of hogs that are packed
together in tiny little pens.
636
00:34:19,358 --> 00:34:20,559
They're
637
00:34:20,659 --> 00:34:24,830
standing over a concrete pit
that's 8 to 12 feet deep.
638
00:34:24,929 --> 00:34:27,899
Antibiotics are in their
feed, in their water.
639
00:34:27,998 --> 00:34:30,969
And then if there's any sign
of coughing or whatever,
640
00:34:31,069 --> 00:34:32,904
they're also injected again.
641
00:34:33,004 --> 00:34:34,572
And they do not
leave until they're
642
00:34:34,672 --> 00:34:36,308
ready to go to the
truck and be butchered.
643
00:34:36,408 --> 00:34:39,277
[waves crashing]
644
00:34:50,222 --> 00:34:53,824
>> Wherever livestock are
kept, food bills always account
645
00:34:53,925 --> 00:34:56,328
for a large proportion
of the cost.
646
00:34:56,428 --> 00:35:00,166
A bird or animal is not
a very efficient factory
647
00:35:00,266 --> 00:35:03,169
for converting animal
food into human food.
648
00:35:03,269 --> 00:35:05,971
And anything that will help
to improve the efficiency
649
00:35:06,071 --> 00:35:08,840
will add to the profitability.
650
00:35:08,940 --> 00:35:11,042
In this, the animal
food industry
651
00:35:11,143 --> 00:35:13,279
is helped by the
specialist laboratory.
652
00:35:16,515 --> 00:35:19,551
>> Back 56 years ago they found
that if they gave very low
653
00:35:19,651 --> 00:35:22,588
levels of antibiotics, the
animals would grow a little bit
654
00:35:22,688 --> 00:35:25,524
faster than if they didn't
have the antibiotics in.
655
00:35:25,624 --> 00:35:26,625
We don't know why.
656
00:35:26,725 --> 00:35:27,859
We didn't know why then.
657
00:35:27,959 --> 00:35:29,361
We still don't know why now.
658
00:35:29,461 --> 00:35:31,763
But we know that that
does make the animal's
659
00:35:31,863 --> 00:35:33,399
grow a little bit faster.
660
00:35:33,499 --> 00:35:35,501
So that's why it
started happening.
661
00:35:35,601 --> 00:35:38,304
And we've really
grown up the industry
662
00:35:38,404 --> 00:35:41,807
with putting those low levels
of antibiotics into the feed.
663
00:35:41,907 --> 00:35:48,214
>> The finding was at Lederle
where the company was making
664
00:35:48,314 --> 00:35:51,617
a tetracycline
for use in people.
665
00:35:51,717 --> 00:35:55,387
The mash from the
tetracycline was
666
00:35:55,487 --> 00:35:57,656
given to chickens
and other animals
667
00:35:57,756 --> 00:36:00,326
and noted that they
seem to grow better
668
00:36:00,426 --> 00:36:03,295
for the same amount of protein.
669
00:36:03,395 --> 00:36:06,632
Well, it turns out that the
substance doing the growth
670
00:36:06,732 --> 00:36:09,501
promotion was none
other than trace amounts
671
00:36:09,601 --> 00:36:12,103
of the tetracycline
left with the carcasses.
672
00:36:12,204 --> 00:36:16,442
Then the industry said, let's
just add it back to the feed.
673
00:36:16,542 --> 00:36:19,611
And so penicillins and
tetracyclines especially
674
00:36:19,711 --> 00:36:23,148
were added back to
feed for what was then
675
00:36:23,249 --> 00:36:28,186
called growth promotion,
later called feed efficiency.
676
00:36:28,287 --> 00:36:32,090
And now being reexamined
because in fact
677
00:36:32,190 --> 00:36:33,959
their extended use is a mistake.
678
00:36:36,462 --> 00:36:39,765
>> For large corporations, what
they want to do is get as much
679
00:36:39,865 --> 00:36:44,202
meat out as quickly and
as cheaply as possible.
680
00:36:44,303 --> 00:36:48,106
That means putting antibiotics
in for growth promotion,
681
00:36:48,206 --> 00:36:50,609
to keep the animals
from getting sick.
682
00:36:50,709 --> 00:36:53,312
And the whole thought
of treating the animals
683
00:36:53,412 --> 00:36:54,646
gets to be almost secondary.
684
00:36:58,384 --> 00:37:00,852
>> Iowa is the biggest hog
producing state in the United
685
00:37:00,952 --> 00:37:02,153
States.
686
00:37:02,254 --> 00:37:04,256
And it's really
interesting to look
687
00:37:04,356 --> 00:37:07,158
at what happened in Iowa
over the past 25 years.
688
00:37:07,259 --> 00:37:11,963
And the way that the place
that hog farming had in Iowa
689
00:37:12,063 --> 00:37:13,299
changed over that period.
690
00:37:13,399 --> 00:37:15,967
>> Eric [? dee ?] produces
2,000 hogs a year on his factory
691
00:37:16,067 --> 00:37:17,135
farm.
692
00:37:17,235 --> 00:37:19,004
He has traded in his
slop bucket for buildings
693
00:37:19,104 --> 00:37:21,907
where the temperature is
controlled, the feed automated,
694
00:37:22,007 --> 00:37:23,509
and the overhead expensive.
695
00:37:23,609 --> 00:37:26,745
In order to be profitable, this
assembly line must run nonstop.
696
00:37:26,845 --> 00:37:29,014
>> We didn't find this
system of technology.
697
00:37:29,114 --> 00:37:31,149
We were forced to look at
this system of technology
698
00:37:31,249 --> 00:37:32,618
if we wanted to stay afloat.
699
00:37:32,718 --> 00:37:34,686
[pigs grunting]
700
00:37:34,786 --> 00:37:40,792
>> So between '82 and 2007, we
go from 50,000 farms to about
701
00:37:40,892 --> 00:37:42,093
8,000 farms.
702
00:37:42,193 --> 00:37:46,264
85% of hog farms in Iowa
went out of business.
703
00:37:46,365 --> 00:37:51,269
The other ones scaled
up dramatically.
704
00:37:51,370 --> 00:37:57,376
The price of a hog went from
$240 in 1982 to about $109
705
00:37:57,476 --> 00:37:59,077
in 2007.
706
00:37:59,177 --> 00:38:00,946
So you saw the
remaining farms were
707
00:38:01,046 --> 00:38:03,315
making way less profit per hog.
708
00:38:03,415 --> 00:38:05,951
And that is one of the
reasons those farmers are
709
00:38:06,051 --> 00:38:09,688
so protective of their right
to douse their hogs every day
710
00:38:09,788 --> 00:38:12,558
with antibiotics because
they've got so many of them,
711
00:38:12,658 --> 00:38:16,462
they've got such tiny,
tight micro thin profit
712
00:38:16,562 --> 00:38:19,197
margins that they're
under severe pressure
713
00:38:19,297 --> 00:38:22,200
to produce as much as
possible, as fast as possible.
714
00:38:22,300 --> 00:38:24,436
>> I'd love to be able to
say that we should only give
715
00:38:24,536 --> 00:38:28,206
antibiotics when they're
absolutely, 100% necessary.
716
00:38:28,306 --> 00:38:30,476
But right now in
certain industries,
717
00:38:30,576 --> 00:38:34,613
as the poultry industry,
the swine industry.
718
00:38:34,713 --> 00:38:36,515
It's an economic necessity.
719
00:38:39,985 --> 00:38:42,588
>> Confinement agriculture,
as it now exists,
720
00:38:42,688 --> 00:38:46,224
could not exist without
antibiotics being used the way
721
00:38:46,324 --> 00:38:47,893
they are now used.
722
00:38:47,993 --> 00:38:50,261
So if you took antibiotics
out of that system
723
00:38:50,362 --> 00:38:53,164
or if you even dialed
back their use,
724
00:38:53,264 --> 00:38:54,933
the system would have to change.
725
00:38:55,033 --> 00:38:58,437
And people within that
agricultural system
726
00:38:58,537 --> 00:39:01,407
say, it's not worth the cost.
727
00:39:01,507 --> 00:39:04,943
Well, tell that to
a mother whose child
728
00:39:05,043 --> 00:39:07,379
dies of an antibiotic
resistant illness.
729
00:39:07,479 --> 00:39:08,980
It's certainly worth
it to that mother.
730
00:39:11,417 --> 00:39:14,553
>> April 16th, 2004--
731
00:39:14,653 --> 00:39:18,690
it was a Friday, absolutely
regular, normal everyday.
732
00:39:18,790 --> 00:39:21,226
And that morning around
6:00 in the morning,
733
00:39:21,326 --> 00:39:23,695
my son who was 18
months old, my son
734
00:39:23,795 --> 00:39:27,833
whose name is Simon Sparrow,
let out this shriek.
735
00:39:27,933 --> 00:39:30,536
And he wasn't acting himself.
736
00:39:30,636 --> 00:39:32,604
He was kind of
under the weather.
737
00:39:32,704 --> 00:39:35,674
But I just thought,
oh, he's 18 months.
738
00:39:35,774 --> 00:39:36,542
Kids get sick.
739
00:39:36,642 --> 00:39:37,909
He'll be fine.
740
00:39:38,009 --> 00:39:41,780
But my husband had a sense that
something was very serious.
741
00:39:41,880 --> 00:39:44,315
So he said, I'm going to bring
him to the emergency room
742
00:39:44,416 --> 00:39:48,053
because I really feel that
there's something wrong here.
743
00:39:48,153 --> 00:39:50,456
And I actually thought
he was overreacting.
744
00:39:50,556 --> 00:39:51,289
I thought, OK, yeah.
745
00:39:51,389 --> 00:39:52,458
Go to the emergency room.
746
00:39:52,558 --> 00:39:53,659
I'll catch up with you later.
747
00:39:55,193 --> 00:39:57,996
I had to get my older
daughter ready for school.
748
00:39:58,096 --> 00:39:59,030
And then I arrived.
749
00:39:59,130 --> 00:40:01,867
My husband said that
the emergency room
750
00:40:01,967 --> 00:40:05,437
folks had administered
all kinds of tests.
751
00:40:05,537 --> 00:40:08,474
But no worries, he's
fine and can go home.
752
00:40:09,941 --> 00:40:13,078
At this point, he was
increasingly having
753
00:40:13,178 --> 00:40:14,513
trouble breathing.
754
00:40:14,613 --> 00:40:16,948
And then right in the
middle of the afternoon
755
00:40:17,048 --> 00:40:19,350
I touched his cheek
and his forehead.
756
00:40:19,451 --> 00:40:20,852
And they were ice cold.
757
00:40:20,952 --> 00:40:24,422
And I completely freaked out
because I was used to fevers.
758
00:40:24,523 --> 00:40:26,692
If you touch the
forehead and you
759
00:40:26,792 --> 00:40:30,061
can tell when that child has
a fever because it's so hot.
760
00:40:30,161 --> 00:40:36,301
But I had never felt ice
cold on a child's head.
761
00:40:36,401 --> 00:40:39,971
So I freaked out and
I called the doctor
762
00:40:40,071 --> 00:40:42,173
at the emergency room.
763
00:40:42,273 --> 00:40:43,408
And I explain what's going on.
764
00:40:43,509 --> 00:40:45,644
And I had her actually
listened to his breathing.
765
00:40:45,744 --> 00:40:50,682
And it was kind of like
[breathes in and out]..
766
00:40:50,782 --> 00:40:52,784
And she said, hang up the phone.
767
00:40:52,884 --> 00:40:54,486
Call 911 immediately.
768
00:40:54,586 --> 00:40:56,555
And when the two men
from the ambulance
769
00:40:56,655 --> 00:41:00,125
came up to our apartment, they
did another series of tests.
770
00:41:00,225 --> 00:41:01,359
They said, he's fine.
771
00:41:01,459 --> 00:41:03,428
And at that point, I
felt kind of embarrassed.
772
00:41:03,529 --> 00:41:05,831
Like, oh my gosh, I exaggerated.
773
00:41:05,931 --> 00:41:08,399
I'm making much
ado about nothing.
774
00:41:08,500 --> 00:41:09,200
It's fine.
775
00:41:09,300 --> 00:41:10,602
We can go home now.
776
00:41:10,702 --> 00:41:15,473
But then the medical technician
said, no, because of protocol.
777
00:41:15,574 --> 00:41:17,609
Once you're in the ambulance,
we have to take you
778
00:41:17,709 --> 00:41:18,510
to the emergency room.
779
00:41:18,610 --> 00:41:20,579
So we went to the
emergency room.
780
00:41:20,679 --> 00:41:23,949
And then suddenly I had a
flood of health care people
781
00:41:24,049 --> 00:41:25,584
surrounding me and Simon.
782
00:41:25,684 --> 00:41:28,219
And they kept repeating your
child is very, very sick.
783
00:41:28,319 --> 00:41:30,088
Your child is very, very sick.
784
00:41:30,188 --> 00:41:33,324
And I was just breaking down.
785
00:41:33,424 --> 00:41:34,926
And then they were
asking me questions
786
00:41:35,026 --> 00:41:37,896
like has Simon been to
another country recently?
787
00:41:37,996 --> 00:41:38,730
No.
788
00:41:38,830 --> 00:41:40,065
Has he been to a farm recently?
789
00:41:40,165 --> 00:41:40,999
No.
790
00:41:41,099 --> 00:41:42,400
Has he had all
his immunizations?
791
00:41:42,500 --> 00:41:43,569
Yes.
792
00:41:43,669 --> 00:41:45,336
And then they said,
well, we have to take him
793
00:41:45,436 --> 00:41:47,305
to the intensive care unit.
794
00:41:47,405 --> 00:41:53,078
And then, finally, when I was
allowed in, Simon was in a bed
795
00:41:53,178 --> 00:41:55,547
with all kinds of
tubes connected to him.
796
00:41:55,647 --> 00:41:58,650
[chiming]
797
00:41:58,750 --> 00:42:00,819
He was intubated.
798
00:42:00,919 --> 00:42:02,888
And the doctor, the
attending explained
799
00:42:02,988 --> 00:42:05,256
that he's having a lot
of trouble breathing.
800
00:42:05,356 --> 00:42:08,393
And she said, the only
thing that we know
801
00:42:08,493 --> 00:42:09,895
is that your son
has an infection.
802
00:42:09,995 --> 00:42:12,463
And he's very, very,
very, very sick.
803
00:42:12,564 --> 00:42:14,465
So you need to plan to
be here for a long time.
804
00:42:23,875 --> 00:42:29,948
And then they brought us into
where he was lying down in bed.
805
00:42:30,048 --> 00:42:33,218
And there were at least
10 medical doctors.
806
00:42:33,318 --> 00:42:36,755
And they said that the only
chance that he would have was
807
00:42:36,855 --> 00:42:40,525
if they put him on this machine
called the ECMO machine,
808
00:42:40,626 --> 00:42:44,095
E-C-M-O. It's a
heart-lung machine.
809
00:42:44,195 --> 00:42:45,463
So, of course, we
said, OK, let's
810
00:42:45,563 --> 00:42:47,065
bring him to this machine.
811
00:42:47,165 --> 00:42:49,034
And it was very, very
difficult to see this
812
00:42:49,134 --> 00:42:52,804
because they had to elevate him
so that the machine would work
813
00:42:52,904 --> 00:42:54,606
better for gravity reasons.
814
00:42:54,706 --> 00:42:57,575
And my husband stayed by
his side the whole night.
815
00:42:57,676 --> 00:42:59,044
He was on a stepladder.
816
00:42:59,144 --> 00:43:01,446
And he was stroking
his hair, telling him
817
00:43:01,546 --> 00:43:04,449
about all the things that
they would do together
818
00:43:04,549 --> 00:43:07,018
like fishing, skiing,
all the things
819
00:43:07,118 --> 00:43:09,487
that my husband wanted
to do with Simon.
820
00:43:09,587 --> 00:43:13,058
And in the middle of night,
I was just so beside myself.
821
00:43:13,158 --> 00:43:15,861
I really felt like that
Simon had already died.
822
00:43:15,961 --> 00:43:19,564
And I really felt like
I needed to go back home
823
00:43:19,665 --> 00:43:23,869
to where my daughter was so I
could spend some time with her.
824
00:43:23,969 --> 00:43:27,639
And then I went back at
6:00, 7:00 in the morning.
825
00:43:27,739 --> 00:43:31,743
And that's when the doctor
said that there was really
826
00:43:31,843 --> 00:43:35,546
no chance that Simon
was going to make it.
827
00:43:35,647 --> 00:43:40,618
And at this point,
my son was completely
828
00:43:40,719 --> 00:43:42,187
transformed physically.
829
00:43:42,287 --> 00:43:44,289
He was completely bloated.
830
00:43:44,389 --> 00:43:47,125
He had purple splotches
all over his body.
831
00:43:47,225 --> 00:43:50,495
He had purple tears
coming out of his eyes.
832
00:43:50,595 --> 00:43:57,903
I mean he looked totally like
a different being altogether.
833
00:43:58,003 --> 00:44:00,638
And we agreed to take him
off this ECMO machine.
834
00:44:00,739 --> 00:44:03,541
And that's when he
was pronounced dead.
835
00:44:03,641 --> 00:44:06,544
That was April 17th, a Saturday.
836
00:44:06,644 --> 00:44:10,648
And everybody was just
completely stunned.
837
00:44:10,749 --> 00:44:14,385
No one knew why he had died.
838
00:44:14,485 --> 00:44:20,658
And we had to live with
that for about two months
839
00:44:20,759 --> 00:44:23,762
when we were waiting
for the autopsy results.
840
00:44:23,862 --> 00:44:25,196
And that's what
we were called in.
841
00:44:25,296 --> 00:44:28,099
And we were told that
Simon had contracted
842
00:44:28,199 --> 00:44:30,836
this antibiotic
resistant bacterium.
843
00:44:30,936 --> 00:44:32,037
And it was a new strain.
844
00:44:32,137 --> 00:44:34,539
It was a community
associated strain,
845
00:44:34,639 --> 00:44:36,808
not a health care
associated strain.
846
00:44:36,908 --> 00:44:39,778
And it was a strain of
MRSA staph, specifically
847
00:44:39,878 --> 00:44:43,514
methicillin-resistant
Staphylococcus aureus.
848
00:44:43,614 --> 00:44:47,318
And that's why when the
doctors had given him
849
00:44:47,418 --> 00:44:52,190
a broad spectrum of
antibiotics before he died,
850
00:44:52,290 --> 00:44:54,159
nothing was working.
851
00:44:54,259 --> 00:44:58,897
And what is so frustrating even
to this day nine years later,
852
00:44:58,997 --> 00:45:01,933
we have absolutely
no idea how Simon
853
00:45:02,033 --> 00:45:03,769
contracted this bacterium.
854
00:45:03,869 --> 00:45:05,136
We don't know even where.
855
00:45:11,276 --> 00:45:14,079
It happened in
less than 24 hours.
856
00:45:16,614 --> 00:45:21,987
Really don't even have words
to describe how we felt
857
00:45:22,087 --> 00:45:23,654
after learning all of this.
858
00:45:23,755 --> 00:45:27,125
[music playing]
859
00:45:46,544 --> 00:45:51,149
>> In the 70s, the FDA
expressed serious concern about
860
00:45:51,249 --> 00:45:53,284
antibiotic resistance on farms.
861
00:45:53,384 --> 00:45:56,487
But by that time, the
practice was so entrenched.
862
00:45:56,587 --> 00:45:59,690
And the interests
involved were getting
863
00:45:59,791 --> 00:46:02,994
so big and powerful that
the genie was already
864
00:46:03,094 --> 00:46:03,795
out of the bottle.
865
00:46:05,263 --> 00:46:07,198
>> Today, the Food and Drug
Administration said that unless
866
00:46:07,298 --> 00:46:09,167
drug companies can
prove their safety,
867
00:46:09,267 --> 00:46:12,603
the number of antibiotics used
in poultry feed will be banned
868
00:46:12,703 --> 00:46:13,939
as of next year.
869
00:46:14,039 --> 00:46:16,641
And there will be a similar
ban on food for hog, sheep,
870
00:46:16,741 --> 00:46:17,642
and cattle by mid '73.
871
00:46:19,010 --> 00:46:23,048
>> When something that is
approved by the FDA is not
872
00:46:23,148 --> 00:46:24,582
shown to be safe
for human health,
873
00:46:24,682 --> 00:46:28,219
FDA has to stop the
approval for that drug.
874
00:46:28,319 --> 00:46:31,522
>> We're creating resistant
organisms that may ultimately
875
00:46:31,622 --> 00:46:35,160
transfer that resistance to
organisms that cause human
876
00:46:35,260 --> 00:46:36,494
disease.
877
00:46:36,594 --> 00:46:38,329
>> But do you think the use
of animal feeds constitutes
878
00:46:38,429 --> 00:46:40,698
the sort of health hazard
where there could be a severe
879
00:46:40,798 --> 00:46:41,499
epidemic?
880
00:46:41,599 --> 00:46:43,234
>> Absolutely.
881
00:46:43,334 --> 00:46:45,070
>> And when FDA
made those findings,
882
00:46:45,170 --> 00:46:47,272
those obligations followed.
883
00:46:47,372 --> 00:46:50,708
But for the next 35
years, actions stalled.
884
00:46:50,808 --> 00:46:53,979
[music playing]
885
00:47:03,388 --> 00:47:04,890
>> It's a very complex issue.
886
00:47:04,990 --> 00:47:09,094
And there continues to remain
gaps in the understanding.
887
00:47:09,194 --> 00:47:13,264
And I think that has driven
the inability to kind of move
888
00:47:13,364 --> 00:47:17,735
forward is that those gaps
over the numbers of years
889
00:47:17,835 --> 00:47:18,970
have always been pointed to.
890
00:47:19,070 --> 00:47:21,572
And say, well, we don't
have definitive enough data.
891
00:47:21,672 --> 00:47:24,075
So, therefore, we
shouldn't take any action.
892
00:47:24,175 --> 00:47:25,944
And I think that's
been the thinking up
893
00:47:26,044 --> 00:47:27,778
until more recently
where I think
894
00:47:27,879 --> 00:47:32,750
we've been pushing for moving
forward with a strategy that
895
00:47:32,850 --> 00:47:34,519
says, well look,
we understand there
896
00:47:34,619 --> 00:47:35,720
are some gaps in the science.
897
00:47:35,820 --> 00:47:37,555
But there is an
awful lot we do know.
898
00:47:37,655 --> 00:47:41,592
>> We've tracked for decades
now outbreaks associated with
899
00:47:41,692 --> 00:47:45,030
particular types of food animal
groups and with products from
900
00:47:45,130 --> 00:47:46,364
food animals.
901
00:47:46,464 --> 00:47:50,035
And if resistant bacteria
are causing those infections,
902
00:47:50,135 --> 00:47:52,737
then we've got to think about
where the pressures were
903
00:47:52,837 --> 00:47:57,408
exerted on those bacteria to,
number one, develop resistance,
904
00:47:57,508 --> 00:47:59,277
and to, number two, get
into the food supply.
905
00:48:06,351 --> 00:48:08,319
>> This is not just
a theoretical risk.
906
00:48:08,419 --> 00:48:11,456
What we see is that most of our
meat and poultry in the United
907
00:48:11,556 --> 00:48:14,725
States are contaminated with
drug-resistant bacteria.
908
00:48:14,825 --> 00:48:17,095
So just for example, if
you go to the grocery store
909
00:48:17,195 --> 00:48:19,830
and you want to buy some ground
turkey, you have about a one
910
00:48:19,931 --> 00:48:23,068
in 300 chance of finding a
tube of the ground turkey
911
00:48:23,168 --> 00:48:25,536
that doesn't have
drug-resistant bacteria in it.
912
00:48:25,636 --> 00:48:27,505
But this year something
came out that really
913
00:48:27,605 --> 00:48:28,639
grabbed my attention.
914
00:48:28,739 --> 00:48:31,842
So this year we saw one
package of ground turkey
915
00:48:31,943 --> 00:48:35,046
had a salmonella strain in it
that was resistant to all eight
916
00:48:35,146 --> 00:48:36,681
drugs that were tested.
917
00:48:36,781 --> 00:48:40,318
So we may be looking at
pan-resistant salmonella.
918
00:48:40,418 --> 00:48:42,420
So most salmonella
infections are self-limiting.
919
00:48:42,520 --> 00:48:44,255
You're uncomfortable
for a while.
920
00:48:44,355 --> 00:48:48,226
You use a lot of toilet paper,
right, but you usually survive.
921
00:48:48,326 --> 00:48:52,163
But when this is pan-resistant,
if your immune system cannot
922
00:48:52,263 --> 00:48:56,634
take care of it, you're very
likely to die of this, right?
923
00:48:56,734 --> 00:48:59,237
It's because your physician
doesn't have any other options
924
00:48:59,337 --> 00:49:00,538
to treat you with this.
925
00:49:04,309 --> 00:49:09,814
>> In response, FDA has chosen
to focus on voluntary measures,
926
00:49:09,914 --> 00:49:13,284
essentially recommendations to
industry that industry is free
927
00:49:13,384 --> 00:49:14,552
to follow or ignore.
928
00:49:14,652 --> 00:49:19,357
>> It enables us to work
in a collaborative way with
929
00:49:19,457 --> 00:49:22,860
the industry and in a
co-operative way so that we can
930
00:49:22,960 --> 00:49:28,033
move forward in a productive
way to get this issue addressed,
931
00:49:28,133 --> 00:49:32,670
but at same time make sure that
these products continue to be
932
00:49:32,770 --> 00:49:35,373
available to the
animal ag community.
933
00:49:35,473 --> 00:49:38,143
And that we make the change
in a real deliberate way,
934
00:49:38,243 --> 00:49:42,247
and it gives us some ability
to phase it in over time
935
00:49:42,347 --> 00:49:44,949
and pay attention to what
those collateral effects may
936
00:49:45,050 --> 00:49:48,886
be as we move forward
implementing the changes.
937
00:49:51,889 --> 00:49:56,394
>> Over and over we see the
influence of money in politics.
938
00:49:56,494 --> 00:49:58,596
And you know what it really
comes down to, I think,
939
00:49:58,696 --> 00:50:01,932
is that when these
industries consolidate
940
00:50:02,033 --> 00:50:04,869
and more and more
of the industry
941
00:50:04,969 --> 00:50:06,804
gets tied up into
fewer and fewer hands.
942
00:50:06,904 --> 00:50:08,473
You get these massive companies.
943
00:50:08,573 --> 00:50:10,341
They make massive
amounts of profits,
944
00:50:10,441 --> 00:50:13,010
and they invest some of those
profits in their lobbying
945
00:50:13,111 --> 00:50:14,412
effort.
946
00:50:14,512 --> 00:50:19,084
>> The idea there was is that
if these two antibiotic could be
947
00:50:19,184 --> 00:50:22,353
limited, then their usefulness
in veterinary therapy
948
00:50:22,453 --> 00:50:25,056
and in human therapy
would be preserved.
949
00:50:25,156 --> 00:50:27,892
>> Feedlot operators
fought that ban and won.
950
00:50:27,992 --> 00:50:29,927
They argued, no
conclusive link has
951
00:50:30,027 --> 00:50:32,097
been established
between antibiotic use
952
00:50:32,197 --> 00:50:34,365
in animals and human disease.
953
00:50:34,465 --> 00:50:36,801
But the government says
that's no longer true.
954
00:50:36,901 --> 00:50:39,637
>> It isn't just the meat
companies who have massive
955
00:50:39,737 --> 00:50:40,705
amounts of power.
956
00:50:40,805 --> 00:50:42,840
It's the animal
pharmaceutical companies
957
00:50:42,940 --> 00:50:45,643
that make lots and lots of
money selling the stuff.
958
00:50:45,743 --> 00:50:47,044
They have a vested interest.
959
00:50:47,145 --> 00:50:49,280
The fast food industry-- they
don't really care how it gets
960
00:50:49,380 --> 00:50:50,648
made.
961
00:50:50,748 --> 00:50:52,917
They just want to be able to
offer their triple cheeseburger
962
00:50:53,017 --> 00:50:54,919
or their meat lover's
pizza at a price that
963
00:50:55,019 --> 00:50:56,554
keeps consumers coming back.
964
00:50:56,654 --> 00:50:58,289
They're against these
kinds of measures.
965
00:50:58,389 --> 00:51:02,127
And so you get these powerful
economic interests lined up
966
00:51:02,227 --> 00:51:04,662
with lobbying
power, and it really
967
00:51:04,762 --> 00:51:06,231
isn't that big of
a mystery why we
968
00:51:06,331 --> 00:51:07,465
haven't seen very much change.
969
00:51:12,903 --> 00:51:15,806
>> But now that we know
the extent of the problem,
970
00:51:15,906 --> 00:51:18,676
let us consider what
can be done about it.
971
00:51:18,776 --> 00:51:21,146
Is it a necessary evil?
972
00:51:21,246 --> 00:51:23,381
Is it something science
is unable to fight,
973
00:51:23,481 --> 00:51:27,385
or is it simply too powerful
for the human race to cope with?
974
00:51:27,485 --> 00:51:29,654
I was born in Denmark.
975
00:51:29,754 --> 00:51:32,723
Some years ago, I
went back for a visit.
976
00:51:32,823 --> 00:51:35,826
I was amazed at their progress,
and I took some home movies.
977
00:51:38,529 --> 00:51:40,865
You can see for yourself how
Denmark attacks the problem.
978
00:51:52,143 --> 00:51:58,183
>> [inaudible]
979
00:51:58,283 --> 00:52:04,389
>> In 1992, Denmark made an
agreement with the English
980
00:52:04,489 --> 00:52:06,691
people.
981
00:52:06,791 --> 00:52:09,794
They don't want antibiotic
growth promoters
982
00:52:09,894 --> 00:52:12,297
in the food for the pigs.
983
00:52:12,397 --> 00:52:16,701
And in 1995, it was
banned in Denmark
984
00:52:16,801 --> 00:52:21,372
that you may not use antibiotic
growth promoters for food.
985
00:52:21,472 --> 00:52:25,075
In 1998, it was
banned in Europe,
986
00:52:25,176 --> 00:52:29,046
but I think it was
2004 it was stopped
987
00:52:29,146 --> 00:52:32,850
the use antibiotic growth
promoters totally in Europe.
988
00:52:32,950 --> 00:52:43,628
But in Denmark we
started already in 1992.
989
00:52:43,728 --> 00:52:47,965
>> 200 females and
no one is screaming.
990
00:52:48,065 --> 00:52:49,734
>> As soon as we started
looking after it,
991
00:52:49,834 --> 00:52:51,636
we could see that this
resistance was all over
992
00:52:51,736 --> 00:52:53,738
the place in our food animals.
993
00:52:53,838 --> 00:52:56,407
It was in our food products,
and it was actually also
994
00:52:56,507 --> 00:52:59,277
in healthy humans in the
community in Denmark,
995
00:52:59,377 --> 00:53:03,614
even though there was
extremely limited amount of use
996
00:53:03,714 --> 00:53:05,015
on the human side at that time.
997
00:53:05,115 --> 00:53:10,488
>> There was a public debate on
whether this was a human health
998
00:53:10,588 --> 00:53:15,993
risk that we used these
antibiotic growth promoters.
999
00:53:16,093 --> 00:53:22,367
And finally, the industry
decided that we could probably
1000
00:53:22,467 --> 00:53:25,770
still have a
profitable production
1001
00:53:25,870 --> 00:53:28,773
without using the
antibiotic growth promoters.
1002
00:53:28,873 --> 00:53:32,977
So in order to, you
could say, accommodate
1003
00:53:33,077 --> 00:53:38,783
the public and our
customers, we decided that we
1004
00:53:38,883 --> 00:53:41,218
would ban them voluntarily.
1005
00:53:41,319 --> 00:53:42,887
It's an industry initiative.
1006
00:53:42,987 --> 00:53:44,221
It was not the government.
1007
00:53:44,322 --> 00:53:47,525
Later on, the EU banned
antibiotic growth promoters,
1008
00:53:47,625 --> 00:53:49,894
but that was seven years later.
1009
00:53:49,994 --> 00:53:54,198
So it was simply because of a
discussion in the public about
1010
00:53:54,299 --> 00:53:56,834
whether this was a problem.
1011
00:54:02,273 --> 00:54:05,175
>> Well, the question is, does
their system work any better?
1012
00:54:11,582 --> 00:54:15,320
>> The bottom line is that today
we in total use approximately
1013
00:54:15,420 --> 00:54:19,724
half the amount of antimicrobial
agents as we did before
1014
00:54:19,824 --> 00:54:24,161
the ban, and we
produce 50% more.
1015
00:54:24,261 --> 00:54:29,199
And at the same time, resistance
has gone down really heavily.
1016
00:54:29,300 --> 00:54:32,069
>> I will not say
I love that ban,
1017
00:54:32,169 --> 00:54:36,574
but the result coming out
of the ban I love that.
1018
00:54:36,674 --> 00:54:39,844
I'm not organic
producer, but I love not
1019
00:54:39,944 --> 00:54:42,780
to give more than necessary.
1020
00:54:42,880 --> 00:54:46,384
>> You have to balance out
what are the costs and what are
1021
00:54:46,484 --> 00:54:48,185
the benefits.
1022
00:54:48,285 --> 00:54:50,755
AGPs, when we
stopped using them,
1023
00:54:50,855 --> 00:54:56,327
we could see that mortality
went up just a little bit,
1024
00:54:56,427 --> 00:54:59,964
daily growth went down
just a little bit,
1025
00:55:00,064 --> 00:55:04,068
but it was not something that
was the end of the industry.
1026
00:55:04,168 --> 00:55:06,203
Otherwise, we wouldn't
be here today.
1027
00:55:06,303 --> 00:55:09,006
And, I mean, we
produce more pigs today
1028
00:55:09,106 --> 00:55:13,944
than we did 12 years
ago, way more pigs.
1029
00:55:20,117 --> 00:55:22,687
>> Well, of course, we hear this
argument all the time that this
1030
00:55:22,787 --> 00:55:25,089
might be feasible to do
something in a small country
1031
00:55:25,189 --> 00:55:26,256
like Denmark.
1032
00:55:26,357 --> 00:55:27,392
But come on.
1033
00:55:27,492 --> 00:55:30,728
Denmark is producing 28
million pigs every year.
1034
00:55:30,828 --> 00:55:34,699
That's basically the same amount
as the state of Iowa does.
1035
00:55:34,799 --> 00:55:36,867
I think it's about
30 million pigs.
1036
00:55:36,967 --> 00:55:38,603
So if we could do it
in Denmark, of course
1037
00:55:38,703 --> 00:55:39,670
you could do it in Iowa.
1038
00:55:39,770 --> 00:55:41,205
And Iowa's probably
the state in the US
1039
00:55:41,305 --> 00:55:43,040
that's producing most pigs.
1040
00:55:43,140 --> 00:55:46,310
So it's not so difficult.
It is actually feasible,
1041
00:55:46,411 --> 00:55:50,748
and, of course, you can scale
it up to any state in the US.
1042
00:56:00,558 --> 00:56:03,561
>> Well, it sounds
like ABC, doesn't it?
1043
00:56:03,661 --> 00:56:06,797
Well, it's that easy,
and it's up to you.
1044
00:56:13,203 --> 00:56:16,407
>> I don't know about you, but
I hate the idea of the Swedes,
1045
00:56:16,507 --> 00:56:19,043
Norwegians, and Danes thinking
we're a bunch of superstitious
1046
00:56:19,143 --> 00:56:20,411
idiots.
1047
00:56:20,511 --> 00:56:23,514
Let's show them we're as adult
and intelligent as they are.
1048
00:56:23,614 --> 00:56:26,083
So let that be our
plan of conquest,
1049
00:56:26,183 --> 00:56:27,852
the conquest of disease.
1050
00:56:27,952 --> 00:56:30,821
[music playing]
1051
00:56:47,805 --> 00:56:52,142
>> There is no government agency
that feels empowered or indeed
1052
00:56:52,242 --> 00:56:56,814
is empowered to really
watch out for effectiveness
1053
00:56:56,914 --> 00:56:58,549
of antibiotics.
1054
00:56:58,649 --> 00:57:02,186
And I'm not advocating the
creation of a new government
1055
00:57:02,286 --> 00:57:05,523
agency, but certainly if we
didn't have government paying
1056
00:57:05,623 --> 00:57:07,892
attention to the
[? effector's ?] antibiotics,
1057
00:57:07,992 --> 00:57:10,327
most assuredly there's
no private incentive
1058
00:57:10,427 --> 00:57:12,463
to pay attention to this.
1059
00:57:12,563 --> 00:57:14,465
>> If you want to design
interventions to block
1060
00:57:14,565 --> 00:57:16,066
transmission of infections,
you've got to know where
1061
00:57:16,166 --> 00:57:17,134
the infections are.
1062
00:57:17,234 --> 00:57:18,268
You've got to know
where the resistance is.
1063
00:57:18,368 --> 00:57:20,104
You've got to know where
the antibiotic use is.
1064
00:57:20,204 --> 00:57:24,742
Europe has developed a very
sophisticated network that's
1065
00:57:24,842 --> 00:57:27,177
EU wide, and the United
States is behind.
1066
00:57:27,277 --> 00:57:29,446
>> To really understand
resistance and to really
1067
00:57:29,547 --> 00:57:33,350
understand what's going on, it's
probably more important to have
1068
00:57:33,450 --> 00:57:36,787
granular information that allows
you to look at more discrete
1069
00:57:36,887 --> 00:57:40,858
geographic areas, to look at
the correlation of use with
1070
00:57:40,958 --> 00:57:45,863
the resistance rates that may
happen at a more local level.
1071
00:57:45,963 --> 00:57:48,633
>> And what are the challenges
to getting to that more
1072
00:57:48,733 --> 00:57:51,101
granular level?
1073
00:57:51,201 --> 00:57:56,273
>> So it's in essence either
accessing that information
1074
00:57:56,373 --> 00:58:01,979
through vendors who do
gather that information,
1075
00:58:02,079 --> 00:58:04,181
companies such as IMS Health.
1076
00:58:04,281 --> 00:58:08,485
Other vendors that
do provide such data
1077
00:58:08,586 --> 00:58:10,254
may provide a resource
for those that
1078
00:58:10,354 --> 00:58:13,624
are wanting to do
research to look
1079
00:58:13,724 --> 00:58:18,228
at the correlation of resistance
with particular levels
1080
00:58:18,328 --> 00:58:22,600
of anti-microbial drug use.
1081
00:58:22,700 --> 00:58:25,069
>> And this may be a
really naive question,
1082
00:58:25,169 --> 00:58:28,405
but I think it's one that a lot
of regular people would have.
1083
00:58:28,505 --> 00:58:32,509
Why can't we just say, you have
to tell us how much you use?
1084
00:58:32,610 --> 00:58:34,178
There has to be an accounting.
1085
00:58:37,114 --> 00:58:39,850
>> So I'm not sure I can
answer that question exactly,
1086
00:58:39,950 --> 00:58:46,156
but health care records,
health care laws--
1087
00:58:46,256 --> 00:58:50,027
it's not entirely clear to
me how that would happen.
1088
00:58:50,127 --> 00:58:52,697
But the folks that--
1089
00:58:52,797 --> 00:58:59,503
and I'm not sure this is
really something that will--
1090
00:58:59,604 --> 00:59:01,471
it's not my area of
expertise per se as
1091
00:59:01,572 --> 00:59:02,840
far as gathering all this data.
1092
00:59:02,940 --> 00:59:06,744
But there are groups like
IMS Health, Wolters Kluwer,
1093
00:59:06,844 --> 00:59:09,079
other organizations,
Premier Health,
1094
00:59:09,179 --> 00:59:11,515
that are sources of
this type of data.
1095
00:59:11,616 --> 00:59:14,619
And through contracts
with them, they
1096
00:59:14,719 --> 00:59:18,689
can provide different types
of data on anti-bacterial drug
1097
00:59:18,789 --> 00:59:19,924
usage.
1098
00:59:20,024 --> 00:59:23,427
[music playing]
1099
00:59:55,592 --> 00:59:58,562
>> The political and economic
realities behind why we have
1100
00:59:58,663 --> 01:00:03,033
not set up a coordinated federal
network that isn't just looking
1101
01:00:03,133 --> 01:00:07,537
at one or two diseases at a time
but is doing pan surveillance,
1102
01:00:07,638 --> 01:00:10,808
I think those are real policy
questions that need to be
1103
01:00:10,908 --> 01:00:12,142
addressed.
1104
01:00:12,242 --> 01:00:14,011
>> If you do not have these
data to show where you are,
1105
01:00:14,111 --> 01:00:16,480
you have absolutely no
clue where you're going.
1106
01:00:16,580 --> 01:00:19,083
You cannot monitor what is the
effect of the interventions you
1107
01:00:19,183 --> 01:00:19,917
do.
1108
01:00:20,017 --> 01:00:21,151
You don't know which kind of--
1109
01:00:21,251 --> 01:00:24,855
what you should target,
what you should do about it.
1110
01:00:24,955 --> 01:00:28,125
And so surveillance
is really the essence
1111
01:00:28,225 --> 01:00:30,360
to the basis of
everything for anything
1112
01:00:30,460 --> 01:00:34,865
you do both before and
also for the future.
1113
01:00:34,965 --> 01:00:39,136
>> You have to have an
independent FDA and USDA,
1114
01:00:39,236 --> 01:00:40,771
and independent
regulatory authorities,
1115
01:00:40,871 --> 01:00:43,073
to be able to look at these
products to analyze them
1116
01:00:43,173 --> 01:00:47,544
on a continuing basis and
call the chips where they may.
1117
01:00:47,644 --> 01:00:49,479
And that sometimes
creates political problems
1118
01:00:49,579 --> 01:00:52,482
on Capitol Hill and
elsewhere, but that
1119
01:00:52,582 --> 01:00:54,051
is what the public expects.
1120
01:00:57,554 --> 01:01:01,658
>> This fight is probably
the fight of a lifetime.
1121
01:01:01,759 --> 01:01:03,593
I don't think there's
any question about that.
1122
01:01:03,694 --> 01:01:08,532
If 148,000 people die a year
of uncontrollable infections,
1123
01:01:08,632 --> 01:01:10,600
we've got a problem
on our hands,
1124
01:01:10,701 --> 01:01:13,938
particularly since a decade
or two ago that wouldn't
1125
01:01:14,038 --> 01:01:15,405
have been a problem at all.
1126
01:01:15,505 --> 01:01:17,808
And it is up to us to stop it.
1127
01:01:17,908 --> 01:01:20,110
And it is heartbreaking to me--
1128
01:01:20,210 --> 01:01:21,779
not to say stupid--
1129
01:01:21,879 --> 01:01:25,149
that we would take one of
the most single advances
1130
01:01:25,249 --> 01:01:29,887
in medicine in our lifetime
or in this last century
1131
01:01:29,987 --> 01:01:31,355
and simply waste it.
1132
01:01:31,455 --> 01:01:32,656
And it infuriates me.
1133
01:01:47,537 --> 01:01:50,741
>> If you look now at our
current antibiotic pipeline,
1134
01:01:50,841 --> 01:01:55,445
I think that it would be
appropriate to be concerned.
1135
01:01:55,545 --> 01:01:58,348
There aren't nearly enough
drugs coming forward.
1136
01:02:11,996 --> 01:02:15,966
>> If you're a pharma company
and you spend 10 years
1137
01:02:16,066 --> 01:02:17,134
and a billion dollars--
1138
01:02:17,234 --> 01:02:19,236
those are the usually
agreed to numbers--
1139
01:02:19,336 --> 01:02:22,840
10 years and a billion
dollars developing a drug,
1140
01:02:22,940 --> 01:02:26,844
and you bring that drug
out and within a year
1141
01:02:26,944 --> 01:02:28,345
bacteria are resistant to it.
1142
01:02:28,445 --> 01:02:31,715
And within three years a lot of
bacteria are resistant to it,
1143
01:02:31,816 --> 01:02:33,851
and within five years
maybe physicians
1144
01:02:33,951 --> 01:02:35,920
don't want to prescribe
your drug anymore
1145
01:02:36,020 --> 01:02:38,588
because they're not sure if it's
going to work in their patients
1146
01:02:38,688 --> 01:02:39,924
or not.
1147
01:02:40,024 --> 01:02:41,525
Why would you make that drug?
1148
01:02:41,625 --> 01:02:43,861
How are you going to recoup
that billion dollars?
1149
01:02:43,961 --> 01:02:45,830
When you look at it
through that lens,
1150
01:02:45,930 --> 01:02:50,100
making something like
Viagra or statins or insulin
1151
01:02:50,200 --> 01:02:52,302
that people will take for
the rest of their lives,
1152
01:02:52,402 --> 01:02:53,537
that makes a lot more sense.
1153
01:02:57,374 --> 01:02:59,877
>> The second side of the
coin is the regulatory.
1154
01:02:59,977 --> 01:03:03,247
The Food and Drug Administration
has completely changed the way
1155
01:03:03,347 --> 01:03:06,516
that it looks at
antibiotic clinical trials,
1156
01:03:06,616 --> 01:03:10,888
and the reasons for this
relate to very Byzantine
1157
01:03:10,988 --> 01:03:13,824
statistical concepts.
1158
01:03:13,924 --> 01:03:18,028
The effect is that
companies know,
1159
01:03:18,128 --> 01:03:20,564
A, they don't know how to
get new clinical trials done
1160
01:03:20,664 --> 01:03:21,698
for antibiotics.
1161
01:03:21,798 --> 01:03:24,701
And even successfully
completing those trials,
1162
01:03:24,801 --> 01:03:27,504
you have a much lower chance
of getting a drug approved
1163
01:03:27,604 --> 01:03:29,306
now than in the past.
1164
01:03:29,406 --> 01:03:32,176
So tell industry, tell
investors that it's
1165
01:03:32,276 --> 01:03:34,144
going to take much
longer than it used to.
1166
01:03:34,244 --> 01:03:36,480
It's going to be much more
expensive than it used to be,
1167
01:03:36,580 --> 01:03:38,348
and you're going to have a
much higher risk of failure
1168
01:03:38,448 --> 01:03:40,584
even if you successfully
complete your phase three
1169
01:03:40,684 --> 01:03:44,955
trials, and watch those
investors run for the hills.
1170
01:03:45,055 --> 01:03:48,225
That's what we've done as
a matter of public policy
1171
01:03:48,325 --> 01:03:51,996
in antibiotic development.
1172
01:03:52,096 --> 01:03:54,198
>> We need to encourage
developers to be willing
1173
01:03:54,298 --> 01:03:57,667
to bring forward antibiotics
that might be antibiotics that
1174
01:03:57,767 --> 01:03:59,436
we don't use very often.
1175
01:03:59,536 --> 01:04:03,507
And I think it is not reasonable
to expect new antibiotics
1176
01:04:03,607 --> 01:04:05,209
to all be best selling drugs.
1177
01:04:05,309 --> 01:04:07,244
That, in fact, if they
become best selling drugs,
1178
01:04:07,344 --> 01:04:10,514
we're probably not
using them correctly.
1179
01:04:10,614 --> 01:04:13,017
>> What we need to go after
is thinking through where
1180
01:04:13,117 --> 01:04:15,685
we're going to get our
antibiotics rather than trying
1181
01:04:15,785 --> 01:04:18,622
to fork over a lot of money to
some big pharma company to come
1182
01:04:18,722 --> 01:04:19,924
up with the next blockbuster.
1183
01:04:20,024 --> 01:04:22,359
Because what's that
really going to solve?
1184
01:04:22,459 --> 01:04:25,362
That's kind of like,
you have a new car
1185
01:04:25,462 --> 01:04:27,497
and you drive it on a
road which is really bad.
1186
01:04:27,597 --> 01:04:30,000
So your new car goes bad,
and so you say, well,
1187
01:04:30,100 --> 01:04:33,703
what I really need to fix that
problem is another new car.
1188
01:04:33,803 --> 01:04:36,140
No, what we really
need is a better road.
1189
01:04:39,709 --> 01:04:42,546
>> If we don't develop any
new drugs for blood pressure
1190
01:04:42,646 --> 01:04:45,615
in the next 50 years, that's OK.
1191
01:04:45,715 --> 01:04:46,984
The stuff we have
today are going
1192
01:04:47,084 --> 01:04:50,220
to work just as well 50 years
from now as they do today.
1193
01:04:50,320 --> 01:04:52,789
But if we don't develop
any new antibiotics,
1194
01:04:52,889 --> 01:04:56,360
the nature of the beast is
that the stuff we have today
1195
01:04:56,460 --> 01:04:57,861
are not going to work anymore.
1196
01:04:57,962 --> 01:05:00,965
That's bacteria using
their genes to adapt.
1197
01:05:01,065 --> 01:05:03,233
We have to develop new
ones, or we will not
1198
01:05:03,333 --> 01:05:04,701
have effective ones at all.
1199
01:05:04,801 --> 01:05:07,104
[music playing]
1200
01:05:14,378 --> 01:05:18,748
>> The tragedy of the commons
exists when any individual
1201
01:05:18,848 --> 01:05:20,584
who's using a
particular resource--
1202
01:05:20,684 --> 01:05:22,552
let's just call it fisheries.
1203
01:05:22,652 --> 01:05:24,854
And you think, well, a
problem with fisheries
1204
01:05:24,955 --> 01:05:27,091
is that there is too many
people catching fish,
1205
01:05:27,191 --> 01:05:30,260
because any fish they
leave in the ocean
1206
01:05:30,360 --> 01:05:32,296
is basically lost to them
because someone else is
1207
01:05:32,396 --> 01:05:33,663
going to catch it.
1208
01:05:33,763 --> 01:05:36,000
And that's exactly the same
problem with antibiotics, which
1209
01:05:36,100 --> 01:05:38,902
is if I don't use
their effectiveness,
1210
01:05:39,003 --> 01:05:40,537
it's gone tomorrow
because someone else
1211
01:05:40,637 --> 01:05:42,772
is going to be using
up their effectiveness.
1212
01:05:42,872 --> 01:05:45,809
And in a sense, it
takes the problem
1213
01:05:45,909 --> 01:05:48,245
of antibiotics out of the
realm of medical science,
1214
01:05:48,345 --> 01:05:51,315
which it is a medical
problem, but it's really
1215
01:05:51,415 --> 01:05:56,020
a problem of behavior of
individuals and of societies.
1216
01:05:56,120 --> 01:05:58,855
>> The over-prescription
and misuse of antibiotics is
1217
01:05:58,955 --> 01:06:03,693
a classic example of the
tragedy of the commons.
1218
01:06:03,793 --> 01:06:05,895
If I was the only physician
in the country that
1219
01:06:05,996 --> 01:06:08,832
was prescribing antibiotics to
people with viral infections,
1220
01:06:08,932 --> 01:06:11,401
it would have almost
no impact on the spread
1221
01:06:11,501 --> 01:06:13,770
of antibiotic resistance
upon bacteria.
1222
01:06:13,870 --> 01:06:17,307
When every physician does it
and when it's done in animals,
1223
01:06:17,407 --> 01:06:21,345
it's done on a tremendously
widespread industrial scale.
1224
01:06:21,445 --> 01:06:25,782
That has a negative detrimental
effect on society as a whole.
1225
01:06:25,882 --> 01:06:29,453
And the time for bickering
over half measures
1226
01:06:29,553 --> 01:06:32,356
and debating the
nuances is over.
1227
01:06:32,456 --> 01:06:33,990
We're past all that.
1228
01:06:34,091 --> 01:06:36,793
It's time to sit
down in a serious way
1229
01:06:36,893 --> 01:06:40,997
and fundamentally redesign the
processes by which we discover,
1230
01:06:41,098 --> 01:06:43,867
use, and protect antibiotics.
1231
01:06:47,637 --> 01:06:52,642
>> We can try and figure out a
way to protect ourselves from
1232
01:06:52,742 --> 01:06:56,513
the very dangerous microbes
that are out there,
1233
01:06:56,613 --> 01:07:01,985
and that probably will
require us to accept some risk
1234
01:07:02,086 --> 01:07:04,054
associated with life.
1235
01:07:04,154 --> 01:07:08,625
That is, if we walk around
into our environment,
1236
01:07:08,725 --> 01:07:12,329
it's probably better
for us in the long run
1237
01:07:12,429 --> 01:07:15,031
to get exposed to the
microbes in the dirt
1238
01:07:15,132 --> 01:07:18,102
and on our mother
and other places.
1239
01:07:18,202 --> 01:07:22,005
So you sort of have to accept
that occasionally some of them
1240
01:07:22,106 --> 01:07:24,741
are going to make you
sick, and hopefully we'll
1241
01:07:24,841 --> 01:07:27,244
have treatments
that will allow us,
1242
01:07:27,344 --> 01:07:32,916
if they make you really
sick, to get rid of them.
1243
01:07:33,016 --> 01:07:37,721
>> The best quote that explains
our relationship with microbes
1244
01:07:37,821 --> 01:07:40,924
came from Nobel laureate
Dr. Joshua Lederberg,
1245
01:07:41,024 --> 01:07:44,494
who wrote in the magazine
Science that the future
1246
01:07:44,594 --> 01:07:47,564
of humanity and microbes will
likely evolve as episodes
1247
01:07:47,664 --> 01:07:51,235
of our wits versus their genes.
1248
01:07:51,335 --> 01:07:54,904
Their genes allow them to adapt
to anything we throw at them.
1249
01:07:55,004 --> 01:07:58,808
It's up to us to use our wits
to keep up with their genes.
1250
01:07:58,908 --> 01:08:01,778
[music playing]
1251
01:09:25,461 --> 01:09:27,231
[MUSIC - JONATHAN
STONE PHILLIPS,
1252
01:09:27,331 --> 01:09:36,306
"I SAW IT DARKEN
A SWIMMING POOL"]
1253
01:09:36,406 --> 01:09:41,411
>> I remember in middle school
I saw it darken a swimming pool.
1254
01:09:41,511 --> 01:09:42,779
It's growing.
1255
01:09:42,879 --> 01:09:44,147
It's growing.
1256
01:09:44,247 --> 01:09:45,949
It's growing.
1257
01:09:46,049 --> 01:09:47,283
It's taking over me.
1258
01:09:52,755 --> 01:09:55,625
You shouldn't push
up against it.
1259
01:09:55,725 --> 01:09:58,193
Don't move it, or
you'll offend it.
1260
01:09:58,295 --> 01:09:59,128
It's growing.
1261
01:09:59,228 --> 01:10:00,464
It's growing.
1262
01:10:00,564 --> 01:10:02,632
It's growing.
1263
01:10:02,732 --> 01:10:03,933
It's taking over me.
1264
01:10:25,989 --> 01:10:28,925
Sometimes it covers everything.
1265
01:10:29,025 --> 01:10:31,160
Sometimes it's only
there between the trees.
1266
01:10:31,261 --> 01:10:32,596
It's growing.
1267
01:10:32,696 --> 01:10:34,063
It's growing.
1268
01:10:34,163 --> 01:10:35,699
It's growing.
1269
01:10:35,799 --> 01:10:36,532
It's taking over me.
1270
01:10:42,739 --> 01:10:45,475
It's the color of
misplaced fruit.
1271
01:10:45,575 --> 01:10:47,811
I hate to say it, but right
now it's probably near you.
1272
01:10:58,121 --> 01:11:01,958
[inaudible]
96178
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