
My Husband Became a Poster Child of the Post-Antibiotic Era - susiecambria
https://www.thedailybeast.com/how-my-husband-became-a-poster-child-of-the-post-antibiotic-superbug-era
======
whytaka
It’s been a number of years now that I have become aware of MRSA and
superbugs. The moment I read on this is also the moment I have come to be
aware of phage therapy as a promising path of overcoming this new threat.

This article yet again reports on the lack of awareness about bacteriophages
in the medical community. I just can’t understand why it is like that. I, an
idiot, have heard about it. How do people, who seemingly work with superbugs
all the time and understand the threat, not know this thing that is amongst
the very first things one is exposed to when one takes a superficial glance at
the available literature?

~~~
AllegedAlec
> This article yet again reports on the lack of awareness about bacteriophages
> in the medical community.

A shortlist of answers:

\- Bacteriophages are evolutionarily close to viruses. Their proteins will
resemble viral proteins, so the body will most likely initiate an immune
response against it.

\- Bacteriophages are really quite specific in what they'll infect. This makes
them much less useful as an antibacterial. You'd spend a lot of time and money
on making one that would infect your mrsa strain, and mrsa would probably just
start the arms race, leaving you back at the start.

\- Bacteriophages are (evolutionarily close to) viruses, and thus also have
the immense mutation rate of those. Even if you were to make one that had all
the properties you wanted, it'd probably get rid of most of them because they
are evolutionarily disadvantages.

\- Probably a few other fairly good reasons which my coffee-deprived brain
can't think off right at this moment.

~~~
ddebernardy
Those are all potentially valid reasons to not pay much attention to it as a
solution for multi-resistant bacteria.

However, none of them explain why medical professionals are not even aware
that bacteriophages are a thing, in contrast with laypeople like the parent
poster (or myself, and presumably many more on HN since there have been a few
articles on this topic over the years).

~~~
robbiep
The medical profession is aware, they just aren’t scaled up for use in any
meaningful sense - essentially to be able to meaningfully fight bacterial
infections with phases a hospital or clinic would need to type the bacteria
and screen it against potentially hundreds or more phages (even if they are
already specific to the bacteria) to find the ones that are going to be most
effective. So, there are time constraints, delivery mechanisms and also
logistics to overcome.

A challenge for a startup?

------
dgudkov
Another article that describes the same story with additional details:
[https://www.motherjones.com/environment/2018/05/the-best-
vir...](https://www.motherjones.com/environment/2018/05/the-best-viral-news-
youll-ever-read-antibiotic-resistance-phage-therapy-bacteriophage-virus/)

------
gumby
One factor that will return once people start to panic is table manners, many
of which seem fussy (separate saving utensils, a butter knife, not putting
used utensils onto the table) but actually evolved for hygiene reasons.

Sadly of course like any complex behavior it was also hijacked for sumptuary
purposes (grape shears, egg spoons, not finishing your plate in some cultures)
but I hold out a hope (probably in vail) that those kinds of rules won't be
revived.

~~~
Stratoscope
> _One factor that will return once people start to panic is table manners,
> many of which seem fussy (separate serving utensils, a butter knife, not
> putting used utensils onto the table) but actually evolved for hygiene
> reasons._

When I was a kid growing up in the late 1950s, I thought we had this problem
solved.

All the local restaurants kept a jar of mustard and a jar of mayonnaise on
each table. (Yes, mayo sitting out all day, but let's ignore that for now.)

They didn't have separate utensils for these jars, you just used the table
knife from your place setting. This led to a problem.

What if you had already cut your burger in half and then decided you want more
mayo or mustard? You certainly wouldn't use a dirty table knife that would get
bits of lettuce and tomato and bread and beef into the condiments.

Fortunately, my mom taught us basic sanitation: before you dip your table
knife into the mustard or mayo jar, you must first lick it clean!

~~~
elyobo
Missed opportunity to say that you "thought we had this problem licked" ;)

------
HillaryBriss
_...for most superbugs, health departments and the US Centers for Disease
Control and Prevention (CDC) don’t track who acquires them, nor do they know
how many recovered or died. The most recent CDC report estimates that 23,000
people die in the U.S. each year from superbug infections, based on data from
2010. But a recent report estimated that at least 153,000 people died from
superbug infections the same year, an estimate that is nearly seven-fold
higher. We are allowing most superbugs to maintain their invisibility under
the radar, where they are spreading quietly. Unreported. Undetected. And,
increasingly, untreatable._

this isn't really scary at all. i'm not scared. are you scared? why be scared?

~~~
jen_h
The point of her article wasn’t to push despair, but rather to urge the
Western medical establishment to get moving on phage research.

Bacteriophages as a solution to our antibiotic resistance crisis have been
largely ignored in the West due to unpatentability, research mainly performed
in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved
her husband’s life where antibiotics failed...and the only reason they even
were able to go that route was because she’s an epidemiologist who pulled some
strings, pulled research teams together, got approvals, and managed the
project herself.

~~~
Fomite
Having seen her speak in person at IDWeek, I think an important thing to
recognize is that the amount of work that went into treating her husband was
pretty damned heroic - and it's _not clear_ that that's not the standard for
phage therapy.

I literally have a standard "Why phage are a problem", from the perspective of
an infectious disease epidemiologist whose been super-interested in phage for
like...a decade.

1) There's no such thing as a "broad spectrum" phage. They're organism
specific, and that means not only would you need to keep a phage library on
hand, but you'd have to do a lot of diagnostic tests. That's going to be both
expensive and tricky. There are treatment guidelines for things like sepsis
right now that are basically un-doable with phage therapy because of the time
it takes to tune a phage library.

2) Phages are living things. Not only is that a weird regulatory framework to
be in for a drug, but it also means that you need to be able to keep phage
alive. In contrast, antibiotics are inert.

3) Phage therapy is also relatively new in the West, which means there's just
less of a R&D infrastructure behind it.

There have been people working on commercializing phage therapy since I was in
undergrad (I'm now a tenure-track professor). The problem is it's hard, and
antibiotics are so much better as a treatment that there's kind of a ceiling
on the excitement that they can generate.

Also, I would like to note that phage therapy wasn't only ignored due to
unpatentability. A couple other reasons:

1) Antibiotics were superior in basically every respect. It's hard to justify
decades of sustaining research into the fussy, expensive, edge-case
alternative to something that works amazingly well.

2) Phage therapy _was_ used in the West. Due to the technology at the time, it
had a tendency to, well, kill people, due to contamination with bacterial
endotoxins.

3) It's not clear phage can be turned into anything other than a pretty
bespoke, custom tailored product. Even in the East it's not doable "at scale"
in the way we talk about antibiotics.

~~~
superbug_slayer
As the author of the op-ed you are referring to, allow me to chime in. It's
true that a huge effort went into saving my husband's life with phage therapy
but as a result of that, it's getting easier to treat other cases. I'll
comment on your other points too:

1) Broad spectrum phages don't exist in nature but gene-editing techniques can
be applied and this technology now exists. Several biotechs are now working in
this space.

2) Phages are not hard to keep 'alive'. They need to be refrigerated and kept
away from sunlight.

3) True that phage therapy is relatively new in the West but the field is
exploding. There are very few pharmas still developing antibiotics and very
few in the pipeline, esp for gram-negatives, so there is an imperative to have
alternatives to antibiotics.

With an ever-expanding phage library of well characterized phages, it is
possible to generate personalized phage cocktails in days. An antibiotic takes
a decade to develop, at around a billion $, and has collateral damage on the
microbiome. For more on the story, check out ThePerfectPredator.com

~~~
Fomite
For the record, your talk at IDWeek last year was one of the highlights of the
conference.

To touch on a few of your points:

1) I'm hopeful about these, and have been sort of idly following them, but I
think they're a long way from anywhere close to the utility the average
HackerNews reader is hoping to get out of them.

2) When compared to "There's an inert, shelf-and-temperature stable blister
pack of these living at the bottom of a bag" they're hard to keep alive.

While not relevant in your husband's case, the vast burden of AMR is going to
end up falling on the global poor, and in those cases, solutions that require
a cold chain aren't reliable solutions.

3) It is exploding, but I've been following phage research for 15 years now,
and it's one of those technologies that has lived in the "any day now" space
that whole time. So I tend to try to temper the expectation of folks because I
fear that it's going to end up, at best, as a supplemental solution to a very
complex problem, rather than the "a new technology will get us out of this"
path the popular media sometimes portrays it as.

------
concerned209
Any recommendations on what an individual could do to help? Organizations to
donate to? Challenges that could be tackled by a startup? Promising companies
to consider investing in?

Also, can anybody explain why the CDC doesn’t mandate reporting?

~~~
DoreenMichele
I'm having trouble figuring out how to reply to the way you are framing the
problem space.

There are several Einstein quotes along the lines of "A problem cannot be
solved using the same thinking that created it."

The problem of antibiotic resistance won't be solved with the same mindset
that got us here.

One thing contributing to the rise of antibiotic resistance is poor
santitation in developing countries. Another is poverty.

There is also research into how to break up biofilm and thereby reverse
antibiotic resistance. It points to issues with body chemistry which can
basically be tied to diet.

I think there are clearly avenues we can pursue, but most people are extremely
dismissive of those avenues. So they simply aren't being pursued in earnest.

~~~
benj111
"One thing contributing to the rise of antibiotic resistance is poor
santitation in developing countries. Another is poverty."

I assume this is why you were getting downvotes? I was going to too, but it
does actually check out.

[https://www.omicsonline.org/open-access/antibiotic-abuse-
in-...](https://www.omicsonline.org/open-access/antibiotic-abuse-in-
developing-countries-2167-7689.1000e106.php?aid=6039)

~~~
DoreenMichele
The very article we are discussing talks about a man getting an antibiotic
resistant infection in Egypt, then being flown to Germany and eventually the
US with the infection still unresolved. It terms it "Iraqibacter" and gives a
brief origin of this class of microbes as starting in the Middle East and
being exported to Europe and America.

So if that line you quoted is getting me downvotes, then everyone downvoting
me has failed basic reading comprehension.

I have read other things that state more directly that we breed antibiotic
resistant infections in less developed countries, no _reading between the
lines_ required.

But I have also read up on research into stunting. It has pertinent findings
about lack of sanitation fostering low grade chronic infections that basically
cause failure to thrive that isn't readily resolvable because the problem
isn't rooted in the individual. It is rooted in the lack of sanitation of a
larger area.

Sources:

The right gut microbes help infants grow

[http://www.sciencemag.org/news/2016/02/right-gut-microbes-
he...](http://www.sciencemag.org/news/2016/02/right-gut-microbes-help-infants-
grow)

What causes stunting?

[https://borgenproject.org/what-causes-
stunting/](https://borgenproject.org/what-causes-stunting/)

Beyond Malnutrition: The Role of Sanitation in Stunted Growth

[https://ehp.niehs.nih.gov/doi/10.1289/ehp.122-A298](https://ehp.niehs.nih.gov/doi/10.1289/ehp.122-A298)

Pertinent quotes from that last article:

 _In countries such as India, for instance, stunting occurs even among well-
fed children, and that’s led investigators to consider other causes,
especially poor sanitation and hygiene. Evidence shows that children who live
without adequate sanitation, hygiene, and clean drinking water don’t grow as
well as children who do.

In somewhat newer thinking, researchers are exploring the possibility that
poor hygiene and a lack of sanitation induce a gut disorder called
environmental enteropathy (EE) that diverts energy from growth toward an
ongoing fight against subclinical infection._

~~~
benj111
The quoted comment _could_ read as just blaming poorer people etc, which is
how I read it at first, after further digging the comment seems justified.
Reading your comment I can't see another reason for the downvote, and
antibiotic resistance being more common in developing nations wasn't something
I was that aware of, so I was confirming to others you aren't being racist or
anything.

Maybe they should have done their own research? I don't know. The sample size
of one in the article by itself doesn't justify the sweeping statement you
made.

Ultimately and unfortunately people will say unsubstantiated and unpleasant
things and some reasonable comments get caught in people's 'spam filter'.

~~~
DoreenMichele
It is not a sample size of one. She gave the history of a thing common enough
to have a nickname.

 _so I was confirming to others you aren 't being racist or anything._

Thank you.

------
NyashMyash
I'm russian. And for me this article sounds completely idiotic - phage
research was always ongoing in SU and literally everyone is aware of the
alternative to antibiotics. At the moment there are lab networks available
across all the modern russia where you may take a test and find a best phage
to your bacterias. One of several mass-produced phages.

Moreover, if you dig into soviet medicine, you may find several awesome
things. At the moment there are _two_ widely available st.aureus vaccines in
russia. For those who work with farm animals. These vaccines may be used for
both prevention and treatment. I've used them for myself to treat multiple-
antibiotic resistant st.aureus infection and got rid of it.

The other interesting thing is a synhetic analogue of thymopoietin - an
incredible immune stimulant which may in multiple cases help you to deal with
an infection without antibiotics.

Unfortunately, russian doctors are idiots and russian medicine is almost dead
and noone is interested in any stuff from there.

I, personally, regret that we didn't hear any news about epimerox - that only
substance would solve 80% of our problems with bacterias, including multi-
resistent ones.

~~~
rini17
Is it possible to order some to the EU? I'm having unfortunate combination of
staph infection+ ciprofloxacin intolerance.

~~~
StreamBright
[https://www.rbth.com/lifestyle/326184-foreigner-medical-
assi...](https://www.rbth.com/lifestyle/326184-foreigner-medical-assistance-
russia)

~~~
NyashMyash
These things (st. vaccinces) are mostly unknown to usual russian doctors, they
are produced for farm workers. A typical therapist wouldn't prescribe you that
stuff - they are not aware of their existence. Again - russians doctors are
idiots, but there is some amazing soviet legacy you may greatly benefit from.
And you don't _really_ need a prescription to buy the stuff.

------
StreamBright
I wish there were a nanotechnology startup that would address MRSA. In theory,
you can develop nanobots that attack specific types of bacteria. Not sure if
this would work:

[https://www.youtube.com/watch?v=5bQhGS8V6dQ](https://www.youtube.com/watch?v=5bQhGS8V6dQ)

~~~
NyashMyash
You don't need nanorobots.

You may just pick old soviet vaccines and resolve this particular problem (see
my other post in this topic).

Also there are a lot of great antibiotics (see epimerox) which still aren't on
the market because of many different reasons.

------
hackerbabz
Is it possible to establish a living will with her organization?

I would love to have a hotline my next of kin can call to begin treatment
whether or not my doctors are aware of its availability.

------
mensetmanusman
Why aren’t all hospital surfaces coated with silver?

~~~
Fomite
There's a lot of work in working antimicrobial sufaces - silver, copper, some
interesting structural patterns, etc.

The problem is it's not particularly clear they work, and they _are_ very
expensive, and often a pain to clean.

------
spraak
It's not just antibiotics, but some types of vaccines are creating
evolutionary pressure and new strains of the pathogen. E.g. for pertussis

> it is thought that B. pertussis is adapting under acellular vaccine mediated
> immune selection pressure, towards vaccine escape [1]

> an increase in asymptomatic infection with concomitant increases in
> transmission and increased selection pressure for Bordetellapertussis
> variants that are better able to evade vaccine-mediated immunity than older
> isolates [2]

[1]
[https://academic.oup.com/femspd/article/73/8/ftv064/2467598](https://academic.oup.com/femspd/article/73/8/ftv064/2467598)

[2]
[https://www.sciencedirect.com/science/article/pii/S156713481...](https://www.sciencedirect.com/science/article/pii/S1567134816300636)

~~~
phkahler
>> some types of vaccines are creating evolutionary pressure...

Wouldn't it be nice if we had more eradication programs? Evolution is going to
work around every vaccine eventually unless we eradicate the disease. Yes,
this is a hard problem but I think long term its worth it. Eventually we might
get good at it.

~~~
spraak
I don't believe that eradication is possible, but I'm curious to hear more
what your thoughts are

~~~
fzeroracer
Eradication is absolutely possible. High enough vaccination rates would help
prevent further evolution of viruses, eventually containing them and then
removing them provided there aren't alternative vectors like animals or pets.

Unfortunately, certain other efforts are compromising this.

~~~
Fomite
It's not at all clear the pertussis vaccine creates a strong and lasting
immunity enough to be an eradication target.

Honestly, it's not one of the more promising eradication targets.

------
brohee
And people still wonder why civilized countries forbid prophilactic
antibiotics usage in livestock....

