The Next Pandemic

[Music]

[Applause]

by now we’re all very familiar with the

coronavirus pandemic

more familiar than we ever hoped to be

but did you know that there is

another pandemic not one that spikes in

a matter of weeks or months

but one that is slow growing it’s a slow

motion pandemic

it’s one that’s caused by our routines

and our choices and the food we eat

you will see it in your lifetime i have

i remember as a medical student a girl

came in with an ear infection

and after talking to the attending

supervising me i

learned that there were no antibiotics

that could work for this particular type

of bacteria because

the bacteria was resistant it had

mutated

and no antibiotics could work it was a

hopeless feeling

to tell the mom that there was nothing

modern medicine could offer and the

child

would have to suffer through the

infection running its course for a week

or two

well that was a rare event and now

that’s becoming more common even today

as a surgeon we’ll do routine surgery on

someone who’s otherwise healthy

and then afterwards sometimes an

infection will set in

caused by a resistant bacteria one of

those common resistant bacterias

that we see in the hospital setting is

called c diff

or clostridium difficile we call it c

diff

about a third of severe cases of this c

diff infection are resistant

to every antibiotic available sometimes

the body can’t fight the infection we

actually do an operation

to remove the infected organ just

because

no antibiotics are available we’re

seeing this more and more

as a matter of fact the reason for it is

that the rate of mutation

is now accelerating faster than our

ability to create new antibiotics

you can see in this graph the number of

new antibiotics fda

approved every year used to be four

or five a year now it’s one to two

antibiotics a year

but the rate of mutation in the bacteria

is growing exponentially

some experts say by 2050 in our lifetime

we could see

up to 10 million people die a year

from resistant bacteria at this current

rate of growth

imagine the coronavirus map this is the

map that my

johns hopkins colleagues created to

track coronavirus

imagine this tracking resistant bacteria

infections from resistant bacteria and

deaths from resistant bacteria

this is the slow moving pandemic but

it’s not a fate we have to accept it’s

one we can act on

but we’ve got to do it quick the rate of

mutating

is getting faster bacteria in the first

25 years that they were studied took on

average

21 years to mutate around antibiotics

in the subsequent 25 years they took

about 13 years

and in the last 25 years it’s taken

about one year

for antibiotics to mutate and become

resistant

to known antibiotics

you know bacteria are not as attractive

artistically as viruses they don’t get

the same

media attention they don’t necessarily

spike in a short period of time

and bacteria mutate quickly they can

mutate

around a vaccine unlike viruses which

tend to be more stable

and a vaccine can be effective an entire

season or sometimes

longer bacteria are different

today about one-third of all

bacteria that cause human illness

has resistance to at least one

antibiotic and some

multiple we’re seeing more and more the

consequences

in the hospital among patients that come

to us

about 2 million people a year

come to their doctor because of bacteria

with resistance to antibiotics and about

000 to 35 000 people a year right now

die from resistant bacteria resistant to

antibiotics

about a third of the countries that

report to the world health organization

report widespread antimicrobial

resistance that’s today

it’s so bad that the world health

organization has issued a statement

saying that anti-microbial resistance is

a global crisis that threatens

a century of progress in health

that century of progress began in 1928

when dr alexander fleming noticed after

coming back

from vacation for two weeks when his

laboratory was closed

that one of the auger gels that was

growing a bacteria called staphylococcus

was covered with a mold that grew over

the auger

the mold may have come in through the

window it may have come in from a

lab on another floor of that london

building there was another lab working

with molds but he noticed it killed all

the bacteria

they repeated the experiments him and

his team and they noticed it was only

one type of mold

that killed the bacteria that

effectively a mold called penicillin

within 10 years two scientists would

help

convert this penicillin into a

therapeutic and quickly it saved

thousands ultimately millions of lives

you see up until that point in human

history

many people died from bacteria people

died from infections all the time people

didn’t die as commonly from cancer

or heart disease they just didn’t live

that long many were injured

or they acquired an infection from

somebody else

one of the leading causes of death among

women in the world

was infection after childbirth and still

is in some remote parts of africa

this was a major advancement maybe one

of the greatest scientific advancements

in the history of modern medicine

ultimately

thousands of soldiers in world war ii

would have their lives saved by

penicillin

mass production began and in 1945

dr fleming and his two colleagues

accepted the nobel prize

but when he accepted that prize in his

speech

fleming warned of the problem

of antibiotic overuse

he was right doctors began to prescribe

antibiotics liberally and the

consumerist culture demanded it

almost with a disregard or a lack of

understanding about the long-term

problem of resistance that was accruing

antibiotics became commonplace now look

i’ve seen as a doctor antibiotics save

lives

i’ve seen medications save lives

but now we are prescribing 154 million

antibiotics a year that’s one antibiotic

prescription

for every two people in the united

states

how many of you have taken an antibiotic

in the last couple years

we have a culture of taking a medication

in a reactive fashion when many times

it’s not the right solution

our health care system has become a

reactionary

health care system sometimes ignoring

the underlying causes of the problem and

instead simply

reacting but we need a proactive health

care system not a reactionary health

care system

sometimes we want to pill for everything

i had one

patient actually tell me that he wanted

an antibiotic even though he knew

it was not going to work

in 1997 we prescribed as a medical

community in the united states 2.4

billion prescriptions

last year it was around 5 billion did

disease really double

over that time no we have a crisis

of appropriateness it’s time for us to

address this

and actually listen to the voice of

doctors which we surveyed in a national

study

we conducted at johns hopkins asking

2100 doctors around the country

in your opinion what percent of all

medications we prescribe

are unnecessary they said 22 percent

when people on the front lines of any

industry are speaking up like that

we need to listen the cdc says about 30

percent of all the antibiotics

prescribed are completely unnecessary

it’s time we start talking about other

therapies

when medications are not the right

therapy

can we start talking about cooking

classes for patients with diabetes

and the quality of one’s sleep in

preventing high blood pressure

can we start talking about using ice and

physical therapy

instead of opioids and surgery for back

pain

can we talk about food as medicine and

foods that are

pro-inflammatory and anti-inflammatory

in addressing the inflammatory state can

we talk about the effects

of antibiotics can we talk about these

issues in a way

that’s honest look the opioid crisis was

a crisis around

one medication there are many other

medications that have

been over prescribed i’ve over

prescribed opioids myself

most of my career i can’t believe i look

back

and think about the number of times i

gave an opioid prescription to a patient

that really did not need it

or prescribed too many opioids for the

surgery

that i performed i feel terrible with

good intentions and bad science i over

prescribed

we’ve got to start addressing many of

these problems

with some degree of humility and start

talking about

a proactive and not a reactive

healthcare system

it’s important with antibiotics because

antibiotics are like putting

tnt in the microbiome the microbiome

is a beautiful equilibrium of over a

hundred million different types of

bacteria that normally live in the gi

tract

they perform a lot of functions they’re

involved in digestion

they produce important molecules like

vitamins in some cases

they even produce serotonin which is

involved in mood

the more we learn about the microbiome

the more we’re learning about the

connection

between the microbiome and health

the more we’re learning about some of

the unintended consequences

of things that we used to prescribe

liberally

like tetracycline for acne

those antibiotics are like tnt in the

microbiome and after the explosion of

the antibiotic

ripping through the microbiome guess

what happens

that void is overpopulated with an

overgrowth of other types of bacteria we

now talk about

overgrowth syndromes we now know that

some inflammatory

conditions are associated with it the

more we learn about the microbiome the

more we learn about its connection

to health

some people tell me that they take

antibiotics because

they’re totally safe well not true

a study from johns hopkins by some of my

colleagues found that one in five

antibiotics

delivered in the hospital actually have

adverse side effect like worsening renal

function

this is important because 50 percent of

patients in the hospital get an

antibiotic today we need to think

about the judicious use of antibiotics

in fact my colleagues who authored the

paper concluded

that these findings magnify the

importance

of the judicious use of antibiotics this

is good

sound medicine this is

a proactive sound medical

system well

if over prescribing is one of the

drivers

of antimicrobial resistance and

something that we

can act on these are entirely actionable

causes

of this pandemic the other

is where most antibiotics are used and

you may not know this

but 70 to 80 percent of all antibiotics

are not used in humans they’re used

in farming antibiotics in livestock is a

major driver

of antibiotic resistance up to 20

percent of all the infections

that we see in humans where resistance

is a part of the

bacteria that organism originated from

the problem of overuse of antibiotics in

livestock

70 to 80 percent of all the antibiotics

produced

are used in animals why

for no good reason it’s so the animals

can be crowded

and used in factory farming techniques

and sometimes cruel conditions

is this where you want to get your meat

from is this

the type of farming you want to support

with your dollars that

are used to purchase things at

restaurants and grocery stores

we can do better we can do better

here’s what we need to do number one we

need to think twice

about taking antibiotics when there’s no

good clinical indication

stop demanding of your doctors that they

give you an antibiotic

when they recommend against it

make sure you’re on the right antibiotic

just because

zpac is easy to say doesn’t mean it’s

the right antibiotic for you

and we as doctors could do more to

prevent transmission of resistant

bacteria within the hospital setting

educating each other on things like hand

washing because

sanitizing gels do not prevent the

transmission

of some types of infection like c diff

which is rampant

in some hospital settings now

we can ask everybody to do more for

those of you interested in the problem

of the high price

of drugs in the united states if you’re

concerned about our high drug spend in

the united states let me tell you

the number one way to lower our drug

spend overnight

is to stop taking drugs we don’t need

think about your purchasing decisions

think about the next time you go to a

restaurant

ask about sourcing when you go to the

grocery store

ask where the salmon comes from is it

from a fish farm where antibiotics are

routinely used and sometimes

other pollutants and heavy metal

accumulates or does it come

from fresh waters

ask where the hamburger comes from

does it come from a farm where the

cattle are not routinely given

antibiotics and raised in a humane

fashion

or does it come from a factory farm

where the animals are routinely given

antibiotics

look if a cow is sick the cow may need

antibiotic but to give antibiotics to

every cow

is not smart it’s not wise it’s not

financially prudent

and it breeds the resistance that we’re

seeing these are decisions that we can

make

every time we make a purchase it’ll

create some

societal pressure it’ll create demand in

the marketplace already we’ve seen

some companies respond to that demand

for healthier food

as a matter of fact the public interest

group pirg

has created a scorecard on how some

companies are doing

in the sourcing of their food looking at

things like the routine use of

antibiotics

it turns out that some companies like

mcdonald’s

kfc subway have made commitments

to try to improve significantly on their

sourcing

and to stop the routine use of

antibiotics we can help

drive this change and reduce

antimicrobial

resistance

when bill gates gave his ted talk

talking about

the risk of a future viral pandemic many

people know he was

talking about a virus but do you know he

was also talking about

microbes or bacteria it is still

very much a risk and not only is it a

risk

that pandemic has already set in

this is our opportunity to take steps

through our everyday routines

decisions and the food we eat to try to

address this global pandemic

so if i were to ask you

if there was something you could have

done before the coronavirus pandemic

to help stop that pandemic would you

have done it

here’s something where we can do

something so the next time you go to

purchase food or go to the grocery store

the next time you go to a physician’s

office

with a minor viral infection or ask

about the option of

antibiotics please keep in mind what you

can do

to help stop and fight the next global

pandemic

thank you

you