The Next Pandemic
[Music]
so
[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
23
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
an
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
an
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