All language subtitles for Resistance.2015.1080p.WEBRip.x264.AAC-[YTS.MX].eng

[music playing]

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>> We have a very skewed
sense of our relationship with

microorganisms in general
and bacteria specifically.

>> They collectively outweigh
human beings by 100 million

times.

They can replicate 500,000
times faster than we can.

And they've been doing
this for 1,000 times

longer than our
species has existed.

>> We've just touched the corner
of understanding the diversity

of the microbes
that are out there.

We've barely
scratched the surface.

And we need to understand
this because, again, they

make plants functional.

They affect the movement
of methane, and hydrogen,

and nitrogen, and phosphorus.

They affect the carbon fixation
and the plankton in the oceans.

Viewing them as
important players

in our ecosystem in
the same way people

have viewed forests and
grasslands would probably

make us treat the
world in a better way.

[chatter]

>> My name is Robert Beam.

I'm Jesse's father.

[chatter]

>> I'm Christy Beam.

I'm Jesse's stepmom.

[chatter]

>> And then just step
out for a second.

And we'll pull this up.

>> We were actually
at cross country camp.

>> See how tall you are.

>> And I think it
was the second day,

he started developing a fever.

The following day we came
back here to Kentucky.

>> Now you can step away.

>> And he was really--

getting dramatic with him.

Jesse Beam does not
do sick very well.

So he was kind of--

I thought he was playing it.

And he was kind of
moping around the house

and crawling at one
point out of his bedroom.

And I told him to get up.

And he did.

So you think he's playing it.

Next day while
I'm at the office,

he calls me wanting
to go to the hospital.

So I call his pediatrician.

And she said, get him
in here right now.

Finally got us a room.

Got an X-ray.

They found pneumonia
in his right lung.

Figured that was what
we were dealing with.

So I called Christy and told
her we're in the hospital.

He's got pneumonia.

She's trying to calm me down.

Told me not to worry about it.

You know, kids get pneumonia.

They'll be fine.

He'll probably stay in the
hospital for a day or two.

All night long he just kept
getting worse and worse.

His temperature would
get pretty high.

Or, at least his body
temperature was high.

But his oral temperature was
never really spiking real high.

He started hallucinating around
4:00, 5:00 in the morning.

And that's when I--

I went to help him
go to the bathroom.

And when we stood him up,
his front was really clammy.

And his back would
almost burn your hands.

And I told the nurse that.

So she came in.

And they had to do a
rectal temperature.

And his internal temperature
at that point was 105.9.

She called in the
critical care team.

His pediatrician showed up, who
made the call that he needed

to be at a pediatric hospital.

Again, I'm still
thinking pneumonia.

So I told Jesse I was
going run to the house,

get him some clean
clothes, get him his games.

And I'd be down
there to Vanderbilt.

In about-- I don't know
how much longer it was.

But I was about Goodlettsville
when they called me and told me

that they were there.

They'd made it.

Jesse made the flight well.

But his body was
doing a lot of work.

[music playing]

That's when they told me
they put him in a coma.

[music playing]

[beeping]

[music playing]

We started with daptomycin.

And then we went to clindamycin.

We went to vancomycin, which
he finished off vanc upstairs.

>> Yeah, and he was on
all three at one time.

And that's whenever
they told us that, look,

he's on all three medicines.

We've done everything we can do.

You know--

>> If the bacteria
doesn't stop growing now,

then there's nothing else.

>> There's nothing
else we can do.

We've got nothing
else to pull from.

[beeping]

[music playing]

>> Antibiotics are basically
poisons that kill bacteria

and don't kill us.

[music playing]

They often have some effects
on the human body as well.

But for infections, it's
going to do one of two things

to a bacteria.

It either kills it or
it makes it stronger.

[music playing]

>> But what we do
with antibiotics--

because we give the wrong
doses of antibiotics to people,

or we give the right doses, but
people end up dosing themselves

incorrectly because they don't
take a full prescription,

or because we give antibiotics
to healthy farm animals,

what we do in all
those situations

is we set up a sort of
Darwinian battleground

within the body of the
human or the animal who's

getting the antibiotics, in
which the weak susceptible

bacteria are knocked
out by the drug.

But the strong survive.

>> And it unfortunately occurs
more rapidly than you might

think.

[music playing]

Because they go so quickly
as a community of organisms,

if there's a way to become
resistant, they can find it.

[music playing]

>> About three quarters of
the way through my fellowship,

we began to see just an
explosion of highly resistant

infections.

And that was concordant
with it happening all

over the country and the world.

There's nothing unique
about our setting.

And I remember the
first patient that I

took care of who had an
untreatable infection.

Could not be treated.

And it was a woman in her 20s,
who had two small kids, who

had leukemia.

[clears throat]

Sorry.

[coughs]

[clears throat]

And she developed an
infection in her blood

by an acinetobacter.

So we started treating
it with the drug

that we had left
at the time, which

was a drug called imipenem.

That was the big gun.

That was the last ditch.

And she looked like she was
getting better at first.

But then the
infection came back.

And it was resistant
to the imipenem.

It developed resistance in the
middle of a course of therapy.

And when it came back, I have
this just vivid recollection

of looking at the
computer screen.

[music playing]

And you just see a printout
on the computer screen

of all the antibiotics that
the bacteria is resistant to--

resistant, resistant,
resistant, resistant, resistant.

There was nothing.

It was resistant to everything.

And I couldn't fathom
how in the 21st century

an infectious disease specialist
would run out of stuff.

I mean this is--

since penicillin, we've
expected that we're

going to have relatively
inexpensive, safe, tremendously

effective drugs to
treat infections.

And this woman had
returned to 1935.

She had returned to
the pre-antibiotic era.

And she died.

There was nothing to do.

>> Antibiotics were the only
thing we ever had in all

of human history that really
stopped infectious diseases.

And we took that just
miraculous, precious substance,

and we completely squandered it.

And it astonishes me sometimes
that we don't ask ourselves,

how is it that we
squandered this?

And why can't we stop?

[waves crashing]

[cheering]

[waves crashing]

>> I came home from
work one afternoon.

I'd been working under
a boat all day painting.

And I was extra stiff.

My back hurt.

So I thought, well, maybe
I'll get in the bathtub.

We have a Jacuzzi tub.

So I filled it up with
hot water and got in it.

And that's pretty much
the last thing I remember.

>> But I remember.

>> Glad she remembers.

>> We also thought that we
might be sore because we were

training really hard for the
Molokai to Oahu Outrigger Canoe

Race, which is pretty
intense workouts.

And my back hurt.

So I called to make
an appointment for him

to see his regular doctor.

And from there, he went
for CAT scans and tests.

And the CAT scan showed that
he had lesions on his spine.

They had discovered it was
Methicillin-resistant staph.

So he was on vancomycin.

And it was an
emergency situation

to open him up and
clean those out.

>> Apparently, I'd picked
up this staff either from

the water in the marina or
surfing next door at Doheny,

which is right
adjacent to the marina.

Between the sepsis
and the surgery,

I've lost use of my legs.

>> Let's tie your shoelaces.

[groan]

OK.

>> You know, I haven't really
taken the time to grieve about

it too much because
just too much to grieve.

Do this without my
pants falling off.

I've always been able
to bait my own hook.

And I can't do that anymore.

It's hard.

It's really hard.

>>

This is a man who
was surfing one day

and had his spine opened the
next day from a resistant

infection.

And I think the thing
that's come home to me

is it can happen to
anybody, anytime, anywhere.

Nobody is safe.

Don't get me wrong.

Antibiotics saved my life.

I'm really grateful for them.

But I do feel that the
likelihood of me getting this

was probably because of our sort
of rampant use of antibiotics

in the first place.

[cheering]

[chatter]

>> It's clear that people don't
quite understand the extent

of usage of antibiotics
in our everyday life.

We know that they're
used on farm animals.

Do we know that they're put into
household products, sanitation

products?

Do we know that some
300,000 pounds are

sprayed on fruit trees--

>> --on kitchen counters,
in our wall materials,

school cafeteria
trays, on everything--

>> --to supposedly improve
their antibacterial activity?

But for what?

>> Virtually all the antibiotics
that I've ever been used have

come from organisms that are in
the world around us from soil

fungi, or from something
growing on bread,

or other organisms
that are out there.

And they've been in a
struggle for existence

for billions of years.

And we have just come in at this
last minute basically and said,

we're going to take
those chemicals

and spray them into
the world around us

in these massive doses.

And what happens is is
that most of the microbes

will in fact be killed by
some of those chemicals.

And the ones that
survive now will

be resistant to the chemical
that you're threw at it.

So you throw another
chemical at those microbes.

And most of them
are killed again.

And some survive.

And they will now be resistant
to both of the chemicals

that you've thrown at them.

And if we keep going
down this path,

the microbes in
the world around us

will be resistant to
most of the chemicals

that we can throw at them.

And now if one of those microbes
also happens to cause disease,

then we have nothing
left in our arsenal

to throw at it because we've
wasted all of these tools

at everything.

[music playing]

>> People talk about antibiotic
resistance taking us back

to a pre-antibiotic era.

And what I think
they are envisioning

when they say that
is the way things

were in the 19th century,
the 18th century, or earliest

when people died of
infections because they

tripped and fell in
front of the plow

that their oxen were dragging.

Or, they fell into the works of
the factories of the Industrial

Revolution.

And people say to
themselves, well, we

don't have that anymore.

We don't farm with
oxen and plows.

We don't have huge filthy
factories like that.

So we're not really at risk.

But what they don't
think about is

that most of the structure
of modern medicine

relies on the deployment
of antibiotics.

If we didn't have antibiotics
anymore, if we went to a pre

or post antibiotic era, there
would be no transplants.

Heart infections might
kill 50% of people again.

Childbirth might be
much more dangerous.

To take antibiotics out
of the medical system

is to shut down a good
part of the medical system.

>> Penicillin was our
first real antibiotic.

That is a substance made by
another biologic creature,

which is able to
inhibit the growth

or kill another
biologic creature.

>> 1928-- Alexander Fleming
leaves a window open in his

laboratory.

And something blows
into the window

and contaminates
his culture plates.

And when he looks at
them two weeks later,

he can see that there's
little dead zones in the staph

and the mold at the
center of the dead zones.

Turns out to be the
source of the penicillin.

>> While he surmised that
this was an important finding,

he could not see it
as a therapeutic.

>> Then two other British
scientists, Dr. Florey and Dr.

Chain, began developing
its usefulness for fighting

infection inside the human body.

>> So during the
First World War,

many more people died of
infectious disease than died

of actual battle wound injury.

During the Second
World War, antibiotics

had just been introduced.

But then scaling up production
to a mass scale, which

would allow many soldiers
to be saved by these drugs,

required someone to figure
out how to make these.

>> Dr. Florey and an
assistant, Dr. Heatley,

came to the United States to
start a search for new sources

of penicillin.

Agents from the
Department of Agriculture

were instructed to
send moldy foodstuffs

from every part of the country.

One day it led to
a moldy cantaloupe.

The mold from this melon gave
200 times more penicillin

than any that had
been tested before.

This was the turning point.

[music playing]

[MUSIC - BO CARTER, "BANANA IN
YOUR FRUIT BASKET"]

>> Penicillin was tried
in different environments,

in different places
during the war.

And a need from the
military was to have

some of this wonder drug
for venereal disease, which

was rampant among
the military groups.

>> We average 30 venereal
disease cases each year out

of every 1,000 men in uniform.

That means 300,000 men put
out of action each year

in a 10 million man army.

And every one of those
men is a casualty

as far as combat is concerned.

[laughing]

Figure that.

300,000 casualties
without even a battle.

Well, I'm sorry to have
to run out on you Colonel.

But I'm swamped with work.

>> Let me put my--

>> Thank you, Major.

>> --banana in your--

>> Goodbye.

>> Goodbye.

--fruit basket.

Then I'll be satisfied.

>> The question was at a time
when you have a miracle drug

that's saving lives in
hospitals in London,

can we really allow it to be
used for the results of playing

around in the military?

And the story goes
that Winston Churchill

was involved in that decision.

And while it wasn't
direct, there

was a little notation on
the side of the request.

And that was Churchill's
sign that, yes, yes,

save our military.

But let's not make a big
announcement about it.

>> Let me put my banana
in your fruit basket.

Then I'll be satisfied.

>> So penicillin arrives.

And it's a miracle drug.

People who would have died of
things like blood poisoning

are now cured in 48 hours.

The problem is we almost
immediately overuse it.

>> When I first got
interested in resistance,

it was because of penicillin
resistance in gonorrhea.

And turns out that the
origins of penicillin

resistant in gonorrhea were
from brothels in Vietnam

where the US Army had
given out penicillin

to all the sex workers.

>> Not to treat, but to
prevent venereal disease

in the soldiers.

>> This indiscriminate use
of the antibiotic drug has

contributed to the appearance
of a strain of gonorrhea

completely resistant
to penicillin.

The new strain was first
detected in this country

last year in infected
military personnel returning

from the Orient.

>> So it was in fact
someone's decision to protect

the military from getting the
disease that led to a strain

and eventually a whole number
of strains of the bacterium,

which were no longer controlled,
killed by penicillin.

>> And as a result now,
penicillin doesn't work

for gonorrhea for the most part.

>> Alexander Fleming, the man
who discovered penicillin,

warned the medical community
in the New York Times interview

in 1945 that physicians
were wasting penicillin.

We need to understand why
is it that physicians over

prescribe antibiotics.

Because if you're
going to fix that,

you need to understand
the root cause.

The reason docs overprescribe
antibiotics is fear.

It's not so much
fear of being sued.

It's fear of being wrong.

It's fear of I have a
patient in front of me.

There's a 95% chance that
this patient has a virus.

There's still a 5% chance
that it's a bacteria.

And they have exactly
the same symptoms.

I can't distinguish with
any certainty beyond that.

Well, it's just this--
one prescription

isn't going to ruin things.

And what if I'm wrong
about this patient?

It could really hurt her
or him if it's not a virus.

And I don't give an antibi--

I'm just going to
give the script

and give them the
antibiotic just to be sure.

If you don't address
that fear that

occurs at that moment when
that patient is the physician's

responsibility, not
society at large,

then it's not going to work.

>> Where that gets really
challenging for us as providers

is that when we see patients
who have cough, and fever,

and are missing school
or missing work,

we feel a need to be able to
intervene to be able to cut

those symptoms short and
get people back to health.

Since we don't have good
therapies for viruses,

we tend to focus a lot on
those bacterial infections

that we do have antibiotics for.

The problem is is that for
every patient that we treat

with antibiotics we're breeding
a certain sense of resistance

in the community, that's fine
for infections that absolutely

require antibiotics.

But where we really
get into trouble

is that we prescribe antibiotics
for maybe five people.

Maybe only two or three of
them actually need antibiotics.

And only two or three of them
will those antibiotics actually

make them better faster.

>> And we need things like
rapid diagnostic tests.

So when this patient is
in my office, I run a test

and a printout comes out.

And it says, oh, this
patient has a virus.

Now I have no more fear.

Now I'm comfortable
explaining to the patient

you have a virus.

We don't have any
treatment for it.

But it's just going to go away.

You don't need an antibiotic.

>> If you have a cold,
stay home, stay in bed.

This is the prescription
which common sense

and medical science recommend.

>> And that feeling
of being ineffective,

that feeling of not being able
to cure all ills is sometimes

really tough.

I've taken care of
several teenagers

over the past few years
that have suffered

from community acquired
methicillin-resistant staph

aureus infections.

In all of those
situations, I remember

at least one moment where I
had to tell the family that I

didn't think their child
was going to survive

this devastating infection.

And that's typically done
in an environment where

the child's on a ventilator.

They may be on a cardiac bypass
unit called ECMO, where we're

doing all of the work for them,
doing the work of the kidneys,

and the heart, and the lungs.

It's usually after
a very grueling week

or maybe two weeks of antibiotic
use that is not effective.

And it's usually in
the setting where

I have the
conversation that we've

been able to have some
victory over the bacteria.

But because the bacteria
was there for so long

and because the
inflammatory response

was so great, that things aren't
going the way they need to be.

[beeping]

[hammering]

[hammering]

>> It was within a day that they
had come back and told us it

was MRSA blood infection.

>> They think it
was in his nose.

And that it just
started floating

through his bloodstream and
found a weak spot to attack,

which ended up being his knee.

Then it attacked his lungs.

And then it just
eventually started

taking all of his organs.

[beeping]

He'll probably need
other surgeries.

[beeping]

>> And the growth plate on his
thigh bone and his femur is

involved in all this.

So it's not growing.

So this leg is
shorter than this leg.

So probably down the
road we'll do something

to equal the two out.

[beeping]

All right.

>> Want me to get a couple more.

>> I think this
will do it, Susan.

>> OK.

[beeping]

>> Could you put family
in a room, please?

[beeping]

>> The hardest part I think
was walking in there that first

time and seeing your child
laying there with medicine all

behind him--

>> Oh, Lord.

>> --and wires, and machines,
and only enough room for you

to walk by his feet.

And you can't do anything.

And we just felt helpless.

>> I don't know.

Because I mean nobody
wants to think about death.

You don't want to die.

I just knew like it was
getting to the point--

I mean, I knew it
had to be serious.

They wouldn't just fly me
down there for no reason.

And I just--

I don't know.

I kind of gave up, I guess.

[music playing]

>> 20 more.

[chatter]

>> Like the stuff I still take
for granted I'd say is school.

But things I don't take
for granted that I used to

is like--

before all this happened,
like taking a shower.

The first time I got back in
the shower I was in hospital.

And my dad was helping me.

And I cried because that
was first time I felt

the water hit me on the feet.

[chatter]

>> This has affected
his life and long term.

He keeps thinking.

I'm going to be better in a
month, or two months, or three

months.

And it's hard for him to try to
wrap his brain around the fact

that he's got plates, and
screws, and pins in his leg.

And his lung is--

>> [inaudible]

>> --shrunken

>> Does that hurt?

>> There's always going to be
that fear of what happens if.

What happens if
he's 20 years old

and something starts going wrong
with the sutures in his lung?

What happens if he
breaks that leg again,

and it's chronic osteomyelitis,
and it never heals, and it's

always going to be broken?

[music playing]

But I think overall I want him
to get the most out of life.

[beeping]

[music playing]

There's something out there.

There's some reason this
kid was not allowed to go.

And I can't wait
to see what it is.

[beeping]

[music playing]

>> To make a difference
to antibiotic resistance,

the thing that we have to do is
to stop misusing antibiotics.

We have to stop misusing them
or using them inappropriately

in human medicine.

And we have to stop
misusing them and using them

inappropriately in agriculture.

Why do those two
things keep going on?

I think it's really two
different situations.

I think in the case of medicine,
it's mostly just inertia.

That medicine is a big,
complicated enterprise.

And it's hard to get new
best practices, I guess

they would say, into
the hands of hospitals

and to convince everyone
of what has to happen.

But in agriculture, it's
a different situation.

You hear over and over
again in agriculture,

we're not really sure if
the use of antibiotics

is contributing to resistance.

[music playing]

Yes, it is.

It's not a scientific
question any more.

It's a question of politics.

And it's a question
of economics.

But it's really not
a science question.

[music playing]

[clucking]

[buzzing]

[pigs grunting]

>> The agriculture believed
that with antibiotics they could

grow healthier, fatter
animals quicker.

And then it evolved
the fact that they

found that they could keep
animals in some pretty

deplorable conditions--

unsanitary, unhealthy.

But if they put some antibiotic
in their food every day,

they felt that they were
stopping the animal illness.

And that's about
the same as trying

to sprinkle antibiotic
on your children's cereal

every morning.

It makes about as much sense.

>> Today, agriculture is going
far beyond nature to produce

new miracles for an even
better, more abundant life.

>> Well, we produce 9 billion
food animals in the United

States every year.

So those are animals
that we raise for meat.

And those 9 billion
animals-- most of those

are raised in Concentrated
Animal Feeding

Operations, or CAFOs, and given
regular doses of antibiotics.

And what we know is that
about 80% of those antibiotics

are used non-therapeutically.

And they're used to make
the animals grow faster

and to prevent
diseases that may just

be occurring because of
the way we're raising them.

[music playing]

[engine roaring]

>> It's as if someone said, what
would be the best way to come

up with a novel pathogen
that we can't control?

Hmm, let's get a bunch
of creatures together.

Let's put them together
in close quarters.

Let's put them literally
over their own manure.

Let's feed them the same thing.

And let's just to sort
of ramp it up one-- let's

put daily small
doses of antibiotics.

So we're making sure to select
for bacterial strains that

can survive these antibiotics.

Let's do that.

>> He's got a support your
local farmer sign there.

He just does that
because he can.

He knows he's not a farmer.

He's an industrial pig producer.

They're still working on that
glass building back there.

Like I said, there's a 600 head,
a 1,200 head, an 1,800 head,

and now another
1,200 head facility.

But if you looked
in the building,

you'll find somewhere
between 1,100 and 1,500 head

of hogs that are packed
together in tiny little pens.

They're

standing over a concrete pit
that's 8 to 12 feet deep.

Antibiotics are in their
feed, in their water.

And then if there's any sign
of coughing or whatever,

they're also injected again.

And they do not
leave until they're

ready to go to the
truck and be butchered.

[waves crashing]

>> Wherever livestock are
kept, food bills always account

for a large proportion
of the cost.

A bird or animal is not
a very efficient factory

for converting animal
food into human food.

And anything that will help
to improve the efficiency

will add to the profitability.

In this, the animal
food industry

is helped by the
specialist laboratory.

>> Back 56 years ago they found
that if they gave very low

levels of antibiotics, the
animals would grow a little bit

faster than if they didn't
have the antibiotics in.

We don't know why.

We didn't know why then.

We still don't know why now.

But we know that that
does make the animal's

grow a little bit faster.

So that's why it
started happening.

And we've really
grown up the industry

with putting those low levels
of antibiotics into the feed.

>> The finding was at Lederle
where the company was making

a tetracycline
for use in people.

The mash from the
tetracycline was

given to chickens
and other animals

and noted that they
seem to grow better

for the same amount of protein.

Well, it turns out that the
substance doing the growth

promotion was none
other than trace amounts

of the tetracycline
left with the carcasses.

Then the industry said, let's
just add it back to the feed.

And so penicillins and
tetracyclines especially

were added back to
feed for what was then

called growth promotion,
later called feed efficiency.

And now being reexamined
because in fact

their extended use is a mistake.

>> For large corporations, what
they want to do is get as much

meat out as quickly and
as cheaply as possible.

That means putting antibiotics
in for growth promotion,

to keep the animals
from getting sick.

And the whole thought
of treating the animals

gets to be almost secondary.

>> Iowa is the biggest hog
producing state in the United

States.

And it's really
interesting to look

at what happened in Iowa
over the past 25 years.

And the way that the place
that hog farming had in Iowa

changed over that period.

>> Eric [? dee ?] produces
2,000 hogs a year on his factory

farm.

He has traded in his
slop bucket for buildings

where the temperature is
controlled, the feed automated,

and the overhead expensive.

In order to be profitable, this
assembly line must run nonstop.

>> We didn't find this
system of technology.

We were forced to look at
this system of technology

if we wanted to stay afloat.

[pigs grunting]

>> So between '82 and 2007, we
go from 50,000 farms to about

8,000 farms.

85% of hog farms in Iowa
went out of business.

The other ones scaled
up dramatically.

The price of a hog went from
$240 in 1982 to about $109

in 2007.

So you saw the
remaining farms were

making way less profit per hog.

And that is one of the
reasons those farmers are

so protective of their right
to douse their hogs every day

with antibiotics because
they've got so many of them,

they've got such tiny,
tight micro thin profit

margins that they're
under severe pressure

to produce as much as
possible, as fast as possible.

>> I'd love to be able to
say that we should only give

antibiotics when they're
absolutely, 100% necessary.

But right now in
certain industries,

as the poultry industry,
the swine industry.

It's an economic necessity.

>> Confinement agriculture,
as it now exists,

could not exist without
antibiotics being used the way

they are now used.

So if you took antibiotics
out of that system

or if you even dialed
back their use,

the system would have to change.

And people within that
agricultural system

say, it's not worth the cost.

Well, tell that to
a mother whose child

dies of an antibiotic
resistant illness.

It's certainly worth
it to that mother.

>> April 16th, 2004--

it was a Friday, absolutely
regular, normal everyday.

And that morning around
6:00 in the morning,

my son who was 18
months old, my son

whose name is Simon Sparrow,
let out this shriek.

And he wasn't acting himself.

He was kind of
under the weather.

But I just thought,
oh, he's 18 months.

Kids get sick.

He'll be fine.

But my husband had a sense that
something was very serious.

So he said, I'm going to bring
him to the emergency room

because I really feel that
there's something wrong here.

And I actually thought
he was overreacting.

I thought, OK, yeah.

Go to the emergency room.

I'll catch up with you later.

I had to get my older
daughter ready for school.

And then I arrived.

My husband said that
the emergency room

folks had administered
all kinds of tests.

But no worries, he's
fine and can go home.

At this point, he was
increasingly having

trouble breathing.

And then right in the
middle of the afternoon

I touched his cheek
and his forehead.

And they were ice cold.

And I completely freaked out
because I was used to fevers.

If you touch the
forehead and you

can tell when that child has
a fever because it's so hot.

But I had never felt ice
cold on a child's head.

So I freaked out and
I called the doctor

at the emergency room.

And I explain what's going on.

And I had her actually
listened to his breathing.

And it was kind of like
[breathes in and out]..

And she said, hang up the phone.

Call 911 immediately.

And when the two men
from the ambulance

came up to our apartment, they
did another series of tests.

They said, he's fine.

And at that point, I
felt kind of embarrassed.

Like, oh my gosh, I exaggerated.

I'm making much
ado about nothing.

It's fine.

We can go home now.

But then the medical technician
said, no, because of protocol.

Once you're in the ambulance,
we have to take you

to the emergency room.

So we went to the
emergency room.

And then suddenly I had a
flood of health care people

surrounding me and Simon.

And they kept repeating your
child is very, very sick.

Your child is very, very sick.

And I was just breaking down.

And then they were
asking me questions

like has Simon been to
another country recently?

No.

Has he been to a farm recently?

No.

Has he had all
his immunizations?

Yes.

And then they said,
well, we have to take him

to the intensive care unit.

And then, finally, when I was
allowed in, Simon was in a bed

with all kinds of
tubes connected to him.

[chiming]

He was intubated.

And the doctor, the
attending explained

that he's having a lot
of trouble breathing.

And she said, the only
thing that we know

is that your son
has an infection.

And he's very, very,
very, very sick.

So you need to plan to
be here for a long time.

And then they brought us into
where he was lying down in bed.

And there were at least
10 medical doctors.

And they said that the only
chance that he would have was

if they put him on this machine
called the ECMO machine,

E-C-M-O. It's a
heart-lung machine.

So, of course, we
said, OK, let's

bring him to this machine.

And it was very, very
difficult to see this

because they had to elevate him
so that the machine would work

better for gravity reasons.

And my husband stayed by
his side the whole night.

He was on a stepladder.

And he was stroking
his hair, telling him

about all the things that
they would do together

like fishing, skiing,
all the things

that my husband wanted
to do with Simon.

And in the middle of night,
I was just so beside myself.

I really felt like that
Simon had already died.

And I really felt like
I needed to go back home

to where my daughter was so I
could spend some time with her.

And then I went back at
6:00, 7:00 in the morning.

And that's when the doctor
said that there was really

no chance that Simon
was going to make it.

And at this point,
my son was completely

transformed physically.

He was completely bloated.

He had purple splotches
all over his body.

He had purple tears
coming out of his eyes.

I mean he looked totally like
a different being altogether.

And we agreed to take him
off this ECMO machine.

And that's when he
was pronounced dead.

That was April 17th, a Saturday.

And everybody was just
completely stunned.

No one knew why he had died.

And we had to live with
that for about two months

when we were waiting
for the autopsy results.

And that's what
we were called in.

And we were told that
Simon had contracted

this antibiotic
resistant bacterium.

And it was a new strain.

It was a community
associated strain,

not a health care
associated strain.

And it was a strain of
MRSA staph, specifically

methicillin-resistant
Staphylococcus aureus.

And that's why when the
doctors had given him

a broad spectrum of
antibiotics before he died,

nothing was working.

And what is so frustrating even
to this day nine years later,

we have absolutely
no idea how Simon

contracted this bacterium.

We don't know even where.

It happened in
less than 24 hours.

Really don't even have words
to describe how we felt

after learning all of this.

[music playing]

>> In the 70s, the FDA
expressed serious concern about

antibiotic resistance on farms.

But by that time, the
practice was so entrenched.

And the interests
involved were getting

so big and powerful that
the genie was already

out of the bottle.

>> Today, the Food and Drug
Administration said that unless

drug companies can
prove their safety,

the number of antibiotics used
in poultry feed will be banned

as of next year.

And there will be a similar
ban on food for hog, sheep,

and cattle by mid '73.

>> When something that is
approved by the FDA is not

shown to be safe
for human health,

FDA has to stop the
approval for that drug.

>> We're creating resistant
organisms that may ultimately

transfer that resistance to
organisms that cause human

disease.

>> But do you think the use
of animal feeds constitutes

the sort of health hazard
where there could be a severe

epidemic?

>> Absolutely.

>> And when FDA
made those findings,

those obligations followed.

But for the next 35
years, actions stalled.

[music playing]

>> It's a very complex issue.

And there continues to remain
gaps in the understanding.

And I think that has driven
the inability to kind of move

forward is that those gaps
over the numbers of years

have always been pointed to.

And say, well, we don't
have definitive enough data.

So, therefore, we
shouldn't take any action.

And I think that's
been the thinking up

until more recently
where I think

we've been pushing for moving
forward with a strategy that

says, well look,
we understand there

are some gaps in the science.

But there is an
awful lot we do know.

>> We've tracked for decades
now outbreaks associated with

particular types of food animal
groups and with products from

food animals.

And if resistant bacteria
are causing those infections,

then we've got to think about
where the pressures were

exerted on those bacteria to,
number one, develop resistance,

and to, number two, get
into the food supply.

>> This is not just
a theoretical risk.

What we see is that most of our
meat and poultry in the United

States are contaminated with
drug-resistant bacteria.

So just for example, if
you go to the grocery store

and you want to buy some ground
turkey, you have about a one

in 300 chance of finding a
tube of the ground turkey

that doesn't have
drug-resistant bacteria in it.

But this year something
came out that really

grabbed my attention.

So this year we saw one
package of ground turkey

had a salmonella strain in it
that was resistant to all eight

drugs that were tested.

So we may be looking at
pan-resistant salmonella.

So most salmonella
infections are self-limiting.

You're uncomfortable
for a while.

You use a lot of toilet paper,
right, but you usually survive.

But when this is pan-resistant,
if your immune system cannot

take care of it, you're very
likely to die of this, right?

It's because your physician
doesn't have any other options

to treat you with this.

>> In response, FDA has chosen
to focus on voluntary measures,

essentially recommendations to
industry that industry is free

to follow or ignore.

>> It enables us to work
in a collaborative way with

the industry and in a
co-operative way so that we can

move forward in a productive
way to get this issue addressed,

but at same time make sure that
these products continue to be

available to the
animal ag community.

And that we make the change
in a real deliberate way,

and it gives us some ability
to phase it in over time

and pay attention to what
those collateral effects may

be as we move forward
implementing the changes.

>> Over and over we see the
influence of money in politics.

And you know what it really
comes down to, I think,

is that when these
industries consolidate

and more and more
of the industry

gets tied up into
fewer and fewer hands.

You get these massive companies.

They make massive
amounts of profits,

and they invest some of those
profits in their lobbying

effort.

>> The idea there was is that
if these two antibiotic could be

limited, then their usefulness
in veterinary therapy

and in human therapy
would be preserved.

>> Feedlot operators
fought that ban and won.

They argued, no
conclusive link has

been established
between antibiotic use

in animals and human disease.

But the government says
that's no longer true.

>> It isn't just the meat
companies who have massive

amounts of power.

It's the animal
pharmaceutical companies

that make lots and lots of
money selling the stuff.

They have a vested interest.

The fast food industry-- they
don't really care how it gets

made.

They just want to be able to
offer their triple cheeseburger

or their meat lover's
pizza at a price that

keeps consumers coming back.

They're against these
kinds of measures.

And so you get these powerful
economic interests lined up

with lobbying
power, and it really

isn't that big of
a mystery why we

haven't seen very much change.

>> But now that we know
the extent of the problem,

let us consider what
can be done about it.

Is it a necessary evil?

Is it something science
is unable to fight,

or is it simply too powerful
for the human race to cope with?

I was born in Denmark.

Some years ago, I
went back for a visit.

I was amazed at their progress,
and I took some home movies.

You can see for yourself how
Denmark attacks the problem.

>> [inaudible]

>> In 1992, Denmark made an
agreement with the English

people.

They don't want antibiotic
growth promoters

in the food for the pigs.

And in 1995, it was
banned in Denmark

that you may not use antibiotic
growth promoters for food.

In 1998, it was
banned in Europe,

but I think it was
2004 it was stopped

the use antibiotic growth
promoters totally in Europe.

But in Denmark we
started already in 1992.

>> 200 females and
no one is screaming.

>> As soon as we started
looking after it,

we could see that this
resistance was all over

the place in our food animals.

It was in our food products,
and it was actually also

in healthy humans in the
community in Denmark,

even though there was
extremely limited amount of use

on the human side at that time.

>> There was a public debate on
whether this was a human health

risk that we used these
antibiotic growth promoters.

And finally, the industry
decided that we could probably

still have a
profitable production

without using the
antibiotic growth promoters.

So in order to, you
could say, accommodate

the public and our
customers, we decided that we

would ban them voluntarily.

It's an industry initiative.

It was not the government.

Later on, the EU banned
antibiotic growth promoters,

but that was seven years later.

So it was simply because of a
discussion in the public about

whether this was a problem.

>> Well, the question is, does
their system work any better?

>> The bottom line is that today
we in total use approximately

half the amount of antimicrobial
agents as we did before

the ban, and we
produce 50% more.

And at the same time, resistance
has gone down really heavily.

>> I will not say
I love that ban,

but the result coming out
of the ban I love that.

I'm not organic
producer, but I love not

to give more than necessary.

>> You have to balance out
what are the costs and what are

the benefits.

AGPs, when we
stopped using them,

we could see that mortality
went up just a little bit,

daily growth went down
just a little bit,

but it was not something that
was the end of the industry.

Otherwise, we wouldn't
be here today.

And, I mean, we
produce more pigs today

than we did 12 years
ago, way more pigs.

>> Well, of course, we hear this
argument all the time that this

might be feasible to do
something in a small country

like Denmark.

But come on.

Denmark is producing 28
million pigs every year.

That's basically the same amount
as the state of Iowa does.

I think it's about
30 million pigs.

So if we could do it
in Denmark, of course

you could do it in Iowa.

And Iowa's probably
the state in the US

that's producing most pigs.

So it's not so difficult.
It is actually feasible,

and, of course, you can scale
it up to any state in the US.

>> Well, it sounds
like ABC, doesn't it?

Well, it's that easy,
and it's up to you.

>> I don't know about you, but
I hate the idea of the Swedes,

Norwegians, and Danes thinking
we're a bunch of superstitious

idiots.

Let's show them we're as adult
and intelligent as they are.

So let that be our
plan of conquest,

the conquest of disease.

[music playing]

>> There is no government agency
that feels empowered or indeed

is empowered to really
watch out for effectiveness

of antibiotics.

And I'm not advocating the
creation of a new government

agency, but certainly if we
didn't have government paying

attention to the
[? effector's ?] antibiotics,

most assuredly there's
no private incentive

to pay attention to this.

>> If you want to design
interventions to block

transmission of infections,
you've got to know where

the infections are.

You've got to know
where the resistance is.

You've got to know where
the antibiotic use is.

Europe has developed a very
sophisticated network that's

EU wide, and the United
States is behind.

>> To really understand
resistance and to really

understand what's going on, it's
probably more important to have

granular information that allows
you to look at more discrete

geographic areas, to look at
the correlation of use with

the resistance rates that may
happen at a more local level.

>> And what are the challenges
to getting to that more

granular level?

>> So it's in essence either
accessing that information

through vendors who do
gather that information,

companies such as IMS Health.

Other vendors that
do provide such data

may provide a resource
for those that

are wanting to do
research to look

at the correlation of resistance
with particular levels

of anti-microbial drug use.

>> And this may be a
really naive question,

but I think it's one that a lot
of regular people would have.

Why can't we just say, you have
to tell us how much you use?

There has to be an accounting.

>> So I'm not sure I can
answer that question exactly,

but health care records,
health care laws--

it's not entirely clear to
me how that would happen.

But the folks that--

and I'm not sure this is
really something that will--

it's not my area of
expertise per se as

far as gathering all this data.

But there are groups like
IMS Health, Wolters Kluwer,

other organizations,
Premier Health,

that are sources of
this type of data.

And through contracts
with them, they

can provide different types
of data on anti-bacterial drug

usage.

[music playing]

>> The political and economic
realities behind why we have

not set up a coordinated federal
network that isn't just looking

at one or two diseases at a time
but is doing pan surveillance,

I think those are real policy
questions that need to be

addressed.

>> If you do not have these
data to show where you are,

you have absolutely no
clue where you're going.

You cannot monitor what is the
effect of the interventions you

do.

You don't know which kind of--

what you should target,
what you should do about it.

And so surveillance
is really the essence

to the basis of
everything for anything

you do both before and
also for the future.

>> You have to have an
independent FDA and USDA,

and independent
regulatory authorities,

to be able to look at these
products to analyze them

on a continuing basis and
call the chips where they may.

And that sometimes
creates political problems

on Capitol Hill and
elsewhere, but that

is what the public expects.

>> This fight is probably
the fight of a lifetime.

I don't think there's
any question about that.

If 148,000 people die a year
of uncontrollable infections,

we've got a problem
on our hands,

particularly since a decade
or two ago that wouldn't

have been a problem at all.

And it is up to us to stop it.

And it is heartbreaking to me--

not to say stupid--

that we would take one of
the most single advances

in medicine in our lifetime
or in this last century

and simply waste it.

And it infuriates me.

>> If you look now at our
current antibiotic pipeline,

I think that it would be
appropriate to be concerned.

There aren't nearly enough
drugs coming forward.

>> If you're a pharma company
and you spend 10 years

and a billion dollars--

those are the usually
agreed to numbers--

10 years and a billion
dollars developing a drug,

and you bring that drug
out and within a year

bacteria are resistant to it.

And within three years a lot of
bacteria are resistant to it,

and within five years
maybe physicians

don't want to prescribe
your drug anymore

because they're not sure if it's
going to work in their patients

or not.

Why would you make that drug?

How are you going to recoup
that billion dollars?

When you look at it
through that lens,

making something like
Viagra or statins or insulin

that people will take for
the rest of their lives,

that makes a lot more sense.

>> The second side of the
coin is the regulatory.

The Food and Drug Administration
has completely changed the way

that it looks at
antibiotic clinical trials,

and the reasons for this
relate to very Byzantine

statistical concepts.

The effect is that
companies know,

A, they don't know how to
get new clinical trials done

for antibiotics.

And even successfully
completing those trials,

you have a much lower chance
of getting a drug approved

now than in the past.

So tell industry, tell
investors that it's

going to take much
longer than it used to.

It's going to be much more
expensive than it used to be,

and you're going to have a
much higher risk of failure

even if you successfully
complete your phase three

trials, and watch those
investors run for the hills.

That's what we've done as
a matter of public policy

in antibiotic development.

>> We need to encourage
developers to be willing

to bring forward antibiotics
that might be antibiotics that

we don't use very often.

And I think it is not reasonable
to expect new antibiotics

to all be best selling drugs.

That, in fact, if they
become best selling drugs,

we're probably not
using them correctly.

>> What we need to go after
is thinking through where

we're going to get our
antibiotics rather than trying

to fork over a lot of money to
some big pharma company to come

up with the next blockbuster.

Because what's that
really going to solve?

That's kind of like,
you have a new car

and you drive it on a
road which is really bad.

So your new car goes bad,
and so you say, well,

what I really need to fix that
problem is another new car.

No, what we really
need is a better road.

>> If we don't develop any
new drugs for blood pressure

in the next 50 years, that's OK.

The stuff we have
today are going

to work just as well 50 years
from now as they do today.

But if we don't develop
any new antibiotics,

the nature of the beast is
that the stuff we have today

are not going to work anymore.

That's bacteria using
their genes to adapt.

We have to develop new
ones, or we will not

have effective ones at all.

[music playing]

>> The tragedy of the commons
exists when any individual

who's using a
particular resource--

let's just call it fisheries.

And you think, well, a
problem with fisheries

is that there is too many
people catching fish,

because any fish they
leave in the ocean

is basically lost to them
because someone else is

going to catch it.

And that's exactly the same
problem with antibiotics, which

is if I don't use
their effectiveness,

it's gone tomorrow
because someone else

is going to be using
up their effectiveness.

And in a sense, it
takes the problem

of antibiotics out of the
realm of medical science,

which it is a medical
problem, but it's really

a problem of behavior of
individuals and of societies.

>> The over-prescription
and misuse of antibiotics is

a classic example of the
tragedy of the commons.

If I was the only physician
in the country that

was prescribing antibiotics to
people with viral infections,

it would have almost
no impact on the spread

of antibiotic resistance
upon bacteria.

When every physician does it
and when it's done in animals,

it's done on a tremendously
widespread industrial scale.

That has a negative detrimental
effect on society as a whole.

And the time for bickering
over half measures

and debating the
nuances is over.

We're past all that.

It's time to sit
down in a serious way

and fundamentally redesign the
processes by which we discover,

use, and protect antibiotics.

>> We can try and figure out a
way to protect ourselves from

the very dangerous microbes
that are out there,

and that probably will
require us to accept some risk

associated with life.

That is, if we walk around
into our environment,

it's probably better
for us in the long run

to get exposed to the
microbes in the dirt

and on our mother
and other places.

So you sort of have to accept
that occasionally some of them

are going to make you
sick, and hopefully we'll

have treatments
that will allow us,

if they make you really
sick, to get rid of them.

>> The best quote that explains
our relationship with microbes

came from Nobel laureate
Dr. Joshua Lederberg,

who wrote in the magazine
Science that the future

of humanity and microbes will
likely evolve as episodes

of our wits versus their genes.

Their genes allow them to adapt
to anything we throw at them.

It's up to us to use our wits
to keep up with their genes.

[music playing]

[MUSIC - JONATHAN
STONE PHILLIPS,

"I SAW IT DARKEN
A SWIMMING POOL"]

>> I remember in middle school
I saw it darken a swimming pool.

It's growing.

It's growing.

It's growing.

It's taking over me.

You shouldn't push
up against it.

Don't move it, or
you'll offend it.

It's growing.

It's growing.

It's growing.

It's taking over me.

Sometimes it covers everything.

Sometimes it's only
there between the trees.

It's growing.

It's growing.

It's growing.

It's taking over me.

It's the color of
misplaced fruit.

I hate to say it, but right
now it's probably near you.

[inaudible]