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[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]