Antibiotic Apocalypse

Doctor and special correspondent Avir Mitra takes Executive Editor Soren Wheeler, plus a live studio audience, on a journey from the operating room to inside the body to the farm to the sewers and back again—searching for answers to an alarming threat to humanity’s existence as we know it: antibiotic resistance in bacteria. This live show, performed in New York City and also in Little Rock, Arkansas, is part of a series we’re doing with Avir that we are calling “Viscera.” Each event is a conversation that takes the audience on a journey into a quirk or question or mystery inside of us, and gives them a visceral experience of the viscera within us. The previous installment of the series was called “The Elixir of Life.” (https://radiolab.org/podcast/the-elixir-of-life)Special thanks to all of Little Rock Public Radio (especially Grace Zafasi and Jonathan Seaborn), Thomas Patterson, The Greene Space staff, CALS Ron Robinson Theater, Tom Philpott, Stephen Roach, Kate Shaw, Alex Wong, Maryn McKenna, and Kerri McClimen. If you are a patients or a doctor, and you are interested in phage therapy, please contact [email protected] EPISODE CREDITS: Reported by - Avir MitraProduced by - Jessica YungSound design contributed by - Jeremy Bloom and Jessica YungFact-checking by -Natalie Middleton EPISODE CITATIONS: Videos - Check out the video from the Viscera live show (and a bonus Q&A with Bruce Stewart-Brown and Steffanie Strathdee) on Radiolab’s YouTube (https://zpr.io/3BK9MqJYVKQA). A deep dive (https://zpr.io/WNQNfgiNvKeZ) on bacteriophages with Avir Mitra and Steffanie Strathdee, also on Radiolab’s Youtube.. Books - The Perfect Predator (https://theperfectpredator.com/) by Dr. Steffanie Strathdee’s telling of her battle against a killer superbug. Plucked (https://zpr.io/PudGMEuzgU9X) by Maryn Mckenna a detailed accounting of chicken farming’s practice of using antibiotics. Signup for our newsletter!! It includes short essays, recommendations, and details about other ways to interact with the show. Sign up (https://radiolab.org/newsletter)! Radiolab is supported by listeners like you. Support Radiolab by becoming a member of The Lab (https://members.radiolab.org/) today. Follow our show on Instagram, Twitter and Facebook @radiolab, and share your thoughts with us by emailing [email protected]. Leadership support for Radiolab’s science programming is provided by the Simons Foundation and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

• 0:01Speaker 00

  Wait, you're listening.

• 0:03Speaker 01

  Okay.

• 0:04Speaker 00

  All right.

• 0:05Speaker 01

  Okay.

• 0:07Speaker 00

  All right.

• 0:08Speaker 02

  You're listening to Radiolab.

• 0:11Speaker 00

  Radiolab.

• 0:11Speaker 02

  From...

• 0:12Speaker 00

  WNYC.

• 0:14Speaker 01

  See?

• 0:14Speaker 00

  Yep.

• 0:22Speaker 00

  Hi, everybody. Thank you for coming out tonight. Welcome to our home station, WNYC.

• 0:30Speaker 03

  Hey, I'm Latif Nasr, here with our executive editor, Soren Wheeler.

• 0:35Speaker 00

  Hello, Latif.

• 0:36Speaker 03

  The only one with the key to the executive bathroom, Radiolab's executive bathroom. I've never been in there myself, but the reason I've pulled Soren out of the executive bathroom here onto the mic is because a little while back, here in New York City...

• 0:53Speaker 00

  Welcome to our home turf at the GreenSpace here.

• 0:56Speaker 03

  You got onstage to do a little live show.

• 0:58Speaker 00

  I did, it's true. Tonight, we are doing a live taping of a thing that we've been playing around with lately. This was the latest in a series of shows that we've been doing with our favorite and only ER doctor reporter, Avir Mitra.

• 1:12Speaker 03

  Right. You may have heard the one I was onstage with him for about CPR.

• 1:17Speaker 00

  Right.

• 1:17Speaker 03

  Or the one Lulu did with him about breast milk.

• 1:20Speaker 00

  Right.

• 1:21Speaker 03

  And so this time, we were like, every once in a while, it's nice to give you some air, to air you out a little bit.

• 1:28Speaker 00

  Let me out of the closet?

• 1:29Speaker 03

  Yeah, that's right.

• 1:30Speaker 00

  And because tonight is a live taping, we will be keeping it loose. We will have some audience interaction. We will have some live guests who can come up and say...

• 1:38Speaker 03

  And part of the reason it was so fun, this one, was because you're an editor and you were just editing him in real time, like tweaking, adjusting, you're dialing it in, you're like, okay, we're done with this, let's move on.

• 1:50Speaker 00

  Yeah.

• 1:50Speaker 03

  Yeah, it's sort of funny, like you can hear this is what Soren does behind the scenes, anyway.

• 1:56Speaker 00

  I mean, we were actually trying to keep it loose, you know, like not dialing it in too much and a little bit of a seat of the pants kind of thing. But also, you know, the show, what the show was about was antibiotic resistance, which...

• 2:09Speaker 03

  Sexiest topic.

• 2:10Speaker 00

  It was, the funny thing about that is it was something that I sort of knew about quite a bit, you know? Like, we get pitches about it, we've done shows about it. You know, I think more generally, all of us sort of like... Catch some passing news bit about it here or there once every couple of years and then move on with our lives. But Aver in his position as a doctor, he was able to make it so much more visceral. And honestly, a little bit more terrifying. But at the same time, because he reported it out and looked in all these places and tried to figure out what was going on. He also, I think by the end, gave me for sure. And hopefully all of us, like a sort of a different

• 2:54Speaker 00

  and maybe even hopeful way of looking at it.

• 3:00Speaker 03

  Well, let's play it.

• 3:02Speaker 00

  Okay.

• 3:06Speaker 03

  Here you go.

• 3:07Speaker 00

  So help me welcome out Dr. Avir Mitra.

• 3:16Speaker 04

  Hey, hey. Thank you. Thank you, guys. Wow, a lot of people. I love that.

• 3:22Speaker 00

  I gotta say that every story you've ever brought me, I feel like starts at your job. Like some, somebody walks through your doors at the ER with some, I don't know, injury or disease or what have you.

• 3:33Speaker 04

  That is what today's kind of about. But as I was thinking about it, I kind of realized it goes back even further than that. It goes back to 2006. This thing that happened with my dad, actually.

• 3:45Speaker 00

  Your dad is a doctor, right?

• 3:46Speaker 04

  Yeah, yeah, he's a doctor. My mom's a doctor. My grandmom's a doctor. But at the time, I didn't want to be a doctor. I just wanted to be like a rock star. That was my dream.

• 3:56Speaker 05

  You went to med school. Then you decided you don't want to be in med school. You want to be a musician. And being an old practical man, as I am, I knew that's not going to work. I told you a thousand times that the difference between a large pizza and a musician, which pizza, large pizza feeds a family.

• 4:19Speaker 00

  Bold to let this room laugh at you like that. Like us to...

• 4:23Speaker 04

  That's why I go to therapy.

• 4:24Speaker 00

  Fair share.

• 4:25Speaker 04

  But the point is, like, at this time in my life, you know, I was going every day to band practice, hanging out with my buddies, staying up till 5:00 in the morning. Meanwhile, my dad is waking up early. He's going to work at a hospital. And he was seeing this sort of interesting change take place.

• 4:40Speaker 05

  We have been seeing infected hand patients, hand infection patients, coming all the time to us with various reasons. It could be a small scratch. It could be a pin puncture. And we were treating them, basically, with a 48 hours' worth of antibiotic, IV antibiotic or PO antibiotic. And it used to get resolved easily. And then, suddenly, we started to see these patients were not really getting better within that short period of time. So we said, "That doesn't make any sense. Why is it so that we're seeing so many patients?" And we started doing some culture for each and every patient who came into the emergency room on a routine basis.

• 5:22Speaker 04

  So he's doing this at work, and he sort of comes up with this idea, like, "Let's do a research project about this. Let's see what's going on." So he turns to me, because, you know, English isn't his first language. He doesn't know how to use a computer. I'm a pretty smart kid. So he's like, "Why don't I get you to help me write this paper?"

• 5:37Speaker 05

  You were the only person who has absolutely nothing going on at that stage with the music, etc. Instead of sitting idle, I thought, "If I keep you busy doing some medical papers, later on, if you ever plan to reapply, these papers might help the guys who are looking at your application saying, 'He's not a complete derelict.'"

• 6:00Speaker 04

  Well, I wasn't sitting idle because I was doing music at that time.

• 6:03Speaker 05

  It's a derelict in the sense you're doing music.

• 6:07Speaker 00

  I do feel like I should step in and let you all know. Avir was a little bit of a legit rock star. I mean, you had a record. You had gigs. You were on Conan O'Brien.

• 6:15Speaker 04

  That's true. That's true. But this was later, right? At the time, I was broke. I was living in the basement. It was not a good look. I get it, you know? But anyway, back to the topic. You know, what we found in this paper is that these papers... Were coming in with infections, the bacteria was MRSA.

• 6:31Speaker 00

  Oh, sure. Like, I feel like MRSA is like the late 90s news, super hospital bug.

• 6:36Speaker 04

  Yeah, MRSA was like a typical bacteria that had become resistant. And it was a thing that had already existed, but it was the type of bug, the type of infection you could get like if you were super sick, you know, you're like in the hospital for months and you're getting all these meds like. But what this paper found is that people were coming in off the street who had like never been in a hospital. Kid falls off a skateboard, cut. He's got MRSA. So what we found is that actually this bacteria that lived in one place, it's sort of like escaped.

• 7:04Speaker 05

  It doesn't stay limited to that patient or that limited to that facility. It essentially escapes and then it becomes a risk factor for the general population.

• 7:14Speaker 04

  So yeah, you know, I had that experience. I wrote up this paper and I didn't think much of it because I was like, whatever, I'm in a band. But eventually, you know, I go to med school, now 10 years go by and now I'm actually showing up in the ER as a resident. And at this point, you know, MRSA is just like a common thing. Probably three or four of you have MRSA here. It's like just a thing that people have. But I wasn't worried about it because we had a drug called vancomycin, which can treat MRSA. So it's not like incurable. So now I'm working in the ER, a year goes by and then it's weird. All of a sudden I start seeing patients who have resistance to vancomycin. So now the vancomycin isn't working. It's like, okay, so at least we have a class of antibiotics called carbapenems. A little bit more rare, but I can use those drugs for those patients.

• 8:00Speaker 00

  But you have a backup.

• 8:01Speaker 04

  Yeah, I have that backup. I can use it. But then another year goes by and then I'm starting to see patients that are resistant to the carbapenems. That's not working anymore. And so then at that point, I have to go to this drug, colistin, which is like just this crazy old drug that like I don't even want to use. It's got a bunch of side effects and basically I feel like I'm being backed into a corner all of a sudden. It's just this simple infection and now it's like I have to do all this stuff and I have no choice.

• 8:30Speaker 00

  I gotta say, like, as we've been talking about this, like, obviously I've known about antibiotic resistance and I'm sure many of us here have, but like. How long have you been a doctor? 10 years?

• 8:40Speaker 04

  10 years, yeah.

• 8:40Speaker 00

  It's like, I'm not that that's not a lot, but it's not a lot.

• 8:42Speaker 04

  Yeah.

• 8:43Speaker 00

  And I feel like, you know, you, in that short time, you have been sitting there literally watching drugs that you could use slip away. I mean, it's sort of like the pace of it. Like, while we've all been distracted by presidential politics or maybe, you know, a pandemic, like, this has been happening right in front of your eyes.

• 9:02Speaker 04

  Yeah. No, it honestly is terrifying to like go up to work and see this happen. I don't know, it's just scary because it's like, if we don't have antibiotics, like, we're not really doctors. Like, you can't get a surgery if you don't have antibiotics. You can't get a C-section. Like, you're basically useless without these drugs, you know? And that's why I kind of start to have these nightmares where it's like, am I just everything I know about medicine? Is it just this like little bubble that we're living in?

• 9:32Speaker 00

  What do you mean by like little bubble?

• 9:34Speaker 04

  What I mean is like, okay, let's zoom way, way out. All right, for hundreds of thousands of years, we've been human beings and we've been fighting bacteria. But for like most of that time, we have been losing. Like, just think about it, like, back in the day, you get a little simple UTI, like, you die. Have sex with the wrong person, you get disfigured for life. You catch a little cold, turns into pneumonia. I mean, basically you gotta move somewhere like Arizona, try your best, or you probably just die. Like, that is the way the world has always been. Until not that long ago, like, less than 100 years ago,

• 10:15Speaker 04

  Alexander Fleming, he basically just observed that fungi were producing a chemical that was killing bacteria. So he basically just isolated that chemical.

• 10:26Speaker 00

  So that's penicillin, right?

• 10:28Speaker 04

  That's penicillin. And like, everything we've done since then has been a variation on that theme. We tweak it a little bit here, find a different fungus there. But it's the same idea and it's basically this idea that has allowed like civilization as I guess we all know it to exist. Like, that's how we've won wars. That's how we live in a city. That's how we're all in this room together and like people aren't dying, you know? Everything we do is just based on kind of this idea.

• 10:54Speaker 00

  And that is the bubble that you feel like is bursting?

• 10:58Speaker 04

  That's the like 100 year bubble.

• 11:00Speaker 00

  I mean, does that mean that you actually feel like, what are we looking at in the five, 10 years that there are bugs out there that no drug works on?

• 11:09Speaker 04

  Well, maybe I can like, share a story?

• 11:12Speaker 00

  Yeah.

• 11:13Speaker 04

  All right.

• 11:13Speaker 00

  As your editor, I recommend you do.

• 11:15Speaker 04

  I know, can't just be me blathering.

• 11:18Speaker 00

  Let's move.

• 11:20Speaker 04

  All right, all right. So this is Stephanie Strati.

• 11:23Speaker 00

  Yeah.

• 11:23Speaker 04

  She's an infectious disease epidemiologist at University of California, San Diego. But here, she's just going on vacation with her husband, Tom, to Egypt. We ended up going at a time when there had been a terrorist attack in Sharm El Sheikh a couple of weeks prior. So all of the people from the West had canceled and we were the only one on this cruise ship. So it was really kind of a ghostly experience. I remember standing at the front of the boat, doing one of those Titanic things like, and then we'd had this lovely seafood tower for dinner and we're looking at the stars. It was really romantic. And then all of a sudden, Tom started to turn a bit green and he was losing his stomach

• 12:06Speaker 04

  contents all night. So I called a doctor to the ship and the doctor first gave him an intravenous antibiotic and some fluids and said, oh, he'll be right as rain by, you know, dinner. And he wasn't. He was worse. So they get off the ship at this point. They go to a clinic in Egypt where they're trying some other medicines. It's not working. So they actually ship him to a bigger hospital in Germany. Well, he was in an ICU in Frankfurt where they have some of the best gastroenterologists in the world. But when the culture came back, the doctor said, I've got some terrible news. This is the worst bacteria on the planet. It's Asinobacter bomanii. And I went, what?

• 12:47Speaker 04

  And when he said it again, I realized, wait a second. This was an organism that I used to plate on my petri dishes back at the University of Toronto when I was a student in the 1980s. And all we needed was the lab coated gloves back then. How can this be the worst bacteria on the planet? So despite all this treatment, he's getting all these antibiotics, he's getting worse and worse. At this point, he's on a breathing machine, he's getting sicker. So they package him up and send him back home to the University of California, San Diego, the ICU there. I have a chart of all the different antibiotics that it was resistant to right off the top. And I call those the gorillacillins that are the heavy duty antibiotics that have to be infused into the patient and that have a lot of toxic side effects.

• 13:31Speaker 04

  He was on all of those in a cocktail, but there was no other alternative. In fact, we didn't even know if these antibiotics were going to do anything. And I pointed to a whole bunch of them on the wall and the doctor said, you know, there's nothing that will kill this thing. I said, well then, why are we treating him with all of these antibiotics? And they said, because we don't know what else to do.

• 13:55Speaker 04

  This is probably a dumb question, but emotionally, what are you going through at this time? Well, I felt like it was God's cruel joke that here I am, an infectious disease epidemiologist, and I had no idea that antimicrobial resistance had gotten this bad over the last few decades, that an organism, a wimpy bacteria, as one of the doctors called it, that has

• 14:20Speaker 00

  acquired these superpowers and is now like killing my husband? Like, what? Like, how could this be? How can, how can an infection that you acquire on vacation to a guy who's, you know, so healthy that he was crawling backwards down into a pyramid one day and then two days later he's fighting for his life? Like, this just doesn't happen, does it?

• 14:43Speaker 00

  I mean, it's, yeah, it's crazy just to think about like that, what she said, that she was, this was a bacteria that she was plating with just gloves and then it's become this thing that we can do nothing about.

• 14:53Speaker 04

  Yeah. Yeah, it's scary, man. I mean, like, look- And this was 10 years ago that this happened. I'm showing up to work and I'm seeing cases like this where no antibiotic works. I gotta mix and mingle different antibiotics to try our best. And I don't know, it's it's just a scary feeling because I feel like I'm watching a world war that's happening basically right under our noses and we're not really paying attention to it. And then somehow like I'm at the front lines of this and I'm like, how did this happen to me? Like, why am I here? I guess that's why I wanted to come here and talk today because I wanted to sort of zoom out and take a big picture of like, okay, there's this global war. Like, what is really going on here?

• 15:32Speaker 00

  Well, just, I mean, so now that we've got you, it's sort of like a little bit out of doctor mode and into maybe reporter or investigative looker mode. Like, back me up a little bit because you talk about it as a world war. Yeah, like, give me the layout of, you know, unpack that metaphor for me a bit. Like, what's the battlefield? Who are the combatants?

• 15:48Speaker 04

  Okay.

• 15:48Speaker 00

  Lock me up to it.

• 15:49Speaker 04

  Yeah, so we could start with sort of who who is this battle between, right? Because you got us and humans and on the one side.

• 15:57Speaker 00

  Or us and bacteria.

• 15:58Speaker 04

  Or us and bacteria, yes, yeah. I forgot I was human. Us, team us, I promise I'm human. We're on this side. Think about what we have, right? Like, we're composed of trillions of cells. We have like huge brains. We have all these muscles. We have fancy degrees. We have chat GPT. We have everything. And on the other side, we have bacteria that are like single-celled organisms. They don't go to school. They don't know how to read. They don't have brains. They don't even have a single neuron. They don't have any muscles. Like, they, you know, just put them in the air and they'll probably just die.

• 16:36Speaker 00

  I gotta say, it raises the question, which is sort of like, how in the hell are we losing?

• 16:40Speaker 04

  No, I know. That's exactly what I think about. And yet, I'm sitting at work and watching us lose it. And that's where I get to thinking. And I don't know, I've grown to have a respect for these guys because I'm like, I actually fundamentally think that they're like better than us.

• 16:55Speaker 04

  I really do.

• 16:56Speaker 00

  And what, like?

• 16:57Speaker 04

  I mean, sure, we have all this stuff, you know, but they can actually just evolve better than we can at a very fundamental level.

• 17:05Speaker 00

  Well, explain how something can evolve, like, because they got, like, they've the faster lifespan, they mutate easier, like, what, how do you evolve better?

• 17:15Speaker 04

  I could describe it, but I'd rather kind of just show you.

• 17:17Speaker 00

  Yeah, let's do it.

• 17:18Speaker 04

  But you guys have to be involved, all right, with some crowd participation. All right, I'm gonna set up a hypothetical scenario here, we're gonna watch evolution happen. Let's pretend you guys are all humans, and me, Dr. Mitra, I'm gonna try to kill everyone in this room, the way I'm doing it is by-

• 17:35Speaker 00

  This is, by the way, not a typical public radio-

• 17:37Speaker 04

  Right, right.

• 17:38Speaker 00

  -tactic.

• 17:39Speaker 04

  Right. It's an aggressive donation request, you know?

• 17:44Speaker 00

  Or else.

• 17:44Speaker 04

  Yeah.

• 17:45Speaker 00

  No, okay, all right, how are you gonna do it?

• 17:46Speaker 04

  The only way out is if you donate. No, I'm gonna seal all the windows, everything, and just suck all the oxygen out of the room. So you all are gonna suffocate to death, I'm sorry, I know some of you guys, I apologize. But, and I need a volunteer, I need one volunteer, ideally a single person, all right, what's your name? Danielle. Danielle, so sucking out all the oxygen in the room, everybody dying, we got that, but Danielle, she didn't even know that she has a random mutation where she can hold her breath for 20 minutes, so while everybody else dies, you're gonna live. So let's think about, like, from an evolutionary perspective, if we want this trait, ability to hold your breath, to spread, how's that gonna happen?

• 18:28Speaker 04

  Well, Danielle has to go on some dates, meet someone- Yeah. -that she's into.

• 18:35Speaker 00

  We don't need a doctor to tell us what has to happen.

• 18:38Speaker 04

  Right, right. You get the idea, Danielle.

• 18:41Speaker 00

  We get the idea.

• 18:43Speaker 04

  Then maybe that special miracle of birth will happen.

• 18:47Speaker 00

  Yeah, so that's, that's human evolution, we gotta wait a while, but that's just human, that's just evolution.

• 18:52Speaker 04

  That's evolution, but it's a specific type of evolution, really, it's called vertical gene transfer.

• 18:59Speaker 00

  Vertical, like?

• 19:00Speaker 04

  Like, her genes pass down to the children and grandchildren, they go down the generational tree, so while Danielle has to have sex-

• 19:10Speaker 04

  Bacteria have a sex pilus.

• 19:13Speaker 00

  So at this point in the show, Avir put up a picture right behind us on stage. And it had these like two gray blobs. It's kind of a grainy picture. And there's this, this tube just like shooting out from one of them, connecting it to the other one on the other side.

• 19:29Speaker 04

  It's a different thing. This doesn't look like Danielle at all, actually.

• 19:33Speaker 00

  No.

• 19:34Speaker 04

  But it turns out-

• 19:34Speaker 00

  More like a date. That's what I'm recognizing for you.

• 19:37Speaker 04

  Exactly. About a billion years ago, bacteria evolved this crazy trick where they're able to just generate a tube out of their bodies and just suck into the bacteria next to them. It doesn't even have to be the same species. They can just create a tube and connect to the person next to them.

• 19:52Speaker 00

  And they're, and they're shooting genes, I assume? Like that's where-

• 19:56Speaker 04

  So they make this tube and then they can make a copy of some of their genes and just send them over to the person next to them.

• 20:02Speaker 00

  Wow. That's pretty cool.

• 20:03Speaker 04

  So that's the sex pilus. And so I kind of want to use this now as an example. Okay, so we're going to try the same scenario again. Instead of you guys being humans, now you're all bacteria. Okay, you all have a sex pilus. So I need to pick someone in the audience. I'm gonna pick, what's your name? Rich. Rich, the bacteria.

• 20:23Speaker 04

  You have a special mutation. Let me explain. In this scenario, all you need to live is light. Okay, that's what you need as bacteria. So let's go ahead and turn all the house lights down. And as these are turning down, you guys are all slowly dying.

• 20:36Speaker 00

  This is getting weird, yeah.

• 20:37Speaker 04

  But Rich, the bacteria, has a special mutation. He didn't even know he had it. He has the ability to make his own light. So Rich, please tell me that you have a little glow stick.

• 20:46Speaker 00

  Just to explain, by the way, we'd actually handed out glow sticks to everybody in the audience as they came in the door. But-

• 20:52Speaker 04

  Only Rich, the special bacteria. You can go ahead and turn on that glow stick for us. And hold it up.

• 20:57Speaker 00

  Yeah, kind of wave it around, let us see it.

• 20:59Speaker 04

  All right. So using the sex-

• 21:02Speaker 04

  Sister is like, no one's ever been to a rave, I guess.

• 21:06Speaker 04

  All right. So, Rich, anyone you tap on the shoulder can then turn on their glow stick. Don't do it yet, don't do it yet. We're gonna time this, okay? And then once you, you know, once you get tapped, you can turn on your glow stick and you can tap people around you.

• 21:21Speaker 00

  Yeah, when you get tapped, also spread the tap.

• 21:23Speaker 04

  And let's see how long it takes for this trait to spread everywhere, okay? On my count. Ready, three, two, one, go.

• 21:33Speaker 00

  Okay.

• 21:34Speaker 04

  Hold him up so we can see him. Let's see this happen.

• 21:37Speaker 00

  So, Aver and I are standing onstage in the dark, and it was actually pretty cool to watch this happen. You could sort of see Rich's light spread to the next person, then next. And at first, it was actually pretty slow and sort of halting.

• 21:51Speaker 04

  These guys are still dying over here. They're struggling.

• 21:54Speaker 00

  But then it started to like, spread pretty quickly. It took a little while to get like, over to different sections.

• 21:59Speaker 04

  This is the VIP section is all dying.

• 22:01Speaker 00

  But really, once it got going, it went fast.

• 22:03Speaker 04

  Amazing.

• 22:04Speaker 00

  And suddenly, the whole theater was sort of like a sea of little wiggling lights.

• 22:09Speaker 04

  Alright, nice. Let's bring the house lights up. Give yourselves a round of applause. That was actually really cool.

• 22:16Speaker 00

  That was amazing. That was great. That was really amazing to watch.

• 22:19Speaker 04

  You guys are great bacteria. That was so good.

• 22:21Speaker 00

  Everybody, give yourself a round of applause.

• 22:25Speaker 04

  So, what you just witnessed is actually horizontal gene transfer, right? So while humans have to pass genes down, you guys can pass genes horizontally. You could just pass them to each other.

• 22:37Speaker 00

  Meanwhile, I think Danielle is still like, trying to find that date.

• 22:40Speaker 04

  Right. She's not so sure about the last day she went on. It's gonna be some time.

• 22:44Speaker 00

  I mean, I want you to take your time, but...

• 22:46Speaker 04

  Right, exactly. So, you know, you gotta think about that. Look at how fast that spread. And now, you take into account that for every single human being on Earth, there are 30 trillion bacteria, okay?

• 22:58Speaker 00

  Per person.

• 22:58Speaker 04

  Per person.

• 22:59Speaker 00

  So that's me 30 trillion, you 30 trillion, 30 trillion, 30 trillion.

• 23:03Speaker 04

  Exactly. This is just unbelievable. There's universes of bacteria for every single human being. And all it takes is for like, one mutation to happen in one of those bacteria, and then that trait is gonna spread like wildfire.

• 23:15Speaker 00

  So what we're up against is like, terrifying numbers of blazingly fast and nimble tiny little enemies.

• 23:23Speaker 04

  Exactly. It really is like, our brains versus their sex pillus.

• 23:30Speaker 04

  And their sex pillist is winning, basically.

• 23:33Speaker 00

  Well, but okay, but this is actually where I was hoping that our brains might come back in. Because, okay, sex pillist and trait tricks and we do a drug, they figure out a way around it. But then we come up with a new drug.

• 23:43Speaker 04

  Well, that's the idea. Problem is like, we haven't really been coming up with new antibiotics. We sort of fell off a cliff. Like, we haven't come up with a new antibiotic, a significant one, since like 1980.

• 23:55Speaker 00

  Oh.

• 23:55Speaker 04

  We just don't, we just don't anymore.

• 23:57Speaker 00

  Why, why is there not, there's zero new antibiotics since 19, whatever that is?

• 24:01Speaker 04

  Yeah.

• 24:02Speaker 00

  Why?

• 24:03Speaker 04

  It's mostly like an economic issue. You know, you think about how much money it costs to do all these trials to invent a drug. That's going to cost you like a billion dollars. So that's a lot if we all have to chip in on that, you know? And you're going to do all this to make a drug. It might work. And if it does, bacteria, just in a matter of like two, three years, are going to figure out a way around it. So it's, it's just kind of like a money losing proposition for pharmaceutical companies. So they're just not going to do it.

• 24:28Speaker 00

  All right. So that means that you then are literally just sitting around using the same drugs over and over again. Meanwhile, every time you use one, the bacteria has a chance to train up on it and figure a way around it.

• 24:41Speaker 04

  Yeah. And that's how like a little trickle of bacterial resistance that's always been around. It's like turning into an avalanche. It's scary. I talked to the WHO, there's a whole chapter of the WHO dedicated to this. And they told me that currently, as of today, one in six infections is resistant to the antibiotic that used to work for it. Like, you have to use something else. And currently today, a million people a year are dying from infections that they used to survive, like a couple of years ago. And obviously, that number's about to get a lot bigger, too.

• 25:16Speaker 00

  Do you remember when you were pitching me this story? And I said, "Well, you can't just leave these people depressed and destitute."

• 25:24Speaker 04

  No, I know.

• 25:24Speaker 00

  And you remember I said, like, "There's somewhere there's going to have to be a ray of hope." And I'm thinking, "Now is it?"

• 25:28Speaker 04

  I had this, okay, okay.

• 25:30Speaker 00

  So with some prodding, Aver did eventually talk about how they're dealing with the rise of antibiotic resistance in hospitals.

• 25:39Speaker 04

  Committees that are filled with annoying people that will email me if I do something wrong, or they pull me into a Zoom meeting, or there's like all these like protocols we gotta follow.

• 25:47Speaker 00

  Basically making sure that they don't use antibiotics in a way that give the bacteria a chance to evolve or resist the drug and then pass that resistance along.

• 25:55Speaker 04

  You know, we want to treat things only if there's really an infection and then really kill everything. Like, you know, we don't want there to be like any survivors that can live to tell the tale of what happened.

• 26:08Speaker 00

  But Avir, you did have a little bit more darkness that you wanted to stare at. Although I promise it does eventually lead us to a more hopeful space eventually. And that will all come right after this quick break. Stick around.

• 26:28Speaker 02

  Radiolab is supported by Capital One. With no fees or minimums on checking accounts, it's no wonder the Capital One Bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how Capital One cafes are open seven days a week to assist with your banking needs, even on weekends. It's pretty much all he talks about, in a good way. What's in your wallet? Terms apply. See CapitalOne.com/BankGuy. Capital One, N.A., Member FDIC.

• 26:53Speaker 01

  After some actual fake polls came to light, pollsters are in the hot seat. But they say, don't be too quick to dismiss the entire industry.

• 27:02Speaker 02

  People want to raise taxes on the rich. I can tell you that definitively because we know it from polling. And if we lose trust in polls, we have no way to understand what Americans want to be done.

• 27:15Speaker 01

  On this week's On the Media from WNYC. Find On the Media wherever you get your podcasts.

• 27:28Speaker 00

  This is Radiolab. I'm Storm Wheeler, and we are back on stage with Dr. Avir Mitra, who is giving us his frontline view of what he calls a world war between us and bacteria. And at this point in the show, Avir told us that as he was reporting all of this out, he realized it wasn't just a problem with him giving antibiotics to a patient in the hospital.

• 27:51Speaker 04

  Like, we also give them to animals. I don't know why that never occurred to me. But if I had to ask you, like, of all the antibiotics given in the US, what percentage would you say go to humans versus animals?

• 28:06Speaker 00

  I don't know. It's like, I feel like it's one of those things where I'm supposed to guess bigger than I would think, but um, I don't, I have no idea. Half. I don't know.

• 28:13Speaker 04

  Oh, it's reasonable, but actually 70% of all the antibiotics given are given to animals.

• 28:20Speaker 00

  Another way of putting that is that every year here in the US, we humans take about seven pounds of antibiotics, whereas farm animals are given 30 million pounds every year. So basically, cows and pigs and chickens are getting four times the amount of antibiotics that we humans are getting.

• 28:38Speaker 04

  Yeah, I had no idea. They're basically just mixing their food with antibiotics. They mix the water. They're drinking water with antibiotics. They like spray it on the ground. They inject them with antibiotics. It's just like a real-

• 28:51Speaker 00

  This is not like, just if they get sick.

• 28:54Speaker 04

  No, no, no. This isn't just if they get sick. It's just very willy-nilly. In many cases, these are the same antibiotics that we use, treating like the same infections that we get.

• 29:06Speaker 00

  So, Avir ended up talking to a scientist, a guy named Lance Price. He's the founding director of the Antibiotic Resistance Action Center at George Washington University. But before he was that, he was researching this exact problem, the use of antibiotics on farms. And the thing that he was specifically trying to figure out was, what effect could the use of all these antibiotics on farm animals have on us?

• 29:31Speaker 04

  So, he designs a study, and like all good studies, it involves poop. It's like a common theme in radio lab, I feel like, right?

• 29:38Speaker 00

  Which comes up a lot.

• 29:39Speaker 04

  So he, he designs this study. Alright, so what he does, he decides to study the poop of chicken catchers. The person who goes around the chicken farm and picks up the chickens by their necks with their hands and throws them in the chicken truck when they're like ready to get harvested, basically. So they're touching a lot of chickens. So what he does is he measures the bacteria in the poop of these chicken catchers versus the bacteria in the poop of like, regular people like, you know, you and I.

• 30:06Speaker 01

  So we, we cultured all this poo, and then we analyzed the data. And the, the one thing that popped out like really strong- Was gentamicin resistance. And so it turned out that the chicken catchers had 32 times the risk for carrying gentamicin resistant E. coli as their peers.

• 30:31Speaker 04

  So basically, these chickens, before they even hatched, they would poke a hole in the egg and inject that egg with gentamicin. Then the chickens would grow up, they're being fed gentamicin, like left, right, center. And so the E. coli that live in the gentamicin were eventually learning from this, becoming resistant to the gentamicin. Those bacteria were jumping from the chickens onto the hands of the chicken catchers, into the mouths of the chicken catchers, enough to the degree where they're literally shitting out resistant bacteria.

• 30:58Speaker 01

  And look, if you're an epidemiologist and you get three times the difference, you're doing cartwheels down the hall, right? So you're like, I found something, look at this, it's miraculous. But this was 32 times, and I just said, we've got to be doing something wrong, right? So we looked at the numbers over and over, and it was clean.

• 31:20Speaker 00

  So the person handling a chicken is 32 times more likely to have a resistant form of E. coli in their bodies than someone who's not handling a chicken.

• 31:28Speaker 04

  Yeah, exactly. And then they find out that, okay, these chicken catchers are going home, that resistant bacteria is getting into their children. Then they find that those bacteria are spreading through the schools of the children. They later find out that if you're driving behind that chicken truck, carrying chickens, those bacteria are getting off of the truck, in through your air vents, and landing in the cars behind them, onto the people behind it. It's like, it's truly insane. And then when you really just sit back and think about it, like, then these chickens go die, they get packaged up with the bacteria in them, and they get sent to like, all of our houses, really.

• 32:03Speaker 00

  Do you remember when like 10 minutes ago, I was like, can we like?

• 32:08Speaker 00

  Do you use a turn to hope thing?

• 32:10Speaker 04

  No, I know, I know, but like, look, this is, to me, this is exciting. This is good because like, I'm spending my whole life in the ER, like, trying to be super anal, like, no, you're not getting into zithromycin, like, not giving you a Z-Pak. But really, like, this is where the real battle is happening. I've been on the wrong battlefront the whole time.

• 32:27Speaker 00

  Well, but so then what, I mean, okay, what's your next move? Like, you gonna call up Big Chicken?

• 32:31Speaker 04

  Well, I did the Radiolab thing, yes, that's actually exactly what I started emailing people, I was doing, I was trying to do the Radiolab thing. So I emailed Tyson Chicken, and they weren't into me. But I kept looking, I kept looking. Eventually, I was able to find one guy who is a higher up at a chicken company, big deal guy, and he actually agreed to talk to me.

• 32:57Speaker 00

  Great.

• 32:58Speaker 04

  So, let's bring him up. This is Bruce Stuart Brown. He's the chief medical officer at Purdue Chicken.

• 33:10Speaker 00

  Bruce.

• 33:10Speaker 05

  Nice to see everybody.

• 33:11Speaker 00

  Thank you for coming.

• 33:12Speaker 05

  Thank you.

• 33:13Speaker 00

  Thank you for agreeing to talk about this. I wanted to just break in and say that I actually had figured that this was gonna be the point in his reporting where Aver would hit a wall. And so, it really felt like a sort of strange, but very cool opportunity to sit down and talk to somebody who's on the inside of one of the biggest chicken producers in the country.

• 33:31Speaker 05

  Yeah, so I'm a veterinarian, and I started at Purdue in 1998 as a field veterinarian, and just kind of getting used to how commercial chicken was raised and the process of being a veterinarian specifically for chickens. And in 2002, we got in a room together and talked about the fact that concerns around antibiotic use had hit the radar for us. And that means that people were calling in or writing and saying, "Look, I heard you guys use a lot of antibiotics in chickens." And they wondered why. And in this meeting, then, Jim produced a third generation-

• 34:17Speaker 05

  CEO of Chairman of the company at the time and Jim is going, first of all, tell me why we use all those antibiotics and then second, tell me how we cannot use all those antibiotics. Let's make it a project and start now.

• 34:37Speaker 00

  Let me, let me ask you at that moment in time when you're, when the big cheese has showed up and said, we're going to do this. What's your reaction?

• 34:44Speaker 05

  I'm going, oh my man, we have, we have got to change everything. If, if you just pulled out the antibiotics, you are likely going to have to treat quite a few chickens and that's not right. That's not a great thing.

• 34:59Speaker 00

  So what do you end up doing to make up, if you're going to take the antibiotics out, what do you have to do to make up for that?

• 35:04Speaker 05

  First thing is you have to redefine clean. You have to decide, in our case, that we thought this egg was clean. It's got to be cleaner. So there's four ways a chicken companies were using antibiotics, including us. One is it was going in every egg as, as, as.

• 35:24Speaker 00

  Like injected into the?

• 35:25Speaker 05

  Injected into the egg with a vaccine to keep the vaccine clean as you vacci, you have this tremendous opportunity on chicken to vaccinate the embryo. It's amazing, honestly, that you can get the vaccine started, you know, in, in an embryo. But you do poke a hole in the egg and the egg did come out of the rear end of a hen, which is the same place, you know, manure comes out of. So it can be dirty and the idea was keep it clean with the antibiotic. Okay, that's the first.

• 35:56Speaker 00

  So cleaning chicken cloaca is step number one?

• 36:00Speaker 05

  Yeah, well, but the other parts were there was antibiotics in the feed. Every bite of feed from day old had an antibiotic in it in those days.

• 36:10Speaker 06

  Even though they weren't sick, just in case they might be, and it helps their gut stay healthy through all the challenges. So we were putting antibiotics in the feed for that.

• 36:19Speaker 04

  Then when I, when I went down to the farm, I'm seeing that the, the things they used to feed these birds were other animal parts. And so that gives them gastrointestinal illnesses because it's like, you know, kind of gross food. And so then they got to use antibiotics. So then they decide to like, change the feed.

• 36:39Speaker 06

  Yeah, we had to change, we had to look at the feed a whole new way. Take the antibiotics out, take the animal byproducts out because those are irritants, put in probiotics, good bacteria, things that help the digestion, the digestive tract of a chicken operate optimally. Same thing, you know, you're probably all familiar with the good bug thing. It's, it's really big.

• 37:03Speaker 00

  So is this all like, is it, you're going along, is it working? Does it seem like you're getting somewhere? I don't know, maybe there's some other things you had to do too, but.

• 37:10Speaker 06

  Yeah, well, we, we did have to work on the chicken house. And the change in feed, the change in approach to feed was a big deal. The cleaner eggs was a big deal. But changing the way you care for chickens became the thing. So raise these chickens in a way that even if nobody cared, you used antibiotics, you wouldn't use them. The whole thing became about caring for chickens in a way that you'd never, let, let a chicken be a chicken. Put things in the chicken house so they can get up off the floor. Let them exercise. Put some windows in the chicken houses, back in the chicken house. The traditional industrial

• 37:51Speaker 06

  chicken house has zero windows. And it's all artificial light. Put some windows back in. Expand the floor space to something above the floor. Chickens like to do three things. They like to climb, they like to perch, and they like to hide. And in a traditional chicken house, they don't get to do much of any of that. And, and so get that back in there. Take the stressors away from the way you raise chickens as much as you can and learn all the time.

• 38:22Speaker 00

  Can I get you like, I mean, over how long did this take? And, and maybe where did you land? Where, where are we at now?

• 38:27Speaker 06

  2016, we were done.

• 38:30Speaker 00

  Wait, does done, done means what?

• 38:32Speaker 06

  All the antibiotics were out of the feed, out of the eggs. Not using any antibiotics for anything other than treating sick flocks.

• 38:42Speaker 00

  Yeah.

• 38:44Speaker 00

  Thank you for the chicken. Uh, and thank you for coming up here and talking to us. All right, everybody.

• 38:55Speaker 00

  That, I mean, it is actually imagining, imagining the chicken leaving its well lit coop to go out to its little sort of playground exercise area with maybe a like probiotic parfait in hand.

• 39:05Speaker 04

  Yeah.

• 39:06Speaker 00

  It's delightful, other than the fact that we are eventually going to slaughter and eat them.

• 39:10Speaker 04

  Right.

• 39:10Speaker 00

  And, and I gotta say, you know, like also to take in consideration just what like the overall, the animal industry is doing. Should we be doing it, the climate?

• 39:20Speaker 04

  Of course.

• 39:20Speaker 00

  It's like, yeah.

• 39:21Speaker 04

  Yeah, yeah, exactly. It's like there, you know, there's a lot of problems with eating meat in general. You know, you could think about climate change, you could think about ethics and this doesn't solve all of that. But certainly in just a proof of concept, you know? To me, it's interesting, like the antibiotics were sort of masking cruel treatment towards these animals. Like you can treat them however you want, but if you pump them with enough antibiotics, they live. And once you remove those antibiotics, all of a sudden you're sort of seeing the truth of what you're doing. And if you treat them better, they're healthier, you're healthier. What we do to them comes back to us. I don't know.

• 39:55Speaker 00

  Yeah.

• 39:55Speaker 04

  It's kind of an interesting proof of concept. I'm into it.

• 39:58Speaker 00

  Yeah, I guess I'm just like back thinking about the war because like, let's say that everybody went full Bruce. And there's maybe a cow Bruce and a pig Bruce and, and, but even then.

• 40:09Speaker 04

  Turkey Bruce.

• 40:10Speaker 00

  Like, yeah, like given the way you've described what's going on globally. I mean, is, is even that a, any kind of decisive move on our part? Or are we?

• 40:21Speaker 04

  The way I see it, everything that Bruce is doing, that's sort of playing great defense. Right? Like let's stop training these guys to get better. But I agree, you know, at some point we have to go on offense. Like any good war. And so I do have one more story I want to share with you guys that kind of takes us there. And honestly, I think this is the part that gives me really the most hope, the most excitement.

• 40:43Speaker 00

  All right, good.

• 40:43Speaker 04

  But to get there, we're gonna have to go back to like a dark place, been the theme of the night. But we got to go back to Stephanie Strathey.

• 40:51Speaker 00

  Who went with her husband, Tom, and then Tom gets sick and, okay.

• 40:53Speaker 04

  Exactly. So one day, the doctors came to me and said, you know, Steph, you realize that Tom's on life support, right? His, he's on a ventilator to keep his lungs working. He's on three medications called pressors to keep his heart working. And now his kidneys are blinking on and off. So that's the trifecta where we stop talking about organs that are having problems working. We're talking about whole systems, whole body systems. And I'm like, okay, okay, like, speak to me. And they said, well, do you want to start kidney dialysis? And so what they were really asking me is, do I want to pull the plug? And that

• 41:37Speaker 04

  moment was just like, I can't believe this is happening, you know, when you have your advanced directives and you, you know, you sit down with your partner and you write a will and, and, you know, he had said to me, hey, you know, if I'm ever like brain dead, please like, you know, pull the plug. But this situation, it was his brain that was alive. It was his body that was dying. And I had no idea what he would want me to do. So the doctors are looking at me and they're saying, okay, you know, what do you want to do? And I said, okay, I think we should ask Tom what he wants to do. And then they said, well, he's in a coma, Steph, like, how, how is he going to communicate? I said, well, you know, let's see, let's just see. So I had this conversation with Tom that

• 42:19Speaker 04

  you just never think that you're gonna have to have with somebody. And I said, hey, honey, I am, I know you're, you're fighting really hard and you have to be really tired. But I need to know if you want to live. And if you want to live, I need you to tell me by squeezing my hand, and I will leave no stone unturned.

• 42:42Speaker 01

  And I remember that moment like it was just yesterday. I still get chills just talking about it. I waited for a whole minute and I thought, oh my God, he's not going to squeeze my hand. And then all of a sudden he squeezed really hard. And I thought, oh yeah, like, you know, I pumped my little blue gloved fist in the air. And then I thought, oh crap, like, what am I going to do now? I'm not a doctor.

• 43:07Speaker 00

  I mean, the question in the room here, I, for me at least, is what did she do next?

• 43:14Speaker 04

  Yeah, well, we can ask her. Stephanie, come on up.

• 43:19Speaker 00

  All right, we will get Steph's story and what happened to her and Tom next, right after this quick break. This week on the New Yorker Radio Hour, will House Democrats try once again for impeachment? Let's not make a fetish out of impeachment. Let's not make a taboo out of impeachment. We understand it's not a panacea, but it is an essential tool in the constitutional toolbox. That's always there. Congressman Jamie Raskin joins us next time on the New Yorker Radio Hour from WNYC. Listen wherever you get your podcasts.

• 43:56Speaker 00

  Hey, it's Radiolab. I'm Soren Wheeler, back on stage with Avir Mitra. And we'd been hearing the story of Stephanie Strathey and her husband, who was suffering from a bacterial infection that no antibiotic drugs seem to be able to treat. And at this point in the show, we actually got Stephanie up on stage to share with all of us what exactly she had to do next.

• 44:26Speaker 01

  Hey, everybody. I can't believe I'm on Radiolab. I'm geeking out.

• 44:32Speaker 00

  Thank you for coming. I'm going to just go in with the first one, the big question that we're all left with, I think. What do you do next?

• 44:41Speaker 01

  Well, I was terrified. I mean, some of the top infectious disease physicians are at University of California, San Diego. They were our colleagues caring for Tom. And, but, you know, I was his wife and I wanted him to live. And I thought, okay, like, if he dies, I want to know that I did my very, very best. So I'm an

• 45:03Speaker 05

  AIDS researcher by training. And I learned as an AIDS researcher that there are experimental treatments that got studied while we were doing clinical trials. And there should be some experimental treatments that we could use to save Tom. So I hit the research. I I went on PubMed, which is a search engine that the National Library of Medicine makes it freely available. And I entered the keywords, asinobacteribomania, the superbug that was killing him, alternative treatments. And up popped something called bacteriophage therapy, or phage therapy for short.

• 45:37Speaker 00

  The phage? And what is bacteriophage? Or what's a phage? Or?

• 45:42Speaker 05

  Bacteriophage are are viruses that have naturally evolved to attack bacteria. They're the oldest, most populous organism on the planet. And they they kill bacteria.

• 45:53Speaker 04

  So are you saying just like how like I can catch a cold? Like a bacteria can catch its own cold type of thing?

• 45:59Speaker 05

  Yeah. Well, what was weird is that I learned about bacteriophage when I was a student at the University of Toronto back in 1986. Like, like, it was just mentioned in class, but I never knew that they had had ever been used to treat like bacterial infections. But they were discovered before penicillin. It's just that they had been, you know, popularized in the former Soviet Union. And that was seen as kind of Russian medicine and and fell out of favor in the West.

• 46:29Speaker 00

  OK, so the idea then is that you're going to put a virus into Tom to fight the bacteria? And are there? Is it like, oh, when you're doing the PubMed Googling, it's like, here's the one to you? Like, what are you coming?

• 46:43Speaker 05

  Yeah, well, that was the other problem. Well, first, I got that my colleagues at the University of California, San Diego said, wow, what an interesting and intriguing idea. If you can find phages that are a match for Tom's bacterial isolate, we'll call the FDA and see if they'll give us permission to give it to him on a compassionate basis because he's going to die. But turns out, there's like 10 million trillion trillion phages on the planet. Like, that's, that's more than all the stars in the sky. So that was even more daunting. And and luckily, I was able to find researchers that agreed to help with the help of Dr. Chip Schooli, the head of infectious diseases at the time at the University of California, San Diego.

• 47:22Speaker 01

  We we found people and even the US Navy, who had been sourcing phages from the bilges of ships around the world.

• 47:30Speaker 00

  From like the inside of the underneath the ship?

• 47:32Speaker 01

  Yeah.

• 47:32Speaker 00

  Like scraping off viruses that like?

• 47:35Speaker 01

  But but you know, the best place to actually go for phage is where there's a lot of bacteria. And you know where there's a lot of bacteria?

• 47:42Speaker 00

  I feel like this is going back to poop.

• 47:44Speaker 01

  It's going back to poop. So it turns out that sewage and barnyard waste and duck pond waste, that kind of stuff, the stuff from like, like the farms that Bruce was talking about, that's a perfect place to source phage. So within a couple of weeks from my first email asking total strangers for help, to the day that we treated Tom with these viruses that attack bacteria, it was only three weeks.

• 48:09Speaker 00

  Three weeks of people tromping through the sewers and scraping the bottom of Navy boats and like sending like?

• 48:14Speaker 01

  Well, some of these are already samples that were in labs. But but literally, yeah, you know? So, you know, I couldn't believe that we were doing this. But, you know, like Tom's in a coma. I said, you don't believe like, we're gonna be like pumping like, you know, like purified shit into you to see if you're gonna live. Like, it's just like, I can't believe this is my life. But that's essentially what we did.

• 48:34Speaker 00

  And that was then, did you say three weeks later?

• 48:37Speaker 01

  Three weeks, that's all it took. Like, compare that to an antibiotic that takes 10 to 15 years to develop in a price tag of a billion dollars or more.

• 48:46Speaker 00

  Yeah.

• 48:46Speaker 01

  But, you know.

• 48:47Speaker 00

  Okay, so you?

• 48:48Speaker 01

  So that's what we did. We, um, it was, it was the scariest day of my life. But me and Tom's two daughters said, okay, let's do it. He's, you know?

• 48:59Speaker 00

  And is it send it in, in an injection, an IV?

• 49:02Speaker 01

  First, we put them in the catheters in his abdomen because that was the closest to the source of the infection, which was in his gut. And then we injected them. And it was a billion phages per dose every two hours. And two to three days later, he like, he was like, within hours of dying, I was told, he lifted his head off the pillow, opened his eyes and kissed his daughter's hand. Carly was on shift at that day. And everybody in the ICU freaked out. There were like people cheering, there were people crying. I was crying too. It was, it was the happiest day of our lives.

• 49:41Speaker 00

  Wow.

• 49:46Speaker 00

  Can you, how much do you know about like, I mean, the virus goes in and attacks the bacteria, but like, how do you, how much do you know about how, why this is so effective? Or what's actually happening in there? Or how this is going down? Like, what's actually going on inside the body?

• 50:02Speaker 01

  Well, in Tom's case, there was something else that was a bit of an opportunistic kind of situation, because a couple of the phages were synergistic with one of the antibiotics.

• 50:14Speaker 00

  What does that mean? How does it, virus synergistic with a-

• 50:17Speaker 01

  Let me explain this. Okay, so you're a bacteria, okay?

• 50:21Speaker 00

  Okay.

• 50:21Speaker 01

  And I'm a phage, and a vere is the antibiotic, okay? And we're both trying to kill you, all right? Okay?

• 50:28Speaker 00

  Why is this-

• 50:28Speaker 04

  Typical day at the office, for sure.

• 50:31Speaker 01

  Now, you're a bacteria-

• 50:32Speaker 00

  So much death-

• 50:33Speaker 01

  You do not have a brain in this example, okay? Like, I don't know about regular life-

• 50:38Speaker 04

  Just in this example?

• 50:39Speaker 01

  But you have to make a genetic decision about who you would rather face, him or me. And I'm scarier than he is, okay? You do not want to have to deal with phage. So you decide to take off your shirt. Now, okay, okay.

• 50:57Speaker 00

  Nobody wants that.

• 50:58Speaker 01

  I know that this is not that kind of show, people. But, but your shirt is, is, is your slimy biofilm layer. Okay, that's your superpower.

• 51:07Speaker 04

  It's his resistance, basically, right?

• 51:09Speaker 01

  But that's where the receptor for the phage is, is on your shirt.

• 51:13Speaker 00

  Okay, so if I get rid of my biofilm shirt receptor, you can't attach?

• 51:17Speaker 01

  That's right, and so I, I die. But, in doing so, you have made yourself susceptible to a vere's, the antibiotic, okay?

• 51:26Speaker 00

  Cause he loves nothing more than a shirtless-

• 51:27Speaker 01

  So he kills you!

• 51:30Speaker 01

  He gets you! So-

• 51:32Speaker 00

  So it's like, it's a one-two punch, kind of thing?

• 51:35Speaker 01

  That's right, so there's an indirect effect.

• 51:36Speaker 00

  Or even if one starts to work, you can, you, so, but does that mean that, like, when you use phage therapy, not only do you have a new way of getting at this bug, you've un-resistanced it? Like, you've dialed back the resistance that had developed over the years of whatever? And now, is it, now a bacteria can actually be newly susceptible to a drug that it was-

• 51:57Speaker 01

  That's right. So, you know, phage therapy is now going through clinical trials all around the world. It's, phage is all the rage, people. But.

• 52:04Speaker 04

  She's not gonna say this, but actually, she is the one like, setting up all these clinics all over the place. Yeah, she is.

• 52:10Speaker 01

  No, no, no.

• 52:12Speaker 04

  Yeah, she is.

• 52:12Speaker 01

  Well, at the University of California, San Diego, we do have what became the first dedicated phage therapy center, called the Center for Innovative Phage Applications and Therapeutics, or IPATHS. So, we do provide phage therapy to people that have no... But, but there's many, many around the world now. And of course, I didn't do this all by myself.

• 52:31Speaker 00

  I mean, but I hear a lot happening, but I also have to wonder a little bit, like, why, like, I didn't know more about this already, why Aver wasn't already thinking about this as something he might have to use some, like, why isn't this already happening everywhere?

• 52:45Speaker 01

  Yeah. Well, you know, when COVID came on the scene, everybody, you know, felt it right away, right? It was a pandemic that hit hard, hit fast. With antimicrobial resistance, it's a slow burn. So, you don't really know or feel it unless it hits you in your personal life. Like, you're Aver, you're an emergency room doctor, or you're his dad, and, and you know, you're seeing patients that used to be treatable that aren't treatable anymore. Or you're me, like, whose husband is suddenly dying. And, you know, we have kind of let this creep up on us. But, you know, also with COVID, we had four vaccines, or five vaccines, developed within a year, right?

• 53:27Speaker 01

  And so, if we had the political will to move phage therapy forward, we could be doing a lot more than we are. So, those trials are getting done now, but it, the pace is not fast enough to overcome the pace at which resistance is spreading.

• 53:42Speaker 00

  Can I ask you the sort of like, embarrassingly typical question that a Radiolab person might ask?

• 53:48Speaker 01

  With your shirt on, yeah.

• 53:52Speaker 00

  So, in the moment that Tom came back, like, I don't know, talk to me about how that felt. I mean, I feel like there's... Relief, I heard joy, but is there pride? Like, I don't know, give me a little bit on that.

• 54:04Speaker 01

  Well, I think that Tom deserves a lot of credit in this too, because that man had so much resilience to bounce back. And, you know, he had been in the hospital nine months. He'd lost 100 pounds. He lost all of his muscle mass. He had to learn how to walk, how to talk, how to do everything all over again. And now he's the face of evidence-based hope.

• 54:28Speaker 00

  Yeah.

• 54:29Speaker 01

  You know?

• 54:30Speaker 00

  That's an amazing thought. Thank you, Stephanie. Thank you for sharing your story with us. Thank you for being here tonight.

• 54:36Speaker 04

  Thanks for having me, everybody.

• 54:41Speaker 01

  So cool.

• 54:45Speaker 01

  Wow.

• 54:46Speaker 00

  All right, Avir.

• 54:49Speaker 00

  So we've been through a lot together.

• 54:51Speaker 04

  Yeah. Thanks for coming on this journey of trauma with me, guys. I appreciate it.

• 54:57Speaker 00

  But I, you know, like, starting from a place of sort of like seeing this happen in front of your eyes, dealing with it on a day-to-day basis, turning to try to sort of start and understand it and do the reporter thing, or at least the research thing, and finding all what you found and sharing all that with us. I guess I'm, I am a little bit curious just like where you're at now. Like, are you still in therapy? Or?

• 55:18Speaker 04

  Yeah, definitely, definitely. I mean, you know, I still, I still have a shift tomorrow, so I still gotta go to work. You know, I still gotta see this stuff, so it's still there. But I guess, I don't know. I mean, thinking about all this stuff makes me think about the whole thing a little bit differently.

• 55:32Speaker 00

  How so?

• 55:34Speaker 04

  I mean, okay, let's think about it. Like, when I was first thinking about it, I'm thinking it's humans versus bacteria, you know? And I'm at the middle of this. It's all about me and like that kind of thing. And as I'm thinking about it more, it's like, it's not really. It's humans, bacteria, there's animals, animals probably playing a bigger role than humans. And then if you think about it some more, it's like, wow, all our antibiotics, our whole weaponry, comes from fungi, because they've been battling bacteria for longer than we've even been around. And now I'm listening to Stephanie, it's like, oh, there's this whole class of viruses that's been fighting bacteria for longer than the fungi have been around. So I don't know, I guess I'm just looking at the shape of this a little bit differently.

• 56:16Speaker 04

  It's like, there's a lot of players here, and if anything, we're just like the newest kid on the block.

• 56:21Speaker 00

  But it does also then feel so much more, it feels like maybe overwhelmingly complex.

• 56:27Speaker 04

  Yes, it is, but I don't know, I guess in a weird way, like, I'm realizing we're so young as a species, there's so much we don't know. There's so much left to learn, and I don't know, I just think there's hope in that.

• 56:41Speaker 00

  Yeah, I can see that.

• 56:43Speaker 04

  Well, I guess, before we go, just wanted to play one more quote, because I feel like the show can't end without hearing this. I did talk to Tom, and I just wanted you guys to hear him. I asked him if he remembered by any chance that moment where Stephanie squeezed his hand and asked him if he wanted to live.

• 57:02Speaker 00

  And this is, he's in a coma, and she...

• 57:04Speaker 04

  Right, at this time, he's in a coma, he's completely out of it, he's on the verge of death, and Stephanie asks him, "Do you want to live?"

• 57:13Speaker 06

  At that moment, I thought I was a snake in a canyon, curled up under a bush, and there is a wooden platform that visitors could come and view me from. And they would look down, and I would look up, and I could see people through this haze of my milky eyes. It would be hot sometimes, sometimes it was cold. When the night came, I was really alone, disintegrating molecule by molecule, you

• 57:58Speaker 06

  know, just kind of sinking down bit by bit. My vision, because it was blurred by the milkiness over my eyes, I couldn't see her, but I could hear her in the distance. She said, "I know you've been through a lot, and I know that it's hard, and if you want to let go, um, it's okay, you can go."

• 58:39Speaker 06

  There was kind of a pause that I had. And I realized I was a snake.

• 58:51Speaker 06

  I tried to figure out how to squeeze her hand because I was desperate to squeeze her hand, but I didn't know how without hands.

• 59:04Speaker 06

  So I thought and thought, and then I thought, well, I'm a snake. I can wrap my body around her hand and squeeze.

• 59:13Speaker 06

  So that's what I did.

• 59:39Speaker 00

  Thank you, Avir.

• 59:40Speaker 04

  Thank you, guys.

• 59:50Speaker 00

  Of course, also a big thanks to Lance and Tom, who gave us their time and talked to us, and Avir's dad for being willing to throw shade at his son.

• 1:00:02Speaker 03

  Well, thank you, Soren, for, you know, being on stage, helping out Avir, pushing him around, editing him in real time, making all that happen.

• 1:00:10Speaker 00

  Obviously, I had a lot of fun doing it. A couple of quick thanks. Thanks to Tom Philpott, Stephen Roach, Kate Shaw, Carrie McLennan, Alex Wong, and Maren McKennan. This episode was reported by Avir Mitra, it was produced by Jessica Jung, and fact-checked by Natalie Middleton. The live show itself took place at WNYC's Green Space Performance Center. And thank you, of course, to the staff there who make those kinds of events work. Also, the folks on the Radiolab team who helped us make it happen. Sarah Sandback, Natalia Ramirez, Anissa Vietz, David Gabel, Tanya Chaling, Harry Fortuna, and Jeremy Bloom. I also want to mention that we actually did a first run of this show down in Little Rock, Arkansas.

• 1:00:54Speaker 00

  Little Rock Public Radio, the public radio station down there, invited us down to be part of their annual celebration. And it was a ton of fun. So, thanks a bunch to Little Rock Public Radio, and in particular to Grace Soufassi, Jonathan Seaborn, and Sarah Buford. And that's it. So, we will just go out, as we do with most of our live shows, by letting one of the listeners from the audience come up and read the Radiolab credits.

• 1:01:22Speaker 03

  Hi, I'm AJ. I'm from Jersey. And here are the staff credits. Radiolab is hosted by Lulu Miller and Latif Nasser. Soren Wheeler is our executive editor. Sarah Sandback is our executive director. Our managing editor is Pat Walters. Dylan Keith is our director of sound design. Our staff includes Jeremy Bloom, W. Harry Fortuna, David Gabel, Maria Paz Gutierrez, Sindhu Nyanasamvando, Matt Keelty, Mona Madgavkar, Annie McEwen, Alex Neeson, Sarah Carey, Anissa Vietz, Ariane Whack, Molly Webster, and Jessica Young, with help from Rebecca

• 1:02:07Speaker 03

  Rand.

• 1:02:16Speaker 05

  Hi, I'm Daniel from Madrid. Leadership support from Radiolab Science Programming is provided by the Simons Foundation and the John Terpentow Foundation. Foundational support from Radiolab was provided by the Alfred P. Islam Foundation.