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Speaker 1: Hi Prognosis listeners. This month, we're looking back at some

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Speaker 1: of our favorite stories from the podcast. On this episode,

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Speaker 1: we explore how superbugs are threatening cancer patients in India

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Speaker 1: and what that crisis might mean for the rest of

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Speaker 1: the world. Thanks and enjoy. Learning that you have cancer

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Speaker 1: can be terrifying, And every two seconds, somewhere in the world,

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Speaker 1: another person gets the diagnosis. That's four people just since

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Speaker 1: I started talking. But there are places where the fear

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Speaker 1: of dying from cancer is amplified by an added treacherous

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Speaker 1: risk that the cancer treatment will bring on a deadly

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Speaker 1: infection from a killer superbug that even the most potent

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Speaker 1: antibiotics available are powerless to tame. It's called extreme drug resistance,

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Speaker 1: and they can create a devastating dilemma For some patients.

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Speaker 1: The treatment for their tumors may kill them faster than

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Speaker 1: the tumors themselves. Welcome to Prognosis, the podcast about health

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Speaker 1: and science, medical technology, and the changes that are underway

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Speaker 1: across the world. I'm your host, Michelle fay Cortes. This season,

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Speaker 1: we're examining one of the dangers that keeps public health

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Speaker 1: officials awake at night. It's been described as a silent

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Speaker 1: tsunami of catastrophic proportions one of the gravest threats to

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Speaker 1: human health. I'm talking about antimicrobial resistance, more commonly known

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Speaker 1: as the irreversible rise of superbugs. The waning potency of

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Speaker 1: critical antibiotics is happening faster than even the most dire forecasts. Tragically,

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Speaker 1: cancer patients are at the front line of this global emergency.

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Speaker 1: The conundrum is playing out sporadically in hospitals in many countries,

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Speaker 1: portending a global problem. One doctor in India is sounding

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Speaker 1: the alarm even as he works tirelessly to arrest this

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Speaker 1: unbolden crisis. Here's Bloombrooks Jason Gale with the story. Abdul

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Speaker 1: Ghafour was raised in the South Indian state of Kerala,

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Speaker 1: beside a river and rice fields that stretched as far

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Speaker 1: as the eye could see. He'd often hold the hand

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Speaker 1: of his grandfather, who was blind since early youth, and

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Speaker 1: guide him along the narrow paths across the farm. School

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Speaker 1: was in a local village, wherefore was inspired to become

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Speaker 1: a teacher. But he was emboldened to reach even higher

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Speaker 1: by the missile Man of India. A. P. J. Abdul

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Speaker 1: Kalam was a rocket scientist from humble beginnings who eventually

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Speaker 1: became President of India. His example encouraged the young student

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Speaker 1: to train instead to be a doctor. The meaning of

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Speaker 1: the word doctor dossie that is to teach. A doctor

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Speaker 1: is a teacher, not just a healer. I always wanted

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Speaker 1: to become a teacher, and I became a doctor. So

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Speaker 1: I am a teacher and a doctor. To be a

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Speaker 1: doctor is a noble profession. Patients come to you with

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Speaker 1: their complaints. You examine them, You do the necessary investigations

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Speaker 1: and find out what's wrong with them. You prescribe them

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Speaker 1: medication and do the other necessary medical interventions. And you

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Speaker 1: get a satisfaction when you treat patients because you're curing

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Speaker 1: their ailments and as a human being, you're helping your

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Speaker 1: fellow human beings. Dr G four is now in his forties.

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Speaker 1: He's an infectious diseases physician and clinical microbiologist in Chennai,

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Speaker 1: the largest city in southern India. The satisfaction Dr Gefo

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Speaker 1: said he gets from treating his patients well, it's fading.

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Speaker 1: And the reason it's fading is because it's becoming harder

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Speaker 1: to save his patients from diseases like cancer, and it's

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Speaker 1: not the cancer itself that is becoming more and more

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Speaker 1: of a threat to his patients. It's the infections that

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Speaker 1: can come after chemotherapy. Dr. Goford remembers one case not

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Speaker 1: too long ago at twenty year old college student with

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Speaker 1: acute my Lloyd leukemia. Is one of the worst type

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Speaker 1: of cancer you can get, one of the worst type

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Speaker 1: of blood cancer you'll get. Well, the treatment would give

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Speaker 1: him more time. It's punishingly aggressive. The young man will

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Speaker 1: be left with no immunity for weeks, leaving him vulnerable

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Speaker 1: to infections, especially from bacteria he's carrying inside him. God,

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Speaker 1: they are expecting us to cure their cancer with chemotapi

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Speaker 1: and there are wonderful chimotapy drugs. And then we explain

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Speaker 1: into the family, yeah, your cancer will be controlled, but

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Speaker 1: then you may die of infection. The outlook is grim

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Speaker 1: either way. It's a choice between certain death from one

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Speaker 1: threat and the possibility of a faster death from another.

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Speaker 1: The student undergoes chemotherapy, and the chemo, as expected, wipes

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Speaker 1: out the white blood cells needed to defend against the

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Speaker 1: bacteria entering his bloodstream. On one, and you don't have immunity,

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Speaker 1: and on the other hand, you've got billions or trillions

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Speaker 1: of bacteria waiting to jump and jumping into your blood,

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Speaker 1: but there's no defense. What will happen you antibiotic? And

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Speaker 1: if the even if you do antibiotic, the death rate

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Speaker 1: is and has expected. The bacteria get into the patient's blood.

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Speaker 1: Dr gofour tries to fight back. He knows the bacteria

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Speaker 1: are resistant to the most potent antibiotic available, so he

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Speaker 1: tries another calliston. It's a last resort option, and it

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Speaker 1: subdues the infection, but barely. Dr G four is still

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Speaker 1: giving the same drug and the infection is still lingering.

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Speaker 1: And then it happens. A single bacterium undergoes a genetic mutation,

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Speaker 1: giving it resistance to that last resort antibiotic. It multiplies

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Speaker 1: exponentially and it soon becomes the dominant strain, poisoning his bloodstream.

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Speaker 1: And Dr G four is almost out of options. He

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Speaker 1: has one last hope, a cocktail of antibiotics, ones that

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Speaker 1: administered by themselves wouldn't work, but together could do something.

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Speaker 1: This is a desperate It can be called combination therapy,

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Speaker 1: combination of anti polytics, and still the patient will die.

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Speaker 1: The chance of the patient dying is more than eight

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Speaker 1: in this scenario, and tragically, as expected, the young man dies.

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Speaker 1: For me, it's become a daily issue. If you ask

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Speaker 1: me the number of patients I've seen dying due to

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Speaker 1: a DOS infection, it's on a daily basis. So many

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Speaker 1: of my patients, cancer patients died due to drug resistance

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Speaker 1: after kimotorapy. For me, it's a day today scenario. Those

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Speaker 1: multi drug resistant bacteria, those superbugs are proliferating globally on

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Speaker 1: all continants and in all countries. But in few places

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Speaker 1: is the problem more worrisome than in India. Here, drug

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Speaker 1: resistance has reached extreme levels. That's because of the massive

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Speaker 1: use of antibiotics coupled with poor hygiene and sanitation. The

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Speaker 1: devastating impact that's having on cancer patients has turned Dr

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Speaker 1: go For into one of India's fiercest crusaders on the subject.

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Speaker 1: We are facing a difficult scenario. To give chemotherapy and

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Speaker 1: cure the cancer and get at regorously infection and the

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Speaker 1: patient dying of infections. We don't know what to do,

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Speaker 1: the world doesn't know what to do in the scenario.

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Speaker 1: If you're talking about the post antibiotic era, you first

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Speaker 1: see that in cancer patients. For cancer patients are the

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Speaker 1: most vulnerable group of patients you can ever come across

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Speaker 1: in your clinical practice. Dctr go four posts regularly about

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Speaker 1: their suffering on Twitter and LinkedIn. Discussing superbugs is a

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Speaker 1: sensitive and politically charged subject in India. It risks casting

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Speaker 1: a shadow over the country's medical tourism industry, which the

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Speaker 1: Indian government predicts could bring in nine billion dollars a

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Speaker 1: year by the superb crisis is probably highest in countries

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Speaker 1: like India. The situation is getting worse, definitely getting worse

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Speaker 1: because the drug resistance rate the superbug grade is increasing

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Speaker 1: on a daily basis, so the number of paciously dying

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Speaker 1: are really high. Scientists have measured the burden of drug

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Speaker 1: resistance in India in various ways. One has been to

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Speaker 1: count the number of babies dying from sepsis as a

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Speaker 1: result of a bacterial blood stream infection not cued with antibiotics.

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Speaker 1: An Indian newborn dies every ten minutes. That way, it

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Speaker 1: works out to more than fifty eight thousand babies a year.

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Speaker 1: No one is immune in dr Gofor's home state of

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Speaker 1: Tamil Nadu. The former Chief Minister a celebrated actress died

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Speaker 1: in late two thousand and sixteen from an unstoppable bloodstream infection.

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Speaker 1: I work with cancer patients, a group of patients with

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Speaker 1: the lowest level of immunity. And if you don't have

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Speaker 1: antibiotics to treat infections in cancer patients, you are in

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Speaker 1: a very difficult scenario. Infection can't be in the chur

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Speaker 1: it can be in the brain, it can be a demon,

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Speaker 1: it can be urine, it can be blood, it can't

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Speaker 1: be anywhere. And if you don't have antibartics to treat disinfections,

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Speaker 1: basically these patients die in front of your eyes. Around

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Speaker 1: the world, at least seven hundred thousand people die annually

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Speaker 1: from drug resistant infections. That number will balloon to ten

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Speaker 1: million deaths a year by twenty fifty and will cost

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Speaker 1: the world more than one hundred trillion dollars in lost

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Speaker 1: economic output without corrective actions. That's according to a review

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Speaker 1: led by former Goldman Sachs economist Jim O'Neill three years ago.

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Speaker 1: Lord O'Neill is the British economist who coined the term

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Speaker 1: brick as a reference to Brazil, Russia, India and China.

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Speaker 1: These rapidly emerging markets have become symbols of the shift

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Speaker 1: in economic power toward the developing world. As chairman of

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Speaker 1: Goldman Sachs Asset Management Division, you oversaw more than eight

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Speaker 1: hundred billion dollars of investments. In two thousand and fourteen,

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Speaker 1: then UK Prime Minister David Cameron asked him to focus

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Speaker 1: on the anti microbial resistance crisis. Lord O'Neill knew a

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Speaker 1: little about the subject back then, but he had the

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Speaker 1: finance acumen to demonstrated significance and to make the economic

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Speaker 1: argument for tackling it. I recently caught up with him

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Speaker 1: to ask Lord O'Neill about the findings of his two

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Speaker 1: thousand and sixteen review and the impact it's had since

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Speaker 1: its release. What we suggested is howthing quicker than if

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Speaker 1: anything then we could eventually happen. So I'm as surprise,

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Speaker 1: not really because it's kind of what we said could happen,

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Speaker 1: but it seems to be growing evidence that it's something quicker,

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Speaker 1: and I think it's a sign of the scale of

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Speaker 1: the resistance problem. Lord O'Neill's review predicted that by fifty

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Speaker 1: more people will die from superbug infections then from cancer

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Speaker 1: and diabetes. Bind still none of that seems to be

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Speaker 1: corralling the kind of action he and his team called for.

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Speaker 1: Their recommendations were for forty two billion dollars to be

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Speaker 1: spent over ten years to boost the supply of new medicines, vaccines,

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Speaker 1: and diagnostic tools, and introduce mechanisms to reduce the demand

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Speaker 1: for antibiotics. What it really tells me is that no

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Speaker 1: governments anywhere really wants to spend any money on particularly

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Speaker 1: giving incentives to new use of drugs to be found

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Speaker 1: and developed. I don't think they understand the urgency of it. Oh,

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Speaker 1: it's clearly not an agor prioity. And I think a

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Speaker 1: major dilemma of modern life is that in powallel of this,

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Speaker 1: governments don't like to spend money on prevention, and they

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Speaker 1: end up spending more, rather wastefully, on the response to outbreak.

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Speaker 1: And it's it's really quite stupid. Before the nineties, something

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Speaker 1: as simple as a scratch knee could turn into a

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Speaker 1: fastering sore that risks ending in fatal septic shock. Antibiotics

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Speaker 1: changed that and in just one generation, added decades to

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Speaker 1: average life expectancy. These drugs literally laid the foundation for

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Speaker 1: modern medicine, surgery, organ transplants, chemotherapy, and c sections could

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Speaker 1: be performed with a high degree of safety thanks to

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Speaker 1: the bacteria stopping ability of antibiotics. The life extending opportunities

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Speaker 1: afforded by these wonder drugs have always been precarious. Almost

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Speaker 1: as soon as scientists discovered ways to muke bacteria with antibiotics,

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Speaker 1: they were disappointed to learn bacteria could master ways to

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Speaker 1: nuke antibiotics in return. For the past eighty years, humans

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Speaker 1: and bacteria have been locked in a race for survival.

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Speaker 1: Between the nineteen fifties and seventies, a slew of antibiotic

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Speaker 1: export humans clearly ahead, but that lead is being lost

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Speaker 1: in startling and horrifying ways. The development of new antibiotics

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Speaker 1: is virtually dried up as drugmakers focused on more lucrative medicines,

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Speaker 1: such as those for treating cancer, cardiovascular disease, and diabetes.

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Speaker 1: Bacteria have seized the opportunity to exert one of their

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Speaker 1: most powerful advantages over humans. Three and a half billion

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Speaker 1: years of evolution on this planet. It's allowed these microbes

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Speaker 1: to amass a treasure trove of genetic tools to evade

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Speaker 1: every kind of weapon thrown at them, and bacteria share

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Speaker 1: their drug evating genes freely and easily with gems from

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Speaker 1: the same and different species. These genes are often carried

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Speaker 1: on the microbial equivalent of a thumb drive that enables

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Speaker 1: one bacterium to quickly and efficiently pass, for example, the

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Speaker 1: blueprint for nine different mechanisms of drug resistance to another germ.

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Speaker 1: These fortifying genes have spread like wildfire in response to antibiotics.

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Speaker 1: We use and abuse these miracle cures on a daily basis.

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Speaker 1: We take them when they're not needed, like for viral infections.

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Speaker 1: We use them to fatten farm animals faster, We sprayed

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Speaker 1: them on crops, and we dump them in drains and rivers,

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Speaker 1: contaminating the environment. All of that contributes to the rise

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Speaker 1: and rise of disease, causing germs that are hard, expensive,

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Speaker 1: and in some cases impossible to treat. Dr G four

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Speaker 1: spent five years training at London's Royal Free Hospital, an

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Speaker 1: institution with a long history where thousands of cholera patients

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Speaker 1: were treated in the early eight hundreds. He returned to

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Speaker 1: India more than a decade ago. Back home, Dr Gofour

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Speaker 1: was alarmed to find about one to two of infection

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Speaker 1: is among hospital patients were caused by an extreme form

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Speaker 1: of drug resistant bacteria. When it came back to India

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Speaker 1: in two thousand eight, people like me and many many

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Speaker 1: of us started talking about all the superbug crisis is

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Speaker 1: going to happen. It's going to be a catastrophic crisis

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Speaker 1: in a few years time. One of the reasons why

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Speaker 1: Dr Gafford saw this superbug crisis unfold as quickly as

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Speaker 1: it did has to do with how bacteria spread and

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Speaker 1: how harmless chams can turn into untreatable pathogens. Species like E.

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Speaker 1: Coli and Clepsyella pneumonia carried in arogastro intestinal tracks. They

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Speaker 1: aid digestion and vitamin production. These friendly bacteria are also

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Speaker 1: in animals, and they're in fecal matter which we dispense,

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Speaker 1: including the family dog. The bathroom is often the nexus.

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Speaker 1: Each person sheds an estimated thirty trillion bacterial cells daily

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Speaker 1: in their feces. Airborne germs known as toilet plume aerosols

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Speaker 1: are created when the bacteria are hit with a flash

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Speaker 1: of water. Then they can land on surfaces, creating what

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Speaker 1: the late elma in a microbiologists from Dartmouth Medical School

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Speaker 1: described as air feckal veneer. In places where people defecate

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Speaker 1: in their open and sewage isn't properly handled and treated.

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Speaker 1: That veneer is more like a shag pile carpet, and

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Speaker 1: it means fecal germs are readily ingested via contaminated food

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Speaker 1: and water. If you've had travelers diarrhea, it was most

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Speaker 1: probably caused by equally a prime feckal germ. Gross, right,

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Speaker 1: but it helps explain how the most resistant superbugs entered

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Speaker 1: the public water supply in places like New Delhi, reside

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Speaker 1: in the bodies of tens of millions of people, and

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Speaker 1: have emerged as global public health of the enemy number one.

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Speaker 1: If your sanitation scenario is not good in the community,

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Speaker 1: the superbug spread in the water systems, superbug sprayer in

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Speaker 1: the environment, healthy people ingest eat the superbug in the

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Speaker 1: food and water. India's toilet shortage has contributed to a

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Speaker 1: sanitation crisis that stoked the superbug crisis. Prime Minister Norandermodi

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Speaker 1: is trying to fix that with the largest toilet building

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Speaker 1: spree in human history. Well, that's great news for public

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Speaker 1: health and could eventually make a huge difference for now

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Speaker 1: potentially deadly gams continue to invade people systems there's an

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Speaker 1: easy way to tell if someone is harboring drug resistant

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Speaker 1: bacteria in their bow. You test their waste. Three years ago,

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Speaker 1: Dr Gofour and colleagues collected a thousand stool samples from

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Speaker 1: healthy at all volunteers across three cities. They found one

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Speaker 1: in every fifteen urban Indians carry in their intestines and

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Speaker 1: shed in their stool. Common bacteria that are resistant to

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Speaker 1: a class of last line antibiotics known as carbon penum.

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Speaker 1: When doctors use a carbon penum, it typically means none

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Speaker 1: of the standard therapy is work, and if superbugs that

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Speaker 1: are resistant to carbon penems are spreading in the environment

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Speaker 1: and contaminating food and water, it accelerates the loss of

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Speaker 1: a critical treatment. Doctors like A four can use. Carbon

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Speaker 1: Panum is the most important antibiotic available in the clinical practice.

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Speaker 1: We can call the extremely drug resistant bacteria. They're not

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Speaker 1: hospital bug, the god from the food and water they

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Speaker 1: consume every day. The bacteria like E. Coli are normal

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Speaker 1: bacteria off your inderstine. If they get an opportunity to

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Speaker 1: enter the blood, of course, then it's severe sepsist, severe infection.

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Speaker 1: If you don't treat, you will die of these infections.

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Speaker 1: But it's not just the food and order that's causing

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Speaker 1: India's superbug crisis. India is the world's largest manufacturer and

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Speaker 1: user of antibiotics for human health, and it's the fourth

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Speaker 1: biggest user in food producing animals. These drugs are easy

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Speaker 1: to get, often obtainable without a prescription, and that means

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Speaker 1: it's easy for bacteria to develop resistance. The problem in

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Speaker 1: India is it's not regulated. That's Dr Bovner Siroe. She's

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Speaker 1: worked in medical oncology in India and the UK for

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Speaker 1: twenty five years. I first interviewed her in New Delhi

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Speaker 1: for a story on superbugs a decade ago and we've

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Speaker 1: kept in touch. So if I go up to a pharmacy,

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Speaker 1: what if I even phone call a pharmacy, they will

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Speaker 1: deliver the antibiotics at home and and that's a fact

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Speaker 1: definitely in small towns, which is wrong. There should be

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Speaker 1: some form of regulation for prescription of antibiotics. What the

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Speaker 1: indiscriminate use of antibiotics does is it promotes antibiotic resistance.

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Speaker 1: Being all that, Dr Syrilee isn't seeing in her practice

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Speaker 1: the same levels of extreme drug resistance that Dr Gofour

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Speaker 1: and other specialists around India have reported, but she's alert

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Speaker 1: to the problem. In London, Dr SyRI we would consult

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Speaker 1: via Skype to reduce her patients travel costs. In India,

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Speaker 1: she does this to minimize her patient's contact with health

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Speaker 1: care facilities where superbugs are concentrated in sick patients and

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Speaker 1: can spread because of inadequate cleaning and infection control practices.

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Speaker 1: Antibiotic resistance is a huge concern for both oncologists and

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Speaker 1: cancer patients worldwide, whether it's it's in UK or India.

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Speaker 1: One of the commonest side effects of treatment is that

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Speaker 1: the patients are immuno compromised. Antibiotic resistance is a discussion

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Speaker 1: that we have to have with all patients that are

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Speaker 1: going to undergo immuno suppressive treatment. If a patient absent

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Speaker 1: infection with a multi drug resistant organism and you're not

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Speaker 1: able to treat that infection, the cancer may be curable,

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Speaker 1: but we lose the patient to the infection, which is

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Speaker 1: unacceptable in this day and age. I think antibiotic resistance

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Speaker 1: is a huge concern for all of us. Cancer treatment

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Speaker 1: breaches the body's natural defenses in multiple ways. For instance,

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Speaker 1: the skin gets pierced when the needle is inserted for

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Speaker 1: an intravenous infusion, but there's a critical vulnerability patient's face

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Speaker 1: when they undergo chemotherapy. Those potent drugs target cells that

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Speaker 1: grow and divide quickly as cancer cells do, but there's

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Speaker 1: often some collateral damage to healthy cells too. Hair can

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Speaker 1: fall out and the mucous membrane that lines the digestive

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Speaker 1: tract from the mouth to the anus can effectively slough off.

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Speaker 1: Injury to that protective barrier can enable bacteria from the

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Speaker 1: gastro intestinal tract to enter the blood string and causing infection.

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Speaker 1: Bloodstream infections are very common in cancer patients with low

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Speaker 1: white blood cell levels. When the culprit is a carbon

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Speaker 1: PanAm resistant gam after two thirds of patients die. One

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Speaker 1: study found a New Delhi almost three quarters of patients

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Speaker 1: with leukemia and other blood cancers harbor those dangerous bugs.

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Speaker 1: Here's dr Abdulga for again. The death rate of patient

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Speaker 1: with the carbon ponum resistant superbug and the blood is

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Speaker 1: anywhere sixty to seventy percentage. So if I if I

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Speaker 1: have a pay cancer chimotrappy patient with a carbonon resistant

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Speaker 1: superbula in the blood, I can predict the chance of

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Speaker 1: that patient dying is sixty percentage or more. If that

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Speaker 1: is also a callist in resistance, I can predict the

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Speaker 1: chance of that patient is dying is eighty percentage or more.

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Speaker 1: That means a patient is getting this infection is most

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Speaker 1: likely these patients will die and this has become a

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Speaker 1: day earlier routine for people like me. In countries with

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Speaker 1: high superber grades, we are literally living in post antibiotic era,

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Speaker 1: especially in South Asia and militring countries. And Dr gefour

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Speaker 1: reminds us that creating awareness and changing behavior is a

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Speaker 1: mammoth task. India is a large country one point three

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Speaker 1: billion population, seventy five thousand hospitals, one million doctors, half

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Speaker 1: a million pharmacies is a fuge challenge. The present momentum

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Speaker 1: is not enough. We need to really understand the magnitude

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Speaker 1: of the challenge and find solution on the ground that's

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Speaker 1: not really happening. Dr G four has spent years speaking

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Speaker 1: about the issue. In two thousand and twelve, he convened

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Speaker 1: a symposium that led to a national road map to

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Speaker 1: tackle the problem. Dr GO four was lauded internationally for

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Speaker 1: taking positive action, but it put him in the crosshairs

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Speaker 1: of some of India's healthcare businesses. Dr Gefford himself works

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Speaker 1: in a private hospital. Many of my friends in the

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Speaker 1: health care industry have told me what you do is

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Speaker 1: adversely affecting our business. This is my answer to them. No,

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Speaker 1: I'm trying to protect our business because if people like

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Speaker 1: me don't talk, policies won't change, If our patients will die.

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Speaker 1: How can we How can we sustain an industry so very,

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Speaker 1: very very difficult scenario. The industry you are trying to

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Speaker 1: protect sometimes blame you, and that's a real painful scenario

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00:25:41,359 --> 00:25:45,480
Speaker 1: people like me are facing. Dr Gerford told me there

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Speaker 1: is progress, but it's slow. In July, the Indian government

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Speaker 1: limited the use of Colliston. That drug of last resort

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00:25:55,359 --> 00:25:58,560
Speaker 1: was discovered in the nineteen fifties, but doctors quickly stopped

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Speaker 1: using it because of its toxic effects on the kidneys.

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Speaker 1: While humans weren't using colliston, the drug was in popular

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Speaker 1: use on poultry farms, where farmers fed it to animals

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Speaker 1: to stave off disease and hasten their growth. But the

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Speaker 1: Ministry of Health and Family Welfare ordered a stop to

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Speaker 1: that practice. The results of that policy are yet to

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Speaker 1: be seen, and maybe too late. Five years ago, I

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Speaker 1: visited one of India's largest private neannatal intensive care units.

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Speaker 1: Colliston was the go to drug there for treating babies

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Speaker 1: with sepsis because nothing else worked as well. Two years later,

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Speaker 1: the same hospital had seen two cases of Colliston resistant infections.

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Speaker 1: It's a tragedy familiar to Dr Go four. I used

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Speaker 1: to see patients quite sporadically, maybe once in six months,

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Speaker 1: once a year, I get this kind of bacteria, but assistant.

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Speaker 1: Everything that has changed. No I treat a collistems assistant

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00:27:00,000 --> 00:27:04,000
Speaker 1: infection once in two weeks. It's nothing unusual for me.

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Speaker 1: So I can't remember the number of patients with the

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00:27:06,840 --> 00:27:10,520
Speaker 1: panned regorously infections. I have treated, treated dozens and dozens

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Speaker 1: of patients with the panned regorously infections of my my

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00:27:13,359 --> 00:27:16,200
Speaker 1: career or the last few years. In the last few years,

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Speaker 1: for Dr four, both his missions as a teacher and

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00:27:20,160 --> 00:27:24,840
Speaker 1: a doctor have become harder. By speaking out about the crisis,

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00:27:24,880 --> 00:27:28,680
Speaker 1: he faced criticism from within his own industry and as

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00:27:28,720 --> 00:27:32,320
Speaker 1: a doctor. The spread of superbugs has meant his tools

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00:27:32,400 --> 00:27:37,000
Speaker 1: for treating his patients are deteriorating. More and more. He

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00:27:37,080 --> 00:27:40,240
Speaker 1: sees cases like the young student he couldn't save and

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00:27:40,320 --> 00:27:45,240
Speaker 1: these cases weigh on him. It was actually a disappointment

390
00:27:45,440 --> 00:27:49,040
Speaker 1: because as a doctor, as an infection specialist, living in

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Speaker 1: twenty first century, with all the inventions and discoveries in

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00:27:53,400 --> 00:27:57,880
Speaker 1: modern medicine, especially ongology, I felt my hands are tied

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00:27:58,440 --> 00:28:02,800
Speaker 1: because I can't chew are my patients infection? If I

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00:28:02,840 --> 00:28:06,280
Speaker 1: can't cure my patients infection? How aver all wonderful the

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00:28:06,400 --> 00:28:09,359
Speaker 1: field of oncology is how about? What about developments in

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00:28:09,400 --> 00:28:11,679
Speaker 1: the field of oncology? They are not going to be

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00:28:11,760 --> 00:28:23,080
Speaker 1: useful because we know cancer patients die of infection, but

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00:28:23,400 --> 00:28:27,480
Speaker 1: there is still some hope. Aside from the government restricting

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00:28:27,520 --> 00:28:31,960
Speaker 1: the use of Colliston, there is one possible cocktail that

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00:28:32,119 --> 00:28:36,000
Speaker 1: could help in the fight against these extreme superbugs. An

401
00:28:36,000 --> 00:28:39,479
Speaker 1: intravenous infusion of two antibiotics that finds the cells as

402
00:28:39,720 --> 00:28:46,000
Speaker 1: zappa sefter in combination with another injectable antibiotic, which bristolmized

403
00:28:46,040 --> 00:28:50,080
Speaker 1: squibbs cells as a zac AM. I asked a clinical

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00:28:50,120 --> 00:28:54,400
Speaker 1: microbiologist in Mumbai if that cocktail is something doctors are

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00:28:54,560 --> 00:28:57,880
Speaker 1: already using in India. It's being looked at, she said,

406
00:28:57,920 --> 00:29:03,960
Speaker 1: but it's extremely expensive, about three hundred to four dollars

407
00:29:04,000 --> 00:29:08,200
Speaker 1: a day. That's roughly double what Indians earned per month

408
00:29:08,360 --> 00:29:11,920
Speaker 1: on average. Government hospitals wouldn't be able to afford it,

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00:29:12,400 --> 00:29:16,000
Speaker 1: so patients would have to pay out of pocket, and

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00:29:16,040 --> 00:29:19,720
Speaker 1: only the wealthy could pony up that kind of money.

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00:29:20,480 --> 00:29:25,240
Speaker 1: There's another critical aspect to treating sepsis and cancer patients. Time.

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Speaker 1: Doctors have a limited window, perhaps only eighteen hours, to

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00:29:29,520 --> 00:29:33,640
Speaker 1: administer the right antibiotic once a patient develops fever to

414
00:29:33,720 --> 00:29:38,040
Speaker 1: prevent a fatal bloodstream infection. That tends to make doctors

415
00:29:38,080 --> 00:29:40,560
Speaker 1: are on the side of caution and to use the

416
00:29:40,600 --> 00:29:44,600
Speaker 1: most powerful drugs available. You can't blame them. They want

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00:29:44,600 --> 00:29:47,880
Speaker 1: to save their patient's life, but it's also what's sparing

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00:29:47,920 --> 00:29:52,320
Speaker 1: the overuse of critically important antibiotics and driving the superbout crisis.

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00:29:54,480 --> 00:29:58,880
Speaker 1: And finally, there's something else we have no way of

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00:29:58,960 --> 00:30:03,040
Speaker 1: knowing how be this crisis really is. When a cancer

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00:30:03,120 --> 00:30:08,560
Speaker 1: patient dies from an infection, cancer non infection will most

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00:30:08,600 --> 00:30:12,680
Speaker 1: likely be the primary diagnosis recorded on the death certificate,

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00:30:13,280 --> 00:30:16,520
Speaker 1: So the World Health Organization and its specialist arm, the

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00:30:16,560 --> 00:30:20,320
Speaker 1: International Agency for Research on Cancer, have no clue how

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00:30:20,320 --> 00:30:24,200
Speaker 1: many people die in this way. Doctors like gofore, so

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00:30:24,360 --> 00:30:28,640
Speaker 1: the number is large. And growing. The globalized nature of

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00:30:28,680 --> 00:31:02,240
Speaker 1: superbugs means cancer patients everywhere will eventually face this horrendous dilemma.

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Speaker 1: And that's it for this week's prognosis. Thanks for listening.

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Speaker 1: Do you have a story about healthcare in the US

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Speaker 1: or around the world we want to hear from you.

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Speaker 1: Find me on Twitter at bay Cortes or send me

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Speaker 1: an email m Cortes at Bloomberg dot net. If you

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Speaker 1: were a fan of this episode, please take a moment

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Speaker 1: to rate and review us. It really helps new listeners

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00:31:26,040 --> 00:31:30,720
Speaker 1: find the show, and don't forget to subscribe. This episode

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Speaker 1: was produced by Tober FORHS. Our story editor was Rick Shine.

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Speaker 1: Special thanks to ari Alstetter and Ruth Pollard who helped

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Speaker 1: with reporting, and Drew Armstrong. Our healthcare team leader, Francesca

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Speaker 1: Leaves had a Bloomberg podcast. We'll be back next week

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Speaker 1: with the new episode. See you then,