WEBVTT - Superbugs Force a Deadly Choice for Cancer Patients (Rebroadcast) 0:00:00.240 --> 0:00:05.120 Hi Prognosis listeners. This month, we're looking back at some 0:00:05.200 --> 0:00:08.879 of our favorite stories from the podcast. On this episode, 0:00:09.200 --> 0:00:13.200 we explore how superbugs are threatening cancer patients in India 0:00:13.440 --> 0:00:15.680 and what that crisis might mean for the rest of 0:00:15.680 --> 0:00:29.240 the world. Thanks and enjoy. Learning that you have cancer 0:00:29.360 --> 0:00:33.560 can be terrifying, And every two seconds, somewhere in the world, 0:00:33.880 --> 0:00:38.120 another person gets the diagnosis. That's four people just since 0:00:38.120 --> 0:00:41.320 I started talking. But there are places where the fear 0:00:41.360 --> 0:00:45.280 of dying from cancer is amplified by an added treacherous 0:00:45.400 --> 0:00:48.920 risk that the cancer treatment will bring on a deadly 0:00:48.960 --> 0:00:53.120 infection from a killer superbug that even the most potent 0:00:53.120 --> 0:00:59.320 antibiotics available are powerless to tame. It's called extreme drug resistance, 0:00:59.800 --> 0:01:02.560 and they can create a devastating dilemma For some patients. 0:01:03.520 --> 0:01:06.360 The treatment for their tumors may kill them faster than 0:01:06.400 --> 0:01:11.959 the tumors themselves. Welcome to Prognosis, the podcast about health 0:01:11.959 --> 0:01:16.080 and science, medical technology, and the changes that are underway 0:01:16.120 --> 0:01:21.440 across the world. I'm your host, Michelle fay Cortes. This season, 0:01:21.640 --> 0:01:24.240 we're examining one of the dangers that keeps public health 0:01:24.280 --> 0:01:27.720 officials awake at night. It's been described as a silent 0:01:27.800 --> 0:01:32.800 tsunami of catastrophic proportions one of the gravest threats to 0:01:32.880 --> 0:01:38.640 human health. I'm talking about antimicrobial resistance, more commonly known 0:01:38.800 --> 0:01:43.000 as the irreversible rise of superbugs. The waning potency of 0:01:43.040 --> 0:01:49.800 critical antibiotics is happening faster than even the most dire forecasts. Tragically, 0:01:50.080 --> 0:01:53.080 cancer patients are at the front line of this global emergency. 0:01:53.960 --> 0:01:57.320 The conundrum is playing out sporadically in hospitals in many countries, 0:01:57.760 --> 0:02:02.040 portending a global problem. One doctor in India is sounding 0:02:02.040 --> 0:02:05.880 the alarm even as he works tirelessly to arrest this 0:02:06.040 --> 0:02:17.560 unbolden crisis. Here's Bloombrooks Jason Gale with the story. Abdul 0:02:17.600 --> 0:02:21.200 Ghafour was raised in the South Indian state of Kerala, 0:02:21.480 --> 0:02:25.160 beside a river and rice fields that stretched as far 0:02:25.240 --> 0:02:27.799 as the eye could see. He'd often hold the hand 0:02:27.840 --> 0:02:31.120 of his grandfather, who was blind since early youth, and 0:02:31.240 --> 0:02:35.320 guide him along the narrow paths across the farm. School 0:02:35.400 --> 0:02:38.960 was in a local village, wherefore was inspired to become 0:02:38.960 --> 0:02:42.360 a teacher. But he was emboldened to reach even higher 0:02:42.680 --> 0:02:46.320 by the missile Man of India. A. P. J. Abdul 0:02:46.400 --> 0:02:50.239 Kalam was a rocket scientist from humble beginnings who eventually 0:02:50.480 --> 0:02:54.600 became President of India. His example encouraged the young student 0:02:54.760 --> 0:02:57.840 to train instead to be a doctor. The meaning of 0:02:57.919 --> 0:03:03.400 the word doctor dossie that is to teach. A doctor 0:03:03.600 --> 0:03:07.840 is a teacher, not just a healer. I always wanted 0:03:07.880 --> 0:03:10.960 to become a teacher, and I became a doctor. So 0:03:11.160 --> 0:03:14.160 I am a teacher and a doctor. To be a 0:03:14.200 --> 0:03:18.240 doctor is a noble profession. Patients come to you with 0:03:18.280 --> 0:03:22.919 their complaints. You examine them, You do the necessary investigations 0:03:23.040 --> 0:03:26.600 and find out what's wrong with them. You prescribe them 0:03:26.919 --> 0:03:32.920 medication and do the other necessary medical interventions. And you 0:03:32.960 --> 0:03:36.280 get a satisfaction when you treat patients because you're curing 0:03:36.320 --> 0:03:39.760 their ailments and as a human being, you're helping your 0:03:39.840 --> 0:03:44.560 fellow human beings. Dr G four is now in his forties. 0:03:44.840 --> 0:03:49.280 He's an infectious diseases physician and clinical microbiologist in Chennai, 0:03:49.440 --> 0:03:53.240 the largest city in southern India. The satisfaction Dr Gefo 0:03:53.360 --> 0:03:57.280 said he gets from treating his patients well, it's fading. 0:03:57.920 --> 0:04:01.440 And the reason it's fading is because it's becoming harder 0:04:01.560 --> 0:04:05.400 to save his patients from diseases like cancer, and it's 0:04:05.400 --> 0:04:08.480 not the cancer itself that is becoming more and more 0:04:08.520 --> 0:04:11.640 of a threat to his patients. It's the infections that 0:04:11.720 --> 0:04:16.000 can come after chemotherapy. Dr. Goford remembers one case not 0:04:16.120 --> 0:04:19.200 too long ago at twenty year old college student with 0:04:19.400 --> 0:04:22.960 acute my Lloyd leukemia. Is one of the worst type 0:04:23.000 --> 0:04:25.400 of cancer you can get, one of the worst type 0:04:25.440 --> 0:04:28.200 of blood cancer you'll get. Well, the treatment would give 0:04:28.279 --> 0:04:33.000 him more time. It's punishingly aggressive. The young man will 0:04:33.040 --> 0:04:36.680 be left with no immunity for weeks, leaving him vulnerable 0:04:36.720 --> 0:04:42.080 to infections, especially from bacteria he's carrying inside him. God, 0:04:42.080 --> 0:04:46.400 they are expecting us to cure their cancer with chemotapi 0:04:46.440 --> 0:04:49.680 and there are wonderful chimotapy drugs. And then we explain 0:04:49.760 --> 0:04:53.120 into the family, yeah, your cancer will be controlled, but 0:04:53.240 --> 0:04:57.760 then you may die of infection. The outlook is grim 0:04:57.960 --> 0:05:01.839 either way. It's a choice between certain death from one 0:05:01.920 --> 0:05:06.320 threat and the possibility of a faster death from another. 0:05:07.080 --> 0:05:12.760 The student undergoes chemotherapy, and the chemo, as expected, wipes 0:05:12.800 --> 0:05:15.200 out the white blood cells needed to defend against the 0:05:15.200 --> 0:05:19.359 bacteria entering his bloodstream. On one, and you don't have immunity, 0:05:19.640 --> 0:05:22.640 and on the other hand, you've got billions or trillions 0:05:22.640 --> 0:05:26.000 of bacteria waiting to jump and jumping into your blood, 0:05:26.000 --> 0:05:30.800 but there's no defense. What will happen you antibiotic? And 0:05:30.839 --> 0:05:33.640 if the even if you do antibiotic, the death rate 0:05:33.760 --> 0:05:40.160 is and has expected. The bacteria get into the patient's blood. 0:05:41.000 --> 0:05:44.640 Dr gofour tries to fight back. He knows the bacteria 0:05:44.760 --> 0:05:48.599 are resistant to the most potent antibiotic available, so he 0:05:48.800 --> 0:05:53.440 tries another calliston. It's a last resort option, and it 0:05:53.560 --> 0:05:58.200 subdues the infection, but barely. Dr G four is still 0:05:58.240 --> 0:06:02.520 giving the same drug and the infection is still lingering. 0:06:03.560 --> 0:06:09.920 And then it happens. A single bacterium undergoes a genetic mutation, 0:06:10.720 --> 0:06:15.400 giving it resistance to that last resort antibiotic. It multiplies 0:06:15.839 --> 0:06:21.880 exponentially and it soon becomes the dominant strain, poisoning his bloodstream. 0:06:21.880 --> 0:06:25.359 And Dr G four is almost out of options. He 0:06:25.480 --> 0:06:30.200 has one last hope, a cocktail of antibiotics, ones that 0:06:30.279 --> 0:06:34.960 administered by themselves wouldn't work, but together could do something. 0:06:35.680 --> 0:06:38.719 This is a desperate It can be called combination therapy, 0:06:38.800 --> 0:06:41.680 combination of anti polytics, and still the patient will die. 0:06:41.760 --> 0:06:44.160 The chance of the patient dying is more than eight 0:06:45.040 --> 0:06:51.080 in this scenario, and tragically, as expected, the young man dies. 0:06:52.360 --> 0:06:57.320 For me, it's become a daily issue. If you ask 0:06:57.400 --> 0:06:59.760 me the number of patients I've seen dying due to 0:07:00.000 --> 0:07:04.200 a DOS infection, it's on a daily basis. So many 0:07:04.240 --> 0:07:08.600 of my patients, cancer patients died due to drug resistance 0:07:08.640 --> 0:07:17.120 after kimotorapy. For me, it's a day today scenario. Those 0:07:17.200 --> 0:07:22.800 multi drug resistant bacteria, those superbugs are proliferating globally on 0:07:22.880 --> 0:07:27.480 all continants and in all countries. But in few places 0:07:27.640 --> 0:07:31.920 is the problem more worrisome than in India. Here, drug 0:07:31.960 --> 0:07:36.679 resistance has reached extreme levels. That's because of the massive 0:07:36.840 --> 0:07:42.560 use of antibiotics coupled with poor hygiene and sanitation. The 0:07:42.680 --> 0:07:47.200 devastating impact that's having on cancer patients has turned Dr 0:07:47.320 --> 0:07:51.880 go For into one of India's fiercest crusaders on the subject. 0:07:52.760 --> 0:07:58.080 We are facing a difficult scenario. To give chemotherapy and 0:07:58.200 --> 0:08:02.000 cure the cancer and get at regorously infection and the 0:08:02.000 --> 0:08:04.720 patient dying of infections. We don't know what to do, 0:08:05.280 --> 0:08:08.280 the world doesn't know what to do in the scenario. 0:08:08.960 --> 0:08:12.560 If you're talking about the post antibiotic era, you first 0:08:12.720 --> 0:08:16.600 see that in cancer patients. For cancer patients are the 0:08:16.640 --> 0:08:20.080 most vulnerable group of patients you can ever come across 0:08:20.080 --> 0:08:24.200 in your clinical practice. Dctr go four posts regularly about 0:08:24.200 --> 0:08:28.760 their suffering on Twitter and LinkedIn. Discussing superbugs is a 0:08:28.960 --> 0:08:33.920 sensitive and politically charged subject in India. It risks casting 0:08:33.960 --> 0:08:38.240 a shadow over the country's medical tourism industry, which the 0:08:38.280 --> 0:08:41.920 Indian government predicts could bring in nine billion dollars a 0:08:42.000 --> 0:08:48.160 year by the superb crisis is probably highest in countries 0:08:48.200 --> 0:08:52.320 like India. The situation is getting worse, definitely getting worse 0:08:52.360 --> 0:08:56.319 because the drug resistance rate the superbug grade is increasing 0:08:56.920 --> 0:09:00.880 on a daily basis, so the number of paciously dying 0:09:01.400 --> 0:09:05.640 are really high. Scientists have measured the burden of drug 0:09:05.720 --> 0:09:09.960 resistance in India in various ways. One has been to 0:09:10.040 --> 0:09:12.920 count the number of babies dying from sepsis as a 0:09:12.960 --> 0:09:17.840 result of a bacterial blood stream infection not cued with antibiotics. 0:09:18.800 --> 0:09:23.200 An Indian newborn dies every ten minutes. That way, it 0:09:23.240 --> 0:09:27.040 works out to more than fifty eight thousand babies a year. 0:09:27.840 --> 0:09:31.320 No one is immune in dr Gofor's home state of 0:09:31.440 --> 0:09:36.080 Tamil Nadu. The former Chief Minister a celebrated actress died 0:09:36.120 --> 0:09:39.960 in late two thousand and sixteen from an unstoppable bloodstream infection. 0:09:41.080 --> 0:09:45.360 I work with cancer patients, a group of patients with 0:09:45.400 --> 0:09:49.560 the lowest level of immunity. And if you don't have 0:09:50.080 --> 0:09:55.760 antibiotics to treat infections in cancer patients, you are in 0:09:55.800 --> 0:09:59.880 a very difficult scenario. Infection can't be in the chur 0:10:00.320 --> 0:10:02.760 it can be in the brain, it can be a demon, 0:10:02.840 --> 0:10:04.960 it can be urine, it can be blood, it can't 0:10:04.960 --> 0:10:09.880 be anywhere. And if you don't have antibartics to treat disinfections, 0:10:10.240 --> 0:10:16.440 basically these patients die in front of your eyes. Around 0:10:16.480 --> 0:10:20.160 the world, at least seven hundred thousand people die annually 0:10:20.200 --> 0:10:24.840 from drug resistant infections. That number will balloon to ten 0:10:24.960 --> 0:10:28.320 million deaths a year by twenty fifty and will cost 0:10:28.360 --> 0:10:31.520 the world more than one hundred trillion dollars in lost 0:10:31.559 --> 0:10:36.400 economic output without corrective actions. That's according to a review 0:10:36.520 --> 0:10:40.440 led by former Goldman Sachs economist Jim O'Neill three years ago. 0:10:41.320 --> 0:10:44.240 Lord O'Neill is the British economist who coined the term 0:10:44.360 --> 0:10:48.120 brick as a reference to Brazil, Russia, India and China. 0:10:48.800 --> 0:10:52.640 These rapidly emerging markets have become symbols of the shift 0:10:52.720 --> 0:10:56.840 in economic power toward the developing world. As chairman of 0:10:56.920 --> 0:11:01.160 Goldman Sachs Asset Management Division, you oversaw more than eight 0:11:01.200 --> 0:11:05.880 hundred billion dollars of investments. In two thousand and fourteen, 0:11:06.040 --> 0:11:09.640 then UK Prime Minister David Cameron asked him to focus 0:11:09.679 --> 0:11:14.199 on the anti microbial resistance crisis. Lord O'Neill knew a 0:11:14.280 --> 0:11:16.800 little about the subject back then, but he had the 0:11:16.840 --> 0:11:21.400 finance acumen to demonstrated significance and to make the economic 0:11:21.520 --> 0:11:24.800 argument for tackling it. I recently caught up with him 0:11:24.840 --> 0:11:27.800 to ask Lord O'Neill about the findings of his two 0:11:27.840 --> 0:11:31.360 thousand and sixteen review and the impact it's had since 0:11:31.400 --> 0:11:36.920 its release. What we suggested is howthing quicker than if 0:11:36.960 --> 0:11:41.160 anything then we could eventually happen. So I'm as surprise, 0:11:41.280 --> 0:11:43.319 not really because it's kind of what we said could happen, 0:11:43.400 --> 0:11:46.280 but it seems to be growing evidence that it's something quicker, 0:11:47.000 --> 0:11:49.000 and I think it's a sign of the scale of 0:11:49.000 --> 0:11:53.880 the resistance problem. Lord O'Neill's review predicted that by fifty 0:11:54.280 --> 0:11:58.280 more people will die from superbug infections then from cancer 0:11:58.440 --> 0:12:02.880 and diabetes. Bind still none of that seems to be 0:12:02.960 --> 0:12:06.040 corralling the kind of action he and his team called for. 0:12:06.800 --> 0:12:09.760 Their recommendations were for forty two billion dollars to be 0:12:09.800 --> 0:12:14.120 spent over ten years to boost the supply of new medicines, vaccines, 0:12:14.160 --> 0:12:18.760 and diagnostic tools, and introduce mechanisms to reduce the demand 0:12:18.760 --> 0:12:22.880 for antibiotics. What it really tells me is that no 0:12:23.160 --> 0:12:28.000 governments anywhere really wants to spend any money on particularly 0:12:28.679 --> 0:12:31.960 giving incentives to new use of drugs to be found 0:12:31.960 --> 0:12:36.600 and developed. I don't think they understand the urgency of it. Oh, 0:12:36.600 --> 0:12:41.120 it's clearly not an agor prioity. And I think a 0:12:41.160 --> 0:12:46.439 major dilemma of modern life is that in powallel of this, 0:12:47.160 --> 0:12:51.600 governments don't like to spend money on prevention, and they 0:12:51.840 --> 0:12:56.760 end up spending more, rather wastefully, on the response to outbreak. 0:12:57.280 --> 0:13:03.760 And it's it's really quite stupid. Before the nineties, something 0:13:03.840 --> 0:13:06.920 as simple as a scratch knee could turn into a 0:13:07.000 --> 0:13:12.719 fastering sore that risks ending in fatal septic shock. Antibiotics 0:13:12.800 --> 0:13:16.760 changed that and in just one generation, added decades to 0:13:16.800 --> 0:13:21.720 average life expectancy. These drugs literally laid the foundation for 0:13:21.800 --> 0:13:27.079 modern medicine, surgery, organ transplants, chemotherapy, and c sections could 0:13:27.080 --> 0:13:29.800 be performed with a high degree of safety thanks to 0:13:29.840 --> 0:13:35.360 the bacteria stopping ability of antibiotics. The life extending opportunities 0:13:35.400 --> 0:13:40.640 afforded by these wonder drugs have always been precarious. Almost 0:13:40.640 --> 0:13:44.280 as soon as scientists discovered ways to muke bacteria with antibiotics, 0:13:45.000 --> 0:13:48.240 they were disappointed to learn bacteria could master ways to 0:13:48.559 --> 0:13:52.600 nuke antibiotics in return. For the past eighty years, humans 0:13:52.600 --> 0:13:55.920 and bacteria have been locked in a race for survival. 0:13:56.720 --> 0:14:00.800 Between the nineteen fifties and seventies, a slew of antibiotic 0:14:00.800 --> 0:14:04.920 export humans clearly ahead, but that lead is being lost 0:14:04.960 --> 0:14:10.040 in startling and horrifying ways. The development of new antibiotics 0:14:10.160 --> 0:14:14.240 is virtually dried up as drugmakers focused on more lucrative medicines, 0:14:14.320 --> 0:14:18.559 such as those for treating cancer, cardiovascular disease, and diabetes. 0:14:19.640 --> 0:14:22.520 Bacteria have seized the opportunity to exert one of their 0:14:22.560 --> 0:14:26.480 most powerful advantages over humans. Three and a half billion 0:14:26.600 --> 0:14:30.920 years of evolution on this planet. It's allowed these microbes 0:14:30.960 --> 0:14:35.040 to amass a treasure trove of genetic tools to evade 0:14:35.080 --> 0:14:40.920 every kind of weapon thrown at them, and bacteria share 0:14:40.960 --> 0:14:44.440 their drug evating genes freely and easily with gems from 0:14:44.480 --> 0:14:49.320 the same and different species. These genes are often carried 0:14:49.320 --> 0:14:53.080 on the microbial equivalent of a thumb drive that enables 0:14:53.120 --> 0:14:57.000 one bacterium to quickly and efficiently pass, for example, the 0:14:57.080 --> 0:15:02.560 blueprint for nine different mechanisms of drug resistance to another germ. 0:15:02.680 --> 0:15:07.720 These fortifying genes have spread like wildfire in response to antibiotics. 0:15:08.680 --> 0:15:12.800 We use and abuse these miracle cures on a daily basis. 0:15:13.640 --> 0:15:16.400 We take them when they're not needed, like for viral infections. 0:15:17.240 --> 0:15:21.360 We use them to fatten farm animals faster, We sprayed 0:15:21.400 --> 0:15:23.960 them on crops, and we dump them in drains and rivers, 0:15:24.040 --> 0:15:28.040 contaminating the environment. All of that contributes to the rise 0:15:28.600 --> 0:15:33.120 and rise of disease, causing germs that are hard, expensive, 0:15:33.600 --> 0:15:40.920 and in some cases impossible to treat. Dr G four 0:15:41.000 --> 0:15:44.520 spent five years training at London's Royal Free Hospital, an 0:15:44.560 --> 0:15:48.920 institution with a long history where thousands of cholera patients 0:15:48.920 --> 0:15:52.080 were treated in the early eight hundreds. He returned to 0:15:52.120 --> 0:15:56.240 India more than a decade ago. Back home, Dr Gofour 0:15:56.440 --> 0:15:59.880 was alarmed to find about one to two of infection 0:16:00.080 --> 0:16:03.800 is among hospital patients were caused by an extreme form 0:16:03.920 --> 0:16:07.240 of drug resistant bacteria. When it came back to India 0:16:07.280 --> 0:16:10.600 in two thousand eight, people like me and many many 0:16:10.640 --> 0:16:13.600 of us started talking about all the superbug crisis is 0:16:13.640 --> 0:16:17.520 going to happen. It's going to be a catastrophic crisis 0:16:17.720 --> 0:16:20.440 in a few years time. One of the reasons why 0:16:20.560 --> 0:16:24.800 Dr Gafford saw this superbug crisis unfold as quickly as 0:16:24.840 --> 0:16:28.440 it did has to do with how bacteria spread and 0:16:28.480 --> 0:16:34.920 how harmless chams can turn into untreatable pathogens. Species like E. 0:16:35.040 --> 0:16:40.960 Coli and Clepsyella pneumonia carried in arogastro intestinal tracks. They 0:16:41.040 --> 0:16:46.040 aid digestion and vitamin production. These friendly bacteria are also 0:16:46.080 --> 0:16:51.080 in animals, and they're in fecal matter which we dispense, 0:16:51.640 --> 0:16:56.480 including the family dog. The bathroom is often the nexus. 0:16:57.280 --> 0:17:02.640 Each person sheds an estimated thirty trillion bacterial cells daily 0:17:02.760 --> 0:17:08.560 in their feces. Airborne germs known as toilet plume aerosols 0:17:08.600 --> 0:17:11.800 are created when the bacteria are hit with a flash 0:17:11.920 --> 0:17:15.960 of water. Then they can land on surfaces, creating what 0:17:16.080 --> 0:17:19.919 the late elma in a microbiologists from Dartmouth Medical School 0:17:20.240 --> 0:17:25.040 described as air feckal veneer. In places where people defecate 0:17:25.119 --> 0:17:28.760 in their open and sewage isn't properly handled and treated. 0:17:29.480 --> 0:17:34.199 That veneer is more like a shag pile carpet, and 0:17:34.240 --> 0:17:37.960 it means fecal germs are readily ingested via contaminated food 0:17:38.000 --> 0:17:42.080 and water. If you've had travelers diarrhea, it was most 0:17:42.080 --> 0:17:46.320 probably caused by equally a prime feckal germ. Gross, right, 0:17:46.880 --> 0:17:51.040 but it helps explain how the most resistant superbugs entered 0:17:51.040 --> 0:17:54.680 the public water supply in places like New Delhi, reside 0:17:54.680 --> 0:17:58.120 in the bodies of tens of millions of people, and 0:17:58.160 --> 0:18:01.040 have emerged as global public health of the enemy number one. 0:18:02.119 --> 0:18:05.440 If your sanitation scenario is not good in the community, 0:18:05.800 --> 0:18:10.919 the superbug spread in the water systems, superbug sprayer in 0:18:10.960 --> 0:18:16.720 the environment, healthy people ingest eat the superbug in the 0:18:16.800 --> 0:18:21.080 food and water. India's toilet shortage has contributed to a 0:18:21.080 --> 0:18:26.880 sanitation crisis that stoked the superbug crisis. Prime Minister Norandermodi 0:18:26.960 --> 0:18:29.760 is trying to fix that with the largest toilet building 0:18:29.800 --> 0:18:33.439 spree in human history. Well, that's great news for public 0:18:33.480 --> 0:18:37.719 health and could eventually make a huge difference for now 0:18:38.000 --> 0:18:42.439 potentially deadly gams continue to invade people systems there's an 0:18:42.440 --> 0:18:45.360 easy way to tell if someone is harboring drug resistant 0:18:45.359 --> 0:18:49.080 bacteria in their bow. You test their waste. Three years ago, 0:18:49.320 --> 0:18:53.200 Dr Gofour and colleagues collected a thousand stool samples from 0:18:53.200 --> 0:18:57.000 healthy at all volunteers across three cities. They found one 0:18:57.040 --> 0:19:01.880 in every fifteen urban Indians carry in their intestines and 0:19:02.080 --> 0:19:05.800 shed in their stool. Common bacteria that are resistant to 0:19:05.840 --> 0:19:10.399 a class of last line antibiotics known as carbon penum. 0:19:10.440 --> 0:19:13.760 When doctors use a carbon penum, it typically means none 0:19:13.800 --> 0:19:17.359 of the standard therapy is work, and if superbugs that 0:19:17.359 --> 0:19:20.639 are resistant to carbon penems are spreading in the environment 0:19:20.680 --> 0:19:24.800 and contaminating food and water, it accelerates the loss of 0:19:24.920 --> 0:19:28.800 a critical treatment. Doctors like A four can use. Carbon 0:19:28.880 --> 0:19:32.919 Panum is the most important antibiotic available in the clinical practice. 0:19:33.400 --> 0:19:37.119 We can call the extremely drug resistant bacteria. They're not 0:19:37.200 --> 0:19:39.960 hospital bug, the god from the food and water they 0:19:40.000 --> 0:19:45.560 consume every day. The bacteria like E. Coli are normal 0:19:45.760 --> 0:19:49.679 bacteria off your inderstine. If they get an opportunity to 0:19:49.840 --> 0:19:54.280 enter the blood, of course, then it's severe sepsist, severe infection. 0:19:55.000 --> 0:19:57.720 If you don't treat, you will die of these infections. 0:19:58.320 --> 0:20:00.960 But it's not just the food and order that's causing 0:20:01.080 --> 0:20:05.959 India's superbug crisis. India is the world's largest manufacturer and 0:20:06.160 --> 0:20:09.720 user of antibiotics for human health, and it's the fourth 0:20:09.720 --> 0:20:13.720 biggest user in food producing animals. These drugs are easy 0:20:13.760 --> 0:20:17.359 to get, often obtainable without a prescription, and that means 0:20:17.400 --> 0:20:21.320 it's easy for bacteria to develop resistance. The problem in 0:20:21.320 --> 0:20:26.040 India is it's not regulated. That's Dr Bovner Siroe. She's 0:20:26.040 --> 0:20:28.960 worked in medical oncology in India and the UK for 0:20:29.040 --> 0:20:32.359 twenty five years. I first interviewed her in New Delhi 0:20:32.400 --> 0:20:34.880 for a story on superbugs a decade ago and we've 0:20:34.960 --> 0:20:38.320 kept in touch. So if I go up to a pharmacy, 0:20:39.040 --> 0:20:41.920 what if I even phone call a pharmacy, they will 0:20:41.960 --> 0:20:45.639 deliver the antibiotics at home and and that's a fact 0:20:46.040 --> 0:20:49.800 definitely in small towns, which is wrong. There should be 0:20:49.920 --> 0:20:54.480 some form of regulation for prescription of antibiotics. What the 0:20:54.560 --> 0:20:59.920 indiscriminate use of antibiotics does is it promotes antibiotic resistance. 0:21:00.040 --> 0:21:03.920 Being all that, Dr Syrilee isn't seeing in her practice 0:21:04.240 --> 0:21:07.719 the same levels of extreme drug resistance that Dr Gofour 0:21:07.800 --> 0:21:11.560 and other specialists around India have reported, but she's alert 0:21:11.600 --> 0:21:14.680 to the problem. In London, Dr SyRI we would consult 0:21:14.760 --> 0:21:18.880 via Skype to reduce her patients travel costs. In India, 0:21:19.080 --> 0:21:22.720 she does this to minimize her patient's contact with health 0:21:22.760 --> 0:21:27.439 care facilities where superbugs are concentrated in sick patients and 0:21:27.480 --> 0:21:31.080 can spread because of inadequate cleaning and infection control practices. 0:21:31.680 --> 0:21:37.080 Antibiotic resistance is a huge concern for both oncologists and 0:21:37.240 --> 0:21:41.400 cancer patients worldwide, whether it's it's in UK or India. 0:21:42.160 --> 0:21:46.720 One of the commonest side effects of treatment is that 0:21:46.960 --> 0:21:52.280 the patients are immuno compromised. Antibiotic resistance is a discussion 0:21:52.359 --> 0:21:55.920 that we have to have with all patients that are 0:21:55.960 --> 0:22:00.320 going to undergo immuno suppressive treatment. If a patient absent 0:22:00.440 --> 0:22:05.399 infection with a multi drug resistant organism and you're not 0:22:05.480 --> 0:22:08.760 able to treat that infection, the cancer may be curable, 0:22:09.240 --> 0:22:11.520 but we lose the patient to the infection, which is 0:22:11.600 --> 0:22:16.360 unacceptable in this day and age. I think antibiotic resistance 0:22:16.480 --> 0:22:20.280 is a huge concern for all of us. Cancer treatment 0:22:20.320 --> 0:22:25.000 breaches the body's natural defenses in multiple ways. For instance, 0:22:25.320 --> 0:22:27.600 the skin gets pierced when the needle is inserted for 0:22:27.640 --> 0:22:32.359 an intravenous infusion, but there's a critical vulnerability patient's face 0:22:32.440 --> 0:22:36.840 when they undergo chemotherapy. Those potent drugs target cells that 0:22:36.920 --> 0:22:41.080 grow and divide quickly as cancer cells do, but there's 0:22:41.080 --> 0:22:45.120 often some collateral damage to healthy cells too. Hair can 0:22:45.160 --> 0:22:48.760 fall out and the mucous membrane that lines the digestive 0:22:48.800 --> 0:22:52.480 tract from the mouth to the anus can effectively slough off. 0:22:53.320 --> 0:22:57.040 Injury to that protective barrier can enable bacteria from the 0:22:57.040 --> 0:23:01.440 gastro intestinal tract to enter the blood string and causing infection. 0:23:02.680 --> 0:23:06.560 Bloodstream infections are very common in cancer patients with low 0:23:06.600 --> 0:23:09.760 white blood cell levels. When the culprit is a carbon 0:23:09.760 --> 0:23:14.280 PanAm resistant gam after two thirds of patients die. One 0:23:14.320 --> 0:23:18.400 study found a New Delhi almost three quarters of patients 0:23:18.440 --> 0:23:22.280 with leukemia and other blood cancers harbor those dangerous bugs. 0:23:22.960 --> 0:23:27.440 Here's dr Abdulga for again. The death rate of patient 0:23:27.520 --> 0:23:29.919 with the carbon ponum resistant superbug and the blood is 0:23:30.040 --> 0:23:33.720 anywhere sixty to seventy percentage. So if I if I 0:23:33.760 --> 0:23:37.800 have a pay cancer chimotrappy patient with a carbonon resistant 0:23:37.800 --> 0:23:41.679 superbula in the blood, I can predict the chance of 0:23:41.760 --> 0:23:45.919 that patient dying is sixty percentage or more. If that 0:23:46.080 --> 0:23:48.600 is also a callist in resistance, I can predict the 0:23:48.680 --> 0:23:52.400 chance of that patient is dying is eighty percentage or more. 0:23:52.840 --> 0:23:56.159 That means a patient is getting this infection is most 0:23:56.200 --> 0:23:59.639 likely these patients will die and this has become a 0:23:59.760 --> 0:24:02.879 day earlier routine for people like me. In countries with 0:24:03.040 --> 0:24:08.280 high superber grades, we are literally living in post antibiotic era, 0:24:08.600 --> 0:24:13.959 especially in South Asia and militring countries. And Dr gefour 0:24:14.080 --> 0:24:18.320 reminds us that creating awareness and changing behavior is a 0:24:18.440 --> 0:24:23.040 mammoth task. India is a large country one point three 0:24:23.080 --> 0:24:28.280 billion population, seventy five thousand hospitals, one million doctors, half 0:24:28.320 --> 0:24:35.120 a million pharmacies is a fuge challenge. The present momentum 0:24:35.520 --> 0:24:39.359 is not enough. We need to really understand the magnitude 0:24:39.359 --> 0:24:43.800 of the challenge and find solution on the ground that's 0:24:43.840 --> 0:24:47.880 not really happening. Dr G four has spent years speaking 0:24:47.880 --> 0:24:51.080 about the issue. In two thousand and twelve, he convened 0:24:51.080 --> 0:24:54.119 a symposium that led to a national road map to 0:24:54.160 --> 0:24:58.399 tackle the problem. Dr GO four was lauded internationally for 0:24:58.480 --> 0:25:01.840 taking positive action, but it put him in the crosshairs 0:25:01.880 --> 0:25:05.800 of some of India's healthcare businesses. Dr Gefford himself works 0:25:05.800 --> 0:25:08.520 in a private hospital. Many of my friends in the 0:25:08.520 --> 0:25:11.680 health care industry have told me what you do is 0:25:12.040 --> 0:25:16.600 adversely affecting our business. This is my answer to them. No, 0:25:17.160 --> 0:25:21.239 I'm trying to protect our business because if people like 0:25:21.400 --> 0:25:26.200 me don't talk, policies won't change, If our patients will die. 0:25:26.800 --> 0:25:31.320 How can we How can we sustain an industry so very, 0:25:31.480 --> 0:25:34.800 very very difficult scenario. The industry you are trying to 0:25:34.880 --> 0:25:40.840 protect sometimes blame you, and that's a real painful scenario 0:25:41.359 --> 0:25:45.480 people like me are facing. Dr Gerford told me there 0:25:45.720 --> 0:25:50.160 is progress, but it's slow. In July, the Indian government 0:25:50.240 --> 0:25:54.720 limited the use of Colliston. That drug of last resort 0:25:55.359 --> 0:25:58.560 was discovered in the nineteen fifties, but doctors quickly stopped 0:25:58.640 --> 0:26:01.640 using it because of its toxic effects on the kidneys. 0:26:02.400 --> 0:26:06.000 While humans weren't using colliston, the drug was in popular 0:26:06.119 --> 0:26:09.080 use on poultry farms, where farmers fed it to animals 0:26:09.119 --> 0:26:12.960 to stave off disease and hasten their growth. But the 0:26:13.000 --> 0:26:15.879 Ministry of Health and Family Welfare ordered a stop to 0:26:15.960 --> 0:26:19.720 that practice. The results of that policy are yet to 0:26:19.760 --> 0:26:24.199 be seen, and maybe too late. Five years ago, I 0:26:24.359 --> 0:26:27.960 visited one of India's largest private neannatal intensive care units. 0:26:28.640 --> 0:26:31.479 Colliston was the go to drug there for treating babies 0:26:31.520 --> 0:26:35.640 with sepsis because nothing else worked as well. Two years later, 0:26:36.119 --> 0:26:40.080 the same hospital had seen two cases of Colliston resistant infections. 0:26:40.840 --> 0:26:44.760 It's a tragedy familiar to Dr Go four. I used 0:26:44.800 --> 0:26:49.439 to see patients quite sporadically, maybe once in six months, 0:26:49.880 --> 0:26:53.400 once a year, I get this kind of bacteria, but assistant. 0:26:53.400 --> 0:26:59.840 Everything that has changed. No I treat a collistems assistant 0:27:00.000 --> 0:27:04.000 infection once in two weeks. It's nothing unusual for me. 0:27:04.280 --> 0:27:06.840 So I can't remember the number of patients with the 0:27:06.840 --> 0:27:10.520 panned regorously infections. I have treated, treated dozens and dozens 0:27:10.520 --> 0:27:13.199 of patients with the panned regorously infections of my my 0:27:13.359 --> 0:27:16.200 career or the last few years. In the last few years, 0:27:16.200 --> 0:27:20.080 for Dr four, both his missions as a teacher and 0:27:20.160 --> 0:27:24.840 a doctor have become harder. By speaking out about the crisis, 0:27:24.880 --> 0:27:28.680 he faced criticism from within his own industry and as 0:27:28.720 --> 0:27:32.320 a doctor. The spread of superbugs has meant his tools 0:27:32.400 --> 0:27:37.000 for treating his patients are deteriorating. More and more. He 0:27:37.080 --> 0:27:40.240 sees cases like the young student he couldn't save and 0:27:40.320 --> 0:27:45.240 these cases weigh on him. It was actually a disappointment 0:27:45.440 --> 0:27:49.040 because as a doctor, as an infection specialist, living in 0:27:49.119 --> 0:27:53.320 twenty first century, with all the inventions and discoveries in 0:27:53.400 --> 0:27:57.880 modern medicine, especially ongology, I felt my hands are tied 0:27:58.440 --> 0:28:02.800 because I can't chew are my patients infection? If I 0:28:02.840 --> 0:28:06.280 can't cure my patients infection? How aver all wonderful the 0:28:06.400 --> 0:28:09.359 field of oncology is how about? What about developments in 0:28:09.400 --> 0:28:11.679 the field of oncology? They are not going to be 0:28:11.760 --> 0:28:23.080 useful because we know cancer patients die of infection, but 0:28:23.400 --> 0:28:27.480 there is still some hope. Aside from the government restricting 0:28:27.520 --> 0:28:31.960 the use of Colliston, there is one possible cocktail that 0:28:32.119 --> 0:28:36.000 could help in the fight against these extreme superbugs. An 0:28:36.000 --> 0:28:39.479