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Speaker 1: Learning that you have cancer can be terrifying, and every

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Speaker 1: two seconds, somewhere in the world, another person gets the diagnosis.

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Speaker 1: That's four people just since I started talking. But there

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Speaker 1: are places where the fear of dying from cancer is

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Speaker 1: amplified by an added treacherous risk that the cancer treatment

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Speaker 1: will bring on a deadly infection from a killer superbug

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Speaker 1: that even the most potent antibiotics available are powerless to team.

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Speaker 1: It's called extreme drug resistance, and it can create a

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Speaker 1: devastating dilemma for some patients. The treatment for their tumors

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Speaker 1: may kill them faster than the tumors themselves. Welcome to Prognosis,

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Speaker 1: the podcast about health and science, medical technology, and the

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Speaker 1: changes that are underway across the world. I'm your host,

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Speaker 1: Michelle fay Cortes. This season, we're examining one of the

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Speaker 1: dangers that keeps public health officials awake at night. It's

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Speaker 1: been described as a silent tsunami of catastrophic proportions, one

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Speaker 1: of the gravest threats to human health. I'm talking about

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Speaker 1: antimicrobial resistance, more commonly known as the irreversible rise of superbugs.

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Speaker 1: The waning potency of critical antibiotics is happening faster than

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Speaker 1: even the most dire forecasts. Tragically, cancer patients are at

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Speaker 1: the front line of this global emergency. The conundrum is

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Speaker 1: playing out sporadically in hospitals in many countries, portending a

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Speaker 1: global problem. One doctor in India is sounding the alarm

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Speaker 1: even as he works tirelessly to arrest this unbolding crisis.

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Speaker 1: Here's Bloomberg's Jason Gale with the story. Abdulgaf was raised

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Speaker 1: in the off Indian state of Kerala, beside a river

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Speaker 1: and rice fields that stretched as far as the eye

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Speaker 1: could see. He'd often hold the hand of his grandfather,

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Speaker 1: who was blind since early youth, and guide him along

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Speaker 1: the narrow paths across the farm. School was in a

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Speaker 1: local village, wherefore was inspired to become a teacher. But

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Speaker 1: he was emboldened to reach even higher by the Missile

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Speaker 1: Man of India, A. P. J. Abdul Kalam, was a

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Speaker 1: rocket scientist from humble beginnings who eventually became President of India.

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Speaker 1: His example encouraged the young student to train instead to

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Speaker 1: be a doctor. The meaning of the word doctor dosire,

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Speaker 1: that is, to teach. A doctor is a teacher, not

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Speaker 1: just a healer. I always wanted to become a teacher,

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Speaker 1: and I became a doctor, so I am a teacher

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Speaker 1: and a doctor. To be a doctor is a normal profession.

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Speaker 1: Patients come to you with their complaints, You examine them,

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Speaker 1: You do the necessary investigations and find out what's wrong

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Speaker 1: with them. You prescribe them medication and do the other

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Speaker 1: necessary medical interventions. And you get a satisfaction when you

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Speaker 1: treat patients because you're curing their ailments and as a

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Speaker 1: human being, you're helping your fellow human beings. Dr G

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Speaker 1: four is now in his forties. He's an infectious diseases

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Speaker 1: physician and clinical microbiologist in Chennai, the largest city in

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Speaker 1: southern India. The satisfaction Dr Gefer said he gets from

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Speaker 1: treating his patients well, it's fading. And the reason it's

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Speaker 1: fading is because it's becoming harder to save his patients

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Speaker 1: from diseases like cancer. And it's not the cancer itself

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Speaker 1: that is becoming more and more of a threat to

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Speaker 1: his patients. It's the infections that can come after chemotherapy.

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Speaker 1: Dr G four remembers one case not too long ago,

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Speaker 1: at twenty year old college student with a cute my

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Speaker 1: Lloyd leukemia is one of the worst type of cancer

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

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Speaker 1: cancer you'll get. Well, the treatment would give him more time.

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Speaker 1: It's punishingly aggressive. The young man will be left with

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Speaker 1: no immunity for weeks, leaving him vulnerable to infections, especially

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Speaker 1: from bacteria he's carrying inside him. God, they are expecting

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Speaker 1: us to cure their cancer with chemotapi and a wonderful

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Speaker 1: chemotherapy drugs, and then we explain into the family, yeah,

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Speaker 1: your cancer will be controlled, but then you may die

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Speaker 1: of infection. The outlook is grim either way. It's a

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Speaker 1: choice between certain death from one threat and the possibility

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Speaker 1: of a faster death from another. The student undergoes chemotherapy,

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Speaker 1: and the chemo, as expected, wipes out the white blood

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Speaker 1: cells needed to defend against the bacteria entering his bloodstream.

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Speaker 1: On one and you don't have immunity, And on the

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Speaker 1: other hand, you've got billions or trillions of bacteria waiting

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Speaker 1: to jump and jumping into your blood, but there's no defense.

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Speaker 1: What will happen du antibiotic and if the even if

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Speaker 1: you du antibiotic, the death rate is and has expected.

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Speaker 1: The bacteria get into the patient's blood. Dr Gofour tries

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Speaker 1: to fight back. He knows the bacteria are resistant to

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Speaker 1: the most potent antibiotic available, so he tries another colliston.

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Speaker 1: It's a last resort option, and it subdues the infection,

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Speaker 1: but barely. Dr GO four is still giving the same drug,

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Speaker 1: and the infection is still lingering. And then it happens.

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Speaker 1: A single bacterium undergoes a genetic mutation, giving it resistance

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Speaker 1: to that last resort antibiotic. It multiplies exponentially and it

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Speaker 1: soon becomes the dominant strain, poisoning his bloodstream, and Dr

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Speaker 1: G four is almost out of options. He has one

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Speaker 1: last hope, a cocktail of antibiotics, ones that administered by

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Speaker 1: themselves wouldn't work, but together could do something. This is

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Speaker 1: a desperate attempt. We called combination therapy, combination of anti polytics.

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Speaker 1: And still the patient will die. The chance of the

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Speaker 1: patient dying is more than eighty percent age in this scenario,

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Speaker 1: and tragically, as expected, the young man dies. For me,

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

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Speaker 1: number of patients I've seen dying due to drugs infection,

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Speaker 1: it's on a daily basis. So many of my patients

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Speaker 1: cancer patients died due to drug resistance after chemotherapy. For me,

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Speaker 1: it's a day today scenario. Those multi drug resistant bacteria,

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Speaker 1: those superbugs are proliferating globally on all consonants and in

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Speaker 1: all countries. But in few places is the problem more

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Speaker 1: worrisome than in India. Here, drug resistance has reached extreme levels.

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Speaker 1: That's because of the massive use of antibiotics coupled with

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Speaker 1: poor hygiene and sanitation. The devastating impact that's having on

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Speaker 1: cancer patients has turned Dr go for into one of

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Speaker 1: India's fiercest crusaders on the subject. We are facing a

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Speaker 1: difficult scenario to give chemotherapy and cure the cancer and

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Speaker 1: get a drugs infection and the patient dying of infections.

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Speaker 1: We don't know what to do. The world doesn't know

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Speaker 1: what to do in the scenario. If you're talking about

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Speaker 1: the post antibiotic era, you first see that in cancer patients.

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Speaker 1: For cancer patients are the most vulnerable group of patients

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Speaker 1: you can ever come across in your clinical practice. Dr

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Speaker 1: four posts regularly about their suffering on Twitter and LinkedIn.

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Speaker 1: Discussing superbugs is a sensitive and politically charged subject in India.

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Speaker 1: It risks casting a shadow over the country's medical tourism industry,

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Speaker 1: which the Indian government predicts could bring in nine billion

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Speaker 1: dollars a year by The superbl crisis is probably highest

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

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Speaker 1: getting worse because the drug resistants rate the superbug grade

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Speaker 1: is increasing on a daily basis, so the number of

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Speaker 1: patients dying are really high. Scientists have measured the burden

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Speaker 1: of drug resistance in India in various ways. One has

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Speaker 1: been to count the number of babies dying from sepsis

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Speaker 1: as a result of a bacterial bloodstream infection not cued

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Speaker 1: with antibiotics. An Indian new born dies every ten minutes.

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Speaker 1: That way, it works out to more than fifty eight

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Speaker 1: thousand babies a year. No one is immune. In Dr

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Speaker 1: Geffer's home state of Tamil Nadu. The former Chief Minister,

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Speaker 1: a celebrated actress, died in late two thousand and sixteen

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Speaker 1: from an unstoppable bloodstream infection. I work with cancer patients,

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Speaker 1: a group of patients with the lowest level of immunity,

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Speaker 1: and if you don't have antibiotics to treat infections in

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Speaker 1: cancer patients, you are in a very difficult scenario. Infection

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Speaker 1: can be in the chest, it can be in the brain,

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Speaker 1: It can be a demon, it can be urine, it

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Speaker 1: can be blood. It can't be anywhere. And if you

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Speaker 1: don't have antibiotics to treat disinfections, basically these patients die

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Speaker 1: in front of your eyes. Around the world, at least

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Speaker 1: seven hundred thousand people die annually from drug resistant infections.

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Speaker 1: That number will balloon to ten million deaths a year

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Speaker 1: by twenty fifty and will cost the world more than

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Speaker 1: one hundred trillion dollars in lost economic output without corrective actions.

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Speaker 1: That's according to a review led by former Goldman Sachs

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Speaker 1: economist Jim O'Neill three years ago. Lord O'Neill is the

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Speaker 1: British economist who coined the term brick as a reference

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Speaker 1: to Brazil, Russia, India and China. These rapidly emerging markets

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Speaker 1: have become symbols of the shift in economic power towards

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Speaker 1: the developing world. As chairman of Goldman Sachs Asset Management Division,

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Speaker 1: he oversaw more than eight hundred billion dollars of investments.

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Speaker 1: In two thousand and fourteen, Then UK Prime Minister David

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Speaker 1: Cameron asked him to focus on the anti microbial resistance crisis.

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Speaker 1: Lord O'Neill knew little about the subject back then, but

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Speaker 1: he had the finance acumen to demonstrate its significant and

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Speaker 1: to make the economic argument for tackling it. I recently

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Speaker 1: caught up with him to ask Lord O'Neill about the

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Speaker 1: findings of his two thousand and sixteen review and the

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Speaker 1: impact it's had since its release. What we suggested is

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Speaker 1: happening quicker than if anything then we could eventually happen.

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Speaker 1: So I'm a surprise, not really because it's kind of

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Speaker 1: what we said could happened, but it seems to be

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Speaker 1: growing evidence that it's something quicker, and I think it's

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Speaker 1: a sign of the scale of the resistance problem. Lord

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Speaker 1: O'Neill's review predicted that by fifty more people will die

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Speaker 1: from superbug infections then from cancer and diabetes combined. Still

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Speaker 1: none of that seems to be corralling the kind of

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Speaker 1: action he and his team called for. Their recommendations were

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Speaker 1: for forty two billion dollars to be spent over ten

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Speaker 1: years to boost the supply of new medicines, vaccines, and

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

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Speaker 1: What it really tells me is that no governments anywhere

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Speaker 1: really wants to spend any money on particularly giving incentives

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Speaker 1: to new use or drugs to be found and developed.

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

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Speaker 1: it's clearly not a major priority. And I think a

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Speaker 1: major dilemma of modern life is that in power al

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Speaker 1: of this, governments don't like to spend money on prevention,

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Speaker 1: and they end up spending more, rather wastefully, on response

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

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Speaker 1: something as simple as a scratch need could turn into

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Speaker 1: a festering sore that risk ending a fatal septic shop.

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

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Speaker 1: to average life expectancy. These 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 nuke 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 new

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Speaker 1: antibiotics port humans clearly ahead, but that lead is being

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

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Speaker 1: antibiotics is virtually dried up as drugmakers focused on more

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Speaker 1: lucrative medicines, such as those for treating cancer, cardiovascular disease,

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Speaker 1: and diabetes. Bacteria have seized the opportunity to exert one

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Speaker 1: of their most powerful advantages over humans. Three and a

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Speaker 1: half billion years of evolution on this planet. It's allowed

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Speaker 1: these microbes to amass a treasure trove of genetic tools

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Speaker 1: to evade every kind of weapon thrown at them. And

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Speaker 1: bacteria share their drug evating genes freely and easily with

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Speaker 1: gems from the same and different species. These genes are

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Speaker 1: often carried on the microbial equivalent of a thumb drive

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

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Speaker 1: the blueprint for nine different mechanisms of drug resistance to

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Speaker 1: another jam. These fortifying genes have spread like wildfire in

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Speaker 1: response to antibiotics. We use and abuse these miracle cures

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Speaker 1: on a daily basis. We take them when they're not needed,

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Speaker 1: like for viral infections. We use them to fatten farm

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Speaker 1: animals faster. We sprayed them on crops, and we dumped

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Speaker 1: them in drains and rivers, contaminating the environment. All of

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Speaker 1: that contributes to the rise and rise of disease, causing

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Speaker 1: germs that are hard, expensive, and in some cases impossible

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Speaker 1: to treat. Dr go four spent five years training at

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Speaker 1: London's Royal Free Hospital, an institution with a long history

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Speaker 1: where thousands of cholera patients were treated in the early

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Speaker 1: eight hundreds. He returned to India more than a decade ago.

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Speaker 1: Back home, Dr go four was alarmed to find about

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Speaker 1: one to two percent of infections among hospital patients were

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Speaker 1: caused by an extreme form of drug resistant bacteria. When

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Speaker 1: it came back to India in two thousand eight, people

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Speaker 1: like me and many many of us started talking about

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Speaker 1: all the superbug crisis is going to happen. It's going

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Speaker 1: to be a catastrophic crisis in a few years time.

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Speaker 1: One of the reasons why Dr Gafford saw this superbug

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Speaker 1: crisis unfold as quickly as it did. Has to do

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Speaker 1: with how bacteria spread and how harmless chams can turn

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Speaker 1: into untreatable pathogens. Species like E. Coal I and clepsy

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Speaker 1: yellow pneumonia carried in arogastro intestinal tracks. They aid digestion

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Speaker 1: and vitamin production. These friendly bacteria are also in animals,

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

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

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Speaker 1: sheds an estimated thirty trillion bacterial cells daily in their feces.

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Speaker 1: Airborne germs known as toilet plume aerosols are created when

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Speaker 1: the bacteria are hit with a flash of water. Then

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Speaker 1: they can land on surfaces, creating what the late Elma

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Speaker 1: f in a micro biologists from Dartmouth Medical School described

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Speaker 1: as a fickle veneer. In places where people defecate in

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Speaker 1: their open and sewage isn't properly handled and treated, that

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

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Speaker 1: means fecal jams are readily ingested via contaminated food and water.

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Speaker 1: If you've had travelers diarrhea, it was most probably caused

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Speaker 1: by equally a prime feckal Germ gross right, but it

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Speaker 1: helps explain how the most resistant superbugs entered the public

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

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Speaker 1: bodies of tens of millions of people, and have emerged

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Speaker 1: as global public health enemy number one. If you're sanitation

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Speaker 1: scenario is not good in the community, the superbug spread

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Speaker 1: in the water systems, superbug spread in the environment. Healthy

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Speaker 1: people ingest eat the superbugs in the food and water.

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Speaker 1: India's toil at shortage has contributed to a sanitation crisis

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Speaker 1: that stoked the superbug crisis. Prime Minister Norander Emoti is

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

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

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

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Speaker 1: deadly gems continue to invade people's systems. There's an easy

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

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

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Speaker 1: Dr Gafour 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 pennam.

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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: is the most important antibiotic available in the clinical practice.

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Speaker 1: We can call the extremely Druger system bacteria. They're not

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Speaker 1: hospital but the god from the food and water they

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Speaker 1: consume every day. The bacteria like E. Colila 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 water that's causing

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Speaker 1: India's superbow 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 Syrie. 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: We know 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 as 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 immunosuppressive treatment. If a patient gets an

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Speaker 1: infection with a multi drug resistant organism and we'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 a 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 in 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

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Speaker 1: off injury to that protective barrier can enable bacteria from

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Speaker 1: the gastro intestinal tract to enter the blood stream and

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Speaker 1: cause an infection. Bloodstream infections are very common in cancer

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Speaker 1: patients with low white blood cell levels when the culprit

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Speaker 1: is a carbon PanAm resistant jam after two thirds of

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Speaker 1: patients die. One study found a New Delhi almost three

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Speaker 1: quarters of patients with leukemia and other blood cancers. How

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Speaker 1: are those dangerous bags? Here's dr Abduga for again. The

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Speaker 1: death rate of patient with a carbon pon and resistant

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Speaker 1: superbug and the blood is anywhere sixty to seventy percentage.

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Speaker 1: So if I if I have a pay cancer chemotrapy

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Speaker 1: patient with a carbon resistant superbul CPSLA in the blood,

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Speaker 1: I can predict the chance of that patient dying is

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Speaker 1: sixty percentage or more. If that is also a colistint resistance,

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Speaker 1: I can predict the chance of that patient is dying

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Speaker 1: is eighty percentage or more. That means a patient is

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Speaker 1: getting this infection is most likely these patients will die.

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Speaker 1: And this has become a daily routine for people like

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Speaker 1: me in countries with high superbul grades. We are literally

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Speaker 1: living in post antibiotic era, especially in South Asia and

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Speaker 1: militrding countries, and Dr gofour reminds us that creating awareness

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Speaker 1: and changing behavior is a mammoth task. India is a

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Speaker 1: large country one point three billion population, seventy thousand hospitals,

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Speaker 1: one million doctors, half a million pharmacies. Eight is a

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Speaker 1: huge challenge. The present momentum is not enough. We need

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Speaker 1: to really understand the magnitude of the challenge and find

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Speaker 1: solution on the ground that's not really happening. Dr G

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Speaker 1: four has spent years speaking about the issue. In two

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Speaker 1: thousand and twelve, he convened a symposium that led to

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Speaker 1: a national road map to tackle the problem. Dr GO

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Speaker 1: four was lauded internationally for taking positive action, but it

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Speaker 1: put him in the crosshairs of some of India's health

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Speaker 1: care businesses. Dr Go for himself works in a private hospital.

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Speaker 1: Many of my friends in the healthcare industry have told

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Speaker 1: me what you do is adversely affecting our business. This

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Speaker 1: is my answer to them, No, I'm trying to protect

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Speaker 1: our business because if people like me don't talk, policies

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Speaker 1: won't change. If our patients will die. How can we

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

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

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Speaker 1: blame you, and that's a real painful scenario people like

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Speaker 1: me are facing. Dr Gerford told me there is progress,

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

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Speaker 1: use of Colliston. That drug of last resort was discovered

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Speaker 1: in the nineteen fifties, but doctors quickly stopped using it

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Speaker 1: because of its toxic effects on the kidneys. While humans

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Speaker 1: weren't using colliston, the drug was in popular use on

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Speaker 1: poultry farms, where farmers fed its animals to stave off

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Speaker 1: disease and hasten their growth. But the Ministry of Health

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Speaker 1: and Family Welfare ordered us stop to that practice. The

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Speaker 1: results of that policy are you to be seen, and

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Speaker 1: maybe too late. Five years ago I visited one of

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Speaker 1: India's largest private ne andatal intensive care units. Colliston was

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Speaker 1: the go to drug there for treating babies with sepsis

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

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

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Speaker 1: It's a tragedy familiar to Dr G 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 colistem resistant

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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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Speaker 1: pand regorously infections I have treated. I treat dozens and

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

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Speaker 1: my career or the last few years. In the last

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Speaker 1: few years, for Dr four, both his missions as a

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Speaker 1: teacher and a doctor have become harder. By speaking out

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Speaker 1: about the crisis, his face criticism from within his own industry,

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Speaker 1: and as a doctor, the spread of superbugs has meant

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00:27:12,359 --> 00:27:16,840
Speaker 1: his tools for treating his patients are deteriorating more and more.

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Speaker 1: He sees cases like the young student he couldn't save,

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Speaker 1: and these cases weigh on him. It was actually a

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Speaker 1: disappointment because as a doctor, as an infection specialist, living

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

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Speaker 1: in modern medicine, especially oncology, I felt my hands are

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Speaker 1: tied because I can't cure my patients infection. If I

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Speaker 1: can cure my patients infection, however, wonderful the field of

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Speaker 1: oncology is how about what about developments in the field

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Speaker 1: of oncology. They are not going to be useful because

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Speaker 1: we know cancer patients die of infection, but there is

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Speaker 1: still some hope. Aside from the government restricting the use

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Speaker 1: of Colliston, there is one possible cocktail that could help

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Speaker 1: in the fight against these extreme superbugs, an intravenous infusion

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Speaker 1: of two antibiotics that fires the cells as Zafa sefter,

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Speaker 1: in combination with another injectable antibiotic which Bristol Myers Squibs

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00:28:26,960 --> 00:28:31,480
Speaker 1: sells as a zac dam. I asked a clinical microbiologist

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Speaker 1: in Mumbai if that cocktail is something doctors are already

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Speaker 1: using in India. It's being looked at, she said, but

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Speaker 1: it's extremely expensive, about three hundred to four d dollars

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Speaker 1: a day. That's roughly double what Indians earned per month

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Speaker 1: on average. Government hospitals wouldn't be able to afford it,

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Speaker 1: so patients would have to pay out of pocket and

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00:28:56,520 --> 00:29:00,120
Speaker 1: only the wealthy could pony up that kind of money.

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Speaker 1: There's another critical aspect to treating sepsis and cancer patients.

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Speaker 1: Time doctors have a limited window, perhaps only eighteen hours

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Speaker 1: to administer the right antibiotic once a patient develops fever

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Speaker 1: to prevent a fatal bloodstream infection. That tends to make

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Speaker 1: doctors are on the side of caution and to use

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Speaker 1: the most powerful drugs available. You can't blame them. They

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Speaker 1: want to save their patient's life. But it's also what's

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Speaker 1: spurring the overuse of critically important antibiotics and driving the

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Speaker 1: superbiut crisis. And finally there's something else. We have no

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Speaker 1: way of knowing how big this crisis really is. When

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Speaker 1: a cancer patient dies from an infection, cancer not infection,

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Speaker 1: will most likely be the primary diagnosis recorded on the

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Speaker 1: death certificate, So the World Health Organization and its specialist arm,

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Speaker 1: the International Agency for Research on Cancer, have no clue

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Speaker 1: how many people die in this way. Doctors, like before

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Speaker 1: say the number is large and growing. The globalized nature

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Speaker 1: of superbugs means cancer patients everywhere will eventually face this

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

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Speaker 1: for listening. Do you have a story about healthcare in

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Speaker 1: the US or around the world we want to hear

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Speaker 1: from you. Find me on Twitter at a Cortes or

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Speaker 1: send me an email m Cortez at Bloomberg dot net.

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

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Speaker 1: a moment to rate and review us. It really helps

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Speaker 1: new listeners find the show, and don't forget to subscribe.

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Speaker 1: This episode was produced by Tobfheas. Our story editor was

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Speaker 1: Rick Shine. Special thanks to ari Alstetter and Ruth Pollard

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Speaker 1: who helped with the reporting, and Drew Armstrong. Our health

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Speaker 1: care team leader, Francesca Leaves had a Bloomberg podcast. We'll

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Speaker 1: be back next week with the new episode. See you then,