WEBVTT - Superbugs Force a Deadly Choice for Cancer Patients 0:00:08.600 --> 0:00:12.280 Learning that you have cancer can be terrifying, and every 0:00:12.280 --> 0:00:16.280 two seconds, somewhere in the world, another person gets the diagnosis. 0:00:17.079 --> 0:00:20.680 That's four people just since I started talking. But there 0:00:20.680 --> 0:00:23.239 are places where the fear of dying from cancer is 0:00:23.280 --> 0:00:28.360 amplified by an added treacherous risk that the cancer treatment 0:00:28.440 --> 0:00:31.920 will bring on a deadly infection from a killer superbug 0:00:32.479 --> 0:00:37.879 that even the most potent antibiotics available are powerless to team. 0:00:37.920 --> 0:00:41.159 It's called extreme drug resistance, and it can create a 0:00:41.200 --> 0:00:45.400 devastating dilemma for some patients. The treatment for their tumors 0:00:45.640 --> 0:00:50.920 may kill them faster than the tumors themselves. Welcome to Prognosis, 0:00:51.200 --> 0:00:55.040 the podcast about health and science, medical technology, and the 0:00:55.160 --> 0:00:58.640 changes that are underway across the world. I'm your host, 0:00:58.760 --> 0:01:03.120 Michelle fay Cortes. This season, we're examining one of the 0:01:03.240 --> 0:01:06.800 dangers that keeps public health officials awake at night. It's 0:01:06.840 --> 0:01:12.080 been described as a silent tsunami of catastrophic proportions, one 0:01:12.080 --> 0:01:15.600 of the gravest threats to human health. I'm talking about 0:01:15.640 --> 0:01:21.400 antimicrobial resistance, more commonly known as the irreversible rise of superbugs. 0:01:22.400 --> 0:01:26.680 The waning potency of critical antibiotics is happening faster than 0:01:26.800 --> 0:01:31.480 even the most dire forecasts. Tragically, cancer patients are at 0:01:31.520 --> 0:01:35.200 the front line of this global emergency. The conundrum is 0:01:35.200 --> 0:01:38.920 playing out sporadically in hospitals in many countries, portending a 0:01:38.920 --> 0:01:43.480 global problem. One doctor in India is sounding the alarm 0:01:43.520 --> 0:01:47.520 even as he works tirelessly to arrest this unbolding crisis. 0:01:48.280 --> 0:01:59.360 Here's Bloomberg's Jason Gale with the story. Abdulgaf was raised 0:01:59.360 --> 0:02:02.640 in the off Indian state of Kerala, beside a river 0:02:03.000 --> 0:02:06.080 and rice fields that stretched as far as the eye 0:02:06.120 --> 0:02:09.120 could see. He'd often hold the hand of his grandfather, 0:02:09.160 --> 0:02:12.760 who was blind since early youth, and guide him along 0:02:12.760 --> 0:02:16.160 the narrow paths across the farm. School was in a 0:02:16.160 --> 0:02:20.400 local village, wherefore was inspired to become a teacher. But 0:02:20.480 --> 0:02:23.920 he was emboldened to reach even higher by the Missile 0:02:24.040 --> 0:02:27.400 Man of India, A. P. J. Abdul Kalam, was a 0:02:27.480 --> 0:02:32.200 rocket scientist from humble beginnings who eventually became President of India. 0:02:32.800 --> 0:02:36.360 His example encouraged the young student to train instead to 0:02:36.440 --> 0:02:40.320 be a doctor. The meaning of the word doctor dosire, 0:02:40.760 --> 0:02:45.200 that is, to teach. A doctor is a teacher, not 0:02:45.440 --> 0:02:49.480 just a healer. I always wanted to become a teacher, 0:02:49.960 --> 0:02:52.560 and I became a doctor, so I am a teacher 0:02:52.639 --> 0:02:56.440 and a doctor. To be a doctor is a normal profession. 0:02:57.280 --> 0:03:01.000 Patients come to you with their complaints, You examine them, 0:03:01.320 --> 0:03:05.000 You do the necessary investigations and find out what's wrong 0:03:05.040 --> 0:03:09.160 with them. You prescribe them medication and do the other 0:03:09.400 --> 0:03:14.639 necessary medical interventions. And you get a satisfaction when you 0:03:14.720 --> 0:03:18.280 treat patients because you're curing their ailments and as a 0:03:18.360 --> 0:03:23.320 human being, you're helping your fellow human beings. Dr G 0:03:23.480 --> 0:03:26.680 four is now in his forties. He's an infectious diseases 0:03:26.720 --> 0:03:30.800 physician and clinical microbiologist in Chennai, the largest city in 0:03:30.919 --> 0:03:34.639 southern India. The satisfaction Dr Gefer said he gets from 0:03:34.760 --> 0:03:39.200 treating his patients well, it's fading. And the reason it's 0:03:39.200 --> 0:03:43.040 fading is because it's becoming harder to save his patients 0:03:43.080 --> 0:03:47.360 from diseases like cancer. And it's not the cancer itself 0:03:47.440 --> 0:03:49.520 that is becoming more and more of a threat to 0:03:49.560 --> 0:03:54.360 his patients. It's the infections that can come after chemotherapy. 0:03:54.600 --> 0:03:57.080 Dr G four remembers one case not too long ago, 0:03:57.280 --> 0:04:00.520 at twenty year old college student with a cute my 0:04:00.680 --> 0:04:04.040 Lloyd leukemia is one of the worst type of cancer 0:04:04.240 --> 0:04:06.200 you can get, one of the worst type of blood 0:04:06.240 --> 0:04:09.560 cancer you'll get. Well, the treatment would give him more time. 0:04:09.800 --> 0:04:14.080 It's punishingly aggressive. The young man will be left with 0:04:14.280 --> 0:04:19.360 no immunity for weeks, leaving him vulnerable to infections, especially 0:04:19.440 --> 0:04:23.640 from bacteria he's carrying inside him. God, they are expecting 0:04:23.720 --> 0:04:27.599 us to cure their cancer with chemotapi and a wonderful 0:04:27.680 --> 0:04:31.360 chemotherapy drugs, and then we explain into the family, yeah, 0:04:31.440 --> 0:04:34.960 your cancer will be controlled, but then you may die 0:04:35.279 --> 0:04:39.960 of infection. The outlook is grim either way. It's a 0:04:40.040 --> 0:04:44.640 choice between certain death from one threat and the possibility 0:04:44.960 --> 0:04:49.839 of a faster death from another. The student undergoes chemotherapy, 0:04:49.880 --> 0:04:54.080 and the chemo, as expected, wipes out the white blood 0:04:54.080 --> 0:04:57.919 cells needed to defend against the bacteria entering his bloodstream. 0:04:58.080 --> 0:05:00.520 On one and you don't have immunity, And on the 0:05:00.520 --> 0:05:04.599 other hand, you've got billions or trillions of bacteria waiting 0:05:04.680 --> 0:05:07.560 to jump and jumping into your blood, but there's no defense. 0:05:08.160 --> 0:05:12.280 What will happen du antibiotic and if the even if 0:05:12.279 --> 0:05:17.480 you du antibiotic, the death rate is and has expected. 0:05:18.000 --> 0:05:22.560 The bacteria get into the patient's blood. Dr Gofour tries 0:05:22.600 --> 0:05:26.279 to fight back. He knows the bacteria are resistant to 0:05:26.320 --> 0:05:31.040 the most potent antibiotic available, so he tries another colliston. 0:05:31.800 --> 0:05:35.240 It's a last resort option, and it subdues the infection, 0:05:35.880 --> 0:05:39.800 but barely. Dr GO four is still giving the same drug, 0:05:40.520 --> 0:05:46.000 and the infection is still lingering. And then it happens. 0:05:47.200 --> 0:05:52.240 A single bacterium undergoes a genetic mutation, giving it resistance 0:05:52.279 --> 0:05:58.040 to that last resort antibiotic. It multiplies exponentially and it 0:05:58.200 --> 0:06:02.800 soon becomes the dominant strain, poisoning his bloodstream, and Dr 0:06:02.800 --> 0:06:06.560 G four is almost out of options. He has one 0:06:06.680 --> 0:06:11.520 last hope, a cocktail of antibiotics, ones that administered by 0:06:11.560 --> 0:06:16.479 themselves wouldn't work, but together could do something. This is 0:06:16.480 --> 0:06:20.680 a desperate attempt. We called combination therapy, combination of anti polytics. 0:06:20.720 --> 0:06:22.960 And still the patient will die. The chance of the 0:06:23.000 --> 0:06:26.240 patient dying is more than eighty percent age in this scenario, 0:06:27.160 --> 0:06:33.159 and tragically, as expected, the young man dies. For me, 0:06:33.200 --> 0:06:38.080 it's become a daily issue. If you ask me the 0:06:38.160 --> 0:06:41.320 number of patients I've seen dying due to drugs infection, 0:06:41.720 --> 0:06:45.680 it's on a daily basis. So many of my patients 0:06:45.720 --> 0:06:50.760 cancer patients died due to drug resistance after chemotherapy. For me, 0:06:51.360 --> 0:06:59.560 it's a day today scenario. Those multi drug resistant bacteria, 0:07:00.040 --> 0:07:05.000 those superbugs are proliferating globally on all consonants and in 0:07:05.000 --> 0:07:09.240 all countries. But in few places is the problem more 0:07:09.279 --> 0:07:14.800 worrisome than in India. Here, drug resistance has reached extreme levels. 0:07:15.920 --> 0:07:20.000 That's because of the massive use of antibiotics coupled with 0:07:20.080 --> 0:07:25.120 poor hygiene and sanitation. The devastating impact that's having on 0:07:25.280 --> 0:07:29.240 cancer patients has turned Dr go for into one of 0:07:29.320 --> 0:07:34.920 India's fiercest crusaders on the subject. We are facing a 0:07:34.920 --> 0:07:40.400 difficult scenario to give chemotherapy and cure the cancer and 0:07:40.480 --> 0:07:44.000 get a drugs infection and the patient dying of infections. 0:07:44.160 --> 0:07:47.160 We don't know what to do. The world doesn't know 0:07:47.360 --> 0:07:50.320 what to do in the scenario. If you're talking about 0:07:50.360 --> 0:07:55.240 the post antibiotic era, you first see that in cancer patients. 0:07:55.240 --> 0:07:59.400 For cancer patients are the most vulnerable group of patients 0:07:59.480 --> 0:08:02.840 you can ever come across in your clinical practice. Dr 0:08:03.000 --> 0:08:06.680 four posts regularly about their suffering on Twitter and LinkedIn. 0:08:07.560 --> 0:08:12.480 Discussing superbugs is a sensitive and politically charged subject in India. 0:08:13.240 --> 0:08:18.080 It risks casting a shadow over the country's medical tourism industry, 0:08:18.160 --> 0:08:21.760 which the Indian government predicts could bring in nine billion 0:08:21.880 --> 0:08:27.600 dollars a year by The superbl crisis is probably highest 0:08:27.920 --> 0:08:32.120 in countries like India. The situation is getting worse, definitely 0:08:32.160 --> 0:08:35.839 getting worse because the drug resistants rate the superbug grade 0:08:35.960 --> 0:08:40.480 is increasing on a daily basis, so the number of 0:08:40.520 --> 0:08:45.520 patients dying are really high. Scientists have measured the burden 0:08:45.559 --> 0:08:50.080 of drug resistance in India in various ways. One has 0:08:50.120 --> 0:08:53.080 been to count the number of babies dying from sepsis 0:08:53.080 --> 0:08:57.120 as a result of a bacterial bloodstream infection not cued 0:08:57.240 --> 0:09:02.360 with antibiotics. An Indian new born dies every ten minutes. 0:09:02.440 --> 0:09:05.680 That way, it works out to more than fifty eight 0:09:05.720 --> 0:09:10.560 thousand babies a year. No one is immune. In Dr 0:09:10.600 --> 0:09:14.319 Geffer's home state of Tamil Nadu. The former Chief Minister, 0:09:14.880 --> 0:09:18.120 a celebrated actress, died in late two thousand and sixteen 0:09:18.280 --> 0:09:23.679 from an unstoppable bloodstream infection. I work with cancer patients, 0:09:24.200 --> 0:09:28.240 a group of patients with the lowest level of immunity, 0:09:29.200 --> 0:09:33.680 and if you don't have antibiotics to treat infections in 0:09:33.800 --> 0:09:39.640 cancer patients, you are in a very difficult scenario. Infection 0:09:39.679 --> 0:09:42.160 can be in the chest, it can be in the brain, 0:09:42.280 --> 0:09:44.360 It can be a demon, it can be urine, it 0:09:44.440 --> 0:09:46.880 can be blood. It can't be anywhere. And if you 0:09:46.920 --> 0:09:52.720 don't have antibiotics to treat disinfections, basically these patients die 0:09:53.080 --> 0:09:57.880 in front of your eyes. Around the world, at least 0:09:57.920 --> 0:10:02.280 seven hundred thousand people die annually from drug resistant infections. 0:10:03.000 --> 0:10:06.760 That number will balloon to ten million deaths a year 0:10:06.800 --> 0:10:09.560 by twenty fifty and will cost the world more than 0:10:09.840 --> 0:10:14.680 one hundred trillion dollars in lost economic output without corrective actions. 0:10:15.480 --> 0:10:18.400 That's according to a review led by former Goldman Sachs 0:10:18.480 --> 0:10:22.720 economist Jim O'Neill three years ago. Lord O'Neill is the 0:10:22.760 --> 0:10:26.120 British economist who coined the term brick as a reference 0:10:26.160 --> 0:10:30.960 to Brazil, Russia, India and China. These rapidly emerging markets 0:10:31.160 --> 0:10:34.480 have become symbols of the shift in economic power towards 0:10:34.520 --> 0:10:39.840 the developing world. As chairman of Goldman Sachs Asset Management Division, 0:10:40.320 --> 0:10:44.040 he oversaw more than eight hundred billion dollars of investments. 0:10:45.160 --> 0:10:48.120 In two thousand and fourteen, Then UK Prime Minister David 0:10:48.160 --> 0:10:52.520 Cameron asked him to focus on the anti microbial resistance crisis. 0:10:53.600 --> 0:10:56.800 Lord O'Neill knew little about the subject back then, but 0:10:56.880 --> 0:11:00.760 he had the finance acumen to demonstrate its significant and 0:11:00.840 --> 0:11:04.520 to make the economic argument for tackling it. I recently 0:11:04.520 --> 0:11:07.120 caught up with him to ask Lord O'Neill about the 0:11:07.160 --> 0:11:10.280 findings of his two thousand and sixteen review and the 0:11:10.360 --> 0:11:14.640 impact it's had since its release. What we suggested is 0:11:14.960 --> 0:11:19.679 happening quicker than if anything then we could eventually happen. 0:11:19.800 --> 0:11:22.840 So I'm a surprise, not really because it's kind of 0:11:22.840 --> 0:11:24.920 what we said could happened, but it seems to be 0:11:24.920 --> 0:11:28.079 growing evidence that it's something quicker, and I think it's 0:11:28.120 --> 0:11:31.440 a sign of the scale of the resistance problem. Lord 0:11:31.440 --> 0:11:35.959 O'Neill's review predicted that by fifty more people will die 0:11:36.040 --> 0:11:42.079 from superbug infections then from cancer and diabetes combined. Still 0:11:42.120 --> 0:11:44.560 none of that seems to be corralling the kind of 0:11:44.600 --> 0:11:48.480 action he and his team called for. Their recommendations were 0:11:48.520 --> 0:11:51.040 for forty two billion dollars to be spent over ten 0:11:51.160 --> 0:11:54.680 years to boost the supply of new medicines, vaccines, and 0:11:54.760 --> 0:11:59.960 diagnostic tools, and introduce mechanisms to reduce the demand for antibiotics. 0:12:00.760 --> 0:12:04.600 What it really tells me is that no governments anywhere 0:12:04.840 --> 0:12:10.120 really wants to spend any money on particularly giving incentives 0:12:10.160 --> 0:12:13.079 to new use or drugs to be found and developed. 0:12:13.880 --> 0:12:17.040 I don't think they understand the urgency of it. Oh, 0:12:17.080 --> 0:12:21.560 it's clearly not a major priority. And I think a 0:12:21.600 --> 0:12:26.679 major dilemma of modern life is that in power al 0:12:26.720 --> 0:12:30.359 of this, governments don't like to spend money on prevention, 0:12:31.440 --> 0:12:36.479 and they end up spending more, rather wastefully, on response 0:12:36.520 --> 0:12:43.760 to outbreak. And it's it's really quite stupid. Before the nineties, 0:12:43.880 --> 0:12:47.200 something as simple as a scratch need could turn into 0:12:47.200 --> 0:12:51.120 a festering sore that risk ending a fatal septic shop. 0:12:52.480 --> 0:12:57.040 Antibodics changed that and in just one generation added decades 0:12:57.120 --> 0:13:02.160 to average life expectancy. These literally laid the foundation for 0:13:02.280 --> 0:13:07.480 modern medicine. Surgery, organ transplants, chemotherapy, and c sections could 0:13:07.559 --> 0:13:10.240 be performed with a high degree of safety thanks to 0:13:10.280 --> 0:13:15.839 the bacteria stopping ability of antibiotics. The life extending opportunities 0:13:15.840 --> 0:13:21.040 afforded by these wonder drugs have always been precarious. Almost 0:13:21.080 --> 0:13:24.800 as soon as scientists discovered ways to nuke bacteria with antibiotics, 0:13:25.480 --> 0:13:28.679 they were disappointed to learn bacteria could master ways to 0:13:29.000 --> 0:13:33.000 nuke antibiotics in return. For the past eighty years, humans 0:13:33.040 --> 0:13:36.400 and bacteria have been locked in a race for survival. 0:13:37.160 --> 0:13:40.600 Between the nineteen fifties and seventies, a slew of new 0:13:40.679 --> 0:13:44.880 antibiotics port humans clearly ahead, but that lead is being 0:13:45.040 --> 0:13:49.760 lost in startling and horrifying ways. The development of new 0:13:49.800 --> 0:13:53.640 antibiotics is virtually dried up as drugmakers focused on more 0:13:53.720 --> 0:13:58.120 lucrative medicines, such as those for treating cancer, cardiovascular disease, 0:13:58.120 --> 0:14:02.720 and diabetes. Bacteria have seized the opportunity to exert one 0:14:02.720 --> 0:14:05.960 of their most powerful advantages over humans. Three and a 0:14:06.000 --> 0:14:10.560 half billion years of evolution on this planet. It's allowed 0:14:10.640 --> 0:14:14.600 these microbes to amass a treasure trove of genetic tools 0:14:14.679 --> 0:14:20.080 to evade every kind of weapon thrown at them. And 0:14:20.240 --> 0:14:24.360 bacteria share their drug evating genes freely and easily with 0:14:24.440 --> 0:14:29.080 gems from the same and different species. These genes are 0:14:29.160 --> 0:14:32.160 often carried on the microbial equivalent of a thumb drive 0:14:32.840 --> 0:14:36.920 that enables one bacterium to quickly and efficiently pass, for example, 0:14:37.400 --> 0:14:41.680 the blueprint for nine different mechanisms of drug resistance to 0:14:41.800 --> 0:14:46.760 another jam. These fortifying genes have spread like wildfire in 0:14:46.800 --> 0:14:51.960 response to antibiotics. We use and abuse these miracle cures 0:14:52.040 --> 0:14:55.520 on a daily basis. We take them when they're not needed, 0:14:55.560 --> 0:14:59.400 like for viral infections. We use them to fatten farm 0:14:59.440 --> 0:15:03.240 animals faster. We sprayed them on crops, and we dumped 0:15:03.280 --> 0:15:06.880 them in drains and rivers, contaminating the environment. All of 0:15:06.920 --> 0:15:11.160 that contributes to the rise and rise of disease, causing 0:15:11.200 --> 0:15:16.360 germs that are hard, expensive, and in some cases impossible 0:15:16.400 --> 0:15:23.040 to treat. Dr go four spent five years training at 0:15:23.080 --> 0:15:27.440 London's Royal Free Hospital, an institution with a long history 0:15:27.440 --> 0:15:30.400 where thousands of cholera patients were treated in the early 0:15:30.480 --> 0:15:34.240 eight hundreds. He returned to India more than a decade ago. 0:15:35.080 --> 0:15:38.560 Back home, Dr go four was alarmed to find about 0:15:38.720 --> 0:15:42.640 one to two percent of infections among hospital patients were 0:15:42.640 --> 0:15:46.680 caused by an extreme form of drug resistant bacteria. When 0:15:46.720 --> 0:15:49.800 it came back to India in two thousand eight, people 0:15:49.880 --> 0:15:52.320 like me and many many of us started talking about 0:15:52.400 --> 0:15:55.640 all the superbug crisis is going to happen. It's going 0:15:55.720 --> 0:15:59.120 to be a catastrophic crisis in a few years time. 0:15:59.760 --> 0:16:03.000 One of the reasons why Dr Gafford saw this superbug 0:16:03.040 --> 0:16:06.640 crisis unfold as quickly as it did. Has to do 0:16:06.720 --> 0:16:11.080 with how bacteria spread and how harmless chams can turn 0:16:11.120 --> 0:16:16.800 into untreatable pathogens. Species like E. Coal I and clepsy 0:16:16.880 --> 0:16:22.400 yellow pneumonia carried in arogastro intestinal tracks. They aid digestion 0:16:22.440 --> 0:16:27.160 and vitamin production. These friendly bacteria are also in animals, 0:16:27.640 --> 0:16:32.720 and they're in fecal matter which we dispense, including the 0:16:32.840 --> 0:16:38.320 family dog. The bathroom is often the nexus. Each person 0:16:38.400 --> 0:16:44.040 sheds an estimated thirty trillion bacterial cells daily in their feces. 0:16:45.200 --> 0:16:49.960 Airborne germs known as toilet plume aerosols are created when 0:16:49.960 --> 0:16:53.840 the bacteria are hit with a flash of water. Then 0:16:53.880 --> 0:16:57.120 they can land on surfaces, creating what the late Elma 0:16:57.160 --> 0:17:01.200 f in a micro biologists from Dartmouth Medical School described 0:17:01.240 --> 0:17:05.600 as a fickle veneer. In places where people defecate in 0:17:05.640 --> 0:17:10.120 their open and sewage isn't properly handled and treated, that 0:17:10.240 --> 0:17:14.760 veneer is more like a shag pile carpet, and it 0:17:14.800 --> 0:17:18.800 means fecal jams are readily ingested via contaminated food and water. 0:17:19.800 --> 0:17:23.440 If you've had travelers diarrhea, it was most probably caused 0:17:23.440 --> 0:17:27.600 by equally a prime feckal Germ gross right, but it 0:17:27.680 --> 0:17:32.000 helps explain how the most resistant superbugs entered the public 0:17:32.000 --> 0:17:35.320 water supply in places like New Delhi, reside in the 0:17:35.400 --> 0:17:39.280 bodies of tens of millions of people, and have emerged 0:17:39.280 --> 0:17:43.480 as global public health enemy number one. If you're sanitation 0:17:43.520 --> 0:17:47.560 scenario is not good in the community, the superbug spread 0:17:48.000 --> 0:17:53.560 in the water systems, superbug spread in the environment. Healthy 0:17:53.680 --> 0:17:58.439 people ingest eat the superbugs in the food and water. 0:17:59.280 --> 0:18:02.880 India's toil at shortage has contributed to a sanitation crisis 0:18:03.320 --> 0:18:07.480 that stoked the superbug crisis. Prime Minister Norander Emoti is 0:18:07.480 --> 0:18:10.600 trying to fix that with the largest toilet building spree 0:18:10.720 --> 0:18:14.240 in human history. Well, that's great news for public health 0:18:14.320 --> 0:18:19.000 and could eventually make a huge difference for now potentially 0:18:19.040 --> 0:18:23.120 deadly gems continue to invade people's systems. There's an easy 0:18:23.119 --> 0:18:26.359 way to tell if someone is harboring drug resistant bacteria 0:18:26.440 --> 0:18:29.600 in their bow. You test their waste. Three years ago, 0:18:29.760 --> 0:18:33.640 Dr Gafour and colleagues collected a thousand stool samples from 0:18:33.640 --> 0:18:37.439 Healthy at All volunteers across three cities. They found one 0:18:37.480 --> 0:18:42.320 in every fifteen urban Indians carry in their intestines and 0:18:42.520 --> 0:18:46.240 shed in their stool common bacteria that are resistant to 0:18:46.280 --> 0:18:49.800 a class of last line antibiotics known as carbon pennam. 0:18:50.880 --> 0:18:54.240 When doctors use a carbon penum, it typically means none 0:18:54.240 --> 0:18:57.800 of the standard therapy is work, and if superbugs that 0:18:57.840 --> 0:19:01.080 are resistant to carbon penems are spreading in the environment 0:19:01.119 --> 0:19:05.280 and contaminating food and water, it accelerates the loss of 0:19:05.359 --> 0:19:09.240 a critical treatment doctors like A four can use. Carbon 0:19:09.760 --> 0:19:13.359 is the most important antibiotic available in the clinical practice. 0:19:13.840 --> 0:19:17.560 We can call the extremely Druger system bacteria. They're not 0:19:17.680 --> 0:19:20.399 hospital but the god from the food and water they 0:19:20.440 --> 0:19:26.000 consume every day. The bacteria like E. Colila are normal 0:19:26.200 --> 0:19:30.119 bacteria off your inderstine. If they get an opportunity to 0:19:30.280 --> 0:19:34.720 enter the blood, of course, then it's severe sepsist, severe infection. 0:19:35.440 --> 0:19:38.719 If you don't treat, you will die of these infections. 0:19:38.760 --> 0:19:41.400 But it's not just the food and water that's causing 0:19:41.520 --> 0:19:46.440 India's superbow crisis. India is the world's largest manufacturer and 0:19:46.600 --> 0:19:50.120 user of antibiotics for human health, and it's the fourth 0:19:50.160 --> 0:19:54.160 biggest user in food producing animals. These drugs are easy 0:19:54.200 --> 0:19:57.800 to get, often obtainable without a prescription, and that means 0:19:57.840 --> 0:20:01.760 it's easy for bacteria to develop resistance. The problem in 0:20:01.760 --> 0:20:06.480 India is it's not regulated. That's Dr Bovner Syrie. She's 0:20:06.480 --> 0:20:09.399 worked in medical oncology in India and the UK for 0:20:09.480 --> 0:20:12.800 twenty five years. I first interviewed her in New Delhi 0:20:12.840 --> 0:20:15.360 for a story on superbugs a decade ago and we've 0:20:15.400 --> 0:20:18.800 kept in touch. So if I go up to a pharmacy, 0:20:19.480 --> 0:20:22.360 what if I even phone call a pharmacy, they will 0:20:22.400 --> 0:20:26.080 deliver the antibiotics at home. And and that's a fact 0:20:26.520 --> 0:20:30.239 definitely in small towns, which is wrong. There should be 0:20:30.359 --> 0:20:34.919 some form of regulation for prescription of antibiotics. What the 0:20:35.000 --> 0:20:40.400 indiscriminate use of antibiotics does is it promotes antibiotic resistance. 0:20:40.480 --> 0:20:44.400 We know that Dr Syrilee isn't seeing in her practice 0:20:44.680 --> 0:20:48.159 the same levels of extreme drug resistance that Dr Gofour 0:20:48.280 --> 0:20:52.000 and other specialists around India have reported, but she's alert 0:20:52.080 --> 0:20:55.120 to the problem. In London, Dr SyRI we would consult 0:20:55.240 --> 0:20:59.320 via Skype to reduce her patients travel costs. In India, 0:20:59.520 --> 0:21:03.160 she as this to minimize her patient's contact with health 0:21:03.200 --> 0:21:07.879 care facilities where superbugs are concentrated in sick patients and 0:21:07.920 --> 0:21:11.520 can spread because of inadequate cleaning and infection control practices. 0:21:12.160 --> 0:21:17.520 Antibiotic resistance is a huge concern for both oncologists and 0:21:17.680 --> 0:21:21.840 cancer patients worldwide, whether it's it's in uk or India. 0:21:22.600 --> 0:21:27.160 One of the commonest side effects of treatment is that 0:21:27.400 --> 0:21:32.760 the patients are immuno compromised. Antibiotic resistance is a discussion 0:21:32.800 --> 0:21:36.360 that we have to have with all patients that are 0:21:36.440 --> 0:21:40.840 going to undergo immunosuppressive treatment. If a patient gets an 0:21:40.840 --> 0:21:45.840 infection with a multi drug resistant organism and we're not 0:21:45.960 --> 0:21:49.200 able to treat that infection, the cancer may be curable, 0:21:49.720 --> 0:21:51.960 but we lose the patient to the infection, which is 0:21:52.040 --> 0:21:56.840 unacceptable in this day and age. I think antibiotic resistance 0:21:56.920 --> 0:22:00.720 is a huge concern for all of us. Cancer treatment 0:22:00.760 --> 0:22:05.440 breaches the body's natural defenses in multiple ways. For instance, 0:22:05.760 --> 0:22:08.040 the skin gets pierced when a needle is inserted for 0:22:08.080 --> 0:22:12.800 an intravenous infusion, but there's a critical vulnerability patient's face 0:22:12.880 --> 0:22:17.320 when they undergo chemotherapy. Those potent drugs target cells that 0:22:17.359 --> 0:22:21.520 grow in divide quickly as cancer cells do, but there's 0:22:21.520 --> 0:22:25.560 often some collateral damage to healthy cells too. Hair can 0:22:25.600 --> 0:22:29.199 fall out, and the mucous membrane that lines the digestive 0:22:29.280 --> 0:22:32.520 tract from the mouth to the anus can effectively slough 0:22:32.640 --> 0:22:37.400 off injury to that protective barrier can enable bacteria from 0:22:37.400 --> 0:22:40.919 the gastro intestinal tract to enter the blood stream and 0:22:41.000 --> 0:22:46.080 cause an infection. Bloodstream infections are very common in cancer 0:22:46.119 --> 0:22:49.360 patients with low white blood cell levels when the culprit 0:22:49.480 --> 0:22:53.280 is a carbon PanAm resistant jam after two thirds of 0:22:53.320 --> 0:22:57.640 patients die. One study found a New Delhi almost three 0:22:57.760 --> 0:23:01.320 quarters of patients with leukemia and other blood cancers. How 0:23:01.440 --> 0:23:06.080 are those dangerous bags? Here's dr Abduga for again. The 0:23:06.200 --> 0:23:09.240 death rate of patient with a carbon pon and resistant 0:23:09.240 --> 0:23:12.600 superbug and the blood is anywhere sixty to seventy percentage. 0:23:13.200 --> 0:23:15.840 So if I if I have a pay cancer chemotrapy 0:23:15.880 --> 0:23:20.159 patient with a carbon resistant superbul CPSLA in the blood, 0:23:20.400 --> 0:23:23.679 I can predict the chance of that patient dying is 0:23:23.960 --> 0:23:28.200 sixty percentage or more. If that is also a colistint resistance, 0:23:28.240 --> 0:23:30.919 I can predict the chance of that patient is dying 0:23:31.080 --> 0:23:34.760 is eighty percentage or more. That means a patient is 0:23:34.800 --> 0:23:38.480 getting this infection is most likely these patients will die. 0:23:38.920 --> 0:23:42.280 And this has become a daily routine for people like 0:23:42.400 --> 0:23:46.280 me in countries with high superbul grades. We are literally 0:23:46.320 --> 0:23:51.399 living in post antibiotic era, especially in South Asia and 0:23:51.560 --> 0:23:56.640 militrding countries, and Dr gofour reminds us that creating awareness 0:23:56.720 --> 0:24:01.040 and changing behavior is a mammoth task. India is a 0:24:01.160 --> 0:24:06.800 large country one point three billion population, seventy thousand hospitals, 0:24:07.080 --> 0:24:11.440 one million doctors, half a million pharmacies. Eight is a 0:24:11.520 --> 0:24:17.480 huge challenge. The present momentum is not enough. We need 0:24:17.520 --> 0:24:21.320 to really understand the magnitude of the challenge and find 0:24:21.400 --> 0:24:26.600 solution on the ground that's not really happening. Dr G 0:24:26.760 --> 0:24:30.040 four has spent years speaking about the issue. In two 0:24:30.040 --> 0:24:33.119 thousand and twelve, he convened a symposium that led to 0:24:33.160 --> 0:24:36.840 a national road map to tackle the problem. Dr GO 0:24:36.960 --> 0:24:41.000 four was lauded internationally for taking positive action, but it 0:24:41.119 --> 0:24:43.400 put him in the crosshairs of some of India's health 0:24:43.400 --> 0:24:47.280 care businesses. Dr Go for himself works in a private hospital. 0:24:48.000 --> 0:24:50.080 Many of my friends in the healthcare industry have told 0:24:50.119 --> 0:24:55.240 me what you do is adversely affecting our business. This 0:24:55.400 --> 0:24:59.040 is my answer to them, No, I'm trying to protect 0:24:59.080 --> 0:25:04.199 our business because if people like me don't talk, policies 0:25:04.320 --> 0:25:08.000 won't change. If our patients will die. How can we 0:25:08.280 --> 0:25:12.600 how can we sustain an industry so very, very very 0:25:12.600 --> 0:25:17.080 difficult scenario. The industry you are trying to protect sometimes 0:25:17.800 --> 0:25:22.240 blame you, and that's a real painful scenario people like 0:25:22.400 --> 0:25:27.480 me are facing. Dr Gerford told me there is progress, 0:25:27.520 --> 0:25:31.320 but it's slow. In July, the Indian government limited the 0:25:31.440 --> 0:25:36.360 use of Colliston. That drug of last resort was discovered 0:25:36.359 --> 0:25:39.520 in the nineteen fifties, but doctors quickly stopped using it 0:25:39.960 --> 0:25:43.640 because of its toxic effects on the kidneys. While humans 0:25:43.640 --> 0:25:46.879 weren't using colliston, the drug was in popular use on 0:25:47.040 --> 0:25:50.200 poultry farms, where farmers fed its animals to stave off 0:25:50.240 --> 0:25:54.200 disease and hasten their growth. But the Ministry of Health 0:25:54.200 --> 0:25:58.240 and Family Welfare ordered us stop to that practice. The 0:25:58.320 --> 0:26:01.639 results of that policy are you to be seen, and 0:26:01.720 --> 0:26:05.439 maybe too late. Five years ago I visited one of 0:26:05.480 --> 0:26:09.800 India's largest private ne andatal intensive care units. Colliston was 0:26:09.880 --> 0:26:13.000 the go to drug there for treating babies with sepsis 0:26:13.040 --> 0:26:16.639 because nothing else worked as well. Two years later, the 0:26:16.760 --> 0:26:20.520 same hospital had seen two cases of Colliston resistant infections. 0:26:21.320 --> 0:26:25.200 It's a tragedy familiar to Dr G four. I used 0:26:25.240 --> 0:26:29.879 to see patients quite sporadically. Maybe once in six months. 0:26:30.320 --> 0:26:33.840 Once a year, I get this kind of bacteria, but assistant. 0:26:33.880 --> 0:26:40.280 Everything that has changed. No, I treat a colistem resistant 0:26:40.400 --> 0:26:44.440 infection once in two weeks. It's nothing unusual for me. 0:26:44.720 --> 0:26:47.280 So I can't remember the number of patients with the 0:26:47.320 --> 0:26:50.439 pand regorously infections I have treated. I treat dozens and 0:26:50.520 --> 0:26:53.560 dozens of patients with the panned regorously infections of my 0:26:53.560 --> 0:26:56.120 my career or the last few years. In the last 0:26:56.160 --> 0:26:59.359 few years, for Dr four, both his missions as a 0:26:59.440 --> 0:27:04.160 teacher and a doctor have become harder. By speaking out 0:27:04.200 --> 0:27:08.560 about the crisis, his face criticism from within his own industry, 0:27:08.800 --> 0:27:12.359 and as a doctor, the spread of superbugs has meant 0:27:12.359 --> 0:27:16.840 his tools for treating his patients are deteriorating more and more. 0:27:17.400 --> 0:27:20.119 He sees cases like the young student he couldn't save, 0:27:20.640 --> 0:27:24.440 and these cases weigh on him. It was actually a 0:27:24.760 --> 0:27:29.359 disappointment because as a doctor, as an infection specialist, living 0:27:29.400 --> 0:27:33.680 in twenty first century, with all the inventions and discoveries 0:27:33.720 --> 0:27:37.840 in modern medicine, especially oncology, I felt my hands are 0:27:37.920 --> 0:27:43.240 tied because I can't cure my patients infection. If I 0:27:43.280 --> 0:27:47.240 can cure my patients infection, however, wonderful the field of 0:27:47.240 --> 0:27:50.240 oncology is how about what about developments in the field 0:27:50.240 --> 0:27:53.040 of oncology. They are not going to be useful because 0:27:53.280 --> 0:28:04.359 we know cancer patients die of infection, but there is 0:28:04.600 --> 0:28:08.320 still some hope. Aside from the government restricting the use 0:28:08.359 --> 0:28:13.080 of Colliston, there is one possible cocktail that could help 0:28:13.080 --> 0:28:17.680 in the fight against these extreme superbugs, an intravenous infusion 0:28:17.720 --> 0:28:20.919 of two antibiotics that fires the cells as Zafa sefter, 0:28:21.720 --> 0:28:26.920 in combination with another injectable antibiotic which Bristol Myers Squibs 0:28:26.960 --> 0:28:31.480