1 00:00:02,120 --> 00:00:03,920 Speaker 1: There's a question. I've been waiting a long time to 2 00:00:03,960 --> 00:00:06,800 Speaker 1: ask you phage or phage? 3 00:00:08,440 --> 00:00:11,600 Speaker 2: I say phage. Some people say fage. 4 00:00:12,119 --> 00:00:15,600 Speaker 1: Faj Come on, get the fuj out of here. What 5 00:00:15,720 --> 00:00:16,000 Speaker 1: is it? 6 00:00:17,000 --> 00:00:19,919 Speaker 2: I think phage and phage are so similar that we 7 00:00:20,280 --> 00:00:25,119 Speaker 2: can work with that. It's Greek for killer or to 8 00:00:25,239 --> 00:00:25,799 Speaker 2: sort of eat. 9 00:00:26,480 --> 00:00:29,240 Speaker 1: But in English. Yeah, so you're saying, you say phage 10 00:00:30,000 --> 00:00:30,520 Speaker 1: rhymes with. 11 00:00:30,560 --> 00:00:32,600 Speaker 2: Age, I say phage. 12 00:00:33,080 --> 00:00:36,239 Speaker 1: I'm talking with Tom Ireland. He is a science journalist 13 00:00:36,240 --> 00:00:39,080 Speaker 1: who just wrote a book called The Good Virus, and 14 00:00:39,200 --> 00:00:43,640 Speaker 1: it is all about phages. Phages are these amazing viruses 15 00:00:43,800 --> 00:00:45,800 Speaker 1: that have sort of flown under the radar since they 16 00:00:45,800 --> 00:00:48,000 Speaker 1: were discovered in the first part of the twentieth century. 17 00:00:48,720 --> 00:00:54,440 Speaker 1: Phages also known as bacteria phages are viruses that kill bacteria, 18 00:00:55,120 --> 00:00:57,440 Speaker 1: and that is a very useful trait if you need 19 00:00:57,480 --> 00:01:00,680 Speaker 1: to kill bacteria that are making someone really sick. And 20 00:01:00,720 --> 00:01:03,360 Speaker 1: in fact, Tom told me people are now turning to 21 00:01:03,400 --> 00:01:06,720 Speaker 1: phages to try to treat infections that can't be cured 22 00:01:06,800 --> 00:01:07,840 Speaker 1: with antibiotics. 23 00:01:08,440 --> 00:01:11,679 Speaker 2: I think this year is the year that it all changes, 24 00:01:11,720 --> 00:01:16,319 Speaker 2: because the crisis of drug resistance is so acute and 25 00:01:16,480 --> 00:01:19,480 Speaker 2: so scary. Now that we have to take it seriously. 26 00:01:19,520 --> 00:01:23,520 Speaker 2: So the World Economic Forum this year named phage therapy 27 00:01:23,560 --> 00:01:26,640 Speaker 2: in their top ten Emerging technologies for twenty twenty three. 28 00:01:27,240 --> 00:01:30,360 Speaker 2: You know, we're not just guessing and throwing viruses into 29 00:01:30,360 --> 00:01:33,960 Speaker 2: people with bloodstream anymore. This is a kind of modern 30 00:01:34,520 --> 00:01:38,240 Speaker 2: phage therapy two point zero, and there's some real momentum 31 00:01:38,240 --> 00:01:39,200 Speaker 2: building behind the idea. 32 00:01:39,240 --> 00:01:43,680 Speaker 1: Now, we spend a lot of time on this show 33 00:01:43,720 --> 00:01:47,720 Speaker 1: talking about viruses that are bad for humans, Viruses that 34 00:01:47,840 --> 00:01:51,120 Speaker 1: make us sick, viruses that have killed hundreds of millions 35 00:01:51,160 --> 00:01:55,240 Speaker 1: of people. Today, for the season finale, we bring you 36 00:01:55,320 --> 00:01:59,600 Speaker 1: a shocking twist show about viruses that are good for people, 37 00:02:00,080 --> 00:02:04,200 Speaker 1: Viruses that help us fight disease. We'll hear the story 38 00:02:04,240 --> 00:02:07,040 Speaker 1: of one of the first scientists to study phages. He 39 00:02:07,160 --> 00:02:10,239 Speaker 1: was kind of a genius, but also he was kind 40 00:02:10,240 --> 00:02:13,799 Speaker 1: of shady. And then we'll talk to a scientist who 41 00:02:13,800 --> 00:02:17,760 Speaker 1: collects phages in lakes and sewage plants and then uses 42 00:02:17,800 --> 00:02:21,560 Speaker 1: them to treat patients with life threatening infections that cannot 43 00:02:21,600 --> 00:02:26,280 Speaker 1: be treated with antibiotics. I'm Jacob Goldstein. This is incubation 44 00:02:39,360 --> 00:02:42,919 Speaker 1: in the world on planet Earth right now. How many 45 00:02:43,000 --> 00:02:45,840 Speaker 1: phages not kinds of phages, but phages. 46 00:02:46,280 --> 00:02:49,440 Speaker 2: So there's a number that goes around a lot. It's 47 00:02:49,440 --> 00:02:53,799 Speaker 2: a very rough calculation, but it's ten with thirty one 48 00:02:53,880 --> 00:02:56,480 Speaker 2: zeros after it. One way of thinking of that is 49 00:02:57,840 --> 00:03:01,920 Speaker 2: a trillion phages for every grain of sand on the planet. 50 00:03:05,040 --> 00:03:06,639 Speaker 2: So just just crazy numbers. 51 00:03:07,400 --> 00:03:09,120 Speaker 1: I don't know what to do with that. You said 52 00:03:09,120 --> 00:03:11,200 Speaker 1: a trillion for every grain of sand. That's like a 53 00:03:11,200 --> 00:03:13,080 Speaker 1: come on kind of number, right, I mean, I guess 54 00:03:13,080 --> 00:03:15,720 Speaker 1: one way to think of it is like we actually 55 00:03:15,800 --> 00:03:18,440 Speaker 1: live on phage planet. Like we think we're the main 56 00:03:18,520 --> 00:03:20,560 Speaker 1: thing going on on the planet, but maybe we aren't. 57 00:03:21,160 --> 00:03:24,400 Speaker 2: Yeah, life is evolved in a soup of viruses, and 58 00:03:24,440 --> 00:03:27,839 Speaker 2: most of those viruses are phages. And if a kind 59 00:03:27,840 --> 00:03:31,720 Speaker 2: of alien life form was to just pluck a random 60 00:03:31,919 --> 00:03:35,840 Speaker 2: bit of the Earth and look for life, they would 61 00:03:35,840 --> 00:03:38,000 Speaker 2: probably find phages and nothing else, you know, if they 62 00:03:38,040 --> 00:03:39,840 Speaker 2: just took a random bit of sea water. 63 00:03:40,040 --> 00:03:40,800 Speaker 3: Huh. 64 00:03:40,880 --> 00:03:43,280 Speaker 1: So we've been talking about phages at this sort of 65 00:03:43,680 --> 00:03:49,120 Speaker 1: macro level, big picture level at a more micro level, 66 00:03:49,160 --> 00:03:52,400 Speaker 1: like what's a phage look like? I know they're very small, 67 00:03:52,640 --> 00:03:55,600 Speaker 1: but if you look really closely, what to look like? 68 00:03:56,520 --> 00:03:59,560 Speaker 2: So one of the reasons I'm so interested in phages. 69 00:03:59,640 --> 00:04:04,520 Speaker 2: Is that actually extraordinary looking things? And there was some 70 00:04:06,600 --> 00:04:10,760 Speaker 2: discussion in the phage community that the lunar landers were 71 00:04:10,760 --> 00:04:13,760 Speaker 2: actually based on a certain type of phage. I was 72 00:04:13,800 --> 00:04:17,200 Speaker 2: never able to confirm that, but they have a remarkably 73 00:04:17,240 --> 00:04:19,960 Speaker 2: similar structure, and they look almost like kind of tiny 74 00:04:20,279 --> 00:04:26,240 Speaker 2: robotic nano machines or spiders. They're weirdly angular. So they 75 00:04:26,279 --> 00:04:30,800 Speaker 2: have this twenty sided head which looks quite sinister, which 76 00:04:30,839 --> 00:04:33,680 Speaker 2: contains all of the DNA. Then they have this long 77 00:04:34,240 --> 00:04:38,520 Speaker 2: tail which actually acts like a kind of molecular syringe 78 00:04:38,560 --> 00:04:43,760 Speaker 2: which can inject the genes from the head into the bacteria. 79 00:04:43,800 --> 00:04:46,559 Speaker 2: And then they have these kind of spider like little 80 00:04:46,600 --> 00:04:49,560 Speaker 2: legs which they use to land on the surface of 81 00:04:49,560 --> 00:04:52,960 Speaker 2: the bacteria and bind to it. There's this head that 82 00:04:53,000 --> 00:04:56,400 Speaker 2: has the payload in whether that's astronauts or genes, and 83 00:04:56,440 --> 00:05:01,040 Speaker 2: then the landing legs. And then once once the phage 84 00:05:01,120 --> 00:05:06,240 Speaker 2: is landed and injects the DNA, and it essentially hijacks 85 00:05:06,279 --> 00:05:08,600 Speaker 2: the bacteria and turns it into a virus factory. 86 00:05:09,200 --> 00:05:09,719 Speaker 3: Amazing. 87 00:05:10,279 --> 00:05:14,200 Speaker 1: You know, viruses are generally thought of as bad, and 88 00:05:14,240 --> 00:05:18,960 Speaker 1: it is sort of delightful to encounter this large universe 89 00:05:19,480 --> 00:05:22,320 Speaker 1: of helpful viruses, like I'm very happy to be discovering 90 00:05:22,360 --> 00:05:23,320 Speaker 1: these good viruses. 91 00:05:24,160 --> 00:05:27,599 Speaker 2: Yeah, and they vastly outnumber the ones that we fear 92 00:05:27,880 --> 00:05:31,880 Speaker 2: and hate. It's really interesting that the idea of using 93 00:05:31,920 --> 00:05:35,200 Speaker 2: them to kill bacteria and kill the bacteria that caused 94 00:05:35,240 --> 00:05:38,720 Speaker 2: disease is not new at all. You know, they were 95 00:05:38,760 --> 00:05:43,640 Speaker 2: being used in medicine decades before the first real antibiotic, penicillin. 96 00:05:44,080 --> 00:05:46,400 Speaker 2: They were being used in the twenties and the thirties, 97 00:05:46,839 --> 00:05:51,480 Speaker 2: and this idea of using them as allies as medicines 98 00:05:51,560 --> 00:05:55,599 Speaker 2: is becoming you know, it's being taken really seriously again. Yeah. 99 00:05:55,720 --> 00:05:56,080 Speaker 3: Right. 100 00:05:56,360 --> 00:06:00,159 Speaker 1: That goes back to the early part of the twentieth century. 101 00:06:00,640 --> 00:06:03,839 Speaker 1: And there is this key figure who you write a 102 00:06:03,839 --> 00:06:07,320 Speaker 1: lot about in your book. Really interesting story. So tell 103 00:06:07,360 --> 00:06:09,239 Speaker 1: me about him. Tell me about Felix Durell. 104 00:06:10,240 --> 00:06:14,920 Speaker 2: So, Felix Durel's fascinating character, a real maverick. He's kind 105 00:06:14,920 --> 00:06:19,440 Speaker 2: of self taught, volatile, has none of the diplomacy that 106 00:06:19,560 --> 00:06:22,960 Speaker 2: was expected of kind of gentlemen scientists of the early 107 00:06:23,000 --> 00:06:26,440 Speaker 2: twentieth century. There's a dispute about whether he's French or 108 00:06:26,440 --> 00:06:30,520 Speaker 2: Canadian or Belgian because he kept changing his name. He 109 00:06:30,560 --> 00:06:34,120 Speaker 2: didn't really go to college to university. He spent his 110 00:06:34,279 --> 00:06:37,919 Speaker 2: teenage years traveling around Europe. He moved over to Canada, 111 00:06:38,240 --> 00:06:42,719 Speaker 2: declared himself a microbiologist. He was commissioned by the Canadian 112 00:06:42,720 --> 00:06:46,880 Speaker 2: government to make whiskey from maple syrup, which maybe the 113 00:06:46,920 --> 00:06:50,480 Speaker 2: most Canadian thing I've ever heard. And then he had 114 00:06:50,520 --> 00:06:54,839 Speaker 2: this period of kind of conducting completely wild, lawless science 115 00:06:55,320 --> 00:07:00,880 Speaker 2: as an infectious disease doctor in Mexico and Watemala, where 116 00:07:00,920 --> 00:07:03,480 Speaker 2: he was really given free reign to do what he wanted. 117 00:07:03,680 --> 00:07:09,800 Speaker 2: So a really unconventional background, very brash and terrible diplomacy, 118 00:07:09,960 --> 00:07:12,720 Speaker 2: you know. So he made lots of enemies. People were 119 00:07:12,800 --> 00:07:15,480 Speaker 2: very suspicious of him, and he was just, you know, 120 00:07:15,680 --> 00:07:19,920 Speaker 2: just the ultimate kind of outcast, I suppose in a 121 00:07:20,960 --> 00:07:22,840 Speaker 2: very important scientific field. 122 00:07:23,200 --> 00:07:26,520 Speaker 1: How does Dourell make his discovery about features. 123 00:07:26,840 --> 00:07:31,760 Speaker 2: In the nineteen tens, He essentially stumbles across this amazing 124 00:07:31,800 --> 00:07:35,840 Speaker 2: of observation, which is that he has plates of bacteria 125 00:07:36,000 --> 00:07:39,280 Speaker 2: that he's working on. It's called a lawn of bacteria. 126 00:07:39,720 --> 00:07:42,040 Speaker 2: It doesn't look like much, but it's kind of opaque 127 00:07:42,080 --> 00:07:44,560 Speaker 2: and milky, and that means all of your bacteria is 128 00:07:44,600 --> 00:07:48,720 Speaker 2: growing nicely on whatever medium. You've given it to grow on. 129 00:07:49,080 --> 00:07:52,840 Speaker 2: And he starts noticing on some of his plates there's 130 00:07:52,920 --> 00:07:56,280 Speaker 2: holes and there's literally nothing there. Ah, And he takes 131 00:07:56,360 --> 00:07:58,960 Speaker 2: a little touch from the middle of one of these holes, 132 00:07:59,360 --> 00:08:02,880 Speaker 2: and he just which is another plate of completely healthy, uniform, 133 00:08:02,960 --> 00:08:07,120 Speaker 2: milky bacteria. A hole starts growing on that too, And 134 00:08:07,160 --> 00:08:09,680 Speaker 2: then he can do this indefinitely. He can take a 135 00:08:09,760 --> 00:08:13,560 Speaker 2: touch from the hole and touch it on another healthy 136 00:08:13,560 --> 00:08:17,320 Speaker 2: plate of bacteria. The hole starts growing again. So he 137 00:08:17,440 --> 00:08:21,600 Speaker 2: knows this isn't just something that's a kind of antibacterial chemical. 138 00:08:22,080 --> 00:08:26,200 Speaker 2: This has the power of replication. This is growing at 139 00:08:26,360 --> 00:08:29,640 Speaker 2: the expense of the bacteria. So it's a double whammy 140 00:08:29,760 --> 00:08:34,480 Speaker 2: of scientific discovery because he's he's found something that seems 141 00:08:34,480 --> 00:08:38,480 Speaker 2: to be killing bacteria really quickly and really efficiently, all 142 00:08:38,520 --> 00:08:41,800 Speaker 2: at once. He has a suite of theories. He theorizes 143 00:08:41,880 --> 00:08:45,400 Speaker 2: that this is a virus that kills bacteria. He works 144 00:08:45,440 --> 00:08:47,880 Speaker 2: out that they are replicating inside the bacteria and then 145 00:08:48,480 --> 00:08:53,600 Speaker 2: bursting out. He also theorizes that phages are maybe part 146 00:08:53,640 --> 00:08:57,160 Speaker 2: of our immune system, and that when someone spontaneously recovers 147 00:08:57,160 --> 00:09:01,240 Speaker 2: from a disease, perhaps it's phages in our guts or 148 00:09:01,320 --> 00:09:04,720 Speaker 2: in our body that has helped us recover from that disease. 149 00:09:09,320 --> 00:09:12,880 Speaker 2: So as well as being completely groundbreaking, that latter idea 150 00:09:12,920 --> 00:09:14,720 Speaker 2: of them being part of our immune system was kind 151 00:09:14,760 --> 00:09:16,840 Speaker 2: of heretical at the time. You know, it was a 152 00:09:16,880 --> 00:09:18,439 Speaker 2: completely wild and wacky theory. 153 00:09:19,120 --> 00:09:23,120 Speaker 1: This is a moment when there are no antibiotics in 154 00:09:23,160 --> 00:09:25,560 Speaker 1: the world, right, this is the moment when, no matter 155 00:09:25,600 --> 00:09:28,200 Speaker 1: how rich you are, if you get a little infection 156 00:09:28,880 --> 00:09:32,720 Speaker 1: on your foot, you might die from it. Right, truly, 157 00:09:32,840 --> 00:09:36,800 Speaker 1: like there is no way to reliably and safely kill bacteria. 158 00:09:36,880 --> 00:09:39,720 Speaker 1: So like this is a huge, huge thing. 159 00:09:40,400 --> 00:09:44,520 Speaker 2: Yeah, when he presented these ideas to the world, the 160 00:09:44,720 --> 00:09:48,880 Speaker 2: establishment of these huge you know, microbiologists of the time 161 00:09:49,080 --> 00:09:52,440 Speaker 2: they just said, there's no way this is true. I 162 00:09:52,480 --> 00:09:57,640 Speaker 2: think one of them actually said, if this microbe exists, 163 00:09:57,920 --> 00:10:00,680 Speaker 2: I would have found it by now. People just couldn't 164 00:10:00,679 --> 00:10:03,880 Speaker 2: believe that he'd discovered this entirely new form of life 165 00:10:04,200 --> 00:10:06,800 Speaker 2: that had such a powerful potential use in medicine. 166 00:10:07,200 --> 00:10:11,319 Speaker 1: So he has discovered this incredible thing, there's this obvious 167 00:10:11,640 --> 00:10:16,960 Speaker 1: potential for clinical applications, right, how does he try and 168 00:10:17,000 --> 00:10:20,840 Speaker 1: take this idea and actually use it as a treatment. 169 00:10:22,120 --> 00:10:26,120 Speaker 2: Yes, So this is before clinical trials. Felix Drel walks 170 00:10:26,160 --> 00:10:30,040 Speaker 2: into a children's hospital in Paris and says, I have 171 00:10:30,120 --> 00:10:33,600 Speaker 2: a way of treating dysentery, this horrible inflammation of the 172 00:10:33,640 --> 00:10:38,080 Speaker 2: bowels which causes you to essentially have such severe diarrhea 173 00:10:38,080 --> 00:10:42,160 Speaker 2: that you die. And they decide to give a dose 174 00:10:42,200 --> 00:10:46,640 Speaker 2: of phases to two young kids from a particular family 175 00:10:46,880 --> 00:10:52,360 Speaker 2: who've come in with very severe dysentery, and you know, 176 00:10:52,480 --> 00:10:53,640 Speaker 2: they make a full recovery. 177 00:10:53,760 --> 00:10:56,320 Speaker 1: I mean, one question is how often does that happen 178 00:10:56,400 --> 00:10:57,559 Speaker 1: in the absence of treatment? 179 00:10:57,720 --> 00:10:57,920 Speaker 2: Right? 180 00:10:58,000 --> 00:11:00,640 Speaker 1: Like the reason you really want a randomize trial is 181 00:11:00,679 --> 00:11:03,440 Speaker 1: to know is this the treatment, is it in this 182 00:11:03,520 --> 00:11:06,359 Speaker 1: case the phage, or is it just would have happened anyway. 183 00:11:07,000 --> 00:11:10,520 Speaker 2: Exactly So Durrell he tries it on a few more 184 00:11:10,600 --> 00:11:15,200 Speaker 2: kids in this hospital. It's successful. He's essentially selling his 185 00:11:15,280 --> 00:11:19,920 Speaker 2: own cocktails of phages for various different bacterial diseases, and 186 00:11:19,960 --> 00:11:25,600 Speaker 2: he's in this really unusual situation where the establishment microbiologists 187 00:11:26,120 --> 00:11:31,960 Speaker 2: are still suggesting he's wrong, and they don't believe his theory, 188 00:11:31,960 --> 00:11:34,960 Speaker 2: and they're trying to disprove his theory. But he is 189 00:11:35,200 --> 00:11:39,160 Speaker 2: a great salesman of these phage based potions and he 190 00:11:39,480 --> 00:11:43,440 Speaker 2: starts traveling the world and selling them to ministries of 191 00:11:43,480 --> 00:11:46,559 Speaker 2: health and hospital directors, and they don't really care what 192 00:11:47,240 --> 00:11:50,400 Speaker 2: the kind of academics are saying. And within a decade, 193 00:11:50,679 --> 00:11:51,960 Speaker 2: phages are everywhere. 194 00:11:52,120 --> 00:11:56,880 Speaker 1: Does it work? Like? I can't tell? Like he still 195 00:11:56,920 --> 00:11:59,520 Speaker 1: seems shady, Like it could be snake oil. 196 00:11:59,840 --> 00:12:03,400 Speaker 2: I think Felix Drell, who had an understanding of phages 197 00:12:03,559 --> 00:12:06,240 Speaker 2: that was greater than anyone else on the planet. He 198 00:12:06,400 --> 00:12:11,520 Speaker 2: developed a way of actually understanding which strains of bacteria 199 00:12:11,559 --> 00:12:14,520 Speaker 2: were circulating in a given place at a given time, 200 00:12:14,880 --> 00:12:18,520 Speaker 2: and then creating a remedy based on phages that he 201 00:12:18,600 --> 00:12:22,320 Speaker 2: knew could kill those bacteria. As soon as pharmaceutical companies 202 00:12:22,360 --> 00:12:25,120 Speaker 2: got involved and started trying to make products that were 203 00:12:25,160 --> 00:12:29,280 Speaker 2: like mass market products, you know, it was completely hit 204 00:12:29,320 --> 00:12:33,360 Speaker 2: and miss. So there was this complete inconsistency. At the time. 205 00:12:33,440 --> 00:12:38,400 Speaker 2: People didn't understand phages well enough, and so phages got 206 00:12:38,440 --> 00:12:41,599 Speaker 2: this reputation as being inconsistent, which they really struggled to 207 00:12:42,120 --> 00:12:44,880 Speaker 2: shake off until antibiotics came along. 208 00:12:45,120 --> 00:12:50,520 Speaker 1: So let's talk about that. So antibiotics come along in 209 00:12:50,760 --> 00:12:56,360 Speaker 1: the what nineteen thirties, nineteen forties, Ah, what does the 210 00:12:56,440 --> 00:12:59,680 Speaker 1: rise of antibiotics mean for phage therapy. 211 00:13:01,200 --> 00:13:04,640 Speaker 2: Penicillin was discovered, it was you know, it really was 212 00:13:04,720 --> 00:13:07,040 Speaker 2: a miracle drug. You know, you could mass produce it. 213 00:13:07,559 --> 00:13:10,880 Speaker 2: Doctors knew that if a bacterial disease was one of 214 00:13:10,920 --> 00:13:14,920 Speaker 2: these forty different types of bacteria, if it was caused 215 00:13:14,920 --> 00:13:18,280 Speaker 2: by those bacteria, then penicillin was good for it. And 216 00:13:18,360 --> 00:13:22,560 Speaker 2: so really that phage therapy started to look logistically very 217 00:13:22,600 --> 00:13:25,680 Speaker 2: difficult to administer. You know, you've got to match the 218 00:13:25,720 --> 00:13:28,080 Speaker 2: phage to the bacteria, or you've got to create a 219 00:13:28,120 --> 00:13:31,000 Speaker 2: cocktail of different phages. It just all of a sudden 220 00:13:31,120 --> 00:13:34,320 Speaker 2: seemed like a kind of wild and old fashioned and 221 00:13:34,360 --> 00:13:37,880 Speaker 2: backwards way to treat bacterial infections. And in the West, 222 00:13:37,920 --> 00:13:40,679 Speaker 2: at least, the idea of using phages was like, rah, 223 00:13:41,360 --> 00:13:41,839 Speaker 2: forget it. 224 00:13:42,559 --> 00:13:46,199 Speaker 1: So what's the end of the story of Felix Durell. 225 00:13:47,480 --> 00:13:49,640 Speaker 2: Well, it's not a happy ending for him. Really. He 226 00:13:50,080 --> 00:13:53,520 Speaker 2: died without any kind of acknowledgment of his work. He 227 00:13:53,559 --> 00:13:57,840 Speaker 2: was actually nominated for the Nobel Prize about thirty times 228 00:13:58,200 --> 00:14:01,120 Speaker 2: but never won it. He was a genius in his 229 00:14:01,160 --> 00:14:04,280 Speaker 2: own way and really set the ball rolling for this 230 00:14:04,400 --> 00:14:08,959 Speaker 2: idea of using phages to treat bacterial infections. 231 00:14:10,320 --> 00:14:15,440 Speaker 1: So let's talk about the present. Antibiotics are amazing, but 232 00:14:16,240 --> 00:14:22,000 Speaker 1: bacteria are constantly evolving to resist antibiotics. Ken phages help 233 00:14:22,080 --> 00:14:23,480 Speaker 1: us with intibiotic resistance. 234 00:14:24,600 --> 00:14:27,000 Speaker 2: Yeah, they absolutely can. I mean, it's as I've said, 235 00:14:27,040 --> 00:14:31,120 Speaker 2: it's not straightforward. This is very different to having a 236 00:14:31,120 --> 00:14:35,200 Speaker 2: pharmaceutical chemical that we can use on millions of people. 237 00:14:35,240 --> 00:14:39,080 Speaker 2: There is lab work involved with each case, and you're 238 00:14:39,120 --> 00:14:43,680 Speaker 2: talking about treating people with a living, evolving thing, often 239 00:14:43,720 --> 00:14:45,920 Speaker 2: that's been found in a kind of river or a sewer. 240 00:14:46,440 --> 00:14:49,840 Speaker 2: So there's just huge numbers of like logistical and regulatory 241 00:14:49,960 --> 00:14:53,040 Speaker 2: challenges around this. But you know, they have been evolving 242 00:14:53,080 --> 00:14:56,560 Speaker 2: for billions of years to kill bacteria. They are amazingly 243 00:14:56,560 --> 00:15:00,800 Speaker 2: good at it, and there are countless examples now of 244 00:15:00,840 --> 00:15:04,440 Speaker 2: phage therapy being used to save the life of people 245 00:15:04,520 --> 00:15:08,680 Speaker 2: who have infections that are resistant to every known antibiotic 246 00:15:08,920 --> 00:15:09,720 Speaker 2: in the cabinet. 247 00:15:13,040 --> 00:15:16,400 Speaker 1: Tom Ireland's book is called The Good Virus, The Amazing 248 00:15:16,440 --> 00:15:19,600 Speaker 1: Story and Forgotten Promise of the Phage. We'll be back 249 00:15:19,600 --> 00:15:21,640 Speaker 1: in just a minute to talk to a scientist who 250 00:15:21,760 --> 00:15:34,960 Speaker 1: is using phages to treat disease. Now. In the first 251 00:15:34,960 --> 00:15:37,600 Speaker 1: half of today's show, Tom Ireland talked about how phage 252 00:15:37,600 --> 00:15:40,760 Speaker 1: therapy is being used today to treat people who have 253 00:15:40,960 --> 00:15:44,840 Speaker 1: antibiotic resistant infections. In the second half of today's show, 254 00:15:45,120 --> 00:15:47,440 Speaker 1: I'm going to talk with one of the few researchers 255 00:15:47,440 --> 00:15:50,800 Speaker 1: in the country who is actually doing this work. His 256 00:15:50,920 --> 00:15:54,560 Speaker 1: name is Ben Chan. He's a research scientist in ecology 257 00:15:54,600 --> 00:15:58,560 Speaker 1: and evolutionary biology at Yale. How did you come to 258 00:15:58,600 --> 00:16:01,760 Speaker 1: be a phage guy? How to get into phages? 259 00:16:02,840 --> 00:16:06,720 Speaker 4: Back in grad school I studied amphibian biology. I studied 260 00:16:06,720 --> 00:16:09,240 Speaker 4: parental care behavior of poison dart frogs. 261 00:16:10,720 --> 00:16:12,000 Speaker 3: And you got to do this. 262 00:16:12,000 --> 00:16:15,680 Speaker 4: Amazing field work in amazing places and loved it. And 263 00:16:15,720 --> 00:16:19,560 Speaker 4: there was this fungal disease that's driving amphibian decline. 264 00:16:19,800 --> 00:16:20,840 Speaker 3: And what I really. 265 00:16:20,560 --> 00:16:22,680 Speaker 4: Wanted to do is I wanted to engineer the skin 266 00:16:22,800 --> 00:16:27,080 Speaker 4: microbiome of these poisoned dart frogs by making the bacteria 267 00:16:27,200 --> 00:16:30,160 Speaker 4: produce anti fungals so that they'd be resistant to this disease. 268 00:16:30,200 --> 00:16:31,480 Speaker 4: And I was like, that's how I'm going to save, 269 00:16:31,800 --> 00:16:35,160 Speaker 4: you know, frogs, And I wanted to do so with 270 00:16:35,320 --> 00:16:37,360 Speaker 4: a phage. Actually, I was going to engineer these bacteria 271 00:16:37,400 --> 00:16:38,000 Speaker 4: with phage. 272 00:16:38,360 --> 00:16:40,800 Speaker 1: Ben told me he couldn't get funding for his save 273 00:16:40,880 --> 00:16:44,040 Speaker 1: the Frog's idea. But he wanted to continue his work, 274 00:16:44,440 --> 00:16:47,880 Speaker 1: and in twenty thirteen he started working at a lab 275 00:16:47,920 --> 00:16:50,760 Speaker 1: at Yale where he finds and studies phages. And it 276 00:16:50,840 --> 00:16:53,840 Speaker 1: was there that Ben connected with the surgeon at Yale 277 00:16:53,920 --> 00:16:56,840 Speaker 1: New Haven Hospital. The surgeon told him about this one 278 00:16:57,080 --> 00:16:58,280 Speaker 1: really challenging case. 279 00:16:58,920 --> 00:17:02,040 Speaker 4: So this guy had and aneurysm on his A order. Right, 280 00:17:02,160 --> 00:17:05,720 Speaker 4: the vessels weaken, and when that's a vessel in the body, like, 281 00:17:05,760 --> 00:17:08,280 Speaker 4: if that thing explodes, that's really bad news, right, especially 282 00:17:08,320 --> 00:17:10,959 Speaker 4: the A order, which is like the largest vessel. So 283 00:17:11,040 --> 00:17:13,320 Speaker 4: they you know, bring him into surgery. They cut out 284 00:17:13,320 --> 00:17:17,199 Speaker 4: that piece and replace it with a plastic piece. And 285 00:17:17,240 --> 00:17:20,080 Speaker 4: then it turns out that got infected somehow, So he's 286 00:17:20,080 --> 00:17:22,720 Speaker 4: got this artificial graft onto his heart and then there's 287 00:17:22,760 --> 00:17:25,480 Speaker 4: like pseudomonius bacteria growing on it. 288 00:17:29,400 --> 00:17:31,320 Speaker 1: So to be clear, he has this infection in a 289 00:17:31,359 --> 00:17:33,720 Speaker 1: place you really don't want an infection. Yeah, it's a 290 00:17:33,760 --> 00:17:38,400 Speaker 1: bacterial infection, So great, give him antibiotics. They give him antibiotics. 291 00:17:38,440 --> 00:17:43,080 Speaker 4: What happens, it sort of just suppresses it at best, right, 292 00:17:43,280 --> 00:17:45,000 Speaker 4: So it won't go away with antibiotics, but you can, 293 00:17:45,080 --> 00:17:47,840 Speaker 4: you know, prevent it more or less from killing you, 294 00:17:47,960 --> 00:17:49,800 Speaker 4: I guess, but it's like a slow battle that eventually 295 00:17:49,800 --> 00:17:53,880 Speaker 4: you're gonna lose, and so they're kind of out options. 296 00:17:54,160 --> 00:17:58,840 Speaker 1: So this patient has is infected with this bacteria that 297 00:17:58,880 --> 00:18:01,960 Speaker 1: you can't wipe out with antibiotics. So how does that work? 298 00:18:02,000 --> 00:18:05,200 Speaker 1: How does the bacteria survive the antibiotics? 299 00:18:05,240 --> 00:18:08,400 Speaker 4: Yeah, So there's a few ways that bacteria can survive 300 00:18:08,840 --> 00:18:09,840 Speaker 4: antibiotic exposure. 301 00:18:09,920 --> 00:18:10,040 Speaker 1: Right. 302 00:18:10,040 --> 00:18:12,159 Speaker 4: They can either have an enzyme that chops up the 303 00:18:12,440 --> 00:18:16,160 Speaker 4: antibiotic before it does its job, or they can decrease permeability. 304 00:18:16,560 --> 00:18:20,040 Speaker 4: And then there's this other way, which is called antibiotic eflux, 305 00:18:20,080 --> 00:18:23,160 Speaker 4: where it's the antibiotic gets into the cell and could 306 00:18:23,200 --> 00:18:25,960 Speaker 4: otherwise function and kill the bacteria. But there are these 307 00:18:26,000 --> 00:18:29,919 Speaker 4: special pumps that the bacteria have that recognize antibiotics and 308 00:18:29,960 --> 00:18:32,280 Speaker 4: other sort of toxins and then they pump it out 309 00:18:32,320 --> 00:18:34,320 Speaker 4: before it can do what it's meant to do. 310 00:18:34,640 --> 00:18:39,120 Speaker 3: That's rad yeah, the way they're so smart, right, the yeah. 311 00:18:39,400 --> 00:18:41,840 Speaker 1: And so that's what's going on in this case. Right, 312 00:18:41,880 --> 00:18:44,639 Speaker 1: The bacteria inside this guy has a pump. So you 313 00:18:44,640 --> 00:18:47,600 Speaker 1: give him antibiotics, it goes into the bacteria and the 314 00:18:47,640 --> 00:18:49,360 Speaker 1: bacteria pumps it back out. 315 00:18:49,240 --> 00:18:51,840 Speaker 4: Yeah, and so our natural response would be like, okay, 316 00:18:51,920 --> 00:18:54,280 Speaker 4: let's just throw more antibiotics there, right, And when you 317 00:18:54,320 --> 00:18:56,679 Speaker 4: do that, it makes them make more pumps, right. 318 00:18:56,760 --> 00:18:59,480 Speaker 3: So there it's a tough arms race. 319 00:18:59,520 --> 00:19:04,320 Speaker 1: It's the kind of antibiotic versus pathogen arms. 320 00:19:04,200 --> 00:19:05,080 Speaker 3: Race, yeah, exactly. 321 00:19:05,600 --> 00:19:07,399 Speaker 4: And the more you get in, eventually you're going to 322 00:19:07,440 --> 00:19:08,800 Speaker 4: start seeing some side effects. 323 00:19:08,880 --> 00:19:09,000 Speaker 2: Right. 324 00:19:09,040 --> 00:19:12,320 Speaker 4: You can only put so much chemical in someone before 325 00:19:12,320 --> 00:19:13,360 Speaker 4: there's there's problems. 326 00:19:13,480 --> 00:19:15,600 Speaker 1: Yeah, And what is your idea when you show up? 327 00:19:15,640 --> 00:19:17,720 Speaker 4: So I just was like, well, why don't we try 328 00:19:17,760 --> 00:19:19,639 Speaker 4: to use you know, a bacteria phage, which is a 329 00:19:19,680 --> 00:19:21,880 Speaker 4: virus of bacteria to try and kill this infection because 330 00:19:21,880 --> 00:19:24,560 Speaker 4: it's independent of antibiotic resistance, right, And that's not like 331 00:19:25,200 --> 00:19:27,680 Speaker 4: my idea. Right, They've been doing this since they found 332 00:19:27,720 --> 00:19:30,080 Speaker 4: bacteria phages, or they've been trying it. But I was like, 333 00:19:30,119 --> 00:19:32,480 Speaker 4: you know, it's been years since we've actually done this 334 00:19:33,000 --> 00:19:35,359 Speaker 4: seriously in the United States. Maybe we should, Maybe this 335 00:19:35,400 --> 00:19:38,360 Speaker 4: would be a good case to try it. And so 336 00:19:38,520 --> 00:19:41,080 Speaker 4: the surgeon was like, perfect, let's try it. 337 00:19:41,680 --> 00:19:44,679 Speaker 1: Okay, So the surgeon's on board. What do you do 338 00:19:44,720 --> 00:19:45,080 Speaker 1: from there? 339 00:19:45,680 --> 00:19:48,560 Speaker 4: The first thing is we get the isolate, so the 340 00:19:48,600 --> 00:19:51,760 Speaker 4: clinical lab guy here in the hospital was like, Okay, 341 00:19:51,800 --> 00:19:54,480 Speaker 4: here's your plate of bacteria. So we take this bacteria 342 00:19:54,480 --> 00:19:56,360 Speaker 4: back to the lab and we need to make sure 343 00:19:56,400 --> 00:19:58,600 Speaker 4: that we have a phase that can kill the bacteria. 344 00:19:58,720 --> 00:20:00,760 Speaker 3: Right, ok So we've got this like, you know, fridge 345 00:20:00,800 --> 00:20:01,920 Speaker 3: full of phage. 346 00:20:01,840 --> 00:20:05,080 Speaker 1: And the fridge full of phages, like all different phages, Yeah, 347 00:20:05,280 --> 00:20:07,879 Speaker 1: more or less. How many different phages. 348 00:20:07,680 --> 00:20:08,359 Speaker 3: Do you have. 349 00:20:11,680 --> 00:20:15,400 Speaker 4: Within an order of magnitude one thousand, a thousand? 350 00:20:15,440 --> 00:20:18,399 Speaker 1: So how do you come to have a fridge with 351 00:20:18,680 --> 00:20:19,199 Speaker 1: a thousand? 352 00:20:19,440 --> 00:20:19,640 Speaker 3: Yeah? 353 00:20:19,800 --> 00:20:21,399 Speaker 1: Different kinds of phage. 354 00:20:21,760 --> 00:20:26,040 Speaker 4: Yeah, so you know, regular trips to the sewage treatment 355 00:20:26,280 --> 00:20:29,240 Speaker 4: plant or you know, we're collecting from rivers, our ocean, 356 00:20:29,280 --> 00:20:32,520 Speaker 4: water lakes. We have all different phages for all different 357 00:20:32,520 --> 00:20:36,320 Speaker 4: bacteria because they're really really host specific. So it's not 358 00:20:36,359 --> 00:20:38,240 Speaker 4: like I can take any Coli phage and try to 359 00:20:38,320 --> 00:20:40,760 Speaker 4: kill Staph aureus with it or something. We had sort 360 00:20:40,760 --> 00:20:43,560 Speaker 4: of built up this library of Pseudomonus phages and we 361 00:20:43,600 --> 00:20:46,600 Speaker 4: took his sample and we basically tested all these phages 362 00:20:46,640 --> 00:20:49,639 Speaker 4: on his bacteria I see which ones would kill it. 363 00:20:49,920 --> 00:20:53,480 Speaker 4: And so we had phages and we've had one that 364 00:20:53,680 --> 00:20:57,560 Speaker 4: was I think slightly biased, really cool and that the 365 00:20:57,640 --> 00:21:00,240 Speaker 4: receptor binding site. So what the phage use is to 366 00:21:00,320 --> 00:21:04,440 Speaker 4: grab onto the bacteria and recognize it was this eflux 367 00:21:04,440 --> 00:21:05,800 Speaker 4: pump that we were talking about. 368 00:21:06,320 --> 00:21:06,639 Speaker 3: Huh. 369 00:21:06,960 --> 00:21:09,919 Speaker 4: So you know it in a sea of pseudomonas, not 370 00:21:10,000 --> 00:21:13,560 Speaker 4: all of them have these eflux pumps, and so the 371 00:21:13,600 --> 00:21:15,960 Speaker 4: phage is like looking for just those guys. 372 00:21:16,640 --> 00:21:21,119 Speaker 1: So specifically, this phage, this particular phase that you're optimistic about, 373 00:21:21,400 --> 00:21:25,439 Speaker 1: is actually targeting the thing that allows some of the 374 00:21:25,480 --> 00:21:30,040 Speaker 1: bacteria to resist the antibiotics exactly. So this phage is 375 00:21:30,080 --> 00:21:34,880 Speaker 1: sort of optimal to use in combination with antibiotics. Yeah, right, 376 00:21:34,920 --> 00:21:39,479 Speaker 1: because either the bacteria has a pump and is therefore 377 00:21:39,480 --> 00:21:43,679 Speaker 1: antibiotic resistant but targeted by the phage, or it doesn't 378 00:21:43,680 --> 00:21:46,160 Speaker 1: have a pump, in which case the antibiotics will kill 379 00:21:46,160 --> 00:21:46,760 Speaker 1: it exactly. 380 00:21:46,880 --> 00:21:47,120 Speaker 3: Yep. 381 00:21:47,440 --> 00:21:49,399 Speaker 1: It's a great theory, yeah theory. 382 00:21:49,960 --> 00:21:51,919 Speaker 4: Yeah, yeah, but that's what we had to go with, right. 383 00:21:51,960 --> 00:21:53,960 Speaker 4: It was this this theory and that like the thinking 384 00:21:54,000 --> 00:21:57,679 Speaker 4: that the phage it could either it could kill all 385 00:21:57,680 --> 00:21:59,960 Speaker 4: the bacteria, right and that would be a great out 386 00:22:00,080 --> 00:22:03,040 Speaker 4: come for this guy, or it could kill a lot 387 00:22:03,080 --> 00:22:04,920 Speaker 4: of them and then they could evolve resistance, which would 388 00:22:04,920 --> 00:22:07,439 Speaker 4: not be ideal. But it'd be antibiotic ex sensitive, so 389 00:22:08,240 --> 00:22:10,440 Speaker 4: maybe a win. And we tested it in the lab 390 00:22:10,480 --> 00:22:13,119 Speaker 4: and everything looked great. So I brought this data to 391 00:22:13,200 --> 00:22:15,040 Speaker 4: the surgeon. I was like, look, it seems like it's 392 00:22:15,080 --> 00:22:18,040 Speaker 4: pretty good at what it does. And then he's like, well, 393 00:22:18,119 --> 00:22:20,399 Speaker 4: let's try it cuz you mean, what else we need 394 00:22:20,480 --> 00:22:22,960 Speaker 4: to do? So, you know, it gets the FDA on 395 00:22:23,000 --> 00:22:25,399 Speaker 4: the phone and like, okay, here's a few things you 396 00:22:25,440 --> 00:22:26,760 Speaker 4: need to do to make sure that you're not going 397 00:22:26,800 --> 00:22:31,840 Speaker 4: to like do harm. So we did those quality control 398 00:22:31,920 --> 00:22:34,800 Speaker 4: things and then then they're like, okay, cool'll do it. 399 00:22:34,960 --> 00:22:37,800 Speaker 4: So we had the FDA, the institution, everyone was on board, 400 00:22:38,240 --> 00:22:41,160 Speaker 4: and then all we had to do was the actual procedure. 401 00:22:41,520 --> 00:22:44,360 Speaker 1: So once you get the approval, you've got a patient 402 00:22:44,480 --> 00:22:47,840 Speaker 1: out in the world. You've got this one kind of 403 00:22:47,920 --> 00:22:50,440 Speaker 1: phage yeap, how do you get it into the guy? 404 00:22:50,600 --> 00:22:54,560 Speaker 4: Yeah, so it's like a little clear vial. It's a 405 00:22:54,600 --> 00:22:59,160 Speaker 4: clean phage only solution. And then we brought that from 406 00:22:59,200 --> 00:23:02,119 Speaker 4: the fridge over to the hospital. I just in like 407 00:23:02,200 --> 00:23:04,399 Speaker 4: a little foam cooler, and then we go to the 408 00:23:04,440 --> 00:23:07,840 Speaker 4: operating room where they had had this guy sedated and ready, 409 00:23:08,240 --> 00:23:12,240 Speaker 4: and then the surgeons there, he's like, Okay, we're gonna 410 00:23:12,240 --> 00:23:14,399 Speaker 4: do this. One of the nurses is like, okay, do 411 00:23:14,440 --> 00:23:16,920 Speaker 4: you guys need the like the crash cart. 412 00:23:16,960 --> 00:23:18,639 Speaker 1: To be clear, that crash card is for if the 413 00:23:18,680 --> 00:23:21,639 Speaker 1: patient's heart stops beating, essentially if they die. 414 00:23:21,840 --> 00:23:25,280 Speaker 4: Yeah, And so I'm like, all right, well, now it's 415 00:23:25,280 --> 00:23:28,280 Speaker 4: like definitely real, like it was real before, but now 416 00:23:28,280 --> 00:23:32,080 Speaker 4: it's like, dude, like, don't screw this up. Then they 417 00:23:32,119 --> 00:23:33,800 Speaker 4: start they're like, okay, so here's what we're gonna do. 418 00:23:33,800 --> 00:23:35,879 Speaker 4: We're gonna take this crazy long needle and we're just 419 00:23:35,920 --> 00:23:38,800 Speaker 4: gonna like jam it way down by the base of 420 00:23:38,840 --> 00:23:40,680 Speaker 4: the air or to The hope was they would take 421 00:23:40,680 --> 00:23:45,199 Speaker 4: this needle and get down into the area like and 422 00:23:45,280 --> 00:23:48,520 Speaker 4: puncture a little area where there was the bacteria. Right, 423 00:23:48,520 --> 00:23:50,760 Speaker 4: So they wanted to get into the spot, rinse it out, 424 00:23:50,800 --> 00:23:51,840 Speaker 4: and then shoot in the phage. 425 00:23:52,320 --> 00:23:53,119 Speaker 3: And that was the dream. 426 00:23:53,440 --> 00:23:55,760 Speaker 4: And they just couldn't puncture this area because there's all 427 00:23:55,800 --> 00:24:00,400 Speaker 4: this scar tissue, and so then they're like, well, we're 428 00:24:00,400 --> 00:24:01,840 Speaker 4: just gonna have to call it because we can't get 429 00:24:01,840 --> 00:24:03,439 Speaker 4: in there, and if we push too hard, you know, 430 00:24:03,560 --> 00:24:05,080 Speaker 4: like stab the guy in the heart. 431 00:24:05,240 --> 00:24:07,560 Speaker 3: So we're stuck. And then this. 432 00:24:07,680 --> 00:24:10,480 Speaker 4: Surgeon was like, okay, so here's what we can do. 433 00:24:10,800 --> 00:24:13,320 Speaker 4: This draining hole here that's draining out of him already. 434 00:24:13,880 --> 00:24:15,920 Speaker 4: What if we just pipe the phage up that hole 435 00:24:15,960 --> 00:24:18,560 Speaker 4: and then it'll track back to the infection site. 436 00:24:18,880 --> 00:24:19,479 Speaker 3: We can try that. 437 00:24:20,200 --> 00:24:22,680 Speaker 4: So he, you know, he calls the pharmacy, gets the 438 00:24:23,080 --> 00:24:25,920 Speaker 4: some antibiotic, mixes it with the phage in the operating 439 00:24:25,960 --> 00:24:27,800 Speaker 4: room in a syringe, and he just like just basically 440 00:24:27,880 --> 00:24:30,080 Speaker 4: pokes it in there and just like shoots it in. 441 00:24:30,320 --> 00:24:32,119 Speaker 1: Shoots it into the hole on the guy's on the 442 00:24:32,160 --> 00:24:32,840 Speaker 1: patient's chest. 443 00:24:32,920 --> 00:24:35,960 Speaker 4: Yeah, So then he covers it up with a bandage 444 00:24:36,000 --> 00:24:41,359 Speaker 4: and he's like, let's see what happens. Right, So they 445 00:24:41,400 --> 00:24:43,800 Speaker 4: close him up and then they discharge him the next 446 00:24:43,880 --> 00:24:46,959 Speaker 4: day and then like I'm like, okay, I wonder if 447 00:24:47,000 --> 00:24:51,480 Speaker 4: it worked. I'm sitting here like everything's fine. Like then 448 00:24:51,520 --> 00:24:54,480 Speaker 4: like it turns into like weeks and I'm like, dude, 449 00:24:55,160 --> 00:24:57,640 Speaker 4: and then uh, the surgeon just emails me like out 450 00:24:57,640 --> 00:24:59,520 Speaker 4: of the boy's like, oh, you'll never guess you turned 451 00:24:59,560 --> 00:25:01,359 Speaker 4: up in my off looks like a million bucks. 452 00:25:01,400 --> 00:25:02,200 Speaker 3: Everything's fine. 453 00:25:02,520 --> 00:25:04,640 Speaker 1: So it worked. So the Finch therapy works. 454 00:25:04,680 --> 00:25:06,040 Speaker 3: Yeah, as far as we can tell. 455 00:25:06,560 --> 00:25:10,600 Speaker 1: Like the infection that had been persisting for years by 456 00:25:10,640 --> 00:25:12,719 Speaker 1: that point, it just went away entirely. 457 00:25:12,800 --> 00:25:16,720 Speaker 4: Yep, yeah, five years and then gone. So he stopped 458 00:25:16,720 --> 00:25:18,960 Speaker 4: antibiotics and then he was fine. 459 00:25:19,240 --> 00:25:23,600 Speaker 1: So this this whole thing happened several years ago, right 460 00:25:23,640 --> 00:25:26,440 Speaker 1: like seven years ago now, and I'm curre's what's happened 461 00:25:26,480 --> 00:25:28,920 Speaker 1: since then? Like, have you still been treating other patients? 462 00:25:28,960 --> 00:25:31,719 Speaker 1: Do you hear from people who were interested in phage therapy? 463 00:25:32,280 --> 00:25:35,600 Speaker 4: So that first case was twenty sixteen, and then we 464 00:25:35,680 --> 00:25:38,440 Speaker 4: treated another seventeen and then like eighteen nineteen, like you 465 00:25:38,520 --> 00:25:41,439 Speaker 4: just went crazy from there. Then things went like extra crazy, right, 466 00:25:41,480 --> 00:25:44,440 Speaker 4: So you get emails all the time from people from 467 00:25:44,600 --> 00:25:47,920 Speaker 4: their physicians, from their loved ones, from whoever who had 468 00:25:47,920 --> 00:25:52,320 Speaker 4: these horrible infections. I mean, you know, like how big 469 00:25:52,359 --> 00:25:54,760 Speaker 4: of a problem antibiotic resistance is, right, You read the 470 00:25:54,800 --> 00:25:57,280 Speaker 4: news and the headlines and stuff, but like I feel 471 00:25:57,320 --> 00:26:00,000 Speaker 4: like it really hits home when someone sends you in 472 00:26:00,080 --> 00:26:03,080 Speaker 4: email that's like, dude, here's my story. I've been on 473 00:26:03,200 --> 00:26:06,119 Speaker 4: these antibiotics constantly. I'm writing you from a hospital on 474 00:26:06,119 --> 00:26:10,520 Speaker 4: my phone right now. This fucking sucks, like like things 475 00:26:10,520 --> 00:26:12,359 Speaker 4: aren't working, and like when you get like after the 476 00:26:12,400 --> 00:26:14,480 Speaker 4: first you know, ten of those, You're like, this is 477 00:26:14,520 --> 00:26:17,920 Speaker 4: like a really serious issue, Like it really hits home 478 00:26:17,920 --> 00:26:21,040 Speaker 4: more when when someone sends you a note like that. 479 00:26:21,800 --> 00:26:24,639 Speaker 1: So where where are we now? Is phage therapy like 480 00:26:24,960 --> 00:26:27,320 Speaker 1: a thing in US medicine? And I just don't hear 481 00:26:27,359 --> 00:26:29,440 Speaker 1: about it because there's a lot I don't hear about. 482 00:26:30,080 --> 00:26:32,840 Speaker 4: It's slowly becoming a thing more with these clinical trials 483 00:26:32,880 --> 00:26:37,119 Speaker 4: going on and like compassionate cases being treated fairly regularly. 484 00:26:36,880 --> 00:26:40,720 Speaker 1: And so in the US at this point, like rough 485 00:26:41,000 --> 00:26:44,200 Speaker 1: order of magnitude estimate how many people a year, say, 486 00:26:44,240 --> 00:26:45,600 Speaker 1: are treated with phage therapy? 487 00:26:45,800 --> 00:26:49,679 Speaker 4: Ooh, within an order of magnitude you know, one hundred, 488 00:26:50,119 --> 00:26:53,240 Speaker 4: one hundred, Yeah, so very small yeah still yeah yeah. 489 00:26:53,280 --> 00:26:56,880 Speaker 1: And you mentioned some clinical trials that are ongoing. I mean, 490 00:26:57,960 --> 00:27:00,760 Speaker 1: is it the kind of thing where if those clinic trials, 491 00:27:01,480 --> 00:27:05,760 Speaker 1: you know, demonstrate safety and efficacy, it'll become a much 492 00:27:05,800 --> 00:27:08,080 Speaker 1: bigger thing. It'll be thousands or tens of thousands of 493 00:27:08,080 --> 00:27:09,840 Speaker 1: people that you're being treated with phage therapy. 494 00:27:10,040 --> 00:27:12,359 Speaker 4: Well, we'll find out. I guess we're sort of finding 495 00:27:12,359 --> 00:27:15,119 Speaker 4: out as we go. But you know, the safety problem 496 00:27:15,200 --> 00:27:17,400 Speaker 4: is it's not an issue I think that's that's got 497 00:27:17,400 --> 00:27:21,480 Speaker 4: a lot of support that they're safe. The efficacy we're 498 00:27:21,680 --> 00:27:24,800 Speaker 4: trying to figure out still, but you know, assuming all 499 00:27:24,840 --> 00:27:28,280 Speaker 4: goes well on these trials, unfortunately, it probably comes down 500 00:27:28,359 --> 00:27:34,320 Speaker 4: to people deciding economically how to make it work. 501 00:27:34,520 --> 00:27:34,720 Speaker 3: Right. 502 00:27:35,720 --> 00:27:38,320 Speaker 1: What are some of the limits of phage therapy. 503 00:27:38,400 --> 00:27:40,560 Speaker 4: You know there are cases in which it hasn't seemed 504 00:27:40,560 --> 00:27:43,000 Speaker 4: to have done anything. The problem with those is that 505 00:27:43,040 --> 00:27:48,159 Speaker 4: they don't often get written up and published, so we 506 00:27:48,200 --> 00:27:51,199 Speaker 4: don't know what we're not doing correctly in a lot 507 00:27:51,240 --> 00:27:53,359 Speaker 4: of these cases, or why it may have failed. But 508 00:27:53,600 --> 00:27:55,000 Speaker 4: that's changing now a little bit. 509 00:27:55,760 --> 00:27:58,960 Speaker 1: Like in this story you told of this one compassionate 510 00:27:59,040 --> 00:28:04,600 Speaker 1: use case, very bespoke, right, and if we want it 511 00:28:04,680 --> 00:28:07,320 Speaker 1: to get to tens of thousands of patients a year 512 00:28:07,480 --> 00:28:11,280 Speaker 1: or thousands of patients a year, even seems like you 513 00:28:11,280 --> 00:28:13,480 Speaker 1: would want it to be less bespoke, You would want 514 00:28:13,520 --> 00:28:18,680 Speaker 1: it to be more industrialized and standardized. Is it possible 515 00:28:18,760 --> 00:28:21,479 Speaker 1: to do that or is the nature of phage therapy 516 00:28:21,600 --> 00:28:24,880 Speaker 1: such that it has to remain you know, very kind 517 00:28:24,880 --> 00:28:26,280 Speaker 1: of artisanal one by one. 518 00:28:27,280 --> 00:28:29,600 Speaker 4: I think it's somewhere in the middle. So it's not 519 00:28:29,720 --> 00:28:33,280 Speaker 4: just me like you know, custom brewing a batch for 520 00:28:33,359 --> 00:28:36,600 Speaker 4: every person that has an infection. So we're past that part. 521 00:28:37,040 --> 00:28:39,600 Speaker 4: But I think it's also not someone just comes in 522 00:28:39,640 --> 00:28:41,960 Speaker 4: and like, here's an injection of phage and you're done. 523 00:28:42,560 --> 00:28:46,280 Speaker 4: But standardization and distribution and all these things are details 524 00:28:46,280 --> 00:28:50,400 Speaker 4: we have to sort of establish. But it's it's definitely doable. 525 00:28:50,640 --> 00:28:54,080 Speaker 4: And the part that I really really love about phage 526 00:28:54,120 --> 00:28:58,080 Speaker 4: therapy is that it it more or less democratizes a 527 00:28:58,120 --> 00:29:02,800 Speaker 4: lot of infection management in that the cost is not crazy, 528 00:29:02,840 --> 00:29:05,000 Speaker 4: the technology is not crazy. I mean there's some meant 529 00:29:05,000 --> 00:29:08,120 Speaker 4: there's some costs, but like any country can do it. 530 00:29:10,000 --> 00:29:13,040 Speaker 1: If things go well, what does phage therapy look like 531 00:29:13,120 --> 00:29:14,360 Speaker 1: five or so years from now? 532 00:29:15,520 --> 00:29:17,760 Speaker 3: I would see it being more readily available. 533 00:29:18,200 --> 00:29:22,040 Speaker 4: I would love to see, you know, people all over 534 00:29:22,040 --> 00:29:24,920 Speaker 4: the world having access and producing their own pages. I 535 00:29:24,960 --> 00:29:26,080 Speaker 4: mean to take a lot of work, but I think 536 00:29:26,080 --> 00:29:28,720 Speaker 4: we could do in five years. 537 00:29:29,600 --> 00:29:31,320 Speaker 3: It was great to talk with you. Thank you for 538 00:29:31,400 --> 00:29:32,680 Speaker 3: your time. Great to talk to you. 539 00:29:34,080 --> 00:29:37,000 Speaker 1: Thanks to my guest today, Tom Ireland and Ben Chan. 540 00:29:42,640 --> 00:29:45,720 Speaker 1: Incubation is a co production of Pushkin Industries and Ruby 541 00:29:45,800 --> 00:29:49,920 Speaker 1: Studio at iHeartMedia. It's produced by Gabriel Hunter chang Ariela 542 00:29:49,960 --> 00:29:53,840 Speaker 1: Markowitz and Amy Gaines McQuaid. Our editors are Julia Barton 543 00:29:53,920 --> 00:29:57,880 Speaker 1: and Karen Shakerjie Mastering by Anne Pope, fact checking by 544 00:29:57,920 --> 00:30:01,400 Speaker 1: Joseph Fridman. Our executive p you Sirs Are Katherine Girardeau 545 00:30:01,520 --> 00:30:04,680 Speaker 1: and Matt Romano. I'm Jacob Goldstein. Thanks for listening.