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tv   Steffanie Strathdee Thomas Patterson The Perfect Predator  CSPAN  April 20, 2019 8:01am-9:00am EDT

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impact of evolutionary science is on politics. and marie brenner describes the life of marie colvin. and the new book the president's will be released. the past few weeks we've been airing q&a program used as source material for the book. this weekend we feature the presidency of drew jackson. did you know that booktv is always available on the go. "after words" is available as podcasts and you can listen live on our c-span app. first up, dr. strathdee and dr. patterson describe their search for a cure for an antibiotic superbug. >> all right, i think we are ready. good evening and thank you for coming out tonight to warwick's books. it is through your generous
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support of an independent bookstore were able to bring some of the best authors to the village. as usual before we get started please make sure you silence electronic devices. phones, pagers, ankle braces, make sure everything is turned off. we have great events coming up very soon on march 18 we welcome back susan meisner on her nenovel the last year of the war. on the 25th we have just a few more seats left. will host actor comedian pat oswald to discuss his late wife's moving book about the golden state killer called i'll be gone in the dark. like i said, tickets are going fast. on the 26th, we will discuss the book, deep medicine.it's a fascinating book about technology and medicine. and you can subscribe to our emails and get all of the events that are coming up. as a side note tonight as units we do have cameras here.
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c-span is ing filming tonight of the event. be on your best behavior, no cussing or anything like that. [laughter] when we have question-and-answer tonight please raise your hand because they will make sure that is a b you. connect event. many consider enough to proclaim our spouse to be a lifesaver. [laughter] for one of two nights cast, that utterance was more than a phrase. in a story that reads like a michael crayton or robin cook thriller, we felt the desperate journey from the gusty desert to egypt to sterile rooms of modern medicine. however, in the end it is a 100-year-old treatment that comes to the rescue. dr. strathdee has obtained her bsc, msc and phd from the university of toronto. a dual citizen of canada and the united states. an infectious disease
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epidemiologist and dean of global health sciences and professor of and chair after the ucsd school of medicine. also the therapeutics and adjunct professor john hopkins and -- that is a mouthful. and dr. patterson obtained -- he is an evolutionary sociobiologists. and an experimental psychologist. a professor of psychiatry at uc san diego. his renowned expertise and behavioral innovations among hiv-positive persons andthhiv a sexually transmitted infections. please give a warm warwick's
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books welcome to steffanie strathdee and thomas paterson. >> testing, am i on? can you hear me in the back? can you hear me now? can you hear me now? [laughter] i am doing and ad. do you want to try turning it on? hi tech. makes noise. >> there we go. >> good job. thank you.>> you may begin. >> thank you very much. i'm going to start this just to remind you, intrepid travels out the two travel insurance. because this story that i began back on thanksgiving in 2016.
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>> 2015. >> 2015. [laughter] we went to egypt. one of my bucket list countries. having a wonderful evening. last evening on our vacation. across from the valley of the kings and it was a gorgeous place. small town there, with a wonderful meal on the top of the ship, starlit night, i was feeling great, having done all this hiking around, just felt wonderful. not a problem in the world. went to bed, started throwing up and things went bad, very bad, very quickly. i just kept getting sicker and sicker and sicker. i just could not stop throwing up. i'm not one that likes to call doctors. working in the medical school. [laughter] i decided i did not want to see
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a doctor. but i did not get better and she finally assisted, we are bring a dr. here. and a dr. came in i was just miserable. and he said, you're dehydrated, probably got food poisoning. we will give him some antibiotics, pump them up so he will be good in the morning. in the morning i was feeling worse, i was getting sicker, i was feeling like you can't imagine how bad. at this point, the dr. came back. and they said he is going into shock. we need to take him to a clinic. and they loaded me on a gurney, just a -- at the time, i was 100 pounds more than i am now. i'm not trying to sell a weight loss program, i assure you. [laughter] they managed to carry me across three ships to the shore and of these ancient steps that the
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egyptians had built. looking down seeing the steps thinking god, if they slip i'm going to get my skull cracked, everything will go wrong. they get me in this ambulance and it is 1:00 in the morning. and the lights are shining through the ambulance window and they are going through these bumpy roads. and every bump they had i was in agony. i mean complete agony. they would come up to a shopping mall, that is the only way to describe it. there was no hospital, it wasn't a clinic in the usual sense of the word. there was, just four steps up to the beginning of what was later to become the beginning of my odyssey. and i think stef can pick it up but best from there. >> is actually emotional reliving it. but it is a pleasure being here to share our story with you. tom got sick or actually this
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clinic.and they did the best that they could. we were in luxor at the time. they thought they could handle him but they realize very soon after we arrived that he had complications. they first diagnosed him with pancreatitis. which is basically inflammation of the pancreas. i thought great, we have a diagnosis so we know how to treat it.by this time i got on the phone and call the head of infectious diseases here at uc san diego who was a personal friend and had ballast out when tom and i got another superbug on another trip much earlier. i know that we sound like we are just walking infectious disease magnets or something. [laughter] and trip basically said the pancreatitis is a symptom of a larger problem. we are to find out what that is
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you need to get them out of there as fast as possible. so lucky i was able to convince the travel insurance company to medevac him and we got him to germany. they are, they found that this pancreatitis was caused by a gallstone that had lodged in his bile duct.and caused an abscess to form because there is a buildup of fluids. he had been totally asymptomatic but the dr. showed me the brown murky petri fluid. he says if this just formed recently it would be clear but it is not. there is something growin it, it's been there for a while. and we are culturing it. the reason we have you in isolation here is because there's a lot of superbugs in the middle east and other places and we are trying to make sure that you know, we do not spread it to any of the other patients. i thought this is just a precaution, ri he was fully gowned and gloved and had a mask over his face that covered more of his face then women, who are the nurses
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in luxor wearing hijabs. the dr. stood ways from the bed and said i'm sorry to tell you but this is the worst news we could have had. it is the worst bacteria on the planet. it is called -- and i said what? i am an infectious disease epidemiologist i haven't graduate degree but maybe it was his accent, but i said can you write that down? he wrote that down and i said, i remember this organism from my microbiology days. i remember pleading this on a petri dish and looking at this wimpy little bacteria. we did not need any special precautions, with gloves and a lab coat and that was it! and so i sat there while tom is going in and out of consciousness. i did my homework, i was reading on the internet about this organism that would become
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the number one threat to human health on the world health organization list of the 12 deadliest superbugs on the planet. i said how did this happen? when a couple of decades this would be bacteria is now this number one killer? turns out the bacteria is what i call bacteria kleptomaniacs. a steeles antibiotic resistance genes from other cteria. while the throat antibiotics and other bacteria get wiped out, this organism has got all of its arsenal and moves in for the kill. we create all this wonderful space because we killed all the other bacteria in the michael byam. that's exactly what was happening without this gallstone pancreatitis, which is a very horrible condition, in and of itself, was the big problem. but it turned out this superbug was actually the thing taking him down over the next several months. so i will not belabor the whole story but we get them back to san diego. he was medevac again.
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travel insurance paid for two jets and seven ambulance is to get home. there was $38 between the two of us that we paid for this. i think it is a little bit more now. [laughter] the last time, we just went to costa rica last week and it was a little more than that. but nevertheless, it was well spent. and when we got him here, to what is now the jacobs medical center. one of the biggest icu strife in the world. top doctors, they ran all of the tests on his bacteria isolate and were shocked. because now it was fully resistant. it had been partially sensitive to just a couple of antibiotics in germany but now it was fully resistant. they were very shocked by this. i turned to the doctors and i said well, why sit still informative and in a biotics on his iv pole if it is resistant to all of them?
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one of the doctors turned to me and said, those are to make us feel better. i went, all great. [laughter] so i knew i was going to be in for something but nobody really prepared me for the wild ride we were going to have. tom's daughters were at the bedside throughout this ordeal. we had countless friends who had came and we had vigils at the bedside. but the goal initially was to try to stabilize him so that maybe his own immune system could kick this thing because obviously there was no antibiotics that were going to do it. he was to ask for surgery so they just punched these holes basically in his abdomen to try to siphon out the infected fluid. and that worked for a while. in fact they thought, he seems to be a bit stable and he went to a regular ward and he was there for a while. but he was pretty much entirely deliri he often didn't recognize me. there was a funny moment, i
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mention it in the book in passing but it is one of the funnier moments that happened. i said i have to find humor even in the darkest hours. and i came up to him and you know everybody who entered the room had these yellow gowns on. and blue gloves and masks and so we all kind of look the same. and i could tell he didn't recognize me and i said honey, do you know who i am? and he looks at me and he knows he should know but he doesn't know. and i give you a clue. you been married twice in your life. once, there is the old wife and there is the new wife. which one am i? and he says, the old one? [laughter] he swears to this day that he was telling a joke and i didn't get it. [laughter] do you still stand by that? >> yes, dear.
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[laughter] >> i know i am not going to get the truth out of him. there was another time they also recognize he did not know who i was. and i think i was particularly frustrated on this one particular day. i drew the curtains and i flashed him. [laughter] i said, if i wasn't your wife, would i be doing this? and i knew from the look on his face, that whoever he was, i was stark raving mad! [laughter] those are the only light moments that we had, except for the striptease i tried and i see on valentine's day and that, he was in a deep coma. we had a male nurse was very amused. [laughter] we actually became somewhat infamous in the icu because we did whatever we could you know. his daughter would bring him a guitar, his other daughter would read to him from the burn books. you know we had balloons around
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the bed on his birthday. you know, we just did the best we could. but the saddest part was that the day before he was supposed to be discharged to a long-term acute care facility one of his internal drains slept. we didn't know at the moment that it happened. but all of a sudden the doctor, nurse and i were happened to be there. he just went into shock immediately. i do not know if you ever see what septic shock looks like but basically your heart rate increases rapidly, blood pressure drops, he developed a fever and often there is rigorous shaking. the shaking is not just a shiver. it is a shaking so badly that the bedframe hits the wall. and that's what happened. right before her eyes. until the dr. called the icu staff and he was rushed back into the icu the day before we were supposed to get out.
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and i just got, oh my god, what is going on? they called anesthesiology, i didn't know why. one of the dr. said this because he had to put him on a ventilator. i knew that was life support because it is basically a breathing apparatus because your lungs have failed. basically the infection was all the way through his body. this bacteria has been in this abscess in his abdomen. but when the drains slept appalled all the infected fluid in his abdomen, in his bloodstream. so he went septic. he had all sorts of complications as a result of but that is went from that moment on, it was a little more each day. i finally figured out he wasn't going to make it, i took matters into my own hands and i had the talk with him. many of you who are in long-term relations will have talk to your partner about what
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happens if you are on life support someday. we had this talk and we had a will done and a living will and power of attorney and all that. he said, if i'm ever brain-dead, pull the plug. i thought it was pretty black and white. but what do you do in your body is dying and your brain is alive? i mean i didn't know what he would want. i know i wanted him to live but i thought it would be really unfair to keep him alive just for my sake. this one day when his eyebrows were twitching and i thought maybe you could hear, asked him if he wanted to live. and i told him that i loved him very much. and that i want to grow old with you, honey. and, i was holding his hand and i said, if you can hear me and you want to live, please squeeze my hand and i will leave no stone unturned. and i waited and i thought, he is not goin smy hand. i am going to have to let him
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go. all of a sudden he squeezed my hand really hard. it's like he couldn't figure out how and then he squeezed. it wasn't until months later that i found out exactly what was going on inside your brain. this is what you have to tell them because it's still kind of loopy. >> as stef eluded to, during the time i was in the hospital, she was having one experience and i was having an entirely different experience. for me, i was living in a world of having hallucinations, delusions, etc. really started in egypt. i thought that al-shabaab was trying to kill me and was going to televise my murder and whatnot. and there they were blowing hookah in my mask.
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and whatnot. would surface and come back to consciousness and everything will be better again. and i would have a different hallucination later. the particular that i was talking about was hallucinating that i was in the state. solution nations in the book in my mind were real experiences. not my dreams. i was a snake for this period of time. for a couple of weeks there was a film crew documenting death. and i was the subject. the only thing that was alive was a little red light. and i was in a canyon and a path coming down and people would come down and stand over me talk. it is worth digressing a bit and tell you how i think these hallucinations originated. remember, i have a toxin in my blood. i have sleep deprivation like you cannot imagine because they
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are waking up every hour to draw blood, to check and make sure that i'm still alive. there are toxic -- antibiotics that are actually contributing to this. and being in an icu, you will get hallucinations if you're there for any length of time. in any case. so i will just tell you that people were coming into my room and standing over me and talking. and they were talking about me dying. and i was hearing this. you're not a loaf of bread when you're in a coma. you still can hear. you don't hear like you and i hearing right now. you are in a distance but you incorporated into this weird mindset that you have. this funny thing. the snake, they had put a tube down my throat. this long slithery tube that looked like a snake. there standing over me talking
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about death. there is beatles music playing in this hallucination. they are playing music all the time! [laughter] so, all that's going on is i am interpreting everything going on in this haze of what's happening. and then stef comes to me and says do you want to live? and i am like hell yeah i want to live. but i am a snake, have no hands. so trying to figure out how to wrap my body around her hand and squeeze. that was a long pause she had. me thinking about how to problem solve this? and it was able to really control the muscle in my snake body. the manly snake that i was. [laughter] and i managed to squeeze her hand and let her know i wanted to live. for me i think one of the big lessons i want people to take home from this book is, you
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should remember when you visit people in the hospital, no matter how bad a shape they seem to be in, speak kindly, speak positively, try to support them. for me, i believe that knowing what i do know about the research, being a research what do you think i do when i get out of my coma is every studies naturally. at least 50 percent of people that have these deep hallucinations and go into comas like this, with cognitive impairment. i didn't, or least i pretend that i didn't. [laughter] i am hiding it pretty well, i think. so far anyway! i believe they love the reason i'm able to maintain my cognitive ability throughout this experience was my daughters were talking to me, stef was talking to me, they
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organize people to sit my bedside and talk to me all the time. and when somebody touched me it was like an electric shock when off. it just gave me power. you just can't imagine how it felt. so i think those are really important lessons for people to remember as you are doing it. and i always get the question, so i will try to short-circuit this party and they will get on to the story. did you come close to death? had seven cases of septic shock. each one of those cases, you are pretty much bound to die. and did you see the other side? well, i saw what i thought was the other side. but i saw the light of life. i did not see bright light on the other side of heaven, i did not see angels coming down to me, i am sorry to say maybe i have led a bad life. [laughter] i had the usual privilege of practicing dying and i hope to do it better next time. [laughter] so, the bottom line is, the ears are true experiences that you have in this state. but anyway, i squeezed stef 's
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hand and -- >> then i realized, what do i i am a infectious asis not my specialty. and the top infectious disease doctors in the world said they been working on him and are out of options. so i do it anybody would do. i went home and i googled it. [laughter] luckily, google for scientists is something different. anyone can exit. it is called pubmed. i put in keywords like superbug, alternative treatments and then within one hour ahead different treatments. some were totally
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inappropriate. some other could only be used on the skin but he was fully colonized. but in this article, there was sage therapy. i knew it sages were because i had this old degree i remembered this was short for sages. turn that it's 100 times smaller than bacteria. they are viruses, tiny viruses that are invisible to the naked eye. but they have evolved to attack bacteria. so the term bacteria sage is from the greek word that means bacteria either. so there could bacteria sage be used to treat tom? i delved into the medical history little bit. found it was discovered, 100 years ago by french-canadian. and he had used these to treat people with bacterial infections successfully.in fact, he was a book that was a
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pulitzer prize winner in the 1920s. so this had a heyday for a while. but when penicillin came on the scene, which is around the time of world war ii, the west considered it a wonder drug because it was for a while. and parts of the world that had easy access to antibiotics like russia, hung onto sage therapy where it is still offered to this day. and of course, russia was an enemy of the west and so, if you are a proponent of sage therapy were a commie sympathizer. and so of course this geopolitical biologist is one of the reasons why it was forgotten the west. iona go through all of the gory details because some of them are gory but i managed to get this for tom. with the help of not only our department of medicine that allowed us to try this but seemed like a crazy you know,
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last minute type of treatment. one dr. described it as, a hail mary pass. in the fourth quarter of the game where there is one minute left and the quarterback is blindfolded. that's how it was considered. but a global network of researchers, including those from texas a&m, san diego state universiresearchers from switzerland, belgium, they all offered sages. and a local company donated as well. the navy even got involved. there was another story in and of itself. at the 11th hour, i mean obvious, spoiler alert, he lived! [laughter] but our book is really not about why, it is about how. it's about lessons about the global superbug crisis but also, 100-year-old forgotten secure that has been buried for
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quite some time. and we have kind of been i guess heralded with the revitalization of sage therapy in the west. as a field of tom's case, which went viral, literally, in a good way. other people have been treated with sage therapy around the world and we used this intravenously because he was fully colonized with the bacteria. and that could have killed him but i knew we didn't have any resort, really, this is our last opportunity to save him. so he lived and other people have been treated here in san diego with sage therapy. and around the world. and now, infectious disease providers are turning to us at uc san diego because we had the first dedicated sage therapy center in north america. and so, this center now is a beacon.
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it used to be that patients and their families were contacting us for help. but now, it is doctors and we are trying to move sage therapy into clinical trials. we have two small trials being planned right now.and if it is shown efficacious in trials it can be licensed alongside its products but now it is considered experimental treatment being improved on a case-by-case basis. if you have a superbug infection would know that somebody does or does not respond to any antibiotics, you can contact us. we will help. tom? >> yeah, people often ask, are you covered fully? and i spent nine months in the hospital which would not have had to spend had there been sage therapy available in the beginning. i could have gone up very quickly. but the rule of thumb is, it takes five times as long to
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recover as the time you're in the hospital. about four years for me to recover. i am three years into the recovery now. i'm getting stronger, putting on weight. although i cannot put on a lot of weight. people ask if i have any side effects? i lost part of my pancreas, gallbladder, i have numbness in my feet mostly from the antibiotics. i have got you know, stomach problems. digestion which you would expect. but, we were just in costa rica and i was birdwatching and hiking and i am at work and i've written a lot more papers. and so, i can't complain. husband back. >> the other part that is important to understand that people don't really just get off the top of their head, yes,
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this was a physical problem. but just as weakly as important was a psychological problem. it was a psychological problem for me you know, not only was it the hallucination but i had ptsd from the experience. as did steffanie and my daughters. imagine coming to hospital, they are telling that your dad is going to die and repeatedly, this is a roller coaster for them.so, when you have one of these kind of experiences, be prepared for not just the physical, but also the psychological ramifications. and so, now we can answer some questions if you have any. yes? [inaudible question] >> yeah.
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i mean i wish it would gone that way. they did not take my gallbladder out. it rotted out of me. >> mindedness don't have sludge. that's what you're gallbladder had. where does sludge come from? he said i don't know. [laughter] >> i can speak to that. >> do know you how you might have contracted this superbug? >> okay so the question was, do you know how i got this superbug? the answers, we know i got the superbug in egypt. because it was a superbug strain from egypt. they could identified genetically. where exactly is uncertain. i could have gotten from dirt, the pyramids i climbed around in, you know, ve could have gotten it from one of those evil spirits that came up. who knows!
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probably, i got in the clinic. most superbugs are acquired in hospitals. that is where you're most likely to get one. i probably got it there. so you know, there's not much you can do about it. and the kind of follow-up questions usually, are you going to travel again? heck yeah! will you go back to egypt? sure! i will not pay for the trip this time, they can pay me! [laughter] [inaudible question] dealing with the doctors, what would be your best advice? you as a patient, to doctors. >> as a caregiver, because i was visiting tom in the hospital, i was the patient's wife more than anything else.
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my advice is to really be an advocate. and learn as much as you can. in the book, i really describe it like a crash course in medicine. where try to absorb as much information as i can through reading but also, uc san diego, was invited to join rounds. that a family centered rounds approach and so, the inclusion, a caregiver in rounds allowed me to ask questions and learn. because at rounds, a teaching hospital like uc san diego, the residents actually learning from the attending provider. and also, you have an opportunity to you know, lender experience and observations because you know your partner or your family member better than anybody else. seek and sa, is wanting is such and such. or yesterday, he like this or you could, you are there all
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the time. you can see things that they don't see. and i believe they can also prevent a lot of medical errors. because i have stopped a few myself. >> for doctors, from the doctor's perspective, first i can tell you from my side of it as a patient, be careful what you say, obviously, is what i am saying. don't be talking about futility over the patient. because even if they are in a coma they are likely to hear that. but i can tell you that when i go into the icu now, to visit, doctors come up to me and hug me and cry and tell me that i have changed the way they do medicine. that they don't give up now. that i was as close to death as any of them have ever seen and yet, here i am. and it taught them a valuable lesson. i think the lesson for a dr. is, don't give up! i mean, if -- obviously there
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are times when it really is futile but don't try to talk possibly can. [inaudible] >> is her chance of this being used more and more into -- >> the question is, if this therapy is being used more regularly, is an opportunity for them to mutate themselves? yes, in fact, what's happening is, it is kind of like miniature warfare between bacteria and this. so the bacteria developed their own armaments against this and so they ve the crispers that have been in the news and we use them now for gene editing. they were developed by bacteria to resist this phage and the return have anti-crispers. so you can imagine that one has a shield, the other has a spear
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and their developing this, in this fight against one one of the interesting things that happens, the bacteria can become resistant to the phage. it is demonstrated in tom's case and the navy was ready for this. they said you know, we don't know how long it will take. even though we were eight were going into the same receptor. when they realize by looking at his bacterial isolate that it mutated and it was resistant to the phage they were ready. and they developed a second generation phage cocktail. that was actually able to attack the immune bacteria. and they do this within a week. so that really proved to them that personalized phage therapy on demand is a reality. and as a result of that new company called adopt a phage
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therapeutics was developed. in his sicilian branch with the navy was doing. i should acknowledge that tom and i actually have stock in the company. [laughter] we decide to take advantage of that opportunity. but what this resistance from the, to the phage can be overcome. the fact that resistance occurs isn't going to be a doomsday kind of opportunity for phage therapy. >> will phage therapy ever be more than just a last resort? >> will phage therapy ever be more than a last resort? we hope so. it can be adjunct antibiotics or in a case where the baths are fully you know, not used anymore because of resistance. phage therapy could replace it
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in those cases. i think there was another question in the back. the fellow behind you, sorry. >> there must be many types of phages. how did you figure out what sequence to use them in or how many did you have to try before you got anywhere? >> is an estimated 10 million, trillion, trillion phages on the planet. in fact the dr. from san diego state university has been the pioneering work, the ecology of phages. when i realized this i was really overwhelmed with how my going to find the phage no matches bacteria? luckily, those not my job. it was with the phage researchers needed to do. but i did need to find those receptors. i went back to google and i put his superbug and and phage and i found researchers in the u.s. that were studying this.
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who i contacted. they were total strangers. basically, and i had a talk where i walk you through visually, what they do to find phage. but because bacteria are in sewage, etc. great place to find what praise upon them whicare the phage. we searched sewage for his phage and i can literally say that my husband is full of, you know what. [laughter] i will not say a bad word because of c-span. imagine a petri dish with bacterial colonies and incubated. these glossy blobs in each one is a bacterial colony. you can put a sample of sewage or pond water or whatever on that petri dish and incubate it and if there is a phage active against that bacterial isolate, it will come back looking like
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swiss cheese. there will be a whole, literally in the agar. you know that it has a noisy bacterial colonies they can pluck it out and add more bacteria and grow it. that is what was done and then has to be purified. that is where san diego came in in the 11th hour because we had to re-purify this massive quantity of phage preparation in time to save his life. a lot of planets had to line up to make this happen. and some of the research to pick the exact right phage that will out with the immune system, those kind of things we still do not know how. we are doing more research and promoting research to be able to optimize phage therapy. yes? >> so the phage comes in and eats the bacteria. i'm getting a pac-man image.
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>> yes. >> then you have this virus in your body. so, yipee! i have a virus. what then? >> the virus only exist as long as there is bacteria that they match to eat. and so, once the bacteria are gone, then naturally are excreted by the body. in fact the liver and spleen are part of the reticular endothelial system. which includes macro phages -- they are naturally excreted. the other thing to know is that we are a wash with phages.
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our bodies have 30 billion in and out of our system every single day. we know a lot about the micro biome but most people just think about the bacteria. they don't realize that the gatekeepers are the phages. there is fungi and archaea and lots of other organisms in our micro biome as well. and phage have been called the viral dark matter of the micro biome. as a result of tom's case, the american got project that is led by doctor rob knight who is a famous researcher at san diego, people pay him to test there poop. now he's not tested just for the bacteria but for the phage because he's come to appreciate the value that the phage have in the micro biome. maybe someday according to rob, you could have phage products or probiotics that include phage that can groom the micro biome and get rid of the nasty ones. we don't know enough about the micro bombs to promote the products now. they do exist but it is likely that the phage are not the right ones for you.
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this whole field is in its infancy. yes? >> you say that the phage was given intravenously. was it a drip? how do they know how much to give you? >> yes, so the question is, phage were given intravenously. was it on a drip and how did we know how much to give him? there was a lot of unknowns. this is part of the book where we focus in on the dr. and had an inkling how to do this. there was no protocol for intravenous phage therapy. and tom's case report is the first on this. even in the former soviet union and in poland, phage therapy is there is generally oral or through a nebulizer or through catheters. and the abdomen.
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we did first was we put the phage through the catheters so that we could see well, the worst place, the center of his infection was the abscess. we thought if he lives through the administration of phages through the catheters that will get them and administer them intravenously. if there's a hidden reservoir bacteria become resistant we don't have any other phage ready and then he will die. so we got some estimates of how many phages would be appropriate and we figured that -- a billion phages per dose was the estimate. and that was kind of an educated guess to be honest. it was thought that if you under dose with phages it
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could be worse because it could be eliminated by the human immune system but if you get too many phages and they will just be excreted because they don't find enough bacteria. so we obviously did something right. [laughter] but there are more questions than answers. and we have treated all the other cases that we been involved in intravenously as well. we have to go topically at first. we have not had any side effects. we will read he was going to have septic shock episode. of course that was the scariest moment of my life because it was something i came up with and i was putting forward and if i killed him, even though he was going to die anyone it was on my head and i had to tell his daughters. right? that was at the monumental like suffocating woman for me. that i described in agonizing detail in the book. yes, in the middle? >> talk about the beneficial aspects of the phage therapy, would be the side effects or symptoms?
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what symptoms were there, short-term? >> were the negative aspects of phage therapy? we not seen any side effects in any of the cases we have treated. however, there are some theoretical negatives. there are two lifecycles of phage. one is the lytic cycle. which is basically the phage blows the cell up and turns it before that does it turns the cell into a phage manufacturing plant person are all these baby phages. they burst out of this bacterial cell. that is the phage rage that we want. the other cycle is what they call temperate phages. when the phage enters the bacterial cell and integrates its genetic material into the dna of the bacterial cell and it hit the snooze button, as i say. we don't want that because we are the bacterial cell to die and we want the phage to
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multiply. these phage, temperate phages can carry temperate genes are resistance genes. these days those are being screened out or through gene editing techniques that are newly developed. you can actually turn a temperate phage into a lytic phage. in fact the first human case to be treated with a genetically modified phage will be reported in the next month or two. that is a direct result of tom's case. that the administration was done intravenously, it worked. but that will bring the gene editing folks to the phage therapy world.it means we can potentially improve upon nature. it is a very exciting time. yes, in the back? >> what was the timeframe from your first google and trying to
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use the phage to some success with the treatment? >> yes, i'm glad you asked the question. in section 1 of the most miraculous parts of the story. i sent my email to these phage researchers in february 22nd 2016 and we administered the phage march 16, almost exactly 3 years ago. i still get goosebumps on march 16 every year. compare that to an antibiotic that would take you know, 10 to 15 years to develop, at least $80 million and become you know, useless to resistance. there is no comparison. that is why we think that phage therapy offers a real future. the other interesting thing is that in tom's case and several others we've seen synergy between the phage and the antibiotic. the phage and antibiotic operating pressure on the bacteria at the same time. and although the bacteria do not have brains, they are not
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thinking, they have to make a decision, a genetic decision as to how to mutate to protect themselves. and in these cases that we have observed, they mutated to become sensitive to the antibiotics again. there's actually a phage research team at yale that is just using phage therapy to re-sensitize bacteria to antibiotics.let's just assume worst case scenario, phage therapy fills in clinical trials. but if it's only purpose is to resurrect antibodies that were not usable anymore because of resistance, it is still a game changer. that is making the pharmaceutical companies finally pay attention. because up until now they've not figured out how to make money off of this. with gene editing and the antibiotic synergy is becoming an area of intense interest. [inaudible] how long did it take until tom responded? we injected phages into the
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abdominal catheters on the 15th, the 17th we were with the navy and then he woke up on the 18th, kissed his daughter's hand. that is not the end of it there were more ups and downs i will not get into but he had another septic shock episode and turned out it was not the phages that were killing was another bacteria and so, you know he recovered from that two days later and we restarted the phage therapy. from then on it was an upward trajectory. so it was very, very rapid turnaround. that was what blew everybody away because they thought he was going to die. [inaudible] can any of this work with cancer? that's a good question. phages of the study for several decades in the western world where phage therapy was on the back burner as i mentioned.
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but phages were used to pioneer cancer biology, molecular biology, genetic engineering and this crisper technology. there have been attempts to use phage as vehicles to deliver cancer therapies and also vaccines. and the research is underway. there is also another parallel effort to use some viruses, phage or other kinds of viruses as biotherapy. and with glioblastoma. it is precision medicine, is kind of bringing together several fields together at the same time. any other questions? yes? >> this is a pragmatic question. what travel insurance do you recommend? [laughter] >> we get our travel insurance the university of california. it is the same one i think is called united healthcare.
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i did call them and tell them we had a good news story for them. i don't think they really got onto it yet but i think we should send them a copy of the book. [laughter] maybe we should do commercials! [laughter] great! >> a question in the back. >> yes come in the middle. that is my colleague from twitter. hi! yes, nice to see you. >> is your microphone? >> yes, it is over your head. >> first of all, i would like to thank you for sharing your story. incredible! i really enjoyed reading your book, every page. it is a story of science, medicine and love and a really incredible story. as we know, overuse of antibiotics and misuse of end products is increasingly a problem. particularly in developing countries like egypt, india or
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china. >> yeah. question book is now being translated into chinese. in a difference to chinese, any of the language your book has been translated? i wish more people, i hope more readers can enjoy and learn from your book. >> thank you very much. in fact, you raise a very important issue we have not talked about tonight. which is the global superbug crisis. one of the reasons we decided to write this is if i am in the start situation with the antimicrobial resistance problem, then most people in the road probably are too. it is overuse of an apprentice, not to mention people in hospitals but in livestock. that's the biggest problem. 70 percent of antibiotics used in the u.s. and most developed countries are used to you know, promote growth and in chicken and cows and pigs.
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it is not actually to treat the disease or even prevent the disease. it is to use antivirus as growth promoters. there been attempts to clampdown on this. europe has done i mean western europe has done a great job and the uk are leaders in this. but several countries, the u.s. one of them, china, india and south america countries. when tom fell sick, the gene that confers resistance to colston, that is the last resort and basket was reported and pigs in china. it was reported in the top medical journal in the world. i know that you know because you are a scientist. but by the time that one antimicrobial resistance gene was reported, it was in 30 other countries. i mean so here we are, we suffer from a problem of un-detection, on diagnosis and
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that being untreatable. three different problems are facing us now that by 2050, one person every three seconds will die from a superbug infection unless a drastic turnaround is taken. i hate to leave you with dire news but we all need to take efforts to you know, if you're going to eat meat, eat antibiotic free meat. and to put pressure on the legislators to stop using antibiotics. right now there's an effort to try to stop using antibiotics and citrus because the federal government is allowing this to happen. there is no need for it. so anyway, that is the spiel. but hopefully, if you read the book, you will enjoy it. but you will learn a few things along the way. [applause] thank you very much. [applause]
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>> so if everyone will hold their phages right now. we let them get unmiked. and if you make a nice i'll hear. thank you for coming out tonight.
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we take you to the san antonio book festival sunday at 9:00 eastern, american enterprise institute president arthur brooks on his book love your enemies. on american history tv on c-span2, at 10:00 eastern on real america the 1942 us agriculture department film democracy at work in puerto rico profiling the island history and challenges. and and watch this weekend on the c-span networks. >> tom wheeler, what do martin luther and mark zuckerberg have in common? >> they both figured out how

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