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HEFFNER: I’m Alexander Heffner, your host on The Open Mind. The over-reliance of antibiotics and their use in the human food supply have increased resistance to diseases in the last decades. What is the new frontier? What are solutions to avert a public health crisis? Recently a Yale medical team employed phage therapy, a bacteria-killing virus found in a lake, to kill an antibiotic-resistant infection. Meanwhile, IBM science researchers are experimenting with synthetic drugs to kill resistant pathogens. What does a generation of high-tech probiotics look like? A leading expert, Jessica Snyder Sachs answers those questions today. She’s the author of “Good Germs, Bad Germs: Health and Survival in a Bacterial World” which spotlights the pioneering work of scientists developing solutions to both antibiotic-resistant infections and chronic inflammatory diseases. A chronicler of Science and Popular Science, Discover and the New York Times, Snyder Sachs currently works as the director of science communications for the non-profit organization Autism Speaks, where she helps translate the findings of autism researchers for the lay public. Jessica, a pleasure to meet you. Thank you for being here.
SACHS: My pleasure, Alexander.
HEFFNER: What has evolved in your mind in this conversation about the overuse or misuse of antibiotics in America?
SACHS: Well what’s wonderful is that terms like the microbiome, which refers to our good bacteria, have become a household word. I wish it translated more perhaps in the doctor’s office. I think there’s still a tendency, when in doubt prescribe an antibiotic, which is what we need to get away from to slow the speed of drug-resistant infections. But now we do have this appreciation that the on.., it used to be the only good germ was a dead germ, and now we have an appreciation that there is a role for good bacteria in our lives and in keeping us healthy.
HEFFNER: The way that I think about it is really anti and probiotic in the sense that dieticians and nutritionists and people who are concerned about our digestive health for instance are prescribing or recommending probiotic supplements, what you’ll find bacteria in yogurt for instance. So there is a, a new consciousness around what could be positive bacteria in our lives?
SACHS: Agreed, though of course we have to sort the hype from the solid science. What, the researchers who are delving into pro, real probiotics, doing clinical studies, are finding that it matters not only what species of bacteria but what subtype of bacteria and each of ‘em has different effects, good and bad. There’s probably a general health effect of having probiotic foods in your diet, but getting certain protection, let’s say you want a probiotic to protect you because you’re about to take an antibiotic and you don’t want to get one, one of the nasty infections that can result after taking antibiotics. Well which probiotics will do this? It probably won’t just be the one you got in your yogurt this morning.
SACHS: So we need more research in really nailing down their benefits.
HEFFNER: Can you contrast for our viewers who are not familiar the probiotic approach versus the phage approach,
HEFFNER: Two different approaches to how we might resolve the issue of resistance, right?
SACHS: Sure. So there’s attacking our the bad bacteria, so we have bad germs, most of modern medicine, since we realized that so-called germs or microbes could cause disease, has focused on killing them. So whether it’s phages which is a new trick in fighting bacteria or new antibiotics, those are directly attacking the bacteria in a very narrow way, and what we’ve learned in, in modern medicine, that bacteria are great, you throw something at them, they’re gonna evolve around it, versus our immune systems come at infections from many different ways, and one of those aspects that our immune system uses or I should say our microbiome, this combination of us and our resident microbes protects us from bad bacteria by let’s say filling up all the parking spaces so our digestive tract is full of good bacteria. And that protects us from infections because there’s no parking spaces open. You hit our good bacteria with antibiotics and it opens up a door for potentially harmful bacteria. So probiotics is about on one hand protecting us against the bad bacteria, and then there’s a whole other side of it, which is calming the immune system. In our war on germs, some of the most wonderful things we did were clean up our water supply, clean up our food supply, so they don’t have bad germs. But what we’re now realizing is we also kind of moved out all the germs that were calming down our immune system. So now we have epidemics of inflammatory disorders like rheumatoid arthritis and allergies and inflammatory bowel disorders.
HEFFNER: The great fear, Jessica, is that the next pandemic or epidemic will be a resistant one. Isn’t that right?
SACHS: Yes, and for very good reason we now have multi-drug-resistant tuberculosis. We now have infections that shrug, can shrug off everything, and where this gets scary is that we’ve also discovered bacteria share their genes freely. So let’s say you have a resistant bacterium in your body that’s not doing anything, but then you get a disease-causing bacteria and they, they bump up together and they can exchange DNA. Here, you know, slip this into your genome. So once we see this multi-drug resistance appearing, we now know it can spread very fast and very far.
HEFFNER: And what do you do about this problem of you call it DNA pollution, the, what you just described?
SACHS: Right. So yes, in one, you know, in our Discover article we looked into the, the scientists who are looking at DNA pollution. It’s a, a weird concept but in our environment, because bacteria can even scoop up DNA from dead bacteria in a stream, and I followed these researchers going up into the Rocky Mountains, into purer and purer water, and already you’re finding this DNA up here that we’ve bred through bombarding our environment and ourselves with antibiotics. We’ve increased the presence of these genes that convey drug resistance.
HEFFNER: And the pioneers that you chronicle, what is the foundation that they’ve, that we’re developing on now?
SACHS: Right. So I think you’re asking so where do we go from here,
HEFFNER: Yes. Thank you.
SACHS: Now that we know we have this crisis? Well, one of the things that we do need to do immediately is be more judicious in how we use antibiotics. You know, we’re in the middle, you know, of the flu season and people go to their doctors and their doctors give ‘em antibiotics. When antibiotics don’t protect against the flu but there’s well, the flu might lead to a bacterial infection so just to be safe let’s give you this antibiotic.
HEFFNER: Right, that’s what you hear, just to be safe. It’s a,
SACHS: Just to be safe.
HEFFNER: Security blanket.
SACHS: So first and foremost, all the experts I’ve interviewed agreed we have to be more judicious, more careful, slow down. Do we really need an antibiotic here?
SACHS: But we also need new approaches. Phage therapy is one and, and actually goes back quite far. The Russians were doing it fifty years ago. But it’s also something that bacteria can evolve resistance to very fast. In researching “Good Germs, Bad Germs” I kept coming back to vaccination.
SACHS: As in vaccination works with our immune system, it’s a holistic approach. If we can get our immune system to take care of the infection, it comes at an infection from many sides. We’ve done the easy vaccines. Now we still have a lot of things like tuberculosis, strep, and staph that we’re having hard time developing vaccines, but hopefully with genetic technology and genetic research we can understand better how to develop these vaccines.
HEFFNER: Is there something wrong with the scientific approach that we have not seen a new wave of vaccines emerge to counteract,
HEFFNER: The more prevalent diseases that, that is the ultimate preventative step forward.
SACHS: What a very interesting question and, I’d be hesitant to say it’s the scientific approach that’s the problem. There’s a lot of brilliant minds working on these problems, and were already working on these problems ten years ago, and it’s frustrating that they haven’t had breakthroughs. I think it’s a hard nut to, to crack.
HEFFNER: But has the focus been on the vaccine creation?
SACHS: Could there be more focus, of course. I’d love to see more focus.
HEFFNER: Was it diverted in the wake of believing that we were in a post-pandemic or epidemic era?
SACHS: Right, I hear you.
HEFFNER: Or the idea that the diseases for which a vaccine could be developed, even cancer for instance, were too comprehensive in scope to be tackled that way, and was that perhaps,
HEFFNER: Lacking a foresight that you share with us in “Good Germs, Bad Germs?”
SACHS: I think there is renewed interest in vaccines for, for things like cancer and others that aren’t strictly infection, but at the same time, it’s very expensive research, vaccine research, and I think a lot of pharmaceutical companies are going okay, how much are we gonna invest? What’s gonna be our, in, our payoff?
SACHS: And so I think it’s going to take a lot of invest, public investment, like NIH, and renewed interest there.
HEFFNER: Right. We’ve hosted NIH and CDC on these particular topics and the potential in that arena and whether it was Tom Frieden, Maria Freire, Laurie Glimcher always came back to the dollar question.
SACHS: Oh yeah.
HEFFNER: And you are a chronicler of the pioneers who succeeded, so they weren’t cash-strapped. They, they had the resources and the knowhow to tackle the problem.
SACHS: Yeah, I hear what you’re saying, and I’m, we need more investment, whether, are we at a particular time now when we are at a loan investment? I wouldn’t say that. But yes, it always comes down to the dollar and there’s so much research we need. I would say, I would argue this is a priority we have antibiotic-resistant infections. We’re gonna, we don’t want to go back to the day when, you know, there’s nothing we can do, see if the patient survives the night. But yes, it’s a matter of prioritization and how much money you invest.
HEFFNER: One of the things you highlight in the book is the immediate destruction of lives as a function of resistance. And that there was not really a consciousness or an awareness of the severity of the problem.
SACHS: Right, yes and no, as in from the beginning the earliest developers of antibiotics, of, of penicillin, they saw this coming, and they warned. The warning has always been there but we always have stayed one step ahead. We had one more antibiotic coming out.
HEFFNER: But that’s, that’s also the point because you said that the creation of vaccines is a highly expensive proposition, but if you have followed the pharmaceutical or medical industry, you’ll realize that they aren’t incentivized to make more antibiotics because they’re not working.
HEFFNER: They’re not working as readily, so,
HEFFNER: The investment may be smarter and more strategic,
HEFFNER: To be the vaccinations.
SACHS: Absolutely. A lot of this,
HEFFNER: People are gonna pay for the vaccines.
SACHS: Right. Oftentimes I think big pharma wants to come in once something is really showing its promise, so that early stage research where you really bring it right up to this is ready to go into clinical trials with people, that’s a lot, that’s where our public funding of research comes in. Then when it’s looking really good and you have to fund those multi-million dollar clinical trials, pharma tends to step in, whether that’s a good approach to it or not, it’s our approach right now, what we have.
HEFFNER: And the priority is emergency preparedness more than long-term prevention. How would you describe,
SACHS: Our, I think,
HEFFNER: Where we are today?
SACHS: As in, is there more interest in responding to the emergency, the bomb going off right now?
SACHS: I think we are classically stuck in that, you know,
HEFFNER: And what has taught you from your own reading of the scholarship and your own constructive of this narrative which is the history of contemporary antibiotic use and misuse where can we look for the future, you mentioned pioneers but the, the future,
HEFFNER: Scientists who are gonna take the public leadership role.
SACHS: Right. I think we need a lot of support for immunology, understanding the immune system and how it fights infections, and microbiology understanding the bacteria, now my, “Good Germs, Bad Germs” focuses in on bacteria but of course we also have viruses that can make us sick and parasites can make us sick, and greater understanding of how they do make us sick. So sometimes you can control them without just antibiotics. Vaccines being one, probiotics being one, new approaches to detoxify the germs that are making us sick without directly killing them as a way to slow down resistance to the drugs we have.
HEFFNER: And how do you make this more mission-oriented, because,
SACHS: The bigger picture?
HEFFNER: Right. The, in terms of getting the investments from the government to be concerned with individual challenges or achievements,
HEFFNER: It, you know, there has been a renewed interest in space and exploration and part, Tesla and some of the Silicon Valley innovators have attended to those questions of extraterrestrial exploration,
HEFFNER: And there is beginning to be a new wave of philanthropy thanks to the tech moguls,
HEFFNER: Focused on medical challenges but no one has really identified what the, what is the Mars of …
SACHS: Right. Who’s gonna take on that big picture?
HEFFNER: And I’m, yeah.
SACHS: That’s a really good question. I know the Gates Foundation has, has shown a lot of interest in fighting infection in the, especially in the third world,
SACHS: And whether that can be harnessed. The NIH can be harnessed. It’s really taking that, as, as I think you’re elucidating very clearly, the bigger picture, because we have, we are living literally in a bacterial world. We can’t wipe them all out.
SACHS: We have to learn to live with them and that is going to take that less, let’s respond to today’s emergency and, and the bigger picture of how can we coexist with bacteria.
HEFFNER: Right. Well and also how can we coexist, there is a scientific methodology and consensus that vaccines work. But there’s also a groundswell of conspiracy theory and innuendo that have emerged, and perhaps they’ve destabilized the foundation of the community that would pledge for a cancer vaccine.
SACHS: Right I hope not. I certainly hope not. And yes, there is,
HEFFNER: So how do you deal with that problem,
HEFFNER: Of the conspiracy theorists,
SACHS: Well, right.
HEFFNER: Who are selling you fake science?
SACHS: I know there’s a lot of concern, some of the things you see on social media and elsewhere of oh, look at all the vaccines we have in a child’s schedule now, I, versus I, and here you are saying we need more. One of the things I think in educating people and trying to share knowledge in that our vaccines are so much cleaner today than they were before in terms of addressing people’s concerns that they’re too much. In the old days, we didn’t know what it was in a bacteria that triggered a good immune response so we kind of threw it all in there, and they were very inflammation-provoking vaccines thanks to, to science and research, we now more and more vaccines makers know just which antigen to put in there to get the desired effect, without trigging untoward inflammation, and also the research we’ve been doing so much research, so many dozens of studies that have looked into vaccine safety.
Is that enough to convince people who believe in a conspiracy theory, perhaps not. But hopefully it will convince the general public and fortunately our vaccination rates are still very high. Of course when you prevent a disease, it’s less dramatic than when you treat it. So the success of vaccination is that. We don’t know measles, mumps, rubella and, and many of these like they did let’s say when I was a child.
HEFFNER: The response to those critics who cite the epidemic of autism, who cite the allergies that are now more prevalent in this generation than earlier generations, how can you make the argument, you know, that X or Y was the cause of those as opposed to vaccines?
HEFFNER: And it’s, it seems like you have to point to another variable that is triggering this, otherwise people will continue to believe,
SACHS: Absolutely, and I think when it comes to autism that’s, that’s fair in that we don’t understand all the causes of autism. We’re only beginning to understand autism’s development. So it’s, it’s understand…
HEFFNER: But we do understand just quantitatively that it, cases of autism have risen exponentially.
SACHS: Right. And part of that is increased diagnosis,
SACHS: Things that we wouldn’t have recognized as autism fifty years ago, we now know that, we call it autism and we didn’t call it before. We might have called it something else before, so that’s part of it.
SACHS: There is also something going on, it appears, about a real increase and we’re looking for causes and, and there’s a lot of research on what’s so-called environmental risk factors for autism, and by environmental we don’t just mean, you know, chemicals in the environment. We’re talking about older parents, stresses, pre-natal stresses because a lot of autism seems to have pre-natal origins, so we need more research. We need more research to understand the causes, and until we clearly do understand the causes, it’s understandable for parents to try to seek answers on their own, and it’s also true that autism’s outward symptoms tend to appear around the time that kids are getting their two-year vaccinations. But that’s not a causation, necessarily, you know.
SACHS: All these kids, this is when they get these vaccinations, and studies have looked at, you know, vaccinated versus unvaccinated kids and there’s not a difference in rates.
HEFFNER: And there is a historical documentation here that you point to that we keep records now, we also live in a society, we’re living relatively longer and therefore there’s more potential for older parents and that has been cited as a source of greater cases of autism. But if you go back to the bacteria, where we started,
HEFFNER: And think about our, our livelihood dependent upon the good bacteria prevailing in, in this war that has been, you know, since we are homo sapiens, since our birth as a species, what, what is your hope in tackling both autism and cancer, which we talked about because they’re both pervasive and they’re both cited as you know, challenges that we might not be able to achieve and I tend to think of some of the lay reaction to these diseases as still defeatist and I’m wondering if the bacteria can help us empower the scientists and solutions to both of those challenges.
SACHS: Sure. First, in regard to autism, and this is just a sensitivity, I wouldn’t necessary, I wouldn’t call it a disease. We don’t call it a disease, because it’s a wide spectrum and there are many people who embrace their autistic traits,
SACHS: And would not want to be treated and they need support. Maybe accommodation, as in with any disability, you accommodate. Then there are people on the very severely disabled end of the spectrum that, that clearly need and want treatment. Where the micro-biome or good bacteria comes in, there’s an, a relatively new avenue of research with at least a subset of people with autism. There is a correlation with what’s going on in their intestinal tract where we have most of our bacteria. Imbalances in, in the bacteria which cause inflammation. That inflammation communicates itself to the brain and worsens symptoms, and that’s a really important and exciting area of research right now.
HEFFNER: Well that’s the big picture, that, I mean that’s how the bacteria can be identified as both the cause and the potential correction,
HEFFNER: For people who do view it as a medical condition, what about cancer? Long-term prospects for the bacteria to help us in that fight?
SACHS: Right. So right, cancer, well in terms of, well there, there’s two aspects. In terms of bacteria, so, years ago, a doctor named Coley, a cancer physician, found a patient, incurable cancer. Got a bad infection. His tumor disappeared. And he started developing what we call the medical condi, community calls Coley’s toxins, basically injecting bacteria, virulent bacteria into tumors. And sometimes it would get rid of the tumors and he was trying to figure out why that was. But sometimes it would kill the patient. We stopped doing that, but it did seem to direct the immune sys, now cancer researchers are going back and revisiting that, and realizing that somehow that infection triggered the immune system to get rid of the tumor. It recognized cancer, the immune system doesn’t recognize this is wrong, we need to get rid of these cancer cells, so if you can get the immune system to focus in on those cancer cells and treat them as foreign invaders, you have a powerful mechanism to clear the cancer, and that’s what cancer vaccine researchers are trying to do today. Design vaccines maybe instead of with bacteria, take a piece of that person’s tumor cells and show it to the immune system, which is what a vaccine does. It takes something, shows it to immune system, and says this is bad, go get it.
HEFFNER: When would it make logical sense if we can’t just judge it by your knowledge and intuition, that we would make that ultimate stride forward and in two years, in five years, in ten years have some universal knowledge and conclusive medical results that could be scaled?
HEFFNER: What’s the timetable?
SACHS: I think, well it’s already here, on a small scale. We have a lot to learn, and no doubt there’ll be reversals, but yes, we have cancer vaccines now.
HEFFNER: Thank you Jessica.
SACHS: My pleasure.
HEFFNER: And thanks to you in the audience. I hope you join us again next time for a thoughtful excursion into the world of ideas. Until then, keep an open mind. Please visit The Open Mind website at Thirteen.org/OpenMind to view this program online or to access over 1,500 other interviews. And do check us out on Twitter and Facebook @OpenMindTV for updates on future programming.