A Pro and Antibiotic Future – Jessica Snyder Sachs | The Open Mind

A Pro and Antibiotic Future – Jessica Snyder Sachs | The Open Mind


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. HEFFNER: Right. 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, SACHS: Sure. 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? HEFFNER: Mm-hmm. 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. HEFFNER: Yeah 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, SACHS: Right. 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, SACHS: Right. 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? HEFFNER: Right. 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: Right. SACHS: So, 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. SACHS: Mm-hmm. HEFFNER: They’re not
working as readily, so, SACHS: Right. HEFFNER: The investment may be
smarter and more strategic, SACHS: Right. 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? HEFFNER: Right. 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, SACHS: Right. 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, SACHS: Right. 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, SACHS: Right. HEFFNER: And there is
beginning to be a new wave of philanthropy thanks
to the tech moguls, SACHS: Right. 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, HEFFNER: Right. 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. HEFFNER: Right. 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, SACHS: Right. 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? SACHS: Right. 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, HEFFNER: Right. 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. HEFFNER: Mm-hmm. 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. HEFFNER: Right. 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, SACHS: Yes. 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, HEFFNER: Uh-huh. 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, SACHS: Right. 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? SACHS: Right. 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
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