People of Northwest Public Radio
Tue October 22, 2013
Antibiotics Can't Keep Up With 'Nightmare' Superbugs
Originally published on Tue October 22, 2013 3:15 pm
We're used to relying on antibiotics to cure bacterial infections. But there are now strains of bacteria that are resistant to even the strongest antibiotics, and are causing deadly infections. According to the CDC, "more than 2 million people in the United States every year get infected with a resistant bacteria, and about 23,000 people die from it," journalist David Hoffman tells Fresh Air's Terry Gross.
Many people are familiar with the type of resistant infections often acquired in hospitals, caused by MRSA, the acronym for methicillin-resistant Staphylococcus aureus. But most people don't know about the entirely different group of resistant bacteria that Hoffman reports on in Hunting the Nightmare Bacteria, airing Tuesday on PBS' Frontline. The show explores an outbreak of resistant bacteria at one of the most prestigious hospitals in the U.S., and explains why there is surprisingly little research being conducted into new antibiotics to combat these new superbugs.
"We really have a big information black hole about these really, really dangerous bacteria, and we need to know more, and it ought to be a national priority," Hoffman says.
On how bacteria have evolved to be resistant to our antibiotics
Bacteria have been training at this for a long, long time. I think when a lot of people took antibiotics in the '50s and '60s, there was a lot of talk then about "miracle drugs" and "wonder drugs" ... Had we basically pushed back those evolutionary forces? Had we essentially found a way to avoid infectious disease? Well, what we're seeing is this evolutionary process in bacteria. It's relentless, and what happened here was [that] bacteria learned to basically teach each other to swap these enzymes and help each other learn how to beat back our best antibiotics; our last-resort antibiotics didn't work. ...
In the period before World War II ... people that got infections, they had to cut it out. They had to cut off limbs, cut off toes, because there weren't antibiotics. And oftentimes, when people talk about the fact that we might have to go back to a pre-antibiotic age, that's what they mean — that a simple scrape on the playground could be fatal.
On how pharmaceutical companies don't have economic incentive to develop new antibiotics
[In the '50s and '60s] I think there was something like 150 classes of new antibiotics. And although there were warnings then that if we misused them that resistance would grow, you could just see in the marketplace new ones coming on every couple of years. ... I think we got very, very complacent. ... In the '80s and particularly in the '90s we went around the bend a little bit because the science didn't continue to produce new antibiotics at that rate, and the economics of drug development changed rather remarkably. ...
We're bombarded with advertisements that there are drugs now to treat chronic diseases ... that you would take for the rest of your life. And you can imagine, if you're in drug development, if you create and invent one of these drugs that can tackle a chronic disease that people will take forever, the return on investment for the drug companies to develop those big blockbuster drugs ... that became irresistible.
But think about antibiotics. If they're taken properly, you take them only for a short course, a couple of weeks maybe, and then you stop and you forget it, you get better. ... So the economics of making antibiotics wasn't going to make these big profits for the drug companies. And slowly, but with increasing frequency, they begun to pull out of research on antibiotics.
On what's unique about these new strains of bacteria that makes them resistant to antibiotics
One feature of [some antibiotic-resistant] bacteria is that they have kind of a hard armor around them, a shell, which protects them from antibiotics. They also have the ability to pump out the antibiotics or to basically chew it up inside. These ... are very, very difficult to treat; you just don't have antibiotics for them. ...
NDM-1 [an enzyme that makes bacteria antibiotic-resistant] has a very, very unusual but worrisome characteristic, and that is this: It has a mechanism to transfer its genes — its genetic material — which helps it resist antibiotics. It can transform that to other bugs. It can walk around like a coach, giving training and directions to other bacteria ... helping other bacteria become resistant to antibiotics ... teaching them how to do it. ...
NDM-1 is now spreading in the United States. ... There have been 16 cases, and the year before the numbers doubled in a year. You know, it's not an epidemic or anything, but these things are popping up now with more and more frequency in hospitals and in patients around the United States. It's here.
On the bacterial outbreak at the National Institutes of Health Clinical Center and how it spread
This clinical center is a very sophisticated research hospital. Patients are invited there because of research programs going on in the many different institutes of the National Institutes of Heath. It's not a hospital you walk into with a sore throat.
They had enrolled and invited a patient from New York, a woman who had had a major operation, and she was invited for a particular study that they needed to do. When they came they looked at her chart, and they had no warning, but the chart said that this woman had this drug-resistant bacteria ... which they had never seen before. This is a resistant [bacteria] called KPC; it's resistant to some of our most modern, last resort ... antibiotics. They did what they could to prevent this bacteria from spreading. They put her in what's called "enhanced contact isolation." Gloves and gowns for everybody, put her at the end of the ICU in her own room, and they went through with the research they had to do. And after a month ... she seemed to survive it; she was discharged. Everybody at the clinical center breathed a sigh of relief. ...
Then there was a couple weeks of quiet. And then a really, really, surprising thing happened. This particular bacteria started to show up in other patients in routine surveillance of the patients. Suddenly, in the microbiology lab they're beginning to see this thing, and none of these other patients had any contact with the first one. ... So where was this bug? Where was the mechanism that it was moving around? And that was a real crisis. ...
So they went through a series of phases of this war that they carried out to try to deal with this. The first thing that they thought was: Maybe it's just in the environment; maybe it was on door handles; maybe it was on a doctor's hands or gloves. ... So they began to clean a lot of things. ... They did everything they could to bleach and clean and make sure they could stop it, and they still didn't stop it; it started to continue to spread. ...
[They approached a team of genomics specialists, and] the people in genomics had some very tentative early experience of taking a bacteria and taking a look at its entire genetic blueprint. ... So they took a couple samples of this bug that was racing around ... and they started running it through the computers. It takes a while, it took a couple of weeks, but when they got the results back, everybody was completely stunned. ... The results showed that the bug had jumped from patient No. 1 to several other people, and it had jumped by being carried by people who didn't get sick from it. They found out that there were intermediaries, or silent carriers, that were spreading it around. To this day we don't know [if] the silent carriers were other patients [or] hospital workers. They began to see that this wasn't so much a problem of KPC being in the environment as it was people were moving it around.
On how hospitals aren't required to report outbreaks of bacteria resistant to antibiotics
In other countries, take Canada for example, outbreaks are routinely announced by the hospitals. In the European Union they are tracking the rise of resistant [bacteria] in a way that we aren't ... I think a little more better tracking, better information and transparency would make us all more sensitive to these things and maybe wake us up a little bit from this complacency that we got to "miracle drugs" in the '50s and '60s, and realize [that] this is a very, very precarious and precious thing we have. We need to act that way. ...
The data, the information on this entire thread is very, very slim. There is not a national surveillance system reporting to the CDC on these new kinds of infections, and it's something we really need. I think it's something the government knows we need, and we don't have it. There are a few states that require reporting on these kinds of infections. A few require some hospitals to report, and you know, after last March when the head of the CDC first spoke out and called these things "nightmare bacteria" a couple more states signed up and required their hospitals to begin reporting. You can't go to any single place and find out what's going on. ... The last I checked only about 16 hospitals were participating.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. The other day, one of our producers, Amy Salit, suggested that we do an interview about bacteria that are resistant to antibiotics, and my first reaction was I know, it's terrible, but we've covered that, we've talked about the resistant strain of staphylococcus that lives in many hospitals and sometimes infects patients with incisions or open wounds.
But Amy said no, the story's become even worse. There's a different group of bacteria that are increasingly resistant to even the strongest antibiotics. And then she had me watch the new edition of "Frontline" called "Hunting the Nightmare Bacteria," which will be shown tonight on most PBS stations. It's very informative and very alarming.
My guest is the reporter for this "Frontline," David Hoffman. Hoffman is a contributing editor for the Washington Post, where he's also covered foreign affairs, national politics and served as an editor. We previously had him on our show to discuss his 2009 book "The Dead Hand: The Untold Story of The Cold War Arms Race and Its Dangerous Legacy."
David Hoffman, welcome to FRESH AIR. How did you get onto this story?
DAVID HOFFMAN: Terry, it's great to be back, and I got onto this story when the Clinical Center at a really major hospital at the National Institutes of Health, had a really major outbreak. And they had an outbreak of one of these new kinds of bacteria, and I got curious about it because the outbreak caused a lot of panic, a lot of hysteria and a lot of misunderstanding. And I wanted to figure out what really happened.
GROSS: When I started watching your "Frontline," I was hoping that this was going to be about a small number of people who had resistant infections. It's not. Give us a sense of the numbers we're talking about.
HOFFMAN: You know, just recently the Centers for Disease Control and Prevention in Atlanta gave an estimate that more than two million people in the United States every year get infected with a resistant bacteria, and about 23,000 people die from it.
GROSS: Let's start where your "Frontline" starts, with the story of an 11-year-old girl who was suddenly overcome with an infection. She had infected welts all over her body. She had pneumonia. What was the bacteria causing the problem?
HOFFMAN: Well, this young girl, 11-year-old Addie Rerecich, was a very pretty young girl, athletic, loved to play sports, played volleyball and softball. And one day she got a real pain in her hip. And, you know, her mother thought at first it was just kind of athletic thing, maybe pulled a muscle or something like that, but it got worse and worse very quickly, and she had a staph infection.
And this staph infection spread very, very quickly. I think the staph infection may have responded to antibiotics, but they were late, and so it spread all through her body, and it was life-threatening.
GROSS: And then things got even worse. She was on a breathing tube because of the pneumonia, and she got an even more resistant strain of bacteria. What was that?
HOFFMAN: The more resistant strain is called stenotrophomonas. And because Addie had all these tubes in her in the hospital, probably from one of those tubes she got infected with this strain. And the stenotrophomonas was resistant not just to one or two antibiotics but resistant to everything, and her doctor told us, you know, I didn't have any options. And this stuff was just ravaging her. It was life-threatening.
GROSS: And this resistant stenotrophomonas is what's called a gram-negative bacteria, and this gram-negative bacteria is a central focus of your investigation. What is it, and why is it so difficult to treat?
HOFFMAN: Our investigation shows that there's a rising tide of gram-negative bacteria like stenotrophomonas, which are very, very difficult to treat. And one feature of these bacteria is that they have kind of a hard armor around them, a shell, which protects them from antibiotics.
They also have the ability to pump out the antibiotics or to basically chew it up inside, and so these gram-negative bacteria like the one that invaded the Clinic Center at the National Institutes of Health and like the one that Addie had are very, very difficult to treat. You just don't have antibiotics for it.
GROSS: So in the case of Addie, they had to surgically remove her lungs to surgically get out the infection because they couldn't treat it with antibiotics.
HOFFMAN: Just imagine this nightmare that, you know, one day your daughter's playing volleyball, and the next day she's got an infection that can't be treated. Now this didn't happen just the next day but over a period of weeks. It happened very, very quickly. Addie got to the edge of life, where she had an infection that couldn't be treated and therefore required a lung transplant that should cut out the infection because we had no tools. We had no drugs that could've killed it.
And so she waited patiently online as they struggled to keep her alive until a pair of lungs came along, and she could have a lung transplant.
GROSS: OK, so that's one of the stories that you tell in much more detail in your "Frontline." Then you tell the story of a young American man who was in India. He was in a freak train accident, dragged under a train, rushed to the hospital where the doctor kind of hacked off his leg.
When he was well enough to be moved back home to the United States, he was flown to a hospital in Seattle - he lived in Seattle - and a test of the bacteria confirmed the doctor's worst fear. What was the bacteria?
HOFFMAN: This was a bacteria that the doctor had never seen before. It was NDM-1. The ND stands for New Delhi, and it was a particularly vexing bacteria because first of all there wasn't a lot of information about kind of antibiotics you could use, and this young man, when he came back after this, you know, real ordeal in India, you can just imagine, to find out that his problems hadn't ended.
He had a bacteria called NDM-1, which has a very, very unusual but worrisome characteristic. And that is this: It has a mechanism to transfer its genes, you know, its genetic material, which helps it resist antibiotics. It can transfer that to other bugs. It can walk around like a coach, giving training and directions to other bacteria. And what was happening to this fellow was that the NDM-1 was helping other bacteria become resistant to antibiotics. It was teaching them how to do it.
GROSS: I still can't comprehend how that works, how there's an enzyme that not only makes a specific bacteria resistant to antibiotics but that enzyme could be spread to other bacteria and make them resistant, as well.
HOFFMAN: You know, we live in an amazing world that certainly predates us by thousands and thousands and millions of years. And bacteria have been training at this for a long, long time. And I think when a lot of people took antibiotics in the '50s and '60s, and there was a lot of talk then about miracle drugs and wonder drugs, and, you know, had we basically pushed back those evolutionary forces, had we essentially found a way to avoid infectious disease?
Well, what we're seeing is that this evolutionary process in bacteria, it's relentless. And what happened here is bacteria learned to basically teach each other to swap these enzymes and help each other learn how to beat back our best antibiotics. Our last resort, antibiotics didn't work.
GROSS: And when I said that this bacteria confirmed the doctor's worst fear, the doctor knew that this bacteria existed in New Delhi. It hadn't been seen yet in the United States. And this was the first documented case, right?
HOFFMAN: There was a few cases in Europe of people that had come from India to Europe, but certainly it was one of the very first times it had been introduced into the United States. And one of the things that the doctor decided to do when he realized how few options he had was to reach for a very old antibiotic, one that was developed in the 1940s in the United States called colistin.
And this is a case of an antibiotic that sometimes works, but it's very toxic. It can basically wreck your kidneys. And this is a last resort. I mean, this is really the kind of moment that I'm sure a lot of clinicians really fear, when they have to reach on the shelf for something they know will harm you but in hopes that it will save you.
And this case the colistin was just too toxic. They tried it for a while. It didn't stop the NDM-1. But it was eating up this young man, David Ricci, and they had to stop it. Then what?
GROSS: Then what?
HOFFMAN: Then what? They put out a kind of a information call around the world. They scoured, looking for possibilities. They continued to look for other kinds of antibiotics. But like poor Addie, David also had to undergo some more surgery. They basically had to cut off another part of his leg, hoping in the most crude and painful way you can imagine to just cut out the infection.
And Terry, you know, this is a thing that a lot of people forget. But certainly before our lifetimes, but in the period before World War II and certainly for long, long decades before that, people that got infections, they had to cut it out. They had to cut off limbs, cut off toes because there weren't antibiotics.
And oftentimes when people talk about the fact that we might have to go back to a pre-antibiotic age, that's what they mean, that a simple scrape on the playground could be fatal.
GROSS: What kind of shape is David Ricci in now?
HOFFMAN: He's in better shape. You know, he did recover somewhat from losing his leg, and he's got one of these very high-tech artificial ones now that even has, he told me, a roller-blading setting on it. But it's - he certainly has gone back to school and restarted his life, but, you know, he lives really haunted with this idea that they don't really know if the NDM-1 will come back. You can never really wipe these things out.
GROSS: Was the hospital effective in preventive in preventing this bacteria from spreading?
HOFFMAN: As far as I know it was. I don't know a lot of the details about that particular hospital. But NDM-1 is now spreading in the United States. We know that. We know that there have been 16 cases, and the year before, the numbers doubled in a year. You know, it's not an epidemic or anything, but these cases are popping up now with more and more frequency in the hospitals and in patients in the United States. It's here.
GROSS: If you're just joining us, my guest is David Hoffman, and he's the reporter on a new edition of "Frontline" called "Hunting the Nightmare Bacteria." It will be shown tonight on most PBS stations. David let's take a short break here, and then we'll talk some more. This is FRESH AIR.
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GROSS: My guest is David Hoffman, and he's the reporter on a new edition of "Frontline" that airs this evening called "Hunting the Nightmare Bacteria," and it's about new strains of antibiotic-resistant bacteria, and it's actually a very scary story. David Hoffman is a contributing editor to the Washington Post.
We've been talking about a couple of cases where people had this kind of resistant bacteria, and the story that sparked your investigation is a story of an outbreak of a resistant bacteria at the National Institutes of Health's Clinical Center, which is their hospital. How did they end up with a patient that had this kind of resistant bacteria, and what was the bacteria?
HOFFMAN: The bacteria was known as Klebsiella pneumoniae. This Clinical Center is a very sophisticated research hospital. Patients are invited there because of research programs going on in the many different institutes of the National Institutes of Health. It's not a hospital you walk into with a sore throat. It's a very special place, and some of this research is groundbreaking. It helps advance the cause of human health.
So they had enrolled and invited a patient from New York, a woman who had had a major operation, and she was invited for a particular study they needed to do. But when they came, they looked at her chart, and they had no warning, but the chart said this woman has this drug-resistant bacteria, Klebsiella pneumoniae, which they had never seen before.
And this was a resistant Klebsiella pneumoniae called KPC. It's resistant to some of most modern, last-resort, top-flight antibiotics. So they did what they could to prevent this bacteria from spreading. They put her in what's called enhanced contact isolation, gloves and gowns for everybody, put her at the end of the ICU, in her own room, and they went through with the research they had to do, and after a month - the woman also got that horrible antibiotic called colistin.
But after a month she seemed to survive it, and she was discharged. And everybody at the Clinical Center sort of breathed a sigh of relief. You know, we got through that, she came here, she was isolated, she's gone.
And then there was a couple weeks of quiet. And then a really, really surprising thing happened. This particular bacteria started to show up in other patients, in routine surveillance of the patients. Suddenly in the microbiology lab they're beginning to see this thing, and none of these other patients had any contact with any the first one.
They weren't in the same room. Some of them had not even been in the hospital. So where was this bug? Where was the mechanism that it was moving around? And that was a real crisis.
GROSS: Do they know the answer to that now?
HOFFMAN: So they went through, I think, sort of a series of phases of this war, really, that they carried out to try and deal with this. The first thing that they thought was maybe it's just in the environment. You know, maybe it was on door handles. Maybe it was on a doctor's hands or gloves. Maybe it was on the telephone. So they began to clean a lot of things.
You know, they ripped out some sink drains. They brought in this little robot that sprays empty rooms to try and decontaminate it. They did everything they could to bleach and clean to make sure they could stop it, and they still didn't stop it. It started to continue to spread.
And then they had some contacts with the - one of the institutes at the National Institutes of Health is an institute that studies genomics, which is the science of the whole genome of an organism. And the people in genomics had had some very tentative sort of early experience with taking a bacteria and taking a look at its entire genetic blueprint.
You can do that now with computers, you know. You can just basically see all of its DNA. So they took a couple samples of this bug that was racing around, this KPC, and they started running it through the computers. Now it takes a while. It took a couple of weeks. But when they got the results back, everybody was just completely stunned.
HOFFMAN: The results showed that the bug, the Klebsiella, had jumped from patient number one to several other people, and it had jumped by being carried by people that didn't get sick from it. They found out that there were intermediaries or silent carriers that were spreading it around. And to this day we don't really know were the silent carriers other patients, were they hospital workers?
So they began to see that this wasn't so much a problem of the KPC being in the environment as it was people were moving it around. And, you know, standard epidemiology is you look at patient number one, you know that person had it, that woman came to the hospital. Then you look at, oh, patient number two, she gave it to patient number two. They were in the same ward in the same room or whatever.
But when they tried that method, nothing worked. Nothing made any sense. But when they took the genomics and studied how the bug was spreading, the genomics allowed this amazing advance in science to have sort of a time stamp on every single isolate of the bacteria that they could find. And that little time stamp identified exactly where it came from, when.
And so they made a new map, and the new map exposed the silent carriers. It showed that the order that this thing was passed around didn't go one, two, three, four, five; it went one, three, four, eight, two. And this is really important because this is cutting-edge work that shows how something like this can spread that just turned the tables on all the previous knowledge about it.
GROSS: So the takeaway is that it spread through carriers, either patients or staff from the hospital, who never got sick but carried it and passed it on to other people.
HOFFMAN: That's right, and it got worse. After they discovered that, they were still having outbreak. I mean once a week, sometimes twice a week, people were showing up with this drug-resistant Klebsiella. This is an infection with a mortality rate of about 40 percent. So, you know, four in 10 people that get it as a bloodstream infection die. It's a very, very, you know, kind of a dangerous bacteria to have in your bloodstream.
And there were a lot of people who were seriously ill at this hospital. That's why they're there. And it kept spreading and spreading. And, you know, the first patient was there in the summer. The genomics work was done in August. They began to figure out the silent carriers in September. And then they had a whole other new disaster, I think really the moment that caused them the most fear of all, and that came in the autumn, when the bacteria basically got out of the ICU, and suddenly they started having cases of people in the other wards who had never been in the ICU. It jumped out.
GROSS: Do they know how?
HOFFMAN: I think they know that there are silent carriers, that it's possible that a silent carrier spread it. I think they did everything they could. You know, they had a situation where they told even the nurses and the hospital workers, look, if you're working with one of these patients with KPC, you've got to stay strictly with them. You can't work with anybody else.
You've got to - and they even told the nurses in the lunchroom you can't talk to another nurse who's not working with KPC. They created essentially a small, new ICU just for these patients. They did everything they could to try and separate it, but they still to this day don't know why that somehow, finally in December, the outbreak subsided.
But people died in those six months. Six people died directly from KPC out of 18 that got infected, and five more people who had other serious complications, it probably contributed to their deaths. This was in 2011.
So finally in December, you know, the hospital director and deputy director, they came very close to thinking about closing this hospital it was such a severe problem. They decided not to. They did everything they could to try and stop it. And you can imagine their sense of relief when in December the outbreak seems to subside. They didn't have new cases.
But another one cropped up six months later. And when we asked the deputy director of the hospital, Dr. David Henderson, you know, he said in the interview with us, he said I don't think we're ever going to see the end of this.
GROSS: David Hoffman will be back in the second half of the show. His new "Frontline" documentary, "Hunting the Nightmare Bacteria," will be shown tonight on most PBS stations. I'm Terry Gross, and this is FRESH AIR.
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GROSS: This is FRESH AIR. I'm Terry Gross back with journalist David Hoffman. We're talking about new strains of bacteria that are resistant to even the most potent antibiotics. Hoffman reports on these alarming superbugs in his new "Frontline" documentary "Hunting the Nightmare Bacteria," which will be shown tonight on most PBS stations. Hoffman is a contributing editor at the Washington Post.
When we left off, we were talking about a small but dangerous outbreak of resistant bacteria at The National Institute of Health's Clinical Center in 2011. This bacteria, known as KPC, entered the hospital with a sick patient was transferred there. In spite of the center's diligence, the bacteria still managed to be spread through hospital staff and patients who transmitted the bacteria without ever getting sick themselves.
So what were the ethical considerations at the NIH hospital about whether to make a small outbreak of resistant bacteria public or not? Especially, you know, knowing that you have patients going into the hospital not knowing about the potential dangers.
HOFFMAN: You know, all those patients they go to NIH are interested in going there because they're going there for groundbreaking research in many cases could save their lives. And the NIH Clinical Center, which does this research on people on behalf of all, and these other institutes that cooperate with them, they - when they had this outbreak and were fighting it nothing was said publicly, but they took the whole experience - including the genomics and wrote a scientific paper about and they published it in August of 2012, which was as you can imagine some months after the outbreak had subsided. It's a very, very interesting scientific paper and it's a really remarkable bit of detective work that they did find it.
But one of the things that happened when they published this was there was just an enormous amount of public misunderstanding. I mean, there was real hysteria. A local school that's across the highway from the NIH called up and said can we send the kids out to play? And various delegations were coming to the hospital, canceled their trips, and it was really a rational and misunderstood. And one of the things that I think that happened is the Clinical Center actually told the world about something that most hospitals don't speak about. And they did it because they are a center of scientific research and they are devoted to trying to advance some of these things, such as using genomics to track it. And they did what a lot of hospitals in this country wouldn't do today. And you don't hear hospitals publishing scientific research on an outbreak that they had, they oftentimes never talk about it. This Klebsiella pneumoniae that is resistant to antibiotics that happened, that broke out at NIH, was in New York City hospitals for years and years before it happened there.
GROSS: So, but you just put your finger on what I imagine is a problem for hospitals. If you make public the fact the fact that there's been an outbreak of resistant bacteria in the hospital, people will be terrified to go into the hospital. And they'll be terrified in general if you don't make it public, then you're withholding important information and kind of covering up a problem that people should probably be aware of.
HOFFMAN: And I think that we erred too much on a conspiracy of silence about this. In other countries - take Canada for example - outbreaks are routinely announced by the hospitals. In the European Union, they are tracking the rise of resistance in a way that we aren't. They've been tracking it member states since 1999. So I think a little more better tracking, better information and transparency would make us all more sensitive to these things and maybe they would wake us up a little bit from this complacency that we got to miracle drugs in the '50s and '60s and realize this is a very, very precarious and precious thing we have.
GROSS: I'd like to ask you how many hospitals have had outbreaks of these new forms of antibiotic resistant bacteria, but I know you can't really answer that question. Why can't you?
HOFFMAN: The data, the information on this entire thread is very, very slim. There is not a national surveillance system reporting to the CDC on these new kinds of infections. And it's something we really need and I think it's something the government knows winning and we don't have it. And, you know, there are a few states that require reporting on these kinds of infections, a few required some hospitals to report and, you know, after last March, when the head of the CDC first spoke out and called these things nightmare bacteria, a couple more states signed up and required their hospitals to begin reporting. But you can't go to any single place and find out what's going on.
And there's another thing happening here that I think we have to think very, very hard about because hospitals are really critical part of our health care system. You know, we don't want to encourage people to not go to the hospital, but I think hospitals also need to be more open about what really does happen there, about the kinds of infections and outbreaks. And for a long time I think you can understand hospitals weren't open about it. No hospital - many of them, you know, are in competitive situations. Many of them have a lot of difficulties. No hospital wants to tell the public about an outbreak of infection, but they happen.
GROSS: So in most states hospitals are not required to report this and in some ways there's not a lot of incentive to report that there's been resistant bacterial infections spread in the hospital because that would just scare people away. So that's part of the reason why we don't know, right, because hospitals would rather not report it if they don't have to?
HOFFMAN: I think that's true. And also I think the federal government is trying but only gradually to create some kind of system. Part of the problem is that it's very difficult for hospitals to get all this information together. You know, they don't have easy ways to collect the information. And I know the CDC tried to set up sort of an electronic system to track it, but it's voluntary and hospitals have to have the sort of electronic medical records that they can send to the CDC, and a lot of them don't have that particular thing. So the last I checked only about 16 hospitals were participating in this thing. There's maybe I would say, you know, 15 states altogether that are collecting this information. It changes a little bit but we really have a big information black hole about these really, really dangerous bacteria and we need to know more and it ought to be a national priority.
GROSS: Yes. Well, I was watching your "Frontline" and thinking, well, I'm sure America's greatest scientists are on the case trying to come up with antibiotics that can kill these now resistant strains of bacteria. But you describe how there's very few pharmaceutical companies that are actually doing the research. Why is that?
HOFFMAN: When antibiotics were first discovered, they really did seem to be like wonder drugs. And, you know, penicillin was the first and many people could see how soldiers injured in war given penicillin, you know, they beat back infections, they survive. And that in the '50s and '60s, there was a huge surge of these sort of miracle drugs. I think there was something like 150 classes of new antibiotics. And although there were warnings then, that if we misuse them that resistance would grow, you know, you could just see in the marketplace new ones coming on every couple of years. And people said, well, if this one stops working, we have this other one here and science is developing new ones and I think we got very, very complacent by that surge of new ones. And somehow in the '80s and particularly in the '90s, I think we went around the bend a little bit because the science didn't continue to produce new antibiotics at that rate.
And the economics of drug development changed rather remarkably. We all can see all the time because we are bombarded with advertisements that there are drugs now to treat chronic diseases; drugs to treat, you know, cholesterol or whatever, that you would take for the rest of your life. And you can imagine that if you're in drug development, you know, and if you create and invent one of these drugs that can tackle a chronic disease that people will take forever, the return on investment for the drug companies that develop those big blockbuster drugs for chronic diseases, that became irresistible. But think about antibiotics. If they're taken properly, you take them only for a short course, a couple weeks, maybe 14 days, and then you stop. And then you forget it, you get better and you forget it. So the economics of making antibiotics wasn't going to make these big profits for the drug companies and slowly, but with increasing frequency, they begun to pull out of research on antibiotics. They just said, look, we're just not going to make enough of a profit on this. The return on investment just doesn't look good. We're going to make drugs that were going to make a good profit on.
GROSS: My guest is David Hoffman. He's the reporter on the new PBS "Frontline" documentary, "Hunting the Nightmare Bacteria," which will be shown tonight on most PBS stations. More after a break. This is FRESH AIR.
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GROSS: My guest is journalist David Hoffman. We're talking about his new CBS "Frontline" documentary, "Hunting the Nightmare Bacteria." It's about new strains of bacteria that are resistant to even the most potent antibiotics. He says they are surprisingly little research being conducted into new antibiotics.
So how many pharmaceutical companies are actually trying to do research on new forms of antibiotics that can vanquish these resistant bacteria?
HOFFMAN: You know, there are some examples of small biotech startups that are trying to pick it up because in any field, you know, we live in a capitalist society, if there is an opportunity they'll be competition. But the troubling thing is that some of these larger pharmaceutical companies - big pharma, as they're called - which developed really powerful and important research institutions, really whole teams of people with lifetime of experience in going after antibiotics, many of them are the ones that have started to pull away. And we tell the story in the film about Pfizer and its decision to pull out. And that decision was relatively recent, it was last year. And, you know, this was a company that had pioneered antibiotics, that really its whole name was associated with penicillin in the early years of antibiotic development, and they looked and looked at the return on investment and they said, you know, we're going to put our bet on something else. They actually decided to place a maybe more of their investment into vaccines and not into antibiotics. And they closed a very, very sizable antibiotic research facility in Groton, Connecticut.
GROSS: What about the role of government in funding research on antibiotics that could be used against resistant bacteria? Is there much government funding now for antibiotic research?
HOFFMAN: You know, if you look at the funding provided for basic research at the National Institutes of Health, as I said, I think it's 30-plus million dollars a year. This is important work. NIH frequently does that very first stage where they do the basic research. And the next question is after that research is done who is going to invest the R&D to make those findings into new therapies, into new drugs? And that's where we have a problem. Our industry has turned its back on it.
GROSS: So do you think we need to redefine the model for the funding of new drugs, especially when research into like antibiotics that can work on resistant bacteria when it's not really very profitable for profit-making companies to invest in that because there aren't the profits to be made, but it's so important in terms of public health?
HOFFMAN: Maybe we need a new way of thinking about it. You know, there's a lot of talk about this idea of the government and private sector working together. And, you know, I am certainly a big fan of capitalism. I wrote a book about the collapse of Soviet Socialism and the rise of oligarchs in Russia. So I understand the principles of capitalism. But if society has a real need and the market is not fulfilling it, well, that's what we have government for. And so you could imagine more public-private cooperation to try and come up with the antibiotics that we need. And, you know, the pipeline is really running dry. If you also take a look at the history of resistance, you know, and what happened to some of the drugs. There's a terrific chart that the CDC put together that really graphically shows, you know, tetracycline, really important antibiotic, introduced in 1950. By 1959, there were bacteria showing up resistant to tetracycline, you know. Methicillin, 1960. By 1968, resistance. Vancomycin, really big one, introduced in 1972. By 2002, there's staph showing up staff showing up of resistance to Vancomycin. So this cycle requires us to keep pedaling faster. And how do we do that? How do we get the companies to devote the big - it costs a billion dollars. It may take a decade to develop a new drug. And even think about the war on cancer. I mean think about the enormous efforts that are made in this country to deal with various kinds of cancer. And you don't see that kind of leadership when it comes to antibiotics.
GROSS: Yeah. I was thinking how ironic it would be if we're lucky enough to have a big cancer research breakthrough only to have deadly epidemics of resistant bacteria.
HOFFMAN: And, you know, one of the things that is poorly understood by people is that antibiotics were miracles not only because of, you know, you took one and your infection got better, but there were very sophisticated advances in modern medicine that rest on antibiotics. You know, surgeries, transplants, oncology, you know, treating cancer, where you have to suppress an immune system. All is made possible by the fact that we had effective antibiotics.
So, if resistance grows, if we allow these antibiotics to disappear, we're not only threatening you and I when we need one for, you know, a particular - a minor infection that's an inconvenience to us. We're threatening a pillar, a pillar of modern medicine. And that's really worse.
GROSS: You had mentioned that these resistant strains of bacteria are, in part, a result of the overuse of antibiotics, because bacteria are good at evolving and developing resistance to antibiotics. And I'm wondering if you have a sense of which type of overuse of antibiotics is most responsible for the growing resistance. You know, is it prescriptions to individuals? Is it use in factory farming, where a lot of the animals are fed antibiotics with their food? Is it the antibiotic soaps? Is it all of that?
HOFFMAN: Those are all good issues. Let me address them one by one, very quickly. The single most important factor leading to resistance is overuse. There's no question about that. And we've done some of it to ourselves. Yes, a lot of antibiotics, even now, are poorly prescribed by doctors, by clinicians. By some estimates, as much as 50 percent of the antibiotics given to humans are either wrongly or inappropriately given.
In many cases, somebody comes to the doctor, they have a virus. And they get an antibiotic, which is going to be useless in attacking a virus. Or, you know, it's quite possible somebody comes in there emotional. The doctor isn't sure, and he gives them an antibiotic, but they don't really need it, because there's a pressure. There's a feeling to do something. And these were miracle drugs.
So there's a serious problem that I think a lot of people in medicine call stewardship, which really goes to: How do we take care of these drugs? How do we, for example, tell doctors more information about the levels of resistance and what's appropriate and what's not? And then just imagine these clinicians in a hospital setting, where perhaps the situation's more dire. It's more urgent.
And there's a lot of antibiotics given in hospitals. And I've seen some good efforts in hospitals - University of Arizona, for example - that put pharmacists right there on the floor with the doctors. At Johns Hopkins, I saw a small, little spiral-bound book they could put right in a doctor's lab coat. He could whip that thing out and see exactly, you know, what drugs are resistant to what.
We need a lot more of that kind of better stewardship. So with people, there's work to be done. And this is work that's not so much about science. It's about human behavior. It's about choices that doctors make. And, you know, I - on the question of the farm stuff, it's a very complicated question. We investigated this, and we're still investigating it, and we're going to have another film about it early next year. We decided that...
GROSS: You're going to be doing that?
HOFFMAN: We decided that it was a deep and important subject. People are worried about their food supply. There's a large number of antibiotics, by volume, that are used in agriculture, and the impact of that is something that we're investigating still. It's certainly something that has gotten a lot of attention and needs answers to and, you know, we're still looking at it.
GROSS: So did you come across interesting information about antibacterial soaps and cleansers, and what the impact of that is on creating new strains of resistant bacteria?
HOFFMAN: You know, there's a professor at Tufts University who I respect very much, Stuart Levy, who's been working on this problem of antibacterial resistance and antimicrobial resistance for 40 years. And he says that this craze that we had for antibacterials in home cleansers was really kind of an error, that we didn't need them, but by using all this kind of antibacterial stuff - soap suds and so on - and washing it down the drain, we were essentially polluting our environment with the kinds of antibacterials that would create resistance in the environment.
And oftentimes, we don't think of it. It's a little bit like climate change, right? It's somebody else's problem. It's not going to happen to me. But if everybody is doing this and we create resistance in our environment, then we're going to wind up with super bugs in our environment, in our lakes. And that's a problem that we haven't focused on in scientific ways much as I think as we ought to, but it goes right to our choices and our behavior.
Now, when it comes to washing your hands, hand hygiene is a first line of defense for every one of us. Right? You ought to wash your hands and use that antibacterial if it's necessary. But I think putting it in soap suds was going too far.
GROSS: Well, thank you so much for talking with us.
HOFFMAN: Thank you so much for having me.
GROSS: David Hoffman's "Frontline" documentary "Hunting the Nightmare of Bacteria" will be shown tonight on most PBS stations, and after that, it will be available for viewing on the "Frontline" website. You'll find a link on our website, freshair.npr.org. Coming up, Ken Tucker reviews Linda Thompson's new album. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.