Episode length: 24:05 | September 8, 2019
The World to Come - Episode 5: The Power to Rethink Treatment
TESS VIGELAND: When antibiotics fail to fight off an infection - the options are limited. But a treatment that relies on VIRUSES could change the future of healthcare.
STEFFANIE STRATHDEE: Literally, I signed the consent form for kidney dialysis the day that phage therapy began. He was literally within a couple hours of death. So we're just really, really fortunate and we don’t take it for granted. Every day is a gift.
TESS VIGELAND: So he was a miracle.
SAIMA ASLAM: He was a miracle. Yes. And that miracle is going to hopefully lead to other miracles.
TESS VIGELAND: Coming up… you might find this story hard to believe: a remedy that’s as old as the planet, but a feat of modern medicine in the age of antibiotic-resistant bacteria. We’ll learn about bacteriophage therapy, phage therapy for short. Scientists at the University of California San Diego -- and beyond -- think it could win the global fight against superbugs. The World Health Organization says WITHOUT solutions, drug-resistant diseases could lead to millions of deaths a year by 2050.
TESS VIGELAND: This is The World To Come, a podcast brought to you by Bank of America -- exploring life in the future, starting with the visionaries of today. Featuring clients and partners affiliated with Bank of America. I’m Tess Vigeland, and in this episode: the power to rethink medical treatment.
PATRICK WOOD: I think for the healthcare system overall it's an imperative and I think we need to be forward looking on this issue.
TESS VIGELAND: Antibiotic resistance is one of the major threats to our health in the 21st century.
Bank of America Global Research Analyst Patrick Wood studies this issue as part of his work.
PATRICK WOOD: I lead the medical technology team, and my main role is to look at the health care system and understand what it does.
TESS VIGELAND: What is the definition of antibiotic resistance? What does that mean?
PATRICK WOOD: Antibiotics are a weapon that we employ to destroy bacteria. And over time, and as living organisms that they are, they've evolved if you like a form of defense. So you can obviously have oral but also you can have intravenous antibiotics, and over time bacteria gain resistance through exposure. This is very, very problematic for a number of reasons - not in the least clinical outcomes.
TESS VIGELAND: How did we get here, to this point where antibiotics are becoming ineffective? Is it simple overuse, or is it does it go beyond that?
PATRICK WOOD: It's a plethora of causes. While it's an issue that's been flagged, we've all become quite lazy about it over the last 50 years or so. You can see this in a very acute way when people turn up to their local general practitioner and they say, you know, ‘I don't feel very well, give me antibiotics’ and even if that patient actually has a viral infection where antibiotics really won't do much other than destroy your gut flora and in many instances they still pressure their doctor to prescribe them antibiotics.
TESS VIGELAND: Is that really the main problem when you're talking about overuse, is it that people are going in and either asking for antibiotics when they don't need them... or are doctors for some reason giving them out when they aren't necessary, maybe just to placate a patient?
PATRICK WOOD: It is a non inconsiderable proportion of the issue. It’s definitely within there. But overexposure. Non-completing of your prescription over time. Use in agriculture. All of these things have contributed to the issue…
I think at the end of the day, they’re trying to make sure that we have public discourse about the issue because this is really a public health issue where you need both physicians and you also need the public to be thinking about it, and behaving appropriately to control this.
TESS VIGELAND: This discourse is already happening in earnest at the University of California San Diego. It was sparked in the wake of a near-tragedy that happened to two of its professors, who happen to be married. And their journey is changing our understanding of what’s possible in medicine.
TOM PATTERSON: Hi, I’m Tom Patterson.
STEFFANIE STRATHDEE: And I’m Steffanie Strathdee.
TESS VIGELAND: Tom and Steffaine share a single-story ranch home in La Jolla, California.
It’s got a cactus garden, and a giant picture window out to the backyard, with a spectacular view of the Pacific Ocean. And they’re not the only ones enjoying the yard… local wildlife does too.
TOM PATTERSON: All these birds... ooh the hawk is after, see this guy?
TESS VIGELAND: Yeah, oh beautiful.
TOM PATTERSON: He’s a sharpshinned. That’s this nest over there on the top of this tree.
TESS VIGELAND Oh yeah, yeah.
TESS VIGELAND: The view… the birds… all of it became utterly irrelevant a couple of years ago.
Tom is a psychiatry professor at UC San Diego School of Medicine and Steffanie is Associate Dean of Global Health Sciences -- she’s an infectious disease epidemiologist.
Their lives, and the direction of their work, changed forever after a vacation in 2015.
STEFFANIE STRATHDEE: Well, Tom and I have been to about 50 countries together, and on his list was to visit Egypt to see, you know, the wonders of the world and the pyramids. We'd been there for about a week. And it was the last night of our trip we just thought, wow tomorrow we're going to see the Valley of the Kings, and then we go home. Well, it didn't quite turn out that way. Tom got really sick. I thought he had food poisoning.
TESS VIGELAND: What had you been doing that day - I mean, when you thought back? What were you thinking back on in terms of what might have caused this?
STEFFANIE STRATHDEE: Well, I was thinking it was something he ate for dinner because we had seafood and you know we’re on the Nile. And, I was just assuming that he was going to have a garden variety stomach bug and that, you know, he would ride it out. And he didn't.
TOM PATTERSON: I just kept getting worse and worse and my back started hurting and I was getting dehydrated. And when they did call, the doctor came and he said no, we really get to get you to a clinic.
TESS VIGELAND: So you get to the clinic and what happens?
STEFFANIE STRATHDEE: They medi-vac’ed us to Frankfurt, Germany. And there, they confirmed that he had a giant abscess in his abdomen the size of a football. And that's when I started to get worried - really worried.
TESS VIGELAND: Tom, are you out of it at this point?
TOM PATTERSON: By this time I was beginning, I mean throughout the illness I was in and out of a coma and hallucinating. But by the time we got to Germany I was hallucinating a lot, just out of it.
TESS VIGELAND: So then the doctors come back and tell you what?
STEFFANIE STRATHDEE: They said, look, it's the worst news that we could have had. It's the most terrible bacterial infection on the planet and we need to see whether or not it's resistant to multiple antibiotics, because this organism tends to be a superbug. A superbug is resistant to more than two or three antibiotics. The results came back on this one and it was resistant to 15 antibiotics right off the bat.
TESS VIGELAND: Even as the doctors were treating Tom, the bacteria were becoming more and more resistant to the antibiotics, every day.
STEFFANIE STRATHDEE: There was only three antibiotics that it was partially sensitive to at the beginning but by the time we medivaced Tom back home to San Diego, it was resistant to even those. So now it's fully resistant to all antibiotics in the modern medicines arsenal.
TESS VIGELAND: What are you thinking at that point?
STEFFANIE STRATHDEE: Well now I was terrified. I was reading on my own, brushing up on microbiology. You know, I have a degree in microbiology from 35 years ago. So I was catching up on all of what I'd missed over the last couple of decades and getting more and more terrified.
TESS VIGELAND: So your doctors tell you that they've run out of options?
STEFFANIE STRATHDEE: That's right.
STEFFANIE STRATHDEE: Well they basically said, Tom is too weak for surgery. So they said look, we'll siphon out all of this infected fluid and hopefully his immune system will be able to kick in and fight it - and it's the best option we have. And so for a while the superbug was contained in this abscess. But this one particular day when he sat up in bed, one of the tubes inside of him slipped, and it jumped all of that infected fluid into his abdomen and into his bloodstream and right in front of me, a doctor and a nurse he went immediately into septic shock.
TESS VIGELAND: Oh my god.
STEFFANIE STRATHDEE: And he started sweating profusely and then he began to shake. The bed frame was hitting the wall. About 50 percent of people who develop septic shock die right from, right then and there. So they rushed him back to the ICU. They put him on a ventilator to help him breathe, which is life support. They put him into a medically induced coma. From that moment on he was dying a little bit more each day because there was nothing that they could do. Now his body was fully colonized with this superbug.
TESS VIGELAND: But despite odds that were dropping by the hour, Steffanie refused to give up hope. She asked Tom if he wanted to continue the fight.
STEFFANIE STRATHDEE: When it dawned on me that he really was dying, I had a conversation with him. Even though he was in a coma and I said: Honey I know that you're fighting really hard but I want to grow old with you. And if you want to live, please, please somehow, could you just squeeze my hand so that I'll know? And I can leave no stone unturned, I'll do whatever I can to fight this thing. But, the doctors have run out of options. So I waited. And about a minute later he squeezed my hand really hard!
And I was really excited! I fist pumped into the air, I’m like: Yes! And then I realized, like, what am I going to do now? I don’t know how to solve this thing. I’m not a medical doctor, you know? And I thought, well, I'm a scientist and you know, I can at least research some alternative treatments. And so I went to the Internet and up popped a paper which had several different options that we hadn't thought of. And one was phage therapy.
TESS VIGELAND: Phage therapy... That’s P-H-A-G-E by the way. Now, it turns out this is an idea that’s been around for a long time. Phages are these special viruses. Scientists have known about them for more than a hundred years. In fact, they were discovered around the same time as antibiotics. But... antibiotics were a lot easier to use and administer. So, they became the default treatment for bacterial illnesses like pneumonia and mono and infections of all kinds.
As she searched desperately for answers, Steffanie found that research paper taking another look at this science.
The paper said you know... maybe we should give phages another try.
I asked Patrick Wood, the Bank of America Global Research analyst, to explain for us exactly how phage therapy works.
PATRICK WOOD: In basic terms, it is the use of a viral mechanism so a virus, that when most people think of a virus, it’s something that makes you feel bad or is attacking your body and that can be the case but there are a lot of viruses out there phage therapy is the use of viruses that attack bacteria .... And so, they’re viruses that are on your side. Friendly viruses if you like.
TESS VIGELAND: [Laughter] That's something I can't even wrap my head around. A friendly virus. So how does that work? Talk us through the process of how that works within someone's body.
PATRICK WOOD: In this instance, your body doesn't recognize the incoming virus as a threat. And so it doesn't attack it, much like your body doesn't attack the natural bacteria that exists in your gut. The virus attacks the bacteria, destroys it, and so over time they attack faster and faster the bacteria that exists within you.
The real thing is that your body doesn't recognize them as a threat. That bit’s very important.
TESS VIGELAND: So again… this is a friendly virus. It only wants to kill bacteria - and it isn’t going to make you sick.
PATRICK WOOD: It's like the analogy of the lock and the key is because one will only fit uniquely to the other, they’re very specifically tailored only to fit the other one.
TESS VIGELAND: Okay, so the virus that is used in the phage therapy, is that designed specifically for what it's going after - for what it's trying attack?
PATRICK WOOD: Yes. So each virus is bespoke if you like and unique to the target that it's trying to attack. That is the advantage in that it's a sniper rifle not a bazooka.
TESS VIGELAND: Each type of phage has to match a specific type of bacteria. Going back to Steffanie... I wondered how she even began her search for a solution.
TESS VIGELAND: First of all you have stumbled upon this potential treatment that is not in wide use, and then the doctors say you need to go find the viruses. I’m pretty sure your background is not in virus hunting. So what’s your first step at that point?
STEFFANIE STRATHDEE: So I went back to the internet, and I made a list of researchers around the US that were studying these phages that attack his type of bacteria. And it was a mighty short list, a handful of researchers. And I wrote every single one of them, and so... they did find several phages.
TESS VIGELAND: You're just in a race against time?
STEFFANIE STRATHDEE: We were in a total race against time. His kidneys were just hanging on by a thread. He was still on the ventilators, he was on three different medications to keep his heart pumping. And then his kidneys started to fail.
TESS VIGELAND: The phages arrived just in time. The big question was how much of it - how many of them - to give him. No American hospital had ever used phages like this before for this purpose.
Remember, these are live viruses. Living things. Too few and it might not work. Too many and... well, nobody knew what might happen.
STEFFANIE STRATHDEE: So it was a billion phages per dose. A billion viral particles per dose and every two hours we injected these first into the catheters in his abdomen and then when he survived that we injected those in his bloodstream every two hours.
TESS VIGELAND: Are the phages in a syringe and they're just injected into the catheters? Is it that simple?
STEFFANIE STRATHDEE: It was that simple.
TESS VIGELAND: After that… all Steffanie could do was wait. The phage treatment continued with injections every two hours for the next three days. And then... on the third day…
STEFFANIE STRATHDEE: He woke up, from a deep coma to awake and conscious and recognizing people. I leaned over him and I said: honey, it's me and he kissed me. And it was just, like, my heart melted. And it was like, oh my God. It blew us all away.
TESS VIGELAND: Tom, what do you remember if anything about that first time you
TOM PATTERSON: I remember that it wasn’t like in the movies. I do remember being extraordinarily tired, and you know I wouldn't say that I was you know ready to write another paper for a journal. But I was, you know, certainly elated to be alive.
TESS VIGELAND: The phages fought against the antibiotic-resistant bacteria throughout Tom’s system. The infection slowly came under control, and Tom was healing.
It would take several more weeks of treatment to get all of it out of his system. He spent more months in the hospital recovering from the ordeal.
TESS VIGELAND: So there it was. An experimental treatment using live viruses, curing an infection that would have killed Tom. So here’s the big question: can his experience become the therapy of the future?
STEFFANIE STRATHDEE: Heck we saved you with a hundred year old forgotten cure that we don't want to have buried for another hundred years.
TESS VIGELAND: News of Tom’s treatment spread quickly throughout the medical community. Steffanie felt she had a new calling. She wanted others - she wanted the world - to benefit from phages. She gave a TED talk, and then she and Tom wrote a book. And, alongside doctors at UC San Diego, Steffanie helped establish a research center dedicated to bringing phage therapy to others who need it. It’s called the Center for Innovative Phage Applications and Therapeutics and she serves as co-director.
STEFFANIE STRATHDEE: We were getting so many requests from patients all over the world and their doctors and their families for phage therapy. We're fund raising and trying to move phage therapy into clinical trials, to show whether phage therapy is going to be superior or at least equal to antibiotics. And if that's the case then it will mean that the FDA can license it as options for people that are running out of antibiotics.
TESS VIGELAND: I got to visit the Center for Innovative Phage Applications and Therapeutics... IPATH for short. The FDA gave the center clearance in early 2019 for the very first clinical trial of phage therapy in the United States.
Doctor Saima Aslam is one of the primary physicians using the therapy in cases where nothing else is working. She sees and treats antibiotic resistant infections every day. We sat down between patient visits in her office.
SAIMA ASLAM: Tom's case... really I feel like it's a seminal event in a good way, in that we were able to cure an incurable infection really, and have him walk out of the hospital and do well. So I think that is a huge, huge deal and will affect health care in the U.S. and all over the world really.
TESS VIGELAND: Talk about your work with IPATH.
SAIMA ASLAM: So, my role is to be one of the main physicians associated with IPATH. We've actually treated a total of seven patients here at UCSD. I've treated five of them. They've all had come to a point where they lost hope. And I think using bacteriophage therapy gave them hope, and certainly led to successful outcomes for all of them. And we've learned from each patient. From Tom's case we learned we can actually do this, but after each after that we've learned more about dosing. We learned about how to do this as an outpatient. So all of them I think have been seminal in their own way, but certainly you know Tom's was a huge deal.
TESS VIGELAND: What are the challenges facing further usage at this point. Is it is it just simply what we don't know? Or is it a lack of resources? Is it a lack of phages?
SAIMA ASLAM: Well I think there's certainly no lack of phages, they outnumber bacteria by far. The issue is I think we need to learn more about it but we need to learn in a systematic manner and certainly in terms of FDA clearance I think we need to do clinical trials, and try to use them in patients upfront and not when they've run out of all options. And our goal is to make it more mainstream. But yeah, I mean, number one would be research and funding for that research.
TESS VIGELAND: When you look out 10 years, 20 years, 50 years... where do you think phage therapy will fit within medicine?
SAIMA ASLAM: So my hope is that for certain infections we are able to have these pre-formed combinations of maybe three or four or five phages that have good shelf life that you could stock in a pharmacy and actually use it as needed... I think that would be amazing.
TESS VIGELAND: Phages in the pharmacy, and a medication that everyone will someday know about and use. And what about the potential role of phages in the broader healthcare system? Analyst Patrick Wood says there’s a bright future for any treatment that can meet or exceed the promise of antibiotics.
PATRICK WOOD: It probably saves a considerable amount of cost, mostly by keeping patients out of hospitals or in them for a far reduced time. You have this situation in many instances where elderly patients are generally advised not to go to hospitals purely because picking up a resistant infection can be a serious, serious issue for them. With more effective treatment you don't have that same issue. At the end of the day when you have a better clinical solution, you tend to reduce costs the healthcare system, reduce the time the patients spend in hospital - and that can only be a good thing.
TESS VIGELAND: Then if you had the power to make phage therapy workable what would you need to make that happen?
PATRICK WOOD: I think the reality at the end of the day it always comes down to money. I would love the power for a little bit more clinical data and acceptance and development of either new antibiotics or phage therapies or any other solution to antimicrobial resistance that we can get our arms around. I think for the healthcare system overall it's an imperative and I think we need to be forward looking on this issue.
TESS VIGELAND: For Steffanie Strathdee and Tom Patterson, being forward-looking is a way of life. It’s clear they believe that phage therapy is the future. And, I also wanted to know what’s next in their future.
TOM PATTERSON: Travel is on the horizon lots more of it. You know, we've already been to Costa Rica, Africa. We're about to go off to Canada.
TESS VIGELAND: Tom, if you had the power to change anything in the future of medicine based upon what's happened to you, your own personal experience, can you think of what that might be?
TOM PATTERSON: I would say that the one message I like to get through is there's growing evidence - and I think I myself am evidence based hope - that this therapy really does work. And my hope is that thousands and thousands of lives will be saved as a result of my case.
TESS VIGELAND: A goal that now seems possible because of his experience.
Patrick Wood says that he sees the potential of phage therapy as part of a broader, hopeful trend in health care.
PATRICK WOOD: I think one of the most encouraging things about healthcare system now is just how good we have it relative to many prior generations. Thirty years ago if you had to have your knee replaced you'd be in the hospital for three weeks. Nowadays, you can be going home and spending time with your loved ones in one day. It's unbelievable. And so many other areas like minimally invasive surgeries and our understanding of the human body it's just extraordinary. The generations that come after us will have healthier, longer lives [and] that's really what healthcare’s about.
TESS VIGELAND: We’ve explored a century-old remedy for a modern-age medical problem. We’ve also gone this season from a factory that turns plastic bottles into fiber, to how we could harness solar power from space… and much more.
We’ve asked visionaries all over the globe what kind of future they want to create. What would YOU like the power to do?
This is the final episode of this season of The World to Come. If you haven’t heard the others, please go back and listen. You can find out more about the series at BankofAmerica.com/WorldToCome.
I’m Tess Vigeland. Thanks for listening.
BofA Merrill Lynch Global Research is research produced by BofA Securities, Inc. “B-of-A-S” and/or one or more of its non-U.S. affiliates. B-of-A-S is a registered broker-dealer, Member S-I-P-C, and wholly owned subsidiary of Bank of America Corporation.
Any opinions or other information correspond to the date of this recording and are subject to change. This information discusses general market activity, industry or sector trends, or other broad-based economic, market or political conditions and should not be construed as research or investment advice.Hide Transcript
In this episode, we tell the story of how a deadly infection was successfully treated with viruses, and how this treatment could impact the future of healthcare.
In 2015, Tom Patterson was on vacation with his wife, Steffanie Strathdee, when he came down with a life-threatening antibiotic-resistant infection. Steffanie, the Associate Dean of Global Health Sciences at UC San Diego School of Medicine, explains “We were in a total race against time. His kidneys were just hanging on by a thread. I’m not a medical doctor, so I went to the Internet and up popped a paper which had several different options that we hadn't thought of. And one was phage therapy.” In this episode, we tell the story of how Tom’s infection was successfully treated with viruses, and how this treatment could impact the future of healthcare.
A well-known voice for millions of American radio listeners, Tess spent 11 years as an anchor for public radio’s Marketplace. Over her career, she has received numerous national awards, including most recently a 2019 Gracie Award as Best Host/Anchor, and a 2019 National Murrow Award for Continuing Coverage.
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