In what the u. N. Has previously described as a textbook ethnic cleansing to stay with us the stream is up next by for now. Ok on your stream today dr king we are about to talk about antibiotics and the evolution of the superbug i remember that we are right now so if you want to comment on the show you can watch along and talk to us at the same time. Your comments directly to our. And were going to be asking what is the overprescription of antibiotics the lack of access to the right drugs and even the actually doing. It is the into the room. Life before i buy all takes was grim people die because of some of the most basic illnesses and childhood mortality numbers were sky high but that changed in one thousand twenty eight with arguably one of the most important developments in modern medicine when Alexander Fleming discovered palace in a new he was saving millions of lives from infections that just a few years earlier would have been fatal he predicted the organisms would become penicillin resistance and little more than a decade later researchers found that bacteria had already developed resistance to the drug now almost a century later antibiotic resistant infections kill more than twenty thousand people a year in just the u. S. And u. K. And more than seven hundred thousand i nearly around the world so how do we get from miracle drug to superbug heres what happened antibiotics are often prescribed unnecessarily for infections but theyre likely to go away without treatment in many countries antibiotics are also sold over the counter without a prescription from the doctor at the same time in many low Income Countries lack of access to antibiotics actually causes more deaths than resistance multidrug resistant bacteria spread within hospitals as a result of Infection Control and also between people in the community. Bacteria know no boundaries and Extensive International travel and trade help resistant spread from continent to continent. Antibiotic resistance does not only affect humans but also the health of animals and the environment it is connected. Joining us now in new delhi india dr sari a scientist and Public Engagement officer at the Welcome TrustCharitable Foundation and. Our guard is a policy advisor react a Network Dedicated to antibiotic resistance in Atlanta Marin we can as a journalist and author of big chicken a book about the history of ants. Biopic use in agriculture and in new york dr kent separates an Infectious Disease specialist at the Memorial Sloan Kettering Cancer Center and is a professor of medicine and Infectious Diseases at Weill CornellMedical College thank you all for being here so how expert is going to pick get you to frustrate away i want you to tell us each one thing about the soup of out that most people dont know dr kent. The super bowl is very alarming but i would say that it is not at an apocalyptic point as its being advertised its tenacious weve seen it for decades but my day to day life demonstrates that its not the sky is not about the fall. You had thought i would make the point that was also in the video you just showed that we still need to remember that. Many more people will die from the lack of access than from resistance and so even though resistance is the you know of a massive threat that were standing in front of the interventions and the solutions that we need to devise really need to be balanced against the need to ensure that people have improved access to answer but i think that particularly in the middle Income Countries. Weve weve had many times of red in in headlines and weve seen on t. V. One thing that you find the general public do not understand about the superbug is what i think that people dont understand that its not that they themselves are resistant which is what you often hear people say but rather that bacteria resistant and the reason thats so important is that if people think that they themselves are somehow become resistant theyre likely to stop taking their antibiotics early or to not take antibiotics at all which might accidently make things worse dr sorry this is your job to teach people about superbugs whats lesson one o one what is it. Lesson one o one would be that antibiotic resistance. Doesnt mean that he has become resistant to antibiotics it may be the fact the media has become resistant to antibiotics so what we need to understand is the mechanism that by which that is that do you get is becoming resistant and that its not on that. Like doctor said in the beginning it is a natural phenomenon exhibited by bacteria by living species and that is they undergo genetic changes you know throughout their life so it is not true it is its resistance has become the cause of many reasons that im hoping to discuss today in this discussion where you know sorry we have another sorry volcano incidentally who chimed in with what she thinks is the main problem i know you know her she told us that it all begins with excessive consumption of antibiotics a large fraction of antibiotics is not broken down by the body and released in the feces obviously one specific situation there but dr kent when we look at kind of this being a macro problem its been around for a while of course but it seems like the alarm bells are ringing louder than ever ryan mcneal also chimed in saying antibiotic resistance and factions were declared an Urgent Public Health threat more than fifteen years ago but there are still dangerous flaws in the how the u. S. Specifically tracks and responds to outbreaks of superbugs is that the crux of the problem the reporting and the lack of kind of oversight no i think that this is an inevitability that the more sick people there are in hospitals the more antibiotics theyre going to get there and about actually going to get necessarily by simple biology the more resistance were going to see so as we get better at keeping people alive longer they will be exposed to a lot more antibiotics and were going to see resistance parallel to that is a very stupid use of antibiotics for all sorts of things including coal. Aches and pains. Keeping chickens alive after things and that that is much more preventable but i dont think those are the issues that are really driving the real. Force of this which is which is an inevitable consequence of the progress weve made and you know i think we need for a long future we should should respond to what that person asked on twitter which was that do we have adequate tracking of superbugs and the answer is you know the reason that calista resistant bacteria were found in the first place in china was because specific researchers were looking for them it wasnt because of any kind of National Tracking program and we need so many more National Tracking programs in the developing world and also here in the United States just spot superbugs faster when they emerge. I would quibble with that certainly for the United States where i think we do a good job of tracking every perfect job totally in agreement that in china and in other countries if they do know theyre not sharing it with us and thats a big quandary for us to start to get that but theres also a point in. Maybe remembering that the last you know class of antibiotic that was actually discovered was discovered in one thousand nine hundred eighty seven thats a long time ago and and since then weve really seen a lot of. Well most of the pharmaceutical industries that retreat from from that area of r. And d. And so what were facing today and the reason why its also becoming. Issue is is we are running out of medicines in our medicine cabinets the tree you know common infections and. And you know if we look at the pipeline i mean that theres really not much promising there and so its likely that a new drug will be you know ten years away from coming to the market so if you have that sort of you also and yet the point that the pipeline stinks the pipeline stinks and its been horrible for a while and its very depressing but the Drug Companies dont see this as something that they want to go after theres no defense of that let me just show you something hey hey you told us about that the last time the antibiotic was developed nine hundred eighty seven on reacts website all the different ways antibiotics to use starting at blood infections going all the way up pay for Cancer Treatment so if the last i got it was developed in ninety eighty seven but we use it for modern medicine. Why which development stop be direct be candid why we dont see any line to buy or to go there. So i doubt it there are two main reasons for that one is that i think all the low hanging spills have been kicked and what were looking at now is scientifically a lot more difficult today to see develop new drugs and discover. New mechanisms of action at the buttocks that work against the most persistent bacteria out there but the other. The other side of the story is also that as a body such as not as economically look pretty good for. The pharmaceutical industry to to invest in this is youre going to be spending well i mean youre going to be taking the drug for you know noncommunicable ceases or lifestyle diseases you know perhaps for the rest of your life where its an antibiotic youll really take it for a short period of time and so i mean we see that there just isnt market failure for. New antibiotics and that urgently needs to be addressed by governments. And funders alike and really we replenish i mean we need urgent replenishment of the antibiotic pipeline stands and that requires radical changes to do the research and Development Model that. That would rely on the Development Today about you know i see i see both the doctors nodding as youre speaking which i think is probably a good sign that what youre saying makes sense but i wanted to say and we have and i may become the doctor dr joseph err on twitter says antibiotics revolutionized health care before postop infections killed millions now we take them for granted weve created our own worst enemies so obviously in that Historical Context hes outlining you know maybe how a solution became a problem but ryan mcneil who we heard from earlier and it seemed as though dr kent was agreeing with he now is saying we found the system referring to that system of reporting we were talking about the doctor can suggest is better handled here in america than elsewhere he says we found a system that often seems more concerned with protecting the reputations of Health Care Facilities then informing patients is it that also compounded by this kind of capitalist you know industry is that hurting and is that as big a problem as we kind of refer to. Its definitely a very big problem and i think before. I talk about the Drug Discovery by flying i think i would like to put it in an Indian Perspective and which is that as you know later india consumes highest amount of antibiotics in the water we also have. You know close to fifty seven thousand young babies dying every year so it is it is a huge problem when we cant even of thing in one country is good if the humans in one country are good we can forget that really is a very very we really are interconnected to do you know more than ever before and if if we look out over the counter consumption of prescription of antibiotics in india is a regular affair i can go to any pharmacy in india and i can buy an antibiotic i dont need anything any antibiotic that you want you can get by just walking up to a little chemist and just nice to me let me ask you this because you cant describe to a stupid use of antibiotics or lets lets address the stupid use talk to sarah tell us all the things that you do know neat antibiotics for that people will go and ive asked that doctor all by over the counter lets do it now. Ok so to begin with if you have a sore throat bridges generally caused by white houses and not by bacterial infections yes so most of the upper respiratory little desire every just write me a prescription for an antibiotic you would say what. I would say i would see. How you feeling when i want to know the doctor like i was here i would leave that to dr king and its on i just do not get antibiotics for self right dr sarah continue what we what we wanted good what else you have for the idea so a lot of people in india also began to write explode diarrhea and all the do mean i think i would say if you surround me my familys and my family and friends. At the drop of a hat when they have gone without really trying to find out much of what tests cough last diarrhea she was on the subject of poop dr sarah cooper is really important because hes one of the reasons in developing countries why super bugs are developing can you can you make that connection for us yes not only i mean i can talk about india where we dont have a very robust Public Health system we dont have you know very good sanitation and that and of course you know not. So you would systems. So that needs a lot of resistant bacteria out and then alignment and with. Human being that animal quite easily and of course you know as you know india is has one point five billion people so were living quite close to each other so i dont have a closed with animals. And because of poor sanitation these resistant bacteria find you know find a very easy. You know body so if you look at sanitation issues in developing well and you know china really hard to stop open definition that helps with how resistant bacteria antibiotics that that thats thats one of the key issues dr ken. Ok interesting well you know when we start i dont want to interrupt but its funny because a lot of comments are coming about india with this problem and we have a car started rehearsing stricter regulation of prescribing antibiotics here in india they hand out antibiotics like halloween candy so i see doctors there are nodding youre nodding i dont want to hear three things so i guess confirming that reality but i also sad that its a sad laugh theres a lot of sadness in that of course and i know thats true and i was funded stem that thats true and also when you look to solutions you know we were just talking about feces the problem that that poses specifically for india we actually had a video comment that came in about this from iran saying very kind of talking about efficient Treatment Options i want to get your thoughts on this take a listen. Treatment plants received this from a variety of sources. Human never been released to hospital afterwards. Around no four and of these from pharmaceutical industries and we know that these are all full of microbes and that they may carry a lot of antibiotic resistance so its very important that oversee vet shipment clarks must be running at full capacity and running very efficiently as a result of which to some extent they can plea didnt rule in. Getting the problem of and you michael has just. So dr sarra is that a good solution and dr ken id love your thoughts as well afterwards whatever they export has spoken so i cant help but agree with them. That is needed i think we almost have no wall street regulations around baffin ones that we need to reverse and what a body needs and then why meant in general so we definitely need triple regulations there if you want to tackle antibiotic resistance in india. But i dont want to comment yet you know oh yeah go ahead dr ken because obviously thats not a problem that you know faces us here in america as you were referring to approx only in puerto rico now where theyre dealing with of course sewage problems of her own but is that do you think in the spectrum of all the problems is that a big one i think yeah i think over the counter purchase which is a complicated issue because its over the counter for the convenience and the cost savings for the patient there is an advantage to the patient to being able to buy it i think thats gargantuan and i think the other is. Plumbing issues you know were talking about who yes i think its really important that we look at the issue of the degree to which we give antibiotics to animals globally twice as many antibiotics and go into animals as into humans and they were not would that say it was one more time because i feel this is like a mind blowing moment so in the well to get the most people takes animals livestock get on average twice as many antibiotics as humans do by volume in some countries including here in the United States much higher than that and so in the same way that were talking about resistant bacteria being part of sewage they are also part of animal manure which contaminates the environment which is used as fertilizer which distributes antibiotic resistant bacteria through the environment in a way that is not well tracked and its a part of the issue that as as were talking about these very very Serious Problems in the developing world really doesnt get enough attention because of course appetites for meat are rising in the developing world which pushes the use of even more antibiotics to produce more livestock. A whole book about this let me just show it to her way so they can see what you are talking about here big chick a me incredible story of how antibiotics created a modern agriculture and changed the way the world eats if this is an issue in terms of creating simple bouts of contributing to the superbug problem whats your solution. So where we need to get to is the antibiotics are used in meat animals to increase their growth to protect them against the conditions that theyre held in and also a small percentage are used to treat infections and what we should be doing is reducing the use as much as possible to just treating infections and its really challenging because developing economies want to buy more and more meat understandably their citizens want to eat meat but we have to help coach those economies how to grow meat animals without over using antibiotics in the way that the west talk them to do what dr ken when you hear that i mean