'Superbugs' Book Chronicles Rise Of Antibiotic-Resistant Pathogens

NPR's Don Gonyea speaks with Dr. Matt McCarthy about his book Superbugs: The Race to Stop an Epidemic. McCarthy explains how these bacteria evolve to resist available antibiotics.

DON GONYEA, HOST:

Superbugs - it may sound like another sci-fi superhero movie, but physician and author Matt McCarthy warns that the topic of lethal bacteria is not to be taken lightly. In his new book, "Superbugs: The Race To Stop An Epidemic," McCarthy explains how these pathogens have built up a resistance to our current arsenal of antibiotics. He joins us now from WBUR in Boston. Dr. McCarthy, welcome.

MATT MCCARTHY: Thank you for having me.

GONYEA: You start the book five years ago in New York. You're a staff physician at New York Presbyterian Hospital. It's early, early morning. And you get a buzz on your hip, your phone. And you go quickly to the E.R. where you meet a patient named Jackson (ph). What was going on?

MCCARTHY: Well, Jackson had come into my E.R. because he had been shot, and an area surrounding the bullet wound - which was still lodged in his leg - appeared infected. And while I was examining him, a medical student handed me a piece of paper that revealed the results of a microbiological test which showed that Jackson had contracted a superbug.

And the terrifying part for him and for our team is that the infection was only treatable with one antibiotic called colistin. And that's a drug that fell out of favor years ago because it was so outrageously toxic. But here we were on the cusp of so much medical advancement, and we were reaching for outdated drugs to treat patients because the bacteria had evolved and mutated in ways that we only had incredibly limited treatment options.

GONYEA: From there, you take us back 100 years to a World War I battlefield in France, a field hospital actually. Tell us why you are connecting these two moments.

MCCARTHY: Well, I connect those moments because there was a similar situation of a young physician treating a bullet wound. And he was practicing medicine in the days before antibiotics. His name was Alexander Fleming. And he was only using antiseptic fluid and scalpels.

He knew there was a better way. And he eventually stumbled upon the first antibiotic, penicillin. And that ushered in this remarkable era of drug discovery. We call the 1950s the golden age of antibiotic development. And we - seemed like every month a new lifesaving drug was appearing. But then something happened, which is in the 1960s and '70s, a number of prominent scientists came out and said we've got this infectious disease issue covered. It's time to look on to more pressing conditions like heart disease and cancer. And essentially, we took our eye off the ball.

GONYEA: You make the point that among the drugs approved each year by the FDA, very few are antibiotics. You write that the development of antibiotics has seemingly come to a halt just when more drugs are needed. That last part's an actual quote from your book. Are we in a crisis situation right now regarding this?

MCCARTHY: We're certainly heading that way. This is one of the most important issues in modern medicine that very few people are talking about. For the past 75 years, we've relied on a partnership between the federal government and big pharma to bring new antibiotics to market. And what we're seeing is that that partnership is dissolving, and it's dissolving for the simple reason that pharmaceutical companies increasingly are having trouble making a profit off of antibiotics.

The reason for that is if you think about an antibiotic, they are prescribed in short courses. And doctors are very stingy about doling them out. And even the best new antibiotic may wear out its welcome when the bacteria become resistant. So what we're finding is that these companies say, why would we want to make a product that doctors don't want to prescribe? This is a disaster for public health because we're seeing that superbugs are emerging faster than we ever expected. And companies are saying we don't want to be in this business.

Now to address this, there are a number of policy proposals on the table. They're called push and pull incentives, which can entice these companies to stay in the antibiotic business. A push incentive might be something where you go to a company that's making billions of dollars and say we'll cut your corporate tax rate if you promise to invest some of those profits into new antibiotics. This is a sure-fire way to get more money into the pipeline. However, many people recoil at the idea of giving a tax break to a multi-billion dollar company.

GONYEA: We started our conversation talking about the patient you referred to as Jackson - a gunshot wound, you had some difficult choices to make with him in terms of treatment. How did it work out for him?

MCCARTHY: Well, without giving away too much, he does - his story does have a happy ending. But it does not involve antibiotics. And I think that his case is emblematic of the fact that we're increasingly shifting away from the typical model of using antibiotics to treat infections. And there is an array of new treatment options that are coming out - things like bacteriophages and CRISPR-based gene-editing techniques, where we can use a molecular scalpel to modify a strand of nucleic acids to create a new treatment that will cure patients.

But what I want readers to appreciate is how difficult it will be to bring those discoveries into your local hospital based on the current financial model. In many cases, it simply will never happen because the challenges of getting a drug approved by the FDA are so formidable that companies just don't want to go there.

GONYEA: That was Dr. Matt McCarthy. He is an infectious disease doctor at Weill Cornell and the author of "Superbugs." Dr. McCarthy, thank you.

MCCARTHY: Thanks so much for having me.

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