There once was a man named Albert Alexander. He was a policeman — “[American accent] Hey.” — in England. “[British accent] Hello.” One day on patrol, he cut his cheek — “Ouch!” — which led to a terrible infection. See, this was back in 1941, before patients had antibiotics. These were the days when a little scratch could kill you. “Or you got an ear infection and you died. A cat bite and you died. Or you stepped on a stick and you died. All of a sudden, antibiotics come along and bang.” The antibiotic era had begun. Soon a slow and painful death became a seven-day course of antibiotics and a $10 copay. And Albert? Albert was the first patient in the world to receive the antibiotic — penicillin. And it worked. “We just came up with a lifesaving, life-extending drug, one of the greatest developments in human history. Except not.” That’s Matt Richtel, a science reporter for The New York Times. For the past year, Matt’s been talking to health experts to find out if we are reaching the end of the antibiotic era. Modern medicine depends on the antibiotic. “And having used it so much, we’re now putting it at risk. Is our fate sealed?” “First off, I don’t think people respect bacteria enough.” This is Ellen Silbergeld, one of the leading scientists studying antibiotic resistance. “Bacteria rule the world. We are just a platform for bacteria. Within the human body, there are more bacterial cells than there are human cells. So we are, in fact, mostly bacteria.” “Alexander Fleming —” the man who discovered penicillin “— in his Nobel speech said, hang on, be aware. When you start killing this stuff off, it’s going to fight back.” “Did we pay any attention to that? No.” “The C.D.C. got our attention today with a warning about what it calls ‘nightmare bacteria.’” “These are bacteria that are resistant to most, if not all, antibiotics.” When we take antibiotics to kill infections, some bacteria survive. It used to be they’d replicate, and eventually resistance would grow. But now, they’re way more efficient and share drug-resistant genes among themselves. So every time we take an antibiotic, we risk creating stronger, more resistant bacteria. And stronger, more resistant bacteria means less and less effective antibiotics. And this is a problem because we take lots of antibiotics. “Money gets made over the sale of antibiotics.” Big money. Globally, the antibiotics market is valued at $40 billion. And in the U.S., the C.D.C. estimates that about 30 percent of all prescribed antibiotics are not needed at all. That’s 47 million excess prescriptions. And in many places outside of the U.S., you don’t even need a prescription. “You can walk into a pharmacy. A pharmacist will diagnose you and give you antibiotics. I tend to think of it as a story of Darwinian forces multiplied by the pace and scale of global capitalism. In an interconnected world — travel, import, export — we’re moving the bugs with us.” “I can go to a meeting in China or Vietnam or some place —” This is Lance Price, the director of the Antibiotic Resistance Action Center. “I can become colonized by untreatable E. coli. And I might not have any symptoms. But you can get colonized. And you can become this sort of long-term host.” So you could be healthy and still spreading bad bacteria without even knowing it. “Drug-resistant bacteria have never been able to travel the world as fast as they do today.” And that’s just part of the problem. “You should know that about 80 percent of antibiotic production in this country goes into agriculture.” “Why on earth did somebody think putting antibiotics in agriculture was a great idea?” “We’ve said, hey, look, cram these animals together. Don’t worry too much about hygiene or trying to keep them healthy. Just give them antibiotics. And then in a couple weeks, you’re going to have full-grown animals that you can chop up and eat. Right? And you can make money off of that.” “Nobody was making the connection between feeding animals antibiotics and the fact that the food would be carrying drug-resistant bacteria.” So Ellen did a study. She compared different kinds of store-bought chicken. And she found that poultry raised with antibiotics had nine times as much drug-resistant bacteria on it. “Now, let’s talk about the vegetarians. I just want you to understand, you’re not safe. You know all these outbreaks that take place among the lettuce and the things like that. Have you ever wondered how that happened? It’s because animal manure is used in raising crops. Organic agriculture lauds the use of animal manure.” “Unless you’re just a complete, ‘I’m a vegan, and I only hang out with vegans, and I eat sterilized vegetables,’ you know, it’s very likely that you’re picking up the same bacteria.” Resistant bacteria seep into the groundwater, fly off the back of livestock trucks and hitch a ride home on the hands of farm workers, all of which makes trying to pinpoint exactly where resistant bacteria is originating extremely difficult. And even when it seems like there is a clear source, things still aren’t so simple. “No one wants to be seen as a hub of an epidemic.” Say your grandmother makes you a rump roast. And then that rump roast makes you sick. Well, if you live in France, or Ireland, or pretty much anywhere in the E.U., packaged meat has a tracking label. You can figure out exactly what farm that meat came from. But in the U.S., not even the top public health officials can do that. “Most countries have animal ID laws. We don’t.” Pat Basu, former chief veterinarian for the U.S.D.A.’s Food Safety and Inspection Service, basically one of the top veterinarians in the country. “Let me start at the beginning. We got a case where we had resistant bacteria causing illness in people. There were sick people that C.D.C. identified.” “More than 50 people in eight counties have gotten an unusual strain of salmonella linked to pork.” “This is not your grandmother’s pathogen anymore. This is a new bug.” Health officials traced the outbreak back to the slaughterhouse and identified six potential farms where the outbreak could have come from. But then the investigation shut down. “The individual farmers have to agree voluntarily to share the data with these investigators who go out. We couldn’t go any further back. It was a dead end.” 192 people sick, 30 hospitalizations and zero access for health officials to investigate the farms. “The secrecy is maintained because there are big economic forces behind it. Farms are scared of losing their ability to get antibiotics. Hospitals are scared of driving away patients.” “Well, as a physician, I do get very upset. I get very upset, as a patient, that information is being withheld.” This is Kevin Kavanagh, a doctor and a consumer advocate for patients. “Drug-resistant bacteria is a huge problem. If it occurs at a restaurant, if it occurs in a cruise ship, you know about this immediately —” “A salmonella outbreak —” “within days or hours of an outbreak occurring.” “This morning, Chipotle is keeping dozens of its restaurants in the Pacific Northwest closed —” “But yet, in a hospital, it can take you months or even over a year until this data appears on a governmental website or reported by the C.D.C.” In the U.S., hospitals are under no obligation to inform the public when a bacterial outbreak occurs. “Defend and deny. They are very concerned about the short-term economic benefits, rather than looking at long-term problems.” “There’s always this response like, well, but there’s still a drug, right? Like, this isn’t the end.” Remember Albert Alexander? — “Hello. Ouch!” — the first patient to be given penicillin? Well, his story didn’t end there. Five days after he started recovering, the hospital ran out of the new drug, and Mr. Alexander died. Today, we don’t have to worry about antibiotics running out. We have to worry about using them so much that they stop working altogether. “— want to know why a metro health department didn’t shut down a restaurant —” “It’s a very resistant bacteria —” “We really need to change the way we use antibiotics. Because the way we use antibiotics is destroying them.” “It’s putting at risk the entire system of care that we depend on for lengthening our lives and improving the quality of our lives.” The British government commissioned a study which predicted a worst case scenario where more people will die by 2050 of these infections than will die of cancer. “That’s a generation from now.” “It takes 10 years to identify, develop, test and bring to market a new antibiotic. And it takes a billion dollars.” “This is a common issue for humanity.” “Very similar to global warming.” “You can’t control it as a single company. You can’t control this as a single government.” And because the bacteria are now working together so efficiently — “Unless the world acts consistently together, it doesn’t make a difference.”