00:00Antibiotics.
00:08Behind the scenes, they enable much of modern medicine.
00:12We use them to cure infectious diseases,
00:14but also to safely facilitate everything from surgery
00:18to chemotherapy to organ transplants.
00:21Without antibiotics, even routine medical procedures
00:25can lead to life-threatening infections,
00:28and we're at risk of losing them.
00:30Antibiotics are chemicals that prevent the growth of bacteria.
00:35Unfortunately, some bacteria have become resistant
00:39to all currently available antibiotics.
00:42At the same time, we've stopped discovering new ones.
00:46Still, there's hope that we can get ahead of the problem.
00:49But first, how did we get into this situation?
00:53The first widely used antibiotic was penicillin,
00:56discovered in 1928 by Alexander Fleming.
01:00In his 1945 Nobel Prize acceptance speech,
01:03Fleming warned that bacterial resistance had the potential
01:08to ruin the miracle of antibiotics.
01:10He was right.
01:11In the 1940s and 50s, resistant bacteria already began to appear.
01:17From then until the 1980s, pharmaceutical companies countered the problem of resistance
01:23by discovering many new antibiotics.
01:26At first, this was a highly successful and highly profitable enterprise.
01:32Over time, a couple things changed.
01:35Newly discovered antibiotics were often only effective for a narrow spectrum of infections,
01:41whereas the first ones had been broadly applicable.
01:44This isn't a problem in itself, but it does mean that fewer doses of these drugs could be sold,
01:51making them less profitable.
01:53In the early days, antibiotics were heavily overprescribed,
01:57including for viral infections they had no effect on.
02:01Scrutiny around prescriptions increased, which is good, but also lowered sales.
02:06At the same time, companies began to develop more drugs that are taken over a patient's lifetime,
02:12like blood pressure and cholesterol medications,
02:15and later, antidepressants and anti-anxiety medications.
02:20Because they are taken indefinitely, these drugs are more profitable.
02:25By the mid-1980s, no new chemical classes of antibiotics were discovered.
02:30But bacteria continued to acquire resistance,
02:34and pass it along by sharing genetic information between individual bacteria,
02:39and even across species.
02:41Now, bacteria that are resistant to many antibiotics are common,
02:46and increasingly, some strains are resistant to all our current drugs.
02:52So, what can we do about this?
02:54We need to control the use of existing antibiotics, create new ones,
02:58combat resistance to new and existing drugs,
03:02and find new ways to fight bacterial infections.
03:06The largest consumer of antibiotics is agriculture,
03:09which uses antibiotics not only to treat infections,
03:13but to promote the growth of food animals.
03:16Using large volumes of antibiotics increases the bacteria's exposure to the antibiotics,
03:22and therefore, their opportunity to develop resistance.
03:27Many bacteria that are common in animals, like Salmonella, can also infect humans,
03:32and drug-resistant versions can pass to us through the food chain,
03:37and spread through international trade and travel networks.
03:41In terms of finding new antibiotics, nature offers the most promising new compounds.
03:47Organisms like other microbes and fungi have evolved over millions of years to live in competitive environments,
03:54meaning they often contain antibiotic compounds to give them a survival advantage over certain bacteria.
04:01We can also package antibiotics with molecules that inhibit resistance.
04:07One way bacteria develop resistance is through proteins of their own that degrade the drug.
04:13By packaging the antibiotic with molecules that block the degraders,
04:18the antibiotic can do its job.
04:20Phages—viruses that attack bacteria but don't affect humans—
04:25are one promising new avenue to combat bacterial infections.
04:30Developing vaccines for common infections, meanwhile, can help prevent disease in the first place.
04:36The biggest challenge to all these approaches is funding, which is woefully inadequate across the globe.
04:43Antibiotics are so unprofitable that many large pharmaceutical companies
04:48have stopped trying to develop them.
04:50Meanwhile, smaller companies that successfully bring new antibiotics to market
04:55often still go bankrupt, like the American startup Achaogen.
05:00New therapeutic techniques like phages and vaccines face the same fundamental problem
05:06as traditional antibiotics.
05:08If they're working well, they're used just once, which makes it difficult to make money.
05:13And to successfully counteract resistance in the long term,
05:17will need to use new antibiotics sparingly,
05:20lowering the profits for their creators even further.
05:24One possible solution is to shift profits away from the volume of antibiotics sold.
05:30For example, the United Kingdom is testing a model
05:34where healthcare providers purchase antibiotic subscriptions.
05:38While governments are looking for ways to incentivize antibiotic development,
05:42these programs are still in the early stages.
05:45Countries around the world will need to do much more.
05:48But with enough investment in antibiotic development and controlled use of our current drugs,
05:54we can still get ahead of resistance.
05:57The world is full of accidental inventions that have had major impacts on our lives.
06:05The potato chip, the microwave oven, post-it notes.
06:09But did you know that the first antibiotic was invented by accident?
06:14Has any mistake in human history saved more lives?
06:18Learn more about this fascinating story with this video.
06:21You
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