Soren Wheeler (2:38)

Welcome to our home turf. At the green space here.

Latif Nasser (2:40)

You got on stage to do a little live show.

Soren Wheeler (2:43)

I did, it's true. Tonight we are doing a live taping of a thing that we've been playing around with lately. This was the latest in a series of shows that we've been doing with our favorite and only ER doctor reporter, Aver Mitra.

Latif Nasser (2:57)

Right. You may have heard the one I was on stage with him for about cpr. Or the one Lulu did with him about breast milk. And so this time we Were like, every once in a while it's nice to give you some air, to air you out a little bit.

Soren Wheeler (3:13)

Let me out of the closet.

Latif Nasser (3:14)

Yeah, that's right.

Soren Wheeler (3:15)

And because tonight is a live taping, we will be keeping it loose. We will have some audience interaction. We will have some live guests who can come up.

Latif Nasser (3:23)

And part of the reason it was so fun, this one, was because you're an editor and you were just editing him in real time, like tweaking, adjusting. You're dialing it in. You're like, okay, we're done with this, let's move on. Yeah, it's sort of funny. Like, you can hear this is what Soren does behind the scenes anyway.

Soren Wheeler (3:41)

I mean, we were actually trying to keep it loose, you know, like not dialing it in too much and a little bit of a seat of the pants kind of thing. But also, you know, the show. What the show was about was antibiotic resistance, which sexiest topic it was. The funny thing about that is it was something that I sort of knew about quite a bit. You know, like, we get pitches about it, we've done shows about it. You know, I think more generally, all of us sort of like, catch some passing news, bit about it here or there once every couple years, and then move on with our lives. But Avere, in his position as a doctor, he was able to make it's so much more visceral and honestly a little bit more terrifying. But at the same time, because he reported it out and looked in all these places and tried to figure out what was going on, he also, I think by the end gave me for sure and hopefully all of us sort of a different and maybe even hopeful way of looking at it.

Latif Nasser (4:45)

Well, let's play it.

Soren Wheeler (4:47)

Okay,

Latif Nasser (4:50)

Here you go.

Soren Wheeler (4:51)

So help me. Welcome out Dr. Aver.

Dr. Aver Mitra (5:00)

Hey. Hey. Thank you. Thank you, guys.

Soren Wheeler (5:03)

Wow.

Dr. Aver Mitra (5:05)

A lot of people love that.

Soren Wheeler (5:07)

I gotta say that every story you've ever brought me, I feel like starts at your job, like somebody walks through your doors at the ER with some, I don't know, injury or disease or what have you.

Dr. Aver Mitra (5:18)

That is what today's kind of about. But as I was thinking about it, I kind of realized it goes back even further than that. It goes back to 2006, this thing that happened with my dad, actually.

Soren Wheeler (5:30)

Your dad is a doctor, right?

Dr. Aver Mitra (5:31)

Yeah, yeah, he's a doctor. My mom's a doctor, My grandmom's a doctor. But at the time, I didn't want to be a doctor. I just wanted to be like a rock star. That was my dream.

Aver's Dad (5:41)

He went to med school. Then he decided, you don't want to be in med school. You want to be a musician. And being an old practical man as I am, I knew that's not going to work. I told you a thousand times that the difference between a large pizza and a musician. Which pizza? Large pizza fits a family.

Soren Wheeler (6:04)

Bold to let this room laugh at you like that. Like us.

Dr. Aver Mitra (6:08)

That's why I go to therapy.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (6:09)

Fair share.

Dr. Aver Mitra (6:10)

But the point is, like, at this time in my life, you know, I was going every day to band practice, hanging out with my buddies, staying up till five in the morning. Meanwhile, my dad is waking up early, he's going to work at a hospital. And he was seeing this sort of interesting change take place.

Aver's Dad (6:25)

We have been seeing infected hand patients, hand infection patients coming all the time to us with various reasons. It could be a small scratch, it could be a pin puncture. And we were treating them basically with a 48 hours worth of antibiotic, IV antibiotic or PO antibiotic. And it used to get resolved easily. And then suddenly we started to see these patients who are not really getting better within that short period of time. So we said, that doesn't make any sense. Why is it so that we are seeing so many patients? And we started doing some culture for each and every patient who came into the emergency room on a routine basis.

Dr. Aver Mitra (7:06)

So he's doing this at work and he sort of comes up with this idea, like, let's do a research project about this. Let's see what's going on. So he turns to me because, you know, English isn't his first language. He doesn't know how to use a computer. I'm a pretty smart kid. So he's like, why don't I get you to help me write this paper?

Aver's Dad (7:22)

You are the only person who has absolutely nothing going on at that stage with the music, et cetera. Instead of sitting idle, I thought if I keep you busy doing some medical papers later on, if you ever plan to reapply these papers might help the guys who are looking at your application saying, he's not a complete derelict.

Dr. Aver Mitra (7:44)

Well, I wasn't sitting idle because I was doing music at that time.

Aver's Dad (7:47)

There's a derelict in the sense you're doing music.

Soren Wheeler (7:52)

I do feel like I should step in and let you all know Avere was a little bit of a legit rock star. I mean, you had a record, you had gig, you were on Conan o'. Brien.

Dr. Aver Mitra (7:59)

That's true, that's true. But this was later, right? At the time I was broke. I was living in the basement. It was not a good look. I get it. But anyway, back to the topic. What we found in this paper is that these patients were coming in with infections. The bacteria was MRSA.

Soren Wheeler (8:15)

Oh, sure. I feel like MRSA is the late 90s news. Super Hospital bug.

Dr. Aver Mitra (8:21)

Yeah, MRSA was a typical bacteria that had become resistant, and it was a thing that had already existed, but it was the type of bug, the type of infection you could get. Like, if you were super sick, you know, you're, like, in the hospital for months and you're getting all these meds, like. But what this paper found is that people were coming in off the street who had, like, never been in a hospital. Kid falls off a skateboard cut, he's got mrsa. So what we found is that actually this bacteria that lived in one place, it sort of, like, escaped.

Aver's Dad (8:48)

It doesn't stay limited to that patient or that limited to that facility. It essentially escapes, and then it becomes a risk factor for the general population.

Dr. Aver Mitra (8:59)

So, yeah, I had that experience. I wrote up this paper, and I didn't think much of it because I was like, whatever, I'm in a band. But eventually I go to med school. Now 10 years go by, and now I'm actually showing up in the ER as a resident. And at this point, MRSA is just, like, a common thing. Probably three or four of you have MRSA here. It's like, just a thing that people have. But I wasn't worried about it because we had a drug called vancomycin, which can treat mrsa. So it's not, like, incurable. So now I'm working in the er. A year goes by, and then it's weird. All of a sudden, I start seeing patients who have resistance to vancomycin. So now the vancomycin isn't working. It's like, okay, so at least we have a class of antibodies called carbapenems, a little bit more rare, but I can use those drugs for those patients.

Soren Wheeler (9:44)

But you have a backup.

Dr. Aver Mitra (9:45)

Yeah, I have that backup. I can use it. But then another year goes by, and then I'm starting to see patients that are resistant to the carbapenems that's not working anymore. And so then at that point, I have to go to this drug, Colistin, which is, like, just this crazy old drug that, like, I don't even want to use. It's got a bunch of side effects, and basically, I feel like I'm being backed into a corner all of a sudden. Just this simple infection, and now it's like, I have to do all this stuff, and I have no choice, I gotta say.

Soren Wheeler (10:16)

Like, as we've been talking about this, like, obviously I've known about antibiotic resistance, and I'm sure many of us here have, but, like, how long have you been a doctor? 10 years.

Dr. Aver Mitra (10:24)

10 years.

Soren Wheeler (10:25)

It's like, I'm not that. That's not a lot, but. It's not a lot.

Dr. Aver Mitra (10:27)

Yeah.

Soren Wheeler (10:27)

And I feel like, you know, you. In that short time, you have been sitting there, literally watching drugs that you could use slip away. I mean, it's sort of like the pace of it. Like, while we've all been distracted by presidential politics or maybe a pandemic, this has been happening right in front of your eyes.

Dr. Aver Mitra (10:47)

Yeah. No, it honestly is terrifying to go up to work and see this happen. I don't know. It's just scary because it's like, if we don't have antibiotics, we're not really doctors. You can't get a surgery if you don't have antibiotics. You can't get a C section. You're basically useless without these drugs. And that's why I kind of start to have these nightmares where it's like, am I just. Everything I know about medicine, is it just this, like, little bubble that we're living in?

Soren Wheeler (11:16)

What do you mean by, like, little bubble?

Dr. Aver Mitra (11:19)

What I mean is, like, okay, let's zoom way, way out. All right? For hundreds of thousands of years, we've been human beings and we've been fighting bacteria. But for, like, most of that time, we have been losing. Like, just think about it. Like, back in the day, you get a little simple uti. Like, you die, have sex with the wrong person, you get disfigured for life, you catch a little cold, turns into pneumonia. I mean, basically, you gotta move somewhere, like Arizona. Try your best, or you probably just die. Like, that is the way the world has always been until not that long ago. Like, less than 100 years ago. Alexander Fleming, he basically just observed that fungi were producing a chemical that was killing bacteria. So he basically just isolated that chemical.

Soren Wheeler (12:11)

So that's penicillin, right?

Dr. Aver Mitra (12:12)

That's penicillin. And, like, everything we've done since then has been a variation on that theme. We tweak it a little bit here, find a different fungus there, but it's the same idea. And it's basically this idea that has allowed, like, civilization, as I guess we all know it, to exist. Like, that's how we've won wars. That's how we live. In a city. That's how we're all in this room together. And, like, people aren't dying. You know, everything we do is just based on kind of this idea.

Soren Wheeler (12:38)

And that is the bubble that you feel like, is bursting.

Dr. Aver Mitra (12:42)

That's the, like, hundred year bubble.

Soren Wheeler (12:44)

I mean, does that mean that you actually feel like, what are we looking at in the five, 10 years that there are bugs out there that no drug works on?

Dr. Aver Mitra (12:54)

Well, maybe I can, like, share a story. Yeah, all right.

Soren Wheeler (12:58)

As your editor, I recommend you do.

Dr. Aver Mitra (13:01)

Can't just be me blathering. Let's move. All right. All right. So this is Stephanie Strathi. She's an infectious disease epidemiologist at University of California, San Diego. But here she's just going on vacation with her husband Tom to Egypt.

Stephanie Strathy (13:17)

We ended up going at a time when there had been a terrorist attack in Sharm El Sheikh a couple of weeks prior to. So all of the people from the west had canceled, and we were the only one on this cruise ship. So it was really kind of a ghostly experience. I remember standing at the front of the boat doing one of those Titanic things, like. And then we had had this lovely seafood tower for dinner, and we're looking at the stars. It was really romantic. And then all of a sudden, Tom started to turn a bit green and he was losing his stomach contents all night. So I called a doctor to the ship, and the doctor first gave him an intravenous antibiotic and some fluids and said, oh, he'll be right as rain by, you know, dinner. And he wasn't.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (14:02)

He was worse.

Dr. Aver Mitra (14:03)

So they get off the ship at this point. They go to a clinic in Egypt where they're trying some other medicines. It's not working. So they actually ship him to a bigger hospital in Germany.

Stephanie Strathy (14:13)

Well, he was in an ICU in Frankfurt where they have some of the best gastroenterologists in the world. But when the culture came back, the doctor said, I've got some terrible news. This is the worst bacteria on the planet. It's Acinetobacter bomanii. And I went, what? And when he said it again, I realized, wait a second. This was an organism that I used to plate on my petri dishes back

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (14:39)

at the University of Toronto when I

Stephanie Strathy (14:41)

was a student in the 1980s. And all we needed was the lab

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (14:44)

coat of gloves back then.

Stephanie Strathy (14:45)

How can this be the worst bacteria on the planet?

Dr. Aver Mitra (14:48)

So despite all this treatment, he's getting all these antibiotics. He is getting worse and worse. At this point, he's on a breathing machine he's getting sicker. So they package him up and send him back home to the University of California, San Diego, the icu.

Stephanie Strathy (15:01)

There I have a chart of all the different antibiotics that it was resistant to right off the top. And I call those the gorilla cylins that are the heavy duty antibiotics that have to be infused into the patient and that have a lot of toxic side effects. He was on all of those in a cocktail. There was no other alternative. In fact, we didn't even know if these antibiotics were gonna do anything. When I pointed to a whole bunch of them on the wall and the doctor said, you know, there's nothing that will kill this thing. I said, well, then why are we treating him with all of these antibiotics? And they said, because we don't know what else to do.

Dr. Aver Mitra (15:39)

This is probably a dumb question, but emotionally, what are you going through at this time?

Stephanie Strathy (15:47)

Well, I felt like it was God's cruel joke that here I am, an infectious disease epidemiologist, and I had no idea that antimicrobial resistance had gotten this bad over the last few decades, that an organism, a wimpy bacteria, as one of the doctors called it, that has acquired these superpowers and is now, like, killing my husband. Like, what? Like, how could this be?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (16:11)

How can.

Stephanie Strathy (16:12)

How can an infection that you acquire on vacation to a guy who's, you know, so healthy that he was crawling backwards down into a pyramid one day, and then two days later, he's fighting for his life? Like, this just doesn't happen, does it?

Soren Wheeler (16:28)

I mean, it is, yeah. It's crazy just to think about, like, that what she said, that she was. This was a bacteria that she was plating with just gloves, and then it's become this thing that we can do nothing about.

Dr. Aver Mitra (16:38)

Yeah. Yeah, it's scary, man. I mean, like, look. And this was 10 years ago that this happened. So I'm showing up to work, and I'm seeing cases like this where no antibiotic works. I gotta mix and mingle different antibiotics to try our best. And I don't know, it's. It's just a scary feeling because I feel like I'm watching a world war that's happening basically right under our noses. And, you know, we're not really paying attention to it. And then somehow, like, I'm at the front lines of this, and I'm like, how did this happen to me? Like, why am I here? I guess that's why I wanted to come here and talk today, because I wanted to sort of zoom out and take a big picture of like, okay, there's this global war. Like, what is really going on here?

Soren Wheeler (17:16)

Well, I mean, so now that we've got you, it's sort of like a little bit out of doctor mode and into maybe reporter or investigative looker mode. Like, back me up a little bit. Cause you talk about it as a world war. Like, give me the layout of, you know, unpack that metaphor for me a bit. Like, what's the battlefield? Who are the combatants? Okay, walk me up to it.

Dr. Aver Mitra (17:34)

Yeah. So we could start with sort of who. Who is this battle between? Right, because you got us and humans and on the one side.

Soren Wheeler (17:41)

Or us and bacteria.

Dr. Aver Mitra (17:43)

I mean, us and bacteria. Yes. Yeah, I forgot I was human. Us. Team us. I promise I'm human. We're on this side. Think about what we have, right? Like, we're composed of trillions of cells. We have like huge brains, we have all these muscles, we have fancy degrees, we have ChatGPT. We have everything. And on the other side, we have bacteria that are like single celled organisms. They don't go to school, they don't know how to read, they don't have brains, they don't even have a single neuron, they don't have any muscles. Like, they just put them in the air and they'll probably just die.

Soren Wheeler (18:21)

I got to say, it raises a question which is sort of like, how in the hell are we losing?

Dr. Aver Mitra (18:25)

No, I know. That's exactly what I think about. And yet I'm sitting at work and watching us lose it. And that's where I get to thinking. And I don't know, I've grown to have a respect for these guys because I'm like, I actually fundamentally think that they're like, better than us. I really do. I mean, sure, we have all this stuff, but they can actually just evolve better than we can at a very fundamental level.

Soren Wheeler (18:50)

Well, explain how something can evolve, like, because they got like, they faster lifespan, they mutate easy year. Like, what? How do you evolve better?

Dr. Aver Mitra (18:59)

I could describe it, but I'd rather kind of just show you.

Soren Wheeler (19:01)

Yeah, let's do it.

Dr. Aver Mitra (19:02)

But you guys have to be involved. All right, there's some crowd participation. All right, I'm going to set up a hypothetical scenario here where we're going to watch evolution happen. Let's pretend you guys are all humans and me, Dr. Mitra, I'm going to try to kill everyone in this room. The way I'm doing it is this

Soren Wheeler (19:20)

is, by the way, not a typical public radio.

Dr. Aver Mitra (19:22)

Right, right.

Soren Wheeler (19:23)

Tactic.

Dr. Aver Mitra (19:24)

Right. It's an aggressive donation Request or else.

Latif Nasser (19:29)

Yeah.

Soren Wheeler (19:29)

No. Okay. All right.

Dr. Aver Mitra (19:31)

The only way out is if you donate. No. I'm gonna seal all the windows, everything, and just suck all the oxygen out of the room. So you all are gonna suffocate to death. I'm sorry, I know some of you guys, I apologize, but. And I need a volunteer. I need one volunteer, ideally a single person. All right. What's your name? Danielle. Danielle. So sucking out all the oxygen in the room, everybody dying, we got that. But Danielle, she didn't even know this. She has a random mutation where she can hold her breath for 20 minutes. So while everybody else dies, you're going to live. So let's think about, from an evolutionary perspective, if we want this trait, ability to hold your breath to spread. How's that going to happen? Well, Danielle has to go on some dates, meet someone that she's into.

Soren Wheeler (20:19)

We don't need a doctor to tell us what has to happen. You get the idea? We get the idea.

Dr. Aver Mitra (20:28)

Then maybe that special miracle of birth will happen.

Soren Wheeler (20:31)

Yeah. So that's human evolution. We gotta wait a while. But that's just human. That's just evolution.

Dr. Aver Mitra (20:37)

That's evolution. But it's a specific type of evolution, really. It's called vertical gene transfer.

Soren Wheeler (20:43)

Vertical, like.

Dr. Aver Mitra (20:44)

Like down the generation, passed down to the children and grandchildren. They go down the generational tree. So while Danielle has to have sex, bacteria have a sex pilus.

Soren Wheeler (20:58)

So at this point in the show, Avere put up a picture right behind us on stage. And it had these, like two gray blobs. It's kind of a grainy picture. And there's this tube just like shooting out from one of them, connecting it to the other one on the other side.

Dr. Aver Mitra (21:14)

It's a different thing. This doesn't look like Danielle at all, actually.

Soren Wheeler (21:17)

No, but it turns out more like a date.

Dr. Aver Mitra (21:22)

Exactly. About a billion years ago, bacteria evolved this crazy trick where they're able to just generate a tube out of their bodies and just suck into the bacteria next to them. It doesn't even have to be the same species. They can just create a tube and connect to the person next to them.

Soren Wheeler (21:38)

And they're shooting genes, I assume. Like, that's right.

Dr. Aver Mitra (21:40)

So they make this tube, and then they can make copy of some of their genes and just send them over to the person next to them.

Soren Wheeler (21:46)

Wow, that's pretty cool.

Dr. Aver Mitra (21:48)

That's the sex pilus. And so I kind of want to use this now as an example. Okay, so we're going to try the same scenario again instead of you guys being Humans now, you're all bacteria. Okay? You all have a sex pillus. So I need to pick someone in the audience. I'm going to pick. What's your name?

Soren Wheeler (22:03)

Rich.

Dr. Aver Mitra (22:04)

Rich. Rich the bacteria. You have a special mutation. Let me explain. In this scenario, all you need to live is light. Okay? That's what you need is bacteria. So let's go ahead and turn all the house lights down. And as these are turning down, you guys are all slowly dying.

Soren Wheeler (22:20)

This is getting weird. Yeah.

Dr. Aver Mitra (22:21)

But Rich the bacteria has a special mutation. He didn't even know he had it. He has the ability to make his own light. So, Rich, please tell me that you have a little glow stick.

Soren Wheeler (22:31)

Just to explain, by the way, we actually handed out glow sticks to everybody in the audience as they came in

Dr. Aver Mitra (22:35)

the door, but only Rich the special bacteria. You can go ahead and turn on that glow stick for us and hold it up.

Soren Wheeler (22:42)

Yeah. Kind of wave it around. Let's see it.

Dr. Aver Mitra (22:43)

All right, so using the sex. No one's ever been to a rave, I guess. All right. So, Rich, anyone you tap on the shoulder can then turn on their glow stick. Don't do it yet. Don't do it yet. We're gonna time this, okay. And then once you, you know, once you get tapped, you can turn on your glow stick and you can tap people around you.

Soren Wheeler (23:05)

Yeah. When you get tapped, also spread the tap.

Dr. Aver Mitra (23:07)

And let's see how long it takes for this trait to spread everywhere. Okay, on my count. Ready? Three, two, one, go. Okay, hold him up so we can see him. Let's see this hat.

Soren Wheeler (23:22)

So Avere and I are standing on stage in the dark, and it was actually pretty cool to watch this happen. You could sort of see Rich's light spread to the next person and next. And at first, it was actually pretty slow and sort of halting.

Dr. Aver Mitra (23:35)

These guys are still dying over here.

Tom (patient, voiceover) (23:38)

No list.

Soren Wheeler (23:38)

But then it started to, like, spread pretty quickly. It took a little while to get, like, over to different sections.

Dr. Aver Mitra (23:44)

The VIP section is all dying.

Soren Wheeler (23:46)

But really, once it got going, it went fast.

Dr. Aver Mitra (23:48)

Amazing.

Soren Wheeler (23:49)

And suddenly the whole theater was sort of like a sea of little wiggling lights.

Dr. Aver Mitra (23:53)

All right, nice. Let's bring the house lights up. Give yourselves a round of applause. That was actually really cool.

Soren Wheeler (24:01)

That was great.

Dr. Aver Mitra (24:02)

That was really.

Soren Wheeler (24:02)

That was really amazing to watch.

Dr. Aver Mitra (24:03)

You guys are great bacteria. That was so good.

Soren Wheeler (24:06)

Everybody give yourself a round of applause.

Dr. Aver Mitra (24:10)

So what you just witnessed is actually horizontal gene transfer, right? So while humans have to pass genes down, you guys can pass genes horizontally. You could just pass them to Each other.

Soren Wheeler (24:21)

Meanwhile, I think Danielle is still like trying to find that date and we could like.

Aver's Dad (24:25)

Right.

Dr. Aver Mitra (24:25)

She's not so sure about the last day she went on. There's going to be some time.

Soren Wheeler (24:29)

I want you to take your time. But.

Dr. Aver Mitra (24:31)

Right, exactly. So you know, you got to think about that. Look at how fast that spread. And now you take into account that for every single human being on earth there are 30 trillion bacteria. Okay.

Soren Wheeler (24:42)

Per person.

Dr. Aver Mitra (24:43)

Per person.

Soren Wheeler (24:44)

So that's me. 30 trillion.

Stephanie Strathy (24:45)

You.

Soren Wheeler (24:45)

30 trillion. 30 trillion. 30 trillion, exactly.

Dr. Aver Mitra (24:48)

It's just unbelievable. There's universes of bacteria for every single human being and all it takes is for like one mutation to happen in one of those bacteria and then that trait is going to spread like wildfire.

Soren Wheeler (25:00)

So what we're up against is like terrifying numbers of blazingly fast and nimble, tiny little enemies.

Dr. Aver Mitra (25:08)

Exactly. It really is like our brains versus their sex pilus and their sex pillus is winning basically.

Soren Wheeler (25:17)

Well, okay, but this is actually where I was hoping that our brains might come back in because, okay, sex pillis and trait tricks. And we do a drug, they figure out a way around it, but then we come up with a new drug.

Dr. Aver Mitra (25:28)

Well, that's the idea. Problem is like we haven't really been coming up with new antibiotics. We sort of fell off a cliff. Like we haven't come up with a new antibiotic, a significant one, since like 1980. We just don't, we just don't anymore.

Soren Wheeler (25:42)

Why, why is there not. There's zero new antibiotics since 19, whatever that is.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (25:46)

Yeah.

Soren Wheeler (25:46)

Why?

Dr. Aver Mitra (25:47)

It's mostly like an economic issue. You know, you think about how much money it costs to do all these trials to invent a drug that's gonna cost you like a billion dollars. So that's a lot if we all have to chip in on that, you know. And you're gonna do all this to make a drug? It might work. And if it does, bacteria just in a matter of like two, three years, they're going to figure out a way around it. So it's just kind of like a money losing proposition for pharmaceutical companies. So they're just not going to do it.

Soren Wheeler (26:14)

So that means that you then are literally just sitting around using the same drugs over and over again. Meanwhile, every time you use one, the bacteria has a chance to train up on it and figure a way around it.

Dr. Aver Mitra (26:25)

Yeah. And that's how like a little trickle of bacterial resistance that's always been around. It's like turning into an avalanche. It's scary. I talked to the who. There's A whole chapter of the WHO dedicated to this. And they told me that currently, as of today, one in six infections is resistant to the antibiotic that used to work for it. Like, you have to use something else. And currently today, a million people a year are dying from infections that they used to survive, like, a couple years ago. And obviously that number's about to get a lot bigger, too.

Soren Wheeler (27:00)

Do you remember when you were pitching me this story and I said, well, you can't just leave these people depressed and destitute.

Dr. Aver Mitra (27:08)

No, I know.

Soren Wheeler (27:09)

And you remember I said, like, there's somewhere there's going to have to be a ray of hope. And I'm thinking now is I had this.

Dr. Aver Mitra (27:14)

Okay, okay.

Soren Wheeler (27:15)

So with some prodding, Aver did eventually talk about how they're dealing with the rise of antibiotic resistance. In hospitals.

Dr. Aver Mitra (27:23)

We have, like, committees that are filled with annoying people that will email me if I do something wrong or they pull me into a zoom meeting, or there's, like, all these protocols we gotta

Soren Wheeler (27:31)

follow, basically making sure that they don't use antibiotics in a way that give the bacteria a chance to evolve or resist the drug and then pass that resistance along.

Dr. Aver Mitra (27:40)

You know, we want to treat things only if there's really an infection and then really kill everything. Like, you know, we don't want there to be, like, any survivors that can live to tell the tale of what happened.

Soren Wheeler (27:53)

But Avere, he did have a little bit more darkness that he wanted to stare at. Although I promise it does eventually lead us to a more hopeful space. Eventually. And that'll all come right after this quick break. Stick around.

Lulu Miller (28:13)

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Latif Nasser (29:30)

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Soren Wheeler (31:54)

This is Radiolab. I'm Storm Wheeler and we are back on stage with Dr. Aver Mitra, who is giving us his frontline view of what he calls a World war between us and bacteria. And at this point in the show, Avere told us that as he was reporting all of this out, he realized it wasn't just a problem with him giving antibiotics to a patient in the hospital.

Dr. Aver Mitra (32:18)

Like we also give them to animals. I don't know why that never occurred to me. But if I had to ask you, like, of all the antibiotics given in the us, what percentage would you say go to humans versus animals?

Soren Wheeler (32:32)

I don't know. I feel like it's one of those things where I'm supposed to guess bigger than I would think, but I have no idea. Half, I don't know.

Dr. Aver Mitra (32:40)

It's reasonable, but actually 70% of all the antibiotics given are given to animals.

Soren Wheeler (32:46)

Another way of putting that is that every year Here in the US we humans take about 7 pounds of antibiotics, whereas farm animals are given 30 million pounds every year. So basically, cows and pigs and chickens are getting four times the amount of antibiotics that we humans are getting.

Dr. Aver Mitra (33:05)

Yeah, I had no idea.

Soren Wheeler (33:06)

Wow.

Dr. Aver Mitra (33:07)

They're basically just mixing their food with antibiotics. They mix the water, they're drinking water with antibiotics, they spray it on the ground, they inject them with antibiotics.

Soren Wheeler (33:16)

It's just like this is not just if they get sick.

Dr. Aver Mitra (33:20)

No, no, no, this isn't just if they get sick. It's just very willy nilly in many cases, these are the same antibiotics that we use treating the same infections that we get.

Soren Wheeler (33:32)

So Aver ended up talking to a scientist, a guy named Lance Price. He's the founding director of the Antibiotic Resistance Action center at George Washington University. But before he was that he was researching this exact problem, the use of antibiotics on farms. And the thing that he was specifically trying to figure out was what effect could the use of all these antibiotics on farm animals have on us.

Dr. Aver Mitra (33:57)

So he designs a study, and like all good studies, it involves poop. It's like a common theme in Radiolab. I feel like it comes up a lot. So he designs this study. All right, so what he does, he decides to study the poop of chicken catchers. The person who goes around the chicken farm and picks up the chickens by their necks with their hands and throws them in the chicken truck when they're like ready to get harvested, basically. So they're touching a lot of chickens. So what he does is he measures the bacteria in the poop of these chicken catchers versus the bacteria in the poop of regular people like you and I.

Lance Price (34:32)

So we cultured all this poo and then we analyzed the data. And the one thing that Popped out really strong was gentamicin resistance. And so it turned out that the chicken catchers had 32 times the risk for carrying gentamicin resistant E. Coli as their peers.

Dr. Aver Mitra (34:58)

Basically, these chickens, before they even hatched, they would poke a hole in the egg and inject that egg with gentamicin. Then the chickens would grow up, they're being fed gentamicin, like, left, right, center. The E. Coli that live in the gentamicin were eventually learning from this, becoming resistant to the gentamicin. Those bacteria were jumping from the chickens onto the hands of the chicken catchers into the mouths of the chicken catchers, enough to the degree where they're literally shitting out resistant bacteria.

Lance Price (35:25)

And look, if you're an epidemiologist and you get three times the difference, you're doing cartwheels down the hall, right? So you're like, I found something.

Dr. Aver Mitra (35:34)

Look at this.

Lance Price (35:34)

It's miraculous. But this was 32 times. And I just said, we've got to be doing something wrong.

Dr. Aver Mitra (35:40)

Right?

Lance Price (35:40)

So we looked at the numbers over and over, and it was clean.

Soren Wheeler (35:46)

So the person handling a chicken is 32 times more likely to have a resistant form of E. Coli in their bodies than someone who's not handling a chicken.

Dr. Aver Mitra (35:54)

Yeah, exactly. And then they find out that, okay, these chicken catchers are going home, that resistant bacteria is getting into their children. Then they find that those bacteria are spreading through the schools of the children. They later find out that if you're driving behind that chicken truck carrying chickens, those bacteria are getting off of the truck, in through your air vents and landing in the cars behind them onto the people behind it. It's like. It's truly insane. And then when you really just sit back and think about it, then these chickens go die. They get packaged up with the bacteria in them, and they get sent to all of our houses. Really?

Soren Wheeler (36:30)

Do you remember when, like, 10 minutes ago, I was like, can we

Dr. Aver Mitra (36:35)

do

Soren Wheeler (36:35)

the Turn to Hope thing?

Dr. Aver Mitra (36:37)

No, I know, I know, but, like, look, this is. To me, this is exciting. This is good because, like, I'm spending my whole life in the er, like, trying to be super anal. Like, no, you're not getting into Zithromycin. Like, not giving you a Z pack, but really, like, this is where the real battle is happening. I've been on the wrong battlefront the whole time.

Soren Wheeler (36:54)

Well, but so then what? I mean, okay, what's your next move? Like, you going to call up Big Chicken?

Dr. Aver Mitra (36:58)

Well, I did the radio lab thing. Yes, that's actually exactly What I started emailing people I was doing, I was trying to do the Radiolab thing. So I, I emailed Tyson Chicken and they weren't into me, but I kept looking, I kept looking. Eventually I was able to find one guy who is a higher up at a chicken company, big deal guy. And he actually agreed to talk to me.

Soren Wheeler (37:24)

Great.

Dr. Aver Mitra (37:25)

So let's bring him up. This is Bruce Stewart Brown, he's the chief medical officer at Purdue Chicken.

Bruce Stewart Brown (37:36)

Bruce, nice to see everybody.

Soren Wheeler (37:38)

Thank you for coming. Thank you, thank you for agreeing to talk about this. I want to just break in and say that I actually had figured that this was going to be the point in his reporting where Avere would hit a wall. And so it really felt like a sort of strange but very cool opportunity to sit down and talk to somebody who's on the inside of one of the biggest chicken producers in the country.

Bruce Stewart Brown (37:57)

Yeah. So I'm a veterinarian and I started at Purdue in 1998 as a field veterinarian and just kind of getting used to how commercial chicken was raised and the process of being a veterinarian specifically for chickens. And in 2002 we got in a room together and talked about the fact that concerns around antibiotic use had hit the radar for us. And that means that people were calling in or writing and saying, look, I heard you, you guys use a lot of antibiotics in chickens. And they wondered why. And in this meeting then Jim used, Jim Perdue's a third generation CEO of chairman of the company at the time. And Jim is going, first of all, tell me why we use all those antibiotics. And then second, tell me how we can not use all those antibiotics. Let's make it a project and start now.

Soren Wheeler (39:03)

Let me, let me ask you at that moment in time when you're, when the big cheese has showed up and said, we're going to do this, what's your reaction?

Bruce Stewart Brown (39:10)

I'm going, oh, my man, we have, we have got to change everything. If you just pulled out the antibiotics, you are likely going to have to treat quite a few chickens. And that's not right. That's not a great thing.

Soren Wheeler (39:26)

So what do you end up doing to make up? If you're gonna take the antibiotics out, what do you have to do to make up for that?

Bruce Stewart Brown (39:31)

First thing is you have to redefine clean. You have to decide in our case that we thought this egg was clean, it's gotta be cleaner. So there's four ways chicken companies were using antibiotics, including us. One is it was going in every egg as a Very like, injected into the egg. Injected into the egg with a vaccine to keep the. As you vaccinate, you have this tremendous opportunity in a chicken to vaccinate the embryo. It's amazing, honestly, that you can get the vaccine started in an embryo, but you do poke a hole in the egg. And the egg did come out of the rear end of a hen, which is the same place manure comes out of, so it can be dirty. And the idea was keep it clean with the antibiotic. Okay, that's.

Soren Wheeler (40:23)

So cleaning chicken cloaca is step number one.

Bruce Stewart Brown (40:26)

Yeah, well, but the other parts were there was antibiotics in the feed. Every bite of feed from day old had an antibiotic in it in those days, even though they weren't sick, just in case they might be. And it helps their gut stay healthy through all the challenges. So we were putting antibiotics in the feed for that.

Dr. Aver Mitra (40:45)

Then when I went down to the farm, I'm seeing that the things they used to feed these birds were other animal parts. And so that gives them gastrointestinal illnesses. Cause it's like kind of gross food. And so then they gotta use antibiotics. So then they decide to, like, change the feed.

Bruce Stewart Brown (41:05)

Yeah, we had to change. We had to look at the feed a whole new way. Take the antibiotics out, take the animal byproducts out, because those are irritants. Put in probiotics, good bacteria, things that help the digestion, the digestive tract of a chicken. Operate optimally. Same thing. You know, you probably all familiar with the good bug thing. It's. It's really big.

Soren Wheeler (41:29)

So is this all, like, is it. You're going along, is it working? Does it seem like you're getting somewhere? I don't know. Maybe there's some other things you had to do too. But.

Bruce Stewart Brown (41:37)

Yeah, well, we. We did have to work on the chicken house and the change in feed. The change in approach to feed was a big deal. The cleaner eggs was a big deal. But changing the way you care for chickens became the thing. Raise these chickens in a way that even if nobody cared, you used antibiotics, you wouldn't use them. The whole thing became about caring for chickens in a way that you'd never let a chicken be a chicken. Put things in the chicken house so they can get up off the floor, let them exercise. Put some windows in the chicken houses back in the chicken house. The traditional industrial chicken house has zero windows and it's all artificial light. Put some windows back in, expand the floor space to something above the floor. Chickens like to do three things. They like to climb they like to perch and they like to hide. And in a traditional chicken house, they don't get to do much of any of that. And so get that back in there. Take the stressors away from the way you raise chickens as much as you can and learn all the time.

Soren Wheeler (42:48)

Can I get you to like, I mean, over how long did this take and maybe where did you land? Where are we at now?

Bruce Stewart Brown (42:54)

2016. We were done.

Soren Wheeler (42:56)

Wait, does done means what?

Bruce Stewart Brown (42:58)

All the antibiotics were out of the feed, out of the eggs. Not using any antibiotics for anything other than treating sick flocks.

Soren Wheeler (43:08)

Yeah. Thank you for the chicken and thank you for coming up here and talking to us. All right, everybody. That, I mean, it is actually imagining the chicken leaving its well lit coop to go out to its little sort of playground exercise area with maybe a probiotic parfait in hand. Yeah, it's delightful. Other than the fact that we are eventually going to slaughter and eat them.

Dr. Aver Mitra (43:36)

Right, right.

Soren Wheeler (43:37)

And I gotta say, you know, like, also to take in consideration just what, like the overall the animal industry is doing. Should we be doing it? The climate, of course. Like.

Dr. Aver Mitra (43:47)

Yeah, yeah, yeah, exactly. It's like there's a lot of problems with eating meat in general. You know, you could think about climate change, you can think about ethics, and this doesn't solve all of that. But certainly in just a proof of concept, to me, it's interesting, the antibiotics were sort of masking cruel treatment towards these animals. Like, you can treat them however you want, but if you pump them with enough antibiotics, they live. And once you remove those antibiotics, all of a sudden you're sort of seeing the truth of what you're doing. And if you treat them better, they're healthier, you're healthier. What we do to them comes back to us. I don't know. Yeah, it's kind of an interesting proof of concept. I'm into it.

Soren Wheeler (44:24)

Yeah. I guess I'm just like back thinking about the war because let's say that everybody went full Bruce, and there's maybe a cow Bruce and a pig Bruce, but even then turkey Bruce. Like, yeah, like, given the way you've described what's going on globally, I mean, is even that any kind of decisive move on our part, or are we.

Dr. Aver Mitra (44:48)

The way I see it, everything that Bruce is doing, that's sort of playing great defense.

Soren Wheeler (44:52)

Right.

Dr. Aver Mitra (44:52)

Like, let's stop training these guys to get better. But I agree, you know, at some point we have to go on offense like any good war. And so I do have one more story I want to share. With you guys, that kind of takes us there. And honestly, I think this is the part that gives me really, the most hope, the most excitement.

Soren Wheeler (45:09)

All right, good.

Dr. Aver Mitra (45:10)

But to get there, we're going to have to go back to, like, a dark place been the theme of the night. But we got to go back to

Soren Wheeler (45:16)

Stephanie Strathy, who went with her husband Tom. And then Tom gets sick and.

Dr. Aver Mitra (45:19)

Okay, exactly.

Stephanie Strathy (45:21)

So one day the doctors came to me and said, you know, Steph, you realize that Tom's on life support, right? He's on a ventilator to keep his lungs working. He's on three medications called pressors to keep his heart working. And now his kidneys are blinking on and off. So that's the trifecta where we stop talking about organs that are having problems working. We're talking about whole systems, whole body systems. I'm going, okay, okay, like, speak to me. And they said, well, do you want to start kidney dialysis? And so what they were really asking me is, do I want to pull the plug? And that moment was just like, I can't believe this is happening. You know, when you have your advanced directives and, you know, you sit down with your partner and you write a will, and, you know, he had said to me, hey, you know, if I'm ever, like, brain dead, please, like, you know, pull the plug. But this situation, it was his brain that was alive. It was his body that was dying. And I had no idea what he would want me to do. So the doctors are looking at means, and they're saying, okay, you know, what do you want to do? And I said, okay, I think we should ask Tom what he wants to do. And then he said, well, he's in a coma. Stuff like, how is he gonna communicate? I said, well, you know, let's see. Let's just see. So I had this conversation with Tom that you just never think that you're gonna have to have with somebody. And I said, hey, honey, I am. I know you're fighting really hard, and you have to be really tired, but I need to know if you want to live. And if you want to live, I need you to tell me by squeezing my hand, and I will leave no stone unturned. And I remember that moment like it was just yesterday. I still get chills just talking about it. I waited for a whole minute, and I thought, oh, my God, he's not gonna squeeze my hand. And then all of a sudden, he squeezed really hard. And I thought, oh, yeah. I pumped my little blue gloved fist in the air. And then I thought, oh crap, what

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (47:31)

am I gonna do now?

Stephanie Strathy (47:32)

I'm not a doctor.

Soren Wheeler (47:35)

I mean, the question in the room here for me at least is what did she do next?

Dr. Aver Mitra (47:40)

Yeah, well, we can ask her. Stephanie, come on up.

Soren Wheeler (47:45)

All right, we will get Steph's story and what happened to her and Tom next right after this quick break.

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Stephanie Strathy (continued) / Infectious Disease Epidemiologist (50:01)

This week on the New Yorker Radio Hour, I'll talk with the actor John Lithgow, who's on Broadway playing the author Roald Dahl, whose anti Semitic statements caused an international scandal.

Soren Wheeler (50:11)

His anti Semitism is obvious like like a leaky car battery.

Tom (patient, voiceover) (50:17)

It's just in between the lines, in

Soren Wheeler (50:19)

some cases just explicit.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (50:21)

John Lythgoe joins me next time on the New Yorker Radio Hour from wnyc. Listen wherever you get your podcasts

Soren Wheeler (50:31)

hey, it's Radiolab. I'm Soren Wheeler back on stage with Aver Mitra, and we'd been hearing the story of Stephanie Strathy and her husband, who was suffering from a bacterial infection that no antibiotic drugs seem to be able to treat. And at this point in the show, we actually got Stephanie up on stage to share with all of us what exactly she had to do next.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (50:56)

Hey, everybody. I can't believe I'm on Radio Lab. I'm geeking out.

Soren Wheeler (51:03)

Thank you for coming. I'm gonna just go in with the first one. The big question that we're all left with. I think, what do you do next?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (51:11)

Well, I was terrified. I mean, some of the top infectious disease physicians are at University of California, San Diego. They, our colleagues caring for Tom. But, you know, I was his wife, and I wanted him to live. And I thought, okay, like, if he dies, I want to know that I did my very, very best. So I'm an AIDS researcher by training, and I learned as an AIDS researcher that there are experimental treatments that got studied while we were doing clinical trials, and there should be some experimental treatments that we could use to save Tom. So I hit the research. I went on PubMed, which a search engine that the National Library of Medicine makes it freely available. And I entered the keywords acinetobacteromania, the superbug that was killing him, alternative treatments, and up popped something called bacteriophage therapy, or phage therapy for short.

Soren Wheeler (52:07)

And what is bacteriophage, or what's a phage?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (52:10)

Bacteriophage are viruses that have naturally evolved to attack bacteria. They're the oldest, most populous organism on the planet, and they kill bacteria.

Dr. Aver Mitra (52:22)

So are you saying just, like, how I can catch a cold, like a bacteria can catch its own cold type of thing? Yeah.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (52:28)

Well, what was weird is that I learned about bacteriophage when I was a student at the University of Toronto back in 1986. It was just mentioned in class, but I never knew that they had ever been used to treat, like, bacterial infections. But they were discovered before penicillin. It's just that they had been, you know, popularized in the former Soviet Union, and that was seen as kind of Russian medicine and fell out of favor in the West.

Soren Wheeler (52:57)

Okay, so the idea then is that you're gonna put a virus into Tom to fight the bacteria. And is it like, oh, when you're doing the PubMed Googling, it's like, here's the one to you. Like, what, Are you coming?

Stephanie Strathy (53:12)

Yeah.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (53:12)

Well, that was the other problem. Well, first I got my colleagues at the University of California, San Diego, said, wow, what an interesting and intriguing idea. If you can find phage that are a match for Tom's bacterial isolate, we'll call the FDA and see if they'll give us permission to give it to him on a compassionate basis because he's gonna die. But turns out there's like 10 million trillion trillion phages on the planet. Like, that's more than all the stars in the sky. So that was even more daunting. And luckily, I was able to find researchers that agreed to help. With the help of Dr. Chip Schooley, the head of infectious diseases at the time at the University of California, San Diego, we found people, and even the US Navy who had been sourcing phages from the bilges of ships around the

Soren Wheeler (53:58)

world, from the inside of the. Underneath the ship, scraping off viruses.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (54:03)

But. But the best place to actually go for phage is where there's a lot of bacteria, you know, where there's a lot of bacteria sources.

Soren Wheeler (54:11)

I feel like this is going back to poop.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (54:12)

It's going back to poop. So it turns out that sewage and barnyard waste and duck pond waste, that kind of stuff, the stuff from, like, the farms that Bruce was talking about, that's a perfect place to source phage. So within a couple of weeks from my first email asking total strangers for help, to the day that we treated Tom with these viruses that attack bacteria, it was only three weeks.

Soren Wheeler (54:37)

Three weeks of people tromping through the sewers and scraping the bottom of Navy boats and, like, sending, like.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (54:42)

Well, some of these were already samples that were in labs, but literally, yeah, you know, so, you know, I couldn't believe that we were doing this, but, you know, like, Tom's in a coma. I said, you don't believe, like, we're gonna be, like, pumping, like, you know, like, purified shit into you to see

Bruce Stewart Brown (54:58)

if you're gonna live.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (54:59)

Like, it was just like, I can't believe this is my life.

Stephanie Strathy (55:01)

But that's.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (55:02)

That's essentially what we did.

Soren Wheeler (55:03)

And that was then. Did you say three weeks later?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (55:06)

Three weeks. That's all it took. Like, compare that to an antibiotic that takes 10 to 15 years to develop and a price tag of a billion dollars or more.

Soren Wheeler (55:14)

Yeah, okay, so you.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (55:17)

So that's what we did. It was the scariest day of my life. But me and Tom's two daughters said, okay, let's do it. He's, you know, and is it.

Soren Wheeler (55:28)

Send it in. In an injection, An IV first we

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (55:31)

put them in the catheters in his abdomen because that was the closest to the source of the infection, which was in his gut. And then we injected them, and it was a billion phages per dose every two hours. And two to three days later, he, like. He was like, within hours of dying, I was told, he lifted his head off the pillow, opened his eyes, and kissed his daughter's hand. Carly was on shift that day, and everybody in the ICU freaked out. There were, like, people cheering. There were people crying. I was crying, too. It was the happiest day of our lives.

Soren Wheeler (56:10)

Wow.

Aver's Dad (56:14)

Can you.

Soren Wheeler (56:15)

How much do you know about, like. I mean, the virus goes in and attacks the bacteria, but, like, how do you. How much do you know about why this is so effective or what's actually happening in there or how this is going down? Like, what's actually going on inside the body?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (56:30)

Well, in Tom's case, there was something else that was a bit of an opportunistic kind of situation because a couple of the phages were synergistic with one of the antibiotics.

Soren Wheeler (56:42)

What does that mean? How does a virus synergistic with a.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (56:46)

Let me explain this, okay? So you're a bacteria. Okay?

Soren Wheeler (56:49)

Okay.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (56:49)

And I'm a phage. And Avir is the antibiotic. Okay? And we're both trying to kill you.

Stephanie Strathy (56:55)

All right?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (56:56)

Okay. Why is this keeping typical now?

Stephanie Strathy (57:00)

You're a bacteria.

Soren Wheeler (57:01)

So much death.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:02)

You do not have a brain in this example.

Tom (patient, voiceover) (57:04)

Okay.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:05)

Like, I don't know about regular life, just in this example, but you have to make a genetic decision about who you would rather face, him or me. And I'm scarier than he is. Okay? You do not want to have to deal with phage. So you decide to take off your shirt now.

Stephanie Strathy (57:23)

Okay.

Latif Nasser (57:24)

Okay.

Dr. Aver Mitra (57:25)

This is better.

Stephanie Strathy (57:26)

I know that.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:27)

This is not that question of show, but your shirt is your slimy biofilm layer. That's your superpower.

Dr. Aver Mitra (57:35)

It's his resistance, basically. Right.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:37)

But that's where the receptor for the phage is. Is on your shirt.

Soren Wheeler (57:41)

Okay, so if I get rid of my biofilm shirt receptor, you can't attach.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:46)

That's right. And so I die. But in doing so, you have made yourself susceptible to Avere's the antibiotic.

Soren Wheeler (57:54)

Because he loves nothing more than a shirtless.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (57:56)

So he kills me.

Stephanie Strathy (57:58)

He gets you.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (58:00)

So.

Soren Wheeler (58:00)

So it's like. It is. It's a one, two punch.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (58:03)

That's right.

Soren Wheeler (58:04)

Or even if one starts to work, you can. So. But does that mean that, like, when you use phage therapy, not Only do you have a new way of getting at this bug. You've unresistence it. Like, you've dialed back the resistance that it developed over the years of whatever. And now is it now a bacteria can actually be newly susceptible to a drug that it was.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (58:25)

So, you know, phage therapy is now going through clinical trials all around the world. It's. Phage is all the rage, people.

Dr. Aver Mitra (58:32)

But she's not going to say this, but actually, she is the one, like, setting up all these clinics all over the place. Yes, she is. Yes, she is.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (58:40)

Well, at the University of California, San Diego, we do have what became the first dedicated phage therapy center called the center for Innovative Phage Applications and Therapeutics, or iPath. So we do provide phage therapy to people.

Aver's Dad (58:53)

That's what I said.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (58:54)

That have. No, but there's many, many around the world now. And of course, I didn't do this all by myself.

Soren Wheeler (58:59)

I mean, but I hear a lot happening. But I have to wonder a little bit, like, why I didn't know more about this already, why aver wasn't already thinking about this as something he might have to use. Why isn't this already happening everywhere?

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (59:14)

Yeah, well, when Covid came on the scene, everybody felt it right away.

Stephanie Strathy (59:19)

Right.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (59:19)

It was a pandemic that hit hard, hit fast. With antimicrobial resistance. It's a slow burn, so you don't really know or feel it unless it hits you in your personal life. Like, you're a veer. You're an emergency room doctor, or you're his dad, and you're seeing patients that used to be treatable that aren't treatable anymore, or you're me, whose husband is suddenly dying, and we have kind of let this creep up on us. But also with COVID we had four vaccines or five vaccines developed within a year. Right. And so if we had the political will to move phage therapy forward, we could be doing a lot more than we. So those trials are getting done now, but the pace is not fast enough to overcome the pace at which resistance is spreading.

Soren Wheeler (60:11)

Can I ask you the sort of, like, embarrassingly typical question that a Radiolab person might ask with your shirt on? So in the moment that Tom came back, like, I don't know, talk to me about how that felt. I mean, I feel like there's relief. I heard joy, but is there pride? Like, I don't know, give me a little bit on that.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (60:32)

Well, I think that Tom deserves a lot of credit in this, too, because that man had so much resilience to bounce back. And he had been in the hospital nine months. He'd lost £100, he lost all of his muscle mass. He had to learn how to walk, how to talk, how to do everything all over again. And now he's the face of evidence based hope.

Soren Wheeler (60:57)

Yeah.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (60:58)

You know, that's an amazing thought.

Soren Wheeler (61:00)

Thank you, Stephanie. Thank you for sharing your story with us. Thank you for being here.

Stephanie Strathy (continued) / Infectious Disease Epidemiologist (61:04)

Thanks for having me, everybody.

Dr. Aver Mitra (61:09)

So cool. Wow.

Soren Wheeler (61:15)

All right, Aver. So we've been through a lot together. Yeah.

Dr. Aver Mitra (61:21)

Starting coming on this journey of trauma with.

Soren Wheeler (61:26)

But I am, you know, like starting from a place of sort of like seeing this happen in front of your eyes, dealing with it on a day to day basis, turning to try to sort of start and understand it and do the reporter thing, or at least the research thing, and finding all what you found and sharing all that with us. I guess I am a little bit curious just like where you're at now. Like, are you still in therapy or.

Dr. Aver Mitra (61:46)

Yeah, definitely. Definitely. I mean, you know, I still have a shift tomorrow, so I still gotta go to work. You know, I still gotta see this stuff. So it's still there, but I guess, I don't know. I mean, thinking about all this stuff makes me think about the whole thing a little bit differently.

Soren Wheeler (62:01)

How so?

Dr. Aver Mitra (62:02)

I mean, okay, let's think about it. Like when I was first thinking about it, I'm thinking it's humans versus bacteria, you know, And I'm at the middle of this. It's all about me and like that kind of thing. And as I'm thinking about it more, it's like it's not really. It's humans, bacteria, there's animals, Animals probably playing a bigger role than humans. And then if you think about it some more, it's like, wow, all our antibiotics, our whole weaponry comes from fungi because they've been battling bacteria for longer than we've even been around. And now I'm listening to Stephanie, it's like, oh, there's this whole class of viruses that's been fighting bacteria for longer than the fungi have been around. So I don't know, I guess I'm just looking at the shape of this a little bit differently. It's like there's a lot of players here. And if anything, we're just like the newest kid on the block.

Soren Wheeler (62:50)

But it does also then feel so much more. It feels like maybe overwhelmingly complex.

Dr. Aver Mitra (62:56)

Yes, it is. But I don't know, I guess in a weird way, like I'm realizing we're so young as a species, there's so much we don't know. There's so much left to learn and I don't know, I just think there's hope in that.

Soren Wheeler (63:10)

Yeah, I can see that.

Dr. Aver Mitra (63:12)

Well, I guess before we go, just wanted to play one more quote because I feel like the show can't end without hearing this. I did talked to Tom and I just wanted you guys to hear him. I asked him if he remembered by any chance that moment where Stephanie squeezed his hand and asked him if he wanted to live.

Soren Wheeler (63:30)

And this is. He's in a coma. And she.

Dr. Aver Mitra (63:32)

Right at this time, he's in a coma. He's completely out of it. He's on the verge of death. And Stephanie asked him, do you want to live?

Tom (patient, voiceover) (63:41)

At that moment, I thought I was a snake. In a canyon, curled up under a bush. And there is a wooden platform that visitors could come and view me from. And they would look down and I would look up and. And I. I could see people through this haze of my milky eyes. It would be hot sometimes. Sometimes it was cold. When the night came, I was really alone, disintegrating molecule by molecule, you know, just kind of sinking down bit by bit. My vision, because it was blurred by this, the milkiness over my eyes. I couldn't see her, but I could hear her in the distance. She said, I know you've been through a lot and I know that it's hard and if you want to let go, it's okay. You can go. There was kind of a pause that I had and I realized I was a snake. I tried to figure out how to squeeze her hand because I was desperate to squeeze her hand, but. But I didn't know how without hands. So I thought and thought and then I thought, well, I'm a snake. I can wrap my body around her hand and squeeze. So that's what I did.

Soren Wheeler (66:07)

Thank you, Avere.

Dr. Aver Mitra (66:09)

Thank you guys.

Soren Wheeler (66:19)

Of course. Also, a big thanks to Lance and Tom who gave us their time and talked to us and Aver's dad for being willing to throw shade at his son.

Latif Nasser (66:31)

Well, thank you, Soren, for, you know, being on stage, helping out Avere, pushing him around, editing him in real time, making all that happen.

Soren Wheeler (66:39)

Obviously, I had a lot of fun doing it. A couple quick thanks. Thanks to Tom Philpott, Stephen Roach, Kate Shaw, Kerry McClellan, Alex Wong and Maren McKinnon. This episode was reported by Aver Mitra that was produced by Jessica Jung and fact checked by Natalie Middleton. The live show itself took place at WNYC's Green Space Performance Center. And thank you, of course, to the staff there who make those kinds of events work. Also the folks on the Radiolab team who helped us make it happen. Sara Sambach, Natalia Ramirez, Anitza Vietza, David Gable, Tanya Challing, Harry Fortuna, and Jeremy Bloom. I also want to mention that we actually did a first run of this show down in Little Rock, Arkansas. Little Rock Public Radio, the public radio station down there invited us down to be part of their annual celebration, and it was a ton of fun. So thanks a bunch to Little Rock Public Radio and in particular to Grace Sufassi, Jonathan Seaborn and Sarah Buford. And that's it. So we will just go out as we do with most of our live shows, by letting one of the listeners from the audience come up and read the Radio Lab.

AJ (Audience Member Reading Credits) (67:49)

Craig Credits hi, I'm AJ I'm from Jersey, and here are the staff credits. Radiolab is hosted by Lulu Miller and Latif Nasser. Soren Wheeler is our executive editor. Sarah Sandbach is our executive director. Our managing editor is Pat Walters. Dylan Keith is our director of sound design. Our staff includes Jeremy Bloom, W. Harry Fortuna, David Gable, Maria Paz, Gutierrez, Sindhu Nyanasambang, Matt Kielty, Mona Mad Gavkar, Annie McEwen, Alex Neeson, Sarah Carey, Anissa Viet, Arianne Wack, Molly Webster, and Jessica Young, with help from Rebecca Rand.

Dr. Aver Mitra (68:45)

Hi, I'm Daniel from Madrid.

Aver's Dad (68:46)

Leadership support from Radiolab. Science programming is provided by the Simons foundation and the John Templeton Foundation. Foundational support from Radiolab was provided by the Alfred P. Sloan Foundation.

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