The quest to outwit superbugs

Released in 1997, the lyrics of Richard Ashcroft’s emotive and string-filled ballad: “the drugs don’t work, they just make me worse” is now a ground reality, as resistance to drugs has thrown millions into the throes of the biggest medical emergency of our time. Assigning medical meanings to the lyrics, Professor Sally Davies had cautioned the world on the diminishing power of anti-microbial and anti-bacterial drugs in her 2013 book, The Drugs Don’t Work. Alarming as it is, antibiotic resistance is currently the cause for an estimated 7,00,000 deaths globally, and a business-as-usual scenario may force this figure to swell to 10 million deaths per year by 2050. In other words, the superbugs evolved out of such resistance are consuming every week a staggering 32 Boeing 747s full of people every week.

This phenomenon has emerged as a man-made disaster since antibiotic development after Alexander Fleming’s accidental discovery of penicillin in the mid-20th century did not keep pace with the growing microbial resistance, leaving the pipeline of drugs almost on the verge of drying up.

As antibiotics are given in small doses over short courses, their research and development did not generate profit margins for pharma companies, and consequently, no new class of antibiotics has been discovered in the past three decades.

In the meantime, bacteria has mutated so fast that most antibiotics are left ineffective and redundant. However, for decades, this remained the best-kept secret in medicine.

With anti-microbial resistance attaining global attention, it is no secret that the world is moving towards a dark, post-antibiotic future. It may already have, given that in 2017 only 41 antibiotic drugs were in clinical development, compared to more than 500 for cancer. Just when the world needs more antibiotics to fight infections, their development has shockingly come to a halt.

Medical trials

In these troubled times, Superbugs: The Race to Stop an Epidemic is a narrative of hope written from the frontlines of clinical trials to fight resistant infections. Taking the readers on a ride through the troubled history and uncertain future of medicine, author Matt McCarthy provides a gripping account of how he led a clinical trial to save Jackson, a gunshot-infected victim, from a likely amputation or a possible loss of life. In an unnerving and unpleasant world of medicine that has held itself accountable to shareholders and not patients, McCarthy has chartered a course of action to evoke Big Pharma to invest in the drugs than can save millions of lives and prove financially viable.

It was a sense of urgency that led McCarthy to avoid colistin, the last-resort medicine to treat life-threatening infection, as it had proved ineffective (rather fatal) on patients on two counts. Interestingly, to save colistin from becoming ineffective in humans, the Indian government has already banned its manufacture, sale and use in the poultry industry, which could curb the spreading of associated superbugs.

McCarthy had other reasons to put a new drug, Dalbavancin (or Dalba) on a trial, for which he needed volunteers. What followed is an educative and inspiring story of people like Ruth, George, Erwin, Gerard and Jennifer who had successfully volunteered to let future skin-infection patients — nearly 20 million people develop a skin infection each year — deflect from the perils of the modern hospital.

Superbugs could not have better timed, as anti-microbial resistance has gained worldwide attention as an important public health challenge, with serious impact on economy and development. It is relevant for India, which is home to deadly infections like diarrhoea, pneumonia, typhoid, encephalitis and dengue, with the cumulative human casualty across different age groups in excess of five million each year.

The answer lies in dirt

While the challenge is to get the most out of the existent formulations by avoiding overuse and false prescriptions, there is also a need for a more focussed hunt for antibiotics in most unlikely of places, viz sewage, polluted lakes, and the intestines of insects. After all, Dalba was made by extracting a large molecule from a bacterium found in Indian soil in the 1980s, during a hunt for antibiotics.

An essential takeaway from this path-breaking book is that microbes are engaged in making new chemicals under our feet that could eventually end up saving millions of lives. Just beneath the topsoil are tiny molecules that could alleviate disease and stomp out epidemics. Researchers like Sean Brady at Rockefeller University have now confirmed that ‘dirt’ is the best place to find antibiotics. Brady’s team found two dozen new drugs from the genes harboured in the dirt at Prospect Park in Brooklyn.

Instances like these are pointers towards developing a strategy to scan the most unexpected of places for next big breakthrough in medicine. As Sally Davies believes, nothing less than economic incentive for the pharmaceutical industry will make it scan the dirt lying all around.

McCarthy’s knack of storytelling comes handy in weaving an interesting narrative that unravels the complexities of working among biomedical researchers, the pharmaceutical industry, and the drug administration. Superbugs are throwing up both new challenges and fresh opportunities as they pop up with equal ease in New Delhi and New York — overcrowding and insanitation being a common feature of urban living.

Superbugs is a passionate account of one person’s quest for easing the tension between institutional bureaucracy and patient care, while testing a life-saving drug for the society at large.

The story holds ethical and moral underpinnings, a compelling combination that allows the author to shed few tears as he describes the stories of his patients. It makes for an informative and absorbing reading, equally urgent and empathetic, on a subject that is close to our skin. Superbugs is a must-read tale of medical ingenuity.

The reviewer is an independent writer, researcher and academic.