00:12

This is my great uncle, my father's father's younger brother. His name was Joe McKenna. He was a young husband and a semi-pro basketball player and a fireman in New York City. Family history says he loved being a fireman, and so in 1938, on one of his days off, he elected to hang out at the firehouse. To make himself useful that day, he started polishing all the brass, the railings on the fire truck, the fittings on the walls, and one of the fire hose nozzles, a giant, heavy piece of metal, toppled off a shelf and hit him. A few days later, his shoulder started to hurt. Two days after that, he spiked a fever. The fever climbed and climbed. His wife was taking care of him, but nothing she did made a difference, and when they got the local doctor in, nothing he did mattered either.

01:13

They flagged down a cab and took him to the hospital. The nurses there recognized right away that he had an infection, what at the time they would have called "blood poisoning," and though they probably didn't say it,they would have known right away that there was nothing they could do.

01:33

There was nothing they could do because the things we use now to cure infections didn't exist yet. The first test of penicillin, the first antibiotic, was three years in the future. People who got infections either recovered, if they were lucky, or they died. My great uncle was not lucky. He was in the hospital for a week, shaking with chills, dehydrated and delirious, sinking into a coma as his organs failed. His condition grew so desperate that the people from his firehouse lined up to give him transfusions hoping to dilute the infection surging through his blood.

02:13

Nothing worked. He died. He was 30 years old.

02:19

If you look back through history, most people died the way my great uncle died. Most people didn't die of cancer or heart disease, the lifestyle diseases that afflict us in the West today. They didn't die of those diseases because they didn't live long enough to develop them. They died of injuries -- being gored by an ox,shot on a battlefield, crushed in one of the new factories of the Industrial Revolution -- and most of the time from infection, which finished what those injuries began.

02:56

All of that changed when antibiotics arrived. Suddenly, infections that had been a death sentence became something you recovered from in days. It seemed like a miracle, and ever since, we have been living inside the golden epoch of the miracle drugs.

03:17

And now, we are coming to an end of it. My great uncle died in the last days of the pre-antibiotic era. We stand today on the threshold of the post-antibiotic era, in the earliest days of a time when simple infectionssuch as the one Joe had will kill people once again.

03:40

In fact, they already are. People are dying of infections again because of a phenomenon called antibiotic resistance. Briefly, it works like this. Bacteria compete against each other for resources, for food, by manufacturing lethal compounds that they direct against each other. Other bacteria, to protect themselves,evolve defenses against that chemical attack. When we first made antibiotics, we took those compounds into the lab and made our own versions of them, and bacteria responded to our attack the way they always had.

04:19

Here is what happened next: Penicillin was distributed in 1943, and widespread penicillin resistance arrived by 1945. Vancomycin arrived in 1972, vancomycin resistance in 1988. Imipenem in 1985, and resistance to in 1998. Daptomycin, one of the most recent drugs, in 2003, and resistance to it just a year later in 2004.

04:50

For 70 years, we played a game of leapfrog -- our drug and their resistance, and then another drug, and then resistance again -- and now the game is ending. Bacteria develop resistance so quickly that pharmaceutical companies have decided making antibiotics is not in their best interest, so there are infections moving across the world for which, out of the more than 100 antibiotics available on the market, two drugs might work with side effects, or one drug, or none.

05:27

This is what that looks like. In 2000, the Centers for Disease Control and Prevention, the CDC, identified a single case in a hospital in North Carolina of an infection resistant to all but two drugs. Today, that infection, known as KPC, has spread to every state but three, and to South America, Europe and the Middle East. In 2008, doctors in Sweden diagnosed a man from India with a different infection resistant to all but one drug that time. The gene that creates that resistance, known as NDM, has now spread from India into China, Asia, Africa, Europe and Canada, and the United States.

06:16

It would be natural to hope that these infections are extraordinary cases, but in fact, in the United States and Europe, 50,000 people a year die of infections which no drugs can help. A project chartered by the British government known as the Review on Antimicrobial Resistance estimates that the worldwide toll right now is 700,000 deaths a year.

06:50

That is a lot of deaths, and yet, the chances are good that you don't feel at risk, that you imagine these people were hospital patients in intensive care units or nursing home residents near the ends of their lives, people whose infections are remote from us, in situations we can't identify with.

07:14

What you didn't think about, none of us do, is that antibiotics support almost all of modern life.

07:23

If we lost antibiotics, here's what else we'd lose: First, any protection for people with weakened immune systems -- cancer patients, AIDS patients, transplant recipients, premature babies.

07:39

Next, any treatment that installs foreign objects in the body: stents for stroke, pumps for diabetes, dialysis, joint replacements. How many athletic baby boomers need new hips and knees? A recent study estimates that without antibiotics, one out of ever six would die.

08:02

Next, we'd probably lose surgery. Many operations are preceded by prophylactic doses of antibiotics. Without that protection, we'd lose the ability to open the hidden spaces of the body. So no heart operations, no prostate biopsies, no Cesarean sections. We'd have to learn to fear infections that now seem minor. Strep throat used to cause heart failure. Skin infections led to amputations. Giving birth killed, in the cleanest hospitals, almost one woman out of every 100. Pneumonia took three children out of every 10.

08:49

More than anything else, we'd lose the confident way we live our everyday lives. If you knew that any injury could kill you, would you ride a motorcycle, bomb down a ski slope, climb a ladder to hang your Christmas lights, let your kid slide into home plate? After all, the first person to receive penicillin, a British policeman named Albert Alexander, who was so ravaged by infection that his scalp oozed pus and doctors had to take out an eye, was infected by doing something very simple. He walked into his garden and scratched his face on a thorn. That British project I mentioned which estimates that the worldwide toll right now is 700,000 deaths a year also predicts that if we can't get this under control by 2050, not long, the worldwide toll will be 10 million deaths a year.

10:01

How did we get to this point where what we have to look forward to is those terrifying numbers? The difficult answer is, we did it to ourselves. Resistance is an inevitable biological process, but we bear the responsibility for accelerating it. We did this by squandering antibiotics with a heedlessness that now seems shocking.Penicillin was sold over the counter until the 1950s. In much of the developing world, most antibiotics still are.In the United States, 50 percent of the antibiotics given in hospitals are unnecessary. Forty-five percent of the prescriptions written in doctor's offices are for conditions that antibiotics cannot help. And that's just in healthcare. On much of the planet, most meat animals get antibiotics every day of their lives, not to cure illnesses, but to fatten them up and to protect them against the factory farm conditions they are raised in. In the United States, possibly 80 percent of the antibiotics sold every year go to farm animals, not to humans,creating resistant bacteria that move off the farm in water, in dust, in the meat the animals become.Aquaculture depends on antibiotics too, particularly in Asia, and fruit growing relies on antibiotics to protect apples, pears, citrus, against disease. And because bacteria can pass their DNA to each other like a traveler handing off a suitcase at an airport, once we have encouraged that resistance into existence, there is no knowing where it will spread.

12:05

This was predictable. In fact, it was predicted by Alexander Fleming, the man who discovered penicillin. He was given the Nobel Prize in 1945 in recognition, and in an interview shortly after, this is what he said:

12:23

"The thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to infection with a pencillin-resistant organism." He added, "I hope this evil can be averted."

12:40

Can we avert it? There are companies working on novel antibiotics, things the superbugs have never seen before. We need those new drugs badly, and we need incentives: discovery grants, extended patents, prizes, to lure other companies into making antibiotics again.

13:05

But that probably won't be enough. Here's why: Evolution always wins. Bacteria birth a new generation every 20 minutes. It takes pharmaceutical chemistry 10 years to derive a new drug. Every time we use an antibiotic,we give the bacteria billions of chances to crack the codes of the defenses we've constructed. There has never yet been a drug they could not defeat.

13:37

This is asymmetric warfare, but we can change the outcome. We could build systems to harvest data to tell us automatically and specifically how antibiotics are being used. We could build gatekeeping into drug order systems so that every prescription gets a second look. We could require agriculture to give up antibiotic use.We could build surveillance systems to tell us where resistance is emerging next.

14:15

Those are the tech solutions. They probably aren't enough either, unless we help. Antibiotic resistance is a habit. We all know how hard it is to change a habit. But as a society, we've done that in the past. People used to toss litter into the streets, used to not wear seatbelts, used to smoke inside public buildings. We don't do those things anymore. We don't trash the environment or court devastating accidents or expose others to the possibility of cancer, because we decided those things were expensive, destructive, not in our best interest.We changed social norms. We could change social norms around antibiotic use too.

15:17

I know that the scale of antibiotic resistance seems overwhelming, but if you've ever bought a fluorescent lightbulb because you were concerned about climate change, or read the label on a box of crackers because you think about the deforestation from palm oil, you already know what it feels like to take a tiny step to address an overwhelming problem. We could take those kinds of steps for antibiotic use too. We could forgo giving an antibiotic if we're not sure it's the right one. We could stop insisting on a prescription for our kid's ear infection before we're sure what caused it. We could ask every restaurant, every supermarket, where their meat comes from. We could promise each other never again to buy chicken or shrimp or fruit raised with routine antibiotic use, and if we did those things, we could slow down the arrival of the post-antibiotic world.

16:29

But we have to do it soon. Penicillin began the antibiotic era in 1943. In just 70 years, we walked ourselves up to the edge of disaster. We won't get 70 years to find our way back out again.

16:50

Thank you very much.

16:52

(Applause)

00:12

這是我的曾伯父笨忌， 我的父親的父親的弟弟 他叫喬·麥肯納 他是一位年輕的丈夫 和一位半職業(yè)籃球運動員踪危， 還是一位紐約市消防員 家族史中說他非常喜愛當一名消防員懂讯， 在1938年匹中，放假的一天官册， 他選擇去消防站 他想幫忙，于是就開始擦拭所有的黃銅刻剥， 消防車上的欄桿馋记，墻上的配件， 其中的一個消防水管的噴嘴蝇狼， 一塊巨大阅畴，沉重的金屬， 從架子上掉了下來迅耘，并砸中了他 幾天之后贱枣，他的肩膀開始疼痛 再過了兩天监署，他突發(fā)高燒。 高燒不退纽哥，并且不斷攀升 他的妻子一直在照顧他钠乏， 但是她所做的一切都沒有用， 當他們請來醫(yī)生時春塌， 也對他無能為力

01:13

他們攔下了一輛出租車晓避， 把他帶到醫(yī)院 那里的護士馬上看出他得了感染， 當時候的人把它叫敗血癥只壳， 盡管他們沒有說什么俏拱， 他們肯定馬上就知道 他們已經(jīng)無力醫(yī)治了

01:33

他們什么辦法都沒有 是因為我們現(xiàn)在擁有的 治療感染的藥品在那時還沒有存在 第一個青霉素，抗生素的測試吼句，三年之后才發(fā)生 當時一旦得了感染锅必， 能夠康復算是幸運的， 要不然就沒命了 我的曾伯父沒有那么幸運 他在醫(yī)院待了一個星期惕艳，一直打寒顫搞隐， 脫水，并且神志不清远搪， 他的器官衰退劣纲，進入了昏迷狀態(tài) 他的狀況十分危急， 消防站的人排隊給他輸血谁鳍， 希望能稀釋他血液中的感染

02:13

一切都沒有用癞季，他最終不幸去世了 他年僅30歲

02:19

如果回顧歷史， 有許多人離世的情況同我曾伯父類似 許多人并不是因為癌癥或心臟病去世棠耕， 不是現(xiàn)在折磨我們的生活習慣病 他們沒有患上那些疾病是因為他們活不到 得那些疾病的年齡 他們是因身體受傷而死 -- 被牛角頂傷余佛， 在戰(zhàn)場上中彈， 在工業(yè)革命的新工廠中粉身碎骨 -- 很多時候窍荧，是因為得了感染辉巡， 因傷勢造成的感染

02:56

當抗生素到來時，一切都變了 曾經(jīng)意味著死亡的感染突然 變成了幾天就能恢復的病 它就像奇跡 從此以后蕊退， 我們就一直生活在特效藥的黃金時代中

03:17

現(xiàn)在郊楣，它即將結(jié)束了 我的曾伯父在前抗生素時代 最后的日子中去世的 我們現(xiàn)在已經(jīng)能看到后抗生素時代的到來感染會像從前一樣致命， 殺死喬（曾伯父）的致命感染會卷土重來

03:40

其實瓤荔， 這些感染已經(jīng)奪取了很多人的性命了 人們再次死于感染因為有一種現(xiàn)象 叫做抗生素抗藥性 簡單的來說净蚤，它的原理是這樣的 細菌為了資源和食物相互競爭， 有的細菌會針對性地制造 致命的化合物攻擊對方 其它的細菌則用化合物保護自己输硝， 發(fā)展防御系統(tǒng)對抗這些化學攻擊 我們最初發(fā)明抗生素時今瀑， 我們在實驗室中創(chuàng)造了 我們自己版本的化合物 細菌像往常一樣對我們的攻擊作出了響應

04:19

接下來是這樣的： 青霉素是在1943年發(fā)布的， 而廣泛的青霉素耐藥性在1945年就到來了 萬古霉素出現(xiàn)在1972年， 萬古霉素耐藥性就在1988年 亞胺培南于1985年橘荠， 抗藥性在1998年又出現(xiàn)了 2003年的達托霉素是最新的藥物之一屿附， 抗藥性在2004年就緊跟而至

04:50

在這70年中， 我們像是在做一個蛙跳的游戲 -- 一種藥物哥童，一種抗藥性挺份， 接下來又一種藥物，又一個抗藥性 --現(xiàn)在這個游戲結(jié)束了 細菌的抵抗力極快贮懈， 以至于制藥公司 認為生產(chǎn)抗生素不是他們的最佳利益匀泊， 所以現(xiàn)在各種感染風靡全球， 市場上可購買到的100多種 抗生素中朵你， 可能只有兩種藥物會管用各聘， 并帶有副作用 或者一個藥，甚至沒有

05:27

看上去就是這個樣子的 在2000年撬呢， 疾病控制與預防中心（CDC）伦吠， 鑒定有一例患者 在一家位于北卡羅來納的醫(yī)院里 除了兩種藥外，對其它藥物都有抗藥性 現(xiàn)在魂拦，這種感染被稱為KPC， 除了3個州外搁嗓，已經(jīng)傳播到了美國各地芯勘， 還有南美，歐洲 和中東地區(qū) 在2008年腺逛，瑞典醫(yī)生 確診一名來自印度的男子患有的感染 只對一種藥沒有抗藥性 創(chuàng)造這種抗藥性的基因 叫做NDM荷愕，現(xiàn)在已經(jīng)從印度傳播到 中國，亞洲棍矛，非洲安疗， 歐洲和加拿大，還有美國

06:16

我們真心希望 這些感染病例只是罕見情況够委， 但是其實荐类， 在美國和歐洲， 每年都有50,000人 死于無藥可救的感染 一項由英國政府特許的項目 叫做抗生素抗藥性評審 預計每年全球死亡人數(shù)有700,000

06:50

這個數(shù)字巨大茁帽， 然而這個比例還是很小玉罐， 所以我們感覺不到風險， 你想象他們是醫(yī)院里的病人 在重癥監(jiān)護室或者住在療養(yǎng)院中潘拨，接近生命的盡頭吊输， 感覺他們離我們很遠， 他們的狀況我們還很陌生

07:14

你們想不到的是铁追， 我們所有人都想不到的是 抗生素支撐著幾乎所有的現(xiàn)代生活

07:23

如果我們失去了抗生素季蚂， 我們還會失去所有這些東西： 首先，所有免疫系統(tǒng)較弱的人 都失去了保護 -- 癌癥患者，艾滋病患者扭屁， 器官移植接受者算谈，早產(chǎn)嬰兒

07:39

接下來，任何需要在人體中 安裝異物的治療： 中風時使用的支架疯搅， 治療糖尿病的胰島素磊 透析濒生，關(guān)節(jié)置換 嬰兒潮一代的運動員有多少需要髖關(guān)節(jié)， 膝關(guān)節(jié)置換幔欧？ 一個近期的研究預計如果沒有抗生素罪治， 每六個人中就會有一人死亡

08:02

接下來，我們可能會失去手術(shù) 很多手術(shù)的進行 需要預防性劑量的抗生素 如果沒有這個措施礁蔗， 我們就不可能對人體隱蔽的器官開刀 于是就不會有心臟手術(shù)觉义， 沒有前列腺活檢， 沒有剖腹產(chǎn) 我們會懼怕那些現(xiàn)在看似微小的感染咽喉炎以前會導致心臟衰竭 皮膚感染會發(fā)展成截肢 即使在最干凈的醫(yī)院浴井， 孕產(chǎn)婦的死亡率 幾乎達到百分之一每10個孩子中晒骇， 肺炎會奪走3個孩子的生命

08:49

更重要的是， 我們失去了生活的信心 如果你知道任何傷口都有可能致命磺浙， 你還會不會去騎摩托車洪囤， 從雪山上飛馳而下， 爬上梯子去掛你的圣誕彩燈撕氧， 讓你的孩子滑進本壘嗎瘤缩？ 畢竟，第一名接受青霉素的病人伦泥， 一名叫阿爾伯特·亞歷山大英國警察剥啤， 他的感染嚴重到他的頭皮都滲出了膿液， 一只眼睛也被醫(yī)生摘除了不脯， 他的感染的起因十分微不足道 他走進他的花園府怯，然后臉上被刺劃傷了 剛才我提到的英國項目預計現(xiàn)在每年的 全球死亡人數(shù)為700,000人 他們也預測如果我們無法在2050年前 控制現(xiàn)在的情況， 在不久的將來防楷， 全球死亡人數(shù)會上升到一千萬

10:01

我們是如何走到這一步的牺丙， 面對這些可怕的數(shù)字 我們的未來將何去何從？ 殘酷的現(xiàn)實是域帐， 這都是我們的所作所為 抗藥性是一個必然的生物過程赘被， 但是我們要為加快這一過程承擔責任 我們隨心所欲地濫用抗生素的行為 現(xiàn)在看來十分觸目驚心 青霉素在上世紀50年代之前是非處方藥 在很多發(fā)展中國家，很多抗生素依舊是 在美國肖揣，醫(yī)院給出的 50%的抗生素都是沒有必要的 醫(yī)生辦公室中開出的45%的藥 都是抗生素治不了的病 這只是在醫(yī)療系統(tǒng)中的數(shù)據(jù) 在全球很多地方民假， 許多家畜每天都進食抗生素， 不是為了治療疾病龙优， 而是把它們催肥羊异，為了在 工廠化養(yǎng)殖的環(huán)境下保護它們 在美國事秀，每年大約有80%的 抗生素是賣給農(nóng)場動物的， 不是病人野舶， 于是創(chuàng)造了抗藥性細菌易迹， 它們從農(nóng)場流到了 水里，到灰塵中平道， 到這些動物最終變成的肉制品中 水產(chǎn)養(yǎng)殖也依賴抗生素睹欲， 尤其是在亞洲， 水果種植也依靠抗生素一屋， 讓蘋果窘疮，梨，柑橘遠離病害冀墨， 由于細菌能夠互相傳遞DNA 就像一個旅客在機場托運行李闸衫， 一旦我們促進這種耐藥性， 就無法控制它的傳播

12:05

這是可預測的 事實上诽嘉，發(fā)現(xiàn)青霉素的科學家蔚出， 亞歷山大·弗萊明早已預測到了 他在1945年獲得諾貝爾獎表彰，在之后的一個采訪中虫腋，他說：

12:23

“濫用青霉素的無知的人 將在道德上為他人的死負責骄酗， 他的無知帶來了耐藥性的問題， 導致那些人為此喪命悦冀∷煮荩“他補充道：”我希望能夠 避免這個厄運〕牛“

12:40

我們能避免它嗎？ 有些公司正在研發(fā)新型抗生素掸掏， 一些超級細菌從未見過的東西 我們十分迫切地需要這些藥物茁影， 我們也需要一些獎勵： 研發(fā)補助，延長專利丧凤， 獎金等等募闲， 去吸引其它公司再次制造去抗生素

13:05

但是這還不夠 這就是原因：大自然的進化總會贏 細菌每20分鐘就能生成新的一代 藥物化學家需要花10年 才能制成一種新的藥 每次我們使用一種新的抗生素時， 我們就給了細菌數(shù)億次機會 去破解我們建造的 防御系統(tǒng)的密碼 迄今為止愿待，任何藥物都不能夠 打敗它們

13:37

這是一場不公平的戰(zhàn)爭浩螺， 但是我們能夠改變它的結(jié)果 我們能夠創(chuàng)造一個系統(tǒng)去收集數(shù)據(jù)， 并且自動仍侥、具體地 告訴我們抗生素是如何被使用的 我們可以在藥物訂購系統(tǒng)中放置守門人要出， 再次檢查每一個處方 我們可以要求在農(nóng)業(yè)中不再使用抗生素 我們可以構(gòu)建監(jiān)控系統(tǒng) 及時告知我們哪里出現(xiàn)了抗藥性

14:15

這些是科技解決方案 這些還不夠， 我們都要出一份力 抗生素耐藥性是一種習慣 我們都知道改掉一種習慣是很難的 但是作為社會中的一員农渊， 我們曾經(jīng)做到過 人們曾經(jīng)在馬路上隨便扔垃圾患蹂， 曾經(jīng)不系安全帶， 曾經(jīng)在公共場所抽煙 我們不再這么做了 我們不破壞環(huán)境， 不引發(fā)巨大事故传于， 不再使別人得到患有癌癥的風險囱挑， 因為我們懂得那些事情代價太高， 具有毀滅性沼溜，對我們沒有一點益處 我們改變了社會規(guī)范 我們也可以改變抗生素使用的規(guī)范

15:17

我知道抗生素耐藥性的規(guī)模 看似巨大平挑， 但是如果你對氣候變化感到憂慮， 于是去購買熒光燈泡系草， 或者考慮到棕櫚油毀林通熄， 就每次閱讀一盒餅干上的標簽 你應該已經(jīng)知道 用生活中的一點一滴去改變一個大問題 是什么樣的感覺 我們也可以用這樣的方式 去改變抗生素的使用 如果不確定我們是否正確使用抗生素， 那就放棄它 我們可以 不要執(zhí)意為孩子的耳部感染開處方悄但， 而是先查明起因 我們可以詢問每一家餐廳棠隐， 每一家超市 它們的肉制品是從哪里來的 我們可以做承諾 不再購買長期使用抗生素養(yǎng)殖的 雞，蝦或水果檐嚣， 若果我們能做到這些助泽， 我們可以減緩后抗生素時代的到來

16:29

但是我們要馬上開始行動 青霉素在1943年開啟了抗生素時代 僅僅70年后，我們已經(jīng)走在災難的邊緣 我們沒有70年的時間 去找到我們的出路

16:50

謝謝大家嚎京！

16:52

（掌聲）

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