6 ms·

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solu

by jen_h 7y ago

The point of her article wasn’t to push despair, but rather to urge the Western medical establishment to get moving on phage research. Bacteriophages as a solution to our antibiotic resistance crisis have been largely ignored in the West due to unpatentability, research mainly performed in Eastern Europe, etc — but her story is that a bacteriophage cocktail saved her husband’s life where antibiotics failed...and the only reason they even were able to go that route was because she’s an epidemiologist who pulled some strings, pulled research teams together, got approvals, and managed the project herself.

Mirioron 7y ago
So, why isn't government funded research being done on it then? I often hear about how the government funds a lot of medical research, so this seems like the perfect thing for them to fund.
- Fomite 7y ago
  What makes you think they're not?
DoreenMichele 7y ago
From the article: Alternatives to antibiotics are desperately needed. She's not pushing phage research per se, just research into alternatives generally.
- jen_h 7y ago
  Did you stop reading there, by chance?
  - deleted 7y ago
    [deleted]
  - throwaway5752 7y ago
    Shame on whoever downvoted you. The full last 5 paragraphs are devoted to bacteriophages, which are what ultimately saved the author's husband. The author is "Co-Director of the Center for Innovative Phage Applications and Therapeutics" at UCSD (https://profiles.ucsd.edu/steffanie.strathdee https://profiles.ucsd.edu/steffanie.strathdee) It closes on "The possibility of living in a post-antibiotic era where simple surgeries or scrapes could lead to an infection that requires limb amputation or results in death means we need to improve AMR surveillance, diagnosis and treatment. This includes antibiotics, but should also include phage therapy. We can’t afford to bury a promising alternative to antibiotics for another hundred years." She is absolutely pushing phage research. Not exclusive to any alternatives, but that is basically the point of the article.
pkaye 7y ago
I've heard that phages have a narrow target. They are not broad spectrum like antibiotics. Most of the time you don't know they exact bacteria that is causing the infection and to figure out may take days.
- Fomite 7y ago
  This is the major problem, in my view, with phage. You cannot treat until you've not only diagnosed the infection, but tuned the phage library being used. That's slow, even at major hospitals, and a major problem in places where diagnostic availability is limited.
Fomite 7y ago
Having seen her speak in person at IDWeek, I think an important thing to recognize is that the amount of work that went into treating her husband was pretty damned heroic - and it's not clear that that's not the standard for phage therapy. I literally have a standard "Why phage are a problem", from the perspective of an infectious disease epidemiologist whose been super-interested in phage for like...a decade. 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West, which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenure-track professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate. Also, I would like to note that phage therapy wasn't only ignored due to unpatentability. A couple other reasons: 1) Antibiotics were superior in basically every respect. It's hard to justify decades of sustaining research into the fussy, expensive, edge-case alternative to something that works amazingly well. 2) Phage therapy was used in the West. Due to the technology at the time, it had a tendency to, well, kill people, due to contamination with bacterial endotoxins. 3) It's not clear phage can be turned into anything other than a pretty bespoke, custom tailored product. Even in the East it's not doable "at scale" in the way we talk about antibiotics.
- BurningFrog 7y ago
  Are you saying there might be some survivor bias in this article? Maybe 100 other equally qualified spouses tried equally ambitious programs to save someone, they all died, and we never heard about it...
  - Fomite 7y ago
    Not necessarily as much as... Right now, antibiotics are a point-and-shoot, frontline treatment for things, and phage therapy is a sort of "treatment of last resort" bespoke therapy. Are phage super-useful for cases like the one in the article, where you have something super-resistant like Acinetobacter? Yes. Is there much hope, near term, that they'll work as a drop-in replacement for the antibiotics we're losing? No.

by jen_h 7y ago

Mirioron 7y ago

So, why isn't government funded research being done on it then? I often hear about how the government funds a lot of medical research, so this seems like the perfect thing for them to fund.

Fomite 7y ago
What makes you think they're not?

DoreenMichele 7y ago

From the article: Alternatives to antibiotics are desperately needed. She's not pushing phage research per se, just research into alternatives generally.

jen_h 7y ago
Did you stop reading there, by chance?
- deleted 7y ago
  [deleted]
- throwaway5752 7y ago
  Shame on whoever downvoted you. The full last 5 paragraphs are devoted to bacteriophages, which are what ultimately saved the author's husband. The author is "Co-Director of the Center for Innovative Phage Applications and Therapeutics" at UCSD (https://profiles.ucsd.edu/steffanie.strathdee https://profiles.ucsd.edu/steffanie.strathdee) It closes on "The possibility of living in a post-antibiotic era where simple surgeries or scrapes could lead to an infection that requires limb amputation or results in death means we need to improve AMR surveillance, diagnosis and treatment. This includes antibiotics, but should also include phage therapy. We can’t afford to bury a promising alternative to antibiotics for another hundred years." She is absolutely pushing phage research. Not exclusive to any alternatives, but that is basically the point of the article.

pkaye 7y ago

I've heard that phages have a narrow target. They are not broad spectrum like antibiotics. Most of the time you don't know they exact bacteria that is causing the infection and to figure out may take days.

Fomite 7y ago
This is the major problem, in my view, with phage. You cannot treat until you've not only diagnosed the infection, but tuned the phage library being used. That's slow, even at major hospitals, and a major problem in places where diagnostic availability is limited.

Fomite 7y ago

Having seen her speak in person at IDWeek, I think an important thing to recognize is that the amount of work that went into treating her husband was pretty damned heroic - and it's not clear that that's not the standard for phage therapy. I literally have a standard "Why phage are a problem", from the perspective of an infectious disease epidemiologist whose been super-interested in phage for like...a decade. 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West, which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenure-track professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate. Also, I would like to note that phage therapy wasn't only ignored due to unpatentability. A couple other reasons: 1) Antibiotics were superior in basically every respect. It's hard to justify decades of sustaining research into the fussy, expensive, edge-case alternative to something that works amazingly well. 2) Phage therapy was used in the West. Due to the technology at the time, it had a tendency to, well, kill people, due to contamination with bacterial endotoxins. 3) It's not clear phage can be turned into anything other than a pretty bespoke, custom tailored product. Even in the East it's not doable "at scale" in the way we talk about antibiotics.

BurningFrog 7y ago
Are you saying there might be some survivor bias in this article? Maybe 100 other equally qualified spouses tried equally ambitious programs to save someone, they all died, and we never heard about it...
- Fomite 7y ago
  Not necessarily as much as... Right now, antibiotics are a point-and-shoot, frontline treatment for things, and phage therapy is a sort of "treatment of last resort" bespoke therapy. Are phage super-useful for cases like the one in the article, where you have something super-resistant like Acinetobacter? Yes. Is there much hope, near term, that they'll work as a drop-in replacement for the antibiotics we're losing? No.