4 ms·
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 dam
by Fomite 8y 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 8y agoAre 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 8y agoNot 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.
- superbug_slayer 7y agoAgree!
- superbug_slayer 7y agoAs the author of the op-ed you are referring to, allow me to chime in. It's true that a huge effort went into saving my husband's life with phage therapy but as a result of that, it's getting easier to treat other cases. I'll comment on your other points too: 1) Broad spectrum phages don't exist in nature but gene-editing techniques can be applied and this technology now exists. Several biotechs are now working in this space. 2) Phages are not hard to keep 'alive'. They need to be refrigerated and kept away from sunlight. 3) True that phage therapy is relatively new in the West but the field is exploding. There are very few pharmas still developing antibiotics and very few in the pipeline, esp for gram-negatives, so there is an imperative to have alternatives to antibiotics. With an ever-expanding phage library of well characterized phages, it is possible to generate personalized phage cocktails in days. An antibiotic takes a decade to develop, at around a billion $, and has collateral damage on the microbiome. For more on the story, check out ThePerfectPredator.com
- Fomite 7y agoFor the record, your talk at IDWeek last year was one of the highlights of the conference. To touch on a few of your points: 1) I'm hopeful about these, and have been sort of idly following them, but I think they're a long way from anywhere close to the utility the average HackerNews reader is hoping to get out of them. 2) When compared to "There's an inert, shelf-and-temperature stable blister pack of these living at the bottom of a bag" they're hard to keep alive. While not relevant in your husband's case, the vast burden of AMR is going to end up falling on the global poor, and in those cases, solutions that require a cold chain aren't reliable solutions. 3) It is exploding, but I've been following phage research for 15 years now, and it's one of those technologies that has lived in the "any day now" space that whole time. So I tend to try to temper the expectation of folks because I fear that it's going to end up, at best, as a supplemental solution to a very complex problem, rather than the "a new technology will get us out of this" path the popular media sometimes portrays it as.