8 ms·

Amazing story, but the fact that the patient’s mother had to suggest phage therapy, and that the specialists didn't know much about it is pretty damning.

sterlind 7y ago
Phage therapy is a blind spot for Western medicine. It's a new category of drug, which means lots of work to get it through FDA or UK trials, and it's not a single molecule - it's a process. There's little point to taking a single combination of phages, packing them into a pill and ramming it through the clinical trials process - it'll be way too specific to be worth it. Instead, the entire pipeline - keeping a library of bacteriophages, testing them for efficacy against samples, modifying them for increased virulence, screening for safety - needs to be approved, and run for each patient. That's too experimental for the FDA, and the FDA is too rigid to allow approval for such pipelines (except in rare cases, like CAR-T immunotherapy.) Plus the UK has that anti-gene therapy law because of a disastrous adenovirus trial that killed six healthy volunteers. The West is too risk-averse and conservative to make the big bureaucratic changes to allow this. Russia had no such hangups, which is why phage therapy flourished there.
- ummonk 7y ago
  >Plus the UK has that anti-gene therapy law because of a disastrous adenovirus trial that killed six healthy volunteers. Wait, what? Have a link for the uninformed?
  - Spare_account 7y ago
    As far as I can tell from a quick search, there is neither an anti-gene therapy law, nor has any trial resulted in any deaths in the UK. The closest I can get in the UK is the Parexel incident in 2006 where six men experienced a cytokine storm unexpectedly and were hospitalised as a result. https://www.bbc.com/news/health-22556736 https://www.bbc.com/news/health-22556736
- roywiggins 7y ago
  The West was lucky enough to invent penicillin which rather limited the appeal of phage research- you don't need phages if you haven't discovered antibiotic resistance, and once you've committed to using broad-spectrum antibiotics you'll just do what we did, which is switch between them. It sounds like the USSR was just not very good at producing its own antibiotics, so phage therapy remained popular there, as it wasn't any less effective than their poor quality antibiotics, which ended up causing resistance there before they did in the West. If you've managed to spur resistance, and you have persistent supply problems with your antibiotics, pushing forward with phage research makes a lot of sense. http://discovermagazine.com/2017/oct/the-cold-wars--modern-resistance http://discovermagazine.com/2017/oct/the-cold-wars--modern-r...
  - adrianN 7y ago
    You don't have to discover antibiotic resistance, it's obvious to anybody working with bacteria. In fact the inventor of Penicillin warned against it already in 1945, only a few years after mass-production became possible.
- perilunar 7y ago
  > It's a new category of drug Well that's the thing — it's not new. It dates back to the 1920s. I heard about it years ago, so for physicians in late 2017 to watch for months as a patient with antibiotic-resistant infections declines and then to "send her home with palliative care" — that is just appallingly negligent.
  - jlg23 7y ago
    We might have read the same articles "years ago", because I too remember to have read about that in pseudo-scientific publications (could have been about the Eliava Institute[1], that rings a bell with me). As probably did the mother of the patient who "suggested" phage therapy. Instead of blaming doctors (see below), we should praise the internet for allowing even these niche-topics to reach the masses. Wikipedia gives a nice summary of the political aspects of why lots of doctors educated in the west never learned about it[2]. According to the same article, it became accessible to the average practitioner in the west only 4 years ago: In June 2015 the European Medicines Agency hosted a one-day workshop [...] and in July 2015 the National Institutes of Health (USA) hosted a two-day workshop [...] And that just means that the tickle-down of knowledge within the medical community started at that point. Given that patients and their relatives are notorious for consulting google first and only then their doctors[3][4], I personally applaud the doctors for being so open minded to dig into the alternative treatment. [1] https://en.wikipedia.org/wiki/Phage_therapy#History https://en.wikipedia.org/wiki/Phage_therapy#History [2] https://en.wikipedia.org/wiki/George_Eliava_Institute https://en.wikipedia.org/wiki/George_Eliava_Institute [3] Like the sales person turned manager who skimmed Wikipedia for programming related topics and then gives you detailed, nonsensical advice and questions your expertise when you roll your eyes, frantically searching for a nice way of saying "STFU, my BS-dector maxed out" ..... [4] https://twitter.com/DrPascalMeier/status/699202717030490112 https://twitter.com/DrPascalMeier/status/699202717030490112
    - perilunar 7y ago
      If this was just a case of a random patient and their GP, I'd agree with you. But this was a double lung transplant, at the Great Ormond Street Hospital, one of the world's best children's hospitals. After 9 months of decline: "It was at this point that the patient’s mother brought up the idea of phage therapy. Spencer didn’t know much about it, but there was a hospital microbiologist, Dr. James Soothill, who’d worked on the viruses and agreed to help." So they had a microbiologist on staff who knew about phage therapy. They had a patient with a life threatening antibiotic resistant infection. It took them 9 months to connect the two, and it only happened because the patient's mother suggested it? Sorry, but that is just completely messed up.
- altfredd 7y ago
  > Phage therapy is a blind spot for Western medicine. It's a new category of drug It is a branch of traditional medicine, approximately 100000 years old and counting. "Western medicine" ignores phage therapy, because growing a bunch of mud in a bowl does not bring anyone 10000% cuts. Cultivating phages still requires labor and equipment, and can be quite profitable, just not 10000% profitable, — because pretty much anyone can do it.
  - Mvandenbergh 7y ago
    >It is a branch of traditional medicine, approximately 100000 years old and counting. No it isn't.
  - jdietrich 7y ago
    Antibiotics aren't commercially valuable, which is a critical problem - drug companies have no interest in developing new antibiotics, because they won't see a return on their investment. This is one area of medicine where the problem isn't drug company profiteering, but the lack of profit. https://www.idsociety.org/10x20/ https://www.idsociety.org/10x20/
    - Whack-kneed 7y ago
      Perhaps not, but the market for industrial antibiotics in everything from cattle-feed to shredded-cheese is huge and begs if not deservesdeserves to be taxed to make page therapy economically feasible. Unless you have another approach to fighting antibiotic resistant infections.
wetpaws 7y ago
US is pretty arrogant when it comes to everything outside of their worldview
perlgeek 7y ago
I know of several cases where patients heard from friends or relatives about experimental or new treatments that were a perfect fit for their situation, but that specialists had never heard of. It's worth the time and effort to research conditions that affect you (or your family) and actively seek non-standard treatments that your doctors don't know about. Don't blindly trust their expertise.

sterlind 7y ago

Phage therapy is a blind spot for Western medicine. It's a new category of drug, which means lots of work to get it through FDA or UK trials, and it's not a single molecule - it's a process. There's little point to taking a single combination of phages, packing them into a pill and ramming it through the clinical trials process - it'll be way too specific to be worth it. Instead, the entire pipeline - keeping a library of bacteriophages, testing them for efficacy against samples, modifying them for increased virulence, screening for safety - needs to be approved, and run for each patient. That's too experimental for the FDA, and the FDA is too rigid to allow approval for such pipelines (except in rare cases, like CAR-T immunotherapy.) Plus the UK has that anti-gene therapy law because of a disastrous adenovirus trial that killed six healthy volunteers. The West is too risk-averse and conservative to make the big bureaucratic changes to allow this. Russia had no such hangups, which is why phage therapy flourished there.

ummonk 7y ago
>Plus the UK has that anti-gene therapy law because of a disastrous adenovirus trial that killed six healthy volunteers. Wait, what? Have a link for the uninformed?
- Spare_account 7y ago
  As far as I can tell from a quick search, there is neither an anti-gene therapy law, nor has any trial resulted in any deaths in the UK. The closest I can get in the UK is the Parexel incident in 2006 where six men experienced a cytokine storm unexpectedly and were hospitalised as a result. https://www.bbc.com/news/health-22556736 https://www.bbc.com/news/health-22556736
roywiggins 7y ago
The West was lucky enough to invent penicillin which rather limited the appeal of phage research- you don't need phages if you haven't discovered antibiotic resistance, and once you've committed to using broad-spectrum antibiotics you'll just do what we did, which is switch between them. It sounds like the USSR was just not very good at producing its own antibiotics, so phage therapy remained popular there, as it wasn't any less effective than their poor quality antibiotics, which ended up causing resistance there before they did in the West. If you've managed to spur resistance, and you have persistent supply problems with your antibiotics, pushing forward with phage research makes a lot of sense. http://discovermagazine.com/2017/oct/the-cold-wars--modern-resistance http://discovermagazine.com/2017/oct/the-cold-wars--modern-r...
- adrianN 7y ago
  You don't have to discover antibiotic resistance, it's obvious to anybody working with bacteria. In fact the inventor of Penicillin warned against it already in 1945, only a few years after mass-production became possible.
perilunar 7y ago
> It's a new category of drug Well that's the thing — it's not new. It dates back to the 1920s. I heard about it years ago, so for physicians in late 2017 to watch for months as a patient with antibiotic-resistant infections declines and then to "send her home with palliative care" — that is just appallingly negligent.
- jlg23 7y ago
  We might have read the same articles "years ago", because I too remember to have read about that in pseudo-scientific publications (could have been about the Eliava Institute[1], that rings a bell with me). As probably did the mother of the patient who "suggested" phage therapy. Instead of blaming doctors (see below), we should praise the internet for allowing even these niche-topics to reach the masses. Wikipedia gives a nice summary of the political aspects of why lots of doctors educated in the west never learned about it[2]. According to the same article, it became accessible to the average practitioner in the west only 4 years ago: In June 2015 the European Medicines Agency hosted a one-day workshop [...] and in July 2015 the National Institutes of Health (USA) hosted a two-day workshop [...] And that just means that the tickle-down of knowledge within the medical community started at that point. Given that patients and their relatives are notorious for consulting google first and only then their doctors[3][4], I personally applaud the doctors for being so open minded to dig into the alternative treatment. [1] https://en.wikipedia.org/wiki/Phage_therapy#History https://en.wikipedia.org/wiki/Phage_therapy#History [2] https://en.wikipedia.org/wiki/George_Eliava_Institute https://en.wikipedia.org/wiki/George_Eliava_Institute [3] Like the sales person turned manager who skimmed Wikipedia for programming related topics and then gives you detailed, nonsensical advice and questions your expertise when you roll your eyes, frantically searching for a nice way of saying "STFU, my BS-dector maxed out" ..... [4] https://twitter.com/DrPascalMeier/status/699202717030490112 https://twitter.com/DrPascalMeier/status/699202717030490112
  - perilunar 7y ago
    If this was just a case of a random patient and their GP, I'd agree with you. But this was a double lung transplant, at the Great Ormond Street Hospital, one of the world's best children's hospitals. After 9 months of decline: "It was at this point that the patient’s mother brought up the idea of phage therapy. Spencer didn’t know much about it, but there was a hospital microbiologist, Dr. James Soothill, who’d worked on the viruses and agreed to help." So they had a microbiologist on staff who knew about phage therapy. They had a patient with a life threatening antibiotic resistant infection. It took them 9 months to connect the two, and it only happened because the patient's mother suggested it? Sorry, but that is just completely messed up.
altfredd 7y ago
> Phage therapy is a blind spot for Western medicine. It's a new category of drug It is a branch of traditional medicine, approximately 100000 years old and counting. "Western medicine" ignores phage therapy, because growing a bunch of mud in a bowl does not bring anyone 10000% cuts. Cultivating phages still requires labor and equipment, and can be quite profitable, just not 10000% profitable, — because pretty much anyone can do it.
- Mvandenbergh 7y ago
  >It is a branch of traditional medicine, approximately 100000 years old and counting. No it isn't.
- jdietrich 7y ago
  Antibiotics aren't commercially valuable, which is a critical problem - drug companies have no interest in developing new antibiotics, because they won't see a return on their investment. This is one area of medicine where the problem isn't drug company profiteering, but the lack of profit. https://www.idsociety.org/10x20/ https://www.idsociety.org/10x20/
  - Whack-kneed 7y ago
    Perhaps not, but the market for industrial antibiotics in everything from cattle-feed to shredded-cheese is huge and begs if not deservesdeserves to be taxed to make page therapy economically feasible. Unless you have another approach to fighting antibiotic resistant infections.

wetpaws 7y ago

US is pretty arrogant when it comes to everything outside of their worldview

perlgeek 7y ago

I know of several cases where patients heard from friends or relatives about experimental or new treatments that were a perfect fit for their situation, but that specialists had never heard of. It's worth the time and effort to research conditions that affect you (or your family) and actively seek non-standard treatments that your doctors don't know about. Don't blindly trust their expertise.