Maryn McKenna: What do we do when antibiotics don’t work any more?

Translator: RAQUEL TORRES Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

This is my great uncle,

Este é o meu tío avó,

my father's father's younger brother.

o irmán máis novo do pai de meu pai.

His name was Joe McKenna.

Chamábase Joe McKenna.

He was a young husband and a semi-pro basketball player

Era un marido mozo e un xogador de baloncesto semiprofesional

and a fireman in New York City.

e un bombeiro en Nova York.

Family history says he loved being a fireman,

A historia familiar di que adoraba ser bombeiro,

and so in 1938, on one of his days off,

así que en 1938, nun dos seus días libres,

he elected to hang out at the firehouse.

decidiu ir pasa-lo tempo á estación de bombeiros.

To make himself useful that day, he started polishing all the brass,

Para facer algo útil aquel día, empezou a sacarlle brillo ó latón,

the railings on the fire truck, the fittings on the walls,

ás varandas dos camións, ós accesorios das paredes,

and one of the fire hose nozzles,

e unha das boquillas das mangueiras,

a giant, heavy piece of metal,

un enorme e pesado anaco de metal,

toppled off a shelf and hit him.

caeu dun estante e golpeouno.

A few days later, his shoulder started to hurt.

Uns días despois, comezou a doerlle o ombro.

Two days after that, he spiked a fever.

Dous días despois, empezou a ter febre.

The fever climbed and climbed.

A febre subía e subía.

His wife was taking care of him,

A súa muller coidaba del,

but nothing she did made a difference, and when they got the local doctor in,

pero nada semellaba dar resultado, e cando chegou o médico,

nothing he did mattered either.

nada do que el fixo importou tampouco.

They flagged down a cab and took him to the hospital.

Colleron un taxi e levárono ó hospital.

The nurses there recognized right away that he had an infection,

Alí as enfermeiras souberon decontado que tiña unha infección,

what at the time they would have called "blood poisoning,"

o que daquela chamarían "intoxicación do sangue"

and though they probably didn't say it,

e aínda que probablemente non o dixeron,

they would have known right away

daríanse conta ó instante

that there was nothing they could do.

de que non podían facer nada por el.

There was nothing they could do because the things we use now

Non podían facer nada porque as cousas que usamos agora

to cure infections didn't exist yet.

para curar infeccións aínda non existían daquela.

The first test of penicillin, the first antibiotic,

A primeira proba da penicilina, o primeiro antibiótico,

was three years in the future.

tivo lugar tres anos despois.

People who got infections either recovered, if they were lucky,

A xente que collía infeccións ou ben se recuperaba, se tiñan sorte,

or they died.

ou morrían.

My great uncle was not lucky.

O meu tío avó non tivo sorte.

He was in the hospital for a week, shaking with chills,

Estivo no hospital unha semana, tremendo cos calafríos,

dehydrated and delirious,

deshidratado e delirando,

sinking into a coma as his organs failed.

afundíndose nun coma a medida que os seus órganos fallaban.

His condition grew so desperate

O seu estado era tan desesperado

that the people from his firehouse lined up to give him transfusions

que os seus compañeiros bombeiros se aliñaban para facerlle transfusións

hoping to dilute the infection surging through his blood.

coa esperanza de diluír a infección que invadía o seu sangue.

Nothing worked. He died.

Nada funcionou. Morreu.

He was 30 years old.

Tiña 30 anos.

If you look back through history,

Se lle botamos unha ollada á historia,

most people died the way my great uncle died.

a maioría da xente morría do mesmo xeito que o meu tío avó.

Most people didn't die of cancer or heart disease,

A maioría non morría de cáncer ou do corazón,

the lifestyle diseases that afflict us in the West today.

as enfermidades que nos afectan hoxe en Occidente.

They didn't die of those diseases because they didn't live long enough

Non morrían desas enfermidades porque non vivían o tempo suficiente

to develop them.

para desenvolvelas.

They died of injuries --

Morrían por feridas...

being gored by an ox,

turrábaos un boi,

shot on a battlefield,

disparábanlles no campo de batalla,

crushed in one of the new factories of the Industrial Revolution --

ou esmagábaos unha máquina nalgunha das novas fábricas da Revolución Industrial...

and most of the time from infection,

e a maior parte do tempo por infeccións,

which finished what those injuries began.

que acababan o que esas feridas comezaran.

All of that changed when antibiotics arrived.

Todo iso cambiou coa chegada dos antibióticos.

Suddenly, infections that had been a death sentence

De súpeto, infeccións que antes eran unha sentenza de morte

became something you recovered from in days.

convertéronse en algo do que te recuperabas en días.

It seemed like a miracle,

Parecía un milagre,

and ever since, we have been living inside the golden epoch of the miracle drugs.

e dende entón, estamos vivindo na época dourada dos medicamentos milagre.

And now, we are coming to an end of it.

E agora... estamos chegando á súa fin.

My great uncle died in the last days of the pre-antibiotic era.

O meu tío avó morreu nos últimos días da era preantibióticos.

We stand today on the threshold of the post-antibiotic era,

Hoxe estamos no limiar da era postantibióticos,

in the earliest days of a time when simple infections

nos primeiros días dun tempo no que infeccións tan simples

such as the one Joe had will kill people once again.

como a que tivo Joe matarán á xente outra vez.

In fact, they already are.

De feito, xa o están facendo.

People are dying of infections again because of a phenomenon

A xente está morrendo por infeccións outra vez por causa dun fenómeno

called antibiotic resistance.

chamado resistencia ós antibióticos.

Briefly, it works like this.

En resumo, funciona así.

Bacteria compete against each other for resources, for food,

As bacterias compiten entre elas polos recursos, polo alimento,

by manufacturing lethal compounds that they direct against each other.

creando compostos letais que unhas dirixen contra outras.

Other bacteria, to protect themselves,

Outras bacterias, para protexerse,

evolve defenses against that chemical attack.

evolucionan creando defensas contra ese ataque químico.

When we first made antibiotics,

A primeira vez que creamos antibióticos,

we took those compounds into the lab and made our own versions of them,

levamos eses compostos ó laboratorio e creamos as nosas propias versións deles,

and bacteria responded to our attack the way they always had.

e as bacterias responderon ó noso ataque igual que o fixeron sempre.

Here is what happened next:

Isto é o que pasou a continuación:

Penicillin was distributed in 1943,

A penicilina distribuíuse en 1943,

and widespread penicillin resistance arrived by 1945.

e a resistencia xeneralizada á penicilina chegou en 1945.

Vancomycin arrived in 1972,

A vancomicina chegou en 1972,

vancomycin resistance in 1988.

e a resistencia á vancomicina en 1988.

Imipenem in 1985,

O imipenem apareceu en 1985,

and resistance to in 1998.

e a resistencia a este en 1998.

Daptomycin, one of the most recent drugs, in 2003,

A daptomicina, un dos medicamentos máis recentes, apareceu en 2003,

and resistance to it just a year later in 2004.

e a resistencia a este só un ano máis tarde, en 2004.

For 70 years, we played a game of leapfrog --

Durante 70 anos, xogamos a superar a súa resistencia

our drug and their resistance,

cun novo medicamento,

and then another drug, and then resistance again --

e despois outro medicamento, e outra resistencia máis...

and now the game is ending.

e agora o xogo está rematando.

Bacteria develop resistance so quickly that pharmaceutical companies

As bacterias desenvolven resistencias tan rápido que as compañías farmacéuticas

have decided making antibiotics is not in their best interest,

decidiron que facer antibióticos non lles convén,

so there are infections moving across the world

así que hai infeccións movéndose por todo o mundo

for which, out of the more than 100 antibiotics

para as que, dos máis de 100 antibióticos

available on the market,

dispoñibles no mercado,

two drugs might work with side effects,

dous poden funcionar con efectos secundarios,

or one drug,

ou un,

or none.

ou ningún.

This is what that looks like.

Esta é a pinta que ten.

In 2000, the Centers for Disease Control and Prevention, the CDC,

No ano 2000, o Centro para a Prevención e o Control de Enfermidades, o CDC,

identified a single case

identificou un único caso

in a hospital in North Carolina

nun hospital en Carolina do Norte

of an infection resistant to all but two drugs.

dunha infección resistente a tódolos antibióticos excepto dous.

Today, that infection, known as KPC,

Hoxe, esa infección chamada KPC,

has spread to every state but three,

xa se estendeu a tódolos estados, con tres excepcións,

and to South America, Europe

e a América do Sur, Europa

and the Middle East.

e Oriente Medio.

In 2008, doctors in Sweden

En 2008, en Suecia os médicos

diagnosed a man from India with a different infection

diagnosticaron un home da India cunha infección distinta

resistant to all but one drug that time.

resistente a tódolos medicamentos excepto a un.

The gene that creates that resistance,

O xene que crea esa resistencia,

known as NDM, has now spread from India into China, Asia, Africa,

coñecido como NDM, xa se estendeu dende a India ata China, Asia, África,

Europe and Canada, and the United States.

Europa, Canadá e os Estados Unidos.

It would be natural to hope

Sería normal esperar

that these infections are extraordinary cases,

que estas infeccións fosen casos extraordinarios,

but in fact,

pero de feito,

in the United States and Europe,

nos Estados Unidos e Europa,

50,000 people a year

50.000 persoas morren cada ano

die of infections which no drugs can help.

de infeccións que ningún medicamento pode curar.

A project chartered by the British government

Un proxecto encargado polo goberno británico

known as the Review on Antimicrobial Resistance

coñecido como a Análise da Resistencia Antimicrobiana

estimates that the worldwide toll right now is 700,000 deaths a year.

estimou que pagamos un prezo global de 700.000 mortes ao ano.

That is a lot of deaths,

Iso son moitas mortes,

and yet, the chances are good that you don't feel at risk,

e con todo, é moi probable que non te sintas en perigo,

that you imagine these people were hospital patients

que imaxines que esa xente eran pacientes hospitalizados

in intensive care units

en unidades de coidados intensivos

or nursing home residents near the ends of their lives,

ou residentes de asilos preto do fin das súas vidas,

people whose infections are remote from us,

xente cuxas infeccións nos son remotas,

in situations we can't identify with.

en situacións coas que non nos sentimos identificados.

What you didn't think about, none of us do,

No que non pensaches, ningún de nós o fai,

is that antibiotics support almost all of modern life.

é en que os antibióticos manteñen case toda a vida moderna.

If we lost antibiotics,

Se perderamos os antibióticos,

here's what else we'd lose:

isto é o que perderiamos tamén:

First, any protection for people with weakened immune systems --

Primeiro, calquera protección para xente con sistemas inmunes debilitados

cancer patients, AIDS patients,

pacientes con cancro, con SIDA,

transplant recipients, premature babies.

pacientes con transplantes, bebés prematuros.

Next, any treatment that installs foreign objects in the body:

Despois, calquera tratamento que introduza obxectos estraños no corpo:

stents for stroke, pumps for diabetes,

stents para os infartos, bombas para a diabetes,

dialysis, joint replacements.

a diálise, as próteses.

How many athletic baby boomers need new hips and knees?

Canta xente atlética de mediana idade precisa novas cadeiras e xeonllos?

A recent study estimates that without antibiotics,

Un estudo recente estima que sen os antibióticos,

one out of ever six would die.

un de cada seis morrería.

Next, we'd probably lose surgery.

Deseguido, probablemente perderiamos a cirurxía.

Many operations are preceded

Moitas operacións van precedidas

by prophylactic doses of antibiotics.

de doses profilácticas de antibióticos.

Without that protection,

Sen esa protección,

we'd lose the ability to open the hidden spaces of the body.

perderiamos a capacidade de abrir os espazos escondidos do corpo.

So no heart operations,

Así que nada de operacións cardíacas,

no prostate biopsies,

nada de biopsias de próstata,

no Cesarean sections.

nada de cesáreas.

We'd have to learn to fear infections that now seem minor.

Teriamos que aprender a temer infeccións que agora semellan menores.

Strep throat used to cause heart failure.

As infeccións de gorxa adoitaban causar fallos cardíacos.

Skin infections led to amputations.

As infeccións cutáneas levaban a amputacións.

Giving birth killed, in the cleanest hospitals,

Dar a luz mataba, nos hospitais máis limpos,

almost one woman out of every 100.

a case unha de cada 100 mulleres.

Pneumonia took three children out of every 10.

A pneumonía levaba 3 de cada 10 nenos.

More than anything else,

Sobre todo,

we'd lose the confident way we live our everyday lives.

perderiamos a confianza coa que vivimos o noso día a día.

If you knew that any injury could kill you,

Se souberas que calquera ferida podería matarte,

subiríaste nunha moto,

would you ride a motorcycle,

bomb down a ski slope,

esquiarías por unha pista empinada,

climb a ladder to hang your Christmas lights,

subirías a unha escada para poñer as luces de Nadal,

let your kid slide into home plate?

deixarías que os teus fillos xogasen ó béisbol?

After all, the first person to receive penicillin,

Despois de todo, a primeira persoa que recibiu penicilina,

a British policeman named Albert Alexander,

un policía británico chamado Albert Alexander,

who was so ravaged by infection that his scalp oozed pus

que estaba tan devastado pola infección que o seu coiro cabeludo supuraba pus

and doctors had to take out an eye,

e os médicos tiveron que extirparlle un ollo,

was infected by doing something very simple.

infectouse facendo algo moi simple.

He walked into his garden and scratched his face on a thorn.

Rabuñou a cara cunha espiña no seu xardín.

That British project I mentioned which estimates that the worldwide toll

O proxecto británico que mencionei que estima unha mortalidade global

right now is 700,000 deaths a year

de 700.000 persoas ó ano na actualidade

also predicts that if we can't get this under control by 2050,

tamén predí que se non conseguimos controlar a situación para o 2050,

not long, the worldwide toll will be 10 million deaths a year.

non tan lonxe, a mortalidade global será de 10 millóns ó ano.

How did we get to this point

Como chegamos ata este punto

where what we have to look forward to

onde podemos ter que enfrontar

is those terrifying numbers?

eses aterradores números?

The difficult answer is, we did it to ourselves.

A difícil resposta é que nolo causamos nós mesmos.

Resistance is an inevitable biological process,

A resistencia é un proceso biolóxico inevitable,

but we bear the responsibility for accelerating it.

pero nós somos os responsables de aceleralo.

We did this by squandering antibiotics

Fixémolo malgastando antibióticos

with a heedlessness that now seems shocking.

cunha despreocupación que agora nos parece sorprendente.

Penicillin was sold over the counter until the 1950s.

A penicilina vendeuse sen receita ata a década dos 50.

In much of the developing world, most antibiotics still are.

En moitos países en desenvolvemento, isto aínda pasa coa maioría dos antibióticos.

In the United States, 50 percent

Nos Estados Unidos, o 50%

of the antibiotics given in hospitals are unnecessary.

dos antibióticos que se dan nos hospitais son innecesarios.

Forty-five percent of the prescriptions written in doctor's offices

O 45% das receitas feitas polos médicos

are for conditions that antibiotics cannot help.

son para enfermidades que os antibióticos non poden curar.

And that's just in healthcare.

E iso é só na asistencia sanitaria.

On much of the planet, most meat animals get antibiotics every day of their lives,

Por todo o planeta, os animais de carne reciben antibióticos a diario,

not to cure illnesses,

non para curar enfermidades,

but to fatten them up and to protect them against

senón para engordalos e para protexelos contra

the factory farm conditions they are raised in.

as condicións nas que son criados.

In the United States, possibly 80 percent

Nos Estados Unidos, posiblemente o 80%

of the antibiotics sold every year go to farm animals, not to humans,

dos antibióticos vendidos anualmente van a animais de granxa, non a humanos,

creating resistant bacteria that move off the farm

creando bacterias resistentes que saen das granxas

in water, in dust,

na auga, no po,

in the meat the animals become.

na carne na que se converten os animais.

Aquaculture depends on antibiotics too,

A acuicultura tamén depende dos antibióticos,

particularly in Asia,

particularmente en Asia,

and fruit growing relies on antibiotics

e o cultivo de froitas depende dos antibióticos

to protect apples, pears, citrus, against disease.

para protexer mazás, peras, cítricos, contra enfermidades.

And because bacteria can pass their DNA to each other

E dado que as bacterias poden pasar o seu ADN dunhas a outras

like a traveler handing off a suitcase at an airport,

como un viaxeiro pasando unha maleta nun aeroporto,

once we have encouraged that resistance into existence,

unha vez que fomentamos a existencia desta resistencia,

there is no knowing where it will spread.

é imposible saber ata onde se espallará.

This was predictable.

Isto era predicible.

In fact, it was predicted

De feito, prediciuno

by Alexander Fleming, the man who discovered penicillin.

Alexander Fleming, o home que descubriu a penicilina.

He was given the Nobel Prize in 1945 in recognition,

Gañou o Premio Nobel en 1945,

and in an interview shortly after, this is what he said:

e nunha entrevista pouco despois, isto é o que dixo:

"The thoughtless person playing with penicillin treatment

"A persoa inconsciente que xogue cun tratamento de penicilina

is morally responsible for the death of a man

é moralmente responsable pola morte do home

who succumbs to infection

que sucumba á infección

with a pencillin-resistant organism."

por un organismo resistente á penicilina."

He added, "I hope this evil can be averted."

Engadiu, "espero que este mal poida ser evitado."

Can we avert it?

Podemos evitalo?

There are companies working on novel antibiotics,

Hai empresas traballando en novos antibióticos,

things the superbugs have never seen before.

cousas que os supermicrobios nunca viron antes.

We need those new drugs badly,

Necesitamos eses novos medicamentos con urxencia,

and we need incentives:

e necesitamos incentivos:

discovery grants, extended patents,

bolsas para os descubrimentos, patentes prolongadas,

prizes, to lure other companies into making antibiotics again.

premios que atraian a outras empresas para volver facer antibióticos.

But that probably won't be enough.

Pero probablemente non abondará.

Here's why: Evolution always wins.

Polo seguinte motivo: a evolución sempre gaña.

Bacteria birth a new generation every 20 minutes.

As bacterias crean unha nova xeración cada 20 minutos.

It takes pharmaceutical chemistry 10 years to derive a new drug.

Á química farmacéutica lévalle 10 anos crear un novo medicamento.

Every time we use an antibiotic,

Cada vez que usamos un antibiótico,

we give the bacteria billions of chances

dámoslle ás bacterias miles de millóns de oportunidades

to crack the codes

para descifrar os códigos

of the defenses we've constructed.

das defensas que construímos.

There has never yet been a drug

Ata agora nunca existiu un medicamento

they could not defeat.

que non puidesen vencer.

This is asymmetric warfare,

Trátase dunha guerra asimétrica,

but we can change the outcome.

pero podemos cambiar o resultado.

We could build systems to harvest data to tell us automatically and specifically

Poderiamos crear sistemas que recompilen datos que nos digan de xeito automático

how antibiotics are being used.

e específico como se están usando os antibióticos.

We could build gatekeeping into drug order systems

Poderiamos crear filtros nos pedidos de medicamentos

so that every prescription gets a second look.

para que cada receita sexa revisada dúas veces.

We could require agriculture to give up antibiotic use.

Poderiamos esixirlle á agricultura que renuncie ó uso de antibióticos.

We could build surveillance systems

Poderiamos crear sistemas de vixilancia

to tell us where resistance is emerging next.

que nos digan onde vai emerxer a próxima resistencia.

Those are the tech solutions.

Esas son as solucións tecnolóxicas.

They probably aren't enough either,

É probable que tampouco abonden,

unless we help.

a menos que nós axudemos.

Antibiotic resistance is a habit.

A resistencia ós antibióticos é un hábito.

We all know how hard it is to change a habit.

Todos sabemos o difícil que é cambiar un hábito.

But as a society, we've done that in the past.

Pero como sociedade, xa o fixemos no pasado.

People used to toss litter into the streets,

A xente adoitaba tirar lixo nas rúas,

used to not wear seatbelts,

non poñía o cinto de seguridade,

used to smoke inside public buildings.

fumaba dentro dos edificios públicos.

We don't do those things anymore.

Xa non facemos esas cousas.

We don't trash the environment

Non estragamos o medio ambiente

or court devastating accidents

nin buscamos devastadores accidentes

or expose others to the possibility of cancer,

nin expoñemos a outros á posibilidade dun cancro,

because we decided those things were expensive,

porque decidimos que esas cousas saían caras,

destructive, not in our best interest.

que eran destrutivas, non nos conviñan.

We changed social norms.

Cambiamos as normas sociais.

We could change social norms around antibiotic use too.

Tamén poderiamos cambiar as normas sociais sobre o uso dos antibióticos.

I know that the scale of antibiotic resistance

Sei que a dimensión da resistencia dos antibióticos

seems overwhelming,

semella abafante,

but if you've ever bought a fluorescent lightbulb

pero se algunha vez mercaches unha lámpada fluorescente

because you were concerned about climate change,

porque te preocupaba o cambio climático,

or read the label on a box of crackers

ou liches a etiqueta dunha caixa de galletas

because you think about the deforestation from palm oil,

porque pensas na deforestación debida ó aceite de palma,

you already know what it feels like

xa sabes o que se sente

to take a tiny step to address an overwhelming problem.

ó dar un pequeno paso para resolver un enorme problema.

We could take those kinds of steps for antibiotic use too.

Tamén poderiamos tomar esa clase de medidas no uso dos antibióticos.

We could forgo giving an antibiotic if we're not sure it's the right one.

Poderiamos renunciar a dar un antibiótico se non estamos certos de que é o correcto.

We could stop insisting on a prescription for our kid's ear infection

Poderiamos non insistir nunha receita para a infección de oído do noso neno

before we're sure what caused it.

antes de estar seguros de qué a causou.

We could ask every restaurant,

Poderiamos preguntar a cada restaurante,

every supermarket,

a cada supermercado,

where their meat comes from.

de onde vén a súa carne.

We could promise each other

Poderiamos prometernos

never again to buy chicken or shrimp or fruit

non volver mercar polo ou gambas ou froita

raised with routine antibiotic use,

criados co uso rutineiro de antibióticos,

and if we did those things,

e se fixeramos esas cousas,

we could slow down the arrival of the post-antibiotic world.

poderiamos retrasar a chegada do mundo postantibióticos.

But we have to do it soon.

Pero temos que facelo axiña.

Penicillin began the antibiotic era in 1943.

A penicilina deu comezo á era dos antibióticos en 1943.

In just 70 years, we walked ourselves up to the edge of disaster.

En só 70 anos, camiñamos ata a beira do desastre.

We won't get 70 years

Non imos ter 70 anos

to find our way back out again.

para atopar unha saída outra vez.

Thank you very much.

Moitas grazas.

(Applause)

(Aplausos)