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

Prevoditelj: Maja Covic Recezent: Ivan Stamenković

This is my great uncle,

Ovo je moj prastric,

my father's father's younger brother.

mlađi brat mog djeda po očevoj strani.

His name was Joe McKenna.

Zvao se Joe McKenna.

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

Bio je mlad, oženjen, poluprofesionalni igrač bejzbola

and a fireman in New York City.

i vatrogasac u New Yorku.

Family history says he loved being a fireman,

Obiteljska predaja kaže da je volio svoj posao,

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

i tijekom jednog svog slobodnog dana 1938. godine

he elected to hang out at the firehouse.

provodio je vrijeme u vatrogasnoj postaji.

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

Da bude koristan, primio se laštenja mjedenih predmeta,

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

ograde na vatrogasnom vozilu, opreme na zidovima.

and one of the fire hose nozzles,

jedna od glava vatrogasnih šmrkova,

a giant, heavy piece of metal,

koja je ogroman i težak metalni predmet,

toppled off a shelf and hit him.

pala je s police na njega.

A few days later, his shoulder started to hurt.

Poslije par dana počelo ga je boliti rame.

Two days after that, he spiked a fever.

Dva dana kasnije, dobio je vrućicu.

The fever climbed and climbed.

Vrućica mu se pogoršavala.

His wife was taking care of him,

Supruga ga je njegovala,

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

no ništa nije pomagalo, a kada su pozvali liječnika

nothing he did mattered either.

ni on nije mogao pomoći.

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

Odvezli su ga taksijem u bolnicu.

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

Medicinske sestre su odmah shvatile da se radi o infekciji,

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

što se u to vrijeme zvalo "otrovanje krvi"

and though they probably didn't say it,

i iako to vjerojatno nisu rekle,

they would have known right away

sigurno su odmah znale

that there was nothing they could do.

da mu ni na koji način ne mogu pomoći.

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

Nisu mu mogle pomoći jer sredstva koja mi danas koristimo

to cure infections didn't exist yet.

za liječenje infekcija, tada još nisu postojala.

The first test of penicillin, the first antibiotic,

Prvi test za penicilin, prvi antibiotik,

was three years in the future.

došao je tek tri godine kasnije.

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

Ljudi koji su se inficirali, ili su bili te sreće da se oporave,

or they died.

ili su umirali.

My great uncle was not lucky.

Moj prastric nije imao sreće.

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

Tjedan dana je proveo u bolnici, drhteći od zimice,

dehydrated and delirious,

dehidriran i u bunilu,

sinking into a coma as his organs failed.

tonući u komu dok su mu otkazivali organi.

His condition grew so desperate

Stanje su se toliko pogoršalo

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

da su njegovi kolege iz vatrogasne stanice čekali u redu da bi mu dali transfuziju,

hoping to dilute the infection surging through his blood.

nadajući se da će razrijediti infekciju koja je kolala u njegovim žilama.

Nothing worked. He died.

Ništa nije pomoglo. Umro je.

He was 30 years old.

Imao je 30 godina.

If you look back through history,

Ako pogledate kroz povijest,

most people died the way my great uncle died.

većina ljudi umirala je poput mog prastrica.

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

Većina ih nije umirala od raka ili srčanih bolesti,

the lifestyle diseases that afflict us in the West today.

od čega danas boluju ljudi na Zapadu.

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

Nisu umirali od tih bolesti jer nisu živjeli dovoljno dugo

to develop them.

da bi ih razvili.

They died of injuries --

Umirali su od ozljeda:

being gored by an ox,

teško ih je ranio vol,

shot on a battlefield,

bili su propucani na bojištu,

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

zdrobljeni u novim tvornicama industrijske revolucije,

and most of the time from infection,

a većinu vremena od infekcije,

which finished what those injuries began.

koja bi dovršila što su one ozljede započele.

All of that changed when antibiotics arrived.

Sve se to promijenilo pojavom antibiotika.

Suddenly, infections that had been a death sentence

Odjednom su se infekcije, koje su nekoć bile smrtonosne,

became something you recovered from in days.

mogle izliječiti u nekoliko dana.

It seemed like a miracle,

To je bilo poput čuda,

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

i otada živimo u zlatnom dobu čudesnih lijekova.

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

A sada se primičemo njegovu kraju.

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

Moj prastric umro je u posljednim danima pred-antibiotičke ere.

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

Danas se nalazimo na pragu post-antibiotičke ere,

in the earliest days of a time when simple infections

u najranijim danima kada će najjednostavnije infekcije,

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

poput one koju je imao Joe, ponovo usmrćivati ljude.

In fact, they already are.

To se zapravo već i događa.

People are dying of infections again because of a phenomenon

Ljudi ponovo umiru od infekcija zbog fenomena

called antibiotic resistance.

koji se naziva rezistencija na antibiotike.

Briefly, it works like this.

To, ukratko, djeluje ovako.

Bacteria compete against each other for resources, for food,

Bakterije se međusobno bore za hranu,

by manufacturing lethal compounds that they direct against each other.

tako da proizvode smrtonosne spojeve kojima se međusobno napadaju.

Other bacteria, to protect themselves,

Druge bakterije, kako bi se zaštitile,

evolve defenses against that chemical attack.

razvijaju zaštitu protiv tih kemijskih napada.

When we first made antibiotics,

Kada smo prvi put stvorili antibiotike,

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

uzeli smo te spojeve u laboratorij i od njih napravili naše verzije,

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

a bakterije su na naš napad odgovorile jednako kao što uvijek čine.

Here is what happened next:

Evo što se potom dogodilo:

Penicillin was distributed in 1943,

Penicilin se počeo izdavati 1943.,

and widespread penicillin resistance arrived by 1945.

a već do 1945. raširila se rezistencija bakterija na penicilin.

Vancomycin arrived in 1972,

Vankomicin je proizveden 1972.,

vancomycin resistance in 1988.

a rezistentnost na njega 1988.

Imipenem in 1985,

Imipenem je razvijen 1985.,

and resistance to in 1998.

a rezistentnost na njega 1998.

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

Daptomicin, jedan od najnovijih lijekova, razvijen je 2003.,

and resistance to it just a year later in 2004.

a rezistentnost na njega samo godinu nakon toga - 2004.

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

Natezali smo se s bakterijama 70 godina,

our drug and their resistance,

naš lijek i njihova rezistencija,

and then another drug, and then resistance again --

onda drugi lijek, i potom ponovo rezistencija,

and now the game is ending.

a sada se to primiče kraju.

Bacteria develop resistance so quickly that pharmaceutical companies

Bakterije razvijaju rezistenciju toliko brzo da su farmaceutske tvrtke

have decided making antibiotics is not in their best interest,

odlučile da im se više ne isplati proizvoditi nove antibiotike,

so there are infections moving across the world

pa se svijetom šire infekcije

for which, out of the more than 100 antibiotics

za koje, od više od sto antibiotika

available on the market,

dostupnih na tržištu,

two drugs might work with side effects,

dva lijeka možda djeluju s nuspojavama,

or one drug,

ili jedan lijek,

or none.

ili nijedan.

This is what that looks like.

Ovako to izgleda.

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

2000. godine, Centar za kontrolu i prevenciju bolesti,

identified a single case

identificirao je

in a hospital in North Carolina

u bolnici u Sjevernoj Karolini

of an infection resistant to all but two drugs.

infekciju rezistentnu na sve osim dva lijeka.

Today, that infection, known as KPC,

Ta se infekcija, zvana KCP, do danas

has spread to every state but three,

raširila na sve savezne američke države osim tri,

and to South America, Europe

kao i na Južnu Ameriku, Europu

and the Middle East.

i Bliski Istok.

In 2008, doctors in Sweden

Liječnici u Švedskoj su 2008. godine

diagnosed a man from India with a different infection

dijagnosticirali čovjeku iz Indije jednu drugu infekciju

resistant to all but one drug that time.

koja je je otporna na sve osim jednog lijeka.

The gene that creates that resistance,

Gen koji stvara tu rezistentnost,

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

zvan NDM, proširio se iz Indije na Kinu, Aziju, Afriku,

Europe and Canada, and the United States.

Europu, Kanadu i SAD.

It would be natural to hope

Normalno je nadati se

that these infections are extraordinary cases,

da su te infekcije iznimke,

but in fact,

no u stvarnosti,

in the United States and Europe,

u SAD-u i Europi

50,000 people a year

50.000 ljudi godišnje

die of infections which no drugs can help.

umre od infekcija kojima nema lijeka.

A project chartered by the British government

Britanska vlada pokrenula je projekt

known as the Review on Antimicrobial Resistance

zvan Pregled antimikrobske rezistencije

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

koji procjenjuje da trenutno 700.000 ljudi na svijetu godišnje umre od ovoga.

That is a lot of deaths,

To je jako puno smrtnih slučajeva,

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

no mi se uglavnom ne osjećamo ugroženo,

that you imagine these people were hospital patients

jer vjerujemo da su ti ljudi bili pacijenti u bolnici,

in intensive care units

na odjelima intenzivne njege,

or nursing home residents near the ends of their lives,

ili se približavali kraju života u staračkim domovima.

people whose infections are remote from us,

Ljudi čije infekcije su daleko od nas,

in situations we can't identify with.

u situacijama s kojima se ne možemo poistovjetiti.

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

No nitko od nas nije razmišljao o tome

is that antibiotics support almost all of modern life.

da se gotovo čitav moderan život oslanja na antibiotike.

If we lost antibiotics,

Da izgubimo antibiotike,

here's what else we'd lose:

izgubili bismo i sljedeće:

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

Bilokakvu zaštitu za pacijente s oslabljenim imunosustavom:

cancer patients, AIDS patients,

pacijente s rakom, AIDS-om,

transplant recipients, premature babies.

primatelje novih organa, nedonošćad.

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

Nadalje, bilokakva terapija kojom se ugrađuju strana tijela u organizam:

stents for stroke, pumps for diabetes,

stentovi za moždani udar, pumpe za šećernu bolest,

dialysis, joint replacements.

dijalizu, nadomjesci za zglobove.

How many athletic baby boomers need new hips and knees?

Koliko 50-70-godišnjaka koji se bave sportom treba novi kuk ili koljeno?

A recent study estimates that without antibiotics,

Nedavna studija procjenjuje da bi bez antibiotika

one out of ever six would die.

svaka šesta osoba umrla.

Next, we'd probably lose surgery.

Vjerojatno ne bismo više imali kirurgiju.

Many operations are preceded

Prije mnogih operacija pacijentima se daju

by prophylactic doses of antibiotics.

profilaktičke doze antibiotika.

Without that protection,

Bez te zaštite,

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

ne bismo više mogli otvarati tijela pacijenata.

So no heart operations,

Ne bi bilo operacija srca,

no prostate biopsies,

biopsije prostate,

no Cesarean sections.

carskog reza.

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

Morali bismo se priviknuti na strah od zaraza koje nam se sada čine beznačajne.

Strep throat used to cause heart failure.

Streptokokna upala grla prije je uzrokovala zatajenje srca.

Skin infections led to amputations.

Kožne infekcije vodile su do amputacija.

Giving birth killed, in the cleanest hospitals,

Žene su umirale tijekom rađanja, u najčišćim bolnicama,

almost one woman out of every 100.

gotovo svaka stota žena.

Pneumonia took three children out of every 10.

Troje od desetero djece umiralo je od upale pluća.

More than anything else,

Više od ičega drugog,

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

izgubili bismo sigurnost s kojom živimo svakodnevni život.

If you knew that any injury could kill you,

Da znate da vas bilokakva ozljeda može ubiti,

would you ride a motorcycle,

biste li vozili motor,

bomb down a ski slope,

jurili na skijalištu,

climb a ladder to hang your Christmas lights,

penjali se na ljestve da objesite božićne lampice,

let your kid slide into home plate?

dopustili svome djetetu da se baca po nogometnom terenu?

After all, the first person to receive penicillin,

Naposljetku, prva osoba koja je primila penicilin,

a British policeman named Albert Alexander,

britanski policajac Albert Alexander,

who was so ravaged by infection that his scalp oozed pus

kojeg je toliko uništila infekcija da mu je iz lubanje curio gnoj,

and doctors had to take out an eye,

i liječnici su mu morali izvaditi oko,

was infected by doing something very simple.

zarazio se radeći nešto vrlo jednostavno.

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

Ušetao se u svoj vrt i ogrebao lice trnom.

That British project I mentioned which estimates that the worldwide toll

Onaj britanski projekt koji sam spomenula prema kojemu trenutno na svijetu

right now is 700,000 deaths a year

svake godine umire 700.000 ljudi

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

također predviđa da će, ako ovu situaciju ne stavimo pod kontrolu do 2050. godine,

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

u kratkom roku godišnje umirati 10 milijuna ljudi.

How did we get to this point

Kako smo došli do ove situacije

where what we have to look forward to

u kojoj predviđamo

is those terrifying numbers?

takve strašne brojke?

The difficult answer is, we did it to ourselves.

Teška je istina da smo si sami to prouzročili.

Resistance is an inevitable biological process,

Rezistencija je neizbježan biološki proces,

but we bear the responsibility for accelerating it.

no mi smo odgovorni za njeno ubrzavanje.

We did this by squandering antibiotics

To smo prouzročili dijeljenjem antibiotika

with a heedlessness that now seems shocking.

takvom bezbrižnošću koja nam se sada čini šokantnom.

Penicillin was sold over the counter until the 1950s.

Penicilin se prodavao bez recepta do 1950-ih.

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

Većina antibiotika još uvijek se tako prodaje diljem razvijenog svijeta.

In the United States, 50 percent

U SAD-u 50 posto

of the antibiotics given in hospitals are unnecessary.

antibiotika koji se daju u bolnicama su nepotrebni.

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

45 posto recepata koje izdaju liječnici

are for conditions that antibiotics cannot help.

daje se za stanja kojima antibiotici ne pomažu.

And that's just in healthcare.

I to je samo stanje u zdravstvu.

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

Diljem planeta, većina životinja uzgajana za meso dobiva antibiotike svaki dan,

not to cure illnesses,

ne radi izlječenja bolesti,

but to fatten them up and to protect them against

već da ih se ugoji i zaštiti od

the factory farm conditions they are raised in.

uvjeta na farmi na kojoj su uzgajana.

In the United States, possibly 80 percent

U SAD-u oko 80 posto antibiotika

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

prodanih svake godine najmjenjeno je životinjama na farmama, a ne ljudima,

creating resistant bacteria that move off the farm

stvarajući tako rezistentne bakterije koje sa farmi odlaze

in water, in dust,

u vodu, prašinu

in the meat the animals become.

i meso koje te životinje postaju.

Aquaculture depends on antibiotics too,

Akvakultura također ovisi o antibioticima,

particularly in Asia,

posebice u Aziji,

and fruit growing relies on antibiotics

i uzgoj voća oslanja se na antibiotike

to protect apples, pears, citrus, against disease.

radi zaštite jabuka, krušaka i citrusa protiv bolesti.

And because bacteria can pass their DNA to each other

S obzirom da bakterije mogu međusobno prenositi svoj DNK

like a traveler handing off a suitcase at an airport,

poput putnika koji predaje putnu torbu u zračnoj luci,

once we have encouraged that resistance into existence,

jednom kada izazovemo tu rezistenciju,

there is no knowing where it will spread.

ne možemo znati kamo će se sve ona raširiti.

This was predictable.

Ovo smo mogli predvidjeti.

In fact, it was predicted

To je zaista i predvidio

by Alexander Fleming, the man who discovered penicillin.

Alexander Fleming, čovjek koji je okrio penicilin.

He was given the Nobel Prize in 1945 in recognition,

Za priznanje je 1945. godine dobio Nobelovu nagradu,

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

a u intervjuu koji je nedugo potom dao, evo što je izjavio:

"The thoughtless person playing with penicillin treatment

"Bezumna osoba koja se igra terapijom penicilinom

is morally responsible for the death of a man

moralno je odgovorna za smrt čovjeka

who succumbs to infection

koji podlegne infekciji

with a pencillin-resistant organism."

uzrokovanom organizmom koji je rezistentan na penicilin."

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

Dodaje: "Nadam se da se ovo zlo može izbjeći."

Can we avert it?

Možemo li to izbjeći?

There are companies working on novel antibiotics,

Neke tvrtke rade na novim antibioticima,

things the superbugs have never seen before.

stvarima koje superbakterije nisu nikada vidjele.

We need those new drugs badly,

Jako su nam potrebni ti novi lijekovi,

and we need incentives:

i trebamo poticaje:

discovery grants, extended patents,

subvencije za otkrića, proširene patente,

prizes, to lure other companies into making antibiotics again.

nagrade, kako bismo privukli druge tvrtke da ponovo počnu proizvoditi antibiotike.

But that probably won't be enough.

No to vjerojatno neće biti dovoljno.

Here's why: Evolution always wins.

Zato što evolucija uvijek pobjeđuje.

Bacteria birth a new generation every 20 minutes.

Svakih 20 minuta stvara se nova generacija bakterija.

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

Farmaceutskim tvrtkama treba deset godina da naprave novi lijek.

Every time we use an antibiotic,

Svaki put kada koristimo antibiotik,

we give the bacteria billions of chances

dajemo bakterijama milijardu šansi

to crack the codes

da razbiju šifre

of the defenses we've constructed.

zaštita koje smo izgradili.

There has never yet been a drug

Dosad nije bilo lijeka

they could not defeat.

kojeg nisu uspjele pobijediti.

This is asymmetric warfare,

Ovo je neravnopravno ratovanje,

but we can change the outcome.

ali možemo izmijeniti njegov ishod.

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

Možemo izgraditi sustave za prikupljanje podataka koji nam automatski i konkretno

how antibiotics are being used.

govore kako se antibiotici koriste.

We could build gatekeeping into drug order systems

Možemo izgraditi kontrolu nad pisanjem recepata

so that every prescription gets a second look.

tako da se svaki recept pregledava.

We could require agriculture to give up antibiotic use.

Mogli bismo tražiti od poljoprivrede da više ne koristi antibiotike.

We could build surveillance systems

Mogli bismo izgraditi nadzorne sustave

to tell us where resistance is emerging next.

koji bi otkrivali gdje se pojavila nova rezistencija.

Those are the tech solutions.

To su tehnološka rješenja.

They probably aren't enough either,

Ni ona vjerojatno nisu dovoljna,

unless we help.

osim ako mi ne pomognemo.

Antibiotic resistance is a habit.

Rezistencija na antibiotike je navika.

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

Svi znamo koliko je teško izmijeniti naviku.

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

No, to smo kao društvo već ranije radili.

People used to toss litter into the streets,

Ljudi su običavali bacati smeće po cesti,

used to not wear seatbelts,

nisu vezali sigurnosni pojas u autima,

used to smoke inside public buildings.

pušili su u javnim zgradama.

We don't do those things anymore.

Više to ne radimo.

We don't trash the environment

Ne zagađujemo okoliš,

or court devastating accidents

ne izazivamo strašne nesreće,

or expose others to the possibility of cancer,

niti ne izlažemo druge mogućem oboljenju od raka,

because we decided those things were expensive,

jer smo zaključili da nam je to skupo,

destructive, not in our best interest.

destruktivno i da nam nije u interesu.

We changed social norms.

Promijenili smo društvene norme.

We could change social norms around antibiotic use too.

Mogli bismo promijeniti društvene norme i kod uporabe antibiotika.

I know that the scale of antibiotic resistance

Znam da se razina rezistencije na antibiotike

seems overwhelming,

čini nepobjediva,

but if you've ever bought a fluorescent lightbulb

no ako ste ikada kupili štednu žarulju

because you were concerned about climate change,

jer se brinete zbog klimatskih promjena,

or read the label on a box of crackers

ili ste pročitali sastav namirnica na kutiji krekera

because you think about the deforestation from palm oil,

jer razmišljate o deforestaciji zbog palminog ulja,

you already know what it feels like

već znate kako je to kada

to take a tiny step to address an overwhelming problem.

učinite malen korak radi naoko nepobjedivog problema.

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

Mogli bismo poduzeti takve korake i u uporabi antibiotika.

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

Mogli bismo odustati od davanja nekog antibiotika ako nismo sigurni da je dobar.

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

Mogli bismo prestati inzistirati na receptu ako nam dijete ima upalu uha

before we're sure what caused it.

prije nego utvrdimo što ju je uzrokovalo.

We could ask every restaurant,

Mogli bismo pitati svaki restoran,

every supermarket,

svaki supermarket,

where their meat comes from.

odakle dolazi njihovo meso.

We could promise each other

Mogli bismo jedni drugima obećati

never again to buy chicken or shrimp or fruit

da nikada više nećemo kupiti piletinu, škampe ili voće

raised with routine antibiotic use,

uzgajane uz pomoć rutinske uporabe antibiotika,

and if we did those things,

i ako se toga držimo,

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

mogli bismo usporiti dolazak post-antibiotičkog svijeta.

But we have to do it soon.

No to moramo učiniti brzo.

Penicillin began the antibiotic era in 1943.

Penicilin je 1943. godine započeo eru antibiotika.

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

U samo 70 godina doveli smo se do ruba propasti.

We won't get 70 years

Nećemo imati dodatnih 70 godina

to find our way back out again.

da pronađemo izlaz iz ovoga.

Thank you very much.

Hvala vam.

(Applause)

(Pljesak)