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

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

This is my great uncle,

Ovo je moj prastric,

my father's father's younger brother.

mlađi brat oca mog oca.

His name was Joe McKenna.

Zvao se Džo Mekena.

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

Bio je mlad suprug i poluprofesionalni košarkaš

and a fireman in New York City.

i vatrogasac u Njujorku.

Family history says he loved being a fireman,

Porodična istorija kaže da je voleo da bude vatrogasac,

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

pa je tako 1938. godine, kada je imao slobodan dan,

he elected to hang out at the firehouse.

odabrao da provede vreme u vatrogasnom domu.

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

Da bi bio koristan tog dana, počeo je da polira sav mesing,

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

ogradu na vatrogasnom vozilu, armature na zidovima,

and one of the fire hose nozzles,

a jedna od mlaznica vatrogasnog creva,

a giant, heavy piece of metal,

ogroman, teški komad metala,

toppled off a shelf and hit him.

srušila se sa police i udarila ga.

A few days later, his shoulder started to hurt.

Nekoliko dana kasnije, počelo je da ga boli rame.

Two days after that, he spiked a fever.

Dva dana nakon toga, izbila mu je temperatura.

The fever climbed and climbed.

Groznica se pojačavala i pojačavala.

His wife was taking care of him,

Njegova žena je brinula o njemu,

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

ali nije vredelo šta god da je činila, a kada su doveli lokalnog lekara,

nothing he did mattered either.

nije vredelo ni ono što je on činio.

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

Zaustavili su taksi i odveli ga u bolnicu.

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

Medicinske sestre su tamo odmah prepoznale da on ima infekciju,

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

ono što su u to vreme zvali „trovanje krvi”,

and though they probably didn't say it,

i mada verovatno to nisu rekli,

they would have known right away

znali su odmah

that there was nothing they could do.

da se ništa ne može učiniti.

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

Nisu mogli ništa da učine jer stvari koje danas koristimo

to cure infections didn't exist yet.

da izlečimo infekcije tada još nisu postojale.

The first test of penicillin, the first antibiotic,

Prvo testiranje penicilina, prvog antibiotika,

was three years in the future.

bilo je tri godine kasnije.

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

Ljudi koji bi dobili infekciju ili bi se oporavili, ako su imali sreće,

or they died.

ili bi umrli.

My great uncle was not lucky.

Moj prastric nije imao sreće.

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

Bio je u bolnici nedelju dana, tresući se od groznice,

dehydrated and delirious,

dehidriran i u delirijumu,

sinking into a coma as his organs failed.

upadao u komu dok su mu organi otkazivali.

His condition grew so desperate

Njegovo stanje je postalo toliko beznadežno

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

da su se ljudi iz vatrogasnog doma poređali da mu daju krv,

hoping to dilute the infection surging through his blood.

nadajući se da će razblažiti infekciju koja juri kroz njegovu krv.

Nothing worked. He died.

Ništa nije delovalo. Umro je.

He was 30 years old.

Imao je 30 godina.

If you look back through history,

Ako pogledate unazad kroz istoriju,

most people died the way my great uncle died.

većina ljudi je umrla na način na koji je moj prastric umro.

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

Većina ljudi nije umrla od raka ili bolesti srca,

the lifestyle diseases that afflict us in the West today.

oboljenja vezanih za način života koja nas danas pogađaju na zapadu.

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

Nisu umrli od tih bolesti zato što nisu živeli dovoljno dugo

to develop them.

da bi ih razvili.

They died of injuries --

Umrli su od povreda -

being gored by an ox,

tako što bi ih probo vo,

shot on a battlefield,

bili bi pogođeni na bojnom polju,

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

smrskani u jednoj od novih fabrika industrijske revolucije -

and most of the time from infection,

i većinom od infekcija,

which finished what those injuries began.

koje bi dokrajčile ono što bi povrede započele.

All of that changed when antibiotics arrived.

Sve se to promenilo kada su stigli antibiotici.

Suddenly, infections that had been a death sentence

Odjednom, infekcije koje su pre bile smrtna presuda

became something you recovered from in days.

postale su nešto od čega se oporavlja za nekoliko dana.

It seemed like a miracle,

Delovalo je kao čudo,

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

i od tada živimo u zlatnoj epohi čudesnih lekova,

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

a sada, približavamo se njenom kraju.

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

Moj prastric je umro poslednjih dana preantibiotičke ere.

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

Danas stojimo na pragu postantibiotičke ere,

in the earliest days of a time when simple infections

najranijih dana vremena kada će obične infekcije,

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

poput one koju je Džo imao, ponovo ubijati ljude.

In fact, they already are.

U stvari, već ih ubijaju.

People are dying of infections again because of a phenomenon

Ljudi ponovo umiru od infekcija zbog fenomena

called antibiotic resistance.

zvanog otpornost na antibiotike.

Briefly, it works like this.

Ukratko, dešava se sledeće.

Bacteria compete against each other for resources, for food,

Bakterije se međusobno nadmeću zbog sredstava, zbog hrane,

by manufacturing lethal compounds that they direct against each other.

proizvodeći smrtonosna jedinjenja koja usmeravaju jedna protiv druge.

Other bacteria, to protect themselves,

Druge bakterije, da bi se zaštitile.

evolve defenses against that chemical attack.

razviju odbrane protiv tog hemijskog napada.

When we first made antibiotics,

Kada smo prvi put napravili antibiotike,

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

odneli smo ta jedinjenja u laboratoriju i napravili njihove verzije,

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

a bakterije su uzvratile na naš napad kao što su to uvek činile.

Here is what happened next:

Evo šta se zatim dogodilo.

Penicillin was distributed in 1943,

Penicilin je distribuiran 1943. godine,

and widespread penicillin resistance arrived by 1945.

a rasprostranjena otpornost na penicilin nastupila je do 1945. godine.

Vancomycin arrived in 1972,

Vankomicin je stigao 1972. godine,

vancomycin resistance in 1988.

otpornost na vankomicin - 1988. godine.

Imipenem in 1985,

Imipenem - 1985. godine,

and resistance to in 1998.

a otpornost na njega - 1998. godine.

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

Daptomicin, među skorijim lekovima, 2003. godine,

and resistance to it just a year later in 2004.

a otpornost na njega samo jednu godinu kasnije, 2004. godine.

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

Sedamdeset godina se igramo trule kobile -

our drug and their resistance,

naš lek i otpornost na njega,

and then another drug, and then resistance again --

a onda drugi lek, pa ponovo otpornost -

and now the game is ending.

i sada se igra završava.

Bacteria develop resistance so quickly that pharmaceutical companies

Bakterije razvijaju otpornost tako brzo da su farmaceutske kompanije

have decided making antibiotics is not in their best interest,

odlučile da pravljenje antibiotika nije u njihovom najboljem interesu,

so there are infections moving across the world

tako da se svetom šire infekcije

for which, out of the more than 100 antibiotics

za koje, od preko 100 antibiotika

available on the market,

dostupnih na tržištu,

two drugs might work with side effects,

dva leka bi mogla delovati uz nuspojave,

or one drug,

ili jedan lek,

or none.

ili nijedan.

This is what that looks like.

Ovako to izgleda.

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

Godine 2000, Centar za kontrolu i prevenciju bolesti, CDC,

identified a single case

identifikovao je jedinstveni slučaj

in a hospital in North Carolina

u bolnici u Severnoj Karolini

of an infection resistant to all but two drugs.

infekcije otporne na sve osim dva leka.

Today, that infection, known as KPC,

Danas se ta infekcija, poznata kao KPC,

has spread to every state but three,

proširila na svaku državu osim tri,

and to South America, Europe

na Južnu Ameriku, Evropu

and the Middle East.

i na Srednji Istok.

In 2008, doctors in Sweden

Godine 2008, doktori u Švedskoj

diagnosed a man from India with a different infection

dijagnostikovali su kod čoveka iz Indije drugačiju infekciju,

resistant to all but one drug that time.

otpornu na sve osim jednog leka.

The gene that creates that resistance,

Gen koji stvara tu otpornost,

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

poznat kao NDM, sada se proširio iz Indije u Kinu, Aziju, Afriku,

Europe and Canada, and the United States.

Evropu, Kanadu, i SAD.

It would be natural to hope

Bilo bi prirodno nadati se

that these infections are extraordinary cases,

da su te infekcije izuzetni slučajevi,

but in fact,

ali u stvari,

in the United States and Europe,

u Sjedinjenim Državama i Evropi,

50,000 people a year

50 000 ljudi godišnje

die of infections which no drugs can help.

umre od infekcije kojoj nikakvi lekovi ne mogu pomoći.

A project chartered by the British government

Projekat koji je osnovala britanska vlada

known as the Review on Antimicrobial Resistance

poznat kao Pregled otpornosti na antibiotike

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

procenjuje da je svetski gubitak u ovom trenutku 700 000 smrti godišnje.

That is a lot of deaths,

To je mnogo smrtnih slučajeva,

pa ipak, dobri su izgledi da ne osećate da ste pod rizikom,

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

that you imagine these people were hospital patients

da zamišljate da su ti ljudi bili bolnički pacijenti

in intensive care units

na intenzivnoj nezi

or nursing home residents near the ends of their lives,

ili stanari staračkog doma pri kraju svog života,

people whose infections are remote from us,

ljudi čije su infekcije udaljene od nas,

in situations we can't identify with.

u situacijama u kojima se ne možemo pronaći.

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

Ono što niste pomislili, niko od nas nije,

is that antibiotics support almost all of modern life.

je da antibiotici igraju ulogu u skoro čitavom savremenom životu.

If we lost antibiotics,

Ako izgubimo antibiotike,

here's what else we'd lose:

evo šta bismo još izgubili:

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

prvo, svaku zaštitu za ljude sa oslabljenim imunim sistemom -

cancer patients, AIDS patients,

pacijente obolele od raka i side,

transplant recipients, premature babies.

pacijente sa izvršenom transplantacijom, prerano rođene bebe.

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

Zatim, svaki tretman kojim se unose strani objekti u telo:

stents for stroke, pumps for diabetes,

stentovi kod moždanog udara, pumpe kod dijabetesa,

dialysis, joint replacements.

dijalizu, artroplastiku.

Za koliko atletskih pripadnika bejbi bum generacije

How many athletic baby boomers need new hips and knees?

su potrebni novi kukovi i kolena?

A recent study estimates that without antibiotics,

Skorije istraživanje pokazuje da bi bez antibiotika

one out of ever six would die.

umro jedan od svakih šest.

Next, we'd probably lose surgery.

Potom bismo verovatno izgubili hirurgiju.

Many operations are preceded

Mnogim operacijama prethode

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.

izgubili bismo mogućnost da otvaramo skrivena mesta u telu.

So no heart operations,

Dakle, nema operacija na srcu,

no prostate biopsies,

nema biopsija prostate,

no Cesarean sections.

nema carskog reza.

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

Morali bismo da naučimo da se bojimo infekcija koje se sada čine neznatnim.

Strep throat used to cause heart failure.

Upala grla je ranije izazivala otkazivanje rada srca.

Skin infections led to amputations.

Infekcije kože su dovodile do amputacija.

Giving birth killed, in the cleanest hospitals,

Porođaj je ubijao, u najčistijim bolnicama,

almost one woman out of every 100.

skoro jednu ženu na svakih sto.

Pneumonia took three children out of every 10.

Upala pluća je odnosila troje dece od svakih 10.

More than anything else,

Više od svega,

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

izgubili bismo siguran način na koji vodimo naše živote svakog dana.

If you knew that any injury could kill you,

Kada biste znali da bi vas bilo koja povreda mogla ubiti,

da li biste vozili motor,

would you ride a motorcycle,

bomb down a ski slope,

survali se niz skijašku stazu,

climb a ladder to hang your Christmas lights,

peli se uz merdevine da okačite božićne lampice,

let your kid slide into home plate?

dozvolili svom detetu da se strmoglavi u bejzbol utakmici?

After all, the first person to receive penicillin,

Uostalom, prva osoba koja je primila penicilin,

a British policeman named Albert Alexander,

britanski policajac po imenu Albert Aleksander,

who was so ravaged by infection that his scalp oozed pus

koga je toliko razorila infekcija da mu je iz kože na glavi curio gnoj

and doctors had to take out an eye,

i doktori su morali da izvade oko,

was infected by doing something very simple.

zadobio je infekciju radeći nešto vrlo jednostavno.

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

Ušetao je u svoju baštu i ogrebao lice o trn.

That British project I mentioned which estimates that the worldwide toll

Onaj britanski projekat koji sam pomenula koji procenjuje da je svetski gubitak

right now is 700,000 deaths a year

700 000 smrti godišnje u ovom trenutku

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

takođe predviđa da ako ne budemo mogli to da kontrolišemo do 2050. godine,

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

ne dugo, danak će iznositi 10 miliona smrti godišnje.

How did we get to this point

Kako smo došli do ove tačke

where what we have to look forward to

na kojoj očekujemo

is those terrifying numbers?

te zastrašujuće brojeve?

The difficult answer is, we did it to ourselves.

Težak odgovor je: sami sebi smo to uradili.

Resistance is an inevitable biological process,

Otpornost je neizbežni biološki proces,

but we bear the responsibility for accelerating it.

ali mi nosimo odgovornost za njegovo ubrzanje.

We did this by squandering antibiotics

Uradili smo to rasipajući antibiotike

with a heedlessness that now seems shocking.

sa nepažljivošću koja sada deluje šokantno.

Penicillin was sold over the counter until the 1950s.

Penicilin je bio u slobodnoj prodaji do 1950-ih.

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

U mnogim zemljama u razvoju, većina antibiotika je još uvek.

In the United States, 50 percent

U Sjedinjenim Državama,

50 posto antibiotika datih u bolnicama je nepotrebno,

of the antibiotics given in hospitals are unnecessary.

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

45 posto recepata propisanih u doktorskim ordinacijama

are for conditions that antibiotics cannot help.

su za stanja kojima antibiotici ne mogu pomoći,

And that's just in healthcare.

a to je samo u oblasti zdravstva.

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

U većem delu planete, većina životinja koje daju meso

dobija antibiotike svakodnevno,

not to cure illnesses,

ne da bi se izlečile bolesti,

but to fatten them up and to protect them against

već da bi ih ugojili i da bi ih zaštitili

the factory farm conditions they are raised in.

od uslova fabričke farme u kojoj su uzgajane.

In the United States, possibly 80 percent

U Sjedinjenim Državama, verovatno 80 posto

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

antibiotika prodatih svake godine odlaze životinjama sa farme, ne ljudima,

creating resistant bacteria that move off the farm

stvarajući otpornu bakteriju koja se premešta sa farme

in water, in dust,

u vodu, prašinu,

in the meat the animals become.

u meso koje životinje postaju.

Aquaculture depends on antibiotics too,

Akvakultura takođe zavisi od antibiotika,

particularly in Asia,

naročito u Aziji,

and fruit growing relies on antibiotics

i uzgajanje voća se oslanja na antibiotike

to protect apples, pears, citrus, against disease.

da bi se jabuke, kruške i citrusi zaštitili od bolesti.

And because bacteria can pass their DNA to each other

A pošto bakterije mogu da prenose svoj DNK jedna na drugu

like a traveler handing off a suitcase at an airport,

kao putnik koji predaje svoj prtljag na aerodromu,

once we have encouraged that resistance into existence,

jednom kada podstaknemo tu otpornost,

ne zna se gde će se raširiti.

there is no knowing where it will spread.

This was predictable.

To se moglo predvideti.

In fact, it was predicted

Zapravo, to je i predvideo

by Alexander Fleming, the man who discovered penicillin.

Aleksandar Fleming, čovek koji je otkrio penicilin.

He was given the Nobel Prize in 1945 in recognition,

Dobio je Nobelovu nagradu 1945. godine kao priznanje

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

i u intervjuu ubrzo nakon toga, ovo je izjavio:

"The thoughtless person playing with penicillin treatment

„Nepromišljena osoba koja se igra sa penicilinskim lečenjem

is morally responsible for the death of a man

je moralno odgovorna za smrt čoveka

who succumbs to infection

koji podlegne infekciji

with a pencillin-resistant organism."

izazvanoj organizmom otpornim na penicilin.”

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

Dodao je: „Nadam se da se to zlo može izbeći.”

Can we avert it?

Možemo li ga izbeći?

There are companies working on novel antibiotics,

Postoje kompanije koje rade na novim antibioticima,

things the superbugs have never seen before.

stvarima kakve superbube nikada pre nisu videle.

We need those new drugs badly,

Veoma su nam potrebni ti novi lekovi

and we need incentives:

i potrebni su nam podsticaji:

discovery grants, extended patents,

donacije za otkrića, produženi patenti, nagrade,

prizes, to lure other companies into making antibiotics again.

da bismo privukli druge kompanije da ponovo prave antibiotike.

But that probably won't be enough.

Međutim, to verovatno neće biti dovoljno.

Here's why: Evolution always wins.

Evo zašto: evolucija uvek pobeđuje.

Bacteria birth a new generation every 20 minutes.

Bakterije rađaju novu generaciju svakih 20 minuta.

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

Farmaceutskoj hemiji je potrebno 10 godina da bi se proizveo novi lek.

Every time we use an antibiotic,

Svaki put kada koristimo antibiotik,

we give the bacteria billions of chances

dajemo bakterijama milijardu prilika

to crack the codes

da provale šifru odbrana

of the defenses we've constructed.

koje smo izgradili.

There has never yet been a drug

Još nije bilo leka

they could not defeat.

koji nisu uspele da poraze.

This is asymmetric warfare,

Ovo je asimetrično ratovanje,

but we can change the outcome.

ali mi možemo izmeniti ishod.

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

Možemo da izgradimo sisteme za prikupljanje podataka

koji će nam automatski i konkretno reći kako se antibiotici koriste.

how antibiotics are being used.

We could build gatekeeping into drug order systems

Možemo izgraditi kontrolu pristupa u sistemima poretka lekova

so that every prescription gets a second look.

tako da svaki recept bude preispitan.

We could require agriculture to give up antibiotic use.

Mogli bismo da zahtevamo da poljoprivreda odustane od korišćenja antibiotika.

We could build surveillance systems

Mogli bismo da izgradimo sistem nadzora

to tell us where resistance is emerging next.

koji bi nam rekao gde se javlja sledeća otpornost.

Those are the tech solutions.

To su tehnološka rešenja.

They probably aren't enough either,

Verovatno ni ona nisu dovoljna,

unless we help.

osim ukoliko mi pomognemo.

Antibiotic resistance is a habit.

Otpornost na antibiotike je navika.

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

Svi znamo koliko je teško promeniti naviku,

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

ali činili smo to u prošlosti, kao društvo.

People used to toss litter into the streets,

Ljudi su nekada bacali đubre po ulici,

used to not wear seatbelts,

nisu koristili sigurnosne pojaseve,

used to smoke inside public buildings.

pušili su u javnim zgradama.

We don't do those things anymore.

Više ne radimo te stvari.

We don't trash the environment

Ne razbacujemo đubre po okolini

or court devastating accidents

niti prizivamo nesagledive nesreće,

or expose others to the possibility of cancer,

niti izlažemo druge mogućnostima da dobiju rak,

because we decided those things were expensive,

jer smo presudili da su te stvari skupo koštale,

destructive, not in our best interest.

da su bile razarajuće, da nisu bile u našem najboljem interesu.

We changed social norms.

Promenili smo društvene norme.

We could change social norms around antibiotic use too.

Možemo promeniti i društvene norme vezane za korišćenje antibiotika.

I know that the scale of antibiotic resistance

Znam da se razmere otpornosti na antibiotike

seems overwhelming,

čine nesavladivim,

but if you've ever bought a fluorescent lightbulb

ali ako ste ikada kupili fluorescentnu sijalicu

jer ste bili zabrinuti zbog klimatskih promena,

because you were concerned about climate change,

or read the label on a box of crackers

ili ste pročitali deklaraciju na kutiji krekera

because you think about the deforestation from palm oil,

jer razmišljate o seči šuma radi dobijanja palminog ulja,

you already know what it feels like

već znate kakav je osećaj

to take a tiny step to address an overwhelming problem.

kada preduzmete mali korak da biste se bavili ogromnim problemom.

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

Mogli bismo da preduzmemo takve korake i u upotrebi antibiotika.

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

Možemo odustati od davanja antibiotika ako nismo sigurni da je to pravo rešenje.

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

Mogli bismo da prestanemo da insistiramo na propisivanju recepta

za infekciju uha svog deteta dok ne budemo sigurni šta ju je izazvalo.

before we're sure what caused it.

We could ask every restaurant,

Mogli bismo da pitamo svaki restoran,

every supermarket,

svaki supermarket,

where their meat comes from.

odakle dolazi njihovo meso.

We could promise each other

Mogli bismo da obećamo jedni drugima

never again to buy chicken or shrimp or fruit

da nećemo nikada više kupiti piletinu, škampe ili voće

raised with routine antibiotic use,

odgajane uz rutinsku upotrebu antibiotika,

and if we did those things,

i ako bismo to radili,

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

mogli bismo usporiti dolazak postantibiotičkog sveta,

But we have to do it soon.

ali moramo to da uradimo ubrzo.

Penicillin began the antibiotic era in 1943.

Penicilin je započeo antibiotičku eru 1943. godine.

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

Za samo 70 godina, došli smo do ruba propasti.

We won't get 70 years

Nećemo dobiti još 70 godina

to find our way back out again.

da ponovo nađemo izlaz.

Thank you very much.

Mnogo vam hvala.

(Applause)

(Aplauz)