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

譯者: 庭芝 梁 審譯者: Anny Chung

This is my great uncle,

這是我的叔公，

my father's father's younger brother.

我父親的父親的弟弟。

His name was Joe McKenna.

他叫做喬•麥肯納。

他是一位年輕的丈夫， 一位半職業的棒球選手，

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

and a fireman in New York City.

也是一個紐約市的消防員。

Family history says he loved being a fireman,

根據家族歷史記載， 他熱愛著擔任消防員的工作。

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

1938年的某一天， 在他下班之後，

he elected to hang out at the firehouse.

他被排定在消防局內待命。

為了想要幫忙， 他開始擦拭隊上的黃銅製品，

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

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

包括消防車上的扶手、 牆上的配件，

and one of the fire hose nozzles,

然而，當中有一座消防水槍，

a giant, heavy piece of metal,

這個巨大又沉重的金屬製品，

toppled off a shelf and hit him.

從架子上掉了下來，然後砸到他。

A few days later, his shoulder started to hurt.

過了幾天之後， 他的肩膀開始疼痛，

Two days after that, he spiked a fever.

之後又過了兩天，他開始發高燒，

The fever climbed and climbed.

他的體溫不斷升高，

His wife was taking care of him,

他的妻子在一旁照顧他，

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

但是病情並沒有改善，

即使請了醫生來看診，也莫可奈何。

nothing he did mattered either.

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

他們叫了一部計程車，把他送到醫院，

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

醫院的護士馬上判斷出， 他受到了感染，

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

當時他們將這種情況稱為"毒血症"。

and though they probably didn't say it,

雖然他們當時沒有明說，

they would have known right away

但是他們都清楚知道，

that there was nothing they could do.

當時對於這種感染， 是束手無策的。

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

原因在於，現在我們用來 治療感染的藥品，

to cure infections didn't exist yet.

在當時尚未問世。

The first test of penicillin, the first antibiotic,

人類所發現的第一個抗生素 － 盤尼西林，

是在事故發生的三年之後， 才首次進行人體臨床實驗。

was three years in the future.

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

在當時受到感染的患者， 如果不是幸運的康復了，

or they died.

就是只有死亡。

My great uncle was not lucky.

我的叔公並不幸運，

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

他在醫院待了一個星期， 過程中經歷了發抖、

dehydrated and delirious,

脫水、神智不清等症狀，

sinking into a coma as his organs failed.

由於器官衰竭，他陷入昏迷，

His condition grew so desperate

他的情況變得非常危急，

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

消防局的同仁們， 排著隊要輸血給他，

hoping to dilute the infection surging through his blood.

希望能藉由輸血，減輕他的感染現象，

Nothing worked. He died.

但是所有的嘗試都無效， 他最後還是死了。

He was 30 years old.

當時他只有30歲。

If you look back through history,

如果你回顧人類歷史，

most people died the way my great uncle died.

有許多人都像我叔公一樣， 死於感染。

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

而不是死於像癌症或是心臟病

the lifestyle diseases that afflict us in the West today.

這一類現代西方所謂的「文明病」。

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

他們沒有死於這些疾病，

是因為他們活得不夠久， 足以讓這些文明病形成。

to develop them.

They died of injuries --

他們往往死於外傷，

being gored by an ox,

例如被牛的角撞傷、

shot on a battlefield,

在戰場上中彈、

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

或是在工業革命後的 現代工廠裡受傷。

and most of the time from infection,

大部分的外傷，都會演變成為感染，

which finished what those injuries began.

最後導致死亡。

當抗生素出現時，情況改變了。

All of that changed when antibiotics arrived.

Suddenly, infections that had been a death sentence

「感染」突然從死亡的代名詞，

became something you recovered from in days.

變成一個幾天就能康復的疾病。

It seemed like a miracle,

看起來就像是魔法一樣，

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

從那個時候起，我們一直生活在 擁有魔法藥物的黃金時代裡。

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

而到了現在，我們即將面臨 這個時代的結束。

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

我的叔公在「前抗生素時代」末期過世， (指抗生素尚未發明的時代)

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

而我們正站在「後抗生素時代」的開端。

in the earliest days of a time when simple infections

像我的叔公 Joe 所得到的 看起來毫不起眼的感染，

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

現在可能捲土重來， 再次奪走人們的生命。

In fact, they already are.

事實上，這件事已經發生了。

People are dying of infections again because of a phenomenon

人們再次死於感染，

因為出現了稱之為 「抗生素抗藥性」的現象。

called antibiotic resistance.

Briefly, it works like this.

簡單說，它是這樣運作的：

Bacteria compete against each other for resources, for food,

為了爭奪資源與食物， 細菌之間會相互競爭，

by manufacturing lethal compounds that they direct against each other.

並藉由製造致命的化學物質， 來互相對抗。

Other bacteria, to protect themselves,

某些細菌為了保護自己，

會發展出防禦系統， 來對抗化學物質的攻擊。

evolve defenses against that chemical attack.

When we first made antibiotics,

當我們早期製造抗生素時，

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

就是把這些化學物質帶進實驗室， 並模仿合成出抗生素。

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

然而，細菌也不斷地用它們的方式， 來回應我們的攻擊。

Here is what happened next:

接下來的發展是：

Penicillin was distributed in 1943,

盤尼西林在1943年發明，

and widespread penicillin resistance arrived by 1945.

而盤尼西林的抗藥性， 出現在1945年。

Vancomycin arrived in 1972,

萬古黴素在1972年發明，

vancomycin resistance in 1988.

而萬古黴素的抗藥性， 出現在1988年。

亞胺培南在1985年發明，

Imipenem in 1985,

and resistance to in 1998.

而亞胺培南的抗藥性， 出現在1998年。

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

達托黴素，這是2003年的新藥之一，

and resistance to it just a year later in 2004.

而它的抗藥性，僅僅一年之後 在2004年就出現了。

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

70年來，我們研發的新藥， 以及細菌的抗藥性，

our drug and their resistance,

不斷地試圖「超越對方」，

and then another drug, and then resistance again --

然後我們研發出另一種新藥， 然後又出現新的抗藥性......

and now the game is ending.

現在，這個遊戲將要結束了。

Bacteria develop resistance so quickly that pharmaceutical companies

細菌產生抗藥性的速度愈來愈快，

由於不符經濟效益， 使得藥廠決定不再研發新的抗生素。

have decided making antibiotics is not in their best interest,

so there are infections moving across the world

於是，新的感染症再度蔓延全球，

for which, out of the more than 100 antibiotics

在目前市面上能購買得到的

100多種抗生素當中，

available on the market,

two drugs might work with side effects,

某些感染症只有兩種抗生素具有療效， 而且還伴隨著副作用

or one drug,

有些感染症只有一種抗生素可以治療，

or none.

某種感染症甚至還沒有特效藥。

This is what that looks like.

這就是目前的情況。

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

西元2000年，疾病控制和預防中心， 簡稱CDC

identified a single case

證實了一個

in a hospital in North Carolina

在北卡羅萊納州某一所醫院的案例，

of an infection resistant to all but two drugs.

這個感染病例，幾乎 對所有的藥物都有抗藥性， 只有兩種藥物例外。

Today, that infection, known as KPC,

現在我們知道， 這種稱為 KPC 的感染症狀，

has spread to every state but three,

已經散佈到美國各大州， 僅有三個州倖免，

and to South America, Europe

另外還傳染到南美洲、歐洲，

and the Middle East.

以及中東地區。

In 2008, doctors in Sweden

在2008年，瑞典的醫生發現，

diagnosed a man from India with a different infection

有位印度男子得到一種 有別以往的感染病，

resistant to all but one drug that time.

這個案例對所有的抗生素都有抗藥性， 只有一種藥物例外。

The gene that creates that resistance,

造成細菌產生抗藥性的基因，

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

被稱為NDM，目前已經從印度 散播到中國、亞洲、非洲、

Europe and Canada, and the United States.

歐洲、加拿大，還有美國。

It would be natural to hope

我們會理所當然地認為，

that these infections are extraordinary cases,

這些感染病例， 只是非常極端的例子；

but in fact,

但事實上，

in the United States and Europe,

在美國和歐洲，

50,000 people a year

每年有五萬人

die of infections which no drugs can help.

死於無藥可治的感染病。

A project chartered by the British government

這是來自英國政府所進行的

known as the Review on Antimicrobial Resistance

一項關於抗藥性的調查報告，

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

當中估計全球每年有七十萬人， 因感染而死亡，

That is a lot of deaths,

那是非常驚人的死亡人數。

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

即使如此，你我大概 尚未感受到危機，

that you imagine these people were hospital patients

你可能想這些病例， 主要是醫院裡的病人，

in intensive care units

長期於加護病房，

or nursing home residents near the ends of their lives,

或是接受安寧照顧臨終病患，

people whose infections are remote from us,

這些受到感染的病患 與我們相隔甚遠，

in situations we can't identify with.

他們處於我們 無法理解的環境中。

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

但是你或是我們任何人， 都未曾想到過，

is that antibiotics support almost all of modern life.

抗生素幾乎支持著 我們生活中的一切。

If we lost antibiotics,

如果我們失去了抗生素，

here's what else we'd lose:

我們還會失去以下的東西：

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

首先是缺乏免疫系統功能的病患， 他們會失去抗生素的保護，

cancer patients, AIDS patients,

包括癌症病患、愛滋病患、

transplant recipients, premature babies.

接受器官移植的病患，以及早產兒。

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

接下來是，植入人造物品 的所有醫療方式，

stents for stroke, pumps for diabetes,

包括中風治療用的血管支架、 糖尿病幫浦、

dialysis, joint replacements.

血液透析、人工關節。

你能否想像戰後嬰兒潮世代， 現在有多少人需要人工髖和膝關節？

How many athletic baby boomers need new hips and knees?

A recent study estimates that without antibiotics,

一個最近的研究估計顯示， 如果沒有抗生素，

one out of ever six would die.

每六個人當中就會有一位死亡。

Next, we'd probably lose surgery.

接下來，我們很有可能 無法進行各種手術。

Many operations are preceded

許多的手術過程，

by prophylactic doses of antibiotics.

都需要施打預防劑量的抗生素。

Without that protection,

如果沒有這樣的保護，

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

我們就無法切開身體的部位。

So no heart operations,

所以，不會再有心臟手術，

no prostate biopsies,

沒有攝護腺切片檢查，

no Cesarean sections.

沒有剖腹生產。

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

我們必須開始學著害怕那些 現在看來毫不起眼的感染，

Strep throat used to cause heart failure.

抗生素尚未問世前， 咽喉炎曾經引發心臟衰竭、

Skin infections led to amputations.

皮膚感染曾可能導致截肢。

Giving birth killed, in the cleanest hospitals,

過去即使在最乾淨的醫院中， 因難產而死亡的案例，

almost one woman out of every 100.

幾乎每一百位孕婦當中就有一位。

Pneumonia took three children out of every 10.

每10位感染肺炎的兒童當中， 就有3位因此而離開人世。

More than anything else,

更糟的是，

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

我們不再有足夠的自信， 能在日常環境當中，平安地生活。

If you knew that any injury could kill you,

如果你知道， 任何的受傷都可能害死自己，

你還會騎摩托車嗎？

would you ride a motorcycle,

bomb down a ski slope,

你還會從斜坡上進行滑雪跳躍？

climb a ladder to hang your Christmas lights,

你還會爬上梯子， 懸掛聖誕節燈泡？

let your kid slide into home plate?

你還會讓你的孩子滑向本壘？

After all, the first person to receive penicillin,

當初第一位接受盤尼西林治療的人，

a British policeman named Albert Alexander,

一位名叫Albert Alexander 的英國警察，

who was so ravaged by infection that his scalp oozed pus

曾經飽受細菌感染的折磨， 甚至嚴重到頭皮發膿，

and doctors had to take out an eye,

醫生甚至必須 摘除他的一隻眼睛，

was infected by doing something very simple.

而他所受到的感染， 卻是來自於生活中的事物：

當他走進花園時， 他的臉被尖刺劃過。

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

That British project I mentioned which estimates that the worldwide toll

我剛才提到的英國研究報告，

right now is 700,000 deaths a year

估計每年全球死亡人數約七十萬人，

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

另外它也預測了，如果我們無法在 2050年之前控制住這些情況，

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

不久之後，全球每年死亡人數 將攀升至每年一千萬人。

How did we get to this point

我們為何會走到現在這個地步？

where what we have to look forward to

使得我們必須面對

is those terrifying numbers?

眼前這樣的可怕的數字？

The difficult answer is, we did it to ourselves.

令人難堪的答案是： 由我們自己造成的。

Resistance is an inevitable biological process,

抗藥性，是一種必然出現的生物過程，

but we bear the responsibility for accelerating it.

但我們必須承擔加速它的責任，

We did this by squandering antibiotics

我們濫用抗生素， 加速了它的發展，

with a heedlessness that now seems shocking.

當時我們掉以輕心的態度， 現在看來卻怵目驚心。

Penicillin was sold over the counter until the 1950s.

直到1950年代為止， 盤尼西林都可以在藥局專櫃購買，

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

在許多發展中國家， 民眾可以自行買到大部分抗生素。

In the United States, 50 percent

在美國，醫院所提供的抗生素，

of the antibiotics given in hospitals are unnecessary.

有50%其實都不是必要的。

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

由醫生診療後所開出的處方籤，

are for conditions that antibiotics cannot help.

有45%都是抗生素無法發揮作用的。

And that's just in healthcare.

而這只不過是醫療界的情形。

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

在地球上許多地方， 大部分動物每天都在攝取抗生素，

not to cure illnesses,

原因不是為了治療疾病，

but to fatten them up and to protect them against

而是為了加速牠們成長， 用來保護牠們，

the factory farm conditions they are raised in.

以適應工廠以及農舍的生活環境。

In the United States, possibly 80 percent

在美國，每年約有80%的抗生素

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

是賣給農場的動物， 而不是人類，

creating resistant bacteria that move off the farm

這使得農場培養出 具有抗藥能力的細菌，

in water, in dust,

並且透過水、塵埃，

in the meat the animals become.

還有這些動物的肉品，散播各地。

Aquaculture depends on antibiotics too,

水產養殖也很依賴抗生素，

particularly in Asia,

尤其是在亞洲，

and fruit growing relies on antibiotics

水果種植也依賴抗生素，

to protect apples, pears, citrus, against disease.

用來保護蘋果、梨子、 柑橘，避免病蟲害。

And because bacteria can pass their DNA to each other

由於病菌之間可以互相傳遞DNA，

like a traveler handing off a suitcase at an airport,

就像一個旅客， 在機場托運行李一樣，

once we have encouraged that resistance into existence,

一旦我們激發出細菌的抗藥性，

我們無法知道它會散播到哪裡。

there is no knowing where it will spread.

This was predictable.

這種情形是可以預見的。

In fact, it was predicted

事實上，曾有一個預測，

by Alexander Fleming, the man who discovered penicillin.

來自亞歷山大·弗萊明， 他是發現盤尼西林的人。

He was given the Nobel Prize in 1945 in recognition,

他在1945年得到諾貝爾獎，

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

他在獲獎後不久， 接受記者採訪時說過：

"The thoughtless person playing with penicillin treatment

"那些輕率地濫用青黴素治療的人，

is morally responsible for the death of a man

應該對於那些

who succumbs to infection

由於細菌產生抗藥性 受到感染而死亡的人

with a pencillin-resistant organism."

背負道德責任。"

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

他還補充說："我希望 這種罪惡是可以避免的。"

Can we avert it?

我們可以避免嗎？

There are companies working on novel antibiotics,

有些公司致力於研發新型抗生素，

things the superbugs have never seen before.

來對抗從未見過的超級病毒。

We need those new drugs badly,

我們急切需要這些新的藥物，

and we need incentives:

因此需要獎勵政策：

discovery grants, extended patents,

補助研發、延長專利年限、

prizes, to lure other companies into making antibiotics again.

提供獎金，以吸引其他企業 重新投入抗生素的製造。

But that probably won't be enough.

但是，只有這些仍然不夠。

Here's why: Evolution always wins.

原因是：演化最後還是會獲得勝利。

Bacteria birth a new generation every 20 minutes.

細菌每隔20分鐘就能繁殖出下一代。

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

但是在藥物化學領域， 研發一種新藥需要花費10年的時間。

Every time we use an antibiotic,

每一次我們使用抗生素，

we give the bacteria billions of chances

就提供了細菌數十億次的機會，

to crack the codes

來破解我們已經構築的防禦體系。

of the defenses we've constructed.

There has never yet been a drug

沒有任何一種藥物，

they could not defeat.

能完全抵抗細菌的攻擊。

This is asymmetric warfare,

這是一場不對稱的戰爭，

but we can change the outcome.

但我們可以改變結果。

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

我們可以建立一套系統來分析數據，

自動化並且明確地告訴我們，

how antibiotics are being used.

抗生素的使用情況。

We could build gatekeeping into drug order systems

我們可以建立藥物醫囑系統的把關機制，

so that every prescription gets a second look.

對每一個處方籤進行再次確認。

We could require agriculture to give up antibiotic use.

我們可以要求種植農作物時 不再使用抗生素。

We could build surveillance systems

我們可以建立監視系統，

to tell us where resistance is emerging next.

告訴我們下一波的 抗藥性細菌何處出現

Those are the tech solutions.

這些都是運用高科技的解決方案。

They probably aren't enough either,

但是這些建議仍然不夠，

unless we help.

除非我們願意付出心力。

Antibiotic resistance is a habit.

細菌會產生抗藥性， 是一種必然的習性。

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

我們都知道要改變習性 是多麼的困難。

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

但作為社會的一份子， 我們過去曾經做到了。

People used to toss litter into the streets,

過去，人們習慣在路上丟棄垃圾、

used to not wear seatbelts,

習慣開車時不繫安全帶、

used to smoke inside public buildings.

習慣在室內吸煙。

We don't do those things anymore.

可是現在，我們不會再做這些事。

We don't trash the environment

我們選擇"不再亂丟垃圾"、

or court devastating accidents

"避免意外事故的發生"，

or expose others to the possibility of cancer,

或是"不再讓別人暴露於 致癌的環境中"，

because we decided those things were expensive,

因為我們這些行為的代價高昂，

destructive, not in our best interest.

且具有破壞性， 違反個人的利益。

We changed social norms.

因此，我們改變了這些社會規範。

We could change social norms around antibiotic use too.

同樣的，我們可以改變 濫用抗生素的社會風氣。

I know that the scale of antibiotic resistance

我知道，抗生素抗藥性的規模，

seems overwhelming,

已經勢不可擋，

but if you've ever bought a fluorescent lightbulb

但如果你曾經因為

關心氣候變遷 而購買了節能燈泡；

because you were concerned about climate change,

or read the label on a box of crackers

或是因為關心棕櫚樹林的砍伐，

because you think about the deforestation from palm oil,

而在購買餅乾時 仔細閱讀盒子上的成分標籤，

you already know what it feels like

你一定可以體會到那種感覺：

to take a tiny step to address an overwhelming problem.

"要解決大問題，必須從小事做起。”

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

所以，我們也可以把這些行動， 應用在抗生素的使用上。

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

當我們無法確定抗生素是必需的。 我們可以不使用。

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

當我們的孩子感染中耳炎時， 我們不必堅持用抗生素，

before we're sure what caused it.

直到我們找出病因為止。

We could ask every restaurant,

我們可以詢問每家餐廳

every supermarket,

或是超市，

where their meat comes from.

它們的肉品從何而來。

We could promise each other

我們可以承諾，

never again to buy chicken or shrimp or fruit

不再購買長期施用抗生素的 雞肉、蝦子或水果，

raised with routine antibiotic use,

and if we did those things,

如果我們能做到這些事情，

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

就可能減緩 "後抗生素世界" 的到來。

But we have to do it soon.

但是，我們必須盡快採取行動。

Penicillin began the antibiotic era in 1943.

1943年，盤尼西林開啟了 抗生素時代。

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

在短短的70年後， 我們卻讓自己走到了災難的邊緣。

We won't get 70 years

我們不再有另一個70年，

to find our way back out again.

可以尋找未來的出路。

Thank you very much.

非常謝謝大家。

(Applause)

(掌聲)