00:12

This is my great uncle, my father's father's younger brother. His name was Joe McKenna. He was a young husband and a semi-pro basketball player and a fireman in New York City. Family history says he loved being a fireman, and so in 1938, on one of his days off, he elected to hang out at the firehouse. To make himself useful that day, he started polishing all the brass, the railings on the fire truck, the fittings on the walls, and one of the fire hose nozzles, a giant, heavy piece of metal, toppled off a shelf and hit him. A few days later, his shoulder started to hurt. Two days after that, he spiked a fever. The fever climbed and climbed. His wife was taking care of him, but nothing she did made a difference, and when they got the local doctor in, nothing he did mattered either.

01:13

They flagged down a cab and took him to the hospital. The nurses there recognized right away that he had an infection, what at the time they would have called "blood poisoning," and though they probably didn't say it,they would have known right away that there was nothing they could do.

01:33

There was nothing they could do because the things we use now to cure infections didn't exist yet. The first test of penicillin, the first antibiotic, was three years in the future. People who got infections either recovered, if they were lucky, or they died. My great uncle was not lucky. He was in the hospital for a week, shaking with chills, dehydrated and delirious, sinking into a coma as his organs failed. His condition grew so desperate that the people from his firehouse lined up to give him transfusions hoping to dilute the infection surging through his blood.

02:13

Nothing worked. He died. He was 30 years old.

02:19

If you look back through history, most people died the way my great uncle died. Most people didn't die of cancer or heart disease, the lifestyle diseases that afflict us in the West today. They didn't die of those diseases because they didn't live long enough to develop them. They died of injuries -- being gored by an ox,shot on a battlefield, crushed in one of the new factories of the Industrial Revolution -- and most of the time from infection, which finished what those injuries began.

02:56

All of that changed when antibiotics arrived. Suddenly, infections that had been a death sentence became something you recovered from in days. It seemed like a miracle, and ever since, we have been living inside the golden epoch of the miracle drugs.

03:17

And now, we are coming to an end of it. My great uncle died in the last days of the pre-antibiotic era. We stand today on the threshold of the post-antibiotic era, in the earliest days of a time when simple infectionssuch as the one Joe had will kill people once again.

03:40

In fact, they already are. People are dying of infections again because of a phenomenon called antibiotic resistance. Briefly, it works like this. Bacteria compete against each other for resources, for food, by manufacturing lethal compounds that they direct against each other. Other bacteria, to protect themselves,evolve defenses against that chemical attack. When we first made antibiotics, we took those compounds into the lab and made our own versions of them, and bacteria responded to our attack the way they always had.

04:19

Here is what happened next: Penicillin was distributed in 1943, and widespread penicillin resistance arrived by 1945. Vancomycin arrived in 1972, vancomycin resistance in 1988. Imipenem in 1985, and resistance to in 1998. Daptomycin, one of the most recent drugs, in 2003, and resistance to it just a year later in 2004.

04:50

For 70 years, we played a game of leapfrog -- our drug and their resistance, and then another drug, and then resistance again -- and now the game is ending. Bacteria develop resistance so quickly that pharmaceutical companies have decided making antibiotics is not in their best interest, so there are infections moving across the world for which, out of the more than 100 antibiotics available on the market, two drugs might work with side effects, or one drug, or none.

05:27

This is what that looks like. In 2000, the Centers for Disease Control and Prevention, the CDC, identified a single case in a hospital in North Carolina of an infection resistant to all but two drugs. Today, that infection, known as KPC, has spread to every state but three, and to South America, Europe and the Middle East. In 2008, doctors in Sweden diagnosed a man from India with a different infection resistant to all but one drug that time. The gene that creates that resistance, known as NDM, has now spread from India into China, Asia, Africa, Europe and Canada, and the United States.

06:16

It would be natural to hope that these infections are extraordinary cases, but in fact, in the United States and Europe, 50,000 people a year die of infections which no drugs can help. A project chartered by the British government known as the Review on Antimicrobial Resistance estimates that the worldwide toll right now is 700,000 deaths a year.

06:50

That is a lot of deaths, and yet, the chances are good that you don't feel at risk, that you imagine these people were hospital patients in intensive care units or nursing home residents near the ends of their lives, people whose infections are remote from us, in situations we can't identify with.

07:14

What you didn't think about, none of us do, is that antibiotics support almost all of modern life.

07:23

If we lost antibiotics, here's what else we'd lose: First, any protection for people with weakened immune systems -- cancer patients, AIDS patients, transplant recipients, premature babies.

07:39

Next, any treatment that installs foreign objects in the body: stents for stroke, pumps for diabetes, dialysis, joint replacements. How many athletic baby boomers need new hips and knees? A recent study estimates that without antibiotics, one out of ever six would die.

08:02

Next, we'd probably lose surgery. Many operations are preceded by prophylactic doses of antibiotics. Without that protection, we'd lose the ability to open the hidden spaces of the body. So no heart operations, no prostate biopsies, no Cesarean sections. We'd have to learn to fear infections that now seem minor. Strep throat used to cause heart failure. Skin infections led to amputations. Giving birth killed, in the cleanest hospitals, almost one woman out of every 100. Pneumonia took three children out of every 10.

08:49

More than anything else, we'd lose the confident way we live our everyday lives. If you knew that any injury could kill you, would you ride a motorcycle, bomb down a ski slope, climb a ladder to hang your Christmas lights, let your kid slide into home plate? After all, the first person to receive penicillin, a British policeman named Albert Alexander, who was so ravaged by infection that his scalp oozed pus and doctors had to take out an eye, was infected by doing something very simple. He walked into his garden and scratched his face on a thorn. That British project I mentioned which estimates that the worldwide toll right now is 700,000 deaths a year also predicts that if we can't get this under control by 2050, not long, the worldwide toll will be 10 million deaths a year.

10:01

How did we get to this point where what we have to look forward to is those terrifying numbers? The difficult answer is, we did it to ourselves. Resistance is an inevitable biological process, but we bear the responsibility for accelerating it. We did this by squandering antibiotics with a heedlessness that now seems shocking.Penicillin was sold over the counter until the 1950s. In much of the developing world, most antibiotics still are.In the United States, 50 percent of the antibiotics given in hospitals are unnecessary. Forty-five percent of the prescriptions written in doctor's offices are for conditions that antibiotics cannot help. And that's just in healthcare. On much of the planet, most meat animals get antibiotics every day of their lives, not to cure illnesses, but to fatten them up and to protect them against the factory farm conditions they are raised in. In the United States, possibly 80 percent of the antibiotics sold every year go to farm animals, not to humans,creating resistant bacteria that move off the farm in water, in dust, in the meat the animals become.Aquaculture depends on antibiotics too, particularly in Asia, and fruit growing relies on antibiotics to protect apples, pears, citrus, against disease. And because bacteria can pass their DNA to each other like a traveler handing off a suitcase at an airport, once we have encouraged that resistance into existence, there is no knowing where it will spread.

12:05

This was predictable. In fact, it was predicted by Alexander Fleming, the man who discovered penicillin. He was given the Nobel Prize in 1945 in recognition, and in an interview shortly after, this is what he said:

12:23

"The thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to infection with a pencillin-resistant organism." He added, "I hope this evil can be averted."

12:40

Can we avert it? There are companies working on novel antibiotics, things the superbugs have never seen before. We need those new drugs badly, and we need incentives: discovery grants, extended patents, prizes, to lure other companies into making antibiotics again.

13:05

But that probably won't be enough. Here's why: Evolution always wins. Bacteria birth a new generation every 20 minutes. It takes pharmaceutical chemistry 10 years to derive a new drug. Every time we use an antibiotic,we give the bacteria billions of chances to crack the codes of the defenses we've constructed. There has never yet been a drug they could not defeat.

13:37

This is asymmetric warfare, but we can change the outcome. We could build systems to harvest data to tell us automatically and specifically how antibiotics are being used. We could build gatekeeping into drug order systems so that every prescription gets a second look. We could require agriculture to give up antibiotic use.We could build surveillance systems to tell us where resistance is emerging next.

14:15

Those are the tech solutions. They probably aren't enough either, unless we help. Antibiotic resistance is a habit. We all know how hard it is to change a habit. But as a society, we've done that in the past. People used to toss litter into the streets, used to not wear seatbelts, used to smoke inside public buildings. We don't do those things anymore. We don't trash the environment or court devastating accidents or expose others to the possibility of cancer, because we decided those things were expensive, destructive, not in our best interest.We changed social norms. We could change social norms around antibiotic use too.

15:17

I know that the scale of antibiotic resistance seems overwhelming, but if you've ever bought a fluorescent lightbulb because you were concerned about climate change, or read the label on a box of crackers because you think about the deforestation from palm oil, you already know what it feels like to take a tiny step to address an overwhelming problem. We could take those kinds of steps for antibiotic use too. We could forgo giving an antibiotic if we're not sure it's the right one. We could stop insisting on a prescription for our kid's ear infection before we're sure what caused it. We could ask every restaurant, every supermarket, where their meat comes from. We could promise each other never again to buy chicken or shrimp or fruit raised with routine antibiotic use, and if we did those things, we could slow down the arrival of the post-antibiotic world.

16:29

But we have to do it soon. Penicillin began the antibiotic era in 1943. In just 70 years, we walked ourselves up to the edge of disaster. We won't get 70 years to find our way back out again.

16:50

Thank you very much.

16:52

(Applause)

00:12

这是我的曾伯父， 我的父亲的父亲的弟弟 他叫乔·麦肯纳 他是一位年轻的丈夫 和一位半职业篮球运动员， 还是一位纽约市消防员 家族史中说他非常喜爱当一名消防员， 在1938年，放假的一天， 他选择去消防站 他想帮忙，于是就开始擦拭所有的黄铜， 消防车上的栏杆，墙上的配件， 其中的一个消防水管的喷嘴， 一块巨大，沉重的金属， 从架子上掉了下来，并砸中了他 几天之后，他的肩膀开始疼痛 再过了两天，他突发高烧。 高烧不退，并且不断攀升 他的妻子一直在照顾他， 但是她所做的一切都没有用， 当他们请来医生时， 也对他无能为力

01:13

他们拦下了一辆出租车， 把他带到医院 那里的护士马上看出他得了感染， 当时候的人把它叫败血症， 尽管他们没有说什么， 他们肯定马上就知道 他们已经无力医治了

01:33

他们什么办法都没有 是因为我们现在拥有的 治疗感染的药品在那时还没有存在 第一个青霉素，抗生素的测试，三年之后才发生 当时一旦得了感染， 能够康复算是幸运的， 要不然就没命了 我的曾伯父没有那么幸运 他在医院待了一个星期，一直打寒颤， 脱水，并且神志不清， 他的器官衰退，进入了昏迷状态 他的状况十分危急， 消防站的人排队给他输血， 希望能稀释他血液中的感染

02:13

一切都没有用，他最终不幸去世了 他年仅30岁

02:19

如果回顾历史， 有许多人离世的情况同我曾伯父类似 许多人并不是因为癌症或心脏病去世， 不是现在折磨我们的生活习惯病 他们没有患上那些疾病是因为他们活不到 得那些疾病的年龄 他们是因身体受伤而死 -- 被牛角顶伤， 在战场上中弹， 在工业革命的新工厂中粉身碎骨 -- 很多时候，是因为得了感染， 因伤势造成的感染

02:56

当抗生素到来时，一切都变了 曾经意味着死亡的感染突然 变成了几天就能恢复的病 它就像奇迹 从此以后， 我们就一直生活在特效药的黄金时代中

03:17

现在，它即将结束了 我的曾伯父在前抗生素时代 最后的日子中去世的 我们现在已经能看到后抗生素时代的到来感染会像从前一样致命， 杀死乔（曾伯父）的致命感染会卷土重来

03:40

其实， 这些感染已经夺取了很多人的性命了 人们再次死于感染因为有一种现象 叫做抗生素抗药性 简单的来说，它的原理是这样的 细菌为了资源和食物相互竞争， 有的细菌会针对性地制造 致命的化合物攻击对方 其它的细菌则用化合物保护自己， 发展防御系统对抗这些化学攻击 我们最初发明抗生素时， 我们在实验室中创造了 我们自己版本的化合物 细菌像往常一样对我们的攻击作出了响应

04:19

接下来是这样的： 青霉素是在1943年发布的， 而广泛的青霉素耐药性在1945年就到来了 万古霉素出现在1972年， 万古霉素耐药性就在1988年 亚胺培南于1985年， 抗药性在1998年又出现了 2003年的达托霉素是最新的药物之一， 抗药性在2004年就紧跟而至

04:50

在这70年中， 我们像是在做一个蛙跳的游戏 -- 一种药物，一种抗药性， 接下来又一种药物，又一个抗药性 --现在这个游戏结束了 细菌的抵抗力极快， 以至于制药公司 认为生产抗生素不是他们的最佳利益， 所以现在各种感染风靡全球， 市场上可购买到的100多种 抗生素中， 可能只有两种药物会管用， 并带有副作用 或者一个药，甚至没有

05:27

看上去就是这个样子的 在2000年， 疾病控制与预防中心（CDC）， 鉴定有一例患者 在一家位于北卡罗来纳的医院里 除了两种药外，对其它药物都有抗药性 现在，这种感染被称为KPC， 除了3个州外，已经传播到了美国各地， 还有南美，欧洲 和中东地区 在2008年，瑞典医生 确诊一名来自印度的男子患有的感染 只对一种药没有抗药性 创造这种抗药性的基因 叫做NDM，现在已经从印度传播到 中国，亚洲，非洲， 欧洲和加拿大，还有美国

06:16

我们真心希望 这些感染病例只是罕见情况， 但是其实， 在美国和欧洲， 每年都有50,000人 死于无药可救的感染 一项由英国政府特许的项目 叫做抗生素抗药性评审 预计每年全球死亡人数有700,000

06:50

这个数字巨大， 然而这个比例还是很小， 所以我们感觉不到风险， 你想象他们是医院里的病人 在重症监护室或者住在疗养院中，接近生命的尽头， 感觉他们离我们很远， 他们的状况我们还很陌生

07:14

你们想不到的是， 我们所有人都想不到的是 抗生素支撑着几乎所有的现代生活

07:23

如果我们失去了抗生素， 我们还会失去所有这些东西： 首先，所有免疫系统较弱的人 都失去了保护 -- 癌症患者，艾滋病患者， 器官移植接受者，早产婴儿

07:39

接下来，任何需要在人体中 安装异物的治疗： 中风时使用的支架， 治疗糖尿病的胰岛素磊 透析，关节置换 婴儿潮一代的运动员有多少需要髋关节， 膝关节置换？ 一个近期的研究预计如果没有抗生素， 每六个人中就会有一人死亡

08:02

接下来，我们可能会失去手术 很多手术的进行 需要预防性剂量的抗生素 如果没有这个措施， 我们就不可能对人体隐蔽的器官开刀 于是就不会有心脏手术， 没有前列腺活检， 没有剖腹产 我们会惧怕那些现在看似微小的感染咽喉炎以前会导致心脏衰竭 皮肤感染会发展成截肢 即使在最干净的医院， 孕产妇的死亡率 几乎达到百分之一每10个孩子中， 肺炎会夺走3个孩子的生命

08:49

更重要的是， 我们失去了生活的信心 如果你知道任何伤口都有可能致命， 你还会不会去骑摩托车， 从雪山上飞驰而下， 爬上梯子去挂你的圣诞彩灯， 让你的孩子滑进本垒吗？ 毕竟，第一名接受青霉素的病人， 一名叫阿尔伯特·亚历山大英国警察， 他的感染严重到他的头皮都渗出了脓液， 一只眼睛也被医生摘除了， 他的感染的起因十分微不足道 他走进他的花园，然后脸上被刺划伤了 刚才我提到的英国项目预计现在每年的 全球死亡人数为700,000人 他们也预测如果我们无法在2050年前 控制现在的情况， 在不久的将来， 全球死亡人数会上升到一千万

10:01

我们是如何走到这一步的， 面对这些可怕的数字 我们的未来将何去何从？ 残酷的现实是， 这都是我们的所作所为 抗药性是一个必然的生物过程， 但是我们要为加快这一过程承担责任 我们随心所欲地滥用抗生素的行为 现在看来十分触目惊心 青霉素在上世纪50年代之前是非处方药 在很多发展中国家，很多抗生素依旧是 在美国，医院给出的 50%的抗生素都是没有必要的 医生办公室中开出的45%的药 都是抗生素治不了的病 这只是在医疗系统中的数据 在全球很多地方， 许多家畜每天都进食抗生素， 不是为了治疗疾病， 而是把它们催肥，为了在 工厂化养殖的环境下保护它们 在美国，每年大约有80%的 抗生素是卖给农场动物的， 不是病人， 于是创造了抗药性细菌， 它们从农场流到了 水里，到灰尘中， 到这些动物最终变成的肉制品中 水产养殖也依赖抗生素， 尤其是在亚洲， 水果种植也依靠抗生素， 让苹果，梨，柑橘远离病害， 由于细菌能够互相传递DNA 就像一个旅客在机场托运行李， 一旦我们促进这种耐药性， 就无法控制它的传播

12:05

这是可预测的 事实上，发现青霉素的科学家， 亚历山大·弗莱明早已预测到了 他在1945年获得诺贝尔奖表彰，在之后的一个采访中，他说：

12:23

“滥用青霉素的无知的人 将在道德上为他人的死负责， 他的无知带来了耐药性的问题， 导致那些人为此丧命。“他补充道：”我希望能够 避免这个厄运。“

12:40

我们能避免它吗？ 有些公司正在研发新型抗生素， 一些超级细菌从未见过的东西 我们十分迫切地需要这些药物， 我们也需要一些奖励： 研发补助，延长专利， 奖金等等， 去吸引其它公司再次制造去抗生素

13:05

但是这还不够 这就是原因：大自然的进化总会赢 细菌每20分钟就能生成新的一代 药物化学家需要花10年 才能制成一种新的药 每次我们使用一种新的抗生素时， 我们就给了细菌数亿次机会 去破解我们建造的 防御系统的密码 迄今为止，任何药物都不能够 打败它们

13:37

这是一场不公平的战争， 但是我们能够改变它的结果 我们能够创造一个系统去收集数据， 并且自动、具体地 告诉我们抗生素是如何被使用的 我们可以在药物订购系统中放置守门人， 再次检查每一个处方 我们可以要求在农业中不再使用抗生素 我们可以构建监控系统 及时告知我们哪里出现了抗药性

14:15

这些是科技解决方案 这些还不够， 我们都要出一份力 抗生素耐药性是一种习惯 我们都知道改掉一种习惯是很难的 但是作为社会中的一员， 我们曾经做到过 人们曾经在马路上随便扔垃圾， 曾经不系安全带， 曾经在公共场所抽烟 我们不再这么做了 我们不破坏环境， 不引发巨大事故， 不再使别人得到患有癌症的风险， 因为我们懂得那些事情代价太高， 具有毁灭性，对我们没有一点益处 我们改变了社会规范 我们也可以改变抗生素使用的规范

15:17

我知道抗生素耐药性的规模 看似巨大， 但是如果你对气候变化感到忧虑， 于是去购买荧光灯泡， 或者考虑到棕榈油毁林， 就每次阅读一盒饼干上的标签 你应该已经知道 用生活中的一点一滴去改变一个大问题 是什么样的感觉 我们也可以用这样的方式 去改变抗生素的使用 如果不确定我们是否正确使用抗生素， 那就放弃它 我们可以 不要执意为孩子的耳部感染开处方， 而是先查明起因 我们可以询问每一家餐厅， 每一家超市 它们的肉制品是从哪里来的 我们可以做承诺 不再购买长期使用抗生素养殖的 鸡，虾或水果， 若果我们能做到这些， 我们可以减缓后抗生素时代的到来

16:29

但是我们要马上开始行动 青霉素在1943年开启了抗生素时代 仅仅70年后，我们已经走在灾难的边缘 我们没有70年的时间 去找到我们的出路

16:50

谢谢大家！

16:52

（掌声）

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