The Good Wife

Steffanie Strathdee, [is] the associate dean of global health science at the University of California, San Diego. In 2016, she helped revive her husband from a coma with a combination of phage therapy and antibiotics after he’d come back from Egypt with an untreatable bacterial infection, and she’s since become a kind of phage activist, helping others, like the Smiths, coordinate their own phage hunts.

That’s just a sidenote in an article on phages, viruses that kill bacteria. Seems like there’s a movie there.

Phages were long used in the Soviet Union to treat bacterial infections but are only now being studied in the West as bacteria evolve resistance to antibiotics.

Addendum: Dallas Weaver makes excellent points in the comments.


60 Minutes covered this 15 years ago mentioning that US scientists had "only now started" to study these. I guess that went nowhere.

"Phages were long used in the Soviet Union to treat bacterial infections but are only now being studied in the West as bacteria evolve resistance to antibiotics."

"Slavoy oveyana, voleyu spayana,
Krepni i zdravstvuy vo veki vekov
Partiya Lenina, partiya Stalina
Mudraya partiya bol’shevikov!
Stranu ot Kremlya sozdala na zemlye ty
Moguchuyu Rodinu vol’nykh lyudey.
Stoit kak utyos gosudarstvo Sovetov,
Rozhdennoye siloy i pravdoy tvoey."

I've had family members with cancer who resorted to experimental therapy after conventional therapy no longer worked, so I am sympathetic to phage therapy and other new, unconventional therapies. And I appreciate that unconventional therapy not only may not work, but may hasten death. As long as unconventional therapy poses no risks to others, why should I object. "The high bacterial strain specificity of phage therapy may make it necessary for clinics to make different cocktails for treatment of the same infection or disease because the bacterial components of such diseases may differ from region to region or even person to person." In other words, phage therapy isn't like generalized antibiotics, but must be created "on the fly". Is that a problem? Well, a virus is a virus. "Temperate (or Lysogenic) bacteriophages are not generally used therapeutically, as this group can act as a way for bacteria to exchange DNA; this can help spread antibiotic resistance or even, theoretically, make the bacteria pathogenic (see Cholera). Carl Merril claimed that harmless strains of corynebacterium may have been converted into c. diphtheriae that "probably killed a third of all Europeans who came to North America in the seventeenth century". Fortunately, many phages seem to be lytic only with negligible probability of becoming lysogenic." Now, that's reassuring, isn't it.

Done. Arrowsmith by Sinclair Lewis, first published in 1925.

If you want to know why phage therapy has problems evolving in the US, the answer is just three letters: FDA.

As phages are in a continuing red-queen evolutionary game (running as fast as you can to stay in one place) with evolving bacterial defenses and specific phages can be specific to sub-species of bacteria, there is no way of making money in this game if you have to prove "efficacy" to the FDA before you sell your specific phage for a specific sub-species of bacteria that are continually evolving.

To play this game, we will need an automated system to speed up the evolutionary selection of lytic phages as the bacteria evolve with hundreds of variations on the shelf to cover the evolutionary options open to the bacteria. All these variations need instant approval, but that would create a finite risk that the zero risk tolerant FDA won't allow.

In a Petrie dish of E. coli, you can add a lytic phage that will kill 99.9999% of the bacteria in a few hours but by the next day, the bacteria have evolved resistance to that phage. This is what that CRISPER cas9 gene editing system is all about as the bacteria evolve to cut up the virus meanwhile the phage is mutating and evolving methods of countering the defense.

This does not fit the FDA model for a simple specific chemical and billion dollar decade-long approval systems for each chemical. Changing the US FDA appears to be a near-impossible task and our only hope is that bacteria control system based upon phages will evolve with animal culture in some other country, without FDA interference, and then move to humans outside the US and then, after massive numbers of people go somewhere else to treat multi-drug resistant bacteria, we will consider real change.

Is there some reason why the bacteria would not develop resistance to the phage in the human body, and come back just as quickly as the bacteria in the petri dish? If you need to develop a new phage every day, your business model has bigger problems than FDA approval.

Given the quoted six nines efficacy (I have no idea how often that's the case), it seems you would need one or at most two treatments to eliminate the infection.

The idea is to kill enough of the bacteria that the body's immune system can finish off the survivors before the bacteria develop immunity. This is part of the reason you should finish antibiotic courses even after you get well since you don't want any survivors who are much more likely to be resistant now that you introduced them to the antibotic.

'the answer is just three letters: FDA'

Which undoubtedly explains why Poland has been held back from using phages. Though it does not explain why the Poles continue to sell phage treatments (though only at three locations) for under 2000 dollars.

Seems like what might work is for the FDA to approve a genetic "line" of phages which can evolve in concert with the bacteria. Maybe one the parent phage is approved allow a certain finite number of generations to automatically be approved, or a certain number of years before approval must be renewed. That or get out of the way. Obviously the latter is preferable, but the former might be more politically palatable.

Regarding the FDA, perhaps it will come around. The FDA's point person on phage therapy is very careful to say that the agency is not "anti-phage" and is not trying to stymie the growth of the field. Unfortunately, it seems likely that antibiotic resistance will continue to get worse before it gets better. If that ends up being the case, the FDA's willingness to consider new regulatory frameworks could (should!) increase as well.

A very good but not too technical article on phage therapy is here:

Since phages are scientifically known to be effective it would be pretty bad for the FDA to be openly hostile, but methinks they protest too much.

"only now being studied"?

AFAIK it is true the US hasn't done as much with applied/clinical work with them as other countries did. However, studies of bacteriophages vs. bacteria in biology labs have been extensive and important. In particular, mechanisms of bacterial resistance to bacteriophages were dissected down to the level of molecular detail that revealed restriction enzymes, and restriction enzymes are absolutely central to most of the genetic engineering done in the 20th century. (Later the story gets more complicated because of things like the even-whizzier enzymes used in CRISPR --- reasonable molecular biologists back in 1980 might've argued about whether to call them restriction enzymes, more or less like reasonable loggers in 1880 might've argued about whether to call a chainsaw a handsaw.)

"Dallas Weaver makes excellent points in the comments."
Teacher's pet!!

"Seems like there’s a movie there."

Lorenzo's Oil

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