Our hospitals are becoming hazardous places. One can go in with a curable illness and come out with an incurable one. The risk of being infected by a "superbug", bacterial infection that is resistant to antibiotic, is very real. It has always been possible to die from surgical infection, but the arrival of superbugs has increased this risk enormously. Within ten years most of these infections will not be treatable with antibiotics.
This crisis is solely due to overuse of antibiotics. We use antibiotics as a panacea for all illnesses, and doctors have become accustomed to prescribing them as blanket coverage for all complaints. Patients, too, think antibiotics are magic bullets and demand them for every flu of every season. Worse, we use antibacterial agents in household products such as washing-up liquid, bin liners and kitchen utensils. A recent essay in Nature shows how this domestic overuse is leading to resistant bacteria. For example, E coli, one of the most common causes of food poisoning, is developing resistance to triclosan, a common antibacterial agent.
That is the bad news. The good news is that there is a relatively safe and easy cure for drug-resistant strains of infectious bacteria. It's called phage therapy. Bacteriophage, or "bacteria eaters", are viruses extracted from raw sewage. They thrive wherever bacteria thrive - in our bodies, waste products, rivers. Phage therapy has been freely available in the former communist world for decades. Even now, a dilapidated factory in Tblisi, Georgia, is producing supplies of bacteriophage under the most difficult conditions. And we in the west, having spent astronomical sums in a vain attempt to contain killer bugs, are beginning to think about learning from them.
Why didn't we know this before? Why has no research been done in the west on bacteriophage? And what does this tell us about the way science is governed?
The history of bacteriophage reads like a thriller. It starts a century ago with some "local knowledge" in India that a western scientist took seriously. The water of the river Ganges, despite a multitude of polluting sources, does not carry infections. The scientist, putting aside disbelief and mysticism, discovered that there is an anti-infectious agent in the water. Then, during the first world war, a Canadian scientist, Felix d'Herelle, already experienced in work with tropical diseases, took up the work and identified bacteriophage agents, in many varieties and many hosts. In spite of (or perhaps because of) his success, he did not flourish and moved around the world, developing both basic knowledge and therapeutic techniques.
Those who remember Sinclair Lewis's classic novel Arrowsmith will recall that the hero worked on "phage". It was popular in the twenties. But d'Herelle could not control the quality of production and of clinical applications. So the American Medical Association rubbished d'Herelle's work on the effects of bacteriophage as "contradictory". When antibiotics were introduced after the second world war, there was little motivation to look for anything else.
But it was different in the east. George Eliava, a microbiologist, noticed that rivers in Georgia have the same self-purifying properties, and he became an ardent disciple of d'Herelle. The master actually visited Tblisi and might have settled there had Eliava not fallen foul of Stalin. Arrested in 1937, he was executed; but the Bacteriophage Institute he had established in Tblisi continued. In the Soviet Union and elsewhere, especially Poland, bacteriophage therapy developed as a standard method for treating difficult cases, such as infections following burns.
It took a long time for the west to recover from its infatuation with "magic bullets", including broad-spectrum antibiotics. There were two main reasons why phage therapy was seen as inferior for so long. First, it was a product of "eastern" research, conventionally seen as inferior to western science. Second, each bacteriophage can act only on one specific host, seen as a limitation compared with antibiotics which kill everything in their path.
With superbugs now running rampant, the advantages of bacteriophage are clear. They kill the bacteria responsible for the diseases and do not simultaneously kill most of the body's normal, helpful bacteria. They replicate at the place in the body where they are needed. And they can multiply from one to tens of billions in a few hours. Most important, while bacteria can evolve resistance to antibiotics, they cannot do so to phages: the viruses evolve along with them.
Phage therapy is a good example of issues now arising over the governance of science. We are becoming aware that big, expensive science cannot solve all our problems; indeed, it can create new ones. It is relatively easy to advance know-ledge; but it is also easy to create ignorance. The work in developing new broad-spectrum antibiotics may be excellent, but it has to be seen in the context of the research that is not done on assimilating and adapting existing work on bacteriophages.
Excellent science has always been done outside the west, though we have often been blind to it. The problem is that when it is recognised, big business often reaps the benefits. In Georgia they fear that pharmaceutical giants will expropriate the low-tech research done in Tblisi and take out patents on phages.
The case of bacteriophage can be read as a modern parable of science and humanity. On the positive side, we find respect for local knowledge and heroic endeavours for science and healing. On the negative side, there is state political terror, pride, greed and private corporate piracy. Will their superbugs' superbugs be properly enlisted to fight our superbugs? That depends on the coming political struggles for the governance, and soul, of science.
