Steff would like to acknowledge the role of several scientists who were pivotal mentors in her early career: Michael Sukhdeo, Randall Coates, Stanley Read, and Michael V. O’Shaughnessy. She also thanks the anonymous family donors of her Harold Simon endowed chair that has supported her research at UCSD.
Our co-writer, Teresa Barker, was more than a partner in our journey. She relived our experiences, shared in our tears and laughter, and ultimately helped us hone our story so it would speak to everyone. Teresa, you are family now. Her husband, Steve Weiner, was of inestimable support, as were Dolly Joern, Kristen and Rachel Rau, Becca Barker, Aaron and Lauren Weiner, Margaret Browning, Sue Shellenbarger, Leslie Rowan, Elizabeth Leibowitz, Wendy Miller, and others who supported the project in different ways. Teresa’s young grandchildren, Leyna and Aden, were personal reminders of the world of children at stake, whose lives depend on the work of those in science, medicine, and health policy to protect them from the burgeoning superbug pandemic.
We also want to acknowledge the special role of Mallory’s parents, Diane Shader-Smith and Mark Smith, who provided us with endless encouragement as we wrote our book. Even though phages arrived too late to save their daughter Mallory, they pledged the inaugural gift to IPATH, our new phage therapy center at UC San Diego. I was deeply honored that they asked me to write the epilogue in Mallory’s memoir, Salt in My Soul: An Unfinished Life.
We are fortunate to be alive at a time when science and technology have advanced to a point that the zeitgeist made Tom’s cure not just a theoretical possibility but a reality. Without the scores of people who took incalculable risks and devoted time and resources to our struggle, this story would have been an ordinary death, and one of an estimated 1.5 million people who lose their lives to superbugs every year. Our hope is that this book will increase awareness of the growing superbug crisis and propel more research on phage therapy. Knowing that our experience has begun to help others makes the pain and suffering our family endured worthwhile. And for those of you out there who are battling serious superbug infections, we are with you. No retreat.
ABOUT THE AUTHORS
Steffanie Strathdee, PhD
Dr. Steffanie Strathdee obtained her BSc, MSc, and PhD from the University of Toronto. A dual citizen of Canada and the US, she is associate dean of global health sciences, professor and Harold Simon Chair at the University of California, San Diego, School of Medicine. She also co-directs UC San Diego’s Center for Innovative Phage Applications and Therapeutics (IPATH) and UC San Diego Global Health Institute and is an adjunct professor at Johns Hopkins and Simon Fraser Universities. Steffanie is an infectious disease epidemiologist who has nearly twenty years’ experience and over six hundred peer-reviewed publications on the prevention of HIV, sexually transmitted infection, and viral hepatitis among marginalized populations. In 2018, she was one of Time’s Most Influential People in Health Care.
Thomas Patterson, PhD
Dr. Tom Patterson obtained his AB from San Diego State University, his MSc from the University of Georgia, and his PhD from UC Riverside. Tom is an evolutionary sociobiologist and an experimental psychologist. He is a distinguished professor of psychiatry at UC San Diego and has renowned expertise on behavioral interventions among HIV-positive persons and those at high risk of acquiring HIV and sexually transmitted infections. He developed a scale to assess everyday functioning in schizophrenia that has been mandated by the FDA and is in wide use, having been translated into twenty-six languages.
Drs. Patterson and Strathdee have worked as a husband-and-wife research team on the Mexico–US border for over a decade. Their work inspired Jon Cohen’s book Tomorrow Is a Long Time, published in 2015. This is their first book together.
Teresa H. Barker, co-writer
A career journalist and book collaborator, Teresa Barker has co-written more than a dozen published titles in the fields of health, parenting and child development, spirituality, and creativity and aging, including the New York Times bestseller Raising Cain: Protecting the Emotional Life of Boys with Michael Thompson, PhD; The Soul of Money: Transforming Your Relationship with Money and Life with Lynne Twist, and The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age with Catherine Steiner-Adair, EdD, which was named by the Wall Street Journal to the Top Ten Nonfiction Books of 2013.
PERFECT PREDATOR DISCUSSION GUIDE QUESTIONS
Prepared by Deborah Jacobs-Sera, University of Pittsburgh; Steffanie Strathdee, PhD; Thomas Patterson, PhD; and Teresa Barker
1. How do you think Steff’s scientific background helped and/or hindered her approach to dealing with Tom’s illness?
2. What challenges did Tom and Steff face in the clinics in Egypt and Germany? What steps might you take to avoid or address a major illness in a foreign country?
3. Why did it take so long between Alexander Fleming’s discovery of penicillin and its availability for widespread use? What factors precipitated its scale-up?
4. What do Tom’s interludes add to the telling of the story? Which elements in Tom’s hallucinations might correspond to “real” elements (e.g., people, objects, memories, symptoms)?
5. What are some signs that Tom was sometimes aware of his own fragile mental state? As a psychologist, how might that have affected his own shifting sense of reality?
6. What do you think of Steff’s decision to consult a psychic-intuitive counselor and a healer to deal with Tom’s illness?
7. When doctors are divided about what course of treatment to take for a patient, do you think they should they consult family members in the clinical decision-making process?
8. Why is Steff envious of the wife of the of the influenza patient down the hall? How do her thoughts about the flu reflect commonly held attitudes about the illness?
9. Tom’s Acinetobacter infection was a reportable condition to health authorities in Germany but not in the United States. What do you think about these policy differences and how they might influence the spread of antimicrobial resistance?
10. What signs of posttraumatic stress disorder do Tom and Steff experience?
11. What do you think Steff would have done if Tom hadn’t squeezed her hand?
12. In the early twentieth century, passing fecal samples through a Pasteur filter was critical in determining an unidentified agent that could kill bacteria. How?
13. Why was phage therapy not available in the United States when Steff went looking for it?
14. What do you think about the role the FDA played in this story? Do you think patients should have the right to access experimental treatments without any oversight from regulatory agencies like the FDA?
15. What different kinds of bias appear to have played a role in relegating phage therapy to the back burner in the West?
16. What kinds of risks did the teams at the US Navy and Texas A&M undertake to develop an experimental treatment for a total stranger/civilian?
17. Why do characteristics of phage need to be taken into account before using them therapeutically to kill bacteria?
18. What role did gut instinct, intuition, and advocacy play in this story?
19. Why was it considered necessary to treat Tom intravenously with phage therapy? What might the advantages and disadvantages be?
20. How does nature play a reassuring role for Steff and Tom at different times in the story?
21. Why did Chip refer to the war between phage and bacteria as a “Darwinian dance”? Is the Red Queen hypothesis a fitting metaphor? Why or why not?
22. 22. Do you think Tom made a conscious decision to live? Why or why not?
23. What role does Egyptian symbolism play during Tom’s illness and recovery?
24. How might the course of Tom’s illness and recovery have been affected if phage therapy had been available sooner?
25. What kinds of evolution—of microorganisms and human beings—occurred in this story?
26. What are the major causes of antimicrobial resistance? How does this story make
you feel about antimicrobial resistance on a personal level? How can we stop its spread?
27. How might Tom and Steff’s experience as HIV researchers have influenced the ways they dealt with their ordeal?
28. What do you think about Steff’s comment that theirs is a story of privilege?
29. What might Felix d’Herelle have said about the Patterson case if he were still alive?
30. What do you think of the potential for phage therapy to address the superbug crisis in years to come? What hurdles still need to be addressed before it could be scaled up?
TO READERS
The information in this book is not a substitute for professional medical attention. For more resources, check out https://IPATH.UCSD.EDU and ThePerfectPredator.com.
SELECTED CHAPTER REFERENCES
Chapter 3. Disease Detectives
“Foodborne Illnesses and Germs.” Centers for Disease Control and Prevention, https://www.cdc.gov/foodsafety/foodborne-germs.html.
Johnson, Steven. The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books, 2006.
Chapter 4. First Responders
McKenna, Maryn. Superbug: The Fatal Menace of MRSA. New York: Free Press, 2011.
Chapter 5. Lost in Translation
Lax, Eric. The Mold in Dr. Florey’s Coat: The Story of the Penicillin Miracle. New York: Henry Holt, 2004.
Chapter 7. A Deadly Hitchhiker
Lankisch, P. G., M. Apte, and P. A. Banks. “Acute Pancreatitis.” Lancet 386, no. 9988 (July 4, 2015): 85–96.
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Chapter 8. “The Worst Bacteria on the Planet”
Boucher, Helen W., George H. Talbot, John S. Bradley, John E. Edwards, David Gilbert, Louis B. Rice, Michael Scheld, Brad Spellberg, and John Bartlett. “Bad Bugs, No Drugs: No Eskape! An Update from the Infectious Diseases Society of America.” Clinical Infectious Diseases 48, no. 1 (2009): 1–12.
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Chapter 11. Public Enemy No. 1: Under the Radar
Blaser, Martin J. Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues. New York: Picador, 2015.
Chen, L., R. Todd, J. Kiehlbauch, M. Walters, and A. Kallen. “Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella Pneumoniae—Washoe County, Nevada, 2016.” Morbidity and Mortality Weekly Report 66, no. 1 (January 13, 2017): 33.
Cohen B., S. Hyman, L. Rosenberg, and E. Larson. “Frequency of Patient Contact with Health Care Personnel and Visitors: Implications for Infection Prevention.” Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources 38, no. 12 (2012): 560–565. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531228.
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Huslage, K., et al. “A Quantitative Approach to Defining ‘High-Touch’ Surfaces in Hospitals.” Infection Control and Hospital Epidemiology 31, no. 8 (2010): 850–853.
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Laxminarayan, R., and R. R. Chaudhury. “Antibiotic Resistance in India: Drivers and Opportunities for Action.” PLoS Medicine 13, no. 3 (March 2016): e1001974.
Liu, Cindy M., M. Stegger, M. Aziz, T. J. Johnson, K. Waits, L. Nordstrom, L. Gauld, B. Weaver, D. Rolland, S. Statham, J. Horwinski, S. Sariya, G. S. Davis, E. Sokurenko, P. Keim, J. R. Johnson, and L. B. Price. “Escherichia coli ST131-H22 as a Foodborne Uropathogen.” mBio 9, no. 4 (August 2018); DOI: 10.1128/mBio.00470-18.
McKenna, Maryn. Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats. New York: Penguin, 2017.
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Terhune, Chad. “Olympus Told Its US. Executives No Broad Warning about Tainted Medical Scopes Was Needed, Despite Superbug Outbreaks.” Los Angeles Times, July 21, 2016. http://www.latimes.com/business/la-fi-olympus-scopes-emails-20160721-snap-story.html.
Chapter 12. The Alternate Reality Club
Gelling, L. “Causes of ICU Psychosis: The Environmental Factors.” Nursing and Critical Care 4, no. 1 (January–February 1999): 22–26.
Lin, L., P. Nonejuie, J. Munguia, A. Hollands, J. Olson, Q. Dam, M. Kumaraswamy, et al. “Azithromycin Synergizes with Cationic Antimicrobial Peptides to Exert Bactericidal and Therapeutic Activity against Highly Multidrug-Resistant Gram-Negative Bacterial Pathogens.” EBioMedicine 2, no. 7 (July 2015): 690–698.
Chapter 13. Tipping Point: Fully Colonized
Burnham, J., Olsen, M., & Kollef, M. (n.d.). “Re-estimating Annual Deaths Due to Multidrug-Resistant Organism Infections.” Infection Control & Hospital Epidemiology, 1–2. doi:10.1017/ice.2018.304.
Chan, Margaret. “Antimicrobial Resistance in the European Union and the World.” World Health Organization, 2012. http://www.who.int/dg/speeches/2012/amr_20120314/en.
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Seymour, C. W., and M. R. Rosengart. “Septic Shock: Advances in Diagnosis and Treatment.” Journal of the American Medical Association 314, no. 7 (August 18, 2015): 708–717.
“Tackling Drug-Resistant Infections Globally: Final Report and Recommendations.” May 2016. Review on Antimicrobial Resistance, commissioned by Her Majesty’s Government (UK) and the Wellcome Trust. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
Walsh, T. R., and Y. Wu. “China Bans Colistin as a Feed Additive for Animals.” Lancet Infectious Disease 16, no. 10 (October 2016): 1102–1103.
Chapter 14. The Spider to Catch the Fly
Fishbain, J., and A. Y. Peleg. “Treatment of Acinetobacter Infections.” Clinical Infectious Disease 51, no. 1 (July 1, 2010): 79–84.
Garcia-Quintanilla, M., M. R. Pulido, R. Lopez-Rojas, J. Pachon, and M. J. McConnell. “Emerging Therapies for Multidrug Resistant Acinetobacter Baumannii.” Trends in Microbiology 21, no. 3 (March 2013): 157–163.
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Hendrickson, Heather. “Nature’s Ninjas in the Battle against Superbugs.” TED Talk, October 6, 2016. https://www.youtube.com/watch?v=p2ngpKBPfF8.
Kuchment, Anna. The Forgotten Cure: The Past and Future of Phage Therapy. New York: Springer, 2012.
Merabishvili, M., D. Vandenheuvel, A. M. Kropinski, J. Mast, D. De Vos, G. Verbeken, J. P. Noben, et al. “Characterization of Newly Isolated Lytic Bacteriophages Active against Acinetobacter baumannii.” PLoS One 9, no. 8 (2014): e104853.
Mokili, J., Rohwer, F., Dutih, B. E. “Metagenomics and Future Perspectives in Virus Discovery.”Current Opinion in Virology 2, no. 1 (February 2012): 63–77. https://www.sciencedirect.com/science/article/pii/S1879625711001908?via%3Dihub.
Chapter 15. The Perfect Predator
d’Hérelle, Félix. The Bacteriophage, Its Rôle in Immunity. Toronto: University of Toronto, 1922.
Doudna, Jennifer, and Samuel Sternberg. A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution. Boston: Mariner Books, 2017.
Merril, C. R., B. Biswas, R. Carlton, N. C. Jensen, G. J. Creed, S. Zullo, and S. Adhya. “Long-Circulating Bacteriophage as Antibacterial Agents.” Proceedings of the National Academy of Sciences USA. 93, no. 8 (April 16, 1996): 3188–3192.
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