TEDMED 2014
Ramanan Laxminarayan: The coming crisis in antibiotics
Ramanan Laxminarayan: A crise dos antibióticos que vén de camiño
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Os antibióticos salvan vidas. Pero nós, estámolos a empregar de máis e moitas veces non co obxectivo de salvar vidas, senón por exemplo para tratar a gripe ou para criar polos de forma máis barata. O resultado, dinos o investigador Ramanan Laxminarayan, é que os fármacos van deixar de funcionar, a medida que as bacterias se fagan cada vez máis resistentes.
El fainos un chamamento (a pacientes e médicos por igual) para que vexamos os antibióticos --e a súa eficacia constante-- como un recurso esgotable, e que pensemos dúas veces antes de utilizalos.
É unha visión particular que nos amosa como as tendencias médicas poden golpear as nosas vidas
Ramanan Laxminarayan - Drug-resistance economist
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
Double-click the English transcript below to play the video.
(Aplausos)
00:12
The first patient to ever be
treated with an antibiotic
treated with an antibiotic
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O primeiro paciente
que foi tratado con antibióticos
que foi tratado con antibióticos
foi un policía de Oxford.
00:16
was a policeman in Oxford.
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00:17
On his day off from work,
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No seu tempo de lecer,
00:19
he was scratched by a rose thorn
while working in the garden.
while working in the garden.
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namentres traballaba no seu xardín
rabuñouse coa espiña dunha rosa
rabuñouse coa espiña dunha rosa
00:23
That small scratch became infected.
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e esa pequena ferida infectouse.
Nos seguintes días
a súa cabeza foise inflamando,
a súa cabeza foise inflamando,
00:26
Over the next few days,
his head was swollen
his head was swollen
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a causa da aparición de abscesos,
00:29
with abscesses,
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00:30
and in fact his eye was so infected
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e de feito, tiña un ollo tan infectado
que llo tiveron que sacar.
que llo tiveron que sacar.
00:33
that they had to take it out,
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En febreiro de 1941,
00:35
and by February of 1941,
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00:38
this poor man was on the verge of dying.
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o pobre home estaba a piques de morrer.
00:40
He was at Radcliffe Infirmary in Oxford,
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Estaba ingresado
no Radcliffe Infirmary de Oxford
no Radcliffe Infirmary de Oxford
e por sorte para el,
00:43
and fortunately for him,
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había un pequeno equipo médico
00:45
a small team of doctors
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00:47
led by a Dr. Howard Florey
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baixo a dirección do Dr. Howard Florey
00:48
had managed to synthesize
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que conseguira sintetizar
00:50
a very small amount of penicillin,
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un chisco de penicilina,
00:53
a drug that had been discovered
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un fármaco que fora descuberto
12 anos antes por Alexander Fleming,
12 anos antes por Alexander Fleming,
00:55
12 years before by Alexander Fleming
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00:58
but had never actually been
used to treat a human,
used to treat a human,
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pero que xamais se usara
para tratar doenzas humanas
para tratar doenzas humanas
01:01
and indeed no one even
knew if the drug would work,
knew if the drug would work,
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e que ninguén sabía se ía funcionar
01:04
if it was full of impurities
that would kill the patient,
that would kill the patient,
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ou se as impurezas que contiña
matarían o paciente.
matarían o paciente.
Aínda así, Florey e o seu equipo
decidiron usalo,
decidiron usalo,
01:07
but Florey and his team figured
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01:09
if they had to use it,
they might as well use it
they might as well use it
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xa que postos a facelo, mellor con alguén
que fose morrer de tódalas maneiras.
que fose morrer de tódalas maneiras.
01:11
on someone who was going to die anyway.
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Polo tanto, déronlle a menciña
a Albert Alexander,
a Albert Alexander,
01:14
So they gave Albert Alexander,
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01:17
this Oxford policeman, the drug,
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o policía de Oxford,
01:20
and within 24 hours,
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e nas primeiras 24 horas,
01:23
he started getting better.
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comezou a mellorar.
01:25
His fever went down,
his appetite came back.
his appetite came back.
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Baixoulle a febre e recuperou o apetito.
01:29
Second day, he was doing much better.
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No segundo día, a súa mellora
foi considerable,
foi considerable,
01:31
They were starting to
run out of penicillin,
run out of penicillin,
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pero comezaban a quedar sen penicilina
01:33
so what they would do
was run with his urine
was run with his urine
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polo que utilizaron os ouriños deste
01:35
across the road to re-synthesize
the penicillin from his urine
the penicillin from his urine
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co fin de resintetizar máis penicilina
01:38
and give it back to him,
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e administrarlla de novo,
01:40
and that worked.
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o cal funcionou.
01:42
Day four, well on the way to recovery.
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No cuarto día a recuperación
ía por bo camiño.
ía por bo camiño.
01:44
This was a miracle.
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Semellaba un milagre,
01:46
Day five, they ran out of penicillin,
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mais no quinto día, esgotouse a penicilina
01:50
and the poor man died.
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e o coitado morreu.
01:52
So that story didn't end that well,
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Esta historia non rematou ben,
01:55
but fortunately for
millions of other people,
millions of other people,
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pero, por sorte para millóns de persoas,
01:59
like this child who was treated
again in the early 1940s,
again in the early 1940s,
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coma esta nena que foi tratada
a comezos de 1940,
a comezos de 1940,
02:02
who was again dying of a sepsis,
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quen tamén estaba a morrer
por unha septicemia,
por unha septicemia,
02:05
and within just six days, you can see,
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e tan só en seis días, como podedes ver,
02:08
recovered thanks to this
wonder drug, penicillin.
wonder drug, penicillin.
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recuperouse grazas
ao marabilloso fármaco da penicilina.
ao marabilloso fármaco da penicilina.
02:12
Millions have lived,
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Millóns de persoas sobreviviron
02:14
and global health has been transformed.
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e mudou a saúde global.
02:17
Now, antibiotics have been used
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Os antibióticos téñense empregado
02:20
for patients like this,
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en pacientes coma este
02:23
but they've also been
used rather frivolously
used rather frivolously
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aínda que tamén se empregaron á lixeira
nalgunhas circunstancias,
nalgunhas circunstancias,
02:25
in some instances,
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para tratar un simple constipado ou gripe,
02:27
for treating someone
with just a cold or the flu,
with just a cold or the flu,
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enfermidades elas
02:29
which they might not have
responded to an antibiotic,
responded to an antibiotic,
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con moi baixa resposta
aos antibióticos.
02:32
and they've also been
used in large quantities
used in large quantities
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Tamén se teñen empregado
de forma masiva, subterapeuticamente,
02:36
sub-therapeutically, which
means in small concentrations,
means in small concentrations,
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é dicir, en baixas concentracións,
co obxectivo de que galiñas
e porcos engorden moi rápido.
e porcos engorden moi rápido.
02:39
to make chicken and hogs grow faster.
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02:42
Just to save a few pennies
on the price of meat,
on the price of meat,
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Tan só para aforrar algún céntimo
no prezo da carne,
no prezo da carne,
02:46
we've spent a lot of
antibiotics on animals,
antibiotics on animals,
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gastamos moitísimo
en antibióticos para animais,
en antibióticos para animais,
02:49
not for treatment, not for sick animals,
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non para tratar os que están enfermos,
02:51
but primarily for growth promotion.
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senón, principalmente,
para potenciar o seu crecemento.
para potenciar o seu crecemento.
02:54
Now, what did that lead us to?
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Co cal, a que nos levou isto?
02:57
Basically, the massive use of antibiotics
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Basicamente, o uso masivo de antibióticos
03:00
around the world
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por todo o mundo
03:01
has imposed such large
selection pressure on bacteria
selection pressure on bacteria
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trouxo o problema da resistencia
das bacterias
das bacterias
debido ao feito da selección
das máis fortes,
das máis fortes,
03:05
that resistance is now a problem,
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03:08
because we've now selected for just
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grazas a que nós mesmos
fixemos posible a selección.
fixemos posible a selección.
03:10
the resistant bacteria.
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Teño a certeza de que todos leron
nos xornais sobre o tema,
nos xornais sobre o tema,
03:11
And I'm sure you've all read
about this in the newspapers,
about this in the newspapers,
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03:14
you've seen this in every magazine
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que o viron nas revistas que tiñan á man,
03:16
that you come across,
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03:18
but I really want you to appreciate
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pero realmente quero que se dean conta
03:20
the significance of this problem.
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da importancia deste problema.
03:22
This is serious.
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Isto é serio.
A seguinte diapositiva que lles vou amosar
03:23
The next slide I'm about to show you is
of carbapenem resistance in acinetobacter.
of carbapenem resistance in acinetobacter.
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é unha mostra da resistencia
do Acinetobacter ao carbapenem.
do Acinetobacter ao carbapenem.
O Acinetobacter é un perigoso
xerme hospitalario
xerme hospitalario
03:28
Acinetobacter is a nasty hospital bug,
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03:31
and carbapenem is pretty much
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e o carbapenem é un dos tipos
de antibióticos máis poderosos
de antibióticos máis poderosos
03:32
the strongest class of antibiotics
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03:34
that we can throw at this bug.
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que se pode administrar contra ese xerme.
03:36
And you can see in 1999
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Poden ver que en 1999
03:39
this is the pattern of resistance,
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a mostra de datos sobre a resistencia,
03:42
mostly under about 10 percent
across the United States.
across the United States.
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situábase na súa meirande parte
por debaixo do 10 % en todo EE. UU.
por debaixo do 10 % en todo EE. UU.
03:45
Now watch what happens
when we play the video.
when we play the video.
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Agora vexan o que acontece
ao avanzar o vídeo.
ao avanzar o vídeo.
03:58
So I don't know where you live,
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Non sei onde viven vostedes
04:00
but wherever it is, it certainly is a lot worse now
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pero sexa onde sexa,
seguramente a situación
seguramente a situación
é peor agora que no 1999,
04:03
than it was in 1999,
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04:05
and that is the problem of antibiotic resistance.
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ese é o problema
da resistencia aos antibióticos.
da resistencia aos antibióticos.
04:09
It's a global issue
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É un problema mundial
04:11
affecting both rich and poor countries,
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que afecta aos países
pobres e aos ricos por igual
pobres e aos ricos por igual
04:14
and at the heart of it,
you might say, well,
you might say, well,
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aínda que no fondo,
poderiades pensar
poderiades pensar
04:16
isn't this really just a medical issue?
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non pasa nada, só é un problema médico!
04:18
If we taught doctors how not
to use antibiotics as much,
to use antibiotics as much,
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Se lles ensinásemos aos médicos
a non dar tantos antibióticos
a non dar tantos antibióticos
04:20
if we taught patients how
not to demand antibiotics,
not to demand antibiotics,
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e aos pacientes a non pedilos,
04:23
perhaps this really wouldn't be an issue,
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ao mellor non sería un problema
04:25
and maybe the pharmaceutical companies
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e se cadra as compañías farmacéuticas
04:27
should be working harder to develop
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farían o esforzo de desenvolver
04:28
more antibiotics.
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novos antibióticos.
04:30
Now, it turns out that there's something
fundamental about antibiotics
fundamental about antibiotics
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Resulta que hai algo fundamental
sobre os antibióticos
sobre os antibióticos
04:33
which makes it different from other drugs,
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que os fai distintos doutros fármacos,
04:35
which is that if I misuse antibiotics
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e é que se uso antibióticos,
04:37
or I use antibiotics,
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correcta ou incorrectamente,
04:39
not only am I affected but
others are affected as well,
others are affected as well,
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non só é cousa miña
senón que afecta aos demais tamén,
senón que afecta aos demais tamén,
da mesma maneira que se escollo
ir traballar en coche
ir traballar en coche
04:43
in the same way as if I
choose to drive to work
choose to drive to work
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04:45
or take a plane to go somewhere,
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ou coller un avión para ir a algures,
04:48
that the costs I impose on others
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o custo que impoño aos demais
polo quecemento global,
polo quecemento global,
04:50
through global climate change go everywhere,
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distribúese por todas partes,
04:52
and I don't necessarily take
these costs into consideration.
these costs into consideration.
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aínda que eu non teña este custo
en conta necesariamente.
en conta necesariamente.
04:55
This is what economists might
call a problem of the commons,
call a problem of the commons,
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Na economía chamaríanlle a isto
a traxedia dos bens comúns
a traxedia dos bens comúns
04:58
and the problem of the commons is exactly
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e é o mesmo problema
que temos cos antibióticos,
que temos cos antibióticos,
05:00
what we face in the case
of antibiotics as well:
of antibiotics as well:
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05:02
that we don't consider —
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que nós non temos en conta
05:04
and we, including individuals, patients,
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—nós inclúe a todo individuo, pacientes,
05:07
hospitals, entire health systems —
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hospitais, sistemas de saúde completos—
non temos en conta os custos
que lles impoñemos aos demais
que lles impoñemos aos demais
05:11
do not consider the costs
that they impose on others
that they impose on others
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05:13
by the way antibiotics are actually used.
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debido a como empregamos os antibióticos.
05:15
Now, that's a problem that's similar
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É un problema semellante
ao que acontece noutro eido
que ben coñecemos,
que ben coñecemos,
05:17
to another area that we all know about,
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05:19
which is of fuel use and energy,
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o consumo de combustible
e o uso da enerxía,
e o uso da enerxía,
05:21
and of course energy use
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e, por suposto, o consumo de enerxía,
05:23
both depletes energy as well as
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ademais de esgotar os recursos,
05:26
leads to local pollution
and climate change.
and climate change.
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causa contaminación local
e cambio climático.
e cambio climático.
05:29
And typically, in the case of energy,
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E, no caso da enerxía,
05:31
there are two ways in which
you can deal with the problem.
you can deal with the problem.
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hai dúas maneiras de atallar o problema.
05:33
One is, we can make better
use of the oil that we have,
use of the oil that we have,
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Unha é facer un mellor uso
do petróleo que temos
do petróleo que temos
05:37
and that's analogous to making better use
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e, por analoxía,
iso sería facer un mellor uso
iso sería facer un mellor uso
05:39
of existing antibiotics,
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dos antibióticos existentes.
05:41
and we can do this in a number of ways
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Iso podémolo facer de distintas maneiras
05:42
that we'll talk about in a second,
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das que falarei máis adiante
05:45
but the other option is the
"drill, baby, drill" option,
"drill, baby, drill" option,
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pero a outra opción é a opción de
"perfora, perfora",
"perfora, perfora",
05:48
which in the case of antibiotics
is to go find new antibiotics.
is to go find new antibiotics.
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que, no caso dos antibióticos,
tradúcese en atopar novos antibióticos.
tradúcese en atopar novos antibióticos.
05:53
Now, these are not separate.
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Estas opcións non están separadas.
05:55
They're related, because if we invest heavily
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Van da man xa que, se investimos moito
05:58
in new oil wells,
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en novos pozos petrolíferos,
reducimos o incentivo para a conservación
do petróleo existente,
do petróleo existente,
06:00
we reduce the incentives
for conservation of oil
for conservation of oil
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06:03
in the same way that's going
to happen for antibiotics.
to happen for antibiotics.
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do mesmo xeito que ocorrerá
cos antibióticos.
cos antibióticos.
06:06
The reverse is also going
to happen, which is that
to happen, which is that
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No caso contrario sucederá que,
se empregamos os antibióticos
axeitadamente,
axeitadamente,
06:08
if we use our antibiotics appropriately,
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06:10
we don't necessarily have
to make the investments
to make the investments
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non necesariamente teremos que investir
06:13
in new drug development.
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no desenvolvemento de novos fármacos.
06:15
And if you thought that these two were entirely,
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Se pensabades que estabamos en completo
06:18
fully balanced between these two options,
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equilibrio entre estas dúas opcións,
06:20
you might consider the fact that
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en realidade estamos a xogar a un xogo.
06:22
this is really a game that we're playing.
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O xogo da coevolución.
06:24
The game is really one of coevolution,
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06:27
and coevolution is, in
this particular picture,
this particular picture,
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e a coevolución dáse,
nesta imaxe en particular,
nesta imaxe en particular,
06:30
between cheetahs and gazelles.
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entre guepardos e gacelas.
Os guepardos evolucionaron
para correr máis rápido
para correr máis rápido
06:32
Cheetahs have evolved to run faster,
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06:34
because if they didn't run faster,
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xa que, se non o fixesen,
06:35
they wouldn't get any lunch.
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non obterían comida ningunha.
As gacelas evolucionaron
para correr máis rápido
para correr máis rápido
06:37
Gazelles have evolved to run faster because
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06:40
if they don't run faster, they would be lunch.
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pois se non corresen máis rápido,
elas serían a comida.
elas serían a comida.
06:43
Now, this is the game we're
playing against the bacteria,
playing against the bacteria,
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Xogamos ao mesmo contra as bacterias,
06:46
except we're not the cheetahs,
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salvo que nós non somos os guepardos,
06:48
we're the gazelles,
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somos as gacelas,
06:49
and the bacteria would,
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e, no que dura esta curta conferencia,
as bacterias puideron
06:52
just in the course of this little talk,
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06:54
would have had kids and grandkids
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ter fillos e netos,
e achar como ser resistentes
e achar como ser resistentes
06:55
and figured out how to be resistant
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06:58
just by selection and trial and error,
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por selección e ensaio e erro,
07:00
trying it over and over again.
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intentándoo unha e outra vez.
07:02
Whereas how do we stay
ahead of the bacteria?
ahead of the bacteria?
160
410746
3772
Namentres, como lles ganamos
a carreira as bacterias?
a carreira as bacterias?
Nós contamos con procesos
para descubrir fármacos,
para descubrir fármacos,
07:06
We have drug discovery processes,
161
414518
2054
07:08
screening molecules,
162
416572
1630
analizamos moléculas,
07:10
we have clinical trials,
163
418202
1728
facemos probas clínicas,
07:11
and then, when we think we have a drug,
164
419930
2148
e, cando cremos ter un bo fármaco,
07:14
then we have the FDA regulatory process.
165
422078
3745
temos aínda o proceso regulador do FDA.
07:17
And once we go through all of that,
166
425823
2178
Despois de superar todo iso,
07:20
then we try to stay one step ahead
167
428001
2265
procuramos ir un paso por diante
07:22
of the bacteria.
168
430266
2296
das bacterias.
Abofé que isto non é un xogo
que poida prolongarse ou ganarse
que poida prolongarse ou ganarse
07:24
Now, this is clearly not a
game that can be sustained,
game that can be sustained,
169
432562
2777
07:27
or one that we can win
170
435339
1137
tan só innovando para ir por diante.
07:28
by simply innovating to stay ahead.
171
436476
1837
07:30
We've got to slow the pace of coevolution down,
172
438313
3305
Temos que retardar
o proceso da coevolución
o proceso da coevolución
07:33
and there are ideas that we
can borrow from energy
can borrow from energy
173
441618
3682
e hai ideas que podemos coller
emprestadas do campo da enerxía
emprestadas do campo da enerxía
07:37
that are helpful in thinking about
174
445300
1770
que nos poden axudar a pensar
nas medidas que poderíamos tomar
07:39
how we might want to do this in the case
175
447070
1537
07:40
of antibiotics as well.
176
448607
1546
no caso dos antibióticos.
07:42
Now, if you think about how we deal with
177
450153
2240
Pensade, por exemplo, na xestión
do prezo da enerxía.
07:44
energy pricing, for instance,
178
452393
1423
07:45
we consider emissions taxes,
179
453816
1849
Temos uns impostos
sobre as emisións de gases,
sobre as emisións de gases,
07:47
which means we're imposing
the costs of pollution
the costs of pollution
180
455665
2584
onde se teñen en conta
os custos da contaminación,
07:50
on people who actually use that energy.
181
458249
2831
que recaen nas persoas
que consomen esa enerxía.
07:53
We might consider doing that for antibiotics as well,
182
461080
2980
Poderiamos contemplar
facer o mesmo cos antibióticos,
07:56
and perhaps that would make sure that antibiotics
183
464060
2711
o que quizais aseguraría
07:58
actually get used appropriately.
184
466771
2401
que se usan axeitadamente.
08:01
There are clean energy subsidies,
185
469172
2028
Tamén hai subsidios á enerxía limpa,
os cales permiten cambiar a combustibles
08:03
which are to switch to fuels
which don't pollute as much
which don't pollute as much
186
471200
3055
que no contaminan tanto
08:06
or perhaps don't need fossil fuels.
187
474255
2845
ou incluso para non utilizar
combustibles fósiles.
combustibles fósiles.
08:09
Now, the analogy here is, perhaps we need
188
477100
2860
A analoxía neste caso é que quizais
08:11
to move away from using antibiotics,
189
479960
2260
temos que absternos de usar antibióticos,
08:14
and if you think about it, what are
good substitutes for antibiotics?
good substitutes for antibiotics?
190
482220
3716
e se vos poñedes a pensar, cales son
bos substitutos dos antibióticos?
bos substitutos dos antibióticos?
Pois resulta que,
08:17
Well, turns out that anything that reduces
191
485936
2164
calquera cousa que reduza
08:20
the need for the antibiotic would really work,
192
488100
2243
a necesidade de antibióticos sería eficaz.
Por exemplo, mellorar o control
das infeccións hospitalarias
das infeccións hospitalarias
08:22
so that could include improving
hospital infection control
hospital infection control
193
490343
3142
08:25
or vaccinating people,
194
493485
2895
ou vacinar a xente,
08:28
particularly against
the seasonal influenza.
the seasonal influenza.
195
496380
2297
sobre todo contra a gripe estacional.
08:30
And the seasonal flu is probably
196
498677
2531
A gripe estacional é probablemente
08:33
the biggest driver of antibiotic use,
197
501208
3004
o impulsor principal detrás
do consumo de antibióticos,
do consumo de antibióticos,
08:36
both in this country as well
as in many other countries,
as in many other countries,
198
504212
2919
tanto neste país coma en outros moitos,
08:39
and that could really help.
199
507131
2020
e iso realmente podería axudar.
08:41
A third option might include
something like tradeable permits.
something like tradeable permits.
200
509151
4103
A terceira opción suporía algo parecido
aos permisos comercializables.
aos permisos comercializables.
08:45
And these seem like faraway scenarios,
201
513254
4246
Pode que parezan posibilidades remotas,
08:49
but if you consider the
fact that we might not
fact that we might not
202
517500
2427
pero se se tivera en conta
o feito de que quizais
o feito de que quizais
08:51
have antibiotics for many
people who have infections,
people who have infections,
203
519927
3383
non hai antibióticos suficientes
para todos os infectados,
para todos os infectados,
poderiamos contemplar asignar
08:55
we might consider the fact that we might
204
523310
2237
08:57
want to allocate who actually gets to use
205
525547
2311
algúns destes antibióticos
a uns pacientes e non a outros,
a uns pacientes e non a outros,
08:59
some of these antibiotics over others,
206
527858
2714
en función das necesidades clínicas,
09:02
and some of these might have to
be on the basis of clinical need,
be on the basis of clinical need,
207
530572
3326
pero tamén do prezo do tratamento.
09:05
but also on the basis of pricing.
208
533898
1935
Educar aos consumidores
sen dúbida funciona.
sen dúbida funciona.
09:07
And certainly consumer education works.
209
535833
1910
09:09
Very often, people overuse antibiotics
210
537743
2601
Moitas veces, a xente
abusa dos antibióticos
abusa dos antibióticos
09:12
or prescribe too much without necessarily
211
540344
2277
ou estanse a receitar de máis,
sen razón.
sen razón.
09:14
knowing that they do so,
212
542621
1606
09:16
and feedback mechanisms
213
544227
1431
Tamén sabemos que,
ao igual que no caso da enerxía,
ao igual que no caso da enerxía,
09:17
have been found to be useful,
214
545658
1902
os mecanismos de retroalimentación
poden ser útiles.
poden ser útiles.
09:19
both on energy —
215
547560
1929
Se a un o avisan de que está a consumir
09:21
When you tell someone that they're using
216
549489
1540
09:23
a lot of energy during peak hour,
217
551029
1917
moita enerxía durante a hora punta,
un mesmo procura diminuír o seu consumo,
09:24
they tend to cut back,
218
552946
1470
09:26
and the same sort of example has been performed
219
554416
1767
e o mesmo feito dáse
até no caso dos antibióticos.
até no caso dos antibióticos.
09:28
even in the case of antibiotics.
220
556183
1810
09:29
A hospital in St. Louis basically would put up
221
557993
1981
Un hospital de St. Louis
acostumaba poñer nun taboleiro
acostumaba poñer nun taboleiro
09:31
on a chart the names of surgeons
222
559974
4192
os nomes dos cirurxiáns ordenados
09:36
in the ordering of how much antibiotics they'd used
223
564166
2219
por cantos antibióticos
utilizaran no mes anterior
utilizaran no mes anterior
09:38
in the previous month,
224
566385
1944
09:40
and this was purely an
informational feedback,
informational feedback,
225
568329
2342
e só o facían pola
retroalimentación informativa,
retroalimentación informativa,
09:42
there was no shaming,
226
570671
1183
sen intención de humillalos,
09:43
but essentially that provided
some information back
some information back
227
571854
2135
pero, en esencia, proporcionábanlles
09:45
to surgeons that maybe they could rethink
228
573989
1954
aos cirurxiáns unha información
coa que podían reflexionar
09:47
how they were using antibiotics.
229
575943
2229
sobre como usaban os antibióticos.
09:50
Now, there's a lot that can be done
230
578172
2014
Aínda queda moito por facer
09:52
on the supply side as well.
231
580186
2149
en canto á subministración tamén.
09:54
If you look at the price of penicillin,
232
582335
1777
Se miran os prezos da penicilina,
09:56
the cost per day is about 10 cents.
233
584112
1651
o custo por día é duns 10 céntimos.
09:57
It's a fairly cheap drug.
234
585763
1758
É un fármaco bastante barato.
09:59
If you take drugs that have
been introduced since then —
been introduced since then —
235
587521
2137
Os fármacos introducidos
posteriormente
posteriormente
10:01
linezolid or daptomycin —
236
589658
2644
—a linezolida e a daptomicina—
10:04
those are significantly more expensive,
237
592302
1878
son moito máis caros.
10:06
so to a world that has been used to
paying 10 cents a day for antibiotics,
paying 10 cents a day for antibiotics,
238
594180
5451
Nun mundo que está afeito a pagar
10 céntimos ao día por un antibiótico,
10 céntimos ao día por un antibiótico,
10:11
the idea of paying 180 dollars per day
239
599633
2530
a idea de pagar 180 dólares ao día
semella moito
semella moito
10:14
seems like a lot.
240
602163
1567
10:15
But what is that really telling us?
241
603730
1987
Que nos pode dicir isto?
10:17
That price is telling us
242
605717
1965
O prezo estanos a mostrar que no futuro
10:19
that we should no longer
243
607682
1898
no imos ter antibióticos baratos
dos que botar man.
dos que botar man.
10:21
take cheap, effective
antibiotics as a given
antibiotics as a given
244
609580
4117
10:25
into the foreseeable future,
245
613697
1767
Ese prezo é un sinal
10:27
and that price is a signal to us
246
615464
2530
10:29
that perhaps we need to be paying
247
617994
1609
de que ao mellor temos que prestar
10:31
much more attention to conservation.
248
619603
2553
moita máis atención ao aforro.
10:34
That price is also a signal
249
622156
2704
Ese prezo tamén é un sinal
de que ao mellor é hora de comezar
10:36
that maybe we need to start
looking at other technologies,
looking at other technologies,
250
624860
2875
a botarlles unha ollada
a outras tecnoloxías,
10:39
in the same way that
gasoline prices are a signal
gasoline prices are a signal
251
627735
2652
do mesmo xeito que o prezo da gasolina
10:42
and an impetus, to, say,
252
630387
2590
é un sinal e un estímulo
10:44
the development of electric cars.
253
632977
1868
para desenvolver coches eléctricos.
10:46
Prices are important signals
254
634845
1777
Os prezos son sinais importantes
e necesitamos prestarlles atención,
10:48
and we need to pay attention,
255
636622
1586
10:50
but we also need to consider the fact that
256
638208
2452
pero tamén teñan en conta que,
aínda que os prezos nos parezan
insólitos para un antibiótico,
insólitos para un antibiótico,
10:52
although these high prices
seem unusual for antibiotics,
seem unusual for antibiotics,
257
640660
4252
non son nada comparados co prezo diario
10:56
they're nothing compared to the price per day
258
644912
2239
dalgúns fármacos contra o cancro
10:59
of some cancer drugs,
259
647151
1384
11:00
which might save a patient's life only
for a few months or perhaps a year,
for a few months or perhaps a year,
260
648535
3370
que salvan a vida do paciente
durante algúns meses ou quizais un ano,
durante algúns meses ou quizais un ano,
11:03
whereas antibiotics would potentially
261
651905
1770
namentres que o antibiótico podería
salvarlle a vida ao paciente para sempre.
11:05
save a patient's life forever.
262
653675
1826
11:07
So this is going to involve
263
655501
1319
Polo tanto, todo isto esixe un cambio
11:08
a whole new paradigm shift,
264
656820
1962
cara a un novo paradigma,
11:10
and it's also a scary shift because
265
658782
1856
un cambio que dá medo,
11:12
in many parts of this country,
266
660638
2329
xa que en moitos lugares deste país,
11:14
in many parts of the world,
267
662967
1744
e en moitos outros lugares do mundo,
11:16
the idea of paying 200 dollars
268
664711
2069
a idea de pagar 200 dólares
11:18
for a day of antibiotic treatment
269
666780
2891
por un día de tratamento con antibióticos
11:21
is simply unimaginable.
270
669671
2542
é simplemente inimaxinable.
11:24
So we need to think about that.
271
672213
1734
Así que debemos pensar niso.
11:25
Now, there are backstop options,
272
673947
1813
Agora ben, hai outras opcións,
11:27
which is other alternative technologies
273
675760
2676
outras tecnoloxías alternativas
nas que se está a traballar.
11:30
that people are working on.
274
678436
1194
11:31
It includes bacteriophages, probiotics,
275
679630
2652
Entre outras, os bacteriófagos,
os probióticos,
os probióticos,
11:34
quorum sensing, synbiotics.
276
682282
4048
a percepción de quórum e os simbióticos.
11:38
Now, all of these are useful avenues to pursue,
277
686330
3039
Todos son bos camiños para explorar
11:41
and they will become even more lucrative
278
689369
2610
e volveranse aínda máis lucrativos
11:43
when the price of new
antibiotics starts going higher,
antibiotics starts going higher,
279
691979
3081
cando o prezo dos novos antibióticos
comece a subir.
comece a subir.
11:47
and we've seen that the
market does actually respond,
market does actually respond,
280
695060
2897
Xa vimos que o mercado responde
11:49
and the government is now considering
281
697957
2008
e o goberno agora está a pensar
en formas de subvencionar
11:51
ways of subsidizing new
antibiotics and development.
antibiotics and development.
282
699965
3767
novos antibióticos
e o seu desenvolvemento.
e o seu desenvolvemento.
11:55
But there are challenges here.
283
703732
1723
Aínda así existen desafíos.
11:57
We don't want to just throw money at a problem.
284
705455
1575
Non podemos limitarnos
a meterlle cartos ao problema.
a meterlle cartos ao problema.
11:59
What we want to be able to do
285
707030
1519
Queremos ser capaces de investir
en novos antibióticos e tamén
en novos antibióticos e tamén
12:00
is invest in new antibiotics
286
708549
2279
12:02
in ways that actually encourage
287
710828
2976
en maneiras que promovan
12:05
appropriate use and sales of those antibiotics,
288
713804
3020
o uso e venda adecuados
deses antibióticos,
deses antibióticos,
12:08
and that really is the challenge here.
289
716824
2463
e ese é o auténtico desafío.
12:11
Now, going back to these technologies,
290
719287
2329
Volvendo á tecnoloxía,
12:13
you all remember the line from that famous
291
721616
2363
todos recordan esa frase
dunha coñecida película sobre dinosauros:
dunha coñecida película sobre dinosauros:
12:15
dinosaur film, "Nature will find a way."
292
723979
2226
"A vida atopará un camiño".
12:18
So it's not as if these are
permanent solutions.
permanent solutions.
293
726205
3319
Isto non son solucións permanentes.
12:21
We really have to remember that,
whatever the technology might be,
whatever the technology might be,
294
729524
4086
Debemos recordar que,
calquera que sexa a tecnoloxía,
calquera que sexa a tecnoloxía,
a natureza atopará o xeito
de contrarrestala.
de contrarrestala.
12:25
that nature will find some
way to work around it.
way to work around it.
295
733610
2876
12:28
You might think, well,
this is just a problem
this is just a problem
296
736486
2071
Se cadra estades a pensar
12:30
just with antibiotics and with bacteria,
297
738557
2744
que só é un problema cos antibióticos
e as bacterias,
e as bacterias,
pero dáse o feito de que temos exactamente
12:33
but it turns out that we
have the exact same
have the exact same
298
741301
1946
12:35
identical problem in
many other fields as well,
many other fields as well,
299
743247
2734
o mesmo problema en moitos outros eidos,
coa tuberculose multirresistente
(MDR TB),
(MDR TB),
12:37
with multidrug-resistant tuberculosis,
300
745981
2952
12:40
which is a serious problem
in India and South Africa.
in India and South Africa.
301
748933
3562
un grave problema na India e Suráfrica.
12:44
Thousands of patients are dying because
302
752495
1787
Milleiros de pacientes morren porque
12:46
the second-line drugs are so expensive,
303
754282
1834
os fármacos de segunda liña son moi caros
12:48
and in some instances, even those don't work
304
756116
2227
e, ás veces, nin sequera funcionan
12:50
and you have XDR TB.
305
758343
2070
e ademais temos a XDR TB.
12:52
Viruses are becoming resistant.
306
760413
1811
Os virus vólvense resistentes.
12:54
Agricultural pests. Malaria parasites.
307
762224
3166
Están as pragas na agricultura.
Os parasitos da malaria.
Hoxe en día
12:57
Right now, much of the world depends on
308
765390
1783
a meirande parte do mundo
12:59
one drug, artemisinin drugs,
309
767173
3697
depende dun medicamento,
os derivados da artemisina,
fundamentalmente
para o tratamento da malaria.
para o tratamento da malaria.
13:02
essentially to treat malaria.
310
770870
1956
13:04
Resistance to artemisinin has already emerged,
311
772826
2587
A resistencia á artemisina xa chegou
13:07
and if this were to become widespread,
312
775413
2354
e se comezara a espallarse, poría en risco
13:09
that puts at risk
313
777767
1348
o único fármaco co cal tratamos
a malaria con eficacia
a malaria con eficacia
13:11
the single drug that we have to
treat malaria around the world
treat malaria around the world
314
779115
2891
13:14
in a way that's currently
safe and efficacious.
safe and efficacious.
315
782006
3214
e sen perigo, en todo o mundo.
13:17
Mosquitos develop resistance.
316
785220
1798
Os mosquitos vólvense resistentes.
13:19
If you have kids, you probably
know about head lice,
know about head lice,
317
787018
2237
Se teñen fillos, seguro que
lles soarán os piollos,
13:21
and if you're from New York City,
318
789255
1713
e se son da cidade de Nova York,
13:22
I understand that the
specialty there is bedbugs.
specialty there is bedbugs.
319
790968
2733
teño entendido que alí
a especialidade son as chinches.
a especialidade son as chinches.
13:25
So those are also resistant.
320
793701
2255
Pois tamén son resistentes.
13:27
And we have to bring an
example from across the pond.
example from across the pond.
321
795956
2879
Tamén temos un exemplo
no outro lado do charco.
no outro lado do charco.
13:30
Turns out that rats are
also resistant to poisons.
also resistant to poisons.
322
798835
2355
Resulta que as ratas tamén
son resistentes ao veleno.
son resistentes ao veleno.
13:33
Now, what's common
to all of these things is
to all of these things is
323
801190
2701
O que todos estes casos teñen en común
13:35
the idea that we've had these technologies
324
803891
2706
é a idea de que temos estas tecnoloxías
13:38
to control nature only for
the last 70, 80 or 100 years
the last 70, 80 or 100 years
325
806597
4621
para controlar a natureza
desde hai só 70, 80 ou 100 anos
desde hai só 70, 80 ou 100 anos
13:43
and essentially in a blink,
326
811218
3028
e, nun abrir e pechar de ollos,
13:46
we have squandered our ability to control,
327
814246
2551
estragamos a nosa
capacidade para controlala
capacidade para controlala
13:48
because we have not recognized
328
816797
2491
porque non nos demos conta
13:51
that natural selection and
evolution was going to find
evolution was going to find
329
819288
2812
de que a selección natural
e a evolución ían achar
e a evolución ían achar
13:54
a way to get back,
330
822100
1174
como atopar un camiño
13:55
and we need to completely rethink
331
823274
2049
e temos que repensar por completo
13:57
how we're going to use
332
825323
2343
como vamos empregar as medidas
13:59
measures to control biological organisms,
333
827666
3094
para controlar os organismos biolóxicos
14:02
and rethink how we incentivize
334
830760
3464
e reformular como incentivamos
14:06
the development, introduction,
335
834224
2226
o desenvolvemento e a introdución,
14:08
in the case of antibiotics prescription,
336
836450
2668
neste caso a prescrición dos antibióticos,
14:11
and use of these valuable resources.
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e o uso deste valioso recurso.
14:14
And we really now need to
start thinking about them
start thinking about them
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Realmente necesitamos
comezar a consideralos
comezar a consideralos
14:17
as natural resources.
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como recursos naturais.
14:19
And so we stand at a crossroads.
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Agora estamos nunha encrucillada.
14:21
An option is to go through that rethinking
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Unha opción lévanos á reformulación
14:24
and carefully consider incentives
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e a consideración precavida dos incentivos
14:26
to change how we do business.
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para mudar o modelo de negocio.
14:28
The alternative is
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A alternativa é
14:31
a world in which even a blade of grass
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un mundo no que ata unha folla de herba
14:34
is a potentially lethal weapon.
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pode ser unha arma letal.
14:36
Thank you.
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Grazas.
(Aplausos)
14:38
(Applause)
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ABOUT THE SPEAKER
Ramanan Laxminarayan - Drug-resistance economistAt the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health.
Why you should listen
Economist Ramanan Laxminarayan works to improve understanding of drug resistance as a problem of managing a shared global resource. As Director and Senior Fellow at the Center for Disease Dynamics, Economics & Policy (CDDEP), he is interested in cross-disciplinary, pragmatic solutions to reduce drug resistance. He has advised the World Health Organization and World Bank on evaluating malaria treatment policy, vaccination strategies, the economic burden of tuberculosis, and control of non-communicable diseases. He was a key architect of the Affordable Medicines Facility for malaria, a novel financing mechanism to improve access and delay resistance to antimalarial drugs. In 2012, he created the Immunization Technical Support Unit in India, which has been credited with improving the immunization program in the country. He teaches at Princeton.
As he says: "It has been a long time since people died of untreatable bacterial infections, and the prospect of returning to that world is worrying."Ramanan Laxminarayan | Speaker | TED.com