Superbugs: the race to stop an epidemic

By Matt McCarthy

Drug-resistant bacteria — known as superbugs — are one of the biggest medical threats of our time. Here, a doctor, researcher, and ethics professor tells the exhilarating story of his race to beat them and save countless lives.

When doctor Matt McCarthy first meets Jackson, a mechanic from Queens, it is in the ER, where he has come for treatment for an infected gunshot wound. Usually, antibiotics would be prescribed, but Jackson’s infection is one of a growing number of superbugs, bacteria that have built up resistance to known drugs. He only has one option, and if that doesn’t work he may lose his leg or even his life.

On the same day, McCarthy and his mentor Tom Walsh begin work on a groundbreaking clinical trial for a new antibiotic they believe will eradicate certain kinds of superbugs and demonstrate to Big Pharma that investment in these drugs can save millions of lives and prove financially viable. But there are countless hoops to jump through before they can begin administering the drug to patients, and for people like Jackson time is in short supply.

Superbugs is a compelling tale of medical ingenuity. From the muddy trenches of the First World War, where Alexander Fleming searched for a cure for soldiers with infected wounds, to breakthroughs in antibiotics and antifungals today that could revolutionise how infections are treated, McCarthy takes the reader on a roller-coaster ride through the history — and future — of medicine. Along the way, we meet patients like Remy, a teenage girl with a dangerous and rare infection; Donny, a retired firefighter with a compromised immune system; and Bill, the author’s own father-in-law, who contracts a deadly staph infection. And we learn about the ethics of medical research: why potentially life-saving treatments are often delayed for years to protect patients from exploitation.

Can McCarthy get his trial approved and underway in time to save the lives of his countless patients infected with deadly bacteria, who have otherwise lost all hope?

• Language: English
• Publisher: Scribe Publications
• Release date: Jun 4, 2019
• ISBN: 9781925693522

Matt McCarthy

Matt McCarthy is the author of two US bestsellers, The Real Doctor Will See You Shortly and Odd Man Out. He is an assistant professor of medicine at Weill Cornell and a staff physician at NewYork-Presbyterian Hospital, where he serves on the Ethics Committee. His work has appeared in Sports Illustrated, Slate, The New England Journal of Medicine, and Deadspin. He reviews nonfiction for USA Today and is editor-in-chief of Current Fungal Infection Reports.

Book preview

changed.

Prologue

IT WAS JUST after dawn when I felt the buzz on my hip. I broke stride, put down my coffee, and glanced at my pager: I was needed in the emergency room. It was 2014, an unseasonably warm October day, and the text induced a flurry of anxiety and excitement. After eleven years of training, I had accepted a position as a staff physician at NewYork-Presbyterian Hospital, a tertiary care center on the Upper East Side of Manhattan, and a patient had just arrived with a perplexing infection, one that had stumped the team in the ER.

A moment later, I was standing before a group of medical students and residents and my new patient. The young man writhing on the stretcher was an African American mechanic from Queens named Jackson, with dark-green eyes and a small Maltese cross tattooed onto his neck. He had been shot, and a large area surrounding the bullet, which was still lodged in his left leg, looked infected. As I peered into jagged edges of the entry wound just above Jackson’s knee, a student handed me a piece of paper. The printout revealed the results of microbiological test, which caused my eyes to bulge. My patient, I discovered, was infected with a nimble and aggressive new bacterium that was resistant to every antibiotic at my disposal, except for one: colistin.

I had used the drug only a few times in my career and never with good results because it was so outrageously toxic. Colistin might kill bacteria, but it destroyed kidneys and other internal organs in the process, leaving many of my patients with just two options: dialysis or death. Antibiotics that had proven so effective just a short time ago were now useless, and if I wanted to save this young man’s leg, it was my only option. I shook my head and handed the paper back to my student. Not good. More than twenty thousand people die every year in the United States from antibiotic-resistant infections, and the pipeline of drugs to treat them is always on the verge of drying up. I crouched to meet Jackson’s eyes and carefully considered my words. You have an infection, I said. A severe infection.

The man’s gaze darted from me to the men and women standing in a horseshoe behind me. How severe? He took in a small breath of air and held it, waiting for me to say something. It felt like an hourglass had been flipped; suddenly the tiny room was very hot. I took off my white coat and rolled up my sleeves. Quite severe.

His eyebrows raised, and I reflexively extended my arm to hold his hand, but caught myself. I wasn’t supposed to touch this patient without protection. I pivoted back to my team. Everybody out. Now. I pointed toward the door. I’ll be right back. Just outside of his room, I put on a disposable yellow gown and a pair of purple nitrile gloves, and returned to the bedside alone. It’s very hard to treat, I said, but not impossible.

Jackson was now breathing very quickly, on the verge of hyperventilating, as sweat beaded on his forehead. He grasped his thigh, inches above where the bullet had entered. Beneath his fingertips, bacteria were rapidly multiplying, devouring muscle and bone. Am I gonna lose it? he asked. The leg?

In truth, I wasn’t sure. Only colistin had a chance of destroying the infection, but there were no guarantees. The last person I prescribed it to died twelve hours after she received it. The one before that died while receiving it. I don’t think so, I said, as confidently as I could. I squeezed his sweaty hand and tried to imagine how I would summarize the nuances of the case for his wife and children. They would need to take special precautions just to be in the same room with him. We’re going to get through this, I said as his eyes began to water. We will.

I left the room, removed my gown and gloves, and addressed my team. Start colistin, I said. One of the residents frowned as she scurried to a computer to put in the order. Then we vigorously washed our hands and moved on to the next patient.

When rounds were over, I walked across the hospital to the office of my research collaborator, Tom Walsh, director of the Transplantation-Oncology Infectious Diseases Program. Walsh is a wisp of a man, pale and thin like a potato chip, with deep-set eyes, a warm smile, and a surprisingly firm handshake. His modest features are a notable contrast with my own: I have a high forehead, broad shoulders, and a nose that’s slightly too large for my face.

We make for an odd pair.

Walsh is one of the world’s leading authorities on obscure infections, and when he’s not caring for patients, he’s creating new antibiotics to treat them. We had met a few years after I graduated from medical school—I still have the elegant biochemical structures he drew for me during our first interaction—and I’ve been working with him ever since.

In 2009, he moved from the National Institutes of Health (NIH), the federal agency responsible for biomedical research and disease prevention. Walsh brought with him an expansive research consortium—an international team of physicians and scientists who conduct experiments in test tubes, animals, and humans—to develop antibiotics. He is one of the only researchers in the world to oversee a laboratory of this scope; he is an expert in infectious diseases, oncology, pediatrics, internal medicine, pathology, microbiology, and mycology. No one else possesses his breadth of knowledge. Not surprisingly, Big Pharma is eager to work with him. But Tom Walsh does so on his own terms; I once saw him quash a $50 million drug development initiative with three barely audible words: Would not pursue.

He had called me that October morning in a fit of excitement, with news that Allergan, the pharmaceutical giant, wanted us to run a clinical trial: a large-scale human experiment with an unproven drug. The Dublin-based company was developing a promising new molecule and it wanted us to show it was not only safe but effective in treating humans infected with antibiotic-resistant bacteria, known colloquially as superbugs. They had become a persistent problem for us; superbugs didn’t really exist before the 1960s, and they were only sporadically seen in the world until the 1990s. But a combination of poor prescribing practices by doctors along with the indiscriminate use of antibiotics in commercial agriculture and farming exposed bacteria to our precious arsenal of effective drugs, and the microbes figured out ways to neutralize them. Superbugs were now everywhere—even on stray bullets in Queens—and they had become a leading cause of deadly infections in humans. So, what is it? I asked Walsh as I entered his office. He leapt up from his messy desk, hurrying past framed diplomas and awards that covered every inch of the mahogany walls, to greet me. What’s the drug?

Walsh looked exhausted—the man regularly slept only three hours a night—because we were in crisis mode, desperately searching for new antibiotics to treat our patients. I had grown accustomed to watching men and women succumb to infections that had been treatable just a few years ago. When Walsh shook my hand, he brightened. Dalbavancin, he said softly.

My fingers and wrists were still damp from the tense exchange in the emergency room; I wiped them on my khaki pants and sat down in the chair next to his desk. You’re kidding.

He handed me a thick manila folder. I’m not.

Just the word—dalbavancin—brought me back fourteen years, to my days as an undergraduate tinkering around in the laboratory of a future Nobel laureate named Tom Steitz, a biophysicist who was known around campus as the Michael Jordan of crystallography, the branch of science that probes the atomic building blocks of life. Steitz studied protein synthesis, an essential function of nearly all living things, and his discoveries led to all sorts of new drugs, including a handful of antibiotics related to dalbavancin, called dalba for short. Like Tom Walsh, he was a visionary who could see drug development in ways that others couldn’t.

I connected with Dr. Steitz through his son, Jon, who happened to be my teammate on the Yale University baseball team. He and I were pitchers and biochemistry majors, and we were both drafted out of college to play professional baseball; Jon was selected by the Milwaukee Brewers in the third round of the 2001 Major League Baseball draft, and I was taken the following year, in the twenty-first round, by the Anaheim Angels. We briefly thought we were destined for the big leagues.

A year later, after a stint playing minor league baseball in Provo, Utah, I was cut by the Angels and exchanged my baseball mitt for a stethoscope. I enrolled at Harvard Medical School in the fall of 2003, moving to Boston around the time Jon gave up the game and went to Yale Law School. A few weeks after classes began, I attended a lecture by a young and charismatic infectious disease doctor named Paul Farmer, cofounder of the global nonprofit Partners in Health, and immediately knew what I wanted to do with the rest of my life. I was going to study infections to learn how to defeat them.

Let’s get to work, Walsh said, snapping me out of my reverie.

This was the moment everything changed, when I went from a passive observer of drug resistance to an active participant in the race to stop the expanding threat of superbugs. But before I could start the long and winding journey of a clinical trial, I had to familiarize myself with the painful lessons learned from generations of failed studies and appalling ethical lapses, as well as the remarkable scientific advances behind the work of Tom Steitz, Tom Walsh, and others. That extraordinary story, the one that ultimately led me into the hospital room of a terrified mechanic from Queens, begins with a different bullet wound one hundred years earlier, in October 1914, when a soft-spoken military physician noticed something unusual and had a hunch. It’s an adventure dotted with clues that would help me unravel the mystery of Jackson’s infection.

PART 1

A Chance Observation

CHAPTER 1

The Fog of War

THE DOCTOR EXAMINED the fresh wound and shook his head. The bullet had pierced the soldier’s right thigh, pulverizing his femur before exiting the back of the leg, leaving behind a bloody mess. It would soon become infected, and the physician, a captain in England’s Royal Army Medical Corps, closed his large blue eyes and imagined what was to come. There was no shortage of terrible fates befalling soldiers with this kind of injury, from amputation to gangrene, even organ failure. But he was most worried about tetanus—a lethal condition causing paralysis and eventual suffocation—that was terrorizing so many British soldiers in his battlefield hospital on the Western Front.

It was October 24, 1914, and Alexander Fleming, a thirty-four-year-old doctor from Scotland, was caring for a throng of men at a makeshift military base in Boulogne, France, that doubled as a wound-research laboratory. The Great War was just eleven weeks old, and already losses were heavy. British soldiers had arrived in France on August 7; two weeks later, French and British infantry were brutally defeated by the Imperial German Army in a forest fight at the Battle of Ardennes. The unexpected drubbing had triggered a slow and humiliating retreat as the Germans continued their march toward the French capital.

Then, on September 6, something astonishing had happened: thirty miles northeast of Paris, six French field armies and the British Expeditionary Force suddenly halted and counterattacked. For three gruesome days, the battle shifted back and forth along a one-hundred-mile front. Owing to remarkable advances in artillery—powerful new machine guns, howitzers, and mortars—it was one of the bloodiest engagements in the history of warfare.

The Allies’ gambit worked. Devastating losses forced the Germans to abandon plans to invade Paris. The victory, however, came at an extraordinary cost: more than two hundred thousand French and British soldiers were wounded at what would become known as the first Battle of the Marne. In its aftermath, waves of injured men, bathed in blood and riddled with shrapnel, were brought to Fleming’s hospital.

The young doctor grabbed a damp cloth from his surgical bucket and dabbed the soldier’s leg, cleaning mud, blood clots, and shreds of uniform from the gaping exit wound. He picked up a scalpel and carefully excised a small swatch of fabric from the man’s muddy pant leg. This piece of clothing, Fleming hoped, would solve one of the most puzzling questions of World War I: Why were so many soldiers dying of tetanus?

It was a rare disease, typically infecting only one in every hundred thousand people, but in Boulogne it was everywhere. Fleming suspected that the bacteria causing tetanus was embedded in British military uniforms. When soldiers were shot, he reasoned, the organism was introduced into the bloodstream, overwhelming the body’s defenses. Fleming rushed to his laboratory, handling the scrap of dirty clothing with great care. He passed row after row of camp beds holding injured soldiers from Marne, and Mons and Ypres in Belgium. Many had lain on the battlefields for days.

The makeshift laboratory was located in the musty basement of an old casino, beneath high-ceilinged, ornate, once-elegant rooms, and it was covered with signs of Fleming’s ingenuity: incubators he’d heated with paraffin stoves, Bunsen burners running on alcohol, glass-blowing burners using fire bellows, and a matrix of petrol cans and pumps to supply water. At his lab bench, Fleming squeezed the small piece of fabric into an empty test tube and placed it next to a row of tubes that were all incubating clothing from injured soldiers. After adding a special broth to the glass, Fleming returned to his patient and went about the task of dousing the man’s thigh with antiseptic fluid.

Peering closely into the wound, Fleming could imagine how this would play out: For the next few days, discharge from the leg would be reddish-brown and foul smelling, consisting mostly of clotted blood and bacteria. After a week, the dank material would lose its pigment and odor, gradually transforming into a thick soup of pus. If the soldier was unlucky, as many Brits in France were, he would develop fever, restlessness, irritability, palpitations, and, finally, the telltale sign of tetanus: lockjaw. Tetanus caused facial spasms that left many soldiers with a permanent grin—a perverse condition called risus sardonicus—before inducing paralysis and an agonizing, slow death.

The bacterium responsible was a common inhabitant of horse intestines, and its spores—the reproductive units—could lie dormant for years in soil containing traces of manure. Tetanus was an anaerobic organism, which meant it did not grow in the presence of oxygen. Even brief exposure was enough to kill it. So why was it flourishing on the well-tilled fields of Belgium’s Flanders region, where oxygen exposure was constant? And, more importantly, in wounds exposed to air? Fleming thought that the bacteria were hiding out under shrapnel, within the recesses of the wound, where oxygen was scarce and antiseptics were washed away by the discharge of pus. That was why the harsh chemicals that easily killed tetanus in a test tube failed to do so in flesh.

Fleming had come to France at the behest of his mentor, Almroth Wright, a controversial figure who had been the first to mass-produce a vaccine against typhoid fever. In contrast with Fleming, who, owing to his small stature, was often asked to play women in his dramatic society—he took on the role of a vivacious French widow in a production of Arthur W. Pinero’s comedy The Rocket—Wright was a bear of a man, with a bushy brown mustache, small spectacles, and lock of wavy hair parted fiercely to the right. Some suspected he suffered from a hormonal disorder. They, too, made for an unusual pair.

Wright had lobbied hard for his typhoid vaccine to be given to British troops during the war, and when there was some initial hesitation—routine vaccination was not yet en vogue—Wright published an impassioned plea in the London Times, On the Inoculation of Troops Against Typhoid Fever and Septic Infection. The piece had appeared four weeks earlier, on September 28, 1914, just seven weeks after Britain had declared war on Germany in response to its invasion of France. Although the public appeal was unpopular with many doctors—some of whom referred to him as Almost Wright—it worked, and the British army quickly made vaccination against typhoid compulsory.

Sir Almroth Wright

Wright had also recommended vaccination against sepsis, but the director general of the British Army Medical Service, Sir Alfred Keogh, was unconvinced. He suggested more research was needed before mandating a second inoculation. Wright created a wartime research unit to study the bacteriology of wound infection, and this was where Fleming now found himself.

Surrounded by infection, unable to help the thousands of men who were suffering and dying around him, Fleming had become consumed by a desire to discover something that would save his soldiers. But at the moment, he had only antiseptic fluid, wound dressings, an untested antitoxin generated from horse blood, and his scalpel, none of which could protect them from a bacterium that was proving remarkably hard to kill. For some of his infected men, the cure would involve a hacksaw.

The medical world in which Alexander Fleming toiled as he shuttled between injured soldiers and his casino laboratory was defined by two approaches to the treatment of infected wounds: the physiological school, which concentrated its efforts in aiding the natural protective agencies of the body against infection, and the antiseptic school, which aimed at killing the microbes in the wound with a chemical agent. Fleming knew antiseptics worked well in theory, but he worried that the active ingredients—caustic chemicals such as boric acid, flavine, and carbolic acid—might actually be harming his patients. The soldiers simply didn’t get better with antiseptics, and the doctor had a hunch that they might in fact allow the tetanus bacterium to proliferate.

His theory was that abrasive chemicals might work in the central cavity of the wound, but they lacked the penetrative power to clean the tissue at the edges. Something about the periphery allowed bacteria to thrive. It was a radical thought, one that would have had Fleming laughed out of any hospital in Europe, but he was increasingly certain that antiseptics were killing his men, and he was designing an elegant experiment to prove it—one that drew on his life before medicine.

Prior to enrolling at St. Mary’s Hospital Medical School in Central London in 1903, Alexander Fleming had learned an odd craft: glassblowing. Mostly he made tiny figurines—glass cats and scampering mice for family and friends—but when resources were scarce, he made his own research equipment, including test tubes. In Boulogne, Fleming began dreaming of ways to design tubes with contours that would approximate the jagged dimensions and texture of a bullet wound. The experiment was still in its infancy, but if it worked, it would turn the treatment of combat wounds on its head. Antiseptics were central to medical care during the Great War; British military policy mandated their use. Fleming was convinced they were not simply useless, they were dangerous.

But Little Flem, as he was known, was not drawn to controversy, or to combat, or even to conversation. (One colleague claimed that trying to speak with him was like playing tennis with a man who, when he received a serve, put the ball in his pocket.) The doctor knew he had a story to tell; he just had to write it.

MORE THAN SEVENTEEN MILLION military personnel died during World War I, many of them from tetanus. After the fighting was over, Fleming returned to London and to his lab bench in the Inoculation Department at St. Mary’s Hospital. By the time the armistice was signed on November 11, 1918, Fleming had published a dozen papers based on his work at Boulogne, and he was known in academic circles for his ingenious experiments with glassware. But he was a lone voice, and antiseptics still ruled the day.

Haunted by what he had seen on the Western Front, the young doctor spent the next decade in his laboratory, just up Praed Street from Paddington Station, trying to devise ways to destroy harmful bacteria and improve the treatment of infections. It was tedious work, staring at thousands of bacterial colonies in petri dishes in a dimly lit laboratory day after day, but it fulfilled him. He was consumed by a desire to understand how bacteria thrived and, more importantly, how they could be killed.

A chance observation in September 1928, a decade after the war, was briefly cause for celebration. One afternoon, Fleming noticed that the Staphylococcus bacterium—one of the pesky organisms that was so prevalent in battlefield wounds—was killed in the presence of a fungus called Penicillium rubrum. This accidental finding occurred in a discarded petri dish and led to the discovery of what he called a slow-acting antiseptic. Fleming dubbed it penicillin.

On May 10, 1929, he sent his findings to the British Journal of Experimental Pathology. Fleming wrote: Penicillin . . . appears to have some advantages over the well-known chemical antiseptics. . . . If applied, therefore, on a dressing, it will still be effective even when diluted 800 times, which is more than can be said of the chemical antiseptics in use. The utility of this finding, however, was not yet clear. Penicillin could kill bacteria in petri dishes and test tubes, but it failed in the presence of blood. Because the fungus took several hours to exert its effect, Fleming was resigned to the fact that while penicillin might work superficially, it would be destroyed in the human body before it could ever kill the bacteria in a festering wound. Penicillin wouldn’t save injured soldiers or anyone else. Instead, he thought it would serve as a valuable tool for preventing Staph bacteria from contaminating laboratory experiments.

Fleming was not the first scientist to notice that microorganisms could kill bacteria. Others had similarly suspected that their fungal extracts were either too feeble or too toxic to treat human bacterial infections, and they were discarded into the dustbin of history. They simply didn’t realize they were on the precipice of something that would alter the course of human health forever.

Regrettably, Fleming’s penicillin paper was not written in a way to make his findings accessible or reproducible. It was as if the manuscript had been dashed off in midthought. He did not explain how the molecule was purified from the fungus or where one might gain access to his chemical reagents to replicate his work. And he was such a poor public speaker that his lectures did little to inspire colleagues. To make matters worse, Fleming’s collaborator had misidentified his fungus: it was Penicillium notatum, not Penicillium rubrum. Anyone hoping to reproduce his experiment was out of luck.

Sir Alexander Fleming in his laboratory at St. Mary’s Hospital in Paddington, London, October 2, 1943

Investigators at Oxford University and Sheffield University Medical School, however, agreed with Fleming’s assessment that because it killed off laboratory contaminants, penicillin could be useful to isolate and study a bacterium called Bacillus influenzae (now called Haemophilus influenzae), which some thought was responsible for the influenza pandemic of 1918. The outbreak had begun in Spain in May of that year, as World War I was coming to a close, and toward the end of Fleming’s deployment, cases of influenza at his French hospital far outnumbered the wounded. By 1919, twenty million people had died from the infection, and the urgent need for some understanding kept Fleming’s fungal research going. Still, they believed that penicillin was crucial only for studying influenza—no one, not even Fleming himself, realized that he had stumbled upon a rare strain of fungus that produced penicillin at such an extraordinary level that it could be used to treat human infections. By the summer of 1929, just a year after its discovery, he abandoned work on the penicillin molecule. It would be more than a decade, and another world war, before Fleming and colleagues at Oxford would revisit it, teaming up with the burgeoning pharmaceutical industry to create the world’s first mass-produced, commercially available antibiotic.

CHAPTER 2

A Golden Era

FLEMING AND HIS COLLABORATORS are credited with making the first widely accessible antibiotic, but that’s not entirely accurate. Yes, their protocol did lead to mass production and distribution of penicillin in 1945, but it turns out that humans have been consuming antibiotics for millennia, whether they knew it or not. Significant levels of tetracycline, a broad-spectrum antibiotic still used today, have

Reviews for Superbugs

[ahegge_2 · Rating: 4 out of 5 stars]

I received this book through the Early Reviewers program. I thought it was very interesting and engaging. I enjoyed learning about the history of antibiotic and anti fungal medications, while also following the story of the author's evolving medical trial.

[Khuliso · Rating: 4 out of 5 stars]

Brilliant insight into the world of drug development. I thought it would be mostly technical jargon designed for specialists, but it is far from that. It's a well written narrative inviting the reader into the history and advances in medicine.

[eduscapes · Rating: 4 out of 5 stars]

SUPERBUGS: THE RACE TO STOP AN EPIDEMIC by Matt McCarthy traces the advances in medicine that are finding new treatments for antibiotic resistant bacteria.Over the past several decades, many antibiotics have become less effective against increasingly tough strains of bacteria. In this engaging work of nonfiction, McCarthy investigates the past, present, and future of bacteria and antibiotics. The author brings the real-life medical drama to life by sharing the personal experiences of patients fighting for their lives.The author’s personal perspective and detailed examples makes this book unique from many works of popular science nonfiction. The book concludes with source notes that provide interesting insights into the literature connected with the book’s anecdotes.ARC courtesy of the publisher.

[foof2you · Rating: 4 out of 5 stars]

A look inside the amazing world of medicine and the efforts to find new antibiotics and the process of drug trials. This book makes one see why it is so hard to get new drugs to the market and how difficult it is to get people to sign up for the trials.I received this book as part of the Library Thing Early Reviewers.

[bespen · Rating: 5 out of 5 stars]

I received a free copy of this book through LibraryThing’s Early Reviewers program.Superbugs is a fascinating book, and I’m glad I had the chance to review it. This book is a window into the management, and hopefully curing, of difficult antibiotic-resistant infections from the point-of-view of a physician who sees the worst the world has to offer. McCarthy wrote it in a chatty, personable, and slightly ADD style that probably makes it more accessible. This is a difficult thing to get right with a work of popular science, which I take this book to be.There is an infamous rule of thumb that including one mathematical formula in your book will reduce your readers by half. Each additional formula continues the process of exponential decay. McCarthy has clearly decided to maximize his potential readership by avoiding mathematical formulae, or worse, skeletal formulae of organic molecules.However, while he doesn’t show them, he talks about them a lot. If you know what is going on, you can either envision the diagrams or look them up, but organic chemistry isn’t needed to tell the stories that McCarthy wants to tell.The first story is McCarthy’s work with Allergan on the antibiotic dalbavancin, and his journey to learn how to write a protocol for a clinical trial and gain consent from often frightened and bewildered patients who show up in Emergency Rooms with methicillin-resistant Staph Aureus infections. His meandering style allows him to digress into the second story, which is a capsule history of the development of antibiotics, and the sometimes checkered history of human experimentation in medicine.His history of antibiotic development includes well-known figures like Alexander Fleming, and the overlooked, like Elizabeth Lee Hazen and Rachel Brown, who developed nystatin, the first antifungal drug.The book is probably worth it just for this well-done short summary of the powerhouses of modern pharmaceuticals [and more evidence for my theory that the greatest period of technological advancement in the twentieth century was between 1920-1950]By the early 1950s, ninety percent of the prescriptions filled by patients were for drugs that had not even existed in 1938. pg 101 [citing Miracle Cure by William Rosen 2017]However, you also get a good look at how medicine is practiced in the United States today, from the practitioner’s point-of-view. Physicians need to manage conflicts of interest, like the portion of McCarthy’s salary that is paid by Allergan and other corporations, patients that are bound and determined to pursue courses of treatment that the evidence doesn’t support, and the sheer soul-crushing burden of seeing so much suffering day-in and day-out.We Americans expect our doctors to be superhuman: to work without rest, to diagnose without fail, and resist the siren call of wealth. Doctors receive enormous deference for our unrealistic expectations, but a subtext of McCarthy’s book is the toll this takes on our often genuinely selfless and dedicated physicians. Who do in fact accept honoraria and speaking fees from pharmaceutical companies and miss their children while they work long hours.Another interesting aspect of American medical practice is its insularity. Nearly every reference in McCarthy’s book is from a medical journal, which is the mental world of most physicians. However, medicine might progress faster if physicians were to be a little bit more widely read. For example, McCarthy devotes a fair bit of space to the research of Vincent Fischetti, who isolates enzymes from bacteriophages. But phage therapy was a thing before antibiotics were invented, and was largely forgotten in the initial enthusiasm for antibiotics. Phages and adjacent technologies would be a useful adjunct to antibiotics, but medicine, meaning mostly expert physician opinion, has been pointedly disinterested for seventy years or more. I appreciate that McCarthy is trying to do something about that, but reading and citing mostly medical journals is only going to perpetuate the attitude that pushed useful therapies aside because it wasn’t the hot new thing, or because it came from the wrong field.All in all, I enjoyed this book. I think McCarthy did a fine job making the history of antibiotics accessible, and was remarkably honest about himself and his field, frankly admitting the challenges physicians face today. This book could have been dry, but it wasn’t, so I am willing to embrace the rapid alternation between the present and the past. McCarthy made this style work. One can learn a lot about the world, past and present, from this book.In a final note, there is a short letter tucked in my review copy that public results for McCarthy’s dalba study are expected on or around May 21st, just under a week from the publication of this review. I hope everything went well, because I like having options when the bacteria evolve faster than us.

[jonri-4 · Rating: 4 out of 5 stars]

This book was interesting, but it was too unfocused, jumping around from descriptions of individual patients, unethical medical experiments in the past, how antibiotics are found, to what the author likes to listen to when he is reading, to lots of praise of the author's mentor in this field. Despite that, I learned quite a bit about how research protocols are conducted and .why antibiotics haven't been a high priority for researchers. Still, I found the author's "The Real Doctor Will See You Now" more interesting and better written.I read an ARC. I hope the final version has fewer minor text errors.

[conniemcmartin · Rating: 2 out of 5 stars]

If you are looking for a glimpse into superbugs and clinical trials (and the people involved in them), then this book is for you. Though somewhat scattered at times, it's written in a conversational style, making the info accessible to the average person. Personally, I just wanted more of the science stuff. I don't why I had misinterpretted what it was going to be about. I read the synopsis again and it is pretty clear to me [now] that it is a book about case histories of patients in the dalba trial. While I appreciated some of the political aspects of how a new drug gets to market – and some of the personal stories of patients, doctors and researchers – it just felt too heavy on backstory and chitchat to me. That said, plenty of others enjoyed it for the very reasons I didn't. All depends on what you are looking to get out of it.

[pencilstubs-1 · Rating: 5 out of 5 stars]

“Superbugs” has fantastic story-telling despite being a medical/science oriented book. McCarthy provides distinctive, personal details that make both famous researchers and his own patients easy to imagine and relate to. I enjoyed how he smoothly transitioned back and forth between the past and present to keep up the pacing and to convey information on bacteria, antibiotics, and the pharmaceutical industry in a logical and clear way. I learned a lot, though there was just as much terrifying and disheartening things as there was amazing and hopeful things to digest. My only complaint is that I wish there could have been an extra chapter at the end with suggestions on what the average person could do to help prevent superbug infections. I can think of a handful of obvious things, but I’m sure an expert could come up with more.I have some health issues, so the subject matter of antibiotics, infections and superbugs is important to me on a personal level, and I’m glad to now be aware of the impact they have on a worldwide scale and on our collective future. I would recommend this to family and friends since it’s a quick and engaging read and is relevant to everyone. (Please note that I received a free copy of this book in exchange for an honest review.)

[batgrlgothamcity-1 · Rating: 4 out of 5 stars]

I really enjoyed reading this book. I have most of my degrees in school in science and it was wonderful to be able to read something that was both technological but also reader-friendly. I noticed I couldn't put the book down once I started reading it. It's great that there is a book discussing the need to stop using antibiotics so much!

[christiana5 · Rating: 5 out of 5 stars]

This is a fast paced, eminently readable journey into the challenges of modern medicine, where antibiotic resistance is growing, and the financial imperatives of the pharmaceutical industry don't support the needed research into new antibiotics. While that may sound depressing, McCarthy keeps hope alive by sharing his experiences enrolling patients in a clinical trial of a promising new antibiotic. This book also tells the story of McCarthy's mentor, Tom Walsh, who is an amazing medical talent who consults regularly on some of the world's most challenging cases. I received this book free through the Early Reviewers program, in exchange for an honest review. Highly recommended for those with an interest in science and medicine, and the growing threat of antibiotic resistant infections.

[karmabodhi · Rating: 2 out of 5 stars]

While I applaud Dr. McCarthy for his humility in being vulnerable and honest about his troubles with dalba clinical trials (I didn't expect that at all), this book is poorly written. I didn't even make it through the book, and I have a background in microbiology! I was excited to read this book because I thought it would be more about bacteria and antibiotic resistance, not case studies. There's nothing wrong with the patients' stories of course, it just wasn't what I thought the book was going to be about. I also question his morals: "Permanently altering the genetic code can change what it means to be human; it wouldn't be that hard to insert rabbit DNA into a person, and we could do it without someone's consent." For a doctor to make that statement and violate the hippocratic oath was shocking to me, and soured me towards the rest of the book.

[mbookshelf · Rating: 3 out of 5 stars]

Superbugs weaves a narrative surrounding the work that Matt McCarthy and his colleagues undertake everyday to fight the increasing problem of long-trusted antibiotics no longer working against "superbugs." His narrative focuses on his work to test new drugs, the patients he encounters everyday, and his colleagues' work within the medical research field leaving one unsure if he ever sleeps!My biggest issue with the book was that the various strains of the story were hard to follow. The story bounced from one topic to the next without stopping to remind you who a individual was or what disease was being discussed. At points, it just felt like a mish-mash of acronyms and names even though I thought I had probably been introduced to the elements earlier in the narrative. Because of this, the timeline was rather hard to follow as if elements were just added to the story as the author remembered them.All that is to say, as someone will little understanding or knowledge of his field, McCarthy was able to weave a narrative that kept me engaged and left me with a greater appreciation for the work that doctors and scientists undertake everyday to stave on diseases.

[ehousewright-1 · Rating: 4 out of 5 stars]

I can’t really say I thought this book was particularly well written—the stream of consciousness presentation made it somewhat difficult to remember people and situations as you circled back to them again. I might have given it 3 stars—but the content is important and the focus on learning, trying, and caring made it worth one more. The “superbugs” are outsized and alarming and the importance of the quest for new antibiotics is made evident both in general and in very personal terms. The devotion of this doctor to his mentor is truly inspiring—having such people working tirelessly on this difficult quest is so encouraging. It was clear that Dr. McCarthy has evolved during his time on this journey—in particular his admission that the IRB that reviewed his applications to test the drug had been correct in turning down his first attempts showed humility and personal growth. May these doctors prevail in this fight—because what will happen if they don’t was chillingly portrayed here.

[knightlight777 · Rating: 3 out of 5 stars]

Written by Matt McCarthy M.D. this book is a narrative of how a practicing doctor who is also a professor of medicine takes on the endless battle against the bacterial superbugs that threaten our very existence. With some historical perspectives Dr. McCarthy relates his interactions with patients and the application and development of an antibiotic, alba, that he is developing.With the help and encouragement of his mentor Dr. Thomas Walsh, Dr. McCarthy narrates the challenges and obstacles he faces from patient consent forms to the financial forces of Big Pharma. Each case shares its similarities and differences and provides an insight into the toll this work can take not only on the patients but the doctors who must also deal with the setbacks and emotional strains.The book did lack a more descriptive approach into what superbugs are about which I had thought it would be more about. Instead it focuses more on the people afflicted by the infections and reads more like a case study book. However the messages are clear as to implications of why this work is so important. The doctors involved in developing these antibodies we rarely hear of but their persistence and dedication to winning this endless battle is truly a heroic tale.

[nyiper · Rating: 5 out of 5 stars]

Matt McCarthy makes the discussion of superbugs an adventure story, full of twists and turns, emotional triumphs as well as moments of depression. The worry about running out of antibiotics capable of treating the bacteria and fungi that keep on coming to the human race easily brings fear to anyone who happens to think about it but McCarthy and his hero and very close friend and associate, Dr. Thomas Walsh, are on the attack. McCarthy knows how to write for the general public and he describes everything he and Walsh did in his ultimately successful efforts to get the drug---Dalba--into a clinical trial. Along the way he exposes the reader to the complexities and mysteries of the entire world of antibiotic searches--a truly fascinating and remarkable journey, personalized with stories of real people, including scientists, doctors and perhaps most importantly, patients.

[eachurch-1 · Rating: 5 out of 5 stars]

Both frightening and hopeful, reading Superbugs will convince you never to ask for antibiotics for a viral infection again. Superbugs does what all good memoirs do, it places one person’s experience into a larger context. In this case, the history of antibiotics. McCarthy explores both how they came to be used, how they are discovered, and the results of them being overused. (I suppose it is debatable whether this is really a memoir, but McCarthy’s experience and his reactions are key to the story.) Written in clear, accessible prose, it is a compelling story which makes you appreciate your skin, and the creative, essential work done by thoughtful, creative, and extraordinary physician/researchers like McCarthy and Tom Walsh.

[loraineo_8 · Rating: 4 out of 5 stars]

The book begins with the history of antibiotics and the gradual increase in overuse and development of antibiotic resistant bacteria. The author describes numerous true examples of patients who have survived these superbugs and some who don't. Very informative and easy to read.

[riversidereader · Rating: 4 out of 5 stars]

Matt McCarthy is a staff physician at New York-Presbyterian Hospital. This book is primarily focused on his work with a clinical trial of a new antibiotic. The author covers a lot of territory including a brief history of antibiotics, how they are developed and, in some cases, why Big Pharma is not interested in creating new and better antibiotics to fight the emergence of "Superbugs" that have become immune to the current drugs available. We also get to meet his wonderful colleague, Dr. Tom Walsh. I found this book to be an enthralling page turner. The information is written in an accessible style that is easy to understand and keeps the reader interested. I recommend it to anyone with an interest in the current medical establishment.