Microbiologist Lance Price keeps a collection of stuffed animals in his office.
Actually, they’re not animals—they’re giant, plush microbes, and the first thing Price does when I arrive at his Antibiotic Resistance Action Center at the George Washington University in Washington DC is show them to me.
“This one lives in your butt,” he says, holding an oblong E. coli with two googly eyes and several shoe-string flagella, and gesturing in a way that brings to mind this particular bacteria’s diarrheal consequences. He puts the E. coli down and holds up a lumpy, blue Staphylococcus. “This one lives in your nose.”
Then he picks up a plush that looks a lot like Staph, except it is black and has a cape. “And this one…this is MRSA, and this is a superbug.”
Price has dedicated a large portion of his career to studying superbugs—those strains of bacteria that have evolved to become resistant against the medications we use to fight them. Illnesses caused by these bacteria may start off as something relatively common, like a urinary tract or skin infection, but become fatal because there are no tools left to stop them from spreading. MRSA, or methicillin-resistant Staphylococcus aureus, is one of the most common.
MRSA also made it onto a recent World Health Organization list of the 12 most dangerous superbugs, broken down into three categories: critical, high-priority (which includes MRSA), and medium-priority. Globally, low-end estimates suggest suggest (pdf, p. 5) at least 700,000 annual deaths due to antibiotic-resistant infections, and by 2050, that number is predicted to rise to as high as 10 million.
“[Antibiotic resistance] is one of the greatest threats that faces mankind today,” Price says. “I rank it with climate change, terrorism”—he cuts himself off and corrects himself, “I definitely rank it way ahead of terrorism.”
And yet, they’re not met with a sense of urgency, nor with much public education. Even if you happen to know that overuse of antibiotics is contributing to the problem, that knowledge is not necessarily going to give you pause when you try to find relief for your next sinus infection; you just want to get better as quickly as possible.
Superbugs are everywhere now, including the places we go when we’re already sick. In the US, for example, roughly one in 25 patients every day develops an infection during a stay in a healthcare facility every day, according to the Centers for Disease Control. About half of the infections picked up in hospitals are resistant to antibiotics in some kind of way.
Most of us can’t remember a time when infections were fatal, which is why the concept of ultra-evolved bacteria is hard for many people to grasp, says Ramanan Laxminarayan, an economist who runs the Center for Disease Dynamics, Economics & Policy, a public-health research organization in Washington DC. Superbugs are like a microbial time machine that take us back before 1928, when penicillin, the first antibiotic was invented. Says Laxminarayan, “You have to think of it as a new disease which can’t be treated with any drugs that we have.”
According to the Pew Charitable Trusts, doctors in the US prescribe 7.7 million pounds of antibiotics to patients every year. For context, in 2013 the Mayo Clinic estimated these drugs made up 17% of all prescriptions in the US—the most of any category. Just behind them were opioids and antidepressants, at 13% each. The resistance risk is even worse in agricultural settings. Animals raised for the slaughterhouse in the US get 30 million pounds of antibiotics every year. They’re a superbug bonanza.
Price made his first major scientific breakthrough in 2012, when he and his team published foundational work showing that factory farms are hotbeds of antibiotic resistance. Price’s team tracked the evolution of Staph to MRSA on farms in 19 countries on four continents, looking at how a collection of bacteria we usually host on our body with no problem can become an infectious, drug-resistant nightmare.
There are many benign families of Staphylococcus bacteria that live on our skin and in our noses. Humans live in harmony with these guys, which essentially coat our skin and everything we touch. Farmers who handle pigs for a living understandably give some of their own Staph to their swine. Unlike humans, pigs on farms take low doses of antibiotics all the time. These drugs are meant to prevent the spread of infections that would otherwise thrive in the pigs’ dirty, close quarters. Unfortunately, as Price helped discover, these low doses of antibiotics are the perfect catalyst to turn harmless Staph into MRSA.
Microbes divide all the time; Staph doubles every 30 minutes. Rapid reproduction introduces lots of mutations in a bacterial community, and at least some of these mutations can make bacteria resistant to antibiotics. Normally, there are enough non-resistant bacteria in the bunch to out-compete the resistant crew for resources like space and food. But, when antibiotics wipe out even some of the non-resistant bacteria, superbugs have more room to thrive and reproduce.
On top of that, because bacteria reproduce without a partner, they can do something called horizontal gene transfer. Basically, they can take little bits of genetic material—some of which codes for ways to withstand antibiotics—and pass them along to others in the vicinity. So when pigs are crammed in close quarters and given a steady dose of antibiotics, bacteria breed and breed, and eventually produce a thriving population of superbugs.
The cycle then comes full circle: Pigs, in turn, give MRSA back to their farmers, who then unknowingly spread it to their friends and families.
Even if farmers don’t become sick, carrying a drug-resistant bacteria is like carrying a bomb. If presented with an opportunity to detonate—say, on a cut or an already-sick relative—it can cause a fatal infection.
A laughing matter
It’s easy to fall back on ominous language when trying to communicate the gravity of antibiotic resistance. But Price takes a different approach: In a world that seems filled with unrelenting, unsolvable bad news, humor makes new problems—like antibiotic resistance—seem less daunting. When Price mimes diarrhea, it’s not making light of the subject; it makes it relatable.
Scientists have tried to quantify the exact effects of humor in the classroom. In the small studies that have been conducted, they’ve found that students tend to do better on quizzes when their course material is taught with a few jokes peppered in. Humor also tends to be more persuasive. Studies on the efficacy of different advertising methods (paywall) have found the funnier an ad is, the more likely people will want to buy the product.
“Humor is often not the central part of an argument or idea, but is used to help folks process the central message and convince people to accept ideas or claims,” says Alex Borgella, a psychologist at Bates College who studies humor. Making something funny puts information squarely in the listener’s peripheral processing (pdf). This is how we collect information about what we’re being told. We may, for instance, judge information coming from a person in a lab coat to be more authoritative, or something told to us in a bar to be less credible because it’s a more laid-back atmosphere. There’s a lot that shapes whether or not we agree or disagree with what we’re hearing.
Price invites me to watch him teach an environmental health class full of college sophomores. As the students fill in, he laments that he forgot his guitar—he had planned to sing to them. One young woman calls out that he should join their student talent show, which Price jokingly—or was it seriously?—considers before saying he’s too busy. He then gives them a short quiz before lecturing.
As much as he knows about superbugs and how to reduce their chances of spreading, Price says even he hasn’t figured out a way to prevent bacteria from infiltrating his home. Food is a common vector. “My wife is a microbiologist, I am a microbiologist, and I can guarantee that there are bacteria from meat in our house,” he says.
You might think that cooking meat thoroughly is enough to protect you, but bacteria have a way of getting everywhere. Price explains that it’s basically impossible to keep a kitchen clean:
“You know you bring that package of chicken into your house? It’s wrapped in that shrink-wrapped plastic, hopefully not that cellophane stuff where it’s dripping that stuff. You pop that open and there’s that liquid, and your hand’s wet. There are drug-resistant [bacteria] on your hand now, right. There’s E. coli on your hand…so you’re gonna take the chicken, and you already have your pan with hot oil and you’re gonna put it right in there, kill those microbes…. And then you’re gonna take that package, open the cabinet and throw it in the trash can. You’ve just contaminated your cabinet. And then you’re gonna wash your hands immediately, and you’re gonna contaminate your faucet when you turn that on, and you’re gonna pump the soap and contaminate that, and then you’re gonna scrub your hands and sing “Happy Birthday” twice, you’re gonna rinse your hands off, and then you’re gonna shut off the faucet and recontaminate your hands, and then you’re gonna go make a salad. And when you open that package on the countertop, there’s bacteria there.”
Price and his team have found that drug-resistant bacteria in poultry can wind up in our digestive tract, eventually landing in the colon. There, they reside peacefully—until they’re dislodged for whatever reason. Then they can make their way up in the urethra, where they cause urinary tract infections.
The urethra is connected to the bladder, which is connected to the kidneys, which filter all of our blood; if a UTI goes unchecked and reaches the bloodstream, it can be fatal.
What triggers this chain reaction? Sometimes it comes down to improper wiping when using the toilet. But “the most fun way to get a UTI is through sex,” Price says.
Persistence for resistance
Despite the compelling body of scientific research that says the rise of superbugs is a dire threat to humankind, Price says it’s been hard convincing politicians this is a battle worth fighting. Notably, it’s a lot harder to crack jokes among the pomp and circumstance of politics.
So he’s tried more traditional methods: In 2014, he wrote (pdf) to the White House Office of Science and Technology Policy (OSTP), urging the Obama administration to set limits for the use of antibiotics in agriculture and medicine. The administration listened, sort of. In 2015, the OSTP put forward a National Action Plan to combat drug resistance—a largely symbolic gesture suggesting that the US should enact laws by 2020. That said, it was at least a start—but one the current administration likely won’t follow up on. US president Donald Trump has yet to even appoint a director for the OSTP.
But Price remains optimistic. He believes that where science fails to capture a wider audience, money can. “No one listens to microbiologists, but they do listen to economists,” he told his class.
Financially, antibiotic resistance is poised to swallow up a huge portion of global spending. In 2016, a study commissioned by the UK government estimated (pdf, p. 4) that antimicrobial resistance (AMR) will create an annual global financial burden of $100 trillion by 2050. If that isn’t scary enough, the study also estimates that by then, 10 million people would be dying of these infections every year, surpassing the number of deaths currently caused by cancer by almost 2 million.
The UK study was led by Jim O’Neill, a former Goldman Sachs economist and UK treasury minister best known for giving the world useful shorthand for emerging-market investing when he coined the term “BRIC.” In the foreword to the report, O’Neill confessed his own initial curiosity about why he, a macroeconomist, was asked to lead the study when perhaps a health economist would have been a more obvious choice. His quickly discovered answer: This is a macroeconomic problem.
“It is now clear to me, as it has been to scientific experts for a long time, that tackling AMR is absolutely essential,” O’Neill wrote. “It needs to be seen as the economic and security threat that it is, and be at the forefront of the minds of heads of state, finance ministers, agriculture ministers, and of course health ministers, for years to come.”
Every decision counts
The movement to slow down superbugs is happening on a micro level, too. Price, for example, makes the conscious decision to buy meat that’s antibiotic-free. He and his family are just one household unit, of course. But if enough other households get on board, the economic demand will start to drive change, Price believes, and perhaps farm animals raised with antibiotics will become a thing of the past.
The market appears to be moving in that direction already. The consumer polling company Nielsen has found that from 2011 to 2015, the US market for antibiotic-free meat increased by almost 29% while the overall US market for meat increased by only 4.6%. In April 2017, Kentucky Fried Chicken—the second-largest fast-food chain in the world—announced that all of its chicken would be antibiotic-free by 2018. Already, Panera and Chipotle have made the switch to antibiotic-free chicken and pork (beef and turkey are still a work in progress).
Price, meanwhile, is supervising three research projects that can lead to lower usage of antibiotics in medical settings. First, he’s tracking people in Denmark and Minnesota who have tested positive as carriers for strains of MRSA and E. coli, respectively, but aren’t sick. He thinks that these carriers probably have unique colonies of microbes that keep harmful bacterial strains at bay. If he can figure out the right microbial cocktail to neutralize other bacteria that typically cause illness, it could eventually be used as a form of treatment to replace antibiotics.
Ideas like these will only come to fruition years down the line, if at all—innovative science is always a gamble. What Price can do now—and what he knows will work—is keep communicating his message in ways that convince others to listen. If he starts by being goofy in the classroom, maybe his lectures will resonate with students who will tell their friends and family what they’ve learned. And maybe, some of those people will switch to buying antibiotic-free meat, or better yet, be in a position to influence policy that can actually address the problem. It just takes persistence and the willingness to make yourself look silly every now and then.