August 26, 2025 • 51 mins
The development of antibiotics was one of the greatest turning points in the history of medicine. Bacterial infections that were once death sentences were cured within a matter of days after administration of these lifesaving compounds. But the honeymoon didn’t last long, as resistant bacterial strains emerged and spread. Now, antimicrobial resistance poses one of the greatest threats to global health; frankly, we can’t invent new antibiotics faster than resistance develops. Fortunately, there may be a solution, one that has existed even before antibiotics came on the scene: phage therapy, the use of bacteriophages to treat bacterial infections. In The Living Medicine: How a Lifesaving Cure Was Nearly Lost—and Why It Will Rescue Us When Antibiotics Fail, author Lina Zeldovich takes readers through the incredible and long-forgotten story of phage therapy and the doctors who developed it. Tune in to learn how phage therapy, after almost being relegated to a footnote in the history of medicine, is reemerging as a possible solution to the deadly problem of antimicrobial resistance.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is This Podcast Will
Kill You. Welcome to the latest episode in the tp
w k Y book Club series. In these episodes, I
bring on authors of popular science and medicine books and
chat with them about their work, what inspires them, and
how their book can change the way we understand the
(01:04):
world around us. I've gotten to have some incredible conversations
so far this season, and we've got even more great
authors and books lined up for the rest of the year,
so stay tuned. If you'd like to check out what
books we'll be featuring on future episodes, as well as
get the full list of books we've covered in the past,
head over to our website This Podcast will Kill You
(01:25):
dot com. Under the extras tab, click on Bookshop to
go to our bookshop dot Org affiliate page, which has
a list for books featured in these episodes, as well
as other podcast related lists. I'll be adding more books
throughout the rest of this season, so check in regularly
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hearing from you all about the books you've enjoyed. Any
(01:46):
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And also you can now find full video versions of
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(02:09):
subscribed to Exactly Write Media's YouTube channel so you never
miss a new episode. Drop All right, now, let's get
into the book of the week. Antimicrobial resistance is not
a new problem. The first penicillin resistant bacteria appeared just
a heartbeat after the widespread introduction of the antibiotic in
the early nineteen forties, but it is a growing and
(02:32):
deadly one. The WHO estimates that in twenty nineteen, antimicrobial
resistance directly led to one point two seven million deaths
and contributed to four point nine to five million deaths
around the globe. Nearly five million deaths due in part
to antimicrobial resistance. That's more death than HIV, tuberculosis, and
(02:56):
malaria combined. What's more is that these numbers are are
expected to grow in the coming years. Our standard approach
to combating these superbugs has primarily consisted of developing new antibiotics,
a strategy that buys us much needed time, but is
ultimately no match for the rapid evolution of resistance. To
(03:16):
have any hope of curbing infections and deaths due to
antimicrobial resistance, we need to think outside of the antibiotic box. Fortunately,
some researchers have been doing exactly that for over a century.
In this week's episode, I am joined by journalist and
author Lena Zeldovich to discuss her book The Living Medicine,
(03:38):
How a forgotten cure may rescue us when antibiotics fail.
That forgotten cure refers to phage therapy, the use of
bacteria specific viruses called bacteria phases to treat antibiotic resistant infections.
Many of us, such as those of us here in
North America or Western Europe, may have learned about phase
therapy in school, only as a blip in the history
(04:01):
of medicine, if we learned about it at all, soon
overshadowed by the development of antibiotics. Or maybe you learned
about it in our Antibiotic Resistance episode from years back,
which featured Stephanie Strathti sharing her and her husband Tom
Patterson's story, but in other parts of the world, phage
therapy never faded from memory. Rather, it remained a leading
(04:24):
treatment for bacterial infections and a central focus of medical research.
Why it fell out of favor in some countries and
lingered in others gives us insight into how external events
and cultural differences can shape scientific developments. As we're fond
of saying on this podcast, science doesn't happen in a vacuum.
(04:45):
In the living medicine, Zeldovich takes readers through the history
of phage therapy, where we get to meet the visionary
researchers that championed this treatment, discover how phagias are found
and administered, and learn of the profound promise a hold
for the global problem of antimicrobial resistance today. This book
(05:05):
will have you marveling at this forgotten cure and grateful
for those who did not let it slip into permanent obscurity.
I have always been such a fan of phage therapy
and it was a joy to chat with Lena and
learn more about its history and current developments in the field.
I am so excited to share this conversation with you all,
so let's just take a quick break and get into it. Lena,
(05:51):
thank you so much for taking the time to chat
with me today.
Speaker 2 (05:54):
Thank you for having me here. I'm very excited to
talk about all things phages.
Speaker 1 (05:58):
Let's start at the very beginning. What are bacteria phases
and what is phage therapy? Like, what does it mean
if someone is receiving phage therapy.
Speaker 2 (06:08):
So phages are viruses, and this is where it really
gets interesting because we tend to think of viruses as
some really bad things that make us sick. So phagies
are different. Phagies don't have the right biological equipment to
afflict humans. They can only attack bacteria, and that's why
they call bacteria phagis. They prey on bacteria out there
(06:31):
in nature, and they've been doing this for millions of years,
kind of evolving alongside each other. Typically it's like one
phage for one bacteria. They're very peaky at what they eat,
and that makes bacteria phagis our friends. So basically, an
enemy of my enemy is my friend. So we can
use these amazing creatures as alternatives to antibiotics when antibiotics
(06:55):
don't work. And there are different ways of administering you know,
phage therapy, but basically you either drink them for intestinal diseases,
or you put them on skin or wounds, and there
are some trials out there that inject bacteria phages into
the bladder for people who are dealing with recurring UTIs.
(07:17):
You can also administer them intraveniously nowadays, but it's more
complicated because those firm relations must be cleaned from all
sorts of things that may trigger your immune system to
go haywire.
Speaker 1 (07:28):
Yeah, I mean it seems like it can be quite
a complicated process from finding the right phases to purifying
them to then administering them. And I was wondering if
you could just walk me through, you know, how people
go through this process? Where do you find phases?
Speaker 2 (07:45):
So phages? You can find phages everywhere. There are out
there in soil, in water, in the air, in sewage,
on rotten fruit, just basically everywhere on this planet where
there is bacteria, there are phage is that are preying
on it. And like I said, they've been doing this
for millions of years before humans came along. And the
(08:06):
way scientists find these phases is they go out there
and they take samples of everything. They come back to
the lab and they use these samples to isolate phages
and test them on what bacteria phages they just found
will work, and that's how they know that they've got
(08:26):
a phage full. Let's say you know this strain of color,
or this strain of discent theory, or this strain of
something else.
Speaker 1 (08:34):
And then once you have that phage that works for
whatever bacterium you're trying to attack, what's the next step, like,
how do you grow these phases? And then what is
the purification process like? Or maybe why is the purification
process so important?
Speaker 2 (08:51):
The way it works is that first you grow your bacteria,
which is very easy. Most bacteria is fairly easy to grow.
You just put a bunch of like meat scraps, you
cook basically a bullion, and you see this bullion with
bacteria and they just love it. They're so happy there.
(09:11):
They procreate, they grow, and once they have enough there,
you inoculate the proof with phages, and phages set to
work and they attack the bacteria. The way they work
is that they get into bacterial cells, they multiply inside,
and they burst bacterial cell open, and once you have
almost no bacteria there, you know you have a lot
(09:31):
of phages, and that's when the purification step comes in,
and again, if you're just putting phages on your skin
of drinking them, you can actually skip that step. Historically,
it works just fine. What gets tricky is that if
you want to give it somebody intravenously, you don't want
all these bacterial debris in there because your immune system
(09:52):
is going to react to that bacterial debris and taxins
and whatnot and it may go into shock and pure fying. Well,
it sounds kind of simple, but it's not because you
need all just sophisticated equipment. Basically, you need special certifugures
that spin very fast, and they managed to separate phages
(10:12):
from everything else and that's how you get you clean phages. Again,
I said, it sounds very simple, but the right equipment
for that, because we're dealing with like super tiny structures
that only became available fairly recently.
Speaker 1 (10:27):
I'm trying to imagine the timeline for this, and I
know that it can be very different depending on in
the US. You know, right now, I think we're still
at that case by case basis. How do we approach
this from a non case by case basis and what
does that timeline look like like? Do we have to
be reactionary or can we be proactive?
Speaker 2 (10:49):
So I think we still approach this on a per
case basis. If a team of doctors wants to treat
a patient, that is, who's not responding to antibiotics, they
would have to go to the FDA and buy all
this investigational new drug application, these case phages, and they
would receive an approval from the FDA and they would proceed.
Speaker 1 (11:09):
It's such an incredibly like an obvious solution to what
is growing to be an increasingly huge problem, you know,
antibiotic resistance. And I want to kind of get into
the differences between phases and antibiotics in terms of, you know,
in an ideal world where phase therapy does not have
(11:30):
to be approved case by case and it's more of
a routine thing, would there still be cases where antibiotics
would be used over phases.
Speaker 2 (11:41):
Probably. I think at least at this point, it looks
like antibiotics would still be our first line of defense,
and that's because it's just so easy to use them.
As I mentioned, with phages, you need to know what
particular infectious organism you are infected with. Then you would
have to go and find a phage for this particular
(12:04):
infectious organism and maybe you would need more than one.
So if you have it in your library, that may
take hours to days, and if you don't then it
would take days and weeks sometimes. So if you're intibiotics
work in the meantime, you golden. You don't need anything. However,
if you antibiotics don't work anymore, that's when you will
(12:25):
need a phage or multiple phages. I think antibiotics are
still going to be our first line of defense for
a while. The interesting thing about antibiotics and phages and
how like, you know, the pros and cons. You know,
antibiotics are static molecules that we synthesize by chemical reaction
or some other means, and they're static. They don't evolve,
(12:47):
and bacteria are amazing at various mechanisms of resistance that
they just evolve, you know, from one day to the next,
all sorts of tricks. You know. Some of them developed
these pumps they spit on antibiotics out once they enter bacterial cells.
Others have these molecular scissors, you know, enzymes that literally
shred antibiotic molecules to bits. You know, some bacteria have
(13:09):
very slippery out coats. If you'd like. So, antibiotics can
stick to some manage evens surround themselves, like in the
protective ink that also destroys antibiotic molecules. So when we
run into these kind of issues, that's when we need
phages because phages evolve alongside antibiotics for a long long time.
(13:30):
So even if a bacteria develops a resistance to our phage,
the phage will eventually evolve to attack it better. And
it doesn't necessarily have to take a long time to evolve,
because you know that at the level of this microorganism,
it can happen very fast.
Speaker 1 (13:47):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(14:10):
been chatting with Lena Zeldovich about her book The Living Medicine,
How a forgotten cure may rescue us when antibiotics fail.
Let's get back into things. Not only do phases evolve
with or in response to bacteria, they are, as you
describe in your book, an infectious cure. So someone receiving
phase therapy can spread those phases to another individual as well,
(14:34):
which is really just remarkable.
Speaker 2 (14:37):
It's I mean, for me, it was also a total
eye opener, right, because we tend to think of diseases
as contagious, right, Well, so phasis can be contagious too.
And I think we'll get into history and phage therapy
in a little bit. But the first person who realized
that phagius as cure can be contagious was one of
(14:58):
the early phage therapy adopters, Felix Theyrell, who's trying to
stop an outbreak of salmonella in chickens in France, and
he realized that as soon as one chicken would get
a bacteria phage he gave this salmonella, the entire coup
(15:18):
would recover because they'll pack at each other's species, so
it would just spread through all of them and suddenly
they would be not sick anymore.
Speaker 1 (15:26):
That's amazing. I mean also talk about like then you
just have to get one chicken cure and then you're done.
That's it. That's so cool. I'd love to get into
the history now of bacteria fish therapy, and I think
it is it's surprising to a lot of people who
are used to using antibiotics and used to having antibiotics
be the frontline of you know, bacterial infections to realize
(15:50):
that not only fish therapy exists, but that it actually
predates the discovery of antibiotics. And so can you take
me through sort of the almost simultaneous I guess discussies
of bacteria facis.
Speaker 2 (16:02):
So the year is nineteen seventeen, and two things are
happening almost at the same time and two different parts
of the planet. There is Felex Terrell in Paris working
at the Pastoral Institute, which is like the holy grail
of science medical science at the time, and he is
both near a biologist and a medical doctor, which was
(16:24):
very common at the time. And so he's dealing with
patients who have dysentery. And again this is before antibiotics.
You've got dysentery, you might be dead very shortly, and
so people are dying. But one of his patients recovers,
and he figures this has to be something in his
stomach that helped him recover. So he starts looking at
(16:46):
two this person stool samples, and he realizes that there
is no dysentery bacteria in there anymore. So he's like
something skilling it. So let's try this. He takes like
these stool samples and in locum lads other bacteria samples
new with it, and Lloyd behold, Dysenteria bacteria dies there too,
(17:08):
and in the next one and the next one. But
he can't see what it is because phagies are much
smaller than bacteria, and at the time they could see
bacteria under the microscope but not phagis. In fact, that
took an electronic microscope of nineteen thirty to actually see
any virus. So he goes, well, I think I discovered
a parasite of microbes that is so small that we
(17:30):
can't see it. It's invisible, but I know it's there.
And he publishes a paper at the same time out
there in the country of Georgia, in Pilisi, which by
the way is a beautiful city and at the time
it was called the Paris of these really interesting dichotomy.
There is another scientist, the Georgian scientist Giorgi Alaiyava, who
is a little bit younger, not as experienced, but just
(17:53):
came back home from the front lights of World War One,
which just ended where he tended to, you know, six
soldiers who had cholera and dysentery and whatnot, and he
is looking into presence of cholera in the city water
in the river where everybody gets the water from, and
(18:13):
you know, lo and behold, cholera is there, and he
sees it and that's not good news. He's looking at
it through his microscope and something interferes, like he has
to go somewhere. He locks his lab and comes back
to it like a day or two later, and he's
looking at the same samples of water and there's no
color there anymore, which doesn't make any sense. Color doesn't
(18:33):
die a quickly. So he goes back to the river,
brings back water, repeats the same experience, same result. After
a few hours, no cholera. Does it again, same result.
He knows he's onto something, but he can't figure out
what is he onto. Fast forward a few more months.
He has to go to Paris to study at the
(18:55):
Pastor's Institute how to you know, make vaccines and other
meta since because that's again at the time where that's
where everybody went to study. He goes to Paris and
he walks into this really heated debate. So Drell's the
scientific role did not welcome Durrell's finding peacefully because it
(19:17):
really to them it didn't make sense. You know, you're
talking about invisible destroyers that destroyed didn't theory. No, it
also doesn't fit into the established immunity theory you know
at the time. So basically, at that moment, Dyrell is
a laughing stock. And at the moment he's out there
in the countryside dealing with chicken salmonella. So Eliella walks
(19:40):
into Fastero's intitude and right in the middle of all
this and he goes, I've seen that too, and they're like,
all right, another one. But here where the character differences
come into place. Drell was kind of a prickly character,
and he spoke his mind and probably made a fair
mind out of it as in his life. And Elia
(20:02):
was exactly the opposite. He was absolute charmor like people.
He could sweet talk anybody into anything. When I when
I was reading his family's diary, it literally sounded like
when he talked about science, it sounded like poetry. And
he spoke fluent French because he started studied in Geneva.
So he went to the institute director said can I
repeat the experiments? And of course he talked him into it,
(20:24):
and he repeated the experiments and he showed that basically
the same results, and that was kind of like maybe
like that's that's where the things begin to turn a
little bit.
Speaker 1 (20:35):
Yeah, and so is that when like the scientific or
medical implications of these findings. It was not only like okay,
you know, first there's this ground truth thing, are we
seeing what we actually think we're seeing? And then how
soon after that was how can we use this then
to help cure infectious disease?
Speaker 2 (20:56):
Yeah, so fairly soon. I think it was nineteen nineteen
I five, I am not mistaken when they first tried
phages on the very first patient, like a very sick child.
First the medics themselves drank phages and they showed that
nothing happened, and then they gave this phages to a
(21:18):
very sick challenge child like recovered in twenty four hours.
I think there were like a few other children they
drank Pyson theory phages. And I think the next really
big breakthrough was in nineteen twenty five when the rail
managed to cure a couple of cases of bubonic plague.
Speaker 1 (21:38):
What sort of was the turning point for the medical
community then reconsidering phases as a viable thing and as
something that is not just you know, in these guys
head where they're just coming and they're talking about nothing
and they're like, oh, here comes another one. At what
point did that transition happen.
Speaker 3 (21:58):
I think it's sort of like slow happened over like
the next maybe few years, like after nineteen nineteen. But
I think if if the nineteen twenty five when Durrell
cured Bogonic plague was probably a really really big turning
point because everybody like immediately paid attention. I mean, there
was no cure of them from the boguonic plague. You
(22:19):
got it, you died. I mean, it's almost depopulated Europe
in the Middle Ages. So and Durrell was stationed in
some port city in Egypt and a couple of sailors.
Speaker 2 (22:32):
Fell in with the bonic plague, and he had phages
that he brought from India where he eyes related it
from rats. Your rats could carry the plague but not
die from it. So he you know, made these new
phage concoctions and he treated the sailors with phages and
they recover it. And that was just like nothing, you know,
(22:54):
short of a miracle.
Speaker 1 (22:56):
Oh my gosh. I mean to then go from you know,
laughing stock to cure of bubonic plague, this like very
fear disease. That is, that's incredible. And then we go
from that to a whole institute being created for the
explicit reason to study phasianes. Can you tell me a
little bit about this institute?
Speaker 2 (23:16):
So Eliava and Durrell became not just like lifelong friends
but also lifelong collaborators. And so Aliama had this really
grand idea of building a bacteria of age research center
and a treatment center in Bilisi, in Georgia. And at
the time he had a fair amount of money because Stalin,
(23:39):
who was Georgia and himself, was willing to throw a
bunch of money into his home state, especially for things
like medicine, because healthy populations means strong umpire, and he
was building strong umpire. So the plans for the institute
were approved, and you know, there was a crazy amount
(23:59):
of money, even like, you know, several millions, which god
knows how much it would be in today's money, but
it was. It was a very turbulent time in history,
in particular in the history of the Soviet Union, because
Stalin was very paranoid about keeping his grip on the country,
(24:22):
keeping his power, and he wasn't tolerating any dissent, and Eliyaba,
like many brilliant people, was known to speak his mind,
and eventually that cut out with him, so he was
arrested and tortured, like really really brillly tortured. I was
able to find some of the introgation manuals, and when
you looked at it, you could literally see how all
(24:43):
this was constructed. Like, you know, people who were interrogating
him couldn't even decide what they wanted him to say.
Like one day they would want him to say that
he was working with the French intelligence, the next day
was the British intelligence. But the end result was that
he was killed and the center never materialized in all
(25:04):
the glory that it was envisioned. But the concept of
using Phage's as medicines survived because there was really nothing
else at the time, and it basically stayed in Beliezi,
like in the time capsule of sorts, and it was
used through all of the years of Soviet power.
Speaker 1 (25:26):
This huge loss that the Phage therapy field faced, you know,
how was that immediately felt? And then what were some
of the long term implications of that In let's say,
like the decade or so that followed Eliava's death.
Speaker 2 (25:42):
So the diga that followed in Aliava's this was really
it was a really difficult decade because we kind of
like get into World War two, right, So what happened
in late thirties in America is that phage therapy in
the West basically fell out of favor, and for really
interesting reasons. For no fault of phages, it was mostly
(26:08):
because it was kind of misused. People didn't necessarily know
how to grow phages properly, and even when they did,
pagies didn't always work. And that happens too. Sometimes pages
don't work for exama, they don't work for hives, they
don't work for allergies or herpies or whatever. But some
(26:28):
companies advertised pages for this health issues, and of course
fages did nothing to those undermining people's trust and physicians trust,
and so all that prompted some prominent American physicians to
examine medical literature in late nineteen thirties, and they decreed
that pages aren't really trustworthy enough to use this medicines
(26:52):
except maybe for like very specific things like staff. And
then shortly after that, Western medics learned to mass produce
antibiotics and that was the end of phages.
Speaker 1 (27:02):
Yeah, penicillin became the answer, and then.
Speaker 2 (27:05):
The answer, Yeah, pensila became the answer. You know.
Speaker 1 (27:08):
At the same time, though, in the Soviet Union, phases
were being used at a larger scale than they had
been previously. Can you tell me about some of the
prophylactic use of phases during World War Two in Stalingrad?
Speaker 2 (27:21):
Yeah, that is like one of my favorite topics because
it's just so mind buggling and it's like so unknown, right.
Speaker 1 (27:27):
Yeah, and the prophilactic use of phasias, I had no idea.
I always thought of it as a treatment, not a prophylactic. Yeah,
it's amazing.
Speaker 2 (27:35):
So we're now into nineteen forty two and the Nazis
forces are closing and on stalin Grad, like the Soviet
strengthhold on the Vulgar. We were named after Stalin, So
that's so many things are a tie to this CD
you know, like first it bears Stalin's name. Second, siss
on the way to the oil field of the Caucus,
(27:59):
and whoever gets to keep the oil field will win
the war because you need oil to run all this
heavy machinery. And so the battle for Stalar is absolutely brutal.
Neither side can afford to lose the city, and so
sometime in summer, the Moscow hears some rumors about cholera
(28:20):
cases among the German troops, and at first they're very
happy to hear that, because okay, well that's good. And
then they realize that no, it's not good because cholera
doesn't care, doesn't care about front lines, but it's on
one side to oil beyond the other. And they realize
they've got this whole city that they bombed out to
(28:41):
smooth the rings with like sewage broken you know, water
means broken. And they realize it's going to be a disaster,
and so they send a woman there. Her name is
Zinaida Yrmuliva, and she's one of the leading Soviet biologists
on microbiologists at the time, on a tiny plane that
manages to somehow evade the German bombers and actually learn there.
(29:05):
And she comes with this tiny little bag of phages,
and she hears that color has already arrived, and she
knows that she doesn't have enough phages, so she calls
Moscow and says, we need more phages. Moscow loads up
all it's phage Arsenal on a train, and the train
goes to Stalingrad and it never makes it because it
gets bummed out to smooth rains. And she goes, Okay,
(29:29):
we'll have to grow phages here. We've got vulgar right there.
There's got to be cholera in there, and their phages
will be in there, and of course they are. So
they take these samples and they go on the ground,
they go into the basements so that your bombing can
destroy them, and in that in those basements they grow
(29:50):
enough phages to basically give for prefiloxies the entire city
on a daily basis. I think she wrote in her
so fifty thousand people took this bacteria phage daily and
it never before happened in history. And it was so
profound that you couldn't leave the city without having a
certificate that you took your phages, and even bakeries wouldn't
(30:15):
give out bread without that paper.
Speaker 1 (30:17):
I mean, it's such an incredible story, and like you said,
it's such a profound demonstration of the power of phases.
But also it does make sense considering the larger historical context,
how this discovery did not become more widely known and
did not sort of make phages be front and center
of biomedical research at the time. And I want to
(30:39):
kind of talk about that historical context, how this implementation
of prophylactic phasis didn't happen in a vacuum. There's war
as the backdrop, and so can you talk about sort
of this larger context and what that meant for the
distribution of this information.
Speaker 2 (30:56):
Yeah, it's a very good point. I mean, yeah, not
all secrets were and I think that there actually was
some medical collaboration during World War two, and there were
some European American scientists who were working with Zinaida Uni world,
but more so on antibiotics than than phagis. And I
(31:17):
think they just didn't think that pages were realistic enough
that they were like really useful. I don't know why
it didn't happen. Part of it could have been just
like the general mistrust that just never took off.
Speaker 1 (31:32):
Let's take a quick break here, we'll be back before
you know it. Welcome back, everyone. I'm here chatting with
(31:54):
Lena Zeldovich about her book The Living Medicine. Let's get
into some more questions. There was a passage in your
book where you talked about sort of these social and
cultural and scientific differences between the West and the Soviet Union,
and how that sort of led to one pursuing antibiotics
and the other pursuing phases. In terms of again kind
(32:17):
of like as we talked about this reactive versus proactive
approach to medicine and public health, and I was wondering
if you could talk a little bit more about.
Speaker 2 (32:25):
That in America, in the West, I should say, and
in America probably more more. In particular, by the end
of nineteen thirties, the trust in phages kind of dropped,
and I think people that are genuinely thought of them
with suspicions. Even the companies that manufactured phages in nineteen thirties.
(32:48):
By nineteen forties, they switched to antibiotics in the post
war era, synthesizing molecules that worked consistently the same way.
It was easy and cheaper than growing this phoinichy crete
with you know, peaky appetites whose biology sides still didn't
fully understand, and physicians agreed. At the time, a large
(33:08):
percentage of American doctors were private practitioners, and many worked
from their home offices, and they weren't attached to any
bacteriological laboratories or hospitals. They didn't necessarily have you know,
test labs, let alone like complex facilities to synthesize pages.
There in those settings, the easy, ready to use medications
that had a long shelf life and killed a white
(33:31):
spectrum of drums were bound to win, which is what happened.
I mean, they offered all of these advantages, reliable, repeatable, stable,
no significant side effects known at the time. They definitely
went over phages. In the Soviet Union, however, medicine was
a state endeavor, so a family couldn't start a company
(33:51):
to grow phages to make penicillin, and medical school graduates
couldn't open a private practice. Everybody was applied by the states,
and all medicines were made at research institutions or like
large state owned factories, and that made it harder to
produce false advertisements, especially when the director's head was on
(34:12):
the line. Right if their products didn't work or wars
made patient seekert, they could be declared the enemy of
the people and that was it. So consequently, Soviet sciences
had like a very different medical paradigm. Western medics embraced
stability in life in laws in drugs. But the Soviet
(34:35):
medics STYG just learned to exist in this ever shifting landscape.
You know, if peniculin was mass produced today, it didn't
mean that the factor will still be there tomorrow. The
rowing ingredients could vanish, the inventor could be arrested. So
Soviet medics just uced whatever they have in a given day.
They hadn't tabiotics, good, don't have antibiotics all right, let's
(34:58):
go to the nearest river of phages.
Speaker 4 (35:02):
Wow.
Speaker 1 (35:02):
Yeah, that's a fascinating lens to think about, sort of
the differences in what drives innovation and what drives accessibility
to equipment, all of that. And so when antibiotic resistance
started to show up in around the world, which it did,
you know, very soon after penicillin was started to be
widely used. How did phage therapy? How was that used
(35:26):
in the Soviet Union to treat resistant infections.
Speaker 2 (35:29):
Yeah, that's a great question. Like basically, if antibiotic stuff working,
there was always a phage. I mean, Spelici kind of
remained a center of all sorts phages, but there were
other towns in the Soviet Union that produced some phages
and they could treat patients with it. What was really
(35:52):
interesting to me when I was working on this research
is that SPILICI maintain sort of like global by the
Soviet standards, global library of phages, and not only maintained,
but they constantly updated it, and they had literally thousands
and thousands of them. And by updating, I mean they
(36:14):
would continuously gather samples, bacterial samples from all over the
country and they would bring these new samples to the
lapse and they would see, is this bacteria evolving resistance
to our phages? Oops, it is okay, time to find
a better phage. Let's go out to the river. That
(36:34):
literally like went on for years and years and years,
and they never stopped. And they still do that.
Speaker 1 (36:40):
To anticipate the future problems and to be able to
have that in advance. And I think that's why I
keep thinking about phases as being this proactive approach where
you can see almost immediately if you're detecting antibiotic resistance,
you can find a phace for that. As you describe
in your book, there's this incredible moment where the specific
(37:02):
meeting where the knowledge of phage therapy is brought up
in this room, in this academic setting, and in the
US and the American scientists have no idea. They know
what bacteria phagias are, but they have no idea what
phage therapy is. I was wondering if you could sort
of paint me a picture of that story and this
(37:22):
kind of reawakening of knowledge about phaseia's in the West.
Speaker 2 (37:26):
Sure. So we're now in the early nineteen nineties when
the Soviet Union is falling apart, maybe it's already falling apart.
And this Georgian scientist comes from Pilisi to America for
a post doctorate fellowship and he is working in the
laboratory of a fairly well known infectious disease physician, Glenn Morris,
(37:49):
at the Maryland School of Medicine. And one day Glenn Morris,
who was an infectious disease physician, a practicing physician, comes
to the lap and he doesn't look like himself. So
the Georgian his name is Sandra, sees him like that
and he asks, you know what happened? And Glenn says, well,
I just lost a patient to an antibiotic resistant infection.
(38:11):
I mean this this man he battled through new cancer
and chemotherapy and recurring new cancer and chemotherapy, and he
was in his forties, so still fairly young, and and
he went through all of this and then at the
end he succumbed to an antibiotic resistant infection because I
couldn't find an antibiotic to kill this bug that infected him.
(38:33):
And Sandra just went so and the bacteria page didn't
work either, and Glunn just gave him that stare like
this this this this thy like what And when I
was talking to Sandra, and I talked to Sandra so
many times for this book, was just a moment of reckoning.
It was just like, oh my god, these people really
(38:55):
don't know, like we could treat this in my hometown.
Speaker 4 (39:00):
You know.
Speaker 2 (39:00):
He came to America because it was the place to
do science, and how can this be? And so he
basically took it upon himself to work for the next
twenty five thirty years to work with the FDA to
convince him that this was a credible treatment and if
it's done right, it can really save so many lives.
Speaker 1 (39:22):
I mean, what a moment of shock on both sides,
Like what do you mean phisih therapy? What do you mean?
What do you mean phage therapy? Like how do you
not know what this is? What is this?
Speaker 2 (39:31):
Right?
Speaker 1 (39:31):
Yeah, it's such a mind blowing moment, I think. And
then there were several that was like one turning point,
and there seemed to be several turning points. This like
slow momentum growing of interest in phage therapy in the West,
in the US. And can you talk about some of
these major moments that eventually led to people pursuing this
(39:55):
as a legitimate field of research with such potential.
Speaker 2 (39:59):
So initially, when Sandra and Glenn tried to put together
some research proposals to study phigis for medical purposes, they
wouldn't get any money, and in fact, the entire world
would laugh at them, just like they laughed back then,
you know at Dyrell. Eventually Thunder kind of like changed
(40:21):
his new path a little bit and he began to
work on phages for food safety. So bacterial contamination is
a huge problem in the food industry, as we all know,
like almost every week something is being recalled, right, So
his company now makes phage sprays that you spray on letters, meat, sausages,
(40:44):
and whatever that kill very specific food porn pathogens and
they work very well. So it is easier to get
an approval from FDA for food safety or food products
than medical products, because in medical products for people who
are very right. So I think I think I was
somewhere in the middle of two thousand. The first decade
(41:05):
of two thousand was when they get their first approval,
and then they got you know, more approval for different
type of page sprays, and they now manufacture quite a few,
So you could probably count this as a huge milestone,
even though it doesn't appear as huge, but it is
because it basically proved that fijis were safe, you know,
they didn't cause any harm. And then another big milestone
(41:31):
happened a few years down the road, somewhere around twenty sixteen,
when one particular person picked up an antibiotic resistant bacteria
Acina bakta bamania while traveling in Egypt with his wife
and ended up basically on the brink of death in
one of American hospitals. So this is a really unique couple.
(41:55):
The guy's name is Tom Patterson and his wife's name
is Stephanie Trusty, and she is a scientist herself, and
they've tried every antibiotic known to science and none of
them worked, and so she was basically a question of
losing her husband or trying something else. And she said,
I did research, and she's doubled upon phage therapy. And
(42:18):
because she had enough scientific knowledge and she knew enough
people in the scientific field, she was able to work
with scientists whose other scientists who studied phages to create
certain cocktails that were able to kill this bacteria in
her husband. And in fact, it was like a first
(42:40):
round of cocktails, second round of cocktails. And at the
end they also used you know, one warn tabiotic and
that you know, finally cleared it. And that was the
first time the FDA ever approved an investigational new drug
phages for use on humans. And it worked. It worked
so spectacular because there was nothing else to try. Yeah,
(43:02):
and that was a really big pivoting point which kind
of brought phages from scientific obscurity back on the front lines,
and since then a whole bunch of clinical trials were launched.
Speaker 1 (43:16):
That is one of my favorite stories, The Perfect Predator,
which is Stephanie's book, and it is so it is
so amazing because it is sort of this huge moment
that I think raised awareness too, not just within the
scientific community, but more broadly about this possible solution and
(43:38):
how that then sort of paved the way. You know,
if the public wants it, then maybe we should look
more into this. And so that, as you said, has
led to such a resurgence and interest. But there are
still some hurdles to overcome, as you mentioned earlier, like
FDA approval and also incentivizing research into phage therapy. What
(43:58):
are some of those challenges in terms of, like the
logistical side of things, incentivizing research making people even more
aware than they are.
Speaker 2 (44:07):
I think the original challenge was that years back, the
FDA didn't necessarily know how to detest phages like the
If you think about it, the holy grail of a
medicine production is to make sure that medicines don't change,
that they're always the same, and that's what that's how
(44:29):
they pass through studies and we know they're going to
work the same way in just about everybody. Phages are
tricky because they change. They may change within a person
because they multiply, right, so a slightly newer generation of
phages may have slightly different genome. They also again multiply,
which means you give a person a particular dose, but
(44:52):
then there's more phages more than that dose, and you
don't know to what extent they're going to grow, So
how do you even side how much phage to give anybody?
So there was like a lot of challenges like that.
But what the FDA is doing now is that so
they have two centers. There's a Center for Drug Evaluation
(45:12):
and then there's a Center for Biologics Evaluation. And that
Center for Biologic Evaluation regulates products derived from like living sources,
for example flu vaccines, which also changed from one season
to the next, And so that's where phage is now
fall under, and that's the department that regulates it.
Speaker 1 (45:35):
Yeah, I mean, it seems like there is a promising
path forward in terms of getting phage therapy just to
redraw some of the standards that we have to not
just discard them entirely because of these characteristics that they have.
And so how far away do you think that we
are here in the US from phage therapy being like
(45:57):
a routine or at least a more widely available option.
Speaker 4 (46:01):
That's a great question, and I've asked that question almost everybody,
And you know, the best to get is like I
don't know, five to ten years or something.
Speaker 2 (46:12):
It seems that it's moving a little bit faster in Europe,
but I don't think we have a lot of options.
And that's why I think it's it has to go
a little bit faster because our antibiotics are losing their
punch like way too quickly. You know, when I was
working on this book. I first started working on this book.
(46:33):
The CDC's twenty nineteen reports said that every fifteen minute,
someone dies from an antibiotic resistance infection. So we talked
for almost an hour. That's for people. The CDC's twenty
twenty two reports said that it's gotten worse, and then
Newer asked the let's say that by twenty fifty, antibiotic
resistance will kill three people every minute. So like you
(46:57):
do the math, and the United Nations says agreement prediction
ten million US annually by twenty fifty. It's like it's
pretty freaky. So I think it's like necessity is the
mother of invention. So I think necessity will just push
us to getting this to the finished line sooner rather
than later.
Speaker 1 (47:17):
Yeah, I hope. So, I mean, I would love to
see a world in which we have alternatives to antibiotics
as part of just building a wider toolkit to deal
with this growing problem of antibiotic resistance. And I want
to close out the interview by asking you what phages
mean to you personally.
Speaker 2 (47:37):
I've been fascinated with phagi's probably since I was a kid,
because of probably I don't know, maybe six or seven,
when I stumbled upon a phage study in one of
the scientific magazines that we had at home. A lot
of people in my family with scientists. I grew up
(47:58):
with all this stuff, just kind of like sitting there,
and in Russian, the word phage is just three letters
and it's and it starts with a letter F that
looks like a person who is standing with their arms
and their hips, kind of like this very you know,
confident figure that says, don't mess with me. And it
was and the picture of a phage itself kind of
(48:20):
resembled that. So I started reading that study and there
weren't too many familiar words, but I spotted one that
I knew, disent theory, which I was personally acquainted with,
because you know, last summer, the city got a contaminated
shipment of grapes, and so many kids were sick and
(48:41):
they were not enough on tabiotics, and you know, eventually,
my grandfather found some antibiotics somewhere in a pharmacy and
that's what I took. But the study purported that these
page creatures could be used as an alternative to antibiotics,
and that was just so interesting to me that it
sort of stuck with me. And I also like the
(49:03):
page character as a character, so I brought my collared
pencils and, like you, color that page character in different colors,
and the whole thing just stuck with me and it
continues to you know, like some things get lunched in
your head, and that was one of those.
Speaker 1 (49:18):
I love that story. What if just like this thing
that you came across and something about it just stuck
with you. That's wonderful. Well, this has been such a
fascinating conversation. I've long been a fan of phage therapy
and I am just so excited to have read more
about it and understand more about the historical context. So
thanks again so much for taking the time to chat
(49:40):
with me today.
Speaker 4 (49:41):
Oh, thank you for inviting me.
Speaker 1 (50:03):
A huge thank you again to Lena Zeldovitch for taking
the time to chat with me. I didn't know I
could love phage therapy even more, but somehow I do.
If you enjoyed today's episode and would like to learn more,
check out our website this podcast will kill You dot com.
We're all post a link to where you can find
the Living Medicine how a forgotten cure may rescue us
(50:23):
when antibiotics fail, as well as a link to Lena's
website where you can find her other incredible work and
don't forget. You can check out our website for all
sorts of other cool things, including but not limited to, transcripts,
quarantining and Placeibrita recipes, show notes and references for all
of our episodes, links to merch our bookshop dot org,
affiliate account, our Goodreads list, a frettend account form, and
(50:46):
music by Bloodmobile. Speaking of which, thank you to Bloodmobile
for providing the music for this episode and all of
our episodes. Thank you to Leana Squalatchi and Tom Brifocal
for our audio mixing, and thanks to you listeners for listening.
I hope you liked this episode and our loving being
part of the tpwk y book Club. And a special
(51:07):
thank you, as always to our fantastic patrons. We appreciate
your support. So very much well, until next time, keep
washing those hands.
Hi, I'm Aaron Welsh and this is This Podcast Will
Kill You. Welcome to the latest episode in the tp
w k Y book Club series. In these episodes, I
bring on authors of popular science and medicine books and
chat with them about their work, what inspires them, and
how their book can change the way we understand the
(01:04):
world around us. I've gotten to have some incredible conversations
so far this season, and we've got even more great
authors and books lined up for the rest of the year,
so stay tuned. If you'd like to check out what
books we'll be featuring on future episodes, as well as
get the full list of books we've covered in the past,
head over to our website This Podcast will Kill You
(01:25):
dot com. Under the extras tab, click on Bookshop to
go to our bookshop dot Org affiliate page, which has
a list for books featured in these episodes, as well
as other podcast related lists. I'll be adding more books
throughout the rest of this season, so check in regularly
if you'd like to read along. As always, we love
hearing from you all about the books you've enjoyed. Any
(01:46):
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And also you can now find full video versions of
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(02:09):
subscribed to Exactly Write Media's YouTube channel so you never
miss a new episode. Drop All right, now, let's get
into the book of the week. Antimicrobial resistance is not
a new problem. The first penicillin resistant bacteria appeared just
a heartbeat after the widespread introduction of the antibiotic in
the early nineteen forties, but it is a growing and
(02:32):
deadly one. The WHO estimates that in twenty nineteen, antimicrobial
resistance directly led to one point two seven million deaths
and contributed to four point nine to five million deaths
around the globe. Nearly five million deaths due in part
to antimicrobial resistance. That's more death than HIV, tuberculosis, and
(02:56):
malaria combined. What's more is that these numbers are are
expected to grow in the coming years. Our standard approach
to combating these superbugs has primarily consisted of developing new antibiotics,
a strategy that buys us much needed time, but is
ultimately no match for the rapid evolution of resistance. To
(03:16):
have any hope of curbing infections and deaths due to
antimicrobial resistance, we need to think outside of the antibiotic box. Fortunately,
some researchers have been doing exactly that for over a century.
In this week's episode, I am joined by journalist and
author Lena Zeldovich to discuss her book The Living Medicine,
(03:38):
How a forgotten cure may rescue us when antibiotics fail.
That forgotten cure refers to phage therapy, the use of
bacteria specific viruses called bacteria phases to treat antibiotic resistant infections.
Many of us, such as those of us here in
North America or Western Europe, may have learned about phase
therapy in school, only as a blip in the history
(04:01):
of medicine, if we learned about it at all, soon
overshadowed by the development of antibiotics. Or maybe you learned
about it in our Antibiotic Resistance episode from years back,
which featured Stephanie Strathti sharing her and her husband Tom
Patterson's story, but in other parts of the world, phage
therapy never faded from memory. Rather, it remained a leading
(04:24):
treatment for bacterial infections and a central focus of medical research.
Why it fell out of favor in some countries and
lingered in others gives us insight into how external events
and cultural differences can shape scientific developments. As we're fond
of saying on this podcast, science doesn't happen in a vacuum.
(04:45):
In the living medicine, Zeldovich takes readers through the history
of phage therapy, where we get to meet the visionary
researchers that championed this treatment, discover how phagias are found
and administered, and learn of the profound promise a hold
for the global problem of antimicrobial resistance today. This book
(05:05):
will have you marveling at this forgotten cure and grateful
for those who did not let it slip into permanent obscurity.
I have always been such a fan of phage therapy
and it was a joy to chat with Lena and
learn more about its history and current developments in the field.
I am so excited to share this conversation with you all,
so let's just take a quick break and get into it. Lena,
(05:51):
thank you so much for taking the time to chat
with me today.
Speaker 2 (05:54):
Thank you for having me here. I'm very excited to
talk about all things phages.
Speaker 1 (05:58):
Let's start at the very beginning. What are bacteria phases
and what is phage therapy? Like, what does it mean
if someone is receiving phage therapy.
Speaker 2 (06:08):
So phages are viruses, and this is where it really
gets interesting because we tend to think of viruses as
some really bad things that make us sick. So phagies
are different. Phagies don't have the right biological equipment to
afflict humans. They can only attack bacteria, and that's why
they call bacteria phagis. They prey on bacteria out there
(06:31):
in nature, and they've been doing this for millions of years,
kind of evolving alongside each other. Typically it's like one
phage for one bacteria. They're very peaky at what they eat,
and that makes bacteria phagis our friends. So basically, an
enemy of my enemy is my friend. So we can
use these amazing creatures as alternatives to antibiotics when antibiotics
(06:55):
don't work. And there are different ways of administering you know,
phage therapy, but basically you either drink them for intestinal diseases,
or you put them on skin or wounds, and there
are some trials out there that inject bacteria phages into
the bladder for people who are dealing with recurring UTIs.
(07:17):
You can also administer them intraveniously nowadays, but it's more
complicated because those firm relations must be cleaned from all
sorts of things that may trigger your immune system to
go haywire.
Speaker 1 (07:28):
Yeah, I mean it seems like it can be quite
a complicated process from finding the right phases to purifying
them to then administering them. And I was wondering if
you could just walk me through, you know, how people
go through this process? Where do you find phases?
Speaker 2 (07:45):
So phages? You can find phages everywhere. There are out
there in soil, in water, in the air, in sewage,
on rotten fruit, just basically everywhere on this planet where
there is bacteria, there are phage is that are preying
on it. And like I said, they've been doing this
for millions of years before humans came along. And the
(08:06):
way scientists find these phases is they go out there
and they take samples of everything. They come back to
the lab and they use these samples to isolate phages
and test them on what bacteria phages they just found
will work, and that's how they know that they've got
(08:26):
a phage full. Let's say you know this strain of color,
or this strain of discent theory, or this strain of
something else.
Speaker 1 (08:34):
And then once you have that phage that works for
whatever bacterium you're trying to attack, what's the next step, like,
how do you grow these phases? And then what is
the purification process like? Or maybe why is the purification
process so important?
Speaker 2 (08:51):
The way it works is that first you grow your bacteria,
which is very easy. Most bacteria is fairly easy to grow.
You just put a bunch of like meat scraps, you
cook basically a bullion, and you see this bullion with
bacteria and they just love it. They're so happy there.
(09:11):
They procreate, they grow, and once they have enough there,
you inoculate the proof with phages, and phages set to
work and they attack the bacteria. The way they work
is that they get into bacterial cells, they multiply inside,
and they burst bacterial cell open, and once you have
almost no bacteria there, you know you have a lot
(09:31):
of phages, and that's when the purification step comes in,
and again, if you're just putting phages on your skin
of drinking them, you can actually skip that step. Historically,
it works just fine. What gets tricky is that if
you want to give it somebody intravenously, you don't want
all these bacterial debris in there because your immune system
(09:52):
is going to react to that bacterial debris and taxins
and whatnot and it may go into shock and pure fying. Well,
it sounds kind of simple, but it's not because you
need all just sophisticated equipment. Basically, you need special certifugures
that spin very fast, and they managed to separate phages
(10:12):
from everything else and that's how you get you clean phages. Again,
I said, it sounds very simple, but the right equipment
for that, because we're dealing with like super tiny structures
that only became available fairly recently.
Speaker 1 (10:27):
I'm trying to imagine the timeline for this, and I
know that it can be very different depending on in
the US. You know, right now, I think we're still
at that case by case basis. How do we approach
this from a non case by case basis and what
does that timeline look like like? Do we have to
be reactionary or can we be proactive?
Speaker 2 (10:49):
So I think we still approach this on a per
case basis. If a team of doctors wants to treat
a patient, that is, who's not responding to antibiotics, they
would have to go to the FDA and buy all
this investigational new drug application, these case phages, and they
would receive an approval from the FDA and they would proceed.
Speaker 1 (11:09):
It's such an incredibly like an obvious solution to what
is growing to be an increasingly huge problem, you know,
antibiotic resistance. And I want to kind of get into
the differences between phases and antibiotics in terms of, you know,
in an ideal world where phase therapy does not have
(11:30):
to be approved case by case and it's more of
a routine thing, would there still be cases where antibiotics
would be used over phases.
Speaker 2 (11:41):
Probably. I think at least at this point, it looks
like antibiotics would still be our first line of defense,
and that's because it's just so easy to use them.
As I mentioned, with phages, you need to know what
particular infectious organism you are infected with. Then you would
have to go and find a phage for this particular
(12:04):
infectious organism and maybe you would need more than one.
So if you have it in your library, that may
take hours to days, and if you don't then it
would take days and weeks sometimes. So if you're intibiotics
work in the meantime, you golden. You don't need anything. However,
if you antibiotics don't work anymore, that's when you will
(12:25):
need a phage or multiple phages. I think antibiotics are
still going to be our first line of defense for
a while. The interesting thing about antibiotics and phages and
how like, you know, the pros and cons. You know,
antibiotics are static molecules that we synthesize by chemical reaction
or some other means, and they're static. They don't evolve,
(12:47):
and bacteria are amazing at various mechanisms of resistance that
they just evolve, you know, from one day to the next,
all sorts of tricks. You know. Some of them developed
these pumps they spit on antibiotics out once they enter bacterial cells.
Others have these molecular scissors, you know, enzymes that literally
shred antibiotic molecules to bits. You know, some bacteria have
(13:09):
very slippery out coats. If you'd like. So, antibiotics can
stick to some manage evens surround themselves, like in the
protective ink that also destroys antibiotic molecules. So when we
run into these kind of issues, that's when we need
phages because phages evolve alongside antibiotics for a long long time.
(13:30):
So even if a bacteria develops a resistance to our phage,
the phage will eventually evolve to attack it better. And
it doesn't necessarily have to take a long time to evolve,
because you know that at the level of this microorganism,
it can happen very fast.
Speaker 1 (13:47):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(14:10):
been chatting with Lena Zeldovich about her book The Living Medicine,
How a forgotten cure may rescue us when antibiotics fail.
Let's get back into things. Not only do phases evolve
with or in response to bacteria, they are, as you
describe in your book, an infectious cure. So someone receiving
phase therapy can spread those phases to another individual as well,
(14:34):
which is really just remarkable.
Speaker 2 (14:37):
It's I mean, for me, it was also a total
eye opener, right, because we tend to think of diseases
as contagious, right, Well, so phasis can be contagious too.
And I think we'll get into history and phage therapy
in a little bit. But the first person who realized
that phagius as cure can be contagious was one of
(14:58):
the early phage therapy adopters, Felix Theyrell, who's trying to
stop an outbreak of salmonella in chickens in France, and
he realized that as soon as one chicken would get
a bacteria phage he gave this salmonella, the entire coup
(15:18):
would recover because they'll pack at each other's species, so
it would just spread through all of them and suddenly
they would be not sick anymore.
Speaker 1 (15:26):
That's amazing. I mean also talk about like then you
just have to get one chicken cure and then you're done.
That's it. That's so cool. I'd love to get into
the history now of bacteria fish therapy, and I think
it is it's surprising to a lot of people who
are used to using antibiotics and used to having antibiotics
be the frontline of you know, bacterial infections to realize
(15:50):
that not only fish therapy exists, but that it actually
predates the discovery of antibiotics. And so can you take
me through sort of the almost simultaneous I guess discussies
of bacteria facis.
Speaker 2 (16:02):
So the year is nineteen seventeen, and two things are
happening almost at the same time and two different parts
of the planet. There is Felex Terrell in Paris working
at the Pastoral Institute, which is like the holy grail
of science medical science at the time, and he is
both near a biologist and a medical doctor, which was
(16:24):
very common at the time. And so he's dealing with
patients who have dysentery. And again this is before antibiotics.
You've got dysentery, you might be dead very shortly, and
so people are dying. But one of his patients recovers,
and he figures this has to be something in his
stomach that helped him recover. So he starts looking at
(16:46):
two this person stool samples, and he realizes that there
is no dysentery bacteria in there anymore. So he's like
something skilling it. So let's try this. He takes like
these stool samples and in locum lads other bacteria samples
new with it, and Lloyd behold, Dysenteria bacteria dies there too,
(17:08):
and in the next one and the next one. But
he can't see what it is because phagies are much
smaller than bacteria, and at the time they could see
bacteria under the microscope but not phagis. In fact, that
took an electronic microscope of nineteen thirty to actually see
any virus. So he goes, well, I think I discovered
a parasite of microbes that is so small that we
(17:30):
can't see it. It's invisible, but I know it's there.
And he publishes a paper at the same time out
there in the country of Georgia, in Pilisi, which by
the way is a beautiful city and at the time
it was called the Paris of these really interesting dichotomy.
There is another scientist, the Georgian scientist Giorgi Alaiyava, who
is a little bit younger, not as experienced, but just
(17:53):
came back home from the front lights of World War One,
which just ended where he tended to, you know, six
soldiers who had cholera and dysentery and whatnot, and he
is looking into presence of cholera in the city water
in the river where everybody gets the water from, and
(18:13):
you know, lo and behold, cholera is there, and he
sees it and that's not good news. He's looking at
it through his microscope and something interferes, like he has
to go somewhere. He locks his lab and comes back
to it like a day or two later, and he's
looking at the same samples of water and there's no
color there anymore, which doesn't make any sense. Color doesn't
(18:33):
die a quickly. So he goes back to the river,
brings back water, repeats the same experience, same result. After
a few hours, no cholera. Does it again, same result.
He knows he's onto something, but he can't figure out
what is he onto. Fast forward a few more months.
He has to go to Paris to study at the
(18:55):
Pastor's Institute how to you know, make vaccines and other
meta since because that's again at the time where that's
where everybody went to study. He goes to Paris and
he walks into this really heated debate. So Drell's the
scientific role did not welcome Durrell's finding peacefully because it
(19:17):
really to them it didn't make sense. You know, you're
talking about invisible destroyers that destroyed didn't theory. No, it
also doesn't fit into the established immunity theory you know
at the time. So basically, at that moment, Dyrell is
a laughing stock. And at the moment he's out there
in the countryside dealing with chicken salmonella. So Eliella walks
(19:40):
into Fastero's intitude and right in the middle of all
this and he goes, I've seen that too, and they're like,
all right, another one. But here where the character differences
come into place. Drell was kind of a prickly character,
and he spoke his mind and probably made a fair
mind out of it as in his life. And Elia
(20:02):
was exactly the opposite. He was absolute charmor like people.
He could sweet talk anybody into anything. When I when
I was reading his family's diary, it literally sounded like
when he talked about science, it sounded like poetry. And
he spoke fluent French because he started studied in Geneva.
So he went to the institute director said can I
repeat the experiments? And of course he talked him into it,
(20:24):
and he repeated the experiments and he showed that basically
the same results, and that was kind of like maybe
like that's that's where the things begin to turn a
little bit.
Speaker 1 (20:35):
Yeah, and so is that when like the scientific or
medical implications of these findings. It was not only like okay,
you know, first there's this ground truth thing, are we
seeing what we actually think we're seeing? And then how
soon after that was how can we use this then
to help cure infectious disease?
Speaker 2 (20:56):
Yeah, so fairly soon. I think it was nineteen nineteen
I five, I am not mistaken when they first tried
phages on the very first patient, like a very sick child.
First the medics themselves drank phages and they showed that
nothing happened, and then they gave this phages to a
(21:18):
very sick challenge child like recovered in twenty four hours.
I think there were like a few other children they
drank Pyson theory phages. And I think the next really
big breakthrough was in nineteen twenty five when the rail
managed to cure a couple of cases of bubonic plague.
Speaker 1 (21:38):
What sort of was the turning point for the medical
community then reconsidering phases as a viable thing and as
something that is not just you know, in these guys
head where they're just coming and they're talking about nothing
and they're like, oh, here comes another one. At what
point did that transition happen.
Speaker 3 (21:58):
I think it's sort of like slow happened over like
the next maybe few years, like after nineteen nineteen. But
I think if if the nineteen twenty five when Durrell
cured Bogonic plague was probably a really really big turning
point because everybody like immediately paid attention. I mean, there
was no cure of them from the boguonic plague. You
(22:19):
got it, you died. I mean, it's almost depopulated Europe
in the Middle Ages. So and Durrell was stationed in
some port city in Egypt and a couple of sailors.
Speaker 2 (22:32):
Fell in with the bonic plague, and he had phages
that he brought from India where he eyes related it
from rats. Your rats could carry the plague but not
die from it. So he you know, made these new
phage concoctions and he treated the sailors with phages and
they recover it. And that was just like nothing, you know,
(22:54):
short of a miracle.
Speaker 1 (22:56):
Oh my gosh. I mean to then go from you know,
laughing stock to cure of bubonic plague, this like very
fear disease. That is, that's incredible. And then we go
from that to a whole institute being created for the
explicit reason to study phasianes. Can you tell me a
little bit about this institute?
Speaker 2 (23:16):
So Eliava and Durrell became not just like lifelong friends
but also lifelong collaborators. And so Aliama had this really
grand idea of building a bacteria of age research center
and a treatment center in Bilisi, in Georgia. And at
the time he had a fair amount of money because Stalin,
(23:39):
who was Georgia and himself, was willing to throw a
bunch of money into his home state, especially for things
like medicine, because healthy populations means strong umpire, and he
was building strong umpire. So the plans for the institute
were approved, and you know, there was a crazy amount
(23:59):
of money, even like, you know, several millions, which god
knows how much it would be in today's money, but
it was. It was a very turbulent time in history,
in particular in the history of the Soviet Union, because
Stalin was very paranoid about keeping his grip on the country,
(24:22):
keeping his power, and he wasn't tolerating any dissent, and Eliyaba,
like many brilliant people, was known to speak his mind,
and eventually that cut out with him, so he was
arrested and tortured, like really really brillly tortured. I was
able to find some of the introgation manuals, and when
you looked at it, you could literally see how all
(24:43):
this was constructed. Like, you know, people who were interrogating
him couldn't even decide what they wanted him to say.
Like one day they would want him to say that
he was working with the French intelligence, the next day
was the British intelligence. But the end result was that
he was killed and the center never materialized in all
(25:04):
the glory that it was envisioned. But the concept of
using Phage's as medicines survived because there was really nothing
else at the time, and it basically stayed in Beliezi,
like in the time capsule of sorts, and it was
used through all of the years of Soviet power.
Speaker 1 (25:26):
This huge loss that the Phage therapy field faced, you know,
how was that immediately felt? And then what were some
of the long term implications of that In let's say,
like the decade or so that followed Eliava's death.
Speaker 2 (25:42):
So the diga that followed in Aliava's this was really
it was a really difficult decade because we kind of
like get into World War two, right, So what happened
in late thirties in America is that phage therapy in
the West basically fell out of favor, and for really
interesting reasons. For no fault of phages, it was mostly
(26:08):
because it was kind of misused. People didn't necessarily know
how to grow phages properly, and even when they did,
pagies didn't always work. And that happens too. Sometimes pages
don't work for exama, they don't work for hives, they
don't work for allergies or herpies or whatever. But some
(26:28):
companies advertised pages for this health issues, and of course
fages did nothing to those undermining people's trust and physicians trust,
and so all that prompted some prominent American physicians to
examine medical literature in late nineteen thirties, and they decreed
that pages aren't really trustworthy enough to use this medicines
(26:52):
except maybe for like very specific things like staff. And
then shortly after that, Western medics learned to mass produce
antibiotics and that was the end of phages.
Speaker 1 (27:02):
Yeah, penicillin became the answer, and then.
Speaker 2 (27:05):
The answer, Yeah, pensila became the answer. You know.
Speaker 1 (27:08):
At the same time, though, in the Soviet Union, phases
were being used at a larger scale than they had
been previously. Can you tell me about some of the
prophylactic use of phases during World War Two in Stalingrad?
Speaker 2 (27:21):
Yeah, that is like one of my favorite topics because
it's just so mind buggling and it's like so unknown, right.
Speaker 1 (27:27):
Yeah, and the prophilactic use of phasias, I had no idea.
I always thought of it as a treatment, not a prophylactic. Yeah,
it's amazing.
Speaker 2 (27:35):
So we're now into nineteen forty two and the Nazis
forces are closing and on stalin Grad, like the Soviet
strengthhold on the Vulgar. We were named after Stalin, So
that's so many things are a tie to this CD
you know, like first it bears Stalin's name. Second, siss
on the way to the oil field of the Caucus,
(27:59):
and whoever gets to keep the oil field will win
the war because you need oil to run all this
heavy machinery. And so the battle for Stalar is absolutely brutal.
Neither side can afford to lose the city, and so
sometime in summer, the Moscow hears some rumors about cholera
(28:20):
cases among the German troops, and at first they're very
happy to hear that, because okay, well that's good. And
then they realize that no, it's not good because cholera
doesn't care, doesn't care about front lines, but it's on
one side to oil beyond the other. And they realize
they've got this whole city that they bombed out to
(28:41):
smooth the rings with like sewage broken you know, water
means broken. And they realize it's going to be a disaster,
and so they send a woman there. Her name is
Zinaida Yrmuliva, and she's one of the leading Soviet biologists
on microbiologists at the time, on a tiny plane that
manages to somehow evade the German bombers and actually learn there.
(29:05):
And she comes with this tiny little bag of phages,
and she hears that color has already arrived, and she
knows that she doesn't have enough phages, so she calls
Moscow and says, we need more phages. Moscow loads up
all it's phage Arsenal on a train, and the train
goes to Stalingrad and it never makes it because it
gets bummed out to smooth rains. And she goes, Okay,
(29:29):
we'll have to grow phages here. We've got vulgar right there.
There's got to be cholera in there, and their phages
will be in there, and of course they are. So
they take these samples and they go on the ground,
they go into the basements so that your bombing can
destroy them, and in that in those basements they grow
(29:50):
enough phages to basically give for prefiloxies the entire city
on a daily basis. I think she wrote in her
so fifty thousand people took this bacteria phage daily and
it never before happened in history. And it was so
profound that you couldn't leave the city without having a
certificate that you took your phages, and even bakeries wouldn't
(30:15):
give out bread without that paper.
Speaker 1 (30:17):
I mean, it's such an incredible story, and like you said,
it's such a profound demonstration of the power of phases.
But also it does make sense considering the larger historical context,
how this discovery did not become more widely known and
did not sort of make phages be front and center
of biomedical research at the time. And I want to
(30:39):
kind of talk about that historical context, how this implementation
of prophylactic phasis didn't happen in a vacuum. There's war
as the backdrop, and so can you talk about sort
of this larger context and what that meant for the
distribution of this information.
Speaker 2 (30:56):
Yeah, it's a very good point. I mean, yeah, not
all secrets were and I think that there actually was
some medical collaboration during World War two, and there were
some European American scientists who were working with Zinaida Uni world,
but more so on antibiotics than than phagis. And I
(31:17):
think they just didn't think that pages were realistic enough
that they were like really useful. I don't know why
it didn't happen. Part of it could have been just
like the general mistrust that just never took off.
Speaker 1 (31:32):
Let's take a quick break here, we'll be back before
you know it. Welcome back, everyone. I'm here chatting with
(31:54):
Lena Zeldovich about her book The Living Medicine. Let's get
into some more questions. There was a passage in your
book where you talked about sort of these social and
cultural and scientific differences between the West and the Soviet Union,
and how that sort of led to one pursuing antibiotics
and the other pursuing phases. In terms of again kind
(32:17):
of like as we talked about this reactive versus proactive
approach to medicine and public health, and I was wondering
if you could talk a little bit more about.
Speaker 2 (32:25):
That in America, in the West, I should say, and
in America probably more more. In particular, by the end
of nineteen thirties, the trust in phages kind of dropped,
and I think people that are genuinely thought of them
with suspicions. Even the companies that manufactured phages in nineteen thirties.
(32:48):
By nineteen forties, they switched to antibiotics in the post
war era, synthesizing molecules that worked consistently the same way.
It was easy and cheaper than growing this phoinichy crete
with you know, peaky appetites whose biology sides still didn't
fully understand, and physicians agreed. At the time, a large
(33:08):
percentage of American doctors were private practitioners, and many worked
from their home offices, and they weren't attached to any
bacteriological laboratories or hospitals. They didn't necessarily have you know,
test labs, let alone like complex facilities to synthesize pages.
There in those settings, the easy, ready to use medications
that had a long shelf life and killed a white
(33:31):
spectrum of drums were bound to win, which is what happened.
I mean, they offered all of these advantages, reliable, repeatable, stable,
no significant side effects known at the time. They definitely
went over phages. In the Soviet Union, however, medicine was
a state endeavor, so a family couldn't start a company
(33:51):
to grow phages to make penicillin, and medical school graduates
couldn't open a private practice. Everybody was applied by the states,
and all medicines were made at research institutions or like
large state owned factories, and that made it harder to
produce false advertisements, especially when the director's head was on
(34:12):
the line. Right if their products didn't work or wars
made patient seekert, they could be declared the enemy of
the people and that was it. So consequently, Soviet sciences
had like a very different medical paradigm. Western medics embraced
stability in life in laws in drugs. But the Soviet
(34:35):
medics STYG just learned to exist in this ever shifting landscape.
You know, if peniculin was mass produced today, it didn't
mean that the factor will still be there tomorrow. The
rowing ingredients could vanish, the inventor could be arrested. So
Soviet medics just uced whatever they have in a given day.
They hadn't tabiotics, good, don't have antibiotics all right, let's
(34:58):
go to the nearest river of phages.
Speaker 4 (35:02):
Wow.
Speaker 1 (35:02):
Yeah, that's a fascinating lens to think about, sort of
the differences in what drives innovation and what drives accessibility
to equipment, all of that. And so when antibiotic resistance
started to show up in around the world, which it did,
you know, very soon after penicillin was started to be
widely used. How did phage therapy? How was that used
(35:26):
in the Soviet Union to treat resistant infections.
Speaker 2 (35:29):
Yeah, that's a great question. Like basically, if antibiotic stuff working,
there was always a phage. I mean, Spelici kind of
remained a center of all sorts phages, but there were
other towns in the Soviet Union that produced some phages
and they could treat patients with it. What was really
(35:52):
interesting to me when I was working on this research
is that SPILICI maintain sort of like global by the
Soviet standards, global library of phages, and not only maintained,
but they constantly updated it, and they had literally thousands
and thousands of them. And by updating, I mean they
(36:14):
would continuously gather samples, bacterial samples from all over the
country and they would bring these new samples to the
lapse and they would see, is this bacteria evolving resistance
to our phages? Oops, it is okay, time to find
a better phage. Let's go out to the river. That
(36:34):
literally like went on for years and years and years,
and they never stopped. And they still do that.
Speaker 1 (36:40):
To anticipate the future problems and to be able to
have that in advance. And I think that's why I
keep thinking about phases as being this proactive approach where
you can see almost immediately if you're detecting antibiotic resistance,
you can find a phace for that. As you describe
in your book, there's this incredible moment where the specific
(37:02):
meeting where the knowledge of phage therapy is brought up
in this room, in this academic setting, and in the
US and the American scientists have no idea. They know
what bacteria phagias are, but they have no idea what
phage therapy is. I was wondering if you could sort
of paint me a picture of that story and this
(37:22):
kind of reawakening of knowledge about phaseia's in the West.
Speaker 2 (37:26):
Sure. So we're now in the early nineteen nineties when
the Soviet Union is falling apart, maybe it's already falling apart.
And this Georgian scientist comes from Pilisi to America for
a post doctorate fellowship and he is working in the
laboratory of a fairly well known infectious disease physician, Glenn Morris,
(37:49):
at the Maryland School of Medicine. And one day Glenn Morris,
who was an infectious disease physician, a practicing physician, comes
to the lap and he doesn't look like himself. So
the Georgian his name is Sandra, sees him like that
and he asks, you know what happened? And Glenn says, well,
I just lost a patient to an antibiotic resistant infection.
(38:11):
I mean this this man he battled through new cancer
and chemotherapy and recurring new cancer and chemotherapy, and he
was in his forties, so still fairly young, and and
he went through all of this and then at the
end he succumbed to an antibiotic resistant infection because I
couldn't find an antibiotic to kill this bug that infected him.
(38:33):
And Sandra just went so and the bacteria page didn't
work either, and Glunn just gave him that stare like
this this this this thy like what And when I
was talking to Sandra, and I talked to Sandra so
many times for this book, was just a moment of reckoning.
It was just like, oh my god, these people really
(38:55):
don't know, like we could treat this in my hometown.
Speaker 4 (39:00):
You know.
Speaker 2 (39:00):
He came to America because it was the place to
do science, and how can this be? And so he
basically took it upon himself to work for the next
twenty five thirty years to work with the FDA to
convince him that this was a credible treatment and if
it's done right, it can really save so many lives.
Speaker 1 (39:22):
I mean, what a moment of shock on both sides,
Like what do you mean phisih therapy? What do you mean?
What do you mean phage therapy? Like how do you
not know what this is? What is this?
Speaker 2 (39:31):
Right?
Speaker 1 (39:31):
Yeah, it's such a mind blowing moment, I think. And
then there were several that was like one turning point,
and there seemed to be several turning points. This like
slow momentum growing of interest in phage therapy in the West,
in the US. And can you talk about some of
these major moments that eventually led to people pursuing this
(39:55):
as a legitimate field of research with such potential.
Speaker 2 (39:59):
So initially, when Sandra and Glenn tried to put together
some research proposals to study phigis for medical purposes, they
wouldn't get any money, and in fact, the entire world
would laugh at them, just like they laughed back then,
you know at Dyrell. Eventually Thunder kind of like changed
(40:21):
his new path a little bit and he began to
work on phages for food safety. So bacterial contamination is
a huge problem in the food industry, as we all know,
like almost every week something is being recalled, right, So
his company now makes phage sprays that you spray on letters, meat, sausages,
(40:44):
and whatever that kill very specific food porn pathogens and
they work very well. So it is easier to get
an approval from FDA for food safety or food products
than medical products, because in medical products for people who
are very right. So I think I think I was
somewhere in the middle of two thousand. The first decade
(41:05):
of two thousand was when they get their first approval,
and then they got you know, more approval for different
type of page sprays, and they now manufacture quite a few,
So you could probably count this as a huge milestone,
even though it doesn't appear as huge, but it is
because it basically proved that fijis were safe, you know,
they didn't cause any harm. And then another big milestone
(41:31):
happened a few years down the road, somewhere around twenty sixteen,
when one particular person picked up an antibiotic resistant bacteria
Acina bakta bamania while traveling in Egypt with his wife
and ended up basically on the brink of death in
one of American hospitals. So this is a really unique couple.
(41:55):
The guy's name is Tom Patterson and his wife's name
is Stephanie Trusty, and she is a scientist herself, and
they've tried every antibiotic known to science and none of
them worked, and so she was basically a question of
losing her husband or trying something else. And she said,
I did research, and she's doubled upon phage therapy. And
(42:18):
because she had enough scientific knowledge and she knew enough
people in the scientific field, she was able to work
with scientists whose other scientists who studied phages to create
certain cocktails that were able to kill this bacteria in
her husband. And in fact, it was like a first
(42:40):
round of cocktails, second round of cocktails. And at the
end they also used you know, one warn tabiotic and
that you know, finally cleared it. And that was the
first time the FDA ever approved an investigational new drug
phages for use on humans. And it worked. It worked
so spectacular because there was nothing else to try. Yeah,
(43:02):
and that was a really big pivoting point which kind
of brought phages from scientific obscurity back on the front lines,
and since then a whole bunch of clinical trials were launched.
Speaker 1 (43:16):
That is one of my favorite stories, The Perfect Predator,
which is Stephanie's book, and it is so it is
so amazing because it is sort of this huge moment
that I think raised awareness too, not just within the
scientific community, but more broadly about this possible solution and
(43:38):
how that then sort of paved the way. You know,
if the public wants it, then maybe we should look
more into this. And so that, as you said, has
led to such a resurgence and interest. But there are
still some hurdles to overcome, as you mentioned earlier, like
FDA approval and also incentivizing research into phage therapy. What
(43:58):
are some of those challenges in terms of, like the
logistical side of things, incentivizing research making people even more
aware than they are.
Speaker 2 (44:07):
I think the original challenge was that years back, the
FDA didn't necessarily know how to detest phages like the
If you think about it, the holy grail of a
medicine production is to make sure that medicines don't change,
that they're always the same, and that's what that's how
(44:29):
they pass through studies and we know they're going to
work the same way in just about everybody. Phages are
tricky because they change. They may change within a person
because they multiply, right, so a slightly newer generation of
phages may have slightly different genome. They also again multiply,
which means you give a person a particular dose, but
(44:52):
then there's more phages more than that dose, and you
don't know to what extent they're going to grow, So
how do you even side how much phage to give anybody?
So there was like a lot of challenges like that.
But what the FDA is doing now is that so
they have two centers. There's a Center for Drug Evaluation
(45:12):
and then there's a Center for Biologics Evaluation. And that
Center for Biologic Evaluation regulates products derived from like living sources,
for example flu vaccines, which also changed from one season
to the next, And so that's where phage is now
fall under, and that's the department that regulates it.
Speaker 1 (45:35):
Yeah, I mean, it seems like there is a promising
path forward in terms of getting phage therapy just to
redraw some of the standards that we have to not
just discard them entirely because of these characteristics that they have.
And so how far away do you think that we
are here in the US from phage therapy being like
(45:57):
a routine or at least a more widely available option.
Speaker 4 (46:01):
That's a great question, and I've asked that question almost everybody,
And you know, the best to get is like I
don't know, five to ten years or something.
Speaker 2 (46:12):
It seems that it's moving a little bit faster in Europe,
but I don't think we have a lot of options.
And that's why I think it's it has to go
a little bit faster because our antibiotics are losing their
punch like way too quickly. You know, when I was
working on this book. I first started working on this book.
(46:33):
The CDC's twenty nineteen reports said that every fifteen minute,
someone dies from an antibiotic resistance infection. So we talked
for almost an hour. That's for people. The CDC's twenty
twenty two reports said that it's gotten worse, and then
Newer asked the let's say that by twenty fifty, antibiotic
resistance will kill three people every minute. So like you
(46:57):
do the math, and the United Nations says agreement prediction
ten million US annually by twenty fifty. It's like it's
pretty freaky. So I think it's like necessity is the
mother of invention. So I think necessity will just push
us to getting this to the finished line sooner rather
than later.
Speaker 1 (47:17):
Yeah, I hope. So, I mean, I would love to
see a world in which we have alternatives to antibiotics
as part of just building a wider toolkit to deal
with this growing problem of antibiotic resistance. And I want
to close out the interview by asking you what phages
mean to you personally.
Speaker 2 (47:37):
I've been fascinated with phagi's probably since I was a kid,
because of probably I don't know, maybe six or seven,
when I stumbled upon a phage study in one of
the scientific magazines that we had at home. A lot
of people in my family with scientists. I grew up
(47:58):
with all this stuff, just kind of like sitting there,
and in Russian, the word phage is just three letters
and it's and it starts with a letter F that
looks like a person who is standing with their arms
and their hips, kind of like this very you know,
confident figure that says, don't mess with me. And it
was and the picture of a phage itself kind of
(48:20):
resembled that. So I started reading that study and there
weren't too many familiar words, but I spotted one that
I knew, disent theory, which I was personally acquainted with,
because you know, last summer, the city got a contaminated
shipment of grapes, and so many kids were sick and
(48:41):
they were not enough on tabiotics, and you know, eventually,
my grandfather found some antibiotics somewhere in a pharmacy and
that's what I took. But the study purported that these
page creatures could be used as an alternative to antibiotics,
and that was just so interesting to me that it
sort of stuck with me. And I also like the
(49:03):
page character as a character, so I brought my collared
pencils and, like you, color that page character in different colors,
and the whole thing just stuck with me and it
continues to you know, like some things get lunched in
your head, and that was one of those.
Speaker 1 (49:18):
I love that story. What if just like this thing
that you came across and something about it just stuck
with you. That's wonderful. Well, this has been such a
fascinating conversation. I've long been a fan of phage therapy
and I am just so excited to have read more
about it and understand more about the historical context. So
thanks again so much for taking the time to chat
(49:40):
with me today.
Speaker 4 (49:41):
Oh, thank you for inviting me.
Speaker 1 (50:03):
A huge thank you again to Lena Zeldovitch for taking
the time to chat with me. I didn't know I
could love phage therapy even more, but somehow I do.
If you enjoyed today's episode and would like to learn more,
check out our website this podcast will kill You dot com.
We're all post a link to where you can find
the Living Medicine how a forgotten cure may rescue us
(50:23):
when antibiotics fail, as well as a link to Lena's
website where you can find her other incredible work and
don't forget. You can check out our website for all
sorts of other cool things, including but not limited to, transcripts,
quarantining and Placeibrita recipes, show notes and references for all
of our episodes, links to merch our bookshop dot org,
affiliate account, our Goodreads list, a frettend account form, and
(50:46):
music by Bloodmobile. Speaking of which, thank you to Bloodmobile
for providing the music for this episode and all of
our episodes. Thank you to Leana Squalatchi and Tom Brifocal
for our audio mixing, and thanks to you listeners for listening.
I hope you liked this episode and our loving being
part of the tpwk y book Club. And a special
(51:07):
thank you, as always to our fantastic patrons. We appreciate
your support. So very much well, until next time, keep
washing those hands.
Hosts And Creators
Erin Welsh
Erin Allmann Updyke
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