Taming Superbugs Insights From Game Theory Professor David McAdams

Antibacterial Soap

Antibacterial Soap with “Triclosan” Useless in practice Creates health risks CDC recommends regular soap!

Good News 2013: FDA proposes new rules to require soap-makers to demonstrate safety and effectiveness 2014: Bath & Body Works joins others who have removed antibacterials from their products

A Beautiful Mind John Nash, aka Russell Crowe

“No man is an island, entire of itself.” John Donne, 1624

Game = Any situation with multiple decision-makers (or “players”) whose choices impact one another..”

Games of Life HOSPITALSCHOOL HOMEOFFICE

My Own Game-Theory Journey

Business: mobile payments Public policy: alcohol abuse Foreign policy: Somali pirates

October 2013: Debt-ceiling crisis My Own Game-Theory Journey Changing the debt-ceiling game” “ New York Times op-ed

October 2014: Out-of-control western corn rootworm Sorensen Public Policy Lecture at U. Nebraska Lincoln “ The future of pest-resistant crops” My Own Game-Theory Journey

Turning the tables on terrorist kidnappers” January 2015: Terrorist kidnappers “ New York Times op-ed My Own Game-Theory Journey

Debt-ceiling crisis Pest-resistant crops Terrorist kidnappers X X X Antibiotic Resistance

Dr. Mario Raviglione, Director, WHO Global TB Programme Dr. Arjun Srinivasan, Associate Director, CDC Healthcare Associated Infection Prevention Antibiotics discovery team, GlaxoSmithKline Dr. Maria Joyce, Duke hospital, molecular diagnosis expert Professor Gerald Wright, McMaster U, bacterial genome expert Much Help Along the Way

We are poised to achieve complete and lasting victory over antibiotic resistance.

Together, We Can Change the Game #1 – As Consumers STOP INAPPROPRIATE ANTIBIOTIC USE IN LIVESTOCK #2 – As Patients STOP INAPPROPRIATE ANTIBIOTIC USE IN OURSELVES #3 – As Citizens/Taxpayers ACCELERATE SCIENCE BEHIND DIAGNOSIS OF RESISTANCE

The Logic of Rising Antibiotic Resistance Susceptible Bacteria Resistant Bacteria

The Logic of Rising Antibiotic Resistance Susceptible Bacteria Resistant Bacteria

The Logic of Rising Antibiotic Resistance Penicillin doesn’t work anymore!! Resistant Bacteria

“Things as common as strep throat or a child’s scratched knee could once again kill.” Dr. Margaret Chan Director-General “A Post-Antibiotic Future”

Leading Causes of Death Pneumonia and influenza 2.Tuberculosis 3.Diarrhea and enteritis 1.Heart disease 2.Malignant neoplasms [cancer] 3.Cerebrovascular diseases [stroke] 6.Pneumonia and influenza

We Can Avoid a Post-Antibiotic Future #1 – DISCOVER DRUGS FAST ENOUGH #1 – SLOW RISE OF RESISTANCE

We Can Avoid a Post-Antibiotic Future #2 – REVERSE RISE OF RESISTANCE #2 – DISCOVER BETTER DIAGNOSTICS

1928: Accidental Discovery of Antibiotics

January 2006: Soil-dwelling bacteria Resistance Starts in the Soil Scientific article in Science “Microbial resistance to antibiotics currently spans all known classes of natural and synthetic compounds. Soil-dwelling bacteria... are a reservoir of resistance.”

Antibiotic Overuse in Livestock “GROWTH PROMOTION” “SUPERBUGS”

MRSA CC398: Human  Pig  Human JUMPS TO PIGS EASILY TREATABLE DISEASE

JUMPS TO PIGS ACQUIRES RESISTANCE EASILY TREATABLE DISEASE MRSA CC398: Human  Pig  Human

JUMPS TO PIGS ACQUIRES RESISTANCE RE-INFECTS PEOPLE EASILY TREATABLE DISEASE SUPERBUG MRSA CC398: Human  Pig  Human

MRSA in Pigs: Threat to Human Health of grocery carts sampled in Iowa City had MRSA bacteria on them 5% of all meat harbored MRSA as well 3%

of grocery carts sampled in Iowa City had MRSA bacteria on them 5% of “antibiotic-free” meat had MRSA 0% MRSA in Pigs: Threat to Human Health

Game-Changer – ANTIBIOTIC-FREE MEAT

What if Resistance Escapes the Farm? S S S S R R R = resistant bacteria = susceptible bacteria S S S S S

S S S S R R R = resistant bacteria = susceptible bacteria S S S R R What if Resistance Escapes the Farm?

RS S S R R Our Bodies are a Battlefield Susceptible bacteria are a natural “ally” in fight against resistance!!

S S R R S S S R S S S S Patient #1 Our Bodies are a Battlefield Patient #2 Patient #3

S S R R R Antibiotic Treatment Our Bodies are a Battlefield Patient #1 Patient #2

S S R R R R R R R R R R Patient #1 Patient #3 Our Bodies are a Battlefield

Game-Changer – JUDICIOUS ANTIBIOTICS USE

S S R R What If We Could Diagnose Resistance? Standard Treatment Strategies to Disrupt Transmission S R

S S R R What If We Could Diagnose Resistance? Standard Treatment Strategies to Disrupt Transmission S

Game-Changer – NEW DIAGNOSTIC TOOLS Takes DAYSTakes ONE HOUR

We’ve Mapped the “Resistome” … Takes ONE HOUR Visualization of the Antibiotic Resistome

… Now Poised to Transform Medicine!! Takes ONE HOUR Visualization of the Antibiotic Resistome

We Need YOU to Change the Game 1.Buy antibiotic-free meat. 2.Talk with your doctor. Do you really need antibiotics? 3.Support a new frontier in science to detect resistance. 4.Tell your friends what you learned today.