TEDMED 2014
Ramanan Laxminarayan: The coming crisis in antibiotics
Ramanan Laxminarayan: Antibiotiká čaká kríza
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Antibiotiká zachraňujú životy. Používame ich však nadmerne a často ani nie na to, aby sme zachránili životy, ale napríklad na liečbu chrípky, či dokonca pri chove lacnejších kureniec. Výskumník Ramanan Laxminarayan tvrdí, že v dôsledku toho pre nás antibiotiká prestanú účinkovať, pretože baktérie, proti ktorým sú zamerané, budú čoraz rezistentnejšie. Preto nás všetkých (pacientov i lekárov) vyzýva, aby sme antibiotiká, a ich pretrvávajúcu účinnosť, vnímali ako obmedzený zdroj, pri ktorom si musíme dobre rozmyslieť, kedy ho použijeme. Ponúka alarmujúci pohľad na to, ako môžu celosvetové trendy v medicíne zaťať do živého.
Ramanan Laxminarayan - Drug-resistance economist
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
Double-click the English transcript below to play the video.
00:12
The first patient to ever be
treated with an antibiotic
treated with an antibiotic
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Prvý pacient,
ktorého liečili antibiotikami,
ktorého liečili antibiotikami,
bol policajt z Oxfordu.
00:16
was a policeman in Oxford.
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00:17
On his day off from work,
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Jedného dňa mal voľno, robil v záhrade
00:19
he was scratched by a rose thorn
while working in the garden.
while working in the garden.
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a poškriabal sa na tŕni ruže.
00:23
That small scratch became infected.
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Do ranky sa však dostala infekcia.
00:26
Over the next few days,
his head was swollen
his head was swollen
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Do niekoľkých dní mal hlavu samý absces.
00:29
with abscesses,
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V oku mal takú silnú infekciu,
00:30
and in fact his eye was so infected
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že mu ho museli vyoperovať.
00:33
that they had to take it out,
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00:35
and by February of 1941,
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Vo februári 1941
už bol chudák policajt na pokraji smrti.
00:38
this poor man was on the verge of dying.
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Hospitalizovali ho v oxfordskej
Radcliffe Infirmary,
Radcliffe Infirmary,
00:40
He was at Radcliffe Infirmary in Oxford,
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00:43
and fortunately for him,
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kde našťastie práve vtedy
00:45
a small team of doctors
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tím doktora Howarda Floreyho
00:47
led by a Dr. Howard Florey
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00:48
had managed to synthesize
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syntetizoval malé množstvo penicilínu.
00:50
a very small amount of penicillin,
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Ten už 12 rokov predtým objavil
Alexander Fleming,
Alexander Fleming,
00:53
a drug that had been discovered
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00:55
12 years before by Alexander Fleming
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ale dovtedy sa ním nikto
nepokúsil liečiť človeka.
nepokúsil liečiť človeka.
00:58
but had never actually been
used to treat a human,
used to treat a human,
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Netušili ani len to,
či bude vôbec účinkovať,
či bude vôbec účinkovať,
01:01
and indeed no one even
knew if the drug would work,
knew if the drug would work,
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01:04
if it was full of impurities
that would kill the patient,
that would kill the patient,
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pretože obsahoval prímesi,
ktoré mohli pacienta usmrtiť.
ktoré mohli pacienta usmrtiť.
01:07
but Florey and his team figured
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Floreyho tím si však pomyslel,
01:09
if they had to use it,
they might as well use it
they might as well use it
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že ak ho majú niekomu podať,
01:11
on someone who was going to die anyway.
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tak najlepšie tomu, kto aj tak zomiera.
01:14
So they gave Albert Alexander,
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Podali ho teda Albertovi Alexandrovi,
01:17
this Oxford policeman, the drug,
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tomu oxfordskému policajtovi.
Do 24 hodín sa jeho stav zlepšil.
01:20
and within 24 hours,
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01:23
he started getting better.
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Klesla mu horúčka, opäť mal chuť do jedla.
01:25
His fever went down,
his appetite came back.
his appetite came back.
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Na druhý deň sa cítil oveľa lepšie.
01:29
Second day, he was doing much better.
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01:31
They were starting to
run out of penicillin,
run out of penicillin,
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Keď sa im liek začal míňať,
01:33
so what they would do
was run with his urine
was run with his urine
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vynašli sa, zobrali moč pacienta
01:35
across the road to re-synthesize
the penicillin from his urine
the penicillin from his urine
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a resyntetizovali z neho penicilín,
01:38
and give it back to him,
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ktorý znovu podali pacientovi.
01:40
and that worked.
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Fungovalo to.
01:42
Day four, well on the way to recovery.
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Na štvrtý deň bol
na najlepšej ceste k uzdraveniu.
na najlepšej ceste k uzdraveniu.
01:44
This was a miracle.
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Bol to zázrak.
01:46
Day five, they ran out of penicillin,
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Na piaty deň im penicilín došiel úplne
01:50
and the poor man died.
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a pacient zomrel.
Tento príbeh nemal šťastný koniec.
01:52
So that story didn't end that well,
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01:55
but fortunately for
millions of other people,
millions of other people,
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Príbehy miliónov iných ľudí
však šťastne skončili.
však šťastne skončili.
Aj príbeh tohto dieťaťa,
ktoré liečili začiatkom 40. rokov.
ktoré liečili začiatkom 40. rokov.
01:59
like this child who was treated
again in the early 1940s,
again in the early 1940s,
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02:02
who was again dying of a sepsis,
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Umieralo na otravu krvi,
02:05
and within just six days, you can see,
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ale len za 6 dní sa uzdravilo
vďaka novému zázračnému lieku, penicilínu.
02:08
recovered thanks to this
wonder drug, penicillin.
wonder drug, penicillin.
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02:12
Millions have lived,
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Zachránil milióny životov
02:14
and global health has been transformed.
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a zmenil zdravotníctvo na celom svete.
02:17
Now, antibiotics have been used
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Antibiotiká sa však nepodávajú len tým,
02:20
for patients like this,
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ktorí ich potrebujú,
02:23
but they've also been
used rather frivolously
used rather frivolously
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ale ľudia ich niekedy užívajú ľahkovážne,
02:25
in some instances,
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napríklad pri prechladnutí alebo chrípke,
02:27
for treating someone
with just a cold or the flu,
with just a cold or the flu,
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pri ktorých antibiotiká nezaberajú.
02:29
which they might not have
responded to an antibiotic,
responded to an antibiotic,
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02:32
and they've also been
used in large quantities
used in large quantities
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Vo veľkom sa používajú v nízkych dávkach,
02:36
sub-therapeutically, which
means in small concentrations,
means in small concentrations,
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pod terapeuticky účinnou koncentráciou,
na urýchlenie rastu kureniec a ošípaných.
02:39
to make chicken and hogs grow faster.
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V snahe ušetriť pár centov na cene mäsa
02:42
Just to save a few pennies
on the price of meat,
on the price of meat,
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sa pri chove zvierat minulo
množstvo antibiotík.
množstvo antibiotík.
02:46
we've spent a lot of
antibiotics on animals,
antibiotics on animals,
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Nepoužili sa na liečbu chorých zvierat,
02:49
not for treatment, not for sick animals,
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02:51
but primarily for growth promotion.
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ale prednostne na podporu ich rastu.
K čomu to všetko viedlo?
02:54
Now, what did that lead us to?
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Takéto celosvetové používanie antibiotík
02:57
Basically, the massive use of antibiotics
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03:00
around the world
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viedlo k obrovskému selekčnému tlaku
na bakteriálne populácie
na bakteriálne populácie
03:01
has imposed such large
selection pressure on bacteria
selection pressure on bacteria
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03:05
that resistance is now a problem,
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a vznikol problém s rezistenciou,
pretože teraz nás napádajú
len rezistentné baktérie.
len rezistentné baktérie.
03:08
because we've now selected for just
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03:10
the resistant bacteria.
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03:11
And I'm sure you've all read
about this in the newspapers,
about this in the newspapers,
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Som si istý, že ste o tom čítali
v novinách a časopisoch,
v novinách a časopisoch,
03:14
you've seen this in every magazine
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ktoré sa vám dostali do rúk,
03:16
that you come across,
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ale chcem, aby ste si uvedomili,
03:18
but I really want you to appreciate
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03:20
the significance of this problem.
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že ide skutočne o závažný problém.
03:22
This is serious.
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Situácia je vážna.
Uvidíte mapu výskytu kmeňa Acinetobacter
s rezistenciou na karbopeném.
s rezistenciou na karbopeném.
03:23
The next slide I'm about to show you is
of carbapenem resistance in acinetobacter.
of carbapenem resistance in acinetobacter.
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03:28
Acinetobacter is a nasty hospital bug,
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Ide o nebezpečné nemocničné baktérie
03:31
and carbapenem is pretty much
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a karbopenémové antibiotiká
sú tie najsilnejšie,
sú tie najsilnejšie,
03:32
the strongest class of antibiotics
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03:34
that we can throw at this bug.
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ktoré proti nim dokážeme použiť.
03:36
And you can see in 1999
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V roku 1999 to vyzeralo tak,
03:39
this is the pattern of resistance,
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že na väčšine územia USA
bola rezistencia pod 10 %.
bola rezistencia pod 10 %.
03:42
mostly under about 10 percent
across the United States.
across the United States.
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03:45
Now watch what happens
when we play the video.
when we play the video.
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Pozrite, čo sa stane, keď pustím video.
03:58
So I don't know where you live,
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Neviem, kde žijete,
ale nech je to kdekoľvek,
04:00
but wherever it is, it certainly is a lot worse now
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situácia je tam určite horšia
ako v roku 1999
ako v roku 1999
04:03
than it was in 1999,
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04:05
and that is the problem of antibiotic resistance.
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a práve to je podstata nášho problému.
Ide o celosvetový problém,
04:09
It's a global issue
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ktorý sa týka bohatých
aj chudobných krajín.
aj chudobných krajín.
04:11
affecting both rich and poor countries,
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04:14
and at the heart of it,
you might say, well,
you might say, well,
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Možno sa pýtate:
„Nie je to len problém zdravotníctva?“
04:16
isn't this really just a medical issue?
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Ak by sa doktori naučili
nepredpisovať toľko antibiotík
nepredpisovať toľko antibiotík
04:18
If we taught doctors how not
to use antibiotics as much,
to use antibiotics as much,
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04:20
if we taught patients how
not to demand antibiotics,
not to demand antibiotics,
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a ak by sa pacienti naučili
nedožadovať sa ich,
nedožadovať sa ich,
04:23
perhaps this really wouldn't be an issue,
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možno by situácia nebola taká zlá.
04:25
and maybe the pharmaceutical companies
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Farmaceutické spoločnosti by sa možno
mali viac snažiť vyvinúť viac antibiotík.
mali viac snažiť vyvinúť viac antibiotík.
04:27
should be working harder to develop
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04:28
more antibiotics.
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Existuje niečo, čo antibiotiká zásadne
odlišuje od iných liekov.
odlišuje od iných liekov.
04:30
Now, it turns out that there's something
fundamental about antibiotics
fundamental about antibiotics
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04:33
which makes it different from other drugs,
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Keď ich užívam,
04:35
which is that if I misuse antibiotics
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či už vhodne alebo nevhodne,
04:37
or I use antibiotics,
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04:39
not only am I affected but
others are affected as well,
others are affected as well,
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neovplyvňujem len seba, ale aj iných ľudí,
podobne ako keď idem do práce autom,
04:43
in the same way as if I
choose to drive to work
choose to drive to work
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04:45
or take a plane to go somewhere,
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alebo sa rozhodnem niekam letieť,
a tým prispejem ku klimatickým zmenám,
04:48
that the costs I impose on others
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04:50
through global climate change go everywhere,
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ktoré ovplyvňujú ľudí na celom svete.
04:52
and I don't necessarily take
these costs into consideration.
these costs into consideration.
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Na takéto následky však vtedy nemyslím.
Ekonómovia túto teóriu volajú
tragédia obecnej pastviny
tragédia obecnej pastviny
04:55
This is what economists might
call a problem of the commons,
call a problem of the commons,
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04:58
and the problem of the commons is exactly
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a týka sa aj antibiotík.
05:00
what we face in the case
of antibiotics as well:
of antibiotics as well:
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Jednotlivci, pacienti, nemocnice,
či celé zdravotníctva
či celé zdravotníctva
05:02
that we don't consider —
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05:04
and we, including individuals, patients,
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05:07
hospitals, entire health systems —
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neberú do úvahy následky,
05:11
do not consider the costs
that they impose on others
that they impose on others
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ktoré bude mať na iných to,
ako užívajú antibiotiká.
ako užívajú antibiotiká.
05:13
by the way antibiotics are actually used.
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05:15
Now, that's a problem that's similar
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Podobný problém poznáme z inej oblasti.
05:17
to another area that we all know about,
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Ide o využitie palív a energie,
05:19
which is of fuel use and energy,
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05:21
and of course energy use
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ktoré vedie k vyčerpávaniu ich zdrojov
05:23
both depletes energy as well as
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a prispieva k miestnemu znečisteniu
a klimatickým zmenám.
a klimatickým zmenám.
05:26
leads to local pollution
and climate change.
and climate change.
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05:29
And typically, in the case of energy,
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Existujú v podstate 2 spôsoby,
05:31
there are two ways in which
you can deal with the problem.
you can deal with the problem.
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ako sa tento problém dá vyriešiť.
05:33
One is, we can make better
use of the oil that we have,
use of the oil that we have,
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Môžeme lepšie využívať ropu,
ktorú už máme k dispozícii.
ktorú už máme k dispozícii.
Analógiou v medicíne je lepšie užívanie
existujúcich antibiotík
existujúcich antibiotík
05:37
and that's analogous to making better use
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05:39
of existing antibiotics,
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05:41
and we can do this in a number of ways
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a o tom vám o chvíľu poviem viac.
05:42
that we'll talk about in a second,
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Druhá možnosť je držať sa hesla
„vŕtaj veselo ďalej“.
„vŕtaj veselo ďalej“.
05:45
but the other option is the
"drill, baby, drill" option,
"drill, baby, drill" option,
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05:48
which in the case of antibiotics
is to go find new antibiotics.
is to go find new antibiotics.
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V medicíne by sa dalo povedať
„vyvíjaj nové antibiotiká“.
„vyvíjaj nové antibiotiká“.
05:53
Now, these are not separate.
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Tieto 2 spôsoby neexistujú oddelene.
05:55
They're related, because if we invest heavily
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Navzájom sa ovplyvňujú.
Veľké investície do nových ropných vrtov
05:58
in new oil wells,
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znižujú chuť investovať do šetrenia ropou.
06:00
we reduce the incentives
for conservation of oil
for conservation of oil
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06:03
in the same way that's going
to happen for antibiotics.
to happen for antibiotics.
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Platí to aj v prípade antibiotík.
06:06
The reverse is also going
to happen, which is that
to happen, which is that
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Opak je tiež pravdou.
Ak budeme antibiotiká užívať vhodne,
06:08
if we use our antibiotics appropriately,
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06:10
we don't necessarily have
to make the investments
to make the investments
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nebudú až také nutné investície
do vývoja nových liekov.
do vývoja nových liekov.
06:13
in new drug development.
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Ak si myslíte,
06:15
And if you thought that these two were entirely,
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že tieto 2 možnosti existujú v rovnováhe,
06:18
fully balanced between these two options,
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mali by ste si uvedomiť,
06:20
you might consider the fact that
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že sme súčasťou prirodzeného procesu,
06:22
this is really a game that we're playing.
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06:24
The game is really one of coevolution,
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ktorý sa volá koevolúcia.
06:27
and coevolution is, in
this particular picture,
this particular picture,
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Na obrázku vidíte príklad koevolúcie
medzi gepardmi a gazelami.
medzi gepardmi a gazelami.
06:30
between cheetahs and gazelles.
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Gepardy potrebujú byť rýchle,
06:32
Cheetahs have evolved to run faster,
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06:34
because if they didn't run faster,
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lebo ak nie sú rýchlejšie ako korisť,
06:35
they wouldn't get any lunch.
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nemajú čo žrať.
06:37
Gazelles have evolved to run faster because
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Gazely potrebujú byť rýchle,
pretože inak skončia ako žrádlo.
06:40
if they don't run faster, they would be lunch.
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Podobnú hru hráme s baktériami.
06:43
Now, this is the game we're
playing against the bacteria,
playing against the bacteria,
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06:46
except we're not the cheetahs,
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Nie sme však gepardy, ale gazely.
06:48
we're the gazelles,
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Počas mojej prednášky by už baktérie
mali deti a vnúčatá
mali deti a vnúčatá
06:49
and the bacteria would,
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06:52
just in the course of this little talk,
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06:54
would have had kids and grandkids
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a zistili by, ako získať rezistenciu
06:55
and figured out how to be resistant
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pomocou selekcie a metódou pokusu a omylu.
06:58
just by selection and trial and error,
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Skúšali by to, až kým by neuspeli.
07:00
trying it over and over again.
159
408834
1912
07:02
Whereas how do we stay
ahead of the bacteria?
ahead of the bacteria?
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3772
Ako si teda máme pred nimi udržať náskok?
07:06
We have drug discovery processes,
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414518
2054
Máme výrobné postupy pre vývoj liekov,
07:08
screening molecules,
162
416572
1630
molekulárny skríning a klinické testy
07:10
we have clinical trials,
163
418202
1728
07:11
and then, when we think we have a drug,
164
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2148
a keď si myslíme, že máme nový liek,
07:14
then we have the FDA regulatory process.
165
422078
3745
tento musí ešte prejsť
regulačným procesom registrácie.
regulačným procesom registrácie.
07:17
And once we go through all of that,
166
425823
2178
Toto všetko robíme v snahe
udržať si náskok pred baktériami.
udržať si náskok pred baktériami.
07:20
then we try to stay one step ahead
167
428001
2265
07:22
of the bacteria.
168
430266
2296
Je jasné, že si náskok neudržíme,
07:24
Now, this is clearly not a
game that can be sustained,
game that can be sustained,
169
432562
2777
ani túto hru nevyhráme len inováciami.
07:27
or one that we can win
170
435339
1137
07:28
by simply innovating to stay ahead.
171
436476
1837
07:30
We've got to slow the pace of coevolution down,
172
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3305
Musíme znížiť tempo koevolúcie
a pritom sa môžeme inšpirovať
nápadmi z energetiky,
nápadmi z energetiky,
07:33
and there are ideas that we
can borrow from energy
can borrow from energy
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441618
3682
07:37
that are helpful in thinking about
174
445300
1770
ktoré by sa dali uplatniť
aj pri antibiotikách.
aj pri antibiotikách.
07:39
how we might want to do this in the case
175
447070
1537
07:40
of antibiotics as well.
176
448607
1546
07:42
Now, if you think about how we deal with
177
450153
2240
Pozrime sa na oceňovanie energie.
07:44
energy pricing, for instance,
178
452393
1423
Tým, že sa zavádzajú emisné dane,
07:45
we consider emissions taxes,
179
453816
1849
07:47
which means we're imposing
the costs of pollution
the costs of pollution
180
455665
2584
náklady za znečistenie sa presunú na ľudí,
07:50
on people who actually use that energy.
181
458249
2831
ktorí energiu naozaj využívajú.
07:53
We might consider doing that for antibiotics as well,
182
461080
2980
Také niečo by mohlo fungovať
aj pri antibiotikách
aj pri antibiotikách
07:56
and perhaps that would make sure that antibiotics
183
464060
2711
a možno by sa potom používali len vtedy,
07:58
actually get used appropriately.
184
466771
2401
keď je to vhodné.
Dotuje sa získavanie energie
z obnoviteľných zdrojov,
z obnoviteľných zdrojov,
08:01
There are clean energy subsidies,
185
469172
2028
08:03
which are to switch to fuels
which don't pollute as much
which don't pollute as much
186
471200
3055
ktoré nevedú k takému znečisťovaniu
08:06
or perhaps don't need fossil fuels.
187
474255
2845
a nie sú založené na fosílnych palivách.
08:09
Now, the analogy here is, perhaps we need
188
477100
2860
V prípade antibiotík by mohlo ísť o to,
že ich ľudia začnú užívať menej a menej.
08:11
to move away from using antibiotics,
189
479960
2260
08:14
and if you think about it, what are
good substitutes for antibiotics?
good substitutes for antibiotics?
190
482220
3716
Čo by však bola dobrá náhrada antibiotík?
V podstate všetko, čo zníži ich potrebu,
08:17
Well, turns out that anything that reduces
191
485936
2164
08:20
the need for the antibiotic would really work,
192
488100
2243
napríklad lepšie predchádzanie
infekciám v nemocniciach
infekciám v nemocniciach
08:22
so that could include improving
hospital infection control
hospital infection control
193
490343
3142
08:25
or vaccinating people,
194
493485
2895
či očkovanie proti sezónnej chrípke.
08:28
particularly against
the seasonal influenza.
the seasonal influenza.
195
496380
2297
Pri tej sa užíva asi najviac antibiotík
08:30
And the seasonal flu is probably
196
498677
2531
08:33
the biggest driver of antibiotic use,
197
501208
3004
v tejto aj mnohých iných krajinách,
08:36
both in this country as well
as in many other countries,
as in many other countries,
198
504212
2919
takže očkovanie by skutočne mohlo pomôcť.
08:39
and that could really help.
199
507131
2020
Treťou možnosťou by bolo niečo ako
obchodovateľné emisné povolenia…
obchodovateľné emisné povolenia…
08:41
A third option might include
something like tradeable permits.
something like tradeable permits.
200
509151
4103
08:45
And these seem like faraway scenarios,
201
513254
4246
To už možno znie príliš fantasticky,
ale v budúcnosti možno nebudeme mať
antibiotiká pre ľudí s infekciami,
antibiotiká pre ľudí s infekciami,
08:49
but if you consider the
fact that we might not
fact that we might not
202
517500
2427
08:51
have antibiotics for many
people who have infections,
people who have infections,
203
519927
3383
preto by sme mohli začať uvažovať o tom,
08:55
we might consider the fact that we might
204
523310
2237
08:57
want to allocate who actually gets to use
205
525547
2311
že by sme niektoré prideľovali tým,
08:59
some of these antibiotics over others,
206
527858
2714
ktorí ich potrebujú viac ako iní,
09:02
and some of these might have to
be on the basis of clinical need,
be on the basis of clinical need,
207
530572
3326
či už na základe klinickej potreby
alebo ceny.
alebo ceny.
09:05
but also on the basis of pricing.
208
533898
1935
Funguje aj vzdelávanie spotrebiteľov.
09:07
And certainly consumer education works.
209
535833
1910
09:09
Very often, people overuse antibiotics
210
537743
2601
Ľudia často ani nevedia o tom,
že antibiotiká užívajú nadmerne,
09:12
or prescribe too much without necessarily
211
540344
2277
alebo že ich predpisujú priveľa.
09:14
knowing that they do so,
212
542621
1606
09:16
and feedback mechanisms
213
544227
1431
Podobne ako v energetike,
09:17
have been found to be useful,
214
545658
1902
aj tu môže pomôcť spätná väzba.
09:19
both on energy —
215
547560
1929
09:21
When you tell someone that they're using
216
549489
1540
Ak ľuďom poviete,
že počas špičky minú veľa energie,
09:23
a lot of energy during peak hour,
217
551029
1917
majú sklon znížiť spotrebu.
09:24
they tend to cut back,
218
552946
1470
09:26
and the same sort of example has been performed
219
554416
1767
Niečo podobné urobili
v nemocnici v St. Louis,
v nemocnici v St. Louis,
09:28
even in the case of antibiotics.
220
556183
1810
09:29
A hospital in St. Louis basically would put up
221
557993
1981
kde zverejnili zoznam mien chirurgov,
09:31
on a chart the names of surgeons
222
559974
4192
ktorý bol zoradený podľa toho,
09:36
in the ordering of how much antibiotics they'd used
223
564166
2219
koľko antibiotík predpísali
za predchádzajúci mesiac.
za predchádzajúci mesiac.
09:38
in the previous month,
224
566385
1944
09:40
and this was purely an
informational feedback,
informational feedback,
225
568329
2342
Cieľom nebolo chirurgov nejako zahanbiť,
09:42
there was no shaming,
226
570671
1183
ale poskytnúť im spätnú väzbu,
09:43
but essentially that provided
some information back
some information back
227
571854
2135
09:45
to surgeons that maybe they could rethink
228
573989
1954
na základe ktorej mohli zvážiť,
09:47
how they were using antibiotics.
229
575943
2229
ako predpisujú antibiotiká.
09:50
Now, there's a lot that can be done
230
578172
2014
Veľa sa dá urobiť aj na strane ponuky.
09:52
on the supply side as well.
231
580186
2149
Čo sa týka ceny penicilínu,
09:54
If you look at the price of penicillin,
232
582335
1777
pacienta vyjde asi 10 centov na deň.
09:56
the cost per day is about 10 cents.
233
584112
1651
09:57
It's a fairly cheap drug.
234
585763
1758
Je to celkom lacný liek.
09:59
If you take drugs that have
been introduced since then —
been introduced since then —
235
587521
2137
Lieky uvedené na trh neskôr,
10:01
linezolid or daptomycin —
236
589658
2644
na báze linezolidu alebo daptomycínu,
10:04
those are significantly more expensive,
237
592302
1878
sú oveľa drahšie.
Pre ľudí, ktorí si zvykli,
že za antibiotiká platia 10 centov denne,
že za antibiotiká platia 10 centov denne,
10:06
so to a world that has been used to
paying 10 cents a day for antibiotics,
paying 10 cents a day for antibiotics,
238
594180
5451
je veľa čo i len pomyslieť,
10:11
the idea of paying 180 dollars per day
239
599633
2530
že by mali platiť 180 dolárov denne.
10:14
seems like a lot.
240
602163
1567
10:15
But what is that really telling us?
241
603730
1987
Čo nám tá cena naznačuje?
10:17
That price is telling us
242
605717
1965
Nemali by sme už považovať za samozrejmé,
10:19
that we should no longer
243
607682
1898
10:21
take cheap, effective
antibiotics as a given
antibiotics as a given
244
609580
4117
že aj v dohľadnej budúcnosti budeme mať
lacné a efektívne antibiotiká.
lacné a efektívne antibiotiká.
10:25
into the foreseeable future,
245
613697
1767
10:27
and that price is a signal to us
246
615464
2530
Je to tiež signál,
že by sme sa možno mali začať
viac zaoberať šetrením antibiotík
viac zaoberať šetrením antibiotík
10:29
that perhaps we need to be paying
247
617994
1609
10:31
much more attention to conservation.
248
619603
2553
10:34
That price is also a signal
249
622156
2704
a hľadaním iných riešení,
10:36
that maybe we need to start
looking at other technologies,
looking at other technologies,
250
624860
2875
podobne ako bola cena benzínu signál
a podnet pre vývoj elektrického auta.
a podnet pre vývoj elektrického auta.
10:39
in the same way that
gasoline prices are a signal
gasoline prices are a signal
251
627735
2652
10:42
and an impetus, to, say,
252
630387
2590
10:44
the development of electric cars.
253
632977
1868
Ide o dôležitý signál,
10:46
Prices are important signals
254
634845
1777
10:48
and we need to pay attention,
255
636622
1586
ktorý musíme sledovať,
ale zároveň si musíme uvedomiť,
10:50
but we also need to consider the fact that
256
638208
2452
10:52
although these high prices
seem unusual for antibiotics,
seem unusual for antibiotics,
257
640660
4252
že hoci sa nám tieto antibiotiká
môžu zdať pridrahé,
môžu zdať pridrahé,
lieky proti rakovine sú oveľa drahšie
10:56
they're nothing compared to the price per day
258
644912
2239
10:59
of some cancer drugs,
259
647151
1384
a pacientovi dokážu predĺžiť život
o pár mesiacov, či o rok.
o pár mesiacov, či o rok.
11:00
which might save a patient's life only
for a few months or perhaps a year,
for a few months or perhaps a year,
260
648535
3370
11:03
whereas antibiotics would potentially
261
651905
1770
Antibiotiká mu však môžu život zachrániť.
11:05
save a patient's life forever.
262
653675
1826
Čaká nás teda paradigmatická zmena,
11:07
So this is going to involve
263
655501
1319
11:08
a whole new paradigm shift,
264
656820
1962
ktorá môže vzbudzovať strach,
11:10
and it's also a scary shift because
265
658782
1856
11:12
in many parts of this country,
266
660638
2329
pretože pre množstvo ľudí,
či už z tejto krajiny alebo celého sveta,
11:14
in many parts of the world,
267
662967
1744
11:16
the idea of paying 200 dollars
268
664711
2069
je jednoducho nepredstaviteľné,
11:18
for a day of antibiotic treatment
269
666780
2891
že by za antibiotiká mali platiť
200 dolárov denne.
200 dolárov denne.
11:21
is simply unimaginable.
270
669671
2542
Máme sa nad čím zamyslieť.
11:24
So we need to think about that.
271
672213
1734
11:25
Now, there are backstop options,
272
673947
1813
Existujú však aj náhradné riešenia.
11:27
which is other alternative technologies
273
675760
2676
Ide o alternatívne technológie,
na ktorých sa už pracuje,
11:30
that people are working on.
274
678436
1194
11:31
It includes bacteriophages, probiotics,
275
679630
2652
napríklad bakteriofágy, probiotiká,
11:34
quorum sensing, synbiotics.
276
682282
4048
medzibunková bakteriálna komunikácia
alebo synbiotiká.
alebo synbiotiká.
Všetky sa oplatí ďalej rozvíjať
11:38
Now, all of these are useful avenues to pursue,
277
686330
3039
11:41
and they will become even more lucrative
278
689369
2610
a čím viac porastie cena antibiotík,
11:43
when the price of new
antibiotics starts going higher,
antibiotics starts going higher,
279
691979
3081
tým budú lukratívnejšie.
Vieme, že trh na takéto zmeny reaguje
11:47
and we've seen that the
market does actually respond,
market does actually respond,
280
695060
2897
11:49
and the government is now considering
281
697957
2008
a vláda začína uvažovať o tom,
11:51
ways of subsidizing new
antibiotics and development.
antibiotics and development.
282
699965
3767
ako dotovať nové antibiotiká a ich vývoj.
11:55
But there are challenges here.
283
703732
1723
Má to však háčik.
Situáciu nevyriešime len investovaním.
11:57
We don't want to just throw money at a problem.
284
705455
1575
11:59
What we want to be able to do
285
707030
1519
Musíme dokázať peniaze
do nových antibiotík investovať tak,
do nových antibiotík investovať tak,
12:00
is invest in new antibiotics
286
708549
2279
12:02
in ways that actually encourage
287
710828
2976
že podporíme ich vhodné užívanie a predaj.
12:05
appropriate use and sales of those antibiotics,
288
713804
3020
Práve to je tá výzva, ktorej čelíme.
12:08
and that really is the challenge here.
289
716824
2463
Keď už hovoríme o tých technológiách,
12:11
Now, going back to these technologies,
290
719287
2329
určite si spomínate na vetu
zo známeho filmu o dinosauroch:
zo známeho filmu o dinosauroch:
12:13
you all remember the line from that famous
291
721616
2363
12:15
dinosaur film, "Nature will find a way."
292
723979
2226
„Život si vždy nájde cestu.“
12:18
So it's not as if these are
permanent solutions.
permanent solutions.
293
726205
3319
Žiadna z nich nie je trvalé riešenie.
12:21
We really have to remember that,
whatever the technology might be,
whatever the technology might be,
294
729524
4086
Nech už vyvinieme akúkoľvek technológiu,
príroda si nájde spôsob, ako ju obísť.
12:25
that nature will find some
way to work around it.
way to work around it.
295
733610
2876
12:28
You might think, well,
this is just a problem
this is just a problem
296
736486
2071
Možno si myslíte,
že sa to týka len antibiotík a baktérií,
12:30
just with antibiotics and with bacteria,
297
738557
2744
ale ukazuje sa,
12:33
but it turns out that we
have the exact same
have the exact same
298
741301
1946
že rovnaké problémy máme aj inde.
12:35
identical problem in
many other fields as well,
many other fields as well,
299
743247
2734
V Indii a Južnej Afrike je veľký problém
s multirezistentnou tuberkulózou.
s multirezistentnou tuberkulózou.
12:37
with multidrug-resistant tuberculosis,
300
745981
2952
12:40
which is a serious problem
in India and South Africa.
in India and South Africa.
301
748933
3562
Umierajú tam tisíce pacientov,
12:44
Thousands of patients are dying because
302
752495
1787
lebo lieky druhej línie sú pridrahé.
12:46
the second-line drugs are so expensive,
303
754282
1834
12:48
and in some instances, even those don't work
304
756116
2227
Keď neúčinkujú ani tie,
máme extrémne rezistentnú tuberkulózu.
12:50
and you have XDR TB.
305
758343
2070
12:52
Viruses are becoming resistant.
306
760413
1811
Rezistenciu získavajú aj vírusy,
12:54
Agricultural pests. Malaria parasites.
307
762224
3166
poľnohospodárski škodcovia
či parazity malárie.
či parazity malárie.
12:57
Right now, much of the world depends on
308
765390
1783
V súčasnosti máme v podstate jeden liek,
12:59
one drug, artemisinin drugs,
309
767173
3697
založený na artemisiníne,
13:02
essentially to treat malaria.
310
770870
1956
ktorým sa lieči malária,
ale už sa objavili prípady rezistencie.
13:04
Resistance to artemisinin has already emerged,
311
772826
2587
13:07
and if this were to become widespread,
312
775413
2354
Ak sa bude šíriť ďalej,
v nebezpečenstve sa ocitne jediný liek,
13:09
that puts at risk
313
777767
1348
13:11
the single drug that we have to
treat malaria around the world
treat malaria around the world
314
779115
2891
ktorým dokážeme na celom svete
liečiť maláriu bezpečne a efektívne.
liečiť maláriu bezpečne a efektívne.
13:14
in a way that's currently
safe and efficacious.
safe and efficacious.
315
782006
3214
13:17
Mosquitos develop resistance.
316
785220
1798
Komáre sú už tiež rezistentné.
13:19
If you have kids, you probably
know about head lice,
know about head lice,
317
787018
2237
Ak máte deti, asi viete o všiach,
13:21
and if you're from New York City,
318
789255
1713
a ak ste z New Yorku,
13:22
I understand that the
specialty there is bedbugs.
specialty there is bedbugs.
319
790968
2733
asi poznáte problémy s plošticami.
Tieto už tiež získavajú rezistenciu.
13:25
So those are also resistant.
320
793701
2255
13:27
And we have to bring an
example from across the pond.
example from across the pond.
321
795956
2879
Uvediem aj príklad spoza veľkej mláky,
kde našli potkany rezistentné na otravu.
13:30
Turns out that rats are
also resistant to poisons.
also resistant to poisons.
322
798835
2355
13:33
Now, what's common
to all of these things is
to all of these things is
323
801190
2701
Tieto technológie na kontrolu prírody
majú jedno spoločné.
majú jedno spoločné.
13:35
the idea that we've had these technologies
324
803891
2706
13:38
to control nature only for
the last 70, 80 or 100 years
the last 70, 80 or 100 years
325
806597
4621
Poznáme ich asi tak 70, 80 až 100 rokov,
ale v mihu oka sme o kontrolu prišli,
13:43
and essentially in a blink,
326
811218
3028
13:46
we have squandered our ability to control,
327
814246
2551
lebo sme si neuvedomili,
13:48
because we have not recognized
328
816797
2491
že prirodzený výber a evolúcia
nájdu spôsob,
nájdu spôsob,
13:51
that natural selection and
evolution was going to find
evolution was going to find
329
819288
2812
ako nás dobehnúť.
13:54
a way to get back,
330
822100
1174
13:55
and we need to completely rethink
331
823274
2049
Musíme preto úplne prehodnotiť,
13:57
how we're going to use
332
825323
2343
ako budeme využívať opatrenia
na kontrolu biologických organizmov,
na kontrolu biologických organizmov,
13:59
measures to control biological organisms,
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14:02
and rethink how we incentivize
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ako budeme stimulovať vývoj,
uvedenie na trh –
uvedenie na trh –
14:06
the development, introduction,
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a v prípade antibiotík aj predpisovanie –
14:08
in the case of antibiotics prescription,
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14:11
and use of these valuable resources.
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a užívanie týchto vzácnych zdrojov.
14:14
And we really now need to
start thinking about them
start thinking about them
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Naozaj by sme o nich mali začať uvažovať
14:17
as natural resources.
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ako o prírodných zdrojoch.
14:19
And so we stand at a crossroads.
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Stojíme teda na križovatke.
Jedna možnosť je prehodnotiť situáciu
14:21
An option is to go through that rethinking
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a dôkladne sa zamyslieť nad podnetmi,
14:24
and carefully consider incentives
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ktoré nám naznačujú, že má dôjsť k zmene.
14:26
to change how we do business.
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Alternatívnou je svet,
14:28
The alternative is
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14:31
a world in which even a blade of grass
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kde sa dokonca aj obyčajné steblo trávy
môže zmeniť na smrtiacu zbraň.
môže zmeniť na smrtiacu zbraň.
14:34
is a potentially lethal weapon.
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Ďakujem.
14:36
Thank you.
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(potlesk)
14:38
(Applause)
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ABOUT THE SPEAKER
Ramanan Laxminarayan - Drug-resistance economistAt the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health.
Why you should listen
Economist Ramanan Laxminarayan works to improve understanding of drug resistance as a problem of managing a shared global resource. As Director and Senior Fellow at the Center for Disease Dynamics, Economics & Policy (CDDEP), he is interested in cross-disciplinary, pragmatic solutions to reduce drug resistance. He has advised the World Health Organization and World Bank on evaluating malaria treatment policy, vaccination strategies, the economic burden of tuberculosis, and control of non-communicable diseases. He was a key architect of the Affordable Medicines Facility for malaria, a novel financing mechanism to improve access and delay resistance to antimalarial drugs. In 2012, he created the Immunization Technical Support Unit in India, which has been credited with improving the immunization program in the country. He teaches at Princeton.
As he says: "It has been a long time since people died of untreatable bacterial infections, and the prospect of returning to that world is worrying."Ramanan Laxminarayan | Speaker | TED.com