Infectious diseases is a complicated and literally evolving subject, yet if we listen to the top infection doctor, maybe we can make it simple and contribute to a better future. With this in mind, here is an interview with one of the leading infectious diseases physicians, Dr. Brad Spellberg.
Interview With: Brad Spellberg, M.D., FIDSA, FACP
Interview By: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID
As it has been throughout history, today the world faces a variety of serious public health threats from the field of infectious diseases. Even amidst the wonders of the modern technological and antibiotics age, we still face considerable threats. There is Zika Virus, Ebola virus, drug-resistant tuberculosis, multi-drug resistant Gram negative or Gram positive bacteria and so much more. With all of the infectious diseases out there, which is the worst and what can we actually do to address the issues?
Well, perhaps we all do not need to ponder such questions. Perhaps we can leave the heavy lifting up to those who have dedicated their existence on this planet to contemplating the nature of infectious pathogens. After all, if you are looking for advice, don’t you want it from those qualified to administer it?
With this mentality in mind, the following interview is provided with Dr. Brad Spellberg. He is an infection doctor (i.e., infectious diseases physician) who has had a profound impact upon the world through his significant work in infectious diseases. He is a thought leader and someone who is worth taking the time to listen to (see bio below).
It is my hope that readers find this text useful as they shape their opinions about appropriate and safe antibiotic use.
1. What motivated you to become an infectious diseases physician?
I’ve been fascinated by the immune system since I took AP Biology in High School. That interest only grew as an undergrad and I majored in Immunology at UC Berkeley. The fascinating thing about the immune system to me was always the war between human cells and microbial invaders. Clinically, that translates to ID. And of course, the cognitive aspects of the specialty, the fact that it considers all organ systems, the fact that we have the best cure rates for our target diseases of any of the medicine specialties, and the fact that the specialty has public health and policy ramifications are all attractive features as well.
2. You were featured in the Netflix movie “Resistance The Film.” What prompted you to participate in that activity and is there a key point or two you hope to disseminate through this endeavor?
Resistance actually aired in theaters for a while before moving to Netflix. I published a book, Rising Plague, in 2009. The book was intended to make the public aware of the rising crisis of antibiotic resistance.
The producers of Resistance read the book and reached out to me to see if I would be willing to be filmed. The producers were high quality people with very good intentions, and they offered a vehicle to reach more of the general public, so I was glad to participate.
Generally, the messages that I want to get across are that we are running out of antibiotics, we are not developing new ones properly any longer, we do not protect the ones we have well at all, and people need to stop abusing and misusing these life-saving drugs.
Finally, antibiotics are a public trust—we all share in their benefit, and it isn’t acceptable for us to waste them, because when we do, we hurt everyone else in society.
3. Working with the Infectious Diseases Society of America, you published a paper “bad bugs, no drugs” in 2009. Do you feel this problem is much different today than it was then?
Yes, the problem is somewhat different.
There actually has been a surge in the antibiotic pipeline. In 2004 the pipeline was on life support. That is no longer true, in no small part thanks to the efforts of many people to raise awareness of the problem.
The problem now is that the pipeline is being filled with drugs we do not need by small companies that are funded by venture capitalists who neither understand nor care what the unmet need is. They are looking for low risk, high payoff molecules, so they flood the market with [methicillin-resistant Staphylococcus aureus] MRSA skin drugs even though we need no more of those.
The way we pay for discovery, development, and use of antibiotics makes no sense from a public health perspective. Many people are now talking about “de-linking” use of antibiotics from how we pay for them. There are a variety of sophisticated ideas out there about how to do this. Frankly, in my opinion, we should simply adopt a defense contractor model for antibiotic discovery and development, so the public has a say in which ones get developed and in how the drugs get used post-marketing, to reduce abuse, and also set up non-profits whose mission is to discover and develop new antibiotics we need rather than ones VC firms think they can make a ton of money off of at low risk.
4. You have published articles on antibiotic duration, challenges in antibiotic development and other important infectious diseases topics. Are there two or three key messages that you feel are game changers we need to share with other healthcare professionals in 2017?
The core principle has not been well understood, so I’ll emphasize it again. Antibiotics are a shared societal trust. When I use them, it affects your ability to have effective ones to use. When you use them, it affects my future grandchildren’s ability to use them.
This sets antibiotics apart from all other drugs, and virtually all other technologies. There are major policy implications of this reality that have been ignored.
From the perspective of healthcare professionals, the point is, it is not okay to abuse these drugs. It is not okay to prescribe them to make ourselves feel better. Antibiotic misuse is driven by fear of being wrong about what our patients have. Driven by that fear, we prescribe these drugs to make ourselves feel better even when we know they are not indicated or appropriate. I have been quoted before as saying that antibiotics are among the most potent psychoactive drugs in all the pharmacopoeia. They are incredibly potent anxiolytics. They just act on the prescriber rather than the patient.
We need to recognize this about ourselves, and not prescribe them when we should not. When we do prescribe them, we should use proven short-course regimens for infections where this has been studied. There are specific implementation science (e.g., “gentle nudge approach” of public commitment, and audit and feedback) and policy (e.g., public reporting of usage, linking reimbursement to decreasing usage) that would work to help providers behave better. We are a ways off to getting those done, but hopefully in the coming few years we’ll get better at it.
5. What do you think the future of infectious diseases looks like and what can we do to prepare to #SaveAntibiotics?
If you take the long view, we will be having these same discussions decades and centuries from now.
Bacteria will never stop adapting to what we throw at them. There is no “end game.” Providers can help by only prescribing antibiotics when a bacterial infection is proven or likely, by using short-course regimens, by not telling our patients to keep taking the drugs even after they feel much better (that is an urban legend based on no science or reality), and by supporting policy changes that hold society accountable for reducing the amount of antibiotics we use in both humans and agriculture.
I would like to express my utmost appreciation to infection doctor, Dr. Spellberg for taking the time out of his busy schedule to complete this interview.
ABOUT THE INTERVIEWEE
Brad Spellberg, MD FIDSA FACP
Dr. Spellberg is Chief Medical Officer at the Los Angeles County-University of Southern California (LAC+USC) Medical Center. He is also a Professor of Clinical Medicine and Associate Dean for Clinical Affairs at the Keck School of Medicine at USC. He received his BA in Molecular Cell Biology-Immunology from UC Berkeley. He then attended medical school at UCLA, where he received numerous academic honors, including serving as the UCLA AOA Chapter Co-President, and winning the prestigious Stafford Warren award for the topic academic performance in his graduating class. Dr. Spellberg completed his Residency in Internal Medicine and subspecialty fellowship in Infectious Diseases at Harbor-UCLA Medical Center.
Dr. Spellberg has extensive administrative, patient care, and teaching activities. His NIH-funded research interests are diverse, ranging from basic immunology and vaccinology, to pure clinical and outcomes research, to process improvement work related to delivery of care, focusing on safety net hospitals. His laboratory research has focused on developing a vaccine that targets the bacterium Staphylococcus aureus and the fungus Candida; the vaccine is undergoing clinical development. Dr. Spellberg is currently working on the immunology, vaccinology, and host defense against highly resistant Gram negative bacilli, including Acinetobacter and carbapenem-resistant Enterobacteriaceae infections.
Dr. Spellberg has worked extensively with the Infectious Diseases Society of America (IDSA) to attempt to bring attention to the problems of increasing drug resistance and decreasing new antibiotics. His research regarding new drug development was a cornerstone of the IDSA’s white paper, Bad Bugs, No Drugs, and has been cited extensively in medical literature and on Capitol Hill. As a member and then co-chair of the IDSA’s Antimicrobial Availability Task Force (AATF), he first-authored numerous IDSA position papers and review articles relating to public policy of antibiotic resistance and antibiotic development. Finally, Dr. Spellberg is the author of Rising Plague, which he wrote to inform and educate the public about the crisis in antibiotic resistant infections and lack of antibiotic development.
[Last updated, 12-26-2016]
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