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.
HOSPITAL
OFFICE
SCHOOL
Games
of Life
HOME
My Own Game-Theory Journey
My Own Game-Theory Journey
Public policy:
alcohol abuse
Business:
mobile payments
Foreign policy:
Somali pirates
My Own Game-Theory Journey
New York Times op-ed
October 2013: Debt-ceiling crisis
“Changing the
debt-ceiling game”
My Own Game-Theory Journey
Sorensen Public Policy Lecture at U. Nebraska Lincoln
October 2014: Out-of-control western
corn rootworm
“ The future of
pest-resistant crops”
My Own Game-Theory Journey
New York Times op-ed
January 2015: Terrorist kidnappers
“ Turning the tables
on terrorist kidnappers”
My Own Game-Theory Journey
X
X
X
Debt-ceiling crisis
Pest-resistant crops
Terrorist kidnappers
Antibiotic Resistance
Much Help Along the Way
• 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
We are poised to achieve
complete and lasting victory
over antibiotic resistance.
Together, We Can Change the Game
#1 – As Consumers
#2 – As Patients
#3 – As Citizens/Taxpayers
STOP INAPPROPRIATE
ANTIBIOTIC USE IN
LIVESTOCK
STOP INAPPROPRIATE
ANTIBIOTIC USE IN
OURSELVES
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
“A Post-Antibiotic Future”
“Things as common as
strep throat or a child’s
scratched knee could
once again kill.”
Dr. Margaret Chan
Director-General
Leading Causes of Death
1900
2012
1. Pneumonia and influenza
1. Heart disease
2. Tuberculosis
2. Malignant neoplasms [cancer]
3. Diarrhea and enteritis
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 – DISCOVER
BETTER DIAGNOSTICS
#2 – REVERSE RISE
OF RESISTANCE
1928: Accidental Discovery of Antibiotics
Resistance Starts in the Soil
Scientific article in Science
January 2006: Soil-dwelling bacteria
“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
EASILY
TREATABLE
DISEASE
JUMPS TO PIGS
MRSA CC398: Human  Pig  Human
EASILY
TREATABLE
DISEASE
JUMPS TO PIGS
ACQUIRES
RESISTANCE
MRSA CC398: Human  Pig  Human
EASILY
TREATABLE
DISEASE
SUPERBUG
JUMPS TO PIGS
RE-INFECTS
PEOPLE
ACQUIRES
RESISTANCE
MRSA in Pigs: Threat to Human Health
5%
3%
of grocery carts sampled
in Iowa City had MRSA
bacteria on them
of all meat harbored
MRSA as well
MRSA in Pigs: Threat to Human Health
5%
0%
of grocery carts sampled
in Iowa City had MRSA
bacteria on them
of “antibiotic-free” meat
had MRSA
Game-Changer – ANTIBIOTIC-FREE MEAT
What if Resistance Escapes the Farm?
S S
S
S
S
R
S
S
R
S
R
= resistant bacteria
S
= susceptible bacteria
What if Resistance Escapes the Farm?
S R
R
S
S
R
S
S
R
S
R
= resistant bacteria
S
= susceptible bacteria
Our Bodies are a Battlefield
S R
R
S
R
S
Susceptible bacteria are a
natural “ally” in fight
against resistance!!
Our Bodies are a Battlefield
S R
S R
S S
R
S
S
S
Patient #1
S
Patient #2
S
Patient #3
Our Bodies are a Battlefield
S R
R
R
S
Antibiotic
Treatment
Patient #1
Patient #2
Our Bodies are a Battlefield
S R
R R
R R
R
R
R
S
Patient #1
R
Patient #2
R
Patient #3
Game-Changer – JUDICIOUS ANTIBIOTICS USE
What If We Could Diagnose Resistance?
S
S R
R
Standard
Treatment
S
R
Strategies
to Disrupt
Transmission
What If We Could Diagnose Resistance?
S
S R
R
Standard
Treatment
S
Strategies
to Disrupt
Transmission
Game-Changer – NEW DIAGNOSTIC TOOLS
Takes DAYS
Takes ONE HOUR
We’ve Mapped the “Resistome” …
Visualization of the
Antibiotic Resistome
Takes ONE HOUR
… Now Poised to Transform Medicine!!
Visualization of the
Antibiotic Resistome
Takes ONE HOUR
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.