Couple turns to viruses to beat back superbug | Hacker News Reader

Couple turns to viruses to beat back superbug

cbc.ca

85 pointsrhschan41 comments

Phage therapy is often effective and very promising, but it's specific to each infection, labor intensive, and basically impossible to scale up or patent to mass produce like an antibiotic is (perhaps why it hasn't caught on).

https://en.wikipedia.org/wiki/Phage_therapy

Most of the ongoing active use and research is in Poland

https://www.iitd.pan.wroc.pl/en/OTF/

It can scale in distributed fashion. The labor is fine. People working to save people is a completely valid labor, important, meaningful, possible.

It's not like we don't have any free human time. Lots of people need work.

Packaging this into a repeatable, portable process seems worthwhile.

The search for better super antibiotics can continue. If we get lucky, great.

I read there is a group in Poland who will match a phage to an infection in a few days. They need a sample.

Scale that. The world needs it.

> basically impossible to scale up or patent to mass produce like an antibiotic is (perhaps why it hasn't caught on).

I think they mean that the profit motive of pharma giants is an important part of promoting new treatments.

There wouldn't any profit for pharma giants. You can't patent bacteriophage, they're the commonest life form on Earth (if you consider viruses to be a life form), they're extracted from unwanted waste (raw sewage) and they reproduce themselves in bacterial cultures.

This is why their use continued in the Soviet Union when they fell out of favour in the West. Profits don't matter under communism.

The other angle is that regulations (FDA etc) probably make it impossible to legally offer any treatment that doesn't have at least $1B behind it.

Of course they do, and it's just fine.

I'm saying there is sustainable, practical work there. Money to be made. Probably a solid living for lots of people.

If I were in a different place, I would consider it.

It requires very specific skilled labor, but it is a great idea if you can find a way to scale it. There is certainly the demand.

If you have the interest and passion, then come up with a reasonable business plan, find a partner who knows biology/chemistry/medicine very well, and apply to YCombinator? They have the interest.

https://www.ycombinator.com/rfs/#biotech

https://www.ycombinator.com/biotech/

https://www.ycombinator.com/rfs/#healthcare

https://www.ycombinator.com/rfs/#pharmaceuticals

Phage therapy is also relatively common in Russia.

http://www.nature.com/news/phage-therapy-gets-revitalized-1....

Therapeutic bacteriophages were mass-produced in Tbilisi, Georgia, before the collapse of the Soviet Union: http://thelancet.com/journals/lancet/article/PIIS0140-6736(0...

Phage therapy still goes on there https://www.phagetherapycenter.com

Somewhat shocking there is not a clinic for this in the USA, isn't it?

It's great having friends in the right places. Why in these stories is the patient always a researcher or married to a researcher in the field? People die of infections like this every day in every hospital. If i demand of my dieing grandmother's doctor "phone the CDC and let's try some phages" i'd be laughed out of the room. One is left with the distinct impression that, end of life or not, those in the club are provided extreem options the rest of us are not. (See many of the ebola stories.) They may be totally experimental but facing the end most would take experimental over nothing.

Concierge medicine, VIP wards, liquid biopsies with annuals, transplant priority, there are many examples where resources or connections grant access to the upper tier of the medical system.

Thats a little different. That is money, and rarely generates miracle cure stories. This is more of the medical club where doctors and nurses rapidly recieve treatments not availible to outsiders at any price. Im reminded of a heroic effort to save a single local house from a forest fire, water bombers and everything for an empty property in the woods. It was an ex-firechief's vacation/retirement home. Some special treatment cannot be bought.

> Why in these stories is the patient always a researcher or married to a researcher in the field?

Because, usually, listening to a patient's great ideas is a waste of time. This of course is not the case, when the patient has provable knowledge that the doctors have to admit might surpass their own knowledge.

> [treatments] be totally experimental but facing the end most would take experimental over nothing.

Sure, except for that the relatives might sue a doctor after a patient's death. In court you have a much stronger position when the patient obviously had the knowledge to really understand the risks of some treatment.

Last but not least: Experimental therapies are much, much more expensive than standardized ones. You basically have to check all parameters permanently while with standardized therapies you just follow a protocol that dictates what to look out for.

You do not really understand what "experimental treatment" means without doing medical research. In general, it means it is extremely more likely to acutely hurt more than it helps you. I mean like million to one odds.

But for some reason doctors and researchers are viewed as understanding that better than the public. But they're still happy to tell a wife that they might want to call a priest for her husband in a comma...

>"for some reason doctors and researchers are viewed as understanding that better than the public"

Because they have no excuse, a jury would agree they should've known better.

Things might be considerably different if people weren't so litigious when these thing go the wrong way. I can understand doctors being extremely hesitant to suggest experimental therapy if it means they might be bankrupted and unable to work.

"But for some reason doctors and researchers are viewed as understanding that better than the public."

Wait: you're arguing that doctors and researchers don't understand the risks of experimental treatments better than the general public?

Why would you think that?

Do you have a reference for the 1 million number?

No, in my estimation I was being conservative and it is probably much higher though.

Edit: It is much easier to break things you don't understand than fix them.

I think you are overestimating how good conventional medical treatment is. Things like phage treatment are far more likely to help than harm. The reasons they don't happen are much closer to too much hassle, don't have time to bother.

I never made a comparison to conventional (ie, non-experimental) treatments. One thing the FDA does do ok is filter out things that cause lots of acute harm.

I found the original article that the CBC writer based this story on more interesting and entertaining. I submitted it on HN a couple days ago: http://www.sandiegouniontribune.com/news/health/sd-me-bacter...

jfc that site is laden with shitware for your browser

> Bacteriophages were once used as a treatment in the U.S. and Europe, but when penicillin came to the market in the 1950s, their use was largely abandoned outside of Russia and Poland.

I wonder what insights into safety of those therapies doctors in Russia and Poland have to offer.

I believe the general problem with bacterial viruses, is that our body mounts a immune response against them.[1] It works okay for a little bit, but because our immune system "learns" (e.g. clonal selection) the second time they are used they aren't usually effective.

I've read that they kept being used in Russia because Russia didn't have the industrial capacity for antibiotic production & refinement. It would be interesting to know if the Russian/Polish medical communities learned anything novel about bacterial viruses though.

[1] Our immune system doesn't know that they're harmless, and the tricks that some viruses use to avoid are immune system are typically harmful to us, so you wouldn't want to use those ones.

After some research: according to Wikipedia [1] there only place in EU that is researching the phage therapy is a Polish institute of experimental medicine [2]. They offer paid therapies for patients at least 6 years old. Both pages in Polish, use Google Translate to read.

[1] https://pl.wikipedia.org/wiki/Terapia_fagowa [2] http://www.iitd.pan.wroc.pl/pl/OTF/

The Soviet Union, not just Russia.

I enquired a bit for a friend. There seems almost no danger of the phages adversely affecting humans. The bigger danger is probably that they can't find a phage that works and you get ill when other treatments may have worked better. I was enquiring for a friend who has a drug resistant urinary tract infection. You can fedex a urine sample to Tbilisi and for $200 they'll check if they have phages for the bacteria.

The enemy of my enemy is my enemy's enemy -- no more and no less. That fact is gravely important to remember and often forgotten to great detriment.

It kind of sounds like you have a very specific context in mind when you say this. Mind explaining?

Not at all. What I mean to imply is that simply because someone or something aids one in the fight against another doesn't mean that that particular someone or something is friendly towards one. At best, one can infer that, at least for the moment, one isn't that person or thing's most valuable target at the time of aid. It might be a cynical way of looking at things but it helps to distinguish between that which is actually your friend, knowingly sacrificing something of itself for one, and your temporary and unwitting ally ready to turn on one the moment the, by chance or strategy, existing target is eliminated.

To elaborate, the situation described in the article is a case report. In this case, the gamble paid off and the man was cured. However, we rarely hear about the cases in which this gamble was lost and the experimental treatment did not result in a successful return to health. It's human to want to belong and to have others come to our aid. Sadly, it's also human to be thanking the cat for killing mice one day and then cursing it for eating our goldfish the next.

Right. But that's implied by the fact that the phrase exists.

given that the expertise to manufacture and program viruses has matured quite rapidly over the past decade, i think we may look at them not as an "enemy" but more of a tool, i.e. a cellular syringe to be manipulated at will. Why most ppl in that field call them "vectors" these days.

This feels like an episode of House MD.

Phages are being used in Russia. Right now two types of phages are sitting in my fridge.

Can you expand on how they are being used? I'd love to know.

Doctors routinely prescribe phages when they think that antibiotics would be an overkill or if they don't want any side effects from antibiotics.

Here is the list of phages that are sold in Russian pharmacies: https://imgur.com/a/vkEJo

Reply on news.ycombinator.com