Sarah Elizabeth Richards

Then Dudley learned the detail that made his heart sink: The cause was bacterial sepsisa condition resulting from the bodys response to the chemicals it produces when fighting an infectionafter a staph infection had invaded his body.

Although Dudley, a San Diego Pharm.D. and infectious-disease specialist, knew all about out-of-control infections that could kill even healthy patients, his brother-in-laws death was a stark reminder that they can turn so deadly so fast, overwhelming the antibiotics we have to try to stop them.

Like so many experts in his field, Dudley has been living with a quiet anxiety about what could happen if the drugs we depend on to treat everything from pneumonia to gonorrhea to urinary-tract infections someday stopped working. Hes spent the past 14 years racing to develop new antibiotics at a time when microbes are mutating faster than ever to evade or resist the drugs we use to kill them.

This problem of antibiotic resistance is already bigger than anyone thought. Last November, the Centers for Disease Control and Prevention released a disturbing report: More than 2.8 million antibiotic-resistant infections occur in the United States each year, it said, and kill more than 35,000 people.

New drugs could help reverse the trend. Yet the industry that could save us from this threat is desperately broken. Big Pharma has abandoned the highly unprofitable antibiotic business in favor of more revenue-generating drugs for chronic diseases. That leaves a handful of smaller start-ups, like the company run by Dudley, Qpex, struggling to find investor funding, persuade hospitals to adopt the new discoveries, and get insurers to pay for them at a moment when the stakes couldnt be higher. Last year, the biopharmaceutical company Achaogen filed for bankruptcyless than a year after it had won FDA approval for a new antibiotic. Now the question is: Which will evolve and strengthen faster, the health-care system or the bugs?

Scientists have been sounding the alarm that antibiotics might fail us since 1947, when they first documented that certain bugs were resistant to penicillin. That was less than 20 years after British bacteriologist Alexander Fleming accidentally discovered the original antibiotic, in 1928. Before that, surgical wounds and pneumonia could easily turn lethal.

Sir Alexander Fleming accidentally discovered the first antibiotic. From his laboratory at the Wright Fleming Institute in London in 1955, could he have envisioned the antibiotic landscape today?

Its a natural part of evolution that infection-causing bacteria mutate to resist the effects of the antibiotics designed to eradicate them. That means the drugs inevitably become ineffective over time, but weve sped up that process by overusing them. By doing this with drug after drug, weve created superbugs that can be invulnerable to any antibiotic on the market.

The warnings about antibiotic resistance went largely ignored, the thinking in the 50s being that if penicillin stopped working, pharmaceutical companies were making enough other drugs that could just be swapped in instead.

Theres also chatter among health-policy experts about overhauling the way these drug companies are compensated. In whats called market entry reward, the government would pay companies based on how valuable their drugs are to society rather than how well they sell. Last year, the United Kingdom announced a five-year plan to try out such a model.

Former FDA head Scott Gottlieb, M.D., also suggested a model that would allow hospitals to pay a flat fee for a certain number of doses to create more financial incentives for companies to churn out more antibiotics. And in 2019, senators Johnny Isakson (a Georgia Republican) and Bob Casey (a Pennsylvania Democrat) introduced legislation that would make it easier for Medicare to pay for pricier antibiotics and send a signal to hospitals about their importance.

The latest crop of antibiotics in development wont come to market for several years. In the meantime, scientists are using next-generation genetic-sequencing tools to create a test that could identify a bacterial infection within hours instead of days, so doctors would know sooner which drugs might work best.

Many red and transparent medical capsules, filled with

How many more deaths do we have to witness until then? As a society, were willing to pay hundreds of thousands of dollars for new gene therapies or the latest cancer treatments, says Dudley. But this is one of the biggest threats to human health right now. If we dont have effective antibiotics, any infection could turn deadly, the way it did for my brother-in-law.

<h1> What You Can Do to Prevent Superbugs </h1>

The Fatally Slow Quest for Next-Gen Antibiotics

IN JANUARY 2019, Mike Dudley got a call that his 69-year-old brother-in-law had died a mere 48 hours after checking into the hospital with flulike symptoms. He couldnt believe what he was hearing. Just five months earlier, theyd been backpacking together in Californias Ansel Adams Wilderness and Yosemite National Park. The news didnt make any sense.

And in plenty of cases, you cant keep a bad doc down. In a recent yearlong investigation, the Milwaukee Journal Sentinel and MedPage Today found that between 2011 and 2016 at least 500 disciplined doctors were practicing with a clean license in a new state.

<h1> How Bad Docs Keep Their Licenses </h1>

Theres a system in place designed to prevent that, but it doesnt always work. Lisa Robin, chief advocacy officer of the Federation of State Medical Boards (FSMB), says the organization runs a centralized database that alerts other state medical boards if one of their doctors had been disciplined in another state. The Disciplinary Alert Service was put in place specifically to prevent someone who had an issue in one state to move undetected to another state, she says.

Sometimes it actually is effective: Data from 2017 show that 1,866 physicians were disciplined for the first time and that 1,339 reciprocal actions were taken by state boards. But the Sentinel and MedPage investigation charges that doctors can still slip through the cracks or take advantage of reporting loopholes. It also charges that some state boards dont bother to check the National Practitioner Data Bank, which is off limits to the public, when issuing new licenses.

Other docs never get censured in the first place. Part of the problem is the reluctance of colleagues to report negligence or incompetency, says patient safety expert Robert Wachter, M.D. of the University of California San Francisco and author of <a href="https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/1260019608" id="13d4fcc5-5176-3fea-a6c2-d228b559a76d"> The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicines Computer Age </a> . People in the profession protect their own. If you decide to blow the whistle, you can spend the next year in a protracted legal battle, which makes people wish they hadnt done it, he says.

<h1> So how can you protect yourself from a bad doctor? </h1>

Check this database

Robin says consumers can enter their doctors names into FSMBs database, <a href="https://docinfo.org/#!/search/query" id="668f15d5-4fb9-3e2c-a0dd-5ccb9a826d31"> docinfo.org </a> . It will tell you where they are licensed and whether theyve been subject to disciplinary actions. But it's not one-stop researching. If they have a disciplinary action, it will refer you to the respective state medical board website for details on the infraction.

Look up your docs bio

Dr. Wachter recommends checking these things: Do they have admitting privileges at a respected hospital? Do they publish and have developed an area of expertise? Are they board-certified in a specialty? Although standards vary widely among fields, the board-certified designation means they have passed exams and peer review and are expected to keep up with the latest drugs and developments in their field.

Know what reviews can and cant do

Online reviews seem like a good idea, yet how much can you really tell about a doctor with six 4-star ratings and one comment along the lines of My doc is the BEST! on WebMD, Healthgrades, Facebook or Yelp?

Some companies are attempting to make reviews more relevant to consumers. Four years ago, Jake and Deborah Andersons $70,000 three-clinic, two-state journey through the world of fertility clinics inspired them to create the educational resource FertilityIQ, which now has 25,000 patient reviews. If youre looking on Yelp to get a sandwich, you can afford to get it wrong. But in the case of healthcare where lives and budgets are on the line, the margin for error is razor-thin, says Jake Anderson. Reviewers are asked to answer 100 questions and must show proof theyre real patients to prevent sandbagging competitors. He says the best reviews are substantive, specific to your condition and balanced. No doctor is perfect, so you want to hear about their strengths and weaknesses, he says.

<a href="https://www.realself.com/" id="2cae04c0-fabd-3750-a171-3dc6a4d0e510"> RealSelf </a> , the plastic surgery review site with more than 300,000 patient reviews, now gives pointers to patients on how to leave better reviews. Were trying to take reviews to a new level and teach people how to be expert review writers, says Jani Strand, RealSelfs chief brand and communications officer. We want to know exactly why a doctor was good.

Even if your doc is legally in the clear and maybe even comes recommended by people you know, it doesnt mean theyre the doc for you. I know doctors who are technically superb but are jerks. I know others who are lovely people but who dont have great diagnostic skills, says Dr. Wachter. I also know many doctors who are technically good, smart and nice people. You should look for a physician who is all of those things.

How Dangerous Doctors Keep Their Licenses

Removing the wrong kidney. Paying people to pose as patients so docs can illegally dispense pain meds. Performing plastic surgery without a license. The headlines are littered with bad doctor stories. Drug scams, sexual misconduct, drug abuse-you name it. In 2017, the nations 70 state medical boards collectively put 711 of the nations licensed doctors on probation, issued 796 suspensions, and revoked 264 licenses.

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Sarah Elizabeth Richards

Articles written by the author

The Fatally Slow Quest for Next-Gen Antibiotics

How Dangerous Doctors Keep Their Licenses