Matt McCarthy (@drmattmccarthy) is an assistant professor of medicine at Weill Cornell, a staff physician at New York-Presbyterian Hospital, and the author of Superbugs: The Race to Stop an Epidemic.
What We Discuss with Matt McCarthy:
- How antibiotics are abused on a large scale by industrial agriculture, prescription-happy doctors, and mysophobic hand washers.
- Why antibiotic abuse is resulting in the fast-track evolution of once easily vanquished bacteria into superbugs from which we have no known protection.
- How herd immunity works, and why you may be at risk for contracting a once-eradicated disease thanks to anti-vaccination propaganda.
- Why the FDA approval process takes so long for new drugs to safely come to market, and how this hinders innovation in a profit-driven pharmaceutical market.
- How genetic editing through new CRISPR technology may be our best hope for quickly reacting to rapidly adapting superbugs.
- And much more…
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With anti-vaccination lunacy running rampant and major metropolitan areas experiencing an ever-increasing homeless problem that squeezes society’s most destitute into close quarters, the climate is ripe for the return of diseases that were all but eradicated decades ago. But if measles, mumps, tuberculosis, scarlet fever, and bubonic plague on a comeback tour aren’t enough to scare you, here’s something else you can worry about instead: death from antibiotic-resistant strains of bacteria.
In this episode we speak with infectious disease specialist and Superbugs: The Race to Stop an Epidemic author Dr. Matt McCarthy about how superbugs adapt to the overuse of antibiotics, what makes this a recipe for disaster, and why we’re seemingly just sitting here with our hands in our pockets waiting to be wiped out by a plague of our own creation. Listen, learn, and enjoy!
Please Scroll Down for Featured Resources and Transcript!
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Resources from This Episode:
- Superbugs: The Race to Stop an Epidemic by Matt McCarthy
- Matt McCarthy’s Website
- Matt McCarthy at Twitter
- Citrus Farmers Facing Deadly Bacteria Turn to Antibiotics, Alarming Health Officials by Andrew Jacobs, The New York Times
- Core Elements of Hospital Antibiotic Stewardship Programs, CDC
- Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection Symptoms and Causes, The Mayo Clinic
- Five Old-Time Diseases That Are Making a Comeback by Michael Gollust, Health
- Herd Immunity, The History of Vaccines
- Seven Ways to Talk to Anti-Vaxxers (That Might Actually Change Their Minds) by Vanessa Milne, Timothy Caulfield, and Joshua Tepper
- How to Scientifically Dismantle the Four Main Anti-Vaccine Arguments by Adelaida Sarukhan, Barcelona Institute for Global Health
- Vaccine Myths Debunked, Public Health
- Point of View: Why Vaccine Opponents Think They Know More than Medical Experts by Timothy Callaghan, Matthew Motta, and Steven Sylvester, Texas A&M University Health Science Center
- Laws That Criminalize Spread of Infectious Diseases Can Increase Their Stigma by Michelle Andrews, NPR
- The Real Story Behind Penicillin by Dr. Howard Markel
- Dirt Yields Potent Antibiotics: Soil Microbes Make Compounds That Kill Resistant Pathogens, Nature Microbiology
- The Difference Between Latent TB Infection and TB Disease, CDC
- Superbugs Could Kill 10 Million Each Year By 2050, Overtaking Cancer, IFL Science
- Judge Dismisses Johnson & Johnson’s Request to Toss out Lawsuit over Opioids Crisis by Chris McGreal, The Guardian
- How Long Can I Take an Antibiotic to Treat My Acne? American Academy of Dermatology
- Ancient Nubians Made Antibiotic Beer by Jess McNally, Wired
- Colloidal Silver: Is It Safe? The Mayo Clinic
- What is the Institutional Review Board (IRB)? Oregon State University
- Naveen Jain | How Moonshot Thinking Will Save the World, TJHS 184
- Using CRISPR to Fight Antibiotic-Resistant ‘Superbugs’ by Kristen Hovet, Genetic Literacy Project
- Antibiotics Biotech Firms Are Struggling, The Economist
- FDA Orders Recall of New Antibiotic Drug by Paul Recer, AP News
- After 60 Years, Scientists Uncover How Thalidomide Produced Birth Defects, Dana-Farber Cancer Institute
- Unapproved Prescription Drugs: Drugs Marketed in the United States That Do Not Have Required FDA Approval, FDA
- Why the FDA Does Not Approve Supplements by David A. Kessler, Quackwatch
- The Elixir Tragedy, 1937 by Jef Akst, The Scientist
- Q&A with Thomas Walsh, MD: Treating Immunocompromised Patients with Invasive Infections by Jason Hoffman, Cancer Therapy Advisor
- Why Is the World Suffering from a Penicillin Shortage? by Keila Guimaraes, Al Jazeera
- Tracing Paul Farmer’s Influence by David Vine, American University
- Using Anthrax as a Weapon by Nick Caistor, BBC News Online via UCLA
- Thawing Siberian Permafrost Soil Risks Rise of Anthrax and Prehistoric Diseases by Alec Luhn, The Telegraph
- Christopher Columbus Brought a Host of Terrible New Diseases to the New World by Julia Calderone, Business Insider
- The Official Site of Michael Crichton
- Sounding Off: Dr. Drew on How L.A.’s Homeless Problem Is a Public Health Emergency by Alexandra Ward, Contagion
- Nipah Virus Infection, WHO
- Influenza (Avian and Other Zoonotic), WHO
- Howie Mandel | A Conversation About Mental Health, Talent, and Perseverance, TJHS 210
Transcript for Matt McCarthy | The Race to Stop a Superbug Epidemic (Episode 222)
Jordan Harbinger: [00:00:03] Welcome to the show. I'm Jordan Harbinger. As always, I'm here with producer Jason DeFillippo. With all the news lately about the homeless problem in Los Angeles and vaccination drama here in California, bringing back diseases we thought we'd gotten rid of for decades, I thought it was high time we started talking about something more cheerful and upbeat, namely dying of something even more horrible antibiotic-resistant strains of bacteria. You may have heard that overuse of antibiotics has been creating resistant organisms, are superbugs, but what you might not know is that we're actually not developing new weapons in this battle against nasty bacteria. Today, we'll speak with Dr. Matt McCarthy. He's a staff physician at New York-Presbyterian Hospital and an infectious disease specialist. We're going to learn how these superbugs evolve, why they're so concerning, and why we're seemingly just sitting here with our hands in our pockets waiting to be wiped out by a plague of our own creation. I found this discussion fascinating and I think you will as well. I met Matthew through my network and I'm teaching you how to create networks for yourself using our course Six-Minute Networking, which is free over at jordanharbinger.com/course. Most of our guests here on the show subscribe to the course and the newsletter. So come join us, and you'll be in some smart company. All right, here's Dr. Matt McCarthy.
Jordan Harbinger: [00:01:18] I read the Superbugs and it's a little scary because of course everyone, nobody wants to die of a plague. Nobody's really saying we're going to get a crazy plague, but it's also like we're kind of doing it to ourselves right now.
Dr. Matt McCarthy: [00:01:32] That's exactly right. You know, I was giving a talk about the book and someone raised their hand and said, “You know, in the Bible, they said that locusts were cast upon the earth as a penalty for our poor behavior and our superbugs something similar.” And I had never considered it that way but in some ways, that's a fair appraisal of the situation. That on the small scale, doctors are prescribing antibiotics when they shouldn't and patients aren't taking them as directed. And then on the large scale, we're giving antibiotics to cattle in ways we shouldn't and pigs and chickens. We're using tuberculosis drugs in our orange farms.
Jordan Harbinger: [00:02:13] What? For what?
Dr. Matt McCarthy: [00:02:14] There's a front page story in the New York Times two weeks ago that tuberculosis and syphilis drugs are being used for the orange crop because it helps them grow. We use our precious fungal drugs in tulip gardens in the Netherlands. There is a whole array of ways in which we could do better with these important drugs to prevent the spread of superbugs, but in many ways, we're causing their existence.
Jordan Harbinger: [00:02:38] Oh, I see that. Yeah, that makes sense. So it's not just, it's not like this higher power thrusting this upon us. It's like, “Hey if you use this and abuse this, you're going to have a problem.” It's like drugs.
Dr. Matt McCarthy: [00:02:48] Yeah, absolutely. And what we have to get better at is teaching doctors how to use these drugs. And we have people called antibiotic stewards. It's in many hospitals but not in every hospital. It's when a doctor prescribes a valuable antibiotic, there's a check-in place and that's a steward has to approve it. Sometimes I've been the steward, you say, “No, you're using an antibiotic in a way it shouldn't,” and we have to tell the doctor used something else. That can sometimes be a delicate conversation to have because the doctor doesn't necessarily want to use something else. They want to use what they have.
Jordan Harbinger: [00:03:25] So this antibiotic steward is if you prescribed me some kind of crazy Cipro or whatever times 10, whatever new drug, somebody might go, “Whoa, Whoa, Whoa, Whoa, Whoa, this guy has a gut infection that could be probably cured by something lighter weight. Don't use the nuclear option.”
Dr. Matt McCarthy: [00:03:41] A hundred percent. It's exactly what a steward is. And many people don't even know that that is a job that exists.
Jordan Harbinger: [00:03:45] Yeah, I’ve never heard of it.
Dr. Matt McCarthy: [00:03:47] And it's a job that is often unpaid. I did at nights and weekends when I was an infectious disease fellow, and you end up having these conversations with doctors who sometimes can be very frustrated. Imagine it's a surgeon who's done the same type of surgery for 10 years and wants to put the patient on an antibiotic that you've used for 10 years, and then a guy like me says, “No, no, that's actually not the right choice.”
Jordan Harbinger: [00:04:09] 20 years younger than them.
Dr. Matt McCarthy: [00:04:11] Yeah, exactly. And so they say, “What are you talking about? Who are you?” “This is the wrong choice. You need to use something else.” And then that surgeon has to go back to their patient and say, “Actually the steward recommended something else.” And that's not something that many--you can imagine top-flight doctors want to hear. But that's the way, we protect our trove of drugs. Another way to think about it is, and I talk about this in the book, how hard it is to make an antibiotic and how hard it is to make a profit out of one.
Jordan Harbinger: [00:04:41] Yeah, we'll get into that. I've got a whole lot of questions about that. If you want to—
Dr. Matt McCarthy: [00:04:45] Yeah, we can go there.
Jordan Harbinger: [00:04:45] –hold that thought. Because that's what really freaked me out about this was I thought, okay, well if it's an arms race, we're making new ones, so what the hell is the problem in it? There's a whole lot wrong with that process. By the way, you should've heard, you should have seen Howie Mandel. You know, he's got a germ thing.
Dr. Matt McCarthy: [00:05:05] I do, yes.
Jordan Harbinger: [00:05:07] He goes, “What else are you doing while you're here?” And I said, “Oh, tomorrow we have this infectious disease specialist.” And he physically shoved himself away from the table about as far as his chair would go without falling over. And he was, “When is that?” I said, “It's tomorrow.” He goes, “Oh, thank God.”
Dr. Matt McCarthy: [00:05:24] You know, most people are not afraid of me when I walk into a room despite the fact that I'm a superbug hunter and that's what I spend my life thinking about in treating how we really shouldn't know about the op-ed that I wrote about how superbugs are everywhere. That is a problem that people don't necessarily recognize that if you go into your grocery store and swab the meat aisle, swab that the chicken or the beef, there is going to be superbugs on it. If you go to—
Jordan Harbinger: [00:05:53] In small numbers.
Dr. Matt McCarthy: [00:05:54] Yeah, in small numbers, in small numbers. When you cook it, those bugs should go away. But they are also in our hospitals and they are in our schools and in our homes. And what I wanted to write about is the fact that just because a superbug is in this room doesn't mean where our lives are in danger and to understand the risk and to understand how they got here is a way for us to all appreciate what the threat might be. Rather than being fearful, just saying, oh, there are these bugs in our environment and we have immune systems that protect us. Sometimes they get the upper hand and I wanted to write about how they get the upper hand so that we can all sort of be on the same page about this discussion.
Jordan Harbinger: [00:06:35] Is it kind of a critical mass thing? Is it like if you're at a concert and there's one criminal or pickpocket it, chances are you're going to be fine, but if there are more criminals than there are normal people, you're kind of screwed?
Dr. Matt McCarthy: [00:06:45] Yeah, I hadn't thought about it that way, but that's a fair way of describing it. Many people have a superbug called MRSA on their skin and you could live your entire life with that MRSA never affecting you at all. Period.
Jordan Harbinger: [00:06:59] MRSA is an antibiotic-resistant staph.
Dr. Matt McCarthy: [00:07:04] That's exactly right. It's often resistant to oral antibiotics, not always, but we increasingly have to use intravenous treatments and patients can have that on their skin for years, no problem. And then one day you get a big cut and some of that MRSA seeps into your skin, gets into your blood and we've got a big problem. The more you have on your skin, the more likely it is to get into your blood. Once it's in the blood, it can go all over the place. And that's where it gets dangerous.
Jordan Harbinger: [00:07:31] When I was in Egypt, literally 20 years ago, I had all these cuts on my feet because I had seen it all and I stepped in numerous puddles of really like gross camel pee and everything that's in the middle of nowhere in Egypt hiking. And when I got home I got really, really, really sick. It turned out I had a blood infection. It was staph or something, but I was 20. I was like sleeping and eating and working out and they were like, “Here just take this really potent antibiotic.” And I ended up taking it and like overnight symptoms disappeared but I remember they were like, “Take the whole bottle.” So I did.
Dr. Matt McCarthy: [00:08:06] And that's good that you did. And this is one of the ways that superbugs are created if people don't take the whole bottle because bacteria are constantly mutating, constantly evolving. And if you're supposed to take 10 days of an antibiotic and you only take two, the bacteria get a whiff of the drug and say, “Aha, here's what it looks like. Let's create an enzyme to destroy it.” Whereas if you take it for all 10 days, you actually just wipe out the bacteria. So it's constantly trying to fight against what we throw at them.
Jordan Harbinger: [00:08:36] Which is rough because the bacteria’s life—How long did bacteria live? Like a few hours and then they evolve. How does it work?
Dr. Matt McCarthy: [00:08:44] Some can live for decades.
Jordan Harbinger: [00:08:47] The same organism?
Dr. Matt McCarthy: [00:08:49] Yeah because they divide very, very slowly. One to think about that divides slowly, that's hard to treat, is tuberculosis. It's a Mycobacterium that could live in your lung.
Jordan Harbinger: [00:09:01] What does that mean a mold?
Dr. Matt McCarthy: [00:09:03] It's between a mold and a bacteria. It's exactly right. It's so hard to treat because it divides so slowly. If something is dividing very quickly and growing very quickly and you throw a wrench into that organism, it suddenly breaks down and it can't divide the way it wants and it starts making mistakes. The tuberculosis just sits in your lung and hangs out and doesn't do anything. And we have a hard time coming up with drugs that can affect such an inert and just kind of laid-back organism. And many people have it in their lungs for years, no problem. And then they get chemotherapy that wipes out their immune system and then the tuberculosis flares.
Jordan Harbinger: [00:09:44] How come some people --this is totally off-topic-- but how come?
Dr. Matt McCarthy: [00:09:47] I like going off-topic.
Jordan Harbinger: [00:09:49] Yeah. I bet people probably only ask you the same set of questions. How come some people have that tuberculosis shot mark on their arm from other countries? And I don't have that.
Dr. Matt McCarthy: [00:09:58] Yeah. So there is a vaccine for tuberculosis called BCG that is used in a number of countries where the rates are so high that they do that to protect them. So whenever you're thinking about a vaccine, just as a blanket statement, the first question you need to ask yourself is, before you develop the vaccine is how common is that infection in our society? So tuberculosis is relatively uncommon in the United States, so it's not cost-effective and it's not worth it to give us all the vaccine. The problem with this is that people see a condition now like measles and they say, “Oh, there's no measles, so I don't need a vaccine.” And that's actually exactly the wrong thought. The reason that we haven't had measles around for 20 years is because of something called herd immunity. People all get vaccinated and there is no risk to the population. I work in New York where we have a strong anti-vax population. And we also have this other group that hasn't been talked about, which is a number of people will say, “I believe the vaccine works. I just don't want to give it to my kid.”
Jordan Harbinger: [00:11:06] Right. What's that concept in economics, free riding? Where everybody else is taking care of the common things so I'm just not going to but if everyone thinks that way, then no one takes care of their common—
Dr. Matt McCarthy: [00:11:18] That's right. And one of the arguments now is for the kids who are unvaccinated, whether or not they should be allowed to go into public spaces because they're at risk, they could get measles and if you say they can't go, is that child abuse?
Jordan Harbinger: [00:11:31] Right. I think we talked about this on the phone where people were like, “Oh, well it's not fair because to ban my kid from McDonald's,” but it's like, wait a minute. Wait, you're, you don't have like a human right to go play in playland at McDonald’s.
Dr. Matt McCarthy: [00:11:45] You're right. I think these are the same people who are saying, I don't want the government to tell me what to do and tell me that I have to get a vaccination. They're certainly not going to, to hear the government say they're not, not allowed to take their kid to the park. And how do you get through to people who don't want to hear what you have to say? To me, it is a lot like having a political conversation with somebody who disagrees with your politics. I cannot say that I've figured out a way to meet people where they're at and change their minds. I try to meet them where they're at, but then the conversation doesn't always go where I want it to go.
Jordan Harbinger: [00:12:16] Right. Yeah. Well, sometimes you have to meet people so far outside the scope of kind of rational thought that you're going. If I want you to meet me in LA and we're starting in Chicago, it's just going to take longer to get. I think there are a lot of counterarguments that don't make sense to me that I hear from friends of mine that I just think like, “Oh I hate that we're having this conversation.” Like a one that I wrote down from my friend, I won't out him on the show here because he's also sort of like, people know who he is. Arguments that he makes are diseases like measles mostly affect the vaccinated. So vaccines don't work. He says, “Whenever there's a musical outbreak, 85 percent of those people are vaccinated.” And I'm like, “Well, if that's true, which I'm not sure about. There's another reason for it.”
Dr. Matt McCarthy: [00:13:03] There is a popular paper that is passed around the anti-vaccine community, which shows that when people come into the emergency room thinking that they have measles, a small percentage of them actually have just gotten the measles vaccine and are having a reaction to the vaccine having a fever or feeling lousy, even maybe having a rash. And those people may initially be misdescribed as having measles, but they're really just responding to the vaccine. This is a side argument that's meant to confuse people and to mystify things and to cloud the discussion. The simple answer to this is the vaccine works. It's safe when people don't get vaccinated, we have outbreaks. I'm seeing measles now and I did not see it 10 years ago and the reason for that is people aren't getting vaccinated. In my book, I talk more about the bacteria and about the fungi. But you know, these viruses can certainly be just as lethal as any other bacterial superbug. And how do you meet people and say, “You know, you really should get vaccinated.” It's not as simple as that as you can,
Jordan Harbinger: [00:14:12] Right. Yeah, sure. No, if it was that simple, then people will follow it. I'm also not one to be like, “Hey, we need all these regulations for everything.” But herd immunity is one where things like the tragedy of the commons, which we were talking about if you don't vaccinate—people will go, “Well, you know, let these people don't get vaccinated, then they're there are people will die off.” And it's like, well one, it's not them, it's their kid. So there's that. But the other thing is my wife is pregnant right now. It's my unborn kid that's going to get screwed or my newborn that's going to get screwed because some dumb ass took their kid to McDonald's and now my kid gets fricking measles from it.
Dr. Matt McCarthy: [00:14:52] One of the things that people have not always appreciated is that infectious diseases are a political issue and how the government should step in and what they should regulate and not regulate. One of the most important political issues, no one is yet talking about now is how we're going to confront superbugs. How are we going to create more antibiotics at a time when pharmaceutical companies are saying, “We don't really want to make these drugs anymore because we're not making money off of them.” And I talked to people who are on the left and on the right and they all agree that when they walk into the ER they want an antibiotic available and I think there may be some political will to unite in that common fight.
Jason DeFillippo: [00:15:36] You're listening to The Jordan Harbinger Show with our guest Dr. Matt McCarthy. We'll be right back.
Jordan Harbinger: [00:15:41] This episode is sponsored in part by Skillshare. How about instead of watching TV or flipping the channels, trying to find something to entertain yourself, you learn a little bit of a new skill, maybe photography. They've got creative writing, there's design. They have productivity. Jen has been using Skillshare to learn things like video editing, audio editing, whether you're returning to something that you've had a hobby with, I don’t know the last 10, 20 years, whether you want to get a new one, you want to get outside your comfort zone. A little Skillshare has a ton of classes. There are literally thousands and thousands of different subjects in Skillshare and basically, anything you can think of where you want to learn that instead of sifting through random videos on the Internet or like reaction to someone learning this or like spammy crap that wants your email and then never stops billing, you go ahead and use a reputable site like Skillshare, really easy to use. The courses are generally well-designed and it's a lot of fun to learn new stuff. You can really get a handle on something pretty quickly with the Skillshare classes, especially if you're just spending a little bit of time with it each week. It's really kind of a novel way to learn. I highly recommend it. Jason.
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Jordan Harbinger: [00:17:11] This episode is also sponsored by DesignCrowd. Crowdsourcing is how busy people like business owners and yourself get stuff done in the 21st century and thanks to DesignCrowd you can focus on running your business while you hand over your design for the logo, the web design, t-shirt, business card, whatever, to a pool of over 700,000 designers around the world. I like that they keep updating the number every time we do one of these. It's funny, I'm just watching the number of designers climb every time we do a read for DesignCrowd, which is a good sign. So nice growing, growing biz there and they crowdsource the custom work based on your specs. So you pick the design you like best, all the submissions. It works like this. Go to designcrowd.com/jordan. You posted a brief describing what you want from the art that you need. DesignCrowd invites 700,000 plus designers from all over the world, so you get a lot of different sorts of types of designs as well. Within a few hours, you get your first designs over the course of three to 10 days. You can get over a hundred pieces from designers all over the place from Sydney to San Francisco. You pick the one that you like, you approve payment to the designer, and if you don't like any of them for some reason, DesignCrowd offers a money-back guarantee. Jason.
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Jordan Harbinger: [00:19:14] I don't think a lot of people realize that babies who are not old enough to get vaccinated are super vulnerable and old people who are hanging out with their grandkids, whose kid goes to school with some un-vaccinated kid whose parents happen to be anti-vax, those are the people that get sick and die.
Dr. Matt McCarthy: [00:19:29] You're absolutely right. And you know, I never thought about this issue before I had kids. I just kind of went through my life thinking about people who had different thoughts with vaccines than I did. Just like, all right, you know, agree to disagree. And then you have your own kids and you see what measles can do to people or some of these other infectious diseases, influenza and it can terrify you as a father, as a parent. And it takes on a new meaning that you didn't always appreciate it.
Jordan Harbinger: [00:19:57] Yeah. Because I think for myself, I'm of good constitution, even if I got something like that I'd probably be fine because I rest and I would eat right, and I have access to resources and I live in a city where I can go to a good hospital, might not matter. That's right. Or I might give it to my dad who's 74.
Dr. Matt McCarthy: [00:20:15] Think about this too. You know, my father-in-law was getting chemotherapy and we stopped shaking hands and hugging and we just sort of didn't elbow bump for that reason. And you know, you're right, being young and fit may protect you but you could be carrying something that you can pass on to someone.
Jordan Harbinger: [00:20:32] Yes. I mean you, you are careful in your job, but let's say you work at a nursing home, you might be less careful than a physician, but if you've come into contact with this because your own kid is unvaccinated versus his friend is never at your house, you spread that 87 people that you then work with every day.
Dr. Matt McCarthy: [00:20:48] Right. And you know, I'm on the ethics committee and one of the really interesting ethical issues in medicine is how much culpability someone should have for knowingly spreading an infectious disease or negligently. But you know, an example will be if someone has HIV and doesn't use a condom and doesn't tell their partner that they have HIV and the partner contracts it. What is the guilt there? Should that person go to jail? Is it the partner's fault for not insisting on protection knowing that there is some risk? These are issues that we wrestle within the medical ethics world that we often bring in lawyers and clergy, theologians, all kinds of people to try to figure out when something gets spread like HIV or like measles, what's the blame? What's the accountability?
Jordan Harbinger: [00:21:41] Oh man, that's got to be a rough question because everybody's got an opinion on that.
Dr. Matt McCarthy: [00:21:44] Yeah. The great part about medical ethics is it's one of the few areas in life where I can have a very firm strong belief that will be completely upended in half an hour of listening to someone else who's got a different take than I have.
Jordan Harbinger: [00:22:00] That's interesting because we've talked about this on the show before, and I always butcher the quote, but I think it was Charlie Munger who's Warren Buffett's investing partner, and he said something like, the quickness, the speed with which you can change your mind is actually a huge competitive advantage.
Dr. Matt McCarthy: [00:22:17] Yeah. And this is something that happens, when I walk into the hospital every morning, I am in charge of a team of medical students and residents and interns. The great part about practicing medicine is that we're always looking for areas where we're wrong and looking to it. Somebody in medical school once said to me that MD stands for makes decisions and we have to make a hundred, 200, 300 decisions in the span of two hours on rounds. And we are constantly saying, was this the right decision? And if not, why not? What's the evidence? And that's so different than say, my political views where I kind of locked in when I was 18 or 19 and I haven't really changed many of them in decades. That's what's exciting about practicing at an academic medical center is that we're always reviewing the evidence. And when people talk about fake news, doctors are trained to sniff out fake news early in their career. I think that it's something that we need to talk more about. How do we evaluate medical evidence to make decisions that impact our patients?
Jordan Harbinger: [00:23:19] Yeah. Oh, well, of course, every, this is in everyone's best interest. Nobody wants somebody who's like, “Well, you know, my training says this, but I did read something this morning that kind of counteracted that, so I'm not sure now.”
Dr. Matt McCarthy: [00:23:31] This is what medicine used to be there. There's an era that we're in now of called evidence-based medicine. Before that, it was anecdotal medicine.
Jordan Harbinger: [00:23:39] By the way, let's just back up and say what isn't all medicine evidence-based?
Dr. Matt McCarthy: [00:23:46] No, it's not. Think about penicillin I write about is the first commercially available antibiotic and we started giving it to soldiers during World War II. We started giving it to people and it worked and it was quickly approved for use. Today, if a new antibiotic wants to come to market, we have to do 10 years of testing and it costs about a billion dollars. Phase one trials, we have to test it in animals, we have to test it in healthy volunteers. All of this stuff takes a long, long time and companies don't want to take that risk, but we need them to invest in that and to prove that it works because we can't just have doctors going in and saying, “Hey, I got this new drug. I think it works. I saw it on the HuffPost and ensuring that that we're protecting people and not exposing them to dangerous drugs.
Jordan Harbinger: [00:24:33] That leads to a really interesting question that we sort of touched on before, which is how do you even find new antibiotics? Because the discovery of penicillin was what around World War I or something like that.
Dr. Matt McCarthy: [00:24:42] So Alexander Fleming, I start the book in World War I, and then it was actually 10 years later, he went back to his laboratory, which was in London and he was just puttering around and he stumbled upon a Petri dish of a bacterium, that had all died in the presence of a fungus. And he discovered that this fungus was making a chemical that could kill other organisms and that was penicillin. And what we later learned is that beneath our feet in the soil, there is this tremendous diversity of life. There are bacteria and fungi and parasites and they're all pumping out little chemicals trying to kill the other organisms around them.
Jordan Harbinger: [00:25:25] Is it sort of territorial species?
Dr. Matt McCarthy: [00:25:26] Yeah, like a survival of the fittest. And what we are trying to do now is we have recognized that those chemicals that they're sifting out and they're pumping out can actually be drugs, life-saving drugs. And the challenge is finding them. It's like sifting through a needle in a haystack.
Jordan Harbinger: [00:25:42] Well worse because it's in the dirt. How much dirt is there? They’re everywhere.
Dr. Matt McCarthy: [00:25:45] And the question would be, where do you start? You know, do you just look at dirt? You know, there are researchers at Rockefeller University in Manhattan who are sifting through it and they're using big data and they're using artificial intelligence to try to figure out how do you pick that lifesaving drug out. And they're asking for people to send in soil samples. So they'll go look at what's under a Prospect Park in Brooklyn. Or they'll look at Frozen Tundra. They'll look all over the world. Sometimes you know, the bottom of the ocean, looking for these chemicals and then the challenge is you find that drug. It works in a test tube, you then have to spend a billion dollars proving it will be safe in your mother.
Jordan Harbinger: [00:26:29] And it takes forever. Bacteria can change and evolve much faster than we can keep up with them.
Dr. Matt McCarthy: [00:26:35] Well, you know, they are constantly evolving and if we have a lot of antibiotics at our disposal, we can use more than one at a time, which is kind of an interesting concept. Sometimes too, pretty good antibiotics are better than one and they can synergize. And so what we as infectious disease specialists sometimes do is we try to mix and match these drugs to create a synergistic effect so that they're stronger than the sum of their individual parts.
Jordan Harbinger: [00:27:03] One thing I've meant to touch on before. My wife and I call her like an immigrant mark because even though she was born in America, she went to Taiwan in a certain period of her life and they're like, you have to have this. I think a lot of people go, “Oh, well in America we must have a version that doesn't leave a scar.” But we don't have.
Dr. Matt McCarthy: [00:27:23] No, we don't, we don't routinely vaccinate people for tuberculosis.
Jordan Harbinger: [00:27:27] So if her and I were exposed to tuberculosis, she's vaccinated and I'm not.
Dr. Matt McCarthy: [00:27:30] Yeah. So I treat patients with tuberculosis all the time. Many patients have it sitting in their lung, but they're not contagious because they're not coughing it up. What happens is it gets in your lung and your body forms a wall around it. That's almost like an abscess that is just isolated from the world and it doesn't go anywhere. If somebody who has latent tuberculosis, which means it's just kind of hanging out and that's very different than the active tuberculosis, which we think about from like the 1800s where people would die. We call it consumption back then and they would waste away and they would go to these sanitariums and we didn't have any drugs for them, so we would tell them to just get fresh air, you know, go up to the Swiss Alps and live in a cave.
[00:28:19] And now we have all kinds of drugs and that is another area where we're racing to come up with new treatments. There's been a lot of investment from people like the Bill and Melinda Gates Foundation and a lot of philanthropic drive for more drugs. That's in contrast to some of these other superbugs. We've seen that when philanthropy pours in for HIV or for tuberculosis or from malaria, that we can get results. We don't have that happening now for superbugs. People don't find it to be a sexy topic yet or may never. We don't have Warren Buffett's, so whoever said, “We need to put $500 million towards developing new antibiotics.” And that's part of my goal here is to raise awareness so that people see this is a real problem. The World Health Organization is saying that by 2050, 10 million people will die every year worldwide from superbugs. That's more than heart disease and cancer. And that's more than heart disease or cancer, and we don't want to be in a position where 30 years from now that's happening and we're saying, “Why didn't we do anything?” We have a chance now to intervene to invest in new drugs, but this is really the time to act.
Jordan Harbinger: [00:29:32] So why has there been such a slow down in new antibiotic discovery? And I know we touched on this before and you said the approval process takes a year, but there's more to it than that.
Dr. Matt McCarthy: [00:29:42] There's a lot more to it. You're right. The first thing to think about and a patient asked me this a long time ago was why is it so hard to make an antibiotic. The business model is very different for these types of drugs than for other types. So think about a blood pressure medication. A doctor would prescribe it to a patient and say, “Take this every morning for the rest of your life.” That's a great business model for a company that makes that drug. Then think about an antibiotic. There are only prescribed and short courses. Doctors like me are very stingy about doling them out. And then even that best new antibiotic is going to eventually wear out its welcome when the bacteria mutate and evolve. And so what you have are companies saying, “Why do we want to make a drug that doctors don't want to prescribe?” And that is the crux of the problem and what we're finding is that these companies are saying, “We don't want to do this. And if we end up getting a drug approved, we're going to charge so much money for it, $5,000 a dose that we're going to try to recoup our billion-dollar investment in a way that we can aggressively recoup it.” And hospitals don't have to use these drugs. And in fact, many of the best hospitals in the country will say, “That's too expensive. We're not going to use it.” And that's a shame. That's a dangerous place to put patients because you know what I do every morning is I'm at the bedside of a patient trying to come up with a treatment. And I know that many hospitals are not using the newest treatments because they're so expensive. That's different than heart disease or cancer where we have the best chemo. If there's a stellar new cardiovascular drug, we're going to use it. But if there's a brand new antibiotic, we may not, because the finances are so tight with these types of conditions.
Jordan Harbinger: [00:31:30] So drug companies then shift to more profitable diseases. It's weird, but it's almost like they shift or something that's more fashionable, that's going to make more money.
Dr. Matt McCarthy: [00:31:39] You know, I write about an antibiotic in my book and the company that makes it also makes Botox and they make three billion dollars in sales on Botox last year. And so this presents an opportunity where you can say to a company like this, you know, why don't we make a deal where we can entice you to invest in more antibiotics with some of these profits you're making. And these are called push-and-pull incentives. A push incentive is to go to that company and say, “Your corporate tax rate is 20 percent. Let's cut it to 15 percent if you promise to invest a portion of those profits into new antibiotics.” This is a very popular idea with these companies because it's a guaranteed way for them to make more money and for them to invest in new drugs. The idea of giving a tax cut to big pharma is something that a lot of people don't want to think about.
Jordan Harbinger: [00:32:30] Right. That sounds crooked.
Dr. Matt McCarthy: [00:32:31] It does, it does. It's like bailing up the banks and it's like, why should we have to negotiate with the terrorists in this case. Then there's the other option which is called a pull incentive, which is to say if a company does the investment of a billion dollars and they get that drug approved, rather than giving them five years of market exclusivity, you give them 25 years. And that way no generic can challenge them and they can make even more money off the drug. That is a more appealing way of negotiating for me because it means that they have to take the risk upfront. The downside is that they end up charging more for the drug.
Jordan Harbinger: [00:33:12] And then nobody can grab it.
Dr. Matt McCarthy: [00:33:14] And then, some people say, wait a second. Why do we have to convince them? Shouldn't big pharma be wanting to make antibiotics if we all need them?
Jordan Harbinger: [00:33:22] Right? Like, hey, look, if these superbugs are going to kill 10 million people a year, how is that not profitable?
Dr. Matt McCarthy: [00:33:27] Right and what I quote a CEO and in my book as saying, he said, “I have an ethical mandate to charge as much money as possible for the antibiotics that I make because I am accountable to shareholders and not to patients.” And that is a dangerous thing to say, but it's also, it makes us realize just how difficult this is going to be. That these people are saying, “We're accountable not to your patients, Dr. McCarthy. It's to these investors and these investors don't want to go down this road,” and that's going to leave people in the lurch.
Jordan Harbinger: [00:34:01] It really is because it's not short-term profitable especially because as you mentioned in the book in Superbugs, the antibiotics are short courses. So like you don't need three years' worth of this drug or, or even three months, half the time, you need like two weeks or month.
Dr. Matt McCarthy: [00:34:19] Yeah, and you know, there's another school of thought, which is to say the pharmaceutical industry doesn't want to make these drugs. Well, good riddance we should nationalize the production.
Jordan Harbinger: [00:34:30] Yeah., you’re talking the wrong guy.
Dr. Matt McCarthy: [00:34:33] And I'll tell you that theory is gaining traction in England. And the idea is that we should look at antibiotics the way we look at electricity or water as a public good. The problem is if you talk to investors, they say this is a disaster and it's going to curb innovation and it's never going to work. And there was some argument to say it will not work. In England, they've tried this and it has not been a success. I think that what we really need to do is focus on enticing the pharmaceutical industry.
Jordan Harbinger: [00:35:07] Yeah. As unpalatable as it might be, private companies that know how to make money are the best people to come up with innovations that they can get out in a short period of time.
Dr. Matt McCarthy: [00:35:17] I agree. And I'm no economist, you know, I'm a physician and a researcher. But when you talk to the experts in the National Institute of Health and you talk to the top scientists, they say, “We need this pharmaceutical partner that the federal government is very good at investing in scientists who can make these discoveries. But then we need private industry to then develop it.” And I quote, the head of one of the federal agencies, who says people don't realize that the pharmaceutical industry has perfected many difficult aspects of drug development, making sure that the lot is not contaminated and that the distribution and the marketing and these things that they do well and they say, “I work in the federal government. You don't want the federal government doing this aspect.” And so that's, to me, a really interesting political decision or conversation that we're going to be having in 2020 is the antibiotic market is broken. What are you going to do to fix it? What is a candidate’s idea? What is their plan? Because you're going to learn a lot about how they see healthcare. And the government's role in it by how they answer that question. That's a question that no one is asking the candidates yet. Everyone in medicine recognizes we're at this breaking point where we need new drugs. What are the plans? I can't wait to hear them.
Jordan Harbinger: [00:36:35] Yeah, I, myself, I'm curious. The other problem with the drugs and you mentioned this also on Superbugs is they eventually become obsolete. It's not like it's not Botox. I don't know, maybe you can become immune to Botox too, but it just stops working everywhere because the bacteria has evolved. So it's like, oops.
Dr. Matt McCarthy: [00:36:53] Right. No, and that's yet another part of this that those blood pressure drugs aren't just like wearing out, but these antibiotics. When people say that they're different, it's true. It is different than a cholesterol medication. The enticements that we have, I think need to be pretty aggressive because the market is so slim. And what's going to be tricky about these negotiations is big pharma is going to look so bad after the opiate trial that's going on in Oklahoma and some of these other revelations are going to come out that it may be tricky to go to. You know, Johnson & Johnson is on trial right now in Oklahoma for the opiate. The way they've marketed that stuff. To go to them and say, “Hey, could we give you a tax cut so that you go back to making antibiotics because you are really good at that a few years ago.” But those are the conversations we may be having.
Jordan Harbinger: [00:37:44] I mean, that to me, it's just so not like a black and white situation. There's not some sort of clear cut solution. The other problem, of course, that you also mentioned is that it's only given to sick people. So Viagra is like, everyone wants a piece of that, so that's worth a ton of money. But nobody's like, “Oh man, let me get some of that MRSA or whatever.”
Dr. Matt McCarthy: [00:38:08] Or we have the Z-PAK.
Jordan Harbinger: [00:38:10] We need some Cipro.
Dr. Matt McCarthy: [00:38:11] And this is the fundamental problem with it, but part of it is also just raising awareness, but this is a big issue and the more people who are thinking about it, the more people who are engaged with it. You know, I sometimes talk with like business school guys or people in consulting and when they come to appreciate the problem they get really excited because they're like, “Oh, this is clearly an important issue that people aren't thinking about and talking about and they can make a real difference in people's lives.”
Jason DeFillippo: [00:38:39] You're listening to The Jordan Harbinger Show with our guest Dr. Matt McCarthy. We'll be right back after this.
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Jordan Harbinger: [00:42:33] It's amazing how much this stuff does get overprescribed. I went to have my wisdom teeth removed probably, I don't know, 20 years ago or more now. And the oral surgeon said, “Oh man, did you have tetracycline when you were younger?” And I said, “How do you know?” And he goes, “The inside of your teeth are completely brown from this.” And he goes, “How much did you have?” I said, “I took it for years on end as a kid.” Because my dermatologist was like, “Yeah, this is a great way to prevent acne.” I took it for literally, I mean years all through middle and high school, seven years probably. I just stayed on this.
Dr. Matt McCarthy: [00:43:07] Well, you hit on one of the most fascinating parts of the history of antibiotics is that you said that tetracycline was in your teeth and they can see it. And what we have found is researchers who have excavated mummies from Africa are finding that they have tetracycline in their bones as well.
Jordan Harbinger: [00:43:28] In their bone. So it is in my bones, not just my teeth.
Dr. Matt McCarthy: [00:43:30] Well, it's in your teeth and a little bit in the bones. But the idea is that, you know, a millennia ago that human beings recognized that there was something in the environment that they could eat that would help them and that we were consuming antibiotics before we even knew what they were. And we found that the rates of infection in those communities in those societies were lower because they were consuming antibiotics, unwittingly.
Jordan Harbinger: [00:43:56] Where does tetracycline or something naturally occur?
Dr. Matt McCarthy: [00:44:00] You know, I'm not entirely sure where they got that from. I think that's sort of the next step is when you look at a mummy and you're like, “Hey, they got tetracycline in there. How did that happen?” Then you start backtracking and say, “What kind of foods? What kind of things were they eating? Is it from a plant-based diet? Was it from the animals?” And then the other thing that you mentioned was that it was your dentist. And one of the next big frontiers for us is improving the antibiotic prescribing practices of dentists. You know, I mentioned that in the hospital we have these antibiotic stewards who say, “Hey, Mr. Surgeon, Mrs. Surgeon, you can't prescribe this.” We don't have that as much in the dental world. So it's often dentists saying, “Oh yeah, I'll just, just in case I'll give you a prescription for seven days of an antibiotic.” And that leads to one study found 80 percent of antibiotics prescribed by dentists are inappropriate.
Jordan Harbinger: [00:44:51] That's a ton. Well, this is my dermatologist too. “Hey, I have acne.” “Oh, you don't want to get one zit in sixth grade. Here's something that's going to fundamentally alter the composition of your body.”
Dr. Matt McCarthy: [00:45:01] Yeah, that's exactly right.
Jordan Harbinger: [00:45:04] It makes me annoyed because I remember telling my mom, it's probably bad to take a drug every day. And my mom was like, “Yeah. So we asked her,” and she was like, “It's fine. I'm a doctor. You're just an idiot patient who doesn’t know anything.” And I'm like, “Nope, you just want to make money off of this prescription. You don't give a crap that my teeth are going to turn brown.”
Dr. Matt McCarthy: [00:45:22] I mean, you're absolutely right that there are times where people prescribed things and the patient knows more than the doctor. I have this a lot where patients will come to me and say, “Are you familiar with colloidal silver as a way of preventing infection or probiotics?” Or something that maybe not in my wheelhouse and I ended up learning a lot from patients just by the conversations we have at the bedside where they say, “You know, my uncle is using this new treatment, what do you think?” And when I first started out as a doctor, I was inclined to say, “Oh well there's no evidence to use that.” But clearly, this evidence-based medicine that we practice is failing people. And when I hear that, you know, people have a good experience with something, I want to learn more about it and then say, “Oh, has this been tested? If not, why not?” And then that gives me an opportunity to try to bring that new idea into the hospital. The good news is we have a check on that, which is, I can't walk in with some crazy compound and say, “I'm going to give this to all my patients. I have to get approval from the hospital.”
Jordan Harbinger: [00:46:28] Yeah, you don’t make it in your kitchen.
Dr. Matt McCarthy: [00:46:29] That's right. And so there's an ethics committee, it's called an Institutional Review Board, and it's made up of people who are not biased. They just review the compound that I bring in and they say, “You know what? No, we're not going to, this is quackery Dr. McCarthy. We're not going to do it.” Or they say, “Sounds good, let's do it.” And that's one of the things I've written about, or my struggles with this IRB where I'm fighting with them, trying to get stuff approved. And then, you know, sometimes I do, sometimes I don't.
Jordan Harbinger: [00:46:58] If ancient Egyptians had been eating antibiotics randomly or baking it or brewing it or whatever, does that mean that things that I eat now I'm putting bacteria, of course, I'm putting bacteria in my body, but it's living in me until I die. Right? Like beer.
Dr. Matt McCarthy: [00:47:14] Oh, I see what you mean. Yeah. So one of the fascinating parts of the human body is that we have over a trillion bacteria living inside our gut. And every time you take an antibiotic, you alter the composition of that. So, you know, if you took tetracycline for the dental or for the dermatologic reason, it also wipes out a number of the bacteria in your gut. Then you drink a beer and you replace it with the yeast and replace it with other stuff. And then you have, you know, a hamburger and you replace it with whatever was in, in that. And so it's constantly changing. And this is called the microbiome. What people are now looking at is how does that composition of bacteria affect disease. You know, there are thoughts that an overgrowth of a certain bacteria may lead to Alzheimer's or diabetes or high blood pressure. And so that's also one of the next frontiers in medicine is how do we improve our own microbiome so that we don't get some of these diseases. And that's where probiotics come in. People say, all right, so I don't know if I have good bacteria or bad bacteria in there. Why don't I just eat a bunch of the good stuff? And that's an area that we're constantly studying to see what really is the good bacteria.
Jordan Harbinger: [00:48:25] Yeah. A friend of mine who was also on the show, he runs a company called Viome, where they essentially test your stool in crazy panels and he found that 99 percent of the probiotics, they just never colonize your gut. They never make it there because, of course, your digestive tract has acid in there. You can just eat something that has a living thing in it, and then expect it to make it through the gut.
Dr. Matt McCarthy: [00:48:47] Well, I have some buddies who are in investors and they had an idea, which is that you can do a stool transplant, that you can take someone else's bacteria that's in their gut and transplant into someone else. And they said, “What if we got a stool and the bacteria from really rich people or really smart people,” and we called it something like Ivy poop.
Jordan Harbinger: [00:49:14] Like Ivy League.
Dr. Matt McCarthy: [00:49:15] Ivy League, yeah. And you know, it never quite took off.
Jordan Harbinger: [00:49:17] You might want to work on the brain.
Dr. Matt McCarthy: [00:49:19] Yeah, exactly.
Jordan Harbinger: [00:49:20] And also you have to take those pills in a radically different way than you would normally do. Let's just say it's not administrated by mouth.
Dr. Matt McCarthy: [00:49:28] Not ready for prime time.
Jordan Harbinger: [00:49:30] Right. Yeah. Can we use something like CRISPR, which we use to edit genes? Can we use that to create new antibiotics? Can we just print them?
Dr. Matt McCarthy: [00:49:39] This is such a great question. The new advancement in CRISPR, which is this molecular scalpel that can cut DNA and sort of rearrange our genetic code is being used to manipulate viruses and those viruses can cause bacteria to explode. And this whole thing is they're called bacteriophages. And so you can find a bacteriophage, you can use CRISPR to chop it up and rearrange it and then you can target a specific infection. And we just saw that this could work. A 15-year-old girl from Great Britain was saved with this approach and they used three different bacteriophages and use CRISPR to tinker with them. And then they cured her of this infection that was going to kill her.
Jordan Harbinger: [00:50:25] How did you get an infection that was going to kill her 15?
Dr. Matt McCarthy: [00:50:27] Well, she had a weakened immune system predisposed to it and it was a bacterium that's in our bathtubs. It's kind of all over the place. But what I want people to appreciate it when let's say someone forwards you that article and you read it and you say, “Oh my gosh, we've got this new cure for infections,” is to appreciate that that will take at least 10 years and a billion dollars of investment to get that one success story into a generalizable success story where other patients have access to it. And CRISPR is tremendously promising but the question is who's going to take that risk. What company is going to say we are going to put our billion dollars down and try to make a profit off of this? And what we're seeing is that the smaller companies, the startups are not having the success and can't absorb the failures. There's a company called Achaogen that spent years trying to get an antibiotic approved. And last June their product Plazomicin was approved and they filed for bankruptcy in April, right after getting approved. What we are thinking is that it's going to be the big pharmaceutical companies that can actually take on CRISPR because sometimes it'll fail and they can absorb that failure.
Jordan Harbinger: [00:51:43] That makes sense. Or at least they go, “Hey, look, this is going to take three more years. Fine. We have a hundred billion dollars.”
Dr. Matt McCarthy: [00:51:49] Right exactly. “We'll sell some more Botox and keep going.”
Jordan Harbinger: [00:51:52] Yeah. “Good thing we have Cialis keeping us afloat.” So people might go, well, the FDA is the problem. We need to deregulate this. But you, you had an interesting counter-argument about that because apparently, the FDA is not just a pain in everyone's blood. They're doing something important.
Dr. Matt McCarthy: [00:52:07] Yeah. You know, you mentioned you don't like the overregulation of things and that's kind of how my approach was. And I started writing this book and doing research on the FDA and I sent out my manuscript to a number of experts around the world. And one of the common themes I got was you're way too hard on the FDA. And you know, when you get feedback from somebody you can sort of take it or leave it. But when you get six people who have the expertise, who are all saying you're not quite appreciating how hard this is. It made me do a lot more research and come around to this idea that what the FDA has to do is incredibly difficult. Occasionally drugs get approved and then it turns out they're dangerous. I've mentioned in my book this drug called Omniflox, which was an antibiotic approved in the early 90s. Everyone said, “Great, we've got a new drug.” And then people started dying and the FDA had to not just monitor drugs until they get approved, but then the post marketing to make sure things are safe. And you know, people come up with new ideas all the time and they have to be as hard-nosed about sniffing out what's real, what works and what doesn't as anyone. I use the example of thalidomide in the book, which is a drug that was very popular in Europe in the 1950s. One of the companies wanted to market it here, and a single person from the FDA said, we can't approve this even if it's being used in Europe until we are certain it's safe. And this one person said no and she later discovered that the thalidomide was causing birth defects.
Jordan Harbinger: [00:53:44] That's the one where the kids have like no upper arms or hands sticking out or they have like two fingers.
Dr. Matt McCarthy: [00:53:50] That's exactly right. And she saved thousands of kids from growing up this way and she was a member of the FDA who didn't bow to political pressure, didn't bow to doctors and companies who are saying, “Come on, come on, you're taking too long. Let's go, let's go.” And so I think that's a good example.
Jordan Harbinger: [00:54:07] Yeah. I think in Superbugs you'd said something like the FDA has saved more lives than penicillin, which is huge, I mean, think about how many people have had infections that needed to penicillin. Every person in the world has used this.
Dr. Matt McCarthy: [00:54:19] I have a complicated relationship with the FDA where I am, you know, appreciate all that they've done. And on the other hand, I'm still constantly saying, come on, I wish they were a little faster.
Jordan Harbinger: [00:54:30] Yeah. I mean there's probably ways to speed it up, but maybe they're not okay.
Dr. Matt McCarthy: [00:54:33] And they're coming up with new ways where they can fast track drugs for approval. And I think that's the kind of the future of where this needs to go is to say, okay, not every drug is created, created equally. If there is one that looks like it may help society and benefit everyone, like let's give that a quicker review and I think that's a good plan.
Jordan Harbinger: [00:54:51] Yeah. Right. Like Botox can go a little bit further down the next Botox or Cialis can go a little bit further down the food chain than something that helps us kill infections in chronically ill patients. The problem with the FDA as you mentioned is apparently there's so much lobbying that the supplement industry is off-limits, which I always find an interesting cause people will market this supplement. You read it and it goes not regulated by the FDA. The FDA has not evaluated these and it's like, wait, wait, wait. People take a hundred supplements and then get one prescription. I don't know what the actual ratio is, but my closet is full of fricking supplements and I have zero prescription medications.
Dr. Matt McCarthy: [00:55:28] Right. Yeah. This is something that has always intrigued me, that it's simple simply from lobbying efforts that these drugs are like you go to GNC and they've just got aisles of stuff that has just come. It's like the Wild West.
Jordan Harbinger: [00:55:42] It’s complete bull crap. Oh Hey, this helps you metabolize blah, blah, blah better so that it gets to your muscles faster. And it's like, well, who evaluated this? Oh, nobody
Dr. Matt McCarthy: [00:55:51] And I used to take this stuff when I was like in college, in high school and I would take creatine and I would take some of these things and I don't know if they work, I just kind of did it cause that's what everyone else was doing and now I have a very different view of that stuff.
Jordan Harbinger: [00:56:04] Yeah. I know the FDA originally came about because people were putting crazy chemicals and food and people would eat like, “Oh yeah, there's a crapload of preservatives in here that we wouldn't feed pigs but hey feed it to your kids every morning.”
Dr. Matt McCarthy: [00:56:14] That's exactly right. One of the first antibiotics to become available in the United States was a sulfa drug and a company in Tennessee mixed that sulfa antibiotic with some sweet-tasting like elixir so that people would enjoy it when they take this antibiotic. It turned out that the elixir was antifreeze.
Jordan Harbinger: [00:56:35] Oh get out of here.
Dr. Matt McCarthy: [00:56:37] And people died and kids died.
Jordan Harbinger: [00:56:40] Of course, your cat drinks in it because it smells sweet. Your cat drinks it, it's going to die. There's nothing—
Dr. Matt McCarthy: [00:56:44] That's right. And so this is where the FDA essentially came from this. Being once was a very small group of scientists doing little experiments here and there. And then when this happened it changed everything and the FDA was given a lot more resources to actually monitor and make sure that drugs were safe before they came to market, not just afterwards.
Jordan Harbinger: [00:57:05] You've got wonder who said, “Oh, just throw some antifreeze in there.” Like how irresponsible of you at that point.
Dr. Matt McCarthy: [00:57:11] It's one of those things that the person who probably did it probably didn't have a background in chemistry or in anything, just as probably as some guy.
Jordan Harbinger: [00:57:21] It's just that is beyond unbelievable. That's so irresponsible. I would never go, you know, I have no background in this, but let's just do it. I would go, you know, let's just make sure that this isn't taxed at least one person. Take a quick look at this.
Dr. Matt McCarthy: [00:57:35] I got some really great advice when I was in medical school that a way to be successful is to be fearless. Now I don't know that that's true. Sometimes you have to know your limitations and maybe if you're not the guy who should be mixing antifreeze with antibiotics and you know, it was probably some ambitious salesman, and I think that increasingly people need to kind of recognize where their area of expertise ends.
Jordan Harbinger: [00:58:01] Yeah. Look, if you're selling hair care products and you put something in there and some people's hair falls out, it's like, “Ooh, yeah, she gets sued for that.” But if you're like, this will taste better to kids if we put antifreeze in it. You're in trouble a lot.
Dr. Matt McCarthy: [00:58:13] What you're hitting upon is one of the things that I find so fascinating, which is the history of human experimentation and how is it that we test things out on people. And what I like to write about and think about is how we get informed consent from patients. You know, I show up in the hospital treating people, but I also approached them about enrolling in clinical trials. And what I wrestle with are the people who are a bit too eager to join the trial. And I'll say, you know, we've got this new drug. It's really this condition that you have. And I don't think they even necessarily understand what I'm saying, but they say, yeah, sure I'll do it.
Jordan Harbinger: [00:58:47] Well, they trust you so they assume that you're recommending it.
Dr. Matt McCarthy: [00:58:51] Exactly, and you have to make it very clear. We don't know if this treatment's going to work. And somebody caught me in a really wonderful situation where they said, “I just have one question for you. Would you give this drug to your mom?” And that cut through 40 pages worth of discussion of what the risks and benefits were. And it was just on a very human level of like, “Okay, I don't understand what the superbug is. I don't understand what this antibiotic is. Just tell me would you give this to your family member.” And I said, “Yes.” And then the person said, “All right, that's good enough for me.”
Jordan Harbinger: [00:59:25] That's a really good question.
Dr. Matt McCarthy: [00:59:26] Yeah, it is a really good question.
Jordan Harbinger: [00:59:27] That person was very intelligent. We need more people like that. I do understand where you're coming from and where they're coming from. Because it's the conundrum is how do we get new drugs when it seems like everyone needs proof it's going to work before you can test it on people. But we need to test it on people in order to prove that it works. And human trials, human trials are really hard to get approved obviously and for good reason. But also, look, if someone's dying of terminal cancer, shouldn't we go, “Look, this might kill you.” “Yeah. Hello, I'm going to die in six months. Give me the kitchen sink. Feed me a freaking cheesecake for a month if you need to.”
Dr. Matt McCarthy: [01:00:01] Right. So this is something that is incredibly controversial in medicine. So the argument that you just made, which is, I'm dying, so let me try it anyway. I can get behind that very easily. I think that's a good argument. The counter to that is if I'm the researcher trying to create the drug I'm trying to show it works and I think you're going to die. Let's say I think you're going to die in two weeks. I don't necessarily want my drug to be tested on someone who's going to die anyway because it's going to make my drug look bad.
Jordan Harbinger: [01:00:32] Oh really?
Dr. Matt McCarthy: [01:00:34] Well, think about that. I haven't ever been in this position. I'm just sort of thinking hypothetically why, why would you withhold a drug from someone who's dying. And it's because if you give it to a hundred people who are all going to die in the next two weeks, what is the evidence going to be for your drug. It turns out your drug kills people, it looks like. And so that's one of the reasons we sometimes withhold these things. As a parent, I think about with my own family, I would want to have the right to try is what this is called. And I certainly appreciate where people are coming from. And that's one of the reasons I like writing about this stuff is rather than have policy proposals or talking about the finances of something, talk about the human beings in the lives that are impacted by this stuff.
Jordan Harbinger: [01:01:17] Is this your model? We defend the defenseless or is that like a—?
Dr. Matt McCarthy: [01:01:20] That is my mentor, this guy Tom Walsh, who I have spent the past 10 years working with. He is a world expert in a variety of infections, most prominently fungal infections that affect kids. And that's what he wakes up every day thinking I'm going to go out and defend the defenseless. I have tried to absorb some of that from him because it's such a powerful motto and he's a very well known in the infectious disease world, but very essentially unknown outside of it. And that's one of the reasons I wrote about him is I wanted people to become aware of these unsung heroes who are trying to develop new drugs, who are trying to save lives and sort of look at the challenges that they're facing on a daily basis.
Jordan Harbinger: [01:02:07] You mentioned in the book that there's a disparity between poor people in poor countries and then being able to get even basic drugs like penicillin. What's, what's going on here? How come drugs that are pretty common are hard to get?
Dr. Matt McCarthy: [01:02:20] Penicillin, there is this special ingredient in the making of penicillin that has to be produced by only one of four companies around the world.
Jordan Harbinger: [01:02:31] Because of patents stuff.
Dr. Matt McCarthy: [01:02:32] Stuff with that, but also just sort of these manufacturing agreements and it costs roughly $20 million to keep one of those plants open for every year. And so if a company is not making a profit off of a drug like penicillin, they're not going to continue to make it despite the fact that we know in India, there are millions of people who need penicillin to prevent rheumatic heart disease or to prevent other types of infections or to treat other infections. But these companies that manufacture this stuff are just looking at their bottom line and they're not saying, “Oh look, the Sub-Saharan Africa really needs our drug.” They don't care and you know, we'll see periodically these gestures where a company will make their drug available to a poor area. I always feel very mixed emotions about that because I'm glad they're doing something, but I always want so much more and it always comes down to a financial decision.
Jordan Harbinger: [01:03:25] So they can't just ship over excess penicillin from the United States to this to Sub-Saharan Africa or it's just who's going to pay.
Dr. Matt McCarthy: [01:03:33] It's going to, who's going to arrange that? And you know, part of writing this about this story is to just get people to be fired up about it and be like you're just telling me that penicillin is not available in places where they desperately need it and the drug only costs like a couple of bucks and no one's on top of this. That was the outrage that I had as I was working on this. Many of the mentors who I've been drawn to in life are people like Paul Farmer who spends his life trying to get, um, HIV drugs and tuberculosis drugs to people in poor countries. And you know, just the fact that they don't have a voice and trying to give a voice to people who don't have treatment options. Sometimes that's just my patients in New York City and other times people who are in other parts of the world and no one seems to care.
Jordan Harbinger: [01:04:23] That is actually really disgusting in a way. And it reminds me of those commercials from when I was a kid to Sally Struthers being like for 30 cents a day and they showed them or thinks something into some kid's mouth and it's like now he's not going to go blind.
Dr. Matt McCarthy: [01:04:35] Yeah, that's right. And the same thing is true of antibiotic-resistant bacteria. We've just got to sort of enter this into the conversation. My angle on this is not that I am fearful, I'm actually optimistic that we've got all of these new discoveries we're finding whether it's CRISPR or these antibiotics that are in the soil and we just need people to care about this enough to see it through, to get those discoveries to the patients who need them most, whether it's here or in other parts of the world.
Jordan Harbinger: [01:05:10] In the book that there's an interesting story about the anthrax attacks and how there's also anthrax in Siberia. Tell me what’s going on here.
Dr. Matt McCarthy: [01:05:20] This is one of the cool parts about superbugs is that they can be weaponized. This is one of the reasons the department of defense invests in research related to superbugs and to antibiotics because they realize that this is a real national threat. I talk about how there was an anthrax outbreak 20 years ago and it was a disgruntled employee who was mailing anthrax to people.
Jordan Harbinger: [01:05:48] Where do you get anthrax?
Dr. Matt McCarthy: [01:05:49] Well, he worked in an anthrax lab and what ended up happening was we thought this was one-off, that he was this crazy person doing this. But then something happened a few years ago, which is that with the climate-altering, there was some melting in Russia toward the North Pole and it exposed some rain deer carcasses, that had been frozen for years.
Jordan Harbinger: [01:06:17] How many years are we talking about?
Dr. Matt McCarthy: [01:06:19] Decades. Inside the carcasses was anthrax and what we find is that many drug-resistant bacteria could live in one species and kill another one. And so these reindeer may have been just hanging out with anthrax on their skin or on in their mouth but when the ice melted, it allowed the anthrax to get into the community and we had to airlift people out of Russia to protect them. And so when you think about how our climate may continue to change and nobody can really predict what that change will be, we may be seeing other types of infections that become more prominent and anthrax is sort of this case study of what can happen when we started getting exposed to reindeer carcasses.
Jordan Harbinger: [01:07:05] Yeah. Well you also said that there's bacteria in caves underground that's been isolated for over four million years. There's no way anything above ground is immune to something that's four million years old and isolated.
Dr. Matt McCarthy: [01:07:17] You’re right It's like when Christopher Columbus came to the United States.
Jordan Harbinger: [01:07:20] And brought smallpox.
Dr. Matt McCarthy: [01:07:22] That’s right and wiped out all kinds of people. And it's the same thing that you start bringing up stuff from the caves 4,000 feet underground, who knows what's going to happen. But what we can do to prepare ourselves is to have a more diverse collection of antibiotics so that when infections happen, we aren't saying, “Oh my gosh, do we have anything to treat this?” We want to be in a position to say, “We got lots to treat this and let's make a plan and cure this right now.”
Jordan Harbinger: [01:07:48] Yeah. I'm, I'm wondering like, “Oh look, there's a [indiscernible] [01:07:50] under this ice cap. Let’s grab this thing and study it.” And then it's like, “Oh, there's a thing in there that's going to kill half of the population.”
Dr. Matt McCarthy: [01:07:58] That could be a Jurassic Park sequel. But you're absolutely right, we have to handle these things with great care.
Jordan Harbinger: [01:08:04] I know it's like I've been watching too much Discovery Channel or whatever sci-fi reading, what is it, Michael Crichton novels or something. But these things are really filling out and there's stuff in there that we'd just never seen.
Dr. Matt McCarthy: [01:08:15] That's right. He's the one who got me I'm interested in writing. He is a Harvard med guy and I remember being 10 years old reading Michael Crichton books and saying, I want to do this. I want to be a doctor who writes and follows that. He did a very different type of writing. I'm doing more stuff based on what's happening in the hospitals right now, but he is a, a mentor of sorts as well.
Jordan Harbinger: [01:08:39] What about this plague we might get here in LA? I was talking with Dr. Drew last week and he said, “Look Jordan, we got to get these politicians. You're a lawyer. Let's get these politicians on the hook for negligent behavior.” Because what he's saying is there are rats in the homeless in LA. No surprise there. There's a homeless population in LA that is ridiculous. We've had something like a thousand deaths this year in the homeless population and they're getting things like typhoid and the bubonic plague literally. We know this because cops are going to the hospital and going, “Wait, you have typhoid or something crazy and how did you get this?” “Oh, well I arrested homeless people on Skid Row last week and one of them coughed on me or whatever it is.”
Dr. Matt McCarthy: [01:09:21] This is one of the, when we try to predict what the next pandemic is going to be, most people believe it's going to be an infection that goes from animals to humans. One that we hear about a lot now is called the Nipah virus, which is predicted to be one of the next great pandemics. It's N-I-P-A-H and it is similar to like the bubonic plague and some of these other things where if you are constantly exposed to animals that are not housebroken animals that are or are vermin that should be out in the wild somewhere and you're getting bit by those or licked by those, that is how an infection can go from animal to man and can wipe out millions. You think about something like the bird flu, avian influenza, and these things can leap from one species to another. And when you have a large homeless population, um, they may be encountering, you know, rats and dogs and wild dogs and deer, coyote. These infections can leap from one species to another end cause of disaster.
Jordan Harbinger: [01:10:28] Yeah. It's not just people getting bitten by rats, but I'm thinking, my friend, told me the other day, “Oh yeah, we have this neighborhood cat kind of lives outside, but it'll come into my house and it plays with my kids and we feed it and that goes to the neighbor's house and I'm like, and then it goes in the woods and eats a mouse, which has eaten rolling around on the feces of whatever in the woods.” “And then it's coming into your house.”
Dr. Matt McCarthy: [01:10:47] And what we need to have is just more awareness of how this is happening so that we can come up with treatments to prevent this from being some sort of outbreak.
Jordan Harbinger: [01:10:57] Yeah. Wow. Well, I'm glad you're on the case. This is super interesting. Should I shake your hand up? I don’t know.
Dr. Matt McCarthy: [01:11:02] You’re okay. You're okay. I washed my hands.
Jordan Harbinger: [01:11:03] All right. Get the Purell, Jen. Get the Purell out. Thank you very much.
Dr. Matt McCarthy: [01:11:07] All right, that was great.
Jordan Harbinger: [01:11:10] This is a fascinating episode. At the end, I definitely went and washed my hands a lot. Shook hands with this guy who just coming and saying, “I just came straight from the hospital dealing with experimental drugs and infections.” It's like, “Oh, hold on.” What was funny about this episode was afterwards I told him because we went to go do Howie Mandel and it was like a couple of days. It was I think the day before and Howie goes, “What else are you doing this week?” And I said, “Oh, we're going to interview this infectious disease specialist.” And he kicked his chair back and was like, “Wait, when is that?” I said, “Tomorrow.” And he's like, “Oh, oh, thank God.” And I said, “Yeah, we did that on purpose because we weren't sure.” And he's like, “Thank you, I really appreciate that.” He was not kidding. I thought that was kind of funny. So he got in my head and then I did the interview with Matt McCarthy and he's like, yeah, sometimes I have to tell people that I didn't just come straight from work when I go out on dates and stuff like that. That was kind of comical. “What do you do?” “Oh, I'm an infectious disease specialist.” “Check please.”
Jason DeFillippo: [01:12:02] Yes, seriously.
Jordan Harbinger: [01:12:03] Did I let him have a bite of my rice pudding? I can't remember.
Jason DeFillippo: [01:12:06] The check and a gallon of Purell.
Jordan Harbinger: [01:12:08] The check and the gallon of Purell exactly. The book title by the way, is Superbugs. Links to that will be in the show notes. We're teaching you how to connect with great people and manage relationships using systems and tiny habits in our Six-Minute Networking course. That's all free and that's at jordanharbinger.com/course. Do it now. Dig the well before you get thirsty. Don't try to wait until you need something cause everybody knows you just want to slam the phone down when people who you haven't heard from in two years ask for something. These drills are designed to take a few minutes a day. I wish I knew this stuff 20 years ago. It's all free and it's at jordanharbinger.com/course. Most of the guests here on the show do subscribe to the newsletter and the course and you get the newsletter when joining the course. So come join us, and you'll be in some smart company. Speaking of building relationships, tell me your number one takeaway here from Dr. Matt McCarthy. I'm at @JordanHarbinger on both Twitter and Instagram. There's a video of this interview on our YouTube channel at jordanharbinger.com/youtube.
[01:13:04] This show is produced in association with PodcastOne and this episode was co-produced by Jason The Anti-Anti-Vaxxer DeFillippo and Jen Harbinger. Show notes and worksheets are by Robert Fogarty and I'm your host Jordan Harbinger. I read everything you send me, especially reviews, so please review us on Apple Podcasts so that others can find the show. Go to jordanharbinger.com/subscribe if you need instructions on how to do that. And remember, we rise by lifting others. The fee for this show is that you share it with friends when you find something useful and that should be in every episode, so please share the show with those you love and even those you don't. In the meantime, do your best to apply what you hear on the show, so you can live what you listen, and we'll see you next time.
Jordan Harbinger: [01:13:45] This podcast today is sponsored by another podcast called Disgraceland. Disgraceland, great title, I am jealous. It's hosted by Jake Brennan. Disgraceland is a true-crime podcast about musicians specifically getting away with murder, behaving really badly. Each episode traces the most insane criminal stories surrounding our most interesting and infamous pop stars. Jerry Lee Lewis, his fifth wife, dead, Sam Cooke 3 a.m. in a seedy motel dead, Sid and Nancy dead. Why? Because musicians are freaking crazy because crazy things happen to them. We love those things and those people and we let them get away with it. Johnny Cash, Amy Winehouse, Kurt Cobain, the Rolling Stones, the Hell’s Angels run security, all that is on Disgraceland. If you love true crime and you love music, I think you'll love disgrace land so you can listen to that at Apple podcasts on the iHeartRadio app or wherever you're listening to this show.
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