This is my great uncle , my father 's father 's younger brother .
His name was Joe McKenna .
He was a young husband and a semi-pro basketball player and a fireman in New York City .
Family history says he loved being a fireman , and so in 1938 , on one of his days off , he elected to hang out at the firehouse .
To make himself useful that day , he started polishing all the brass , the railings on the fire truck , the fittings on the walls ,
and one of the fire hose nozzles , a giant , heavy piece of metal , toppled off a shelf and hit him .
A few days later , his shoulder started to hurt .
Two days after that , he spiked a fever .
The fever climbed and climbed .
His wife was taking care of him , but nothing she did made a difference , and when they-??? got the local doctor in , nothing he did mattered either .
They-??? flagged down a cab and took him to the hospital .
The nurses there recognized right away that he had an infection , what at the time they-??? would have called " blood poisoning , "
and though they-??? probably did n't say it , they-??? would have known right away that there was nothing they-??? could do .
There was nothing they-??? could do because the things we use now to cure infections did n't exist yet .
The first test of penicillin , the first antibiotic , was three years in the future .
People who got infections either recovered , if they-??? were lucky , or they-??? died .
My great uncle was not lucky .
He was in the hospital for a week , shaking with chills , dehydrated and delirious ,
sinking into a coma as his organs failed .
His condition grew so desperate that the people from his firehouse lined up to give him transfusions hoping to dilute the infection surging through his blood .
Nothing worked . He died .
He was 30 years old .
If you look back through history , most people died the way my great uncle died .
Most people did n't die of cancer or heart disease , the lifestyle diseases that afflict us in the West today .
They-??? did n't die of those diseases because they-??? did n't live long enough to develop them .
They-??? died of injuries -- being gored by an ox , shot on a battlefield , crushed in one of the new factories of the Industrial Revolution -- and most of the time from infection , which finished what those injuries began .
All of that changed when antibiotics arrived .
Suddenly , infections that had been a death sentence became something you recovered from in days .
It-??? seemed like a miracle , and ever since , we have been living inside the golden epoch of the miracle drugs .
And now , we are coming to an end of it .
My great uncle died in the last days of the pre-antibiotic era .
We stand today on the threshold of the post-antibiotic era , in the earliest days of a time when simple infections such as the one Joe had will kill people once again .
In fact , they-??? already are .
People are dying of infections again because of a phenomenon called antibiotic resistance .
Briefly , it-??? works like this . Bacteria compete against each other for resources , for food , by manufacturing lethal compounds that they-??? direct against each other .
Other bacteria , to protect themselves , evolve defenses against that chemical attack .
When we first made antibiotics , we took those compounds into the lab and made our own versions of them , and bacteria responded to our attack the way they-??? always had .
Here is what happened next : Penicillin was distributed in 1943 , and widespread penicillin resistance arrived by 1945 .
Vancomycin arrived in 1972 , vancomycin resistance in 1988 . Imipenem in 1985 , and resistance to in 1998 . Daptomycin , one of the most recent drugs , in 2003 , and resistance to it just a year later in 2004 .
For 70 years , we played a game of leapfrog -- our drug and their resistance , and then another drug , and then resistance again --
and now the game is ending .
Bacteria develop resistance so quickly that pharmaceutical companies have decided making antibiotics is not in their best interest ,
so there are infections moving across the world for which , out of the more than 100 antibiotics available on the market , two drugs might work with side effects , or one drug , or none .
This is what that looks like . In 2000 , the Centers for Disease Control and Prevention , the CDC , identified a single case in a hospital in North Carolina of an infection resistant to all but two drugs .
Today , that infection , known as KPC , has spread to every state but three , and to South America , Europe and the Middle East .
In 2008 , doctors in Sweden diagnosed a man from India with a different infection resistant to all but one drug that time .
The gene that creates that resistance , known as NDM , has now spread from India into China , Asia , Africa , Europe and Canada , and the United States .
It-??? would be natural to hope that these infections are extraordinary cases , in the United States and Europe , 50,000 people a year die of infections which no drugs can help .
A project chartered by the British government known as the Review on Antimicrobial Resistance estimates that the worldwide toll right now is 700,000 deaths a year .
That is a lot of deaths , and yet , the chances are good that you do n't feel at risk , that you imagine these people were hospital patients in intensive care units or nursing home residents near the ends of their lives , people whose infections are remote from us , in situations we ca n't identify with .
What you did n't think about , none of us do , is that antibiotics support almost all of modern life .
If we lost antibiotics , here 's what else we 'd lose : First , any protection for people with weakened immune systems -- cancer patients , AIDS patients , transplant recipients , premature babies .
Next , any treatment that installs foreign objects in the body : stents for stroke , pumps for diabetes , dialysis , joint replacements .
How many athletic baby boomers need new hips and knees ?
A recent study estimates that without antibiotics , one out of ever six would die .
Next , we 'd probably lose surgery .
Many operations are preceded by prophylactic doses of antibiotics .
Without that protection , we 'd lose the ability to open the hidden spaces of the body .
So no heart operations , no prostate biopsies , no Cesarean sections .
We 'd have to learn to fear infections that now seem minor .
Strep throat used to cause heart failure .
Skin infections led to amputations .
Giving birth killed , in the cleanest hospitals , almost one woman out of every 100 .
Pneumonia took three children out of every 10 .
More than anything else , we 'd lose the confident way we live our everyday lives .
If you knew that any injury could kill you , would you ride a motorcycle , bomb down a ski slope , climb a ladder to hang your Christmas lights , let your kid slide into home plate ?
After all , the first person to receive penicillin , a British policeman named Albert Alexander , who was so ravaged by infection that his scalp oozed pus and doctors had to take out an eye , was infected by doing something very simple .
He walked into his garden and scratched his face on a thorn .
That British project I mentioned which estimates that the worldwide toll right now is 700,000 deaths a year also predicts that if we ca n't get this under control by 2050 , not long , the worldwide toll will be 10 million deaths a year .
How did we get to this point where what we have to look forward to is those terrifying numbers ?
The difficult answer is , we did it to ourselves .
Resistance is an inevitable biological process , but we bear the responsibility for accelerating it . We did this by squandering antibiotics with a heedlessness that now seems shocking .
Penicillin was sold over the counter until the 1950s . In much of the developing world , most antibiotics still are .
In the United States , 50 percent of the antibiotics given in hospitals are unnecessary .
Forty-five percent of the prescriptions written in doctor 's offices are for conditions that antibiotics cannot help .
And that 's just in healthcare .
On much of the planet , most meat animals get antibiotics every day of their lives , not to cure illnesses , but to fatten them up and to protect them against the factory farm conditions they-??? are raised in .
In the United States , possibly 80 percent of the antibiotics sold every year go to farm animals , not to humans , creating resistant bacteria that move off the farm in water , in dust , in the meat the animals become .
Aquaculture depends on antibiotics too , particularly in Asia , and fruit growing relies on antibiotics to protect apples , pears , citrus , against disease .
And because bacteria can pass their DNA to each other like a traveler handing off a suitcase at an airport , once we have encouraged that resistance into existence , there is no knowing where it-??? will spread .
This was predictable .
In fact , it-??? was predicted by Alexander Fleming , the man who discovered penicillin .
He was given the Nobel Prize in 1945 in recognition , and in an interview shortly after , this is what he said : " The thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to infection with a pencillin-resistant organism . "
He added , " I hope this evil can be averted . "
Can we avert it ?
There are companies working on novel antibiotics , things the superbugs have never seen before .
We need those new drugs badly , and we need incentives : discovery grants , extended patents , prizes , to lure other companies into making antibiotics again .
But that probably wo n't be enough .
Here 's why : Evolution always wins .
Bacteria birth a new generation every 20 minutes .
It-??? takes pharmaceutical chemistry 10 years to derive a new drug .
Every time we use an antibiotic , we give the bacteria billions of chances to crack the codes of the defenses we 've constructed .
There has never yet been a drug they-??? could not defeat .
This is asymmetric warfare , but we can change the outcome .
We could build systems to harvest data to tell us automatically and specifically how antibiotics are being used .
We could build gatekeeping into drug order systems so that every prescription gets a second look .
We could require agriculture to give up antibiotic use .
We could build surveillance systems to tell us where resistance is emerging next .
Those are the tech solutions .
They-??? probably are n't enough either , unless we help .
Antibiotic resistance is a habit .
We all know how hard it-??? is to change a habit .
But as a society , we 've done that in the past .
People used to toss litter into the streets , used to not wear seatbelts , used to smoke inside public buildings .
We do n't do those things anymore .
We do n't trash the environment or court devastating accidents or expose others to the possibility of cancer , because we decided those things were expensive , destructive , not in our best interest .
We changed social norms .
We could change social norms around antibiotic use too .
I know that the scale of antibiotic resistance seems overwhelming ,
but if you 've ever bought a fluorescent lightbulb because you were concerned about climate change , or read the label on a box of crackers because you think about the deforestation from palm oil , you already know what it-??? feels like to take a tiny step to address an overwhelming problem .
We could take those kinds of steps for antibiotic use too .
We could forgo giving an antibiotic if we 're not sure it-??? 's the right one .
We could stop insisting on a prescription for our kid 's ear infection before we 're sure what caused it .
We could ask every restaurant , every supermarket , where their meat comes from .
We could promise each other never again to buy chicken or shrimp or fruit raised with routine antibiotic use ,
and if we did those things , we could slow down the arrival of the post-antibiotic world .
But we have to do it soon .
Penicillin began the antibiotic era in 1943 .
In just 70 years , we walked ourselves up to the edge of disaster .
We wo n't get 70 years to find our way back out again .
Thank you very much .