Really accessible and interesting read about the history of phage science, and the personalites that drove the research - although some of the scene-setting details about antimicrobial resistance could have been better presented.
This is mostly a history of bacteriophage therapy with an emphasis on the pioneering work of French bacteriologist Felix d'Herelle beginning before World War I. Much of the early work was done during the Great War in places like the Soviet Union to combat bacterial infection associated with battlefield wounds. D'Herelle himself went to such places as India to study cholera phages and was able to save the lives of many people.
Bacteriophages are viruses that exclusively attack bacteria much the same way other viruses attack our cells by invading and taking over the DNA machinery to reproduce themselves. After getting the bacterium to produce perhaps as many as a thousand or more viruses the phages burst open the bacteria cells walls with enzymes and flow out to attack other bacteria. With such a multiplier effect it doesn't take long to infect and destroy billions of bacteria. Typically there are some bacteria that are immune to the particular phage but their numbers are so small that our immune systems finish them off. Some of the cures in the book have been spectacular. Hausler reports on dying patients up and feeling fine in a day or two.
Over the years there were many such successes. However, because the actual studies and experiments were conducted with less rigor than modern standards require and because there were dosage problems and unsubstantiated claims, bacteriophage therapy has had a checkered history. When penicillin and other antibiotics came into widespread use in the forties, phage therapy was all but forgotten. Now with bacteria becoming more and more resistant to antibiotics, interest in phage therapy has returned. Hausler devotes a significant portion of the book describing the problems and promises of phage therapy and explains why progress toward using phages against resistant bacteria has been so slow.
Where it seems likely that new successes will occur (and are occurring) is in veterinarian medicine. Until it becomes easier (and cheaper) to get phage products through the FDA in the US, most of the work will probably be with animals, especially those animals like cows, pigs, and chickens that become our food. With part of the problem of bacteria becoming resistant to antibiotics due to their use in animal feed, using phage therapy instead, or in combination with antibiotics, could become widespread.
While it is true that bacteria evolve and become resistant to their phages, it is also true that phages themselves can evolve to bypass bacterial resistance. In other words there is a primordial "arms war" going on between phages and bacteria of which we can take advantage. One method microbiologists use to find phages that work against specify bacteria is to take water from sewers where the bacteria have been excreted from people or animals and search that water for phages. There will be found the phages that have evolved to attack the bacteria that have evolved!
The book has plenty of endnotes and a good index. Of special interest perhaps are the appendices, one listing common bacteria and what they do to us, and the other detailing the advantages and disadvantages of phage therapy.
All and all this is a good introduction to an exciting and promising area of medical science. But note well the question mark at the end of the book's subtitle: "A Solution to the Antibiotic Crisis?" It would appear that phage therapy will not solve the crisis by itself, but will most likely allow us to rely less on antibiotics, thereby allowing some antibiotics to be used for longer periods of time before bacterial resistance sets in.
Phages are virus that can destroy bacteria including msra type bugs which are increasingly resistant to antibiotics. They have been used for about a hundred years but R&D came to an abrupt end in around 1945 when penecillin appeared. Apart from in Georgia and where phage therapy is still used. This book provides a genuinely fascinating history.
There is a muted resurgence of interest in phages simply because a number of bugs are defying treatment and people are dying again. But phage therapy is not like antibiotic therapy, it's much more complex and personalised. Alot of antibiotics can be made and dispensed for pennies but phage therapy requires a clearer diagnosis of the bug or bugs causing the problem and then the formulation of a cocktail of phages from a well tended phage bank (they're living organisms so they can't just sit on a shelf). It's not simple and it's not cheap.
That this therapy is efficacious can be under no doubt whatsoever and a number of Western companies have spotted the market potential but little has come to light. This is because the FDA who controls drug licensing isn't skilled in understanding this kind of therapy and we're not yet at the point of pre penecillin levels of death and decimation so the pressure and impetus isnt there. We all want a level of confidence that the drugs we take won't do us more harm than good and the necessary clinical trials and efforts to get to market now cost well upwards of $500m; just staggering sums of investment (and risk).
Phage therapy has a couple of really interesting facets. The first is that when you take them they self eliminate - they feed on specific nasty bugs and once they're dead the phages die too. The second is that when they are administered they have a halo effect and their presence in the environment will defend other people - that's great but you can see why this feels like a huge licensing challenge.
What little Western efforts there are with developing phage therapy now seems to be directed at animals where it could still be hugely beneficial as an alternative to antibiotics (which despite having that precious licence still do a lot of damage alongside the good).
The story of Georgian phage therapy is one of the most admirable stories of medicine I have ever, ever heard. I want to hug them all. Absolutely heroic. They have my utmost respect. I am humbled.
My worry is that antiobitic resistance and deaths will sharply escalate and phage therapy will have small waxes and wanes but fundamentally the licensing process (and politics) will fail to face up to a different risk:reward model so phage therapy will be left at the margins and out of reach for pretty much everyone. We will have people dying all over the place again while a viable treatment is in our reach but be crippled to instantiate it and fearful of unknown consequences. We need to start prepping ourselves for some really, really tough debates about where antibiotic resistance is going and it might not be fair to let the FDA struggle alone with this issue.
This book is extremely interesting and very well written. It gives a history of phage therapy, together with its potential applications. Given that antibiotics are increasingly less effective, the world needs an alternative and the potential of phage therapy to provide this is extremely high. This makes it a very important book as it gives a very good overview together with examples. It is also written very much like a novel or thriller and is a real page turner, personally, I could not put it down until I had finished it. I thoroughly recommend this book to anyone who has never heard of phages and would like to know more as well as anyone who is just looking for a good thriller.