#19: What’s the future of antibiotics?

Quinn: Welcome to Important, Not Important. My name is Quinn Emmett.

Brian: And my name is Brian Colbert Kennedy.

Quinn: That's right and this is episode 19 with Dr. Gautam Dantas. And we're talking about fun, how to build new antibiotics in the post-antibiotic era.

Brian: Which, turns out, is really, really scary.

Quinn: Yeah, super scary. I would say, I would use the technical term, fucking terrifying.

Brian: Fucking terrifying. Yeah.

Quinn: But exciting.

Brian: Yeah, he's very optimistic about it.

Quinn: Potentially exciting, let's use that word.

Brian: And then it's really scary.

Quinn: He's more optimistic than we are, which, if that was the other way, not good.

Brian: Oh God, we'd be so fucked.

Quinn: If we were like, "Hey, it's gonna be great."

Quinn: And he'd be like, "Not so much."

Brian: Yeah, and the smartest guy that we know is like, "Nooo."

Quinn: No, you're wrong. Right, yeah, no. Dr. Dantas. Professor of Pathology and Immunology and Biomedical Engineering at the Washington University School of Medicine St. Louis. His Twitter bio is basically everything on your dating profile, Brian, right?

Brian: Same stuff. Bow-tie enthusiast. I'm a husband and father, which is really bad for the dating profile. Microbial ecologist, genomicist, computational biologist, and then fun stuff like home brewer, and gardener, and foodie, and quote pretentious cocktail mixologist.

Quinn: His words, not ours. But again, checks all of our boxes.

Brian: Yeah, we're the same person. 

Quinn: Again, I mean this in the best way. He's like the smartest, most enthusiastic Care Bear of all time. I mean I can't imagine working with this guy, right?

Brian: It seems like it would be a pretty fun job, and what you just said, working with him, not for him, which he pointed out, which was so cool.

Quinn: Yeah, you're feeling kinda shitty today, huh?

Brian: I'm feeling a little shitty today.

Quinn: What do you got going on?

Brian: I don't know. I woke up with a thing in my throat yesterday. Then I started taking all the drugs and then I woke up today with new stuff. 

Quinn: We just talked to one of the planet's, and I guess in that case universe's, premier bacteria folks. That's technical. So, you're not taking any of that ...

Brian: I'm not taking any fucking antibiotics. 

Quinn: No, no. Right, but you're also not taking any of that homeopathic bullshit, right?

Brian: Well, first of all, don't say homeopathic bullshit. 

Quinn: What?

Brian: What do you mean? There's some people that really believe in that. 

Quinn: And they're fucking wrong. Are you kidding me?

Brian: No, I'm just taking the normal stuff. A lot of Zicam. Zicam's supposed to really nip it in the bud. 

Quinn: Isn't that the one that made it so you couldn't smell anymore? Didn't they lose a lawsuit on that?

Brian: Yeah, yeah.

Quinn: Good. How's that going?

Brian: Oh, I smell everything.

Quinn: Great. Well, let's go back to the homeopathic thing here.

Brian: What's it smell like in here?

Quinn: What do you mean some people really believe? Brian, that's the whole point of this fucking podcast. 

Brian: I'm just ... No, agree, but what if some of those people are listening right now and they're thinking, "Oh, maybe I should ..."

Quinn: They can fuck the fuck off.

Brian: No, we don't wanna fuck them the fuck off. We wanna change their minds. 

Quinn: And they should have changed ...

Brian: Listen, everybody's lovely. [crosstalk 00:03:00].

Quinn: Yeah, no. They're all lovely, but that is one I'm not down with. It's just preposterous. 

Brian: No, I know. I know.

Quinn: It's ... Ugh, God.

Brian: I'm taking normal medicine.

Quinn: Empirical evidence.

Brian: You don't have to ... Who are you talking ... I know. I was just saying let's not turn off anybody if they were ... I'm not taking any ... What is a homeopathic drug? Like lemon juice?

Quinn: They're like the little fucking sugar pills and things everybody ... Even CVS still sells ... It's ridiculous. Anyways. 

Brian: I'm feeling fine. I'm happy to be here.

Quinn: I get very few things I'm agro about and it's like, scientific skepticism ... Evidence. Evidence.

Brian: It makes no sense. I got really [crosstalk 00:03:33].

Quinn: Vaccines, great. Homeopathic stuff that your grandma said worked when she rubbed it on her wounds, doesn't work. 

Brian: Giving your children's friends whooping cough. 

Quinn: Right. 

Brian: So, just use the fucking drugs. Yeah, no no. I'm in complete agreement.

Quinn: Okay.

Brian: I'm feeling fine. 

Quinn: You sleeping?

Brian: Yeah. So much sleeping that I overslept this morning, didn't I? And I apologize. I still made it here pretty quickly. I get ready so fucking fast man.

Quinn: But were you ready when you got here though? You were disheveled.

Brian: Disheveled is a strong word. I got in, I settled myself like you said. You brought coffee like the sweet man that you are, and we had a hell of a convo. 

Quinn: I take care of you. 

Brian: You really do. Hey, what's going on with your underwear?

Quinn: Yeah, we can come back to that. So, listen, I was browsing Wirecutter, as you do for other things I don't need.

Brian: Wirecutter's great. 

Quinn: And one of their headlines ... What was it? They don't give you like 40 recommendations like Consumer Reports, which is great. They're just like, "This is the best thing in the category. Buy this thing."

Brian: Love that.

Quinn: And then they give you all the reasons that they're qualified to tell you about it, and then tell you all about the thing, and then also the competitors. Anyways, the point is, they had best boxer briefs for men. 

Brian: I thought they stuck to tech shit. I didn't know they did [crosstalk 00:04:56].

Quinn: No, it was tech and they had another website called The Sweethome or something. They combined them when The New York Times bought them. 

Brian: Oh oh. Got it, got it, got it.

Quinn: Yeah, so they've got all kinds of stuff. 

Brian: Wow, best boxer briefs, huh?

Quinn: Yeah, it's very dangerous. But anyways, I don't think I've ever done boxer briefs. It's either one or the other, but you ...

Brian: It's a fabulous symbiotic ...

Quinn: You seem visibly upset by the fact that I still do boxers. You called them loose shorts. 

Brian: They are not underwear.

Quinn: Am I behind on this?

Brian: Very behind. 

Quinn: I thought that was a thing.

Brian: It was a thing. For sure. And I think that thing is done. 

Quinn: But it's very hard to tell because you can't see what people are wearing. 

Brian: Ever. And especially for [crosstalk 00:05:36].

Quinn: Where like other trends, you walk down the street, you're like, "Whoa. Guess I'm not wearing that. Put my Starter jacket away."

Brian: Yeah, no way. Well yeah, boxers are hard because pants are loose. I think I mentioned it last time, if I wore boxers you'd be able to tell because I would just have this bunch of clothing, fabric ...

Quinn: It would be a nightmare. Right, 'cause you have fucking Mick Jagger pants.

Brian: Under my Mick Jagger pants. But aside from that, just straight comfort and support, they offer none. 

Quinn: But the flip side of support is restriction and ...

Brian: Yeah, I mean don't buy a size too small for yourself. Just-

Quinn: Well, I mean that's what I do.

Brian: It's a correct size. Have you made any changes?

Quinn: No, I just saw this yesterday. 

Brian: I mean I just think you should maybe give it a whirl. 

Quinn: Should I try it?

Brian: You don't have to go straight to briefs.

Quinn: Is it sweaty in there?

Brian: I understand that that would be crazy. 

Quinn: I told you I wear briefs occasionally, but the really nice ones, those Patagonia ones. They're made out of immaculately conceived rare virgin seals.

Brian: I think that plays into your question of are they sweaty. Get the good ones that are made of the breathable fabric and ...

Quinn: I assume, I didn't dive into the Wirecutter thing 'cause I was like, "I can't buy those." But I assume if they call them the best that they're at least breathable. They're not like a concrete wall.

Brian: Yeah, I would imagine.

Quinn: Like a sweat dome. Nobody wants that.

Brian: Nobody wants a sweat dome in their undercarriage, that's for sure.

Quinn: Nope. Gautam doesn't have one of those. 

Brian: Probably not.

Quinn: Nah, he's so great.

Brian: God, he was cool.

Quinn: Let's go talk to that guy.

Brian: Alright, let's talk to Gautam.

Quinn: Alright, bye.

Quinn: Our guest today is Dr. Gautam Dantas and together, we're gonna discuss designing antibiotics in the post-antibiotics age. Dr. Dantas, welcome.

Gautam Dantas: Thank you, Quinn. It's a pleasure to be here. Thanks for having me on.

Brian: Yeah, we're very excited. Gautam, tell us real quick who you are and what you do.

Gautam Dantas: My official title is, I'm a professor of pathology and immunology at Washington University in St. Louis School of Medicine. I have a number of other titles, but they're sort of irrelevant here. Just other affiliations and departments. What I do here is I run a research lab, about 20 to 30 people, where we investigate microbes. So, these bugs that you can't see with the naked eye. Across a whole bunch of different scales. We're interested in, at the 30,000 foot view, how is it that microbes, both individually and in communities, respond to [inaudible 00:07:57]. So, if the environment changes or we try to mess with them, how did they respond? And then, we try to understand that from the perspective of clinical settings, like antibiotic resistance and pathogens, but we also try to sort of turn it on its head and maybe take that information to engineer bacteria to do good things. For instance, better probiotics, better ways in which to produce renewable fuels from plant matter. Things of that ilk. 

Quinn: Small potatoes though.

Brian: Awesome.

Gautam Dantas: Yes, yeah yeah. Very, very limited ambitions in our lab so ...

Quinn: It's kinda like your day Brian.

Brian: I do the exact same thing. That's so wild. 

Quinn: Right, just with coffee. And by the way, this is completely unrelated, but in our research on you, which is, again, always creepy when we say that. 

Brian: We've been looking you up man.

Quinn: I'm trying to think of the way to put this most succinctly, but looking at the people in your lab on your people page, there's like 30 full on geniuses working for you. And I was so excited to see that there's only like three white guys. 

Brian: Yes.

Quinn: That's amazing. It's like, "Finally." Our time is up now.

Gautam Dantas: Right so, one, little correction if you wouldn't mind. Not working for me, but working with me. The reason I come to lab, my major motivation is to hang out with these really cool people and to learn what they're thinking about. I always try to preface every talk I give publicly, to very sincerely say that any good science is team science. And I'm really, really fortunate to work with an awesome team. I think we, honestly, set out more focused on diversity of opinion. I love people who challenge me and make me think in new ways. And I think that has then manifested itself in diversity in other ways. 

Brian: That's so cool to hear.

Quinn: It's kind of the point that feels like folks have been trying to make for a while, which is one leads to the other. Or that's the idea and as you've said here, that has proven itself out. Feels like we could do a much better job of working on things like that. 

Gautam Dantas: Oh, there's no question. I think one of the most depressing and I'm hoping inspirational things I saw at a retreat that we just ... a mini symposium we had here, one of our students rather than spending time on a poster based on kind of their science, which is really cool, they instead presented a kind of provocative finding just looking at the distribution in terms of males, females, underrepresented minorities, and non-American born people in terms of who, and this is a demographic across professors across the nation. And it's as depressing as you might imagine. It's dominated by old white dudes.

Quinn: The worst. 

Gautam Dantas: And then women, who even though they represent well over 50% of undergraduates and graduates by the time you get to tenured faculty, they're down in the sort of middling teens. But probably the worst hit demographic across the board are US domestic minorities in terms of underrepresented folks. What he was doing in this case is just trying to take data and understand how that plays out at a "liberal" place like WashU in terms of who we invite in terms of seminar speakers in terms of their demographics. It's abysmal, right? Across the board, still. Even though it's the young, the people who we don't need to preach to that choir technically anymore who are part of the system. Eventually when you see who actually comes out and gives talks here about their research, it's still dominated by the old white dudes. And again, the worst demographic in terms of even further under-representation are the domestic underrepresented minorities. We just need to do something about that.

Quinn: Yeah, and I'll tell you. We face sort of the same issue here with the guests we try to get on. We are hellbent on having at least half women and many more people of color than the average, wherever the come from. And it's hard. And I'll look up sometime and be like, "Oh shit, we just had three white guys in a row." That is so frustrating as I'm actively working against that, and it's hard. You can be thankful for what all those old white guys have done over the past 50 years, but at the same time, it's like, "Time to go to [inaudible 00:12:30] here." Let's move on.

Gautam Dantas: At least again, you know you just have to seek out the diversity of opinion and I think it'll eventually work itself out. Otherwise, it's just in terms of science, right? Science just doesn't move as fast if you're in the echo chamber. 

Quinn: Well, and you see it come through too in things like, I can't remember if it was Google. There was an artificial intelligence piece that came out a couple months ago that said that it was just terrible using facial recognition for African American folks, and it's 'cause they just didn't train it on African American folks because there was no one in the lab. And it's like, "Yes, of course ..."

Brian: That is maddening. Gautam, let's set up our conversation for today. We are champions of action oriented questions and we are gonna dive deep on today's topic, which is pretty, pretty nerdy.

Quinn: Pretty, pretty nerdy. 

Brian: Pretty nerdy and awesome. And then we're gonna come up with some specific steps that everyone here can take to take action and make a little dent in the universe. Does that sound alright?

Gautam Dantas: Sounds perfect.

Quinn: So, Gautam, we start with one important question to really get to the heart of why you're here today. Instead of saying, tell us your life story; we like to ask, why are you vital to the survival of the species?

Gautam Dantas: Oh, something simple like that. Yeah. Okay.

Brian: Real easy question.

Quinn: Simple. We'll ease you into it.

Gautam Dantas: Exactly. There's no way to answer that question without some recognition of hubris, so I'll start with that. If there's a contribution that I'm making, it's hopefully honestly at the level of enticing other people to want to solve problems with me. It's not actually the specific problems. I mean I certainly think the problems I'm working on are important, but if I was to see myself as somewhat of a catalyst in terms of making this a better future, it's if I can draw in the right group of folks to think in ways that they haven't thought before, to encourage me to think in ways I haven't thought before, and then apply that to some fundamental understanding of how the world works. I think that's hopefully the best contribution I can hope for.

Quinn: I love it. That's great. Groups of diverse folks working together to save the world is like the Avengers, but once again, with fewer white guys. Because if there's anything I realized in watching Infinity War, which was great. 

Brian: It was.

Quinn: It's just like, boy there's a lot of white guys on that screen. Wow.

Gautam Dantas: Exactly.

Quinn: And then they didn't kill any of them. Spoiler alert. Anyways. Brian, did you not see it?

Brian: I haven't seen it yet. 

Quinn: Aw man, I'm sorry.

Brian: It's fine. 

Gautam Dantas: We saw it a few days ago so I think we're in the clear. 

Quinn: Alright Gautam, we're gonna establish some context sort of on our readers' level for today's topic. We call it a few different things, Context 101 with Professor Brian. It's an exclusive history lesson and it's greatly oversimplified. It often veers completely off course and is sometimes very wrong. It's a little bit like a book report you mostly furiously copied from the internet, plastering in your own barely informed opinions late the night before it was due. But that's why we've got you here to correct us.

Gautam Dantas: Fair enough.

Brian: It's so perfect for me to be doing this 'cause that's exactly what I did in school.

Quinn: Yeah, exactly.

Brian: We're usually joking about this stuff, but in this case ...

Quinn: In this specific case ...

Brian: Please remember that we are not doctors and always consult a professional before making changes to your medication.

Quinn: Right, and again, by the way, if you're interested in what's about to happen here, check out our previous episode with the wonderful Dr. [Naheet Vidalia 00:16:08] who remember everyone, be thankful if you have prayers or whatever those things might be at the end of the night, she is your last line of defense between you and basically the [inaudible 00:16:21]. So ...

Brian: So, first off. Let's talk about bacteria, okay? Not just the horrendous things that your child's hands are covered in after crawling around on the airport bathroom floor.

Quinn: My kids are so gross.

Brian: They're cute. But seriously, they're not all that.

Quinn: My kids or bacteria?

Brian: All your children aren't terrible. No, not all bacteria are bad. Don't let people say that. The bacteria in our gut keeps us alive, man. 

Quinn: True.

Brian: Some scientists say that the bacteria in our gut actually control everything from digestion to even our moods. 

Quinn: Right, and that's a eat a varied diet full of plants, kids. Right?

Brian: Yes. And speaking of plants, bacteria aren't plants and they're not animals.

Quinn: Well, what are they?

Brian: They are microscopic single celled organisms that exist in neighborhoods of millions of their friends everywhere, literally everywhere.

Quinn: It's like Brooklyn.

Brian: Growing constantly, mutating, both inside and outside other organisms.

Quinn: Wow. 

Brian: Yeah. We actually came from bacteria and some bacteria can glow. Some bacteria can causes species ending outbreaks also, and basically the entire Earth is just a big ball of bacteria. 

Quinn: That's amazing.

Brian: No bacteria, no cheese. No bacteria, no wine. No pickles, so ... You know, you're welcome.

Gautam Dantas: No bread, no beer. Yup.

Brian: No bread and no beer. Are you kidding?

Quinn: All of the wonderful things. 

Brian: They come in three shapes. Some of them eat food. Some make their own right at home. 

Quinn: It's like my mom with Blue Apron, or she uses Sun Basket I think.

Brian: Oh yeah. Those are so fun. Yes, the bacteria are like your mom. So, what do they eat? Well, they eat everything including, it turns out, antibiotics, which you know, not great Bob.

Quinn: We're gonna get to that. 

Brian: Antibiotics are great. They changed the 20th century. It used to be, "Got an infection? Cool. Here comes the saw. I'm gonna take your leg away from the rest of your body forever." Now you go to urgent care, you walk out in a few to several hours. Quick stop at CVS or whatever, and you're back to normal 10 days later like it never happened. 

Quinn: It's amazing.

Brian: It's easy. It's treatable. It's repeatable.

Quinn: Right? You can thank people like Louis Pasteur, one of my favorite books of all time, The Value of Believing in Yourself.

Brian: That's kind of part of the issue, right? Off, antibiotics, Netflix, repeat. We've become very comfy with this routine.

Quinn: So often, and now having kids, I see this happening all the time, but can I say something?

Brian: Please.

Quinn: Kids ... Let me tell you what happens now. They take a sick day, and you know what they get to do? Watch on TV anything.

Brian: Whatever.

Quinn: Anything that's ever been created from the history of mankind and they can order it with their whiny coughy little voice. "Siri, play Spartacus. Siri, play Finding Nevo. Siri, play Star Trek." You know what I had, Brian? I had whatever my mom was able to fight for at Video Update. Or once the town got fancy, Blockbuster. 

Brian: Ooh. Video Update.

Quinn: Or worn down Indiana Jones tapes we had at home. Anyways. All I'm saying is there's a lot of complaining and it's a little unfair. 

Brian: I remember [crosstalk 00:19:30].

Gautam Dantas: You know there's a lot of people listening to this who have no idea what you just said, right? "Blockbuster?"

Brian: "What were those words?"

Quinn: I know. "Tape?"

Brian: Getting back to bacteria. Very quickly here and the apocalypse that is forthcoming. We're prescribing and taking way too many antibiotics now and too frequently and for too many folks and in way, way, way too many of the animals we eat. And now, guess what? They mutated.

Quinn: My kids?

Brian: No, your kids are fine. The bacteria mutated. 

Quinn: Got it.

Brian: Antibiotics are working less well.

Quinn: Great, so what's the good news?

Brian: Well, the good news is that Gautam's here to tell us how he's gonna single-handedly save us from the future we've created?

Quinn: Perfect.

Brian: Which I think, is that Terminator 2?

Gautam Dantas: Yup, single-handedly. That's right, yeah.

Quinn: That's Terminator 2. Yup. Terminator 2. Gautam. 

Brian: No presh, Gautam.

Quinn: John Connor. Alright, so with that horrendous history lesson, let's focus on our topic of the weeks, which is designing antibiotics and dealing with bacteria, which it seems like we're finding out more and more about in this sort of post new antibiotic ...

Brian: Age. Yeah.

Quinn: So Gautam, you were in the news recently. Like you said, you're very busy. Can you tell us why?

Gautam Dantas: Yeah, sure. So, actually, first of all, Brian, whether you used a cheat sheet or not, that was a great intro, so I think you got it right.

Quinn: You can call it ...

Brian: That was off the top of my head. It was.

Quinn: You can call it a car wreck if you need to.

Gautam Dantas: No, no it wasn't. I think you hit all the right points and so, giving bacteria their due in terms of recognizing that most of them are good. That, not just many of them, in fact the estimate is our gut has trillions of bacteria in each individual [crosstalk 00:21:06].

Brian: Did I say millions? I meant trillions. You probably misunderstood.

Quinn: Just a factor of two.

Gautam Dantas: Lots more zeros, but then there a couple of these bad guys, right? What we gotta do with them, as you said, change 20th century is we try to kill them with these chemicals. About 10 years ago is where the story starts in terms of the one that just got published. We stumbled across this very bizarre finding. We know that as we've used antibiotics to try to treat the bad bugs, to try to kill them over the last 80 or 90 years, more and more of them have become resistant to those antibiotics. We've kind of come to accept that. That resistance is out there and we need to keep ahead of the game by coming with new antibiotics. 

Gautam Dantas: But 10 years ago, in a slightly weird experiment, a kind of bizarre experiment, we stumbled across this finding that there are bacteria out there in the soil that can actually munch on these antibiotics. They eat them as their sole source of food. So, just the way we think of most bacteria using something like glucose, right? Your standard sugar [crosstalk 00:22:06]. These guys were instead using antibiotics. Something actually got lost along the way that I should really emphasize more. Some of the bacteria we found can't even use glucose as their food. They would rather use penicillin. 

Brian: Oh, not even an option. Wow. 

Gautam Dantas: They lost the ability to use glucose, but they can eat these antibiotics. This goes back to what I was saying earlier, right? This is the shock and awe and really scary aspect of working on this because we thought that somehow some Frankenstein bugs had gone into our lab and we had to clear out, but then we calmed down a little bit and started asking why had this happened. This what's taken the 10 years is we described that phenomenon 10 years ago, lots of bugs and lots of different [crosstalk 00:22:47] around the country could munch on pretty much any antibiotic we threw at them. What we just disclosed, just because it took that long to figure out, was how four specific strains of these soil bacteria could utilize penicillin. So, it could eat penicillin; specifically, every single gene, every single pathway laid out. 

Gautam Dantas: Then, as a way in which to hopefully turn the tables on these bugs, we used that information to engineer a new strain of E. Coli to have that same property, the property to eat penicillin, as a potential way to maybe bio-remediate, to clean up all of the antibiotic contamination that comes from, or as you mentioned, wanton and overuse of antibiotics. That was one way in which we think that ... Even the motivation was sort of basic science. Let's understand this bizarre phenomenon. We thought, "Well, what application from this could be that we could actually help in the path of everything we do as humans in terms of dumping all our waste all over the place." One way in which to maybe be a little bit more responsible and come up with a strategy to clean up the antibiotics before they get leached out into the environment.

Quinn: Wow. 

Brian: Yeah.

Quinn: And again, we're always trying to, I don't wanna say dumb things down for our listeners, but our listeners are sort of the nerdy contingent of the Pod Save America folks. If you could clarify one thing for me, is this just something we discovered 10 years ago and we think has been ... they've had this ability or wanton desire to eat antibiotics the whole time or is that a new change?

Gautam Dantas: I should even clarify the record a little bit more. We stumbled across this phenomenon 10 years ago, but when you dig through the literature, there are actually studies dating back to the '60s where people describe a couple of bacteria that they've been able to identify from the environment that could eat a couple antibiotics. Then, there were a couple more reports in the '80s of this happening, but I think we just didn't have the technology back then to then do the one step further, which is to show how. What we did 10 years ago was show that these weren't just one off events, but that these bacteria were pretty diverse. Lots of different bugs could do this, and they could eat lots of different antibiotics. So expanded the kind of what was at the buffet table, if you will. So again, even though that was a big paper for us, in a sense, it was a rediscovery from something that the field had known, at least at some level, 50 years before that.

Quinn: Interesting.

Gautam Dantas: But then I think, maybe the crux of your question, is perhaps how old are these capacities, right? Are these things that have been sort of evolved over the human timescale or are they just old features that we haven't discovered before. And I put my money on the second, right? That is everything that we've done to kind of begin to maybe piece apart why these properties exist. Why do these bugs have this ability to eat our chemotherapeutics points, at least from an ecological perspective, to something that they evolved a really, really, really long time ago. 

Gautam Dantas: The reason we believe ... This is the same thing that happened with antibiotic resistance, right? The intuitive framing of it is a bug is susceptible, that is, it will die if you give it an antibiotic, an antibiotic will kill it, and then over time, it evolves some particular way in which to become resistant. That's the traditional framing of any new property being evolved. But really, when people dug deep if you will, we found as a field that antibiotic resistance in the environment is an ancient property. It's not a new thing. What we're doing is we're allowing existing resistance genes to amplify and [inaudible 00:26:33] into the bad bugs. 

Gautam Dantas: A really, really cool story that came out about 10 years ago now from this group in Canada led by Jer-

Quinn: I'm gonna ...

Gautam Dantas: I'm sorry. Go ahead.

Quinn: No, I was just gonna say, I'm gonna preface this by saying that you might think it's cool and everybody else might think it's fucking terrifying. So please, continue. 

Gautam Dantas: When I say cool, paraphrase fucking terrifying instead of that. Here's the deal. This group goes out, again led by Gerry Wright at McMaster University. They go to the provincial permafrost in Canada and they core out these samples that they can carbon date to be 30,000 years old. From these 30,000 year old samples, they sequence the DNA, and in that DNA sequence they find resistance genes against modern antibiotics. So this was very, very, very clear evidence that resistance in the environment clearly predates any human use of antibiotics. We weren't around making antibiotics 30,000 years ago, let alone 100 years. This was proof even though it's been speculated over and over again this what happened. 

Gautam Dantas: The nice explanation for this is we sort of think of antibiotics as these privileged molecules. These things that we should, and it makes sense, we should treat very carefully. They're gonna kill all of the bad bugs. But how did we find them? Almost all of these drugs that we use in the clinic now that we call antibiotics were originally discovered as natural products of soil bacteria. So, people literally went between the 1940s and 1960s, which was the heyday of this discovery. They cultured up bacteria from the soil and found that, lo and behold, some of them make these compounds, which kill other bacteria. That's all we did. We just borrowed that particular scheme from this very specific group of antibiotic producers. But think of what's going on in this case, right? These bugs have figured out a way in which to produce chemicals that kill lots and lots of other bacteria, which as it turns out would also mean they would kill themselves. If they did have a way in which to resist these really offense toxic molecules, as soon as they evolved that property, they would commit suicide. 

Gautam Dantas: There was this nice theory put forward almost 40-45 years ago by this guy Julian Davies and his colleagues, which was pretty simple. It said the antibiotic producer organisms must be the guys who initially evolved resistance. Basically for self protection. And they have had now over millions of billions of years to disseminate, to pass out these resistance cassettes to everyone else. Our discovery of antibiotic eating, even though it still surprises me when I say that, if you step back for a second and look at it from a bacterium's perspective or microbial community's perspective, it's just one more part of the cycle, right? These bugs are producing antibiotics, and so then some other bugs decided, "Okay it's a toxin, yup. It's gonna kill most of my neighbors and so maybe let's figure out a way in which to eat it." Again, terrifying from the perspective of the clinic, but not bizarre from the perspective of how compounds get exchanged between bacteria and the environment.

Quinn: Well then you also just have to give evolution credit. And again, reminder that bacteria were literally the first thing. They are the, what do the kids say Brian? The OG. The originals. 

Brian: The kids say the OG, yeah.

Quinn: Right? That's where we come from, of course they've had time to evolve and find ways to defeat ... They've been dealing with themselves much less these silly drugs that sounds like we like to say we developed them, but really we've just sort of stolen them.

Brian: Did some borrowing.

Quinn: We did some borrowing. 

Gautam Dantas: To give the organic chemists their due, I mean they have optimized them. We have come up with [crosstalk 00:30:17] versions of them, but the original molecules, yeah. Again, I'm stealing this phrase from a colleague of mine, but the very, very best chemists I know are bacteria. The very, very best biochemists I know are bacteria. They already know how to do these amazingly cool things. If we're lucky, we figure them out and then use them for our benefit. 

Quinn: Which is actually interesting, I would love to talk in a little bit about like you said, how do we turn into a benefit, like how you're just creating E. coli in the lab. But it enlightens a little bit sort of what has been ... and makes less surprising how bacteria has become more adapted to our antibiotics in the sense that we have given, again we've talked about the over-prevalence of antibiotics, especially in our food, in our water, and then in sort of the overprescription among humans. Then it makes it not surprising that bacteria have been able to adapt to those and to create some of these superbugs where some of these folks have going into the hospital the past few years and they've tried 17 different antibiotics including the nukes, and none of them work. And it makes you go, "Oh yeah, well they've been doing that for forever. This is just the next step for them."

Gautam Dantas: That's exactly right and there's also ... I mean I know you told me to keep it sort of nerdy light, but I think there's one important aspect [crosstalk 00:31:45].

Quinn: No, to be clear. Let's do this. We'll dumb it down. You do your part.

Brian: Let's go full on nerd.

Gautam Dantas: Fair enough.

Quinn: It's just if you hear a bunch of silence from our side that's us trying to figure out what the hell's going on. 

Gautam Dantas: Think about bacteria evolve anything, right? One way that they do it is the way everything on our planet evolves; basically by reproducing, right? You pass on your genes and for that reason whatever mutations you have to your kids.

Quinn: Brian's working on that.

Gautam Dantas: That's called sort of classical vertical evolution, right? That is, literally, when the bacteria divide then the new cells they made gets their DNA and if there's a mutation along the way it passes on. So, that's all well and good. And all of us, all living organisms do exactly that. But bacteria do one other thing. One other way in which they evolve, which is just fascinating and awesome and bizarre and is really important for antibiotic resistance, and that's something called lateral or horizontal gene transfers. Vertical gene transfer is the one I told you, right? You give it to your progeny. Horizontal or lateral gene transfer is the ability for bacteria to pass their genes, their genetic material, back and forth between very, very different bacteria, and in so doing, they pass their traits, so their properties, on. The analogous version of this, which we know is ludicrous would be you deciding tomorrow that, "You know what? I really would like to smell like a pineapple all the time." And so what I'm gonna do is I'm gonna go get the DNA that the pineapple uses to smell like a pineapple and somehow that's gonna insert into my genome, and then you're gonna be pineapple [crosstalk 00:33:22].

Brian: Wow. Quinn you would smell amazing. 

Quinn: To be clear, the world needs this [crosstalk 00:33:26].

Gautam Dantas: And you know, people are probably working on crazy [inaudible 00:33:30] techniques that do that, but at least as of now naturally we know that shit can't happen, right?

Brian: Wow.

Quinn: Right. And you said it's called horizontal gene transfer?

Brian: Lateral?

Quinn: I feel like that's the terminology they used in health class in seventh grade when they wanted to teach us about sex, but didn't really wanna do it. They were like, "Listen, it's terrible. It's called horizontal gene transfer."

Brian: Oh yeah. I went to sex right away.

Gautam Dantas: That's how you get the kids interested now. The colloquial version is that's bacterial sex, right? They're passing along genetic material and so again, they're doing it across this vastly different bacteria just moving things back and forth. And think of what happens when that particular type of transfer gives you a huge advantage when all of your neighbors are dying. For instance, when you're getting hit with antibiotics. So you can take a massive population, right? Millions, billions, whatever cells. 

Gautam Dantas: You only need a couple of them to initially have antibiotic resistance genes. This is the genetic material that allows them to be resistant to the antibiotic. Now, if they start moving those genes back and forth with lots of the bacteria around them through this process of bacterial sex or horizontal gene transfer, you've now got a very, very, very fast way to move those properties across and just our dumb luck, bacteria tend to accumulate all of these genes together. So that means in one fell swoop you can move 5, 10, 15 genes from one bug to the other, and what you've done now is, if all of those were resistance genes, in one step, something that can take on the order of 10-15 minutes, right? Or less. You can move the ability to be resistant to 15 antibiotics. 

Quinn: Hold on. They can do this in ... Are you just being facetious? 10-15 minutes?

Gautam Dantas: No, these are measured rates of horizontal gene transfer. 

Quinn: Oh, that's bad. That's insane.

Gautam Dantas: This shouldn't surprise people too much because something like E. coli, right? A workhorse organism in a lab, but also all of us in our guts have maybe two or three strains of benign or good E. coli. They divide every 20 or 30 minutes, right? So their lifetime is 20 or 30 minutes, so it shouldn't be all that surprising that they can also pass DNA at rates that are in fact a lot faster than that. This is the issue. This is why resistance can transfer and why resistance is spread so damn quickly is you had all of this resistance in the environment from millions to billions of years. 

Gautam Dantas: In a sense, we just got lucky that we happened to find a group of chemicals that the originals pathogens, the pathogens that were killing people 100 years ago were not resistant. They're kind of the weird ones almost, right? They happen to be really weak in comparison to the guys in the soil. We start hitting them with antibiotics and every once in a while, when they go out to party, that is when they poop them out, they're gonna interact with some of these guys in the soil and pick up their resistance genes. Then, the amplification starts, so that's the reason we're at this precipice of talking about being shit scared about things. People have been starting to call this the post-antibiotic era and we should be really, really, really scared if that's actually true. Post-antibiotic era is equal to pre-antibiotic era, which meant that you go along with it-

Brian: Oh, I'm scared. 

Quinn: Just World War I basically.

Gautam Dantas: Yeah, exactly right. Think about the ... A lot of people point towards the discovery and then the industrial production of penicillin as changing at least some aspect of World War II, at least.

Quinn: Sure, just the difference between those two wars was 25 years, but penicillin changed everything.

Gautam Dantas: Completely, right? And again, how was that discovered? Completely serendipitously. This is the case of Alexander Fleming winning a Nobel Prize partly because he was sloppy when he went on vacation, right? Of course.

Quinn: Right, which I've been sloppy on vacation and nothing has come of that.

Brian: What prizes have you garnered?

Quinn: I've got three kids. That's what happened.

Gautam Dantas: Of course. That's being facetious. He obviously invented hunting for molecules of this type, but eventually the way he found it was yeah, we know the story. He left his windows open and a mold came and grew on his plate and he saw that the mold had big zones of clearing around it and voila, discovery of penicillin. It took those other chemists, Florey and Chain, almost another 10-15 years to commercialize it, to make it at high scale, but that's the birth of the antibiotic era. 

Quinn: Brian's breathing into a paper bag over here.

Brian: I'm fine. Everything's fine.

Quinn: It sounds like the point is they've been able to do things like this forever, essentially, and the antibiotic era that we're so proud of and has been so effective and has saved probably a billion lives, seems like the moment in a comic book where you defeat the bad guy and you're like, "Yay." And then you realize that wasn't the real bad guy.

Brian: That wasn't the bad guy.

Quinn: That was the henchman. It's whatever now the war has just begun or it was just the thing I ... Oh man. Okay, I'm still kinda processing this. Okay, so that's interesting. So, it's funny, I've been sort of thinking on this theory which, I have to do more thinking on 'cause you've sort of thrown it to a loop a little bit, which is ... Some of these elements still work, which is basically we're clearly, like you said, in a moment of necessary transition, realizing the capabilities that bacteria have had all along. And how they are able to very quickly apply themselves to our relatively puny and temporary whims, which as you said were against some of the weaker bacteria like cholera, which I never heard someone call that one weak, but apparently so, which is also not great news.

Gautam Dantas: Weak in just one of these properties. They're strong in terms of being able to mess with us. To cause us to shit ourselves [crosstalk 00:39:20] in terms of cholera, but they're weak just in the perspective that for whatever reason, those particular bugs which adapted to begin to cause us to have diseases did have resistance mechanisms to those antibiotics and we've changed that.

Quinn: Right and now it's among the things that are left like you said that are ... whether they're new pathogens or things that are being found in the arctic ice coolers, we're finding there's things that we're not quite prepped for. I had kinda had this thought and I'll just blow through, which is sort of a parallel with climate change, which is man creates amazing tool and uses resource to literally in a lot of ways construct the 20th century with fossil fuels. The Industrial Era doesn't happen without that innovation. It's great. He lifts at the time probably started a billion and a half people across the planet out of poverty and creates so much change.

Brian: Seems great.

Quinn: Except that the trade off is it unwittingly causes the planet to catch fever and now we don't have any idea how to undo the damage we've caused, right? We can slow it down, we can start to replace it with other naturally occurring resources, but figuring out how to actually undo it, in that case, it's like carbon capture, might be either not feasible for a variety of technical or financial factors or it just might be impossible right?

Brian: Actually impossible.

Quinn: So, there's trade offs. And for antibiotics it was, "Hey, TB and cholera are a nightmare and have been for I don't know, a couple thousand years, and look we can make them go away, which now you've described was a temporary whim. This stuff is great. Let's use it everywhere, even proactively in these cows that everybody eats and oh no, now we've created climate change in our bodies." That's a horrific analogy.

Gautam Dantas: No, I think it's actually a good analogy. I think that you went towards the Marvel Universe, so I'll go back there too.

Brian: Thank you.

Quinn: We can do DC. Whatever you want.

Gautam Dantas: No, we'll go with the Spidey quote, right? The great power and great responsibility. We've been given these awesome tools and rather than being judicious we just declared game over. We're like, "Wow. We won." We joke and I laugh sometimes that the easiest way to get a bacteria to become resistant is to kind of whisper to them that you vanquish them. Basically, they hear it. Bring it fucking on.

Quinn: Right and that's the thing. Bacteria's in our bodies and it's transmitted among all of us, like you said, it's everywhere and in every living thing is made up for it. We're like, oh no. It's sort of the prevalent ... Until I guess this conversation and your news that has come out and as you're illustrating things is like, "Oh no. It's adapted to our cool tools and because we've used them so much and we can't go back and we have to design for a new world where, very likely, I mean it will happen at some point, a very nasty bug comes and we don't have a treatment for it, which has actually happened to quite a few people. But the big discovery is the post credit scene of Thanos where you're like, "Oh fuck, they've been able to do this all along."

Brian: Are you talking about Infinity War again?

Gautam Dantas: Yup. You probably just pissed a bunch of people off, but nevertheless.

Brian: Including your co-host. 

Gautam Dantas: Exactly. [inaudible 00:42:41] aside, what I'll say is that the silver lining here though is-

Brian: Please.

Gautam Dantas: Much like I think we might be able to do things with climate change is us getting a little bit of humility and beginning to understand how is it that all of these bugs that are out there in the environment, how have they co-existed for millions to billions of years? It's not like somehow the guys who had all the antibiotics wiped the rest of the guys out. Why is it that we have hundreds of different species in our gut and thousands to millions of species in the soil. They figured out a way in which to work it out. And now, I think especially in this era of the microbiome, appreciating that microbes live in communities, there are new strategies being considered to say, "Hey maybe we shouldn't use the warfare analogy. Maybe we shouldn't try to design these offense molecules that basically carpet bomb the entire microbial ecosystem every time we think we're sick.

Quinn: Right. 'Cause there's a lot of good shit in there and we wreck that too.

Gautam Dantas: Exactly right.

Brian: [crosstalk 00:43:40] good idea.

Gautam Dantas: So maybe we begin to understand how is it that kind of microbes collaborate and negotiate and figure out ways ... I know I'm humanizing this, but we can certainly find parallels and ways to say bugs have figured out a way in which to share and figure things out on their own and when some bad stuff happens, they figure out a way in which to bounce back.

Quinn: We've got a lot to learn from it.

Gautam Dantas: If we learn from that, we can come up with a brand new way of making therapeutics, which allows us to still not get sick or at least cure ourselves when we do get sick, but not cause mayhem for all of the good bugs around when we do that. That's actually why I feel like, despite all of this basically being bad news, and quite often there is the sort of tentative hand that goes up at the end of my talk, and I'll paraphrase and they'll basically ask why are we not all dead yet based on what you just told us. And of course, one of the reasons is because humans do have a pretty bad ass immune system so we should thank that for saving us, but I also think that the therapeutics of the future are not gonna be the same kind of antibiotics we've used all this time. Because again, the reason these antibiotics are all so problematic, you kind of alluded to this is, Paul Ehrlich, one of these guys who was the early days of antibiotics, called antibiotics magic bullets. As many times as I remember to do so in a talk, I'll say that no, the antibiotics we know about are more like magic shotguns or more like magic bombs. They get deployed and they wipe everyone out, the good and the bad. 

Gautam Dantas: We need to come up with new ways that are very, very targeted that are able to go in and either suppress or wipe out the bad guys while allowing all of the other good bugs to sort of not just not be hurt, but maybe help us along the way. So that's where I think new therapeutics are going. And I think there's a lot of promise there.

Quinn: Let's turn towards the positive and the proactive and learning from what we've learned. I mean, kill me. Talk to me now about your sort of particular angle and perspective with regards to designing the future of and I almost hesitate now to call them antibiotics because it's clear we need to move on from both that terminology and how it's applied. Again, we can't just carpet bomb these things anymore. So, knowing what you know now. How are we moving forward?

Gautam Dantas: Sure, a number of ways. And some of this is what we're doing directly. There's also a lot of other people doing it too. The most direct application that comes out of the work that we just published, actually it still goes back to the old paradigm. It's still saying even if we come up with new ideas as stop gap measures, we need to figure out ways in which to at least make derivatives of the old antibiotics that push the ball a little bit further down the field. 

Gautam Dantas: One way in which you can do that is when we discovered how these bugs in the soil are eating the antibiotics, it all comes down eventually to enzymes. This is the activity that particular proteins have and we figured out which enzymes break down penicillin in different ways. Effectively, what we've figured out now is a strategy for kind of breaking penicillin down into its smaller building blocks. Any chemical is kind of like a Lego structure. You can take it apart and break it down to the most fundamental building blocks. And it's an old idea that one way in which to make new antibiotics is to break the old antibiotics down into sort of smaller structures and then make sort of chimeric structures to make Franken-molecules. Take half of one molecule and another of another molecule and another of another and you put it together, and once it sticks together chemically, you can test if it has new properties. 

Gautam Dantas: By discovering these bugs that have new activities to break down penicillin, we've potentially liberated, at least in this case, specific building blocks, but also ways in which to, if we keep doing this with other antibiotics, other ways to break them down into these parts that can be built back up. So that's one direct application area where inadvertently by understanding how these bugs are munching on antibiotics, we've kind of liberated or made available building blocks, tools for making new Franken-molecules, but that still keeps us though in the realm of antibiotics. That's still gonna be sort of bombs or shotguns. 

Gautam Dantas: With the rest of our work that our lab works on, which is as I told you, looking at microbial communities, understanding how, for instance antibiotics affect the developing microbiota in kids, in pre-term infants, and in-term infants. A lot of that work is really focused on developing new therapeutics for the future that are micro based. Our engineering of the E. coli strain that could eat penicillin is related in some ways to other work that we're doing to say, "Okay, can we take some strains of E. coli that could actually work as a probiotic where E. Coli, in this case under very strict control, would go into the gut where it's a normal member, but now rather than producing an antibiotic, maybe it produces a very specific type of protein on its surface. So a very specific type of molecule which is heavily tuned towards a very specific pathogen. It does nothing else to any of the other bugs around, but if for some reason, as example, cholera comes through, Vibrio cholerae comes through. Now, this engineered strain, recognizing something that's very exclusive to Vibrio to cholera and then brings it out of the gut.  

Quinn: It sounds like a lot of what we're really trying to focus on with cancer and immunology and the targeted stuff.

Gautam Dantas: Absolutely.

Quinn: In the sense that, and I don't know if I've talked about this before, but I feel like I have this philosophy that we're gonna look back at the 20th century and be like, "Man, there's a few things that we're so thankful and we needed and we built on." But 20 years from now, we're gonna look back and be like, "Man, can you believe that was our best option then." It feels like ... You know driving cars is one of those like, "Holy shit. How did we let humans drive cars?" It was amazing.

Brian: I still think that now. 

Quinn: But a million and a half people died across the world every year. The second is chemotherapy, which has been incredible and has saved so many lives, but is, talk about a shotgun. I mean the most blunt instrument, quite literally humanly possible, as often as bad as the disease itself and we're gonna look back and say, "Well, thank God we had that, but at the same time, do you remember when that was our best option?"

Brian: That was it?

Quinn: And it feels like, hopefully in this case, with that, with targeted therapies which are still incredibly early for cancer.

Brian: That's so exciting. 

Quinn: It seems like that here, which is like it really is a paradigm shift and it's gonna take a hell of a lot of work, but imagine if we could do that, if we could focus on the specific bug without wiping out the good stuff. 

Gautam Dantas: I agree. It is preliminary. We have a ways to go, but it's really promising. And it's also promising when similar strategies come very, very different fields. It's heartening when people are thinking of personalized cancer cell specific therapies at the same time that people are thinking of pathogen virulence specific therapeutics as well. I think this idea that is a bit wishy washy and undefined in terms of personalized medicine, from a molecular perspective at least, really what personalized medicine is saying, not just for the person, but for the specific disease manifestation in that person, we're gonna have a therapy that we can dial up for you. 

Gautam Dantas: The one other thing I do want to mention in terms of ... We shouldn't be overly optimistic. We should maintain some level of being scared, and that is everything you talked about in terms of chemotherapy, the estimate is if our antibiotic resistance rates continue growing the way they do and we don't come up with new antibiotics and ways to fight resistance, it's not really gonna matter that we have chemotherapeutics because as soon as you get immune compromised from whatever cancer treatment you have, you're gonna die because of an infection. Anytime you go in to get your hip replaced ...

Quinn: Right, it's like pneumonia. You don't die from pneumonia. You die 'cause you get something else. 

Gautam Dantas: This is why that's a taste of motivation. There's this really scary report that came out of the UK Prime Minister's office about three or four years ago that said by the year 2050 at current rates, knowing that cancer will continue to increase in rates, by that point antibiotic resistant infections will kill more people on the planet than cancer will. Something like 10 million people will die annually from drug resistant infection. That's one person dying every three seconds from a drug resistant infection. As compared to that 10 million number now is close to about a million. So we have an order of magnitude increase if we don't do something in terms of people dying from drug resistant infections. 

Brian: So on that note, the number of people that will be affected ... Like you said, we're still in the current paradigm, we're not ready to move on quite yet. There was the recent news of childhood disease just tanking in Africa because of basic antibiotic distribution [crosstalk 00:52:40].

Quinn: Which seems so common sense. 

Brian: Right. Oh, we should use these? Great. 

Quinn: However.

Brian: But then the question arises naturally about overprescription, so can you fill us in on that?

Quinn: Are we gonna do the same thing to those kids that we've done to ourselves in the West.

Gautam Dantas: And this is the balance that you always have to walk. Because no matter what, as much as I'm gonna go on my campaign high horse to say, "Be more judicious with antibiotics." If the choice is saving a kid's life, it's a no brainer. [crosstalk 00:53:05] Save that kid's life, no matter country they're from. But I think again, this is where our commitment to understanding how microbes work is gonna come help us. Yes, as a stop gap measure if we realize that broad spectrum over the counter or outpatient antibiotics are gonna help save kids in Africa because it helps with their malnutrition symptoms or whatever, yes, we'll absolutely support that. The WHO actually has a recommendation to do that. But what we need immediately commit to is understanding why is that working. Similarly to this antibiotic eating story, it was fine to describe the phenomenon, but way more important to figure out how it worked. I hypothesized, as many others have, is that the way those antibiotics are working to help those kids is probably at least partly through their microbiome. Through the modulation of the good bugs that are in there. And if we could figure that out, now we could potentially come up with therapies that might be food based or they might be probiotic based that give us the same benefit, but we don't need to use the antibiotics, and so then you don't have resistance.

Gautam Dantas: I think that's the balance. There's always prioritization that occurs. Life is always gonna be more important than anything else. And so we save the lives ...

Quinn: Of course.

Gautam Dantas: And then while we're doing that, we figure out how, and then we'll replace ... And I think that's also in my opinion the way to address the elephant in the room of antibiotic use in agriculture. Certainly, we only use antibiotics in humans, but the rough estimate is something like 80% by weight of antibiotics in the US are used to make our meat cheaper. Now, that's a pretty shitty use [crosstalk 00:54:38].

Brian: 80%.

Quinn: That's unbelievable. 

Gautam Dantas: But again, I don't think that the simple ... Fixing that by banning antibiotic use is not gonna work. The agriculture industry is very powerful and they will legitimately turn around and say, "Why are you trying to destroy our lifestyle?" What we need to do is figure out if they use those antibiotics to make their animals a little bit bigger, why is that working? And again, it's probably gonna come down to some effect of that antibiotic on the host and the microbiome and maybe we can come up with specialized probiotics for animals, which then reserve the antibiotics for us.

Brian: Wow. Yeah, what a shocker. Like duh. Don't just use it and then go great, think about why and how. That might be important.

Gautam Dantas: And that's nuts right? We've been using these antibiotics for animal growth promotion for, God, at least 50 years, if not more. 50, 60 years? It's irresponsible that we as field haven't figured out how they work. 

Brian: Well, this has been incredibly nerdy and fantastic. Getting back to what we first said, what we need to figure out is how our listeners are being affected by this and then how can they contribute to the future, to the next paradigm?

Quinn: So what we wanna work on or sort of what are the big actionable questions the rest of us should be asking of ourselves and sort of using their voice, their vote, and their dollar to help you guys ask the right questions to start pointing us in the right direction so that we can set up the next 25 years, your children, my children. 

Brian: My eventual children.

Gautam Dantas: Well, I think like everything else that we're facing right now, facts matter. Knowledge matters. Education matters. 

Brian: Real facts or alternative facts?

Gautam Dantas: Probably preaching to the choir on this podcast, but I think just taking personal responsibility for understanding the actions you make vis a vis something like antibiotics. There's stats out there to show that if you take any five year age band in the US, it's the zero to five year old age where we dump the most per capita antibiotics in. Put another way, we give our kids more antibiotics than any other part of our lifetimes. When people look at whether that's warranted or not, a huge amount of that antibiotic use, which is really antibacterial use is retrospectively really for a viral infection, which does nothing. You're doing nothing good there. Just the next time that your kid is sick, whoever you are. Or your grandkid is sick, or your friend's kid is sick, just ask your physician point blank is this antibiotic gonna help my kid, as opposed to demanding because your kid is sniffling and you're pissed off and you haven't slept and you're like, "God damn it, just give them some drug and I'll be okay." Most of those antibiotics are unwarranted. Let your physician, let your pediatrician make that decision. So that's one.

Gautam Dantas: The second as you talked about, putting your money where your mouth is and putting your vote where your mouth is, if you will. McDonald's announced a couple years ago they were voluntarily gonna start moving to meat that doesn't have antibiotics in its rearing over the next couple years. Do you think that McDonald's did that because they suddenly became prescient or like, "Let's do good for the world." Bullshit. 

Brian: Definitely. 

Gautam Dantas: They did it because they finally figured out that that's what their consumers wanted. If we go in and start saying, "Okay, you know what? I can't afford to have only organic pure antibiotic free meat for every meal that I have. Maybe once a week for the next year I'm gonna try doing that," and then eventually it'll be a slippery slope and I'll just get used to this idea that you know what? Maybe I'll eat maybe a little bit less meat next year. I can't do it right away. I'll move those savings onto buying meat that was raised without antibiotics.

Gautam Dantas: And then finally it's just very simple things like reporting. So how else are you going to know without collecting data what we should actually fix? What's bizarre is that we have legislation in this country that requires hospitals to report how much antibiotics, what antibiotics they use, what concentrations, all over the place. But there is no such legislation required for how many and what type of antibiotics are used in animal agriculture, and all of that is voluntary. That's a simple law that we can fix.

Brian: Wow, how is that possible?

Quinn: Which, like you said, is insane if 80% of them by volume are going to animals. It's like, "Who gives a shit about the 20% that are going to humans at this point." It's like it's [crosstalk 00:59:03].

Brian: That's insane.

Gautam Dantas: To push back against that. The 20% does matter because-

Quinn: No, of course, it does. But the point is we're missing a phenomenal chunk.

Gautam Dantas: Again, this is just so we can decide how to mitigate. We're not saying that, and this is where, again having the conversation, trying to find the middle ground, trying to say, "Look, we're not asking you for your antibiotic use patterns because we wanna ban this practice. We wanna help you come up with the most sustainable, probably cheaper way for you to eventually grow your meat. We just need the stats right now." I think those are a few methods. Just educate yourself and ask the right questions of your physicians. There's a reason that they're in a hundreds of thousands of dollars in debt. It's because they learned some shit along the way in terms of knowing what prescriptions to give you. Then also, vote for the people or incentivize your politicians and the people who sell you your food that preserve the antibiotics for us.

Quinn: Right, right.

Brian: Yowza. Alright, so we're getting close to time here and Gautam, we cannot thank you enough for being here today and chatting with us. This has been incredible.

Gautam Dantas: Oh my pleasure. It's been fun.

Brian: Yeah, good. Do you have any suggestions on who else we could talk to? Or should talk to, I guess.

Gautam Dantas: About this specific topic or just in general?

Quinn: Well, I mean, I'm sure people never get tired of hearing about how we're all gonna die. What we really focus on, and hopefully that came through in both our invitation to you and our time today, is what are the conversations that need to be happening about things trending towards the ... I hate to use the word existential, but the more impactful things that are either happening to everyone now and either they don't know about it, don't know enough about it, aren't being told enough about it, or it's just getting buried by all the other news every day, or are definitely going to happen to them and their loved ones in the next five to 20 years. So, again, that's everything from biotech and biology to climate change to space exploration to nukes, and stuff like that, but we really wanna try to highlight the ... find the people that can come on that are down in the trenches doing this stuff every day that people don't know about that they can learn from and then again, the goal of these things because we have such an actionable crowd in what is probably the most important year of our lives voting wise to provide them with actions that we can formulate over the course of an episode that they can work on to again, help make some change. 

Gautam Dantas: Sure, yeah so I can suggest a couple including out of my field. Just people who have inspired me in terms of thinking in new ways. 

Quinn: Yes, please.

Gautam Dantas: One is, her name is Rachel Dutton. She actually has been in the news a little bit and she works on something that some people might dismiss as not being serious science, but I think it's some of the most serious science being done out there. She works on the microbiome of cheese.

Quinn: I mean, gotta do that.

Gautam Dantas: Exactly. She's just learned some really incredible things about this ancient process of rotting and fermenting food and how we've figured out how the bacteria out there changing these building blocks into things that are new and really using that not just obviously to have the product of your research be really yummy, but also on a sense of really, really basic fundamental aspects of microbes talking to each other and how they produce compounds that are kind of cooperative versus offensive. She just tells a really cool story so I think she'd be someone who'd be neat to talk to. 

Gautam Dantas: Another person who's way out of my field, but I think she just does really cool work and she's a young assistant professor. Her name is Sarah Hörst. She's at Johns Hopkins University and she works in space, so she literally does rocket science.

Quinn: One of those people.

Gautam Dantas: One of those people. Very humbling to talk to people like that, but I've heard her talk in person once and she's just very eloquent. But also, what I really like about Sarah is that her work is, even though she's only a few years into running her own lab, I mean I follow her on Twitter and on Facebook, she's really passionate about making sure that every one of her mentees is well supported. She thinks about the place of the scientist within the science. She clearly thinks across many scales. All the way to how do you collect data on Saturn down to how to make sure the youngest and the most vulnerable amongst us are well supported. She'd be someone else who I think would be able to provide, again, across these very different scales, a good conversation about what the next steps might be. And if I think of a few other people, I'll send the names your way, but ...

Brian: Yeah, that'd be great. Thank you.

Gautam Dantas: Honestly, I think this is the cool thing about being in science is that virtually anytime you open up a magazine, well a nerdy magazine at least, you're amazed that people are doing such cool awesome wonderful things that you barely understand, but know it's gonna change the way we do things in the future. 

Quinn: And that's the key. We wanna highlight those people on the things they're working on 'cause they're either affecting folks or they're going to, and by the way, on your recommendations please always send them whenever you want. And like we discussed, non-white guys always great.

Brian: Thank you very much for that. 

Gautam Dantas: Neither one of them are white guys. 

Quinn: We'll take it.

Brian: Gautam, we have just a last few questions we like to ask everybody as sort of a little bit of a lightning round if that sounds alright?

Gautam Dantas: Yeah, sure let's do it.

Quinn: Alright, when was the first time ... I gotta move this out of the lightning round. 

Brian: No, lightning's fast.

Quinn: When was the first time in your life you realized you had the power of change or the power to do something meaningful?

Gautam Dantas: Ooh. God. Yeah. That definitely rapid question, right?

Brian: Yeah, go.

Quinn: Look we're working on it.

Gautam Dantas: I think it may have been at some point in my PhD when I was working on something unrelated to what I do now, which is trying to solve the structure of a protein that our lab had designed that had never been seen in nature before. So, it was trying to make just completely from scratch and use a process called X-ray crystallography and I was sitting there even nerdier than I am now, I think. 

Quinn: Impressive.

Gautam Dantas: In a dark room with 3D goggles and for the first time when I saw that structure materialize on the screen, it was close to a moment like, I'm not sure I cried at that point, but I sort of maybe cried inside just to say like, "Jesus Christ, this is super awesome. We can do stuff of this type." It was that point and I'm just really, really, really excited to be part of this. That was a jazzy moment. 

Brian: [crosstalk 01:06:09].

Quinn: I like that that's his previous ... You know what my previous job's like? Lifeguard at a pool.

Brian: I was a stock boy at a gas station. 

Quinn: Alright. People needed you. You were essential. 

Brian: Very good answer Gautam. Gautam, how do you consume the news?

Gautam Dantas: Probably pretty lazily, my home screen is Google News, so I'm sure that they're just preaching to my choir all the time, but one way that I change that a little bit is I kind of try to switch around which sections are sent to me so like, I grew up in India so I try to have the world news US edition and world news India edition and it's bizarre, it's like two different worlds are being looked at. That's the aggregator version. I also have an Android phone so I get news through that. Then, I signed up after the devastation of November 8, 2016, I subscribed to The Washington Post, so I do get their daily briefing, which you know, is super fucking uplifting. 

Brian: Always.

Quinn: On that note.

Brian: Yeah, yeah. This is a perfect segue. [inaudible 01:07:18] If you could Amazon Prime one book to Donald Trump, what would it be?

Gautam Dantas: Oh Jesus. Hopefully there's a book on how to read. But I don't think the dude reads anything so ...

Brian: How come all of our guests say that?

Quinn: We get that every time, but again we're gonna say assume it's either with pictures or someone is going to read it to him.

Gautam Dantas: Oh gosh. Knowing that he won't read it, but maybe one of his advisors would. I might recommend that he reads The Doomsday book. It's this really cool fiction book about, I don't want to give anything away, but it involves a little bit of time travel, but it's just kind of uses it as a way to send this researcher back to the time of the plague, recognizes the humility of humanity in doing so. These are not words that he's gonna recognize, I understand, but maybe some of his advisors might. 

Brian: Perfect.

Quinn: We'll take it. Awesome. Is there anything else you would like to say. Anything truth to power you wanna say to our amazing listeners here before we sign off?

Gautam Dantas: I think you already said it man. This November is a time to not chicken out. Show up and hopefully we'll be in a better path to empower what happens in 2020. Vote.

Quinn: Rock and roll. Rock and roll. Vote.

Brian: Fucking vote.

Quinn: Awesome. Gautam, where can our listeners follow you and your crew of bandits online. 

Gautam Dantas: So, certainly our website we gotta keep as up to date as possible. It's just dantaslab.org. But then I also have a Twitter account @volatilebug.

Quinn: Of course that's what your Twitter handle is. 

Gautam Dantas: Yeah, those are probably the two best. Our lab really has all of the science nerdy stuff. The Twitter account is probably marginally less nerdy, but every once in a while, I'll post something that's a little bit more interesting. 

Quinn: It's all relative.

Brian: Perfect.

Quinn: Awesome. We cannot thank you enough for your time today. This is just fantastic. 

Brian: This has been fantastic. 

Gautam Dantas: Thanks for having me on. I really enjoyed it. 

Quinn: We'll be sure to check in at some point and do this again when you've got another revelation that could kill a billion people. Or save them.

Gautam Dantas: Save them. That's what we're going for.

Quinn: That's what we're going for. Well, thank you so much for your time and of course, for all that you do out there for everybody. 

Quinn: Thanks to our incredible guest today and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dish washing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species. 

Brian: And you can follow us all over the internet. You can find us on Twitter at @importantnotimp. So weird. Also on Facebook and Instagram @importantnotimportant. Pinterest and Tumblr the same thing. So check us out. Follow us. Share us. Like us. You know the deal. And please subscribe to our show wherever you listen to things like this. And if you're really fucking awesome, rate us on Apple Podcast. Keep the lights on. Thanks.

Quinn: Please.

Brian: And you can find the show notes from today right in your little podcast player and at our website importantnotimportant.com. 

Quinn: Thanks to the very awesome Tim Blane for our jamming music, to all of you for listening, and finally, most importantly to our moms for making us. Have a great day.

Brian: Thanks guys.