Well, I think we can all agree that being grounded and shut away by COVID-19 is not exactly what any of us had in mind this spring! I certainly miss seeing everyone at the various events and I hope you are all keeping safe.
But, staying home does offer a bit of time for catching up on things. As there have been a lot of suggestions for movies to be quarantined by, I thought I would offer a list of movies to inspire AMR-focused research.
But, rest easy … I most definitely do not have in mind any of the rare black swan event apocalyptic disease movies in which a virus runs amok … I think we should leave them unnamed and only summarized by year (1971 based on a Michael Crichton novel, 1995 with Dustin Hoffman, 2011 with Matt Damon, and others).
Rather, my focus is movies that reflect the way that ordinary bacterial infections have had a tragic effect on the lives of countless millions … and the way that effective antimicrobial agents would have rendered moot some of the plots and subplots in stories about those lives.
With that in mind, here’s my list of movies to inspire AMR-focused research: each of these movies is great in its own right but each also contains plot elements that take us from uncontrolled infection to the first antibiotic to the computer era:
- Sense and Sensibility (the 2008 mini-series is good, but I really prefer the 1995 movie; both based on the novel by Jane Austen). Crushed in love, the younger Dashwood sister lies down to die in a rainstorm, thus setting off hypothermia, pneumococcal pneumonia, and the recognition of true love. Set in the early 1800s, the movie is spot on with its depiction of the rapid onset of obtundation and then the crisis in the 2nd week of the illness when victims would either die or experience a resolution of the fever.
- The story of the younger sister’s illness is one I often tell … this healthy young woman’s story is prototypical for the high mortality of this common infection in the pre-antibiotic era: mortality rates were 1 in 6 for young people and 2 in 3 for the 60+ patient.
- [post-newsletter addition] Osler’s 1910 Principles and Practice of Medicine has a great description of the clinical syndrome leading up to the crisis during the 2nd week. Go here for an excerpt: search for the word ‘crisis’ at the bottom of page 10.
- And while it’s not a movie, I have to note that Jane Austen herself died in 1817 (link) with a syndrome that strongly suggests Addison’s disease due to adrenal destruction by tuberculosis. The debate has raged on on the precise cause (2009 summary in The Guardian, a 2009 paper in BMJ Medical Humanities), but it seems plausible.
- On this theme, we also have the well-documented deaths of the Brontë sisters (link) in the early 1800s with tuberculosis.
- [post-newsletter addition] And then there’s Mimi who dies of tuberculosis in La Bohème (link to a discussion of the opera; link to a 2008 movie adaptation)…
- Wives and Daughters (link; based on the novel by Elizabeth Gaskell). Set in the mid-1800s, the protagonists Molly and Roger realize their love for each other only at the end of the novel … and then a scarlet fever scare prevents them from speaking before Roger must depart for a trip to Africa! Although the book leaves the story hanging here due the death of the author, the movie adds a satisfying conclusion in which the young lovers are ultimately reunited.
- Little Women (link; based on the novel by Louisa May Alcott): This outstanding 2019 adaption (confession: there are prior versions but I’ve not seen them) tells the coming of age story of four young women during the 1860s in Civil War America. One of the sisters, Beth, progressively declines during the movie due to complications of scarlet fever (my guess would be cardiac injury).
- Out of Africa (link; based on an autobiographical novel by Karen Blixen): Set in the early 1900s, the story of a Danish woman in Africa requires the protagonist to return to Denmark to be treated for syphilis with the arsenical arsephenamine (aka Salvarson or Compound 606). Discovered by Ehrlich in 1907, this was the very first “magic bullet” antibiotic!
- To learn more about the discovery of Salvarsan, try this 2017 article in the Smithsonian Magazine (link).
- Even better, the chapter on Ehrlich in Paul de Kruif’s Microbe Hunters (link to book on Amazon, is available for Kindle) is a fun tour of how Ehrlich went from trypanosomes and Trypan Red to Salvarsan.
- It’s further worth noting that first uses of the next class of antibiotics (the sulfas) were 25 years in the future … and the first uses of the penicillins were almost 30 years away. For more, see the timelines chart in this newsletter.
- [post-newsletter addition] The Third Man (link, based on a novel by Graham Greene): Set in Vienna in the late 1940s, just after the end of World War II, the book and movie are based on a real-life story about sales of counterfeit penicillin. Penicillin was very scarce at the time, highly prized, and hence a tempting opportunity for the ever-present counterfeit drug industry. There is a superb BMJ article (link) that provides an extended discussion of the backstory; let’s hope we don’t see this sordid tale reprised with therapies for COVID-19.
- Raiders of the Lost Ark (link): In a real-world twist, the famous 1930s Cairo marketplace scene when Indiana (Harrison Ford) confronts a master swordsman has an infectious disease backstory. The original plan in the script was for an extended duel pitting Indiana’s whip against his foe’s whirling sword … but Harrison Ford was so ill at the time with a GI syndrome (said to have been dysentery … no further details) that he really did not have the strength to film the planned scene! It was the summer of 1980, the crew had gone to a lot of trouble to be in a great desert location …. what to do? Well, Ford and Spielberg agreed to cut the scene down to a gunshot, with Ford saying to Spielberg, “Let’s just shoot the sucker.” And thus was created one of the most memorable scenes in a memorable movie … I can still remember the startled delight I felt the first time I saw that scene! I have no idea what antibiotic(s) he received, but I’m sure at least one was involved — if you look closely, Harrison Ford really does not look very well. Go here for an additional article, here for a YouTube interview with Terry Richards, the stuntman who played the swordsman, and here for an informative article (sadly, his obituary) on Mr. Richards.
- [post-newsletter addition] A Doctor’s Dream (link): This inspiring 7.5-minute film follows the development of fexinidazole, an all-oral regimen for Human African Trypanosomiasis (HAT, aka sleeping sickness). I realize this is not a bacterial infection, but the theme of the power of a good antimicrobial is universal. Highly recommended!
- 2001: A Space Odyssey (link, based on a book by Arthur C. Clarke): Filmed in 1968 and set mostly in the near-future of 2001, we meet HAL, the deep-thinking computer who drives a key plot element. Coming back from 2001 to the present (!!), we have the 2020 paper by Stokes et al. in which machine-learning is explored as a tool for antibiotic discovery. Halicin, the resulting compound, was named after HAL and served as the idea for a great cover that journal issue. Although halicin probably isn’t a systemic antibiotic, the ideas behind this approach are certainly tantalizing. See the 3-part newsletter series on this topic: one, two, and three.
Stay safe, get out the popcorn, get inspired, and tweet about your favorite antibiotic movie using #FireExtinguishersOfMedicine! Having the right antibiotic / fire extinguisher is truly magical.
All best wishes, –jr
John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.
Current funding opportunities:
- Dates for the 2020 funding rounds for Novo REPAIR Impact Fund will be announced May 2020. Go here for current details.
- 2020 funding rounds for CARB-X have not been announced.
- The Global AMR R&D Hub’s dynamic dashboard (link) summarizes funders and projects by geography, stage, and more.
Upcoming meetings of interest to the AMR community:
- 28 Apr 2020 (online, 17:00-18:30 CEST): GARDP REVIVE webinar. Title: “Inhaled antimicrobials: Do we get the drug to the bug?” Speaker: Harm A. W. M. Tiddens. Go here to register.
- 12 May 2020 (online, 17:00-18:30 CEST): GARDP REVIVE webinar. Title: “Probability of target attainment analyses for dose selection in antimicrobial drug development.” Speaker: Shampa Das. Go here to register.
- 19 May 2020 (online, 17:00-18:30 CEST): GARDP REVIVE webinar. Title: “Assay development for measuring antibiotic accumulation in Gram-negative bacteria.” Speakers. Jessica Blair, Mark Bronstrop, David Six. Go here to register.
- 9 Jun 2020 (online, 17:00-18:30 CEST): GARDP REVIVE webinar. Title: “Test tube to patient: PK/PD of fixed dose beta-lactam/beta-lactamase inhibitor combinations.” Speaker. Vincent Tam. Go here to register.
- 30 Jun 2020 (online, 17:00-18:30 CEST): GARDP REVIVE webinar. Title: “Clinical development of antimicrobials – Phase 1 development challenges.” Speaker. Markus Zeitlinger. Go here to register.
- 9 Jul 2020 (online, 09:00-10:30 CEST): GARDP REVIVE webinar. Title: “The challenges and opportunities for antimicrobial R&D in low- and middle-income countries – India case study.” Speaker: Anand Anandkumar and Kamini Walla. Go here to register.
- 17 Jul-2 Aug 2020 (Marine Biology Laboratory, Woods Hole, MA): Residential course entitled “Molecular Mycology: Current Approaches to Fungal Pathogenesis.” This 2-week intensive training program has run annually for many years and gets outstanding reviews. Go here for details.
- 29 Jul-2 Aug 2020 (Philadelphia, PA): Small World Initiative Instructor Training Workshop – training for undergraduate professors and high school teachers in wet lab techniques, parallel curricula, pedagogical instruction to engage students in the hunt to find new antibiotics in soil. Go here to register.
- 4 Aug 2020 (Silver Spring): FDA workshop entitled “Development Considerations of Antifungal Drugs to Address Unmet Medical Need.” Go here to register.
- 5 Aug 2020 (Silver Spring): FDA workshop entitled “Developing Antifungal Drugs for the Treatment of Coccidioidomycosis (Valley Fever) Infection.” Go here to register.
- September 2020. University of Sheffield (UK). Applications are being taken for a new 1-year (full-time) or 2-year (part-time) Masters of Science course in Antimicrobial Resistance. The program runs annually from September and covers microbiology, clinical practice and policy. The course webpage is here.
- 9-10 Sep 2020 (Washington, DC): US PACCARB public meeting. Go here for details.
- 22-25 Sep 2020 (Albuquerque, New Mexico): Biannual meeting of the MSGERC (Mycoses Study Group Education and Research Consortium). Save-the-date announcement is here, details to follow.
- 26-29 Oct 2020 (Rotterdam), Annual ESPID meeting (European Society for Pediatric ID, #38)
- 10-13 Apr 2021 (Vienna): Annual ECCMID meeting (#31)
- 20-24 June 2021 (Toronto): International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-12). Go here for details.
- 3-7 Jun 2021 (Anaheim), ASM Microbe 2021. Go here for details.
- 8-11 Oct 2021 (Aberdeen, Scotland): 10th Trends in Medical Mycology. Go here for details.
- 16-24 Oct 2021 (Annecy, France): Interdisciplinary Course on Antibiotics and Resistance (ICARe). This is a soup-to-nuts residential course on antibiotics, antibiotic resistance, and antibiotic R&D. The course is very intense, very detailed, and gets rave reviews. Registration is here and is limited to 40 students.