Review of "The Living Medicine: How a Lifesaving Cure Was Nearly Lost - and Why It Will Rescue Us When Antibiotics Fail" by Lina Zeldovich

 

Lina Zeldovich is an award winning journalist and science writer. In this book Zeldovich discusses the use of bacteriophages (phages) - viruses that destroy bacteria - to treat infection and disease.

By now it's well known that 'the miracle of antibiotics' is over. Antibiotics are drugs that destroy bacteria, and antibiotics like penicillin once reliably treated gonorrhea, syphilis, tetanus, anthrax, gangrene, staphylococcus infections, streptococcus infections, meningitis, food-borne intestinal diseases, and so on.



As early as 1940, however, scientists were already seeing the emergence of bacteria resistant to penicillin. To address the problem, researchers developed new and stronger antibiotics, one after another, but bacteria ALWAYS develop resistance sooner or later. This is evidenced by infections such as methicillin-resistant Staphylococcus aureus, or MRSA. According to Zeldovich, "This dreaded superbug now lurks in hospitals, sickening 120,000 American per year and killing about 20,000. MRSA currently responds to vancomycin [used for the treatment of serious, life-threatening infections], but they may learn to repel it."


Staphylococcus aureus

Zeldovich describes an alternative treatment for bacterial illnesses, namely phages. Phages are special kinds of viruses that prey solely on bacteria. Phages look like tiny rockets, a thousand times smaller than their prey, which they pierce with their tails. The phages then reproduce inside the bacteria and burst them open.




Phages attacking a bacteria

The Soviet Union has been using phages to treat diseases for decades, but western countries have been reluctant to embrace this therapy. As Zeldovich notes, "Unfortunately, you can't yet buy a bottle of bacteriophage in your local pharmacy - not over the counter or by prescription. But in the era of skyrocketing antibiotic resistance, these phages might be our best weapons against the next bacterial pandemics."



Zeldovich provides a comprehensive history of medicinal phages, starting with Giorgi Eliava's discovery of bacteria-killing phages in 1917.


Georgi Eliava

Eliava was a trained microbiologist in the Georgian city of Tiflis (Tbilisi), studying the city's drinking water for disease-causing microbes. "And sure enough, there they were....Vibrio cholerae [cholera bacteria] that turned people into emaciated blue corpses, literally sucking their life out of them."


Vibrio cholerae


Patient with cholera

Eliava was examining a microscope slide containing contaminated drinking water, and saw Vibrio cholerae bacteria wiggling around. Eliava happened to leave the slide for a couple of days, and when he looked again, there were no bacteria on the slide. SOMETHING MUST HAVE KILLED THEM! It took some time, but Eliava discovered the 'something' was bacteriophages.

As often happens in science, another researcher also discovered phages in the early 20th century - Félix d’Hérelle, a scientist at the Pasteur Institute in France.


Félix d’Hérelle

D'Hérelle was studying Shigella dysenteriae, the dysentery-causing germs ravaging soldiers during WWI. A recovering patient had dying Shigella dysenteriae microbes in his stools, and when d’Hérelle seeded stool samples onto petri dishes, empty patches developed where Shigella had been destroyed. Once again, the killers were bacteriophages.


Shigella dysenteriae


Patient with dysentery

D’Hérelle became convinced the phages, which devoured specific bacteria, could be beneficial to people, to be curative entities and "agents of natural immunity." Other researchers began to experiment with phages, and their healing power was soon proven. Phages are especially good candidates for remedies because they're abundant in water, soil, and especially in sewage. Scientist Alexander “Sandro” Sulakvelidze, a phage expert, observed, "They are the most plentiful biological entities in any habitat, but sewage is particularly good for phage-hunting because it's teeming with various bacteria that become phage food."

Zeldovich goes on to discuss the development of phage 'therapies', which became ubiquitous in the Soviet Union and used in other places, such as parts of Africa, India, and the Far East.


Researchers developed phage therapies

The author also provides mini-biographies of scientists who studied phages, and Eliava's life in particular is fascinating. Zeldovich writes,"Gregarious and full of burning energy, Eliava embraced his city to the fullest. He instinctively knew how to dress, how to court, how to charm. He appreciated art and literature. He was a passionate dancer and an enthusiastic boxer. He cherished good food and had a sweet tooth. He rode horses [and was] a prankster always ready to pull a joke on a friend." Eliava married the beautiful opera star Amelia Wohl-Levicka, and at the height of his career - when Eliava was building the Tiflis Bacteriophage Institute (later renamed the George Eliava Institute) - the microbiologist tragically got caught up in Stalin's purges.


Amelia Wohl-Levicka


George Eliava Institute for phage therapy

Unlike Eliava, Félix d’Hérelle didn't have a degree in microbiology, but had a passionate interest in the subject. A "restless world traveler", d’Hérelle studied microbes wherever he went, and his wife Marie Caire was his lab assistant. At times, D’Hérelle worked with Georgi Eliava in Tiflis, and the two scientists traveled together, attended microbiology conferences, visited major research centers, and exchanged bacterial cultures and phages with other scientists. Unfortunately, d'Hérelle's travels exposed him to exotic germs, and he contracted amoebiasis (dysentery caused by amoebas) two times, and a long-lasting fever of unknown origin. All this led to d'Hérelle's chronic ill health later in life. D’Hérelle's lasting contributions to science include two important books about bacteriophages.


Entamoeba histolytica (an amoeba that causes amoebic dysentery)





Zeldovich writes about additional scientists as well, and it took a group effort to advance phage therapy. Nevertheless, phage medicines were a hard sell in the west, and "No average American clinician in the United States would try phages for treating bacterial infections."

This began to change in the early 1990s, when Glenn Morris at the University of Maryland offered Alexander “Sandro” Sulakvelidze, from the Soviet Union's Eliava Institute, a postdoctoral fellowship. Sandro informed Morris about phage therapy, and they put together a proposal regarding the use of phages to treat MRSA. There was TREMENDOUS pushback/criticism from American scientists and doctors, and the proposal was denied. However, in 2006, phages were approved for use in food safety.



Afterwards, in 2016, phage medicine was approved in the United States, on 'one-off' grounds, for a man called Thomas Patterson in San Diego. While vacationing in Egypt, Patterson had contracted a 'vicious bug' called Acinetobacter baumannii, which infects many organs and systems. Patterson had tried about fifteen antibiotics, been in and out of comas, and was on the brink of death. Luckily for Patterson, his wife Steffanie Strathdee was an infectious disease epidemiologist, and Strathdee reached out to every medical expert she could find. This led to phage therapy being approved for Patterson on a onetime basis with an 'experimental Investigational New Drug' (eIND). It took a global effort to produce the phage medicine, and it worked. Patterson recovered! After that, several other dying patients were treated with phages on an eIND basis.


Acinetobacter baumannii


Thomas Patterson and his wife Steffanie Strathdee

Finally in 2018, Sandro - who was now President and CEO of the biotech venture Intralytix, Inc. - was approved to do a clinical trial that involved growing phages to treat Crohn's disease, "a chronic inflammation of the gastrointestinal tract that causes pian, diarrhea, fatigue, weight loss, and malnutrition, and has no known cure."


Alexander “Sandro” Sulakvelidze


Crohn's Disease

Sandro then wrote proposals to test phages against other illnesses, all of which laid the groundwork for possible medical applications in the United States. So widespread phage therapy may be in America's future.

Zeldovich covers much more ground in her book, which I'd recommend to everyone with an interest in health and medicine.

Thanks to Netgalley, Lina Zeldovich, and St. Martin's Press for a copy of the book.

 Rating: 5 stars

Review of "Beautiful Ugly: A Novel" by Alice Feeney

London writer Grady Green pens thrillers, and hopes today is his lucky day. Grady is waiting for a call from his agent, who'll tell him if he's made the New York Times best seller list.



As Grady hovers near the phone, his journalist wife Abby is driving home, hoping to celebrate the success of Grady's novel.



When Grady learns his book IS a hit, he phones Abby right away. While the couple extoll the great news, Abby slams on the brakes, saying a woman is laying in the road, and she's going to offer help. Grady strongly discourages his wife, citing possible danger, to no avail. Abby gets out of her car and vanishes.

Grady can't cope with Abby's disappearance. He's unable to write another word; drinks too much; and runs out of money. A year after losing Abby, Grady and his black retriever Columbo are living in a shabby room in a cheap hotel, barely making ends meet.





At this point, Grady's agent Kitty makes an offer Grady can't refuse. Kitty has inherited a cottage on tiny Amberly Island, off the coast of Scotland. The last tenant is gone, and Kitty offers the residence to Grady, suggesting the environment might inspire a new novel.



Grady accepts, packs up his and Columbo's few possessions, and they head for Amberly Island. As soon as Grady and Columbo step off the ferry onto the isle, they begin to meet the residents, all of whom know who Grady is, and most of whom refer to him as 'the author.'



The cottage Grady's staying in, called The Edge, looks rustic on the outside but has all the conveniences, minus a television, radio, or phone. The isolated island has no WiFi; no cell phone service; and no working landlines.



To communicate with the outside world, the ferry - which runs sporadically - carries passengers between the mainland and Amberly Island, and brings in supplies as needed.



Grady soon discovers that Amberly Island is no London. There are only 25 residents, and the sole shop with regular hours is a grocery store/post office. The manager of the grocery store offers to order Grady anything he needs, and The Edge contains a good supply of expensive scotch, so Grady feels he can make do.



As Grady and Columbo are settling into the cottage, Grady finds a hidden compartment in the floor. The space contains the bones of a hand, and the unpublished manuscript of the cottage's previous resident, a well-known author. You can guess what happens next: Grady decides to rework the manuscript into his own 'voice' and submit it as his next book.

In between working on the novel, Grady perambulates around the island and hobnobs with the people. Grady occasionally thinks he sees his wife Abby, but it's never her, and Grady worries that he's hallucinating.





Grady's discomfort is heightened by the fact that someone is slipping envelopes with Abby's old newspaper articles under his door - articles that seem to be hinting at something.



After a couple of months, Grady is VERY antsy, anxious for the day he and Columbo can return to London. Of course things aren't quite that simple......

The chapters about Grady's life are interspersed with flashbacks to the past, when Abby is speaking to a therapist. Abby is admitting she's become disillusioned with her marriage, and is thinking of leaving her husband.



Readers may think they know what's going on, but there are significant plot twists and a head-spinner of a climax.

I enjoyed the book, but feel the author's misdirection is a bit clumsy. Still, this is an enjoyable mystery that kept my attention, and I liked the sweet pooch Columbo.



I listened to the audiobook, narrated by Richard Armitage, who does a fine job.

Thanks to Netgalley, Alice Feeney, and Macmillan Audio for a copy of the book.

 Rating: 3.5 stars

Review of "Head Cases: A Novel of Suspense" by John McMahon

 

 

 

Gardner Camden is an FBI agent with the Patterns and Recognitions Unit (PAR) located in St. Augustine, Florida.



Most agents in the PAR have two characteristics: they made a mistake and were subsequently transferred to the PAR; and they're brainiacs with unique abilities, like eidetic memory, math expertise, etc. Up until now, the PAR agents have been confined to office work, studying the evidence and files from unsolved cases, to look for new clues.



Camden, who's always been socially awkward, observes: "Riddles. Those are my specialty. That is, when I am not studying patterns. Or decoding enigmas. Some might say that solving puzzles is all I'm good for. That leaving my desk in the Jacksonville office of the FBI to interact with real people is not the best use of my time or talent. And I would agree with them."



Now, however, the PAR investigators have been sent to Texas to view a body. Camden recognizes the murdered man as serial killer Ross Tignon. Camden's shocked, and observes 'Tignon is a man I had hunted years ago. I had only stopped hunting him because he supposedly died in a house fire six years ago.' At that time, Tignon's incinerated body was identified by two molars, and the current corpse is missing two molars. Tignon apparently yanked out his teeth to fool the authorities.



In addition to missing teeth, Tignon's body has been defaced by the killer, who cut Tignon open and carved the numbers 5 and 0 into his torso. Moreover, it's later discovered the murderer left a clue INSIDE the body as well.



A few hours after viewing Tignon, the PAR agents are re-routed to New Mexico to observe another body. This victim is Barry Fisher, a serial killer who was JUST paroled for 'old age' after serving 31 years in the penitentiary. Fisher's body is terribly mutilated, with his organs excised and placed in plastic bags in the refrigerator and freezer. As is the case with Tignon, the murderer also left a clue inside a body part.



The PAR concludes A SERIAL KILLER IS TARGETING SERIAL KILLERS.

Camden is assigned to lead this multi-case investigation, a first for him at the PAR. Before long, Gardner starts to get phone calls from the killer, who says to call him God. The PAR agents, however, elect to call the murderer Mad Dog, and Mad Dog's conversation shows he has inside information about the investigation. The murderer must have a source in the FBI, and Camden takes steps to expose the mole while proceeding with the inquiries.



Mad Dog's phone calls, and the clues he leaves behind, demonstrate that he thinks of himself as a partner who's aiding the PAR. When Mad Dog is disabused of this notion, he makes threats.....and takes steps to carry them out.

As the inquiries proceed, several possible suspects are identified, the current murders are linked to past homicides, and the PAR agents must use all their skills to solve the cases.



The novel is a page-turner, with plenty of action. My major criticism is that the brilliant PAR investigators sometimes miss information they should winkle out right away. Author John McMahon probably uses this technique to prolong the suspense, but it's not credible (to me) In any case, this is a good thriller, recommended to fans of the genre.

I listened to the audiobook, narrated by Will Damron, who does an excellent job.

Thanks to Netgalley, John McMahon, and Macmillan Audio for a copy of the book.

 Rating: 3.5 stars