Team:Northwestern/HP/Gold Integrated

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Integrated Practices

Our human practice efforts were incorporated throughout our design. Initially knowing little about the antibiotic field, we conducted several interviews with experts to gain a better understanding. Dr. Mendelson, London, and Levy all provided great insight into the complexity of antibiotic use in today's world

A common theme that was present in all expert interviews was antibiotic over-usage. The cost efficiency and availability of antibiotics makes it appealing for medical professionals to prescribe, especially if the diagnosis of the patient isn't yet clear. This is particularly prevalent in developing nations. Additionally, their is a large patient demand for antibiotics, putting additional pressure on medical professionals to supply.

Fortunately, we took Dr. Mendelson's work and integrated it into our project. Besides researching infectious diseases, Dr.Mendelson advocates for clear use surrounding antibiotic resistance (AR). He thinks that clear language such as "antibiotic resistance" vs "antimicrobial resistance" is necessary to help the population understand the antibiotic epidemic. Hence, this website only uses terms such as "antibiotic resistant" or "drug resistant" infection; these terms, claims Dr.Mendelson, are what most of the population can understand. Below we outline the expert interviews we conducted and our main takeaways.

Health and public policy

Interview with Dr. Mendelson
Dr. Mendelson’s research revolves around Infectious diseases in countries with high rates of antibiotic resistance (AR). He focuses on models of antibiotic stewardship, antibiotic prescription and response, hospital collaborations and the use of antibiotics in surgical pathways. Most his work centers around international policy development for infectious diseases and antimicrobial resistance strategy.

Dr. Mendelson highlights how there are many players in the antibiotic game, not just scientists or doctors. Finance, food production and the general public are often in tandem with the science behind antibiotic resistance (AR). He stressed the importance of education and awareness as well as individual and national responsibility to use antibiotics in a poised manner. Using language that is clear such as "antibiotic resistance" vs "antimicrobial resistance" is also essential to the fight. Dr. Mendelson thinks that carefully planned use of antibiotics will be a lasting solution in addition to new therapies being created to fight bacteria.

Additionally, we asked for suggestions and things to consider when molding our project. Dr. Mendelson proposed that we carry out risk analysis to evaluate the chances of our therapeutic working and weighing the risks and benefits of this delivery system. He also advised us to be specific about what genes we are trying to target while remaining cautious. “Antibiotic Resistance isn’t just because of genes. Superbugs have multiple resistance mechanisms, disabling the genes doesn’t mean it’ll surefire die.”

Takeaway: Our conversation with Dr. Mendelson helped us be more considerate with the language we use when referring to antimicrobial resistance. When talking about antibiotics, this website only uses the terms "antibiotic resistant" or "drug resistant infection"; according to Dr. Mendelson, most of the population can understand these terms, a first step to combating AR worldwide. Dr. Mendelson also convinced us to carry out risk analysis for our protein delivery approach. .



Interview with Dr. London
Dr. London is a WGN radio correspondent and currently resides in rural Maine. Dr. London practices general medicine and is active in healthcare policy. Dr.London recently made news as she devised a reusable epinephrine autoinjector to combat Epipen’s controversial price increase.

Dr. London emphasized the importance of physician-patient relationships and public health policy to lowering the rate of antibiotic overuse. Hospitals are essentially hotbeds of bacteria, more so than individual physician practices. People without insurance (due to de funding) also have the tendency to wait until things are bad before rushing to the emergency room, where carers unfamiliar with the patient prescribe antibiotics “just in case” the problem is a bacterial infection, which it's often not. Dr. London believes our project is a clever idea, as antibiotic resistance must be attacked on all fronts with as many new ideas possible. The onus, however, lies with us to educate the public about gene editing, which often sounds like a dangerous idea to the average citizen.

Takeaway: We tried to take Dr.Londons emphasis on educating the average citizen that genetically modified does not inherently correspond to something negative. For example, while presenting to CTD students, we made an “ethical consideration slide” that balanced the pros and cons of potential genetic engineering applications. Projects such as experimental mosquito (i.e to fight Zika) or GMO foods often get a bad rep in the media, but have many positives such as disease eradication and feeding hungry populations.

Interview with Dr. Levy
Dr. Levy is the director of the Center of Adaptation Genetics and Drug Resistance at Tufts University in Boston, Massachusetts. He studies how Prokaryotic and Eukaryotic cells adapt to environmental signals and hazards. Currently, Dr. Levy is studying the efflux of the Tet Protein and Tetracycline use.

Dr. Levy thinks that the fight against antibiotic resistance should be multifaceted. Treatments to aid conventional antibiotics should be developed, as well as new antibiotics. From his knowledge, Dr. Levy thought that are proposed gened editing therapy was feasible and that "young individuals should be able to try out new techniques". As an afterthought, he mentioned that a easy way to fight antibiotic resistance is swap out your toothbrush multiple times a year, especially after sickness.

Takeaway: Our interview with Dr. Levy gave us confidence that our project could potentially be feasible. Dr. Levy was very encouraging and supportive of the scientific process. However, he gave us advice to do failure analysis on our solution. Often times, treatments improve in some areas over their predecessors and fall short in others.

Interview with Special Agent Mahlock
Scott Mahloch is a former member of the Navy turned FBI agent. After entering the FBI in 2008 and completing training, Mahloch was assigned to Milwaukee Division’s Kenosha Resident Agency, where he worked on a variety of cases. He currently is the Chicago Division’s Weapons of Mass Destruction Coordinator.

Special Agent (SA) Mahloch didn’t have to much to say in relation to antibiotic resistance or the specifics of our project. However, Mahloch did highlight the use of biological threats when it comes to weaponry. He emphasized the importance of being vigilant and aware of ones surroundings while working in a lab and reporting potentially suspicious activity. Mahloch helped us understand that the FBI was not a regulatory agency but is often the eyes to make sure that everything is working smoothly and safely.

Takeaway: There isn't much we can change about our project from Special Agent Mahloch's presentation. However, our team is more aware of the dangers of biology and how it can potentially be used for nefarious acts. If we see something we will definitely say something!


Interview with Dr. Hayden
Dr. Mary Haydenis a professor of Medicine (Infectious Diseases) and Pathology and Director of Clinical Microbiology at Rush University Medical Center in Chicago, IL. Her research interests include the epidemiology and control of antibiotic resistant pathogens in healthcare settings. She has been a member of the CDC-sponsored Chicago Prevention and Intervention Epicenter team since 2006.

Dr. Hayden’s journey with working with infectious diseases began in 2009 when a patient with CRE tragically passed away at Rush University while she was on call. Though CRE and MRSA were not prevalent yet, some of the first cases to be seen were in Chicago. Through her work in the field, she realized that these diseases were remaining undiagnosed in many health facilities. She also realized that the control of antibiotics were being conducted "selfishly” and facilities would set up protocols to protect their own facilities. One of the main programs at the Epicenter is to aid surrounding facilities in developing protocols that will protect them all from the wide spread of antibiotic resistance.

Dr. Hayden emphasized how there are many different methods to protect the population from antibiotic resistant bacteria diseases that stem from them. From good hygiene practices, to using gene sequencing to track the origins of resistant microorganisms, to antibiotic stewardship, she provided many examples of ways to make a difference.

Dr. Hayden stressed that innovation is the way to go if we are planning on finding a replacement or something to go in conjunction with antibiotics. She mentioned that our research seemed promising but reducing overuse would also be vital.

Takeaway: Dr. Hayden really ingrained in us the idea that there are many ways to battle this problem. Dr. Hayden pressed that a novel intervention is needed and commented that we are heading in the right direction.



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