Episode 2 Bang Goes the Theory

Welcome to Bang Goes The Theory, we are here with the science behind

the headlines. Tonight we are looking at something inescapably,

infectious disease. From flu to SARS, our bodies are under threat

of infection from one source or another. If that wasn't bad enough,

recent news stories are full of the biggest weapon against disease has

been blunted. Antibiotics may have become useless against new breeds

of becomes. Today Britain's Chief Medical Officer presented a report

on this subject to the Government. We were granted a preview and it is

a wake-up call, I it kel you. I will speak to her about it later in

the programme. First, Maggie asks if public

transport puts us more at risk from spreading germs. She reveals one

solution to a problem doctors face every day, deciding when to

prescribe antibiotics. Doctors always want to do the best they can

for the patient in front of them. One of the dangers is we overtreat

and give antibiotics where they are not necessary. I find out where not

fin pirbing a course of antibiotics can lead -- finishing a others of

antibiotics can lead to resistance. You have a strain of a superbug

happy able to grow. Gem reveals why different weapons are needed to

combat viruses and bacteria. That should do it. That's tonight

on Bang Goes The Theory. One of the places many of us worry

about picking up coughs and colds on public transport. Planes, trains

and buses. I have been on a mission to see if they really deserve their

reputation as hot beds of infection. . There are lots of people who

unfortunately are quite filthy and don't put their hands over their

mouth. It is almost impossible to avoid. You have to hold your breath

and hope for the best. It is warmer. Dirtier. That is why I don't use

public transport. You don't have fresh air, if I have flown, I

generally get a cold or sore throat after it. It is all about having to

share your air. And on planes that problem can feel especially bad. We

have all had that sinking feeling when you get on plane and hear

someone coughing a few rows back. You instinctively feel if you were

in an enclosed space like on a bus, train or plane, you are far more

likely to catch anything that is going around. Just how infectious

is the air that circulates in a plane?

I have come to this state-of-the- art testing facility in Germany, to

investigate if the air on board a plane really is a soup of other

people's breath. It takes serious technology to work out how the flow

of air in an aircraft cabin can affect the movement of germs, you

need a massive air tight chamber to copy the conditions. And an air

controlled system. To make it as accurate as possible, all the

dummies are heated t feels strange, but helps recreate natural body

heat, and the small thermals of air created bypass injuries on a plane.

Just to show you, take a look at the thermal-images camera, as I

walk along. That face belongs to Victor, he will demonstrate what

happens when you cough as soon as we have taken off.

Are we set to go? Yes, we are set to go. Shall I do the honours.

A little smoke helps to highlight the gentle air movement. We usually

try to develop in the aircraft cabin to have a cross sectional

movement of the air flow. So when you look at the sketch, for example,

we supply the air on the very top and it hits the overhead bin here,

circulates down there and is extracted here.

We can see this circular movement in the test cabin. The steady

currents drag air down from above, and across the cabin to exit

vefrpbts near the floor. Almost -- vents near the floor. None travels

along the floor of the cabin. What happens when someone cows into the

air? Can you do the cough experiment? It is quite home spun

but effective. It is interesting, you can see him doing it now, with

what you start to see is that actually when you cough, the

particles are not going that far. The downward movement of air

carries most coughs and sneezes down towards the floor, where they

get extracted from the cabin. you are travelling by plane, and

you hear someone coughing six rows ahead, you are not worried? No, I'm

not worried by those things. But if the air is sucked, germs and

all, through the floor, where does it go then? Back into another

section of the cabin? Well, no, actually around half of the cabin

air is expelled through vents like this. The other half is routed but

HGPA filters, the same filters found in hospitals in operating

theatres, to keep the air clean and bug-free. That clean, filtered air,

is mixed with the same quantity of fresh air from outside the plane.

That is what comes out of the vents above your seat. The air on the

plane is refreshed roughly every two-to-three minutes. If you

compare it to an office, it is every five-to-ten minutes. If you

are in a cinema, you could be sitting in the same germ-laden hair

for up to 20 minutes. So airbourne germs are not the problem on planes.

Touching condominated surfaces is a far greater risk than breathing the

same air. Germs spread like this wherever you are, on a plane, on a

train, in a school, in the office or going around the shops.

All this suggests that in theory at least, public transport is no more

infectious than any other public space. But do the statistics agree?

For several years researchers across Europe have been monitoring

the health and travel habits of over 30,000 volunteers. What has

that taught you about the risk of catching colds and flu on public

transport? However we look at the data, there is no increased risk of

getting flu-like illness from getting flu-like illness from

taking public transport. We have seen looked at people who

take public transport for over an hour-and-a-half every day. When

they are compared to people who take no public transport, there is

no increased risk. Why is that? It seems so counterintuitive, you are

packed in with all those people you hear coughing and wheezing? That is

a good question, but the short a good question, but the short

answer is we don't really know. A slightly better answer is, the fact

is, when you are on public transport, you really aren't in

people's faces, it is quite an uncomfortable situation. If someone

is facing you with their face right in front of you, you are likely to

look away. The likelihood of someone sneezing or coughing on you

is quite small. Most people would find that really surprising?

found it very comforting, considering I have to take public

transport in every day. Did you identify any areas where you might

be more at risk? Yes, having children under the age of 18.

Children tend to be a bit more tactile, be a bit more in your face

maybe not wash their hands as much as they should. And consistently we

have found that this is a big risk factor for getting the flu.

can't do much about that? So what about when you do get an

infection? There is one thing many of us hope will sort us out every

time, a course of antibiotics. But how much do you really know about

them? In UK hospitals more money is spent on antibiotics than any other

type of drug. Britons take almost 50 million courses of antibiotics a

year. To tackle a range of infections from earache to MRSA.

Antibiotics seem to fight so many infections and are so effective, it

is little wonder they have gained a reputation as cure-all medicine.

Why is it doctors are often reluctant to hand them out when we

turn up at their surgeries feeling ever so poorly? Well, we first need

to look at the actual germs that cause most common infections. Many

of us already know that infectious illnesses are often caused by

viruses or back tearia. But how many of us know actually what --

and bacteria. But how many of us know actually what difference that

make. You normally need a microscope to explore the

differences between viruses and bacteria. But studying things in

lab is not my scene. I find it easier to explain things when I get

my hands dirty and see things properly. That is why I have come

here. The most obvious difference between viruses and bacteria is

size. To us, a single bacteria might be pretty small, a thousandth

of a millimeter. To a virus, they are looking very large. If we scale

things up, and took a typical virus to be the size of a suitcase, in

which case, a bacterium would be the size of a van. The comparison

doesn't end there. Just like this van is a fully functioning machine,

with different working parts for specific jobs, wheels, engine, fuel

pump, windscreen, et cetera. So too is a bacterium. It is a self-

contained unit, with a wall around it, and all the biological

machinery of a living cell. Where as a virus just has a thin

protein coat. Inside it is practically empty, no machinery of

its own. Just a string of genetic material, like DNA, like, in fact,

an instruction manual. Alone it can do nothing, it has to hijack a

living cell and turn it to its own purposes. It is only by using

something else's biological material that a virus can

repeatedly clone itself, before bursting out and infecting

countless more cells, in a destructive chain reaction. These

essential differences mean that we have to use very different weapons

for fighting viruses and bacteria. Of course, one big weapon in a

doctor's tool kit, or medicine bag, is antibiotics. There are several

different types of antibiotics, and because they work in subtley

different ways, it means they are a tremenduously versatile drug.

Some antibiotics like the famous penicillin work by rupturing the

bacteria. Cells have to divide to multiply, and pencil lin stops that.

They keep swelling and burst like a balloon because they can't divide.

What most all antibiotics have in common is the ability to cripple a

particular function of the bacterial cell. There are many ways

of doing this. With so many parts to attack, antibiotics can disable

bacteria in many different ways. With a virus, there is nothing to

disable. This is just the wrong tool for the job. Which is why

antibiotics are useless for viruses. So, unless you have a bacterial

infection there is no point in your doctor prescribing antibiotics.

Nine times out of ten with coughs and colds it is a virus that is

caution the problem. Drugs to combat viruses work in a totally

different way. Most anti-viral drugs need to physically block the

virus from getting into or out of the cell it needs in order to

replicate. That should do it. It seems hard to believe that only

a generation ago many bacterial infections were fatal. A scratch on

the knee could kill. We rightly celebrate new medical breakthroughs,

cancer treatments, for example, that extend lives by months or even,

but antibiotics we seem to take for granted. Even though they save

lives. Not just extending them, every single day. They are truly

impressive. Still to come tonight: Maggie

reveals surprising medical research into new antibiotics.

And I find out why bacterial resistance is such big news. Anti-

bacterial hand washes, gels and cleaning products might not be all

that great, because they too can encourage bacterial resistance.

When did you last get prescribed antibiotics, did you finish the

whole course? On hostly? We hear the same course -- honestly? We

hear the same mess arpblgs you need to finish the course even if you

start feeling better half way through. Once you feel better it is

easy to forget about them, leave them in the cuboard or fridge and

not take them again. What is so good about finishing? It is useful

to think about curing an infection in two cries, one, microbial cure,

where all the back tear is completely eradicated. And then the

symptomatic cure, you feel better and no more symptoms. Even then

there may still be a few bacteria hanging around. That is where the

risk is. They then stand a chance of becoming resistant to the

antibiotics. Liz has been to find out more.

So how do bacteria become resistant. What we have got here is footage

from Harvard University of a bacterial colony growing across an

agar plate, along which are sections with increasing

concentrations of antibiotics. Watch what happens, this is a

bacteria growing on a section with no antibiotics, growing and

dividing, so far so good. It meets the junction to the first

section where there is a low concentration of antibiotic. The

antibiotic initially prevents the bacteria from spreading any further.

But as it is only a low dose, it doesn't kill off all the bacteria

and some invade. Bacteria grow and divide at extremely fast rate. A

new generation is produced every 30-minutes or so. As they divide,

random mutations take place. And sometimes that mutation can lead to

a resistance to a particular antibiotic. That is exactly what's

happening here. You have got a mutated strain now that is

resistant to this antibiotic, and is able to grow quite happily

across the agar. Then the spreading bacteria reaches

a section with 30-times the antibiotic dose. It stops them in

their tracks. But not for long. A lot of it is killed off, but some

of it continues to grow and divide. Most importantly the mutated strain

of bacteria, the one that is resistant to the antibiotic, is

happily growing and dividing across this section of antibiotics.

Initially only killing some of the bacteria allows a stronger strain

to survive. That's how bacteria can evolve to become resistant. It will

happen naturally, to a certain extent, but it can be greatly

speeded up when people take repeated courses or take

antibiotics for the wrong reason, or they don't finish the course.

This effect is not just limited to antibiotics. Anything that kills

bacteria can put pressure on the bugs to evolve resistance. Anti-

bacterial hand washes, gels and cleaning products might not be all

that great. They too can encourage bacterial resistance.

And it is not only in humans that bacteria are becoming resistant to

antibiotics. Talk me through a scenario where it is not an organic

farm like this, animals are in close contact with each other. Do a

lot of farmers give antibiotics on a regular basis? They seem to need

to. If you are trying to produce your meat really cheaply, if you

have a lot of animals Onazi concrete, in housing inside, the

opportunities for disease spread are much greater. In situations

like that antibiotics might be given to a whole herd to stop Anne

fex spreading. Just as we overuse antibiotics in medicine, there is a

danger of overuse in large scaling as well. As farmers try to meet the

demand for low-cost food. I have made a new friend! Oh yes.

So healthy pigs. Is there ever a situation where you have to use

antibiotics with these? We produce 4,000 young pig as year. On that

lot five or six individual pigs fight get a antibiotic treatment a

year. There are times in animal and human medicine where we do need

antibiotics, they are very precious and we need to look after them.

Meanwhile resistant bugs continue to build up in the environment

through use of antibiotics in animals and humans. And that's why

today the UK's Chief Medical Officer released her report

detailing the extent of the problem. What scale are we talking about,

how serious is this, really? I have described an apocalyptic scenario,

where you could go in, for the little operation I had earlier this

week, to release a nerve in my hand, get an infection, but that

antibiotics don't work and I die of it. Or a hip replacement. Let alone

cancer patients who won't be treatable and will die early in

their treatments and organ transplants, kidney, for instance,

where we might not be able to do them. It is a very serious issue

for mankind. How on earth have we let it get to this stage?

haven't put enough focus on it. In this country we have taken quite a

lot of effort in the human field and increasingly in the animal

field, but it is across the world problems. Partly because of travel,

but also because of the transport of food and animals. What

recommendations has your report put forward to tackle this massive

problem? Clearly there are two areas, one is how do we preserve

the antibiotics we have got, that is about using the right anti-

biotic at the right time, in the right dose for the right period.

Then, how do we promote new drug development. That is looking at the

ways you can stimulate big pharmaceutical companies so they

start to invest in again in this area. Do you think antibiotics

still have a place in modern medicine, or are we looking to

something else to sort the problem out? We can't have modern medicine

without antibiotics, we have nothing else to replace them at the

moment. We have to take this very seriously. Now we cannot afford to

lose a focus on this. So, what does the future hold for

the battle since infectious diseases. A couple of series ago I

looked at the cutting-edge research tackling the problem head on, that

research is still going on. Maggie is finding out about the medical

advances being used right now. The immediate challenge is to find

ways to use antibiotics more carefully. But in some areas of

medicine, that's not always straight forward.

In fairness, it is sometimes quite difficult to tell whether an

infection is bacterial or not. The only way is by a blood test, and

typically you can wait two-to-three days for the result.

But wait ing for days -- waiting for days is no good on a hospital

critical care ward, where some bacterial infections can kill

vulnerable patients in a matter of hours. Doctors often prescribe

antibiotics just to be sea. When you take into account farm use, GPs

and hospitals, it is estimated that two third ofs antibiotic use is

either highly questionable or totally unnecessary. And that's a

tragic waste. So the most recent developments are in methods to cut

down that waste. And that could ultimately save many lives. One of

those methods is being introduced here at the Royal Hampshire

Hospital. We popped by today to see how you are. Can you tell us what

brought you into hospital? I have difficulty breathing, I get very,

very breathless. One of the reasons we have come along as the infection

team is to try to decide if you need any antibiotics. We have a

special blood test, which is a relatively new development which

can distinguish between bacterial and viral infection or no infection

at all. I think we will do that on your samples, which will help us

make a decision as to whether or not you need antibiotics. Right, OK.

Maggie this is the biology and immune nolg lab. This is where we

would bring her test to. Her blood is being cultured, they will take

five days to grow bacteria, they may come up in 24 hours if they are

there if we are lucky. This test can be done in two hours which

helps decide whether or not she has a bacterial infection and whether

we have to give antibiotics. test is looking for levels of a

blood protein, which rises during a bacterial infection, but not in a

viral infection. This reason does pro--calcitonin tests, and this is

the read out, it gives us an accurate representation of the

presence in the blood. It is less than 0.05. That indicates for this

particular patient there is no necessity to give antibiotics now.

The doctor closely monitors patients to make sure not giving

them antibiotics is the right decision. And since introducing the

system, this unit has cut down antibiotic use by half. To have a

test like this, which enables us with our clinical diagnosis to be

sure if a patient has or has not got a bacterial infection, is

really useful. It is only being used in handful of places so far.

But the ultimate goal is to make this test economical enough to use

in GPs' surgeries, where 80% of antibiotics are prescribed.

So there is hope in sight. But meanwhile, the hunt is on for the

next generation of antibiotics. Although it has been 25 years since

the last ones were found. This mould, which often grows on bread

is a good source of pencil lin. And most of the penicillin, and most of

it comes from nature, in the soil. The problem is coming to find new

ones is we have looked in most of the obvious places.

So we are now having to look in ever more obscure places, which can

be surprising, even to medical professionals.

Now I have got some rather unusual things on this trolley. So we have

some soil from the Attacama desert. We have some disgusting-looking

sludge from an estuary. And some plants, this is crocodile blood. Do

pass them round. One last thing, we have a few friend! Ahhh. Uhhh.

they cockroaches? They are. Yes. But they can't climb the plastic

walls, we are all right. As unpleasant as these seem to us,

they are all home to microbes, which rely on their own germ-

killing chemicals to survive. There is something that links all of

these things, therapy tension sources of antibiotics. Ohhhh.

these? Yeah, yeah. The brains, crushed, apparently. How did

somebody think of that! In research labs all over the world we are

trying to harness those antibiotics for our use. But the process is a

long, labourious, time-consuming and very expensive one. Every new

antibiotic is expected to cost millions of pounds before it ever

reaches a patient. In the meantime it is critical we all do what we

can to reduce the spread of disease. In fact, simple soap and water

remain the best way to prevent many bacterial, viral and fungal

infections. That's it from this programme, a lot to think about.

There is more on antibiotics in the new health report, and on the myths

of sneezing too on the BBC website. And follow the links to the Open

University, for a bacterial challenge and much more about

microbes. Next week, we put sugar on trial.

Liz finds out why we have such a sweet tooth.

Without sugar, our cells couldn't do their jobs, our muscles wouldn't

work, and most importantly our brains simply wouldn't function. We

meet the doctor, horrified to find his diet has given him fatty liver

disease. It was this wake-up call of needing

to change my lifestyle, this will only get worse if I don't go

something dramatic. Maggie discovers that sugar is a

secret weapon in the fight against infection.