Barbara L. F. Kaplan and William Slikker, Jr. Animals and animal models have been used for centuries to provide us with an understanding…
Interview with Steffanie Strathdee, author of The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug
In 1915, microbiologist Frederick Twort occasionally noticed clear areas disrupting the growth of bacteria on his culture dishes. Twort found that the fluid in these clear areas contained a powerful substance that could kill bacteria. Following up on these observations at his laboratory at the Pasteur Institute in Paris in 1917, microbiologist Félix d’Herelle theorized these agents might be viruses and called them “bacteriophages.” He proposed that these phages could be used therapeutically to save millions of people from deadly infections.
Due to a strange constellation of mishaps, and the fact that these mysterious agents would not be identified until the invention of the electron microscope in the 1940s, d’Herelle’s idea of phage therapy mostly fell to the wayside. Instead, Alexander Fleming’s discovery of the antibiotic penicillin revolutionized the treatment of bacterial infections. But with the emergence of drug-resistant superbugs today, which kill more than 35,000 people a year in the U.S., could phage therapy make a comeback?
Epidemiologist Steffanie Strathdee and her husband, psychologist Thomas Patterson, are no strangers to adventure and novel experiences. But Tom picked up a horrible souvenir during their vacation to Egypt in 2015: a strain of bacteria called Acinetobacter baumannii that became resistant to every antibiotic his doctors threw at it. As Tom laid in a coma, and with all conventional medical options exhausted, Steffanie soldiered on to lead a charge to try phage therapy. The couple’s harrowing ordeal is portrayed in their 2019 medical thriller and memoir, The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug.
I imagine most people would want to forget the kind of nightmare you endured with Acinetobacter, but you decided to relive it and write a memoir. What drove you to make this deeply personal experience public and what were some of the challenges and trepidations in doing so?
Tom and I were deeply moved that a global village of total strangers stepped up to help source and prepare phage to save his life. It made us realize how privileged we are, and we decided we wanted to pay it forward. As an infectious disease epidemiologist, if I was blindsided by the superbug crisis, I knew the average person was unaware. When someone told us that the superbug epidemic didn’t have a ‘public face’ like HIV and cancer, Tom looked at me and raised his eyebrows. In reply, I said, “Honey, you’re it.”
Beyond the lack of awareness about superbugs among the general public, medicine needed a wake-up call too, because phage therapy had unfairly been given a bad rap. At the time Tom was treated, most physicians in the West had never heard of phage therapy and those that had had never thought of trying it on a patient. After our experience, we thought phage therapy was worthy of further study in clinical trials, but since the former Soviet Union had embraced phage therapy around the time of WWII, a deep-rooted bias had taken hold. We discuss this briefly in The Perfect Predator, but readers interested in medical history should check out William Summers’ biography of Felix d’Herelle [Félix d`Herelle and the Origins of Molecular Biology], where it is meticulously documented. It was incredibly ironic that phage had been used as a tool that launched the fields of molecular biology, genetic engineering, cancer biology, and synthetic biology, but the application of phage as a therapeutic tool was largely ‘forgotten’ in the West. In contrast, physicians in the former Soviet Union and Eastern Europe have continued to use phage therapy for decades. We have a lot to learn from them. We hoped that our book would help advance research on phage therapy and de-stigmatize the notion of phage as a therapeutic.
As science writers, many of us hope that our work changes the world for the better. The Perfect Predator is much more than a medical mystery and emphasizes the importance of biomedical research, particularly the neglected arena of superbugs, whose evolution far outpaces antimicrobial drug discovery. Has the book helped raise awareness or spark new interest in phage therapy?
It’s hard to know what kind of impact The Perfect Predator has had on its own, but Tom’s case appears to have influenced the field. At an FDA hearing on phage therapy that took place after he recovered, several presenters referred to “The Patterson case.” The case report published by Dr. Robert “Chip” Schooley, who oversaw the phage therapy protocol and was key to Tom’s survival, has an altmetric over 500, and The Lancet, JAMA, and Nature have all published commentaries about it. In June 2018, UCSD’s Chancellor, Pradeep Khosla, granted Chip and me seed funding to launch the Center for Innovative Phage Applications and Therapeutics (IPATH), which was the first dedicated phage therapy center in North America. Since then, several other programs have been created at research institutions around the U.S., and we all work together on phage hunts to save patients like Tom.
There is also more activity on the research front, both in basic and clinical research on phage, which is sorely needed. The NIH has funded its first two clinical trials of phage therapy, one of which is through the Antimicrobial Resistance Leadership Group, with Chip Schooley as the PI.
On the biotech front, the phage therapy field is really booming, with start-ups working on applications ranging from natural phage to those that are genetically engineered or synthetic. Several of these companies now have backing from pharmas and investment banks. We need their help to bring phage therapy to scale.
Finally, the book itself has had a few unexpected outcomes. Just last month I was contacted by a U.S. Congressman who was so moved by the book that he is hoping to have a Congressional briefing on phage therapy. We also hoped that the book would inspire young people, especially young women, to pursue a career in science. When we receive emails from students who tell us that our book made a difference in their careers, it makes our hearts sing.
With increasing evidence that our gut microbiome plays a critical role in physical and mental health, do you see phage therapy as a feasible means to fashion a patient’s microbiome into a healthier state?
I think phage will have a range of applications down the road. First, as an adjunct to antibiotic therapy. Second, as a prophylactic regimen in cases like cholera, where it could be used to prevent ongoing transmission in an outbreak. Third, as a means of ‘grooming’ the microbiome to weed out harmful bacteria. Fourth, phage is being studied as a replacement for antibiotics in agriculture, aquaculture, and veterinary medicine.
For a variety of reasons, as you nicely articulate in the book, the idea of phage therapy was largely ignored for a century. Are there other “wild ideas” that have been neglected by most experts that you feel warrant more serious attention?
I’m sure there are!
A challenge faced by many science writers is how to balance the enthusiasm for an untested medical treatment with more evidence-based approaches. I realize in Tom’s case that phage therapy was pursued as a last resort, but as a writer, how would you advise writing about the promise of a new but unconventional idea without overhyping it?
Balance is important. In The Perfect Predator, we tried to present the human side of medicine but also the science behind it, from the “known knowns, the unknown knowns, and the unknown unknowns.” It’s always important to make it clear to the reader which statements are based on scientific evidence, and which statements reflect the writer’s own opinions. We included selected references for each chapter and directed readers to our website, ThePerfectPredator.com, where we post relevant resources for readers who want to learn more.
To bring scientists out of the ivory tower and into the lives of everyday people, our books need to be entertaining and accessible. We wrote our book not as “Dr. Strathdee and Dr. Patterson” but as Steff and Tom. Our lives are on a plate, warts and all. That was a bit scary at first.
One of the things I enjoy most about the book is how you expertly weave science and medical history into the narrative. Do you have any tips or tricks you learned while writing or promoting the book that might help budding science writers? Would you mind sharing your writing process?
It helps to have a model, and a few books inspired us. One was Rebecca Skloot’s The Immortal Life of Henrietta Lacks, which masterfully weaves the narrative of Henrietta and her family with the writer’s perspective, alongside the science behind tissue culture, the history of medical ethics, and a social commentary on appropriate reparations. The other was Steven Johnson’s The Ghost Map, which tells the story of John Snow and his role in London’s cholera outbreak in the 1850s that spawned the field of epidemiology.
We also enlisted the help of a co-writer after our agent, Gail Ross, pitched the first draft of our book proposal to several publishers who passed on it because it was deemed to be an “illness memoir”. They all wanted [Richard Preston’s] The Hot Zone. At that point, I had written the first draft of the book in about six months, getting up at 5 AM every day before Tom rose. I wrote feverishly at times; it was clearly part of my healing process. I had started chronologically, beginning the story in Egypt, and I had a hard time deciding what details to leave out. Plus, Tom and I had been on leave and were now headed back to work. We needed help re-casting the story and our co-writer, Teresa Barker, was heaven-sent. Every day, we worked on the manuscript together. I learned a lot about nuance from her.
The hardest but most rewarding part of the writing process for me was capturing Tom’s interludes that describe his descent into delirium and his near-death experiences. Tom was dealing with PTSD at the time, and his hallucinations were haunting him. He would narrate these dream-like interludes to me since it was too painful for him to write them down himself. The rich imagery he described reminded me at times of Saint-Exupéry’s Wind, Sand, and Stars and T.S. Eliot’s Four Quartets, and I tried to channel some of this as I wrote in his voice. I’d then read Tom what I’d written. He’d correct me and then we’d cry a bit. (Little did I know at the time that I had PTSD too). When Kirkus reviewed our book and said these passages were “Dark, surreal, and poetic,” our agent told me that it was the best Kirkus review she had read and that I should put that phrase “on a mug.” I was elated.
We also relied on some “beta readers,” who were mostly friends and colleagues, some of whom knew the story and some who didn’t. We relied on them, as well as our editors, to tell us when the science went over their heads or lost their attention. The biggest debates with our publisher and agents were how heavy to go on the science versus the narrative. After all, the reader knows Tom lives before they read the book. The book is less about the “what” and more about the “how.”
Are you working on any new projects we can look forward to seeing? If you write another book, what is the one thing you’ll do again…and the one thing you won’t do again?
Funny you should ask. I loved writing so much I decided to write a novel. It’s about a female astrovirologist who discovers an extraterrestrial virus that causes a pandemic on Earth, and she needs to clear her name as well as save humanity. The trouble was, I finished writing it just before a real pandemic occurred, and a lot of what I imagined really came true! I’m looking for a publisher right now and am working on the second book in the series. One thing I am doing again is developing an outline, chapter by chapter. And I’m re-reading Arielle Eckstut and David Sterry’s book, The Essential Guide to Getting Your Book Published, which was very helpful when we wrote The Perfect Predator.
One thing I won’t do is allow the imposter syndrome to take over and undermine my writing voice. At times when my confidence feels shaky, I look at the Amazon page for The Perfect Predator and revel after reading the words “Editor’s Choice: Non-fiction.”
Steffanie Strathdee is a Canadian-American infectious disease epidemiologist, Associate Dean of Global Health Sciences, and Harold Simon Professor of Medicine at the University of California San Diego. She’s conducted research on the intersection of HIV and drug use for >20 years and leads a research and training program on the Mexico-US border with her husband, Tom Patterson. Steffanie and Tom’s book, The Perfect Predator, is based on their true story. Steffanie now co-directs the first dedicated phage therapy center in North America, the Center for Innovative Phage Applications and Therapeutics at UC San Diego. In 2018, she was named by TIME magazine as one of 50 Most Influential People in Health Care for her work to bring phage therapy to the U.S. Follow her on Twitter: @chngin_the_wrld.