Taming Superbugs Insights From Game Theory Professor David
McAdams
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Antibacterial Soap
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Antibacterial Soap with Triclosan Useless in practice Creates
health risks CDC recommends regular soap!
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Good News 2013: FDA proposes new rules to require soap-makers
to demonstrate safety and effectiveness 2014: Bath & Body Works
joins others who have removed antibacterials from their
products
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A Beautiful Mind John Nash, aka Russell Crowe
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No man is an island, entire of itself. John Donne, 1624
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Game = Any situation with multiple decision-makers (or players)
whose choices impact one another..
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Games of Life HOSPITALSCHOOL HOMEOFFICE
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My Own Game-Theory Journey
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Business: mobile payments Public policy: alcohol abuse Foreign
policy: Somali pirates
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October 2013: Debt-ceiling crisis My Own Game-Theory Journey
Changing the debt-ceiling game New York Times op-ed
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October 2014: Out-of-control western corn rootworm Sorensen
Public Policy Lecture at U. Nebraska Lincoln The future of
pest-resistant crops My Own Game-Theory Journey
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Turning the tables on terrorist kidnappers January 2015:
Terrorist kidnappers New York Times op-ed My Own Game-Theory
Journey
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Debt-ceiling crisis Pest-resistant crops Terrorist kidnappers X
X X Antibiotic Resistance
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Dr. Mario Raviglione, Director, WHO Global TB Programme Dr.
Arjun Srinivasan, Associate Director, CDC Healthcare Associated
Infection Prevention Antibiotics discovery team, GlaxoSmithKline
Dr. Maria Joyce, Duke hospital, molecular diagnosis expert
Professor Gerald Wright, McMaster U, bacterial genome expert Much
Help Along the Way
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We are poised to achieve complete and lasting victory over
antibiotic resistance.
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Together, We Can Change the Game #1 As Consumers STOP
INAPPROPRIATE ANTIBIOTIC USE IN LIVESTOCK #2 As Patients STOP
INAPPROPRIATE ANTIBIOTIC USE IN OURSELVES #3 As Citizens/Taxpayers
ACCELERATE SCIENCE BEHIND DIAGNOSIS OF RESISTANCE
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The Logic of Rising Antibiotic Resistance Susceptible Bacteria
Resistant Bacteria
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The Logic of Rising Antibiotic Resistance Susceptible Bacteria
Resistant Bacteria
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The Logic of Rising Antibiotic Resistance Penicillin doesnt
work anymore!! Resistant Bacteria
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Things as common as strep throat or a childs scratched knee
could once again kill. Dr. Margaret Chan Director-General A
Post-Antibiotic Future
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Leading Causes of Death 1900 2012 1.Pneumonia and influenza
2.Tuberculosis 3.Diarrhea and enteritis 1.Heart disease 2.Malignant
neoplasms [cancer] 3.Cerebrovascular diseases [stroke] 6.Pneumonia
and influenza
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We Can Avoid a Post-Antibiotic Future #1 DISCOVER DRUGS FAST
ENOUGH #1 SLOW RISE OF RESISTANCE
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We Can Avoid a Post-Antibiotic Future #2 REVERSE RISE OF
RESISTANCE #2 DISCOVER BETTER DIAGNOSTICS
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1928: Accidental Discovery of Antibiotics
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January 2006: Soil-dwelling bacteria Resistance Starts in the
Soil Scientific article in Science Microbial resistance to
antibiotics currently spans all known classes of natural and
synthetic compounds. Soil-dwelling bacteria... are a reservoir of
resistance.
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Antibiotic Overuse in Livestock GROWTH PROMOTION SUPERBUGS
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MRSA CC398: Human Pig Human JUMPS TO PIGS EASILY TREATABLE
DISEASE
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JUMPS TO PIGS ACQUIRES RESISTANCE EASILY TREATABLE DISEASE MRSA
CC398: Human Pig Human
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JUMPS TO PIGS ACQUIRES RESISTANCE RE-INFECTS PEOPLE EASILY
TREATABLE DISEASE SUPERBUG MRSA CC398: Human Pig Human
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MRSA in Pigs: Threat to Human Health of grocery carts sampled
in Iowa City had MRSA bacteria on them 5% of all meat harbored MRSA
as well 3%
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of grocery carts sampled in Iowa City had MRSA bacteria on them
5% of antibiotic-free meat had MRSA 0% MRSA in Pigs: Threat to
Human Health
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Game-Changer ANTIBIOTIC-FREE MEAT
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What if Resistance Escapes the Farm? S S S S R R R = resistant
bacteria = susceptible bacteria S S S S S
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S S S S R R R = resistant bacteria = susceptible bacteria S S S
R R What if Resistance Escapes the Farm?
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RS S S R R Our Bodies are a Battlefield Susceptible bacteria
are a natural ally in fight against resistance!!
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S S R R S S S R S S S S Patient #1 Our Bodies are a Battlefield
Patient #2 Patient #3
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S S R R R Antibiotic Treatment Our Bodies are a Battlefield
Patient #1 Patient #2
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S S R R R R R R R R R R Patient #1 Patient #3 Our Bodies are a
Battlefield
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Game-Changer JUDICIOUS ANTIBIOTICS USE
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S S R R What If We Could Diagnose Resistance? Standard
Treatment Strategies to Disrupt Transmission S R
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S S R R What If We Could Diagnose Resistance? Standard
Treatment Strategies to Disrupt Transmission S
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Game-Changer NEW DIAGNOSTIC TOOLS Takes DAYSTakes ONE HOUR
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Weve Mapped the Resistome Takes ONE HOUR Visualization of the
Antibiotic Resistome
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Now Poised to Transform Medicine!! Takes ONE HOUR Visualization
of the Antibiotic Resistome
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We Need YOU to Change the Game 1.Buy antibiotic-free meat.
2.Talk with your doctor. Do you really need antibiotics? 3.Support
a new frontier in science to detect resistance. 4.Tell your friends
what you learned today.