As a Science Writer i should first start out by pointing out that viruses are microbes as well but it made sense to call this microbes, viruses and destiny because of our two writers. This is ed young and he is a Science Writer for the atlantic, author of a new book, i contain multitudes about the micro biomes. Thus the microbes of our panel title. Here is carl zimmer, Science Writer for the New York Times and author of many books including, most recently, a planet of viruses bid im an author of the book called pandemic which is about how microbes cause pandemics and all these books will be for sale by barnes noble and will be signing them after this session and signing table eight. I hope you guys can come join us for more discussion there too. First before we start id like to ask is anyone here actually a microbiologist . Okay, we have four. So, we cant make anything up. [laughter] correct us if we get anything wrong but i will just we never get anything wrong. Its a really interesting time to talk about microbiology because its been a paradigm shift in recent years. If you think that since the late 19th century we thought about microbes mostly as the malevolent intruders who we sort of have to target with a surgical precision with military might and i call that approach microbial xena phobia and it made sense back then in the beginning because of course, the first microbe we could ask to detect worthy ones that will grow on a dish in a lab and those are often the ones that we are responsible for from the dramatic diseases like anthrax and tuberculosis et cetera. But we now know the genetic sequencing techniques and other new methods is that microbes are everywhere and they are all around us and of course we been here for a lot longer and it is there planet, 4 billion years and all of our interactions have evolved in the context of a microbial world. Now we know that everything from our immune functions to our moods to our dietary preferences and all are linked to the interactions between microbes so what we really need is a new way of thinking about the microbial world and our place in it which is why we think the world tha that said was so important to try to get all of us to understand the science and what it means for us and i think there is a real urgency to that question because i think we can all agree that microbial xena phobia is a paradigm is basically failed. We have seen increasing emergence of highly resistant bacterial pathogens, including some that can resist every single class of antibiotic we can possibly throw at it. That chemical onslaught is creating a worse problem in many ways. Over the last six years we had over 300 new pathogens emerge out of nowhere like ebola virus, the cut virus and these are microbes that, in their original habitat, ebola virus comes out of fast but its been nine in that environment. Yet a couple of years ago ebola virus killed 11000 people in west africa. What we will do is talk half an hour and then have a conversation with you guys. I wanted to start with carl. Every time we have one of these new microbes on the scene i feel like our responses range from either and they are both expressions of powerlessness in a way but on one hand its either panic and hysteria and on the other hand its a denial and dismissal so tell us about the zeke of virus and where should we fall on that continuum . Yeah, zeke virus is one of these emerging diseases that has gone from being completely unknown to something that we talk about at the water cooler within just a matter of months and unfortunately this is not a new thing and this is starting to become a familiar routine we are going through and there are viruses like for example that emerge in the middle east two years ago no one even knew about before and it makes it interesting when you are working on a book about viruses so the First Edition of my book came out in 2011 and when you write about how to get uptodate as much as you can and hope it can stand the test of time when he 14 my editor said you barely say anything about ebola in this book. I think people will want to know about ebola and so i have the opportunity to write about ebola and update the book in the general so the second edition came out in 2015 and there i made sure that there will be ebola. That Ebola Outbreak was something we had never seen before. Ebola had first emerged in 1976 but it was relatively small outbreak effecting just a few hundred people in various parts of Central Africa and then it looks like in december 2013 there was probably the first person to get sick in the new outbreak that was in west africa and it really didnt sort of become something people were aware of until spring 2014 and then by october 2014 it hit its peak. Actually it wasnt until june 2016 that the last case was recorded so we had just a few months without a case of ebola and west africa and this is been years of an outbreak there way bigger than anything before and there were over 28000 cases over 11000 people died so its 40 mortality rate and that is pretty terrifying. And i mean, i dont know what jims thoughts are on it but this was this was an opportunity to see how modern Public Health could handle we had been anticipating for a while and i dont think we did very well at all. I did monitoring it was terrible. The Vaccine Development was ridiculously slow and there been a deck scene in the works for many years but nobody wanted to pay to do more research on it because people thought well, who gets sick with ebola and so actually there was a great spur into go on and put it the experiments into humans and get a vaccine for human ready but and they started really doing serious testing on it in spring 2015 but way after the peak of the epidemic and a lot of people died and many of those deaths would have been avoided because of the vaccine but just now in the last few flareups people are getting what is called ring vaccination where you vaccinate people in the area around an outbreak to break it from spreading further. That is great but why didnt we have that three years ago . I tried to get as much as i could of that into the second edition but i do feel like i could do a Third Addition right now because now looking at the zeke up virus. The story of this virus is eerily familiar and similar to ebola. We knew about the virus back in the 40s and it was identified in the monkey in uganda and then it turned out that people in the area had antibodies to zeke up which suggested that they were being exposed. But people did not Pay Attention to it and was one of many obscure viruses and you can go into Technology Books and find it and it gradually merged or transmitted by mosquitoes that caused ebola and it was only 2007 that there was someone actually registered and outbreak. This was in polynesia, not uganda. Somehow the thing had gotten all the way around the world. There were a couple more outbreaks and they were relatively small. Then they showed up in brazil and things just exploded. So as of now this 2015 outbreak the one that started last year, 55 countries now that have zika that did not have it before. We have it in puerto rico and in miami now and we havent throughout the new world except for chile, uruguay and canada. Probably because theyre not very good for those mosquitoes that carry it. And i dont think its aware enough of how bad things are already. Even in the United States so from puerto rico its especially back over 17000 cases in puerto rico and we are not sure how many of these cases of birth defects that come with zika have been because, probably in the hundreds because we are not realizing zika causes babies to develop very small brains and in the United States the latest count is that there are 43 locally acquired cases and this just happened recently and so they are trying to stock it in miami but theres no reason to think that it will work very well this thing is on the move. So how have we done with zika . I dont think we done fairly well. Here it is in the United States and there has been Animal Research on vaccines and this is the kind of thing you can vaccinate for but will probably just Start Testing vaccines may be in january. Here in the United States we cant even put out the money to control this. There are things we can do like Mosquito Control and research on vaccines and congress is stuck in political games and is not giving out the money. Bear in mind its been the lifetime cost for caring for these kids that have microcephaly is 10 million for a lifetime. That is what we are looking at. We been incredibly pound foolish, penny wise. Were not even being penny wise. We are being foolish but that is what we are looking at again and i think the other parallel that i find it striking here is that this just shows, yet again, how remarkable viruses are. Ed may give us reasons to feel happy and warm and cuddly about the microbial world but im here to freak you out. [laughter] think about it. The zika virus has ten jeans, ebola has seven jeans and they are running rings around us but we had these immune systems that weve evolved for billions of years and they find a way around it and they are thriving and spreading all over the world. What is happening is that theyre all these these viruses, lots and lots of viruses in the Animal Kingdom and they are spilling out as we are basically moving further and further into the zika system and disturbing the homes of bats and of monkeys and of other wildlife and they are finding a very nice, new abundant toast, it is us. Im not totally fatalistic about this. Just a couple of weeks ago a great man named da henderson died and he led the eradication of smallpox. We got rid of smallpox which honestly was way worse than a ebola or zika. That thing kills hundreds of millions, maybe billions of people and we wiped out from the planets. If we have the dedication we can fight these things but you cant just ignore them and pretend we will take care of themselves. So we will do a good cop, bad cop kind of thing. Hes the bad cop. [laughter] ed will tell us the good side of this but i think what is interesting is that we are seeing these new pathogens, new microbes come into human population and of course, the beginning is horrible like zika virus comes into human population totally susceptible, no immunity and you see all this pathology and sickness but what happens over time . Overtime we get used to certain viruses and start to live with them and they start to become part of our ecology so and that is what the micro Biome Research event covering is focusing on. Yeah, im definitely the good cop in this scenario. I dont want to contradict any of the concerns that carl has raised about the book that i wrote, i contain multitudes, is about the more beneficial side of the microbial world and i talked about how microbes have been with us for the longest time, as some of that we evolved in the microbial world and to this day all of us depend on microbes for all sorts of paths of our existence, immunity development. Every human body contains trillions of, tens of trillions, of bacteria as they help to build and calibrate our immune systems and digest our food and they protect us from disease and infections and they may even help to shape our behavior. Even viruses we contain many orders of magnitude, more viruses than we have bacterial cells in our body and most of those actually infect and kill bacteria so they are not harmful to us but part of this teaming ecosystem that lives within us and even though we hear it look like three individuals we are in fact, three large teaming, thriving world. And i talk about them how these microbes are just passengers but do important things and allies are talked about roles they play in humans and if you look in the Animal Kingdom we see all kinds of incredible superpowers that they convey to their hosts. They allow worms, flatworms, to regenerate their entire body and there are birds called hippos which paints their eggs and antibacterial paste and microgrid fluids that help to protect the chicks within from infection. There are even wasps that use viruses encoded within their own dna to kill or to defuse the Human Systems of the caterpillars that they target. In this case, a virus can be a useful ally. One thing i want to talk about now is a case where humans have actually engineered a relationship between an animal and a microbe to help us and to improve our health. Its fine into one of the stories that carl was talking about and the story begins in 1924 when a couple of microbiologists discovered a new type of bacteria that live in the cells of insects. They found it in a mosquito, mosquito they collected near boston good for ages no one knew what this thing was they did not know whether was common or what it did and it took the scientist 12 years to even get the thing a name in one of the named it after his friend, [inaudible]. It took many decades for anyone to work out what [inaudible] did but in the 60s, 70s suddenly realize the thing was everywhere it is in ants, people, and Something Like 40 of species of insects and other and given that those are already a most diverse and rich and numerous animals on the planet that makey successful bacteria in the world and you can think of it as one of the greatest pandemics in the history of life. What it does is host sometimes is a parasite that causes its host harm because it passes down from [inaudible] sometimes it kills him outright and sometimes it transform them into females and sometimes that allows email insects to reproduce asexually by cloning themselves they have no need for males at all. But sometimes it is an ally and it is a mutual list and benefited its hosts pit in bedbugs, for example, it provides [inaudible] that the blood to drink soda acts like a [inaudible] and some caterpillars use it to stop leaves from turning red in the autumn so they can sit within the leaves and continue to eat even as the world yellows and dies around them. But humans have a use for it as well. For 25 years australian scientists have been trying to introduce this bacterium into a species of insects that it does not normally in fact and that insect is the tiger mosquito which spreads bengay fever, yellow fever and the. The reason they done this is twofold. One, when the tiger mosquito contains while vacuum, its for some reason, becomes really bad at spreading the viruses behind these diseases. An infected tiger mosquito is effectively bengay proof on or the roof 12. It also because it is so good and many bladings house in the way of talked about is really good at spreading through wild population so the idea is if you release a small number of these carrion mosquitoes into the wild that when theres a huge generation which is a few months in our time the entire local should carry this microbe and thus be unable to transmit these important human diseases. This has been tested in the laboratory and simulated and mathematical models and it was tested in, i think, 2011 for the first time in a full australian [inaudible] where wolbachia infected mosquitoes were reduced into the wild and very quickly in the span of months you saw that the prevalence of this microbe went from zero to 100 in the mosquitoes in that area. So they now call this eliminate then gay has been testing it in Different Countries around the world. They are scaling it up and going global and theyre testing the approach in brazil, colombia, indonesia and vietnam and they are gearing up to release these mosquitoes over cities with none of the people to see if that can indeed work at the larger scales whether those mosquitoes will spread and whether wolbachia will dominate as much as they expected to and crucially whether that can then drive down the transmission an instance of these diseases that causes harm. The approach has a lot of advantages and it has got the backing of the world health organization, development of the bill and Linda Gates Foundation and it is interesting because it is cheap and probably quite safe, unlike intech decides which are toxic and need to be continuously respray. Wolbachia containing mosquitoes should theoretically be good to go once you release them once. You only need to release them once but there is no genetic modification so its an easier cells for communities have to reject those approaches. And it seems that wolbachia stops the spread of these viruses through many different groups, through competing with nutrients, stimulating the insects immune system and in many ways. That is reassuring because as carl said, irises have a habit of running rings around us and no sensible evolutionary biologists with assuming that evolution will not get the better of us at some point but if the bacterium allows the insect to resist the viruses or to be a bad inspector for those viruses and have many different types of resistance would theoretically need to evolve which would be hard. So, here we have a really interesting approach that is a solution seeker, who knows but we will wait and see. All of this started with basic curiosity about the microbe world and back in 1924 the people who discovered wolbachia cannot possibly have predicted that this was where that science was going to be. One of them, the man who lent his name to this bacteria died in the 50s before anyone realized how common it was. He cannot possibly have foreseen where this research would lead to now and in many ways it is the study of the animal microbe in a nut shell because for the longest time we ignored and neglected microbes thinking them to be irrelevant to us and then we went through a period of and now we are reaching an era of exploration again and of appreciation and of realizing the crucial role but they play in our lives in of those in the entire Animal Kingdom and we are starting to manipulate those partnerships for our own and. And our attempts at doing so [inaudible] but there is tremendous potential here and i think that is where the science of the microbe i am will lead us in the future and why it is the area that excites me so much and why i felt compelled to write a book about it to instill that sons of curiosity led to the discovery of wolbachia. It is interesting that to try to we want to think of microbes in terms of are they good or bad. Right . We have this dichotomy that we are trying to push them into but what youre talking about is the same microbe can behave very different late in different contexts. Absolutely. There is no such thing as a good or bad microbe. Microbes are germs that we need to destroy and they are villains is, i think, wrong but also wrong is the idea that those that live within us are friendly bacteria or good microbes. Really, we are another habitat to them. They been around for billions of years and we are another world for them to inhabit, much like a lump of soil or a drop of water could wolbachia comes in many strains. Some are beneficial to their hosts and some are harmful. Some are both at the same time. We talked about the wasps and those viruses are bad for the caterpillars but not for the wasp. The relationships that microbes have with their hosts are dynamic and can change on a dime and we all need ways containing our multitudes of keeping those relationships happy. The question is when there is a conflict of interest between the microbes we are encountering like zika and smallpox and ebola and what they want to do and we want to do you could define that as a disease, right . That is what happens in the middle of that, right . Sure. For any parasite well, lets put it this way. For anything living in Something Else if it is activities kill off its hosts too soon thats bad news. I mean, this will become extinct because its basically burned down its own house but, you know, if you cant raise a big family and say its time to leave the house, go find another one and then burned down then it would be okay. [laughter] these viruses and other pathogens they involve two Different Levels of deadliness. Sometimes you can see this when in the wild so for example, some fool decided it would be a good idea to traduce rabbits to australia. They took off and they said how will be controlled us and there was this horribly deadly virus that killed hares in europe and they thought they bring it to australia and problem solved. But it started killing them off like crazy and then it started to become less deadly and its still not a good idea for these rabbits to get sick with this virus but it did not get rid of the rabbits. The virus evolved and essentially adjusted its deadliness to be able to get the host in the most efficient way from making more viruses. It is hard for us to we think about things as being good and bad just in the various sort of egocentric way but like you know, these things are evolving and not just evolving over the course of a few years but evolving over millions of years and our language does not suit it. Viruses can be good for us. In fact, none of us literally, none of us, would have been born without viruses because millions of years in the past our ancestors got infected with viruses and basically harnessed those viral genes, coopted them, use them to make proteins in the placenta and these are crucial proteins in the placenta. If you knock out that gene so that for example, mice would have a similar version of this and if you knock out the gene they cant have kids. It does not work. Just recently it is discovered that viruses were harnessed from a muscle so basically there are proteins in her muscles that appear to be generated from a virus gene and that is good. But in order to get that good our ancestors probably went through some horrific hiv like epidemics that nearly wiped out the species and then finally we achieved immunity over them and harnessed a couple of the jeans and went on from there. The whole language of good and bad captured the real strangeness of these little things. There are some scientists and that some viruses that might play a role in our immune system so i talked about the viruses that infect bacteria [inaudible] and they look a little bit like lunar landers [inaudible] so there is this idea that we have loads of them in our bodies and some think its in the mucus [inaudible] but there are just millions or trillions perhaps of these viruses stuck in the mucus with their legs and they are waiting to affect bacteria that pass by and they keep the population of microbes that live within us under check and they help to select for the species of microbes that live within us. You know, its a nice idea but i think it also highlights another aspect of this world that we need to keep these populations in line and the balance of those communities, who is there and who isnt in many of the diseases that carl talked about like the and ebola, r1 microbe and one disease but you can also get illness when communities of microbes shift from the healthy state into an unhealthy one when no particular member is responsible for the disease. It is just that the entire community has gone out of whack. It may be more common than others and maybe you have new invading species that arent there anymore or you lost critical defensive ones but you see this all over the place and you see this in [inaudible] this might apply to the human body to and many illnesses that have become more common in the 21st century have been linked to changes in the micro biome whether its diabetes or allergies and asthma or obesity, heart disease. So what are the limits of the microbiota . Its very hard with these plans attached but they dont live up to the loss of them so they seem to be good in some difficult its really effective at treating a condition. An infectious and while antibiotics and Clinical Trials ttrialsthe transplants have hade 90 success rates have been very effective but even these treatments you are taking a Massive Community and putting them in a person with genetically diseased even that doesnt work consistently for a lot of these other conditions. Even here it is hard to reset. With understanding how ecosystems work like who determines who and why mine is different to yours and how then we can manipulate it so how do we get them to establish themselves and do we need to feed them to give them an advantage and how do they, theres still so much fine tuning we have to do in this field. At th at the same time talking about these shifts in the fragile balance in the ecosystem and if you think about it we use antibiotics dot ed are for farm animals so tha that is held in e environment and all over the place and then we have a love medically unnecessary uses so we are manipulating the context at the same time, and i wonder you mentioned we could do more with vaccinations for sure but what does it mean when we are attacking the grand scale at the background level how does that sort of provoke the behavior packs packs in the 1940s it became widespread and people were like game over, weve done it. And like i said, these things could stop working because the bacteria are evolving really fast and you could end up with bacteria that are resistant. Unfortunately, nothing really happened. There was none back then and now finally we are coming to terms with more and more resistance and it is a struggle because we dont have a lot of new drugs in the pipeline, so you are starting to get the lines in the situation where you have bacteria resistant to everything weve got. So if you get infected with it and they can figure out combined with these resistance genes theres going to be nothing people can do for you and already its been estimated maybe 700,000 people around the world it could go up unless we do stuff and again, i dont mean to be the dark cloud in your day but maybe we can do something about this. People were smart and if we show dedication, we can solve this problem. This is a problem that is solvable. So keeping the antibiotics. Theres huge resistance to that because understand we like to give these to animals and they get bigger. Nobody is quite sure why. You have to set that against treating all of the illnes elems from the antibiotic resistant bacteria they discovered over 100 years ago and actually the doctor that discovered them realize they could actually kill all of these bacteria is with the virus is and he said this could be a drug and so actually people forget this but in the 1920s you could buy powder with these viruses and in paris its being mass produced and it was quite popular. Antibiotics came on the scene and were more reliable because they were just chemicals like viruses are and we were the only place where this kind of approach would continue to be used with the soviet union wounded on the battlefront and suffering from infection and in some cases it is working. Some of those people came to the United States and have been with scientists here trying to bring therapy back into the American European medicine and its been very slow. You cannot be 100 sure that they are going to kill the bacteria that you are secure but there is some progress and major trials going on and the idea is instead of just one chemical youve got a virus and you can do a lot of things like engineer them so you can do experiments and get them to evolve to do a better job or maybe put an extra gene to help them. You can engineer the viruses and theres Research Going on on that now so this is the kind of creativity that we need to fight this fight. Its worth saying that the antibodies accepting such an incredible boost have saved so many lives, but there are costs to that. They were not precise and destroy the bacteria that they relied upon so they do shift the microbiota and a lot of people were looking at whether the shift, how longlasting they a are. Too many and you get problems. That is why you see them happen. Theres the creating space to take hold. People often ask me if its a bad thing. I dont think so. We shouldnt demonize them. Its very much the same as protecting us from these drugresistant infections. Infections. Its scaling back on the use of antibodies and using them judiciously so we use them when we need to and only when we need to and that involves everything from cultural shifts to when there are doctors prescriptions and technological shifts to diagnose illnesses. Theres interesting applications and they largely are microbial weapons to destroy each other and an intense competition. And we mind of those weapons and we did such a good job to discover perhaps the human micro biome might be a potential new source just a few months ago i wrote about a study about how a new potential antibody was discovered about something eight to 10 of people carry this one species. They are battlegrounds and sorts of competition and some parts of the body might be fit so its places where we constantly shove food down so we bombard with nutrients. However it is scarce and resource unless you are eating very weirdly. When you think of the humans and other animals in the ecosystems as more than the individuals that they are and think ecologically about what part of the body is competition going to be fierce among the microbes. There is a park in your book where you call for god is like a rainforest and thrain forest ane a desert. There is like a geographical theres two microphones set up so i hope tha that youll coe and asyou will comeand ask somen you do, just say your name first. I have a question about vaccines and how they were great for eradicating smallpox but we still have a virus that kills tens of thousands of people a year and weve known about it for hundreds of years, the yellow fever is still raging and how there are so many viruse fls we dont even know about and we study these viruses that weve known about. Vaccines or an amazing thing. The fact that we can train our bodies to be ready for a virus before it comes and initiate an attack and physically fight it off is an incredible thing that we can do. But that sort of masks a lot of hard work to treat the populations with smallpox it wasnt like everyone get in line and get your smallpox vaccine. They were collaborating with the Community Leaders and taking vaccines on horseback to the remote areas of ethiopia trying to get the last cases because until you get the last case, its not over. Thats what they ar doing with. We could have been done with polio ten years ago but it is and and during in places like pakistan and nigeria. You have vaccine workers killed by the taliban just as a way of sort of part of the Political Campaign they are sort of builtin problems in the vaccine in a way that the flu virus is a real pain in the neck because it is just constantly turning evolutionary. They are basically doing their own biotechnology and you get a new strain every year. The scientists making the vaccine and a lot of them are still using the basic technology we used in 1950 by trying to grow vaccine and a chicke the cn eggs for example it takes months to do that. They were decided on months ago and we have to hope they get it right and a lot of times they dont. So they are in a situation where what we really need and there are people working on this it targets the part of the environment that change very rapidly to target the parts that change never do things that are essential to the flu virus. You are. A kid and get a flu sho shot. That would be great and a lot of lives would be saved if we are not there yet. I have a question about the incorporation of microbes into the genome. They suggested not just pieces of dna one of those is mitochondria. Mitochondria is definitely right and for anyone that is unfamiliar with them, they contain mitochondria which are things that provide us with energy. They are essential for our lives and they used to be bacteria. They are domesticated bacteria that worked their way into the cell and became further stuck there. One really interesting thing is there is some debate about a lot of important their origin was that it was in fact the origin that includes animals, plants and all this complex life we can see. All of those contain new carriers and mitochondria and involve perhaps the reason for that singularity even though weve taken in bacteria and turned it into so many different types, the reason for the primacy of mitochondria is the singularly improbable event. To develop larger genomes that is again talking about events that happened billions of years ago. All of us carry a form of bacteria within our body. Is what you might find in the soil roaming around in the bacteria and so on. There are some ideas that the behavior of the white blood cells roaming around or just using very old jeans that had been held onto from the single so in sisters and sniffing around looking for bacteria in your blog is not that different than in the soil so it may have been a carryover. I like that idea. Great image. My name is emily and i have a friend that joined the peace corps and shes been there six or seven months now and because she isnt used to the bacteria shes got about seven rounds of antibiotics so far so i was wondering what your thoughts were on the longterm consequences in a relatively short amount of time. It is a tough break. Because of that problem its hard because if you bombard the body with heavy doses you do run into problems. Sometimes we dont have Better Options tha but i think the emeg signs will suggest Better Options by ways of manipulating that ecosystems behind us throwing as many drugs as they n map the problem. I was wondering whether i could ask you to speculate on the potential possibility of another sort of large change of mitochondria entering into our bodies the species or the differentiation of species and whether that is possible and what it might look like for the future possibilities or integration. I can work with this. We are talking about a new species. Basically you take the old species and split it into two. So that process, a lot of i if s driven in nature just by part of it is those populations most people do interpret successful successfully. Then all of a sudden you are diverging. Keep that going fo it going for0 years and weve got these species. So, just wait. [laughter] yes. And i want a credit on that. I have a question regarding antibiotic abuse. More specifically with regards to keeping it to livestock and cattle which most do, given that is most likely necessary for the largescale production that we produce and looking forward that is probably going to require a lot of research because we are probably not going to lose the habit of our meat eating anytime soon, so basically my question iis is there evidence to showing that beef, cattle, etc. Do you find antibiotic molecules in a significant amount that can affect humans . It doesnt quite work like that. What happens is these animals are being fed antibiotics and helping animals and have a micro biome that everyone is talking about. These antibiotics challenge every bacteria that encounters. They might be able survive if they dont, they died. So thadie. So that is going to foster the evolution of these resistant bacteria is. We are talking about the bacteria in the gut. If you go to you shouldnt be eating meat from an animals do. You could have serious problems. We dont have that problem. The problem is to release these they get in the water int and te soil in our trading the resistance bacteria and they just become part of this pool of resistant bacteria and we put so many antibiotic entities that is a tremendous factor in the rise of antibody resistance so that is what happened and we need to put a brake on it. You are saying that its been above 60 , 40 , that changes the question a little bit. Do you look at how it is so prevalent why do they not end up getting it . That is a really good question. I dont think we have a good answer to that yet. Still trying to understand what makes it so good at spreading from post to post. Theres a lot that we dont understand. Is it just because it spreads vertically throughout the population mike talked about from one host to another. So weve gone from cow poop to fecal transplants. Thank you all for coming. [applause] [inaudible conversations] good morning, everyone. On behalf of the council id like to thank you all for beginning your morning with us. We are delighted to welcome cspan book tv to this program. The next pandemic. As a former director of the office of Public Health preparedness and response at the center for Disease Control prevention, doctor kahn has been