Doctor and author Matt McCarthy
Matt McCarthy’s world is challenging, emotional and sometimes deeply personal. He spoke with ANNA KOSMYNINA.
PHYSICIAN AND BEST-SELLING AUTHOR Matt McCarthy was intrigued when, during his internal medicine residency training, a patient waiting for a heart transplant couldn’t have the procedure because of a number of infections.
“Those infections ended up being the most important thing in his life, but they kind of seemed like an afterthought for this guy who was so geared up to get a heart transplant,” he recalls.
The incident helped fuel a desire to explore the important but sometimes overlooked world of infectious diseases and their treatment, and this took McCarthy on a winding path to his current positions as assistant professor of medicine at Weill Cornell Medical College in New York and staff physician at New York-Presbyterian Hospital.
It’s a fast-moving area. In just 15 years, he went from treating most infections with oral antibiotics, many of which stopped working in the past five or six years, to treating those infections with intravenous antibiotics, only to have then also stop working in the past two or three years.
In 10 to 15 years, even the drugs we have now may eventually become ineffective, he warns.
“Doctors were well aware of this, and we were talking about this at conferences and in academic journals, but patients didn’t know about this subtle shift in how we’re treating everything from urinary tract infections, to pneumonia, to heart infections,” he says.
And the human impacts of this trajectory are very real. “It’s very tough to be a doctor who is walking into the room, not to deliver good news, but to deliver bad news, that the infection is spreading. Trying to convey that to people and to stay optimistic can be a very difficult aspect of the job.”
Unfortunately, the costs of investing in antibiotics just don’t stack up for Big Pharma, says McCarthy. It generally takes 10 years and $1 billion to bring a newly discovered potential antibiotic from the laboratory to patients, yet many of the companies that invest in antibiotics routinely lose $50 million with each attempt.
Even a new antibiotic’s approval doesn’t guarantee its use, as many of the top antibiotics are too expensive for hospitals to stock, especially in developing countries. McCarthy says this leads to a larger question of whether or not federal governments should become involved in the development – not just the discovery – of antibiotics to ensure access.
“That’s going to be a really important political issue in our country moving forward, and I think it will be in other countries around the world.”
McCarthy isn’t necessarily an advocate for this hands-on approach by governments, but he does think more incentives are needed to make drug development financially attractive to pharmaceutical companies. Options include tax breaks contingent on investment in development or a longer period of market exclusivity for approved drugs – both controversial proposals.
“There are people who don’t like the idea of giving these kinds of incentives to pharmaceutical companies, but increasingly we’re recognising that that’s what’s needed if we want to continue to have a steady stream of new drugs,” he says. And whether or not a hospital has the means to treat an infection is sometimes only half the battle, as increasingly trade-offs need to be made between treating a patient’s infection or another condition when they’re unable to be treated for both simultaneously.
“We’re pushing patients further than we have ever before. And that means they’re living a bit longer, but they’re also vulnerable to infections... It’s just a hard reality that the downside of all these new chemotherapies is that we have a lot more infections to deal with.”
McCarthy discusses one very personal example – his father-in-law’s illness – in his most recent book, Superbugs: The Race to Stop an Epidemic.
“It was incredibly challenging for me because I knew so much and I could see just how dangerous his infection was,” he says.
“It was a really important moment for me to flip from being the doctor who’s telling people what to do and making these decisions, to being the one on the receiving end, who was anxiously waiting for the doctor’s update.”
It’s a varied and emotional profession.
“There are times where I’m incredibly optimistic. And I walk out of a room of a laboratory and I say, ‘they’re onto
something, the next big thing’, and then I’ll go from that laboratory to a patient’s room who has an infection that’s spiralling out of control, and my optimism fades.”
Although the job certainly has its share of challenging moments, McCarthy regularly tells his medical students: “This is the best job because you have no idea what’s going to happen, every day. It’s just a totally unexpected experience.”
One constant in McCarthy’s world is “the tremendous camaraderie...that forms among doctors”. A standout is his relationship with his mentor of 10 years, Tom Walsh.
“He’s the person who I hear from every morning before anyone else: he texts me or calls me with an interesting scientific update… It’s been my supreme joy to watch how an expert manoeuvres and the frantic phone calls he gets about patients who are dying and how he can calmly give advice that will change people’s lives.”
Mentors are essential in medicine, but these relationships are something people don’t hear enough about, McCarthy says. And even though the medical world is seemingly filled with giants, the physician thinks it’s important to be honest about his experiences in the profession.
“There’s almost a caricature of what the doctor is supposed to be like. And in our country, it has often been a stodgy, old, white man, who was very overconfident, hardworking, but always knew what to do. And anyone who practises medicine knows that’s not an accurate reflection of what medicine is really like.”
Given the pressure to seem highly competent, it can be hard to write about your failings, says McCarthy.
However, he goes to great lengths to humanise himself across his writing. “I wanted to write in a way that said, ‘I’m just a guy who happens to be a doctor... I’m going through the things that other people are going through in their jobs, and I want people to be able to relate to that’.”
McCarthy is confident that all is not lost in the fight against superbugs. One of the most exciting developments, he says, is the use of CRISPR-Cas9, a gene-editing technology, to manipulate the genetic material of viruses that infect bacteria.
It’s an especially promising approach, because traditional antibiotics tend to have a very broad spectrum and will wipe out a variety of bacteria when used.
However, the CRISPR-Cas9 system can be used to attack just one specific species, limiting the side-effects. It also turns out to be more powerful than our current antibiotics and, so far, hasn’t shown the same issues with bacteria developing resistance.
“The testing has been done in very small scale – it’s often on single patients or a couple of patients – but it looks very promising. It’s something that we have to be careful with, because it’s so powerful.”
McCarthy does warn that the development of this type of treatment faces significant structural barriers: it is expensive, and it only treats rare and uncommon infections.
“So while I’m super enthusiastic about this advance scientifically, I’m also equally concerned that it’s not going to reach patients unless we come up with a new incentive structure to get companies to invest in more of this type of research,” he says.
Until then, the “standoff between the pharmaceutical industry and hospitals” is likely to continue, with patients caught in the middle.