I still don't really want to go out and slurp down some untreated river water after reading Lina Zeldovich's The Living Medicine, but a little part kind of does. This book is fascinating, and explores a way of treating bacterial infections in a way that's been dismissed for so many years in western medicine. With the increasing resistance to antibiotics, we likely will have no choice but to learn how to welcome the mighty phage into our bodies, a type of virus that Soviet bloc countries have been using successfully for years to prevent and cure infections. Admittedly, the opportunities for something to go wrong are there, because unlike antibiotics, it will be something very difficult for the FDA to police. Which means there will be plenty of people out there that will crop up with their batches of miracle phages - which may not be anything more than sewage water in the worst cases, and phages that haven't been properly filtered and purified to serve the right purpose in the less worse cases - but the promise of what it can do is mind-boggling. And the thought that it can be done not just for highly industrialized countries but for low and mid-income countries makes it seem somewhat miraculous. The book is a combination of both what phages can do and how they treat bacterial infections as well as a history of how phages were discovered and the often fraught path the researchers that worked with them had to be taken seriously, face communist politics and the dismissal of them as a treatment option in modern Western medicine. Unsurprisingly, many of the medical doctors and researchers that made phages their life work were more interested in improving their efficacy and making them widely available than they were in making money off their discoveries. They were willing to fight to bring them to the people that needed them, willing to die for them, and willing to continue to push for their use when other people dismissed the idea of willingly taking a virus into their body. The very beginning and very end of the book feels a little bit like a selling pitch for the US company that currently manufactures phages, but beyond that I thought the book was fascinating and well-written. A complimentary copy of this book was provided by the publisher. All thoughts and opinions are my own.

Thank you for the eARC!

Whenever you're in schooling for any medical field (I myself am a NP), you hear about superbugs, or infections that have become resistant to antibiotics. You're taught not to prescribe antibiotics without knowing exactly what organism you're battling, and to weight the risks vs. benefits of treating. This is easier said than done as for two main reasons: 1) A lot of the tests you would use to determine the strain of the infection and the best medication to treat it - or sometimes the medication itself - is too expensive (thanks @American healthcare), and 2) many daily ailments such as "colds" are actually caused by viruses and often have no definitive bacteria that can be targeted to treat. But the reality is: you've got patients in your clinic who aren't able to go to work or function day to day and you need to give them something to make them feel better. So you give them the antibiotic anyway. And you figure after years and years of people getting broad spectrum antibiotics can create multidrug resistance and/or superbugs.

What they didn't teach me in school was about phages - so this book was insanely interesting to me. I won't pretend to be more than a nurse (so even for me, some of the science was a bit heavy/not explained fully well) but I for one actually enjoyed how much of the scientists' personal lives Zeldovich included in the book - even if sometimes it did feel a little jolted when placed side by side with the heavier science parts. Not only does it remind us that these scientists were humans who wanted to do well upon the world, but that they're not superhumans - just intelligent and dedicated humans who did something with (albeit incredible) their lives. It also highlights the red tape of government intervention, and opens up the question of how many other potentially life saving inventions/discoveries have been repressed due to it being deemed not profitable enough or too damaging to a country's overall status?

This book almost reads like historical fiction, and I loved every bit of it. But I'm curious to see if this book - and hopefully others - means we'll be seeing more of the phages' clear uses in everyday life.

This book was eye opening in the different infections that are out their and are reliance on antibiotics. This was an informative read.

Thank you so much to NetGalley and St. Martin's Press for my copy of The Living Medicine by Lina Zeldovich in exchange for an honest review. It publishes October 22, 2024.
Wow, this book was so eye-opening! I remember learning about phages in anatomy and physiology and microbiology in college, but barely. I have never heard about this therapy before, and the background story is so important. I am very grateful that Zeldovich took the time and effort to write this book because it is truly so valuable!

An interesting paper on the development of bacteriophages to fight illness that are increasingly resistant to antibiotics.

An intense amount of research went into this book. It comes with a word that is about to become more familiar: phages, short for bacteriophage. It’s the beneficial viruses that protect us from harmful bacteria.

When I first started reading this, I was overwhelmed with the terminology that was new to me. Apparently, America has been slow to adapt this scientific method of curing infectious diseases which was used to save Russia’s soldiers during WWI. Meanwhile, U.S. doctors have prescribed all sorts of antibiotics, the “wonder drugs” for years. And yet, it’s not as effective that it once was with evolving bacterial diseases. It was noted by the United Nations that there’s a possibility that by 2050, an estimated 10 million people could die from deadly forms of bacteria. That alone was shocking to me.

Lina Zeldovich takes readers back to the days when phage therapy was first used. She makes it fascinating by providing a historical account of how scientists worked diligently in their labs with the goal of finding a cure for those who were dying. And she makes it personal so readers can visualize more about the good and difficult parts of their lives.

Giorgi “Gogi” Eliava studied infectious diseases in Georgia and phage therapy in the early 1900s. The book gives you a solid view how he was inspired in his youth, continued his studies of microbiology in college, worked on the front lines in WWI, and finally established the Eliava Institute in Tbilisi, Georgia with government support in 1937. There’s more about his personal life with a stunning opera star. Sadly, it didn’t end well when Stalin was a dictator.

During his life, Eliava became friends with the French microbiologist, Félix d’Hérelle, who had already documented the first antibacterial therapy in 1917 which was named Bacteriophage. They had a vision of the future and d’Hérelle came on board to make the Eliava Institute a world-class, state-of-the-art lab with a hospital for 500, an apartment building for staff and a manufacturing plant. They had big dreams that were destroyed by greed and power of the politicians. What happened was unimaginable!

Yet, there was one scientist who continued to believe and work with phage therapy. Alexander “Sandro” Sulakvelidze from Georgia is credited in the book for his years of research and the start of the company, Intralytix in Baltimore, 1998. Other significant supporters were noted as well for helping with medical cases that were on the edge needing immediate attention.

It’s heart-wrenching and exciting to learn about the possibilities that have been made by researchers, developers, medical professionals and investors with advancements of phage therapy. The timing is right for this book. If antibiotics are no longer as effective, this may be our best bet.

My thanks to St. Martin’s Press and NetGalley for allowing me to read an advanced copy of this book with an expected release date of October 22, 2024.

Bacteriophages, usually shortened to phages, are viruses that infect and replicate within bacteria with the idea that the phages will kill the bacteria causing the infection. I first encountered the idea of bacteriophages while listening to episode Number Forty of the podcast “Bedside Rounds” by Dr. Adam Rodman entitled “Phage,” which was more of the Western view of bacteriophages.

I wasn’t familiar with bacteriophages and, in fact, I don’t think I’d ever encountered the subject during my decades of reading about medical history. I listened to the podcast and immediately forgot about it because, as I said, bacteriophages simply aren’t part of Western medicine.

When I received an invitation from the publishers to read the book The Living Medicine: How a Lifesaving Cure Was Nearly Lost―and Why It Will Rescue Us When Antibiotics Fail, I remembered the podcast and figured this would be a great book to read.

The book didn’t disappoint.

In fact, it’s a very detailed history of the history of bacteriophages, focusing mainly on the work of the scientists in the Soviet Union, especially during the time of Joseph Stalin’s authoritarian dictatorship, when his purges disrupted the vital research being done with bacteriophages.

If you have a keen interest in Soviet Union history of that era, even if you aren’t interested in medical history, the survival of the scientists against that backdrop of the purges of the time made very interesting reading.

Bacteriophages never really took hold in Western medicine due to the discovery of penicillin put it on the back burner. Penicillin and other antibiotics could cure a number of different bacteria while bacteriophages had to be created separately for each different bacterium. It was simply easier to mass produce an antibiotic that could cure many bacteria rather than devote time to producing a cure for one specific bacterium.

But with antibiotic resistant bacteria on the rise due to the overuse of antibiotics, bacteriophage therapy is being seriously looked at again in the West.

The Living Medicine: How a Lifesaving Cure Was Nearly Lost―and Why It Will Rescue Us When Antibiotics Fail is a book that I ended up finding completely fascinating, though I must warn you, it is long and very detailed. But the subject matter deserves the time, and it might just be a lifesaver in the future.

For those of you interested in first-hand account of bacteriophage application, check out the TED Talk from Steffanie Strathdee, “How Sewage Saved My Husband's Life from a Superbug,” a fascinating look at how her husband became sick and how bacteriophage brought him back from death’s door.

4/5 stars

[Thank you to NetGalley and the author for the advanced ebook copy in exchange for my honest and objective opinion, which I have given here.]

An important look at the history of infectious disease. Antibiotics are one way, but using bacteriophages is something the Russians tested on their side of the planet. The history of science isn't pretty or glamorous, but it is definitely miraculous.

The Living Medicine is on my top 5 books of 2024. Zeldovich did a phenomenal job of captivating me from beginning to end. I found myself reading a certain passages more than once because I found the information intriguing. A must read for anyone who reads medical history. Thank you St Martin's Press and Netgalley for this e-ARC.

Thanks Netgalley for allowing me to read this book. This book was eye opening in the different infections and are reliance on antibiotics. An informative read.

The Living Medicine was an incredibly informative read! As someone whose only medical experience is from getting a CNA license my senior year of high school (which I proceeded not to use), I had very little knowledge of most of what was discussed in this book. I’m sure we discussed some of it at some point in one science class or another, but my post-pregnancy brain has retained none of that.

All that being said, medical history is some of my favorite history to read about! I found the intricacies and controversies incredibly fascinating, and I truly admire the passions of the scientists behind the studies. There was very little of this book that I found to be too dry or boring, and on the few occasions my mind started to wander, something interesting would soon pop up again to bring my attention back.

I do think you have to have some interest in medical or scientific history in order to enjoy this book, but that’s probably a fairly obvious conclusion. If you’re one of those people, I highly recommend giving this one a go!  

Thank you so much to NetGalley and St. Martin's Press for the free ARC in exchange for my honest review.

A very interesting read about the history of phages and the researchers who worked with them. I had never heard about phages before I read this book. it is a very interesting subject.

An alternative to antibiotics? Yes. Phages have been around a while but seem to be new to the Western world.

While the first portion did not interest me at all, the rest was excellent.

Anyone interested in the antibiotic debacle would enjoy this.

NetGalley/ St. Martin’s Press October 22, 2024

Lina Zeldovich's book, The Living Medicine: How a Lifesaving Cure Was Nearly Lost—and Why It Will Rescue Us When Antibiotics Fail, explores the world of bacteriophages, or phages. These are viruses that specifically infect and kill bacteria, offering a potential solution to the growing crisis of antibiotic resistance.
The book delves into the tumultuous history of phages, from their discovery in 1917 to their near obscurity as antibiotics took center stage in the mid-20th century. Zeldovich explores the reasons behind this shift, including the ease of production, the use of antibiotics compared to phages, and the rise of powerful pharmaceutical companies.
However, with the growing problem of antibiotic-resistant bacteria, phages are re-emerging as a potential weapon in our fight against infectious diseases. The book examines the current research and development efforts around phage therapy, highlighting its potential to combat a wide range of infections.
As antibiotic resistance escalates into a global health crisis, Zeldovich's work becomes both timely and essential, shedding light on an ancient remedy that may hold the key to our future.
Zeldovich's storytelling is engaging and accessible, skillfully blending rigorous scientific detail with personal narratives and historical context. She delves into the lives of pioneering scientists who first discovered and utilized phages, such as Félix d'Hérelle and George Eliava, and navigates through the complex socio-political landscapes that influenced their work.
She also provides a detailed account of the geopolitical dynamics that influenced medical research, especially during the Cold War era. In the West, antibiotics became the standard treatment for bacterial infections, leading to the neglect of phage therapy. Meanwhile, in places like Georgia, phage research flourished, resulting in a rich repository of knowledge and experience that has now become invaluable as the world faces the looming crisis of antibiotic resistance.
The author's ability to weave together historical accounts and scientific explanations makes for a compelling and thought-provoking read. She also adds anecdotes and case studies, illustrating the profound impact of phage therapy on individuals who had exhausted all other medical options. These stories not only humanize the science but also serve as powerful testimonials to the efficacy of phages.
Her personal connection to the topic adds a rich layer to the narrative. Zeldovich draws on her family's experiences in the Soviet Union, where phage therapy was a common and successful practice. This intimate frame of reference enriches the book, providing a unique perspective on how cultural and political factors shape scientific advancements and healthcare practices.
Zeldovich also explores the innovative research and technological advancements that are propelling phages back into the spotlight. She discusses the potential of genetic engineering to enhance phage efficacy and the promise of personalized medicine tailored to individual patients' infections. The book builds a compelling argument for why phages should be integrated into the mainstream medical arsenal, especially as the pipeline for new antibiotics dries up. The author also emphasizes the global implications of antibiotic resistance and the need for international collaboration in combating bacterial infections. She highlights how phages offer a ray of hope not only for wealthy nations grappling with antibiotic resistance but also for low-resource settings where access to antibiotics is limited.
Strengths:
• THE LIVING MEDICINE tackles a critical issue in public health: antibiotic resistance. As antibiotics become less effective, phages offer a promising alternative. The book also provides a historical perspective on phage therapy, explaining its decline and resurgence.
• The narrative is enriched with vivid descriptions and compelling characters, from passionate scientists to desperate patients, which keeps the reader invested throughout.
Weaknesses:
• The book focuses heavily on the potential of phages, with less exploration of the current challenges in bringing phage therapy to mainstream medicine. While the book avoids overly technical jargon, there are sections that might be challenging for readers unfamiliar with scientific concepts. At times, the story jumps from one focus to another, making it sometimes hard to follow the narrative.
• While THE LIVING MEDICINE is largely an optimistic account of phages' potential, Zeldovich does not shy away from discussing the challenges. She addresses the regulatory hurdles, the need for rigorous clinical trials, and the skepticism within the medical community. However, some readers may find the book's enthusiasm for phages occasionally overshadows these critical perspectives.

This book is a well-researched and informative book that sheds light on a promising area of medical research. It offers a compelling look at phages and their potential to revolutionize how we treat infectious diseases. It is important to note that phage therapy is still in its preliminary stages of development, and more research is needed to determine its efficacy and safety for widespread use. The book does seem to be grounded in scientific research, making the potential of phage therapy seem authentic. To me, it seems like it was written with a scientific background in mind. To that end, this book is highly recommended for medical professionals, microbiologists, and anyone interested in the evolving landscape of healthcare. It also serves as a valuable resource for policy makers and educators looking to understand and address the challenges posed by antibiotic resistance. Zeldovich’s work serves as both a wakeup call and a beacon of hope. This book not only informs but also inspires, making a compelling case for the revival of phage therapy in modern medicine.

What a compelling history! The subtitle summarizes it well: "How A Miraculous Healing Therapy Was Nearly Lost-- And Why It Will Save Humanity When Antibiotics Fail."

"The Living Medicine" reads like a thriller and tells the often-agonizing history of phages. The author began reading about them--in her native Russian-- when she was five years old.
I am not spoiling the story when I say that medical use of phages was common in the Soviet countries and not in North America, where some of the later experiments and studies were performed.

While much of the microbiological study of phages took place in (the former Soviet) Georgia, the first medicinal use occurred in Paris in 1917. Because disease-producing organisms mutate, antibiotics that once worked may no longer do so. Phages only dissolve the cell walls of specific bacteria. The "trick" is to find which phage should be tasked with killing which bacterium.

I thoroughly enjoyed this book. I think that people with biological science backgrounds would find it fascinating, as well as people who have taken antibiotics that didn't work for them and have wondered why not. As I read, I wondered what future phages might have in American medicine.

The story of phages was a complex one to tell. Lina Zeldovich did a wonderful job. The book was such a pleasure to read and I learned so much. I highly recommend it.

Thank you to NetGalley for an advance reader's copy. This is my honest review.

"The Living Medicine" is a fascinating story. I had heard of bacteriophages (phages) but had never thought about the medical benefits of phage therapy. It was interesting to learn that there had been more than a century of research into phages and their benefits for fighting infections and that use of phages was common in the country of Georgia, but relatively unknown in western Europe and the US. I was surprised at how many missed opportunities there have been to utilize phage therapy over the decades. However, I was not surprised by the various reasons that the opportunities were missed -- western prejudice against Soviet-associated innovations; scientific skepticism; capitalism (antibiotics were easier to mass produce and monetize); interpersonal jealousy and politics; and rigid thinking. I am thankful for the men and women who were persistent in their belief that phages existed and were beneficial and were willing to deal with all the frustrations, setbacks, and opposition in order to keep the science alive and advancing.

It is amazing how many lives have been saved in the past due to phage therapy, as detailed in the book. But also disturbing to think how many lives that could have been saved were instead lost because of closemindedness and prejudice.

This book should resonate with a large audience, not only because of the lifesaving potential it discusses, but because it is written a manner that makes the reader feel invested in the people featured in the book. The scientific aspects of the story are also presented in a manner that makes it accessible to the layperson. The author strikes a good balance between not getting caught up in technical jargon but also not dumbing down the science.

First, thank you NetGalley for this e-book copy of Zeldovich's book for my enjoyment.. As a lifetime nurse, I found this very interesting. We all know that antibiotics are prescribed way too often, when many times not necessary for healing. But Zeldovich has made a great case for "phages" which have been around for many years, to cure our infections instead of antibiotics. It was a little dry, and sometimes over my head, but in the long run - a very interesting book, and certainly one to consider in these times of new viruses popping up all the time. Thank you Zeldovichl

This was a fascinating look at what could well be the future of treating antibiotic overuse and its subsequent resistance. In that sense, it's a brilliant and timely story. It's not always the fastest reading book, frankly. There's a lot of very detailed history of the scientists behind the identification of phages and while it's interesting, it's extremely focused - and not exactly what I thought the focus of the book would feature, given the title and subtitle. That's not a bad thing, just a heads up for other readers who may find themselves, like me, curious as to when the book would shift into more of a contemporary, use-of-phages, mode. It's a very interesting read overall, and definitely going to resonate with those with a particular interest in the history of science. It's easy to follow, even when the topics are detailed and technical,

5/5 stars
Recommended if you like: nonfiction, STEM books, medical history, antibacterial resistance

This review has been posted to Goodreads as of 6/21 and will be posted to my book blog on 7/9 and to Instagram 8/4.

Coming into the book I didn't really know much about bacteriophages except what I learned in middle school honors bio. This book provided so much interesting information in a very easy to understand way. It mixes the science of bacteriophages with the history of how they came to be used as 'living medicine.' I absolutely flew through this book and greatly enjoyed reading about bacteriophages...even if some of the antibacterial resistant stuff scared me a bit (I knew it was an issue, but I had no idea just how prevalent it is).

The first chapter provides an overview of antibacterial resistance, how it came about, and just how much risk we're taking by continuing to overuse/overprescribe antibiotics. As much as it seems a distant menace, the threat of a post-antibiotic age is very real, and relatively close at hand, if not already here. The last chapter(s) of the book bring this topic back around, but with a more hopeful tone. By the end of the book we know all about phages and their history in medicine, and the final chapters showcase how researchers and doctors are currently working to get them approved for use, providing us with an invaluable weapon against drug-resistant pathogens.

The bulk of the book discusses how bacteriophages came to be on scientists' radars and the huge controversies that sprung up regarding them, both past and present. I found it super interesting to read about how they occur in the natural world and have been acting as antipathogenic agents for far longer than we've realized. They've acted as protectors against cholera in rivers such as the Ganges and the Mtkvari Rivers, but they also exist in soil and the air.

The middle chapters of the book also deal with the lives and careers of the scientists who studied phages. They were initially laughed off, but over time, phages grew to be taken more seriously, particularly by the Pasteur Institute in France and the (now-named) Eliava Institute in Georgia. The bulk of phage research ended up being carried out at the latter, and Georgia ended up being the rising star of phage research. We learn about the people who studied phages, what their lives and careers were like up until that point, and the ways they changed (if at all) afterward. While this was not meant to be a biography, I found I enjoyed learning about the personal lives of the scientists and liked following their careers from students to stars of their field.

Of course, no good dead goes unpunished, and Georgia ended up under Soviet control, thus placing the country and phages at risk of Soviet-era threats, from a breakdown of manufacturing processes to Stalin's purges. However, for the first period of Soviet rule, the Eliava Institute was able to continue running with great success. They continued to produce cholera- and dysentery-fighting phages, they developed phages that could be used during WWII to save battle wounds and that helped prevent epidemics during front-line sieges. There was even a period after the war when things were going okay...but then the Great Terror came and the Institute nearly fell apart. Phage research likely would've been almost entirely lost if not for the perseverance of the scientists and doctors at the Eliava Institute, both during the purges and later on during the Georgian Civil War.

In part because it was Soviet medicine and in part because a lack of regulations in the early phage period resulted in bad or no outcomes, phage medicine was laughed off in the West even into the 2000s. Even as drug-resistant superbugs were starting to emerge and develop faster resistance to new antibiotics. Again, it was the persevering phage scientists who ensured the research continued and bit by bit phages were (re)introduced into Western medicine until it was deemed okay to use them in lieu of antibiotics for food--apparently a lot of food products are treated with phage sprays to prevent/get rid of infectious pathogens. Once that hurdle was crossed, some of those same scientists began working toward phages for human medicine...and then they started getting approved for human use.

As someone who is allergic to some antibiotics and freaked out by the side effects of others, I'm glad for personal reasons that we're starting to look at effective alternative therapies. On a larger scale, we're starting to look at bacteriophages right when we need to and if clinical trials continue and phages start reaching the market, we have a very real chance of aborting the antibacterial resistant threat before it really consumes us.

I enjoyed this book. The discussion of phages was interesting as was all the biographical information. The tone was conversational and any science was well explained, but I feel that a lot more could have been said about phages without changing the tone of the book. There was a lot of information about Georgia and life under the Soviet Union which I found interesting although not always on-topic. Overall, it was a worthwhile read. Thank you to Netgalley and St. Martin's Press for the advance reader copy.