The Living Medicine

I received a free copy of, The Living Medicine, by Lina Zeldovich. from the publisher and Netgalley in exchange for an honest review. Bacteriophages or "Phages" are viruses that devour bacteria, first developed in 1917, they have been forgotten about and not used as often as antibiotics. I never knew about phages before I read this book. it is a very interesting subject.

Bury the lead? Bury the lede? Whichever one you choose, that’s what’s happening in this book.

Presumably, the editors chose the title and subtitle for this book. They got it right. They knew the most interesting thing in this book for the average 21st-century reader would be the prospect that phages (viruses that attack bacteria) will be the new generation of remedies available as antibiotics become less and less effective.

However, a lot of this book (especially near the beginning) is taken up with some less interesting score-settling in which the author takes a victory lap along with a group of long-ignored and -belittled phage scientists (mostly from the former Soviet region of Georgia). There's no argument, I think, that scientists who studied phages were, for most of the twentieth century, ignored (at best) or ridiculed (at worst) for their contention that phages could be an effective part of a healer's toolkit. Cold War mentality in the West and murderous paranoia in the Soviet space allowed phages to remain more or less a medical secret tucked away in Soviet Georgia during the long period when antibiotics reigned supreme.

Chapters two through seven, inclusive, take up 32% of the book (so says my Kindle) and are mostly devoted to the history of phage research in Soviet Georgia, with an emphasis on the personal lives of the scientists. This is only of interest, I think, if you are a science historian. I read it, of course, because (although I am not a science historian) I was fortunate enough to get a free copy of this book to review. However, if you are not a science historian, but instead are a person with the average amount of work, family obligations, cooking, cleaning, ironing, exercising, etc., but still likes to read edifying books, you could skim these chapters and start reading more carefully from chapter eight through the book's conclusion if you'd like to know more about how phages work, how they were used in the past, and how they may become more frequently administered to sick people in the future.

Returning to the theme of burying the lead/lede, I think that phages are now ready for their close-up in part due to other, more ballyhooed advancements in medical science, specifically, our new-found ability to see and edit the genetic structure of living things, including phages, so that people can spend longer and healthier lives. Phages will have to be closely monitored and edited frequently.

If I'm understanding correctly, up until recently, the use of phages in the treatment of sick people was a bit of a crap shoot, since phages come in two varieties: lytic and lysogenic. Lytic phages are the heroes – these are the ones that are used in the many, many cases in this book where gravely ill patients who resisted all other manner of more traditional therapy were suddenly, almost miraculously, cured. On the other hand, “[l]ysogenic phages are unreliable and dangerous – if not as much for a specific patient but on a global scale because they can turn relatively mild bugs into brutal killers” (Kindle location 3206). Up until recently, it was impossible to have a high degree of confidence that you are completely separating the helpful phages from the nasty ones – making the 20th-century Western medical establishment's reluctance to deal with them seem less unreasonable.

Phages aren't a miracle cure. The author, while enthusiastic about their potential, makes this clear. A traditional antibiotic could (at least in the 20th century) be introduced and remain effective for decades, giving profit-making companies the incentive to make the enormous investments of time and energy necessary to get them to market. Phages are narrower and more specialized: new ones would have to be developed constantly, and perhaps will not fit well into the time-consuming process currently in place which has (effectively) ensured that supplies of prescription medicines are uniform, uncontaminated, and consistently safe to use.

Since the medical information space on the internet is routinely full of misinformation and hysteria, this book might be an interesting one to read to get the full background on a “new” technology that may play a bigger role in our lives.

I received a free advance electronic copy of this book from the publisher via Netgalley.

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.]

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.

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.

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.

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

"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.

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.

An engaging and readable look at alternatives to antibiotics. Phages are readily available, proven in other parts of the world, and just coming to light in the West.

Read this if you are interested in medicine, natural healing, or have an antibiotic-resistant illness. I found it fascinating and highly recommend it. At the very least, you'll have something to talk about with friends - and perhaps you'll even gain an alternative to suggest to someone in medical crisis.

nonfiction, disease-management, historical-figures, historical-places-events, historical-research, history-and-culture, medical-history, medical-progress, feces-borne-diseases, history-of-antibiotic-treatment*****

Excellent textbook relating the history of feces borne diseases and the differing approaches to treatment and eradication. While the US focused on developing more and more antibiotics (and all the problems incipient in that approach), Russia remained focused on a more biologic treatment which enriched no pharmaceutical companies. There is extensive treatment of the history of the results of the kinds of diseases caused by overcrowding as well as wars. Excellent!
I requested and received a free temporary EARC from St. Martin's Press via NetGalley. Thank you!

The Living Medicine by Lina Zeldovich is a captivating exploration of the world of bacteriophages, what they are, how they have been used, and possible uses for human health in the future. The author, a science journalist with the capacity for explaining scientific ideas so they can be understood by a general audience, takes readers on a journey through the fascinating realm of bacteriophages, shedding light on how they may very well rescue us.

Bacteriophages, often referred to simply as phages, are viruses that specifically infect bacteria. Discovered in the early 20th century, bacteriophages have been recognized as important players in various ecosystems, particularly in the context of human health and disease. Phages typically consist of a protein coat surrounding their genetic material, which can be either DNA or RNA. They come in various shapes and sizes, ranging from simple structures to more complex ones. Phages are abundant in natural environments, including soil, water, and the human body. They play a crucial role in regulating bacterial populations and shaping microbial communities. They are key players in horizontal gene transfer among bacteria, influencing bacterial evolution and diversity.

They have been used to target and kill specific pathogenic bacteria that cause infections, including cholera and dysentery, beginning in 1919. Phages can be selected or engineered to specifically target particular bacterial strains while leaving beneficial bacteria unharmed. This targeted approach is particularly valuable in the era of antibiotic resistance when traditional antibiotics may be ineffective against certain bacterial infections. They have also proved useful in treating chronic infections by methicillin-resistant Staph aureus (MRSA) which is notoriously resistant to antibiotics and they may serve as possible treatments in the future for chronic conditions.

Much of the bacteriophage research was done at the George Eliava Institute in Soviet Georgia, but it was largely destroyed in 1991 in the Georgian Civil War. Scientists worked to save whatever phage cultures they could and about 50 people still work at the Institute on phage production. There is still much research that needs to be done into specificity, resistance, immunogenicity, safety, and regulatory hurdles, but Zeldovich's book serves to remind us that bacteriophages helped in the past and may have even more uses in the future.

Thank you to NetGalley and St. Martin's Press for providing me with a copy of this book. It will be published on October 22, 2024.

Thank you, NetGalley and St Martin's Press for this advanced reader's copy. This book was an awesome and informative read as an Infection Prevention RN. I currently see so many multidrug resistant organisms in my patients unfortunately, and so it is inspiring to see there is something other than MORE antibiotics to be able to treat these organisms and help these patients as many of these have no options left. I love that bacteriophages can be used in this way and are a great and unlimited resource.

I've long been interested in bacteriophages and their beneficial properties, and this book is such a fascinating look into not only their history but how they can really help us. This is especially true when it comes to antibiotic resistance, which is a growing problem that threatens our world as we know it. There is a lot to learn about the history of bacteriophages and exactly how they came to be, and their discovery of use, and this book does a great job of telling their story while also stressing the importance of them for our future. This scientific discovery, while not well known yet to the general public, is something we really need to focus to help combat the problem of antibiotic resistance. I think those interested in science and history and what the implications are for our future will enjoy this book and it is a must read!

Thank you to NetGalley, Lina Zeldovich, and St. Martin's Press for the eARC of this book.

The Living Medicine was a very interesting book detailing the research on using bacteriophages to treat bacterial infections instead of antibiotics. I was somewhat knowledgeable of the use of bacteriophages for this use and also for gene therapy, but I did not know the back story of the research that was done in the past in the former soviet union. This is what I love to learn- about the people and processes behind the discoveries. It gives me a greater appreciation for the applications of scientific discoveries.

As a high school biology and anatomy teacher I discuss antibiotic resistance, specifically MRSA and other highly resistance strains, with both of my classes and this book as given me real life examples to share with my students. I would recommend for my school library to obtain a copy and recommend this book to my students.

Really really insightful, in the era of antibiotic therapy, we never heard or hope about miraculous things to happen. Hope this book will be a blessing for many others.