— We are seeing now the emergence globally of some forms of bacteria that are effectively untreatable.
ANNOUNCER: Each year, at least two million people are infected with drug-resistant superbugs.
— They had asked me to sign the papers to let her go, and I did.
ANNOUNCER: And at least 23,000 die from them.
— He had some bugs that they had never seen before.
ANNOUNCER: FRONTLINE investigates how we got here—
— We immediately went on high alert, the equivalent of DEFCON 5.
— No matter what we did, the bacteria was still spreading.
ANNOUNCER: —and why major drug companies are giving up on developing new antibiotics.
— You have to make some very ruthless decisions?
— These are not ruthless decisions. These are portfolio management decisions. Our investors require that of us.
ANNOUNCER: And what happens now.
— There have been covers of magazines about “the end of antibiotics,” question mark.
— I would say you can change the title to “the end of antibiotics,” period.
ANNOUNCER: Tonight on FRONTLINE, Hunting the Nightmare Bacteria.
NARRATOR: This is the story of three seemingly disconnected events beginning at the same time. What they each have in common is a type of infection that is becoming impossible to treat, a type of infection that has triggered deadly outbreaks even at one of our most prestigious hospitals. It is a crisis that is spreading alarmingly fast, threatening everyone, even the healthy.
Our first story starts in Tucson, Arizona, in May 2011.
TONYA RERECICH: When I think about that time, I think about spring, and just how— you know, how busy it was and how beautiful she was.
She was 11-and-a-half years old and just physically perfect, beautiful from head to toe— slim, you know, white-blond hair from being out in the sun, a little bit of freckles across her nose, bright blue eyes, paying attention to what her clothes looked like and her hair, never stopped talking, talked a mile a minute.
That was Addie at that— just, you know, in the month before she got sick.
NARRATOR: Journalist David Hoffman first heard about Addie Rerecich while investigating for FRONTLINE what doctors and government officials are now calling a nightmare, a kind of dangerous bacteria that is increasingly resistant to the strongest antibiotics.
This is what brought us to Tucson, to find out more about an astonishing set of events that began one Sunday, when Addie complained to her mother about a pain in her hip.
TONYA RERECICH: I thought, “Well, you know, she’s just finishing up softball.” She had been to the track meet, you know, all kind of— well, it could have been an injury.
I gave her some ibuprofen. As the night wore on, her pain got worse. She didn’t sleep much that night, woke me up a couple of times asking if she could take a hot bath or have another ibuprofen.
NARRATOR: The next morning, Tonya Rerecich, a nurse for 16 years, took Addie to a local hospital, where they said she had symptoms of a virus. But over the next few days, the pain spread and the fever got worse.
TONYA RERECICH: I was afraid at that point. I remember being very afraid. And so I packed a bag and we went to another hospital that had specialized in children’s care.
I remember thinking, “She looks bad. This is bad. Something’s really, really wrong.”
They put her on antibiotics. They were— her blood pressure was dropping. They were, you know, making space in the ICU for her. The next morning, she needed oxygen via mask. They looked at part of her lungs and diagnosed her with pneumonia.
I remember sitting there, watching the sun come up and thinking, “How did she get so sick? How did this happen so fast?”
SEAN ELLIOT, M.D., Infectious Disease Specialist: I met Addie in a hospital bed in the intensive care unit. She was lying there, breathing quickly. She was scared. She had little infected boils all over her body. What really looked most likely when I saw her was a staph bacteria causing septic shock. And Addie fit a pattern that I recognized with community-associated MRSA.
DAVID E. HOFFMAN, Correspondent: When you say community— I mean, this is what you mean, that a kid picks it up in a playground with a scraped knee, right?
Dr. SEAN ELLIOT: Correct.
NARRATOR: The spread of MRSA, a staph bacteria that causes infections resistant to many antibiotics, has long been a big problem inside hospitals. But over the last two decades, it’s also been found outside, in the community.
Dr. SEAN ELLIOT: In Addie’s case, she was a skin picker. She, as do many kids, picked at her little scabs. And that was likely what introduced the staph infection.
NARRATOR: But the staph was just the start of Addie’s troubles.
Dr. SEAN ELLIOT: She already had evidence of an early pneumonia, and it looked like she was about to get a lot sicker.
TONYA RERECICH: I asked him what were the odds of her making it, getting well.
DAVID E. HOFFMAN: What did he say?
TONYA RERECICH: He said 30 percent. But he had to think about it for a minute, and I knew he was lying to me. I knew. By the time your blood has bacteria in it, you’re in real trouble.
NARRATOR: The staph infection had so damaged her lungs, the doctors had no choice. To save her life, they put her on a lung bypass machine, called ECMO.
TONYA RERECICH: I remember saying, “ECMO?” with a squeaky voice, like, “No! Really? You’re not really talking about ECMO?”
NARRATOR: This was total life support.
TONYA RERECICH: It’s got huge tubes that are put into an artery and a vein. And the patient’s blood comes out of their body, runs through the machine, and the machine does what your lung does.
NARRATOR: The tubes presented a whole new set of dangers.
TONYA RERECICH: Those tubes can harbor bacteria.
NARRATOR: And one of the dilemmas of modern medicine. The interventions that can save you can also put you at serious risk.
Dr. SEAN ELLIOT: Any patient we put on ECMO has a much higher risk of having additional infections. That’s just the nature of the beast.
DAVID E. HOFFMAN: Is that what happened here?
Dr. SEAN ELLIOT: Correct.
DAVID E. HOFFMAN: And she got a particularly nasty one. What was it called?
Dr. SEAN ELLIOT: Stenotrophomonas.
NARRATOR: Stenotrophomonas is an entirely different kind of bacteria from staph. Found in hospitals, it can live inside breathing tubes. And it’s extremely difficult to treat.
Dr. SEAN ELLIOT: The problem with Stenotrophomonas is, even at the outset, it’s already a very resistant bacteria. There are only four or maybe five antibiotics normally that are able to treat that particular bacteria.
NARRATOR: Addie was confronting the frightening new face of antibiotic resistance, a group of bacteria called Gram-negatives.
DAVID E. HOFFMAN: So can you explain to me why these Gram-negatives are so stubbornly nasty?
Dr. SEAN ELLIOT: Gram-negative bacteria— it’s a medical term, and it really references the armor that surrounds the Gram-negative bacteria. That armor makes it very difficult for normal antibiotics to get into the bacteria and to kill it.
So Stenotrophomonas is incredibly difficult to treat because it has that serious body armor surrounding it.
[http://www.pbs.org: More on Gram-negative bacteria]
NARRATOR: The ability of-Gram negatives to aggressively fight off antibiotics was now playing out in Addie.
TONYA RERECICH: She was first put on one antibiotic that’s good for Stenotrophomonas, and it worked for a while. And then guess what? The antibiotic doesn’t work anymore. “Let’s give her a different one.” Well, and then it would, you know, work a couple weeks, three weeks. And then the Stenotrophomonas would sort of, like, bloom back up, rear its ugly head, so to speak.
Finally, one day, they said something I never thought I would hear. The Stenotrophomonas is pan-resistant— “pan” meaning resistant to everything, like a panorama.
NARRATOR: Addie and her mother had entered the post-antibiotic era.
Dr. SEAN ELLIOT: I had to go to her and say, “I don’t have— I don’t have options based on medical science. I’ve run out of options. I don’t see a way out of this.”
TONYA RERECICH: I remember a long weekend went by. And they had asked me to sign the papers to let her go. And I did.
NARRATOR: There was one only hope left of saving Addie’s life, to surgically remove the infection.
TONYA RERECICH: I remember asking the doctors then about lung transplant. And they said no, that it couldn’t be done, that it would be too dangerous.
Dr. SEAN ELLIOT: The problem was that she was too sick to be transplanted. And that sounds a bit strange because you think of a transplant as the final life-saving thing you’ve got. But because of that resistant Stenotrophomonas, the expected survival of transplanting her was not good. In fact, you might say close to zero.
NARRATOR: Doctors faced a question of medical ethics, whether to risk such a valuable resource as a young set of lungs when Addie’s chances of survival were so low.
DAVID E. HOFFMAN: What tipped the balance?
Dr. SEAN ELLIOT: I think it was Addie’s mom, Tonya, who was such a strong advocate and didn’t give up. And it was also the fact that this was not an unresponsive body lying on the table. This was a young girl who was communicating with us and had temper tantrums and sparks of life, which we could all see on the ECMO apparatus.
I mean, the— how can you say no to this, you know, living, alive human being who’s communicating with you?
NARRATOR: But Addie would still have to wait in the intensive care unit, hoping to get a new set of lungs.
As Addie was fighting for her life, a 19-year-old American named David Ricci was about to face another threat on the streets of India.
DAVID RICCI: So after 30 hours on a train, we’ve finally ended up in Calcutta.
NARRATOR: Here, Gram-negatives were spreading in frightening ways, and coming from unexpected places.
DAVID RICCI: I wanted to experience another culture and put myself in an environment where I was serving, where I was helping people. I think India ended up changing me a lot more than I could have ever changed India.
DAVID RICCI: [with children] Eight little monkeys jumping on the bed!
NARRATOR: He had come here with a mission group to work in orphanages.
DAVID RICCI: The momma called the doctor and the doctor said, “No more monkeys jumping on the bed!”
NARRATOR: One morning, the group headed off to work at one of those orphanages, a Mother Teresa home.
DAVID RICCI: It was in the slums of the slums, really, where this orphanage was. So we had to walk through all of these narrow streets that I had never walked through before.
MICHELE FULGINITI, Mission Group Leader: And we basically took a shortcut through the train station. So you crossed over the tracks, and then we were walking adjacent to the train tracks. And as we were going under an overpass—
DAVID RICCI: I was in the very back, walking, and all of a sudden, you know, out of nowhere—
MICHELE FULGINITI: —a train went by. And I noticed— I just remember thinking in my head that it went by, “Wow, that went by really quickly.”
DAVID RICCI: And the momentum and the speed hooked my sleeve and ran me over, and dragged me underneath the train. The wheel ran over my leg and I start losing a ton of blood. I just start bleeding everywhere.
NARRATOR: Ricci was pulled from under the train. Lucky to be alive, he was rushed to a local hospital. A doctor came in.
DAVID RICCI: He reached up on the top shelf and he pulls out this leather bundle. And then, you know, he takes out a big knife, you know, a big machete-type-looking saw-knife. And he just starts telling all, you know, the nurses to hold me down and to hold me steady. And then he just started cutting my leg off, just hacking it off.
MICHELE FULGINITI: We were standing outside and we could hear him screaming the whole time.
DAVID RICCI: And then I passed out.
NARRATOR: Within 24 hours, Ricci was moved to another hospital, and his condition deteriorated quickly.
DAVID RICCI: [home video] Hey, everybody. I talked to the doctors. They said I don’t have that much longer, but I’ll put in a good word for you.
NARRATOR: Ricci was barely hanging on.
DAVID RICCI: Miss you all.
NARRATOR: And by the time his family reached India, there were new complications.
CHERYL PERRON, David Ricci’s Mother: They were just telling us, “We need to take him back in for another surgery,” another surgery. And we didn’t understand why. He almost had surgery every day. And they— they said, you know, “We’ve got to clean up the infection.” And so, you know, I just thought it’s just an infection, you know? I really didn’t realize what they meant by infection.
NARRATOR: What Ricci and his family didn’t know was that they were on the front lines of a superbug crisis that was just beginning to unfold.
INDIAN NEWSCASTER: The study which found the NDM-1 superbug in Delhi’s water samples is making the Indian health establishment see red.
NARRATOR: Researchers had discovered a new danger.
INDIAN NEWSCASTER: Bacteria carrying the gene that produces this NDM-1 enzyme are resistant to very powerful antibiotics.
RAMANAN LAXMINARAYAN, V.P., Public Health Foundation of India: It absolutely was a bombshell. It was unexpected.
INDIAN NEWSCASTER: The Lancet infectious diseases journal found that NDM-1 enzyme in 11 different types of bacteria.
NARRATOR: NDM-1 isn’t bacteria, it’s actually a resistance gene that can turn bacteria into superbugs. NDM-1 is resistant to almost all antibiotics. Even more frightening, it is promiscuous— the resistance gene can jump from bacteria to bacteria, making treatable infections suddenly untreatable.
But there was more. NDM-1 wasn’t just in hospitals. To everyone’s surprise, it was found out in the environment, too.
RAMANAN LAXMINARAYAN: First from a scientific standpoint, we didn’t realize that this could be done quite so easily. It meant that in places where water and sanitation was poor, where there was going to be lots of bacteria sitting next to each other, that you could have very rapid spread of resistance information across unrelated bacteria just out there in the environment, which is a hugely greater risk than if it were only to happen within the bodies of patients who had these infections.
DAVID E. HOFFMAN, Correspondent: So you’re saying that the bacteria were swapping this information just out there on the street without being in a person.
RAMANAN LAXMINARAYAN: That’s correct. So they could transfer resistance genes even when they were in the same puddle of water.
NARRATOR: With the spread of NDM-1, a much wider population is put at risk. And what has health officials around the world especially worried is that NDM-1 is hearty— and it travels.
After two weeks in an Indian hospital, David Ricci was flown home to Seattle and taken to the trauma unit at Harborview Medical Center.
JOHN LYNCH, M.D., Infectious Disease Specialist: I first heard about David’s case in July of 2011. I was sitting in my office doing some work, and one of my colleagues, an orthopedic surgeon, Dr. Doug Smith, gave me a call and asking me if I had known about a patient up on one of our acute care floors with a number of drug-resistant pathogens. I brought up his medical record and saw a huge amount of drug resistance, drug resistance we don’t typically see.
All these “R’s” mean that the bacteria is resistant to that antibiotic.
Knowing that David had come from India, I was immediately concerned, even before seeing David, about bacteria in the wound containing this new type of drug resistance.
NARRATOR: Lab results confirmed Lynch’s worst fears. Ricci had brought NDM-1 into the United States. It was one of the first cases to ever be identified here, and Lynch had little to go on.
Dr. JOHN LYNCH: There’s not a lot of clinical experience with treating these bacteria anywhere— in the literature, there’s no books, there’s no things on it. So we had to figure out what to do for David right then and there.
DAVID RICCI: I get this knock on my door and they open up the door and there’s these doctors. They tell me, “We need to isolate you. We need to put you on your own and quarantine you.”
NARRATOR: Ricci was in the throes of the NDM-1 nightmare. The gene was spreading resistance to other infections in his leg.
CHERYL PERRON: They showed us the list of them. There were about five bugs. And they said all these infections are resistant to antibiotics. And— and when they said that, that’s what worried me because I’m, like, “How is he going to get rid of them?”
NARRATOR: Lynch tried several powerful antibiotics, but they didn’t work. He had only one option left, a 1940s antibiotic called Colistin.
Dr. JOHN LYNCH: We went away from it because of its toxicity and the ability to use new antibiotics. The problem now is we don’t have a lot of new options and we’re going back to some of our older antibiotics.
CHERYL PERRON: The hardest part was watching to see what the antibiotics did to him.
DAVID RICCI: It started to eat away at my organs on the inside, you know? I could just feel it, just— just this poison rushing through my blood.
NARRATOR: The treatment was too toxic.
Dr. JOHN LYNCH: We had to stop the only drug we had left to treat the Gram-negative rods that were in his wounds.
DAVID E. HOFFMAN: So you’re telling me that he had these bugs and you had nothing left to treat him with.
Dr. JOHN LYNCH: At this point, we had nothing left to treat him with.
CHERYL PERRON: I just couldn’t believe that there wasn’t an antibiotic that would fix it, to tell you the truth.
NARRATOR: They would have to cut out more of the infection by cutting off more of Ricci’s leg. But it would be months before they knew whether all of the NDM-1 was gone.
Over the last 10 years, hospitals in the New York City area have become the epicenter of another highly resistant and deadly type of Gram-negative bacteria. This superbug didn’t come from overseas. This one was homegrown.
It lives in the digestive system, and like NDM-1, it’s a gene that can spread its resistance to other bacteria. It’s called KPC. No one knows exactly how many patients in the New York City area have been infected with KPC or how many have died from it.
Nationally, most hospitals aren’t required to report outbreaks to the government, and most won’t talk publicly about them. But as part of FRONTLINE’s investigation, one of the nation’s most prestigious hospitals, the Clinical Center at the National Institutes of Health, the NIH, agreed to recount how it dealt with a major KPC outbreak.
It began in the summer of 2011, when a woman carrying KPC was transferred from a New York City hospital here to the NIH in Bethesda, Maryland.
JULIE SEGRE, Ph.D., Geneticist, NIH: Talking about hospital infections is really difficult for a hospital because what you are saying is that we all know that when you come to the hospital, there are certain risks. But we’ve now laid bare what are those risks.
NARRATOR: The NIH had never treated a case of KPC before. And as the patient was brought into the ICU, the staff was determined to keep the KPC from spreading to other patients.
DAVID HENDERSON, M.D., Dpty. Director, NIH Clinical Center: We immediately went on high alert, the equivalent of hospital epidemiology DEFCON 5, trying to implement as many things as we could think of at the time to prevent any further spread of the organism in the hospital.
NANCY AMES, R.N., ICU Nurse, NIH: They called it KPC, and so we learned later that was klebsiella pneumoniae carbapenemase. And that’s a mouthful. But we really didn’t know what that meant.
TARA PALMORE, M.D., Infectious Disease Specialist, NIH: The patient was placed in what we call enhanced contact isolation, which means everybody who went in the room, including visitors, had to wear gloves and gowns.
NARRATOR: The room was at the end of the hall, separate from other patients. But this was the intensive care unit, where patients are very sick and highly vulnerable. And that presented heightened risks.
Dr. DAVID HENDERSON: It’s the kind of place where the bacteria can spread with ease. People are very busy and there are a lot of things going on. Patients get very sick very quickly and require intervention. The bacteria can be spread on the hands. They can be spread on pieces of equipment that might go from patient to patient. So you have to be really cautious.
NARRATOR: Their efforts to contain the KPC appeared to work. When other ICU patients were tested for KPC—
Dr. TARA PALMORE: We found nothing. So at that point, we thought that there had not been spread of the bacteria.
NARRATOR: The New York patient ultimately recovered and was discharged after four weeks in the hospital.
Dr. DAVID HENDERSON: We really felt like we had dodged a bullet.
NARRATOR: But then a big surprise.
Dr. TARA PALMORE: Five weeks later, unexpectedly—
NURSE: Could you do me a favor? Could you get me just a tube fixator out of the R-T closet?
Dr. TARA PALMORE: —KPC bacteria turned up in a respiratory culture.
NARRATOR: And with it a mystery.
Dr. TARA PALMORE: How this could have spread from the first patient to the second patient.
Dr. DAVID HENDERSON: They were not in ICU at the same time. They didn’t have the same caregivers. They didn’t have the same equipment. So initially, we thought that it might be possible that this was a second introduction of yet another KPC organism.
Dr. TARA PALMORE: I was extremely concerned because the infections with this bacteria had a high mortality rate.
NARRATOR: As they began to investigate, searching for KPC on equipment and testing the patients yet again, they realized the problem was much bigger.
Dr. TARA PALMORE: We started finding other patients in the intensive care unit to whom the bacteria had spread.
NARRATOR: They had an outbreak. The KPC was spreading. The patients were getting sicker. And antibiotics weren’t working.
Dr. TARA PALMORE: And we tried combinations of five, six antibiotics. We tried making oral antibiotics into intravenous antibiotics. We even got an investigational antibiotic from a pharmaceutical company.
DAVID E. HOFFMAN: An experimental one, a test one.
Dr. TARA PALMORE: An experimental antibiotic. And that also did not work.
NARRATOR: Desperate to contain the outbreak, the hospital took unprecedented steps. They created a separate ICU for KPC patients, brought in robots to disinfect empty rooms.
NANCY AMES, R.N., ICU Nurse, NIH: Had monitors here reminding us to wash our hands, built a whole wall up in the other side. We moved every patient in the ICU, completely cleaned it, moved patients back in. And no matter what we did, the bacteria was still— it was still spreading.
Dr. DAVID HENDERSON: We didn’t know what was going on.
NARRATOR: With the hospital in crisis, genetic researchers in building 49 next door were scrambling to figure out how the KPC was spreading.
JULIE SEGRE, Ph.D., Geneticist, NIH: We had now gotten to the point where they were identifying a patient a week, and it was not clear how these patients might be related to each other.
NARRATOR: Julie Segre and her colleague, Evan Snitkin, started to compare the DNA samples of the KPC taken from the patients.
JULIE SEGRE: Are these all the DNAs then?
EVAN SNITKIN, Ph.D., Post-Doctoral Fellow, NIH: Yeah, these are all the DNAs for—
NARRATOR: Each patient had a number.
EVAN SNITKIN: So this shows you, based on the DNA sequences, how we think the bacteria spread throughout the hospital.
NARRATOR: By matching the DNA, they discovered something none of them knew.
EVAN SNITKIN: Three, four and eight were all silent carriers. And what’s scary about that is they can be transmitting to other patients without anyone knowing that they even have the bacteria themselves. So this— this bacteria seemed to have been all over the hospital before they had come up positive.
DAVID E. HOFFMAN: And the hospital didn’t know that?
EVAN SNITKIN: They didn’t know because this bacteria has the capacity to live in the stomach of patients without causing infection.
Dr. DAVID HENDERSON: For me, the data were stunning.
DAVID E. HOFFMAN: Why was it stunning?
Dr. DAVID HENDERSON: Because it became very clear that we had missed the transmission sequence.
[http://www.pbs.org: Inside the NIH outbreak]
NARRATOR: The high-tech genomics revealed a disturbing truth— the outbreak would be much more difficult to contain. And to stop it, they needed to figure out exactly how the KPC was moving through the hospital. Was it on the hands of workers or visitors, or on hospital equipment?
And then, as they urgently searched for silent carriers throughout the rest of the hospital, their worst nightmare came true. The outbreak had spread beyond the ICU.
JULIE SEGRE: That’s a very scary moment. Suddenly, it’s in the general patient population.
NARRATOR: The staff was in a panic. As they looked on helplessly, patients began to die.
NANCY AMES: We felt responsible for it. We are responsible for the patients. You go into a room, and maybe there’s a hole in your glove. It’s a very complex environment. Alarms are ringing. Did you miss something? Did you forget to tell the doctor something? Did I forget to wash my hands between Mr. X and Mrs. Y? Is that why Mrs. Y got KPC?
NARRATOR: There were few options left.
Dr. DAVID HENDERSON: Dr. Gallin asked me if we needed to close the hospital, or if we needed to close the hospital to admissions. Ultimately, we decided not to close the hospital, but—
DAVID E. HOFFMAN: It was a possibility.
Dr. DAVID HENDERSON: Absolutely.
NARRATOR: Instead, they expanded testing hospital-wide and isolated all those found with KPC. Finally, six months after patient one first arrived, the outbreak subsided almost as suddenly as it had begun.
By then, 18 patients had been infected with KPC, and the ultimate tragedy, six people had died from it.
Many inside NIH continue to be concerned.
DAVID E. HOFFMAN: Do you think KPC is now gone from your hospital?
Dr. TARA PALMORE: Oh, no. Absolutely not. I think that— that we have to be extremely vigilant in the coming years because of the increasing rise, the increasing prevalence of KPCs in the United States.
JULIE SEGRE: One of the reasons that really brought me into this field is that I asked the director of clinical microbiology, “What do you do,” you know, “when you isolate one of these bacteria and you see that it is resistant to all known antibiotics?” I said, “Well, what do you do the? And he said, “I pray.”
Well, that’s not really part of how we typically— that means that we have come to the end of how we practice medicine with drugs.
NARRATOR: The prospect of life without antibiotics is barely imaginable for a world that has had a cheap and plentiful supply of them since the end of World War II. They are a staple of modern medicine. It’s hard to recall a time without them, when an infected cut could kill a healthy young person in a matter of days.
But it’s now clear that we are heading back in that direction, that the miracle of these drugs is slipping away.
BRAD SPELLBERG, M.D., Author, Rising Plague: Antibiotics are unique drugs. They’re not like any other class of drugs. Fifty years from today, the cholesterol drugs we have now will work just as well as they work today. The cancer drugs we have now will work just as well as they do today. That’s true of all the other drug classes.
Antibiotics are the only class of drugs that the more we use, the more rapidly we lose. When you use it, it becomes less effective for me, and vice versa.
NARRATOR: That is the essence of antibiotic resistance.
ARJUN SRINIVASAN, M.D., Associate Director, CDC: The more you expose a bacteria to an antibiotic, the greater the likelihood that resistance to that antibiotic is going to develop. So the more antibiotics we put into people, we put into the environment, the more opportunities we create for these bacteria to become resistant.
NARRATOR: But people forgot about the danger of resistance because the drugs were so effective.
Dr. BRAD SPELLBERG: And what they had forgotten was the warning that Alexander Fleming himself, the man who discovered penicillin, gave us in 1945, that resistance was already being seen, and the more we wasted penicillin, the more people were going to die of penicillin-resistant infections.
Dr. ARJUN SRINIVASAN: Bacterial resistance is largely inevitable, but it’s also something that we have certainly helped along the way. We’ve fueled this fire of bacterial resistance. These drugs are miracle drugs, these antibiotics that we have, but we haven’t taken good care of them.
NARRATOR: Public health officials estimate that up to half of all antibiotic use in the U.S. is either unnecessary or inappropriate.
Dr. ARJUN SRINIVASAN: And in overusing these antibiotics, we have set ourselves up for the scenario that we find ourselves in now, where we’re running out of antibiotics.
[http://www.pbs.org: Watch on line]
NARRATOR: But the growing scarcity of effective antibiotics isn’t just a problem of overuse. It’s also been driven by what’s happening inside the drug industry itself.
JOHN REX, M.D., V.P., Clinical Research, AstraZeneca: The place where it started to turn really challenging, I’d say, would be in the ‘80s and the ‘90s, when we began to see occasional bacteria that were very hard to treat. And it became less obvious that you were able to invent new antibiotics. And the brand-new things just weren’t coming at the same pace.
And then in the ‘90s and the first part of this century, we began to see resistant bacteria for which we really didn’t have very much, or anything at all. And we had nothing coming to treat them.
NARRATOR: That’s because most major drug companies were pulling out of the antibiotic research field just as the Gram-negative threat was worsening. One of the last companies to stay was Pfizer, which had made its name on antibiotics. By the mid-2000s, it had set its sights squarely on the Gram-negative problem.
CHARLES KNIRSCH, M.D., V.P., Clinical Research, Pfizer: We thought there was medical need. That’s really what matters. And we thought that, given our history in being able to develop penicillin, the anti-fungals, you know, antibiotics, that in fact, if we put our minds to it, that we would succeed. But this is a highly risky and unpredictable enterprise.
NARRATOR: Despite the risk, Pfizer built a world-class research team in Groton, Connecticut, and brought in a veteran in Gram-negative research, John Quinn.
JOHN QUINN, M.D., Fmr. Pfizer Antibacterial Adviser: In 1983, when I finished my training, almost every pharmaceutical company had an antibiotic development team. And by the time I landed at Pfizer in 2008, we were really down to three big guys and some smaller companies, biotechs and so on.
And I think all of us felt that, you know, we had a moral obligation to continue to work in this area. There was a pressing clinical need. Most companies had abandoned the field, and we were still in the game. We were proud to still be in the game.
NARRATOR: Quinn and his team believed they were onto something big, several different compounds to treat Gram-negatives. The potential breakthroughs got the attention of the company’s science advisers, including Brad Spellberg.
Dr. BRAD SPELLBERG: I felt that their pipeline was probably the most compressive and important anti-bacterial pipeline in the world, focusing on the types of bacteria that we’re really having severe problems with right now.
DAVID E. HOFFMAN: Which are the—
Dr. BRAD SPELLBERG: The highly resistant Gram-negative bacteria. These would have solved problems and saved lives, had they been successfully developed.
NARRATOR: But bringing these drugs to market faced the economic paradox of antibiotics.
Dr. JOHN REX: If you need an antibiotic, you need it only briefly. Indeed, that’s the— that’s the correct way to use an antibiotic. You use it only briefly.
And from an economic standpoint of a developer, that means you’re not— you’re not getting the return on the investment you’ve made because you’ve spent between $600 million and a billion dollars to bring that new antibiotic to market.
DAVID E. HOFFMAN: Wait. You mean it costs up to a billion dollars to bring a new drug to market?
Dr. JOHN REX: It can easily cost up to a billion dollars to bring a new drug to the market. And the initial reaction to it is, “That’s great, and let’s not use it. Let’s use it as little as possible.”
Dr. BRAD SPELLBERG: So here’s a large company saying, “I have— I can make billions off cholesterol drugs, blood pressure drugs, arthritis drugs, dementia, things that I know patients are going to have to take every day for the rest of their lives. Why would I put my R&D dollars into the antibiotic division, that isn’t going to make me any money, when I can put it over here, that’s going to make a lot of money for the company? I answer to the shareholders.”
NARRATOR: That was the problem facing Pfizer in 2011. Its stock had plummeted on Wall Street, and its blockbuster cholesterol drug, Lipitor, was about to lose its patent.
JOHN QUINN, M.D., Fmr. Pfizer Antibacterial Adviser: I received an email on my BlackBerry that there was a mandatory emergency meeting in two hours. Can’t be good. So I called in for the meeting and was told that that announcement had been made that the Groton facility was going to be closed.
NARRATOR: The company ended 70 years of leadership in antibiotic development, leaving its search for a Gram-negative cure unfinished.
Dr. JOHN QUINN: The external people who I spoke to, many of whom are personal friends, said to me, “Well, Pfizer’s just doing what other companies have done. There’s nothing particularly wrong with that. It’s not immoral. We are a capitalist society.”
NARRATOR: FRONTLINE asked Pfizer to explain the decision.
DAVID E. HOFFMAN: I get the sense that you have to make some very ruthless decisions about where to put the company’s capital, about where to invest, where to put your emphasis. And when you pulled out of Gram-negative research like that and shifted to vaccines, do you look back on that and say, you know, “We learned something about this”?
Dr. CHARLES KNIRSCH: These are not ruthless decisions. These are, you know, portfolio decisions about how we can serve medical need in the best way. We want to stay in the business of providing new therapeutics for the future. Our investors require that of us. I think society wants Pfizer to be doing what we do in 20 years. We make portfolio management decisions.
[http://www.pbs.org: More from Charles Knirsch]
JOHN REX, M.D., V.P., Clinical Research, AstraZeneca: It takes a long time to learn to make any class of drug. When a major company leaves an area, we really do have a loss— of skills, of history in terms of understanding how to develop a new antibiotic.
DAVID E. HOFFMAN: The antibiotic pipeline is narrowing. It’s drying up, some people say.
Dr. JOHN REX: I think it’s worse than drying up. I think it is—
DAVID E. HOFFMAN: Really?
Dr. JOHN REX: I think it is terribly close to a drought. This is one of the great catastrophes of our age.
NARRATOR: Widespread antibiotic resistance has been a long time in the making. And with the pharmaceutical industry pulling back from developing new antibiotics, serious questions are now being raised about whether the U. S. government is prepared to confront the problem.
DAVID E. HOFFMAN: Dr. Srinivasan, I’m just thinking back a little bit about history, that when we do have big challenges in public health, oftentimes, we’ve tackled them in a big way. I’m thinking about, for example, HIV/AIDS and how we tackled that problem. And it required a lot of effort, and people were in charge. And I took a look the other day at the research levels devoted to the problem of anti-microbial resistance at NIH. Anti-microbial resistance is way down the list.
Dr. ARJUN SRINIVASAN: Right.
DAVID E. HOFFMAN: It’s actually number 70 on their list. What does that say about the priority?
Dr. ARJUN SRINIVASAN: Well, I think what that points to is the fact that, you know, our research in this area has lagged. We’re going to have to do a lot more in the area of antimicrobial resistance. You know, I think for a long time, we weren’t investing a lot in antimicrobial resistance because we always had new antibiotics to combat the problem.
DAVID E. HOFFMAN: We got complacent.
Dr. ARJUN SRINIVASAN: In a sense, I think we did. You know, there were always new drugs to treat these infections. And so I think the need to do basic research on antimicrobial resistance moved down our priority list.
NARRATOR: But with the spread of Gram-negatives fast accelerating, with new outbreaks of KPC and the rise of NDM-1, last March, the Centers for Disease Control and Prevention decided it was time to sound a loud alarm.
NEWSCASTERS: We now turn to health news tonight.
There’s a warning from the CDC—
—new and extremely dangerous—
—superbug. It’s a deadly nightmare bacteria that—
Even the CDC has called it a nightmare.
A nightmare? I mean, at first, I thought that was someone’s hyperbolic headline until I saw it was the CDC.
Right. The CDC is usually very straight-laced and doesn’t use words like that.
DAVID E. HOFFMAN, Correspondent: If this is a really big public health problem, who’s in charge of this problem for the United States government? Can you tell me who’s in charge?
Dr. ARJUN SRINIVASAN: Who’s in charge of resistance?
DAVID E. HOFFMAN: Of anti-microbial resistance and fighting it and— it’s a threat to public health, right?
Dr. ARJUN SRINIVASAN: It is a threat to public health.
DAVID E. HOFFMAN: So who’s in charge of dealing with that, with coordinating it?
Dr.ARJUN SRINIVASAN: Well— well, I think that, you know, the issue of who’s in charge of combating anti-microbial resistance speaks to the fact that this is a very, very complex problem. So there’s not one single group that can take full ownership of solving the problem of resistance.
DAVID E. HOFFMAN: When I look at the Department of Health and Human Services, for example, I look at the assistant secretaries, there’s not an assistant secretary who deals with anti-microbial resistance. There is for other kinds of health problems. It seems that this is a problem that hasn’t actually registered in the high levels of the government. It’s a crisis, you say.
Dr. ARJUN SRINIVASAN: It is a crisis. It’s indeed a crisis. There are a variety of different issues that have to be addressed. They require a variety of different actions by all of the different federal agencies who are involved in this.
Dr. BRAD SPELLBERG: It’s not that the government agencies are not aware of the problem and are not— and are not doing anything. It’s that we have not had a comprehensive plan for how to deal with antibiotic resistance. We don’t have reporting mechanisms, like they do in Europe, to know where resistance is occurring, who’s using the antibiotics, are we overusing them?
DAVID E. HOFFMAN: Wait. You’re telling me we don’t know the answers to the extent of the problem?
Dr. BRAD SPELLBERG: That’s correct.
DAVID E. HOFFMAN: We don’t have the data?
Dr. BRAD SPELLBERG: That is correct. I do not know how many resistant infections are occurring right now. I don’t know what the frequency of resistance in different bacteria are. We do not have those data.
NARRATOR: FRONTLINE requested an interview with the secretary of Health and Human Services, Kathleen Sebelius. We wanted to ask about the lack of data and the about the priority the department is giving to the new superbug crisis. But she declined to be interviewed.
The CDC now estimates that every year, at least two million people are infected with resistant bacteria, and at least 23,000 die from these infections. That’s more than die from AIDS every year. It is a stark yet incomplete picture.
[http://www.pbs.org: Who’s working to fix the crisis?]
RAMANAN LAXMINARAYAN, V.P., Public Health Foundation of India: So this is a hidden epidemic. It’s a hidden epidemic because there’s nowhere on your death certificate that would say that such and such person died of an infection that could not be treated. And if it’s not a cause of death, then it’s not something that people recognize as something that actually killed them.
If people were dying of these drug-resistant infections and they had a big X on their foreheads which said that they had drug-resistant infections, trust me, there would be policy action.
NARRATOR: It’s been two years since KPC first came to NIH. But as it turns out, the hospital never did fully rid itself of the deadly superbug.
Last year, a young man came to NIH because of complications from a bone marrow transplant. While he was there, he contracted KPC and died, the seventh victim of the outbreak.
DAVID HENDERSON, , M.D., Dpty. Director, NIH Clinical Center: I guess if I had a major message, it would be that it’s never going to end. So this organism and organisms like this are going to be with us ‘til the cows come home, and we have to learn how to deal with them. We have to change our culture in the hospital.
[http://www.pbs.org: Tracking the problem]
NARRATOR: KPC has been found in hospitals in at least 44 states. But that’s just from the hospitals that are reporting it.
As for David Ricci, it’s been two years since his last operation. It had taken three surgeries and another round of highly toxic antibiotics before doctors believed they had removed all the NDM-1 from his leg.
DAVID RICCI: You know, there’s no muscle left on it, and I’ve only got about six inches left, and the bone stops there.
NARRATOR: So far, Ricci has remained healthy, though not entirely free from the fear of NDM-1.
DAVID RICCI: You know, my doctors were pretty straightforward with me. They were very honest and said, you know, there is a good chance that this infection might not go away.
DAVID E. HOFFMAN: Might not ever go away?
DAVID RICCI: Yeah. Yeah. They said, you know, “We don’t have enough experience to know what’s going to happen.”
NARRATOR: NDM-1 has now spread to at least 48 countries. Here in the U.S., there were 16 new cases identified by the CDC last year. This year, that number has already more than doubled.
DAVID E. HOFFMAN: So David was actually sort of a harbinger of something to come.
JOHN LYNCH, M.D., Harborview Medical Center, Seattle: David was an example of something that’s already here. So there are entire continents that have this major problem, public health problem, already. David was simply a sample of that population and new to us. And that’s key because hospitals in any city in the country are going to have patients from all over the world. That globalization, that mobility is going on now. This is already here.
TONYA RERECICH: All right, Addie, let there be light. This is the day that the Lord has made.
NARRATOR: It’s also been two years for Addie Rerecich—
ADDIE RERECICH: Yeah, but it’s, like, not fun. Let there be no light whatsoever! [laughter]
NARRATOR: —two years since she came home after receiving a new set of lungs.
TONYA RERECICH: It was like bringing home a premature baby. We brought home monitors. And she couldn’t do anything for herself. She couldn’t even turn over in the bed. She couldn’t turn side to side. That’s how weak and contracted and debilitated she was.
DAVID E. HOFFMAN: So how are you doing now?
ADDIE RERECICH: Basically, I’m fine. Nothing seems out of whack right now. I seem— I feel pretty good. I look pretty much like I did before. I have all my friends back.
DAVID E. HOFFMAN: Did you understand what was happening to you, or—
ADDIE RERECICH: No.
DAVID E. HOFFMAN: Did anybody talk about infection and what that— what infection meant?
ADDIE RERECICH: No. Basically, what I was told is— I’d say, “I want to go home,” and she’d say— she’d say I couldn’t make the drive home, ever, like I was too sick to go home. [weeps]
TONYA RERECICH: Everything’s hard for Addie now. Everything’s a battle. She has to take a handful of pills twice a day. We have to worry constantly about, you know, picking up a bacteria or a virus. She’s had pneumonia five times in the past two years, bacterial pneumonia that had to be treated with antibiotics. And every time, I wonder, is this the time that we’re going to come up against a bacteria that they don’t have anything to treat it with?
I think for lung transplants, the survival rate— about 80 percent make it a year and about 50 percent make it five years. And every year after that, the risks just go up.
PASTOR: Let’s bow our heads in prayer.
DAVID E. HOFFMAN: People might say, “The story of Addie is horrible, but that won’t happen to my daughter.” Is this— could this happen to anybody?
SEAN ELLIOT, M.D., Infectious Disease Specialist: It happened to Addie. She was healthy. It could happen to anybody. It could happen to your next-door neighbor. It could happen to your child. It could happen to anybody.
Now, I’m not here to practice doomsday thinking, but those bacteria are out there and they’re out there in healthy people in the community.
PASTOR: If you don’t mind standing up, you can walk around and—
TONYA RERECICH: The average person thinks, “Oh, I have an infection. I take an antibiotic, I get better.” Yeah, it’s not that simple anymore.
ADDIE RERECICH: Good morning, Caleb!
MAN: How’re you doing, sweetheart?
ADDIE RERECICH: I’m good. Thank you.
DAVID E. HOFFMAN: Addie didn’t get better, did she.
TONYA RERECICH: No, she never did get better, really. She didn’t. She had to have surgery and take the infection out, but—
DAVID E. HOFFMAN: It may have saved her life.
TONYA RERECICH: For now. Bought her time. That’s what happened. We bought her some time, and I am grateful for every minute of it.
ADDIE RERECICH: Hi, I’m Addie. I don’t think we ever met.
TONYA RERECICH: I remember you. I know I’ve seen you somewhere before!
ADDIE RERECICH: Yeah, me, too! [laughter] Were you my nurse?
TONYA RERECICH: Yeah!
The strong hold of the two major religion are Christian and Islam
- According to the Carnegie Endowment for International Peace, the World Christian Database as of 2007 estimated the six fastest-growing religions of the world to be Islam (1.84%), the Bahá’í Faith (1.7%), Sikhism (1.62%), Jainism (1.57%), Hinduism (1.52%), and Christianity (1.32%). High birth rates were cited as the reason for the growth.
- Monsignor Vittorio Formenti, who compiles the Vatican‘s yearbook, said in an interview with the Vatican newspaper L’Osservatore Romano that “For the first time in history, we are no longer at the top: Muslims have overtaken us”. He said that Catholics accounted for 17.4 percent of the world population—a stable percentage—while Muslims were at 19.2 percent. “It is true that while Muslim families, as is well known, continue to make a lot of children, Christian ones on the contrary tend to have fewer and fewer,” the monsignor said.
Islam by country
From Wikipedia, the free encyclopedia
World Muslim population by percentage (Pew Research Center, 2009).
Islam is the predominant religion in the Middle East, the Sahel, the Horn of Africa, North Africa, and some parts of Asia. Large communities of Muslimsare also found in China, the Balkans, and Russia. Other parts of the world host large Muslim immigrant communities; in Western Europe, for instance, Islam is the second largest religion after Christianity, where it represents 6% of the total population.
According to the Pew Research Center in 2010 there were 49 Muslim-majoritycountries. Around 62% of the world’s Muslims live in South and Southeast Asia, with over 1 billion adherents. The largest Muslim population in a country is in Indonesia, a secular nation home to 12.7% of the world’s Muslims, followed by Pakistan (11.0%), India (10.9%), and Bangladesh (9.2%). About 20% of Muslims live in Arab countries. In the Middle East, the non-Arab countries of Turkey and Iran are the largest Muslim-majority countries; in Africa, Egypt and Nigeria have the most populous Muslim communities.
A study conducted by the Pew Research Center in 2010 and released January 2011found that there are 1.62 billion Muslims around the world. The study found more Muslims in the United Kingdom than in Lebanon and more in China than in Syria.
Map of all the majiour religon in the world
june 28 2008 april 1 2010 sep 4 2013
Islam rest of the world
Figures indicated in the first four columns below are based on the demographic study by the Pew Research Center report of The Future of the Global Muslim Population, as of 27 January 2011.
||Muslim percentage (%) of total population
||Percentage (%) of World Muslim population||Muslim population
|Akrotiri and Dhekelia|
|American Samoa||< 1,000||< 0.1||< 0.1|
|Anguilla||< 1,000||0.3||< 0.1|
|Antigua and Barbuda||< 1,000||0.6||< 0.1|
|Armenia||1,000||< 0.1||< 0.1|
|Aruba||< 1,000||0.4||< 0.1|
|Bahamas||< 1,000||0.1||< 0.1|
|Belize||< 1,000||0.1||< 0.1|
|Bermuda||< 1,000||0.8||< 0.1|
|Bolivia||2,000||< 0.1||< 0.1|
|British Antarctic Territory|
|British Indian Ocean Territory|
|British Virgin Islands||< 1,000||1.2||< 0.1|
|Cape Verde||< 1,000||0.1||< 0.1|
|Cayman Islands||< 1,000||0.2||< 0.1|
|Central African Republic||403,000||8.9||< 0.1|
|Chile||4,000||< 0.1||< 0.1||2,894|
|Colombia||14,000||< 0.1||< 0.1||40,000 to 80,000|
|Cook Islands||< 1,000||< 0.1||< 0.1|
|Costa Rica||< 1,000||< 0.1||< 0.1|
|Czech Republic||4,000||< 0.1||< 0.1|
|Dominica||< 1,000||0.2||< 0.1|
|Dominican Republic||2,000||< 0.1||< 0.1|
|Ecuador||2,000||< 0.1||< 0.1|
|El Salvador||2,000||< 0.1||< 0.1|
|Equatorial Guinea||28,000||4.1||< 0.1|
|Faroe Islands||< 1,000||< 0.1||< 0.1|
|Falkland Islands||< 1,000||< 0.1||< 0.1|
|Federated States of Micronesia||< 1,000||< 0.1||< 0.1|
|French Guiana||2,000||0.9||< 0.1|
|French Polynesia||< 1,000||< 0.1||< 0.1|
|French Southern and Antarctic Lands|
|Greenland||< 1,000||< 0.1||< 0.1|
|Grenada||< 1,000||0.3||< 0.1|
|Guam||< 1,000||< 0.1||< 0.1|
|Guatemala||1,000||< 0.1||< 0.1|
|Guernsey||< 1,000||0.1||< 0.1|
|Guinea Bissau||705,000||42.8||< 0.1|
|Haiti||2,000||< 0.1||< 0.1|
|Hong Kong||91,000||1.3||< 0.1|
|Iceland||< 1,000||0.1||< 0.1||770|
|Isle of Man||< 1,000||0.2||< 0.1|
|Jamaica||1,000||< 0.1||< 0.1|
|Kiribati||< 1,000||< 0.1||< 0.1|
|Laos||1,000||< 0.1||< 0.1|
|Lesotho||1,000||< 0.1||< 0.1|
|Macau||< 1,000||< 0.1||< 0.1|
|Marshall Islands||< 1,000||< 0.1||< 0.1|
|Martinique||< 1,000||0.2||< 0.1|
|Monaco||< 1,000||0.5||< 0.1|
|Montenegro||116,000||18.5||< 0.1||118,477 |
|Montserrat||< 1,000||0.1||< 0.1|
|Nauru||< 1,000||< 0.1||< 0.1|
|Netherlands Antilles||< 1,000||0.2||< 0.1|
|New Caledonia||7,000||2.8||< 0.1|
|New Zealand||41,000||0.9||< 0.1|
|Nicaragua||1,000||< 0.1||< 0.1|
|Nigeria||75,728,000||47.9||4.7||85, 000, 000|
|Niue||< 1,000||< 0.1||< 0.1|
|North Korea||3,000||< 0.1||< 0.1|
|Northern Mariana Islands||< 1,000||0.7||< 0.1|
|Norway||144,000||3.0||< 0.1||163,180 in 2008|
|Palau||< 1,000||< 0.1||< 0.1|
|Papua New Guinea||2,000||< 0.1||< 0.1|
|Paraguay||1,000||< 0.1||< 0.1|
|Peru||< 1,000||< 0.1||< 0.1|
|Pitcairn Islands||< 1,000||< 0.1||< 0.1|
|Puerto Rico||1,000||< 0.1||< 0.1|
|Republic of Congo||60,000||1.6||< 0.1|
|Saint Helena||< 1,000||< 0.1||< 0.1|
|Saint Kitts and Nevis||< 1,000||0.3||< 0.1|
|Saint Lucia||< 1,000||0.1||< 0.1|
|Saint Pierre and Miquelon||< 1,000||0.2||< 0.1|
|Saint Vincent and the Grenadines||2,000||1.7||< 0.1|
|Samoa||< 1,000||< 0.1||< 0.1|
|San Marino||< 1,000||< 0.1||< 0.1|
|Sao Tome and Principe||< 1,000||< 0.1||< 0.1|
|Seychelles||< 1,000||1.1||< 0.1|
|Solomon Islands||< 1,000||< 0.1||< 0.1|
|South Africa||737,000||1.5||< 0.1|
|South Georgia and the South Sandwich Islands|
|South Korea||75,000||0.2||< 0.1|
|Tokelau||< 1,000||< 0.1||< 0.1|
|Tonga||< 1,000||< 0.1||< 0.1|
|Trinidad and Tobago||78,000||5.8||< 0.1|
|Turks and Caicos Islands||< 1,000||< 0.1||< 0.1|
|Tuvalu||< 1,000||0.1||< 0.1|
|United Arab Emirates||3,577,000||76.0||0.2|
|United States Virgin Islands||< 1,000||0.1||< 0.1|
|Uruguay||< 1,000||< 0.1||< 0.1|
|Vanuatu||< 1,000||< 0.1||< 0.1|
|Wallis and Futuna||< 1,000||< 0.1||< 0.1|
|Western Sahara||528,000||99.6||< 0.1|
|South & Southeast Asia||1,005,507,000||24.8||62.1|
|Middle East–North Africa||321,869,000||91.2||19.9|
World Christian Encyclopedia
|3.65%: Bahá’í Faith||2.65%: Zoroastrianism||1.84%: Islam|
|2.74%: Islam||2.28%: Bahá’í Faith||1.70%: Bahá’í Faith|
|2.34%: Hinduism||2.13%: Islam||1.62%: Sikhism|
|1.67%: Buddhism||1.87%: Sikhism||1.57%: Hinduism|
|1.64%: Christianity||1.69%: Hinduism||1.32%: Christianity|
|1.09%: Judaism||1.36%: Christianity|
|Chinese folk religion||390,504,000||22.2||436,258,000||0.11||0.16|
|7 or More||6||5||4||3||2 or Less|
High rate of conversions to Islam
In addition to immigration, the state, federal and local prisons of the United States may be a contributor to the growth of Islam in the country. J. Michael Waller claims that Muslim inmates comprise 17-20% of the prison population in New York, or roughly 350,000 inmates in 2003. He also claims that 80% of the prisoners who “find faith” while in prison convert to Islam. These converted inmates are mostly African American, with a small but growing Hispanic minority. Waller also asserts that many converts are radicalized by outside Islamist groups linked to terrorism, but other experts suggest that when radicalization does occur it has little to no connection with these outside interests.
Concern in United States
Concern over jailhouse conversions to Islam first rose in 2001 when Imam Warith Deen Umara, Islamic chaplain for the New York State prison system, was reported to have praised the September 11 attacks. This prompted members of Congress to call for an investigation of Islam in the nation’s prisons.
In a 2004 report, the Justice Department faulted the prison system for failing to protect against “infiltration by religious extremists.” However, the report made clear that the problem was not radical chaplains, but, rather extremist inmates running worship services.
Mark S. Hamm, a criminologist at Indiana State University, describes a phenomenon he calls “prison Islam.” This consists of “small gang-like cliques that use cut-and-paste versions of the Koran” to give a religious patina to violent and criminal activities. Hamm has identified five such examples since 2005, notably the 2005 Los Angeles bomb plot.
Are the Overwhelming Majority of Muslims Peaceful Moderates
There was once a time when the media and apologists would defiantly proclaim, “Muslim extremists are only a tiny minority!!!”, and Muslims and non-Muslims alike would make nonsensical statements such as “only 0.01 % of Muslims are extremists”, etc.
Today, due to many in-depth polls and studies on the subject (e.g. here and here), this claim has been proven false and Islam‘s apologists have been forced to adapt their rhetoric. Now they tend to claim “the overwhelming majority of Muslims are peace loving moderates”.
So, are the “overwhelming majority” of the world’s 1.5 billion Muslims peace loving moderates? This is an important question. We are now constantly force-fed this claim that they are. But does reality agree with the propaganda?
Dalia Mogahed & John Esposito
Dalia Mogahed and John Esposito co-authored the book “Who Speaks for Islam” which grew out of a 2008 survey conducted by the Gallup polling agency, which was intended to answer this very question.
Unfortunately, the controversy-riddled Dalia Mogahed and John Esposito are both Islam apologists, so there is little surprise that they had to “cook the books” in order to create the desired results.
The authors claim only 7 percent of the world’s Muslims are “political radicals”. Yet in order to reach this figure, they were forced to term Muslims who think 9/11 was “partially” or “some way justified”, who want to impose Shari’ah law, who support suicide bombings, and who oppose equal rights for women, as “moderate” followers of Islam.
From The Weekly Standard:
In that article, she and Esposito wrote: “Respondents who said 9/11 was justified (4 or 5 on the same scale) are classified as radical.” In the book they wrote two years later, they redefined “radical” to comprise a much smaller group–only the Fives. But in her luncheon remarks, Mogahed admitted that many of the “moderates” she and Esposito celebrated really aren’t so moderate after all.
MOGAHED: I can’t off the top of my head [recall the data], but we are going to be putting some of those findings in our [updated] book and our website.
To clarify a couple of things about the book–the book is not a hard-covered polling report. The book is a book about the modern Muslim world that used its polling to inform its analysis. So that’s important: It’s meant for a general audience, and it’s not meant to be a polling report. One very important reason why is because Gallup is selling subscriptions to its data. We are a for-profit company; we are not Pew. We are Gallup. So this isn’t about . . . it was not meant for the data to be free since we paid $20 million to collect [the data] . . . that we paid all on our own. So just to clarify that . . .
So, how did we come up with the word “politically radicalized” that we unfortunately used in the book? Here’s why: because people who were Fives, people who said 9/11 was justified, looked distinctly different from the Fours . . . At first, before we had enough data to do sort of a cluster analysis, we lumped the Fours and Fives together because that was our best judgment.
QUESTIONER: And what percent was that?
MOGAHED: I seriously don’t remember but I think it was in the range of 7 to 8 percent [actually, 6.5 percent].
QUESTIONER: So it’s seven Fours and seven Fives?
MOGAHED: Yes, we lumped these two and did our analysis. When we had enough data to really see when things broke away, here’s what we found: Fives looked very different from the Fours, and Ones through Fours looked similar. [Mogahed then explained that, on another question, concerning suicide bombing, respondents who said 9/11 was only partially justified clustered with those who said it wasn’t justified at all.] And so the Fives looked very different; they broke, they clustered away, and Ones through Fours clustered together. And that is how we decided to break them apart and decided how we were to define “politically radicalized” for our research.
Yes, we can say that a Four is not that moderate . . . I don’t know. . . .You are writing a book, you are trying to come up with terminology people can understand. . . . You know, maybe it wasn’t the most technically accurate way of doing this, but this is how we made our cluster-based analysis.
So, there it is–the smoking gun. Mogahed publicly admitted they knew certain people weren’t moderates but they still termed them so. She and Esposito cooked the books and dumbed down the text. Apparently, by the authors’ own test, there are not 91 million radicals in Muslim societies but almost twice that number. They must have shrieked in horror to find their original estimate on the high side of assessments made by scholars, such as Daniel Pipes, whom Esposito routinely denounces as Islamophobes. To paraphrase Mogahed, maybe it wasn’t the most technically accurate way of doing this, but their neat solution seems to have been to redefine 78 million people off the rolls of radicals.
The cover-up is even worse. The full data from the 9/11 question show that, in addition to the 13.5 percent, there is another 23.1 percent of respondents–300 million Muslims–who told pollsters the attacks were in some way justified. Esposito and Mogahed don’t utter a word about the vast sea of intolerance in which the radicals operate.
And then there is the more fundamental fraud of using the 9/11 question as the measure of “who is a radical.” Amazing as it sounds, according to Esposito and Mogahed, the proper term for a Muslim who hates America, wants to impose Sharia law, supports suicide bombing, and opposes equal rights for women but does not “completely” justify 9/11 is . . . “moderate.”
As you can see from the above figures, 36.6 percent of Muslims think the mass-slaughter of innocent non-Muslim (and some Muslim) civilians on 9/11 was either completely, partially or some way justified. This does not support the claim that the “overwhelming majority” of Muslims are peace loving moderates.
Sure, “peace loving” Muslims, according to this survey, are a majority. But when almost 4 out of every 10 Muslim is a terrorist-supporting “radical”, they are hardly “overwhelming”. It is a proven fact that Islamic extremists are certainly not “a tiny minority”.
Support for Shari’ah & Killing Apostates
As The Weekly Standard’s Robert Satloff rightly pointed out, this “test” involving questions about 9/11 to ascertain who is and who is not a moderate, is fundamentally flawed. Even if a Muslim disagrees with the Islamic terrorist attacks on innocent US civilians, if they still want to impose Shari’ah law on others and if they oppose equal rights for women etc., how on earth could they ever be considered “moderates”?
The number of possible extremists is a lot larger than you would think, when you consider that a Muslim country that has only a little support for Jihad, could still have a large number who support the execution of apostates. The percentage who support execution are obviously extremists regardless of their views on Jihad and visa-versa.
I previously did some number-crunching for “extremists” in Pakistan after it was reported that a December 2010 Pew poll found that even today “The majority of Muslims would favor changing current laws in their countries to ‘allow stoning as punishment for adultery, hand amputation for theft, and death for those who convert from Islam as their religion’”.
Using Pakistan as an example, I noted that the poll found that 76 percent of Pakistanis agree apostates are to be killed. In a country with a population of 172,800,000 (96 percent of whom are Muslim) that would be more than 126 million people in a single country. Conversely only a mere 13 percent of Muslims opposed killing apostates.
So, according to indisputable facts, Muslim “extremists” are not a “tiny minority”, but form the vast majority of the population in Pakistan and some of the other countries polled. In fact, the number of “extremists” in Pakistan alone form about 8 percent of the world’s entire 1.5 billion Muslim population. We reach this shocking figure even before we take into consideration the possibility that a lot of those Pakistanis who disagree with killing apostates may still support jihad.
Over in “moderate” Indonesia, a survey conducted from 2001 to March 2006 found 43.5 percent of Muslim respondents were “ready to wage war for their faith” and 40 percent would use violence against those blaspheming Islam. 85 percent, or 200 million, of the country’s 230 million population are Muslims. This means approximately 87 million Indonesians, or more than 4 out of every 10 Muslim there, is a violent Islamic “extremist”.
Note that this massive figure is not for those Indonesian Muslims who simply support a violent interpretation of Islam, but for those Muslims who are actually prepared to act on them by committing violence against others. If we were to know the number of those who simply support jihad but are not prepared to join in themselves, like in Pakistan, the “extremists” would most certainly be in the majority. And again, this is without taking into consideration that many of the Indonesians who support stoning adulterers to death [42%] or killing apostates [30%] may not support jihad at all, but would also clearly have to be labeled as “extremists” for holding such barbaric views.
The picture is not much brighter when we learn the views of young Western-born Muslims who often tend to be more “extremist” than their older Eastern-born counterparts. For example; in theUnited Kingdom, where 1 out of every 3 British Muslim aged 16 to 24 agree that apostates should be put to death, and where only 3 percent of all Muslims are “consistently pro-freedom of speech“.
In addition to indisputable figures, there is also a lot of anecdotal evidence that suggests the claim that Muslim extremists are only a “tiny minority” or that the “overwhelming majority” of Muslims are peace-loving people, is complete rubbish. For example;
- In Egypt, a mob of nearly 20,000 Muslims attempted to break into and torch a Christian church. They were demanding the death of the church’s pastor. They terrorized the Copts trapped inside (who didn’t even make up 100 in number) by pelting the church with stones, and torching Christian-owned homes and cars. Seriously, how on earth would you find 20,000 “extremist” Muslims in one place if the vast majority of Muslims were peaceful and tolerant?
- In Bangladesh, at the urging of local Muslim leaders, police tortured a pastor and two other Christians for legally proclaiming their religion. The next day, thousands of Muslim villagers demonstrated in front of a local government office chanting, “We want a Christian-free society,” and “We will not allow any Christians in Cuadanga.” There is no way that this was a “few” Muslim extremists, it was probably the entire Muslim population of the village.
- Again in Egypt, a mob of over 3,000 Muslims attacked Copts in the village of Kobry-el-Sharbat (el-Ameriya). Coptic homes and shops were looted before being set ablaze.
- In Pakistan, three churches, two houses of priests, one convent, one high school and the homes of three Christian families were set alight by a mob of around 2,500 Muslims.
- Again in Bangladesh, 20,000 Muslims attacked an Ahmadiyya festival site, torching its canopy, tents and stage while shouting “Allahu Akbar“. Ironically, Ahmadis are the biggest defenders of Islam and often dishonestly pass themselves off as “Muslims” to an ignorant Western audience.
- Again in Egypt, two nuns were trapped inside a guest-house belonging to the Notre Dame Language Schools by an estimated 1,500 angry Muslim villagers brandishing swords and knives. They even threatened to burn them out.
- And more than 300 Egyptian Muslim lawyers (yes, lawyers, not a band of uneducated village folk) issued death-threats and prevented defense lawyers representing a Christian accused of “blasphemy”, from going into court. These educated men even tried to assault the chief judge who managed to escape a lynching via a rear door.
The Insignificant Peaceful Majority
There is a lot of statistical data available about Muslims and in the future I plan on expanding my analysis of Pakistan and Indonesia to cover all Muslim countries. But before I wrap up, I would like to add something that a friend of mine noted:
[…]of 1.5 billion Muslims the overwhelming majority live in peace. Most of them are law obeying citizens. Well that’s true. But so were the Nazis in Germany in the forties. Most of them were good fathers and mothers who only wanted what was best for their children. Only a small percentage worked in concentration camps or committed war crimes. When Muslims get to rule I expect more or less the same. A small group fanatics takes control and the rest are law obeying citizens who will turn their head away when a holocaust occurs. They’ll probably even say that it’s against Islam.
In essence, whatever the case may be, a silent majority is an insignificant one. The situation non-Muslim minorities find themselves in today proves this. All over the Islamic world, Buddhists, Christians, Hindus and other groups are being “ethnically cleansed” from their ancestral homes. To these unfortunate communities who are facing Nazi-like atrocities, the percentage of peace-loving moderate Muslims may as well be 99.99 percent for all the difference it would make to them.
Or if we take this a little further, in the words of Martin Luther King, Jr., “He who passively accepts evil is as much involved in it as he who helps to perpetrate it. He who accepts evil without protesting against it is really cooperating with it.”
ll statistics are referenced. Click on the “read more” tabs to view sources. This is only a sample of available statistics. More statistics arranged according to category can be found in the menu above
Alcohol & Drugs
- Alcohol consumption in Muslim regions of the world (Middle East and North Africa) increased by 25% in 5 years.
- In 2007, Afghanistan produced an extraordinary 8,200 tonnes of opium (93% of the global opiates market).
- Saudi Arabia is the world’s 6th largest consumer of anti-impotence drugs, demand is 10 times that of Russia.
- In 2010 Malaysia was the world’s tenth largest consumer of alcohol. (read more)
- 4 out of 5 Middle-Eastern women are sexually abused between the ages of 3 and 6 by family members.
- More than half of all Yemeni girls are married before reaching puberty.
- About 1 in 10 pregnancies in the Arab world ends in abortion. In Pakistan every 6th pregnancy is terminated.
- 94% of Yemeni children (2-14 yrs) subjected to violence from a parent or guardian. (read more)
Crime & Prejudice
- 2011 Pew study finds Muslims are more “phobic” of non-Muslims than the non-Muslims are “Islamophobic” of Muslims.
- According to FBI 2008 statistics, anti-Muslim incidents in the US are dropping and only account for 1.3% of all hate crimes.
- Jewish victims of hate crimes in the US outnumber Muslim victims by a 10-1 ratio.
- Anti-Christian hate crime incidents outnumber anti-Muslim incidents in the US. (read more)
- Turkey has more journalists in prison than any other country in the world, almost double that of China and Iran.
- 40% of Indonesian Muslims say they would use violence against those blaspheming Islam.
- 78% of British Muslims support punishing people who publish cartoons mocking the Prophet Muhammad.
- Since 1990, 52 people accused of blasphemy in Pakistan have been extra-judicially killed by lynch mobs. (read more)
- Homosexual relationships, acts or behavior illegal in 36 Islamic countries. 10 impose the death penalty for homosexuals.
- As of 1999 in Iran, more than 4000 lesbians and gays had been executed since the 1979 Islamic revolution.
- Two thirds of all reported incidents of anti-gay violence in Amsterdam are by Muslim youths.
- A 2009 Gallup survey could not find a single UK Muslim who approved of homosexuality. (read more)
- The Maldives, an Islamic country with a 100% Muslim population, has the highest divorce rate in the world.
- Turkey tops Europe and US for incidents of violence against women, with 4 out of 10 women beaten by their husbands.
- Divorce rates among Muslims in Malaysia is five-times higher than among non-Muslims.
- 91% of Jordanian university students approve of wife beating. Acceptable reasons include burning a meal. (read more)
- There are 13 countries in the world where the state can execute you for being atheist. Every single one is officially Islamic.
- 9 of the top 10 persecutors of Christians are Islamic countries. Of the top 50 countries, only 12 have a source other than Islam.
- Turkey tops list of countries violating the European Convention on Human Rights (ECHR) for 3 consecutive years.
- As of 2010, Indonesia had over 150 religiously motivated regulations restricting minorities’ rights. (read more)
- Google survey finds mostly Muslim states seek access to sex-related websites (they rank 1, 2, 4, 5, 7 & 8 in the top 10).
- Iranians made the highest number of visits to “immoral sites” on Ashura Day.
- Approximately 2 million online users watch pornographic films each minute in Turkey.
- Pakistan ranked No. 1 in searches for “child sex,” “animal sex,” “rape sex,” “camel sex,” “dog sex,” “rape video.” (read more)
- OIC countries have 8.5 scientists/engineers/technicians per 1,000 population, whilst the world average is 40.7.
- Survey of religious (and irreligious) American physicians finds Muslim physicians are least likely to accept evolution.
- Only 8% of Egyptians, 11% of Malaysians, and 22% of Turks agree that Darwin’s theory is probably or most certainly true.
- 46 Muslim countries contribute 1.17% to world science literature, compared to 1.66% by India and 1.48% by Spain. (read more)
- 1 out of 3 British Muslims aged 16 to 24 believe that Muslim apostates should be executed.
- Majority of world’s Muslims favor changing laws in their countries to allow stoning/amputation for “crimes”, and death for apostasy.
- Only 26% of Muslims in Turkey say they would adhere to laws passed by Parliament if it contradicted religious laws.
- Poll finds neither education nor age explains attitudes toward the role of Shari’ah in legislation. (read more)
- 2012 report finds the majority of world’s terrorism committed by Muslims. Almost 9000 deaths caused by Sunni terrorists in 2011.
- Esposito/Mogahed find almost 4 out of 10 Muslims worldwide are extremists who think 9/11 was totally/partially/somewhat justified.
- More than 95% of all suicide bombing attacks conducted worldwide are carried out by Muslims.
2011 Study finds no link between poverty and support for militant Islamic groups. (read more)
- Pew survey finds all 7 Muslim-majority nations polled have a negative opinion of Jews (2-9% positive).
- Antisemitic incidents around the world more than doubled in 2009 over the previous year.
- Pew survey finds 100% of Jordanians have either “somewhat unfavorable” or “very unfavorable” views of Jews.
- Most violent attacks on Jews in Western Europe comes from people of Arab/Muslim heritage. (read more)
- 2011 Pew poll finds 1 out of every 10 Muslim American thinks President Obama is really a Muslim.
- 46% of UK Muslims believe “the Jewish community in Britain is in league with the Freemasons to control the media and politics.”
- 64% in Egypt, Morocco, Pakistan, and Indonesia believe it is US foreign policy to spread Christianity in the Middle-East.
- Most Muslims in all 8 nations polled in 2011 believe 9/11 attacks were not by Arabs (57-75%).
Education & Employment
- Under the Ottoman empire, worldwide Muslim literacy rates were only 2 to 3% in the early nineteenth century.
- 6 out of 10 Muslims worldwide still cannot read (as opposed to only 2 out of 10 people in “Christendom”)
- Nearly 1 in 3 people in the Arab world are illiterate, including nearly half of all women.
- Muslims in Denmark make up 5% of the population but receive 40% of social-welfare outlays.
Health & Disability
- A rough estimate shows that close to half of all Muslims in the world are inbred.
- Muslim countries have the highest obesity rates among women and 70% of women in the Gulf states are obese.
- 21 out of 22 countries most affected by birth defects per 1000 live births are Muslim majority countries.
- Almost a 1/4 of Muslims say they would only donate an organ if it was going to another Muslim.
- 91 percent of all honor-related killings around the world are carried out by Muslims (84% in US, 96% in Europe).
- The number of honor killings in Pakistan are estimated to be around 2,500 to 3,000 cases every year.
- Nearly 3,000 honor attacks mainly carried out against Muslim women were recorded by British police in 2010.
- More than two-thirds of all murders in the Gaza Strip and West Bank are honor killings.
- Iran has the lowest mosque attendance of any Muslim country, with less than 2% of adults attending Friday services.
- 25% of UK mosques have extremist literature calling for the beheading of lapsed Muslims etc.
- Almost 80 percent (3 out of every 4) of US mosques preach anti-West extremism.
- Mosque attendance is dropping faster than church attendance in the Netherlands.
- Only 3% of the world’s Muslims live in “more-developed regions, such as Europe, N. America, Australia, New Zealand and Japan”.
- Pew study finds Islam loses as many adherents via conversion as it gains. Growing numbers only due to high birth rate etc.
- Muslim population of France only 12%, yet they make up 60 to 70% of all inmates in France’s prisons.
- 75% of new Muslim converts in the US leave Islam within a few years.
Rituals & Festivals
- Productivity of Arab businesses drops by 78%, and there are increases in blood crimes (+1.5%) and theft (+3.5%)
- Child trafficking increases in Yemen during Ramadan as food prices rise and parents struggle to provide for their children.
- In the Netherlands alone, which has only a million Muslims, 100,000 animals were slaughtered in 2010 for Eid al-Adha.
- Number of Jakarta prostitutes caught increased from 94, before Ramadan , to 264 during it.
- There are 164 Jihad verses in the Qur’an & nearly 500 verses (roughly 1 out of every 12) that speak of Hell.
- Practicing Muslims recite anti-Semitic & anti-Christian rhetoric at least 17 times a day, and over 5,000 times a year.
- Compared to Mein Kampf, the non-abrogated Medinan verses of the Qur’an contain more than 2x the amount of anti-Jewish text.
- 122 peaceful Qur’anic verses have been abrogated by the Sword verse (9:5) and Fighting verse (9:29).
- Africans taken (or died in the process of being taken) as slaves by Muslims is estimated to be higher than 140 million.
- 1.25 million white European Christians were captured and sold into the Muslim slave trade between the 16th and 19th century.
- The Islamic slave trade still flourishes in Muslim countries. There are over half a million slaves in Mauritania alone.
- Christian Solidarity International (CSI) has liberated over 80,000 Sudanese slaves taken captive by Arab Muslims.
- In terms of cultural/tribal/religious danger to women, 4 of the 5 most dangerous countries are Muslim majorities.
- Egyptian women are sexually harassed 7 times every 200 meters and well over two-thirds are harassed on a daily basis.
- All 10 countries with the worst gender gaps are countries where Muslims are the majority or Islam is the largest religion.
•Egyptian study contradicts widely held belief that unveiled women are more likely to suffer harassment than veiled ones.