NB: This book, entitled The Perfect Predator, is about viruses. Personally I found it quite encouraging to read about viruses being used for something positive, but your mileage may vary so I thought I’d state that outright. I’ve also written a bit about severe sepsis, septic shock, and other medical emergencies.
Other than what I needed to read for work, not a single medical non-fiction book darkened my door last year. After all, I was spending plenty of time reading papers about covid (plus non-science journalists’ questionable attempts to summarise these papers), and in my off hours I sort of wanted to escape from all of that. However, I have been looking forward to The Perfect Predator: A scientist’s race to save her husband from a deadly superbug since I read about it on Rennie’s blog a couple of years ago. The clue is in the title: this book is about epidemiologist Steffanie Strathdee’s fight to save her husband Tom Patterson’s life after he contracted a multi-drug resistant bacterial infection while they were on holiday. As he deteriorated, she did what any health scientist would: anxiously read reams of papers, some of which were decades old. (That is not a joke or hyperbole. This is what I would do too. This is what I do if a friend or loved one gets diagnosed with something weird. I read a lot of papers about Complex Regional Pain Syndrome in pregnancy a few years ago even though I have never been afflicted with either).
As Patterson deterioratated and slipped into a coma, Strathdee eventually discovered an old field of research that had fallen out of favour in the Anglophone world once antibiotics became widely used, phage therapy. This is, essentially, the use of viruses to eat bacteria. It lost popularity in the US and UK during the Cold War because Russia was really into it and it was therefore deemed to be a bit commie, plus some of the early experiments were hopeless disasters. It would probably have been impossible to get phage therapy fine-tuned before the discovery of the structure of DNA, due to the fact that phages need to be carefully selected against particular bacterial isolates (unlike antibiotics, where you use a drug from a particular class for a particular reason, but don’t need to match nearly so specifically). At the time when Patterson first because ill, the very few centres Strathdee could find that were making serious attempts to use phage therapy clinically were in Eastern Europe. However, she started reaching out to people all over the world who were working on basic science and in vitro experiments using bacteriophages, in the desperate hope that one of them would have the key to treating her husband. One of them responded, and then the race was on.
There were a lot of things that irritated me about this book as a nurse, honestly. For a start, the author’s arrogant assumption that a hospital in the US would be better than one in Germany – which crops up several times – is quite annoying. US healthcare is a bit of a bogeyman in the UK, and in Europe more generally, so to be constantly reminded that the author thinks it’s so much better is somewhat frustrating. From what Strathdee describes, there might be more bells and whistles than an NHS hospital (the doorman wears a suit and the foyer has a plush carpet), but the staffing ratios are actually lower in the expensive private ITU where her husband is treated than they would be in an NHS ITU (in normal times). Germany also has an excellent healthcare system that’s often on the front lines of medical advances. Rationally speaking, if someone I loved was dying in a country where I didn’t speak the language, I know I would desperately want to get them home to the NHS, so I assume this is where Strathdee’s superior tone comes from – but it rankled nonetheless. Lastly, she constantly conflates the term “shock” (emotional state) with “shock” (state of insufficient blow flow to the tissues caused by, in her husband’s case, overwhelming infection and corresponding immune response, leading to decreased circulating blood volume, resulting in hypotension). I don’t really care when members of the public conflate these for artistic effect, but Strathdee is a scientist. She knows better, so I think maybe she could have done better. Related, she also explained what endotoxin was many times. Many. Though perhaps I would have been more forgiving if I hadn’t been preparing a seminar on sepsis while reading this book and therefore deeply embedded in definitions of endotoxin already.
The cutesy, chatty tone of the book juxtaposed alongside the technical detail didn’t really work for me, though I see from other reviews that a lot of people loved it. You hear a lot about Strathdee’s son’s interest in Pokemon and her friends’ various haircuts and the antics of their cats. Taken together with my complaints above, I think maybe what I wanted was for this book to be a bit more academic and professional – which is not the type of book it is, so I suppose it’s unfair of me to judge it, but that’s how I felt. The technical stuff is so well-written – unsurprisingly, since Strathdee is an intellectually respected scientist and therefore experienced at presenting this kind of information in an accessible way – that the tone of the personal stuff felt very jarring to me. Her personal reflections are an essential component of the book, because in many ways it’s about the conflict she experienced between her scientist self and her wife self when her husband was dying of an infectious disease. I think she does a great job of presenting how difficult it is to watch your favourite person dying slowly, and that makes this book a really important resource for healthcare professionals, especially those who work in ITU or other high acuity environments. It’s just that – well, you get a lot of Strathdee’s voice in the book, and honestly I think she’s someone I’d love to work for but struggle to have dinner with.
All these irritations aside, I am so glad I read this book. It captures one of the things I love most about health research: the excitement of taking part in a huge global project. No-one ever has all the pieces, but we build off of each other and teach each other and make each other better. My PhD research was nothing glamorous at all, but it was informed by studies carried out in Malaysia and Sweden in the late 20th century. My own papers, which are of middling quality and were published in out-of-the-way specialist journals, have been cited by a team working in Australia and New Zealand, who have built on them. And because interest in the area is growing, more research is being carried out all the time. After years of patient work by hundreds of people in several continents, we will eventually end up with fewer premature babies scarring or getting infections because of skin damage. That’s beautiful. Being a tiny little part of it is my favourite thing. And you see it in this book writ large and at a rapid pace: the phage treatment that saves Tom’s life is the work of scientists in Texas, San Diego, and Belgium. One of the key researchers was initially inspired by the work of an Indian biotech entrepeneur. And all of them were using the work of scientists who had been plugging away at phage therapy a hundred years ago. It involved the US Navy, two universities, and a small start-up that wasn’t even involved in clinical research but happened to have the right equipment on hand. Reading about all this collaborative work made me tear up a bit – to say nothing of the excitement of proving that a treatment long regarded as the fringe interest of quacks actually works.
On top of that, this is a really extraordinary thriller and love story. For all her voice annoyed me, Steffanie Strathdee is my kind of hero. There are probably very few people in the world who could have done everything she did to save her husband. Obviously, you know going in that Patterson survived – the clue is in his present tense author biography – but that didn’t stop me from feeling tense at the various ups and downs in his journey to recovery. At any moment, something could have gone wrong – there was such a capacity for setbacks within the process, and although you know he lived, you don’t know how each setback will be overcome. Strathdee writes a lot about her previous work at the vanguard of AIDs research during the HIV epidemic in the 90s. This is where she met Patterson, actually, who is a psychologist looking at ways of reducing risky behaviours in high-risk populations. Seeing how she drew on that background, those skills, and turned them to save the man she loved – it’s very moving.
I also appreciated the epilogue, in which Strathdee reflected on the fact that Patterson survived because of advantages almost no-one would have: his wife is an internationally-respected epidemiologist, whose desperate 2am emails to other scientists therefore sounded relatively calm and professional. She happened to have a network of suitably qualified medical doctors as friends and professional contacts, who took over her husband’s care and gave him very obviously preferential treatment. They didn’t need to worry too much about the cost of keeping him in hospital, and both of them were on sabbatical for over a year as he recovered. Strathdee already had plenty of experience writing grant proposals and bids, so navigating the complex bureaucracy involved in getting emergency FDA approval was well within her skillset. These things are true of extremely few people. In the epilogue, she wrote about the steps they’d taken since Patterson’s recovery to try and help more people with phage therapy, including some of the cases where it was sadly unsuccessful. Although the book originally came out in 2019, my edition was released in late 2020 and contains an updated epilogue, where Strathdee wrote about the importance of support for people – patients and families – who have survived an ITU stay. In short, she’s really trying to use a terrible experience to make life better for as many people as she can, which is another thing that makes this book worth reading. The Perfect Predator won’t be for everyone, but if this is a topic that interests you, I really recommend it.