131. Biocide Bashing

BIOCIDES ARE COMING FOR YOU. 

Find out what they are, what the benefits and harms they have, and what we can do to control their use in consumer products. 

This was a fascinating, wide-ranging discussion on the use of agents that can affect the human/animal microbiome and environmental microbes, and the problems with trying to regulate them (in the UK at least). Hope you enjoy it. 

Bios: 

Natalie Bennett has been a Green Party representative in the UK House of Lords for six years, after being leader of the England & Wales Party from 2012-2016. Her first degree - from the University of Sydney - was in agricultural science, and she can get very geeky about soils; she got tardigrades into Hansard (the parliamentary record) for the first time ever in her maiden speech. Her Consumer Products (Control of Biocides) Bill was introduced to the House in January 2025. Her first book is Change Everything: How We Can Rethink, Repair and Rebuild Society, and her second (Green Thinking Unlearning Outdated Ideas in Science, Economics and Politics) will be out from Routledge next April. 

Anastasia “Tash” Theodosiou is an Academic Clinical Lecturer at the University of Glasgow and a Specialty Registrar in Microbiology & Infectious Diseases. Her research explores how the microbiome shapes health and disease, with a particular focus on early life; her PhD produced the world’s first human challenge study performed in pregnancy. She also coined the term microbiotoxicity, a framework for recognising the unintended impacts of antimicrobial products on the microbiome, and is a passionate advocate for embedding microbiome stewardship into clinical practice, prescribing, and policy.

Jame is a podcaster. He works for the NHS on occasion. 

Transcript

Jame: 0:00

Hi everyone. Welcome to the Idiots Podcast. That's infectious disease insight of three specialists. I'm James, that's Tash. This is Natalie, and we're going to tell you everything you need to know about infectious disease.

Speaker: 0:08

Soon, may the editing come to discontinue the Tazo sun one day when the S piece done, we'll take our leave and go.

Jame: 0:18

Tash. Natalie, how you doing?

Natalie: 0:20

Absolutely. Great. Thank you very much. This mo, this mon rainy Monday morning in London.

Jame: 0:23

Tash? Is it rainy in Glasgow?

Tash: 0:25

it's not, it is a rare blue sky day and I'm loving it.

Jame: 0:30

It won't last for long. Of course, but technically the name is Baroness Bennett of Manor Castle for former occasions, but this is not a formal occasion. Former member of the Green Party and current member of the UK House of Lords. Welcome to the show.

Natalie: 0:43

It's lovely to be with you and still very much a member of the Green Party representing the Green Party in the House of Lords. And,

Jame: 0:51

I am not rerecording that, that's all staying in. Yeah. Okay. So current and still member of the Green

Natalie: 0:55

And if anyone's wondering, mana Castle, unfortunately it sounds posh but it's actually the S two area of Sheffield. And anyone who knows Sheffield knows S two is very much the opposite of posh.

Jame: 1:06

Oh, okay. But still has a castle apparently.

Natalie: 1:09

Up the hill on the top of the hill is the castle where Mary Queen of Scots was held captive. And my, my line to explain to my fellow peers about man Castle is that's the last time someone with a title was living in Mana Castle.

Jame: 1:23

see. I feel as a Scott, I should have already known that. But nevermind. And Tash still a specialty registrar in Glasgow and chieftain of the microbio toxicity movement in the uk and the Idiots podcast, microbio toxicity representative also,

Tash: 1:39

Absolutely. Fourth guest appearance. I'm very excited to be here.

Jame: 1:43

Is it, God, is it four already? That's right. So pregnancy and lactation antibiotics. Two microbio toxicity episodes.'cause it was a two-parter. And now back here to talk about biocides. Without any further ado, Tash, what are biocides?

Tash: 2:00

Biocides are antimicrobial products that kill or inhibit microorganisms. So you might be thinking, how is that any different from antibiotics, which we use all the time. So really what it is there's a couple of definitional nuances. So a biocide is anything that kills bacteria. But antibiotics are, when we talk about them as prescribers, are drugs. Now the rest of this episode is all gonna be about consumer biocides. So by definition not pharmaceutical products, which are classed as drugs, regulated as drugs. We're gonna be focusing on consumer biocides, which are therefore not controlled as pharma pharmaceutical products.

Jame: 2:40

Okay, so Nitro and Toin, not a biocide. Methenamine not a biocide. Gentamycin. Not a biocide. Detol biocide.

Tash: 2:49

Exactly. And then it gets a little bit further. So there's a distinction between how you're using them. So something can be a biocide and be applied to an unearthed surface. So like a disinfectant that you would spray on a countertop. It could be a biocide in something that you might apply to living skin. Then it would be an antiseptic. And then we've got an additional domain, which is treated articles. So then you've got textiles or clothing that can have things added to them, like silver nanoparticles, which would then give them bio IAL properties. And again, you can see that all of those things are things that you could go into a shop, buy as a consumer, and yet it would still have bio properties.

Jame: 3:30

I mean, silver nanoparticle sounds very technical. I'm sure there's absolutely no downside to impregnating everything with silver whatsoever. So you've got disinfectants which go in surfaces, antiseptics, which go on surfaces of humans and mammals, and you've got impregnated materials. That can go near people, but are not meant to be going directly onto the person or the surface. Would that be a reasonable definition?

Tash: 3:55

Yeah, and I guess you can, you know what we talked about in the microbio toxicity episodes previously was that anything can be micro biotoxic. So if you're, there's additional complexities that you could be ingesting products as foods that could have an effect on microorganisms, but those would not be classed as consumer biocides. Those would be classed as foods.

Jame: 4:15

And they wouldn't be a drug either.

Tash: 4:17

And it wouldn't be a drug either. No, exactly. There'd be a food.

Jame: 4:19

Yeah. Okay. That sounds very complex. It's a good thing that there's a single regulatory framework to control biocides in all of these different modalities. Isn't that right? Tash?

Tash: 4:30

That, that would be pretty straightforward, wouldn't it? Yeah. Unfortunately there, there isn't so

Jame: 4:35

What,

Tash: 4:36

so depending on the type of agent that you're talking about, de determines who, who regulates it. So the bits that we are most comfortable with, so the pharmaceutical products so this is all the kind of antibiotics that we, as prescribers would give. They would all fall under the MHRA. And so it would be regulated as drugs. So even if the active compound is the same as something that's present in the biocide, it would still be the MHRA regulating it if it's a product

Jame: 5:03

So you mean like chlorhexidine mouthwash, versus Chlorhexidine something else?

Tash: 5:07

So the distinction is if you're making a health claim. When you are marketing it, if there is a health claim, then it requires both proof of efficacy and proof of safety in humans under the MHRA. And that gets something back to something we've talked about before on the pod, which is about what type of research you need to be able to prove that something is effective. If you're making a health claim, you'd have to do a clinical trial to test something as an investigational medicinal product to then be regulated by the MHRA as a drug,

Jame: 5:40

So when we talk about RCTs, we talk about cts clinical trial of a, of an investigation medical product. That's when you're testing a drug to see if it cures cancer, kills, bugs, et cetera, et cetera.

Tash: 5:49

Absolutely. So any agent that you are testing down that pathway would then be regulated by the MHRA. Whereas consumer biocides it can be a little bit con convoluted, so the health and safety executive will regulate lots of consumer biocides. And then you additionally have treated articles, which am I right, Natalie are regulated currently by the department for business and trade.

Natalie: 6:13

That's right. Regulated as in no one thinks about them very much, perhaps is a better way of putting it.

Jame: 6:18

Oh, so this is air quotes very firmly around this regulated here that we're talking about.

Natalie: 6:22

Yes, and we're in a situation here where we have manufacturers and advertisers, in front of the regulators. They put these things out, they're out there, and then someone says, maybe there might be a problem with that. And that's the stage where there might be some thought. So it's very different to the medical pathway where there really is an agreed way of which you have to check things out and you have to test things before you actually start to use them. On the consumer side, it's essentially a wild west. And that's what's happening. And that's something that I'm trying to deal with in that regulatory space.

Jame: 6:53

I see. Okay. And then just to round everything out task the other agencies that can be involved. So the Food and Standards Agency would be food and then animal products would be defra. And then you've mentioned the, business

Tash: 7:08

department for business and trade for treated articles.

Jame: 7:11

treated articles? Fine. Regulation aside, it is a good thing that these things have proven to be perfectly effective. Isn't this right, Natalie?

Natalie: 7:20

I think. you, many of us would've seen the advertising slogans, the billboards the packaging that sells, says, kills 99%. 99% of bacteria kills 99.5% of bacteria. And I'm sure that's objectively true, but you have to ask the question about for Anu from a number of perspectives, what does that actually mean when it's actually used? And is this a good or bad thing for people or the environment? Now one of the obvious areas here is if it kills 99.5% of bacteria the 0.5% of leaves are those that are resistant to the bio side that you are applying, and you've created a giant ecological space in which all of those resistant bacteria. Can actually grow. So that's on the a MR side. Then we get to Tasha's territory, which is very much the question of microbiome toxicity, because of course if it kills bacteria you have a skin microbiome, you have a gut microbiome you have a lung microbiome and you are splashing around, spraying around, putting on your body antibacterial, maybe antiviral substances that are going to kill part of what is your own body. I mean, I was the first person in to use the term hollow bio as invented by Lin Margolis back in the 1970s. The idea that we are actually a composite of prob 50,000 or so different species. And if you are just flinging around, substances that kill part of ourselves then what's the impact of that gonna be on our health and wellbeing? And of course there's also the environmental impacts. Most of these things. The silver that Tash was talking about there's some good research that says it washes out in about nine washes. This is mostly using re reusable products, whether it's socks or period products or other things that are advertised as a, this won't smell. You can keep wearing this again and again, but you will wash it. Eventually that will wash out. And that's then putting more antibacterial substances out into the natural world where we already have an absolute explosion of resistance genes. Really excellent study came out a couple of years ago showing how one of the human impacts has been to massively multiply the amount of resistance genes in the world. So what you're doing is you're really feeding into our own health problems, environmental health problems and antimicrobial resistance.

Jame: 9:37

I would like to mention antibacterial soap versus standard soap. Do you want to just touch on that for a sec?

Natalie: 9:41

Sure. Where most of us on a day-to-day basis will probably have sticky in your faces is that plastic tub of hand wash sitting in the office facilities antibacterial except the CDC in America, the end of last year put out a rather resigned sounding statement saying this is no better than ordinary soap and water and it is damaging. Now it's interesting that the Americans have banned a number of substances from hand wash Trek of Sands, the one that's probably most famous. Many other countries have also banned that from hand wash. The UK has not. You will find that in UK hand washers on sale here. But the problem is that countries try and ban particular substances'cause they identify problems with them. But of course, this is known as the whack-a-mole problem. You ban one's thing. We've seen this happen with long chain PFAS. The forever chemicals was a problem. Some of them, it looked like they were gonna be banned, so they brought in short chain ones, and then they've discovered there's a whole lot of problem with short chain PFAS. What happens is you ban trian and then something else antibacterial gets put in instead. Often worse.

Jame: 10:48

Let me ask then, why are the doing it, is it just a way of differentiating yourself from BOG Standard SOAP to say, like this contains one quarter moisturizing cream. This contains antibacterial compounds, which are known to reduce the instance of hospitals super bug, MRSA, the COVID-19 virus and Ebola, et cetera, et cetera, et cetera. Is it just so that you can utilize it as a marketing tactic, is there any other justification for including these things?

Natalie: 11:15

No, of course, it is worth saying on a medical podcast we're talking about consumer products intended for consumer human use. And the evidence is there was a study in America a few years ago in households with toddlers and small children and there was no difference in illness between households that use antibacterial soap and households that use standard soap and water. So no, there is no practical use case for these in ordinary consumer environments. What there is the chance, as you've rightly identified. To flush up in big headlines on that billboard. This is special, this is different to have the advertising in the supermarket suggesting yes, this costs a pound more, but don't you want the best for your children? Don't you want the best for your family? So it is there as an advertising product. I mean, it costs the company's money obviously, to put these in. So the return they're getting is not a health return, it's a financial return from selling their product for more, possibly selling more of their product.

Jame: 12:14

Yeah, I suppose, people will have seen this recently when a few years ago disinfecting companies start change from this eliminates 99.9% of bacteria on surfaces to this is known to eliminate COVID-19. This is a potent antiviral. This will eliminate 99.9% of germs including the virus. Conveniently missing out to the idea that 70% ethanol would do it. A bit of vinegar with lemon juice would do it on most of your surfaces. That, that you don't really need to use any kind of industrial cleaners in order to do that. The virus was actually pretty easy to get rid of, but it was a new thing that you could use to market the product. And so it got slapped on all the labels without any, as far as I'm aware, any formulation change going on underneath.

Natalie: 12:59

Exactly.

Tash: 13:00

Yeah, I'm picking up on what you just said about how, being able to include claims about viruses probably didn't involve much of a change. You're absolutely right. I mean, as we all know from microbiology, training kills 99.9% of microbes just means a three log reduction in viable counts. This is something that the company would do as part of its validation to be able to sell it. It's not an additional claim that it's making, it's just how you test that in vitro. It'll achieve a three log reduction in microbes. That doesn't mean it's gonna work in the same way in vivo because it's activity, say, on biofilms or it's activity in the context of particularly resistant ecologies. It doesn't really take that into account. It just means that in vitro settings that it was tested, it achieves a three log reduction. As in any loyal listener who's done the Healthcare Infection Society foundation course will know. That only means a three log reduction for. An hour, two hours, this is not sterilization, this is disinfection. So under those in vitro conditions, that's what it means. It's not a lie, it's a true statement, but it's being used as an advertising claim and taken out of context to a consumer who doesn't necessarily know what that means. It's quite a powerful advertising claim. And again, really echoing what Natalie just said, we need to reiterate this is about consumer biocides. So the same chemicals, so say, quaternary ammonium compounds, were absolutely not discrediting the vitally important role that they play, say in cleaning hospitals, because we know that in those settings, not having that disinfection achieved has a very real. Impact on the likelihood of hospital acquired infections, but that's not what we're talking about. We're talking about whether you need an antibacterial soap or an antibacterial disinfectant in your home, and whether you can justify the bystander harms that it causes.

Natalie: 14:51

We've really got to start thinking about, we know now we've got a microbiome but we have companies pumping out the message that says what you should do is you think there might be a bacteria there, kill it. We've had companies telling us, find those bacteria, kill those bacteria, kill those microbes which really doesn't help public understanding. You've got this massive advertising campaign going on, giving people the message that they have to kill bacteria, kill microbes, wherever they are. We have to have an understanding that, as Tasha's just been saying, there are microbes everywhere. They're all there in our environment. They're in ourselves. We are microbes, we are part microbe. And what we are seeing with all of the advertising, all the bombardment people are receiving, it's a real barrier to public understanding of their own bodies of the environments we live in.

Jame: 15:42

Yeah. I suppose as a brief reminder to the loyal listener, we've talked about this in our microbiome toxicity, in our microbiome episodes, but about half of all the cells in your body are not yours. And of those 80% are living in your GI tract, the other 20% are everywhere else, your skin, your your nasopharynx, gentle mucosa and whatnot. And all of them are in balance with each other. And in fact, you get problems when the unbalance of c diff associated diarrhea is really a microbiome disbalance issue. Just a subset of microbio toxicity as everyone's aware. But the, the issue is that when you go messing with that. The obvious examples, when you go give broad spectrum antibiotics that kill all of C diffs enemies, that's a problem. But if you start rubbing crap all over you, which is going to interfere with your microbiome, that's not going to be risk free. So let's talk about the risks now. You have a few examples Natalie, in the recent talk that you gave to bsac, I think last winter about the negative effects of biocides as we have defined them, do you want to just talk about that for a few minutes?

Natalie: 16:50

I think We were just talking about killing bacteria and unbalancing your microbiome. There's some really interesting recent research linking dysbiosis in the mouth microbiome with mental illness. And yet we have antibacterial toothpaste. We have antibacterial soaps. We've already talked about antibacterial shampoos. All of these things are actually likely to interfere with your skin microbiome. And if you've already got problems or, you may be creating problems heading into things like eczema. and there's also some very good research out of America in terms of the vaginal microbiome. And we were talking about the silver in reusable period products the nano silver. And there is evidence that causes vaginal dysbiosis, unbalances the microbiome. So you've basically got your, all different parts of your body you are applying things to or taking things into that are that very likely to have negative effects. And one of the things is also that once you unbalance these things, it can be very difficult to get them back into balance. There's a whole Other issue around about products that claim to do that. But you don't want to go there if you can possibly avoid it.

Jame: 17:55

And to take it a step further inside you've mentioned vaginal douching as well in your talk, so not just like a period, but introducing antiseptics into the vaginal cavity as a way of cleaning it and making it smell nicer. Is that the

Natalie: 18:10

This is particularly the there's a term invented by advertisers called menstrual odor. And so all of these products and, there's been a long time range of products that have promised to deal with. We've only recently started to use the word, but it used to be hint of at menstrual odor. This does not exist. It is not a thing. It's asking you to buy what's probably a very expensive product that will potentially do you harm. This is the kind of thing that you could say. It shouldn't be allowed, it should be banned, but it's very hard. Sometimes the advertisers are, nodding and suggesting to this in ways they're not necessarily explaining it. But we really need to get across to people the idea that, thi this is your healthy body. You don't have to buy expensive products to keep it healthy. If you have a healthy body,

Jame: 18:56

And I take it that there's no male equivalent. There's no falla sock that's silver impregnated that you sheath your penis into to get rid of penile odor. This is kind of targeted that, I think we're gonna talk about this in a sec, about the disproportionate targeting of women

Natalie: 19:11

I did actually see a TikTok video about this. There is now being sold to men as well as women, whole body perfumes sprays, which were making hints in a similar direction. Yes, it's been spread. This is not contained to one gender or one group.

Jame: 19:26

Okay. I'm afraid I have missed that on my algorithm may not have gotten a a hold of that just yet, but I'm sure it's coming. Tash, can you tell us about chlorhexidine mouthwash and why it might not be the best idea to be throwing this around your gob? Surely sterilizing your mouth is a good thing, right?

Tash: 19:43

So I really like this literature because it's quite nuanced. I think as we'll all know, dental caries by Vean streptococci is actually one of the most common bacterial infections of childhood. We often don't think about it as a bacterial infection, but it is with longstanding consequences. So clearly oral hygiene very important. And I think, even as someone who's really into this sort of thing, until I came across this literature, I assumed that, there isn't such a thing as too good an oral hygiene, but I really like this literature because it's been quite nuanced in how they've tried to go beyond just showing an association and trying to show that there actually is potentially a causal relationship between chlorhexidine mouthwashes, the alteration that it causes to the microbiome and the downstream health consequences.

Jame: 20:30

What does it do to the oral microbiome? What are the things that it's doing

Tash: 20:34

so it shifts the balance. So you do get a, an immediate and a sustained increase in your proteobacteria, which tend to be your more pro-inflammatory species. So all of your kind of enterobacter sit within that. And you get a reduction in your bacter disease. And again, we've

Jame: 20:51

are your anos

Tash: 20:53

and we've talked previously about how it's actually quite hard to show harm caused by, microbiome imbalance in humans because it almost it drives me crazy that I have to say this every time, but you don't do clinical trials intending to cause harm, that isn't a thing that's not ethical. So when people say, show me the proof, show me the clinical trial, you're holding your breath in vain. You're not going to do trials where the goal is to hurt people because that's not ethical.

Jame: 21:20

I mean, this drives me insane just throughout infectious disease, some stuff you just can't prove with an RCT and some stuff. An RCT isn't the best modality. Sometimes it's a cohort or an observational study, particularly with stuff that's already on the market. Like you, you aren't going to be able to run an RCT to demonstrate harm. You need. Observational data,

Tash: 21:40

what I was gonna say is actually they have done some interventional studies, which are quite beautiful. So they have not intending to cause harm, but to look at downstream physiological consequences of altering or the oral microbiome. So I think you've heard me say before about one of the putative underlying common effector pathways by which the microbiome exerts its effects is through inflammation. So the microbiome can make a compound or a set of compounds in one part of the body. An exert a systemic effect is because it's making these pro-inflammatory or anti-inflammatory molecules, and that appears to be what's happening in the mouth. So as you shift from your resident aerobes to this more pro-inflammatory proteobacteria state, you start to get a reduced buffering capacity in the mouth. You reduce systemic nitric oxide bioavailability, and that is one of the mechanisms that for a while they have thought. Could explain why there's this observation that people who are regular Chlorhexidine users have increased blood pressure and reduced cardiovascular health. But they've actually now done interventional studies where they can measure systemic reduction in nitric oxide by availability and actually an increase in systolic blood pressure in people who are randomized to chlorhexidine mouthwashes and not in those randomized to placebo. So I think that's quite powerful. It's nice to see it all coming together in a mechanistic way.

Jame: 22:58

And we're not really gonna talk a huge amount about a MR, but you've got a little bit here about, again, about Chlorhexidine and a couple of other compounds being linked to drug resistant selection for pseudomonas. Is that because of a selection for FLX pumps, which also happen to work on the drugs in question?

Tash: 23:16

Yeah, I think so. And I guess with all of these things, it's that it's not just, when you take a drug. The user has a very visceral appreciation that's going into your body, but somehow because you're spraying it onto a surface, you're not appreciating that. It then goes into your waterway and potentially then into crops, potentially then into animals and potentially finds its way back to you in the water that you eventually drink. So it's maybe one step further removed than the AMR induced by the drugs we take. But it's still there.

Jame: 23:46

Yeah, and we've we're now moving into the realm of the one health approach to where, antimicrobial use or antiseptic use or biocide use everywhere throughout the food chain and in the environment will end up affecting us. So we talk about, antimicrobial use as an example, about 90% of it, or some proportion of that is in animals. And then of the 10% remainder, 90% of that is in primary care. And of the remainder, 90% of it is at the front door. Secondary care, antibiotic use is the tip of the iceberg. It's an important tip because a MR selects out in hospitals and then goes into the environment. And, that's why when we use broad spectrum antimicrobial use I remind juniors that, every drug that you give, 90% of it's getting peed out into the toilet. And so that's then going to be going into the environment and selecting out an environmental gram negatives, which are a huge reservoir of a MR Reis genes. But also the, every time you use KF axone, you're telling the patient's guts, microbiome, hey, a drug which lets you survive. Keft axone use is a good idea to keep around. And so we are increasing our incidence of SBLs and CE and carbapenemases. Every time that we, we do that. And that's not to speak about a MR in non gram negative agents. So how do these companies do this? What are the marketing techniques that they are using? The phrases that they're using to sell these biocides just so that people can recognize them in the wild.

Natalie: 25:16

They're not very hard to recognize. They will be splashed in big, colorful letters, antibacterial, anti microbial antiviral but you will also get slightly more subtle things like super strong, super deadly things like that being applied. But I think it's worth going back to what you were just talking about in terms of once the one health perspective of this environmental animal and human health being all together. Bioscience are just one of the things that we are flushing down through our sewers, out into our rivers, et cetera. One of the things I'm very interested in is the whole concept of the cocktail effect and what we've got. Going out in our sewers, in our rivers, in, in our oceans. It's not just the biocides, it's the PFAS, the forever chemicals. It's the micro and nanoplastics, it's the pesticides, it's all the other pharmaceuticals. I mean, there's some really fascinating research about the environmental impacts of ibuprofen. And it has really significant impacts on lots of natural systems. And it's not just one of these. And when we are talking about regulation, what regulators do is tend to only look at what's this one product doing in a more or less pristine environment. None of us live in anything vaguely resembling a pristine environment where all of us getting all of these things. And if you think about the microplastics and the nanoplastics, the PFAS, Essentially, whatever. we do, those levels of those are gonna keep going up for the foreseeable future. And they're all going up at the same time. And I think what we are not yet having anything like enough health thinking about is that cocktail effect. And there's a little bit of preliminary research. It's literally all come out in the last year or so. What happens when you spring tails or freshwater snails or something, you expose them both to microplastics and PFAS. The impact is not just additive, it's multiplicative. The more. Challenges you get from all of these different novel entities in the environment. The worst you are gonna do, whether you are a snail or a spring tail, or ultimately probably a human, and this is all being covered partly by the Stockholm Resilience Center. Their term for all of these things is novel entities. And they say, we've exceeded the planetary boundary for novel entities

Jame: 27:27

just checking in. Tash, is novel entity a subset of microbio toxicity or is microbio a subset of novel entity? I just wanna get my facts straight here.

Tash: 27:35

Maybe that's a lamb grab too far for me.

Jame: 27:38

I see. Okay, very good. Fine. So let's talk about what the peer review are doing about this. So we have a biocide bill which has an official name. Would you like to tell us about that and when it started and how it's going?

Natalie: 27:55

Okay, so this is the control consumer products brackets controller, buyer side bill, and it's a private member's bill, which was brought in under my name because I was lucky in the ballot in the house resorts private members' bill. Now the first thing to say is don't get too excited. Private members', bills virtually never become law. This is a way of raising the issues of starting to explore the regulatory framework of having meetings with civil servants, educating people about the problem. It's a process. I think we could make it a law in a year's time, and it could be done, the political reality is that's not what's gonna happen. But, so what this has been through is we've had, in the House of Lords, it was introduced in the House of Lords, and we had a second reading debate. And you can look up Hansard, which is the record of everything that's said in the House of Lords. And I think I can say, if I say so myself, we had a really good debate with some really great contributions from all kinds of different angles, whether it was women's health angles whether it was more medical, a MR kind of angles. We had a really strong debate. The House of Lords at its best. We are now waiting for a committee stage. I'm not sure whether we are going to get that committee stage before we have a new session of parliament, in which case all bills fall. There's one thing to say about this being really different is I spoke before about the whack-a-mole problem and if you ban certain substances, what I've taken in this is an innovative way of doing this is I've said that you cannot add to a consumer product, a biocide unless you can demonstrate there is a good reason for it. So rather than saying we are banning substance X or substance Y, we are trying to reduce the overall load. None of this is gonna stop any substance being out there in the environment or existing. But if we can just start to reduce the load of a MR, toxic effects, the load of that cocktail, we're all being exposed to, it's trying to take us in the right direction.

Jame: 29:43

so this is taking an MHRA style approach. Okay, you want to use this, you wanna get a license to use this drug, prove it's effective, prove it's safe, and then you can stick it in your cream, your lotion your antiseptic. And I, I guess your fell sock. Yeah, that's right. And I guess some stuff instantly just wouldn't make the cut. So like vaginal douching for example, I'm just trying to imagine a justification for messing with an incredibly complex ecosystem to make it smell slightly flowery. And I just cannot think of a reason why that would pass. So I guess some stuff would be straight off the table. If this came to

Natalie: 30:21

And I think most of it would be, I mean, you take your I'm talking about ordinary socks here for the avoidance of any doubt. Your socks treated with silver, guaranteed not to smell all of that sort of stuff. Yeah, first of all, it washes out in about nine wass anyway, but more than that you're putting that into socks made from artificial fibers. Natural fibers, cotton, and particularly wool are naturally odor. It's part of the nature of the substance. Do we actually need, and, we get into here a whole lot of other of my kind of green political debates about fast fashion, the vast quantity of textiles that are dumped all around the world, all the environmental and plastic waste impacts of all of that. But, if we say that, we don't want socks treated this way. There is an alternative, which is natural fibers. Then there is no justification for that either.

Jame: 31:07

I guess we should just point out to listeners. This is not an excuse to never wash your socks so that the silver doesn't wash out. This is an excuse to change your sock buying habits so that you get something a bit more sustainable. And that might last a bit longer as well, because I guess a lot of this is also, not necessarily increasing the longevity of the product. So being subject to market forces, I guess this is an example of market failure, isn't it? We talk about this with Tash, I think you may have touched on it with drug development and things like that. We talk about the antimicrobial development system in the world is completely broken.'cause the second that we get a drug to market that's useful in treating a MR, we say, thank you very much. This is now reserve antibiotic. We're never going to use it and you're about to go bust. So people are not making antimicrobials'cause it's not profitable. It is profitable selling Holcomb. And you can imagine other words to people if it makes them buy stuff. So if it makes them. Wanting of the product or scared to not use the product if it if the product addresses a fear that they've got my surfaces, my, my, my baby needs to be kept sterile at all costs, nevermind that it's constantly pooping itself and you're having to constantly change its nappy. But if you impregnate silver into the nappy, that will be absolutely fine. The first thing that's gonna happen is get covered with VCs and urine, but as long as it was sterile before then that will be that will be worth paying an extra pound for. But the downstream effect of that are considerable. But also as a relatively new parent, the disproportionate influence that fear has on marketing stuff to. New parents, particularly, and I felt that a lot, particularly when I had my first kid, was that a I knew I was a crap parent. I knew I was the crappiest I was ever going to be as a parent. And with number two, I was a much more relaxed and knew what stuff mattered and what didn't task. You will have been in the same position as well, but that culture of fear around being a new parent and constantly worried that you've gotta keep this thing safe leads to buying a lot of stuff, which on reflection didn't make any difference whatsoever.

Natalie: 33:08

There is such pressure on people these days and also this is where you come into much broader issues of social structure. Many people, particularly in Britain, don't live anywhere near their parents. Either side of the family. They don't have communities around them where people have long-term expert views. People are terribly isolated and then terribly vulnerable.

Jame: 33:27

So I guess the buy-side bill is taking a top down approach to saying you have to prove it's safe first before you can use

Natalie: 33:32

More than safe. You have to prove that it's necessary. It's acknowledging you are going to do harm by you putting bio aside in this product. Whatever this product is, you have to demonstrate that the the balance the harm is outweighed by the actual genuine. There is a use case for this. There is a good reason for this. There's a human and environmental health reason for this. It's actually pretty hard to think of most of the products we're targeting. The CDC last year putting out saying there is no reason to have antibacterial handwash in a consumer setting. That's,

Jame: 34:03

surprising actually.'cause normally the CDC and the FDA I think of as being behind Europe and and the UK in terms of regulation of that stuff, like medicinal supplements and health food supplementation in America's notoriously broken because of regulatory. Failure. So actually this statement that that came out is quite surprising. But very welcome.

Natalie: 34:27

And I think they're also trying to come back. I mean, there was a study done a few years ago in America. It said that younger people wouldn't use a bar of soap'cause they thought it was covered in germs. So there you, there is an awareness to some degree, at least among the regulators that there's a problem here that needs to be tackled of public understanding. But of course you compare, a press release from the CDC versus a barrage of advertising from a giant multinational maker of consumer products. How much does of each of those messages get through? How much do people hear? There's a huge, as the lawyers say, in balance of arms here in getting genuine health information out to the public.

Jame: 35:06

I remember actually the adverts coming in for liquid soap saying oh, your bar soap, it's covered in bacteria, and it's sitting there on, and the bacteria are growing and multiplying on the soap every second that they're leaving, you better switch over to, a hand soap that you squeeze. And then it became, oh, but that hand soap dispenser, you've been touching it with dirty hands. It's probably covered with germs too. The comedian Drow brain has a good little few minutes on the detol, no touch hand dispenser and how ridiculous it's'cause the very next thing you're doing is washing your hands with it. Who cares if it's got a few extra CFUs of e coli sitting on them? Just leave them be okay. They're living in your gut, normally producing vitamin K for you. What's your problem? I suppose that's the other thing that we haven't touched on is that a lot of these germs are actually. Bits that live in you normally. So oh, hospitals, superbug, staph aureus. It's living on your skin right now. What are you going to do about it? Nothing. It's preventing other stuff from colonizing your skin. In fact, you secrete short chain fatty acids onto your skin through sebum all the time to grow these bad boys up. And, oh dear, you've got lots of lactobacillus growing in your vagina. What are you going to do about it? Nothing. They're perfectly happy there. They're actually helping the candida live and the candida's good in that situation. Just leave it be, if you do anything to imbalance them, the candida's gonna overgrow it, and then you're gonna have vul vaginal candida. And that is a problem. Oh no, you've got e coli in your bum. Good. Leave it there. There's a bunch of pathogens, which are, if you detect them in your, stool say Kaba or something like that they're always pathogenic. Or you find it in your bloodstream, you need to do something to get rid of that. But that is not true of a bunch of stuff that's living in you normally. And this idea that we are, a colony essentially for want of a better term, a phrase or an ecosystem of a bunch of stuff that's not you, that I think has no push through with the general public at all? I don't think people think that way. I think that people think the poo is dirty. Your skin's kind of dirty. Your mouth is clean somehow because when you cut yourself, you stick it in your mouth to sterilize it, and your gentle mucosa very dirty indeed. And then that's really difficult to argue against because the advertising media is just a flood of you're dirty. You need to get yourself clean. Nobody's ever going to love you. And your child will die unless you sterilize every available surface to you, including some surfaces inside you for unclear reasons.

Tash: 37:25

And it's a shame because there actually is some really good qualitative data where they've looked at the the sort of language around microbiome focused messaging and it actually really resonates very well with the public.

Jame: 37:37

Well, can you give some examples?

Tash: 37:39

So I mean, I came at it from my research, which is, again, this is a totally different conversation, but using human challenge models to study microbiome development.

Jame: 37:48

Is this about to become a mini advert for funding the next three years of your research

Tash: 37:53

It's not Jane, but thank you. No, so looking at part research participants' perspectives was really important. How do they actually perceive these things? And there's quite a lot of data that quote unquote probiotic rhetoric, not necessarily probiotic in the sense of a tablet that you take that has a bacteria in it, but the idea of these ecological narratives where they've actually trialed it with people, where they look at how it lands. People are really receptive to it. So I think we're short changing people on two counts. We're offering them products that. Probably don't work and could be harmful, but we're not actually offering them, we're almost implying that they're too stupid to engage with reality and to, appreciate the way things really are when actually when you try patient, certainly patients seem particularly receptive to it.

Natalie: 38:38

I think there's an area where there's real progress is the discussion around ultra processed foods and the impact on our health and wellbeing why do some people say it's good to eat 30 different vegetables and fruit every week, which is actually really hard to achieve under our supermarket system because that feeds your microbes. So there is actually there is real progress being made in this area and, I always like to focus on the hope.

Jame: 39:00

That's good because this podcast has not been very hopeful. Up until now

Natalie: 39:05

my top message of hope is that where we are now is profoundly unstable. The one certainty is we'll be in a very different place in five or 10 years time, and that's good news.'cause where we are now is really not very good.

Jame: 39:14

you're assuming that we were gonna be in five or 10 years. Time is better than where we are right now, which judging by the a MR episode that we just released a few weeks before we recorded, this is not necessarily the

Natalie: 39:23

This is where we get to one of my favorite phrases. History is not pre-written. History is made by the actions of people. So I don't know where we'll be in five years, I just know it'll be really different because we are so unstable now, and it's in all of our hands. By making this podcast, by growing awareness of our ourselves as ecosystems, by also growing awareness of the fact that these things have, we depend on a healthy environment to live. I spent a lot of my time saying the economy is a complete subset of the environment. As I said to someone the other day, there is no shareholder value on a dead planet. And so when we start to think about all of these, issues about the microbiome, and we were talking about messages, the bad messages given to people. One of my favorite ones to get to really raise my blood pressure is the, oh, do you know that your sheets and your linens and your towels, there's bacteria on them and so you should wash them. Maybe even every time you use them, you should wash them.

Jame: 40:18

every time you use them, I have to remind myself to do it once. No, I better not say that actually.

Natalie: 40:23

But what is the environmental impact, the climate change impact of the energy the detergents all of the impacts that's having, it's making us a less healthy world. And so what We've gotta go is to under understand that we are not just individual ecosystems. We are all part of a complete ecosystem. Everything that we do that damages the world around us actually eventually damages us.

Tash: 40:46

I think the silver lining to painting such a bleak picture is that. I'm constantly blown away by how much scope there is to do good in our specialty. I mean, if you look at some of the W Ho's, existential threats to humanity infection is like four of them. You've got emerging pandemics, you've got antimicrobial resistance you've got vaccine preventable illness and vaccine hesitancy. Yeah, it's depressing, but how exciting is it that we are in a field where we get to try to change things And the tiny bit of work I've done with you, Natalie, has been so incredibly humbling because actually trying to put some of this work into policy, into practice that could change how we do things is super empowering.

Jame: 41:29

I think Humphrey Applebee sent in an episode of Yes Minister. Every problem is also an opportunity, but there may be some insoluble opportunities. But I suppose that what you, the two of you're trying to tell me is that's not true, and that these are solvable. Issues. I suppose the downside is that biocides are a bit like a MR and that they are having an environmental effect that's very spread out. So like you, you get a viral pandemic that flows, all over the world. That's obviously killing a lot of people in a short period of time. That's quite a big threat. We've just had the COVID report in the uk, so about over 200,000 people killed by the COVID virus in about four years. That's very easy to quantify because it was plastered all over the death certificate. A bunch of people dying of a MR is difficult'cause it kills lots of people, a tiny bit in lots of different countries and it's uneven. So it's happening more in places like Southeast Asia and Africa, it's killing, old and young. It's concentrated into hospitals. The effect of prescribing antimicrobial is not directly linkable to the death. And biocides are probably a bit like that as well.

Natalie: 42:38

Yes, but I think I Wanna pick up, I'm gonna be hopeful. I'm gonna continue to be hopeful.

Jame: 42:42

Sorry, please, a message of hope, if you

Natalie: 42:44

In picking up what Tash said you, the interactions that I've had with her working with Tash reflects interactions I've had with a lot of relatively early career researchers. I've had a whole series of scientific researchers through BSAC, the British Society Forhe Microbial chemotherapy and. I'm seeing in the generation of young professionals coming through now a termination, not just to do the research, get the position, but to actually deal with the problems. And one of the things that, that I really focus on is we need to hear much more, not from the 60 something old professors who did their best work 30 years ago and may not entirely be keeping up with the latest stuff. We need to get these new ideas coming through. And these are ideas that understand, particularly after COVID, if you've formed your professional thinking through COVID you understand that infectious diseases are a really serious threat. It's not just an academic thought. It's a, it's an understanding of reality. And so people have different ways of thinking and we need to bring those ways of thinking into policy, into government. And where I'd start with and answering your point about the diffuse effects, we need to apply. The precautionary principle, let's not put something out there unless it's necessary, unless the benefits outweigh the costs. And we haven't done that. We've just said. Companies can do all this stuff, externalized costs, and then if there's a really big problem, we'll try and clean it up. We need to turn the thinking around. So my message to all of the people listening to this is my message, it is to seven year olds and the 70 year olds, we need a world where everyone makes politics, what they do not have done to them. You sadly cannot these days just, do your professional job, encounter problems and think, oh, someone else will fix that regulatory problem or that systemic problem. Work together with others and be part of dealing with the systematic problems that you run into every day as we all do.

Jame: 44:35

I better not say anything more because everything I've said has been depressing. So let's end on that message of hope. Tash Natalie, thank you for coming on the show.

Natalie: 44:43

Thanks very much.

Tash: 44:44

Thanks so much.

Speaker 2: 44:45

The Idiots Podcast is supported by the British Infection Association. The UK's Premier Infection Association membership is free for trainees and reasonably priced For everyone else to join, see the link in the episode description, questions, comments, suggestions. Send them into Idiots podcasting@gmail.com. Have a five star review in your pocket column, and I would love to have it. Please drop it in your podcast player of choice. We are on Blue sky at idiots dash pod, and if you want to donate to support the show, there's a link to do so in the description. Now that the episode's done, we hope you learn and had lots of fun. So go forth and treat people with some of what you now know.