1. How did having a state health system influence the treatment of infectious disease in 1940s-50s Russia?  

One of the most important outcomes of the USSR having a state health care system was a focus on alternatives to antibiotics. Given the Russian culture of using natural remedies, the cost of antibiotics, and the association of antibiotics with major western countries, it was easy for the country and its doctors to switch to phage therapy, as it was natural, not costly, and was notably different from the antibiotic route the western countries were taking.

2. The Hirszfeld Institute is also intertwined with Russian history.  A tragic quote is given on page 66 by Hirszfeld about the death of his daughter.  Even so, the outcome of these 2 centers has been very different.  Discuss why you think this is so.
Contrast the Phage Therapy Center in Wroclaw with the Eliava Institute in Tbilisis.

Both the Hirszfeld and Eliava Institutes were medical institutes whose founding shared a place in history with WWII. Although they both focused on phages and both involved being shadowed by regimes, the Hirszfeld Institute was successful while the Eliava Institute was not. This is partially due to their geographical locations. The Eliava Institute in Tbilisis was in a much smaller country with much less funding and control, and thus failed in the end. The Hirszfeld Institute was in Poland, a much larger country with more say in the western world. The location of this institution made it easier for it to receive funding for its specialized pursuits of bacteriophage research and immunology.

3. Research in the USA often differs from other countries because of regulations by the FDA and private investments.  Describe the experimental design that Merril used to determine how to select for phages that were not removed by the liver and spleen. Review the Merril, Carlton, and Adhya PNAS paper, focusing on interpreting their figures.

Merril and his team took lood samples from animals, isolated the phage present, and injected them into mice. This process was repeated a number of times until their survival rate was much higher. These phages were named Argo1 and Argo2. Four mice were taken and injected with a lethal dose of bacteria. The mice that were injected with Argo1 and Argo2 were made slightly sick before recovering, the mouse that was treated with Lambda phage had a slightly more severe illness, and the mouse that went untreated died in two days. This supported his hypothesis of the relative strengths of passaged versus unpassaged phages.

4. The most convincing argument for using phage is tied to the increasing problem of antibiotic resistance.  Even so, many still consider phage therapy an alternative therapy.  Chapter 8 describes several start-up companies: Phage Therapy, Phage Biotics, GangaGen, Exponential Biotherapies.  Research these companies and discuss the potential for phage therapy in modern Western medicine. What experiments need to be done?

Although phage therapies are very promising, one major problem that most of these companies have in common is that they don’t follow the rules and regulations set out by the American government. Since they don’t follow the proper protocols, it’s impossible for them to make much progress in America. Because of this, western doctors are distrusting of the capabilities of phage therapy. A phage therapy institute has recently been opened in California, which shows promise since it would have to operate under American protocols and hopefully gain credibility. Large experiments with control groups following proper American protocol have to be performed in order to gain more support and credibility in the States.