Last May, cell biologist and physician Robert Farese received an unusual email. “Have you ever dreamed of singing on stage in an off-Broadway show?” It asked. And does Farese want to audition for a musical about penicillin?
“I thought, ‘Excuse me, what?’” said Farese, who works at Memorial Sloan Kettering Cancer Center in New York City. His confusion was understandable. Antibiotics are not a common or obvious topic in musicals. Where is the drama of drugs?
But the story of penicillin and the many antibiotics and other antibacterial agents discovered after it is actually as dramatic as it is classic. A keen-eyed doctor makes an accidental and miraculous discovery that revolutionizes the world, saving an unimaginable number of lives and ushering in a new era of medicine. But this new, glorious status quo can only last if we pay attention to what we are given. And we weren’t careful.
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musical lifeline, The work, which has just wrapped a month-long run at the Pershing Square Signature Center in New York City, weaves the story of microbiologist Alexander Fleming, who discovered the first antibiotic, and modern doctors grappling with the growing failures of medicine. Farese was one of dozens of touring choir members supporting British actors. Songs from the play were performed at the UN General Assembly’s one-day high-level meeting on antimicrobial resistance (AMR) on 26 September. Approved a global action plan to respond to the crisis.
The musical features microbiologist Alexander Fleming singing with his wife, Greek doctor Amalia Fleming.
The character Aaron is hospitalized with a resistant infection.
May Archacki/Ursa Creative
Drugs used by doctors to treat bacterial, fungal and other microbial infections are becoming increasingly ineffective worldwide as microbes evolve to survive exposure to drugs. In 2021, antibiotic-resistant bacterial infections caused 1.14 million deaths and contributed to approximately 3.57 million deaths. that best estimateA report published this month found that 39 million people will die from these infections between 2025 and 2050.
Today’s dire situation is the result of the overuse or inappropriate use of microorganism-killing compounds in both medicine and agriculture. like lifeline To dramatize, Fleming goes back to 1945, the year this discovery was awarded the Nobel Prize. “The greatest potential for evil… is to use too small a dose and, instead of eliminating the infection, educate microorganisms to resist penicillin,” he said. interview new york times that year. “I hope this evil can be prevented.”
In 2016, Meghan Perry, an infectious disease clinician at the University of Edinburgh, came up with the idea of teaching children about antibiotic resistance through a musical. So she suggested it to her colleague’s spouse, composer and theater company co-founder Robin Healy.
“At first I was a bit skeptical about whether this was a suitable subject for a musical,” says Hiley. “But she persisted, like any clinician scientist would.” Early iterations of the musical include: children play called A framework that changed the worldStudents play singing and dancing bacteria and tell the story of Fleming’s discovery of penicillin.
Over time, Hiley, the show’s composer and lyricist, became fascinated by Fleming’s life story. Scottish doctors treated soldiers during World War I. The front-line treatments for infected wounds at the time were strong antiseptics that often did more harm than good. A once shy scientist later became an international celebrity after discovering a compound that kills bacteria.
The next version of the musical was a Fleming biopic for adults., It was a sold-out production at the 2018 Edinburgh Fringe Festival, says Hiley. A longer version toured to Washington, D.C. and Atlanta in 2022, with support in part from the nonprofit CDC Foundation.
but A framework that changed the world It was still a story about the past. “It’s great to tell Fleming’s story, but his story ends in the 1950s. and [antimicrobial resistance] It’s a really modern story,” Hiley says. “So we decided to be brave and deconstruct everything and create this modern story.”
Fleming sings a duet with the character Jess, a modern-day doctor.
that lifeline A chorus of real scientists and medical experts.
May Archacki/Ursa Creative
lifeline‘s current story follows a group of fictional friends whose lives are upended by an antibiotic-resistant infection. The story is intertwined with Fleming’s, which travels backwards in time, starting with the golden age of antibiotics and ending with the dark days of World War I, leaving audiences with a stark impression of what we take for granted and what we have to lose.
Throughout both acts, a choir of scientists and medical experts describe real-life examples of antibiotic-resistant infections. “We went through all these networks and collected stories from hundreds of people. [about how] AMR impressed them,” says Hiley. Some of these stories end in recovery. Some end in tragedy.
“For me, performing and telling those stories didn’t feel like acting,” says Michelle Chang, a New York City-based infectious disease physician and choir member. “It really felt like I was talking about my work on a different stage, to different people.”
Part of Chang’s job is to consult with doctors to ensure they are prescribing the right antibiotics as part of the hospital’s antimicrobial stewardship program. Many of these programs have sprung up across the country in the past decade. In 2014 only 41% of hospitals We had a comprehensive management program. By 2022, that number will be 97 percent. These care teams collect data on which resistant microorganisms are circulating in hospital systems and consult with physicians to help treat specific patients while preventing the spread of resistance.
However, there is no simple solution to the problem of increasing resistance. This is a global crisis, and one that most severely impacts communities with the fewest resources. Pakistan is currently in extreme turmoil. Outbreak of drug-resistant typhoid fever. The outbreak is largely linked to lack of access to clean water and primarily affects children.
In writing the musical, “we didn’t want to say, ‘This is what you should do,’” Hiley says. “It’s not necessarily up to us as artists.”
lifeline The performers concluded the UN General Assembly meeting on AMR. They played songs inspired by Scottish folk music to highlight the urgent need for governments to make concrete commitments to tackle antimicrobial resistance. The meeting was one of three “high-level” meetings held this week at the 79th General Assembly. The other two dealt with sea level rise and nuclear disarmament.
Despite the musical’s bleak message, it ends on a hopeful note. The choir breaks the fourth wall, with members introducing themselves to the audience and describing their actions that contributed to resolving the crisis.
At first, “we didn’t realize how big of an impact we were having on the show,” said Farese, who studies lipid digestion in cells, which may be important for understanding how pathogens replicate. “Suddenly it went from theater to reality. Many of these people are literally on the front lines of this work. I think that’s very powerful. “I cried when I first saw it.”
