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How and why capitalists made antibiotics ineffective, and what they plan to do about it

New Scientist:

A post-antibiotics era in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century." That was the warning last month from the World Health Organization in its first global report on the growing ability of bacteria to resist antibiotics.

One more thing to panic about! But wait!

The WHO wants to fix the problem by backing unprecedented controls on the pharmaceutical industry – and the industry, mostly, agrees. "There really is a consensus emerging," says John-Arne Røttingen of the Norwegian Institute of Public Health.

This week, the WHO's 194 member states are meeting in Geneva, Switzerland, to endorse a proposed action plan to save antibiotics. It includes a modest-looking call for "new business models to encourage investment in and preservation of new products". Translated, that means we cannot solve this problem if antibiotics research and marketing continue to be governed solely by market forces.

"Governed by solely by market forces." Let the literal meaning of that sink in.

Last week at another meeting in Geneva, healthcare researchers and pharma representatives agreed that companies must be paid more to invent antibiotics – but in a radical departure, profits cannot depend on drug sales.

There are no big profits in antibiotics, says Kevin Outterson, an expert in health law at Boston University, whose report on the issue was presented at the earlier meeting. Normally a company invests a great deal of money in research and development to get a drug to market, then recoups that, and profits, by selling it.

The problem, says Outterson, is mainly that older antibiotics that still work are off-patent and therefore cheap, so new ones that must compete cannot be priced very high. The only profit is in maximising sales – but this inevitably speeds up the development of resistance. So companies have deserted antibiotics in droves: 18 big companies were doing antibiotics R&D in 1990, but only five of those were still doing it in 2011.

Antibiotics could be a nice little business; just not nice enough?

Two remedies are now on the table. One is to jump-start R&D with government money. Both the US BARDA fund, initially intended to foster otherwise unprofitable biodefence drugs, and the EU's New Drugs for Bad Bugs (ND4BB), aim to do this. The WHO wants to push this approach.

The second idea is more novel: de-linkage. This means a company's profits from a drug would not be linked to sales, but instead to prizes, grants or other incentives. To keep resistance from developing as fast as the new drugs are produced, some may not be sold at all until they are absolutely needed, says Outterson.

Leading antibiotics makers broadly support the idea, he says. James Anderson of UK-based pharma giant GlaxoSmithKline backed it in Geneva – as long as the sales limits do not extend to other drugs.

There is little consensus on how to proceed but no lack of proposed schemes. These range from awarding companies cash prizes or extended patents, to "public-private partnerships" in which the government pays for the R&D, then controls sales. De-linkage has wide support in Europe, but not in the US, which resists interference in free markets.

"Interference in free markets.... " BWA-HA-HA-HA-HA-HA-HA!!!! Except when they're rigging or looting them!

Anyhow, I love the idea of "Win cash prizes!" and I wonder what else it could be applied to.

NOTE I hope Riverdaughter sees this and comments or even posts on it.

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hyperpolarizer's picture
Submitted by hyperpolarizer on

One essential thing to do is: ban the use of antibiotics in factory farming, NOW.

This has already been done in Europe. Unfortunately we can't control China, which is pretty much the wild west, as regards what any producer/corporation/agribusiness_entity wants to do.

But we can have regulations at home at least, that are binding, and not voluntary.

No more antibiotics in animal feed. No more prophylactic use of antibiotics to 'prevent disease.' No use of newer and/or more powerful antibiotics for any veterinary purpose. (Yes that will be hard on a lot of pet owners, including me.)

Of course this will make current hog megafarms untenable. No tragedy, say I; either for the pigs, or for the neighbors, who are exposed to airborne swarms of drug-resistant bacteria.

Also, a stop must be put to the goddam he said/she said journalism about whether or antibiotics in animal feed on factory farms do or do not cause drug resistance in bacteria. The science is incontrovertible; it is (and has been for half a century) a cornerstone of modern molecular biology that drug resistance develops fast in response to drugs, and that it can be transmitted from bug to bug.

And yes, although I am now an engineer, long ago in a galaxy far away I was a nucleic acid biochemist.

Just sign me

Elmer Ph.ud.

Submitted by hipparchia on

http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-in-animals-r...

Eighty percent of the antibiotics sold in the United States goes to chicken, pigs, cows and other animals that people eat, yet producers of meat and poultry are not required to report how they use the drugs — which ones, on what types of animal, and in what quantities.

the sanders prize isn't a bad idea, though I prefer Kucinich's version - just pay government employees or contractors to develop the drugs we need:

http://www.theguardian.com/commentisfree/cifamerica/2011/may/31/healthca...

buy drug patents and put them in the public domain:

http://www.universaldrugstore.com/news/articles/John_Edwards_%20Prescrip...

goldberry's picture
Submitted by goldberry on

I posted on antibiotics research last week based on something Derek Lowe posted.
I've been saying for several years now that antibiotics are in danger of becoming extinct and it's a real problem.
I will certainly post on this one and add another post on drug prices that I saw in a article in Nature. It will make your blood boil.
As to grants and prizes, if the idea is to give them to the patent inventors, forget it. Most patents these days have multiple inventors. It would be the equivalent of a bonus. And what most inventors really need these days are jobs. Besides, we make a deal with the companies we work for- it pays for the equipment and reagents and we sign over our patent rights to them. Before the companies got greedy and forgot that patents represented real creativity and hard work, we thought it was a fair exchange.
At this point, I think the only good answer is for the government to pour billions into an R&D effort and controls the sales. Funny how many possible solutions suggested above are the ones that I have also put forward in the past couple of years. You may not like the idea of a patent extension but if it means that the companies don't cut the antibiotic projects due to poor return on short term investment, you may change your mind after the next plague. I think a public private partnership with government putting up most of the cash and private industry applying it's expertise to the development phase is probably the most viable option right now but I'm open to other suggestions.

goldberry's picture
Submitted by goldberry on

I've talked to people in the industry who have had meetings with scientists at the CDC, for example, and they tell me that as it is right now, the government can't handle drug discovery research. The sequester and irregular funding has had a profound impact on how government labs operate. Scientists have a morale problem. Pay is politicized. It's a fricking nightmare. They don't even know the names of the people in their group.
If you read Derek Lowe or myself you will know that from an operational standpoint the best way to discover drugs is to have a corporate lab (don't flinch) of medium size. You don't want a behemoth sized company like Pfizer because that consists to two many other companies that have not been merged properly. A Pfizer sized company works very poorly. You also don't want a company that is too small because there is a problem with resources. A medium sized lab like Vertex or Wyeth (before it was Pfired) is about ideal.
The biggest problem is Wall Street. Wall Street insists on satisfying investors. That means that in the last 20 years, the emphasis has been on short term goals. But drug discovery takes a long time and the FDA keeps upping the regulations. There is nothing wrong with safety but at some point, you start asking for the impossible. There is not ever going to be a drug that has zero side effects. That's great for the class action law crowd but it means the rest of us are left with no effective drugs.
It is a very tough, almost intractable problem. There are so many hands in so many pockets. Inn the end, it is all about money. Who is going to make it and who is going to keep it. Scientists are rarely considered beneficiaries in this mix and most of us are ok with not ever being rich. But we resent having so many years of training and experience under our belts and then having the rest of the left expecting us to live on $37K for the rest of our lives. There's no way to have a life on that much money. Ask an MD to take a cut in pay so that he can't ever buy a house or have kids.
I guess what it all comes down to is the shareholder thing again. If you own the equipment and the reagents, you get to call the shots. That's not the way it used to be until the wave of M&A's made it the only thing that mattered. Now that R&D has been decimated and scientists are totally demoralized and left hanging without work for the past 6 years, this country may not have the research mojo for very much longer to do a full scale manhattan project on antibiotics.
A few years ago, I would have said try patent extensions and cost controls. Now, I think it's going to take an infusion of cash into private-public labs and a lot of waiting. We will all have to be very patient.