Flogging a dead horse
I’ve written about the subject before, I’ll do it again even if it doesn’t really make any difference. Here’s a great piece Maryn McKenna (via Ed Yong). A quote from Hughes’ op-ed which she links to in her article:
“From 1983 to 1987, 16 new antibiotics were approved by the US Food and Drug Administration (FDA); from 2003 to 2007, just 5 were approved. Since 2008, only 2 have been approved”
Here’s a quote from McKenna’s piece:
“Drug resistance is a biologic inevitability — but in the 83-year history of the antibiotic miracle, starting from Fleming’s first recognition of natural penicillin, whenever resistance made one drug useless, another drug came along to save us. Those days are over.
Think for a moment like a pharma company. It’s generally accepted that it takes 10 years and about $1 billion to get a new drug from concept to marketplace. At the end of that investment of time and money, you’re left with a drug that is only taken for weeks at a time, that bacteria will develop some resistance to within a year, that doctors will cease to prescribe once approximately 20 percent of infections demonstrate resistance — and which, if it’s a very, very promising drug, doctors may not prescribe at all, because they want to preserve it for the most dire cases.
if you were a shareholder in that hypothetical company, wouldn’t you want them to make Viagra instead?”
One might ask if that hasn’t always been the case, ie. that there’s always been a trifecta of short time of treatment, risk of low sales even if drug is effective and high fixed costs related to treatment of infectious disease, and if so why did pharma-companies keep developing new drugs before? One reason things have changed is that the alternative potential profits from developing drugs treating life-style related diseases have increased dramatically. Another reason is that the development costs have increased over time, in part because the demands related to obtaining FDA-approval of a drug have increased over time. No matter why things have changed though, there’s no doubt they have; the number of new drugs which were approved in 2003-2007 was less than one third the number of drugs which were approved 20 years earlier in a similar amount of time.
Do remember that this problem is not just related to the fact that, well, bacterial infections kill people. Lots of people. Some infections don’t but that doesn’t mean they can’t be pretty damn bad anyway because of quality of life-issues; ask the deaf kid who went through an untreated ear infection causing hearing loss. But a major problem is also that a lot of medical advances made over the years depend crucially on the ability of doctor’s to deal with infections. Hughes gives the examples of “cancer treatment, surgery, transplantation, and neonatal care” in his piece; that list is not exhaustive, for instance the most common treatment of autoimmune diseases, which are caused by an overactive immune system (roughly speaking), is immunosuppression – which increases the risk of bacterial infection. And yes, there are a lot of autoimmune diseases out there.
Btw, according to McKenna antibiotics aren’t the only drugs we are running out of.