Bacterial resistance to antibiotics is becoming a bigger and bigger issue these days. (See here for the Wiki article on the subject.) I’m wondering how bad it’s likely to get.
I suppose the doomsday scenario is that all antibiotics are rendered ineffective, and we return to the pre-antibiotic age. But I’m wondering if scientists have made assessments of what’s the most likely ultimate outcome in this area.
Well, antibiotics isn’t my particular area, but from a business perspective it gets interesting and difficult.
For a long time, the antibiotics we had were very effective, and so there wasn’t a huge drive for companies to invest in researching new ones. Now, as resistance has become more of an issue, the opposite problem emerges: When a new antibiotic is developed, there is a desire to keep it in reserve to prevent resistance from developing. But, in keeping it in reserve, the market opportunity is diminished, and therefore the incentive to develop them is likewise diminished. A bit of a sticky wicket. One option is to treat new antibiotics like orphan drugs, whereby the use would be limited but the cost (relatively) exorbitant, but that tends to set people off for both the right and wrong reasons. Plus, poor people without [adequate] insurance could need these products as likely as anyone else.
I believe that new antibiotics is a good example of where a public approach makes a lot of sense. The government, or perhaps a consortium of governments, could fund the development of these and then dictate appropriate use because the profit motive would be out of the picture.
To more specifically answer your question: I believe that there are still opportunities to develop novel and effective antibiotics, and these can stave off the doomsday scenario. But, with each succeeding generation of drug, the next hurdle is that much higher. If we don’t manage the armory, we’ll eventually run out of powder and lose the war.
The research budget for finding new antibiotics is small. Pharma companies are mainly very uninterested. They don’t see the required huge return on investment for a new antibiotic. After all, a new, expensive, antibiotic isn’t going to be prescribed a lot and even then is only taken for a couple weeks. Their main goal is develop something that a large percentage of the population is going to be prescribed on a daily basis.
The new(er) antibiotics are frightfully expensive, too. They are usually dosed IV-only, frequently have terrible side effects, and are often hundreds of dollars a dose.
:mad:
In some cases, they’re bringing back old antibiotics, the ones we stopped using (or cut back drastically) because they became ineffective, must be dosed multiple times daily, have nasty side effects, etc. because it’s been long enough that they now work.
The main misuse isn’t even in people. It’s inappropriate use in livestock. Factory farming is a major culprit; however, poultry feed is often dosed with subtherapeutic amounts of tetracycline because it’s been discovered that this drug makes chickens grow faster. :eek: The difference IMNSHO does not justify its use for this reason.
Forgive me, but while you’re right about research for new antibiotics being limited, the pharma companies like many small patient populations very much. Orphan Drugs, those that treat a small patient population are the big movers in the industry because there are special IP and marketing protections which were intended to encourage companies to develop treatment for these. It may be a case of good intentions driving good results, but at tremendous expense to the overall healthcare budget. Cystic Fibrosis treatments are often held as an example of the way the orphan drug designation has helped a patient population.
On the other hand, Gaucher’s Disease has printed money for Genzyme for years and years. They are able to charge $200,000 - $250,000 per year per person (with the disease) and you pay or you die (or at least long-suffer)
I started out my working life as a research microbiologist and find it fascinating that we have overused antibiotics and underused vaccines. We have squandered two of the most significant advances in medicine.
I don’t think we will revert fully to pre-antibiotic days but we may find old diseases (like TB) coming back and some types of surgery become impossible.
In one of Paul Theroux’s stories, he relates how doctors in India will write prescriptions for antibiotics-for just about anything (COMMON COLDS, ETC.0. THIS CAN’T BE GOOD).
Aren’t people with this, and some other rare metabolic diseases, usually totally disabled anyway? I do know that in some states, if you have any of a list of diseases, you are automatically eligible for Medicaid regardless of your income or assets. The most common disease is hemophilia, which also costs millions of dollars over a lifetime to treat; in many cases, Medicaid only pays for treatment of said disease, but in any case, it’s been a lifesaver on many levels for lots of people.
I don’t know a lot about how medicaid works, but I don’t doubt that people with debilitating diseases are insured through it. But nonetheless, costs need to be considered in the aggregate because in the end we’re all swimming in the same pool.
Besides, the point I was making was just that small population diseases can be big dollars for the pharmaceutical companies. Most people don’t know that.
There was a very short article in, I think, last months Popular Science about new antibiotics that will address this problem. In essence, as I understood it anyway, these new drugs will have multiple “hooks” that can attach to a single bacteria. The idea being that the bacteria will have a much harder time adapting.
I have no idea how reasonable/likely/possible/etc this is but it was thrown out there.
One of the points made in an earlier thread on this subject was that a great many of things legitimately treated with antimicrobials are unlikely to become a problem with resistance. Simply because they don’t involve an animal vector. We won’t see a return to the days where a scratch on a rose thorn becomes infected sees off the victim with sepsis.
This isn’t to diminish the thread of the resistant strains of those bacteria, viruses and fungi that are resistant. Worst case may be a dual world - treatable infections, and untreatable. Whilst we have a vastly better understanding of epidemiology and the nature of the threat, modern values make it much harder to enact many of the more draconian measures that may be needed to control things.
It is hard to imagine the re-establishment of sanatoria across the planet and consigning TB patients to them to die.
The manner in which modern hospitals become ridden with MRSA is an example of how hard things are to control as well. Controlling MRSA probably will require more than just new antibiotics.
Maybe we can rotate antibiotics like farmers rotate crops to not ruin soil. Use a batch for a number of years then temporarily retire them when bacteria become resistant. Bring the old ones back decades later when they are effective again. You’d have a number of different drugs “in the bullpen” so to speak over the years. That seems like a good long-term solution to me, but what do I know.
One of the recent Radiolab’s talks about this exact strategy but also incorporating ancient remedies. It’s an interesting show and very relevant to this thread. Highly recommended: