The perverse economics of the antibiotics industry means the human race could be in trouble
Bacteria are outsmarting our drugs.
(Joe Raedle/Getty Images)
R
ight
now, humanity is engaged in an epic battle against fast-adapting and
merciless predators. No, zombies are not beating down doors to tear
chunks of flesh out of the living. Rather, humanity is being hunted by
deadly pathogenic bacteria that have gained resistance to antibiotics.
And thanks to the peculiar incentives
that drive the pharmaceutical industry, it looks like the cavalry may be
a long time in coming.
To understand the current state of the antibiotics market, we have to go back millennia. Humans have co-existed with bacteria throughout our history. They live in our bodies from birth to death. It’s estimated that up to three percent of a typical human's body mass is made up of symbiotic bacteria, which assist us with bodily functions like digesting food.
Most bacteria in the human body are kept in check by the
body’s immune system. But bacteria are constantly evolving to survive
and reproduce. Either the immune system successfully adapts to new
threats, or the body risks being overrun. Sometimes the immune system
will fail to respond to a novel bacterial threat, allowing the bacteria
to kill the host.
Before antibiotics were widely available,
any accident, injury, or medical procedure that allowed pathogenic
bacteria into the body was potentially deadly. One in nine skin
infections was fatal. One in three cases of pneumonia led to death.
Invasive surgeries including caesarean sections left the patient open to
killer infections. Insect bites, burns, and blood transfusions
frequently became a source of infection.
So the discovery of the first antibiotic, penicillin, by Alexander Fleming in 1928 remains one of the high points in medical history.
Antibiotics kill bacteria, which meant wounds were no longer death
sentences. Yet when Fleming won the Nobel Prize for medicine in 1945, he
warned of the dangers of antibiotic resistance:
It is not
difficult to make microbes resistant to penicillin in the laboratory by
exposing them to concentrations not sufficient to kill them… There is
the danger that the ignorant man may easily underdose himself and by
exposing his microbes to non-lethal quantities of the drug make them
resistant. [NobelPrize.org]
Fleming’s prediction was right.
Penicillin-resistant bacteria arrived while the drug was still being
given to only a few patients. Each new class of antibiotics since then
has soon been greeted by resistant bacteria.
One breeding ground for
antibiotic-resistant bacteria is in farm animals. Low doses of
antibiotics have been used since the 1950s to enhance growth. In the
U.S., over 80 percent
of all antibiotics are now used on farm animals. But low doses
encourage resistance, just as Fleming warned. Recent studies show that
antibiotic-resistant bacteria have been found widely in farm animals raised for meat, as well as wild animals, including crows, foxes, and sharks.
Scientists are fighting a running evolutionary battle with the bugs. A patient in New Zealand died this year
after contracting an infection resistant to all known antibiotics.
Doctors declared him the first patient of the "post-antibiotic era." The Centers for Disease Control and Prevention
recently warned that drug-resistant bacteria kill at least 23,000
people annually in the U.S, and cost the health care system $20 billion
per year.
Unfortunately for the human race, research into antibiotics remains costly. One estimate
suggests that the cost of bringing a new antibiotic to market is over
$1 billion, and that new antibiotics lose $50 million on average. There
are far more profitable drugs for pharmaceutical companies to throw
money at, since antibiotics are usually single-serve drugs for humans,
not long-term treatments.
Drugs for chronic conditions tend to be
more profitable. And with drug resistance quickly evolving, rendering
older antibiotics ineffective, pharmaceutical companies have even less
incentive to invest in the drugs.
The economics are perverse. Taking
preventative action today would not be very profitable because there are
fewer potential customers. The incentives to produce more and better
antibiotics only kick in under the worst circumstances, when millions of
people are dying from antibiotic-resistant infections.
With investment, there would be plenty of
reasons to be optimistic about the future. New antibiotics today are
typically discovered by culturing bacteria in a laboratory, and
scientists so far have cultured less than one percent of the bacterial
species on the planet, meaning there is still a huge pool of
possibilities out there that remains untested.
There are also a large variety of organic compounds — for example, from insects — that may hold promise as antibacterials. Some scientists are even looking into the possibility of using nanotechnology to fight bacteria
— tiny machines that can hunt down pathogenic bacteria and destroy
them. Sooner or later, one of these approaches may yield an innovation
that pathogenic bacteria cannot develop resistance to.
In July 2012, President Obama signed the GAIN (Generating Antibiotic Incentives Now) Act, a bipartisan bill to fast-track the creation of new antibiotics. Twelve new antibiotics in development have so far received fast-track status, which should speed up the approval of new drugs for difficult-to-treat conditions.
But whether the law will be sufficient to
create enough new antibiotics to win the evolutionary arms race remains
to be seen. Developing antibiotics is still expensive, and the
antibiotics that we do have are still being over-prescribed for humans and doled out in sub-clinical doses to farm animals — both of which gives bacteria opportunities to develop resistance.
If the problem continues to grow, the
U.S. and other countries will have to invest a whole lot more in
antimicrobial technologies, or create incentives for Big Pharma to do
so. Like the zombie apocalypse, the post-antibiotic world would not be a
pretty place to live in.
John Aziz is the economics and business correspondent at TheWeek.com. He is also an associate editor at Pieria.co.uk. Previously his work has appeared on Business Insider, Zero Hedge, and Noahpinion.
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