This article could have been stronger

She\’s absolutely right of course. We are indeed running out of effective antibiotics.And we assuredly do need to change something so that we continue to discover new classes of them.

I have a feeling, based on no evidence at all, that the problem is at the consumption end: the incentives provided to manufacturers. I\’m unconvinced that regulated health care systems are willing to pay enough to encourage the research and development of those new classes. Anyone better informed than I am please do pitch in (and you wouldn\’t have to be very informed to be better informed than I am).

However, I think the piece could have been stronger about this point:

Back to those sniffles, then. I\’m just going to have to wait for this damn virus to get out of my system. Antibiotics aren\’t going to help, and I certainly don\’t want to become a breeding ground for a new resistant strain of bacterium.

Quite, colds, \’flu, they\’re viri* and antibiotics do precisely fuck all against them. If people demand a pill for a cold give \’em a sugar pill. Have the same effect without the resistance problem.

*And the rules about plurals of Latin words morphed into English ones be damned.

33 thoughts on “This article could have been stronger”

  1. True, but if a cold or flu blocks you up and then you get a bacterial infection in your sinuses, then you’d be the better for an antibiotic.

  2. Pharma is likely to fall off its fiscal cliff within a decade. The patent clock starts running when you register a compound. It takes roughly 10 years on average to get that compound on the market (and with ratcheting up of regulations that time is constantly getting longer) so you only get 10 years in which to recoup the development costs.

    Compare the patent system to copyright, where some rock star can gyrate in a recording studio for a couple of days and his great-grandchildren can continue to wax fat on the exclusive rights.

    The reason this situation has come about is that, apparently, evil big pharma has huge lobbying power, while Bono has none. Or something.

  3. Government constriction of drug developers is one problem.

    My niece, a prominent doctor, suggests there is a big problem with globalization. Drugs are dispersed to Third World countries, where they are improperly used (such as half-dosing), and resistance develops. Resistant strains are then spread back around the world by globalization.

  4. There’s a particular problem with antibiotics, in that if you create a marvellous new antibiotic, medical science is rightly going to want to use it as little as possible, as a “last resort” drug, so as not to create resistant bacteria. So there’s little chance of making a lot of money before the patent runs out.

    The underlying problem is that the patent system is the wrong method for encouraging drug innovation.

    Alice Roberts is right that antibiotics are overused, but the biggest problem is their routine use in agriculture – animals grow faster if you stop them getting minor infections. The EU has cut down on this (huzzah for the EU), but in the USA the FDA seems unlikely to do anything effective.

    __

    The Latin plural of ‘virus’ is an interesting question, if you’re interested in such things, as Tim is not. The word in Latin means ‘venom’, and no one ever thought to write down anything about venoms in Latin, so we don’t know what the plural would have been. Nor are there any grammatically analogous nouns with known plurals. Perhaps the best guess if you really need a Latin plural – say if you’re the Vatican – would be ‘vira’. Certainly not ‘viri’, which is the plural of ‘vir’ – man (insert joke about man-flu). The English plural is certainly ‘viruses’, and I am puzzled as to why Tim is unwilling to use it.

  5. “And the rules about plurals of Latin words morphed into English ones be damned.”
    As soon as I read that I knew there would be a PaulB post on it 🙂
    (An informative one of course.)

  6. Since v?rus is second declension, it’s plural is plainly and obviously v?r?.

    There is no spoken conflict with the plural of man, which is vir?, having a short first i.

    To be sure, they would look the same in writing without marking the long vowel, but that is language for you.

    Nevertheless, the correct English is certainly viruses, so good call, chaps.

  7. Steve M: alas no. While virus was probably second declension in Latin, it was certainly neuter. Neuter nouns do not form their nominative plurals in -i.

  8. Peak Antibiotic then, which like Peak Oil and all the other Peaks, is a movable feast.

    We have been running out of antibiotics since Penicilin was discovered, which is why there are so many, but bacteria continue to evolve and a resistant strain does not necessarily evolve with its resistance to all antibiotics intact, nor do resistant strains all survive.

    Also, if those with resistant bacteria die, then the resistant strains will die with them, and balance will be restored.

    There are few occasions when we need antibiotics, that is to say without them we would die rather than be uncomfortable until our own immune systems do the job.

  9. “I have a feeling, based on no evidence at all, that the problem is at the consumption end: the incentives provided to manufacturers. I’m unconvinced that regulated health care systems are willing to pay enough to encourage the research and development of those new classes.”

    I’m not better informed. But can you expand a little? Why do you think that? It’s got to be a little better than “regulated things are a bit lefty and I don’t like them.” Any actual evidence or prompts to make you think that?

    Like I say, I’m not informed, but curious. For instance, regulated health care systems might pay less (though a true free market ideologue/fruitcake – not you to be fair – would probably argue that due to inefficiencies they’d pay more), but the universal element might make it a bigger market, so more of an incentive.

    Have you got something other than a hunch/prejudice?

  10. So Much for Subtlety

    PaulB – “There’s a particular problem with antibiotics, in that if you create a marvellous new antibiotic, medical science is rightly going to want to use it as little as possible, as a “last resort” drug, so as not to create resistant bacteria. So there’s little chance of making a lot of money before the patent runs out.”

    They will *now* but that was obviously not the case when the first antibiotics came out. They were used with glee and abandon. So this is a consequence of the decline of antibiotics, not the cause.

    “The underlying problem is that the patent system is the wrong method for encouraging drug innovation.”

    Really? An interesting claim. Because I would have thought it was the $17 billion cost of bringing a drug to market. What do you think is the best way to fund those tests?

    “Alice Roberts is right that antibiotics are overused, but the biggest problem is their routine use in agriculture – animals grow faster if you stop them getting minor infections. The EU has cut down on this (huzzah for the EU), but in the USA the FDA seems unlikely to do anything effective.”

    I am not sure I agree. First there is little real evidence of antibiotic-relevant diseases leaping from animals to humans. It is a threat, but I am not sure anyone can point to a case where it has happened. Second, those animals often do have diseases. The more healthy they are, the better off we all are. And third, the more money people make from drugs, the better. Ideally we would just have a lot more antibiotics in the pipeline. We don’t. That is the problem. Rationing them is a second best choice.

    9 John B – “We have been running out of antibiotics since Penicilin was discovered, which is why there are so many, but bacteria continue to evolve and a resistant strain does not necessarily evolve with its resistance to all antibiotics intact, nor do resistant strains all survive.”

    Well that is not quite true. There was a real explosion of research in the 1950s that produced whole new families of antibiotics. Then at some point we peaked but it was a long time after penicillin.

    “Also, if those with resistant bacteria die, then the resistant strains will die with them, and balance will be restored.”

    If they die before they infect anyone else. Antibiotics made us lazy. This is the problem with Golden Staph. It is not hard to control, but nurses have got out of the habit. Because antibiotics were cheap. The same with TB. We know how to control this – we were doing a fine job long before antibiotics came along. But we got lazy. No doubt we will return to some of those old methods but ideally we would get new drugs too.

    11 Luke – “But can you expand a little? Why do you think that? It’s got to be a little better than “regulated things are a bit lefty and I don’t like them.” Any actual evidence or prompts to make you think that?”

    There is a large body of evidence on the problems of the expense of bringing a new drug to the market. It costs billions and takes over a decade. Ever since thalidomide, the regulations have been onerous. No one could discover penicillin now because it would never pass human trials – some percentage of people are allergic to it. Nor could aspirin – it kills guinea pigs. To get a new drug, you need to pass animal trials, then you need to pass human trials – getting permissions from the bureaucracy all along the way. Only if you pass all of those can you go to market. Now that may be sensible. It may not.

    But even if you do all that, you’re not home and free. Because if something comes up later, you’re f**ked. Take Fen-phen. A drug for the treatment of obesity which actually worked. But it turned out that despite all the tests and approvals, some tiny number of patients may have suffered damage to their heart valves – remember this is a drug for obese people, and so while there are good reasons to think the drug did damage heart valves, there may be other reasons why enormously fat people have bad hearts. It cost the company Werth some $20 billion – and when the company itself was eventually taken over a decade later, it was only worth some $68 billion.

    “For instance, regulated health care systems might pay less (though a true free market ideologue/fruitcake – not you to be fair – would probably argue that due to inefficiencies they’d pay more), but the universal element might make it a bigger market, so more of an incentive.”

    It might but I doubt it. Some regulated markets, like France, go hogwild on buying drugs. It costs French people nothing, so doctors hand them out like candy. But then you get systems like the NHS and Canada which are stingy with drugs. So companies get hit twice – they are forced to sell for a discount and then they don’t sell so much.

    No one in their right mind wants to be in the pharmaceutical business right now. The number of new drugs is dropping. Companies get sued all the time. They must be living in fear that some new problem will turn up with an old drug – there is evidence ibuprofen may cause heart damage for instance, which must scare the crap out of most producers. So they have stopped making drugs for sick people unless the State pays them. They want to make drugs for healthy people with non-problems. Viagra was wonderful. That is why you are more likely to get a new drug for depression than you are for heart disease. The only problem is that they look like they will get sued for those too.

    Thalidomide killed the industry. It has just taken it a long time to die. Death by regulation.

  11. I would have thought it was the $17 billion cost of bringing a drug to market. What do you think is the best way to fund those tests?

    The figure usually quoted by drug companies is $1.3bn. Other lower and higher estimates are available, but your number is fantasy. I’d have thought the $1.3bn sum would have been enough to make your point, so why make stuff up?

    One of the reasons why development is so expensive is that companies are putting a lot of their money into drugs which will be used for a long time by a lot of people, which is where the big money is. Since these people are, as you say, quite healthy, the benefits of the drugs are small and need very extensive trials to establish. Furthermore, the relative cost of side effects is comparatively large, increasing legal risk – patients will accept horrible side effects from chemotherapy which keeps them alive, but not from drugs taken prophylactically.

    The costs of developing drugs for sick people are somewhat lower.

    Granting monopolies, which is what the patent system does, creates horrible efficiencies. That might be a price worth paying if it were doing a good job of encouraging innovation, but as we agree, it isn’t.

    A sensible system would abolish patent protections, making all licensed drugs available for manufacture as generics, subject to quality controls (which should be better coordinated than the ones we have now). Then we would actually have a competitive market in drug manufacture, and people would be able to get drugs if they were willing to pay a fair manufacturing cost. Volumes would increase, costs would fall, everyone gains.

    That would vastly reduce drugs spending globally. Take the money the governments save (those with a large private drug-purchasing sector might choose to raise revenue by means of a new tax on it, in exchange for the much lower drug costs) and give it to a global body responsible for encouraging the creation of new drugs. It would hand out most of the money on the basis of a formula related to Quality-Adjusted Life Years gained by patients taking the drug. But it could also offer bounties for drugs such as new antibiotics even if they’re not widely used.

    There’s no alternative to heavy regulation of the pharmaceuticals market, because the what we’d get without it is competition between snake-oil salesmen. But that doesn’t mean we can’t devise a system that works. The problem is that we haven’t tried.

  12. Alice Roberts is right that antibiotics are overused, but the biggest problem is their routine use in agriculture – animals grow faster if you stop them getting minor infections.

    On what are you basing your claim that the biggest problem is antibiotics being used to treat minor infections in order that the animals grow faster? This sounds like spurious nonsense.

  13. It’s not remotely controversial that antibiotic use in agriculture creates selective pressure favouring resistant bacteria. Here‘s one paper: there are hundreds.

  14. It’s not remotely controversial that antibiotic use in agriculture creates selective pressure favouring resistant bacteria.

    No, it isn’t. But it is your claim that farmers overuse them to treat minor infections in order that the animals’ growth is not slowed which is spurious nonsense.

  15. You mean as in completely and undisputably true? Here‘s a review of the practice:

    antibiotics are eight times more likely to be used for non-therapeutic purposes than for treating a sick animal.

    And here‘s a recent FDA report disrecommending the practice. In a non-binding way of course, mustn’t upset the agriculture lobby.

  16. Perhaps I should clarify that this use isn’t to treat anything: that’s not what I wrote. It’s prophylactic – they put it in the feed.

  17. You mean as in completely and undisputably true? Here‘s a review of the practice:

    No, this is a link to an assertion. Allow me to complete your quote (the beginning of which you mysteriously omitted):

    According to estimates, antibiotics are eight times more likely to be used for non-therapeutic purposes than for treating a sick animal.

    According to estimates? Which estimates? And why only estimates? Where is the data? The article is bloody awful. I mean:

    As much as 90 percent of antibiotics given to livestock are excreted into the environment. Resistance spreads directly by contact and indirectly through the food chain, water, air, and manured and sludge-fertilized soils.

    Really? Where is the evidence that resistance to antibiotics is spreading through the air and soil having been excreted by a cow?

    So this is what you mean by “completely and undisputably true”?

  18. What I’m saying is not remotely controversial. Google
    <>
    Then tell us again that all those articles and papers are talking about “spurious nonsense”.

  19. Ah, so now I am expected to go Googling for evidence in support of your nonsense? Nope, I’ll just stick to calling you out on it. If you want to go Googling, do it yourself.

  20. ok, here‘s the first hit for the search I suggested:

    Antibiotic growth promotion in agricultural animal production has been practiced for about 50 yr in the United States and other countries.

    Here‘s the second

    According to the National Office of Animal Health (NOAH, 2001), antibiotic growth promoters are used to “help growing animals digest their food more efficiently, get maximum benefit from it and allow them to develop into strong and healthy individuals”

    The third (from 1999)

    A bill aimed at ending the routine use of antibiotics in farm animals is being introduced in the UK House of Commons.

    It calls for an end to the use of growth-promoting antibiotics in livestock and for restrictions on the routine use of antibiotics for disease prevention on farms

    The decent thing for you to do now would be admit that you’ve got this completely wrong.

    tim adds: I’ve only bothered to look up the third of these. But, really, to be honest, a BBC report on a “bill that has been intorduced into Pariliament”, one that is, by their own admission, supported by

    “The bill is sponsored by Bill Etherington, Labour MP for Sunderland North, supported by five other Labour MPs and one Lib-Dem. ”

    Isn’t actually proof of any scientific contention.

    “Richard Young, of the Soil Association, said: “The use of antibiotics on farms is causing bacteria to become resistant, and that resistance can pass to humans through the food chain. ”

    Soil Association? The trade union for non-antibiotic using farmers?

    This just isn’t dispassionate evidence.

    FFS, P has Michael Meacher in it, arguing that Ritchie’s law should be passed. This isn’t proof of anything other than how stupid politicians are.

  21. The decent thing for you to do now would be admit that you’ve got this completely wrong.

    Right, let’s look at your original claim:

    Alice Roberts is right that antibiotics are overused, but the biggest problem is their routine use in agriculture – animals grow faster if you stop them getting minor infections.

    Which I said was spurious nonsense. So, rather than sending me off on wild goose chases around Google, how about you:

    1. State which antibiotics have been rendered ineffective by such practices, citing evidence confirming that agricultural use was the reason for such.
    2. State which diseases have been found, conclusively, to have become immune to antibiotics as a result of their oversuse in agriculture.
    3. Cite evidence which conclusively shows that the overuse of antibiotics in agriculture is “the biggest problem” in their becoming ineffective against human diseases.

    Otherwise, the decent thing for you to do is admit you are a pompous ass who doesn’t have the first fucking clue what you’re talking about.

  22. it is your claim that farmers overuse them to treat minor infections in order that the animals’ growth is not slowed which is spurious nonsense

    You’ve repeatedly accused me of “spurious nonsense” for saying that antibiotics are used to promote growth in farm animals. And I’ve demonstrated that what I said is precisely true. Instead of backing off, you come back with a smokescreen of demands and abuse.

    It’s not my style to get sweary on the internet. You know what you are. We’ll leave it at that.

  23. And I’ve demonstrated that what I said is precisely true.

    No, you haven’t. You have done no such thing, as I have amply demonstrated in post no. 24.

    Instead of backing off, you come back with a smokescreen of demands and abuse.

    Translation: you called me out on my bullshit.

    It’s not my style to get sweary on the internet. You know what you are. We’ll leave it at that.

    No, your style is to be a pompous ass and run away, offering flimsy excuses, having been caught out spouting nonsense. You certainly have form in this area.

  24. You say that antibiotics are not used as growth promoters in animal feed.

    Where did I say that? Oh, I didn’t. More bullshit.

    For clarity, refer to post 24. Put up, or shut up.

  25. No, it didn’t. The claim that farmers overuse antibiotics in order to treat minor infections so that they don’t slow down growth is spurious nonsense. This is a different prospect from adding antibiotic growth promoters to animal feed, but this is what I assumed you meant from your initial post.

    Glad we got that out of the way.

    Now, in case you missed it, here’s what you actually wrote in your initial post:

    Alice Roberts is right that antibiotics are overused, but the biggest problem is their routine use in agriculture – animals grow faster if you stop them getting minor infections.

    Now, also in case you missed it, I am asking you to:

    1. State which antibiotics have been rendered ineffective by such practices, citing evidence confirming that agricultural use was the reason for such.

    2. State which diseases have been found, conclusively, to have become immune to antibiotics as a result of their oversuse in agriculture.

    3. Cite evidence which conclusively shows that the overuse of antibiotics in agriculture is “the biggest problem” in their becoming ineffective against human diseases.

    So, enough pomposity, enough wriggling: put up, or shut up.

  26. So we agree (hallelujah) that antibiotics are routinely fed to farm animals: the bit that’s spurious nonsense is “in order to treat minor infections”. And that’s something you wrote, not me. I said all along that the antibiotics are prophylactic.

    You’ve established to your complete satisfaction that you talk spurious nonsense.

    This thread is too old now to start a debate on the other points you raise. Suffice it to say that the EU has banned the use of antibiotic growth promoters, and the FDA is discouraging it. If you think they’ve got the science wrong, I suggest you take it up with them.

  27. So we agree (hallelujah) that antibiotics are routinely fed to farm animals:

    Right. But the issue is that you brought it up in a discussion about diseases becoming resistant to antibiotics and that the “biggest problem” is their routine use in agriculture. And this is something you have utterly failed to substantiate.

    the bit that’s spurious nonsense is “in order to treat minor infections”. And that’s something you wrote, not me.

    This approach might work were the thread not there for all to see. You used the term “minor infections”. True, you did not use the word “treat”, but it was a fair assumption in the absence of anything else.

    I said all along that the antibiotics are prophylactic.

    Again your memory and eyesight are failing you. You only mentioned that you were talking about prophylactics in your third post responding to me.

    This thread is too old now to start a debate on the other points you raise.

    Well how convenient! You bluster and pontificate rather than substantiating your nonsense, and then declare the thread too old!

    Put up, or shut up.

  28. As you say, the thread is here for everyone to see. And it shows – you even quoted it just above – that I wrote “stop them getting minor infections”. And prophylaxis means “preventive treatment against diseases”.

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