You’d, sorta, maybe, hope that an outlet like Wired could manage to get the complicated bits right.
But for more than two decades, the household-name pharmaceutical firms that used to lead the market—Eli Lilly and Company, Bristol Myers Squibb, Wyeth, and Novartis, among others—have been backing out of antibiotic production. The underlying reason: simple math. A team of economists estimated in 2016 that it costs $1.4 billion to bring any new drug to market, including a new antibiotic. Yet antibiotics aren’t taken in the volume that, say, cardiovascular drugs are, and don’t command the stratospheric prices of new cancer therapies. Once they pass FDA approval, they earn money slowly. This triggers a fatal mismatch between expenditure and earnings: By one estimate, a new antibiotic has to earn $300 million a year to break even—yet industry records show that few make even $100 million a year.
No, that’s not right. We want the new antibiotics developed, sure. But we DON’T want them used. We want them to be available, but unused, so that we can roll them out occasionally for those few infections that are immune to earlier antibiotics. For, amazingly, it’s use which leads to the immunity, so, to safeguard the usefulness we should use them sparingly to not at all.
“The market is broken,” says Zachary Zimmerman, cofounder and director of the small antibiotic firm Forge Therapeutics, which currently has two new antibiotics under development. “So what we need to do is take the market out of the equation.”
And that’s the sort of cunt that doesn’t help either. Adjustments to the market, sure. None? Tosser.
You really want to produce a drug that a lot of people have to take every day. Repeat prescriptions are the charm. Insulin, statins, omeprazole. Things you take for the rest of your life. They do have to work to some extent, can’t have the customers dying too soon.
In a sense there maybe a point here as the current market means the best outcome for the patient (cure) is not the the best outcome for the supplier (lifetime/long term treatment).
In the case of antibiotics if we want to develop and not use them for now then the current market structure doesn’t work and there needs to be a mechanism to make it worthwhile doing the development and then sitting it on a shelf
and don’t command the stratospheric prices of new cancer therapies
If £50K or so is an acceptable price to treat a kid with a life-saving cancer drug, then so is £50K for an antibiotic if the kid instead has a serious multi-drug resistant staphylococcus infection.
Certainly the parents of the latter kid wouldn’t make any distinction between the types of drug, so who or what is preventing that price signal reaching the drug developers?
Usage levels. New antibiotics simply aren;t used – for the above reason I explained – in the volumes to make the sums add up.
Yep.
Unused/surge capacity is a problem in healthcare in a number of areas, one example is the level of ICU beds as you really don’t want to hit 100% utilisation too often, but then you have administrators complaining about empty beds and missing the point that utilisation rates don’t apply to all scenarios
Really it’s just the same as taking out insurance, hope to never have to use it, but good to have it in place if you do
“They do have to work to some extent”: statins seem to be nearly exempt from that requirement. They do seem to save some people who have already had a heart attack from another one but the effect is weak.. Apparently the mechanism is nothing to do with cholesterol, but reflects the anti-inflammatory property of statins.
But what you want is that they reduce all-cause mortality, and – if I remember correctly – they don’t. Though – and this will please BiS – there’s a bunch at Oxford who claim to be able to torture data to persuade themselves that statins are wunnerful.
The blogger to follow is Malcolm Kendrick who will someday be jailed for daring to be a doctor who pursues logic and evidence in a disinterested fashion, and then speaking his mind about it.
“For, amazingly, it’s large-scale, incorrect use which leads to the immunity,”
Pendantic fix, but..
Correct use of antibiotics does not promote resistance all that much.
The few bacteria that do develop/borrow it generally wouldn’t get the chance to propagate. Shouldn’t if correct medical protocol is followed.
It’s the buggering up of.. that’s got us in the current resistance pickle. Not in part helped by the selfsame pharmaceutical companies that promote using their stuff for everything, especially in the past…
And the best thing to fight bacteria is actually bacteriophages. The Soviets Were Right there..
Can’t wait what the Conspirationists and Fuckwits make of that one, given the sheer creative insanity evidenced around the RNA vaccines..
The one thing I’ve always been taught about antibiotics is: don’t use them as a scattergun, and always take them to the end of the course, well past any symptoms have gone.
Ok, two things. And don’t flush them down the toilet.
Nurse! Bring the comfy chair!
Possibly I’m a cunt too, but I don’t see how we can expect ‘the market’ to spend billions on new antibiotics only to keep them up our collective sleeve for emergencies; all the while with the patent clock ticking. Maybe the cunts are right on this one?
There needs to be a solution, certainly. But when someone says “the market has failed” then they mean that we’d better get the government, the bureaucracy, to do it. And the correct answer is to carefully construct the market so as to make it work. Just like we do with patents on drugs in the first place.
So that’s a yes?
@wd
They’re right something needs to be done and the doer is going to be the government. And in its current structure the market is failing. I think Tim is being harsh on those pointing the current problems out since it’s a common pattern that someone says this stuff and really means something like “the government should nationalise the pharma companies, all pharma research should be state-directed from now on, and we’ll abolish patents on treatments and sell drugs at cost price”. Which I don’t think Tim is alone in thinking would make matters worse… I suspect if the call was something more explicitly like “governments should fund incentives for the development of new antiobiotics to add to our arsenal but not use until we need them, so that pharma companies direct more research in that direction” then Tim would snark less at it.
Tim would not just snark less at it Tim has actually proposed something like that.
2012: https://www.forbes.com/sites/timworstall/2012/04/07/antibiotic-resistance-were-all-gonna-die/
2014: https://www.forbes.com/sites/timworstall/2014/05/03/why-were-running-out-of-antibiotics-is-an-economic-problem-not-a-medical-or-pharmaceutical-one/
2019: https://capx.co/antibiotics-and-the-limits-of-the-free-market/
Darwin: organisms that by gene mutation acquire characteristics that make them best adapted to their environment will be the most effective at reproducing.
Therefore: a bacterium or virus which causes least harm to its host, does not reduce mobility, does not invite treatment, does not kill will spread faster and wider than one that immobilises, causes severe symptoms, kills.
A faster transmitting virus or bacterium is not more dangerous, it is less and its transmission should not be prevented by vaccination or antibiotics just for the sake of it.
Because: the bacteria/virus market is very competitive, so the faster spreading – least harmful – pathogens crowd out the more harmful.
Example: influenza a more severe disease-causing virus across the population than the milder CoV 2, virtually disappeared during the Winters of 2020 and 2021 because various even milder CoV 2 variants moved in, and they in turn crowded out the earlier less mild CoV 2 versions.
So: antibiotic resistant bacteria will die out by immobilising or killing their hosts and be replaced with less aggressive and antibiotic responsive mutations.
For sure the pharma companies know this, and there are now so many generic antibiotics available to cover a wide range of bacterial infections, developing new ones for a small few who won’t respond to these just isn’t worth it.
I worked in healthcare starting in 1970 – coming antibiotic resistant Armageddon has been announced at regular intervals since then – like Peak Oil and Climate Change… always coming; never arriving.
Well, I have a potentially fatal multidrug resistant infection acquired during a short stay in hospital so I am in favour of the development of new 3rd line antibiotics. As both Tim and the scientist point out these cost a great deal to produce and the goal is not to use them. It is not unreasonable to say that there is a market failure.
No. “This version of market structure has failed” or “is failing” is correct. In the sense that it’s not producing the result we desire. But that is not the same as “market failure” which all too many take to mean “all markets will fail at trying to solve this problem”. Sometimes that second is even true. But the assumption that “this structure” means “all market structures” is in itself a logical failure.
Tim; stop digging.