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Imagining the Post-Antibiotic Future
Hugh Pickens DOT Com writes "Health authorities have been struggling to convince the public that the threat of totally drug-resistant bacteria is a crisis. Earlier this year, British chief medical officer Sally Davies described resistance to antibiotics as a 'catastrophic global threat' that should be ranked alongside terrorism. In September, Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: 'If we're not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.' Now Maryn McKenna writes that we are on the verge of entering a new era in history and asks us to imagine what our lives would be like if we really lost antibiotics to advancing drug resistance. We'll not just lose the ability to treat infectious disease; that's obvious. But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. We'll lose any treatment that relies on a permanent port into the bloodstream — for instance, kidney dialysis. We'd lose any major open-cavity surgery, on the heart, the lungs, the abdomen. We'd lose implantable devices: new hips, new knees, new heart valves. We'd lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We'd lose the safety of modern childbirth. We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. 'And it wouldn't be just meat. Antibiotics are used in plant agriculture as well, especially on fruit. Right now, a drug-resistant version of the bacterial disease fire blight is attacking American apple crops,' writes McKenna. 'There's currently one drug left to fight it.'"
If this is a threat that "should be ranked alongside terrorism" then I'm not even going to waste my time reading about it.
Will the market save us by producing something be it at a price, or, is this too big and needs to be done by government money and research?
Antibiotics are arguably an example of a situation that (while not meeting the classic definition of 'market failure') is not a market victory.
If the price of an antibiotic is relatively low, it becomes economically viable as a growth enhancer/mortality reducer in high-density agricultural applications, likely burning through its effectiveness relatively quickly (with some help from being handed out to treat patients whining about the sniffles and being reflexively used on basically anybody admitted to a hospital; but veterinary uses are the big one). If the price is relatively high, you see a strong incentive for poorer users (especially in the 'developing' world) to try to make do by 'stretching' inadequate supplies across longer times or more patients than the supplies can provide adequate doses for. You also have more incentive for diluted and fraudulently labelled, or outright faked, versions to make it into the supply chain.
On the supply side, I don't know why it isn't working; whether biology is just being a stubborn bastard and we'd need to throw ten times as many scientists at the problem, or whether the ROI on penis pills and hair loss and pimping minor rebadges of old drugs is better than doing research; but the steady advances in increasingly resistant bacteria have not caused the invisible hand to keep pace with new drugs (particularly new drugs with novel mechanisms, which would get us further ahead in the arms race than incremental tweaks on resistance-threatened mechanisms.)
Hopefully our biotech is starting to get to the point where we can tailor viruses to specific targets, at least some of the time. Things like this give me some hope. If we can do that, we can do at least some of that kind of tailoring.
PHEM - party like it's 1997-2003!
The summary says:
We'd lose a good portion of our cheap modern food supply because most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock
This the source of the problem, not the effect.
Yes, it does turn out that dosing meat animals with antibiotics even when they are not sick will increase their weight (and hence production) by about 10%, This is a small increase-- but the margin on meat production is low enough that it makes a difference in profitability, and hence if some of the farms do it, pretty much all of them follow.
So, we're losing the ability to use antibiotics because we're spraying them across the landscape, not to cure sickness, but as a fattening agent for cattle.
and protect them from the conditions in which the animals are raised.
This is actually a much smaller use of antibiotics. But, yes, the idea is that we can save money by not bothering with sanitation and health in cattle, but instead just dose them with antibiotics.
Anonymous wrote:
As ranching employs a significant number of people in some states, and agrobusiness has great clout with Congress, this just isn't going to happen. Plus, the average American is not going to accept such a sudden stop to his high meat intake.
Actually, it's a very small effect-- eliminating antibiotic use on cattle would have only a trivial effect on price. The problem is that the low margin on meat production means that if one cattle-production factory does it, everybody has to do so to keep up.
http://www.geoffreylandis.com
Not a market victory, but a classic game theory problem.
With antibiotics in industry, it is in any individual company's best interest to have everyone else move away from it. If a company uses lots of antibiotics while others do not, not only does it make their own product cheaper and fattier, but they will get more time out of the antibiotics. So no company (outside luxury brands) has an interest in being the one or group of ones to stop the practice since all it will do is help some competitor who does not play along. Same goes in health care unfortunately.
The market is definitely causing this. True story:
I know a guy who is a MD and worked most of his career as an antibiotic researcher. His team came up with a new antibiotic that killed everything they tested it on. When he brought the research to the VPs and the CEO, the CEO told him, "You expect me to spend millions of dollars to bring this drug to market only to have the damn doctors keep it in reserve so they can use it as a last resort?"
So, yeah this is a market epic fail. ROI > life. To the morons running these companies, the equation is as simple as that.