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Out of order: The cost of a free market
Everybody talks about the weather, but nobody ever does anything about it.
I’m really starting to feel the same way about the diminishing ranks of useful antibiotics and the burgeoning population of so-called superbugs—microbes that have grown resistant to the drugs of last resort.
I have been writing about and editing on this topic for a decade or so, and have unfortunately grown somewhat jaded in my beliefs on how significant this problem is and whether there is a willingness to help those afflicted with these bugs. And so, I must admit that when a news item appeared a couple of weeks ago heralding the arrival of an “untreatable” superbug in the urinary tract of a Pennsylvania woman, I offered little more than an eye roll (with honest sympathies to the woman).
The well-worn complaint about the pharma industry’s approach to antibiotics is it simply isn’t profitable to produce new antibiotics. To turn a profit from a new antibiotic, the company would have to sell so much of the stuff through over-prescribing that it would quickly become as ineffective as the drugs it replaced.
Interestingly, I am confident that many of the same people who would describe this as yet another evil from a profit-first industry are the same people who would decry any drop in the values of their pension funds, the growth and expansion of which rely on investments in pharma and biotech.
So, accepting the unprofitability of antibiotics development—and completely ignoring examples of companies actively pursuing antimicrobials—how can we ensure we are ready to treat the next generation of superbugs?
“In my opinion, society needs to move towards a defense-contractor model, in part because the economics are very difficult,” Brad Spellberg, chief medical officer at the Los Angeles County-University of Southern California Medical Center told BuzzFeed News. “I don’t think that the for-profit entrepreneurial pharma model is going to be viable.”
Spellberg and many like him have been vocal about the federal government essentially paying pharma companies to produce next-generation antibiotics and letting the drugs cost what they cost, much as the Defense Department contracts companies to produce fighter jets—and really, what is an antibiotic but a molecular fighter jet. They point to the precedent of BARDA’s contracting of anti-bioterrorism vaccine and drug production as evidence that such a system could work.
But my question is why the half-measure? (If you didn’t know before that I am Canadian, this will eliminate any doubt.)
What is stopping the U.S. federal government from getting into the antibiotics business itself? Much as with Medicare, if there is a need for intervention in the healthcare sector, intervene. (I am also pointing this finger at Health Canada and Britain’s NHS, as well as any other government.)
There are academic and government scientists across the country working on the problem of antibiotics and microbial resistance. Organizations like the U.S. Centers for Disease Control and Prevention are constantly investigating and monitoring outbreaks of new and emerging pathogens. And more individuals and non-governmental organizations could be incentivized to change directions or intensify existing programs.
As to the scale-up of any molecules that look good, there is an entire industry of CROs and CMOs that could be hired to optimize formulations, run clinical trials and produce marketable quantities as a candidate compound hits each stage. And not to eliminate pharma and biotech companies from the conversation, they too could be hired as service providers by the government.
Sure, but who would coordinate all of this? You’d need a national microbe czar.
In January, President Obama introduced the idea of a National Cancer MoonShot, asking Vice President Biden to lead the charge on a collective effort to bring cancers to heel. And although cancer remains a significant health threat in the United States, no one will argue that the problem has been lack of effort on the part of the industry or lack of profitability of current and new treatments.
I think the National Cancer MoonShot is a great idea—again, I am Canadian—but I think that as a toe in the healthcare water, it is possibly in the wrong pond. A better pond may right now be giving birth to the next generation of dengue-, Zika- and malaria-carrying mosquitoes, or laden with Clostridium, E. coli and typhus.
And if there is insufficient profit to be made from draining that pond, then maybe this isn’t a job for the free market.