Posted in Rants on July 29th, 2013 by Ed

Several summers ago I contracted two relatively rare infectious diseases at the same time…and right on the tail end of a long bout with mononucleosis. Despite being what the medical profession would consider Young and Healthy at the time (I believe I was 27) the one-two-three punch did a good job of overwhelming my body. At one point I was checked into a hospital with a fever of 105.2 F (40.6 C), which, in medical terminology, is balls high. Had I been very young, very old, or immunocompromised, the phrase "life threatening" would have been used.

For all the flaws of the American health care system, one thing it does pretty well is avoiding the overuse of antibiotics to prevent resistance from developing among infectious agents. Actually, it prescribes some of the common antibiotics (amoxicillin and other penicillin derivatives in particular) like candy. Azithromycin is a first-line treatment now for things as common as strep throat. But the formidable antibiotics of last resort, the "You can have this if you're about to die" drugs, are used more judiciously.

If common sense doesn't dictate this, cost does. I was finally given a course of vancomycin, a staggeringly expensive former last-stand antibiotic. After a few decades, resistance developed and it is now used as an intermediate step between common antibiotics and new "Oh shit" drugs like Zyvox. To skip forward to the very obvious ending, I didn't die.

Vancomycin had a good run. Its four-figure per-dose cost helped doctors ration it and lower the odds of resistance developing. But pathogens will develop resistance to any drug if given enough time, which is why pharmaceutical companies are constantly hard at work on new antibiotics, antivirals, and antiparasitics to stay ahead of the emergence of new infectious threats.

Wait. What I meant was, pharmaceutical companies don't do that at all. I apologize for the confusion.

Nature is shining the spotlight on the development of bacteria that are impervious to the current drugs of last resort, the carbapenems. If penicillin and chicken noodle soup are the Maginot Line against infections, the carbapenems are Dunkirk without the ships. If the carbapenems don't work, medical science can't kick it up another notch. The next step is prayer, and after that is death. Help is not on the way:

It seems unlikely that new drugs will become available soon. Perversely, the rapid advance of resistance and the consequent need to use these drugs sparingly has convinced pharmaceutical companies that antibiotics are not worth the investment.

The Nature piece is well-timed, as I was just having this conversation with a biologist-friend a few days ago. In it I was stunned to learn that, no, Big Pharma is not hard at work on the next wonder drugs. It turns out that there isn't much money to be made from antibiotics, and until recently it seemed like the extant options were working pretty well. Additionally – and this is far beyond my level of knowledge to judge – developing novel antibiotics is challenging. Certainly it's more challenging than the alternatives. The cost-benefit ratio does not support large investments in antibiotics.

Thanks to the glories of our free market, for-profit medical-pharmaceutical complex, we may not have any new antibiotics but we have plenty of new Magic Dick Pills, weight loss drugs, statins (Eat whatever you want!), indigestion remedies (And eat all of it!), chemical means of growing and removing hair, and a prescription drug to treat the scourge of insufficient eyelashes. By leaving the industry to its own devices we are guaranteed the absolute best possible treatments for our most profitable lifestyle diseases. Meanwhile, government research money is directed toward drug treatments for the medical conditions with the best PR team, which is why cancer research is absolutely awash in money with almost nothing to show for it in the last two decades. Oh, and no one cares about AIDS anymore. It needs a new celebrity victim, I guess.

Meanwhile we find ourselves on the brink of a potential public health catastrophe. The invisible hand does indeed allocate the efforts of private industry to the best possible uses, as long as "best" and "most profitable" can be used interchangeably. That's swell until the medical community finds itself with some rather unprofitable and unglamorous needs, exposing the flaws in our system of entrusting the direction of medical research to the whims of an article of right-wing religious faith.