Beware the Superbug
posted by Frank Pasquale
If you or a relative has ever been stuck in an intensive care unit with MRSA, you know how terrible an experience that is. According to Jerome Groopman, it’s probably about to become a much more common one in the US–thanks in part to a pervasive anti-regulatory mindset and multiple failures to publicly invest in drug research the private sector will not support:
[S]tudies. . . . on how often, and for how long, antibiotics should be prescribed . . . are much easier to conduct in countries where medicine is largely socialized and prescriptions are tightly regulated. . . . In Sweden, the government closely monitors all infections, and has the power to intervene as needed. “Our infection-control people have a lot of authority,” Giske said. “This is power from the legislation.” Once a resistant microbe is identified, stringent protocols are put in place, with dramatic results. Fewer than two per cent of the staphylococci in Sweden are MRSA, compared with sixty per cent in the United States. . . .
In the past, large pharmaceutical companies were the primary sources of antibiotic research. But many of these companies have abandoned the field. . . .Drug companies are looking for blockbuster therapies that must be taken daily for decades, drugs like Lipitor, for high cholesterol, or Zyprexa, for psychiatric disorders, used by millions of people and generating many billions of dollars each year. Antibiotics are used to treat infections, and are therefore prescribed only for days or weeks. . . . [Public-private partnerships can start to fill that gap, but] “The difficulty that we are faced with is that our budget has been flat for the last five years,” [NIAID Director Anthony] Fauci told me. “In real dollars, we’ve lost almost fifteen per cent purchasing power,” because of an inflation index of about three per cent for biomedical research and development.
Won’t Grover Norquist be proud of this budget-balancing triumph?
As Kevin Outterson has written, we face a stark choice: either develop conservation strategies for existing antibiotics, or invest in inventing new ones. There is no reason to think a private sector solution can address this issue adequately–note for instance the new questions about a recently commercialized response to sepsis. Ala William James, it’s time to think of the superbug as an enemy to be battled collectively.