Arriving at the Post-Antibiotic World

We are losing a war with bacteria and it may be because we are not putting up a strong enough fight. As bacteria become ever more resistant to the few antibiotics we have and use, the way we practice medicine is being put on uneasy ground.

An Unfortunate Future

If we lose the benefits of antibiotics, due to increasing numbers and strength of antibiotic resistant bacteria, we will be headed for a world fraught with healt- related complications. Our problems will be bigger than an inability to fight infections. In the post-antibiotic world, modern medicine will be in sharp decline. What precisely it will look like remains up for debate. Some, like health writer Maryn McKenna, forecast a world where we lose the ability to: perform surgeries, effectively treat traumatic injuries, safely perform childbirth, treat cancer, or have a reliable food supply. Other reports corroborate those fears and add that the rise of antibiotic resistant bacteria is happening now around the world. In some places, the ability to fight urinary tract infections and gonorrhea has already begun to spin out of control because some of the popular medications used to fight those infections have become useless. The threat is significant but well documented. In fact, the CDC has been attentive to the growing threat for years. Yet, notwithstanding our growing awareness, our bacterial enemy keeps gaining ground.

No New Drugs

The Vox has reported on a frightening reality that, despite a known threat to our ability to fight infections, little is being done to stop our decline. At least from a pharmaceutical standpoint, almost no one is working to create more effective antibiotics to combat the antibiotic resistant bacteria. As early as 2004, the Infectious Disease Society of America (IDSA) was making efforts to educate the public, pharmaceutical companies, and lawmakers about a problem that, ten years ago, the ISDA was calling a potentially “catastrophic” epidemic. Yet, despite the warnings, according to a World Health Organization (WHO) factsheet, no new major types of antibiotics have been developed in the past 30 years. There has been what the WHO calls a “discovery void.” Since 1980, we have been tenuously relying on drugs that are over prescribed and losing effect.

Other Solutions

Researchers have not totally given up. It would be unfair to say that it has been all downhill since Alexander Fleming. Antibiotic alternatives, like the Etoscope, designed by MIT engineer George Kenney, seek to implement the belief that part of the solution to antibiotic resistance is a more sparing use of antibiotics. Growing awareness that common ailments like ear infections don’t need antibiotic management, has led innovators like Kenney to propose new solutions. Instead of relying on the failing world of antibiotics, some believe we can be saved by looking elsewhere.   Beyond innovative devices, other solutions look to diagnostics. The diagnostic theory maintains that by developing more effective diagnostic tools we can prescribe less of the right antibiotics so that infections can be cleared up without generating unnecessary risk of developing antibiotic resistant bacteria. A UK competition, known as the Longitude Prize 2014, seeks to support this solution by rewarding, with £10 million, a team that can design the best diagnostic tool to effectively, cheaply, and reliably identify bacterial infections.

Is Big Pharma to blame?

Pharmaceutical companies might be partly responsible for the decline. Or, more properly stated, the market incentives for pharmaceutical companies may be to blame.”Delinking” is one proposed solution to pharmaceutical stagnation. Delinking refers to the the notion of disconnecting the volume of drug sales from a pharmaceutical company’s return on its investment. The traditional thinking goes something like this: while drug companies hold a patent, they need to sell as much of a drug as possible, so that their investment can be recouped before their patent expires and they are forced to compete in a broader market. Opponents of the “linked” model contend that by connecting volume to profit, pharmaceutical companies are incentivized to sell as much of a drug in a short run as possible, even if it is bad for consumer health. When it comes to antibiotics, pharmaceutical companies have kept their hands clear. If a drug manufacturer will not have a big market for its drug, the drug simply isn’t economical to pursue. So, the argument goes, antibiotics, which by their nature demand short term and limited use, will never be invented in a market where volume is so directly linked to research and development. Proponents of the delinked model say that patent-based incentives won’t bring us a pharmaceutical solution to our antibiotic crisis.

White House Solution

The White House knows there is a problem. The President’s Council on Science and Technology issued an Antimicrobial Resistance Report in April, which sets out a protocol for addressing the growing issue of antibiotic resistant bacteria. The report suggests increased funding for new drugs, federal cooperation, streamlined FDA processes, and notably, a recommendation that the pharmaceutical industry be “delinked.”

The Rise of Bacteria

Will antibiotic resistant bacteria be the downfall of modern bio-medicine? If the skeptics are right, a failure to turn the tide could have irreparable and catastrophic consequences taking us back to a world before Alexander Fleming and the emergence of Penicillin. The risk is greater than it first appears. Our antibiotic safety net is getting weaker and we are, at present, without a backup plan. The question remains: are we arriving at the post-antibiotic world?