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.
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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.
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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.
c u n d gulag says:
Message From For-profit Big Pharma:
You have a deadly infection that we can't cure.
How about one last great boner before you go?
We're all out of antibiotics, but quicker-pecker-uppers we've got plenty of.
You are covered, right?
sluggo says:
Puts a new spin on the words of JM Keynes: "in the long run, your dead."
Arslan says:
It doesn't help when Malthusianism is so popular among the so-called "progressives" that are supposed to be in opposition to the free market theologians.
Marc says:
I love Magic Dick, the harmonica player for J. Geils Band.
Mingent Whizmaster says:
Actually, it was "In the long run, we're all temps."
Facehammer says:
Holy crap Ed, you're on fire lately!
I can add something to this. Development of new antibiotics is challenging for several reasons. It turns out there are actually quite a lot of chemicals out there, and screening them all for something that might actually have the desired effect is a laborious process to say the least. Patent trolling and squatting, and the measures taken to work around it, also make up a fair chunk of the free market's inherent efficiency.
But by far the biggest reason developing antibiotics is hard is the regulation surrounding their testing and release. The vast majority of compounds that are found to have some effect by early-stage research never make it through clinical trials. Needless to say, having to abandon a compound after 10 years of research because it proves unsafe at the final hurdle ain't cheap; but it is, of course, overwhelmingly preferable to the free market alternative, in which the honest would rush out anything that worked regardless of its side effects, and the dishonest would take snake oil and quackery to new depths of deception, delusion and ruthlessness.
deep says:
Not true. There lots are people like me who eat well and are athletic but still have dangerously high blood cholesterol levels. Unless you're suggesting I die so that some corporation won't make it's profit margins?
Jak the Yak says:
There is a glimmer of hope. I know I've seen other articles about things like this: http://www.advisory.com/Daily-Briefing/2012/05/14/Many-MRSA-infections-can-lose-their-antibiotic-resistance
Granted the problem you are really addressing is that things like this might not get the research funding they need, but I was pretty sure that at least one team was making progress in the "how can we induce resistant strains to lose their resistance" line. This has potential to lengthen the time we can rely on existing antibiotics.
BigHank53 says:
There's some promise in phages, viruses bred to attack the bacteria that are infesting the patient. Unfortunately, a lot of the prior art is old and in the public domain now, so the things are hard to patent. Not to mention that if you give someone a live virus, they can just breed up their own stock and don't ever need to buy more from you. This is not the sort of business model that puts a smile on the faces of your stockholders.
A couple years ago a local high school student was killed by a MRSA infection. Thirty-six hours between "I don't feel well" and going to the morgue. I don't think we'll have to lose more than half a dozen senators' grandkids before we see action on this.
Sean says:
The Big Fightback is coming. Woe to those fucktards when it happens: http://truth-out.org/opinion/item/17498-why-arent-americans-fighting-back
Anubis Bard says:
Ed is exactly right – it's market epic fail. I have friends in the industry and it is shocking the rate at which Big Pharma have been dismantling their research pipelines. The business model (now that China is not working out) is mostly to hope a small start-up gets lucky and buy them up quick. University-based research used to pick up more of the slack, but they now also are all about pretending profits must equal public good. Nevertheless, as long as our government keeps it's laser-like focus on promoting the public good over private interests, I think we'll be fine.
Xynzee says:
There was a consideration of bringing back a flooring material that proved insanely effective in killing MRSA bacterium across the spectrum, for hospital use only.
What was this wonder flooring you ask? It's two primary compounds are linseed oil and asbestos. :$
So an almost guaranteed chance of getting an MRSA infection from a hospital visit v. a significant chance of getting mesothelioma? Decisions. Decisions.
@CU: gold!
Talisker says:
It's a deeply worrying problem. One of the reasons for this is something called horizontal gene transfer. Basically bacteria are promiscuous little bastards who swap genetic material freely. If some of Ed's Obscure Deadly Infection bacteria develop vancomycin resistance, they can pass it on to any other bacteria which they may contact, and resistance can appear in other diseases very quickly indeed.
This is a worldwide problem, not just an American one. Even public health care systems such as Britain's NHS outsource drug development to private pharmaceutical companies, sometimes with alarming results.
In fairness, 20 years ago we hadn't yet sequenced the human genome, and no one had the slightest idea how much use advances in genetics would be for treating cancer. It turns out that "curing" cancer is much, much more complicated than we hoped. This doesn't mean that researching cancer was (or is) a waste of time.
The Slate article Ed linked to complains that cancer prevention, which is well understood but not very sexy, tends to be overlooked in the hope for miracle cures. This is true as far as it goes, but "cancer prevention" is really more like "cancer delay". You didn't smoke, exercised, ate your vegetables, and avoided succumbing to lung cancer in your 50s? Mazel tov. The chances are still excellent that some sort of cancer will get you in your 70s, 80s or 90s. So again, cancer research is not as wasteful as you might think.
On the other hand, chances are you will die from *something*, and cancer is more or less the default if you escape everything else.
Southern Beale says:
Well, last week I read a story in Scientific American that said they discovered a super antibiotic in some kind of bacteria found off the coast of California. Cue obvious joke ….. From the link:
"Early tests suggest anthracimycin is 25 to 40 times more potent than today's antibiotics at killing anthrax and other germs, in petri dishes at least. And it wiped out MRSA in 90 percent of infected mice. The results appear in the journal Angewandte Chemie. [Kyoung Hwa Jang et al, Anthracimycin, a Potent Anthrax Antibiotic from a Marine-Derived Actinomycete]"
This is why I do a Good News post every Friday. People need to stop getting bummed out about this stuff. We're gonna be okay, really.
What REALLY has me angry is the fact that all of the super drugs in the world won't do a bit of good if no one can access it. Which is why I'm really puzzled that the anti-socialist Red States think it's okay for the Dept. of Defense to be offering these free health care clinics for the poor. A) the Army is the most socialist agency of the US Govt and b) this is not a solution to our healthcare crisis, but I guess if you don't admit we have a problem in the first place I guess it doesn't matter. Sigh.
Story at the link:
http://southernbeale.wordpress.com/2013/07/29/wait-i-thought-socialized-medicine-was-evil/
Southern Beale says:
Sorry, I forgot the Scientific American link. Here it is:
http://www.scientificamerican.com/podcast/episode.cfm?id=marine-microbe-produces-unknown-ant-13-07-23
Marine Microbe Produces Unknown Antibiotic
A bacterial species at the California coast was found to produce anthracimycin, which showed activity against anthrax and MRSA in initial, nonhuman testing. Christopher Intagliata reports
Big Sister says:
Someone just posted on FB one of those crabby old lady cartoons, picturing the old bat is saying " In 2012 more money was spent on Viagra and boob jobs than on Alzheimer's research. In fourty years, we'll all be walking around with perky breasts and stiff willies and we won't have a fucking clue as to why."
mothra says:
My dear, departed mother, who was born in 1916 and saw a lot of progress in her time on earth, did not hesitate to answer "penicillin" when asked what the greatest/best discovery of the 20th century was. She saw a lot of people drop dead from infection before penicillin was discovered–it was just common. If you fought of the infection, good for you. If not, well, call the undertaker. She also took a really dim view of the anti-vaccination crowd. She herself nearly died from a couple of childhood diseases that now can be prevented by vaccine.
LK says:
Sorry for taking it personally, but your cancer comment is personal for me.
If it wasn't for the last two decades of cancer research, my wife would have died two to four months after diagnosis, and not twenty one months. Make that the last one decade, actually, as the two effective, listed treatments she got were introduced in 2004 and 2006. I know that in the greater scheme of things this is not a lot, but for a woman in her thirties with a months-old baby and a couple of older children at home, this is not "almost nothing". Not by a very, very long shot.
The two problems with cancer are 1) it is not a single disease (there are something like 50 types of lung cancer alone, and the modalities in treatment, while often subtle, can have a huge difference in outcomes); and 2) it is evolutionary on a very short time-scale. The ultimate end-game in cancer treatment, as it is seen by some researchers today, is constant gene-mapping of the tumor, changing treatment whenever a new mutation is spotted that can provide resistance to the current treatment. This means you would need hundreds if not thousands of available drugs, each of them tested and approved for various types of cancer at various stages and conditions. And you would need to be able to biopsy the tumors every few months (and this is tumors in the plural, as different mutations can arise in different places). If this sounds like a nightmare to plan, test, approve and implement, it's because it is. We know today that the problem we are facing is orders of magnitude more complicated than it was believed to be only ten or twenty years ago. And while I agree there is a lot of waste and inefficiency in cancer research and treatment development around the world, calling the results "almost nothing to show for it" is insulting if not worse.
Anubis Bard says:
@mothra,
I think as memory of those times pass, we really lose track of the stakes involved. We burn through each new wonder-drug — with no sure thing coming along as back-up.
Sarah says:
Speaking of the anti-vaccination crowd and Big Pharma's worship of their profit margins, did you know that there is a vaccine for Lyme Disease? It's such a shame that you can't have it, due to the diligent work of anti-vaccine advocates and the PTB at Big Pharma, who looked at these kooks and decided that developing a human vaccine for Lyme Disease wasn't worth the trouble. There is a version for your dog, though. Isn't that good news?
http://www.wbur.org/2012/06/27/lyme-vaccine
Brian M says:
Sarah: read the comments section at the article. The anti-vaccine crowd includes bizarre, fanatic religiously committed people. One person is the commenter in 80% or so of the responses to the article. One of those people who knows one factoid, keeps repeating the one factoid (or question) endlessly, and is utterly convinced that this means everyone with a different opinion is LYING LYING LYING.
cromartie says:
Not all is lost. We eat so much, and treat ourselves so poorly in the process, that we're doing wonders on heart research. Operations on the heart are the single most profitable part of a hospital's operations. Heart health, if nothing else, has benefited immensely from our largess.
Sarah says:
I believe in free speech. I do. But someone like that is Exhibit A for the proposition that unfettered free speech is harmful and should be limited.
Brian M says:
I should be ashamed of myself. I joined the "conversation" (which is one person repeating herself over and over. Having had mumps and measles at the same time as a youngster, I DESPISE anti-vaxxers.
"I think KMDickson must be a paid shill for homeopathy or some of the quack "chelation" doctors out there. Nobody can be that devoted or that insane. She has to be in it for the money. Repeating one factoid or question over and over and over…typical "technique" for these tools.
So…which gang is it? Chelation therapy? Herbal tinctures? Homeopathy? That nutty British doctor Wakefield? Definitely one of the Big Quackery groups.
KMDickson obviously could care less about people suffering from the impacts of Lyme Disease. Not when Ideology…or PROFIT is involved."
Alan C says:
Where's the centrally planned socialist state when you need it?
Nerd paTROLL says:
Wait, so the current patent system that provides a government protected monopoly for these huge pharma companies and allows them to make boatloads on novel drugs while nonpatentable drugs or creating drugs that have to compete with effective enough drugs whose patents (and monopoly pricing) have expired is the free market's fault? And the FDA plus other regulations plus the fact that I imbibe every antibiotic I come across to accelerate this process of antibiotic resistance in bacteria, etc. all add to this web of resource misdirection in the pharmaceutical industry. Private companies that do terrible things while working in a ridiculous system is not a failure of the free market. But what do I know; I have a drinking problem.
just me says:
Ed says:
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
Ah, no. Actually, unequovically, NO!
Over use of antibiotics by the American health care system, and many many other first world countries, is the primary reason things like MRSA, VRE and resistant CDif and TB exist today. Got the sniffles? Burns when you pee? Hurts to swallow? Got a rash? Here, take this. Chances are almost 90 percent you don't need it, but when it goes away in it's own course your gonna think it was the magic pill and be back for more next time $$. And the doc can't afford to say no, just in case, cuz his/her insurance is already $$. And waiting for the lab results before prescribing would require follow up $$
The major secondary reason for antibio resistance is non-compliance among patients. Doc say 10 days of antibios, and I feel better after 6? Why would I take more?? Because: evolution. Because after 6 days only the weaker strains of the bacteria are wiped out and since they are greater in number you feel better. But the few stronger ones, the ones that would have taken a few more doses to kill, you left behind to re-colonize you with thier own, hardier, progeny. But explaining that to a population where a significant proportion of the denizens don't believe in evolushun, yeah, good luck.
Oh, and do flush the remaining pills that you didn't need down the toilet so they enter the water system and promote all normal flora developing super strains through evolu…oh never mind.
The major aquisition point of resistant bacteria in the developed world is nosocomial, yet getting front line workers to wash their hands and change PPE remains a continual challenge for ID teams until an outbreak occurs that costs $$ and garners local media attention. The latter is often the key to the cure.
As for the anti-vaccine crowd, I say: let 'em. What could possibly be the problem? Vaccinate your own kids well and let theirs fall where they may. This is called natural selection and they don't believe in that anyway. Soon enough we won't have to worry about them in the gene pool.
To be certain the BigPharmas have done their share of harm over the decades and being, you know, businesses, focus on what's sexy and therefore lucrative, it's also hard to dispute that better living through chemistry is indeed a reality. Fleming taught us that throwing out the incongruous petri dish is a serious mistake, let's not now throw the baby out with the bath water.
Diana says:
Yes, well, since we're sure to lose half our food supply to global warming, and most of our cities to rising oceans, there ought to be something that will bring the population back into balance. New and improved epidemics are at least going to be quick.
noshoes says:
Couple of things:
In nursing school, we learned that when a patient is suspected of having an infection, we will take a sample of tissue, sputum, urine or poop or something and send it to the lab for a "C & S" (culture and sensitivity), where the lab techs will try to grow (culture) the microorganism in a petri dish then try different antibiotics on it to see what kills it.
Wait, that almost never happens. I've been prescribed antibiotics at least 15 times in my life and NOT ONCE has a C & S been performed. Is lab time too expensive? Is it simply easier to just throw some ATB at your infection and hope it's the right one? Guess so.
Also: my mom is in the hospital right now for a variety of problems. She had an intra-abdominal infection from a gallbladder full of gallstones, so her gallbladder was removed and she was given a two-week IV course of vancomycin and ertapenem (Invanz). In three days she went from being a person with mild cognitive impairment to someone with severe dementia; she couldn't walk, talk clearly, eat, keep her eyes open or remember anything and became totally incontinent. The doctors could not tell us why and sent her to skilled nursing, where she continued to receive the ATBs. We ended up taking her to a neurologist three days after the ATBs ended and he told us to take her to ER, which we did. She was admitted back into the hospital, where CT scans and EEGs showed nothing wrong with her brain.
The next day, she opened her eyes and said "Where the hell have I been for the last two weeks?" An infectious disease doctor mentioned that sometimes older people have reactions like this to the carbapenem drugs.
Beware!
Sarah says:
Jenny McCarthy is slated to take Barbara Walters' place on The View.
Where, indeed.
joel hanes says:
One thing we could and should do is to outlaw the routine use of antibiotics in meat animal feeds. This practice is just short of suicidal.
quixote says:
What BigHank53 said about phages. The other thing Big Pharma doesn't like about them is you need specific phages for specific bacteria. One size does not fit all. The profits, of course, are in prescribing the same pill to billions of people. But phages do work, and they work flawlessly. No side effects.
So don't let anyone tell you we're helpless against antibiotic resistance. We're helpless against market forces, apparently, but that's different.
As for antibiotic resistance disappearing with time, that's indeed true. Resistance is biologically expensive for a bacterium. So if no antibiotics are around, *non*resistant bacteria survive better and the resistant ones are outcompeted. It doesn't even take very long. Ten, twenty years.
Talisker says:
@justme:
Google "herd immunity".
In short, vaccines are not 100% effective. They aren't effective at all on people with weakened immune systems (eg. AIDS patients, or transplant patients on immunosuppressant drugs), or very young infants. But that's OK. All we need is for *enough* people to be immune, so that if one person picks up the disease, it can't be spread through the population.
Vaccination rates are falling below herd immunity levels in certain areas. So for example, babies too young to be vaccinated against whooping cough have started dying from the disease. That's the problem.
Talisker says:
Oh, and personally I don't think kids should get painful, disabling, and potentially deadly diseases just because their parents are idiots. I'm sentimental like that.
falloch says:
Total layperson's observations: We/gov't/big pharma spend or spent enormous amounts of money on cancer research, while the US gov't is intent on deregulation of chemicals/pesticides/ GMOs etc. We all know people who've had cancer that was directly related to their drinking, smoking, drug use, sun exposure, etc. etc. But we all know people who were in good shape, athletic, at a good body weight, pretty happy in their life who've been diagnosed with cancer, and the reaction is 'Huh? How did that happen?' And very few people stand back and look at our chemical cocktail of an environment. Our bodies are still at the 100,000 year threshold, while we exude thousands of new chemical compounds into our environment every year – cleaning products, food 'enhancers', 'beauty' products, furniture finishings, – that we have not yet evolved to deal with at a molecular level. The BBC reported a few weeks ago that now 1 in 3 of us can expect to have cancer in our lifetimes, a statistic that was 1 in 5 only 10 years ago. The BBC said scientists had attributed this increase to the fact that people live longer, but I would like to know what the cancer statistics are in a more isolated part of the world. Yes, if you lived in the deepest most remote part of the Amazon, you might die of snake bite, but what are the statistics for childhood leukemia, or breast cancer, etc. there? The cancer 'cure' industry in the western world is focused on making us responsible for our health, while governments give carte blanche to industries to continue to poison us
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