“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”
Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.”
Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection.
I'm just waiting for people to start reporting ghastly unexpected side effects.
(My eyelashes seem to be getting longer as a consequence of getting myself healthier. But I can't imagine anyone wanting me to say "Just spend 10 years working on your basic health instead of using this stuff". It's really not hip to be square.)
While the eyebrow example is wrong, let's assume that the gist was correct.
In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong?
You want more drugs that save peoples lives? Great! So do I. Here's how we do it.
Make it possible for folks to get rich on drugs that save people's lives. Note - cost controls won't do it (unless we're talking about controlling regulatory costs).
Here's another way - socialize medical research funding, at least for antibiotics.
Antibiotics are inherently less profitable than other drugs because doctors try to avoid using new ones so that the bugs don't develop resistance to them. By the time they're freely used, the patent might have expired, as patents of the kidney-killing drugs mentioned in this article have decades ago.
I don't really see a good market-based solution here.
In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong?
Because having individuals with limited resources independently pursuing their own goals doesn't necessarily maximize overall utility, or even any actual individual's utility. It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same. Since it's difficult to ensure wide-scale cooperation, it doesn't happen and the result is that everyone is worse off.
I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.
> Because having individuals with limited resources independently pursuing their own goals doesn't necessarily maximize overall utility, or even any actual individual's utility.
If folks would rather spend their money on Viagra than antibiotics....
> It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same.
The problem with that theory is that it doesn't account for the claimed observation that eyelash extenders get funding while antibiotics don't.
So, either the theory or observation is wrong.
> I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.
Are you actually claiming that the vast majority of people have more self-interest in eyelash extenders that antibiotics?
Another advantage to lifestyle drugs is that they are unlikely to be taken away by politicians.
Politicians are likely to nationalize/cost control/otherwise interfere with lifesaving drugs. Standing up to those greedy people trying to make money by preventing people's suffering is just good media exposure.
On the other hand, cost controls for an eyelash extender? Seems less likely.
You've hit the nail on the head. I spent several years in one of the biggest antibiotics research centers in big pharma. I watched as they systematically disbanded it. The business folks had decided that there was no money in antibiotics. The reason? The FDA (and similar agencies in other countries) are pretty much guaranteed to make any new, very successful antibiotic a "drug of last resort". This means you can only give it to an individual who has failed all the standard line therapy.
From a business perspective, why develop something if you are never going to be able to sell it in decent enough quantities to make a profit? Now, you could argue that at some point in the future, that drug will become standard line therapy when all the current front line drugs are completely useless. Unfortunately, by that time the drug is off patent and generic competition will ensure there won't be much profit.
This is a complex situation, and I'm not pretending that there is an easy solution. It seems there are a confluence of regulations and politics that conspire to prevent serious attempts at new antibiotics development. The situation is changing somewhat, and my hope is that once the problem becomes more acute, the necessary incentives will be aligned.
"Hi, we're the government. Instead of bombing Iraq, we would like to buy the IP for this critical drug you developed."
It's already developed, and they don't want to commercialize it, so why not sell the IP to the government or a charity. (The government could even theoretically compel the agreement via eminent domain. Or, the pharmaceutical company could donate the drug to the public domain and take a massive tax write off.)
Drug companies do sell or give away IP from time to time. But even in the scenario you suggest, with finite resources, why put money into antibiotics development? Why not just fund cancer research at a higher level? I think most pharmas wouldn't want to take the risk that the governmnt would leave them holding the bag. Contrary to the popular meme, drug companies don't generally want to sit on a drug that is ready to go.
But all that aside, there is nothing stopping the NIH from starting a research program and developing their own antibiotics (or any academic institution). This happens a bit already, but then it comes time to run the clinical trials and develop the research compound into an actual medicine. This requires expertise and infrastructure that does not exist in the public sector at a sufficient level to get the job done.
I haven't read that one, but I read Garrett's earlier one, "The Coming Plague" - it was an hysterical, anti-Western, fear-mongering eco-nut screed. In the decade and a half since she wrote it, not a single one of the "plagues" she claimed were about to break out across the world has shown any signs of getting worse, much less becoming the sort of widespread "disaster" she claimed was imminent.
To me it seems that we are just creating more powerful strains of various bacteria with our use of anti-biotics.
May be it is time we need to look at alternate ways to enhance our immunity so that we are not that much susceptible to bacterial (or virus) infection.
May be alternative medicine or Michael Pollan way of eating.
we need to look at alternate ways to enhance our immunity
Vaccines suit this description. But natural selection will favor bacteria that beat your immunity, however your immunity is enhanced. The bacteria for which we have effective defenses, of whatever kind, we forget about, but the few kinds of bacteria that can harm human beings continue to be surprising. That's the arms race of natural selection.
I've heard it proposed that we could try and work with this instead of against it, by "domesticating" diseases. Take some harmful bacteria, breed a strain that's mostly benign and moderately contagious, then let it loose to displace the more harmful strains while carefully avoiding doing too much to kill it. In other words, create selection pressures that favor mild strains.
Multidrug therapy will become the mainstay. It works for HIV (HAART) because despite the high mutation rate of HIV, it is exceedingly rare for the virus to sustain the ~3 different mutations required to confer resistance to 3 different drugs simultaneously.
I imagine that this will, in fact, be how we end up applying our targeted cancer therapies as well.
Let me put it this way: each base of the genome of a {cancer, bacterium, virus} has some chance of mutation at each replication step. If you target just one protein, then you may need as little as one mutation to confer resistance. In a normal human genome, you would expect this to happen to the nucleotide of interest once every hundred thousand cell divisions. Obviously a cancer has a higher error rate and millions of rapidly dividing cells, so this would occur quickly. If you target two proteins, you would expect both mutations to co-occur once every (100,000 x 100,000) cell divisions. If you target three proteins... Now you are getting somewhere.
Certainly it is not quite this simple. If variants with one mutation are more fit than those without it, then resistance to one drug in the cocktail will be selected for. But with HAART, we have seen that the multidrug approach is fairly - perhaps surprisingly - robust to that possibility.
I know someone who contracted MRSA after randomly scraping his knee. Almost killed him, and it came out of nowhere. Some hospitals have MRSA fatality rates over 20%. Scary as shit! Antibiotics abuse has screwed us, I guess, along with the sloppiness of many healthcare providers.
Patients are equally sloppy. When they feel better, many discontinue antibiotic use. Providers too readily prescribe antibiotics to try to appease patients with, say, an obvious viral respiratory infection, but these are most often less valuable antibiotics such as first generation penicillins anyways.
Judicious antibiotic use is important, both for patient and provider, but there is a more pernicious problem lurking: the use of late-generation antibiotics - still critical for hospital use - in feed to produce larger livestock more cheaply.
MRSA lives in the community just as much, if not more, than it lives in the hospitals. From what I know of the area, some hospitals had up to 80% community-acquired infections as opposed to hospital-acquired infections, this meant that the majority of these patients were being killed by their families. I know many ICU's in the UK have full out bans on any family members entering, because if anyone in an ICU catches MRSA they're gone.
It's easy to blame the healthcare providers, and I'm sure in many cases it is the healthcare providers' fault. However, if they simply flat-out banned people from visiting in the hospital MRSA infection rates (in good hospitals) would drop like a rock.
I wouldn't be surprised if hospitals with MRSA fatality rates over 20% allow visitors in the ICU and don't have well established visitor protocols in the regular hospital. I know some wards in the UK (I have friends and family who work in hospitals) will escort you out if they see you go between patients' beds; essentially they allow you to visit 1 person per day, and they frequently have visiting hours only a couple hours long so they can actively enforce this.
My advice to anyone visiting a friend in hospital, don't touch them. No handshakes, especially no hugs. This seems extreme, but patients have died from MRSA infection in key-hole surgery incisions.
Right, I think it is sloppy of a hospital to allow people to walk in and cause that kind of damage. I think not allowing outsiders into the ICU could be a good move for many.
Despite the on-again off-again media hysteria, it would seem that there is some promising research on the horizon. Check out the TED talk by Kary Mullis:
http://www.ted.com/talks/lang/eng/kary_mullis_next_gen_cure_... "Drug-resistant bacteria kills, even in top hospitals. But now tough infections like staph and anthrax may be in for a surprise. Nobel-winning chemist Kary Mullis, who watched a friend die when powerful antibiotics failed, unveils a radical new cure that shows extraordinary promise."
28 comments
[ 3.0 ms ] story [ 62.7 ms ] thread“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”
Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.”
Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection.
Of course, I'm highly biased in that regard. :-)
This prompted me to look at your info and now reading your website (http://www.healthgazelle.com/) and I am pleased, to say the least.
I added my comment above (or below where ever it appears) without reading your website.
(My eyelashes seem to be getting longer as a consequence of getting myself healthier. But I can't imagine anyone wanting me to say "Just spend 10 years working on your basic health instead of using this stuff". It's really not hip to be square.)
In general, folks tend to produce things that other people are willing to pay for. Why should pharma be any different? And why is this wrong?
You want more drugs that save peoples lives? Great! So do I. Here's how we do it.
Make it possible for folks to get rich on drugs that save people's lives. Note - cost controls won't do it (unless we're talking about controlling regulatory costs).
Antibiotics are inherently less profitable than other drugs because doctors try to avoid using new ones so that the bugs don't develop resistance to them. By the time they're freely used, the patent might have expired, as patents of the kidney-killing drugs mentioned in this article have decades ago.
I don't really see a good market-based solution here.
Because having individuals with limited resources independently pursuing their own goals doesn't necessarily maximize overall utility, or even any actual individual's utility. It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same. Since it's difficult to ensure wide-scale cooperation, it doesn't happen and the result is that everyone is worse off.
I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.
If folks would rather spend their money on Viagra than antibiotics....
> It's entirely possible to have a scenario where, say, nobody would individually pay for something to be researched, but everyone would be willing to chip in a small portion of the cost if everyone else did the same.
The problem with that theory is that it doesn't account for the claimed observation that eyelash extenders get funding while antibiotics don't.
So, either the theory or observation is wrong.
> I don't understand the mindset that sees a problem that, by elementary game theory, doesn't have an optimal outcome reachable by simple self-interest, and proposes that what we need is more self-interest.
Are you actually claiming that the vast majority of people have more self-interest in eyelash extenders that antibiotics?
Politicians are likely to nationalize/cost control/otherwise interfere with lifesaving drugs. Standing up to those greedy people trying to make money by preventing people's suffering is just good media exposure.
On the other hand, cost controls for an eyelash extender? Seems less likely.
From a business perspective, why develop something if you are never going to be able to sell it in decent enough quantities to make a profit? Now, you could argue that at some point in the future, that drug will become standard line therapy when all the current front line drugs are completely useless. Unfortunately, by that time the drug is off patent and generic competition will ensure there won't be much profit.
This is a complex situation, and I'm not pretending that there is an easy solution. It seems there are a confluence of regulations and politics that conspire to prevent serious attempts at new antibiotics development. The situation is changing somewhat, and my hope is that once the problem becomes more acute, the necessary incentives will be aligned.
It's already developed, and they don't want to commercialize it, so why not sell the IP to the government or a charity. (The government could even theoretically compel the agreement via eminent domain. Or, the pharmaceutical company could donate the drug to the public domain and take a massive tax write off.)
But all that aside, there is nothing stopping the NIH from starting a research program and developing their own antibiotics (or any academic institution). This happens a bit already, but then it comes time to run the clinical trials and develop the research compound into an actual medicine. This requires expertise and infrastructure that does not exist in the public sector at a sufficient level to get the job done.
To me it seems that we are just creating more powerful strains of various bacteria with our use of anti-biotics.
May be it is time we need to look at alternate ways to enhance our immunity so that we are not that much susceptible to bacterial (or virus) infection.
May be alternative medicine or Michael Pollan way of eating.
Any ideas?
Vaccines suit this description. But natural selection will favor bacteria that beat your immunity, however your immunity is enhanced. The bacteria for which we have effective defenses, of whatever kind, we forget about, but the few kinds of bacteria that can harm human beings continue to be surprising. That's the arms race of natural selection.
I imagine that this will, in fact, be how we end up applying our targeted cancer therapies as well.
Let me put it this way: each base of the genome of a {cancer, bacterium, virus} has some chance of mutation at each replication step. If you target just one protein, then you may need as little as one mutation to confer resistance. In a normal human genome, you would expect this to happen to the nucleotide of interest once every hundred thousand cell divisions. Obviously a cancer has a higher error rate and millions of rapidly dividing cells, so this would occur quickly. If you target two proteins, you would expect both mutations to co-occur once every (100,000 x 100,000) cell divisions. If you target three proteins... Now you are getting somewhere.
Certainly it is not quite this simple. If variants with one mutation are more fit than those without it, then resistance to one drug in the cocktail will be selected for. But with HAART, we have seen that the multidrug approach is fairly - perhaps surprisingly - robust to that possibility.
Judicious antibiotic use is important, both for patient and provider, but there is a more pernicious problem lurking: the use of late-generation antibiotics - still critical for hospital use - in feed to produce larger livestock more cheaply.
It's easy to blame the healthcare providers, and I'm sure in many cases it is the healthcare providers' fault. However, if they simply flat-out banned people from visiting in the hospital MRSA infection rates (in good hospitals) would drop like a rock.
I wouldn't be surprised if hospitals with MRSA fatality rates over 20% allow visitors in the ICU and don't have well established visitor protocols in the regular hospital. I know some wards in the UK (I have friends and family who work in hospitals) will escort you out if they see you go between patients' beds; essentially they allow you to visit 1 person per day, and they frequently have visiting hours only a couple hours long so they can actively enforce this.
My advice to anyone visiting a friend in hospital, don't touch them. No handshakes, especially no hugs. This seems extreme, but patients have died from MRSA infection in key-hole surgery incisions.