Antibiotics: Pharma’s Lean Spend — And Yours Should be Too

Flu season appears to be in full bloom -- at least from my perspective as I near recovery from this year's latest viral incarnation of the bug. I've been equally distressed by the number of friends and associates who have told me that I need to get an antibiotic.

Viral infections are not bacterial in origin and do not respond to antibiotic medication. And yes, it's wise to have a physician monitor our ailments and determine their origin. But the miraculous discovery of bacteria killing medication by Sir Alexander Fleming in the early 1940s – that revolutionized medicine and cured illnesses that had often been terminal for centuries – has nearly come full circle.

PBS Frontline recently published an edited transcript of an interview with Dr. John Rex, VP of Clinical Research at AstraZeneca, who discusses the complex and scary economic and scientific conundrum of drug resistant bacteria. Dr. Rex describes how the advent of antibiotics drove the early pharmaceutical industry and that into the 1970s, "when bacteria became resistant, chemists would make a new variation, and we would have a new antibiotic."

He goes on to explain how "we really didn’t discover new antibiotics beginning probably in the 1980s. We actually stopped discovering... [and] in the ’90s and the first part of this century, we began to see resistant bacteria for which we really didn’t have very much or anything at all, and we had nothing coming to treat them... we’ve gone from a sense of 'We’ll always have what we need' to a sense of 'We might actually not have what we need now and for sometime in the future.’”

The frightening current reality, according to Dr. Rex, is that the antibiotic pipeline has not only narrowed: "It's worse than drying up... I think it is terribly close to a drought." Without "the appropriate antibiotic, effective antibacterial agents... you can't get cancer treatment, take care of a premature baby, [or] get required artery surgery done. Modern medicine grinds to a halt."

The economic component of this catastrophe is equally troubling. Like it, or not, pharmaceutical companies are accountable to their shareholders. Bringing a new drug to market "can easily cost $1 billion." And unlike other modern meds that are consumed perpetually for lifelong conditions, antibiotics are needed only briefly. When we add in the rationale that newly developed antibodies must be used very sparingly, lest they too become resisted by bacteria, the numbers and projected ROI do not portend profitability.

Dr. Rex suggests: "We need to think about models — for example, an insurance-based model — of paying for an antibiotic. Might be an approach that would make a great deal of sense for government to undertake. Do things to change the economics of the equation so that companies want to invest in this area."

I would like to suggest that we potential consumers of antibiotics can also be proactive. For starters, don't ask your doc for an antibiotic because you think you need it to get well. And if your internist prescribes an antibiotic, ask why. Most generic antibiotics that have been on the market for years are inexpensive and continue to be overprescribed, exacerbating the accelerating resistance that bacteria continually evolve.

Our best actionable personal defense against encountering a drug resistant bacterial infection is to limit our exposure to all antibacterial agents when we are well. Buy fish, poultry, meat and eggs that are antibiotic free and use plain soap (without antibacterial agents) for cleaning and bathing. Our bodies are host to trillions of bacteria and a vast majority of them help to keep us healthy – so stop killing them. Or, in other words, don't throw the baby out with the bath water, and you'll be far less resistant should you seriously need an antibiotic to fight an adverse infection.

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