Economic Paradox of Antibiotic Development

Discussion in 'Politics, Religion, Social Issues' started by ElectronGuru, Nov 5, 2013.

  1. ElectronGuru, Nov 5, 2013
    Last edited: Nov 6, 2013

    ElectronGuru macrumors 65816

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    #1
    I’ve been aware of the problems of bacterial resistance for some time. I was expecting this show to be more of the same. There is that but there's a new problem. There's diminishing incentive to make new ones:

    http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmare-bacteria/

    Drug companies across the board are abandoning antibiotic development. Not because it won’t yield new drugs, but because it doesn’t make economic sense. Antibiotics don’t cost less to create than other drugs, but because their use is limited (by design and necessity), potential sales are also limited. Even a successful new antibiotic can be a big money looser.
     
  2. MOFS macrumors 65816

    MOFS

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    #2
    Er how would an antibiotic that works lose money? If it's the only antibiotic that would work against a particular organism people would be forced to use it.
     
  3. AP_piano295 macrumors 65816

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    1) They cost a lot to develop

    2) They are used for only a short period of time (typically 1-2 weeks)

    3) It will only work until bacteria begin to develop resistance against the new compound

    Antibiotics don't generally just work against one type of organism. This is carpet bombing not precision sniping. A new drug would be used only in situations where they're dealing with the absolutely most drug resistant bugs out there. And those aren't all that common, and doctors will attempt to use new drugs as little as possible. Because as soon as they start using the newest drug bacteria will begin to evolve around it.

    Now think of drugs like:

    Viagra, Vyvanse, Heart Medications, allergy meds, or medications for chronic cancer like GLEEVEC. Patients take these drugs for years this is obviously going to be much more profitable than a drug which will likely be taken for no more than 2 weeks.
     
  4. P-Worm macrumors 68020

    P-Worm

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    #4
    I've heard of this problem before (sorry, I can't remember the source I heard it from) and it sounds like it can have some dire consequences. The problem stems from the fact that bacteria could end up becoming resistant to current antibiotics and even though that would make working antibiotics far more valuable, those antibiotics won't exist unless we invest in the research now. As AP said, right now there isn't a large payoff for developing an antibacterial because of the low/negative return compared to R&D costs.

    We have an economy that is so focused on short term gain right now that larger problems such like this can't get solved in time.

    P-Worm
     
  5. MOFS macrumors 65816

    MOFS

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    The problem is that there is rapid resistance evolving. The trust I'm working in has Ertapenem (with clarithromycin) as first line for CURB 4 pneumonia and acute cholecystitis. Four years ago you had to get microbiology approval just to use Tazocin. Yet these remain expensive. Treating someone for seven days of 1g OD Ertapenem costs approximately £220, and for 1 pt year it costs £11520, and this is an antibiotic we use everyday. To compare these to preventative meds remains difficult. In the UK, NICE will essentially nix drugs that have shakey cost-benefit ratios (so called QALYs) so drugs like Sildenafil/Viagra are rarely given (although it is now off patent so that may change). Antibiotics are necessary and life saving so could always be prescribed as per local microbiology advice.

    Antibiotics remain precious and as multi resistant organisms prevail, more exotic antibiotics will need to be developed and prescribed. The difficulty is developing is technical though, as fewer research avenues appear fruitful. Drug companies will attempt to develop them - they will always be necessary.
     
  6. ElectronGuru, Nov 7, 2013
    Last edited: Nov 7, 2013

    ElectronGuru thread starter macrumors 65816

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    #6
    While not the best analogy, it reminds me of the problem with power companies. They give money to customers to buy more energy efficient appliances, which in turn lowers energy consumption, which in turn reduces revenue, which in turn reduces the money available to give to customers to buy more energy efficient appliances.

    At some point, we will be years behind in development of new antibiotics, some new resistant strain will take off, and we'll be jumping through all kinds of last minute hoops to correct the problem. But 1) it will take the death of thousands to create the impetuous, 2) it will cost much more to correct than it would have to prevent, 3) it will be publicly funded, and 4) it will have been totally foreseeable and preventable.
     
  7. Sydde macrumors 68020

    Sydde

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    There is an obvious answer to the problem of drug resistance, and they do in fact employ these beasties in some areas. It does feel a bit creepy, the idea of infecting oneself to kill an infection, but there are no side effects to speak of (the phages are highly specific) and no lengthy courses of treatment (the things multiply on their own).

    Why we have not been exploring this strategy is not really clear, except, obviously, there is not much profit in it. It appears that the capitalistic ethos will be the death of us in the end.
     
  8. ElectronGuru thread starter macrumors 65816

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    #8
  9. ElectronGuru thread starter macrumors 65816

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    Its happening again, this time with generic drugs...

    In the generic drug industry, market failure occurs when a crowd of different companies that once competed to sell a drug like doxycycline ditch it to pursue more profitable drugs, leaving just one generic supplier—or a new gray-market monopoly able to raise prices just like brand-name manufacturers.

    This happens in part because generic companies are drawn toward the market exclusivity of newer drugs when they come off patent, in part because of bottlenecks in the supply of precursor chemicals, and in part because of shrinking margins in the production of older generic drugs. The stampede leaves the supply of many older but essential medicines in the hands of just a few suppliers, whose production lines are unprepared to deal with surges in demand, leading to shortages of key pharmaceutical agents needed for the treatment of cancer, pneumonia, and heart disease, as well as for basic anesthesia. Prices eventually recede—but by then, usually, other drugs are seeing similar cost surges.

    The presumed virtue of generic competition is also based on a third assumption: that the therapeutic marketplace allows direct interaction between the supply from competing producers and the demands of health care consumers. But in the decades since the passage of Hatch–Waxman, a host of mediating bodies have proliferated between drug manufacturers and the people they help. Beyond prescribing doctors and dispensing pharmacists there are now pharmacy and therapeutics (P&T) committees of hospitals or insurance plans, which determine which drugs are covered and which are not. There are also pharmacy benefit managers (PBMs) and group purchasing organizations (GPOs), two obscure and thinly regulated parts of the health care sector that determine which manufacturers obtain contracts to supply most hospital and pharmacy chains in the United States.

    Unlike countries with single-payer systems, which use the power of the purse to negotiate cheaper prices for brand-name drugs, America chose to pursue generic drugs as a free-market solution to the problem of pharmaceutical access. This solution worked well for three decades but is now showing clear signs of market failure, with price hikes and shortages becoming more severe and more frequent. As the real costs of generic drugs undergo some long-needed scrutiny from federal authorities, we should remember not just the means but the original ends of generic drug policy: wider and fairer access to essential medicines.


    http://www.slate.com/articles/busin...es_why_their_prices_are_suddenly_surging.html
     

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