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Why don't we use for medicines the same procurement procedures we use for aircraft carriers? The USG should just hire someone to develop antibiotics for them. I

Why don't we use for medicines the same procurement procedures we use for aircraft carriers? The USG should just hire someone to develop antibiotics for them. It is a matter of national security too - in case of biological attack having a couple more potent will help a lot. Or having the know how to develop them on demand.

danieltillett 11y ago
Yes this would be one way of doing it. I think we should try a range of different funding models to see which one works best. What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. One thing I should mention is we don’t have to keep developing totally new antibiotics we can develop antibiotics that are tweaks of existing antibiotics. Antibiotic resistance is an arms race that we can never win, but we can stay ahead with continued investment.
- slinkyavenger 11y ago
  We certainly do have to keep developing totally new antibiotics. Problem is many of the new antibiotics that we have are tweaks on existing antibiotics. We're in such a rush to have something useable that side effect profiles get nastier and bacteria develop resistances to entire families of antibiotics.
- amelius 11y ago
  The problem is not coming up with new funding models. The problem is getting them implemented.
- flubert 11y ago
  >What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. What's the best way to quantify the failure? Like a chart showing the bacterial infection death rate for the past 100 years? Costs for the average antibiotic dose over time? Something else? Those data sets seem like they should be available, but are apparently harder for me to find than I would have thought, given the prevalence of all the information available on anti-microbial resistance that pops up for my collection of search terms. Do you see this new work as a departure from, or a continuation of the antibiotics development of the past?
  - roywiggins 11y ago
    How fast people are discovering new antibiotics is the important thing, I would think. Assuming resistance is going to happen no matter what, we need to keep discovering new antibiotics at a steady pace to keep up. Here's one timeline I found in a paper: http://cmr.asm.org/content/24/1/71/F1.expansion.html http://cmr.asm.org/content/24/1/71/F1.expansion.html
    - agumonkey 11y ago
      Just got me thinking, shouldn't we try to have a spectrum of antibiotics switched regularly as some form of 'wear levelling' for bacterial resistance ?
    - flubert 11y ago
      I would think it is important to know the magnitude of the problem. Has the number of death from bacterial infections increased from 1 per million people per year in 1990 to 100 per million people per year today? Has it stayed the same? Has it actually decreased over time, and were just trying to be proactive? I'd don't think it is too odd to want to know.
      - lovemenot 11y ago
        How about a measure of depth of the defence pipeline: total number of efficacious treatments available per million infections, plotted over time? The million infections might need to be weighted by severity of clinical outcome.
        flubert 11y ago
        Great, let's get that data too as long as we are at it. Anyone know how to get it?
        danieltillett 11y ago
        The problem with this is it is often not known how many other antibiotics might have worked. It might be better to measure drugs known not to work as a percentage of the drugs that work for that class of organism. Getting this data is likely to be really hard to get and be very labor intensive.
- refurb 11y ago
  What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. I disagree. Think of it this way. If it were truly laissez faire, then drug makers would charge a price high enough to still make it worthwhile. Unfortunately, the way antibiotics are paid for in US hospitals, the hospitals would lose money each time they used the drug. Hell, we pay ~$80K to cure hepatitis C (millions have it in the US). If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar? What is the benefit to society to save someone's life?
  - ori_b 11y ago
    > If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar? Because a few hundred times 80k is still not much. And even so, many people still can't afford it.
    - tedks 11y ago
      If you can't provide enough value to society that you can spare a few tens of thousands of dollars to cure yourself, are you really worth the cost of developing these drugs, testing them, training doctors, etc.? All of this over-regulation is why medicine is declining in the first place. That shouldn't justify more regulation.
      - knieveltech 11y ago
        That easily makes the top 3 list of most sociopathic things I've read all month, and between mass shootings and debates about refugees it's been a banner month for sociopaths on Facebook. Did you intend to measure the value of a human life in terms of enhancing shareholder value or is this just poorly worded?
        mystikal 11y ago
        Some people are only able to reason about things they can measure.
- deleted 11y ago
  [deleted]
- fucking_tragedy 11y ago
  Many antibiotics are already derivatives of other antibiotics. The problem is that bacteria are developing resistances to whole families of medication. You can tweak erythromycin and get clarithromycin or azithromycin, but that means nothing when the mechanism of action they exploit has been patched in resistant bacteria.
ams6110 11y ago
Based on how most government procurement of bespoke products turns out, they would pay far more than it should cost and get a product that doesn't work.

danieltillett 11y ago

Yes this would be one way of doing it. I think we should try a range of different funding models to see which one works best. What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. One thing I should mention is we don’t have to keep developing totally new antibiotics we can develop antibiotics that are tweaks of existing antibiotics. Antibiotic resistance is an arms race that we can never win, but we can stay ahead with continued investment.

slinkyavenger 11y ago
We certainly do have to keep developing totally new antibiotics. Problem is many of the new antibiotics that we have are tweaks on existing antibiotics. We're in such a rush to have something useable that side effect profiles get nastier and bacteria develop resistances to entire families of antibiotics.
amelius 11y ago
The problem is not coming up with new funding models. The problem is getting them implemented.
flubert 11y ago
>What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. What's the best way to quantify the failure? Like a chart showing the bacterial infection death rate for the past 100 years? Costs for the average antibiotic dose over time? Something else? Those data sets seem like they should be available, but are apparently harder for me to find than I would have thought, given the prevalence of all the information available on anti-microbial resistance that pops up for my collection of search terms. Do you see this new work as a departure from, or a continuation of the antibiotics development of the past?
- roywiggins 11y ago
  How fast people are discovering new antibiotics is the important thing, I would think. Assuming resistance is going to happen no matter what, we need to keep discovering new antibiotics at a steady pace to keep up. Here's one timeline I found in a paper: http://cmr.asm.org/content/24/1/71/F1.expansion.html http://cmr.asm.org/content/24/1/71/F1.expansion.html
  - agumonkey 11y ago
    Just got me thinking, shouldn't we try to have a spectrum of antibiotics switched regularly as some form of 'wear levelling' for bacterial resistance ?
  - flubert 11y ago
    I would think it is important to know the magnitude of the problem. Has the number of death from bacterial infections increased from 1 per million people per year in 1990 to 100 per million people per year today? Has it stayed the same? Has it actually decreased over time, and were just trying to be proactive? I'd don't think it is too odd to want to know.
    - lovemenot 11y ago
      How about a measure of depth of the defence pipeline: total number of efficacious treatments available per million infections, plotted over time? The million infections might need to be weighted by severity of clinical outcome.
      - flubert 11y ago
        Great, let's get that data too as long as we are at it. Anyone know how to get it?
        danieltillett 11y ago
        The problem with this is it is often not known how many other antibiotics might have worked. It might be better to measure drugs known not to work as a percentage of the drugs that work for that class of organism. Getting this data is likely to be really hard to get and be very labor intensive.
refurb 11y ago
What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics. I disagree. Think of it this way. If it were truly laissez faire, then drug makers would charge a price high enough to still make it worthwhile. Unfortunately, the way antibiotics are paid for in US hospitals, the hospitals would lose money each time they used the drug. Hell, we pay ~$80K to cure hepatitis C (millions have it in the US). If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar? What is the benefit to society to save someone's life?
- ori_b 11y ago
  > If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar? Because a few hundred times 80k is still not much. And even so, many people still can't afford it.
  - tedks 11y ago
    If you can't provide enough value to society that you can spare a few tens of thousands of dollars to cure yourself, are you really worth the cost of developing these drugs, testing them, training doctors, etc.? All of this over-regulation is why medicine is declining in the first place. That shouldn't justify more regulation.
    - knieveltech 11y ago
      That easily makes the top 3 list of most sociopathic things I've read all month, and between mass shootings and debates about refugees it's been a banner month for sociopaths on Facebook. Did you intend to measure the value of a human life in terms of enhancing shareholder value or is this just poorly worded?
      - mystikal 11y ago
        Some people are only able to reason about things they can measure.
deleted 11y ago
[deleted]
fucking_tragedy 11y ago
Many antibiotics are already derivatives of other antibiotics. The problem is that bacteria are developing resistances to whole families of medication. You can tweak erythromycin and get clarithromycin or azithromycin, but that means nothing when the mechanism of action they exploit has been patched in resistant bacteria.

ams6110 11y ago

Based on how most government procurement of bespoke products turns out, they would pay far more than it should cost and get a product that doesn't work.