4 ms·

This is genuinely a pretty big problem in the field. The reward for making a good antibiotic is getting a drug that nobody will use since they want to preserve

This is genuinely a pretty big problem in the field. The reward for making a good antibiotic is getting a drug that nobody will use since they want to preserve it for when a bacteria becomes resistant to everything else. We've yet to see really great successes from other approaches like phage therapy, but I do think that long term, the only commercially feasible way to fight bacteria is to use some technology along those lines, where you can keep adapting the therapy to deal with resistance so people will be encouraged to use it and you will have revenues from the product. Still a lot of technical problems to overcome there, but there are interesting approaches (such as using the phage as a CRISPR vector) that go ahead and engineer the phages to get around some of the roadblocks that have stopped them from being useful in general. And we shouldn't underestimate non-antibiotic approaches as well - some good progress in C. diff has been made with stool transplants. Lots of ways to target bad bacteria, unfortunately the one that's worked the best so far is the least commercially sustainable.

newacct583 6y ago
> unfortunately the one that's worked the best so far is the least commercially sustainable. So sustain it non-commercially. Governments have purchased medications in the past, often for exactly this kind of reason. We stockpile vaccines right now, even though the "market" doesn't want to. Really the most notable thing about this article isn't the science, it's the framing of the problem as "difficult" when... it isn't.
- vikramkr 6y ago
  It's politically difficult yeah. If there was like a $500 million or $1 billion dollar reward for bringing a new antibiotic to market (maybe with price regulations on the other end, but i don't think those would matter with antibiotics), this problem would be a long way to solved. Or a GAVI equivalent. But sometimes, scientific problems are easier to solve than political ones. I'd bet on a new breakthrough creating an alternative to antibiotics happening before the (US) government overcomes the political friction required to do what will be framed as bailing out big pharma. Hating big pharma is like the one thing both parties agree on here.
arethuza 6y ago
Globally we spend trillions on weapons (specifically nuclear weapons) that nobody wants to use so the problem doesn't seem completely insurmountable?
- vikramkr 6y ago
  The problem is that in America, creating jobs is a significant focus in government spending, including military spending. There's not a lot of jobs in antibiotics the same way that there are lots of well paying jobs to bring to your congressional district if you fund a plane to nowhere. Elsewhere in the world maybe it's different and there's an opportunity there, but spending decisions like those in the US are very jobs driven and antibiotics just don't really fit into that
  - giantg2 6y ago
    I think that's a slight over generalization, but there's definitely truth there. The DoD is partnering with (funding) phage therapy research companies.
    - arethuza 6y ago
      I can recommend The Shadow World about the global arms trade : http://www.theshadowworldbook.com/ http://www.theshadowworldbook.com/ Mind you - not a book for the easily angered.
      - giantg2 6y ago
        Sounds interesting. I've heard of some of the stuff on this subject but I'm probably not familiar with all the details or examples. Maybe I will check it out.
    - vikramkr 6y ago
      Definitely fair to call it an over generalization - I grew up in a town with a "private sector" that only existed because of government contracts and have worked on pursuing DoD contracts for life sciences applications, and from what I've seen, it's fair to say that creating employment in the US continues to be a very large part of the driving force behind why funding is allocated by the government. The program managers aren't necessarily keeping it front of mind, but the people signing the legislation to give the program managers their funds to manage basically only care about the jobs part, and that bleeds through in a lot of subtle and non-subtle ways
snarf21 6y ago
This is what I really wish the WHO would solve. Have a global fund that every country contributes to based on GDP and/or population. The WHO buys an new drugs from the drug companies and then sets up manufacturing and stockpiles. Then we can get rid of all this drug advertising and reduce the cost of health care. We can stop have the same drug be cheaper in Canada than it is in the US. The drug companies can coordinate with the WHO to develop drugs for the most needed conditions. We don't need a 12th ED drug but a shelf stable anti-venom might be needed globally. If there are vaccines/shots we need globally, we can keep a certain percentage of flu or whatever around and ship to where they are needed. Instead each country has to keep their own stockpile with duplication of effort. In the US, we pay egg farms billions to produce eggs to be used for making flu vaccines for when actually need them but we pay for the farms year round so we have reserved supply. This is silly and there are easier ways to share the costs.
- HeadsUpHigh 6y ago
  Government funding on products never produces cheap products. The problem with drug prices is the cost of dealing with FDA regulations, not the free market. Insulin has no reason to be that expensive if it wasn't for the clusterfuck of IP protection laws that interact with each other and lock basic products out.
- m12k 6y ago
  Even better, let WHO shoulder the cost of trialing promising candidate drugs. The current system means every successful drug needs to also shoulder the cost of developing and (especially) trialing nine other drugs that didn't make it. Basically pharma companies currently work like hedge funds who expect most of their startups to fail but expect to make the money back on a single unicorn from each batch. IMO it would be a much healthier ecosystem if smaller labs could just do the development part.
throwaway_pdp09 6y ago
> is getting a drug that nobody will use That's silly. Of course society will want to use it. It's just that if they're wise[0], they'll use it as needed not spray it about (sometimes literally) [0] If. Big if.
- pbhjpbhj 6y ago
  I think they mean "has a sales profile restrained by public health considerations" - sell sugar pills and your market is comparatively limitless in this respect.

newacct583 6y ago

> unfortunately the one that's worked the best so far is the least commercially sustainable. So sustain it non-commercially. Governments have purchased medications in the past, often for exactly this kind of reason. We stockpile vaccines right now, even though the "market" doesn't want to. Really the most notable thing about this article isn't the science, it's the framing of the problem as "difficult" when... it isn't.

vikramkr 6y ago
It's politically difficult yeah. If there was like a $500 million or $1 billion dollar reward for bringing a new antibiotic to market (maybe with price regulations on the other end, but i don't think those would matter with antibiotics), this problem would be a long way to solved. Or a GAVI equivalent. But sometimes, scientific problems are easier to solve than political ones. I'd bet on a new breakthrough creating an alternative to antibiotics happening before the (US) government overcomes the political friction required to do what will be framed as bailing out big pharma. Hating big pharma is like the one thing both parties agree on here.

arethuza 6y ago

Globally we spend trillions on weapons (specifically nuclear weapons) that nobody wants to use so the problem doesn't seem completely insurmountable?

vikramkr 6y ago
The problem is that in America, creating jobs is a significant focus in government spending, including military spending. There's not a lot of jobs in antibiotics the same way that there are lots of well paying jobs to bring to your congressional district if you fund a plane to nowhere. Elsewhere in the world maybe it's different and there's an opportunity there, but spending decisions like those in the US are very jobs driven and antibiotics just don't really fit into that
- giantg2 6y ago
  I think that's a slight over generalization, but there's definitely truth there. The DoD is partnering with (funding) phage therapy research companies.
  - arethuza 6y ago
    I can recommend The Shadow World about the global arms trade : http://www.theshadowworldbook.com/ http://www.theshadowworldbook.com/ Mind you - not a book for the easily angered.
    - giantg2 6y ago
      Sounds interesting. I've heard of some of the stuff on this subject but I'm probably not familiar with all the details or examples. Maybe I will check it out.
  - vikramkr 6y ago
    Definitely fair to call it an over generalization - I grew up in a town with a "private sector" that only existed because of government contracts and have worked on pursuing DoD contracts for life sciences applications, and from what I've seen, it's fair to say that creating employment in the US continues to be a very large part of the driving force behind why funding is allocated by the government. The program managers aren't necessarily keeping it front of mind, but the people signing the legislation to give the program managers their funds to manage basically only care about the jobs part, and that bleeds through in a lot of subtle and non-subtle ways

snarf21 6y ago

This is what I really wish the WHO would solve. Have a global fund that every country contributes to based on GDP and/or population. The WHO buys an new drugs from the drug companies and then sets up manufacturing and stockpiles. Then we can get rid of all this drug advertising and reduce the cost of health care. We can stop have the same drug be cheaper in Canada than it is in the US. The drug companies can coordinate with the WHO to develop drugs for the most needed conditions. We don't need a 12th ED drug but a shelf stable anti-venom might be needed globally. If there are vaccines/shots we need globally, we can keep a certain percentage of flu or whatever around and ship to where they are needed. Instead each country has to keep their own stockpile with duplication of effort. In the US, we pay egg farms billions to produce eggs to be used for making flu vaccines for when actually need them but we pay for the farms year round so we have reserved supply. This is silly and there are easier ways to share the costs.

HeadsUpHigh 6y ago
Government funding on products never produces cheap products. The problem with drug prices is the cost of dealing with FDA regulations, not the free market. Insulin has no reason to be that expensive if it wasn't for the clusterfuck of IP protection laws that interact with each other and lock basic products out.
m12k 6y ago
Even better, let WHO shoulder the cost of trialing promising candidate drugs. The current system means every successful drug needs to also shoulder the cost of developing and (especially) trialing nine other drugs that didn't make it. Basically pharma companies currently work like hedge funds who expect most of their startups to fail but expect to make the money back on a single unicorn from each batch. IMO it would be a much healthier ecosystem if smaller labs could just do the development part.

throwaway_pdp09 6y ago

> is getting a drug that nobody will use That's silly. Of course society will want to use it. It's just that if they're wise[0], they'll use it as needed not spray it about (sometimes literally) [0] If. Big if.

pbhjpbhj 6y ago
I think they mean "has a sales profile restrained by public health considerations" - sell sugar pills and your market is comparatively limitless in this respect.