The UK’s chief
medical officer (CMO), Professor Dame Sally Davies, made a splash in the
media this week with
her warning that antibiotic resistance is the new climate change. There is a
‘catastrophic threat’ of ‘untreatable’ diseases, she said, which promise to
return us to a ‘nineteenth century’ state of affairs. The CMO has form: she warned the House of
Commons health select committee about the same problem in similarly stringent
terms back in January – a case not so much of apocalypse now, as apocalypse
again.
As with all such stories, reading the
actual CMO’s report leavens
some of the hysterical excesses of the press, which were stoked up by the CMO’s
excitable media appearances. Setting out the epidemiology of infectious
diseases in the UK, the report highlights that while some drug-resistant
infections, such as the well-known Clostridium
difficile (C diff) and MRSA,
are becoming less widespread, there is an increasing occurence of harder to
treat multi-drug resistant bacterial infections, which, although still only in
the hundreds of cases per year, are on the rise. The report states that only
five antibiotics to fight such infections are currently in phase II or III
trials, so the cupboard seems worryingly bare of new, necessary drugs.
So if we’re running short on drugs, how
can we make more? A sensible article in the British Medical Journal from 2010 clearly set out the
challenges facing the development of new antibiotics. Firstly, there are many
regulatory hurdles that make running clinical trials in this area difficult.
More importantly, there is a major financial disincentive for drug companies to
develop antibiotics. Currently, drugs which are profitable are those for
chronic conditions that are prescribed lifelong: painkillers for arthritis,
diabetes drugs, and the like. A drug that you take once to cure you is
unprofitable; doubly so if it is likely to be husbanded to prevent resistance
developing until the patent runs out. A change in government payments to
incentivise new antibiotics, like that which already applies to so-called
‘orphan’ drugs for rare diseases, would be an easy and rational step towards
producing more drugs that meet our needs.
While there is some discussion as to
whether the low-hanging fruit of easily produced effective drugs have already
been picked, if you’re not even trying to harvest from the tree, you’re not
going to find any fruit. As the BMJ article states, only 1.6 per cent of
all drugs in development by big pharmaceutical companies are antibiotics.