Antimicrobial resistance, a market failure

The stock market has a 90-day time horizon. Biology's time horizon is longer. - promoted by Bob_Neer

New York Times Editorial  points us to the World Health Organization’s recent report on the resistance bacteria, viruses, parasites, and fungi are developing to the drugs we’ve developed to control them. The long-term danger is that some species of microbes will overcome all the drugs made to control them. We could enter a world where the danger of infection makes surgery too risky. We’d live our lives differently because minor wounds could turn fatal. Pneumonia used to be the number one cause of death between 1900 and 1937. Without antibiotics, we could see those days return.

This is a serious situation. Resolving it is another case in which we run smack into conservative ideology and its current over-estimation of the value of free markets.

The Market Will Save Us

Following current conservative thinking, if there is a need for new antibiotics demand will increase and the force of the market will pull pharmaceutical companies into the breach to fill the unmet need. That does not accord with the facts, though. We’ve had problems with antibiotic resistance for decades and the last new class of antibiotics was discovered in 1987 – a quarter century ago. The market has clearly not provided adequate incentive.

Why is that? Unlike drugs for chronic conditions like high cholesterol or diabetes, antibiotics are generally only used for a couple weeks at a time, at the very most ninety days. Proving safety and efficacy of antibiotics is not easy and is fraught with ethical questions. So pharmaceutical companies just haven’t invested in them.

Why We Have This Problem

The reason we have this problem to begin with is that 70% of antibiotics are being fed to animals.  Partly that’s due to how we raise animals. Cows develop dyspepsia on an all-corn diet and get much more susceptible to illness. Pigs are now raised so close together that their tails are commonly removed so they won’t bite one another. Animals so close together are at greater risk of spreading disease to one another.

But the real reason is that small, sub-therapeutic doses of antibiotics are administered to livestock on a large scale because it makes them grow faster. For example penicillins are typically fed to pigs to promote growth.

Do you know what else administering sub-therapeutic doses of antibiotics does? It encourages the growth of bacteria resistant to the antibiotic. It’s simple evolution. With a smaller dose, slightly resistant bacteria survive. They can reproduce and form even more resistant bacteria.

As of today, the livestock industry has “voluntary” guidelines to restrain them. You don’t have to be an expert in game theory to realize that every livestock company continues to have an incentive to ignore these guidelines or, better, to pretend publicly to be meeting them while flouting them privately.

Solutions

This is a clear case where regulation is required and urgently to protect our way of life, but conservative ideology stands in the way of getting things done that need to be done. It wouldn’t be a bad thing either if government would begin to fund research into new classes of antibiotics.



Discuss

13 Comments . Leave a comment below.
  1. It All Starts with Food

    Some of us have been warning about antibiotic resistance because of factory farming since the 1970s. Factory farming is an unmitigated public disaster. It is a primary source of obesity and climate change as well as antibiotic resistance. We need to defund the plutocrats who control industrial agriculture and rebuild a system that is based upon something other than gross profits for the people who refuse to put their hands in the dirt.

  2. Anti-bacterial soap too

    Happily anti-bacterial soap is under review. It poses at least two problems: (1) again it’s applied in quantities too low to be effective, so again it can breed resistant bacteria, and (2) it seems to leave significant concentrations in the water supply.

    The market for such products is pretty robust. So regulation might be problematic.

  3. A key change of thinking needs to be....

    … that our collective herd immunity is a commons, just like our interest in the environment in general.

    • Interestingly enough

      The Daily Show had on Dr. Martin Blaser of NYU Med School on last night, he gave a pretty compelling argument that the government should do more, not less, in terms of regulating and creating our drug supply to ensure it’s safely handled and not overproscribed. He didn’t even get into the antibiotics in animals argument, but ending factory farming and the drugging of animals is a good place to start.

      • Except of course for marijuana...

        …where the attitude of you and others seems to be let ‘er rip:(

        • I don't get your point...

          When anti-biotics are overused, they create drug resistant superbugs which we will have no way to control which will result in more people dying.

          When marajuana is overused, then some veterans with PTSD get some relief and some people with the inability to keep food down due to side-effects from medication and/or chemotherapy are able to keep their food down.

          So I don’t follow your “logic”. :)

          • jconway's comment sounded supportive of greater regulation for some drugs...

            …yet he also supports not only medicinal, but full legalization of marijuana for recreational use. It just sounded to me that he is concerned about the overuse of some drugs and rightly so, but ideologically wants to open the flood gates on marijuana.

            • With all due respect

              I do not favor let her rip. You may be confusing me with SomervilleTom in that regard, but in all our conversations on the subject on this blog I have made it abundantly clear that I support a well regulated market for legalized lot. You are above right wing rhetorical tropes like “let we rip” and “open the floodgates”. I was going to recommend a lengthly article in the Washington Monthly for you that favors a state monopoly on marijuana precisely so that suppliers don’t try to make their money off of habitual users and addicts as beer distributors arguably do with the poorly regulated alcohol market.

  4. The "free market" blocks antibiotics

    The development of antibiotics is a case study in how the free market forces pharma companies to make exactly the WRONG decision — in some cases against their own preferences.

    ANY drug takes years to bring to market and costs billions to develop. Clinical trials alone are enormously expensive, and few initially promising compounds make it that far.

    In that context, pharma companies can’t afford to invest in antibiotics. There are precious few in the pipeline, and even those are limited in scope. That means it will take years (approaching a decade) to get the first one, even if full-bore development started today, which it won’t.

    Antibiotics are not profitable. When they are effective, they wipe out their target within days. Companies that are required to focus their resources on profitable activities can’t afford to develop antibiotics.

    The “free market” essentially prohibits the development of the new antibiotics that will be needed to control the resistant strains of bacteria that cause even common childhood disorders like Otitis and Strep Throat.

    It is increasingly likely that our grandchildren will again be dying of what are, today, routine disorders like ear infections.

    • Further reflection though

      The market for drugs at all is entirely a regulatory creation.

      f drugs were regulated the way they were in the nineteenth century or the way herbal supplements are today, we consumers would have only the weakest confidence in them. This or that compound could appear on the market based on hearsay, rumor, or shiny ad campaign alone. Nothing would have to be safe. It wouldn’t have to even be effective. It would just have to be marketable.

      Such a market would create short term rewards for the most convincing ads while trust in drugs, like a common good, would get steadily eroded.

      • True, and ...

        I was addressing the conservative myth that the “free market” will somehow magically produce the antibiotics we need to fight the resistant strains of bacteria we are breeding with “antimicrobial” products (also a gift of the “free market”). I think these new antibiotics require significant public investment. While I’d like the US government to lead the way, I strongly suspect it will not.

        I think it’s very likely that our grandchildren will be dying from infected scratches, strep throat, and ear infections. I think the solutions are likely to come from Europe or Asia, and I think those who can afford it will take their children there for treatment (or simply move there).

        The right wing is transforming America into a third-world nation. Too many Americans like that transformation.

  5. Epistemic closure and the right

    One of the things I keep wondering about is what would break through the right’s echo chamber? To a large segment, something isn’t true unless Fox reports it. The facts of climate change, for example, have no effect at all on the ideologically committed.

    Would the danger of dying of a scratch, of pneumonia, or of a minor surgery be enough to break through the cognitive cocoon? Is that a sufficiently clear, ugly, and personal danger that it might register?

    And if not, what might be enough?

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