Tuesday, August 28, 2012

We're Losing the War on Infectious Disease

A couple of skirmishes in the long-term war against pathogenic bacteria  that human beings have been fighting since the dawn of human beings (before that, our pre-human ancestors fought in the same trenches).

NIH superbug outbreak highlights lack of new antibiotics
As doctors battled a deadly, drug-resistant superbug at the National Institutes of Health’s Clinical Center last year, they turned to an antibiotic of last resort. But colistin, as it’s called, is not a fancy new creation of modern biotechnology. It was discovered in a beaker of fermenting bacteria in Japan — in 1949.

That doctors have resorted to such an old, dangerous drug — colistin causes kidney damage — highlights the lack of new antibiotics coming out of the pharmaceutical pipeline even in the face of a global epidemic of hospital-acquired bugs that quickly grow resistant to the toughest drugs.

It’s a case of evolution outrunning capitalism. Between 1945 and 1968, drug companies invented 13 new categories of antibiotics, said Allan Coukell, director of medical programs at the Pew Health Group. Between 1968 and today, just two new categories of antibiotics have arrived. In 2011, the Food and Drug Administration approved one new antibiotic, which fights one of the many bacteria, Clostridium difficile, causing deadly hospital-borne infections.

Experts point to three reasons pharmaceutical companies have pulled back from antibiotics despite two decades of screaming alarms from the public health community: There is not much money in it; inventing new antibiotics is technically challenging; and, in light of drug safety concerns, the FDA has made it difficult for companies to get new antibiotics approved. As a result, only four of the world’s 12 largest pharmaceutical companies are researching new antibiotics, said David Shlaes, a drug development veteran and consultant.

Last year, Pfizer, the world’s biggest drug company, closed its Connecticut antibiotics research center, laying off 1,200 workers. The company said it was moving the operation to Shanghai. But Shlaes said Pfizer is struggling to open the Chinese facility and has largely abandoned antibiotics.

and in more "good news", CDC moves to keep new resistant gonorrhea at bay
Gonorrhea, a sexually transmitted disease that infects 700,000 Americans a year, already has become resistant to all but one class of antibiotics and could soon become untreatable, federal health officials warned. Doctors at the Centers for Disease Control and Prevention issued new treatment guidelines, hoping to delay the inevitable day when standard drugs no longer work. The guidelines call for withholding a potent oral antibiotic now commonly used to treat the infection. Instead, doctors should use an injectable form to which the gonorrhea bacteria seems less likely to develop resistance, along with a second type of antibiotic pills.
And, of course, multiple antibiotic resistant tuberculosis has been a problem for years.

 There are a few things that need to be done here:

First, we need to end the abuse of the antibiotics that still work; in fact we need to end the abuse of antibiotics in general, and reserve them for illness where they will make a significant difference.  No more prescribing antibiotics for sniffles that will resolve themselves in time.  No more use of antibiotics on a prophylactic basis in raising animals for food.

Second, we need to eliminate any regulatory barriers to antibiotic development (see above).

Third, we need a new approach to infectious diseases.  It's time to bring the power of DNA sequencing, and today's insane computational capabilities to bear, and determine just where a pathogenic bacterium is vulnerable, and develop non-antibiotic, genetically specific means to attack these bacteria.

Fourth, we need to be willing to pay for the new antibiotics, and the genetic approaches I advocate.

Hurry, my health depends on it.

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