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Antibiotics to Fail in 10 Years?

By Roger Bate - October 16, 2003 12:00 AM

Canada has decided to take advantage of breaches in international patent agreements for AIDS drugs and announced it will allow its generic copy-cat producers to supply drugs to poor countries. This move is being hailed by activists as a great advance that will aid the poorest victims of this devastating plague. While the move may have some positive effects in lowering the price of drugs, it is also likely to prove a disincentive to drug innovation and development.

 

At the same time as the Canadians were making their stand, a little known British academic was announcing that current antibiotics might be useless in a decade. Although the two announcements might seem completely unrelated, they are in fact intrinsically linked. Many antibiotics have been developed in the past decade, but the rate of growth has slowed. Indeed the trend is for no growth or even a decline. This is due to the lack of incentive for companies to develop new drugs: Fearing that they might be ripped off -- such as by Canadian generics producers -- they have determined the potential reward for research and development is no longer worth the risk. The results could be stark.

 

Resistance Is Not Futile

 

Ever since Alexander Fleming discovered penicillin there has been a constant battle between bacteria and the antibiotics developed to kill them. Genetic mutations (whether in humans or bacteria) occur constantly and usually provide no benefit, but occasionally they do. Perhaps one in a billion bacterial mutations provide resistance to the antibiotics that previously killed the bacteria. Through natural selection the resistant bacteria may survive and proliferate. Given that bacteria re-produce rapidly and there may be billions of them in an infected person, it is inevitable that antibiotic resistance will eventually develop. Alternatives have to be at hand for which no bacterial resistance exists, and so far there have always been alternatives.

 

Professor Hugh McGavock is a medical specialist for the University of Ulster in Northern Ireland. He says increasing resistance to antibiotics could lead to an end to some surgical procedures because the antibiotics currently essential to prevent infection "will be rendered useless" in the not too distant future. Speaking to the BBC, he compared the potential severity of the crisis of increasing antibiotic resistance to that of the AIDS epidemic.

 

To illustrate the dilemma, Dr. McGavock referred to the problems that are currently posed by the hospital superbug methycilin resistant staphylococcus aureus (MRSA). MRSA is resistant to all drugs but one: vancomycin. It can prove fatal to people with impaired immune systems, or to those allergic to vancomycin. It is found in most hospitals in Britain and in many other places, particularly around the developed world.

 

Finger Pointing

 

The medical profession initially tried to duck the problem by blaming farmers. They claimed that the routine use of similar antibiotics in farm livestock was contributing to drug resistance in humans. This led to public concern, much hysteria and bans on livestock antibiotics in some countries in Europe. The result has often been counterproductive, since cutting down on routine use of antibiotics in feed has meant more therapeutic antibiotics have had to be used when animals become ill. Therapeutic use is more costly, thus making some food products more expensive. For example, pork produced in Denmark and Sweden, where bans have been in place for several years, is more expensive than the rest of Europe. Nevertheless, an EU-wide ban is expected for all routine use of antibiotics shortly, even though, by some medical experts' estimates, it contributes at most 1% of human drug resistance.

 

The second favorite target for doctors is patient behavior. Patients often do not take a full course of antibiotics since they usually stop once they start to feel better. According to Professor McGavock, the "antibiotic will not have killed of all the bacteria, so the bacteria that remain then build up resistance to it. We have already seen some strains of tuberculosis that are resistant to drugs, although this has not happened in big cases in the UK, but this has meant going back to surgery, which was the treatment provided in the 1930s. One way to prevent this resistance is direct observed therapy, ensuring the patients take the drugs properly, but this is expensive." At least this argument has some validity since perhaps as much as 35% of drug resistance is due to a lack of patient follow-through.

 

Doctors acknowledge that they prescribe antibiotics where they may be ineffective just to get patients out the door. But doing this contributes directly to resistance build up. Doctors often don't have the time and resources to carry out laboratory tests to ensure whether antibiotics would be appropriate and prescribe antibiotics by guessing from patients' symptoms.

 

The other contributing factor to resistance, which no one really likes to discuss, is the fact that hospitals are breading grounds for disease. Iatrogenic diseases (those caused by treatment/doctors/hospitals) are increasing in frequency and severity because hospitals are not properly cleaned. It's impossible to know with precision how much dirty hospitals contribute to resistance; some estimates put it at over 15%. But any contribution is disgraceful, since it is so cheap and easy to avoid.

 

Precarious Future

 

The most expensive and effective way to stay ahead of resistance is the discovery and development of new antibiotics. Variations of old antibiotics are always useful but there is often cross-resistance. New variations are resistance-free for only a short amount of time because the bacteria don't have to mutate much to develop resistance. It is therefore important that new classes of antibiotics are developed.

 

According to Jim Eadie of the Association of British Pharmaceutical Industry: "The ability to treat and prevent bacterial disease has been one of the major medical advances in the last century. Obviously there is concern that the ability to treat common infections will be more difficult in the future due to antibiotic resistance. For its part the pharmaceutical industry is helping to discover new antibiotics and vaccines."

 

One has to hope that the brilliance of drug company scientists can continue to outdo doctors' poor prescribing, dirty hospitals and patient slackness. It is also vital that the companies remain profitable, and without patent protection this will become impossible.

 

The Canadian Government may think it is helping poor Africans when it allows drugs to be copied. But they provide a disincentive to the companies that produce the drugs for the elderly of Canada. Perhaps when their patients start dying from MRSA they will think again, but by then it might be too late.

 

Dr. Roger Bate is a visiting fellow at the American Enterprise Institute and a columnist for TechCentralStation.com.

 

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