Saturday, April 9, 2011

Serious Medicine Crash Update--The world confronts a new "superbug" that could jeopardize modern medicine. Yet the antibiotic pipeline is drying up, an 81 percent decline. Health insurance can finance that sickness, but it can't prevent or cure that sickness. In other words, we have an elaborate and expensive system for caring for illness, but not for curing illness.

Once again, we are confronted with a new and potentially lethal epidemic.  The Lancet, the British medical publication, reports on the rise of a bacterial "superbug" that could reintroduce the risk of incurable infection, thus threatening all contemporary surgical practices.   As The Lancet puts it, "The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed."   And yet as the chart above shows, new antibiotics are down by more than four-fifths in the last quarter-century.  

As of now, nobody really knows the extent of the ultimate danger--although public health experts are worried.   After all, even before NDM-1, we have seen the deadly resilience of other kinds of infections, such as MRSA and extensively drug resistant tuberculosis.   In other words, even as we have turned our attention to major new killers among us, such as Alzheimer's Disease, we confront the potential recrudescence of mass contagions, even epidemics.    

Oh wait. we haven't really turned our attention to Alzheimer's.  We have mostly ignored the public health threat posed by Alzheimer's, too--except when it comes to paying for its costs.   We are heavy on insurance and light on cures.   Which, of course, is a formula for ruinous expenses, for individuals and for nations, combined with lack of hope against the ravages of disease.  

And thus we are reminded of the reality that health is more important than health insurance.  That is, medicine is more important than medical-finance mechanisms.   If new deadly strains of bacteria emerge, it matters little that we have health insurance, if at the same time we lack a cure.  Health insurance wouldn't have done any good in the 14th century, during the Black Plague, which killed perhaps a third of Europe.  Nor would health insurance done much good in the 20th century, when the Spanish Flu killed perhaps 50 million worldwide.  And the same could be said, more recently, of HIV/AIDS.   Health insurance is essentially retrospective; it is the financial after-effect, or shadow, of the medicine's ability to prevent or cure a disease--or not.  

Meanwhile, in the 21st century, we face a new superbug in the form of an enzyme, New Delhi metallobeta-lactamase, or NDM-1, that destroys carbapenems, an important category of antibiotics used for challenging hospital infections. NDM-1 has been found in many different kinds of bacteria, as The Wall Street Journal reported.  The Journal's Sten Stovall writes that "some experts warn health-care provision is in danger of reverting back to a pre-antibiotic era in which hip replacements, care of preterm babies and advanced cancer treatment are no longer possible."  And then Stovall quotes David Livermore, director of antibiotic resistance monitoring at the U.K.'s Health Protection Agency: "So much of modern medicine—from gut surgery to cancer treatment, to transplants—depends on our ability to treat infection. If resistance destroys that ability then the whole edifice of modern medicine crumbles."

NDM-1 has been observed in Bangladesh, India, Pakistan, where it is easily found in drinking water and sewage near healthcare facilities.  As The Hindu reported in New Delhi, the Indian government is "in denial" over the threat to public health posed by NDM-1.  And, more ominously for Americans, NDM-1 has also been found in Britain, which qualifies as a near neighbor to the US in this globalized world.   

So we can ask: What is the US government doing about NDM-1?   No doubt officials at the Centers for Disease Control and the Public Health Service are monitoring the news, and doing what they can, but who thinks for a minute that the threat of NDM-1 is anywhere high on the Washington DC agenda?  And even if it were, monitoring a disease is little better than providing health insurance--when confronted with a serious health threat, what's really needed is science, as opposed to finance.  

Meanwhile, as Stovall explains, there's little in the way of new antibiotics: "Over the past three decades only two new classes of antibacterial medicines have been discovered, compared with 11 in the previous 50 years."  Indeed.  As the chart above, put together by Eric Utt of Pfizer, shows, the "pipeline" of new antibiotics is, indeed, running dry--down 81 percent in the last quarter-century.

As the Journal’s Stovall observes, in the US, hospital-acquired, drug-resistant bacterial infections kill 63,000 patients each year and cost $34 billion.  And yet in the current political and economic climate, he continues, we see a lack of financial incentives to spur pharmaceutical companies to invest in researching and developing new antibiotics.  Stovall quotes Astra Zeneca CEO David Brennan: “Discovery needs to be underpinned by new financial mechanisms that allow companies to receive a return on their investment in new drugs, while limiting their use to situations of greatest need."

And yet, Stovall continues, “Experts say it isn't viable for drug companies that spend millions developing a new antibiotic medicine then to be told by regulators to hold it in reserve for the next emergency. A fresh approach and new business model for antibiotics R&D is needed, they say. Options include new models for compound-sharing in discovery research, the revisiting of previously discarded compounds with modern methods, and the involvement of public funding in antibiotic R&D.”

The collapse of the antibiotic production line is another instance of the Serious Medicine Crash; we are seeing plummets in the larger category of new drugs and devices that parallel the collapse of antibiotic production.   Indeed, we are also seeing a collapse of the medical venture capital market.  

If this crash continues and worsens, leaving us vulnerable to public health threats such as NDM-1, then the debate over health insurance that has transfixed American public policy for the last three decades will look like small potatoes--or worse, the debate will look like a dangerous diversion, a diversion that took our collective eye off the ball of our own health and longevity.

Here's a screengrab of the WSJ story: 


  1. I agree with everything you wrote Jim. Cures are what we need and Pharma’s pipe line is drying up faster than a lawyer can say ‘Class Action’. And that is the problem the Hill People are ignoring! We need to flush them down the drain every November until we get a large enough group in there who will do what We The People want!

    But “What is the US government doing about NDM-1?” Now?
    What a magnificent weapon to unleash on Al-Qaeda!
    Hurray for a new black plague. If we use the opportunity right, our CIA can unleash it wherever the Al-Qaeda hang out. I don’t care about Geneva protocols. War is war, and the faster we get it over with the better.

    In the ‘60s, I remember the CIA dosing prostitutes in Nam with an incurable sexual disease which also was called the black plague,- then putting them into the N. Vietnam Generals Cat House. Oh, those were wacky days! I’m not sure, but I seem to remember one of our hollywood movies picked up on that theme. Anyway, maybe I’m wrong about the movie.
    Thanks for evoking the memory. Haven’t thought about that story in decades.

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