Most of us alive today do not remember life before antibiotics. I would have had one more uncle had penicillin been available a year earlier; up through the first half of the twentieth century, many now-minor diseases were fatal. Antibiotics were the original miracle drugs, curing a range of bacterial diseases.
But the antibiotic era may be ending. Antibiotics contain the seeds of their own destruction: A few bacteria occasionally have mutations that lead to resistance, and those quickly multiply. Thus an antibiotic's useful life span is limited. In the 1960s, I used to take Penicillin G for various things. It has been out of general use for decades. A range of other members of that beta-lactam antibiotic family have been developed since then, each one chasing after the newly-resistant strains of bacteria that kept emerging. And other antibiotic families chased after other types of bacteria, or served those with a common allergy to penicillin and its relatives. For a few decades, the pharmaceutical industry kept up with the threat.
But now the bacteria are winning. And we're not doing anything about it. This is the microbiological cousin of global warming, a public health crisis that capitalism can't solve.
The problem is not just that we can't keep creating new antibiotics. It's more systemic than that. We no longer even try. The medical and pharmaceutical industry structure has no room for antibiotic research and development.
Developing a new drug is costly. It begins with a lot of candidate compounds. Some are simply lab-developed molecules that look like they might attack bacteria (viruses are not attacked by antibiotics; anti-viral drugs are even rarer). Some are natural compounds, often alkaloids extracted from plants. Tropical rain forests are a wonderful source of exotic chemicals; with all of those life-forms in balance, the chemistry between them is a great place to look. But rain forest destruction isn't even the biggest problem.
Lots of compounds are tested in the lab to see if they have a useful effect. Those that look promising are then subjected to another range of tests, to see for instance if they're poisonous themselves. Finding something that is both safe and effective is a real needle in the haystack search. It takes time and money. Once a promising compound is found, it is given more in vitro testing and then animal testing before human testing begins. It is tested for toxicity and tested for effectiveness, usually with double-blind testing with real patients.
This process is largely the same regardless of a drug's commercial potential. Big pharma has figured this out, and they now focus primarily on drugs for chronic conditions. If you need Lipitor or another statin for your cholesterol, you take it daily. Prozac or another psy-med is taken daily. Glaucoma drops are taken daily. Go down the list -- the hot-selling drugs are the ones where the prescription gets refilled, not the ones that are used for ten days until the infection is cured.
And the high cost of prescription drugs in the US is not mostly being spent on R&D, no matter what they want you to think. The brand-name drug companies spend more on marketing and advertising than on new-drug development. And a lot of drug development is for copycat drugs, those that are very similar to another one, but different enough to have their own patent. So there are a bunch of statins on the market. And the d-isomers of drugs that came out in achiral (d+l) form, like Nexium, the d-isomer of Prilosec. No biological difference, but a much higher price for the sucker who demands it. Or their insurance carrier.
So antibiotics, where success means you only need a few doses, are a lousy business to invest in. But it gets even worse than that. If an antibiotic turns out to be successful against resistant bugs, then the best thing to do from the public health perspective is to not use it unless it is absolutely necessary. The more an antibiotic is used, the sooner resistance will appear, so once the arrow is in the medical quiver, it should only be fired rarely, so long as alternatives exist. But how does that make for a business? Especially when the high profits to the drug's developer only accrue during the term of the patent, before generics come out at a lower price. Manufacturers want to sell as much as they can during the patent term. That is exactly what should not be done with new antibiotics!
(And let's not forget about the fact that most antibiotics are fed to farm animals, as part of their daily feed, where they breed resistance. That practice should be banned.)
In the meantime, drug-resistant bacteria are spreading. They typically spread in hospitals and nursing homes. In a decade or two, we could end up with epidemics as bad as before antibiotics hit the market.
So what can we do about it? The problem is that nobody in power wants to deal with the problem. American civil religion preaches that the market solves all problems, but antibiotics defy the market, since the goal is to have a small demand and to not use it more than necessary. Thus big pharma simply isn't developing them any more. Nobody is. And the usual solutions make no sense. The old "orphan drug" rule allows even stricter patent protection, so the drug can be retailed for a more ridiculous price. (Some drugs now sell for around $1000/day. Their manufacturers simply assume that the insurance companies will pay.) And even that leads to only limited development.
Antibiotics, properly regulated, are a public good. So their development should be funded as a public good. Raytheon doesn't have to advertise its missiles on TV; Lockheed-Martin doesn't advertise its warplanes. If we can spend hundreds of billions of public dollars on weapons of war designed to fight the Soviets and other no-longer-existent enemies, why can't we spend public money to develop medicine? It needn't all be done by big pharma, either; universities are well-positioned to do the basic research. Then the drugs can be patented by the government, as the funding agency, and made available at a reasonable cost, manufactured like generics. This would help lower overall health care bills too, compared to the purely-capitalist model of pharma funding we now have.
It takes a long time to develop a really new antibiotic -- an unpredictable time, since you never know when you'll find a good one. Research should have started yesterday. It would be a very good investment of public funds, not wasteful spending. Congress' refusal to consider it shows how it is still beholden to private interests, regardless of the public good.