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I suspect this problem will self-correct. It's not that we've run out of choices: it's partially that pharmaceutical companies had the narrow view that developi

I suspect this problem will self-correct. It's not that we've run out of choices: it's partially that pharmaceutical companies had the narrow view that developing new antibiotic drugs is less profitable than developing drugs for chronic illness (e.g., to control cholesterol); once catastrophe hits due to bacteria being resistant to all current drugs, it will be extremely profitable to work on this class of drugs again. Take a look at this interview with Dr. John Rex M.D., (V.P., Clinical Research, AstraZeneca) [1] "Dr. JOHN REX: If you need an antibiotic, you need it only briefly. Indeed, that’s the— that’s the correct way to use an antibiotic. You use it only briefly. And from an economic standpoint of a developer, that means you’re not— you’re not getting the return on the investment you’ve made because you’ve spent between $600 million and a billion dollars to bring that new antibiotic to market." [1] http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/transcript-51/ http://www.pbs.org/wgbh/pages/frontline/health-science-techn...

ProblemFactory 13y ago
Most things in the world eventually self-correct. But before that happens, many people will be hurt and die in the process. For example, we could do away with CDC, FDA and building codes, and rely on Yelp customer reviews of drugs, restaurants and electrical contractors. Eventually the ones that kill people should get bad reviews and go out of business - but this won't help the first victims and their relatives.
- acchow 13y ago
  Intriguing to think about. But what will probably happen is the lack of controls will allow for higher profits - the companies that kill people will have way more money to pay off Yelp to censor bad reviews.
  - Ygg2 13y ago
    True, but Yelp would lose all credibility, so it wouldn't be used to determine anything than dining out.
  - dd36 13y ago
    The companies would pay to post fake reviews. Oh wait. They already do that! Deceptive marketing thresholds and punishments would have to be much higher.
- clinton_sf 13y ago
  > Most things in the world eventually self-correct. But before that happens, many people will be hurt and die in the process. Yes, I understand that, but my point is that this isn't some apocalyptic end to the world as we know it, and it helps to take the long view of how it will unfold and prepare accordingly. As insensitive as it sounds, it's more productive to look at why something bad happened and what we can do about it rather than lamenting that bad things happen in the first place. Sadly, when you look at large groups of people, it's human nature to ignore problems that don't have short term profitable solutions. People have known about this problem for decades and are unable to persuade the decision-makers to proactively prevent this scenario from happening; it'll be interesting to see how it unfolds as an emergency (probably not very well), and what will be done differently after the emergency is handled. Perhaps non-profit groups like the Gates Foundation will work on antibiotic drugs in the future, simply because for-profit pharmaceutical companies aren't going to touch it because it isn't profitable enough. Or perhaps an international group will try to tackle this problem, similar to how they try to tackle other global problems (which isn't promising: look at how we're globally handling environmental issues). As for looking at this problem now, it may be profitable for people to pick up the dropped research in gram-negative antibiotics. The Hacker News crowd would most likely be interested in the bioinformatic aspect of this problem, modeling gram-negative bacteria and its interaction with various compounds.
  - chii 13y ago
    > for-profit pharmaceutical companies aren't going to touch it because it isn't profitable enough. may be it isn't profitable enough because the other problems they chose to focus on is more "important" in the eyes of society. I see profitability as a measure of how important society sees a problem as. Not what people say, or what is morally important, but actual market decisions that drives such profits is the real source of truth.
    - clinton_sf 13y ago
      > but actual market decisions that drives such profits is the real source of truth. Right. Cue up the 2008 financial crisis. > may be it isn't profitable enough because the other problems they chose to focus on is more "important" in the eyes of society. Back to my original comment that this is a self-correcting problem: https://news.ycombinator.com/item?id=6771657 https://news.ycombinator.com/item?id=6771657 But I doubt that society at large evaluated that certain things (that are currently very profitable) are more valuable than avoiding the situation of running out of effective antibiotics. I posit that there's so much information overload, this problem is simply overlooked by the masses (due to human nature) until it's too late.
beat 13y ago
One problem is that antibiotics are themselves somewhat toxic to humans. As the friendly ones become ineffective, the less friendly ones come into play.
skue 13y ago
It won't self-correct overnight. It takes decades of research to identify new antibiotics, ensure they are safe and effective, get them approved, and bring them to market. And you're assuming that there is still a large supply of potential antibiotics waiting to be discovered and which can be discovered relatively quickly. Our current batch of antibiotics already attack bacteria in very different ways. How many new classes can we invent which are effective against bacteria but non-toxic to humans?
ern 13y ago
I've seen comments on HN when this point was raised, that newer antbiotics are also held back for serious cases so sales turn out lower during the patented life of the drug, which provides a further disincentive for developing them. It's also been pointed previously on HN out that vaccines are one-shot drugs that are still developed (indeed, my kids have had 6-in-1 and MMRV combination vaccines, which reduce the number of shots needed by kids-I don't know how that works out for drug companies, but I doubt it increases their volumes) .

ProblemFactory 13y ago

Most things in the world eventually self-correct. But before that happens, many people will be hurt and die in the process. For example, we could do away with CDC, FDA and building codes, and rely on Yelp customer reviews of drugs, restaurants and electrical contractors. Eventually the ones that kill people should get bad reviews and go out of business - but this won't help the first victims and their relatives.

acchow 13y ago
Intriguing to think about. But what will probably happen is the lack of controls will allow for higher profits - the companies that kill people will have way more money to pay off Yelp to censor bad reviews.
- Ygg2 13y ago
  True, but Yelp would lose all credibility, so it wouldn't be used to determine anything than dining out.
- dd36 13y ago
  The companies would pay to post fake reviews. Oh wait. They already do that! Deceptive marketing thresholds and punishments would have to be much higher.
clinton_sf 13y ago
> Most things in the world eventually self-correct. But before that happens, many people will be hurt and die in the process. Yes, I understand that, but my point is that this isn't some apocalyptic end to the world as we know it, and it helps to take the long view of how it will unfold and prepare accordingly. As insensitive as it sounds, it's more productive to look at why something bad happened and what we can do about it rather than lamenting that bad things happen in the first place. Sadly, when you look at large groups of people, it's human nature to ignore problems that don't have short term profitable solutions. People have known about this problem for decades and are unable to persuade the decision-makers to proactively prevent this scenario from happening; it'll be interesting to see how it unfolds as an emergency (probably not very well), and what will be done differently after the emergency is handled. Perhaps non-profit groups like the Gates Foundation will work on antibiotic drugs in the future, simply because for-profit pharmaceutical companies aren't going to touch it because it isn't profitable enough. Or perhaps an international group will try to tackle this problem, similar to how they try to tackle other global problems (which isn't promising: look at how we're globally handling environmental issues). As for looking at this problem now, it may be profitable for people to pick up the dropped research in gram-negative antibiotics. The Hacker News crowd would most likely be interested in the bioinformatic aspect of this problem, modeling gram-negative bacteria and its interaction with various compounds.
- chii 13y ago
  > for-profit pharmaceutical companies aren't going to touch it because it isn't profitable enough. may be it isn't profitable enough because the other problems they chose to focus on is more "important" in the eyes of society. I see profitability as a measure of how important society sees a problem as. Not what people say, or what is morally important, but actual market decisions that drives such profits is the real source of truth.
  - clinton_sf 13y ago
    > but actual market decisions that drives such profits is the real source of truth. Right. Cue up the 2008 financial crisis. > may be it isn't profitable enough because the other problems they chose to focus on is more "important" in the eyes of society. Back to my original comment that this is a self-correcting problem: https://news.ycombinator.com/item?id=6771657 https://news.ycombinator.com/item?id=6771657 But I doubt that society at large evaluated that certain things (that are currently very profitable) are more valuable than avoiding the situation of running out of effective antibiotics. I posit that there's so much information overload, this problem is simply overlooked by the masses (due to human nature) until it's too late.

beat 13y ago

One problem is that antibiotics are themselves somewhat toxic to humans. As the friendly ones become ineffective, the less friendly ones come into play.

skue 13y ago

It won't self-correct overnight. It takes decades of research to identify new antibiotics, ensure they are safe and effective, get them approved, and bring them to market. And you're assuming that there is still a large supply of potential antibiotics waiting to be discovered and which can be discovered relatively quickly. Our current batch of antibiotics already attack bacteria in very different ways. How many new classes can we invent which are effective against bacteria but non-toxic to humans?

ern 13y ago

I've seen comments on HN when this point was raised, that newer antbiotics are also held back for serious cases so sales turn out lower during the patented life of the drug, which provides a further disincentive for developing them. It's also been pointed previously on HN out that vaccines are one-shot drugs that are still developed (indeed, my kids have had 6-in-1 and MMRV combination vaccines, which reduce the number of shots needed by kids-I don't know how that works out for drug companies, but I doubt it increases their volumes) .