“Antimicrobial resistance is widely considered to pose one of the greatest risks to modern medicine faced by this generation.” The opening sentence of yesterday’s House of Commons science and technology committee report paints a bleak picture. The report cites poor stewardship and lack of research focus as the twin causes of this dire situation.
The press has been quick to pick up mentions of GPs handing out antibiotics like placebos to placate patients looking for something more prescriptive than bed rest and plenty of fluids. The report emphasised the key role that education of the public in antibiotic resistance has to play.
However, education is not always straightforward. The BBC was recently criticised for artificially seeking a reporting balance even in areas where there is little or no reputable scientific disagreement. And it is far from alone…
The quest for balance is made worse by the fact that public is quick to pounce on anything that counters the “establishment” view. This kind of over promotion of marginal views has fuelled the growing anti-vaccination movement.
I’m not accusing news services of saying there is no such thing as antibiotic resistance. However, constant medical scare stories seem to encourage the view that healthcare is a highly personal thing that has little or no impact on others – yet nothing could be further from the truth. In this climate, refusing to prescribe antibiotics seems almost like an infringement of human rights.
Unfortunately, antibiotic resistance is a natural process of evolution. There is a strong and obvious evolutionary benefit of developing resistance to a toxin to which any living thing is exposed. Resistant organisms are often out-competed by non-resistant ones but when the toxin is always present, the resistant version soon becomes the norm.
Developing new toxins that work in different ways is probably the most effective way to stop this happening but no totally new classes of antibiotic have been developed for 20 years. Apart from the difficulty of developing them, there are several commercial realities that make antibiotics less attractive development targets than other drugs:
- They have limited use – patients only receive them for a short time and they are seen as treatments of last resort;
- They are inexpensive – especially compared to the several thousands of dollars charged for many cancer drugs;
- They have a short lifespan – the potential of resistance limits sales potential;
- Clinical trials are expensive – it may not always be clear precisely what disease is affecting a patient and diagnosis can lead to delays and greater expense. Also patients with serious bacterial infections need immediate treatment.
So what is the solution? The UK Government recently set up a task force to come up with ways to address the issue. There was some criticism of the appointment of Jim O’Neill ex-Goldman Sachs Chief Economist to head the unit. Comedian, Jeremy Hardy, pointed out that Mr O’Neill’s previous job made him an expert on “parasites that resist all attempts at control.”
However, unless a way is found to effectively balance all of the commercial realities (and I’ve not even mentioned the $4.5 billion global trade in antibiotic “performance enhancers” in animal health) we’re not likely to see much real progress. An estimated 3,000 people die in the UK every year because of antibiotic resistance – if we are going to see this number decline, maybe Jim O’Neill is just the right person.
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