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Comment by zeteo | Hacker News Reader

> we're helpless and the world is again going to be a scary place

Whoa there. According to the article, we have few new antibiotics precisely because the old ones have been so effective:

>Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. [...] They have to develop drugs that will make money, and that’s not an antibiotic.

When we had lots of development effort put into antibiotics, there were lots of new antibiotics discovered. Expect that level of development to come back if / when infections again become a bigger problem than high cholesterol.

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I still worry about the profit motive getting in the way. You'll buy antibiotics for days or maybe weeks; you'll buy drugs for high cholesterol the rest of your life.

This is touched in the FRONTLINE documentary. See 33:40-40:00 here: http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmar...

Basically Pfizer, one of the last companies working on antibiotics for gram-negative bacteria, pulled out due to pressure from shareholders, because there's little money to be made here. You spend billions of dollars on creating an antibiotic, and upon its release the recommended instruction is to "use it as less as possible"? -- there's no money in that obviously, there's more money in cholesterol drugs, ADHD drugs, and other drugs you'll continue taking for a long long time.

I feel bad to steer the discussion this way -- but this it, this perfectly underscores one of the scary faults of capitalism. Everyone wants to see a nice smooth growth curve. Growth is prioritized higher than long-term stability of society. We need to fundamentally re-think this.

Having read this and the article on autonomous corporations, I suddenly understand that the future of capitalism is extinct humans and very financially well-off computers.

Keep in mind that Pfizer's strategy is in response to the incentives offered by the marketplace including regulations set forth by the FDA and patent office. It's not a free market that sense.

It's not hard for the FDA to streamline approval process so that development costs are lowered or for them to offer extended periods of market exclusivity so that costs can be recouped over a longer period of time.

The FDA has already moved on the regulatory aspect and companies have responded. Antibacterials is a much more attractive market now than it was 5 years ago.

I worked for Pfizer, for 2 years in clinical trials to get Linezolid on the market. This was for treating MRSA infections. I was in close contact with nurses & doctors who seemed to think it worked well. Back then (around 10 yrs ago), there was almost no MRSA resistance, unheard of from what I remember.

Then I left and lost track of it all. Wikipedia now says it's 100USD / pill.

If there's really a lot of resistance to Linezolid, that would be quite shocking.

In my project there was a lot more MRSA in "poorer" parts of the country, in hospitals with lower hygiene standards. Hospitals also refused to report their MRSA stats ("it doesn't exist here", not wanting to be known as a place where it's found since it is related to hygiene).

Interesting stuff.

No we don't - this is just where we need to fund government laboratories to research drugs in areas which drug companies do not presently find profitable.

They could patent it and charge $5000 a course to people who are suffering from resistant bacteria. It's the American way.

If that's what's necessary for the company to develop such an antibiotic, why not? State-of-the-art cancer drugs can cost that ore more. I'd rather pay $5k and live, to not being able to do anything.

Remember, it takes 8-12 years and $1,000,000,000 on average to whittle 10,000 drug candidates into 1 fully tested FDA approved drug.

If a company is going to spend a decade and a billion attempting to develop a "management" antibiotic for continual profit, I'm willing to bet the profit motive exists for another company to make a normal antibiotic... that most doctors would happily prescribe over the ridiculous multi-year option...

It's a big risk and I doubt some company will attempt to make a maintenance drug out of antibiotics.

Unless you're implying that profit motive means they simply won't try because it's not insulin or something, which is ridiculous. Profit motive... there is profit to be made in a new antibiotic, there's the motive. Not every pharma company will just let money sit on the table in favor of older drugs nearing the end of patent protection.

Though one recent study of drug development costs had an antibiotic against C. difficile as one of the cheapest to develop.

I've actual found there's a fair amount of interest in antibiotic development among drug companies.

>you'll buy drugs for high cholesterol the rest of your life

Not if you get killed by an infection first.

This humorous observation does not affect the argument, it just derails it. It's easier to make money off drugs for chronic conditions than for one-off infections.

And it's sometimes easier to invent a chronic condition for a drug, than vice versa.

Also many chronic diseases are autoimmune diseases, like asthma or type 1 diabetes. In such patients the immune system gets weaker when in crisis, leaving them vulnerable to infections.

This is not at all how drug development works.

I suppose that's true, but it seems like a perverse incentive to me. Drug companies have a financial incentive to wait for people to die rather than taking action that will prevent people from dying.

Really? The most profitable drug ever is Lipitor which is entirely based on reducing the threat of future health problems. High cholesterol does nothing to you in a short timeframe, but will greatly increase your likelihood of death 20-30 years from now.

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