Saturday, April 17, 2010

Paying the piper

One of the major problems in the fight against antibiotic resistance is how we will pay for the required solutions.  Even though we stand to gain money through prevention of death and sickness and all the additional costs engendered by resistant infections, to prevent these infections or to treat them with new, as yet undiscovered antibiotics, is going to require an investment. As in money (to say nothing of time, energy, dedication . . .).   Of course, this investment would be nothing but good for our economy. Below is an incomplete list of things that have been proposed along these lines.

·      Ban the use of those antibiotics used for growth promotion in animals where resistance might result in resistance in human pathogens.
o   This seems like a no-brainer.  But the large food producers argue that this will slow time to market, increase their costs and increase costs to consumers.
·      Increase infection control efforts in hospitals.
o   Good luck on billing insurance companies for this! 
o   Not only that, but quality improvement measures are now forcing hospitals to eat the costs of certain hospital-acquired infections even though not all of them might have been prevented by good infection control measures. This is because of recent Medicare reimbursement policies where care for some of these infections is no longer reimbursed.  But somehow, these costs will have to be covered.
·      Carry out additional basic and epidemiological research to better understand the origins of resistance in bacteria and how resistance spreads among bacteria.
o   Again – a great idea and necessary.  But as the recent NIH budget suggests, we aren’t willing to pay for this either.
·      Provide incentives for pharmaceutical companies to produce new antibiotics active against resistant pathogens.
o   I think this is a great idea.  But no one who might have to pay for these incentives agrees with me.
o   I noted the European initiative in an earlier blog and I hope that they will actually DO something along these lines – but I’m skeptical.
·      Provide financial disincentives for companies who have abandoned antibiotic research.
o   This is an idea put forth by Dr. Louis Rice.  He feels that since pharmaceutical companies have marketed antibiotics for what some might consider inappropriate use, and that this use led to the more rapid emergence of resistance, they should pay the price.
o   But the fact is that even if we could implement and enforce such a policy, someone would still have to pay and it is not clear that it would be the pharmaceutical companies or their shareholders.

What are the consequences of doing none of the above?  Well, the fact is that infection control efforts will continue to improve since hospitals know that nosocomial infections are not good for their bottom line in any case.  This improvement will simply be at our current slow pace instead of the more urgent pace we could accomplish with additional funding. The same is true for research.  We will keep plodding along with a minimum number of investigators while failing to attract new investigators to the field. As far as incentives (and disincentives) for the pharmaceutical industry – I predict that we will continue to lose large pharmaceutical companies either through continued consolidation or through cost-cutting and prioritization which will always favor chronic diseases over acute bacterial infections.  I predict that the biotech industry will continue to struggle because of an ever-decreasing number of potential large pharma partners for antibiotics.  One potential bright spot for biotechs and biotech-watchers is that innovation there is starting to improve (see my previous blog).   Another potential bright spot is that biotechs are starting to do their own deals – e.g. Cubist and Calixa.  We certainly live in interesting times. 

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