Most of us are aware that antibiotic resistance is growing. Nasty infections and one-time killers, such as pneumonia, gonorrhoea and tuberculosis are threatening to return in new forms, impervious to the drugs that kept them at bay for over 70 years.
A warning, one of many, was issued by Chief Medical Officer Dame Sally Davies last week who declared that we are facing an “apocalyptic scenario” that will lead eventually to people dying from a minor infection after a routine operation.
Such nightmares don’t come out of the blue however. Antibiotic resistance is reaching dangerous levels largely because the interests of the drug companies in selling the drugs, directly conflict with what needs to be done to keep resistance at a manageable level.
The most obvious first step would be to develop new drugs. However that hasn’t been happening for over a decade simple because antibiotics don’t make enough profit. Why? Because they cure people so they don’t have to take them for long. As the CMO said “The companies see greater profits in medicines that treat chronic conditions.” Contrast the four or so new antibiotics in the pipeline with the 800+ for lucrative drugs and vaccines for cancer.
Previous proposals to boost antibiotic production usually include paying drug companies more money to do it. But Davies seemed to be far less accommodating, saying: “There is a broken market model for making new antibiotics”. Could it be she agrees with Body of Evidence that there is a serious problem with our evidence based medicine model which largely relies on commercial companies to decide what to research and develop and what to ignore? We’ll know next month when her plan for tackling the problem will be released.
These are some of the key actions that need to be taken.
a) Cut back on excessive prescribing by GPs who are responsible for handing out about 80% of these drugs. Too often they are given for viral infection like coughs and colds. Even some common infections like bronchitis that are caused by bacteria don’t respond particularly well to antibiotics, so cut back on them too. This is the best known target and progress is being made.
b) Develop better and quicker tests to identify which bug is actually causing the symptoms and then treat it with a drug that specifically targets it. That way fewer other strains will develop resistance. The shot-gun approach of immediately giving a broad-spectrum drug makes resistance more likely.
c) Make sure hospitals follow tough hygiene procedures. These can be very effective at stopping that spread of disease as has been seen by the drop in MRSA cases – from 2000 every three months to fewer than 100.
d) Cut back heavily on antibiotics use on animals, which in the USA now account for 80% of sales. This increases resistance to a number of drugs considered “critically important” for humans by the World Health Organisation. Recently MSA was found in UK milk supplies. Antibiotics are a vital part of factory farming since the conditions make them sick and more vulnerable to infections. Improved conditions such as opportunities for exercise and fresh air (more expensive in the short term) that keeps animals naturally healthy is what is needed.
e) Taking steps to improve human health and immunity too could make a big difference. One place to start would be in hospitals where for years studies have found that a shocking 30% of patients are at high risk for malnutrition. A serious campaign to cut that figure could significantly improve recovery from operations and reduce infections afterwards.
None of these, however, are in the drug companies’ interest since they all threaten to reduce sales, so they are likely to try to counter them.
a) When new antibiotics become available it is highly likely that GPs and hospitals will be encouraged by the companies’ sales forces to increase usage.
b) Drug development will be targeted towards broad-spectrum drugs because they generate bigger sales. The more tightly targeted a drug is the more expensive it will be.
c) Being able to use a new drug is lot more attractive than tiresome hygiene procedures. Companies will exploit this all too human tendency to go for the easier option of increased prescribing when something new is available.
d) Giving antibiotics to animals is hugely attractive because it gets round the limitations of human use. Instead of a brief course the animals get them preventatively for most of their lives. The drugs are literally put in the drinking water. The number of animals needing drip-fed antibiotics continues to increase.
e) Drug companies have consistently shown very little serious interest in testing non-drug methods of improving health.
There is one more point about prescribing to animals that is worth mentioning because it illustrates perfectly just how totally uninterested the drug companies are in tackling antibiotic resistance. In 2011 the government allowed companies to start advertising antibiotics to farmers, over the objections of two professional vet’s organisations the VMD and the BVA.
This flies in the face of steps being taken to tackle antibiotic resistance in the rest of Europe. All other countries are committed to cutting antibiotic prescribing to farm animals; Denmark has cut back from its high level by 50% in two years. Advertising drugs for animal use is banned in all EU countries yet the government thought a relaxation of the rules was a good idea. The only reason for advertising is to increase sales.
What are the chances that the CMO’s new plan will involve such radical measures as developing the drugs on a non-commercial basis, taking seriously non- drugs approaches known to be effective and following the rest of Europe in drastically reducing antibiotic use on animals, starting with banning advertising the drugs to farmers? Without them this latest round of shroud waving will look like a skilful drug company PR exercise.