> The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed If that is so, then that research should be done by the state. The well-being of entire human race cannot be tied to monetary incentives of profiteering.
What are examples of the state actually achieving a research objective better than free enterprise?
The ENTIRE technology core of the US. The government channels taxpayer money to state research organizations like DARPA. They invent things like the Internet. Then they turn over those to the private sector for profit.
I'm not sure. Not only do you need to kill bacteria, you need to not kill or harm humans at the same time. That is a high bar.
You need to kill bacteria, not kill humans and print money. The optimal strategy is to wait as long as possible as the value of a novel drug goes up as resistance goes up.
Hot take, but I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics. The second there’s a new antibiotic, poor countries are going to over-use generics of it and create resistance.
I’m not sure, but what about the space program in the 1960s?
I thought of that too. I don't know enough about it to know if it's a legit counterpoint. My view is that real competition is necessary to efficiently and effectively get to a solution, versus focusing on the bureaucratic mechanics of running the machine that's supposed to be building the solution, which is what happens when government takes things on. But the space program, and maybe the Manhattan project, actually…
> I don't know enough about it to know if it's a legit counterpoint.
Its a gigantic counterpoint. A large swath of the technology used today was developed by NASA and then turned over to the private corporations for them to profit. Socializing the costs. Privatizing the profits.
The Internet iself an argument. It was developed at DARPA with taxpayer money. Then turned over to the private corporations so that they could profit. Another case of socialism for the corporations.
> But with a reduction of taxation I’m pretty sure government tax revenue is still at or near all time highs. As the population grows there’s more and more taxes to spend for this purpose. It’s just a matter of priorities.
> As the population grows there’s more and more taxes to spend for this purpose. but so does the cost to service that growing population.
Basic research scales in a way that treating specific individuals doesn’t. Treating specific individuals can be handled by insurance.
I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinica…
This is actually completely right. I believe there's some policy in the works in the US after talking to a friend who's doing some consulting work to help align the Cost-Benefit side of antimicrobial development. I can't say if there's a plethora of drugs just waiting to be released after CT requirements are lowered, but definitely there is less of an R&D incentive currently because pts who take antimicrobials only t…
Seems likely there’s a fairly small number of possible classes of broad spectrum antibiotics that can be developed. Bacteria don’t just evolve resistance to a single molecule but instead to a vector of attack, and anything you’re giving to people needs to avoid harming human cells.
So ultimately the question becomes how many types of attack are possible?
There’s also pharma world wide. Seems the system is broken if only massive economic upside in the US is what leads to drug discovery and successful clinical trials.
Testing requirements are as high in other rich countries. And existing antibiotics work fine atm. Nobody’s gonna pay to use new ones unless there’s no alternative, both for cost and resistance reasons. So why bother? Might as well postpone development until there’s a real market, right? I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.
Yes and no. Many strategies for delaying antibiotic resistance require having multiple different effective antibiotics at the same time. Thus, getting down to the point where only a few work rapidly speeds up antibiotic resistance.
Unfortunately, antibiotics are the tragedy of the commons writ large, and we’ve been wasting them for minimal gain because even minor private benefit generally outweighs long term consequences.
I am quite sure, that if a sufficient bounty was given out for developing new kinds of antimicrobials, they'd be developed in no time. The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinica…
The problem with developing a new antibiotic is that doctors from third world countries will prescribe them like candy - so the bacteria become resistant to it fast. In fact Im very scared when I read that there are plans to use antibiotics "borrowed" from ants, or bees, because probably the antibiotic will be dumped by tons and become useless after 2-3 years, while all the ants or bees in the world die out. Apart fr…
Your points are all entirely valid, except the "third world country" stuff: all the things you complain about are common in the richest and most developed nations. It's a systemic problem everywhere, not just in poorer countries. In fact, it might be worse in the richer countries because access to these drugs is more affordable (relative to local cost of living) there: farmers in a rich country can easily afford to pump up their livestock on unnecessary antibiotics, whereas poor farmers in some backwards country can't afford that and probably don't have access to the drugs.
There’s also pharma world wide. Seems the system is broken if only massive economic upside in the US is what leads to drug discovery and successful clinical trials.
Testing requirements are as high in other rich countries. And existing antibiotics work fine atm. Nobody’s gonna pay to use new ones unless there’s no alternative, both for cost and resistance reasons. So why bother? Might as well postpone development until there’s a real market, right? I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.
The reason not to postpone development is because it isn't a particularly quick solution. It would be one thing to develop and test them, and then postpone deployment of them. It's another thing to not have a backup plan and hope that one of the antibiotic candidates work out, and quickly.
Modern cities are a huge disease vector. That kind of population density lets sickness run rampant. Untreated TB has something like a 25% mortality rate, and we've already seen drug-resistant (DR) and extreme drug-resistant (XDR) strains of TB. An outbreak of TB that we have no antibiotics for would be devastating.
> The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed If that is so, then that research should be done by the state. The well-being of entire human race cannot be tied to monetary incentives of profiteering.
What are examples of the state actually achieving a research objective better than free enterprise?
The majority of core research has been backed by government funds for a while now. Commercialization and mass market adoption is typically where private enterprise steps in.