Collins’ piece explores the history of the development of antibiotic resistance over the past 7 decades and seeks to elucidate the mechanisms that led to the current situation. Collins starts out by bringing fear into the minds of the reader by citing the number of people who die a year from infections and then bringing in estimates of the people who may die from just resistant infections each year (a nice large eight figure number). This fear drives the rest of the piece, despite the fact that the number is without a basis. The Uppsala conference that this “10 million deaths a year in 2050” comment was referenced from a study that in turn referenced a nonexistent report. While the number is a nice figure to catch the reader’s attention, without an actual study simulation to back up the number, it’s hard to consider seriously the article when the premise is built upon a fallacy.
Nonetheless, the piece continues on to describe how the number of antibiotics created every decade increased from the fifties to the eighties before dropping from the nineties onward. The past fifteen years have been the lowest period since the introduction of anti-microbial agents. This down turn in the creation of new drugs is a product of a lack of profitability of drugs that can be used for a short period of time and then dispensed of. This self-limiting factor of antimicrobial agents is unique compared to drugs servicing chronic diseases. Without an impetus from government entities or private non-profit agencies providing a financial incentives for the creation of new drugs, there is a bleak future for when the current batch of drugs has a significant level of resistance. However, the nature of the growing defunding of science budgets by the federal government in the past few years makes this an ever shrinking possibility. On the other hand, there is a growing amount of money going into large non-profit organizations for the purpose of health improvement globally and locally. However, this influx of money has not been significantly appropriated towards the creation of new antibiotics as of now.
This is exacerbated by the next figure which shows how most of the new drugs that have been created over the past few decades are derivatives of drugs that have already been created. These new derivative drugs are created with slight modifications on the initial backbone. This process reduces the amount of intellectual advancement that is required to create new classes of drugs. The small modifications that are needed keep costs low and also reduce the quantity of testing necessary for approval. This presents a unique perspective on the need of regulation that allows for different approaches to testing requirements. Part of this has already been implemented over the past decade once the lull in development occurred. It is up to time to see if that deregulation has had any effect on the market. In terms of timeline, Collins’ next graph shows how no new major drug classes were created between the early 1960’s and the late 1990’s. This is just further indication of the need for new solutions.
The importance of all this can only be stressed in the following two graphics which show the many different types of resistant bacteria commonly seen now (and their relevant case sizes) and the fact that the US is breeding ground for resistance more than Sweden is, respectively. It is especially important to consider since it showed that there is a growing portion of carbapenem-resistant enterococci and how they are resistant to all the current drugs out there. Without any first line of treatment to these infections there is little to do without a push for stronger drug development. While this may seem like a completely lost situation, there is hope in the fact that at present the number of CRE cases is minimal at best. Without much significant spread the current threat is not large. However, as the CDC indicated in their most recent reports, CRE presents one of the largest threats in the coming years.
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Collins’ piece explores the history of the development of antibiotic resistance over the past 7 decades and seeks to elucidate the mechanisms that led to the current situation. Collins starts out by bringing fear into the minds of the reader by citing the number of people who die a year from infections and then bringing in estimates of the people who may die from just resistant infections each year (a nice large eight figure number). This fear drives the rest of the piece, despite the fact that the number is without a basis. The Uppsala conference that this “10 million deaths a year in 2050” comment was referenced from a study that in turn referenced a nonexistent report. While the number is a nice figure to catch the reader’s attention, without an actual study simulation to back up the number, it’s hard to consider seriously the article when the premise is built upon a fallacy.
ReplyDeleteNonetheless, the piece continues on to describe how the number of antibiotics created every decade increased from the fifties to the eighties before dropping from the nineties onward. The past fifteen years have been the lowest period since the introduction of anti-microbial agents. This down turn in the creation of new drugs is a product of a lack of profitability of drugs that can be used for a short period of time and then dispensed of. This self-limiting factor of antimicrobial agents is unique compared to drugs servicing chronic diseases. Without an impetus from government entities or private non-profit agencies providing a financial incentives for the creation of new drugs, there is a bleak future for when the current batch of drugs has a significant level of resistance. However, the nature of the growing defunding of science budgets by the federal government in the past few years makes this an ever shrinking possibility. On the other hand, there is a growing amount of money going into large non-profit organizations for the purpose of health improvement globally and locally. However, this influx of money has not been significantly appropriated towards the creation of new antibiotics as of now.
This is exacerbated by the next figure which shows how most of the new drugs that have been created over the past few decades are derivatives of drugs that have already been created. These new derivative drugs are created with slight modifications on the initial backbone. This process reduces the amount of intellectual advancement that is required to create new classes of drugs. The small modifications that are needed keep costs low and also reduce the quantity of testing necessary for approval. This presents a unique perspective on the need of regulation that allows for different approaches to testing requirements. Part of this has already been implemented over the past decade once the lull in development occurred. It is up to time to see if that deregulation has had any effect on the market. In terms of timeline, Collins’ next graph shows how no new major drug classes were created between the early 1960’s and the late 1990’s. This is just further indication of the need for new solutions.
The importance of all this can only be stressed in the following two graphics which show the many different types of resistant bacteria commonly seen now (and their relevant case sizes) and the fact that the US is breeding ground for resistance more than Sweden is, respectively. It is especially important to consider since it showed that there is a growing portion of carbapenem-resistant enterococci and how they are resistant to all the current drugs out there. Without any first line of treatment to these infections there is little to do without a push for stronger drug development. While this may seem like a completely lost situation, there is hope in the fact that at present the number of CRE cases is minimal at best. Without much significant spread the current threat is not large. However, as the CDC indicated in their most recent reports, CRE presents one of the largest threats in the coming years.