Huge costs and virtually no gain. A good antibiotic is used during a short term. Furthermore if things go on like today it will probably be destroyed within years by short-sighted, irresponsible use like fattening cattle. Any pharmaceutical company suicidal enough to start development with those odds will probably have put itself out of business long ago already.

This is an existential threat in many ways. Infections we shrug at today are going back to being life-threatening. And it isn't just infectious medicine that's losing power by this. Surgery, for example, get vastly more dangerous, difficult and expensive if there isn't effective antibiotics; in some cases downright impossible.

I think you are right about public funding to the research and expect to see it rise. Where I would really like intergovernmental cooperation is in making sure the new antibiotics are used in a responsible, sustainable way. Routine use like an agricultural food additive should be a felony as far as I'm concerned, and even when used for curing serious disease it should be high priority making sure cures are completed and risk of transmitting resistant bacteria is minimal. We have to protect antibiotics effectively if there is to be much point in developing new ones.

"Furthermore if things go on like today it will probably be destroyed within years by short-sighted, irresponsible use like fattening cattle."

Which of course explains the widespread use of vancomycin for that purpose.

Seriously, while this use of antibiotics is problematic, there's no evidence it's a big problem today---if there was it would be written in flaming letters across the sky.

"Where I would really like intergovernmental cooperation is in making sure the new antibiotics are used in a responsible, sustainable way."

How does this work? What happens to a bad actor who doesn't care or just can't get its act together?

> How does this work? What happens to a bad actor who doesn't care or just can't get its act together?

Governments could refuse entry to people who've visited that country.

And do what at the borders, many if not most of which are porous?

The vast majority of people moving between countries pass openly through airports or border checkpoints where they could be turned back. Yes, there are illegal immigrants and drug traffickers who sneak across the desert or dodge the Coast Guard in motorboats, but they represent an insignificant fraction of total human traffic and opportunities for carrying antibiotic-resistant disease.

The FDA is already creating incentives for antibiotic research.

http://www.fda.gov/Drugs/DevelopmentApprovalProcess/Developm...

Based on the seriousness of the infection being targeted, the FDA is creating accelerated approval pathways. There has already been some discussion about guaranteeing a certain amount of profit for the pharmaceutical company once it hits the market.

It's a start.

Markets are quite bad at developing any kind of reserves. So in the case of antibiotics: we have the antibiotics we need at the moment ( at least mostly). A new antibiotic would be quite expensive to develop, and then it would just sit on a shelf. Thinking about it, it is quite the same as the banking crisis in 2008, there was no secondary banking system, because that would operate at higher cost and therefore get kicked out of the market.

And your single first sentence (this was drafted before you added your second paragraph) hints as to why:

Chronic diseases cannot generally be "cured", just controlled, so patients need a lifetime supply of a drug.

A new antibiotic will only be used in the direst of cases, like vancomycin as mentioned in the article.

It costs so bloody much to get a drug to market that drug companies tend to chase the former, where they can in theory get their money back (that's actually not tending to happen overall), whereas the latter could bankrupt them. Asking the government or charities to play this game is asking for politics to further enter into it, the outcomes are not likely to be good.

I absolutely agree that the financial incentives are mismatched, with private companies less interested in trying to cure or improve underlying medical problems than in treating/controlling symptoms.

"Asking the government or charities to play this game is asking for politics to further enter into it, the outcomes are not likely to be good."

I'm curious where this die-hard free-market willful blindness comes from. I object to the categorical classification of government or charity being bad choices to solve problems.

The nature of the specific market under discussion makes all the difference in the world. The nature of the administrative path from funding to research & development also makes a difference. There can be efficient allocation of funds in government and in private sector charities, just as there can be inefficient allocation of funds due to bad management in private companies devoted to solving the same problems.

Free marketeers have effectively redefined "government run program" to mean inefficient... it may be that most of the time, but there is nothing inherent about government programs that demands inefficiency. There's a similar stigma regarding charity. Those are almost effects of free-market thinking: if everyone is convinced that government and charity are poor ways to solve any problem, then government and charity are left with incompetent administrators, bloated management structure, and poor oversight.

Since this problem is identified as one that the private commercial sector is poorly motivated to solve, the question is not whether public sector or charity should attempt to tackle the problems -- it should -- but how to structure charity or government programs so as not to waste the money they are given to address the problem.

When you talk about efficiency you're going off on a tangent I'm not intending; in this case, I'm much more worried about political choices on what approaches and drugs to pursue, and politics messing with the safety and efficacy testing. Also, anyone thinking there is anything like a "free-market" pharmaceuticals is simply not paying attention.

On the most general principles, I claim politics are a given in organizations of the scale we're talking about. My special claim about governments and charities is that for-profit companies have a governor in that if they don't make a profit, they'll suffer and eventually die. WRT to my testing point, I also don't want the same entity having a large hand in both developing and testing drugs. I'd also want to look at the current and past roles governments have had in pure drug development; it certainly can do amazing things like the wartime push of penicillin mass production, then again that's not the sort of problem we're having today with antibiotic resistance.

"Since this problem is identified as one that the private commercial sector is poorly motivated to solve...."

Which has a whole lot to do with the government's regulation of pretty much everything involved in getting a drug to market. Not everything, certainly, it's hard to develop these sorts of drugs, and I think its telling how many of the families use β-lactam rings. So I claim that changes in laws and regulations are in theory a very fruitful avenue. In theory because the demonization of "profit", especially in the context of saving lives, makes promises a government makes today highly suspect, "I am altering the deal. Pray I don't alter it any further."

So, continuing on the meta track, there are several cases when the private sector fails, which I'll try to categorize:

1. Government intervention screwing up what would work in a purely free market.

2. Markets that free enterprise is not equipped to handle. Massive front-end costs combined with unpredictable or insufficient future revenue (for instance, reducing or eliminating externalities in a way that the company can't capitalize on renders something unworkable for the free market).

3. Markets that have a pathological condition where they are inelastic and when there are less-desirable substitute goods one of which is vastly more profitable.

4. Markets that are monopolies or oligopolies: where there is insufficient competition.

Is it even productive to engage in a discussion focusing on category 1, when pharma has issues in all four categories, and reducing government regulation in any way even if it's merely to reduce unnecessary up-front drug development costs (which I agree is a noble goal) is likely to make some of those other pathologies worse?

edit to reduce clutter: fair enough.

Obviously we have grave disagreements here, enough in my opinion that I don't think it's productive for me to reply further. But I'd add at least a "5": too many monopsonies (http://en.wikipedia.org/wiki/Monopsony), e.g. nation states negotiating directly with drug companies, and insisting on prices barely above the costs of goods (well, I'm sure insisting on less, but settling on that).

>The lack of advancement in antibiotics is a stark contrast to the recent improvements in treatments for so many chronic diseases.

I'm curious to know what diseases you're talking about here. I don't see much improvement in this area at all.