Sunday, April 03, 2011

Placebo: How a sugar pill beame a poison pill. Part 3 of a continuing saga...

Read part 2.

To be sure, the early warning signs were there for the seeing. Sulfa drugs actually predated penicillin, but within two years of their debut became problematic for general usage because so many of the target bacteria had mutated into resistant strains. This omen would be ignored, as would a gloomy caution from the father of penicillin himself.

“The greatest possibility of evil in self-medication is the use of too-small doses so that instead of clearing up infection the microbes are educated to resist penicillin,” Alexander Fleming lamented to
The New York Times in 1945. Fleming foresaw the debut of types of “septicaemia or pneumonia which penicillin cannot save.”

Similar clarion calls were issued, but not heeded, from time to time in the decades that followed. “Little by little,” wrote Harvard infectious disease expert Dr. Maxwell Finland in a 1978 editorial for the New England Journal of Medicine, “we are experiencing the erosion of the strongest bulwarks against serious bacterial infection.” No matter. Two additional decades would pass before a meaningful concerted effort was undertaken to stem the ever-rising tide of antibiotic proliferation. That top-down effort commenced in 1999, a year after doctors and hospitals achieved a dubious milestone: They wrote an unprecedented 80 million prescriptions for penicillin, streptomycin and other antibiotics. That encompassed some 25 million pounds of pills flying out of American pharmacies and hospital dispensaries.

By that time an irreparable amount of damage had been done. In the years between 1945 and 1998, almost every known bacterial pathogen developed resistance to one or more commonly used antibiotics. By 1984, half of all Americans who contracted tuberculosis had a strain that resisted at least one antibiotic. In a recent WHO study, 25 percent of cases of bacterial pneumonia involved microbes that were resistant to penicillin, and an additional 25 percent were complicated by resistance to multiple antibiotics. Each year Americans contract 150,000 cases of pneumonia and 15,000 cases of bacterial meningitis for which effective antibiotics cannot be found. A sobering percentage will die, especially if the patients are elderly and/or infirm.

Bacteria have proved to be authentically diabolical foes of Mankind, displaying a Darwinistic genius that is unmatched in Nature. It appears that one strain can even share key parts of its genetic coding with another strain, thereby “teaching” a wholly different class of bacteria how to defeat a given drug. So it is that nearly all strains of Staphylococcus aureus—which, in the 1950s, could be treated successfully with a single penicillin regimen—today are resistant not just to penicillin but to many other antibiotics as well. Collectively these super-strains are lumped under the familiar umbrella term Methicillin-resistant Staphylococcus aureus, or “MRSA.” MRSA is deemed responsible for 14,000 annual hospital deaths that would not (and should not) have occurred, based on the ailments for which those victims initially were admitted. For surviving patients, MRSA vastly complicates their recoveries and extends their average hospital stay threefold. To such grim figures one must add the 140,000 annual emergency-room visits caused directly by adverse antibiotic reactions, as per a CDC study reported in September 2008. Estimates of the incremental cost antibiotic resistance inflicts on society range as high as $35 billion.

In some hospitals and childcare settings, antibiotic resistance is so entrenched that any attempt at treatment with low-cost, garden-variety antibiotics is pointless. Practitioners must turn instead to more costly, exotic compounds—a tactic that inevitably nurtures resistance to those drugs, too, thus calling for even newer and costlier compounds. “Treatment” becomes a maddening catch-22, a frantic race to stay a step ahead of the ever-evolving infectious agents. It's not only alarmists who think this is a race that bacteria just might win: that the bugs will develop immunity to all existing pharmaceutical countermeasures before we get enough new drugs into the pipeline to combat them. (Strangely enough, it may be the lowly but nearly indestructible cockroach that provides an answer to this riddle. New research shows that chemicals in a roach's brain provide the creature with superior resistance to the bacteria that have themselves become resistant to antibiotic measures. Scientists are exploring ways of harnessing this substance and applying it in human settings.)

The dire predicament has even taken as its casualty many of the antibiotics manufacturers themselves. With the cost of developing and commercializing a new drug now approaching $2 billion, antibiotics manufacturers and their investors have come to see their marketplace niche as unsustainable—a case of throwing good money after bad. Why invest such colossal sums in a new drug that may be obsolete within a year or two? For such reasons, as well as the byzantine vagaries of the drug-approval process, manufacturers are exiting the sector in droves. Thirty-six companies made assorted antibiotics in 1980. At this writing, fewer than a half-dozen remain. Though some of that attrition is a natural byproduct of industry consolidations, there's no question that the sector attracts far less interest these days from biotech firms and the venture capitalists who fund them.

And that is how a sugar pill becomes a poison pill.

To be continued...

1 comment:

Dimension Skipper said...

Hi Steve... Hope the new gig's hummin' along.

And I just wanted to say that I, for one—and for what it's worth—am still hanging around, still reading this series. Still nothing to say on it for the moment really and don't know if I will when all is said and done either, but mostly I'm just biding my time waiting to see where you're going with it.