tisdag 22 oktober 2013

The world is waiting for antibiotics

"I don't think people realize how much we rely on antibiotics," the slender, 31-year-old Laxminarayan told me recently. "We need these drugs for the next 200 years, and we're approaching this in such unimaginative ways that it's scary." 
- Jonathan Rauch, Ideas Change the World—and One Think Tank Quietly Did.
Antibiotic resistant bacteria are of great concern — the health of millions is dependent on medicine's ability to defeat the threat of infectious diseases. The World Health Organization estimates that multi-drug resistance accounts for more than 150,000 deaths each year, more than from tuberculosis.

Without effective antibiotics in health care, humanity would be thrown back to the time when urinary tract infections and pneumonia were lethal. Infant and maternal mortality would rise and ordinary surgical procedures would become risky to perform.

The report The world is waiting for antibiotics - six explanations to the antibiotic resistance problem (Världens väntan på antibiotika - sex förklaringar till antibiotikaresistensproblemet) by Waldemar Ingdahl discusses reasons for antibiotic resistance and what could be done to address the problem .

Often in the public health debate the development of antibiotic resistance is often pitted against the empowerment of the patient. Customer-oriented physicians and the self-interest of the patients, it is said, is increasing the development of resistant bacteria through increased prescribing. Economic theory said to point out antibiotic resistance as an example of the "collective action" problem, where individual actions lead to an outcome that is worse for everyone.

Is it that simple that we patients demand too much, and doctors bend to our will? A closer examination reveals that the causes of antibiotic resistance are more complex, and tied to the inability to develop new antibiotics.

An article giving the high points of the report can be found in The American How to halt the spread of superbugs.

  • Antibiotic resistance is often seen as a direct result of antibiotic prescribing . But the relationship is not clear. In Sweden, the prescription of antibiotics (number of prescriptions per 1,000/inhabitants) decreased over time. Between 1992 and 2011, which is the last year that data are available, prescriptions have declined by about 30 percent. Despite this, the number of outbreaks of antibiotic-resistant bacteria increased.
  • The number of outbreaks of antibiotic-resistant bacteria has increased due to several things. The main reason is that antibiotic resistance is dependent on bacterial evolution, where natural selection constantly creates increasingly resistant bacteria. This makes the development of new antibiotics important.
  • But recent developments do not seem to go in the right direction. Of the classes of antibiotics available in the market today about 75 percent were developed before 1970. Today it takes an average of 8 years for a drug to be approved in the U.S and Europe. The number of new drugs approved per billion dollar invested in research and development has fallen by half every nine years since 1950. This means that companies have over 95 percent fewer drugs per billion dollars they invest in research than they did in 1950, adjusted for inflation.
  • Some argue that the way to fight antibiotic resistance spreading is to diminish patient choice and empowerment. But the Netherlands has the lowest number in Europe of prescription of antibiotics despite a private health insurance system and great opportunities for the patient to choose a doctor.

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