The CNN headline:
“A dreaded superbug found for the first time in a U.S. woman”
A 49-year-old Pennsylvania woman has recovered from an infection caused by a Colistin-resistant bacteria. As a last resort antibiotic, Colistin is a weapon. If it won’t work, then we will need another final defense against superbugs. For now though, the CDC (Centers for Disease Control) says the incident was a “warning sign rather than a catastrophe.”
Where are we going? To antibiotic innovation.
Antibiotic Innovation Constraints
Volume has traditionally been the key to profits for new drugs. With research and development a gamble and generics pulling prices down, the incentive to innovate has been fueled by the chance for a generous return before a patent expires.
With antibiotics, though, there is a glitch.
Reminding us of Darwin, bacterial resistance is just the survival of the fittest. So when antibiotic use becomes more widespread, we have a greater chance of getting a resistant strain.
Consequently profit-seeking pharmaceutical firms experience an anomaly. The better the drug, the less it should be used. Furthermore, a new antibiotic not only benefits the user but also everyone who avoids the bug because someone else had successful treatment. The result? Less is more… except for profits and the incentive to find new antibiotics.
Our Bottom Line: The Tragedy of the Commons
It all adds up to a classic case of the tragedy of the commons. While the individual firm, the individual consumer and even the physician benefit from higher volume, as a community we suffer because the result is antibiotic resistance.
My Sources: Several weeks ago during one of my walks, I enjoyed a BBC “More or Less” podcast on broken antibiotic markets and learned about Boston University’s Kevin Outterson’s research. Once I heard the CNN story, I knew I had an interesting match. Meanwhile, if you want to continue, this Bloomberg “quick-take” has a good antibiotics overview (and my graph) while this Boston Globe column on pricing life-saving overdose drugs explains a related problem.