In a recent post, I discussed some recent reports warning of a looming “post-antibiotic era”, an epidemic of superbugs resitant to all antibiotics. In much of the reporting, there is an accompanying criticism of the pharmaceutical industry for not paying enough attention to the problem. If there is a coming epidemic of antibiotic resistant bacteria, the pharmaceutical industry is the only entity capable of reversing the course. Although academic labs, government organizations, and charities can all play a role in drug discovery and development, ultimately it can’t be done to any significant degree without involvement of the major pharmaceutical companies in some form.
But looking at the rate of regulatory approval for new antibiotics shows a steady decline over the last few decades (see the graph in this article for example). Although pharmaceutical companies are not neglecting the problem of antibiotic resistance entirely – the new drug dalbavancin (Dalvance) for treating methicillin-resistant Staphylococcus aureus was approved just a few weeks ago, for example – the trend is clear.
Derek Lowe says the reason for this is that all the “low-hanging fruit” has been picked: If there ever was a field of drug discovery where the low-hanging fruit has been picked clean, it is antibiotic research. You have to use binoculars to convince yourself that there’s any more fruit up there at all. I wish that weren’t so, very much. But it is. Bacteria are hard to kill. But I don’t know if that’s really the issue. The low-hanging fruit has been picked in nearly every area of drug research. And in my estimation, developing a new antibiotic has got to be a much more tractable problem than developing a new drug for unmet medical needs such as Alzheimer’s disease where the pharmaceutical industry is investing heavily.
So why not do the same for antibiotics?
The only reasonable answer that I see is that the decision makers in the pharmaceutical industry don’t really believe that the post-antibiotic era is near, that there is no significant unmet medical need imminent in this area. And that answer should hold even for the people that have the cynical view that pharmaceutical companies are only driven by greed. Any company that comes up wih a drug to treat a widespread deadly superbug which no other drug can treat will have the opportunity to make a large amount of money.
The current state of the market for antibiotics is that there are numerous options currently available in a competitive environment. For most uses, low cost generic antibiotics with a long history of established medical use will continue to be widely used rather than expensive new medicines. The medical need for new antibiotics to treat resistant strains of bacteria is simply not great enough to entice pharmaceutical companies to invest in the expensive process of bringing a new antibiotic to market. If new wonder drugs are developed to treat superbugs, they aren’t likely to be in high demand by doctors and patients. Therefore, they will not be heavily prescribed, dramatically limiting profitability.