The limits of the market

Here is the review on antimicrobial resistance, considering drug resistant infections which could set back medicine a hundred years. Hip operations would be too risky, if someone might die from a resistant infection after. It is commissioned by the UK Government and partly funded by the Wellcome Trust. It collects evidence of how market failure inhibits development of antimicrobials- generally known as antibiotics- and the economic effects of a failure to contain resistant organisms.

Some resistance develops from insufficiently regulated generic manufacturers in the third world not putting sufficient quantities of active ingredients in pills, or using cheaper less effective alternatives; or even not making the pills properly soluble in the patient’s gut. Because the immune system attacks transplanted organs it needs to be suppressed, so making transplantees more vulnerable to infection.

Here is the industry declaration on resistance (pdf), signed at the World Economic Forum in Davos by 85 companies and nine industry associations in the pharmaceuticals business. They want the law changed, so that “the pricing of antibiotics more adequately reflects the benefits they bring”.

I love the change in language. The “pharmaceuticals” are “antimicrobials”, because of course humans are “biotic”, though the commonly used word is used to journalists. “Antimicrobials” is more accurate but also distances the cognoscenti from the laypeople. I also love the term “New Drugs for Bad Bugs” (ND4BB), a programme of the European Commission.

The review estimates the cost of total antibiotic failure as £100 trillion over thirty years, so continuing resistance would be a great benefit. I do not want that to be the cost to users. The company which patented the last effective antimicrobial could hold humanity to ransom- or even, restrict the treatment to the wealthiest, under precise, controlled conditions, so no microbe would become resistant. However the declaration also commits to making antimicrobials affordable in the third world.

It calls for the removal of incentives to prescribe higher volumes of antibiotics. The more you sell, the more you make- but that increases resistance. It calls for alternatives, such as vaccination and improved diagnostic tests for resistant infections, and for more judicious use of antibiotics in farming. Improved hygiene also inhibits transmission of infection. It admits that new valuation mechanisms and commercial models to make antibiotic research benefit everyone do not yet exist- we stand ready to work with payers and policymakers on new valuation mechanisms and commercial models that specifically address the unique challenges of this market.

A competitive market model has not brought the new antibiotics needed to combat resistant strains, and cannot protect us. We need ways of collaborating for the good of all, to prevent resistance. The human organisations so far created for co-operation for the common good are democratic governments and inter-governmental organisations. Only democratic governments can prevent the exploitation of new antibiotics, or the wrongful use of existing antibiotics, for unjust gain.

Cezanne, Les joueurs des cartes

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