There is still time to ward off medical disaster - but we need to think two steps ahead, not one

IF YOU’RE reading this article, antibiotics have probably saved your life – and not once but several times. A rotten tooth, a knee operation, a brush with pneumonia; any number of minor infections that never turned nasty. You may not even remember taking the pills, so unremarkable have these one-time wonder drugs become.

Modern medicine relies on antibiotics – not just to cure diseases, but to augment the success of surgery, childbirth and cancer treatments. Yet now health authorities are warning, in uncharacteristically apocalyptic terms, that the era of antibiotics is about to end (see “Antibiotic resistance an ‘apocalyptic threat’“). In some ways, it has been this way ever since antibiotics became widely available in the 1940s, because bacteria are continually evolving to resist the drugs. But in the past we’ve always developed new ones that killed them again.

Not this time. Infections that once succumbed to everyday antibiotics now require last-resort drugs with unpleasant side effects. Others have become so dificult to treat that they kill some 25,000 Europeans yearly. And some bacteria now resist every known antibiotic.

Regular readers will know why: New Scientist has reported warnings about this for years. We have misused antibiotics appallingly, handing them out to humans like medicinal candy and feeding them to livestock by the tonne, mostly not for health reasons but to make meat cheaper (New Scientist, 31 March 2012, p 5). Now antibiotic-resistant bacteria can be found all over the world – not just in medical facilities, but everywhere from muddy puddles in India to the snows of Antarctica.


How did we reach this point without viable successors to today’s increasingly ineffectual drugs? The answer lies not in evolution but economics. Over the past 20 years, nearly every major pharmaceutical company has abandoned antibiotics. Companies must make money, and there isn’t much in short-term drugs that should be used sparingly. So researchers have discovered promising candidates, but can’t reach into the deep pockets needed to develop them.

How did we reach this point without successors to today’s increasingly ineffectual drugs?

This can be fixed. As we report this week, regulatory agencies, worried medical bodies and Big Pharma are finally hatching ways to remedy this market failure. Delinking profits from the volume of drug sold (by adjusting patent rights, say, or offering prizes for innovation) has worked for other drugs, and should work for antibiotics – although there may be a worryingly long wait before they reach the market.

One day, though, these will fall to resistance too. Ultimately, we need evolution-proof cures for bacterial infection: treatments that stop bacteria from causing disease, but don’t otherwise inconvenience the little blighters.When resisting drugs confers no selective advantage, drugs will stop breeding resistance.

Researchers have a couple of candidates for such treatment. But they fear regulators will drag their feet over such radical approaches. That, too, can be fixed. We must not neglect development of the sustainable medicine we need, the way we have neglected simple antibiotic R&D.

If we do, one day another top doctor will be telling us that the drugs no longer work – and there really will be no help on the way.

This article appeared in print under the headline “Averting apocalypse now”