Co-evolution of nature, science and economics
The history of antibiotics gives some great examples of how the ‘path taken’ is shaped by the coming together of disparate and sometimes quirky conditions and events and requirements, which then create the conditions for the next part of the journey. Which antibiotics have been developed and are available, and what will happen in the future seem to be influenced as much if not more by economics and politics than by science. Indeed, the story illuminates how our current economic laissez-faire system is putting at risk investment and collaboration in antibiotics research with potential serious impacts for our future health.
This was not a topic on my radar. I was invited to attend a book launch of Dangerous Miracle by Liam Shaw. His aunt is a friend of mine. The book is well written and illuminating and Shaw is a great speaker; do go to hear him if you get the chance.
Two particular stories piqued my interest:
Pfizer and citric acid
The first was the story of how Pfizer became involved with antibiotics.
Shaw explained that antibiotics are naturally occurring molecules made by bacteria and fungi and found in soil. They come, like fossil fuels, from deep time and, like fossil fuels, we are using them up at a ferocious rate.
The bacteria inside us react to antibiotics and can evolve to resist them, triggered by random mutations which allow new strains of bacteria to evolve. Some of these new strains, resistant to the antibiotics we are taking, will survive and thrive when others do not.
Shaw told how Pfizer had found a niche in manufacturing citric acid. Then, during the second world war, when citrus fruit was not easily available, they developed a way of extracting citric acid from fungi, brewing it up in vats.
At the same time, there was a big push to accelerate production of penicillin to save the lives of wounded soldiers (and also, incidentally, to treat their gonorrhoea). The US was leading its production, directed by the US Committee on Medical Research, and they enlisted several institutions as collaborators, sharing technological expertise across universities and companies, circumventing the usual rules of competition and capitalism. Pfizer’s deep tank fermentation process developed for manufacturing citric acid, was found ideal for manufacturing penicillin. So, this was how Pfizer first got into pharmaceuticals – a complex weave of repurposing technology and urgent need – enabled and catalysed by the drive of the US Committee on Medical Research.
The new generation of antibiotics? The unintended consequences of ‘leaving it to the market’
The second story I want to share from Shaw’s work exemplifies the potential downsides of ‘leaving it to the market’. He reflects on the consequences, in our times, of drugs research increasingly being led by/outsourced to the pharmaceutical industry in full pursuit of profits and a desire to dominate the market. He explains how this has led, in the US, to heavy marketing of branded antibiotics and their consequent overuse. In contrast he comments that in the UK, the National Health Service (NHS) has developed purchase contracts with the pharmas which allow it to pay a set amount per annum for access to an antibiotic irrespective of the amounts used. In this way, there is no pressure on doctors to overprescribe and no advantage in heavy advertising; moreover, it keeps the costs stable for the NHS.
Shaw also explains that, despite increasing bacterial resistance, there is little commercial incentive to develop new antibiotics as the current market for those individuals who don’t respond to existing ones is relatively small (merely one million die worldwide from antibiotic resistance at the moment). He says that we need ungently to seek out new antibiotics, both in the soil and synthetically, as it takes 10-15 years to get new medicines into products. But antibiotics research is not regarded as having much commercial advantage compared with, say, drugs for Alzheimer’s or cancer. As he emphasises, the goal of capitalism is financial reward not addressing future social needs; furthermore, there is no incentive to share research or collaborate – as the prize is the patent. This ‘market failure’ concerns him greatly as antibiotic resistance is rising and he can foresee a future in which we are yet again at the mercy of bacteria. As he says, “antibiotics are so fundamental to modern medicine that they are almost a necessary condition of its existence”, and yet, he continues, the industry seems resolved to leave them behind.
I am always excited when new examples that illustrate the workings of the complex world come to light: the shaping of the future through the interplay of events, motives, needs and opportunities; and the systemic weaving of the economic the social the environmental and, in this example, the scientific. The way the dynamics of laissez-faire economics can dominate the agenda, lock-in advantage for the powerful, and limit our collective ability to address unfolding issues of social welfare such as (in this case) antibiotic resistance is also of great concern to Shaw, as it is to me.