The WSJ had a chilling article (and blog post) on a recent study of bacterial resistance a few days ago:
Every time the patient took his medicine, the antibiotics killed the weakest bacteria in his bloodstream. Any cell that had developed a protective mutation to defend itself against the drug survived, passing on its special trait to descendants. With every round of treatment, the cells refined their defenses through the trial and error of survival. “It means that during a normal course of treatment there is an evolutionary revolution going on in your body,” said Stanford University biologist Stephen Plaumbi, author of The Evolution Explosion: How Humans Cause Rapid Evolutionary Change.
The piece reminded me of an LLM thesis I read in May on the unique challenge of developing antibiotics. As Maggie Mahar’s Money Driven Medicine observes, drug companies have a far greater incentive to create pills that need to be taken every day than for one-shot items like most antibiotics–there’s more time to spread payments over. Even more confounding is the tension between the economics of patent terms and the public health consequences of bringing new antibiotics to the market.
Ideally, the medical community “holds in reserve” the newest and strongest antibiotics for those rare cases when they are desperately needed. The majority of cases should be treated with “old standby’s.” The faster the newer antibiotics come into general usage, the more bacterial resistance can develop. But with an effective patent term of less than 20 years, firms have an economic incentive to promote immediate use of a drug before it goes generic.
Kevin Outterson launches an even deeper critique of patents in his article The Vanishing Public Domain: Antibiotic Resistance, Pharmaceutical Innovation, and Public Health. He notes that
The problem is not limited to antibiotics. Variants of the human immunodeficiency (AIDS) virus develop resistance to anti-retroviral drugs. Some pharmaceutical knowledge is exhaustible, a conclusion which upends the conventional wisdom for IP policy stretching back to Jefferson and beyond.
Though drug patents are often justified on the grounds that the drugs they cover eventually go into the public domain, that’s little consolation if resistance renders the drug ineffective by the time it becomes generic.Â