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Re: Guest Post - Apocalypse?

1

Maybe it's part of their plan to save the planet.


Posted by: peep | Link to this comment | 09-30-19 9:39 AM
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2

Got to think that new antibiotics are going to become very valuable indeed once all the existing ones stop working.


Posted by: ajay | Link to this comment | 09-30-19 10:37 AM
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3

The signal works, but there's a lag.


Posted by: Moby Hick | Link to this comment | 09-30-19 10:39 AM
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4

This is not new. Most major pharma shuttered their antibiotic divisions in the 90s. Tropical disease is also becoming increasingly dangerous and ignored at major pharma. The story isn't very complicated, unfortunately. A new antibiotic for TB was just approved in the US, with efforts headed by a nonprofit that was basically given a drug 70% of the way developed. There have been two major approvals in the past three years, but the drugs are esoteric and unlikely to work as broad spectrum treatments. To their credit, pharma has opened their libraries to a number of private-public partnerships for screening work, but so far, I'm not aware of any big wins from huge efforts.

Part of the reason new antibiotics aren't profitable in the US is that they're held as "drugs of last resort," so whatever you develop, your market is going to be very small.

What is killing us bacteria-wise is (1) horrible manufacturing processes (think factory runoff creating resistant strains in water supplies) and (2) negligent use in agriculture.


Posted by: ydnew | Link to this comment | 09-30-19 10:59 AM
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5

There's also the guy on my floor who never washes his hands.


Posted by: Moby Hick | Link to this comment | 09-30-19 11:08 AM
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6

One guy just leaves after he pisses. Another guy leaves the stall without stopping by the sink.


Posted by: Moby Hick | Link to this comment | 09-30-19 11:11 AM
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7

Anyway, I used to get MRSA trainings. I forgot the details, but I'm pretty sure you're supposed to wash things.


Posted by: Moby Hick | Link to this comment | 09-30-19 11:13 AM
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8

Anyway, you can get treatment resistant TB from deer if you hunt them or drink their milk without pasteurization. I read that just today.


Posted by: Moby Hick | Link to this comment | 09-30-19 12:09 PM
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9

I was thinking that if Big Pharma can turn out two vaccines and two treatments for Ebola in the space of five years or whatever then straightforward greed doesn't look like a great explanation. And those things aren't antibiotics.


Posted by: Mossy Character | Link to this comment | 09-30-19 12:19 PM
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10

Maybe viruses are easier? Don't know. Not my area.


Posted by: Moby Hick | Link to this comment | 09-30-19 12:21 PM
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11

LOL


Posted by: Opinionated HIV | Link to this comment | 09-30-19 12:27 PM
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12

I said it wasn't my area.


Posted by: Moby Hick | Link to this comment | 09-30-19 12:47 PM
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13

come over here and say that


Posted by: Opinionated HIV | Link to this comment | 09-30-19 12:50 PM
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14

Writing as a vegetarian, the information in 8 is enormously satisfying.


Posted by: LizSpigot | Link to this comment | 09-30-19 12:52 PM
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15

You need to be vegan to be safe.


Posted by: Moby Hick | Link to this comment | 09-30-19 12:53 PM
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16

It's possible to eat meat without drinking from the teats of deer. Or at least I've never found it necessary.


Posted by: Mossy Character | Link to this comment | 09-30-19 1:02 PM
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17

I am a vegetarian who also abstains from deer milk, primarily for reasons of convenience, not ethics or safety.


Posted by: peep | Link to this comment | 09-30-19 1:03 PM
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18

But you all have deer right there in your gardens.


Posted by: Mossy Character | Link to this comment | 09-30-19 1:05 PM
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19

||
Fucking hell.
|>


Posted by: Mossy Character | Link to this comment | 09-30-19 1:26 PM
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20

The overarching problem is that bacteria evolve too fast for us to keep up with, as long as idiot doctors and idiot farmers overuse our drugs. However, there has been some stuff in the press about a new strategy for attacking bacteria in general, not just one mutation at a time. It (drum-roll) works in mice. Novel antibiotics effective against gram-positive and -negative multi-resistant bacteria with limited resistance.


Posted by: DaveLMA | Link to this comment | 09-30-19 1:35 PM
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21

The Ebola outbreak of 2014 led to HUGE amounts of funding and HUGE investment by industry, because the wealthy countries were scared. Most offerings disappeared almost as quickly. I tried to track down the newly developed Ebola rapid diagnostic tests that had been approved by the FDA and/or the WHO a few months after the outbreak was over (in 2016) and many companies simply didn't exist, had been bought by someone else, weren't producing the test at all. One company was working on a newer version but didn't have any on-hand or available to order. Just..poof, gone.

Ebola funding really upset most of the global health community (TB/malaria/HIV/NTD advocates) because the way we got all that money to throw at the problem was to cut it from somewhere else. (Roughly 1.6 mil people died of TB in 2017; the entire 2014-2016 Ebola outbreak killed 11k people. Extensively drug-resistant TB is TERRIFYING.)

I know nothing about antibiotics, though.


Posted by: parodie | Link to this comment | 09-30-19 1:37 PM
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22

Antibiotic resistance is something that will only be solved with targeted state support because the purpose is to produce a drug which will hardly ever be used but which costs as much to develop as something which sells in huge quantities.

The other problem is that it's global. The places where antibiotic use is out of control in farms are, so far as I remember, mostly in the far east which is also where the demand for meat is growing fastest. But the bugs, once they have evolved, can travel anywhere.


Posted by: NW | Link to this comment | 09-30-19 2:24 PM
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23

My experience of being on an antibiotic that was formerly an antibiotic of last resort (vancomycin), is also that it fucking sucked.*

22 and many of the comments above are right, though. In order for an antibiotic of last resort to be effective, it has to be used rarely. And drugs that are used rarely don't look like good financial bets for pharmaceutical companies.

* https://en.wikipedia.org/wiki/Vancomycin#Side_effects


Posted by: nattarGcM ttaM | Link to this comment | 09-30-19 2:48 PM
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24

No antibiotics is going to mean a lot less PIV sex because a year's UTI is not worth it.

Hardly ever, anyway.


Posted by: clew | Link to this comment | 09-30-19 3:02 PM
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25

When I left the VA, they made me leave my PIV card behind anyway.


Posted by: Moby Hick | Link to this comment | 09-30-19 3:08 PM
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26

Pharma isn't interested in cures, they are interested in ongoing treatment. Essentially rent-seeking the afflicted's health.


Posted by: Chopper | Link to this comment | 09-30-19 3:36 PM
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27

OT (unless it's a deer): There's something under my neighbor's deck watching me cook on the grill for the first time. I have a pork belly kebob for the first time and I think that is connected. I think it's a possum.


Posted by: Moby Hick | Link to this comment | 09-30-19 3:52 PM
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28

Could be a cat.


Posted by: Moby Hick | Link to this comment | 09-30-19 3:54 PM
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29

Well if it isn't connected it's hardly a kebab.


Posted by: Mossy Character | Link to this comment | 09-30-19 4:10 PM
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30

9: Big Pharma didn't, though. ZMapp was developed by government labs in Canada and the US. VSV-EBOV was a developed through government research, then evolved into a public-private partnership. Without public dollars, neither would have happened.


Posted by: ydnew | Link to this comment | 09-30-19 4:26 PM
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Having endured a couple of dosages of Bactrim for what turned out not to actually be MRSA but presented as such initially, I can attest to 23. I had hitherto been unaware that antibiotics could double as hallucinogens, and not in a good way.

Honestly, if I'd had to continue the regimen, I'd have had to do so under both hospital supervision and duress. I literally could not force myself to swallow another pill.


Posted by: (gensym) | Link to this comment | 09-30-19 4:28 PM
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32

26: This kind of thing pisses me off. It's one step away from "Pharma knows how to cure cancer but it's just blueberries (or pot or whatever) so they can't patent it." Pharma CURED Hepatitis C. They charged through the nose for it, but they cured it. They would cure Stage IV cancer if they could. The folks I know in the industry are dedicated to safe and effective treatments and cures, and it's insulting to say they aren't. I have a lot of problems with the industry, but lack of motivation to alleviate human suffering is not one. Yeah, treating rather than curing stuff makes money, but you really think they don't want to cure formerly dread diseases that have been fought to a draw of "manageable chronic condition?"


Posted by: ydnew | Link to this comment | 09-30-19 4:31 PM
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33

Pharma definitely has issues, but have you ever stopped to think about all the SAS programming they require and what they are willing to pay for it?


Posted by: Moby Hick | Link to this comment | 09-30-19 4:59 PM
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34

Thanks ydnew. DaveLMA, you only enlightened mice, so no thanks for you.


Posted by: Mossy Character | Link to this comment | 09-30-19 5:02 PM
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35

As big (well really medium) pharma insider shill, let me also point out that pharmas are investing huge amounts in gene therapy which are ideally a single treatment cure. They'll cost $1M+ which is not compatible with the current US insurance system because whichever company is unlucky enough to be covering the patient that year is expected to eat the whole cost, vs. chronic treatment is covered year to year if the patient changes coverage.
Likewise you could imagine new antibiotics being profitable if they cost $100k to cure patients who would otherwise die, but I'm guessing the people complaining about pharma getting out of antibiotics wouldn't be appreciative of that system either. So I agree public research is the way to go.
Infectious disease is the rare area where animal models are reasonably predictive of humans at least for efficacy, although you never know for sure if metabolism or toxicity will be different for a certain molecule. Saw an interesting talk last week about thalidomide and mouse models and one possible mechanism of why predictive tox failed.


Posted by: SP | Link to this comment | 09-30-19 5:30 PM
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36

Is it because looking at mouse paws is creepy so nobody did it?


Posted by: Moby Hick | Link to this comment | 09-30-19 5:33 PM
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37

Actually there's a mouse model for anti-inflammatories that specifically involves very careful examination of rodent paws.


Posted by: SP | Link to this comment | 09-30-19 5:38 PM
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38

Actually I think it's rats not mice.


Posted by: SP | Link to this comment | 09-30-19 5:39 PM
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39

I was once at a talk where they were studying sheep with knee osteoarthritis. My first thought was how do they find sheep with arthritis. It turns out, you can give a sheep arthritis if you've got a veterinarian around.


Posted by: Moby Hick | Link to this comment | 09-30-19 5:40 PM
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40

SP!

21.1 Re: TB/malaria/other funding vs Ebola, the folks in my circles were not mad (but then, the greater org was helping with Ebola response) about funding, they were mad that there are so many places still in the world without acceptable ways to deliver care to deathly ill patients (who would probably mostly have survived in a country with modern healthcare). In that situation, what is the most bang for your buck? A vaccine that keeps an epidemic from killing EVERY healthcare provider in an affected country and could limit future outbreaks? Worth it. My circles were watching in utter horror, hoping it would burn itself out. The current outbreak is less terrifying given that there are more tools.

XDR-TB is definitely terrifying, but in general, it's not extremely contagious. It's not pandemic material. XDR also doesn't usually mean there is no effective treatment and is about 42% fatal.


Posted by: ydnew | Link to this comment | 09-30-19 5:43 PM
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41

39: I'm glad I'm not the only one who wonders things like that.


Posted by: ydnew | Link to this comment | 09-30-19 5:44 PM
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42

I didn't get the slides or I could send you pictures to look at if you decided you never wanted to eat lamb again.


Posted by: Moby Hick | Link to this comment | 09-30-19 5:46 PM
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43

Wait. You probably already did decide that. Anyway, I'm not around fucking-with-animals science very often.


Posted by: Moby Hick | Link to this comment | 09-30-19 5:46 PM
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44

26 isn't right, but 32 over corrects a bit too. Pharma (big, at least) is quite interested in alleviating human suffering so long as the humans (or their governments, etc.) can pay. I know a lot of people who work in pharma, and for that matter device development. Most of them really are motivated by the abstract idea that the work they are doing "helps people". On the other hand, the BD and other decision making people in these firms absolutely do have regular conversations about margin trade-offs and related that effectively means prioritizing the inconveniences of white middle class Americans and Europeans over the lives of people in developing countries. Ability and willingness to pay is never not a part of the strategy, nor is ROI. Occasionally they are trumped by other concerns or strategic goals, naturally.


Posted by: soup biscuit | Link to this comment | 09-30-19 5:49 PM
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45

I'm glad I've been offline long enough to merit a ! since it suggests my attempts to reduce social media use are at least partially working.


Posted by: SP | Link to this comment | 09-30-19 5:50 PM
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46

39: osteoarthritis is among the milder things they give animal models. Cancer research is no joke this way. Nor are surgical models.


Posted by: soup biscuit | Link to this comment | 09-30-19 5:53 PM
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47

45: SP!


Posted by: soup biscuit | Link to this comment | 09-30-19 5:53 PM
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48

apparently I'm drunk and blathering online today. apologies all 'round.


Posted by: soup biscuit | Link to this comment | 09-30-19 5:55 PM
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49

There's no way I'm ever apologizing for that.


Posted by: Moby Hick | Link to this comment | 09-30-19 5:59 PM
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50

44 is partly right- certainly there's a market analysis done before deciding whether to enter a disease area- but the assumption that this always leads to focus on European and US exclusively or even primarily is not true. I have examples but can't get into details.


Posted by: SP | Link to this comment | 09-30-19 6:02 PM
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51

Yeah, 44 is pretty much where I fall - hence why no Big Pharma antibiotic programs. Ability to profit is certainly THE factor, but what I was reacting to was the suggestion that durable cures are withheld or not pursued in favor of ongoing treatments. Which is (AFAIK) simply not true. There are a lot of completely fucked up decisions made in pharma, both sciencewise and businesswise, but I legit can't imagine anyone walking away from a cure for basically anything.


Posted by: ydnew | Link to this comment | 09-30-19 6:07 PM
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52

50 that wasn't what I was claiming (plenty of examples too, same problem). I'm saying it's (almost) never not part of the conversation. So it doesn't end up with primarily or exclusively targeting , sure, but there is a statistical bias in a sense, that the level of investment roughly is as affected by the ability to pay as it is by need. And there are different ways to get paid, I am saying this in a non judgemental way, it's the way that market works.

Apologies for drunk probably doesn't make sense still.


Posted by: | Link to this comment | 09-30-19 7:43 PM
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53

52 me, whups.

And yes to 51, people are it withholding known cures for ongoing revenue afaik


Posted by: Soup biscuit | Link to this comment | 09-30-19 7:44 PM
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54

Let's all list our SAT scores and how much we've sold out.


Posted by: Moby Hick | Link to this comment | 09-30-19 7:45 PM
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55

52 ramble continued : when I say "statistical bias" I'm hand waving about the industry as a whole. Individual actors may specialize elsewhere.


Posted by: | Link to this comment | 09-30-19 7:51 PM
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56

54: or worse, how much public money we have consumed


Posted by: | Link to this comment | 09-30-19 7:52 PM
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57

I think they redid the scale for both, so I young people can't get a 1,600 on selling out now.


Posted by: Moby Hick | Link to this comment | 09-30-19 7:53 PM
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56: The public paid me poorly enough that I think they came out fine.


Posted by: Moby Hick | Link to this comment | 09-30-19 7:55 PM
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59

||

NMM to Jessye Norman

|>


Posted by: Barry Freed | Link to this comment | 09-30-19 9:26 PM
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60

A new antibiotic for TB was just approved in the US

TB Alliance hired my company to write, assemble, and submit the New Drug Application for pretomanid. It's been one of my primary projects for the past year.


Posted by: apostropher | Link to this comment | 09-30-19 10:14 PM
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61

No antibiotics is going to mean an end to routine surgery: every hip replacement will become life-threatening. So - no sex and then you die. It's obviously God's will.


Posted by: NW | Link to this comment | 10- 1-19 1:31 AM
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60: That one is very interesting to me. I'm happy for TB Alliance (the folks there are super nice), but I am legit not sure how big a win it is for the field. It had been kicking around for years and years as a candidate, but nobody was able to find a use where it outperformed an existing drug (either on its own or in combo), not for lack of trying. They did a good job finding a situation and designing a trial to give the data they needed for approval, and it's generally good to have more options available for use, but my big hope is that this high profile win gets the field further attention and funding to develop drugs with substantive improvements over current.


Posted by: ydnew | Link to this comment | 10- 1-19 3:52 AM
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63

soup biscuit!


Posted by: teofilo | Link to this comment | 10- 1-19 4:53 AM
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64

OP and 26 and similar: Pharma companies that don't make money don't survive. Pharma companies that don't survive don't develop new drugs. Bringing drugs through development to trials to approval to market costs approximately $zillions and takes approximately $forever, and sometimes fails. This is pretty straightforward economics. I don't see the US government lining up to support drug development and trials very often.


Posted by: DaveLMA | Link to this comment | 10- 1-19 5:29 AM
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