The financial barrier to developing antibiotics? No big payday for drug companies

The financial barrier to developing antibiotics? No big payday for drug companies


JUDY WOODRUFF: But first: our series on antibiotics
and the dangerous so-called superbugs building resistance to them. It’s a joint project from our science correspondent,
Miles O’Brien, and our economics correspondent, Paul Solman. Last night, Miles looked at the clear and
present dangers for patients. Tonight, we start tackling the hunt for new
drugs, and why the market for creating them has just about collapsed. Here’s Paul’s report. It’s part of our weekly series Making Sense. PAUL SOLMAN: So, Russian emigre, 1989, came
here speaking no English. How do you like capitalism? DR. SLAVA EPSTEIN, Northeastern University: I
embrace it. PAUL SOLMAN: Slava Epstein has been embracing
novelty his entire life. Told he’d never make it as an astrophysicist
in the former Soviet Union, he swapped telescope for microscope and became a biologist instead. Then, unable to find an academic job upon
emigrating to the U.S., he volunteered at university labs while doing odd jobs to survive. DR. SLAVA EPSTEIN: Painting houses takes no English. Repairing roofs doesn’t take very much English. Paving driveways with bricks can be a silent
job. PAUL SOLMAN: And nearly 30 years later, Epstein
is still getting his hands dirty, looking for new antibiotics. DR. SLAVA EPSTEIN: One gram of dirt like this
contains roughly, give or take, 10 billion cells. PAUL SOLMAN: And as he told my colleague Miles
O’Brien: DR. SLAVA EPSTEIN: One percent has been more or
less explored. The remaining 9.9 billion cells per gram have
not. PAUL SOLMAN: Now, digging up dirt is actually
a grand old tradition in antibiotics research. NARRATOR: One hundred samples of soil to be
scientifically searched for a lifesaving organism. PAUL SOLMAN: A project made that much more
urgent by the onset of World War II, and the wounded soldiers who filled England’s hospitals. MARIE-LOUISE KERR, History of Science Museum:
Chambers of horror seemed the best way to describe those septic wards. PAUL SOLMAN: Marie-Louise Kerr of the History
of Science Museum in Oxford, where penicillin was developed into a drug. But, by the end of World War II, penicillin
is a key factor in the Allies winning the war, right? MARIE-LOUISE KERR: Definitely. America was able to produce penicillin on
a much larger scale. And, yes, by 1944 to’ 45, there was enough
penicillin to treat every soldier involved in D-Day and also civilians as well. PAUL SOLMAN: But just two years after that,
penicillin-resistant staph infections were already being reported, a pattern that’s been
repeated for every antibiotic since. DR. SLAVA EPSTEIN: Resistance arises very quickly
to antibiotics. Really, in clinical use, it takes just a few
years. PAUL SOLMAN: Now this wasn’t much of a problem
during the so-called golden age of antibiotic discovery and development, but that age has
been over for decades. KEVIN OUTTERSON, Boston University: The last
time that we had a new class of gram-negative antibiotics, approved for human use, that
drug was discovered the year that I was born, 1962. So we have had no new classes discovered in
my entire lifetime. PAUL SOLMAN: Boston University law Professor
Kevin Outterson specializes in health law. KEVIN OUTTERSON: So, these drugs worked well
for our parents and grandparents’ generation, but they won’t work that way forever. Resistance will undermine them. We have to replace them. PAUL SOLMAN: OK, clear enough: As today’s
antibiotics begin to lose their oomph, a clear and present danger lurks. But here’s where prudent medicine runs into
the hard truths of economics. DR. JOHN REX, Former Pharmaceutical Industry Executive:
Early on, if you bring in a new drug that goes one bacterium further, so to speak, you
would say, I really need that, I need it today. I’m going to start using that today. PAUL SOLMAN: Dr. John Rex is a former pharmaceutical
industry executive. DR. JOHN REX: But now you invent a new antibiotic
that hits the very most resistant bacteria in the world, what we as a community want
you to do with it is sit on it, OK, and save it for just that rainy day. PAUL SOLMAN: That’s because the last thing
we want to do, as a society, is use a new superdrug too soon, spurring the evolution
of superdrug-resistant bugs that will eventually render the new drug worthless. So then the increasing awareness of the overuse,
potential overuse of an antibiotic because it will create resistance makes the economics
worse? DR. JOHN REX: It does. And also our awareness of how hard it is to
find them, so once we have found this precious jewel, we need to protect it, because every
use of an antibiotic, even a correct use, drives resistance. KEVIN OUTTERSON: This is not a question of
if this is a problem. It’s when. PAUL SOLMAN: John Rex and Kevin Outterson
are both working on a new project called CARB-X, a public-private partnership to spur development
of new antibiotics, because the market just can’t do the job by itself. After all, why would a drug company spend
a fortune developing a new antibiotic, when no responsible doctor will prescribe it until
there’s no alternative? KEVIN OUTTERSON: From the company perspective,
it’s a disaster, because their novel, cutting-edge, exciting product doesn’t sell. PAUL SOLMAN: And it’s a product in which they
have presumably invested a huge amount of capital. KEVIN OUTTERSON: Hundreds of millions of dollars. PAUL SOLMAN: Meanwhile, the patent that keeps
any other company from making and selling a generic version runs out after only 14 years. KEVIN OUTTERSON: Two of the most highly used
antibiotics in the United States, last-ditch antibiotics, are Colistin and Vancomycin. And both of them have been off patent for
decades. At the time that they entered the market,
we had better drugs. Now we need them, right? So this is a classic example of, if it’s useful,
it’s saved for the future, which makes the commercial prospects very difficult. PAUL SOLMAN: Another problem: For a relatively
rare infection, a company might have to charge tens or even hundreds of thousands of dollars
to get a return on its investment. KEVIN OUTTERSON: You see that for cancer. PAUL SOLMAN: Right. KEVIN OUTTERSON: It’s impossible to do that
for antibiotics. PAUL SOLMAN: Why not? KEVIN OUTTERSON: We lack the diagnostics that
would tell the doctor immediately that this antibiotic is the one that would save this
person’s life. PAUL SOLMAN: As if all that weren’t enough
of an economic disincentive for investing in new antibiotics, infectious disease specialist
Lindsey Baden points out yet another one: length of treatment. DR. LINDSEY BADEN, Infectious Disease Specialist:
Often, the treatments are short, a week or two, and intermittent. And that’s very different than for hypertension,
diabetes, hypercholesterol, where it’s a treatment every day for the rest of your life. PAUL SOLMAN: So does that mean that the market
as currently constructed can’t come up with new antibiotics; there just won’t be the investment
to making them? KEVIN OUTTERSON: We won’t get the sort of
antibiotics we really need. What about the antibiotic that saves the life
and returns you to full health of somebody who’s 20 or 30 or 40? That antibiotic is worth, truthfully, millions
of dollars. In any other field, there would be venture
capitalists running around funding these pre-clinical ideas. For antibiotics, because there’s no big payday
at the end, the business model is broken, there’s very little private capital. PAUL SOLMAN: So how does society change the
economics to solve a problem that could be as important to the future of humanity as
any? DR. SLAVA EPSTEIN: Well, I happen to be an optimist. PAUL SOLMAN: That’s where Slava Epstein comes
in. DR. SLAVA EPSTEIN: An incurable optimist. PAUL SOLMAN: Yes, still dancing to his own
beat. And while it still takes two to tango, Epstein’s
eternal optimism is all his own. DR. SLAVA EPSTEIN: The probability of overwhelming
success is over 100 percent. PAUL SOLMAN: Well, 100 percent seemed a tad
high to both me and Miles O’Brien. Is Slava Epstein a piece of work or not? And I use that phrase in the best possible
sense. MILES O’BRIEN: Absolutely. And he wouldn’t be offended. But his optimism, I wonder about. Now, you’re the expert on the invisible hand,
though I have a certain amount of expertise on this myself. But let’s put that aside. Everybody I have spoken to along the way about
this says this just cries out for some government intervention. PAUL SOLMAN: Yes, and that’s where we’re going
with the next story. How does government get involved when the
market can’t seem to solve a problem, as is the case here? For the “PBS NewsHour” I’m economics correspondent
Paul Solman. MILES O’BRIEN: And I’m science correspondent
Miles O’Brien.

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