| A radical plan to save antibiotics Drug resistance is fast destroying the power of antibiotics. Tighter infection control and incentives for drug companies to invent more antibiotics are usually proposed as the answer. But the authors of a new paper say we have to think out of the box.What are we to do about the diminishing power of antibiotics - once the miracle drugs that looked set to end infectious diseases? We know the problem is becoming very serious - here is a piece I wrote about the alarming prospects for a future without antibiotics.But we don't hear much in the way of imaginative answers. So it's refreshing to read a paper out this morning from Aaron Kesselheim, from Brigham and Women's Hospital and Harvard Medical School in Boston, and Kevin Outterson, a professor at Boston University Law School.Their analysis, published in the journal Health Affairs, says the usual idea, to give pharmaceutical companies financial incentives to invent and manufacture more antibiotics, won't work. One of the reasons we are in this parlous state of affairs, they say, is that drug companies in the past have tried too hard to sell more tablets. Of course, the misuse of the drugs - physicians over-prescribing and patients not completing the course - is largely to blame, but companies have been disciplined for promoting wrong uses of antibiotics. They cite two cases involving Pfizer. In one of those, in 2005, the company, they say, was warned by the Food and Drug Administrationthat its 'misleading promotion' of linezolid (Zyvox) as a treatment for a wide range of methicillin-resistant Staphylococcus aureus (MRSA) infections 'poses serious public health and safety concerns because of its potential to result in inappropriate use'. The FDA concluded that the clinical trial data did not support linezolid's use for those conditions.Kesselheim and Outterson say that infection control, including handwashing, can work and so can guidelines on prescribing, but they have limitations. So do the various proposals on incentives to drug companies, from extending patents to handing out cash prizes, they say. Limiting the use of antibiotics depresses company sales, while incentives do not directly tackle the resistance problem - companies may still look to short-term profits by trying to encourage greater use of the drug.Their big idea is to reward both hospitals and drug companies for what they do to keep antibiotics effective. Take, for example, a new drug, or a conservation program for an existing drug, that treats or reduces vancomycin-resistant Enterococcus and leads to fewer intensive care unit admissions for patients with this infection. A value-based reimbursement plan would allow part of the savings to be shared with the manufacturer of the product and with the hospital that put the infection control program in place. Under such a proposal, the combined increase in antibiotic reimbursement should be substantial - amounting at least to several billion dollars a year. This approach would close some of the gap between the private cost and societal value of antibiotics.Radical? I think so. But it makes some sense. We would be paying for antibiotics to work and keep on working - not for more and more drugs that quickly become useless. I can imagine this being a nightmare to negotiate between the interested parties. But at least it's a new idea. Like new antibiotics, we are short of those.AntibioticsDrug resistancePharmaceuticals industryInfectious diseasesSarah Boseleyguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds guardian.co.uk |
2010 Gives West a Respite From Fire The fire season still has some weeks to go, but it is running neck and neck with the one in 2003 for the title of least severe. feeds.nytimes.com |
Junking a Virtuous Bag Some SunChips fans complained that a new bag's crinkly plant-based material was obnoxiously loud. feeds.nytimes.com |
Denver Zoo hatches 4 Komodo dragons By 2010-10-15T02:56:52ZDENVER (AP) -- The Denver Zoo says it's become the only zoo in the world to hatch endangered Komodo dragons for a third time.... hosted.ap.org |
New to Nature No 25: Allamanda calcicola A beautiful evergreen, found in semi-arid BrazilThe plant genus Allamanda includes about a dozen species of evergreen climbers and shrubs native to Latin America. Species occur from Mexico to Argentina, and a number of cultivars are popularly grown in tropical gardens. The last time a new species was reported was 1940.A key strategy by the Brazilian government to meet targets of the Convention on Biological Diversity is the "Programa de Pesquisa em Biodiversidade (PPB)". Scientists working in the PPB in semi-arid, calcareous outcrops in Bahia have discovered a beautiful new species, Allamanda calcicola, that flowers from January to March.Quentin Wheeler is director of the International Institute for Species Exploration, Arizona State UniversityBiologyWildlifeBrazilguardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds guardian.co.uk |