England's chief medical officer on why the drugs don't work

Large-scale resistance to antibiotics is inevitable, yet new antibacterials aren't emerging. Why?

The Drugs Don’t Work: a Global Threat
Sally C Davies, with Jonathan Grant and Mike Catchpole
Penguin Specials, 112pp, £3.99

Professor Dame Sally Davies, England’s chief medical officer, likens the impending crisis in antimicrobial drug resistance to global warming. In both instances scientists foresee a problem and can offer solutions. In neither case is our response anywhere near sharp enough, Davies fears. Acting on antibiotic resistance should be the easier of the two; no one has a vested interest in denying the risk. Why then are we stumbling towards a selfmade but preventable calamity?

Alexander Fleming is credited with discovering antibiotics. In the summer of 1928, while working at St Mary’s hospital in London, he went on holiday and left an open plate of bacteria behind. Returning to work, he found a fungus growing on the plate that had killed the bacteria with a chemical that he named penicillin. In 1930s Oxford, Howard Florey and Ernst Chain produced enough penicillin to prove its healing ability. The penicillin production programme that followed during the Second World War is a classic tale of ingenuity under adversity. By engaging American pharmaceutical companies, the Allies were able to cure soldiers of otherwise fatally infected wounds.

Bugs create chemicals to kill other bugs as part of an aeons-old microbial arms race, so drug-hunters turned to soil microbes to help fight a range of diseases. Streptomycin, discovered in America in 1943, even cured tuberculosis, one of mankind’s greatest afflictions. Today, however, roughly a third of the world’s population still carries TB. Of the nearly 9,000 cases reported in the UK in 2011 hundreds of sufferers were resistant to at least one drug. Half a dozen cases carried incurable, “extensively drug-resistant” strains of TB. Cholera, leprosy, typhoid fever and syphilis all remain global scourges. Just last year several people in Edinburgh died after inhaling legionnaire’s disease-causing bacteria. Dozens of Germans died in 2011 after eating beansprouts contaminated with E coli.

Luckily, for now at least, we can still treat most bacterial infections, but some bacterial cells can yield over a billion progeny in just 24 hours. Genetic mutations stimulating drug resistance are inevitable. Cases of penicillin resistance appeared almost immediately: methicillin, a more stable derivative of penicillin, enjoyed only a few years of success before resistance emerged. Methicillin-resistant Staphylococcus aureus (MRSA) now kills hundreds in British hospitals every year.

Yet new antibacterials aren’t emerging. The reasons for this are primarily economic. Antimicrobial agents are usually given in shortterm doses. Compare that to statins, taken by affluent westerners with high cholesterol over decades. Most antibiotics are also off-patent, which has driven prices down. The estimated $1bn it costs to develop a drug inflates the cost of new medicines. Cash-strapped health services will use cheaper, old drugs until their utility is all but gone.

Davies fears that time might come quickly. Resistance genes are flourishing out there and bacteria are remarkably happy to share their genes. The widespread imprudent use of antibiotics has created perfect conditions to select those resistance genes and global air travel can carry resistant bugs around the world in hours.

Davies offers possible solutions. Fifteen years ago the pharmaceutical industry had largely abandoned diseases of the poor – malaria, tuberculosis, sleeping sickness, bilharzia and so on. An anti-sleeping sickness drug, called eflornithine, was even about to be withdrawn because sufferers couldn’t pay for it. When eflornithine was shown to prevent unwanted hair growth, however, pharmaceutical companies fell over themselves to produce it. Economics dictated that a drug could be made to “treat” unwanted facial hair but not to save lives. New models were needed to combat diseases of the poor. Groups such as the Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative emerged to help promote drug development. A decade on, the first new drugs are poised to appear. The pharmaceutical industry itself, though, is in crisis and shedding staff at an alarming rate.

If a pestilential Armageddon really is upon us, a cynical company might gamble on huge profits, getting new antimicrobials ready for when the competition fails. But the economic models won’t shift until the evidence becomes overwhelming. Davies also talks of incentivisation – a £50m prize to develop a new antibiotic, for instance. Given development costs, $1bn would be more realistic. Yet even that’s a snip compared to the taxpayers’ bank bailouts. Surely saving life trumps life savings. Whatever it takes, though, action is needed now. The big pharmaceutical companies continue to abandon their anti-infective programmes and with them goes the expertise and capacity that will be needed when the crisis hits.

Michael Barrett is Professor of Biochemical Parasitology at the University of Glasgow

Who decides which drugs are made, and which ones we have access to? Image: Getty

This article first appeared in the 30 October 2013 issue of the New Statesman, Should you bother to vote?

Home Alone 2: Lost in New York
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The best film soundtracks to help you pretend you live in a magical Christmas world

It’s December. You no longer have an excuse.

It’s December, which means it’s officially time to crack out the Christmas music. But while Mariah Carey and Slade have their everlasting charms, I find the best way to slip into the seasonal spirit is to use a film score to soundtrack your boring daily activities: sitting at your desk at work, doing some Christmas shopping, getting the tube. So here are the best soundtracks and scores to get you feeling festive this month.

A Charlie Brown Christmas (1965)

Although this is a children’s film, it’s the most grown-up soundtrack on the list. Think smooth jazz with a Christmas twist, the kind of tunes Ryan Gosling is playing at the fancy restaurant in La La Land, plus the occasional choir of precocious kids. Imagine yourself sat in a cocktail chair. You’re drinking an elaborate cocktail. Perhaps there is a cocktail sausage involved also. Either way, you’re dressed head-to-toe in silk and half-heartedly unwrapping Christmas presents as though you’ve already received every gift under the sun. You are so luxurious you are bored to tears of luxury – until a tiny voice comes along and reminds you of the true meaning of Christmas. This is the kind of life the A Charlie Brown Christmas soundtrack can give you. Take it with both hands.

Elf (2003)

There is a moment in Elf when Buddy pours maple syrup over his spaghetti, washing it all down with a bottle of Coca Cola. “We elves like to stick to the four main food groups,” he explains, “candy, candy canes, candy corns and syrup.” This soundtrack is the audio equivalent – sickly sweet, sugary to an almost cloying degree, as it comes peppered with cute little flutes, squeaky elf voices and sleigh bells. The album Elf: Music from the Motion Picture offers a more durable selection of classics used in the movie, including some of the greatest 1950s Christmas songs – from Louis Prima’s 1957 recording of “Pennies from Heaven”, two versions of “Sleigh Ride”, Eddy Arnold’s “Santa Claus is Coming to Town” and Eartha Kitt’s 1953 “Santa Baby”. But if a sweet orchestral score is more your thing, the Elf OST of course finishes things off with the track “Spaghetti and Syrup”. Just watch out for the sugar-rush headache.

Harry Potter (2001-2011)

There are some Christmas-specific songs hidden in each of the iconic Harry Potter scores, from “Christmas at Hogwarts” to “The Whomping Willow and The Snowball Fight” to “The Kiss” (“Mistletoe!” “Probably full of knargles”), but all the magical tinkling music from these films has a Christmassy vibe. Specifically concentrate on the first three films, when John Williams was still on board and things were still mostly wonderful and mystical for Harry, Ron and Hermione. Perfect listening for that moment just before the snow starts to fall, and you can pretend you’re as magical as the Hogwarts enchanted ceiling (or Ron, that one time).

Carol (2015)

Perhaps you’re just a little too sophisticated for the commercial terror of Christmas, but, like Cate Blanchett, you still want to feel gorgeously seasonal when buying that perfect wooden train set. Then the subtly festive leanings of the Carol soundtrack is for you. Let your eyes meet a stranger’s across the department store floor, or stare longingly out of the window as your lover buys the perfect Christmas tree from the side of the road. Just do it while listening to this score, which is pleasingly interspersed with songs of longing like “Smoke Rings” and “No Other Love”.

Holiday Inn (1942)

There’s more to this soundtrack than just “White Christmas”, from Bing Crosby singing “Let’s Start The New Year Off Right” to Fred Astaire’s “You’re Easy To Dance With” to the pair’s duet on “I’ll Capture Your Heart”. The score is perfect frosty walk music, too: nostalgic, dreamy, unapologetically merry all at once.

The Tailor of Gloucester (1993)

Okay, I’m being a little self-indulgent here, but bear with me. “The Tailor of Gloucester”, adapted from the Beatrix Potter story, was an episode of the BBC series The World of Peter Rabbit and Friends and aired in 1993. A Christmastime story set in Gloucester, the place I was born, was always going to be right up my street, and our tatty VHS came out at least once a year throughout my childhood. But the music from this is something special: songs “The Tailor of Gloucester”, “Songs From Gloucester” and “Silent Falls the Winter Snow” are melancholy and very strange, and feature the singing voices of drunk rats, smug mice and a very bitter cat. It also showcases what is in my view one of the best Christmas carols, “Sussex Carol.” If you’re the kind of person who likes traditional wreaths and period dramas, and plans to watch Victorian Baking at Christmas when it airs this December 25th, this is the soundtrack for you.

Home Alone (1990-1992)

The greatest, the original, the godfather of all Christmas film soundtracks is, of course, John William’s Home Alone score. This is for everyone who likes or even merely tolerates Christmas, no exceptions. It’s simply not Christmas until you’ve listened to “Somewhere in My Memory” 80,000 times whilst staring enviously into the perfect Christmassy homes of strangers or sung “White Christmas” to the mirror. I’m sorry, I don’t make the rules. Go listen to it now—and don't forget Home Alone 2: Lost in New York, which is as good as the first.

Anna Leszkiewicz is a pop culture writer at the New Statesman.