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?

NANCY JO IACOI/GALLERY STOCK
Show Hide image

There are only two rules for an evening drink: it must be bitter, and it must be cold

A Negroni is the aperitif of choice in bars everywhere from London to Palermo - and no wonder.

The aperitif has the odd distinction of being the only alcohol that can always rely on a sober audience: it is the opener, the stimulant, a spur to the appetite for good food and good conversation. This preparatory beverage is considered the height of sophistication, and certainly nobody labouring in field or factory ever required a pep to their evening appetite. Still, to take a drink before one starts drinking is hardly clever behaviour. So why do it?

One reason is surely the wish to separate the working day from the evening’s leisure, an increasingly pressing matter as we lose the ability to switch off. This may change the nature of the aperitif, which was generally supposed to be light, in alcohol and character. Once, one was expected to quaff a pre-dinner drink and go in to dine with faculties and taste buds intact; now, it might be more important for those who want an uninterrupted meal to get preprandially plastered. That way, your colleagues may contact you but they won’t get much sense out of you, and pretty soon they’ll give up and bother someone else.

The nicest thing about the aperitif, and the most dangerous, is that it doesn’t follow rules. It’s meant to be low in alcohol, but nobody ever accused a gin and tonic or a Negroni (Campari, gin and vermouth in equal portions) of that failing; and sherry, which is a fabulous aperitif (not least because you can keep drinking it until the meal or the bottle ends), has more degrees of alcohol than most wines. An aperitif should not be heavily perfumed or flavoured, for fear of spoiling your palate, yet some people love pastis, the French aniseed drink that goes cloudy in water, and that you can practically smell across the Channel. They say the scent actually enhances appetite.

Really only two rules apply. An aperitif should be bitter – or, at any rate, it shouldn’t be sweet, whatever the fans of red vermouth may tell you. And it must be cold. Warm drinks such as Cognac and port are for after dinner. Not for nothing did Édith Piaf warble, in “Mon apéro”, about drowning her amorous disappointments in aperitifs: fail to cool your passions before sharing a table, and you belong with the barbarians.

On the other hand, conversing with your nearest over a small snack and an appropriate beverage, beyond the office and before the courtesies and complications of the dinner table, is the essence of cultured behaviour. If, as is sometimes thought, civilisation has a pinnacle, surely it has a chilled apéro carefully balanced on top.

The received wisdom is that the French and Italians, with their apéritifs and aperitivos, are the experts in these kinds of drinks. Certainly the latter are partial to their Aperol spritzes, and the former to such horrid, wine-based tipples as Lillet and Dubonnet. But the English are good at gin and the Americans invented the Martini. As for Spain, tapas were originally snacks atop a covering that kept the flies out of one’s pre-dinner drink: tapa means lid.

Everywhere, it seems, as evening approaches, people crave a drink that in turn will make them salivate: bitterness, the experts tell us, prepares the mouth to welcome food. The word “bitter” may come from “bite”, in which case the aperitif’s place before dinner is assured.

I like to think that a good one enables the drinker to drown all sour feelings, and go in to dinner cleansed and purified. Fanciful, perhaps. But what better lure to fancy than a beverage that exists only to bring on the evening’s pleasures?

Nina Caplan is the Louis Roederer Pio Cesare Food and Wine Writer of the Year

Nina Caplan is the 2014 Fortnum & Mason Drink Writer of the Year and 2014 Louis Roederer International Wine Columnist of the Year for her columns on drink in the New Statesman. She tweets as @NinaCaplan.

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times