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?

Andrew Burton/Getty Images
Show Hide image

Sex and the city: the novel that listens in on New York

Linda Rosenkrantz's Talk captures the conversations of a sex-obsessed city.

Especially for New Yorkers such as the ones in Linda Rosenkrantz’s novel Talk, summertime is both maddening and delicious: it’s a limbo during which no serious work is possible, because some crucial decision-maker at the top of the chain is inevitably out of town, so even the most ambitious strivers must find a way to fill their days with something other than striving. It’s a time to take stock of what has happened and speculate about the future – that comfortably abstract time that starts the day after Labor Day and is as blank as the opening page of a new notebook on the first day of school. Meanwhile, because little can be done, there is nothing to do but dissect, analyse, explain, confide, complain, chat and kibitz. Talk is a book that more than lives up to its name.

Realising that the lazy conversations that fill up the days during this liminal time might be revealing, Linda Rosenkrantz took her tape recorder to East Hampton, New York, in the summer of 1965. She spent more than a year transcribing the tapes, leaving her with 1,500 pages of text featuring 25 different speakers, which she then whittled down to 250 pages and three characters. The result is a slim novel told in conversations – though Rosenkrantz has said that it was her publisher, “wary of possible legal ramifications”, who insisted on presenting it as fiction.

Emily Benson, a party girl and sometime actress, spends her weekends lying on the beach with Marsha, a working girl who has rented a house there for the season. Often they are joined by their friend Vincent, a painter who is almost as boy-crazy as they are; despite this, he and Marsha share a love that verges on the erotic but never quite manages it. All are around thirty and are single, though none really wants to be.

They pay lip-service to literary and political concerns, listing authors, musicians and political figures such as Kennedy, Castro, Mailer and Roth, but mostly their talk is about sex (they would rather sleep with Mailer than Roth and Castro than Kennedy). Sex acts and their consequences are anatomised in detail, with orgies and abortions brought up as casually as the recipe for salad dressing. Emily is infatuated with a married man named Michael Christy – they always refer to him by his first and last names. Marsha has a few casual involvements but none seems likely to take the place of Vincent, especially as he not only talks to her endlessly but sometimes, after a few glasses of wine, playfully asks to see her vagina or breasts. To the extent that the novel has a plot, it’s a love story but not about Michael Christy or any of the other men who merit recurring mentions. The three friends comprise a love triangle that even they, with their self-consciously avant-garde attitudes, don’t seem to recognise for what it is.

It takes a few pages to get used to the oddness of reading a novel in dialogue form and to stop being annoyed by the characters’ oh-so-Sixties affectations. Everything is “far out” and the word “scene” is deployed with alarming frequency – at one point, Emily memorably dismisses a menu suggestion by declaring that she doesn’t want to “get into a whole home-made pie-making scene”.

It is harder to get past the characters’ attitudes to race. An early chapter shows them being very impressed that Marsha has a “Negro” analyst (although, Marsha says in a casually appalling aside, “You don’t think of him, say, if you want to invite a Negro to a party”).

But these are unvarnished slices of chatty vérité: this was how arty thirtysomething New Yorkers in 1965 talked and thought about their lives. A television show set in 1965 might be criticised for being too on the nose if it reproduced, say, Emily’s rhapsodies about her LSD experience. “I was intimately a part of every pulsebeat of every sun that came up on everybody’s life,” she tells Vincent, and goes on to cite Salinger. These conversations actually happened. And luckily, at the moment when that alone ceases to be enough to sustain the reader’s interest, the characters begin to reveal enough about themselves to become interesting as more than a page of history.

Marsha, it turns out, is very funny and winningly down-to-earth. Emily and Vincent are much too impressed with their own promiscuity and sexual appetites; they relish listing their conquests and describing sex acts in a way that, in 2015, might seem uncool even among 14-year-olds. Marsha’s sex talk, however, is frank and hilarious. In one of her wittiest moments, she describes a liaison that left her with welts on her back and the ruse she then employed to explain them away when her mother came over from Westchester the next day to help her try on bathing suits. Indeed, the guy seems to have been worth the welts: “The time I passed out, we wound up in the shower together and it was very, very wild ecstatic lovemaking, one of the great moments of my life. Except I was worried about my hair getting wet.” Marsha has the best lines in the book. While the friends are debating whether to go to a party, she deploys her finest: “I don’t want to talk to people I don’t know. I can hardly talk to the people I do know.”

As we grow more attached to Marsha, Emily seems increasingly irritating in comparison. But I’m sure if you transcribed the dialogue of many charismatic people they would seem as tiresome and self-involved as Emily does – and we know she must be charming because of how excited Vincent and Marsha are about being around her and how much they miss her when she skips a weekend or two. Still, she’s a bit much. At one point, while discussing their sexual preferences on the beach (again), she cuts Marsha off mid-sentence, saying: “I haven’t quite finished with me.” She never does.

Marsha is also interested in herself but in her case the interest seems merited. Towards the end of the novel, we learn that she has been spending the summer writing a book. Could it be the one we are holding? In the final chapter, as the two women unpack from the summer, Marsha reports telling her therapist about “what a horrible person I emerged as on the tapes and how all the three of us talk about is sex and food and yet how I felt we were the only people who communicate in the whole world”. It may be that the book has doubled back on itself to become about its own composition or that Rosenkrantz is Marsha (she has recently admitted that “one of these three taped ‘characters’ is moi”.)

In this light, the book stands as an early entrant in a field that is now in full flower: works by women who use their lives and personae as raw material for their art, such as Chris Kraus’s influential 1997 novel, I Love Dick, and Sheila Heti’s How Should a Person Be? (2010). Stephen Koch points out in his fine introduction that Talk also paved the way for TV shows such as Girls and Broad City, in which fiction is grounded in the creators’ real-life personae.

Unlike those ongoing sagas, Talk is ­finite: autumn came and the experiment was over. Did Michael Christy ever leave his wife for Emily? Did Marsha finally let go of Vincent enough to make space for a heterosexual man in her life? A lot of plans were made that summer but we will never know whether all they amounted to was talk.

Emily Gould’s novel “Friendship” is published by Virago

Talk is out now from NYRB Classics (£8.99)

This article first appeared in the 27 August 2015 issue of the New Statesman, Isis and the new barbarism