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?

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Politicians and fashion? Why their approach can be telling

My week, from spying on the spies to Theresa May’s fashion charm offensive – and how Sadiq stole hearts.

About nine months ago I was asked if I wanted to spend a morning with Zac Goldsmith, as he appeared to be wakening from the slumber that had obviously taken hold of him when he decided to run for mayor of London. However, after about three minutes in his company (maybe less, actually) I realised that not even his campaign team – let alone voters in the Borough of Southwark – thought he had a hope in hell of winning.

There was only ever going to be one winner, and the enthusiasm with which Sadiq Khan has been greeted by London has been heartwarming. He won the politician award at GQ’s Men of the Year Awards a few weeks ago, and I’d never heard such a roar as he leapt up on stage to collect it. Well, I’ve heard such roars for the likes of Michael Caine, Elton John and Amy Schumer, but rarely for a politician. In fact, the last time there was such fulsome applause for a politician at the GQ awards was when we gave one to a pre-Sextator David Blunkett. Perhaps I shouldn’t be surprised: the last time Noel Gallagher graced us with his presence, he asked: “Is this what a Conservative party conference looks like?”

 

On the dole

The recent past is being hauled over so repeatedly that soon there are going to be ­retrospectives of events that happened only last week. Or next week. On paper, the new exhibition at the V&A in London, entitled “You Say You Want a Revolution? Records and Rebels 1966-1970”, seemed slightly behind the curve, but the reality is very different – as it’s probably the best exhibition you’ll see in London this year.

This is all down to the curation, which was handled by Geoffrey Marsh and Victoria Broackes, the wizards behind “David Bowie Is”, the most successful show in the V&A’s history. It’s a terrific exhibition, although being reminded of the cultural and political insurrection of the Sixties also reminds you of the period’s seemingly innate optimism as a new London was mushrooming into life. Winston Churchill was dead, abortion was about to be made legal and the rise in happiness seemed exponential. Britain was experiencing almost full employment (though the government wobbled slightly in the spring of 1966 when it was announced that the jobless total had gone up to half a million). It never occurred to anyone that there might not be a job
waiting for them when they left school or their red-brick university.

 

Priced out

There certainly won’t be a house waiting for them, not if they intend to live in London. The marketing bods behind the new development at Battersea Power Station came in to make a presentation at Vogue House a few weeks ago, showing us lots of slides and videos about their fabulous ­development. There’s a Frank Gehry this and a Frank Gehry that, a swimming pool, a private members’ club and lots of artisanal independent retailers selling organic rhubarb and fancy beer, blah blah blah.

Their roll-call of “good things” included the ominous words “affordable housing”, but this appears to be anything but. After the presentation, I promptly stuck my hand up and asked them what they actually meant by affordable housing. The answer I got wasn’t satisfactory, so I asked again: “What does your entry-level accommodation cost?” And the very charming man with the lapel-mike coughed apologetically and almost whispered, “£350,000.” At which point I made my excuses and left.

The idea that my daughters can one day get on the property ladder in London is pure fantasy, and they certainly won’t be living in Battersea, or indeed anywhere near it.

 

Back in fashion

Last Thursday, Theresa May hosted her first reception at Downing Street for the British fashion industry, an event that usually takes place twice a year, and which is attended by fashion designers, industry figures, newspaper and magazine editors and the like. ­Samantha Cameron was always a significant supporter of the sector (which contributes more to the country’s GDP than the car industry), as was Sarah Brown before her, and it is instructive that May has decided to follow in their footsteps.

It’s also telling that Mrs Cameron was not only invited to the event at No 10 but turned up, which says a lot about both women. Theresa May is a fundamentally shy person, yet she not only made a pitch-perfect speech in front of a Brexit-sensitive (and quite possibly suspicious) crowd, but chose to embrace the opportunity to espouse the growing importance of an industry that was so closely associated with the wife of her predecessor. There is such a lot of noise at the moment surrounding the PM’s apparent lack of interest in remaining on good terms with David Cameron, so one wonders what, if anything, is going on here. Taken at face value, May’s move at the reception was extremely classy.

 

The spying game

The following day I found myself in Cheltenham for a five-hour briefing on counterterrorism, cyber-defence, drug smuggling and child kidnapping at GCHQ.

I had expected the place to be like the Foreign Office, but it’s actually more like Google, Apple or Nike, and feels as though it could easily be a campus on America’s “Left Coast”.

There is an incredible sense of purpose at GCHQ, a feeling that they are all working for the common good, and frankly I found it infectious. While the denizens of Silicon Valley might be very adept at pushing the frontiers of consumerism, designing training shoes, telephones and algorithms, it felt far more appropriate to be spending time with men and women obsessed with making the world safer.

Dylan Jones is the editor-in-chief of GQ and a trustee of the Hay Festival

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