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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Conjuring the ghost: the "shape-shifting, queer, violent, hippie genuis" of David Litvinoff

A new biography tracks down the elusive Kray confidant who became a friend of Mick Jagger and Keith Richards.

David Litvinoff is a mythic character to anyone with an interest in London during the Sixties. An intimate of the Krays, he was a tough and violent Jew from the East End. He was also a musical genius with an unrivalled knowledge of jazz, the blues and rock that made him a valued friend of Mick Jagger and Keith Richards. It was his ability to move from the East End to Chelsea, from the dives of Soho to Notting Hill, that was the critical factor in the extraordinary vision of London that Donald Cammell and Nicolas Roeg conjured into the film Performance, for which Litvinoff is credited as dialogue coach. And yet, even though all this is known and recorded, he remains a ghost, a figure who wrote nothing and who systematically destroyed all the records of his life he could lay his hands on. Even his exact role in Performance is shrouded in mystery. He is said to have dictated much of the script to Cammell. This biography claims that Jagger’s mesmerising song on the soundtrack, “Memo from Turner”, was in fact a memo from Litvinoff.

Multiple reports describe him as the most brilliant talker London had known since Coleridge, but although there are rumours of tapes they have always been just rumours. I’d have thought he was a figure who would defeat any biographer – a shape-shifting, queer, violent, hippie genius lost in a mist of hallucinogens – but Keiron Pim’s account of this extraordinary character is a magisterial work of scholarship. He tracks down all the living witnesses; he has also unearthed letters, and even some of those long-lost tapes.

The story that emerges is even harder to believe than the legend. Litvinoff came out of the Jewish East End but he was from one of its most talented families. His name was not even Litvinoff: his mother’s first husband went by that name but David was the son of her second, Solomon Levy. Long before he met the Krays or the Stones, he was a gossip columnist on the Daily Express, practically inventing the Chelsea set that shocked the prim Fifties. By that time he had met Lucian Freud, who painted him in an astonishing study, the working title of which was Portrait of a Jew. Litvinoff was furious when Freud exhibited it with the new description of The Procurer, and the bad blood between these two men, both of whom inhabited the drinking clubs of Soho and the Krays’ gambling joints, remained for the rest of their lives. In fact, it is Freud who comes over as the villain of the book, fingered by Pim as the man behind the most violent assault on Litvinoff: he was knocked unconscious at the door to his own flat, on the top floor, and awoke to find himself naked and tied to a chair suspended from the balcony, nose broken and head shaved bald.

I learned much from this book: a period working for Peter Rachman before he became involved with the Krays; sojourns in Wales and Australia when he was fleeing threats of violence. The big discovery for me, however, was Litvinoff’s encyclopaedic knowledge of the jazz and blues traditions that gave birth to rock’n’roll. He taught the Stones a lot but he taught Eric Clapton even more – they were both living at the Pheasantry building on the King’s Road, and Litvinoff seems to have had unlimited access to the most recherché back catalogues and the most recent unreleased recordings. The book traces, but does not comment on, a transformation from an amphetamine-fuelled hard man in the Fifties and early Sixties to the oddest of hallucinogen hippies by the Summer of Love in 1967.

But, for all Litvinoff’s knowledge, wit and gift for friendship, his tale is a tragedy. A man who could talk but couldn’t write; an out gay man long before it was acceptable, who seems never to have been at ease with his sexuality; a proud Jew without any tradition of Judaism to which he could affiliate. Above all, this was a man who lived to the full the extraordinary moment when London dreamed, in Harold Wilson’s Sixties, that class was a thing of the past. Back from Australia in the early Seventies, Litvinoff awoke again to find that it had indeed been a dream. His suicide in 1975 was cold and deliberate. He had outlived his time. 

Colin MacCabe edits Critical Quarterly

Jumpin’ Jack Flash: David Litvinoff and the Rock’n’Roll Underworld by Keiron Pim is publisyhed by Jonathan Cape (416pp, £16.99)

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser