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Comment by venomsnake | Hacker News Reader

Why don't we use for medicines the same procurement procedures we use for aircraft carriers? The USG should just hire someone to develop antibiotics for them. It is a matter of national security too - in case of biological attack having a couple more potent will help a lot.

Or having the know how to develop them on demand.

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Yes this would be one way of doing it. I think we should try a range of different funding models to see which one works best. What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics.

One thing I should mention is we don’t have to keep developing totally new antibiotics we can develop antibiotics that are tweaks of existing antibiotics. Antibiotic resistance is an arms race that we can never win, but we can stay ahead with continued investment.

We certainly do have to keep developing totally new antibiotics. Problem is many of the new antibiotics that we have are tweaks on existing antibiotics. We're in such a rush to have something useable that side effect profiles get nastier and bacteria develop resistances to entire families of antibiotics.

The problem is not coming up with new funding models. The problem is getting them implemented.

>What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics.

What's the best way to quantify the failure? Like a chart showing the bacterial infection death rate for the past 100 years? Costs for the average antibiotic dose over time? Something else? Those data sets seem like they should be available, but are apparently harder for me to find than I would have thought, given the prevalence of all the information available on anti-microbial resistance that pops up for my collection of search terms.

Do you see this new work as a departure from, or a continuation of the antibiotics development of the past?

How fast people are discovering new antibiotics is the important thing, I would think. Assuming resistance is going to happen no matter what, we need to keep discovering new antibiotics at a steady pace to keep up.

Here's one timeline I found in a paper: http://cmr.asm.org/content/24/1/71/F1.expansion.html

I would think it is important to know the magnitude of the problem. Has the number of death from bacterial infections increased from 1 per million people per year in 1990 to 100 per million people per year today? Has it stayed the same? Has it actually decreased over time, and were just trying to be proactive? I'd don't think it is too odd to want to know.

How about a measure of depth of the defence pipeline:

total number of efficacious treatments available per million infections, plotted over time? The million infections might need to be weighted by severity of clinical outcome.

Great, let's get that data too as long as we are at it. Anyone know how to get it?

The problem with this is it is often not known how many other antibiotics might have worked. It might be better to measure drugs known not to work as a percentage of the drugs that work for that class of organism.

Getting this data is likely to be really hard to get and be very labor intensive.

The problem seems to be that an assertion was originally made that we are supposed to accept as true, without any way of quantifying whether it is accurate.

Just got me thinking, shouldn't we try to have a spectrum of antibiotics switched regularly as some form of 'wear levelling' for bacterial resistance ?

>Do you see this new work as a departure from, or a continuation of the antibiotics development of the past?

It is a continuation of some great science that doesn’t ever make it to market. There have been a lot of interesting new antibiotics discovered over the last 20 years or so that just have not been picked up.

What we have learned over the last 25 years is the traditional laissez faire model has failed us when it comes to antibiotics.

I disagree.

Think of it this way. If it were truly laissez faire, then drug makers would charge a price high enough to still make it worthwhile. Unfortunately, the way antibiotics are paid for in US hospitals, the hospitals would lose money each time they used the drug.

Hell, we pay ~$80K to cure hepatitis C (millions have it in the US). If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar? What is the benefit to society to save someone's life?

> If you have an antibiotic that cures a highly resistant infection that happens maybe a few hundred times in the US, why not charge something similar?

Because a few hundred times 80k is still not much. And even so, many people still can't afford it.

If you can't provide enough value to society that you can spare a few tens of thousands of dollars to cure yourself, are you really worth the cost of developing these drugs, testing them, training doctors, etc.?

All of this over-regulation is why medicine is declining in the first place. That shouldn't justify more regulation.

That easily makes the top 3 list of most sociopathic things I've read all month, and between mass shootings and debates about refugees it's been a banner month for sociopaths on Facebook. Did you intend to measure the value of a human life in terms of enhancing shareholder value or is this just poorly worded?

Some people are only able to reason about things they can measure.

Let's ignore profit for a minute. These drugs still cost money to discover and produce. Who pays for it?

We put a price on human life all the time, not just for drugs.

Agreed and I find this utterly appalling. For me this is a damning indictment of capitalism and a clear indicator that there has to be a better way to handle task prioritization and resource allocation in a modern society.

Is there any system where you can avoid it? Even in a command economy system trade offs have to be made. If you have resources X to spend, you need to figure out what to spend it on. That means you're putting a dollar figure on a human life. I don't see how it could be avoided.

I don't claim to have answers and would definitely support experimentation in this arena. Political systems are certainly ripe for disruption.

The point of providing value to society in the first place is so that people can experience the benefit of it.

> If you can't extract enough value from society so that you can spare a few tens of thousands of dollars to cure yourself

Fixed. I also generally feel casual disregard towards human life and suffering as long as the human in question is not me, but lets call things with their real names.

With a price of drug per year being twice the average income in the richest country in the world - that creates impossible situation by definition for half of its populace.

Also value provided is not always correlated with value extracted - a janitor for a modest fee keeps my house clean. A hedge fund manager ruins the global economy just when I must enter my prime growing years in earnings and make sure I am at a disadvantage at both the cohort before and after me.

Which of those two lives is more valuable to me?

"With a price of drug per year being twice the average income in the richest country in the world - that creates impossible situation by definition for half of its populace."

Even worse. There are a few gigantic outliers at the upper end of the scale. That means that the number of people below average income will be >50%. What you want to check against in such cases is the median (50:50 split by definition).

"Also value provided is not always correlated with value extracted"

That is exactly one of the main problems society is struggling with. How do we even measure value provided? It's a subjective measure to begin with. In the case of the hedge funds manager, it's probably net-negative for most people (but I'm sure her friends would disagree).

Then again. True laissez fair would mean no patents. So I think its fair to assume that it would be radically different in which actors are involved and in which constellations they collaborate. In such a system I wonder if "drug makers" would be able to charge much more than the production cost. Is first mover enough to cover RnD? I suspect not in which case "drug makers" would probably not be "drug inventors"

Many antibiotics are already derivatives of other antibiotics. The problem is that bacteria are developing resistances to whole families of medication. You can tweak erythromycin and get clarithromycin or azithromycin, but that means nothing when the mechanism of action they exploit has been patched in resistant bacteria.

Based on how most government procurement of bespoke products turns out, they would pay far more than it should cost and get a product that doesn't work.

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