Searching for Drugs
The biggest story about health care this morning appears in the business pages, not the political section, of the New York Times. It is headlined “A Rising Hospital Threat: Infections Unfazed by Antibiotics Become More Common.” A new category of bacteria is “already killing tens of thousands of hospital patients each year.” These “Gram-negative” germs apparently beat out even the more widely known drug-resistant “methicillin-resistant Staphylococcus aureus” – or MRSA for short – in their immunity to virtually every sort of treatment. And no relief is in sight, the article suggests, “for a combination of business reasons and scientific challenges.”
To find out about the business reasons, you have to turn to a sidebar headed “Deadly Germs Largely Ignored by Drug Firms.” Even there, you read through five paragraphs of medical information before getting to this: “The difficulty of killing Gram-negative germs is not the only reason for the dearth of new drugs. Another is that many big drug companies have scaled back or abandoned antibiotic development. Antibiotics are typically taken for a only a week or two, after which the patient is cured. They are simply not as lucrative as drugs for other diseases that are taken for a long time to manage a long-term condition.”
My reflections on this article went in a half-dozen directions, including several having to do with mortality in general and the false hopes we place in modern medicine. But it also reminded me of the false hopes we place, when it comes to health care, in the market. I became convinced of that in the 1970s when I spent considerable time studying health-care systems and economics. My conviction was refreshed a few years ago by a reading of Medicine and the Market, a major comparative study of health-care systems by Daniel Callahan and Angela A. Wasunna.
Still, the development of new drugs was one area where the market model actually made some sense, certainly compared to the idea that when my physician recommends a CAT scan or MRI to investigate a sudden onset of double vision I’m going to shop around for the best scan for a buck in the New York area. Of course it has been long recognized that drug research and development are skewed toward the needs of the well-to-do while those of the impoverished remain neglected. A few compensatory measures have been set into place. And now here is a new distortion, the lack of incentive to develop drugs that might actually cure, and cure quickly, rather than keep you drug dependent. Is there a solution?