

How patent protection for antibiotics creates incentives to render them useless - mbrubeck
https://www.techdirt.com/articles/20120620/07513919403/how-extending-patent-protection-antibiotics-creates-perverse-incentives-to-render-them-useless.shtml

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crusso
I'm confused. Patents are the cause of a decrease in effectiveness of
antibiotics?

I was in Mexico last week and could buy many types of antibiotics over-the-
counter without a prescription, and the prices all seemed below what you'd see
for comparable generic drugs in the US. Obviously they're not even interested
in medical supervision when distributing antibiotics (and a bunch of other
drugs). My assumption is that they're even less interested in who owns what
patent.

Drug companies pushing doctors to use their products seems like a drop in the
bucket compared with policies that make antibiotics cheaply and easily
available without supervision from those trained in medicine.

That said, I'm opposed to abusing the patent system by granting longer
patents. Protect those willing to create new and useful drugs so they can make
a profit... but keep them on their toes by not letting the rest on their
laurels forever while they milk some patent dry.

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tytso
The flip side of patent protection is this is what encourages drug companies
to spend the multiple years of drug research and drug approval to develop new
antibiotics.

I certainly agree that the patent system is non-optimal and should
overhauled/replaced, but we also have to figure out a better way of funding
drug development as part of that project. Maybe more government funding of
basic drug research? Perhaps, but then it becomes a highly political issues
(i.e., something the Republican Party would fight tooth and nail against).

~~~
slowpoke
_> The flip side of patent protection is this is what encourages drug
companies to spend the multiple years of drug research and drug approval to
develop new antibiotics._

That's patently wrong (pun intended).

At least in Europe, a major part of the income of the pharma concerns come
from the government[1] - and as such indirectly the public. Furthermore, most
of that money doesn't even go to research. but into marketing and other things
which have nada to do with research. Pharma concerns generally spent only
about 15% of their budget on actual research[2].

Furthermore, this system encourages the development of treatments instead of
cures. It's a lot more profitable to bind a patient to a daily mix of pills
than it is to give them a shot that cures their disease. Or develop other
completely unnecessary shit, like all these "Anti-Aging" products.

This system is all sorts of fucked up, and it's ignorant to claim that it's
the only alternative. I'll make the bold claim that without medical patents,
we'd have already gotten rid of AIDS and severely reduced the mortality of
cancer.

[1]:
[http://www2.piratpartiet.se/an_alternative_to_pharmaceutical...](http://www2.piratpartiet.se/an_alternative_to_pharmaceutical_patents)
[2]:
[http://www.sciencedaily.com/releases/2008/01/080105140107.ht...](http://www.sciencedaily.com/releases/2008/01/080105140107.htm)

~~~
tytso
I did say that there were other possibilities, including government funding of
research. However, it is a strong article of faith amongst the American right-
wing politicians that the marketplace is always more efficient at directing
money to be funded at the "right" research approaches than letting the
government try to do that.

They would point at how (in-)efficiently the Chinese government directed
funding of building and roads in 2nd-tier cities where entire city blocks of
apartment buildings are empty as an example of that.

While I don't agree with that entirely --- there are more definitions of
"right" than just what makes the most $$$: witness the vast amount of money
being poured into statin research, which I'm not convinced is the best place
to devote time, attention and cash if your valuation function was based on
improving the overall health of the country or or of the world --- it is fair
to say that it's a bit too easy to just say, "oh, we'll just let government
fund the pharma development". This begs the question of whether or not you
trust politicians to decide how much money to devote towards R&D, and how the
money should be spent. Fundamentally, it's a lot more complicated than I
suspect the Pirate Party has acknowledged.

------
DiabloD3
Dupe: <https://news.ycombinator.com/item?id=4180605>

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jballanc
The problem is not the drugs, themselves, but rather what they are used to
treat: short-term infections. Compare this to things like statins (cholesterol
drugs), which are almost always used for the remaining lifespan of the
patient. Then consider the primary affected populations. Poor populations
(with poor sanitation, access to clean drinking water, and regular health
care) that have little disposable income are going to be the major consumers
of antibiotics. High cholesterol, on the other hand, is a disease of the
affluent.

So I think the article is wrong that extended patent protection will lead to
more antibiotic abuse. Pretty much any short-term market approach to
antibiotics will lead either to their over-use for marginally reasonable
purposes, or simply result in less investment overall (compare the number of
new antibiotics to the number of new statins over the last 2 decades).

No, antibiotics (and bacterial countermeasures in general) seem to me to be
more amenable to an insurance approach. Most people don't expect to die in a
fire, but they do spend money on the possibility. Most people, similarly,
don't expect to die from a bacterial infection. Today, that means they don't
spend any money on the possibility. That needs to change.

The challenge, of course, is that when the shit hits the fan, good luck
justifying _not_ providing antibiotics to people who didn't pay their
"premiums". So, really, you need something like car insurance, where everyone
(and here I also mean every _country_ ) is required to buy in.

~~~
anothermachine
> So, really, you need something like car insurance, where everyone (and here
> I also mean every country) is required to buy in.

[https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...](https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act)

~~~
jballanc
A step in the right direction, but the challenge gets even more interesting:
usually, the way insurance remains profitable (or even possible) in a market
economy is that those with the highest risk pay the largest premiums. Except,
when it comes to antibiotics, those at greatest risk (third-world countries)
are also those least able to pay their fair share, let alone a correspondingly
larger portion.

A tough nut to crack for sure...

------
codesuela
I always wondered, isn't there a limited supply of how many Antibiotics "we"
can create/synthesize? I only have a very limited understanding of Biology I'd
love if someone could explain to me whether the "post-antibiotic era" is a
real thread and at some point bacteria will get resistant to all the
antibiotics we have at our disposal.

~~~
jballanc
There will always be new targets for new antibiotics. That's not the problem.
The problem is that we started, with Penicillin, by picking off the low-
hanging fruit. Now the bacteria are playing an impressive game of catch-up.
Soon, the speed with which they will be able to develop new resistances will
overtake the speed at which we can develop new antibiotics. (Also, more potent
antibiotics are more likely to have nasty side-effects.)

The good news is that the Russians have already done a great deal of work
toward the post-antibiotic era by working on bacteriophage therapies.
Bacteriophages are the long-term end-game to keeping bacteria in check, since
they can be made to evolve at the same or faster speeds than bacteria.

What is needed now is more research into bacteriophages, and much, _much_ more
research into Evolutionary Dynamics, so that we have some clue what is going
on (and so that we can better predict the future development of resistances).

Of course, it's kinda hard to do research into Evolutionary Dynamics when the
richest country in the world has political leaders that still question the
validity of evolution...

~~~
Daniel_Newby
" Bacteriophages are the long-term end-game to keeping bacteria in check ..."

Unfortunately bacteriophages are just ordinary viruses, so the human body can
and will develop antibodies against them.

~~~
jballanc
Sure, the human body can develop antibodies against literally anything, living
or not. But antibody production is not instantaneous and can have a lag time
of 7 to 10 days, which should be sufficient time for the phages to do their
work. Also, since phages do not enter human cells, you won't get the typical
response from APC's or Helper T-Cells, which will lead to even more sluggish
antibody response.

Bottom line: none of the research done on phage therapy has indicated that
this is a blocker.

So far, the main blockers to the development of phage therapy are: the FDA
doesn't know how to approve them, companies don't know how to patent them, and
people freak out when a doctor says: "Now I'm going to give you a virus..."

~~~
Daniel_Newby
My hypothesis is that immunizations can be dramatically improved. Bacteria use
a variety of secreted toxins, quorum sensing factors, biofilm scaffolds, and
so forth. It would be very good if we could immunize against the few thousand
most common virulence factors. Those pathways also provide ripe targets for
conventional drugs.

"But antibody production is not instantaneous and can have a lag time of 7 to
10 days, which should be sufficient time for the phages to do their work."

Once, which don't get me wrong is very nice for the patient. But cutting the
rate of fatal childhood infections 50% from the natural rate is not good
enough. We want 99.99%.

"Also, since phages do not enter human cells, you won't get the typical
response from APC's or Helper T-Cells, ..."

They do when their bacterial hosts are endocytosed.

~~~
jballanc
Immunizations are, ultimately, subject to the same problems of evolved
avoidance as antibiotics.

The current approach to treating diseases reminds me of the story of how the
Yugoslav army shot down an F-117. They had spotters telling them when the
F-117 got close, they operated radar that could almost, sorta see them, and
they relied on a proximity fuse, a generous damage radius, and a helluva lot
of luck. We may currently be able to determine roughly what an infection is,
and how it's likely to behave, but we're far, far from being able to determine
any of this with sufficient accuracy.

What's really needed is a combination approach, but even a combination
approach is useless until we understand more about how bacteria evolve...

~~~
Daniel_Newby
Immunity against bacterial virulence factors tends to be persistent. The
nature of the proteins is that they cannot change much without losing
function. (Unlike viral surface coats.)

