Being an old chemistry major and being interested in science in general I was quickly reeled in.
Specifically the feature focused on outbreaks of KPC, an increasingly found form of gram-negative bacteria that are resistant to known antibiotics.
From a paper found on the National Institutes of Health website by Ryan et al.:
Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are a group of emerging highly drug-resistant Gram-negative bacilli causing infections associated with significant morbidity and mortality.
Basically this once rare form of bacteria has had outbreaks at hospitals, beginning in the New York and New Jersey area. Since it is not impacted by known antibiotics there is no known cure. It has proven fatal and other survivors have lost limbs. They live in fear of the infection returning.
There are other gram negative bacteria as well, deadly and resistant to existing antibiotics, that are showing up as well. From an article in the New York Times:
The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.
On a more general level the story dealt with the lack of development of new antibiotics to combat these increasingly prevalent and potent bugs. There are many reasons for this but the market does play a role.
According to the story it costs between $600 million and $1 billion dollars to develop a new drug and bring it to market. Obviously the pharmaceutical companies have to recoup that money and eventually show a profit. For antibiotics that can prove problematic.
Antibiotics have been over prescribed and overused. The two biggest transgressors are medicine and agriculture. Antibiotics are prescribed routinely at the first sign of a sniffle. They are extensively used in modern factory-farming agriculture in the raising of livestock. They get into the food supply and water supply.
With all this use comes decreased effectiveness as the bacteria mutate and develop resistance to the drugs. Evolution can be a bitch.
The other part of the scarcity is the economics of it all. There is a recognition that antibiotics are overused. And by their very nature antibiotics, even when used properly, are only intended for a finite period of time until the patient gets better.
Therein lies the rub. Why spend a billion dollars developing something that should be used sparingly and only for a short period of time?
As one pharmaceutical company worker put it (paraphrasing), I can produce a cholesterol drug that people need to basically take every day for the rest of their lives, and make billions in profits, or put a billion dollars into developing a new antibiotic that even those using it will only need for a period of days or weeks.
In the face of these increasingly toxic gram negative resistant bacteria there are now only one or two major companies working actively on new lines of antibiotics. Pfizer built a whole new facility to work on the issue but pulled the plug a couple of years ago. As the report stated we are about to enter a brave new world of increasingly deadly bacteria combined with decreasing availability and efficacy of antibiotics. The studies in the U.S. have not been done to determine how many of the approximately 99,000 bacterial deaths each year are from Gram negative bacteria. But in Europe where such studies have been done it is thought that 2/3 of the 25,000 bacterial deaths each year can be ascribed to the gram negative strains. Source for these figures is the same New York Times article cited above.
As I watched this show it struck me that here again we see the practical limits of leaving everything up to the free market. The pharmaceutical companies are not villains in this story, they are pursuing profits in a legal and lawful way, nothing egregious about that. But you can't argue that having no research and development of antibiotics is in the public interest.
The free market tells the companies to develop and market drugs for chronic conditions. The public interest says we need sane policies about antibiotic use and a steady supply of existing antibiotics and development of drugs to combat the gram negative bacteria.
So there are several ways to address the issue. The free market purists say "oh well the increased mortality we are about to experience is the price of freedom." Most humans would find that answer unsatisfying and at some level, grotesque. On the other side one might argue for government takeover of something so important and vital to the public health and safety. In between are a range of other options.
It would seem to me that between the NIH and CDC here, or maybe even under the guise of the WHO of the UN, governments could direct and fund independent research and development of necessary, but not profitable, drugs. Or governments could provide incentives and money to private companies to ensure the work was done and new antibiotics were available. The mechanics of how the costs and profits are split would be an interesting detail to work out.
But the larger point is this, the free market does not always arrive at the answer that is in the best interest of the public, or the nation, certainly not in the long run.
We saw that with the whole discussion over energy policy in the late 70's and early 80's. We started down the path of energy independence and government providing seed money into the development of clean, renewable energy sources. Then Reagan pulled the plug on all of it and said the free market would decided what energy sources were best. Since the production and distribution channels already existed for fossil fuels we know what answer the market came up with. And as a country and a planet we would have been in a much better place if the Carter initiatives around energy had been allowed to continue.
The whole matter of development and availability of effective antibiotics is just another example. The market doesn't know public or national interest. It does not take a long range view in its cost/benefit analysis. That is why we have governments.