This is genuinely a pretty big problem in the field. The reward for making a good antibiotic is getting a drug that nobody will use since they want to preserve it for when a bacteria becomes resistant to everything else. We've yet to see really great successes from other approaches like phage therapy, but I do think that long term, the only commercially feasible way to fight bacteria is to use some technology along those lines, where you can keep adapting the therapy to deal with resistance so people will be encouraged to use it and you will have revenues from the product. Still a lot of technical problems to overcome there, but there are interesting approaches (such as using the phage as a CRISPR vector) that go ahead and engineer the phages to get around some of the roadblocks that have stopped them from being useful in general. And we shouldn't underestimate non-antibiotic approaches as well - some good progress in C. diff has been made with stool transplants. Lots of ways to target bad bacteria, unfortunately the one that's worked the best so far is the least commercially sustainable.
The problem is that in America, creating jobs is a significant focus in government spending, including military spending. There's not a lot of jobs in antibiotics the same way that there are lots of well paying jobs to bring to your congressional district if you fund a plane to nowhere. Elsewhere in the world maybe it's different and there's an opportunity there, but spending decisions like those in the US are very jobs driven and antibiotics just don't really fit into that
The US military spends a considerable amount of money on biomedical research, usually on diseases and procedures that no one else prioritizes for funding, including the rest of the government, because it is neither politically fashionable nor lucrative. The boring but important stuff that no politician will ever talk about in front of a camera.
As a well-known example, modern trauma medicine was practically invented by the US Army. They systematically invested in research for the better part of a century to maximize survival rates, minimize recovery times, and restore full body function post-trauma to the extent possible. If you are in a serious car crash, most of the procedures to optimize your outcome were originally developed in a battlefield context by the military.
They also fund a lot of research for relatively common diseases that attract little government funding otherwise due to lack of fashionability e.g. multiple sclerosis. Their incentives are different than either the rest of government or the private sector, and that is probably a good thing.
Yup. BARDA (Biomedical Advanced Research and Development Authority) which is responsible for supporting the development of bioterrorism countermeasures has a number of grants for research that overlaps nicely with antiinfective development.
Because based upon WTO agreements and others, the US cannot force all contractors and suppliers to hire only or mostly within the US.
The one exception is “national security”. So military spending is the most efficient to create jobs in the US because you can prevent hiring in other countries.
An example in the opposite direction is US subsidies for solar energy. These subsidies do create some jobs installing them, but the majority of jobs end up created overseas in other countries like China.
Interesting, one of the areas that the UK government and the EU are apparently arguing over is our apparently quite right wing government wants more freedom to support UK companies through state aid than the 'socialist' EU would like.
If we were to be constrained by WTO rules (an organisation hardcore Leavers seem very fond of) perhaps we can expect an increase in UK arms spending, though this being the UK no doubt this won't mean any improvements for the people at the sharp end of things.
Government procurement is interesting, eh. We've recently spent something like £1Billion on masks - hundreds of millions to companies which seem all to have connections to Tory faithful ... and AFAICT none of which have provided useable masks. (Aside from corruption why would they pay if the product isn't useable??!).
I dare say defence procurement will be similar.
Here's to cutting all that contracting red-tape the EU had us wade through. /s
> ... to pay the Debts and provide for the common defence and general Welfare of the United States
Right after "common defence" comes "general warfare" but for some reason that's something most Americans (or at least their politicians) seem to prefer to ignore.
Most Americans agree that "the welfare of others" ought to be cared for, they just disagree who ought to be primarily responsible for the care. With too broad an understanding of "general welfare" you'd wind up with a 10th amendment that means nothing, because "the general welfare" includes everything, so the Federal government is the only government. I would hate to make Federal lawmakers spend brainpower making laws regarding snow removal that worked equally well in LA and AK.
The 'common defence and welfare' provide the reasons for taxation, and are enumerated in the following items. Note that James Madison — who wrote much of the Constitution — vetoed a federal works bill because he found it unconstitutional. The Wikipedia article at https://en.wikipedia.org/wiki/Taxing_and_Spending_Clause#Gen... is pretty good.
I think it's pretty obvious that the narrow view is the only defensible one.
I'm not an historian or a lawyer so I'm not sure exactly what the founding fathers had in mind or if they even held a consistent view of the question.
However two things seem clear to me.
1) In practice in the US today the "general welfare" clause is interpreted expansively when it suits the purposes of the politicians. This is also supported by the article you link: "To date, the Hamiltonian view of the General Welfare Clause predominates in case law. ".
2) I think that most people throughout the developed world believe that ensuring the general welfare of a country's citizens is an essential function of government. Outside of the US, especially in Europe and democratic Asia this is probably an extremely dominant view. In the US you hear a lot of very vocal people, apparently such as yourself, argue against it, but I think that's a minority view even here.
> I think that most people throughout the developed world believe that ensuring the general welfare of a country's citizens is an essential function of government.
State governments are sovereign, too, and have far fewer constitutional restrictions on what they may do. I may not agree with the social-welfare schemes dreamt up by Texans, Michiganders or Californians, but they do not effect me, so it's not really my business. OTOH a federal social-welfare scheme effects me and is patently unconstitutional.
Definitely fair to call it an over generalization - I grew up in a town with a "private sector" that only existed because of government contracts and have worked on pursuing DoD contracts for life sciences applications, and from what I've seen, it's fair to say that creating employment in the US continues to be a very large part of the driving force behind why funding is allocated by the government. The program managers aren't necessarily keeping it front of mind, but the people signing the legislation to give the program managers their funds to manage basically only care about the jobs part, and that bleeds through in a lot of subtle and non-subtle ways
Sounds interesting. I've heard of some of the stuff on this subject but I'm probably not familiar with all the details or examples. Maybe I will check it out.
The EU has more people than the US, now granted there are some poor people in that count, but it is still more than enough to make whatever difference you blame America for not making all alone.
The steel man defense for nuclear weapons is just that: nobody wants to use them.
Since the development of nuclear weapons, there's been no outright wars between the major powers for nearly a century. We've lived through the most peaceful period in all of human history. It's debatable how much nuclear armarment contributed to that. But prima facie, it certainly seems like a major reason that the US, Russia, or China haven't gone to war with each other.
Given the carnage of the previous two world wars, it seems to me that every dollar spent on nuclear weapons was worth it ten times over.
In this particular case I wasn't, for once, arguing against nuclear weapons but rather that spending comparable amounts on antibiotics might actually bring benefits.
That's silly. Of course society will want to use it. It's just that if they're wise[0], they'll use it as needed not spray it about (sometimes literally)
I think they mean "has a sales profile restrained by public health considerations" - sell sugar pills and your market is comparatively limitless in this respect.
> unfortunately the one that's worked the best so far is the least commercially sustainable.
So sustain it non-commercially. Governments have purchased medications in the past, often for exactly this kind of reason. We stockpile vaccines right now, even though the "market" doesn't want to.
Really the most notable thing about this article isn't the science, it's the framing of the problem as "difficult" when... it isn't.
It's politically difficult yeah. If there was like a $500 million or $1 billion dollar reward for bringing a new antibiotic to market (maybe with price regulations on the other end, but i don't think those would matter with antibiotics), this problem would be a long way to solved. Or a GAVI equivalent. But sometimes, scientific problems are easier to solve than political ones. I'd bet on a new breakthrough creating an alternative to antibiotics happening before the (US) government overcomes the political friction required to do what will be framed as bailing out big pharma. Hating big pharma is like the one thing both parties agree on here.
This is what I really wish the WHO would solve. Have a global fund that every country contributes to based on GDP and/or population. The WHO buys an new drugs from the drug companies and then sets up manufacturing and stockpiles. Then we can get rid of all this drug advertising and reduce the cost of health care. We can stop have the same drug be cheaper in Canada than it is in the US. The drug companies can coordinate with the WHO to develop drugs for the most needed conditions. We don't need a 12th ED drug but a shelf stable anti-venom might be needed globally.
If there are vaccines/shots we need globally, we can keep a certain percentage of flu or whatever around and ship to where they are needed. Instead each country has to keep their own stockpile with duplication of effort. In the US, we pay egg farms billions to produce eggs to be used for making flu vaccines for when actually need them but we pay for the farms year round so we have reserved supply. This is silly and there are easier ways to share the costs.
Even better, let WHO shoulder the cost of trialing promising candidate drugs. The current system means every successful drug needs to also shoulder the cost of developing and (especially) trialing nine other drugs that didn't make it. Basically pharma companies currently work like hedge funds who expect most of their startups to fail but expect to make the money back on a single unicorn from each batch. IMO it would be a much healthier ecosystem if smaller labs could just do the development part.
Government funding on products never produces cheap products. The problem with drug prices is the cost of dealing with FDA regulations, not the free market. Insulin has no reason to be that expensive if it wasn't for the clusterfuck of IP protection laws that interact with each other and lock basic products out.
