Some notes from The Plague Years with Matt McCarthy
About superbugs and the looming antibiotic crisis. It also provides some ideas about how to incentivise important research when the profit motive can not.
Full the Waking Up podcast #166 : https://samharris.org/podcasts/166-plague-years/
We relaxed for too long, and we are now behind the curve with antibiotics. By 2050, infections might be killing more people than cancer. We need investment into research now, for the future. Otherwise we might find ourselves falling back to older treatments like amputation!
Part of the problem is that antibiotics are not a very appealing investment for big pharma. It is expensive to prove an antibiotic is safe, but the duration of its usefulness is limited. So we should look at different financial models. Antibiotics are different from other drugs because we want to minimise their use, but we really need them to be there in emergencies. “Like a fire extinguisher.”
An alternative model might be if hospitals pay for a subscription. Another might be for more state-funded research. And another might be tax cuts for companies who agree to open source their discoveries.
Another continuing problem is the overuse: We not only pump antiobiotics into farm animals, but also into oranges and tulips! We can try to legislate for more responsible use of antibiotics, but there are powerful lobbies trying to prevent it.
More excusable, but no less problematic, doctors face an ethical dilemma between doing what is best for the patient (prescribing a powerful catch-all antibiotic as a precaution), and doing what is best for society as a whole (limiting overuse to limit resistance). Some hospitals combat this by having “antiobiotic stewards” who only allow a doctor to use an antibiotic after some lengthy discussion and debate. (The steward may say no to the doctor, and recommend an alternative drug instead.)
There is a constant war raging in the soil, between bacteria, microbes and fungi. If we can tap into this natural arms race, we may find some new solutions there.
Infectious disease doctors are very important but they don’t get paid well because they don’t do many procedures.
There was another interesting podcast about possible improvements in the US medical system.
But I only managed to take a few notes on that:
Currently AI and automation are saving time, allowing a doctor to see more patients than before. Although the doctors themselves would prefer to use the extra time to spend more time with their patients!
At 1:14:10 the interviewee Eric Topol describes his attempt to fight back against a big pharma scandal. Despite the existence of clinical evidence, the company refused to stop distributing this particular drug, and were never held responsible, in part due to their ability to hire expensive lawyers. It cost the doctor 10 years of his life, it harmed his career and his family. He said he would not try the same again, because he realises the futility. So he is focusing on other areas for improvement instead.