The looming superbug crisis: Politics, profit, and Big Pharma | Matt McCarthy | Big Think

The discovery of antibiotics is one of the most remarkable stories in medicine. There was this young military physician named Alexander Fleming who was taking care of injured soldiers in 1914 at a makeshift military hospital in France. And he noticed that many of the soldiers had infections that were not getting better with the tools that he had to treat them, which was largely his surgical scalpel and also antiseptic fluid.

And he was just 34 years old at the time, but Fleming recognized that there had to be a better way. And after the war was over, he went back to his laboratory at St. Mary's Hospital and started tinkering around. And it wasn't until nearly 15 years later that he stumbled upon this fungus that was producing a chemical that was so extraordinary that it could kill almost every bacteria in its path.

And the chemical that that fungus was producing is what we now know is penicillin. What's interesting about that story is that the discovery did not lead to a commercially available drug right away. In fact, Alexander Fleming didn't realize that he was on the cusp of some incredible discovery. It took another World War, and teaming up with the burgeoning pharmaceutical industry and a number of other researchers at Oxford University, before everyone fully recognized what he had stumbled upon in his laboratory in the late 1920s.

And that discovery of penicillin ushered in what we now know of as the golden era of antibiotic development. The 1950s was a period when there was a new drug being discovered seemingly every few months. And the life expectancy of humans shot up because of all of these fantastic discoveries.

But then there was a problem, which is that we were so successful finding new antibiotics, that a number of prominent physicians and scientists came out and said, "We got this infectious disease issue kicked. It's time to look for more pressing issues like heart disease and cancer." And so we started focusing our attention on treating those diseases just as the bacteria were being exposed to our precious arsenal of antibiotics.

And that set up a very difficult situation, which is that the bacteria were mutating when we took our eye off the ball. And we didn't recognize the scope of the problem until the 1990s. And that's when we first recognized that there were all of these drug resistant bacteria around us, which we now think of as superbugs.

Yeah, so when we talk about bacteria evolving into superbugs, what we mean is that they are mutating to develop machinery and enzymes that can evade even our most powerful antibiotics. My favorite one is something called an efflux pump. And it's a microscopic vacuum cleaner that bacteria have developed that can suck up an antibiotic and spit it out.

One of the other things I really like are these enzymes that they have created that chew up antibiotics. And they scavenge for metals, like zinc. And they can chop up even the most complex or nuanced medication that we throw at them. And so bacteria are constantly doing this whether we recognize it or not.

And so what's been fascinating to see is how quickly they can evolve. This is a remarkable insight that we can now discover this. But it also sets up a very perilous situation for the companies that want to create new antibiotics. They know that if they make a new drug, the bacteria will eventually figure out a way to outfox them and become resistant to it.

And that's a problem. We count on the pharmaceutical industry to help us make new drugs. And increasingly, they're saying it's simply not worth it. It's too risky. And the reason for that is, if you compare an antibiotic to, say, a blood pressure medication, a blood pressure medication is prescribed by a doctor like me.

And I say, "Take this every day." And you may take it the rest of your life. That's a great business model. Now compare that to an antibiotic where doctors are stingy about doling them out. We only prescribe them in short courses. And eventually, even that best new antibiotic is going to wear out its welcome when the bacteria become resistant. So ...