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Doctor Outlines Plan To Battle Antibiotic Resistance In 'The Washington Post'


Unless we shift course, superbugs will become a fact of life. That line come from Zeke Emanuel, chair of the Department of Medical Ethics And Health Policy at the University of Pennsylvania. In The Washington Post, he lays out a four-pronged approach to avoid what he calls this nightmare scenario. Part of his argument is that antibiotics right now are too cheap, and he joins us to discuss the problem. Welcome to the program.

ZEKE EMANUEL: Nice to be here with you.

SHAPIRO: So there was news last week that a woman in Pennsylvania had a bacteria that was resistant to what's known as an antibiotic of last resort, and that's hit off this latest wave of concern about superbugs. Explain why you believe the price of antibiotics is partly to blame.

EMANUEL: Well, you know, the course of new, quote, unquote, "expensive antibiotics" might be $4,500 or $5,000. But a course of course of chemotherapy drug for cancer or a drug to fight multiple sclerosis can be $75,000, $100,000, $150,000 for a year of treatment.

And if you're a drug company thinking about, where do I invest in terms of research and development - do I develop a $5,000, or do I developed $150,000 drug - you're almost naturally going to go to the $150,000 drug. And so I think that's a, you know - a major, major reason that we only have 37 antibiotics now in clinical development.

SHAPIRO: Could raising the prices of antibiotics have negative consequences as well?

EMANUEL: Well, of course. It's going to happen (laughter). Everything has a positive and negative consequence. The negative consequence is it's more expensive to treat these infections. Some people might not get them because the drugs are too expensive, although that's pretty unlikely in the United States.

But I think in general, we have to shift the incentive structure for researchers and drug companies. Otherwise we're just not going to have enough development.

SHAPIRO: Now, you've proposed that governments offer a $2 billion prize to drug companies for developing new antibiotics. Is this something that had been tried with other drugs before? Are prizes an effective motivator?

EMANUEL: I don't know that they've been tried with any other drugs before. But we know in the past that prizes have worked. Napoleon offered a prize for someone who could preserve food for his army, and he got a guy who figured out how to sterilize food in a bottle and then a tin can. There was a prize by the British government to figure out naval navigation to go across the ocean. And Netflix offered a prize - actually, a very modest prize (laughter) - for figuring out people's movie preferences.

So prizes have worked and have stimulated a lot of people to think about solutions. And from the perspective of the health system just in America - forget the rest of the world - we spend $20 billion on treating people with antibiotic-resistant infections.

So this is a small fraction of that, and it's absolutely vital because if we have bacteria that we can't treat, there are going to be a lot of people dying for lack of antibiotics. And that is not a scenario we can put up with.

SHAPIRO: So as you say, the numbers of antibiotics being developed are far lower than the numbers of, for example, cancer drugs being developed. And you also say that doctors over prescribe these drugs. Explain what's going on.

EMANUEL: Yeah. We know from reports of antibiotic prescribing practices in hospitals that 20 to 50 percent of the antibiotics that are prescribed are either inappropriate for the actual organism or absolutely unnecessary to treat it.

And we know that produces side effects like C. difficile and other infection and that in the outpatient setting, in the physician's office, about a third of the antibiotics are inappropriate or unnecessary because they're treating viral infections, or they're treating self-limited infections. That breeds a lot of resistance in the bacteria in the community, and that is a huge problem.

SHAPIRO: One thing you don't mention in this piece is the role of patients. Is there something that patients should be doing differently in this problem?

EMANUEL: So there are two main things patients should be doing differently. One - don't demand antibiotics for sore throats, runny noses, ear infections and put your doctor in the unfortunate circumstance of satisfying your demand and violating what he or she thinks is an appropriate care.

And the second is, when you do get a prescription for antibiotics, we know that a lot of patients do not complete the course of antibiotics. Instead of taking the full 10 days of an antibiotic, you take three or four. You're feeling better. You stop. Well, then you've just bred some resistant organisms that are then going to proliferate, and the antibiotics that we have will not be as effective. And that is also a very big problem out there.

SHAPIRO: Doctor Zeke Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and he's also a senior fellow at the Center for American Progress. Thanks for joining us.

EMANUEL: Thank you for having me and talking about superbugs and antibiotics. Transcript provided by NPR, Copyright NPR.

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