In the last couple of weeks there has been a lot of kerfuffle about antibiotic resistant microbes. I remember first hearing about this looming problem in the late 1960s when I was about 13 years old. It was about the same time as we heard about the dangers of pollution and “the greenhouse effect”. I don’t think it was because I had particularly insightful school science teachers (although they were very good) – it was because that was the era when a lot of people began to be aware of these kinds of immense global problems.
Anyway, here we are 40 odd years later and now the Chief Medical Advisor to the UK Government has decided it’s time to really get the ball rolling. Well done her – it’s always nice to see the high-ups in the medical profession acting in a timely fashion. Presumably this is the kind of thing we pay them for?
Dame Sally laid out the general picture like this:
“Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”
She also came up with this rather telling comment: “This is…not a science issue. This is an issue of markets and economics”. As if to back up that second comment, the Prime Minister appointed a top financier rather than a top scientist to coordinate ideas for government solutions.(REF/LINK 3 below).
Ahead of that Whitehall initiative, and presumably in an attempt to influence the agenda, the New Statesman magazine and the Wellcome Trust organised a round table forum on the issue – a discussion involving the good, the great and the powerful of various kinds including scientists, drug company representatives and a maverick politician. Their ruminations are really quite revealing in terms of how a global solution to this terrible threat might be framed.
A lot of the discussion at the Statesman/Wellcome round table focused on why it might be that the huge and well-funded international corps of scientists and technicians has not only failed to produce new antibiotics, but actually hasn’t even been trying very hard. Apparently it’s because the real money in medicinal compounds lies in producing pills that huge swathes of the world’s population will take on a daily basis rather than medicines which they will only need a few times in the course of a whole life – so there’s not enough money in it.
In a nutshell we seem to have ended up with a global pharmaceutical industry that operates on the very simple motto that “the best buck is obviously a fast one but the second best buck is a big one.” One particular highlight of the Statesman/Wellcome forum was the statement by the Global Head of Infection for medical industry giant Astra-Zeneca who said “Pharmas and biotechs are all businesses… and the way to engage with business is to provide incentives.”
I understand just about enough about political economy to know that this kind of short-termism is the price you pay for enjoying the many sybaritic benefits of a free market system. But in the past (on at least two occasions – but probably many more) this system has been hijacked and dragooned into service on behalf of a larger objective.
In the 1940’s, realising that private industry was unlikely to come up with a new weapon of mass destruction just as a commercial punt, the American administration went into ‘command’ mode and organised the Manhattan Project to develop nuclear bombs. Jean-Louis Racine describes how,
“[a]t its peak…the US government employed 130,000 people in the Manhattan Project …The project’s size together with several other features made it a classic case of what I would call “brute-force innovation”: it was centrally-planned, closed, and science-driven…through the Manhattan Project the government spearheaded the research, developed, testing and deployment of a revolutionary technology from start to finish over a span of four years. And there were no startups, spin-offs, royalty incentives, public-private-partnerships, venture capitalists, crowdsourcing, first-mover advantage, standard-setting or IPOs. Basically none of the buzzwords we associate with disruptive innovation in the 21st Century”.
In other words, the USA felt that world civilisation was under threat and reacted by suspending its “normal” relationship with enterprise, profit and commercial freedom.
My second example wasn’t even precipitated by impending global catastrophe, merely scientific curiosity and the desire to know about something “because it was there”. In an interesting article about what global science/tech can do if it gets directed by government, Alex Knapp takes us through the eye-watering sums involved in finding an invisible little thing called the Higg’s Boson by building the mother and father of all machines in huge underground caverns which apparently had to be excavated for this sole purpose.
“The Large Hadron Collider took about a decade to construct, for a total cost of about $4.75 billion. There are several different experiments going on at the LHC,..(which cost)..a total of about $5.5 billion a year. The remainder of the funding for those experiments is provided by international collaborations. Computing power is also a significant part of the cost of running CERN – about $286 million annually. Electricity costs alone for the LHC run at about $23.5 million per year. The total operating budget of the LHC runs to about $1 billion per year…..Taking all of those costs into consideration, the total cost of finding the Higgs boson ran about $13.25 billion. That’s a large amount, but there are over 50 billionaires on the Forbes list actually worth more than that. The money itself is provided by the CERN member countries, and a little over 70% of the annual budget is provided by Germany, the U.K., Italy, France and Spain. The money for the experiments also comes from large institutions such as universities and observer governments such as the United States, India, and Russia.”
If the kind of centralised state authority exhibited by Manhattan and the kind of funding thrown at the LHC were both directed at the antibiotic problem, we would very soon be in a very different place to where we are now. Having had a churchy upbringing, when I heard the drug companies whining about the need for profit, I found myself thinking about the half-dead robbery victim, lying on the Jerusalem to Jericho road before the Good Samaritan turned up. And I realised that at least the Pharisee and the Levite only “passed by on the other side”. Which was a pretty poor show to be sure, but not even those paragons of amoral insouciance said: “Help that bloke who’s dying in the street? Well, I could – but only if you make it worth my while”.