The Rationale Why Pharmaceutical Organizations are Not Incentivized to Develop Antibiotics and Why This is Dangerous for the Worlds Next Pandemic

antibiotic-resistanceWithin 5 short years of release, approximatly 20% of antibiotics become subject to resistance from bacterial pathogens which means that antibiotic proliferation is chronologically limited within its life expectancy. Coupled with this, if an antibiotic is highly effective, the scientific and medical community often rally against its usage so that such a tool can be saved in reserve for a global bacterial pandemic. In either scenario, return upon investment is less than what it would be with a different class of medication (e.g. selective serotonin re-uptake inhibitor, statin, hypnotic etc.) which is why pharmaceutical organizations are less interested in research and development dedicated to antibiotic medicine in favor of other, more profitable medication categories. This lack of investment however is myopic and will inevitably backfire upon the pharmaceutical industry as a whole if new antibiotics are not developed because medications used to treat cancer will become less in demand due to the fact that cancer patients are highly likely to acquire an infection during treatment when their immune system is comprised, with this infection often killing the patient if antibiotic solutions are not available. This would expectedly lead to a sharp decline in cancer medication treatment and subsequently pharmaceutical sales of related medications as patients would be likely to adopt living the rest of their life as fully as possible and forgoing treatment as they would be damned if they accept the cancer treatment and develop an infection which kills them but also damned if they don’t accept the treatment and let the cancer run its course which is almost always fatal

To provide comparison of the research, development, and manufacturing contrast between oncology medications and antibiotics, as of 2020, there are currently 800 medications in development for cancer and hypertension whilst only 28 antibiotic medications undergoing that same research phase and development process, with 2 of these antibiotics expected to become fully developed and able to reach the market and patients. The last new antibiotic class, lipopeptides, were introduced in 1984 with a gap referred to as an “antibiotic void” occurring during the 1990’s, 2000’s, 2010’s, and now moving into the 2020’s. The urgency of this threat is projected to become dire within the coming decades, with scientists predicting that by 2050, medicine could potentially come full circle to the pre-antibiotic era, with microbes which are completely and totally resistant to every antibiotic known to medicine

A Revolutionary Breakthrough in Oncology Treatment

T-cell-cancer

Cancer kills 9,000,000 (9 million) people each year and despite having searched for centuries, a cure has yet to be discovered by scientists. At the center of the immune system is the T cell, a type of leukocyte which respond against bacterial and viral infections alike in an effort to keep their host healthy and alive. T cells determine between threatening and non-threatening foreign and non-foreign bodies within a host by leveraging a molecule upon the surface of all cells referred to as the “T cell receptor”. Jim Allison was the first person to successfully isolate and purify the molecule which recognizes this lock and key model for infectious disease, auto-immune disease, and other innocuous substances within the body be they foreign or internally created. In 1987, French scientist Pierre Golstein and his team discovered a new protein upon the surface of T cells which he named “CTLA-4”. To study CTLA-4 in laboratory rats, Allison had to build and design a rat antibody, a Y shaped protein which would trigger a reaction by CTLA-4. Cancers are mutations and should in theory be visible to the immune system, which is why the scientific community has struggled with the paradox of why tumors go undetected by the immune system for decades. There is no discernible reason as to why the immune system can recognize and resist influenza or any other foreign or domestic body but not cancer. Allison theorized that tumors have evolved an ability to fool the immune system, engaging CTLA-4 which turns on the T cells response to halt its search and destroy measures. Allison hypothesized that if he inserted a Y shaped antibody to block the gap in between the tumor and T cells, the tumor would no longer have its ability to hide, a trait which has been evolved by tumor cells over hundreds of millions of years. This would allow the T cell to infiltrate, attack from within the tumor, shrink, and ultimately kill the growth. Allison spent the next decade trying to turn this revolutionary breakthrough discovery into a medication which could be provided to cancer patients. Allison found Alan Korman, a scientist creating medications for auto-immune disease which provided him with the expert he required to turn this idea into a reality. Korman was tasked with taking the CTLA-4 antibody which Allison and partner Max Krummell developed for laboratory rats, and turn it into a medication which could safely work within human beings with this medication subsequently being named “Ipilimumab” (pronounced “ipi-lim-ooh-mab”). Korman ended up collaborating with a friend from graduate school, Nils Lonberg to accomplish this task. Ipilimumab consists of an intramuscular injection into the leg and a 90 minute intravenous medication drip in comparison to chemotherapy and radiation therapy which take months of treatment to complete and have devastating effects upon overall health as both bad and good tissue are destroyed in an effort to eradicate all tumor cells. Allison’s work with laboratory rats demonstrated that with the help of this newly developed antibody, T cells gained the ability enter into tumors and expand their size in an effort to destroy them from the inside out. This means that the fact that tumors grow initially upon administration is a positive marker and indicative of the medication working as it demonstrates successful infiltration of the tumor cells themselves. Patients often report feeling better after a few treatment sessions, sometimes even a single session, despite computer tomography scans demonstrating that their tumors are growing larger, which under normal circumstances would make a patient feel worse. Some patients even noted increased improvement after having stopped the Ipilimumab treatment, with no further therapy required. On March 25, 2011, the U.S. Food and Drug Administration released approval for Ipilimumab. Ipilimumab and its successors have treated nearly 1,000,000 (1 million) patients worldwide with many of these patients achieving permanent remission which is essentially the definition of having been cured of cancer. Although these medications do not work in every single case, they have definitively demonstrated to be a miracle medication for hundreds of thousands of people thus far. After completing this revolutionary discovery, Allison was awarded the Nobel Prize in Medicine in 2018 for his series of discoveries related to T cells and their ability to halt cancer in its progression in perpetuity