[JunkDNA]

You're right that it's about profits when pharma is involved, but you are wrong about the reason (otherwise vaccines would not exist). I can tell you from firsthand experience that the length of time someone is on a drug makes almost no difference in where research priorities are.

The primary issue with antibiotics is that since the late 1990's, if you succeed, and you develop the best antibiotic the world has ever seen, the FDA will require it to be a "drug of last resort". It will therefore sit on the shelf and be guaranteed to not be prescribed very much during the life of its patent. Once enough time goes by, and other drugs come out if (and that's a big if) it is no longer a drug of last resort, it is likely off patent and therefore can be made in generic form for pennies by generic manufacturers. Regardless of what you think about patents, these incentives are completely misaligned with companies going all-in and taking a risk on new antibiotics.

[giarc]

Vaccines are a bit of a different class as some are exempt from adverse reaction lawsuits and therefore risk is reduced for the companies manufacturing the vaccine.

I think your assessment that my argument is "wrong" is inappropriate. You'll see that my argument is supported by the WHO (Bulletin of the World Health Organization 2011;89:88–89).

>Another reason is commercial. Antibiotics, in particular, have a poor return on investment because they are taken for a short period of time and cure their target disease. In contrast, drugs that treat chronic illness, such as high blood pressure, are taken daily for the rest of a patient’s life. “Companies have figured out that they make a lot more money selling the latter drugs than they do selling antibiotics,” Spellberg says, highlighting the lack of incentive for companies to develop antibiotics.

[Fomite]

And yet in a recent survey of drug development costs, "Difficid", by Optimer Pharmaceuticals, was one of the most inexpensive to develop.

I also really don't buy the "return on investment" argument, as curing a bacterial disease rarely provides immunity.

It's also not my experience as a researcher in the area - several drug companies are actively funding research.

[giarc]

Fidaxo also may not be that great or cost effective[1]. Optimer, I believe has been bought by Cubist and delisted from Nasdaq. 1. Clin Infect Dis. 2013 Aug;57(4):555-61

[Fomite]

I do know their most promising findings don't get reflected in clinical trials well. But "The Drug Companies aren't there" isn't addressed by a small drug company specializing in ID getting bought about by another drug company that has tons of ID products for half a billion dollars.

[vxNsr]

As a citizen of earth and a member of humanity it hurts to hear that people who's very business is saving lives are largely driven by profits for their company and not the goal of the company: saving lives. While I know this naive I wish it weren't.

[maxerickson]

Do you know if NIH uses any of their funding in a DARPA like manner?

[JunkDNA]

They do this to a certain extent, but the problem here is that the "R" part of "R&D" is not really at issue. While there's a lot of focus in the popular press on "finding" new antibiotics, that part can be addressed by basic research grants. I don't believe we're wanting for proof of concept kinds of things. Unlike with engineering, where once you've got a proof of concept, you can refine and iterate to make it production quality, biology is completely arbitrary.

The issue comes with the "D" part of R&D. That is the expensive part with drugs because you start having to do very tightly controlled animal model studies progressing further into clinical trials with humans. The popular notion that you "discover" a drug is not how things work in reality. Often you discover a whole raft of closely related chemical entities that appear to do what you think they do. You tweak based on further studies in order to improve efficacy and safety. But the system is sort of nondeterministic in the sense that even altering the structure slightly often has knock-on effects you can't predict. Assuming you get something decent, that's what gets made into the an actual medicine. There's a whole branch of applied chemistry that specializes in this called medicinal chemistry. In many cases, you'll read about some promising new antibiotic that has been discovered in an academic lab, but once the chemists take a look at it, you realize there's no way to make a drug out of it. The reasons can be any or all of: the therapeutic dose would be too high, it blows out the liver, it can't be made into pill, the compound is unstable and can't have a good shelf life, it can't be taken orally, etc... Working out all those kinds of problems has always been the realm of pharmas and biotech startups. Academics aren't interested in that stuff because it's not basic research, it's highly applied and is mostly trial and error based on decades of doing this kind of work.

At a macro-level, this is fundamentally what ails the entire pharma sector right now. The development part of making drugs is so expensive and such a complete and utter crap-shoot, that few new drugs of any sort are actually being produced. The last decade has been one of prolonged decline in the industry in terms of truly new drugs and there is no obvious mechanism available to us to make it less so.

[Fomite]

In fairness, the NIH has started pushing "translational research" really hard in recent years.