[danieltillett]

I am a microbiologist. It is not that you want to target basic cell structures, but you want to either target multiple systems, or target systems that have a large number of modular interactions. It is relatively easy to create/discover new chemicals that kill bacteria specifically, but if these new chemicals only target one specific component then the bacteria rapidly evolve resistance. All the good antibiotics we have interact with complex systems like ribosomes that are made up of multiple interacting modules.

The reason we are having trouble finding new classes of antibiotics is that we are already have chemicals that target most of the interacting and essential cellular modules in bacteria. If you already are targeting 90% of all the possible targets you will find it very hard to discover any new classes of antibiotics.

Of course the solution is not to worry too much about finding new classes and just keep tweaking the current antibiotics to keep ahead of the bacteria. The only problem with this strategy is that the economics of antibiotic development is totally broken so the pharmaceutical companies have in the main stopped spending money on finding new antibiotics. What we need to work on is a new way of paying for new antibiotic development.

[DennisP]

It seems strange to me that we're willing to spend trillions of tax dollars on the military, but when it comes to the bacteria that attack us every day, we throw up our hands and just take whatever the free market finds profitable to provide.

[hga]

http://en.wikipedia.org/wiki/Public_good

Plus drugs are one of the very most heavily regulated "free markets" in the US ... and as others have noted, there are laws like the Bayh-Dole Act (https://en.wikipedia.org/wiki/Bayh%E2%80%93Dole_Act) which can make the process much more of a government-non-profit-corporate partnership. There is also a "Generating Antibiotic Incentives Now" (GAIN) in effect, with an bipartisan Antibiotic Development to Advance Patient Treatment in the works.

So, no, we don't "just take whatever the free market finds profitable to provide", where "profitable" has "the visible foot" of the government strongly weighting one side of the balance scale. Not to mention very strong medical policy to restrict new novel antibiotics like this one to the cases where they're really needed.

[danieltillett]

The medical policy is a major component of the problem. What the drug companies have discovered is if they release a new antibiotic that the doctors put it on the shelf with the plan to only use the antibiotic in emergencies. Of course when this happens the drug company makes no money and so rightly concludes that antibiotic development is not profitable.

There have been lots of proposals to overcome this. My personal favourite is each country agrees to pay a straight cash bonus for each new antibiotic developed with a different valued bonus in proportion to the need. The drug companies would then not need to worry if the antibiotic was used or not and we would have on tap new antibiotics to use as resistance arises.