Tuesday, October 30, 2007

Even more about MRSA

In today's WSJ (A19) was yet another article about methicillin-resistant Staphylococcus aureus, a.k.a. MRSA ("mersa"). (Don't you just love long technical words?) Its dramatic title: "Attack of the Superbugs." The author's (Scott Gottlieb) main argument is that we should concentrate on developing new drugs that work in fundamentally new ways, rather than simply focusing on preventing the spread of these bacteria. Sure, alcohol-sanitizer dispensers and general sanitary practices are good, he says, but we are "educating bacteria at our own expense" by antibiotic overuse and misuse.

He makes his case very effectively, although part of me wants to just go back to the good old days of soap and water, letting your kids eat dirt (courtesy of my microbiology teacher--when they're young and running around in the yard, eating about a teaspoon in the course of a day can actually help their immune systems!), and perhaps even eating organic. You're going to live about 80 years anyway, so don't get frantic about absolute sterility of everything you touch.

Why don't large drug companies develop more antibiotics? According to Gottlieb, there are several reasons. One: Infections generally last only up to a few weeks, and the doctors generally keep good drugs off-limits "as a last resort." Two: The regulation process is "capricious"--should developers use the "non-inferiority" test (i.e. the drug is "no worse" than similar ones already existing) or the better-than-a-placebo test? Three: As a result of this muddle, the FDA has raised qualifications for drugs in certain areas, worsening the morass.

Gottlieb's proposed solutions...(1) Incentives! Extraordinary drugs for extraordinary bugs. (2) The FDA should clarify its guidelines by collaborating with other pharma-related industries and organizations. (3) Develop faster screenings (such as the "'rapid' strep test") that cut down to hours the days that are usually required to identify a pathogen.

And don't forget to wash your hands!

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