Second, something I've been predicting for years: the end of antibiotics.
Last September, Walsh published details of a gene he had discovered, called NDM 1, which passes easily between types of bacteria called enterobacteriaceae such as E. coli and Klebsiella pneumoniae and makes them resistant to almost all of the powerful, last-line group of antibiotics called carbapenems. Yesterday's paper revealed that NDM 1 is widespread in India and has arrived here as a result of global travel and medical tourism for, among other things, transplants, pregnancy care and cosmetic surgery.No new antibiotics means the end of transplant surgery and the return of appendicitis, pneumonia, and tuberculosis as major killers.
"In many ways, this is it," Walsh tells me. "This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing enterobacteriaceae. We have a bleak window of maybe 10 years, where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with."
And this is the optimistic view – based on the assumption that drug companies can and will get moving on discovering new antibiotics to throw at the bacterial enemy. Since the 1990s, when pharma found itself twisting and turning down blind alleys, it has not shown a great deal of enthusiasm for difficult antibiotic research. And besides, because, unlike with heart medicines, people take the drugs for a week rather than life, and because resistance means the drugs become useless after a while, there is just not much money in it.
This was inevitable, in the long term. Bacteria were always going to evolve past whatever blocks we put in their way. But it's undeniable that we have drastically shortened the effective window of current antibiotics through sheer neglect. It's been 65 years since the discovery of penicillin. These were gifts from the gods if anything was, and we chewed through them like a Hollywood starlet with an 8-ball of coke.
See the LA Times for a more optimistic take.