Sean Roche: Resistance—what society needs to learn from the microbes

sean_rocheThe first week in July saw extensive media coverage of the looming specter of microbial antibiotic resistance. The basic problem: Big Pharma isn’t developing new antibiotics. We look on, seemingly helpless, in the face of ever evolving strains of dangerous, resistant “superbugs.”

The logic of this scenario is familiar, and mirrors perfectly our apparent helplessness in the wake of the slow motion unfolding of the planet’s ecological collapse. We know that fossil fuels are toxic for the environment, and yet Big Oil continues its voracious extraction, unabated, as the climate warms year on year.

What is the underlying pathology here? Put simply, we live in a world in which the profit motive overrides the human motive. Of course, free market converts see no problem with this. A central doctrine of free market fundamentalism is belief in the market’s benevolent “invisible hand,” a hand that opens generously and gives in the face of human needs. This miraculous “invisible hand,” devotees claim, will ensure that profit and human interests are aligned. And yet, as experience teaches so often, this hand delivers a bloody punch on the nose instead.

It’s sad to say, but Big Pharma seems much more interested in the health of shareholder portfolios than the health of the global citizenry. If the human motive (affordable drugs for poor countries, new antibiotics, etc.) does not align with the profit motive, then that’s just too bad.

New antibiotics are simply not profitable. They will be costly to develop, and then held in special clinical reserve to use only when other agents fail. By comparison, they just don’t compete with cholesterol lowering drugs. If there’s one thing the world (and shareholders) can do with, it’s yet another statin. This absurd situation belies another myth: that of the endless beneficial progress of capitalism. On the contrary, the profit motive can keep innovation on a tight leash—progress can be stifled as often as it is set free.

The list of Big Pharma’s sins is well known: disease mongering, overpricing, bribery, falsification and concealment of data, and pulling research from unprofitable areas such as neuroscience. And so on. Alas, like a toxin, the profit motive spreads and pervades all the tissues of the social body. We need to learn the Darwinian lessons from our microbial ancestors. We need to resist, evolve, and adapt.

In the face of the evolving crisis that is antibiotic resistance, the logical adaptation is to wrest control of the research agenda from Big Pharma’s executive boardroom, and hand it back to a state whose interest is more invested in the health of its citizens. And yes, perhaps ultimately the pharmaceutical industry should be in public, not private hands. The human motive must triumph over the profit motive. Resistance is the key.

Sean Roche is a consultant psychiatrist in North London, and was a visiting research fellow in philosophy at King’s College London 2012-14. After completing his philosophy PhD in 2011 he has maintained a research interest in philosophical and political issues that are relevant to both psychiatry and medicine.

I declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare.