It would be nice to be able to report that the much trumpeted "end of antibiotics" is just a slice of media alarmism. But it isn't. The danger that just about all our existing antibiotics will soon be powerless against resistant bacteria, as recently claimed in the journal Lancet Infectious Diseases, is all too real. A paper in that journal reports the emergence and spread of strains of common pathogens, such as E coli and the pneumonia bug K pneumoniae, containing a gene that confers resistance even against current last-resort antibiotics called carbapenems. Such bacteria, Chris Walsh of Harvard Medical School confirms, "are on the brink of being impossible to treat with existing antibiotics." And without antibiotics, even routine surgery could cause fatal infections. Antibiotic resistance has been with us since penicillin revolutionised medicine. So why the problem now? Partly, it's simply becoming harder to find new drugs to expand the arsenal. But the difficulties also stem from practices within the pharmaceutical industry. "This is a very grim time in antibacterial drug development," says Gerry Wright, a specialist in antibiotic resistance and discovery at McMaster University in Ontario. "The reasons are complex, but the fact that many pharmaceutical companies have moved to focus on chronic diseases is one." Wright is one of several specialists who have been warning for years about the danger. In 2004, Carl Nathan, of Cornell University, decried the way companies look for profitable blockbuster antibiotics. Widespread use of these general-purpose drugs for chronic infections quickly breeds resistance in bacteria. But if their use is restricted, profits fall and funding and expertise leach away. This, along with regulatory hurdles, the effects of a spate of "big pharma" mergers, and a myopic focus on hitting tried-and-tested biochemical targets in the pathogens, has almost dried up the antibiotic development pipeline. Nathan called for an overhaul in the way new antibiotics are sought and brought to market, including a vigorous not-for-profit pharmaceutical sector. Something certainly needs to change: this is a global problem for which the market may not offer any solution. "Multi-drug resistant bacteria will continue to spread," says Wright. "There is no chance that the problem will go away." EMBRYO RESEARCH AT RISK The government's plan to dismantle the Human Fertilisation and Embryology Authority (HFEA) is an act of vandalism. The Health Protection Agency (HPA), also to be chopped, supplies vital advice about infectious diseases, but its expertise can conceivably be transferred intact within the civil service. However the HFEA, the independent regulator that oversees fertility treatment and human embryo research, is different. First set up in 1991, its responsibilities ballooned as developments in embryology and assisted conception accelerated. Its recent wrestling with the ethics of human-animal hybrid embryos and stem-cell research seems a long way from treatments for infertility, but there is an inextricable link between them—historically and scientifically. This is one reason why the plan floated by the health secretary, Andrew Lansley, to parcel out its work to three other bodies is naive and dangerous. Decisions about these delicate matters, at the forefront of reproductive and biomedical technology, require a comprehensive overview of the context—and ever more so as time goes by. The real tragedy is that the HFEA did its job so well, as attested by the fact that it managed to upset both conservatives for perceived liberalism, and scientists for alleged restrictiveness (despite Britain having one of the most permissive embryo research frameworks in the world). It was genuinely independent, refusing to kowtow to government, scientists, IVF clinics, religious groups or public opinion. Doubtless some of its decisions could be criticised, but they were always taken with sober consideration. It was a bulwark against the hazards of both a laissez-faire free market in infertility treatment and knee-jerk reactionary prohibition. It will be a miracle if the same acumen can be assembled from the scattered remains.
