Ethical conflicts in public health research and practice: antimicrobial resistance and the ethics of drug development

Abstract

Since the 1960s, scientists and pharmaceutical representatives have called for the advancement and development of new antimicrobial drugs to combat infectious diseases. In January 2005, Senate Majority Leader Bill Frist (R-TN), MD, introduced a biopreparedness bill that included provisions for patent extensions and tax incentives to stimulate industry research on new antimicrobials. Although government stimulus for private development of new antimicrobials is important, it does not resolve long-standing conflicts of interest between private entities and society. Rising rates of antimicrobial resistance have only exacerbated these conflicts. We used methicillin-resistant Staphylococcus aureus as a case study for reviewing these problems, and we have suggested alternative approaches that may halt the vicious cycle of resistance and obsolescence generated by the current model of antimicrobial production.

FIGURE 1—

Number of new drug classes introduced between 1935 and 2005 ^a Sulfanomides. ^b Penicillins, aminoglycosides, cephalosporins. ^c Chloramphenicol, tetracyclines, macrolides, lincosamides, streptograms. ^d Glycopeptides, rifamycins. ^e Nitroimidiazoles, quinolones. ^f Trimethoprim. ^gOxazolidinones ^hLipopeptides.