Category Archives: science
Will the National Security Council Spearhead Government Effort to Combat Antibiotics Resistance by New Superbugs?
The President’s Council of Advisors On Science And Technology (PCAST) issued a report in September to the president on the increasing resistance of killer bacteria to existing antibiotics and the threat it poses to the United States and the rest of the world. The report received minimum fanfare but was referenced in today’s NY Times article “Superbugs Kill India’s Babies and Pose an Overseas Threat” concerning the increase in antibiotic-resistant bacteria in India and the threat this poses to the rest of the world. The PCAST report reviews the growth of this problem of drug-resistant bacteria and offers potential solutions.
The PCAST report starts off with us imagining a world without antibiotics, like it was at the turn of the 20th century when “…as many as nine women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every nine people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite…” And the list goes on. We’ve grown accustomed to having antibiotics at our beck and call. Infection? Run to the doctor and get a shot. Magically you’re cured. Only that’s now changing. In India, according to the Times article, as many as 58,000 babies die annually from infections caused by these so-called superbugs which thrive in India’s sewers, rivers, and people due to poor sanitation. While this is only a fraction of the infant deaths in India, the number is increasing dramatically every year. More importantly, now some of these bugs have migrated to Europe and the US to join those that we already have here. Furthermore, these new so-called superbugs are virtually immune to all existing antibiotics.
This issue of the growing number of so-called superbugs is not new but it’s rising in importance. According to the PCAST report the CDC estimates the cost to our economy of the health care related to these infections at $20-35B. This will only go up as more of these superbugs appear and become more common. This issue has arisen from the overuse of antibiotics in humans and in agriculture. Furthermore, there are few new antibiotics in the pipeline because of the difficulty in creating these drugs, the long and expensive development and testing process required , and the lower profit numbers associated with antibiotics.
The limitation in the profit making ability of antibiotics is not to be taken lightly. Most of the superstar drugs today are lifestyle drugs in the sense that they don’t cure you but they control symptoms over your lifetime. They’re medicine you’re likely to be on for the rest of your life. A recent Tuft study estimated the cost of bringing a drug to market at more than $2.5BLifestyle drug development costs can be recovered over years, as opposed to drugs like antibiotics which involve a short twenty or thirty pill prescription and you’re done. We can see the impact of the costs for short run drugs in lifesaving cancer drugs that are taken for a relatively short time by a limited number of people and cost hundreds of thousands per year. In contrast, the “lifestyle” drugs taken over many years, e.g., cholesterol control, heart, and arthritis drugs, cost in the $5000/yr range. The expenditures for developing both types of drug are relatively similar. It’s the number of people using them and the length of time they’re used that result in the different prices to the user. There is some concern that the development and clinical costs for antibiotics may be still higher, making it even more difficult to recover costs.
The PCAST report recommends appointing a member of the National Security Council as Director for National Antibiotic Resistance Policy (DNARP), who would report to the president to help coordinate a top-level government-wide Task Force on Combating Antibiotic Resistant Bacteria (TF-CARB) that is co-chaired by the Secretaries of Agriculture, Defense, and Health and Human Services. They will be tasked with developing steps to address the antibiotic-resistant bacteria that include:
- Expanding the surveillance of antibiotic use. The report indicates that 50% of antibiotic prescriptions are not needed and that is “a major contributor to rising antibiotic resistance.” This effort will include funding support for improved data gathering by local public health organizations to report on the use of antibiotics and to gain better data on the scope of the problem.
- Increasing the longevity of existing drugs by better managing their use, addressing outbreaks, and working to reduce the growth in antibiotic-resistant organisms. This includes addressing the issue of the use of antibiotics in agriculture.
- Increasing the rate at which new drugs to combat these infections are developed. This includes adding additional direct federal funding to support R&D, using non-traditional organizations such as DARPA (the Defense Advanced Projects Agency), addressing the costs and time required to approve these drugs, creating new economic incentives to pharmaceutical companies, and offering prizes (similar to the X prize) for new diagnostics.
Some may feel this is another power grab by the government and that it can be simply addressed by market forces. Well, the fact is, the market hasn’t responded yet because of the cost and profit issues mentioned earlier. The PCAST working group included members of the agricultural, biotech, and pharmaceutical industries from such organizations as AstraZeneca, Iroko Pharmaceuticals, GSK, Norvartis, and Smithfield Foods. To wait for the market to respond will be too late. The reduced effectiveness of antibiotics is rapidly becoming a major public health issue that will eventually impact all of us, especially our children and grandchildren. Hopefully, this effort will not be stymied by the rancor and partisanship in Washington.
Last week two of the so-called commercial space vehicles under development failed in fiery splendor. To some it’s vindication that the “NASA” way is correct. To others it displays the hubris of the billionaires funding these vehicles. Others wonder why we’re even wasting our time with this stuff when there are so many other problems in the world.
Some may think what I’m about to write as corny. Other might see it as far-fetched and pie-in-the-sky (or worse). That’s okay. Because I suspect there will be others who’ll get it. Why go into space? Why spend all the money and time and risk? Why try to cut the cost of space travel?
Why go into space? Because it’s there. Humans have always been a race of explorers. Or at least some of us have been explorers. That’s what drove us up the road to civilization. Not everyone is an explorer. When the American West was opened up in the 19th century, some elected to follow the exhortation to “Go West”, while many others elected to stay in their cities on the East Coast or on their family farms. As I said that’s okay. There should be room for both. When aviation began in its early years during the 1920s some elected to fly with the barnstormers while others elected to remain on the ground and watch. That’s okay, too. Now virtually everyone flies.
Why go into space and why spend all the money and time and risk? To ensure the survival of the human race. As long as we’re stuck on one world we’re vulnerable to destruction. It may be a natural disaster. An asteroid. Or the “ring of fire” volcanoes suddenly erupting. Or simply a plague. It could be human induced climate change. Or maybe a war. If we had substantial settlements on other worlds or in space the human race would survive. Pie-in-the-sky and far-fetched? Maybe. But it’s the pursuit of those pie-in-the-sky and far-fetched dreams that brought us to civilization.
What about the risk? No one is forcing astronauts to fly into space. No one is forcing those who h bought tickets on Virgin Galactic to purchase those tickets. Beyond that, risk is the price of advancement. Remember risk vs. reward. Or that old saying, “Nothing ventured, nothing gained.” Advancement comes at a price, and there are those who are willing to pay that price. There are those who aren’t. That’s fine, too. As for risk, what we’re seeing now is not any different than in the early days of aviation when crashes were far more common. Or even in the early days of the space program. Remember (and I’m dating myself) all those Vanguards blowing up on the launch pad before we finally got a Redstone to work and put the first US satellite into orbit? Remember Apollo One and the three astronauts who died in the fire?
Space is full of natural resources. Solar radiation which can kill is also a source of energy. Ice is plentiful. So is hydrogen. Those we know. We suspect that some of the asteroids may be rich in metals. Pie-in the sky? Maybe. But so was the transcontinental railroad. Or building a plantation in the wilds of Virginia in the 1600s. Some scoff. Some take action. History is full of people who say we can’t or shouldn’t. Fortunately, history of full of those who ignore the nay-sayers.
Why cut the cost of going into space in the face of huge risks? The American West was not really opened up until the transcontinental railroad was built. Airlines weren’t really successful until the DC-3 and later airliners cut the cost and time to travel (as well as improved reliability). Airlines really took off when the airport infrastructure was built. Even the automobile wasn’t going anywhere (excuse the pun) as a means of mass transportation until Henry Ford built the Model T for everyone.
What about those billionaires? If they are driven by ego so what? Isn’t that the definition of an entrepreneur? Someone who is so sure of what they have to do and who may be willing to risk everything. Some say they’re just playing. Well, I guess so were those rich British aristocrats and merchants who funded that plantation in Virginia in the 1600s. So, to Elon Musk and Richard Branson and the others, you have the money and the will. More power to you. Do it. It’s how we got here.
Note: Part of this appeared as a comment on a NY Times article.
I’m a trained project manager with a project management certification or PMP. As such, part of my PMP training includes risk management, a process used in industry to manage the prospective risks or uncertainties encountered during a project. After reviewing the discussion on global warming I’ve come to a conclusion that risk management needs to be applied to the global warming debate. Risk management provides an approach to dealing with an issue that has some probability of occurrence and has the potential for devastating consequences. If you know something is definitely going to happen it’s easier to weigh the costs and make a decision to deal with the consequences if they’re bad enough to warrant action. It becomes more difficult to deal with the consequences of something that might happen. In the latter case, you have to weigh the costs of mitigating something that might not happen (and therefore you’ve wasted the money) versus not doing something and dealing with the consequences. The tradeoff is like determining to purchase insurance.
The idea of my applying risk management to global warming came about during my involvement in a number of LinkedIn group discussions centering on whether global warming/climate change is real or not, and to what degree humanity is responsible for it. Some of the discussions occurred in LinkedIn discussion groups representing science organizations, or at least people interested in science, and were quite technical in nature. The discussions delved into interpretation of geological data particularly from ice cores and evidence of past climate cycles. In the discussions, it seemed to me the term global warming referred to human-influenced changes in climate, while climate change is used for natural, long term changes in climate.
The media has reported that a majority of climate scientists support the idea of human-influenced global warming. In these LinkedIn discussions I observed the scientific opposition centered on the interpretation of geological data, and the lack of validation of climate models. It was pointed out in the LinkedIn discussions that the primary climate prediction model is in its 11th generation of iteration and we’re still not accurately modeling what has occurred already, no less the future. A recent article in the NY Times confirmed that the simulations are struggling, not because they’re wrong, but because they are limited by the complexity of the system and also by current computer capabilities.
To me, with my experience as an engineering project manager, it comes as no surprise that computer models and simulations sometimes don’t match measured data perfectly. The more complex a system, the more difficult it is for a computer model to perfectly match real world data. In some instances, as in the case of climate modelling, it becomes an iterative process, where each successive version of the model gets closer to the data as the modelers gain a better understanding of the physics, i.e., the response, of the system to various inputs. Sometimes, if a system is complex enough, it becomes a matter of available computer power. However, even when the model correlation to the data isn’t perfect, the simulations can be used to predict data trends. The models then become qualitative tools to help make decisions concerning a course of action.
Climate models are among the most complicated of all technical simulations, requiring the most powerful computers we have. I expect it will be a while before we can solve these models with a fine enough grid to get us the answers we need. Problem is, while we’re waiting, the Earth may be changing.
Prompted by the discussions and my thought of applying risk management to global warming I did research into the consequences of global warming, focusing on the potential impact to the coast of the United States if the oceans rise 7-10 feet as predicted. This is one of the primary outcomes described by climate scientists. Note, I was dealing with these as potential outcomes. So if the seas rise by the levels expected, a good portion of Manhattan would be under water, as would parts of the Carolinas, the Florida peninsula, and parts of Texas. The West Coast, with its higher shorelines, at least north of Los Angeles, would be less impacted. If you look at these consequences worldwide it gets even worse. Coastal flooding due to storm surge will also increase significantly. There will be many more Hurricane Sandys, and they will become more violent.
I also investigated the predicted weather pattern shifts across the US. Increased droughts are projected for the West Coast, including more forest fires and water shortages. Parts of the Midwest would also face severe droughts, key habitat changes, and higher temperatures severely impacting its ability to continue acting as the breadbasket of America. Alterations in habitats to birds and other animals will have major consequences on the insect population. There is also an expectation for the East Coast of increased occurrences of storms like Hurricane Sandy, possibly with even more increased intensity. Weather over the Midwest is also expected to turn more violent.
These were indeed dire predictions. Even if they’re only half right, the negative impact on our economy, and the potential for loss of life are still very high. Project management practices dictate that when identifying a risk with consequences to the project potentially as dire as the global warming predictions, even if the engineering simulations were mixed or uncertain, a risk mitigation plan is required. Even if you believe the probability is only 20% that global warming is real, the consequences are significant enough to require a plan and a response.
So how do we deal with a risk like this? In industry, risk management provides a process to address risk. A quick sidelight. I received my PMP certification from the Project Management Institute, which is recognized worldwide. PMI publishes the Guide to Project Management Body of Knowledge (PMBOK®) which summarizes the best processes involved in project management. Risk management is one of those processes included in the PMBOK®. There are four methods of dealing with risk:
- Accept the risk: Acknowledge the risk and accept the consequences.Let’s look at the four options of dealing with the risks of global warming and climate change:
- Avoid the risk: Remove the risk by eliminating whatever is causing the risk
- Transfer the risk: Pass it on to someone else, e.g., purchasing insurance
- Mitigate the risk: Make changes to reduce the probability of the risk occurring or prepare plans to ameliorate the consequences once they happen
Let’s look at the four options of dealing with the risks of global warming and climate change:
- Avoiding the risk involves eliminating the causes of the risk. I don’t believe we have a really good option for avoiding global warming/climate change at this point. If the changes are the result of natural climate processes, as some advocate, there is little we can do to avoid them. If they’re due to human influence, I think it’s impractical to expect an instantaneous change to less polluting energy sources. It’s unreasonable to expect every country in the world, or even the major polluters, to stop using fossil fuels immediately. It will take a decade or more to get the plan in place and to begin making all the changes. Politically, it just isn’t going to happen. Besides, we’re already seeing some of the predicted effects. I believe we’re just too far along to avoid at least some of the global warming/climate change consequences. (This is different than mitigating them which will be described later).
- Transferring the risk is the next method of dealing with risk. To me this method is unacceptable because the consequences are even half as bad as predicted, there isn’t enough insurance money in the world to pay for the consequences, not to mention the cost in lives lost to flooding and famine. The only thing we’d be doing is transferring the consequences to our children.
- Accepting the risk signifies indicates the risk is acceded to because the cost of risk avoidance is unacceptable compared to the cost of the consequence. This category is usually used only for risks with low impact consequences or for risks with damaging consequences but with an extremely low probability of occurrence. Opponents of global warming will obviously favor this approach. It’s the one seen as having the least near-term impact on the economy because we continue on our path of utilizing fossil fuels.
- Finally, the fourth method, risk mitigation. This involves taking action to reduce the probability of occurrence of the risk or to reduce its impact. Risk mitigation, then, requires we start addressing those consequences regardless of cause (natural or manmade). For example, we can begin planning our response to coastal flooding on a national scale. If there is a significant probability that human-induced component to changes in climate, then it may also not be too late to reduce the impact and perhaps even influence the degree to which it occurs (as opposed to completely avoiding it). We can accomplish this by reducing the emission of greenhouse gases by increasing the use of alternative energy sources. Replacing old industries with new is part of the creative destruction process that has occurred throughout human industry. (See my LinkedIn Pulse post Horse Manure, Buggy Whips, and Global Warming) In creative destruction, the displaced workers often find work in the new industry.
In my opinion, it comes down to which is worse:
- Accepting the impact of global warming/climate change happening and we aren’t prepared for it with all of the consequences because we wanted to keep the status quo, or
- Waiting for 100% proof that global warming is real in order to protect the status quo and then finding out that it’s too late for many of the mitigations identified, or
- Begin the mitigations identified to reduce the effects of global warming/climate change (and accepting the cost of near-term economic dislocations) and then finding out climate change is a false alarm.I guess your answer depends on whether you care more about yourself or your grandkids.
The process of creative destruction is often ignored in the debate about global warming, climate change, or whatever people decide to call it, Opponents focus on the costs of making changes as we convert to renewable energy and the reduction in our carbon footprint. They claim these technology changes will damage the economy while insisting the supposed high costs of renewable energy and sustainable manufacturing will cost the United States millions of jobs and weaken our economy. To that I say balderdash.
The introduction of new technologies is accompanied by something called creative destruction when leading companies, or even industries, apparently successful at the time of the introduction, disappear. For example, the arrival of the industrial revolution brought about an end to those magnificent artisans of the pre-industrial economies. e.g., the blacksmith, the shoemaker, the weaver, etc. While those old jobs disappeared and were replaced, instead, by factory and white collar positions. We moved from a rural society to an urban society.
Along with that change came a new set of issues. In 1900 there were 100,000 or more horses in New York City, creating thousands of pounds of manure that had to removed. Hundreds if not thousands of workers toiled daily to clean up that mess. When it was introduced, the automobile was touted as a means of cleaning up the cities (among other things). I bet t the workers who cleaned those city streets along with buggy whip makers were among those who derided these new fangled toys, and probably shouted, “Get a horse!” With the introduction of the car came hundreds of companies trying to make them and capture the market. The manure workers and buggy whip makers probably also pointed to the failing early automobile companies as showing the folly of this technology. (Just like the opponents of global warming are decrying the failure of companies like Solyandra). And true to form most of these companies went out of business or were bought out. The car seemed to be a toy, a plaything of the rich, much as the Tesla electric car is today.
Then along came Henry Ford and the Model “T” automobile and everything changed. He made the Model “T” “everyman’s” car while paying the highest wages in the industry to enable his workers to afford to own their own car. Sure, at the time, it was probably still more expensive to purchase than a horse, but what you could do with it! Now the average worker could afford cars.
What do you think happened to those workers who cleaned the manure off city streets? They probably ended up with jobs paving them. And those who worked for the buggy whip makers? They found higher paying jobs in automobile factories. One man’s risk is another’s opportunity.
I’m reminded of that wonderful diatribe by Danny DeVito in the movie “Other People’s Money” where he played a 1980s style corporate raider, Larry the Liquidator, trying to take over a family-run wire-making manufacturing firm in New England. In his diatribe he talks about buggy whip makers. “You know, at one time there must’ve been dozens of companies makin’ buggy whips.And I’ll bet the last company around was the one that made the best goddamn buggy whip you ever saw.” Then the zinger. “Now how would you have liked to have been a stockholder in that company?”
Yes, there will be disruption as we switch to renewable energy and sustainable manufacturing. But in the long run, new industries will be created and the economy will grow based on those new industries. That’s just the way the world works. And, better yet, we may have saved the world for our children and grandchildren, but that’s a subject for another day.