{"id":9269,"date":"2019-06-30T12:06:35","date_gmt":"2019-06-30T16:06:35","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9269"},"modified":"2019-07-04T15:47:52","modified_gmt":"2019-07-04T19:47:52","slug":"antibiotic-development-is-broken-brothers-in-id-practice-and-this-years-winner-of-the-id-related-social-media-award","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/antibiotic-development-is-broken-brothers-in-id-practice-and-this-years-winner-of-the-id-related-social-media-award\/2019\/06\/30\/","title":{"rendered":"Antibiotic Development Is Broken, Brothers in ID Practice, and This Year’s Winner of the ID-Related Social Media Award"},"content":{"rendered":"
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“I do not like thunderstorms,” said every dog, ever.<\/p><\/div>\n

I am currently rounding on the inpatient ID service, the new ID fellows arrive shortly, and Louie needs intensive doggy psychotherapy after yesterday’s strong thunderstorms here in Boston.<\/p>\n

Busy times!<\/p>\n

As a result, today’s post has no unifying theme. But what it lacks in cohesiveness it more than compensates in value, as here are three highly interesting ID-related items for your perusal.<\/p>\n

1. Antibiotic development is broken — and how to fix it.\u00a0<\/strong><\/p>\n

This fascinating perspective<\/a> in the New England Journal of Medicine<\/em> focuses on the problems with our current model of antibiotic drug development. Why are for-profit companies abandoning antibiotic research? If antibiotic resistance is such a problem, why isn’t this “market opportunity” giving us new and better antibiotics?<\/p>\n

The absolute number of infections caused by each type of resistant bacterium is relatively small. Each newly approved antibiotic thus captures an ever-shrinking share of an increasingly splintered market \u2014 a problem that will only worsen over time. Short treatment durations and a coordinated program of antibiotic stewardship also contribute to low sales.<\/p><\/blockquote>\n

The authors’ proposed solution is to fund nonprofit organizations to develop antibiotics. Unlike private companies, they would not be beholden to shareholders to generate rapid profits. Relatively small revenues for a large private company — tens of millions of dollars annually — would, for a nonprofit, be a substantial win, and a chance to reinvest this money into further research.<\/p>\n

Now they just have to convince some entity — government? philanthropy? — to invest the seed money to get this started.<\/p>\n

A big hurdle, yes, but at least it’s a path forward.<\/p>\n

2.\u00a0 Two brothers chat about being in ID practice — together.<\/strong><\/p>\n

For many academic ID fellowships, the intense first year of clinical care is followed by years of research training, with relatively little clinical work occasionally sprinkled in.<\/p>\n

Research fellows might have a once-weekly half-day in clinic, or an occasional weekend seeing consults.<\/p>\n

That’s the pathway Dr. Steve Threlkeld followed here in Boston when I first knew him as a brilliant ID fellow. (I was just starting my first faculty job.) However, he soon came to the realization that his true love was patient care, not research.<\/p>\n

So he did something novel — he joined his brother Mike’s private ID practice<\/a> in Memphis, Tennessee.<\/p>\n

Steve and Mike chatted with me on this OFID podcast<\/a> about private practice ID, what it has in common with academic ID and what’s different, how to be a blue-leaning clinician<\/a> in a red-leaning state, and the unique opportunities and challenges of being the only sibling-owned private ID practice in the universe<\/em>.<\/p>\n

OK, someone contact me if I’m wrong about that last part.<\/p>\n

Available also on iTunes<\/a>, Overcast<\/a>, and soon other podcast places.<\/p>\n

3. This Year’s Winner of ID-Related Social Media Award.<\/strong><\/p>\n

I don’t know Dr. Philip Lee, but if there’s an Academy Award for ID content on social media, he’s the unequivocal 2019 winner — and we’re only halfway through the year.<\/p>\n

Click on this Twitter thread for the incontrovertible proof:<\/p>\n

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Taylor Swift as antibiotics. A thread. pic.twitter.com\/dY6We2VYkv<\/a><\/p>\n

— Dr Philip Lee (@drphiliplee1) June 7, 2019<\/a><\/p><\/blockquote>\n