摘要：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. THE DEVELOPMENT AND USE of antimicrobials exemplify a classic problem in public health ethics: the conflict between the private interests of individual entities (patients, physicians, and corporations) and the public interest of society at large. In the United States, the commodification of antimicrobials exacerbates this conflict. Antimicrobials are produced and distributed by private interests (pharmaceutical and biotechnology companies) for the purpose of generating profit. They are consumed by individuals who have the financial means to purchase them and they are developed and allocated on the basis of market criteria (generation of profit and ability to pay) rather than on the basis of benefit to the public at large. An increase in antimicrobial resistance intensifies the problems generated by these conflicts of interest. We used methicillin-resistant Staphylococcus aureus (MRSA) as a case study for examining these problems. We focus on the vicious cycle of resistance and obsolescence generated by the current use of antimicrobial drugs and propose some alternative approaches to future antimicrobial development.
