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1 1 (November 2015)

handle is hein.amenin/aeiaadn0001 and id is 1 raw text is: November 2015 Antimicrobial resistance: How substandard medicines contribute By Roger Bate The possibility of reverting to the pre-antibiotic era is increasing. With dirty hospitals, poor prescribing practices by physicians, and poor patient adherence to correct antibiotic use, the threat was already real. But now an increase in the production of substandard medicines is probably accelerating antibiotic resistance. The UK government predicts that antimicrobial resistance (AMR) could cost society afortune within decades. The threat ofAMR is increasing because of poor-quality medications, and India is ground zero when it comes to most of the problems. Given that antibiotics are so cheap in India, antibiotic use is, in effect, a substitute for proper sanitation. It is not surprising that new versions of AMR are now emanating from India. My team ' research shows that at least 6percent of thousands of antimicrobial medicines sampled from 19 emerging nations are substandard. In nearly every nation, poor-quality medicines made in India were found. Of the substandard products w e procured, 40 percent were made by legal and government-protected Indian manufacturers. But India is not the only problem case, and a global effort is required to identify sloppy production and prevent these products from being used. T he British government recently assessed the risks of antimicrobial resistance (AMR) undermining health systems in emerging markets and the devel- oped world. Returning to a pre-antibiotic era would mean that many surgical procedures now taken for granted would become high risk, and currently treat- able diseases could become a likely death sentence. The potential costs are enormous, undermining trade and economic growth over the next few decades. The UK government report suggests that by 2050, per- haps 6.2 percent of global production ($14.2 trillion) would be lost because of AMR (KPMG 2014). Right now, few major pharmaceutical companies prioritize manufacturing antimicrobial agents, because the prof- its are far lower than in other areas of research, such as cancer, hypertension, or diabetes. So with few financial incentives for companies to find new antimicrobial agents, the future may be bleak-with old medicines becoming obsolete and few new medicines emerging. Most causes of AMR are well-known and covered by the UK government report. Dirty hospitals have encouraged dangerous strains of disease, such as methicillin -resistant Staphylococcus aureus (MRSA) and Clostridium difficile. The main drivers of AMR in the West are probably doctors prescribing antibi- otics for viral infections and patients not completing courses of antibiotics as they should. But one aspect of this debate that has not been addressed sufficiently is medicine quality, which is especially a problem in emerging markets. Poor-quality medicines are a danger to patients, but they also are a risk to everyone because they accelerate resistance. In the cutthroat world of cheap generic drug produc- tion, the lowest-cost provider usually wins the contract to supply-whether it is for a pharmacy chain, a hos- pital, or even an entire health service. As a result, legiti- mate manufacturers are constantly looking for ways to lower costs and beat the competition. AMERICAN ENTERPRISE INSTITUTE

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