Biotechnology, Health, Medical, Pharmaceutical industry, Science

Big pharma failing to address our greatest medical threat

GLOBAL HEALTH SECURITY

Intro: Drug-resistant infections now kill more people every year than HIV or malaria, yet only six companies remain active in antibiotic research

Writing in the last few days, Professor Lord Darzi, FRS, said that big pharma is failing to tackle our greatest medical threat.

The world-renowned and eminent surgeon says that every caesarean section, joint replacement, and round of chemotherapy depends on antibiotics. In medicine as in war, a successful attack needs a solid defence. Antibiotics are not medicine’s glamourous front line – they are its foundations. And those foundations are crumbling.

Citing that drug-resistant infections now kill 1.27 million people every year, by 2050 the toll could reach eight million. The current mortality rate is more than HIV or malaria. The World Health Organisation (WHO) has warned that one in six bacterial infections is already resistant to standard treatment.

Yet this growing threat has been neglected by the very industry that has the capacity and resources to confront it. The major pharmaceutical companies walked away from antibiotics when they stopped generating lucrative returns. In the 1980s there were 18 companies involved in antibiotic research. By 2020 the number had fallen to six. The rest have pivoted to focus on expensive but highly remunerative medicines to beat cancer and long-term conditions such as obesity.

The ways in which these new medicines attack disease is indeed transformative, but they do not save lives all by themselves. Patients undergoing treatment are at higher risk of infection, but without effective antibiotics, the surgeon cannot operate safely, the oncologist cannot deliver chemotherapy, and the transplant physician cannot suppress rejection.

It is strategically incoherent to innovate relentlessly in attack while underinvesting in defence. The defensive arsenal is not optional infrastructure. It is foundational.

Between 2011 and 2020, US venture capital invested just $1.6bn in antimicrobials, compared with $26.5bn in oncology. The antimicrobial pipeline has declined by 35 per cent since 2021, from 92 to 60 projects, according to the 2026 AMR Benchmark report by the Access to Medicine Foundation, last month. Half are led by GlaxoSmithKline (GSK), which is carrying a disproportionate share of the large-company burden.

There are now only 3,000 active antimicrobial resistance (AMR) researchers worldwide, against 46,000 in oncology. When antibiotic programmes close, 90 per cent of researchers leave the field entirely. The talent and expertise needed for these medicines is collapsing alongside the drug pipeline.

This weakness puts at risk the pharmaceutical industry’s own growth. In 2024, global oncology revenues exceeded $200bn and R&D investment surpassed $40bn. Yet one-third of cancer patients develop bacterial infections during treatment, and up to half of these are now resistant – causing delays, dose changes, and poorer outcomes.

Developing new antibiotics is especially challenging. Most drugs succeed commercially by reaching as many eligible patients as possible. But for antibiotics, good stewardship means reserving novel agents for resistant infections – precisely the behaviour that collapses commercial returns.

In 2020, a consortium of more than 20 major pharmaceutical companies committed around $1bn to bridge the “valley of death” between discovery and profitability by creating the AMR Action Fund. The fund’s ambition was to deliver two to four new antibiotics by 2030. To date, it has delivered one – pivmecillinam, for urinary tract infections.

Bold initiatives such as this $1bn scheme look impressive. But there is a danger of their becoming “guilt capital” – spending that looks responsible but does not change the underlying economics. Without genuine pull incentives, and without adequate investment in diagnostics, stewardship, and surveillance alongside drugs, the spending risks being perceived as reputational insurance rather than strategic investment.

Most tellingly, the fund itself acknowledges it “struggled to find investment opportunities in clinical development exactly because the pipeline is insufficient”. When a $1bn fund cannot find enough assets worth backing, the problem is not capital. It is upstream failure to generate candidates and downstream failure to create a market that rewards success.

The conclusion is quite simple. We need a new approach.

First, build a sustainable pipeline through modern discovery – including AI-enabled research that must prove itself with real-world data – and implement payment models that reward access rather than volume. The UK’s subscription-style scheme is now being expanded. Similar approaches in other countries could create a viable global market.

Second, reduce misuse through transformative diagnostics. Rapid pathogen identification and resistance profiling at point-of-care would cut inappropriate prescribing – the single largest driver of resistance – and protect new drugs from the fate of their predecessors. A deadline should be called: no antibiotic prescription without a diagnosis by 2030.

Third, strengthen stewardship, surveillance, and access so that new antibiotics are protected, monitored, and reach patients appropriately anywhere in the world – particularly in low-income and middle-income countries where the burden of resistance is heaviest.

In 2028, we will mark the centenary of Alexander Fleming’s discovery of penicillin at St Mary’s Hospital in London – a moment that launched the antibiotic era and transformed human health. The centenary should be a moment of celebration. It risks becoming a memorial if action is not taken.

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Health, Mental Health, Psychology, Wellbeing

Gratitude: Is it understood properly enough?

HEALTH & WELLBEING

THE word “gratitude” is ubiquitous and everywhere these days. On mental health leaflets and in magazine columns, it is also emblazoned on mugs and seen often on motivational posters. All this is the result of more than two decades’ research in positive psychology which has found that having a “gratitude practice” – such as jotting down three to five things you are thankful for most days – brings a host of psychological and physical benefits.

Most of us will not want to seem, well, ungrateful. Even amongst sceptics, it is likely that they too would have been persuaded to take up the gratitude habit. When we remember to do it, we will feel better: more cheerful and connected, inclined to see the good already present in our lives. Counting your blessings, whether that’s noticing a beautiful sunset or remembering how your neighbour went out of their way to help you earlier, is free and attractively simple. But there underlies the problem. In our eagerness to embrace gratitude as a cure-all, have we lost sight of its complexity and its edge?

In positive psychology, gratitude is generally defined as a wholly good thing, a spontaneous feeling of joyful appreciation. But back in 1923, the Harvard psychologist William McDougall believed gratitude – especially when directed towards another person, rather than an experience in the more abstract way of, say, being “grateful to be alive” – was more difficult and complex to understand. Of course, there was awe for the generosity of the human spirit, and tender feelings towards the person who had given up their time to help. But there were also quiet feelings of envy or embarrassment, a sense of the “superior power” of the helper and even what McDougall called “negative self-feeling” (which today we’d call “low self-esteem”). The Japanese expression arigata-meiwaku (literally: “annoying thanks”) gets to the heart of what he meant. Arigata-meiwaku is the feeling you have when someone insists on performing a favour for you, even though you don’t want them to, yet convention dictates you must be grateful anyway. There’s a reason all this feels so annoying: being grateful throws off the balance of power and increases feelings of obligation. There’s your benefactor at the top, bathed in a sunshine glow of generosity. And there’s you, at the bottom, doffing your cap.

It might seem mean-spirited to focus on how being thankful can also obligate, diminish, or even confuse us. But as #feelingblessed becomes a performative norm, these aspects of gratitude are even more important to understand, particularly for the role they play in how hierarchical structures are reinforced in our world. A bleak tale about compulsory gratitude is that of the 13-year-old orphan Eyo Ekpenyon Eyo II. In 1893, he travelled from his home in British-occupied west Africa to take up a scholarship in a missionary school in Colwyn Bay, Wales. Less than six months after arriving, Eyo wrote to his patron, expressing thanks but begging to return home. The cold weather had made him poorly, and he feared for his life. It was a reasonable worry since three west African pupils had already died at Colwyn Bay.

Some time later Eyo did secure a passage home, but not before the British press got hold of the story. In a vicious outpouring of anger, they called him “spoilt”, “ungrateful”, and a “little prince”; their language soaked in colonial assumptions about who ought to feel grateful to whom. Not much has changed since. In The Ungrateful Refugee the author Dina Nayeri describes how, as a child refugee from Iran, she was expected to feel “so lucky, so humbled” to be in the United States. Only later did she understand how this “politics of gratitude” had subtly worked to transform her human right to refuge into a gift, one that had to be repaid by staying submissive and uncomplaining, being a “good immigrant” who stayed firmly in her lane.

This connection between power and the demand for gratitude reaches into many parts of life. When people in high-power positions are made to feel insecure, such as by having their failings and shortcomings pointed out, they commonly berate those who they perceive as inferior to them for being ungrateful. Consider the recent incident in the White House when Donald Trump and JD Vance took Volodymyr Zelensky to task for failing to show sufficient gratitude earlier this year.

These costs are part of what psychologists now call the “dark side” of gratitude. One common objection to the gratitude movement is that it risks “toxic positivity”, encouraging people to ignore and repress more painful feelings. But feeling thankful can lead to other dangers, too. People are more likely to transgress moral codes on behalf of someone else if they feel grateful to them. Members of historically marginalised groups, including women and LGBTQ+ people, are less likely to complain about unfair treatment if they are reminded first how lucky they are compared with the past. And, as studies with women in abusive relationships show, when people have been gaslit into believing they cannot survive without an abuser, gratitude makes them feel obliged to stay. Is it apt to ask, then, whether all those motivational posters should come with caveats and health warnings?

Given these arguments there is a lot to think about while trying to jot down three things you feel grateful for so you can retire peacefully at night.

Yet, the lessons of the latest research remind us that, like all emotions, feeling grateful is neither wholly good nor wholly bad. Too little, and we risk being entitled or rude, alienating those who try to help us. Too much, and we may leave ourselves open to exploitation by amplifying the power someone holds over us. Context, as always, is necessary and should always be relative.  

There are strategies that help mitigate the risk. Focusing on circumstances rather than individuals (broadly, feeling grateful for or that, rather than grateful to) can side-step the issue of power. And if you notice someone – a boss, parent, friend, or partner – expecting more gratitude than you want to give, you might ask yourself why. What might seem like ungrateful behaviour in our hierarchical world may really be an act of self-preservation, even one of political defiance.

And sometimes gratitude does need to have an expiration date. For all we may feel thankful, sometimes we have to release ourselves from the burden and move on with our lives. Gratitude is important. But so is paying attention to its limits.

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Britain, Government, Health, NHS, Politics

The abolition of NHS England

HEALTH

Intro: The Labour Government’s shake-up of the NHS in England aims to cut waste and shift resources, but the looming funding gap raises doubts about its impact

THE UK Government’s decision to abolish NHS England – the world’s largest quango – was cast as a bold strike against bureaucracy. The move is designed to cut waste, “shift money to the frontline”, and by placing the NHS in England under direct democratic control. It is a declaration of intent from Sir Keir Starmer who wants Labour not to be the party of bigger government but the party of smarter government. That’s the theory, at least. The reality, as with most things in government, is more complicated.

The announcement happens to be less of a grand health reform and more a strategic positioning exercise. Wes Streeting, the Health Secretary, and the architect of this plan, is engaged in a delicate balancing act: convincing the Treasury that the NHS can stay within budget, while simultaneously lobbying for more money that he knows the health service will inevitably require. The cull of NHS England is a useful and headline-grabbing moment. It is one that will allow Mr Streeting to claim that he is shifting cash from managers to patient care, a necessary concession when preparing to argue for more Treasury investment.

The problem is that the numbers don’t add up. The savings from axing NHS England will be modest. The organisation’s cost to the Treasury is £2bn, a tiny fraction of the NHS’s £183bn budget for 2025/26. Of this, about £400m is spent on staff who work directly with local NHS bodies, and these roles will probably continue in some form. The savings come nowhere near enough to fill next year’s estimated £6.6bn funding gap. At best, it frees up a few hundred million pounds. At worst, it shifts costs elsewhere while causing months of upheaval in an already overstretched system.

The NHS faces mounting pressure to cut costs, with the Chancellor, Rachel Reeves, insisting that it must live within its means. Hospital trusts will need to tighten their belts even further. It does not take a health economist to recognise that when resources are cut, patient demand does not magically disappear – it simply resurfaces elsewhere. If community services shut-down to balance the books, then the pressure on GPs and A&E departments will only intensify. If the health service is told to do more with less, the risk is that it simply ends up doing less with less.

Sir Keir’s embrace of Mr Streeting’s reform agenda is a calculated gamble. The PM is backing an NHS overhaul that may not deliver as promised. His endorsement, however, bolsters Mr Streeting’s standing with the Treasury, which faces a looming fiscal shortfall. With tax rises off the table, and Ms Reeves’ fiscal straitjacket firmly in place, spending cuts after 2025/26 seem an inevitability.

The NHS may have won big in the last budget, but as the Darzi report warned, it remains in “serious trouble”. Years of under-investment and overcrowded hospitals, with no relief from an overstretched social care system, have left it desperately struggling. Without greater funding, it cannot meet the rising demand of an ageing population, let alone expand its workforce. The Health Secretary must keep pressing the Treasury for the resources he needs, cloaking each plea for cash in the fashionable language of “modernising reform”.

Such rhetorical agility is a skill that Westminster normally rewards. Consider, for example, how Universal Credit came into being. But whether he delivers on his three big shifts – moving care out of hospitals, prioritising prevention, and digitising the NHS – remains to be seen. If the health service deteriorates further, the government will soon find that it has not only failed to fix the NHS in England but has taken ownership of its decline.

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