Category Archives: Medical

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, Medical, Science

Menopause misery. HRT isn’t the only answer

HEALTH

DR MAX PEMBERTON, an NHS psychiatrist and medical doctor, wrote recently on the significant shift in many doctors’ attitude towards Hormone Replacement Therapy (HRT). For far too many years, peri- and post-menopausal women have to had to fight hard for their right to access this medication.

An increasing number of doctors are now open to the idea that prescribing HRT can have real benefits for their patients – and, undoubtedly, this has made a life-changing difference for many women. Even though some 13million women in the UK are going through the menopause, it is estimated that one in four have to visit their GP at least three times before getting appropriate treatment.

Last year, official draft guidelines were issued to GPs which said alternative treatments should be considered. These included talking therapies “alongside or as an alternative to” HRT to help reduce menopause symptoms such as insomnia, low mood, and hot flushes. These guidelines have now been revised with health officials backtracking after accusations of “medical misogyny” – the implication being that menopausal symptoms were “all in the mind”. The guidance issued by NICE now advises that HRT should be offered as the first line of treatment. Some may believe this a positive development, but Dr Pemberton is unsure.

The medic is known to be a keen fan of HRT and he has seen many patients’ lives transformed by it. But he goes on to say that HRT isn’t suitable for everyone and that talking therapies can help those women presenting with symptoms that have a psychological component.

Dr Pemberton says that many women talk about no longer feeling like themselves, a disconcerting sense of something having changed, a vague undercurrent of unease, despair, and discombobulation. Trying to address what causes this turmoil is far more complicated than simply a blip in hormone levels. And neither can it be explained away by a woman’s dissatisfaction with life and her sense of loss and malaise as a chemical reaction.

That’s not to say that hormones don’t play an important part. Medical professionals know that fluctuations in hormones can be responsible for low and poor mood.

Over the years, Dr Pemberton has seen far too many women struggling to cope and for whom HRT has been hugely beneficial – helping them, for instance, to manage anxiety caused by the menopause.

But the medic also believes there are other factors that contribute to a woman’s sense of losing herself. He points out that low mood and anxiety are a result of complex social and psychological factors, rather than simple biology.

Changes to the body, disrupted sleep, hot flushes, and so on, he says, can make any woman feel out of control and depressed.

Dr Pemberton documents and records other issues he’s heard women talk about – for example, erratic mood swings and out-of-character behaviour. There are stories of women having affairs, quitting their jobs, or leaving their husbands around the menopause.

While some would seek to blame this all on fluctuations in hormone levels, the evidence for this isn’t that compelling.

The clinician says it’s not at all clear that drops in oestrogen and progesterone, the female sex hormones that start to decline in menopause, are entirely responsible.

Rather, the medic believes that the menopause acts like a ticking clock. It suddenly makes women open their eyes and review their lives. Much of the trauma and emotional turmoil that besets many women as they navigate menopause isn’t the consequence of fluctuating hormones but of a re-evaluation of their life’ situation. For many, their sense of self and identity is closely bound up with their roles within their family, particularly those who are mothers, who may feel bereft at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that’s more judgmental about how woman age than men. For a lot of women in their 50s and 60s, they have given the best years of their lives to other people and their careers, and now they’re not sure why. A vast number of menopausal women now feel invisible.

Dr Pemberton has had many menopausal and post-menopausal women attending his clinics and hearing the sad story that they no longer feel like a woman.

It is here, he says, that these people would surely benefit from having the time and space to explore and discuss their feelings and situation. That’s where talking therapies can play a vital role for many who have become desperately unhappy.

In the opinion of Dr Max Pemberton, the answer to many complex problems precipitated by the menopause aren’t always going to be found in HRT pills, patches, and gels.

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Health, Medical, Research, Science

Blood test that can detect Alzheimer’s 15 years before onset

ALZHEIMER’S DISEASE

A SIMPLE blood test can detect Alzheimer’s disease up to 15 years before symptoms begin, a major trial has found. It paves the way for a national screening programme.

The trial found that the test was as accurate as the current gold standard for diagnosing the condition.

For the first time, doctors were able to say if a person had a high, medium, or low chance, of having the disease – ruling out further invasive procedures.

Experts have said it would “revolutionise” diagnosis, making Alzheimer’s as easy to test and detect as for other routine health conditions such as high cholesterol.

Patients could expect results within days of visiting their GP, rather than the years it currently takes to get a diagnosis. This could have huge implications for future treatments, removing the barriers for a diagnosis – such as long waits for spinal taps or brain scans – and speeding up trials.

It could also pave the way for screening over-50s once more effective treatments become available.

Made by diagnostics company ALZpath, it was found to be 97 per cent accurate at detecting traces of the “tau” protein, which was linked to developing Alzheimer’s disease during the eight-year trials. These proteins start to build up on the brain 10 to 15 years before symptoms start showing.

Researchers in Sweden found high levels of the “tau” protein in the blood test corresponded to high levels of Alzheimer markers seen in expensive diagnostic brain scans and painful lumbar punctures.

The more of this leaked “tau” brain protein in the blood, the more likely or advanced the Alzheimer’s disease was in the tests involving 786 people. Growing evidence suggests biomarker changes like these can be detected in the blood years before other signs of the disease appear in the brain.

It means if scientists can find a way to stop these protein levels from rising, they could effectively halt Alzheimer’s in its tracks.

With breakthrough treatments such as donanemab and lecanemab on the horizon, experts say it is vital to have quick and reliable diagnoses. Professor David Curtis of University College London Genetics Institute said this was “one half of the solution”, while we await effective treatments.

He added: “This potentially could have huge implications. Everybody over 50 could be routinely screened every few years, in much the same way as they are now screened for high cholesterol.”

Around 900,000 people in the UK live with dementia – with Alzheimer’s the most common form. The growing ageing population means numbers are expected to rise to 1.6million by 2040, making a cheap screening tool vital to get to grips with the challenge.

Alzheimer’s Research UK analysis found 74,261 people died from dementia in 2022 compared with 69,178 a year earlier, making it the country’s biggest killer. While previous blood tests have shown promise, these findings have caused particular excitement given the high accuracy levels, large study size, and because the test already exists commercially.

It is also the first time a blood test has been found to be at least as good as a painful lumbar puncture or spinal tap for detecting elevated levels of the tau protein, according to the research team at the University of Gothenburg, Sweden.

Lumbar punctures involve taking fluid from the patient’s spinal cord. The inexpensive tests – priced at around £150 – could also be used to monitor a patient’s condition, allowing more tailored trials or treatment in future.

Dr Richard Oakley, of the Alzheimer’s Society, urged that more research would be needed, but said: “This study is a huge welcome step in the right direction as it shows that blood tests can be just as accurate as more invasive and expensive tests.

“It suggests results from these tests could be clear enough to not require follow-up investigations for some people living with Alzheimer’s disease, which could speed up diagnosis.”

The tests would need regulatory approval before widespread use. But they could form part of NHS trials starting imminently and looking to roll out blood tests for Alzheimer’s within the next five years.

The scientists’ findings were first published in JAMA Neurology.

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