We agree that falling life expectancy is an economic problem - just a different one

The Office for National Statistics tells us that lifespans aren't going to increase as we once thought they would. We agree entirely that this is an economic problem. It isn't, however, the one that such as Danny Dorling are screaming about.

Since we launched BRAVE NEW EUROPE we have stressed the violence of austerity. In 2013 David Stuckler and Sanjy Basu wrote a convincing book entitled “The Body Economic – Why Austerity Kills” concerning the short term effects upon health of austerity. In this article Danny Dorling and Stuart Gietel-Basten present arguments of how austerity kills long term.

Changes in life expectancy which are coincident with austerity (not that the UK has actually had any, government spending continues to rise in real terms) are not necessarily caused by austerity. This should be clear to any user of the scientific method - a group which may or may not include human geographers and sociologists.

What the ONS has actually said is:

Antibiotic resistance has caused a fall in life expectancy for the first time, the Office for National Statistics has said. 

Life expectancy in future years has been revised down after the statistics authority said that "less optimistic views" about the future had to be taken into account. 

Opinions on "improvements in medical science" had declined, it said, and fears of the "re-emergence of existing diseases and increases in anti-microbial resistance" meant people would not live as long as was previously expected.

We agree entirely that antibiotic resistance is an economic problem. In fact, it's a regulatory problem, we've got the regulations working against economic reality. We should thus change them in order to get them aligned of course.

The standard drug development incentive is the patent system. This is an economic solution to an economic problem, it costs a $ billion (less perhaps for an antibiotic) and a decade to get a new drug approved and once it is then anyone could (and would) copy it. Who would do this for no potential profit, it's a classic public goods problem. The answer is an artificial monopoly in the guise of that patent which protects for a decade of commercial life (20 years in full, minus regulatory approval time). Agreed, not a perfect system but a logical at least reaction to the basic public goods problem.

This does not work for antibiotics. For once a new one is developed we do not allow it to be widely used. We insist, instead and probably quite rightly, that it be held in reserve to only treat those infections which do not respond to the older treatments. That way we delay any build up of resistance to the new drug. But, obviously, we also deny the developers of the new antibiotic their chance to make their money back by widespread use of their new product.

Therefore few to no one develops new antibiotics. The problem here is in our economic system to deal with the public goods problem. We thus need a new one. No not for the entirety of the drug development system, just one to deal with this specific subset of it.

Purely by chance another discussion of the same basic point appeared concerning phages:  

If you want to know why phage therapy has problems evolving in the US, the answer is just three letters: FDA.

As phages are in a continuing red-queen evolutionary game (running as fast as you can to stay in one place) with evolving bacterial defenses and specific phages can be specific to sub-species of bacteria, there is no way of making money in this game if you have to prove “efficacy” to the FDA before you sell your specific phage for a specific sub-species of bacteria that are continually evolving.

To play this game, we will need an automated system to speed up the evolutionary selection of lytic phages as the bacteria evolve with hundreds of variations on the shelf to cover the evolutionary options open to the bacteria. All these variations need instant approval, but that would create a finite risk that the zero risk tolerant FDA won’t allow.

In a Petrie dish of E. coli, you can add a lytic phage that will kill 99.9999% of the bacteria in a few hours but by the next day, the bacteria have evolved resistance to that phage. This is what that CRISPER cas9 gene editing system is all about as the bacteria evolve to cut up the virus meanwhile the phage is mutating and evolving methods of countering the defense.

This does not fit the FDA model for a simple specific chemical and billion dollar decade-long approval systems for each chemical. Changing the US FDA appears to be a near-impossible task and our only hope is that bacteria control system based upon phages will evolve with animal culture in some other country, without FDA interference, and then move to humans outside the US and then, after massive numbers of people go somewhere else to treat multi-drug resistant bacteria, we will consider real change.

Quite possibly an extreme view but note the basic underlying point again. Our regulatory structure, set up to deal with that economic public goods problem, isn't appropriate for the economic incentives in this specific space. The answer thus is to change the regulatory structure to more closely accord with economic reality, isn't it? 

We could even say that, as with Danny Dorling, government action is necessary. But it isn't thus true that the answer is for government to be spraying yet more on the welfare state, is it? Government just needs to be doing what it is doing rather better instead. Sadly, a much harder task.