But what to do about the weak antibiotic pipeline? As McKenna points out, antibiotics typically aren’t big moneymakers, and if they’ll run out within a few years then drug companies don’t have much incentive to develop new ones. A massive new government research program is needed (prize-based models sound good), yesterday.

But the really terrifying possibility is that there simply aren’t that many more new antibiotics to be discovered. People hate pharmaceutical companies, but while the industry has done a lot of terrible things it’s also true that they have spent untold billions on failed research. Focus on stuff like Cialis is driven, at least in part, by thirty years of failed moon-shot attempts to cure stuff like Alzheimer’s.

What’s more, most spectacular drug successes were discovered without researchers truly understanding the underlying causal mechanism. Everyone knows the story of penicillin being discovered by accident, but what is less well known is that most other antibiotics (indeed most drugs in general) were also discovered either by accident or by simple trial-and-error testing of thousands of random substances (or modifications thereof). Even drugs based on highly-studied things like the cholesterol enzyme pathway have failed spectacularly, leading to a total upheaval of underlying the biological model.