Meaningful research and the "antibiotic apocalypse"

I wanted to share a recent article at BBC news that caught my eye, especially considering a conversation Mike, Jim, and I had just the other day regarding the argument that any kind of public health service in the U.S. would hurt medical research, which is currently funded in large part by American pharmaceutical companies.  It seems to me, at least, that the general assumption behind that argument is that nobody else in the world is making real, significant contributions to medical discovery and that if the U.S. offers a public option, which could hinder pharmaceutical profits, then research will suffer.

The BBC news article discusses a new project examining life from isolated areas of deep oceanic trenches for fresh ideas on antibiotics.  The two things I wanted to sort of highlight from the article are: 1) the research is being led by scientists from Aberdeen University in Scotland, a country that coincidentally has a public health service; and 2) the last sentence of this quote - the bold font is mine:

"Project leader Marcel Jaspars, professor of chemistry at the University of Aberdeen, said: "If nothing's done to combat this problem, we're going to be back to a 'pre-antibiotic era' in around 10 or 20 years, where bugs and infections that are currently quite simple to treat could be fatal."
He said there had not been a "completely new" antibiotic registered since 2003 - "partially because of a lack of interest by drugs companies as antibiotics are not particularly profitable"."

It's cherry-picking, I know, but I wanted to share because we were just talking about the idea.  Money is absolutely important when it comes to research. But maybe the approach and general philosophy behind research can and should sometimes be of greater importance than who can dump the most money into a problem (and the foreseeable profit that can be made from a discovery).

The Incredible Shrinking Medicare Tab

Every year in January the Congressional Budget Office releases its Budget and Economic Outlook for the next decade (they also produce an abbreviated update to the year's outlook in the late summer, as they did last August). Just this week they released this year's: The Budget and Economic Outlook: Fiscal Years 2013 to 2023.

In these documents the CBO, among other things, projects how much the federal government is going to be spending on Medicare in each year. What's fascinating is that if you look at each of these documents, every time they release a new one their projections for Medicare spending each year shrink. Click on this, a simple compilation of their Medicare spending projections (in billions of dollars) going back to the January 2010 report (i.e. the last budget outlook before health reform became law):

What the CBO is doing here is just acknowledging what's already known: Medicare spending growth right now (particularly on a per capita basis) has slowed to a crawl. A turn of events that is, to borrow a phrase from HHS, "unprecedented in the history of the Medicare program." What's amusing is that it continues to surprise the CBO and they have to keep revising their already-revised-downward projections even more. But as they say in this week's report:

In recent years, health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated. (For example, in 2012, federal spending for Medicare and Medicaid was about 5 percent below the amount that CBO had projected in March 2010.) In response to that slowdown, over the past several years, CBO has made a series of downward technical adjustments to its projections of spending for Medicaid and Medicare. From the March 2010 baseline to the current baseline, such technical revisions have lowered estimates of federal spending for the two programs in 2020 by about $200 billion—by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program.

This doesn't mean Medicare doesn't still face big challenges: even if it sustained last year's per capita growth rate of just a bit more than 0% (a big if and a major challenge), the Baby Boomers are going to continue aging into the program. That means total spending is going to swell, even if per capita costs remain at historic lows. But it's worth remembering sometimes that things are not always quite as grim as they seem.