HIV and ID Observations

“I do not like thunderstorms,” said every dog, ever.

I am currently rounding on the inpatient ID service, the new ID fellows arrive shortly, and Louie needs intensive doggy psychotherapy after yesterday’s strong thunderstorms here in Boston.

Busy times!

As a result, today’s post has no unifying theme. But what it lacks in cohesiveness it more than compensates in value, as here are three highly interesting ID-related items for your perusal.

1. Antibiotic development is broken — and how to fix it. 

This fascinating perspective in the New England Journal of Medicine focuses on the problems with our current model of antibiotic drug development. Why are for-profit companies abandoning antibiotic research? If antibiotic resistance is such a problem, why isn’t this “market opportunity” giving us new and better antibiotics?

The absolute number of infections caused by each type of resistant bacterium is relatively small. Each newly approved antibiotic thus captures an ever-shrinking share of an increasingly splintered market — a problem that will only worsen over time. Short treatment durations and a coordinated program of antibiotic stewardship also contribute to low sales.

The authors’ proposed solution is to fund nonprofit organizations to develop antibiotics. Unlike private companies, they would not be beholden to shareholders to generate rapid profits. Relatively small revenues for a large private company — tens of millions of dollars annually — would, for a nonprofit, be a substantial win, and a chance to reinvest this money into further research.

Now they just have to convince some entity — government? philanthropy? — to invest the seed money to get this started.

A big hurdle, yes, but at least it’s a path forward.

2.  Two brothers chat about being in ID practice — together.

For many academic ID fellowships, the intense first year of clinical care is followed by years of research training, with relatively little clinical work occasionally sprinkled in.

Research fellows might have a once-weekly half-day in clinic, or an occasional weekend seeing consults.

That’s the pathway Dr. Steve Threlkeld followed here in Boston when I first knew him as a brilliant ID fellow. (I was just starting my first faculty job.) However, he soon came to the realization that his true love was patient care, not research.

So he did something novel — he joined his brother Mike’s private ID practice in Memphis, Tennessee.

Steve and Mike chatted with me on this OFID podcast about private practice ID, what it has in common with academic ID and what’s different, how to be a blue-leaning clinician in a red-leaning state, and the unique opportunities and challenges of being the only sibling-owned private ID practice in the universe.

OK, someone contact me if I’m wrong about that last part.

Available also on iTunes, Overcast, and soon other podcast places.

3. This Year’s Winner of ID-Related Social Media Award.

I don’t know Dr. Philip Lee, but if there’s an Academy Award for ID content on social media, he’s the unequivocal 2019 winner — and we’re only halfway through the year.

Click on this Twitter thread for the incontrovertible proof:

Taylor Swift as antibiotics. A thread. pic.twitter.com/dY6We2VYkv

— Dr Philip Lee (@drphiliplee1) June 7, 2019

And fear not! One-a-Day ID Learning Units are coming soon.