Designed obsolescence and drug resistance: are they really that different?

My recent ‘bad luck’ with iPhones, iPad and a Sony Vaio laptop had me thinking about obsolescence, so much so that I fell asleep trying to remember the very word. What about pharmaceuticals, are they designed to become obsolete? Are we living in a world in which the things we rely on ultimitately become obsolete at an alarming rate?

Over the past year I had an iPad 2 that needed complete replacement in 6 months as it failed to charge. A nearly 2 year old iPhone 4 replaced first due to failure of the video sound / speaker phone, then that in turn was replaced in about 4 months due to failed headphone jack. The months old Sony Vaio has travelled to Texas 4 times since November to have the hard disk replaced each time, ultimately to be exchanged for another laptop. To me this failure of technology is alarming, but is it planned? Perhaps gone are the days when a device you had made a significant investment in would last for many years. A laptop usually lasts me 2 years before it starts to have some issue (fan, power cord, battery etc). My first printer lasted me over 5 years, since then I am replacing them every 2 years, creating singlehandedly a mountain of used IT related hardware. I depend on these tools to do my work.

This had me thinking about what else we depend on in life and can we tolerate obsolescence. I was naturally thinking about drugs which are much more important than my IT hardware needs. Sure there are drugs that have been around for over 100 years like Aspirin , quinine, digoxin, paracetamol etc and they are still in wide use today. But there are also diseases which become resistant to drugs e.g. isoniazid resistance and Tuberculosis, artemisinin resistance and malaria due to genetic mutations or the efflux of drugs out of the bacteria or parasite, respectively. There are also examples of other drug resistance/ diseases like melarsoprol resistance and Human African Trypanosomiasis and Candida species resistance to antibiotics (as well as combinations of antibiotics). Drug resistance also is well known in cancers and there is a role in other diseases like epilepsy,  HIV, hepatitis, schizophrenia and beyond. Sure I am mixing up the obvious here, human tolerance to drugs and viruses that mutate to resist the drug/s which have very different mechanisms.  However beyond the thousands of examples of papers on drug resistance there appears to be relatively little written on obsolescence and drugs in general. Diseases are certainly complex and drugs are relatively simple in comparison. But I am not aware that anyone has really analyzed why some drugs can still be useful after 100 omore years and others can be obsolete within a few years of release. Are we unwittingly designing-in obsolescence into new drugs, do we need to think about how we can make them more stable in the face of mutations in their targets in the same way we can design in ‘resistance’/ stability to metabolism and efflux? Is this even possible?

Designing longevity in drugs perhaps flies in the face of rational business decisions because of the short patent lifetime (and yet Bayer still holds onto Aspirin) and the ultimate move to generic drugs, in which case the innovator has to come up with a new molecule for the disease in question or leave home empty handed. Which begs the question, has our system of innovation, patents, Hatch-Waxman Act driven the pharmaceutical companies to designed obsolescence, because there is no long term financial benefit of a drug that has a 100 year lifetime for them anymore? Repositioning or repurposing old drugs for new uses certainly could help a drug remain in use and relevant and thus avoiding obsolescence. I think a lifetime analysis of drugs would be interesting or has this already been done?

A world in which we have to replace drugs for a major disease / infection/ virus every 2 years would be intolerable if not a public health disaster. And yet there is certainly concern that we are seeing increasing levels of drug resistance. Perhaps its time for a rethink about how we discover, target and ultimately design drugs to have a long life so that we can prosper.




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