9 ms·

The case for an antibiotics tax

95 points by tpatke 13y ago

drjesusphd 13y ago
This is a great idea. The point of a tax is to impose penalties that exist in real life, but are not part of the original transaction: externalities. Widespread use of antibiotics has a cost associated with it that must be paid by someone, and it should be part of the price of antibiotics. Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. Costs associate with pollution, greenhouse gases, moral hazard, etc. are all risks and costs that must be mitigated at the transaction level, otherwise the market fails.
- spacehome 13y ago
  > Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. That's a fairly disturbing way to frame progressive taxation. In the other examples of taxing externalities, we intentionally discourage the behavior by taxing it. Do you intend to discourage people from becoming rich by taxing it? Also, it takes both rich and poor to have inequality. Why not tax poor people more to discourage poverty?
  - ihsw 13y ago
    There are some economic/social theories that suggest homelessness is an adequate and necessary deterrent to poverty. However, I'm not going to address a flaw in your logic, namely that the only role of taxation is deterring undesirable behavior.
    - Houshalter 13y ago
      >There are some economic/social theories that suggest homelessness is an adequate and necessary deterrent to poverty. Is the implication here that if homeless didn't exist, it would actually be ok to tax/punish poverty? Otherwise why even bring that up?
  - drjesusphd 13y ago
    > Do you intend to discourage people from becoming rich by taxing it? That's not the intention, but perhaps a side-effect. A minor one, at that. I'd imagine it would be very difficult to discourage people from becoming rich. A progressive tax schedule certainly does not do much discouraging right now. Now that I answered your question, perhaps you can return the courtesy: Does there or does there not exist a high enough degree of income inequality such that there is a cost borne by society?
  - fleitz 13y ago
    Progressive taxation? That's a good joke. In what countries that have 'progressive taxation' do the rich actually pay a higher percentage of tax on all sources of income / wealth?
- dnautics 13y ago
  sorry, generally speaking the point of a taxes is NOT to cover externalities, it is to control the populace and to fill the coffers of the state. Exactly what externalities do cigarette taxes cover? International trade duties? Taxes generally fail in the pursuit of correcting externalities because taxes are set by policy and committees are notoriously bad at pricing. The generally better way to cover externalities is by propertization (so a carbon AUCTION - and not cap-and-trade which has all sorts of politically motivated loopholes and subsidies - would be smarter than a carbon TAX). Furthermore there are plenty of activities that incur externalities (such as homelessness) which we probably shouldn't be taxing. An even better way to correct externalities is to stop making them externalities through social action - get people to value things like companies that destroy the environment less. It's hard work, but you just have to not be lazy in your social action.
  - breischl 13y ago
    I agree with your overall point. However, the implicit claim that there are no externalities to cigarette smoking is silly. There are clearly effects on everyone who might be nearby when you're smoking. In the event that you're covered by any sort of public health insurance, which is nearly certain in old age with Medicare and increasingly probable at younger ages, then the effects on your own health become a problem for everyone else.
    - ataggart 13y ago
      >In the event that you're covered by any sort of public health insurance ... then the effects on your own health become a problem for everyone else. A vile argument. The idea that the state is empowered to curtail people's personal activities simply because the state chose to subsidize the personal health care costs of those activities should be anathema in a free and civilized society.
      - breischl 13y ago
        Once we've chosen to subsidize health care, then everyone has a financial interest in everyone else's behavior. I agree that it's a vile situation, but I tend to think it's a reason to avoid government-subsidized health care in the first place. Once we've got it, ignoring the financial consequences is just stupid.
ronaldx 13y ago
The primary use-case of antibiotics remains: curing bacterial illnesses. We should not seek to increase the price of this for the least well-off in society. This would potentially have a net negative effect as it allows bacterial infection to spread, requiring increased antibiotic use. Besides, a tax on use wouldn't impact upon doctor's behaviour in the desired way (reduce non-essential use): since the doctor is still making a net profit from the prescription and it (still) acts as a convenient placebo.
- deleted 13y ago
  [deleted]
- ImprovedSilence 13y ago
  RTFA. It's a tax for use of antibiotics on livestock, not humans.
  - ericcumbee 13y ago
    Which the cost will be passed along to the consumer.
    - potatolicious 13y ago
      And rightly so. There's no good reason why we should have cheap meat if the cost is hugely increasing our susceptibility to global pandemic. OP was talking about taxing human-use antibiotics - i.e., we shouldn't do things that will increase the price of drugs that people literally need to avoid dying.
    - ronaldx 13y ago
      I'm sorry that you've been downvoted - because you are right. This is a tax on poor people that won't affect the majority of readers... it increases the minimum cost of producing meat. If we can't figure out high-production meat farming then eventually we're saying that meat should be something only for the wealthy.
      - 13y ago
jchrisa 13y ago
Or we could ban giving them to animals
- Millennium 13y ago
  That's too blunt of an instrument, though. Antibiotics still have legitimate veterinary uses. A small tax per unit might stand a better chance, though. Something that might not be onerous at the low quantities one typically buys antibiotics for when they intend to use it legitimately, but adding up to something prohibitive in the mass quantities needed for industrial-scale prophylaxis.
cleaver 13y ago
I've read that the most effective way for the state to control the public's behaviour is a combination of taxes and subsidies (sorry, don't recall the source). Simply tax bad behaviour and subsidize good behaviour. Other means are possible, but less efficient. The user fee could work, depending on the scale... if it is possible to be small enough to not deter individual use, but large enough to deter mass use in agriculture, then it stands a chance. As an aside, the common practice of municipal hotel taxes never made sense to me. Wouldn't a city wish to encourage people to visit?
jswinghammer 13y ago
The basic problem is that one intervention is seeking to fix another. Crop subsidies are the reason why these antibiotics are so widely used. Farmers are encouraged to feed animals food they aren't meant to eat which makes them so sick they need antibiotics to stay alive long enough to be slaughtered. Just end those crop subsidies and let things take care of themselves. A few agribusinesses will be pissed but the rest of us will be much better off.
- maerF0x0 13y ago
  Or ban feeding an animal something that is not part of its "natural" diet. Then we have the fun of debating if cows naturally eat corn and soy. Chickens will be particularly fun because they historically ate the scraps from the humans (what we now call "compost" :P), they were the old form of food recycling.
  - maxerickson 13y ago
    Grain finishing was done before the discovery of antibiotics.
    - ericd 13y ago
      Does grain finishing get grass-fed-tasting compounds out of the meat?
      - maxerickson 13y ago
        Probably. I can only cop to having read about it some. One of the big goals is to increase the fat content of the meat.
        jswinghammer 13y ago
        I'm sure it tastes better and in small doses is probably fine. If the cow is eating enough corn to get sick then you have obviously made a huge mistake.
esteb_li 13y ago
I feel that the problems we face with antibiotics is similar to those we face with oil. It's common knowledge that the two will disappear and there's people out there fighting to try to protect us and we have a silent majority going about their business and ignoring all the warning signs. So yeah, tax 'em
JoeAltmaier 13y ago
Too little, too late. There was a CDC report that the 'age of antibiotics' is over and there is little point in limiting their use now. Lets move the conversation on to something productive: what next?
- Fomite 13y ago
  A last ditch effort to preserve the ones that still work, and limit the amount of resistance that develops buys a considerable amount of with for "what next". Drug pipelines are not hackathons. They need time.
- angersock 13y ago
  Mass die-offs, plagues, civil unrest ultimately culminating in the end of first-world civilization?
- work_account_1 13y ago
  Link to report?
  - Fomite 13y ago
    http://blogs.cdc.gov/safehealthcare/2013/03/05/the-beginning-of-the-end-of-antibiotics/ http://blogs.cdc.gov/safehealthcare/2013/03/05/the-beginning... is the CDC blog article about this report: http://www.cdc.gov/vitalsigns/HAI/CRE/ http://www.cdc.gov/vitalsigns/HAI/CRE/ which is about the rise of CREs in healthcare.
- rwallace 13y ago
  Bollocks. The complete loss of effectiveness of antibiotics is not something that has already happened; they are still saving lives as I write this post. It is something that will happen if we don't change our behavior. Whether we change our behavior quickly enough has still to be decided.
  - JoeAltmaier 13y ago
    The opportunity to prevent the creation of antibiotic-resistant diseases is gone, that is the point. Go ahead and use your antibiotics, and if you are lucky they will do something. Its useful to think in more than black and white. But sometimes thresholds are crossed; the 'prevent the creation of difficult diseases' threshold has been passed years ago.
squozzer 13y ago
You would think we'd learn by now that when someone proposes a tax to control behavior, it's not about the behavior, it's about finding a justification to grab money. For example, the soda tax. Why not treat them as controlled substances? All you need is a propaganda campaign a la Barry Bonds, et al.
diego_moita 13y ago
But how do you fix antibiotics abuse in other countries? Antibiotic resistant bacteria are spreading a lot faster in Russia, Pakistan, India, South East Asia and Latin America. And with international tourism growing it is just a matter of time before it reaches everywhere in the world.
- scotty79 13y ago
  There is not so much problem of antibiotics overuse in poorer countries as there is a problem of antibiotics misuse. Where antibiotics are expensive people tend not to take them long enough so they fail to kill bacteria that were sligtly resistant to the antbiotic and this also contibutes toward increasing antibiotics resistance. You could probably do a lot of good by requiring from the pharmaceutical companies that want to sell antibiotics on american market to ship half of their production to Russia and such for free. That would increase price of antibiotics for americans to prevent overuse and make them available in poor countries to prevent misuse.
mekoka 13y ago
There was recently an interview posted here on HN about the end of antibiotics (http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/ http://www.pbs.org/wgbh/pages/frontline/health-science-techn...). In short, the interviewee Dr. Arjun Srinivasan was pleading for a serious conversation about what to do to further regulate their usage, because some bacteria are developing increased resistance to most, if not all, antibiotics available. What's stunning to me about all these articles is that, after all these alarms have been raised and as all the people responsible seem to be contemplating solutions to regulate antibiotic usage, nobody's mentioning alternative methods to fight bacteria. Following the afore mentioned article one commenter remarked that Dr. Srinivasan did a great job or spooking us, but there was absolutely no mention of bacteriophage during the interview, which got me curious. Turns out phage therapy (http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy) has been used successfully for close to 100 years in Russia and Georgia. According to this Wikipedia page http://en.wikipedia.org/wiki/Bacteriophage http://en.wikipedia.org/wiki/Bacteriophage Phages were discovered to be antibacterial agents and were used in Georgia and the United States during the 1920s and 1930s for treating bacterial infections. They had widespread use, including treatment of soldiers in the Red Army. However, they were abandoned for general use in the West for several reasons: - Medical trials were carried out, but a basic lack of understanding of phages made these invalid. - Phage therapy was seen as untrustworthy, because many of the trials were conducted on totally unrelated diseases such as allergies and viral infections. - Antibiotics were discovered and marketed widely. They were easier to make, store and to prescribe. - Former Soviet research continued, but publications were mainly in Russian or Georgian languages, and were unavailable internationally for many years. - Clinical trials evaluating the antibacterial efficacy of bacteriophage preparations were conducted without proper controls and were methodologically incomplete preventing the formulation of important conclusions. Their use has continued since the end of the Cold War in Georgia and elsewhere in Central and Eastern Europe. In other words the reason why western countries stopped considering them, and to some extent continue to shun them, is lack of understanding. I am wondering then, if we have to have these "serious conversations" about regulation of antibiotics for the sake of the threat posed by over-consumption, how serious can it really be if we have to wear blinders and continue to pretend that what the Russians and Georgians have been doing is utter sorcery?
ihsw 13y ago
> The agency is asking the makers of animal drugs to voluntarily alter their labels so that farmers can no longer buy antibiotics to promote animal growth (a fairly common practice). I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary.
- reuven 13y ago
  I think that it's everything together. Basically, giving animals antibiotics means that you have more animals (and animal weight) which can be sold at market. If it were more expensive to give antibiotics to the animals, farmers might rethink the equation, deciding to instead raise more, smaller animals in more sanitary environments. Michael Pollan's excellent book, "The Omnivore's Dilemma," describes at great length the way in which non-factory farms operate, and why he believes they don't need the same sorts of sanitary rules that the government places on factory farms. I have no way of knowing whether he's right, but there's definitely some logic to the claim that antibiotics are addressing the symptom, rather than the root cause.
- maxerickson 13y ago
  Much of the use is as a feed additive. Some of the antibiotics shift the chemistry of the rumen, which increases the efficiency of the feed and also prevents a condition the animals get when they don't adjust to grain. I think there are also antibiotics that promote growth through some other mechanism, and feedlots also tend to have higher therapeutic use of antibiotics.
- Fomite 13y ago
  > I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary. Antibiotic use for growth and for prophylactic treatment due to farm conditions are both common uses, and industry is pretty unapologetic about both. Watching a presentation by the National Pork Board at a public health conference was...eye-opening. Or at least it was before I walked out because I couldn't take the disingenuousness anymore.
alexeisadeski3 13y ago
My fellow libertarians: Milton Friedman, freedomist gadfly, was in favor of government regulation to protect the population from contagion. The regulation and restriction of antibiotics falls firmly within even a minimalist state's purview. In other words, the government has a clearer mandate to restrict antibiotic use than it has to restrict heroin use.
- Xdes 13y ago
  >Milton Friedman was in favor of government regulation to protect the population from contagion. I'm gonna call source since none of the literature I've read from Friedman holds such a position. If anything the whole prescription drug system should be abolished and drugs should be marketed directly to consumers.
  - alexeisadeski3 13y ago
    I think Milton would agree with you regarding abolishing the prescription drug system. The (only?) exception being antibiotics, which contributes to contagion. Source was an interview which I watched, so... it'll be hard to find. EDIT: Never count out Google! "FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.." http://www.hoover.org/multimedia/uncommon-knowledge/26936 http://www.hoover.org/multimedia/uncommon-knowledge/26936
    - Xdes 13y ago
      >FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.. And then Friedman gets cut off when he is about to get into the examples. Knowing Friedman I would assume his examples would consist of incidents that the the private industries have quite a deal of trouble handling such as a violent outbreak or an extreme vaccine shortage. I would not play off Friedman's words to call for regulation, taxation, or any other restriction of free trade for antibiotics.
      - alexeisadeski3 13y ago
dllthomas 13y ago
I think this is clearly a good idea. Tax antibiotics, use the revenues to help subsidize development of future antibiotics.
tippivenus 13y ago
There are two components to anti-biotic use that are taken together very harmful. The first as has been amply described by the author is the flat over use of anti-biotics where they are not needed. The second and perhaps more relevant human example is that humans tend not to finish their full course of anti-botics allowing resistant mutations to gain a greater foot hold. Other than long acting or implanted delivery mechanisms I am not sure that we can ever really ensure compliance with the full regimen in all patients.
m-photonic 13y ago
From what I've heard, in parts of Asia it's common for antibiotics to be sold over the counter, and a lot of the worst drug-resistant strains come out of the developing world. It's a much bigger deal than American agriculture, given the classes of antibiotics involved.

95 points by tpatke 13y ago

This is a great idea. The point of a tax is to impose penalties that exist in real life, but are not part of the original transaction: externalities. Widespread use of antibiotics has a cost associated with it that must be paid by someone, and it should be part of the price of antibiotics. Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. Costs associate with pollution, greenhouse gases, moral hazard, etc. are all risks and costs that must be mitigated at the transaction level, otherwise the market fails.

spacehome 13y ago
> Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. That's a fairly disturbing way to frame progressive taxation. In the other examples of taxing externalities, we intentionally discourage the behavior by taxing it. Do you intend to discourage people from becoming rich by taxing it? Also, it takes both rich and poor to have inequality. Why not tax poor people more to discourage poverty?
- ihsw 13y ago
  There are some economic/social theories that suggest homelessness is an adequate and necessary deterrent to poverty. However, I'm not going to address a flaw in your logic, namely that the only role of taxation is deterring undesirable behavior.
  - Houshalter 13y ago
    >There are some economic/social theories that suggest homelessness is an adequate and necessary deterrent to poverty. Is the implication here that if homeless didn't exist, it would actually be ok to tax/punish poverty? Otherwise why even bring that up?
- drjesusphd 13y ago
  > Do you intend to discourage people from becoming rich by taxing it? That's not the intention, but perhaps a side-effect. A minor one, at that. I'd imagine it would be very difficult to discourage people from becoming rich. A progressive tax schedule certainly does not do much discouraging right now. Now that I answered your question, perhaps you can return the courtesy: Does there or does there not exist a high enough degree of income inequality such that there is a cost borne by society?
- fleitz 13y ago
  Progressive taxation? That's a good joke. In what countries that have 'progressive taxation' do the rich actually pay a higher percentage of tax on all sources of income / wealth?
dnautics 13y ago
sorry, generally speaking the point of a taxes is NOT to cover externalities, it is to control the populace and to fill the coffers of the state. Exactly what externalities do cigarette taxes cover? International trade duties? Taxes generally fail in the pursuit of correcting externalities because taxes are set by policy and committees are notoriously bad at pricing. The generally better way to cover externalities is by propertization (so a carbon AUCTION - and not cap-and-trade which has all sorts of politically motivated loopholes and subsidies - would be smarter than a carbon TAX). Furthermore there are plenty of activities that incur externalities (such as homelessness) which we probably shouldn't be taxing. An even better way to correct externalities is to stop making them externalities through social action - get people to value things like companies that destroy the environment less. It's hard work, but you just have to not be lazy in your social action.
- breischl 13y ago
  I agree with your overall point. However, the implicit claim that there are no externalities to cigarette smoking is silly. There are clearly effects on everyone who might be nearby when you're smoking. In the event that you're covered by any sort of public health insurance, which is nearly certain in old age with Medicare and increasingly probable at younger ages, then the effects on your own health become a problem for everyone else.
  - ataggart 13y ago
    >In the event that you're covered by any sort of public health insurance ... then the effects on your own health become a problem for everyone else. A vile argument. The idea that the state is empowered to curtail people's personal activities simply because the state chose to subsidize the personal health care costs of those activities should be anathema in a free and civilized society.
    - breischl 13y ago
      Once we've chosen to subsidize health care, then everyone has a financial interest in everyone else's behavior. I agree that it's a vile situation, but I tend to think it's a reason to avoid government-subsidized health care in the first place. Once we've got it, ignoring the financial consequences is just stupid.

ronaldx 13y ago

The primary use-case of antibiotics remains: curing bacterial illnesses. We should not seek to increase the price of this for the least well-off in society. This would potentially have a net negative effect as it allows bacterial infection to spread, requiring increased antibiotic use. Besides, a tax on use wouldn't impact upon doctor's behaviour in the desired way (reduce non-essential use): since the doctor is still making a net profit from the prescription and it (still) acts as a convenient placebo.

deleted 13y ago
[deleted]
ImprovedSilence 13y ago
RTFA. It's a tax for use of antibiotics on livestock, not humans.
- ericcumbee 13y ago
  Which the cost will be passed along to the consumer.
  - potatolicious 13y ago
    And rightly so. There's no good reason why we should have cheap meat if the cost is hugely increasing our susceptibility to global pandemic. OP was talking about taxing human-use antibiotics - i.e., we shouldn't do things that will increase the price of drugs that people literally need to avoid dying.
  - ronaldx 13y ago
    I'm sorry that you've been downvoted - because you are right. This is a tax on poor people that won't affect the majority of readers... it increases the minimum cost of producing meat. If we can't figure out high-production meat farming then eventually we're saying that meat should be something only for the wealthy.
    - 13y ago

jchrisa 13y ago

Or we could ban giving them to animals

Millennium 13y ago
That's too blunt of an instrument, though. Antibiotics still have legitimate veterinary uses. A small tax per unit might stand a better chance, though. Something that might not be onerous at the low quantities one typically buys antibiotics for when they intend to use it legitimately, but adding up to something prohibitive in the mass quantities needed for industrial-scale prophylaxis.

cleaver 13y ago

I've read that the most effective way for the state to control the public's behaviour is a combination of taxes and subsidies (sorry, don't recall the source). Simply tax bad behaviour and subsidize good behaviour. Other means are possible, but less efficient. The user fee could work, depending on the scale... if it is possible to be small enough to not deter individual use, but large enough to deter mass use in agriculture, then it stands a chance. As an aside, the common practice of municipal hotel taxes never made sense to me. Wouldn't a city wish to encourage people to visit?

jswinghammer 13y ago

The basic problem is that one intervention is seeking to fix another. Crop subsidies are the reason why these antibiotics are so widely used. Farmers are encouraged to feed animals food they aren't meant to eat which makes them so sick they need antibiotics to stay alive long enough to be slaughtered. Just end those crop subsidies and let things take care of themselves. A few agribusinesses will be pissed but the rest of us will be much better off.

maerF0x0 13y ago
Or ban feeding an animal something that is not part of its "natural" diet. Then we have the fun of debating if cows naturally eat corn and soy. Chickens will be particularly fun because they historically ate the scraps from the humans (what we now call "compost" :P), they were the old form of food recycling.
- maxerickson 13y ago
  Grain finishing was done before the discovery of antibiotics.
  - ericd 13y ago
    Does grain finishing get grass-fed-tasting compounds out of the meat?
    - maxerickson 13y ago
      Probably. I can only cop to having read about it some. One of the big goals is to increase the fat content of the meat.
      - jswinghammer 13y ago
        I'm sure it tastes better and in small doses is probably fine. If the cow is eating enough corn to get sick then you have obviously made a huge mistake.

esteb_li 13y ago

I feel that the problems we face with antibiotics is similar to those we face with oil. It's common knowledge that the two will disappear and there's people out there fighting to try to protect us and we have a silent majority going about their business and ignoring all the warning signs. So yeah, tax 'em

JoeAltmaier 13y ago

Too little, too late. There was a CDC report that the 'age of antibiotics' is over and there is little point in limiting their use now. Lets move the conversation on to something productive: what next?

Fomite 13y ago
A last ditch effort to preserve the ones that still work, and limit the amount of resistance that develops buys a considerable amount of with for "what next". Drug pipelines are not hackathons. They need time.
angersock 13y ago
Mass die-offs, plagues, civil unrest ultimately culminating in the end of first-world civilization?
work_account_1 13y ago
Link to report?
- Fomite 13y ago
  http://blogs.cdc.gov/safehealthcare/2013/03/05/the-beginning-of-the-end-of-antibiotics/ http://blogs.cdc.gov/safehealthcare/2013/03/05/the-beginning... is the CDC blog article about this report: http://www.cdc.gov/vitalsigns/HAI/CRE/ http://www.cdc.gov/vitalsigns/HAI/CRE/ which is about the rise of CREs in healthcare.
rwallace 13y ago
Bollocks. The complete loss of effectiveness of antibiotics is not something that has already happened; they are still saving lives as I write this post. It is something that will happen if we don't change our behavior. Whether we change our behavior quickly enough has still to be decided.
- JoeAltmaier 13y ago
  The opportunity to prevent the creation of antibiotic-resistant diseases is gone, that is the point. Go ahead and use your antibiotics, and if you are lucky they will do something. Its useful to think in more than black and white. But sometimes thresholds are crossed; the 'prevent the creation of difficult diseases' threshold has been passed years ago.

squozzer 13y ago

You would think we'd learn by now that when someone proposes a tax to control behavior, it's not about the behavior, it's about finding a justification to grab money. For example, the soda tax. Why not treat them as controlled substances? All you need is a propaganda campaign a la Barry Bonds, et al.

diego_moita 13y ago

But how do you fix antibiotics abuse in other countries? Antibiotic resistant bacteria are spreading a lot faster in Russia, Pakistan, India, South East Asia and Latin America. And with international tourism growing it is just a matter of time before it reaches everywhere in the world.

scotty79 13y ago
There is not so much problem of antibiotics overuse in poorer countries as there is a problem of antibiotics misuse. Where antibiotics are expensive people tend not to take them long enough so they fail to kill bacteria that were sligtly resistant to the antbiotic and this also contibutes toward increasing antibiotics resistance. You could probably do a lot of good by requiring from the pharmaceutical companies that want to sell antibiotics on american market to ship half of their production to Russia and such for free. That would increase price of antibiotics for americans to prevent overuse and make them available in poor countries to prevent misuse.

mekoka 13y ago

There was recently an interview posted here on HN about the end of antibiotics (http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/ http://www.pbs.org/wgbh/pages/frontline/health-science-techn...). In short, the interviewee Dr. Arjun Srinivasan was pleading for a serious conversation about what to do to further regulate their usage, because some bacteria are developing increased resistance to most, if not all, antibiotics available. What's stunning to me about all these articles is that, after all these alarms have been raised and as all the people responsible seem to be contemplating solutions to regulate antibiotic usage, nobody's mentioning alternative methods to fight bacteria. Following the afore mentioned article one commenter remarked that Dr. Srinivasan did a great job or spooking us, but there was absolutely no mention of bacteriophage during the interview, which got me curious. Turns out phage therapy (http://en.wikipedia.org/wiki/Phage_therapy http://en.wikipedia.org/wiki/Phage_therapy) has been used successfully for close to 100 years in Russia and Georgia. According to this Wikipedia page http://en.wikipedia.org/wiki/Bacteriophage http://en.wikipedia.org/wiki/Bacteriophage Phages were discovered to be antibacterial agents and were used in Georgia and the United States during the 1920s and 1930s for treating bacterial infections. They had widespread use, including treatment of soldiers in the Red Army. However, they were abandoned for general use in the West for several reasons: - Medical trials were carried out, but a basic lack of understanding of phages made these invalid. - Phage therapy was seen as untrustworthy, because many of the trials were conducted on totally unrelated diseases such as allergies and viral infections. - Antibiotics were discovered and marketed widely. They were easier to make, store and to prescribe. - Former Soviet research continued, but publications were mainly in Russian or Georgian languages, and were unavailable internationally for many years. - Clinical trials evaluating the antibacterial efficacy of bacteriophage preparations were conducted without proper controls and were methodologically incomplete preventing the formulation of important conclusions. Their use has continued since the end of the Cold War in Georgia and elsewhere in Central and Eastern Europe. In other words the reason why western countries stopped considering them, and to some extent continue to shun them, is lack of understanding. I am wondering then, if we have to have these "serious conversations" about regulation of antibiotics for the sake of the threat posed by over-consumption, how serious can it really be if we have to wear blinders and continue to pretend that what the Russians and Georgians have been doing is utter sorcery?

ihsw 13y ago

> The agency is asking the makers of animal drugs to voluntarily alter their labels so that farmers can no longer buy antibiotics to promote animal growth (a fairly common practice). I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary.

reuven 13y ago
I think that it's everything together. Basically, giving animals antibiotics means that you have more animals (and animal weight) which can be sold at market. If it were more expensive to give antibiotics to the animals, farmers might rethink the equation, deciding to instead raise more, smaller animals in more sanitary environments. Michael Pollan's excellent book, "The Omnivore's Dilemma," describes at great length the way in which non-factory farms operate, and why he believes they don't need the same sorts of sanitary rules that the government places on factory farms. I have no way of knowing whether he's right, but there's definitely some logic to the claim that antibiotics are addressing the symptom, rather than the root cause.
maxerickson 13y ago
Much of the use is as a feed additive. Some of the antibiotics shift the chemistry of the rumen, which increases the efficiency of the feed and also prevents a condition the animals get when they don't adjust to grain. I think there are also antibiotics that promote growth through some other mechanism, and feedlots also tend to have higher therapeutic use of antibiotics.
Fomite 13y ago
> I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary. Antibiotic use for growth and for prophylactic treatment due to farm conditions are both common uses, and industry is pretty unapologetic about both. Watching a presentation by the National Pork Board at a public health conference was...eye-opening. Or at least it was before I walked out because I couldn't take the disingenuousness anymore.

alexeisadeski3 13y ago

My fellow libertarians: Milton Friedman, freedomist gadfly, was in favor of government regulation to protect the population from contagion. The regulation and restriction of antibiotics falls firmly within even a minimalist state's purview. In other words, the government has a clearer mandate to restrict antibiotic use than it has to restrict heroin use.

Xdes 13y ago
>Milton Friedman was in favor of government regulation to protect the population from contagion. I'm gonna call source since none of the literature I've read from Friedman holds such a position. If anything the whole prescription drug system should be abolished and drugs should be marketed directly to consumers.
- alexeisadeski3 13y ago
  I think Milton would agree with you regarding abolishing the prescription drug system. The (only?) exception being antibiotics, which contributes to contagion. Source was an interview which I watched, so... it'll be hard to find. EDIT: Never count out Google! "FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.." http://www.hoover.org/multimedia/uncommon-knowledge/26936 http://www.hoover.org/multimedia/uncommon-knowledge/26936
  - Xdes 13y ago
    >FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.. And then Friedman gets cut off when he is about to get into the examples. Knowing Friedman I would assume his examples would consist of incidents that the the private industries have quite a deal of trouble handling such as a violent outbreak or an extreme vaccine shortage. I would not play off Friedman's words to call for regulation, taxation, or any other restriction of free trade for antibiotics.
    - alexeisadeski3 13y ago

dllthomas 13y ago

I think this is clearly a good idea. Tax antibiotics, use the revenues to help subsidize development of future antibiotics.

tippivenus 13y ago

There are two components to anti-biotic use that are taken together very harmful. The first as has been amply described by the author is the flat over use of anti-biotics where they are not needed. The second and perhaps more relevant human example is that humans tend not to finish their full course of anti-botics allowing resistant mutations to gain a greater foot hold. Other than long acting or implanted delivery mechanisms I am not sure that we can ever really ensure compliance with the full regimen in all patients.

m-photonic 13y ago

From what I've heard, in parts of Asia it's common for antibiotics to be sold over the counter, and a lot of the worst drug-resistant strains come out of the developing world. It's a much bigger deal than American agriculture, given the classes of antibiotics involved.