The ethics of prescribing antibiotics
Antibiotics are overprescribed. That is, they are given out in many cases where they will achieve little or nothing for the patient. On its own, this would merely be wasteful, but usage of antibiotics increases the development of antibiotic resistant organisms and this is bad for everyone. Today's Guardian has an article suggesting that antibiotic resistance could become a *very* big problem, with all major antibiotics becoming ineffective within a couple of generations (see also the original research in the Lancet). This leads to some very interesting questions concerning the ethics of prescribing antibiotics.
Losing antibiotics would be disastrous for humanity. It is estimated that antibiotics have saved over 80 million lives since the 1940s, so losing them (without having an adequate replacement) would lead to millions of deaths. It is thus of paramount importance that this is not allowed to happen, and one of the most important planks in any approach is to stop overprescribing them. However, this is easier said than done: health services have been trying to cut down on prescriptions for a long time, and it has become an international issue. The new antibiotic resistant strains appear to have arisen in India, but have spread around the world. Thus, fixing the problem in one country is not enough.
The case of antibiotics parallels many cases of pollution or environmental destruction, where individual action has diffuse negative effects on many others. For example, driving a car releases carbon dioxide which moves the whole world very slightly closer to global warming. In such situations, there is often a call for taxes so that the person gaining the benefit (of driving their car) pays costs equivalent to the damages they cause. As is mentioned in the Guardian article, a similar thing could be done for antibiotics. We are currently not paying the true cost of antibiotics and this encourages us to use them profligately. If instead there was a world-wide tax on antibiotics, we would stop using them on viral infections and depending on the size of the tax, might only use them on the most serious bacterial infections, increasing the length of time before anti-biotic resistance takes hold and thus increasing the benefits we get from these amazing drugs.
A perennial criticism of such 'Sin taxes' is that they may put an unfair burden on the poorest people (in this case, the world's poorest people). This is only true if the taxes are done in a simplistic manner. Like other sin taxes, they could instead be made 'revenue neutral', or even progressive so that the world's poorest people are the joint beneficiaries of the tax. If the antibiotics situation is as dire as these recent reports suggest, then such a tax would be well worth looking into before it becomes too late.