The case for an antibiotics tax

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.<p>Much like there&#x27;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.

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&#x27;t meant to eat which makes them so sick they need antibiotics to stay alive long enough to be slaughtered.<p>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.

My fellow libertarians:<p>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&#x27;s purview.<p>In other words, the government has a clearer mandate to restrict antibiotic use than it has to restrict heroin use.

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.

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.

I feel that the problems we face with antibiotics is similar to those we face with oil. It&#x27;s common knowledge that the two will <i>disappear</i> and there&#x27;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 &#x27;em

From what I&#x27;ve heard, in parts of Asia it&#x27;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&#x27;s a much bigger deal than American agriculture, given the classes of antibiotics involved.

Or we could ban giving them to animals

There was recently an interview posted here on HN about the end of antibiotics (<a href="http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/" rel="nofollow">http:&#x2F;&#x2F;www.pbs.org&#x2F;wgbh&#x2F;pages&#x2F;frontline&#x2F;health-science-techn...</a>). 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&#x27;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&#x27;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 (<a href="http://en.wikipedia.org/wiki/Phage_therapy" rel="nofollow">http:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Phage_therapy</a>) has been used successfully for close to 100 years in Russia and Georgia. According to this Wikipedia page <a href="http://en.wikipedia.org/wiki/Bacteriophage" rel="nofollow">http:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Bacteriophage</a><p><pre><code> 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. </code></pre> In other words the reason why western countries stopped considering them, and to some extent continue to shun them, is lack of understanding.<p>I am wondering then, if we have to have these &quot;serious conversations&quot; 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?

I&#x27;ve read that the most effective way for the state to control the public&#x27;s behaviour is a combination of taxes and subsidies (sorry, don&#x27;t recall the source). Simply tax bad behaviour and subsidize good behaviour. Other means are possible, but less efficient.<p>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.<p>As an aside, the common practice of municipal hotel taxes never made sense to me. Wouldn&#x27;t a city wish to <i>encourage</i> people to visit?

Too little, too late. There was a CDC report that the &#x27;age of antibiotics&#x27; is over and there is little point in limiting their use now. Lets move the conversation on to something productive: what next?

The primary use-case of antibiotics remains: curing bacterial illnesses.<p>We should not seek to increase the price of this for the least well-off in society.<p>This would potentially have a net negative effect as it allows bacterial infection to spread, requiring increased antibiotic use.<p>Besides, a tax on use wouldn&#x27;t impact upon doctor&#x27;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.

&gt; 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).<p>I was under the impression that growth is secondary to supplementing the animal&#x27;s immune system, especially since factory farms are terribly unsanitary.

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

You would think we&#x27;d learn by now that when someone proposes a tax to control behavior, it&#x27;s not about the behavior, it&#x27;s about finding a justification to grab money. For example, the soda tax.<p>Why not treat them as controlled substances? All you need is a propaganda campaign a la Barry Bonds, et al.