HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, April 7, 2011

Antibiotic Resistance on the Rise, Thanks to Capital Misallocation on a Grand Scale

As Kevin Outterson & Aaron Kesselheim have been arguing for years, antibiotic resistance is a huge and growing problem. The Guardian's Frank Swain offers an international perspective:

An unusually hardy strain of Klebsiella pneumoniae was isolated from a 59-year-old Swedish patient who had been treated in a New Delhi hospital. The bacterium was found to be indifferent to even our most powerful antibiotics. To make matters worse, the genes that gave it this superpower were found on a small ring of DNA that is easily traded between different species of bacteria.
New Delhi metallo-beta-lactamase (NDM-1) has since turned up in more than 16 countries across the world, including Britain. A study published in Lancet Infectious Diseases today shows the resistance factor has spread to 14 different species of bacteria. . . In a report published last year, the US Institute of Medicine described antimicrobial resistance as "a global public health and environmental catastrophe", while the WHO called the rise of NDM-1 a "doomsday scenario of a world without antibiotics".

Econbloggers on both left and right are worried. But the chairman of the Board for the Canadian Committee on Antibiotic Resistance says that, despite these tocsins, "The problem is that it is somewhat akin to climate change and so slow and insidious that people, and notably our politicians, are lulled asleep." I am worried by the chair's climate analogy: it may speed antibiotic activism to the same graveyard of "socialist ideas" that high speed rail recently crashed into. (Yes, that metaphor was as ugly as the political process that provoked it.)  Obama advisor Cass Sunstein's dismissal of the precautionary principle is far closer to administration policy than, say, Lisa Heinzerling's, Robert Verchick's, or Greg Mandel's and James Thuo Gathii's rehabilitations of the concept. Official Democrats endlessly dither over risk prospects, while Red America is not even that concerned

One of the most Republican demographic groups -- affluent white men -- is the demographic with the highest number of confident risk takers. Among academic researchers, this phenomenon is known as "the white male effect." A 1992 study reported in the journal Risk Analysis found that, in a survey of 1,512 people, men saw less risk than women from each of twenty-five potential health hazards including nuclear waste, pesticides, blood transfusions, radon, and X-rays: "Sizeable differences between risk perceptions of men and women have been documented in dozens of studies. Men tend to judge risks as smaller and less problematic than do women."

Why invest in future antibiotics if risk is seen as so manageable?  As Edsall noted, in other studies of Americans, "fully 69 percent believe[d] they are 'above average' in their overall personality and character, and 86 percent [said] their intelligence is above average."  A culture of "self-help" encourages individuals to think they can outwit the superbug, if they are smart and savvy enough.  

But there is a deeper problem that American culture is only beginning to grapple with. As FT editor Martin Wolf recently noted in a address at the LSE, the US has been the beneficiary of enormous capital inflows since the beginning of the Bush administration, and has spectacularly wasted them. Charged with efficiently allocating capital, the finance sector has instead opted, by and large, for get-rich-quick schemes. That mentality has affected every sector, including pharma.  Even in a society where national priorities are set by an increasingly small group, one would think that drug-resistant bacteria would stir some coordinated response. But when money is primarily thought of as a way to earn more money, even the most pressing needs can be left neglected.  Perhaps that's why Americans are increasingly suspicious of the "free market" and financial institutions. [FP]

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