07 November 2010

Rationing antibiotics (and carbon dioxide)

I was talking to a scientist friend about catastrophic AGW, and he gave me some version of the "precautionary principle:" it's justifiable to expend any amount of resources in order to avert a small but non-zero chance of catastrophic results.  He thought it was self-evidently true that when benefits are sufficiently large you can ignore the costs side of the equation.

My response was to ask why he was not interested in spending trillions to avert the small but non-zero chance of other catastrophes, namely a viral or antibiotic-resistant bacterial epidemic, or a collision with a Near-Earth Object.  It seems odd that most people who are willing to trade a percent or two of growth rate to avert the possibility of one particular disaster, and in doing so condemn billions to languish longer in poverty, have not considered doing the same to prevent other, similarly dangerous, eventualities.

Along these lines, a potential cap-and-trade-like scheme for antibiotics:
NY Times | Andrew Pollack | Antibiotics Research Subsidies Weighed by U.S.

The world’s weakening arsenal against “superbugs” has prompted scientists to warn that everyday infections could again become a major cause of death just as they were before the advent of penicillin around 1940. [...]

For example, scientists have become alarmed by the spread from India of a newly discovered mutation called NDM-1, which renders certain germs like E. coli invulnerable to nearly all modern antibiotics. [...]

Ramanan Laxminarayan, who directs the Extending the Cure project on antibiotic resistance at Resources for the Future, a policy organization, said the government should focus on conserving the effectiveness of existing antibiotics. That could be done by preventing unnecessary use in people and farm animals and requiring better infection control measures in hospitals.

“There’s not a recognition yet that we should think about antibiotics as a natural resource and we should conserve them like we do fish,” Mr. Laxminarayan, an economist, said. Kevin Outterson, an associate professor of law at Boston University, said one way to encourage both new development and conservation would be to pay drug companies to develop new antibiotics but not to aggressively market them. Incentives, he said, “must be conditioned on the companies’ changing their behavior.”
Rationing antibiotics seems like an extremely good analog to rationing fuel.  You have to ask individuals to forgo using a resource now, and suffer in the process, in the chance that society might regret them having used it in the future.  The received wisdom now seems to be that asking someone to forgo using a gallon of diesel fuel is appropriate, but that asking someone to forgo a Z-pak is not.

This seems like another seen-vs-unseen situation: someone has to a look a (potentially) infected person in the eye and say "no meds for you; take your chances and tough it out," but we're not burdened by knowing in advance who will end up to taking their chances with a lighter, less-safe vehicle when we increase CAFE standards.

This was a scary stat:
About 100,000 Americans a year are killed by infections acquired in hospitals, many resistant to multiple antibiotics. Methicillin-resistant staphylococcus aureus, or MRSA, the best known superbug, now kills more Americans each year than AIDS.
I want to know where the MRSA ribbons and wrist bands and 10-K races and Oprah specials are.
Another factor discouraging investment, some experts say, is that the F.D.A. recently made it harder for new antibacterial drugs to win approval.
I wonder why that is?
“We don’t have any patient groups for Acinetobacter,” said Robert J. Guidos, the [Infectious Diseases Society of America]’s vice president for public policy and government relations, referring to a drug-resistant bacterium.
Oh. That explains it. Not enough political pressure.

I understand why people are distressed that drugs get developed with an eye towards pharma companies' customers' desires.  But is it any better that they get developed based on which advocacy group can raise the biggest hue and cry, or which  has the best lobbyist?
“There is a market failure,” said Representative Henry A. Waxman, a California Democrat and the chairman of the House Energy and Commerce Committee, who said he was considering introducing legislation. “We need to look at ways to spur development of this market.”
How typical that the government has contributed to the problem of low antibiotic research, and the response to this is for a statist to establish a new government program.  Backing off on the harmful FDA policy doesn't give Waxman a chance to hand out other people's money to his donors and clients like a new tax credit would.

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