This is the third in the series of four winners from the 2012 guest post blog contest.

by Emma Carline

In recent years, concern has been growing over increased bacterial resistance to antibiotics. An article from The Guardian now asks if we are ready to face the “post-antibiotic apocalypse”. The article comes in reaction to worrying updates on the spread of infectious bacteria containing the NDM1 gene, bacteria’s latest weapon against our most powerful category of antibiotics. Because antibiotics have become integral to medical practices today such as organ transplant, surgery, and chemotherapy, there is certainly reason to panic (Boseley 2010). However, panic is not an excuse for recklessness. Professor Richard James of the centre for healthcare associated infections at the University of Nottingham, proposes that antibiotic resistance be combatted by taxing antibiotic treatments (Boseley 2010). However, merely slapping a tax on antibiotics is both a careless and ethically insensitive method of dealing with the problem. If we want to avert the prophesied antibiotic apocalypse, the first step we should take is to reform doctors’ prescribing practices.

Since antibiotic overuse has been found to be correlated with antibiotic resistance, most proposed plans of action by specialists like James aim to reduce the amount of antibiotics we use. Taxing antibiotics may accomplish this, but it places an unfair burden on patients. For who ultimately controls how much antibiotics are being used? It’s not the patients. While a patient’s decision to undergo a treatment may be limited by their paycheck, it also depends on how dangerous they believe their condition is, according to their doctor’s diagnosis. If we trust doctors as medical authorities, we generally have confidence in their prescriptions. Thus if a doctor wrongly encourages a patient to take antibiotics, and an antibiotic tax is in place, the patient literally pays the price for their doctor’s diagnosing mistake. Because doctors are so influential in patients’ choices of treatment, it does not make sense to restrict antibiotic use by making patients pay a tax for antibiotic treatments.

It is not only ethically wrong, but inefficient. Taxing antibiotics cuts down on antibiotic use by taking advantage of people’s spending limitations while ignoring antibiotic misuse. This results in people being given antibiotics that don’t actually need them and denying antibiotics from those who do. Taxing antibiotics could demand thousands of dollars from patients while ignoring the issues that caused the pandemic in the first place. If we must reduce antibiotic use, we should first stop prescribing them when they’re not needed. Studies show that overprescribing is commonplace. A 2011 study in Michigan showed that 77.2% of adults diagnosed with bronchitis were prescribed antibiotics by doctors. The vast majority of cases of bronchitis are not caused by bacteria and do not require antibiotics at all. It has been estimated that up to 50% of antibiotic prescriptions are inappropriate. Instead of penalizing people for listening to doctor’s advice, we should aim to make that advice better. Taxing is an inefficient approach to solving the bacterial resistance problem as it does not amend the practices that caused the problem itself.

Not only is regular review of doctors’ prescribing practice needed, but also new medical research. While antibiotics have been developed to fight specialized strains of bacteria they are useless if doctors cannot identify the type of infection a patient has.  As a result, “broad spectrum” antibiotics are used extensively. These antibiotics fight a broad range of bacteria and are used when the exact strain of bacteria is not known. If more research was devoted to developing tests for diagnosing different bacterial infections, we could lessen our dependence on these non-specific mass-produced antibiotics, which are most susceptible to resistance from bacteria. By improving diagnostic tests, we can reduce both antibiotic overuse and misuse – without pinching pennies from patients.