Indian Superbugs

As a followup on my libertarian case for prescription laws, I note this recent story on Indian superbugs that are totally antibiotic-resistant:

India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort.

So this is not just a domestic problem, but an international one. Drug-resistant bacteria are now spreading across the globe. Soon we may re-enter the dark age when “[t]hings as common as strep throat or a child’s scratched knee could once again kill,” in the words of WHO chief Margaret Chan. If the Indian government is not going to regulate antibiotics on its own initiative, other governments need to impose sanctions on it in order to force it to do so.

14 thoughts on “Indian Superbugs

  1. And if they don’t comply, physical coercion beyond that required to uphold sanctions? Maybe. Since I think you are right to conclude that domestic coercion is authorized than it would stand to reason that international coercion could be necessary as a form of self-help to defend against such a large threat to life. However, just as with lots of other good ends, it would stand to reason that non-coercive measures should be attempted first before resorting to force (including sanctions which rely on force). Of course, this assumes that the threat isn’t so iminent as to justify leaping a few steps on the road to force — like carrots before sticks.

    1. I don’t think the threat is so imminent or serious that something like military force or threatening it would be justified. But trade sanctions? Yeah, potentially.

      1. Sure – and they don’t provide a casus belli (unless particularly severe).

  2. If the Indian government is not going to regulate antibiotics on its own initiative, other governments need to impose sanctions on it in order to force it to do so.

    I have no idea what India’s current laws are (by default I just assume they are highly illiberal but have carve-outs for privileged constituencies), but I am almost sure that the government would not be able to enforce any adequate regulation of antibiotics. What the government *can* do is create a lucrative market for antibiotic related bribes.

  3. You beg the question that the lack of regulation is what causes the super bugs. The article mentioned a host of causes other than an unregulated anti-biotic market. To the extent that anti-biotics cause super bugs, that is because the anti-biotics are improperly used. This is a problem that is caused by doctors and patients, not the anti-biotics.

    1. Well, the reason for the misuse is that patients do not take into account the negative externality of their antibiotic use.

      1. Again, that is an issue with the doctor and the patient or the pharmacist(in some countries) and patient. The doctor or the pharmacist(in some countries) has a duty to prescribe in a manner that is efficacious to the patient and the community. The anti-biotics and their manufacturers are not the problem or cause of the misuse.

        In countries like Mexico, many of the same generic anti-biotics are presribed by pharmacists not doctors. Mexican pharmacists still rely heavily on injectable anti-biotics instead of oral. Thus, patients get the effective dose and you don’t see the creation of these super bugs as much in Mexico as in India where the oral drugs are distributed more readily.

        This brings to light another aspect of anti-biotic resistance which gets no traction, which is that the promotion of oral anti-biotics over injectibles is the cause of most anti-biotic resistance. People who receive an injectible always get the efficacious dose. People who take oral anti-biotics might or might not; it just depends on whether they decide to finish their prescription after they begin to feel better. If all doctors prescribed injectibles there would be no serious issue of anti-biotic resistance today.

        Injectibles are a loser for the doctors and the pharmaceutical industry. Injectibles keep the patient in the office longer and require additional staff to administer, meaning fewer office visits per day and less money. And injectibles mean far fewer sales for the pharmaceutical companies. This is a market mechanism at work here. A meaningful regulatory solution would be to mandate the use of injectibles by doctors and pharmaceutical manufacturers. Or allow pharmacists to administer injectibles in the store so the the doctors can maintain the patient churn through the office without interruption or additional staff.

      2. OK, but that’s sort of like saying that legalizing murder is OK because people should know that they have a moral duty not to murder other people. True, people should know that – but the law should work with people as they are, not as they ought to be.

      3. You make a very tortured analogy. I have a different analogy. Blaming the pharmaceutical manufacturers for anti-biotic resistance is a lot like blaming gun manufacturers for murder. The mis-administration and mis-use of oral anti-biotics is the problem, and in every case that boils down to the doctor or pharmacist and the patient. Additonally, as the article details, in a place like India, there are a host of other public health problems which contribute to anti-biotic resistance.

      4. I’m not blaming the antibiotic manufacturers; I am blaming the doctors and patients. The Indian government should enforce the prescription laws on doctors more vigorously, because they can’t be counted on to do the right thing out of the goodness of their hearts.

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