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The case for an antibiotics tax

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Re: The case for an antibiotics tax

#31

Post by alexeisadeski3 »

Xdes wrote: post #30
alexeisadeski3 wrote: post #28

My fellow libertarians: 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's purview. In other words, the government has a clearer mandate to restrict antibiotic use than it has to restrict heroin use.

>Milton Friedman was in favor of government regulation to protect the population from contagion. I'm gonna call source since none of the literature I've read from Friedman holds such a position. If anything the whole prescription drug system should be abolished and drugs should be marketed directly to consumers.

I think Milton would agree with you regarding abolishing the prescription drug system.

The (only?) exception being antibiotics, which contributes to contagion.

Source was an interview which I watched, so... it'll be hard to find.

EDIT: Never count out Google!

"FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.."

http://www.hoover.org/multimedia/uncommon-knowledge/26936

Re: The case for an antibiotics tax

#32

Post by Fomite »

mekoka wrote: post #22

There was recently an interview posted here on HN about the end of antibiotics ( http://www.pbs.org/wgbh/pages/frontline/health-science-techn... ). 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's stunning to me about all t…

It isn't actually a "lack of understanding" - I was doing research into phage therapy over a decade ago, and the field has progressed since then.

There are however a number of problems with phage therapy, and this is from the perspective of someone who likes phage therapy:

- Phages are usually very bacteria specific, there isn't really a "broad spectrum" phage. The therapy used in Russia and Georgia is often a bespoke formulation for each individual patient. This is:

a. Really, really hard for the FDA to approve. b. Expensive as all hell. c. Involves keeping "banks" of phages around, and creating custom cocktails of them. This is, as mentioned, expensive as hell, and manpower intensive.

- Phage therapy is fairly novel in the West, due to some problems in the early days of phage therapy followed swiftly by the discovery of penicillin. It's an entirely different method of treatment, which means all the clinical knowledge doctors currently have is invalid, and has to be relearned. That's tough.

- There's no promise a bacteria has a phage associated with it, and synthetic phages are, at this point, a pretty distant prospect.

- When bacterial cell walls rupture, they create endotoxins. Endotoxins are bad - indeed, in the early experiments with phage therapy in the West, insufficiently pure phage solutions with endotoxins in them were responsible for some deaths. Right now, phage therapy is most often used in dire cases, where side effects like that are less of a thing. For a bad case of Strep throat? There's some serious clinical trials that need to be done.

- It's a hell of a lot harder to give someone a 14 day course of bacteriophages to take home than it is a 14 day course of antibiotics.

Phage therapy is a really fascinating field, and I think it has a lot of potential. But to say we shun them due to a lack of understanding, or acting like what the Russians and Georgians do is "utter sorcery" ignores a great deal of the research that takes place here. The real problem is, even while we struggle with resistance, antibiotics are profoundly superior as a general purpose drug. The reasons the Russians used them so heavily is because they had trouble getting antibiotics.

But seriously, "What about phages?" isn't exactly a new idea.

Re: The case for an antibiotics tax

#33

Post by Fomite »

sp332 wrote: post #18
jswinghammer wrote: post #10

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't meant to eat which makes them so sick they need antibiotics to stay alive long enough to be slaughtered. Just end those crop subsidies and let things take care of themselves. A few agribusinesses will be pissed but the res…

The animals aren't generally sick. They are fed antibiotics at a very low dose because one of the side-effects is faster weight gain.

There are three uses of antibiotics in veterinary settings:

1. Treating actually sick animals 2. Low-dose treatments to promote growth 3. Prophylactic treatment to prevent initial infection

Both 2 and 3 are widespread, and a problem.

Re: The case for an antibiotics tax

#34

Post by Fomite »

work_account_1 wrote: post #27
JoeAltmaier wrote: post #13

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

Link to report?

http://blogs.cdc.gov/safehealthcare/2013/03/05/the-beginning... is the CDC blog article about this report: http://www.cdc.gov/vitalsigns/HAI/CRE/ which is about the rise of CREs in healthcare.

Re: The case for an antibiotics tax

#35

Post by dnautics »

drjesusphd wrote: post #2

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. Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. Costs associat…

sorry, generally speaking the point of a taxes is NOT to cover externalities, it is to control the populace and to fill the coffers of the state. Exactly what externalities do cigarette taxes cover? International trade duties?

Taxes generally fail in the pursuit of correcting externalities because taxes are set by policy and committees are notoriously bad at pricing. The generally better way to cover externalities is by propertization (so a carbon AUCTION - and not cap-and-trade which has all sorts of politically motivated loopholes and subsidies - would be smarter than a carbon TAX). Furthermore there are plenty of activities that incur externalities (such as homelessness) which we probably shouldn't be taxing.

An even better way to correct externalities is to stop making them externalities through social action - get people to value things like companies that destroy the environment less. It's hard work, but you just have to not be lazy in your social action.

Re: The case for an antibiotics tax

#36

Post by drjesusphd »

spacehome wrote: post #16
drjesusphd wrote: post #2

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. Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. Costs associat…

> Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. That's a fairly disturbing way to frame progressive taxation. In the other examples of taxing externalities, we intentionally discourage the behavior by taxing it. Do you intend to discourage people from becoming rich by taxing it? Also, it takes both rich and poor to have inequality. Why not tax poor…

> Do you intend to discourage people from becoming rich by taxing it?

That's not the intention, but perhaps a side-effect. A minor one, at that. I'd imagine it would be very difficult to discourage people from becoming rich. A progressive tax schedule certainly does not do much discouraging right now.

Now that I answered your question, perhaps you can return the courtesy:

Does there or does there not exist a high enough degree of income inequality such that there is a cost borne by society?

Re: The case for an antibiotics tax

#37

Post by maxerickson »

ihsw wrote: post #23

> 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). I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary.

Much of the use is as a feed additive. Some of the antibiotics shift the chemistry of the rumen, which increases the efficiency of the feed and also prevents a condition the animals get when they don't adjust to grain.

I think there are also antibiotics that promote growth through some other mechanism, and feedlots also tend to have higher therapeutic use of antibiotics.

Re: The case for an antibiotics tax

#38

Post by Xdes »

alexeisadeski3 wrote: post #31
Xdes wrote: post #30

Earlier quoted context omitted.

>Milton Friedman was in favor of government regulation to protect the population from contagion. I'm gonna call source since none of the literature I've read from Friedman holds such a position. If anything the whole prescription drug system should be abolished and drugs should be marketed directly to consumers.

I think Milton would agree with you regarding abolishing the prescription drug system. The (only?) exception being antibiotics, which contributes to contagion. Source was an interview which I watched, so... it'll be hard to find. EDIT: Never count out Google! "FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.." http://www.hoover.org/multimedia/uncommon-knowled…

>FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example..

And then Friedman gets cut off when he is about to get into the examples. Knowing Friedman I would assume his examples would consist of incidents that the the private industries have quite a deal of trouble handling such as a violent outbreak or an extreme vaccine shortage.

I would not play off Friedman's words to call for regulation, taxation, or any other restriction of free trade for antibiotics.

Re: The case for an antibiotics tax

#39

Post by alexeisadeski3 »

Xdes wrote: post #38
alexeisadeski3 wrote: post #31

Earlier quoted context omitted.

I think Milton would agree with you regarding abolishing the prescription drug system. The (only?) exception being antibiotics, which contributes to contagion. Source was an interview which I watched, so... it'll be hard to find. EDIT: Never count out Google! "FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.." http://www.hoover.org/multimedia/uncommon-knowled…

>FRIEDMAN There is room for some public health activities to prevent contagion, such a thing as for example.. And then Friedman gets cut off when he is about to get into the examples. Knowing Friedman I would assume his examples would consist of incidents that the the private industries have quite a deal of trouble handling such as a violent outbreak or an extreme vaccine shortage. I would not play off Friedman's wor…

Antibiotics do constitute a violent outbreak, or at least direly threaten to release one.

Re: The case for an antibiotics tax

#40

Post by fleitz »

maerF0x0 wrote: post #17
jswinghammer wrote: post #10

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't meant to eat which makes them so sick they need antibiotics to stay alive long enough to be slaughtered. Just end those crop subsidies and let things take care of themselves. A few agribusinesses will be pissed but the res…

Or ban feeding an animal something that is not part of its "natural" diet. Then we have the fun of debating if cows naturally eat corn and soy. Chickens will be particularly fun because they historically ate the scraps from the humans (what we now call "compost" :P), they were the old form of food recycling.

I'm pretty sure human beings are not "supernatural" beings, therefore everything that we do including feeding cows stuff that makes them sick is "natural".

Now if humans are "supernatural" than cows are also "supernatural" because they've been created by humans. Cows are a product of centuries of human genetic engineering.

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