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 associate with pollution, greenhouse gases, moral hazard, etc. are all risks and costs that must be mitigated at the transaction level, otherwise the market fails.
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.
I agree with your overall point. However, the implicit claim that there are no externalities to cigarette smoking is silly. There are clearly effects on everyone who might be nearby when you're smoking.
In the event that you're covered by any sort of public health insurance, which is nearly certain in old age with Medicare and increasingly probable at younger ages, then the effects on your own health become a problem for everyone else.
>In the event that you're covered by any sort of public health insurance ... then the effects on your own health become a problem for everyone else.
A vile argument. The idea that the state is empowered to curtail people's personal activities simply because the state chose to subsidize the personal health care costs of those activities should be anathema in a free and civilized society.
Once we've chosen to subsidize health care, then everyone has a financial interest in everyone else's behavior. I agree that it's a vile situation, but I tend to think it's a reason to avoid government-subsidized health care in the first place. Once we've got it, ignoring the financial consequences is just stupid.
This cuts both ways, though — with private insurance, insurers have a financial interest in focusing on current rather than lifetime expenditures, leading to both subpar outcomes in general and overestimation of costs related to lifespan-shortening behaviors like smoking.
With that said, high taxes on tobacco products in particular are primarily seen (by proponents and detractors) as means to reduce smoking for general, not exclusively economic, public health reasons.
But at least with private insurance it's a voluntary contract between you and the company, and not a forced one between you and every other taxpayer in the country. While other members of your insurance group have a financial interest in your behavior, the government and the rest of the taxpayers don't.
Tobacco taxes are certainly justified in many different ways, but public health is one of those ways. I'm also reminded of the big settlement the tobacco companies had to pay to all the states about 10-15 years ago, which was justified by the extra expense imposed on Medicare/Medicaid. That wasn't a tax, though it was functionally similar.
>There are clearly effects on everyone who might be nearby when you're smoking.
I don't think this is true. It only applies when indoors and probably for a very long period of time (ie living with the person, not just being at a restaurant.) Furthermore you can ban public smoking indoors as many places do, that's not the same as a tax.
>In the event that you're covered by any sort of public health insurance, which is nearly certain in old age with Medicare and increasingly probable at younger ages, then the effects on your own health become a problem for everyone else.
This is a problem with public healthcare, not smoking.
Certainly the duration and density of secondhand smoke matters, but I doubt that any amount of it is good. I can go dig up the research if you really care.
To your particular example of being in a restaurant, the increasingly-popular ban on smoking in bars and restaurants was largely driven by the negative health effects on the staff. Though again, I believe the effects on other patrons were non-zero.
>>This is a problem with public healthcare, not smoking.
We're agreed there. But getting rid of the public healthcare doesn't seem to be a realistic option at this point.
If anyone actually believed the argument we should tax smokers because of externalities, upon hearing this fact they would immediately say "we should tax non-smokers!"
> 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 people more to discourage poverty?
> 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?
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 rest of us will be much better off.
Strangely, here in the UK, corn fed meat (i.e. with antibiotics) is a premium product over grass fed one. So, the problem is a bit deeper than that.
There are other problems that are solved by antibiotics: overcrowding and mass production. Nothing to do either with crop subsidies.
And similarly that's not an easy problem to solve. Very few organizations defend quality meat. Small, local farmer are easy target for various animal rights group. Big groups on the other hand are generally ignored.
They keep the animals in unhealthy, unnatural conditions where they will get sick more often. The antibiotics are there to combat that and the side effects of eating corn (in the case of cows) make them very unhealthy and prone to getting sick as well. The whole thing is a mess.
> Just end those crop subsidies and let things take care of themselves. A few agribusinesses will be pissed but the rest of us will be much better off.
I don't disagree with your conclusion about what needs to be done, but you can't "just end those crop subsidies" with a flip of a switch.
We're talking about millions of people and tens of thousands of jobs directly affected, and huge secondary effects to the entire food industry (and everyone who eats food) in the United States as the price of corn and corn-related products goes up.
This would drive the cost per calorie on the bottom end of the market up not insignificantly.
It would have to be a gradual reduction in subsidy over a period of time, ending at zero after a number of years.
Otherwise, you just fuck millions of normal people over— everyone from the people who work at these agribusinesses to the ultra-poor barely scraping by on the cheapest 1500kcal/day they can find to buy.
I realize all that but pulling the cord is the only sane thing to do. The food that gets produced is basically poison anyway so excluding it isn't the end of the world. I would be fine with increasing food stamps before continuing these market distorting crop subsidies.
No I don't agree. If the food you eat is making you sick, fat, and tired then it isn't doing much good for you. There's more than enough food without cheap corn. The problem is distribution and perverted incentives-not lack of affordable food. Also what's produced isn't actually all that cheap. It's cheap for the producers of processed foods but the taxpayer pays the real cost, the farmers make almost no real money from their work (unless they're a very large farm who can operate at a massive scale), and the taxpayer picks up the extra cost of the sickness these awful foods create. It sounds pretty expensive to me.
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.
I'm sure it tastes better and in small doses is probably fine. If the cow is eating enough corn to get sick then you have obviously made a huge mistake.
Curiously enough I'd expect meat to get cheaper because its' production would have to get a lot more thoughtful to be profitable. Right now what we have is expensive in direct and indirect costs. The meat is of poor quality and will make people sick so all these government programs pay for these costs on this side of the equation too. Basically the consumer pays for the meat, subsidies, AND healthcare to cover the cost of the subsidies making the meat of poor quality that made them sick.
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.
>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.
About the only effective thing you can start doing is MSRA wards in hospitals and a system of rotating antibiotics. Developing new antibiotics would probably also be a good idea, no idea what the situ looks like there.
Antibiotics are used in commercial farming because they increase weight. The tax simply needs to be enough that (weight(antibioticked cow) - weight(non-antibioticked cow))*(price of beef) < (cost of antibiotics). Maybe that's "on the order of 10,000% or more", but I'd like to see numbers.
Yes, but commercial farming is the single largest use of antibiotics. Cutting out that use would significantly improve things. We should continue to address other issues (educational campaigns hammering home the fact that antibiotics do nothing for viruses, and encouraging completion of the full course when you are taking antibiotics).
Name-dropping Milton Friedman would be useful to court Friedmanites, not necessarily libertarians. I'm guessing that his son David (http://daviddfriedman.blogspot.com/), who is even more libertarian than his father, would likely have a different opinion.
But how do you fix antibiotics abuse in other countries? Antibiotic resistant bacteria are spreading a lot faster in Russia, Pakistan, India, South East Asia and Latin America. And with international tourism growing it is just a matter of time before it reaches everywhere in the world.
There is not so much problem of antibiotics overuse in poorer countries as there is a problem of antibiotics misuse. Where antibiotics are expensive people tend not to take them long enough so they fail to kill bacteria that were sligtly resistant to the antbiotic and this also contibutes toward increasing antibiotics resistance.
You could probably do a lot of good by requiring from the pharmaceutical companies that want to sell antibiotics on american market to ship half of their production to Russia and such for free. That would increase price of antibiotics for americans to prevent overuse and make them available in poor countries to prevent misuse.
There are two components to anti-biotic use that are taken together very harmful. The first as has been amply described by the author is the flat over use of anti-biotics where they are not needed. The second and perhaps more relevant human example is that humans tend not to finish their full course of anti-botics allowing resistant mutations to gain a greater foot hold. Other than long acting or implanted delivery mechanisms I am not sure that we can ever really ensure compliance with the full regimen in all patients.
I feel that the problems we face with antibiotics is similar to those we face with oil. It's common knowledge that the two will disappear and there's people out there fighting to try to protect us and we have a silent majority going about their business and ignoring all the warning signs. So yeah, tax 'em
From what I've heard, in parts of Asia it's common for antibiotics to be sold over the counter, and a lot of the worst drug-resistant strains come out of the developing world. It's a much bigger deal than American agriculture, given the classes of antibiotics involved.
That's too blunt of an instrument, though. Antibiotics still have legitimate veterinary uses.
A small tax per unit might stand a better chance, though. Something that might not be onerous at the low quantities one typically buys antibiotics for when they intend to use it legitimately, but adding up to something prohibitive in the mass quantities needed for industrial-scale prophylaxis.
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 these articles is that, after all these alarms have been raised and as all the people responsible seem to be contemplating solutions to regulate antibiotic usage, nobody's mentioning alternative methods to fight bacteria. Following the afore mentioned article one commenter remarked that Dr. Srinivasan did a great job or spooking us, but there was absolutely no mention of bacteriophage during the interview, which got me curious. Turns out phage therapy (http://en.wikipedia.org/wiki/Phage_therapy) has been used successfully for close to 100 years in Russia and Georgia. According to this Wikipedia page http://en.wikipedia.org/wiki/Bacteriophage
Phages were discovered to be antibacterial agents and were used in Georgia and the United States during the 1920s and 1930s for treating bacterial infections. They had widespread use, including treatment of soldiers in the Red Army. However, they were abandoned for general use in the West for several reasons:
- Medical trials were carried out, but a basic lack of understanding of phages made these invalid.
- Phage therapy was seen as untrustworthy, because many of the trials were conducted on totally unrelated diseases such as allergies and viral infections.
- Antibiotics were discovered and marketed widely. They were easier to make, store and to prescribe.
- Former Soviet research continued, but publications were mainly in Russian or Georgian languages, and were unavailable internationally for many years.
- Clinical trials evaluating the antibacterial efficacy of bacteriophage preparations were conducted without proper controls and were methodologically incomplete preventing the formulation of important conclusions.
Their use has continued since the end of the Cold War in Georgia and elsewhere in Central and Eastern Europe.
In other words the reason why western countries stopped considering them, and to some extent continue to shun them, is lack of understanding.
I am wondering then, if we have to have these "serious conversations" about regulation of antibiotics for the sake of the threat posed by over-consumption, how serious can it really be if we have to wear blinders and continue to pretend that what the Russians and Georgians have been doing is utter sorcery?
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.
I've read that the most effective way for the state to control the public's behaviour is a combination of taxes and subsidies (sorry, don't recall the source). Simply tax bad behaviour and subsidize good behaviour. Other means are possible, but less efficient.
The user fee could work, depending on the scale... if it is possible to be small enough to not deter individual use, but large enough to deter mass use in agriculture, then it stands a chance.
As an aside, the common practice of municipal hotel taxes never made sense to me. Wouldn't a city wish to encourage people to visit?
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?
A last ditch effort to preserve the ones that still work, and limit the amount of resistance that develops buys a considerable amount of with for "what next".
Drug pipelines are not hackathons. They need time.
Bollocks. The complete loss of effectiveness of antibiotics is not something that has already happened; they are still saving lives as I write this post. It is something that will happen if we don't change our behavior. Whether we change our behavior quickly enough has still to be decided.
The opportunity to prevent the creation of antibiotic-resistant diseases is gone, that is the point. Go ahead and use your antibiotics, and if you are lucky they will do something.
Its useful to think in more than black and white. But sometimes thresholds are crossed; the 'prevent the creation of difficult diseases' threshold has been passed years ago.
The primary use-case of antibiotics remains: curing bacterial illnesses.
We should not seek to increase the price of this for the least well-off in society.
This would potentially have a net negative effect as it allows bacterial infection to spread, requiring increased antibiotic use.
Besides, a tax on use wouldn't impact upon doctor's behaviour in the desired way (reduce non-essential use): since the doctor is still making a net profit from the prescription and it (still) acts as a convenient placebo.
And rightly so. There's no good reason why we should have cheap meat if the cost is hugely increasing our susceptibility to global pandemic.
OP was talking about taxing human-use antibiotics - i.e., we shouldn't do things that will increase the price of drugs that people literally need to avoid dying.
If it's a choice between meat being something only for the wealthy and a prevalence of untreatable bacteriological infections, I'm going to go with the former.
Maybe the wealthy should stop eating meat too. Is it okay to torture animals for pleasure? If it is, then we should repeal the laws we currently have against it. But if it's wrong - as most people would say it is - then maybe we should stop behaving as though it becomes okay when it's done out of sight.
> 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.
I think that it's everything together. Basically, giving animals antibiotics means that you have more animals (and animal weight) which can be sold at market. If it were more expensive to give antibiotics to the animals, farmers might rethink the equation, deciding to instead raise more, smaller animals in more sanitary environments.
Michael Pollan's excellent book, "The Omnivore's Dilemma," describes at great length the way in which non-factory farms operate, and why he believes they don't need the same sorts of sanitary rules that the government places on factory farms. I have no way of knowing whether he's right, but there's definitely some logic to the claim that antibiotics are addressing the symptom, rather than the root cause.
> I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary.
Antibiotic use for growth and for prophylactic treatment due to farm conditions are both common uses, and industry is pretty unapologetic about both.
Watching a presentation by the National Pork Board at a public health conference was...eye-opening.
Or at least it was before I walked out because I couldn't take the disingenuousness anymore.
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.
You would think we'd learn by now that when someone proposes a tax to control behavior, it's not about the behavior, it's about finding a justification to grab money. For example, the soda tax.
Why not treat them as controlled substances? All you need is a propaganda campaign a la Barry Bonds, et al.
Much like there's a cost associated with income inequality, so we tax the rich more to supposedly cover that cost. Costs associate with pollution, greenhouse gases, moral hazard, etc. are all risks and costs that must be mitigated at the transaction level, otherwise the market fails.