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Megan McArdle’s recent take on antibiotic resistance in The Atlantic is a smart look at the incentives that skew the debate on antibiotics in the U.S. – namely the fact that these wonder drugs currently play out a classic tragedy of the commons scenario. While we all share the benefit of preserving these treatments into the future, patients have little individual incentive to forego antibiotics, instead often taking them “just in case” for viral illnesses.  Likewise, efforts to conserve antibiotics run counter to pharmaceutical companies, who are rewarded (in revenue) with drug sales.  While we need drug companies enlisted in developing new antibiotics, instead of recognizing that the drugs are limited resources, McArdle asserts, instead “we handle them like consumer electronics.”

The articles draws on Extending the Cure research from Kevin Outterson and Aaron Kesselheim on innovative mechanisms to tie antibiotic conservation as a public health goal to financial incentives.  What if we could reward pharmaceutical companies with enhanced reimbursements for meeting “effectiveness targets” for new antibiotics, solving the problem of a flagging antibiotic pipelines as well as the temptation to oversell new drugs?  This is one of several ideas McArdle documents for correcting the pharmaceutical market by introducing a public-private partnership – admittedly difficult to implement in practice.

The article also draw heavily on expertise from CDDEP director Ramanan Laxminarayan, who oversees Extending the Cure as well as CDDEP’s Global Antibiotic Resistance Partnership (GARP), for some international perspective.  While the U.S. could do much nationally to curtail resistance, the issue will ultimately be tackled on a global scale.  Likening the issue to global warming, Dr. Laxminarayan points out that “[i]n developed countries, [antibiotic resistance] is manifested in slightly higher average prices of antibiotics. In poorer countries, it manifests as more people sick and dying of resistant infections.”  Unfortunately, this disparity continues until we begin seriously addressing resistance on a global scale, and we’re on track to do that only “when a lot of antibiotics have failed.”

But, McArdle points out that countries can start to rethink business models for drug dispensing and development, even in the absence of international guidelines. Read more about the economics of antibiotic resistance on The Atlantic’s website: Resistance is Futile.

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