I was happy to see the New York Times writing about drug resistance and overuse of antibiotics yesterday. If you haven’t seen it yet: Free Antibiotics May Contribute to Drug Resistance, Officials Say. The content is good, the title less so. The title of the related blog post, Are Free Antibiotics Good for You? is even more misleading.

So let’s be more accurate with our wording. All antibiotic use, whether lifesaving or just because you like that it’s pink and tasty, whether you pay through the nose or are handed a sample, contributes to bacterial resistance. All antibiotic use has costs to both the individual and society, but antibiotics can also offer valuable benefits. What the Times means to discuss is whether the new policy of certain supermarket chains—giving antibiotics away to people with a prescription—will increase consumption of the drugs and thus resistance. As I commented on the NYT Well Blog:

The real question is: does the availability of “free” antibiotics increase prescribing rates? Physician prescribing is influenced by perceived patient demand, and doctors might well assume that demand will increase as cost to patients decreases.

I’m not saying that it’s a harmless policy. I’m saying let’s not jump the gun. Antibiotic use, which contributes to resistance, can only increase if prescriptions increase.

Chapter 3 of the ETC report briefly explores pricing and patient demand for antibiotics. Policy solutions to growing resistance aimed at reducing consumption through increasing cost to the consumer--like a tax on antibioitcs or increasing copayments--have serious drawbacks as they're likely to lead to consumers switching to older, cheaper drugs. This increases selection pressure and could speed the development of resistance. It aslo diminishes incentives for development of new antibiotics.

Alternatively, consider strategies that don't affect price, like restrictions on dispensing, promoting substitutes, patient education, infection control and vaccination.