The case for an antibiotics tax
washingtonpost.com
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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.
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.
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.
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.
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.
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.
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.
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.
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?
However, I'm not going to address a flaw in your logic, namely that the only role of taxation is deterring undesirable behavior.
Is the implication here that if homeless didn't exist, it would actually be ok to tax/punish poverty? Otherwise why even bring that up?
In what countries that have 'progressive taxation' do the rich actually pay a higher percentage of tax on all sources of income / wealth?
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?
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.
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.
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.
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.
That's nice hyperbole but there are literally millions subsisting on those artificially cheap, subsidized corn syrup calories.
Not having sufficient carbohydrate intake without resorting to stealing is certainly worse for them, can't you agree?
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.
Natural being defined as something their bodies are "designed" (have fun with that one) to digest.
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.
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.
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.."
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.
Restricting antibiotics (further than they are currently) may or may not help, but is certainly within the purview of a limited libertarian state.
Restricting most (all?) other medications is not.
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.
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.
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.
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?
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.
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?
Drug pipelines are not hackathons. They need time.
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.
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.
[1]: http://www.motherjones.com/tom-philpott/2011/07/what-usda-do...
The article is proposing that the tax be applied to every use: "But why limit it to farms?".
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.
This is a tax on poor people that won't affect the majority of readers... it increases the minimum cost of producing meat.
If we can't figure out high-production meat farming then eventually we're saying that meat should be something only for the wealthy.
I was under the impression that growth is secondary to supplementing the animal's immune system, especially since factory farms are terribly unsanitary.
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.
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.
I think there are also antibiotics that promote growth through some other mechanism, and feedlots also tend to have higher therapeutic use of antibiotics.
Why not treat them as controlled substances? All you need is a propaganda campaign a la Barry Bonds, et al.