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Argues that current demand-side policy of the Food and Drug Administration and the Centers for Disease Control is the wrong route to address the issue of antibiotic resistance as it reduces the value to a pharmaceutical company of investing in the creation of new antibiotics. In this light, three externalities associated with antibiotic usage are discussed: public health, antibiotic resistance, and supply-side externalities. A cost-benefit analysis of FDA policies related to increased antibiotic scrutiny ensues, finding that requiring additional testing for antibiotics makes little sense with respect to patient welfare. Two harmful effects on antibiotic resistance of this FDA policy are denying the market use of an additional antibiotic, Ketek, and the loss of pharmaceutical company incentive to develop new antibiotics.

Beginning in the 1940s, mass production of antibiotics involved the industrial-scale growth of microorganisms to harvest their metabolic products. Unfortunately, the use of antibiotics selects for resistance at answering scale. The turn to the study of antibiotic resistance in microbiology and medicine is examined, focusing on the realization that individual therapies targeted at single pathogens in individual bodies are environmental events affecting bacterial evolution far beyond bodies. In turning to biological manifestations of antibiotic use, sciences fathom material outcomes of their own previous concepts. Archival work with stored soil and clinical samples produces a record described here as 'the biology of history': the physical registration of human history in bacterial life. This account thus foregrounds the importance of understanding both the materiality of history and the historicity of matter in theories and concepts of life today.

AbstractMany common bacterial pathogens have become increasingly resistant to the antibiotics used to treat them. The evidence suggests that the essential cause of the problem is the extensive and often inappropriate use of antibiotics, a practice that encourages the proliferation of resistant mutant strains of bacteria while suppressing the susceptible strains. However, it is not clear to what extent antibiotic use must be reduced to avoid or reverse an epidemic of antibiotic resistance, and how early the interventions must be made to be effective. To investigate these questions, we have developed a small system dynamics model that portrays changes over a period of years to three subsets of a bacterial population— antibiotic‐susceptible, intermediately resistant, and highly resistant. The details and continuing refinement of this model are based on a case study of Streptococcus pneumoniae, a leading cause of illness and death worldwide. The paper presents the model's structure and behavior and identifies open questions for future work. Copyright © 2000 John Wiley & Sons, Ltd.

AbstractThis paper connects ideas from recent literature on the economics of intellectual property (IP) to address the question: Did the strengthening and broadening of IP rights from important patent policy changes in the US promote greater innovation? The analysis rests on the theory of cumulative innovation, which shows that if IP rights on a pioneer invention extend to follow‐on research and impediments to contracting exist, then strengthening patents can actually reduce overall innovation. Recent empirical studies are consistent with the theory: patents can significantly deter follow‐on research in "complex" technology areas where contracting is difficult (computers, electronics, telecommunications) but not in drugs, chemicals and human genes. I outline remedies from court decisions and antitrust policy for addressing inefficiencies from patent trolling, patent thickets and the anti‐commons of fragmented ownership. I then apply the analysis to the antibiotics market, drawing on recent research, to examine how patent and competition policies can be used to improve incentives for drug development in the battle against antibiotic resistance. The literature provides persuasive evidence that the policy changes overreached in broadening and strengthening IP rights and reveals important patent reforms for improving the effectiveness of patent systems in the US and Canada.

Daily and Ehrlich have described the current state of our epidemiological environment in chilling detail. While their point is that human beings interact and affect the epidemiological environment in a variety of ways, the development of antibiotic resistance in bacteria strikes us as one aspect that we can begin to analyse immediately. The evolution of resistance to antibiotics is a function of their use by humans. The more we use, the more selective pressure is placed upon bacteria to develop resistance. This is further complicated by how they are used. Both the duration and the amounts used affect the change in the level of resistance. Finally, the primary feature driving the concern over the use of these drugs is that the evolution of resistance makes these 'miracle' drugs exhaustible. We can try to develop new and better antibiotics, but it is uncertain how successful we will be and how expensive they will be if we are successful.