When I teach our Science of Life course, which is our version of Intro Biology, I cover lots of topics that will be helpful to future health professionals, because that’s what 70% of this class typically is.  I focus particularly on the importance of evolutionary thinking for medical issues.  This might be the only evolution these students ever get!  I also try to get very long discussions going on the implications of the biological issues for making public policy, either good or bad.

One issue that we always discuss is how to fight antibiotic resistance in general and multiple drug resistant strains of many disease organisms.  The simple answer to this huge problem is for doctors to stop prescribing antibiotics like candy, and for farmers to stop giving antibiotics in feed to livestock.  See here for a recent review of how antibiotic resistance evolves and a history of antibiotics.

How would we reverse antibiotic resistance?  It’s pretty simple.  Stop prescribing antibiotics like candy, and stop giving them to livestock in feed.  At present, antibiotics flood the environment, and so are potent agents of natural selection for resistanse everywhere.

However, everyone has strong short-term incentives to not do this.  Livestock are somewhat larger when fed antibiotics, and so farmers make more money when feeding their livestock antibiotics.  Even this will stop being effective soon, but until that happens, farmers who don’t feed their livestock antibiotics make less money.

The incentives on doctors are even more perverse.  Imagine a doctor in an exam room with a mother and her child who has an ear ache.  The doctor tells the mother that her child’s ear infection will clear itself up (the child has an immune system) in a few days, and so the doctor doesn’t want to give the child any prescription.  The mother is furious because she wants the doctor to do something to help her child.  And so the doctor eventually gives in and prescribes a course of antibiotics for the child.  If the doctor had not, the mother would have stopped bringing her family to this doctor.

The problem is even larger at the societal level.  Imagine what would happen if a legislator proposed a law that would make it harder for doctors to prescribe antibiotics and banned antibiotics in animal feed.  Even though this is the only way to keep these important drugs available and effective for human health, this legislator’s rivals would scream bloody murder that this law would “restrict life saving drugs from you” and “attack family farmers”.

How will the country make effective public policy concerning human health in such an environment?

 

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