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Antibiotics

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Brian Gates
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Is it moral for the state to restrict access to antibiotics if misuse of these drugs can result in antibiotic-resistant pathogens and hence create a public health hazard?

No. Because the use of antibiotics does not create a public health hazard in any sense of the word.

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It is not moral for the state to restrict access to any drug.

I don't agree.

If there is evidence that the use of certain antibiotics may spread antibiotic-resistant strains of virulent pathogens, control over the use of those antibiotics by the government can be moral, as any other matter of self-defense or national security.

I remember having read from Ayn Rand that in case of epidemics, the government could confine people or impose measures that normally would be perceived as invasive or people's privacy or freedom in order to avoid the spread of a dangerous epidemic.

So in principle, we cannot say that it is immoral for the state to restrict acces to any drug.

We should consider the whole context: what is the scientific evidence, the potential consquences, and what specific measures are being proposed.

Certainly, in the vast majority of cases it would not be necessary to restrain citizens from normal activities, and government would feel tempted to gain power over people by producing hysteria (like in the climate change issue or terrorism). But as I say, it is a matter of cleary understanding the context.

Edited by Hotu Matua
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No. Because the use of antibiotics does not create a public health hazard in any sense of the word.

If antibiotics are not used for the full course of treatment some of the bacteria survive and are immune to the antibiotics. That is why TB is now very difficult to treat. There are a whole variety of "superbugs" which came about because people did not use their antibiotics correctly.

Bob Kolker

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If there is evidence that the use of certain antibiotics may spread antibiotic-resistant strains of virulent pathogens, control over the use of those antibiotics by the government can be moral, as any other matter of self-defense or national security.

I don't agree either, but not for this reason.

The rand example and this one are not the same. For the same reason that point source pollution immediately causing damage to someone's health or property is objectively is quite different than diffuse pollution (say from a million cars) is not.

If one person can directly damage you, then the govt has a right to call such damage a crime. If a million people only by virtue of each of their individual actions can, well, that is a state of nature. It is not an objective threat and should not be considered any sort of crime.

You are correct that context is important, but this case does not provide the context to justify.

Plus, there is not this sort of evidence.

Edited by KendallJ
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If there is evidence that the use of certain antibiotics may spread antibiotic-resistant strains of virulent pathogens

There isn't, since they don't. Not only do they not spread such patogens (this part is obvious), as far as I know they don't even cause them to be born.

The widespread use of a type of antibiotic may make it inefective over time, which is different. Ayn Rand was in favor of preventing people who are sick from infecting others with a deadly or permanently debilitating disease, because that would be initiation of force, and a violation of the rights of others. She didn't favor restricting private ownership in the name of the "common good". Allowing the government to decide how to make best use of antibiotics would be no different than allowing it to do the same with any other resource, man made or natural.

Antibiotics, like everything else, should be private property, and up to the owner to decide how they should be used and to whom they should be sold, not the government. And the types of antibiotics which aren't private property, should not be government property. Like all other things with expired patents or copyrights, they should be free to use, for all who can make them. (if that would happen consistently, there would be probably be a few strains of ab which would be only sold at a higher price, assuring that they are mostly only used when cheaper strains fail, or in emergencies)

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I don't agree.

If there is evidence that the use of certain antibiotics may spread antibiotic-resistant strains of virulent pathogens, control over the use of those antibiotics by the government can be moral, as any other matter of self-defense or national security.

I remember having read from Ayn Rand that in case of epidemics, the government could confine people or impose measures that normally would be perceived as invasive or people's privacy or freedom in order to avoid the spread of a dangerous epidemic.

So in principle, we cannot say that it is immoral for the state to restrict acces to any drug.

We should consider the whole context: what is the scientific evidence, the potential consquences, and what specific measures are being proposed.

Certainly, in the vast majority of cases it would not be necessary to restrain citizens from normal activities, and government would feel tempted to gain power over people by producing hysteria (like in the climate change issue or terrorism). But as I say, it is a matter of cleary understanding the context.

I agree with Jake's and Kendall's analysis of what the problem is with your objection. Over use of an antibiotic is not the initiation of force, and since it is not the action of just an individual but of an entire group of individuals the government can not regulate it any more than it can regulate an individual running down Fifth Avenue because if 10,000 people ran down Fifth Avenue the stampede might kill someone.

So, yes we can say it is immoral for the state to restrict access to any drug since law is (should be) written for the purpose of protecting individual rights and no other.

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About antibiotics, let's start with two known facts:

1) The human body, inside and out, is rife with bacteria. Most are beneficial, and needed, symbiotic bacteria which helps you digest food among other things, some are harmless interlopers that don't find a congenial spot to breed a colony, a few are harmful infectious agents. All are vulnerable to antibiotics.

2) Bacteria can exchange genetic material with each other, even accross diferent species.

Now, some people get an uspet stomach when they take antibiotics. That's because they're killing much of their intestinal flora (the symbiotic bacteria), which menas they can't fully digest food. Some people don't experience this side effect (I don't), or experience a very mild form of it. This has something to do with dosages, the kind of antibiotic prescribed and what resistance to the medication his native bacteria have developed.

The symbiotes have the best chance of developing resistance, particularly to antibiotics you use often. They are more exposed to it. So it is possible for your intestinal flora to gain resustance and pass it to other bacteria that may hapen accross. Food is rife with abcteria, too, regardless of how well it's cleaned or cooked before consumption. Bacteria float about in the air and settle on to anything they happen accross (the same is true of fungal spores).

Whether or not this kind of acquired resistance is passed to dangerous bacteria, such as those responsible for pneumonia and other serious diseases, is not a settled issue. But the possibility does exist. Therefore it makes a great deal of sense to limit the use of antibiotics to such times as its necessary.

I'm vehemently opposed to popping penicillin at the first sign of a cold. For one thing the common cold is caused by a virus, which can't be affected by penicillin or any other antibiotic; for another it may cause resistance issues later on. On the other hand it amkes perfect sense to take antibiotics when you're diagnosed with an infection, or to dust deep wounds with sulfa to prevent outside bacteria from settling in.

But this is a matter for doctors and common people to act upon. People should know not to take antibiotics when they won't do any good and may do future harm, and doctors should refuse to prescribe them for sniffles and minor scratches. This is not something the government should meddle with. There's no need, there's no clear proof and it will eventually cause more harm than good as most government regulations do.

BTW some treatments are developed by bucking conventional wisdom or using drugs for purposes other than those intended. The simlpe idea of doctors washing their hands before examining a patient was resisted for decades. Some medications for one condition may be better for a different one, but this is discovered as a side effect of the original intent. When government regulates treatments, it kill such innovation.

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  • 2 weeks later...

Antibiotics don't spread disease.

However, taking antibiotics when you don't need to is harmful to you and to us all, in an Epidemiological context.

We all have normal bacterial flora, this is true. Our normal epidermal flora, Staphylococcus aureus, exists as a first line of defense against pathogens that come into contact with your skin. The Escherichia coli in your gut help you digest food and make Vitamin K, a necessary part of blood coagulation. But sometimes these bacteria can become pathogenic, both to the host and to other people.

All bacteria have some sort of antibiotic resistance. But when you take antibiotics, especially broad-spectrum antibiotics, you kill off all the bacteria that are susceptible to it, leaving only those with high resistances. Those bacteria are left to breed unchecked in a way, and they are spread from person to person resulting in some actual infections. An example: MRSA (Methicillin resistant Staphylococcus aureus), VRE (Vancomycin resistant Enterococci), MDRTB (Multi-drug resistant TB)... all of these "superbugs" are a result of overuse and incorrect use of antibiotics.

Bacteria also discharge plasmids when they die. Plasmids are like little bundles of rogue DNA that other bacteria can "eat" and incorporate into their own code. When MRSA bugs die, for instance, other bacteria can "eat" the remnant DNA from these bugs and quite easily incorporate, for instance, a "drug-resistance gene" code from the dying bugs into their own genetic code. It's quite amazing.

Drug companies are trying to stay ahead of this, like for instance putting clavulanic acid into Amoxicillin so that the drug has a higher chance of breaking bacterial resistance to penicillin (which we all know was given out like candy during WW2). But it's a very real issue that misuse and over-prescribing of antibiotics contributes to the spread of drug-resistant microbes.

So in my opinion, which I base on my knowledge and experience in the field of nursing (and the fact that I LOVED microbiology), I feel that the medical professionals have the responsibility to educate the public on when to use and when NOT to use antibiotics (like for colds... I can't tell you how many people come in with a cold and want penicillin. NO.)

As far as whether it's moral for the state to restrict the access to these drugs... I'm not sure. The state's intentions are good, in that they want to reduce the spread of and creation of drug-resistant strains of bacteria. But I can forsee a bureaucratic nightmare of requisite forms and authorizations to dispense that would make my and my colleagues' jobs harder. I think that the State Health Department has a moral obligation to EDUCATE the public on the use of these drugs, but to go so far as to restrict access... no. Doctors simply need to prescribe less antibiotics.

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