I’m not sure that availability of antibiotics OTC in most of the world is good evidence that they don’t pose a problem. The main danger of gasoline is that it could catch on fire. It’s easy to see cause and effect if that were happening. If OTC antibiotic use was causing problems, that would require epidemiologists to figure out, and a political solution to fix. I’m not confident that most of the world is well-positioned to catch and fix any issues that may be arising from OTC antibiotic sales.
There’s reason to ask about the relative contributions to drug resistance of self-medication at home, hospital antibiotic use, and antibiotic use on factory farms. We hear about drug resistance mostly in hospitals, but I’d want to check whether this is reporting bias before believing that hospitals are the main drivers of antibiotic resistance.
I’d also question the degree to which antibiotic resistant bacteria can be “trafficked” from place to place. If antibiotic resistant bacteria develop inside a hospital, does that make the bacteria that people pick up outside of the hospital more likely to be drug resistant?
I wouldn’t be too surprised if antibiotic resistance is a local, hospital-centric phenomenon, with home antibiotic use posing a negligible threat of causing users to contract antibiotic-resistant bacteria. But I do not have data to back that up. It would be an interesting research project.
I’d be more concerned that some people would harm their gut bacteria or kidneys by overconsuming antibiotics. But I’m not confident about this. It’s just the most obvious direct consequence of expanded and unregulated access to antibiotics, and it’s where I’d start if I were to research possible negative consequences of parachuting into Chad with a backpack full of amoxycillin.
This isn’t my field, but there are tons of people who could give concrete and specific answers to all of these questions, and so it seems silly to continue speculation.
To be clear, I don’t think the claim that self-medicated antibiotic use causes more antibiotic resistance is obvious bullshit. Maybe the effect size is close to zero outside of hospitals, maybe it’s not, but the claim isn’t obvious bullshit either way.
The “obvious bullshit” part is the (implicit) claim that the cost outweighs the benefit, or is even remotely on the same order of magnitude, especially when we’re talking about an area where the alternative is usually “don’t use antibiotics at all”.
Yeah, it seems in the neighborhood of worrying that giving parachutes to people being pushed out of planes might lead to manufacture of low-quality parachutes to meet the demand, resulting in a net increase in deaths from plummeting to the ground.
I’m not sure that availability of antibiotics OTC in most of the world is good evidence that they don’t pose a problem. The main danger of gasoline is that it could catch on fire. It’s easy to see cause and effect if that were happening. If OTC antibiotic use was causing problems, that would require epidemiologists to figure out, and a political solution to fix. I’m not confident that most of the world is well-positioned to catch and fix any issues that may be arising from OTC antibiotic sales.
There’s reason to ask about the relative contributions to drug resistance of self-medication at home, hospital antibiotic use, and antibiotic use on factory farms. We hear about drug resistance mostly in hospitals, but I’d want to check whether this is reporting bias before believing that hospitals are the main drivers of antibiotic resistance.
I’d also question the degree to which antibiotic resistant bacteria can be “trafficked” from place to place. If antibiotic resistant bacteria develop inside a hospital, does that make the bacteria that people pick up outside of the hospital more likely to be drug resistant?
I wouldn’t be too surprised if antibiotic resistance is a local, hospital-centric phenomenon, with home antibiotic use posing a negligible threat of causing users to contract antibiotic-resistant bacteria. But I do not have data to back that up. It would be an interesting research project.
I’d be more concerned that some people would harm their gut bacteria or kidneys by overconsuming antibiotics. But I’m not confident about this. It’s just the most obvious direct consequence of expanded and unregulated access to antibiotics, and it’s where I’d start if I were to research possible negative consequences of parachuting into Chad with a backpack full of amoxycillin.
We can stop speculating about these questions—the answers exist and are relatively easy to check.
https://academic.oup.com/cid/article/27/Supplement_1/S12/459194 (Horizontal transfer is where the resistance is “trafficked” between different pathogens.)
https://academic.oup.com/cid/article-abstract/33/3/364/277722 (Geographic spread is very common, but you need better tracking to see exactly where and what the routes are.)
This isn’t my field, but there are tons of people who could give concrete and specific answers to all of these questions, and so it seems silly to continue speculation.
Thanks for finding these!
To be clear, I don’t think the claim that self-medicated antibiotic use causes more antibiotic resistance is obvious bullshit. Maybe the effect size is close to zero outside of hospitals, maybe it’s not, but the claim isn’t obvious bullshit either way.
The “obvious bullshit” part is the (implicit) claim that the cost outweighs the benefit, or is even remotely on the same order of magnitude, especially when we’re talking about an area where the alternative is usually “don’t use antibiotics at all”.
Yeah, it seems in the neighborhood of worrying that giving parachutes to people being pushed out of planes might lead to manufacture of low-quality parachutes to meet the demand, resulting in a net increase in deaths from plummeting to the ground.