Ethics and drug resistance

Bioethics

Volumn 21, Issue 4, 2007, Pages 218-229

  Selgelid, Michael J ^a  

^a AUSTRALIAN NATIONAL UNIVERSITY   (Australia)

Author keywords

Distributive justice; Drug resistance; Ethics; Externalities; Infectious disease; Public goods; Self interest

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT; ANTIVIRUS AGENT;

ACQUIRED IMMUNE DEFICIENCY SYNDROME; ANTIBIOTIC RESISTANCE; BIOETHICS; DRUG EFFICACY; DRUG INDUSTRY; DRUG USE; HEALTH CARE SYSTEM; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE; INFECTION; MALARIA; MEDICAL ETHICS; MEDICOLEGAL ASPECT; PUBLIC HEALTH SERVICE; REVIEW; TUBERCULOSIS; WORLD HEALTH ORGANIZATION;

ATTITUDE TO HEALTH; BIOETHICS; DRUG RESISTANCE; DRUG THERAPY; HEALTH POLICY; HUMANS;

EID: 33947206655     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2006.00542.x     Document Type: Review

References (86)

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3. US Congress, Office of Technology Assessment. 1995. Impacts of Antibiotic-Resistant Bacteria, OTA-H-629. Washington, DC. Government Printing Office: 39.
4. Which would be used to fight mosquitoes and thus malaria.
5. L. Garrett. 1994. The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Penguin: 30-31.
6. Ibid: 36.
7. Ibid: 33.
8. T. McKeown. 1988. The Origins of Human Disease. Cambridge, MA: Blackwell.
9. rd EMBL/EMBO joint Conference on Science and Society - Infectious Diseases: Challenges, Threats and Responsibilities. Heidelberg, Germany, 2002.
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11. See Garrett, op. cit. note 5;
12. and J. Lederberg, R. Shope and S.C. Oaks (eds.). 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington DC: National Academy Press.
13. See www.unaids.org [Accessed 30 August 2006].
14. Which will be needed, for example, to fight resistant strains of HIV.
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16. See also L.B. Reichman and J.H. Tanne. 2002. Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis. New York: McGraw Hill: x-xi;
17. P. Farmer. 1999. Infections and Inequalities: The Modern Plagues. Berkeley, CA: University of California Press.
18. World Health Organization. 2002. Fact Sheet No 104. Tuberculosis. Available at http://www.who.int/mediacentre/factsheets/fs104/en/print.html [Accessed June 2004].
19. WHO, op. cit. note 10.
20. World Health Organization. 1999. Report on Infectious Diseases, Chapter 16, Removing Obstacles to Healthy Development, available at http://www.who.int/infectious-disease-report/pages/textonly.html, p. 2 [Accessed 30 August 2006].
21. See M.J. Selgelid. Ethics, Economics, and AIDS in Africa. Developing World Bioeth 2004; 4: 96-105.
22. Global Forum for Health Research. 2002. The 10/90 Report on Health Research 2001-2002. Geneva. Global Forum for Health Research.
23. For social/political/economic explanation of the 10/90 divide, see D.B. Resnik. The Distribution of Biomedical Research Resources and International Justice. Developing World Bioeth 2004; 4, 1: 42-57.
24. US Congress, Office of Technology Assessment, op. cit. note 3.
25. WHO, op. cit. note 10.
26. S.L. Knobler, S.M. Lemon, M. Najafi, and T. Burroughs (eds.). 2003. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment. Institute of Medicine, Workshop Summary. Washington DC: National Academies Press: 20.
27. Karl Ekdahl, Ethical Issues from the ECDC Perspective. Presentation at the Bioethical Implications of Globalisation Processes (BIG) workshop on Globalization and New Epidemics: Ethics, Security and Policy Making. The European Commission, Brussels, Belgium, 22 May 2006. (Note that he was not here expressing official ECDC position on this matter; this is his personal view.)
28. WHO, op. cit. note 10.
29. It has recently been touched on, however, by C.B. Smith et al. Are there Characteristics of Infectious Diseases That Raise Special Ethical Issues? Developing World Bioeth 2004; 4, 1: 1-16;
30. and P. Farmer and N. Gastineau Campos. Rethinking Medical Ethics: A View from Below. Developing World Bioeth 2004, 1; 4: 17-41.
31. M.J. Selgelid. Ethics and Infectious Disease. Bioethics 2005; 19, 3: 272-289.
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34. For an accessible review of the mechanisms of drug resistance, see Levy, op. cit. note 2.
35. One example is plasmid exchange during a sex-like process called conjugation. See Levy, op. cit. note 2, for more on the mechanisms of resistance transference.
36. i.e. disease-causing.
37. WHO, op. cit. note 10, Chapter 3.
38. Antibiotics are effective against bacteria - not viruses.
39. US Congress, Office of Technology Assessment, op. cit. note 3, p. 11.
40. Ibid: 13.
41. Ibid: 11.
42. Smith et al., op. cit. note 26, p. 12.
43. WHO, op. cit. note 10, Chapt. 3.
44. Levy, op. cit. note 2.
45. Harris Interactive. 2002. Harris Interactive Data Show Most Are Reasonably Well Informed on the Use and Abuse of Antibiotics, available at http://www.harrisinteractive.com/news/printerfriend/index.asp?NewsID=421 [Accessed 19 June 2004].
46. Levy, op. cit. note 2, p. 137.
47. Ibid.
48. Vanomycin-resistant bacteria in food, and cases of human infection with drug-resistant Salmonella typhimurium and multi drug-resistant campylobacteriosis, for example, have all been traced to farm animals. WHO, op. cit. note 10.
49. See also World Health Organization. 2001. WHO Global Strategy for Containment of Antimicrobial Resistance, available at www.who.org [Accessed 30 August 2006].
50. By 'under-consumption' I refer to insufficient consumption rather than non-consumption.
51. Farmer, op. cit. note 14, p. 255.
52. See also P. Farmer. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA: University of California Press.
53. P. Farmer. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA. University of California Press.
54. Reichman et al., op. cit. note 14, p. 90.
55. Ibid: 53.
56. Ibid: 90.
57. For more on tuberculosis in the former Soviet Union, see Farmer, op. cit. note 46;
58. Farmer et al., op. cit. note 26;
59. and L. Garrett. 2000. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion.
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61. Surveillance and impact assessment are important for tracking and appreciating the problem of drug resistance.
62. Improved diagnostics would contribute to surveillance and drug sensitivity testing. The latter would facilitate the making of timely, appropriate prescription decisions.
63. US Congress, Office of Technology Assessment, op. cit. note 3.
64. Corporate reluctance to enter the vaccine market due to liability concerns is well illustrated by the Swine Flu fiasco of 1976 and, more recently, US government difficulty procuring anthrax vaccine. See, respectively, Garrett, op. cit. note 5;
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66. A. Sen. 1999. Development as Freedom. New York. Anchor Books.
67. Even if (1) negative liberty and (2) efficiency/utility were maximally promoted by free markets, ethical questions about how the promotion of these should be balanced against potentially conflicting legitimate social aims to promote (3) equality and (4) positive liberty remain.
68. 'Efficiency' may be used to refer to overall utility, for example. This is how I have been using the term except where otherwise specified. 'Efficiency' may alternatively be used to refer to pareto-optimality, which is further explained below, and which is often (and sometimes mistakenly) used as a proxy for overall utility.
69. A. Buchanan. 1985. Ethics, Efficiency, and the Market. Totowa, NJ: Rowman & Littlefield.
70. Ibid: 14-15, for more on assumptions.
71. Ibid: 15.
72. Public goods are also standardly defined as goods which are non-excludable and non-rivalrous - 'once they are provided, no one can readily be excluded from their consumption, and one person's consumption does not prevent anyone else from consuming them'. R.D. Smith et al. Preface, in Global Public Goods for Health: Health Economic and Public Health Perspectives, R. Smith, R. Beaglehole, D. Woodward, and N. Drager eds. New York: Oxford University Press: ix. Though my argument will focus on the issue of externalities - because this is crucial to challenging the standard argument that free markets lead to pareto optimal outcomes - it should be recognized that freedom from infectious disease and freedom from drug resistant disease - just like clean air - meet both of these criteria.
73. Except for the fact that pareto optimality might sometimes serve as a useful proxy for aggregate utility, there is no good argument that free markets would maximize efficiency qua utility even when ideal market conditions are met.
74. Harrison and Lederberg, op. cit. note 28;
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78. N. Daniels. 1985. Just Health Care. New York: Cambridge University Press.
79. R.D. Smith & J. Coast. Antimicrobial Drug Resistance, in Global Public Goods for Health: Health Economic and Public Health Perspectives, R. Smith et al. eds. New York: Oxford University Press: 76.
80. A third reason in favor of increasing access to medicine is the idea that this would promote positive (if not negative) liberty as well. A fourth reason is that the Universal Declaration of Human Rights recognizes a human right to health. A fifth reason is that the poor are often victims of past injustices warranting reparation.
81. The idea that 'side constraints' might be violated in order to avoid 'catastrophic moral horror' is suggested (though perhaps not fully admitted) even by Robert Nozick. R. Nozick. 1974. Anarchy, State, and Utopia. New York: Basic Books: 30n.
82. Smith et al., op cit. note 66.
83. S. Sterckx. Patents and Access to Drugs in Developing Countries: An Ethical Analysis. Developing World Bioeth 2004; 4, 1: 58-75.
84. For proposals regarding alternative incentive schemes see M. Kremer and R Glennerster. 2004. Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases. Princeton, NJ: Princeton University Press;
85. and T. Pogge. Human Rights and Global Health: A Research Program. Metaphilosophy 2005; 36, 1/2: 182-209.
86. Smith et al., op cit. note 66.