Only Two Things Scare Me:

And one of them is antibiotic resistance. Along with my regular co-author, Bill Sage, I’ve just sent off a new article to the law reviews, titled Combating Antimicrobial Resistance: Regulatory Strategies and Institutional Capacity.

Antibiotic resistance is a major public health problem. Every year, two million Americans acquire bacterial infections in the hospital, and 70% of those infections are resistant to at least one antibiotic. MRSA (methicillin-resistant Staph aureus) has attracted the most media attention: the CDC estimated that MRSA caused 94,000 life-threatening infections, and 18,650 deaths in 2005.

Congress and many states are currently debating legislation to reduce antibiotic resistance. The article blends regulatory theory and comparative institutional analysis to explain how we can use regulation to lower the risk of antibiotic-resistant bacterial infection, rationalize the use of existing antibiotics, and encourage innovation. We canvass the full range of regulatory options that are available, and explain the compatibility or incompatibility of particular regulatory strategies with existing legal and regulatory systems.

Here’s the abstract of the article:

Amnesia is a common, important, but rarely noted side effect of antibiotics. Apart from medical historians, few recall the severe morbidity and mortality once associated with acute bacterial infection. However, decades of antibiotic overuse and misuse have compromised the long-term availability and efficacy of these life-saving therapies. If designed and implemented appropriately, regulation can reduce the risk of bacterial infection, reserve antibiotics for circumstances where they are necessary, and rationalize the use of the most powerful agents. Regulation of antibiotic resistance can be justified, and should be guided, by both efficiency and fairness. A range of regulatory options are available – some information-based, some incentive-based, some command-and-control – each of which has indications, strengths, and weaknesses. A desired set of regulatory strategies must then be matched with the appropriate legal and regulatory institutions. A renewed focus on regulatory and institutional design has significant potential to reduce antibiotic-resistant bacterial infections and increase the effective life of existing and new antibiotics.

You can download a copy of the article here.