[KGIII]

There are loads of problems with that. I agree, in principle, but I'll give you an example of a problem that already is happening.

Not every drug you take is limited to impacting just you. A good example is antibiotics. We are having serious issues with drug-resistant bacteria. Allowing people to just take antibiotics of their own free will is absolutely certain to increase the number of drug-resistant bacteria. This will, with absolute certainty, result in an increase people being killed through no fault of their own.

Could this be prevented? Nope. One might say people could be educated and that they'd make the right choices, but the very idea of that is farcical. The planet is not populated with people who make bright choices and exhibit a propensity for long-term thinking.

I very much believe in allowing autonomy over self, and I've strongly supported these ideals. However, that has to have limits in a functioning society. As much as I'd like to say we should be able to take all the drugs, there is a need to draw some lines. We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.

[xpinguin]

Do you really think, that general populace's misuse of antibiotics could cause the development of resistant bacterial strains en masse?

I might be wrong, and if so, please don't hesitate to provide some factual paper, yet my intuition suggests that in order to obtain solely by selection (under the pressure of a _single_ bioactive substance), a bacterial strain, that is, simultaneously:

- resistant to the aforementioned substance

- stable: resistance is not lost after the generation or so, past the moment when exposure is over

- contagious: strain is resistant to different immune systems (w/o losing its resistance to the substance, of course),

one either needs to perform a directed selection (eg. like that for apple-trees), or to create an environment, where really _huge_ bacterial population could thrive and persist for a long time: like that in hospitals or farms, - where not only frequent turnover of living organisms along with the regular exposure to antibacterial substances do happen, but also some intermediate vessels (medical instruments, ground, water supply, etc.) are available for bacteria to flourish in-between living hosts.

[croatially]

> Do you really think, that general populace's misuse of antibiotics could cause the development of resistant bacterial strains en masse?

Of course not. There's 7 billion people, and just a tiny percentage uses antibiotics.

There's around 60 billion land mammals raised by humans every year, throughout their life most of them use the strongest antibiotics. It speeds up growth, it prevents silly deaths, increases profit.

Diseases, plagues will come from livestock, as they always did, not from humans.

[dbrazel]

In the absence of antibiotics, there is selective pressure to eliminate the genes or mutations that confer resistance. However, there are opposing factors - antibiotic resistance genes are often carried on plasmids, independent genetic elements that can be exchanged between bacteria. Plasmids that contain antibiotic resistance genes frequently also contain heavy metal resistance genes[1]. This allows for co-selection, where the presence of, for example, mercury pollution from coal-fired power plants will maintain antibiotic resistance in antibiotic-free environments[2,3]. Plasmids can act as parasites on their bacterial hosts - many carry pairs of genes that encode both a toxin and a less stable antitoxin. If the plasmid is lost, the bacterium will die[4]. All of these mechanisms can maintain antibiotic resistance without antibiotic exposure.

[1]: http://www.cell.com/trends/microbiology/abstract/S0966-842X(...

[2]: https://link.springer.com/article/10.1007/s00284-012-0194-4

[3]: http://www.tandfonline.com/doi/abs/10.1080/01490450902889072

[4]: http://www.annualreviews.org/doi/abs/10.1146/annurev.micro.5...

[specialist]

I think bad policy leads to bad outcomes. When people are given good information, they make good decisions, on the whole.

As a parent, I was pretty pissed off when I learned that over use of antibiotics harms my child, my society.

As a citizen, I'm pretty pissed off that (one aspect) of the opioid epidemic is because doctors changed pain management protocols, without any followup testing, assessment.

“We started it”: Atul Gawande on doctors’ role in the opioid epidemic

https://www.vox.com/2017/9/8/16270370/atul-gawande-opioid-we...

[specialist]

Deregulated (or decriminalized) doesn't mean unguided, untracked.

Why should antibiotics be treated any differently than psychoactives? And how could empowering individuals, accepting mistakes will be made, be any worse than our (USA) current system? We currently have people self-medicating with supplies from pet stores and veterinarians.

Actually, thinking about it, to your point, poor compliance is because of barriers to care. Making it easier to receive care will improve outcomes.

The most successful efforts replace enforcement (of controlled substances) with treatment, counseling. Imagine if all drugs could be bought at your local pharmacy, where customers can be advised, counseled.

My pharmacist is just a pill pushing bookkeeper. I'll have to ask her if she'd like to use her degree, training, experience for actually helping people, rather than just checking eligibility and collecting copays.

[chicob]

>Could this be prevented? Nope

Pharmaceutical marketing has a role in antibiotics mis-usage, and it can be regulated a lot better. I know people that take AB for the flu, or simply don't take the whole prescription. But at least where I live one cannot get AB without a prescription. Why would a doctor prescribe AB for common viral diseases? Bahamas, that's why.

>We can move those lines, and I think we should, but eliminating them entirely is absolutely certain to harm innocent people at a level I am unwilling to support.

I agree. It's a bit like seat belts or bike helmets: they're mandatory for our own good. Before it was mandatory, people use it if they wanted and took unnecessary risk.

But there's always a fuzzy middle ground...

The general reaction for substance usage goes around 'well it's really up to you, unless you're driving/someone depends on you'.

But as for driving a bike not wearing a helmet, people are a lot less lenient, even if the only person harmed is the self. And this is even before considering welfare, hospital expenditure and such.

Do we need protection from ourselves? Does this just boil down to economic and state welfare efficiency? Less diseases is good because Economy? Or is this a way of maneuvering Economy towards a place where economic interest aligns with principles of human dignity? Sometimes I wonder.

[KGIII]

The comment I was responding to was suggesting that we deregulate all drugs, including prescription drugs without addiction potential. I was mostly addressing that and using antibiotics as a good example.

With antibiotics, it's a bit like vaccinations. Vaccinations are as effective as they are because they provide herd immunity. Not everybody is vaccinated and the vaccinations aren't always effective, but enough people are vaccinated so that it provides protection for everyone, including those who haven't been vaccinated.

Antibiotics are similar, though the effect probably has a different name. Bacteria reproduces very, very quickly and the growth is exponential. We already have a problem where bacteria has evolved to be resistant to our current crop of antibiotics.

It's also important to note that developing safe antibiotics is extremely difficult. I believe I read that there are only two new antibiotics currently in the human testing phase and that no new antibiotics have made it to market in over a decade.

So, we already have a problem with antibiotics being over-prescribed and bacteria evolving to survive the attack. This is a known problem and an increase in people taking antibiotics is going to speed this up. This isn't something that's in doubt, it is absolutely what will happen if humans are given unrestricted access to antibiotics.

We will take more, we will see bacteria evolve, and that is going to result in stringer infections that kill people who may have, as individuals, never once abused antibiotic medications. It's not quite the same as herd protection, but it is fairly close.

I'm pretty much in favor of legalizing drugs. I absolutely believe we should be able to take drugs. I even believe we should be allowed to take drugs that have a good chance at killing us. I firmly believe the right to life should also include the right to die.

What I don't believe in is that the right to life includes the right to harm others. With all rights, there is a risk of harm to others. That is just a fact of a free society. The problem here is that these acts will harm many. Many, many people would be harmed by this.

I absolutely support the right to own a firearm. In no way do I support the right of an individual to own a weapon of mass destruction. I'm okay with someone owning a fully automatic firearm. I'm not okay with someone owning a nuclear weapon.

Does that make sense? I'm trying to explain it as well as I can.

It's not really protection from ourselves, unless you mean collectively. It's protection from others who would cause us harm through ignorance. From an economical viewpoint, healthier people are more productive - to touch on your last thoughts. Fewer diseases is good. Fewer diseased people is even better. Unfettered access is going to increase the number of sick and suffering, and not necessarily through the fault of the afflicted.

[sulizilxia]

The antibiotics example is one type where I admit some kind of regulation (aside from competency) might be in order. I.e., where tragedy of the commons-type scenarios arise.

Still, even in that case, I think you might be better off regulating at the point of sale by pharmacists, kind of akin to pseudoephedrine. I also think situation isn't quite as clear cut as it seems on the surface, in that currently antibiotics are overprescribed anyway, suggesting that our current regulatory regime isn't really working in those cases well either. In any event, my sense of the antibiotics literature is that a, if not the, major contributor to environmental antibiotic resistance is agricultural in nature.

[tim333]

Regarding antibiotics, although I don't have numbers, in most 3rd world countries they are freely available in shops for prices starting at less than $1. I wouldn't mind betting more lives are saved by their free availability where there isn't easy/cheap access to doctors than are lost through drug resistance.

[kwhitefoot]

What do you get for a dollar? A whole course or just one pill? And how much of a person's income is that price, is it really cheap or does it just seem so to those of us who are in rich countries?

[tim333]

Last time I did it it was 30c for a course (8 pills) of Cipro in Cambodia. I assume that's fairly cheap for locals too - you can't buy much of anything for that even in Cambodia.

[JamesBarney]

I still think anti-biotics should be heavily taxed, with exceptions if you have been diagnosed with a bacterial infection

[KGIII]

They currently come with the added price of needing a prescription. Doctors usually charge for this service. I'm not sure that a tax is going to do much to dissuade people.

[JamesBarney]

A large amount of anti-biotics are used livestock. Also I think I'd anti-biotics cost an extra $100 if the doctor is giving you a just in case anti-biotics then I think some people would think twice.

[Fnoord]

Don't worry, many wouldn't think twice. They simply can't afford $100 USD meds.

[craftyguy]

> Not every drug you take is limited to impacting just you. A good example is antibiotics.

Is there anyone addicted to antibiotics? No? Red herring.

[KGIII]

Red herring? It was a direct response to your comment about making all drugs, including prescription drugs, deregulated. It was YOU who mentioned, specifically, drugs of abuse and other medication.

[craftyguy]

That wasn't my comment..

[occultist_throw]

Actually, yes.

It turns out there's some HIV antiretroviral that, instead of being ingested, is smoked proves one hell of a high.

The problem is that in Africa where these drugs are readily available, they are being smoked. The worry is, that HIV will mutate and become immune to those ARV's.