Environment International 29 (2004) 1105 www.elsevier.com/locate/envint
Book review Battling Resistance to Antibiotics and Pesticides: An Economic Approach This book is a collection of 12 articles, originally written for a conference on the economics of resistance organized by the Resources for the Future in 2001. The book contains three parts. The first part is devoted to the question of how to achieve efficient use of pharmaceuticals and pesticides when there is a risk of resistance. The second part concerns the estimation of the costs of resistance and the impact of uncertainty concerning the development of resistance on the actions of private agents in the economy. The final part deals with the impact of the market structure on the development of resistance against antibiotics and pesticides. According to the editor, the book is intended for ‘‘professionals in the medical, public health and agricultural arenas’’, as well as for economists ‘‘studying the economics of resistance to antibiotics and pesticides’’. After a short review of the three different parts of the book, I will return to the issue of the audience of this book. The first part of the book concerns the efficient use of antibiotics and pesticides when this use puts selective pressure on bacteria to develop resistance against such measures. The analysis is performed using dynamic models based on the Pontryagin maximum principle. In order to avoid the development of resistance, the results suggest the introduction of policy instruments such as treatment heterogeneity (against antibiotic resistance) and refuge areas (against pesticide resistance). The second part of the book contains five chapters. The first three chapters are devoted to the measurement of the costs of resistance and the impact of resistance on physician prescription behavior. As such, the first three chapters concern the design of empirical models in order to study the size of the impact of antibiotic resistance. Two of the studies also include some empirical work in the form of regression analysis. These chapters are easy to follow, suppressing complicated mathematical tools. In the final two chapters, the authors analyze the effects of uncertainty on the behavior of private agents in the economy, using real option techniques. Such techniques consider both the dynamics of the problem and uncertainty. In addition, the real option techniques allow the inclusion of the (possibly) irreversible effects of antibiotic resistance in the analysis.
The third part of the book deals with the effects of the market structure on the development of resistance, and how society may create systems inducing the correct incentives for private firms to implement the socially desirable resource allocation. The findings reveal that a monopoly firm might actually produce a resource allocation closer to the socially desirable allocation than competitive firms, and that the patent system has serious shortcomings as an instrument for promoting R&D and achieving efficient resource allocations in the presence of antibiotic and pesticide resistance. Thus, this book cover some (or actually most) of the analytical tools and models used by economists to analyze the problem of antibiotic resistance this far. Therefore, the book should be of interest not only to economists, but also to physicians and other health care personnel, epidemiologists and biologists. This is further emphasized by the fact that several of the authors of the book suggest interdisciplinary cooperation as a way of improving the quality of research in this field. This, however, brings me back to the question concerning the audience of the book. As mentioned above, the target audience consists (at least in part) of professionals in the medical, public health and agricultural arenas. There are, however, some analytical tools used in this book, such as the theory of real options and dynamic analysis based on the Pontryagin maximum principle, which are quite complex and probably only known by researchers and scholars, and not by most health care personnel. Although there is a short, nonmathematical commentary at the end of most of the chapters in the book, the use of such mathematical tools limits the target audience for this book somewhat. Nonetheless, the book is a welcome addition to the small existing literature on the effects of antibiotic and pesticide resistance. It provides a good review of both the analytical tools used to study the effects of resistance, as well as of the economic policy measures that might be available to fight resistance to antibiotics and pesticides. Niklas Rudholm Department of Economics, Umea University, Umea 901 87, Sweden E-mail address: [email protected]
Tel.: +46-90-786-9940; fax: +46-90-77-2302 1 February 2003