Thinking clearly about wealth – antibiotics edition
I’ve experienced a massive surge in my blogging productivity recently, driven by a) figuring out I could write emails to myself on the train to and from work and then publishing them when I get home, b) going from 5-10 hits per post to 50-100 which seems to have energised me somewhat and c) friends and others saying very nice things about what I’ve been writing. So thank you all for your support, and I hope I can keep the quality (and your interest) high.
[now resuming regular programming]
This morning, I was re-watching the short presentations given by a number of my favourite bloggers at the Kauffman Institute back in April. All the talks are available online, and all are worth watching (only 5-15 minutes each). But the one that stands out in particular for both importance as a topic and incredibly astute analysis is Megan McArdle on antibiotics, which she calls in one of her slides “The world’s most broken market”. I highly recommend you watch the presentation and read her post at The Atlantic on the same topic.
Her point got me thinking about something I wrote a couple of weeks ago. In my post on the 99% meme, I said this
… if I had decided to do a Philosophy PhD instead of being a consultant and had zero income, I would still have had the option to take a high-paying job. That option is a form of wealth, even if I had chosen not to exercise the option.
I’m starting to come to the view that what matters from the standpoint of living standards is not income, but wealth. But when I say that wealth is what matters, I mean to construe it extremely broadly. One of the problems with the market for antibiotics is that our over-consumption is reducing the chance that we will be able to purchase antibiotics in the future which successfully treat disease. Knowing how to make pills in large quantities that can successfully fight disease is one of our most valuable assets, but the consumption of antibiotics reduces the value of that asset by increasing resistance. It’s capital depreciation.
Can you really imagine a world without bankable, go-to antibiotics? Here are some of the consequences Megan lists
- Without antibiotics, there would be very little elective surgery. Before sulfa drugs, surgery was a very serious business with a high risk that a patient might die of some complicating infection.
- Without antibiotics, forget organ transplants. The immune suppression would almost certainly be fatal in a pretty short time period. HIV would also be more dangerous.
- Without antibiotics, retirements would get shorter again. Before antibiotics, the average 60 year old who caught pneumonia was more likely than not to die of it than not. That’s why they used to call pneumonia the “old man’s friend”. Nor is pneumonia the only potential killer.
- Without antibiotics, maternal mortality would be a lot higher. So would mortality from abortions, dramatically. While backalley abortions were horrible, and did kill people up until legalization, the theatrical figures thrown around by the pro-choice movement were mostly due to the lack of antibiotics, not the butchery of the freelance abortionists. Between 1936 and 1960, the number of deaths from abortions seems to have fallen by something between 80-95%. Looking strictly at mortality, you’d probably be much better off getting an illegal abortion with antibiotics than a legal one without.
- Neonates would also be much more likely to succumb to infection, since their immune systems are underdeveloped.
- Chronic infections can lead to various sorts of cancer (H. Pylori, the bacteria that causes ulcers, also causes stomach cancer). These would take more people before they got Alzheimer’s.
- The severely disabled would have much shorter life spans. Without antibiotics, there would be no way to treat the bed sores, or the lung and urinary tract infections that are common for people with limited sensation or mobility.
- Strep and its evil cousins, scarlet and rheumatic fevers, would once again be a major killer and disabler of children.
I’d also add onto that list the fact that a reduction in infectious disease-fighting capital has consequences for one of humanity’s most successful innovations for increasing productivity and living standards: cities. The intermingling and interbreeding of ideas, the relative ease with which you can build organisational capital, sufficient economies of scale for niche goods and activities that small numbers of people value very highly… all these things and more cities bring to the world. But if that world is without antibiotics, cities become a relatively more dangerous place to live*. And that is not good for our future economic prospects.
Wealth of this kind cannot be measured, and ‘assets’ of this kind cannot be identified as anything other than abstract entities; theoretical leftovers of grossly simplifying economic models of reality. But that does not mean that they aren’t some of the most valuable assets we have. Thinking about wealth more broadly is, I would claim, a necessary condition of correctly identifying where our energies ought to be directed when it comes to evaluating and agitating about public policy.
*Think of it this way, cities might still increase our productivity, but city dwellers would be subjecting themselves to massive tail risks