A Modest Proposal

For Preventing those Most Valuable of Medicines,

Antibiotics, from Being Lost to our Pharmacopeia, and for Job Creation too*

It is a melancholly Object to those who have received the benefit of a prescription of antibiotics to hear forecasts that antimicrobial resistance will result in 300 million premature deaths by 2050. Instead of grumbling about our sore throats or infected wounds for a few days before being returned to good health through the action of antibiotics, we will be entering (or rather, re-entering) an era where such seemingly insignificant problems could result in serious illness, disability, and even death.

I think it is agreed by all Parties that antibiotic resistance is a serious grievance to be forestalled as much as possible; and therefore whoever could find out a fair, cheap and easy method of preserving the incredible power of antibiotics would deserve so well of the publick, as to have his (or her) Statue set up for a preserver of the Nation.

But my Intention is very far from being confined to reducing antibiotic resistance; it is of a much greater extent, and shall take in the whole number of humans, all of whom at some point need a course of antibiotics.

As to my own part, having turned my thoughts for many Years, upon this important Subject, and maturely weighed the several Schemes of other Projectors, I have always found them grossly mistaken in their computation. It is true a sick individual will obediently take their prescribed antibiotics until they begin to feel better, at which point they decline, intentionally or by forgetting to consume the remainder of the course of medicine, leading their attacking bacteria to develop resistance to that antibiotic, not only in that individual but in individuals all over. It is exactly at the point of feeling better, a day or two into the course of treatment, that I propose to provide for people, in such a manner, as, instead of contributing to the plague of antibiotic resistance, they shall, on the Contrary, preserve their own health, the health of others, and the efficacy of antibiotics.

There is likewise another great Advantage in my Scheme, that it will enable the full employment of their fellow countrymen who, in some fields and occupations, have been displaced by non-human competitors such as computers and robots.

The question therefore is, how shall the ill be induced to take their full course of antibiotics and not to quit them until the bacterial agent is fully killed, unable to rise again more wily for its exposure to the killing agent?

I am assured by our researchers that education, entreaties, and reminders only go so far in inducing individuals to take their full course of antibiotics.

I shall now therefore humbly propose my own thoughts, which I hope will not be liable to the least Objection.

I have been assured by very knowing public health professionals that when the ill cannot be persuaded to act in both their own good and for the good of others that we may rely upon force, albeit of the least restrictive sort that will result in the desired outcome.

I do therefore humbly offer it to publick consideration that all individuals taking antibiotics be watched as they receive their medicines and that such checks (of their mouths, etc.) be made so as to ascertain that the antibiotics were, indeed, consumed.

[I have reckoned that, if an individual prefers, they might be allowed to be fitted with an intravenous port through which they might receive their antibiotics under the supervision of a medical professional.]

I grant that this program will be expensive, but it will ensure the proper use of antibiotics, preserving them for the generations to come.

This program will have one other Collateral advantage by necessitating the hiring of sufficient individuals so as to dispatch trained observers throughout the land in sufficient intervals to observe the use of antibiotics on the scheduled dictated by prescribing physicians.

Thus, rather than $100 trillion (£64 trillion) lost to the global economy by 2050 from antimicrobial resistance, this program will be a net boon to the global economy, in that it will requiring the employment of thousands of new members of the health profession.

Training of these individuals would not be arduous, and indeed, the task of directly observing the use of antibiotics could be done on a part-time basis, thereby making the position attractive to those individuals who for whatever reason are unable to commit to full-day employment.

It is not improbable that some scrupulous People might be apt to Censure such a Practice, (although indeed very unjustly) as a little bordering upon a public health over-reach, which, I confess, hath always been with me the strongest objection against any Project, how well soever intended. However, I think the advantages by the Proposal which I have made are obvious and many, as well as of the highest importance.

For first, as I have already observed, it would greatly the risk of antibiotic resistance, thereby saving lives both in the near and distance future.

Secondly, the employees who observe the use of antibiotics will be gainfully employed members of society, trained to care out a task that can only be conducted by a human, in that it may involve tact, cajoling, persistence, cleverness, kindness, or other human emotions.

Thirdly, Whereas it is conceivable that the task of directly observing antibiotic use could be carried out by some sort of non-human device such as a “drone,” it is also conceivable that a patient, if so inclined, could outwit an inanimate drone. Thus, the occupation of antibiotic observer is properly considered to be part of the “high-touch” professions that are more immune to being diverted away from human employees and to computers. Thus, this program would offer employment and hence a host of other socioeconomic advantages to currently underemployed humans.

Fourthly, the repeat visits by the antibiotic observers would relieve patients from the necessity of recalling when to take their medicine and would relieve sleep-deprived parents and other home-based caretakers from having to devote time and attention to recalling when to give their charges the next dose of antibiotics.

Fifthly, as the observers would always have access to additional supplies of medicine, this program would provide a solution for those situations in which a distraught toddler backhands the bottle of amoxicillin, spilling it everywhere and leaving too little to accomplish the prescribed dosing regime.

Sixthly, This would be a great Inducement (at least to those who do not wish to be observed taking their antibiotics) to cease begging healthcare workers for antibiotics even upon being told their ailment is viral. Furthermore, this population may well be induced to not seek medical care at all, thereby alleviating long wait times at emergency departments, urgent care centers, and doctor’s offices.

Many other advantages might be enumerated: for instance, the antibiotic observers may be able to, in their visits to patients, gain information that would be of use to other public health efforts: for instance, whether the patients smoke, drink sodas or eat unhealthfully, have smoke detectors, etc. But this, and many others I omit being studious of Brevity.

I can think of no one Objection, that will possibly be raised against this Proposal, unless it be that individual liberty will be circumscribed in the name of the common good. This I freely own, and it was indeed one Principal design in offering it to the World.

I am not so violently bent upon my own Opinion, as to reject any Offer, proposed by wise Men (or Women), which shall be found equally Cost-Efficient, Easy, and Effectual. But before something of that kind shall be advanced in Contradiction to my Scheme, and offering a better, I desire the Author, or Authors will be pleased maturely to consider two points. First, As things now stand, how they will be able to ward off the already-present, and evergrowing, threat of antibiotic resistance? And Secondly. I desire those who dislike my Overture, and may perhaps be so bold to attempt an Answer, that they will first ask those who are in need of antibiotics whether they would like to be left alone to take a non-working therapy or if they would prefer to take a viable, useful, and potentially life-saving therapy in the presence of an observer who may as well simply be considered to be a form of Friendly Visitor?

I Profess in the sincerity of my Heart that I have not the least personal Interest in endeavouring to promote this necessary Work having no other Motive than the publick Good of my Country, by protecting our antibiotic effectiveness, providing for the ill, employing the unemployed, and giving some company to the ill, who may well be homebound, shut in and lonely. None of my ailments are treatable by antibiotics, and I am not (yet) in search of a job.

*Too much cough syrup plus reading headlines about antibiotic resistance led me to channel Jonathan Swift.

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