exacerbated by society’s chronic misuse and overuse of antibiotics. 16
Antibiotic resistance results when bacteria mutate, or acquire new genes, in
ways that reduce or eliminate the effectiveness of antibiotics. 17 The majority
of microorganisms, which have little resistance to the antibiotic, are
destroyed, while those with the highest resistance reproduce their genetic
information. 18 This process may occur until an entire bacterial species
becomes resistant to a certain antibiotic. 19
Alexander Fleming, the father of antibiotics who developed penicillin in
1928, had the foresight to warn against the misuse of antibiotics and predicted
the dangerous phenomenon of resistance. 20 In his 1945 Noble Prize
acceptance speech, he cautioned that, “the ignorant man may easily
underdose himself and by exposing his microbes to non-lethal quantities of
the drug that make them resistant.” 21 Then, in 1967, U.S. Surgeon General
William H. Stewart asserted, “[t]he time has come to close the book on
infectious diseases.” 22 Nearly half a century later, that book is still open
precariously wide. Moreover, the economic cost of antibiotic resistance is
steep. 23 Indeed, each day, policymakers fail to act, and it becomes more
difficult and increasingly expensive to address drug resistance in the future. 24
A. Factors Contributing to Antibiotic Resistance
Antibiotic-resistant organisms arise from many factors cumulatively and
cannot be reduced to a single cause. 25 Factors contributing to antibiotic
16. See STUART B. LEVY, THE ANTIBIOTIC PARADOX: HOW THE MISUSE OF ANTIBIOTICS
DESTROYS THEIR CURATIVE POWERS (2d ed. 2002); see also Ventola, supra note 4, at 277–283
(illustrating how a physicians’ tendency to over-prescribe and patients’ tendency to fail in
completing the course of treatment are two societal factors which have contributed to antibiotic
17. NATIONAL STRATEGY, supra note 8, at 4.
18. DAN J. TENNENHOUSE, 2 ATTORNEY’S MEDICAL DESKBOOK § 22: 24, Westlaw
(database updated Oct. 2015).
19. See Bacquero & Blázquez, supra note 12, at 484.
20. Alexander Fleming, Penicillin, Nobel Lecture (Dec. 11, 1945) in NOBEL LECTURES
83, 93, http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf.
22. See, e.g., Ross Upshur, Ethics and Infectious Disease, 86 BULL. WORLD HEALTH ORG.
654, 654 (2008), http://www.who.int/bulletin/volumes/86/8/08-056242/en/.
23. See BAD BUGS, supra note 1, at 10.
24. Press Release, Ctrs. for Disease Control & Prevention, CDC Year in Review:
“Mission: Critical” (Dec. 15, 2014), http://www.cdc.gov/media/releases/2014/p1215-2014-
25. INST. OFMED.FORUM ONEMERGINGINFECTIONS, 5 Factors Contributing to the
Emergence of Resistance, in THE RESISTANCE PHENOMENON IN MICROBES AND INFECTIOUS
DISEASE VECTORS: IMPLICATIONS FOR HUMAN HEALTH AND STRATEGIES FOR CONTAINMENT:
WORKSHOP SUMMARY 130, 130 (Stacey L. Knobler et al. eds., The National Academies Press