therapies used to treat them, present a major threat to current and future medical advances (Neu, 1992; Murray, 1994; Tomasz, 1994). Resistant bacteria causing global concern include multi-drug-resistant Mycobacte rium tuberculosis, penicillin-resistant Streptococcus pneumoniae, and methicillin-resistant Staphylococcus aureus (Neu, 1992; Tomasz, 1994; Cox et al., 1995). The effects of antimicrobial resistance (AMR) are documented in developed and developing nations alike, although arguably with greater potential for harm in the developing world, where many of the second- and third-line therapies for drug-resistant infections are unavailable, and many of the narrow spectrum antimicrobials available in the developed world are not affordable (Fasehun, 1999; Smith, 1999). However, despite increasing awareness, across both the medical (Levy, 2002) and lay communities (Cannon, 1995), of the rising prevalence of resistance, there is little evidence that the use of antimicrobials is changing.
The potential impact of this increasing antimicrobial resistance on health care expenditure and population morbidity and mortality is causing professional, government, and public concern (House of Lords Select Committee on Science and Technology, 1998; Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance, 1998; American Society for Microbiology, 1995; OTA, 1995; World Health Organization [WHO], 2001). Indeed, the United States considers the potentially destabilizing economic and social effects of antimicrobial resistance, as well as its potential in biological warfare, sufficient to classify antimicrobial resistance as a national security risk (Kaldec et al., 1997; CIA, 2000; World Bank, 2001).
Economics is based on the fundamental premise that our resources (goods, services, time, raw materials, and all else that we use to make something else) are limited compared to what we want from them (which is virtually unlimited). On a personal level this means that one’s time and wealth are limited compared to what we would like to be able to do. Nationally, this also applies, with national resources limited compared to what they could be used for. At all levels this means that choices have to be made. As individuals we have to choose whether to have a new car or holiday, or spend time working or playing golf. Nationally, we have to decide whether to have more health care, more education, more defense, or more consumer items. Economics then is fundamentally the study of choice.
However, there are other disciplines that study choice, such as psychology and sociology, so what makes economics special? The “angle” of economics is that choice is studied from the perspective of efficiency. That is, that economists study choices that can be (have been) made with a view to assessing whether the most benefit will be (was) gained from the resources