Since their discovery in 1928, antibiotics have saved millions of lives. However, due to misuse or excessive consumption, e.g. for only minor illnesses, and use in large-scale livestock farming, the development of antibiotic-resistant bacteria is increasing steadily simultaneously. This constitutes one of the most important global challenges in healthcare today. Every time antibiotics are used, the personal benefit - fighting a (mild) bacterial infection - conflicts with the collective benefit - maintaining the effectiveness of antibiotics. Researchers at the University of Erfurt and the Bernhard-Nocht-Institute have investigated this social dilemma in a project funded by the German Research Foundation together with the Universities of Vienna and Copenhagen. For this purpose, a new behavioral game was developed in which the role of social information in antibiotic use can be explored.
The study, in which Prof. Dr. Cornelia Betsch and Dr. Lars Korn from the University of Erfurt and the Bernhard-Nocht-Institute were involved, is based on the assumption that when people decide to take antibiotics, they are often unaware that antibiotic resistance can increase as a result of their behavior and that they may potentially harm the community. In addition, there is usually a lack of information on the instances in which other patients are taking antibiotics, he said. Social information of this kind, however, could reduce the overuse of antibiotics - the researchers hypothesized - by reducing uncertainty, clarifying the social consequences of actions, and increasing trust among each other that everyone is making an effort to protect the effectiveness of antibiotics.
To answer the questions of whether antibiotics are overused even when the underlying social dilemma is known, and whether the decision to take an antibiotic is indeed influenced by social information, the researchers conducted a laboratory experiment with more than 270 participants. They used the recently developed game "I-Resist". Behavioral games are simplified but precise abstractions of social situations in which decisions - unlike in thought experiments - have real consequences. In the I-Resist game, pairs of participants played with each other over ten rounds. They had 60 seconds per round to solve certain tasks. For each completed task, they received 0.20 EUR. In each round, the players " became ill " with a mild or a severe disease. A mild illness reduced the amount of time they had available to solve the tasks by 50 seconds, while a severe illness reduced the amount of time they had available by the full 60 seconds. By taking a medicine, the entire time could be restored and thus more money could be earned. However, after ten times of taking the drug within one game, the drug lost its effectiveness.
The subjects performed the game under two different experimental conditions: without social information or with social information. In the latter, they received feedback after each round about the severity of the other player's illness and their decision to take the medication. However, they also knew that the other player was receiving the same information about them.
The researchers came to a surprising result: even when the study participants were aware of the social dilemma, antibiotic use was more likely to be associated with a selfishly motivated overuse of the drug. However, when individuals were aware of each other's medication use, overuse decreased. The researchers conclude that individuals are more likely to enter into a social contract - in the sense of restricting medication use for the good of society - if they share their use decisions with each other. Thus, the presence of social information could help increase trust and feelings of fairness and motivate increased sharing. Cornelia Betsch, a professor of health communication at the University of Erfurt, concludes, "For political health campaigns, these study results lead to the recommendation that while education about resistance is important, we also need a social understanding that everyone should cooperate in not wasting the important medications and that sick people should refrain from taking them unless it is urgently medically necessary."
The study Behavioral determinants of antibiotic resistance: The role of social information was published in the peer-reviewed journal Applied Psychology: Health and Well-Being: https://iaap-journals.onlinelibrary.wiley.com/doi/10.1111/aphw.12345