Of antibiotics and globalisation

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: to penicillin.

The antibiotic divide has been leapt on by some north Europeans as a stick for bashing feckless Latins. Flemish nationalists from the Dutch-speaking north of Belgium note that Europe’s antibiotic frontier runs right through their country, with French-speakers in the south consuming far more than Flemings. Belgians as a whole consume twice as many as their Dutch neighbours. Questions have even been asked in the Belgian parliament about how the kingdom ended up on the wrong side of a “Latin v Calvinist” divide.

Herman Goossens, a Flemish doctor who has also worked in the Netherlands, sees a cultural element to antibiotic use, but is wary of politically charged talk about pill-munching

Francophones. He notes that southern Belgium is also home to lots of former coalminers with chronic ailments. He prefers to talk of different attitudes to risk. In the Netherlands, if somebody has a nasty cold and their doctor gives them antibiotics, they will say “my doctor is a coward, he goes straight for the strong drugs,” says Mr Goossens. “That is very different in Flanders.”

Dominique Monnet, at the European Centre for Disease Prevention and Control, an EU agency, sees a link between drug use and a population’s tolerance of uncertainty. But he adds caveats.

Germany’s low use of antibiotics, for example, must take into account the popularity of alternative medicine, he says. One study found that 40% of Germans disliked antibiotics, fearing they weaken the body’s natural immunities.

And economic and structural factors cannot be ignored. Some countries require a doctor’s certificate for people off work with flu—and, while at the doctor, why not ask for a prescription? Some impose drug budgets on family doctors, which they may not exceed.

Expensive modern antibiotics are less often prescribed in ex-communist countries. Places like Belgium and France allow patients to shop around among doctors, so that those who refuse to prescribe may lose income. In Greece, Italy and Spain, it is shockingly easy to buy antibiotics without a prescription, and self-medication is popular. An undercover survey in Athens in 2008 secured antibiotics without a prescription in almost all the pharmacies visited.

The protectionist drug