We often keep them at home, perhaps leftover from a previous treatment. Antibiotics are precious drugs for treating bacterial infections: when used correctly, they can save lives and relieve symptoms of otherwise serious illnesses.However, these drugs must not be used carelessly. They require an informed approach that considers not only individual health, but also the health of the community: every improper use contributes to the selection of resistant strains — bacteria capable of surviving antibiotic action.
For this reason, November 18 marks the European Antibiotic Awareness Day, an opportunity to reflect on a crucial public health issue at the intersection of science and society.
To mark the occasion, we interviewed Professor Carlo Martini, Associate Professor of Epistemology and Philosophy of Science at UniSR, to understand how cognitive biases and deeply rooted beliefs can influence our awareness of how these drugs are used.

An Epistemological Question

Using antibiotics correctly does not simply mean following your doctor’s prescription — although that remains essential for treatment success. It also involves gaining awareness of improper use, often influenced by cognitive biases or distortions that guide our decisions, including healthcare choices.

So what are the cognitive distortions at play in our health-related decisions? This question is deeply epistemological in nature. Epistemology — from the ancient Greek epistḗmē, meaning “knowledge” — is the discipline that studies how knowledge is acquired and transmitted. Because it focuses on the transmission of knowledge, epistemology, and especially social epistemology, shows how what we believe we know is filtered through biases — the mental shortcuts that steer us away from rationality and influence our judgments and decisions — as well as through prejudices and preconceptions.

The Need to Do Something

According to Professor Martini, two factors make the misuse of antibiotics not only a medical issue, but an epistemological and philosophical one as well.

The first concerns the transmission of knowledge: scientific information on the proper use of antibiotics is often not communicated clearly to non-experts.
“The most emblematic case is the flu,” Martini explains. “It’s a viral illness that causes recognizable symptoms such as fever or sore throat, and people often — mistakenly — believe antibiotics can help. This makes it necessary to explain, for example, the difference between viral and bacterial infections, a crucial distinction for an appropriate treatment plan.”

The second factor involves cognitive biases, such as the illusion of control — the false belief that our actions can influence outcomes even when they have no real effect.
“We often think we can induce positive outcomes through actions that are not actually effective — as in the case of taking antibiotics for viral infections,” says Martini. Simply taking a drug can make someone feel they acted proactively and contributed to recovery, even if the healing was due solely to the body’s natural processes.

He offers a lighthearted analogy: pedestrian crossing buttons. Often, pressing the button doesn’t actually shorten the wait, but gives pedestrians the impression of activating something — a sense of control that makes the wait feel shorter.
“The same principle helps explain why some people take antibiotics even when they aren’t needed: the act itself provides comfort and reinforces the illusion of doing something helpful,” Martini notes. “This reflects a human need — the need to act. Even if the action brings no benefit, it makes us feel better, while doing nothing makes us anxious. That’s why people often take antibiotics believing they may help, even when they won’t.”

Thinking in Terms of Causality

Another factor influencing antibiotic use is personal experience with the drug.

A striking study shows that antibiotic misuse is often driven by patient expectations, shaped by previous experiences in which similar symptoms disappeared quickly thanks to antibiotics.
“Personal experiences accumulated over time can reinforce the mistaken belief that antibiotics are always necessary or always helpful,” Martini explains.
This cognitive distortion stems from an evolutionary mechanism that leads us to interpret events in terms of cause and effect.
“From childhood, we learn through experience and develop a tendency to see the world in terms of before and after, cause and effect,” he says. “But we often confuse simple correlation with causation.”
“So if I once took an antibiotic for a viral infection and got better, I may wrongly assume the drug was effective — when in fact recovery would have happened anyway as part of the natural course of the illness.”

Cumulative Effect and Externality

Taking an antibiotic often seems harmless or irrelevant.
“We think that, at worst, the drug will be useless, or we might experience minor side effects,” Martini says.
But when millions of individuals make the same choice, the impact on public health becomes urgent. This is the cumulative effect: small individual behaviors that add up to produce a significant collective outcome.

Each person's inappropriate or repeated antibiotic use contributes to bacterial resistance in the community, creating what economists call an externality — an effect (positive or negative) imposed on individuals who didn’t choose it.
In healthcare, the costs of resistance do not fall on the single patient who takes the antibiotic, but on society as a whole — over time.
“In other words, resistance becomes a problem only when many inappropriate prescriptions accumulate,” Martini explains.

The real challenge is learning to think cumulatively:
“We struggle to understand how a single action can contribute to collective harm,” he says. “Antibiotic resistance is the result of this cumulative effect. Every time we misuse antibiotics, we contribute — little by little — to the selection of resistant bacteria. On its own, it seems trivial; repeated millions of times, it becomes a global issue: infections become harder to treat, therapies less effective, healthcare costs higher.”

An Interdisciplinary Approach

Interview by Andrea Iotti