Illustration by Peter Schrank

EUROPE'S leaders began 2009 in a spooked frame of mind, and not just because of wars over Gaza and gas. The street riots in Greece before Christmas left several fretting that conditions may be ripe for wider unrest, even a “European May 1968”. The French president, Nicolas Sarkozy, was so alarmed by his chats with fellow European Union summiteers in December that he went home and postponed a school reform that was sparking protests.

As unemployment rises, governments are sure to face calls to shield their voters with protectionist barriers to trade. Most EU leaders are sensible folk who know that such policies may look attractive to individuals but would harm the wider public. Whether they are brave enough to explain this to their voters is another matter. Even if they are, voters in some countries may refuse to believe them, taking the view that their rulers are liars, interested only in looking after themselves.

Without a crystal ball, it is impossible to predict where political trouble might strike. So Charlemagne has a suggestion. There has been much recent research into a public-health problem that shares some surprisingly similar features: the overuse of antibiotics. Consumption of these drugs varies strikingly across Europe, with Greeks, the heaviest users, taking three times as many as the Dutch, who use the fewest. Rather like trade protection, the popping of an antibiotic offers false comfort to individuals. In an anonymous 2008 survey, Greek paediatricians said that 85% of parents demanded antibiotics for children with the common cold virus. As with political debates over free trade, some people appear to suffer from a corrosive lack of trust when the authorities tell them that they are demanding the wrong thing. Even when told that antibiotics cannot fight viruses, 65% of Greek parents in the survey insisted they did until their doctors gave in.

Scientists talk of a broad north-south divide in Europe, with the Dutch, Germans, Scandinavians and Baltics consuming few antibiotics, but lots being guzzled in the Mediterranean. The main users are Greece, Cyprus, France and Italy, with Spain almost as high once illicit sales without a prescription are counted. Just as with trade barriers, pill-popping has bad side-effects. For example, in most north European countries, penicillin can deal with a common nasty, streptococcus pneumonia in all but 5% of cases. But in high antibiotic consumers like Cyprus, France and Spain, more than a quarter of cases do not respond 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

But above all, many experts come back to levels of anxiety, and intolerance for uncertainty, as a key driver of antibiotic demand. And this may explain one final correlation. A Eurobarometer poll last year asked Europeans whether globalisation offered an opportunity for economic growth. The map of the results is remarkably similar to the map of antibiotic consumption. Compare countries that use the most antibiotics with those most sceptical of the benefits of globalisation. Four of the top five match; and, at the other end of the scale, six of the bottom ten match. (America, a place addicted to interventionist medicine, would be near the top of an EU chart for antibiotic use: it is also a country currently wrestling with strong protectionist instincts.)

Yet this correlation also gives grounds for hope. Education and transparency work wonders in reducing antibiotic use: public information campaigns in France and Belgium have been notably successful. Cultural differences cannot be erased altogether: some societies will always be more trusting or anxious than others. But trust can be built. Many forms of protection are illusory, and may harm your family and neighbours. Those in authority should explain this, whether it is a popular message or not.