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Letter From The Editor: Antibiotic Resistance

Opinion

You do not have to always agree with Marion Nestle to admire her skills as a communicator.

One tactic she has used lately is to lay out a few facts with some questions to get her many readers thinking and commenting.

And I’m not above stealing a good idea.

Class, the topic I’d like you to address this week is antibiotic resistance.

Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic.

Antibiotics are integral in the treatment of many foodborne diseases, making this an important issue for the food safety community.  According to the Infectious Diseases Society of America (IDSA):

-Antimicrobial resistance is recognized as one of the greatest threats to human health worldwide.

-Drug-resistant infections take a staggering toll in the United States and across the globe. Just one organism, methicillinresistant Staphylococcus aureus (MRSA), kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease, and homicide combined.

-Nearly 2 million Americans per year develop hospital-acquired infections (HAIs), resulting in 99,000 deaths – the vast majority of which are due to antibacterial-resistant pathogens.

-Two common HAIs alone (sepsis and pneumonia) killed nearly 50,000 Americans and cost the U.S. health care system more than $8 billion in 2006.

-Based on studies of the costs of infections caused by antibiotic-resistant pathogens versus antibiotic-susceptible pathogens, the cost to the U.S. health care system of antibiotic resistant infections is $21 billion to $34 billion each year and more than 8 million additional hospital days.

-Antibiotics are becoming less and less effective, in part due to over-prescription and inappropriate use.

-New antibiotic development has slowed to a standstill due to market failure and regulatory disincentives.

If I am reading scientists correctly, there are multiple theories for antibiotic resistance and agreement that some occurs naturally in the environment.   Some of these theories involve antibiotic uses by both humans and animals.

Yet, is it just me,  or is antibiotics used in animal agriculture the only thing we hear about when antibiotic resistance comes up?

Last week we had ten U.S. Senators demanding that more antibiotic sales data be extracted from agricultural businesses and then patting themselves on the back for their less than profound suggestions being the “beginning of the process of addressing the issue of antibiotic resistance.”

Now I know all ten are egotistical blowhards, but if collecting more data about agricultural uses of antibiotics is the “beginning,” then we are in trouble.

Am I wrong to look at antibiotic resistance as a big circle with animal issues maybe involving a 25 percent slice with lots of other unknowns out there?

Who’s articulating an overall scientifically-based strategy?  People are drying in hospitals every day over antibiotic resistance, shouldn’t somebody be taking this seriously?

Also color me suspicious, but when U.S. Senators are questioning the use of “disease prevention” treatment for sick farm animals, might there not be some other agendas at work here?  (Okay, that was more of a statement.)

I just have this feeling that allowing animal diseases to go untreated would not contribute to food safety.

Antibiotic resistance is complex issue.   Help direct our coverage by suggesting people we should talk to and places we should go.  Where’s the cutting edge research being done?

This is not just some problem on the farm we haven’t solved.  It’s bigger, broader, and more complex.   Now, please submit your answers.

© Food Safety News
  • NYFarmer

    I also like Dr. Nestle’s approach with the Q and A. As a working dairy farmer I have found the coverage on the issue to be “dumbed down” black or white coverage. In 40 years as a dairy farmer, I’ve seen antibiotics used in mature cows to treat a sick cow only. Calves are a different story..little calves may be fed medicated feeds. Some milk replacer formulas have an antibiotic additive and farmers occasionally use them if there is a reason. These cost more. The reasons for me might be…calf sickness spotted in a few calves, sickness in the neighborhood, etc. The BEST approach is always to avoid getting into it in the first place.
    Dairy is an area where milk is tested on the farm before going into the milk truck, it is tested and re-tested at the plant before going into process. Last year, some 3.2 MILLION tankers or milk were tested for presence of antibiotics, only 621 positive tests resulted and were dumped. Dairy farmers have been trying to get even better at managing how they use antibiotics to treat a sick cow. Webinars held on antibiotics management were booked solid, veterinarians have stepped up education and awareness to clients, farmers are reading labels in greater detail. A simple lab test called the Delvo test (pioneed by the Dutch I believe) is now available on just about every farm…from the 30 cow dairy down the road on up to the largest of NY dairy farms. This test can be used in the farmers dining room table to test the milk fast and accurately. Sure, there is more we can try to do, and we will, but I’ve outlined the practices of the average dairy farm in the Northeast (average 100 cows). Ask a cheesemaker or yogurt maker. Yogurt is big business in NY. Presence of antibiotics in the milk ruins the culture.
    NOW….turn to media coverage and organic dairy processor websites that scream…..80 percent antibiotics used in livestock…television shows showing photos of dairy cows implying that farmers routinely pump diary cows full of antibiotics. The Today SHow proclaimed in March of 2011 that milk was so full of antibiotics and hormones that you would not want to give it to teenage girls (Organic Valley quickly pushed that segment out on twitter and put it on their website). I have had total strangers accost me when I try to speak to the public about dairy accusing me of pumping the cows “full of antibiotics”, etc.
    So, how can we get to the truth when there is so much over-generalization and marketing spin out there?

  • Gail Cramer

    It is not treating sick animals that is the problem. It is the continued use of antibiotics in feed given to healthy animals that is a large part of the problem. No that is not the whole problem but don’t try to minimize the issue either.
    We continue to allow corporations to pile on antibiotics to try to up their profit with out regard to the health of the people eating the end product.
    Antibiotics should be banned from animal feed. Treat individual animals as needed for any illness but there is no excuse to blanket feed antibiotics to farm animals.
    If food animals are being held and treated so poorly as to cause all of them to become sick then the larger problem is treatment and handling of food animals and still we should not be blanket shoving antibiotics in to them.
    Antibiotics should also be removed from all cleaning products, hand soap, dish soap, laundry soap etc. It is not necessary and is only a marketing ploy to make people think they are being more “healthy”. Plain soap and water work just as well when used on a regular basis. Try teaching people to just wash their hands. It works.

  • Clayton

    The problem has been with flagrant overuse and abuse of antibiotics in human medicine (particularly pediatrics) here and abroad. The medical system desperately needs overhauling — it isn’t just cost of health care…that is merely a symptom of a health delivery system run amok. Sure, we should keep our thumb on antibiotic use in agriculture — placing these drugs under supervision by veterinarians is a good first step — but the problem with MRSA is a human problem, sourced from humans….however much angry anti-agriculture hacks would prefer to believe MRSA magically appears out in the back 40. Just try getting 10 senators to stand up to our moneyed health care juggernaut…in any meaningful way.
    Oh, and I don’t share your admiration for Marion Nestle. An elderly fanatic like her can only operate from the shelter of tenured professorship at a second-rate school like NYU. Her catty sophomoric pronouncements overshadow any academic accomplishments she may have (I don’t know of any) and make her appear long past due for retirement.

  • pawpaw

    Dan,
    See this link to a short explanation in Scientific American, also links therein: http://www.scientificamerican.com/article.cfm?id=antibiotic–in-food-animals
    The PEW Health Group has been taking this seriously for some time, and has thoughtful reports available, with specific recommendations. Worth reading their summaries, and even their reports and recommendations, whether you agree with them or not. Multiple links at PEW on this issue.
    6 years ago we moved from a hobby farm, bought a farm, and now are raising meats as a primary source of family income. Hence, we see nuances in this issue that are lost in political sound bites. For instance, INJECTABLE penicillin or oxytetracyline, to treat specific, occasional infection or injury is categorically different than constantly feeding low levels of antibiotics to all animals in a flock or herd, to increase weight gain and minimize widespread disease in close quarters. The latter strategy is much more likely to cause antibiotic-resistant microbial pathogens, because of constant exposure to the drug. My 25 years of teaching college-level microbiology also informs my opinions. If I read the reports correctly, up to 70% of all antibiotics used yearly are what’s included in animal feed, not to treat disease after the fact.
    Politician sound bites, as you note, are not the place to understand an issue. Few if any who want to restrict antibiotic use are arguing against treating sick animals. It’s the antibiotics in the daily feed at issue here, though the ag industry and its apologists obscure this.
    Here’s where some proposals on restricting antibiotic use are over-reaching and endanger any meeting of minds: Many farms are distant from their nearest vet. It would cost more to take our animal to the vet, or bring the vet here, than some animals are worth. So we reserve the right to stock injectable antibiotics on the farm, for timely and cost-effective attention. Again, we need to distinguish pinpoint treatment, which is the minority of antibiotic use, and much less likely to cause antibiotic resistance.
    Though my children are on the slim side of weight charts, enough that pediatricians have noted interest, we or our doctors have never considered feeding my children daily antibiotics to help them gain a bit faster. Why is it then, in many quarters, considered sound practice to constantly feed antibiotics to young and growing animals, almost until slaughter?

  • http://burningbird.net Shelley

    First, I have to defend the politicians behind the letter. This is an odd mix of people, and no specific agenda could be easily represented by the group.
    Secondly, the letter was signed by 13 Senators, and was, in my opinion, quite lucid and not unreasonable.
    http://foodpoisoningbulletin.com/2012/senators-urge-fda-to-strengthen-guidelines-on-food-animal-antibiotic-use/
    Back in a second comment with my opinion.

  • http://burningbird.net Shelley

    The WHO has a good page on antimicrobial resistance. It provides a comprehensive list on causes of this resistance:
    -inadequate national commitment to a comprehensive and coordinated response, ill-defined accountability and insufficient engagement of communities
    -weak or absent surveillance and monitoring systems
    -inadequate systems to ensure quality and uninterrupted supply of medicines
    -inappropriate and irrational use of medicines, including in animal husbandry
    -poor infection prevention and control practices
    -depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products.
    In the United States, various campaigns have been underway to address this problem, as detailed at the CDC:
    http://www.cdc.gov/drugresistance/campaigns.html
    The over-prescribing of antibiotics has been a news item for as long as I can remember, and the necessity of taking all antibiotics when prescribed has been emphasized to people for years.
    More importantly, implementing practices that enable us to avoid antibiotic use altogether have also been encouraged for years. How many times have we been told to wash our hands, and frequently?
    Research is underway on antimicrobial resistance:
    http://www.niaid.nih.gov/topics/antimicrobialresistance/Pages/default.aspx
    Part of this overall strategy is improving antibiotic use in agriculture. Most antibiotics in use today are being used on farms. We can’t ask people to change their daily lives without also demanding that farms change their daily procedures.
    Using antibiotics for growth purposes needs to be ended, now.
    Using antibiotics as a way of compensating for poor or insufficient agricultural practices also needs to end now. To use an analogy, antibiotic use on farms today would be equivalent to having children eat out of garbage pans and play in infectious disease wards–all without once washing their hands. Instead, they’d be given daily doses of antibiotics.
    Does this sound like an effective strategy for children? Then why is it an effective strategy for our food animals?
    Shoving too many animals into too tight spaces without a healthy environment and enough people to adequately care for them, and then using antibiotics to head off the inevitable diseases that result is atrocious animal husbandry.
    As the Senators noted in their letter, organizations such as the FDA need to provide clear, concise guidelines, as well as create and implement an appropriate monitoring and guidance plan.
    The FDA basically punted on antibiotic use. The Senators politely called them on it.

  • http://burningbird.net Shelley

    PS.
    I don’t want to come off as a Marion Nestle fangirl, but I pretty much like everything she does.

  • Sarah

    It is just too easy to leap to oversimplified conclusions about how and where drug resistant infections develop. Plus it is much too easy to frighten people with the specter of dreadful flesh eating monsters. Thus it is the perfect whipping boy of every anti-farm, anti-food, anti-technology, anti-progress crackpot to go ballistic over. It is a great fund raiser for money pits like PEW, HSUS, etc. Not to mention its obvious popularity among purveyors of faddish overpriced organic foods whose sales rely solely upon smearing their competition. Vacuous politicians find it a most convenient distraction from real issues of governance, like mending our wrecked economy or fixing our unaffordable elitist health care system. And there is the added job-securing benefit for pols and nanny-staters of urgently invoking larger and more intrusive government as the preferred remedy. So, so much more lucrative to cuff farmers around over imagined indiscretions than to wise up and get down to intelligent thinking.

  • Ted

    Thanks for the vitally important correction Shelley. Of course 13 egotistical blowhards generate more hot air than 10 egotistical blowhards (30% more, to be precise). Thanks also for warning us of your imminent return to break some more wind against common sense on this thread. We know we can count upon all of you to do what’s expedient to bash food and farming, even if it is not scientifically or ethically justified. OK, we’re braced so let ‘er rip!

  • Aubrey K.

    Touche, Dan.
    Once again, you’ve dared to expose a fundamental truth.
    There isn’t a lot of credible cutting-edge research implicating animal agriculture with any degree of statistical certainty. Why not? Probably because there is little funding for professional scientific research that most likely would exonerate “industrial farming” only to implicate nosocomial infections from within hospitals and outpatient clinics. Much better to speculate and smear than to risk an embarrassing indictment of the health care industry itself.
    Careful monitoring of epidemiologic trends in antibiotic resistant infections generally refutes the popular notion an unmanageable epidemic is spiraling out of control worldwide. Indeed, alarmist’s insistence America’s pets and domestic livestock must be deprived of antibiotic medicines amounts to a cruel draconian solution in search of a correspondingly catastrophic problem (but trying desperately not to search very hard). Doubt that? Plink around in the Resistance Map data and see for yourself:
    http://www.cddep.org/ResistanceMap/overview
    One reasonable caution — give yourself the benefit of a full and unbiased overview of the charts and tables instead of cherrypicking the 4 or 5 scary looking bar charts out of 400 or 500 total graphs.
    Without all the hyperbole of the lunatic fringe, the extent to which they demagogue this issue becomes readily apparent. And their various sick agendas are easily detected among their spastic hypochondriac outbursts. Have they developed resistance to valium or lithium therapy, do you suppose? At any rate, they do need to have their dosages adjusted.

  • doc raymond

    50% of antibiotics used in animals are not used in human medicine, such as ionophores used to prevent Coccidiomycosis in grow out facilities for poultry. Another 30% are in the tetracycline category, a category rarely used in human medicine any more. MRSA is a human health issue as a result of that bacteria developing resistance to nearly every antibiotic available, and PEW tries to link it to agriculture–but Methicillin is not used as a growth promotant or feed additive in feed animals.

  • FarmerGreen

    Devoting my spare time to animal rescue, I would like to point out one animal welfare impact of the push for “organic” dairy on the cows themselves. In my part of the country, any organic cow that receives even a single shot of antibiotics for sickness is required to thrown out of the herd. That generally means she is slaughtered..ie, a bullet in the head. The cow pays the price for this rule. Do consumers know? I’d far rather be a cow in one of the dairy farms where I would be treated with an antibiotic, if needed, keep segregated in sick bay and milk dumped out till lab tested clear, and then nursed back to health to rejoin the herd.

  • http://burningbird.net Shelley

    If, as so many of your commenters note, there is no relationship between antimicrobial resistance and agriculture, than what the Senators asked for should, indeed, prove so. They should encourage the good Senators efforts.
    However, we already have at least one proven example where antimicrobial resistance was passed from hog to human–and I really doubt the incident was isolated. So for the rest of us, asking for a reduction of antibiotic use is a fair request. Bluntly, asking for a return to good animal husbandry is more than a fair request, and not just because of antibiotic use.
    “FarmerGreen”, I find it unlike you work with animal welfare. If you did, then you’d know that all milk cows eventually get sent to slaughter, and that this rarely involves a “bullet to the head”.
    Another typical FSN troll. Too many.

  • PFTM

    It is not true that FDA has not addressed this issue. They withdrew the approval for fluoroquinolones in poultry, placed strict limitations on their use elsewhere, and prohibited extrabel use of cephalosporins (these two classes among the three critically important classes per WHO along wiht macrolides). They devised a qualitative risk assessment for resistance at it relates to food safety, which is applied to all new animal antimicrobial applications, and is being used to evaluate all drugs in food animal production. They have published a document outlining the phasing out of growth promotion indications, and mandated veterinary oversight.
    Are they slow? Yes. But they have done nearly everything scientifically justifiable short of calling on everyone to join the vegan fast.

  • http://www.foodsafetyanalysis.com/introduction M. “Mike” Mychajlonka, Ph. D.

    The issue of antibiotic resistance is, indeed, serious, even though it has been discussed and debated for decades now. I agree that this issue stems not from the occasional treatment of farm animals with antibiotics but from continual law-dose antibiotic exposure. The way this world once worked, the many pharmaceutical companies who once operated in this country and elsewhere could be counted on to constantly produce new antibiotic entities. As antibiotic resistance developed to established antibiotics, the new entities found a ready market niche and supplanted the old. The result was that antibiotic resistance to “old” drugs did not seem so scary because we always had a “new” drug. Today, a business (pharmaceutics) hugely dependent upon international respect for intellectual property has begun to make the move to an area of the world (China) with little apparent regard for intellectual property. The prospect for “new” antibiotics is dicey at best. Research and researchers were both once highly valued for their ability to bring us the “future.” The perceived value of research and researchers (i.e., working for wealth) was diminished by the rise of deregulated financial instruments (i.e., shortcut to wealth), which promised to bring easy riches to everyone connected to them. That bubble collapsed in 2008, sending the world into a panic. Four years later, we are still feeling the aftershocks. Is it any wonder that discussions, like this one about antibiotic resistance, seem to have a post-apocolyptic feel to them? Will simply banning the agricultural use of antibiotics raise the cost of meat? It seems very likely. Is there a solution to this problem? Yes. Is it a simple solution? No. Is this world ready to return to a search for answers or is it still looking for the next shortcut? That is the question.

  • http://www.foodanimalconcerns.org Steven Roach

    Dan,
    You write for a food safety newsletter so it is no wonder that all you hear about is the contribution of animals to the problem. resistance in food does largely come from food animal antibiotic use. If instead you were the editor of a medical journal or a newsletter aimed at doctors, public health officials, etc then you would hear a lot more about hospital acquired infections. Nobody argues only address the animal side it is just that there is lot of room for improvement there – antibiotics used for non-medical purposes and no medical oversight of the use.

  • http://drbirdnotes.blogspot.com/ Dr. Gregory

    What most folks are forgetting in this discussion is that for food bearing animals, antibiotic use is highly controlled. There are guidelines in place that ensure that no residues are present in the meat, milk and eggs we eat. Further as the milk example given in the comments foods are tested for antibiotics and their residues. So, in essence US foods are clear of these substances.
    If we wait for animals to become deathly ill before using antibiotics, the use of antibiotics both in volume and strength of therapy will increase. The use of antibiotics by humans may prove to be a larger factor in resistance than is given in the news. Further study may prove this out.

  • http://Waronbacteria@blogspot.com John Symns

    The World Health Organization stated that antibiotics would be useless in the next few years. There is already totally drug resistant TB in at least three countries. There are many bacteria such as E Coli 104H4 that can only be treated with one antibiotic. It is time to get off antibiotics and go back to phage therapy. In the US Phage Therapy is already used on our food to kill bacteria. Until our there is a public outcry the drug lobbyist will have their way and we won’t see Phage therapy in this country.

  • http://burningbird.net Shelley

    Antimicrobial resistance isn’t the only issue with CAFOs.
    No matter how much we seek to bury our heads in the lagoon, this form of livestock management is not sustainable. Food safety is more than just pathogens–it’s also about enabling food systems that can healthily sustain people with minimum harm to an already overtaxed ecosystem, and in such a way that we maximize practices that work with the livestock, naturally.
    And we have to seriously consider what are sustainable forms of livestock, too.
    You can’t just pick and choose each issue and develop a cohesive plan that will last more than a year or two. It’s just not that simple.
    It’s not that simple for antibiotic resistance, and it’s not that simple for food safety.
    http://www.theatlantic.com/health/archive/2012/08/how-industrialized-farming-could-facilitate-pandemic-swine-flu/261356/

  • http://www.foodsafetyanalysis.com/introduction M. “Mike” Mychajlonka, Ph. D.

    Doc Raymond -
    You state that “ . . . MRSA is a human health issue” at the same time as you reject any link to agriculture because “ . . . Methicillin is not used as a growth promotant or feed additive in feed animals.” In a recent article [MBio (Jan/Feb 2012) Vol. 3(1) e00305-11], you will find the statement: “MRSA can be selected for by a number of broad-spectrum cephalosporins that are used in food animal production in the United States and Europe.” So, you don’t need to specifically feed animals Methicillin to generate MRSA. Resistance is cross-developed according to mode of action.

  • http://www.microharmony.com Susan Vintilla-Friedman

    Note that the FDA guidance of April 2012 recommends “phasing out the agricultural production use of medically important drugs and phasing in veterinary oversight of therapeutic uses of these drugs”:
    http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm299802.htm
    In other words, it is not seeking to ban the use of antibiotics to treat diseases in animals. And it is only a recommendation at this point.

  • Anita

    Pawpaw makes the same mistake most Americans seem to make: assuming that big is bad. Contrary to what nonfarmers like to believe, the larger farms tend to do a better job of manure management, as just one example.
    Most real farms have herd health visits by veterinarians at least monthly. Those are like well-child visits, not included in the number of visits to treat sick or injured animals. Many larger have their own veterinarians on staff. The animals are not lacking appropriate veterinary care. The farmers who do feed antibiotics do it according to carefully conducted research, in amounts indicated by the research. Nobody pumps their animals full of antibiotics. Nobody feeds antibiotics so they can cram animals into tight, dirty quarters. That is the stuff of fiction.
    I’ve been on a lot of farms, big and small; the only place I’ve seen animals in manure up to their knees or fed poorly or cared for poorly is on hobby farms, not real farms. I am not a farmer; I do not work for so-called big agribusiness. I grew up on an average size farm that is still an average size farm. I have two degrees in agriculture and know that productive farmers are well educated people with the same kind of values and families as the rest of us. It’s sad to see those who choose to farm as our grandparents did bash the more productive farms. I, for one, am thankful for our productive farmers; we need them to feed a growing population. I have seen how much farmers love their animals and their land, and do the best for them, regardless of the size of their operation.