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Are You a Victim of Farming's Drug Problem?

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The 2000s were go-go years for the microbe sector.

E. coli, Campylobacter, Salmonella and Listeria flourished in the food supply; S. aureus, S. pneumoniae and C. difficile gained footholds in hospitals and the community and Acinetobacter got all the way to Iraq where it threatened our troops.

But when the late Sen. Edward Kennedy introduced legislation to discourage the overuse of antibiotics (AB) responsible for life-threatening antibiotic resistance (AR) in humans 2007, it gained no traction.

"It seems scarcely believable that these precious medications could be fed by the ton to chickens and pigs," said the bill's background text. "These precious drugs aren't even used to treat sick animals. They are used to fatten pigs and speed the growth of chickens. The result of this rampant overuse is clear: meat contaminated with drug-resistant bacteria sits on supermarket shelves all over America."

antibiotic

Worse, when the FDA issued a directive in 2008 to ban non-therapeutic use of cephalosporin ABs in livestock-drugs also used in humans-to curtail resistance, irate lobbyists stormed Capitol Hill and the Bush administration backed down.

But now, with a new administration and Congress seated, Kennedy's bill has a House version, support from 300 organizations including the American Medical Association, American Public Health Association, American Academy of Pediatrics and American College of Preventive Medicine-and a good chance of passage.

The Preservation of Antibiotics for Medical Treatment Act (PAMTA) sponsored in the House by Rep. Louise M. Slaughter (D-NY)-who has degrees in both microbiology and public health-would phase out non-therapeutic use of "medically important antibiotics" in livestock and strengthen standards for approval of new livestock ABs while still allowing their use in sick animals. Eighty-four percent of grower-finisher swine farms, 83 percent of cattle feedlots, and 84 percent of sheep farms currently use ABs non-therapeutically says the bill. Seventy percent of ABs are fed to livestock not people in the US.

Many people who've rented apartments in large complexes know the resistance problem first hand. Monthly visits from the exterminator don't mean you have no bugs-they mean you have bionic bugs-on top of pesticide exposure!

Nor is veterinary use the only resistance culprit. ABs are also abused by hospitals, clinics and doctors to prevent infection and to "treat" a virus when patients, especially parents of young children, want the psychological assurance of a pill. Even AB hand sanitizers and laundry detergents contribute to resistance, as do natural AB treatments like tea tree oil. In fact AR might be the ultimate biological demonstration of the principle, "That which doesn't kill you makes you stronger."

Europe banned human-use ABs in livestock in 1998 and all non-therapeutic ABs in 2006, making it a test kitchen for AR reduction-especially Denmark, the world's largest pork exporter. In Denmark, AB use is down 51 percent and bacteria and AR bacteria are also down, says the Pew Campaign on Human Health and Industrial Farming, with no increase in the cost of meat. Sweden, Norway and the Netherlands have also reported AR reductions as has Australia.

Reductions of AB use are also underway in European hospitals like Norway where testing and isolating patients with MRSA (methicillin resistant S. aureus) and prescribing fewer ABs has brought down the AR rate, according to an in-depth AP report. Similar successes with screening for S. aureus upon hospital admission were reported by the New England Journal of Medicine in January.

On the surface, a bill addressing AR infections which kill 70,000 in the US a year-19,000 from MRSA alone-and could return us to pre-AB medicine circa 1908- once we use our "last bullet"-looks like a no brainer. That's why the Animal Health Institute (AHI) and newly merged Pfizer/Wyeth (Fort Dodge) and Merck/Schering-Plough (Intervet) animal drug giants are lobbying so hard against it. In fact PAMTA may be the only bill that pits veterinarians against doctors!

ABs aren't causing AR says agribusiness and even if they are, we're not using human drugs and even if we're using human drugs, we're cutting down on them and even if we're not cutting down on them, the drugs are FDA approved and undergo vigorous risk assessment in a parody of defenses that includes everything but denial of using ABs in the firs place.

Actually, agribusiness' use of ABS increased by 13 percent from 2006 to 2007 according to the AHI-to offset "high grain prices" and "capture both the economic efficiencies and the health benefits derived from the use of these products." Those "efficiencies" included ten million pounds of tetracycline fed to livestock in one year.

In addition to worrying about Rep. Slaughter, agribusiness worries about the public health bent FDA is taking under its new directors, Commissioner Margaret A. Hamburg, MD, a former New York City health commissioner and Deputy Commissioner Joshua Sharfstein, MD, the number two officer and a former food safety staffer for Rep. Henry Waxman (D. CA). Especially since Sharfstein announced FDA's support of PAMTA at a House Rules Committee on the legislation in June, without even briefing agribusiness.

"You deliberately tried to blindside some of us on this committee, and we don't appreciate that," said Rep. Leonard Boswell (Dem. IA) to the FDA's new senior adviser on food safety, Michael Taylor after determining that Sharfstein's remarks had White House Office of Management and Budget seal of approval. Boswell, who was chairman of the House agriculture subcommittee on livestock last year, was the only pro-AB voice at the PAMTA rules hearings.

ABs are popular with Concentrated Animal Feeding Operations (CAFOs) and lucrative for agribusiness for two simple reasons: Less Space and Less Feed.

Raising turkeys without ABs "would result in a decrease in density or an increase in the amount of land needed to raise the additional turkeys needed to meet the consumer demand," said National Turkey Federation's Michael Rybolt at the 2008 cephalosporin hearings, admitting ABs enables crowding. It would create greater feed needs, "an increase in manure" and tie up more land for crop production said Rybolt.

While ABs do squeeze more nutrients out of feed by killing gut bacteria, causing "growth" say scientists, a Johns Hopkins University study in Public Health Reports in 2007 found their cost cancelled out profits for chicken farmers.

Evidence of AR infections-urinary tract, intestinal, upper and lower respiratory, ear, skin, even TB and STDs-is not hard to find in hospital and community. In fact, MRSA was reported plentiful on Florida swimming beaches at the American Association for the Advancement of Science annual meeting in 2009.

ABMs are also found in ground water, soil, and in crops and workers near manure lagoons and industrial farms and are in many of the foods we eat. Consumer Reports found over 60 percent of microbes detected in chickens from 22 states were resistant and an FDA inspection found cephalosporin directly injected directly into eggs at a US hatchery. Bon Appetit.

But don't look for many new ABs in the pharmaceutical pipeline. There's less money in developing drugs taken for 10 days (unless you're an animal) than in heart, arthritis, diabetes and psychoactive meds taken for life. And recent AB development disasters- Ketek (black boxed for hepatotoxicity) Trovan (severely restricted for hepatotoxicity) and Zyvox (part of the biggest fraud settlement in US history)-don't raise hopes.

Of course there are other ways to attack bacteria. Scientists are looking at algeliferin, isolated from sponge, which can break down bacteria's biofilm, radiation, ultrasound, chlorine dioxide and ammonia (reported to produce E. coli laced "pink slime" for the school lunch program by the New York Times last month.)

Scientists are even talking about seraticin, an AB isolated from the secretions of maggots from the common green bottle fly. And bacteriophages, intracellular parasites that multiply inside bacteria like viruses, a "new" therapy discovered in...1915.

Martha Rosenberg is a columnist and cartoonist, who writes about public health

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