Note: This is a revised version of an article originally authored with Dr. Robert Gould and just published in a medical publication -- bios and source information below.
By Robert Gould and Steve Heilig
"Centers for Disease Control sounds alarm on deadly, untreatable superbugs," USA Today, March 2013
"Study shows bacteria moves from animals to humans," New York Times, March 2013
As soon as antibiotics were discovered and developed for medical use, bacteria began the Darwinian "arms race" that has been fought ever since, with pathogens developing resistance to antibiotics, necessitating continual development of new types of medications and increasingly difficult infect agents arising with increasing regularity. Some of the most informed experts have been warning that humans are now starting to lose more of these battles every year. The specter of untreatable and virulent outbreaks, local or pandemic, increases with each decade; as a review put it a decade ago, "Antimicrobial resistance has reached crisis stage in human medicine."
Physicians have increasingly been educated and urged to be judicious in antibiotic use for many years now, with increasing success. But as it turns out, up to 70-80 percent of all antibiotics produced -- certainly more than half, at a minimum -- are in fact used in farm animals to get them to market quicker and bigger. As it also turns out, this continual, low-level use is a perfect way to breed resistant strains, which can then find their way into humans. Reports on this potential threat appeared as long ago as 1976 in the New England Journal of Medicine -- and government panels set up make recommendations on the threat were tainted by industry-linked scandal from the start.
A decade ago, a coalition of concerned medical and public health organizations convened a meeting at the San Francisco Medical Society (SFMS), co-chaired by UCSF Chancellor Emeritus Phil Lee, M.D. and the late Lester Breslow, M.D., Dean of the UCLA School of Public Health and past-president of the American Public Health Association. Spurred by an SFMS-initiated policy adopted by the American Medical Association urging less use of antibiotics in agriculture, the assembled group developed strategy to move such policy forward. We weren't just "outsiders" to agriculture; even the editor of California Farmer, the state's leading agriculture journal, attended the meeting and then editorialized: "We call on producers and vets to stop overuse of all antibiotics ... Antibiotic resistance is a wake-up call that ag must answer."
A subsequent editorial in the Western Journal of Medicine by Lee, Breslow, and Heilig concluded:
Leading experts unequivocally state that our current practices of feeding antibiotics to animals goes against "a strong scientific consensus that it is a bad idea" and that the long stalemate on this issue constitutes a "struggle between strong science and bad politics."
The intentional obfuscation of the issue by those with profit in mind is an uncomfortable reminder of the long and ongoing battle to regulate the tobacco industry, with similar dismaying exercises in political and public relations lobbying and even scandal. As with tobacco control, science and health concerns should take precedence over profit in regulating the overuse of antibiotics in the production of meat and other agricultural products. Antibiotics do have a place on farms, but the benefits of their use can likely be preserved while minimizing harm. We need to learn more about the extent of risk, but the delay tactic of allowing current practices to continue while "more research" is conducted is unacceptable. Enough is already known to justify a more cautious, preventive approach.
Momentum was being gained. Based on the growing scientific evidence and policy statements such as the AMA's, the European Union recommended a ban on the use of non-therapeutic antibiotics in livestock production in 2006, a policy still being implemented. Alas, that more science-based approach has remained elusive here in the United States -- but not for scientific reasons. It comes down to political power and the marketplace. Some of the pressure "consumers" can add by buying only meat produced without antibiotics will certainly help, but it should be admitted that broader and stronger regulations will still be necessary for real change. Still, big institutions can lead the way; locally, the University of California, San Francisco (UCSF) Academic Senate Coordinating Committee, the School of Pharmacy Faculty Council, and the School of Medicine Faculty Council unanimously approved a resolution to phase out the procurement of meat and poultry raised with non-therapeutic antibiotics at UCSF. The resolution also encourages all University of California campuses to do the same.
But again, beyond consumer pressure, much better regulation is warranted. Rep. Louise Slaughter (D-NY), the only microbiologist in Congress, has four times introduced the "Preservation of Antibiotics for Medical Treatment Act" (PAMTA), and did so again just after the CDC warning quoted at the top of this article. PAMTA would ban non-therapeutic uses of medically important antibiotics in food animal production. Also recently, a group of medical and public health leaders, including Dr. Lee and SFMS President Dr. Shannon Udovic-Constant, Kaiser's chief of infectious diseases Dr. Stephen Follansbee, and many others, wrote to political leaders to:
... require stronger reporting requirements for livestock antibiotic sales and distribution that can help illustrate current use patterns, explain resistance trends, and monitor progress in assuring responsible livestock antibiotic use. Such reporting would provide critical information to help track progress in reducing the inappropriate use of antibiotics and help target attention where it is needed.
The battle to reduce agricultural use of antibiotics continues. The stakes are high -- and may be even higher than before. We've previously stressed that this is not really an issue of personal dietary health -- the residue of antibiotics in our food has not been a primary concern. But as evidence that even the low-level antibiotics in our food and water can alter our gut flora -- our "microbiome" -- in unhealthy ways, even that perspective may need to change. The power of big money -- pharmaceutical and agricultural -- makes for a prolonged battle, as the profits in the status quo are huge. But if science loses in this case, humanity's fate may indeed be to end, as T.S. Eliot warned in another context, "not with a bang, but a whimper."
Dr. Gould is a professor at UCSF and President-Elect of Physicians for Social Responsibility http://www.psr.org/. Steve Heilig is a director of programs at both the San Francisco Medical Society and Commonweal http://www.commonweal.org/. This is a revised version of a piece appearing in the current "Food Policy" issue of San Francisco Medicine, the journal of the San Francisco Medical Society, online at http://www.sfms.org.
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