At the end of an ad set to air during Super Bowl XLIX, a scantily-clad supermodel takes a bite out of Carl's Jr.'s new "All-Natural" hamburger. Bold letters flash across the screen: No Antibiotics.
The risqué nature of the commercial has triggered some controversy, but perhaps not as impassioned as the debate that continues over the widespread use of antibiotics by livestock producers -- and the role the practice may play in rising rates of antibiotic-resistant infections in humans.
"This ad tells you that Carl's Jr. sees this as enough of a mainstream issue," said Michael Hansen, senior scientist with Consumers Union, the policy and action division of Consumer Reports. "They're realizing that this is something people want and not just something that a bunch of activist, doomsday folks are trying to push."
Brad Haley, chief marketing officer for CKE Restaurants, the parent company of Carl's Jr., confirmed Hansen's hunch: "We sell what people want to buy."
The new burger, made from free-range, grass-fed cattle that are never exposed to antibiotics, steroids or added hormones, is a "revolutionary thing" for the fast food industry, said Haley. "The research clearly points to this being something of greater and greater importance to upcoming generations," he added, noting sales of the burger have "exceeded projections" since its debut six weeks ago.
The World Health Organization, U.S. Centers for Disease Control and Prevention and other scientific experts warn that the misuse and overuse of antibiotics in both humans and animals is posing a dire threat to public health. Twenty-three thousand Americans die every year from pathogens that were once easily treatable, but can now withstand modern medicine's full arsenal of antibiotics.
Overall, cattle, swine, chickens and other livestock receive about three-quarters of the nation's antibiotics -- with most of those drugs administered in low concentrations to prevent the spread of disease or to simply to promote growth. Just as an incomplete course of antibiotics can result in the rise of a more virulent infection in a person, this sublethal use in animals means bacteria that can withstand the drugs will survive, reproduce and pass on their resistance to the next generation of bugs on the farm.
Industry representatives argue that just because food animals consume the bulk of antibiotics, responsibility for the human health problem doesn't necessarily rest on them. Emerging research, however, does suggest that animal antibiotics may affect human health via multiple pathways: direct or indirect contact with food, water, air or anywhere urine or manure goes. Further, because bacteria can swap genetic traits, even farm use of antibiotics not considered important in human medicine could promote cross-resistance to the more critical drugs.
A study published last week builds on evidence of the mobility of bacteria, antibiotics and those swappable bits of DNA that code for antibiotic resistance. Researchers found that all the contaminants hitched rides on windblown dust from beef cattle feedlots.
"It doesn't imply that it causes the spread of antibiotic resistance," said Phil Smith, an expert in terrestrial ecotoxicology at Texas Tech University, and co-author of the paper. "But it certainly makes you wonder about the possibility."
Tara Smith, an expert in infectious disease and antibiotic resistance at Kent State University in Ohio, was not surprised by the new findings. Her own research has detected the airborne spread of bacteria, and has linked proximity to feeding operations with an increased risk of methicillin-resistant staphylococcus aeureas, or MRSA, infections.
This dispersal may even extend to a neighboring farm raising pigs, chickens or cattle without antibiotics. "There are still a lot of ways that even meat products not raised with antibiotics could be exposed to antibiotic-resistant bacteria," said Smith. Research by Hansen's team at Consumer Reports found chicken labeled antibiotic-free carried about as much bacteria as conventional meat, although far fewer of the bugs were resistant to antibiotics.
"We really need antibiotic-free from the farm to the fork," added Smith.
The U.S. Food and Drug Administration currently offers voluntary guidance to the pharmaceutical industry on the use of antibiotics in livestock, including a request that drugmakers change their labels by December 2016 to exclude uses for growth promotion. It has not yet imposed a ban or mandatory restrictions.
Jonathan Kaplan, director of the food and agriculture program for the non-profit Natural Resources Defense Council, is among critics who point to a potential loophole in the voluntary plan. While a company might stop feeding healthy animals low doses of antibiotics directly for growth promotion, they could still add the drugs to animal feed under a different label -- under the pretext of illness prevention.
"Unfortunately, consumers are leading the FDA on this issue," said Kaplan.
A budget proposal released by the White House this week follows the same weak federal formula, at least from the agricultural side, Kaplan and other critics say. The 2016 plan doubles the funds to tackle antibiotic resistance, allocating money for improved antibiotic stewardship in hospitals, the development of new drugs and diagnostics, and even increased investments into the FDA's phase-out of medically-important antibiotics from use in food animals. But critics complain that the plan includes no sign that the federal regulator will actually require significant antibiotic reduction or compel antibiotic-use reporting by the livestock industry.
"Investing in stewardship, surveillance, and developing new antibiotics is important, but we must address the most significant cause of antibiotic resistance -– overusing antibiotics in agriculture," Rep. Louise Slaughter (D-N.Y.), the only microbiologist in Congress, said in a statement. "If the FDA continues to allow industry to police itself under a voluntary policy, the misuse will continue to create superbugs that even new antibiotics may be unable to treat."
Kent State's Smith agreed. "Without a mechanism and regulations to actually force any hands," she said, "it's just lip service."
Experts and advocates also agreed that consumer demand alone may continue to prove a powerful force. Whole Foods and Chipotle are among a growing number of grocery and restaurant chains that offer antibiotic-free meat options. (An "antibiotic-free" label doesn't always mean that no antibiotics were used in raising the animal, although products from Whole Foods and Carl's Jr. do meet the U.S. Department of Agriculture's "never ever" designation.) McDonald's is currently facing pressure to follow suit.
"The public is going to have to demand this for their own sake," Slaughter told The Huffington Post in October. "Your government is not going to protect you."
"As demand increases from consumers, and as other restaurant chains and grocery chains introduce products, then producers will devote more and more production to all-natural items," added Haley, noting that limited domestic production drove his company to Australia in order to find enough antibiotic-free beef for the new Carl's Jr. burgers.
"Super Bowl Sunday, and any other time you reach for a product raised without antibiotics, you are sending a powerful message back to the industry," said Kaplan. "And it's making a difference."
Regardless of whether it's labeled antibiotic-free, Kaplan advised always taking extra precautions when handling, storing and cooking meat. The USDA just released detailed recommendations on the preparation of chicken wings and other popular big-game foods in time for Sunday.
"You have to assume that any raw meat you bring home is contaminated with bacteria," Kaplan said, "and probably antibiotic-resistant bacteria."