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FDA not doing enough to combat increase in antibiotic-resistance from overuse of antibiotics in livestock

Avinash Kar

Posted May 3, 2011 in Health and the Environment

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We’ve all heard or read at least one disaster story about. infections in hospitals—someone goes to the hospital to get treated for something minor, but then ends up dramatically more sick from an infection they got at the hospital, one that spread because it was resistant to antibiotics.  This is scary enough, but what about getting that same infection from handling meat? 

A recent study sampled 136 samples of meat and poultry and found an astounding 47% of them contained antibiotic-resistant strains of Staph. bacteria, and that overall almost 25% of the 136 samples contained Staph. bacteria resistant to 3 or more antibiotics.  Of course, scientists have known for a long time that meat sold at retail is routinely infected with antibiotic-resistant bacteria, such as Salmonella and E. coli—for example the highlights of the latest Meat Annual Report from the National Antimicrobial Resistance Monitoring System point out that 38% of chicken breasts and 51% of ground turkey samples tested contained strains of Salmonella bacteria resistant to 3 or more types of antibiotics—but the new study emphasizes yet another dimension of the problem: that our food exposes us not only to drug-resistant strains of bacteria like Salmonella that cause food-borne sickness, but also to drug-resistant strains of bacteria such as Staph. that can cause other kinds of diseases.* 

Recently, I blogged about the introduction of a bill in Congress to eliminate use of antibiotics in animals that are not sick—that is, the routine and low-level use of antibiotics for promoting faster weight gain and preventing diseases associated with crowded, unsanitary conditions.  Such nontherapeutic uses are linked to the rise of antibiotic-resistant bacteria that imperil our health.  A person who becomes sick because of antibiotic resistant bacteria becomes that much harder to treat with our current toolkit of antibiotics and thus faces greater health risks.  In some cases, treatment is no longer possible.  Just as an unfinished course of prescribed antibiotics poses a greater risk of creating superbugs resistant to antibiotics, low level or suboptimum doses of antibiotics used in livestock production pose a greater risk of creating antibiotic resistance in bacteria—essentially, what doesn’t kill them, makes them stronger. 

Groups like the World Health Organization (WHO) and the US Centers for Disease Control (CDC) have recognized growing antibiotic resistance in bacteria as a major public health threat.  The CDC calls antibiotic resistance one of its “top concerns.”  The WHO focused on antibiotic resistance for World Health Day 2011 and recommends the reduced use of antibiotics in food-producing animals to combat antibiotic resistance. 

With livestock use responsible for an astonishing 80% of all antibiotic use in the US, it is an obvious place to reduce misuse of antibiotics.  Perhaps even more astounding is that an estimated 70% of all antibiotics used in the US are used at low levels for non-therapeutic purposes on livestock. The Food and Drug Administration (FDA), which is supposed to safeguard our health, has acknowledged the problems with the misuse of antibiotics and recognized the threat that it poses.  But FDA has done very little except suggest to the politically powerful livestock industry that it might think about changing its practices. 

FDA actually concluded in the mid-1970s that the non-therapeutic use of some antibiotics poses a risk to human health, but has done little of substance to follow up on that conclusion  in the intervening 30 plus years.  FDA’s Deputy Commissioner told a Congressional Subcommittee in 2010 that “FDA believes the overall weight of evidence available to date supports the conclusion that using medically important antimicrobial drugs for production purposes is not in the interest of protecting and promoting the public health.”  FDA has even recognized that “it is critically important that antimicrobial drugs be used as judiciously as possible in an effort to minimize resistance development.”  But that hasn’t prompted FDA to do much except rely on largely voluntary measures.

And the irony is that where non-therapeutic uses have been eliminated, industry has benefited.  In Denmark, the world’s largest pork exporter, pork production has actually increased since antibiotic use for growth promotion was ushered out in the mid 1990s, while antibiotic use has fallen drastically, by almost 40%, in the same period.

The magazine Scientific American recently published an editorial calling for the elimination of non-therapeutic use of antibiotics in livestock and explained exactly how the Danish meat producers met the challenge, as did this Grist piece:  the open secret is weaning pigs later so that they build up greater immunity before being separated from their mothers, making sure that the pigs are housed in cleaner, less crowded, more sanitary conditions, and improving the quality of their feed.

You know FDA is behind the times when even many in the industry are out ahead of it.  Even major food chains (like McDonald’s and Dairy Queen) and some very large poultry producers (like Tyson Foods, Perdue Farms, Foster Farms, and Gold Kist) are taking steps that the FDA is too hesitant to take—McDonald’s announced in 2003 that it will not buy chicken from producers that use antibiotics for routine disease prevention, and the four poultry producers state that they have stopped using antibiotics for growth promotion.  Chipotle, the Mexican food chain, has even gone so far as to urge FDA to impose mandatory restrictions on the non-therapeutic use of antibiotics in livestock.  The problem is so obvious that even kids are trying to do something about it (see this story about an enterprising 11-year old), while FDA waits.

The fact that many have felt the need to turn to Congress on this issue, even though FDA has the authority to fix the problem on its own, should be embarrassing for the agency.  But instead it is just part of the pattern of inaction and failure to protect public health that is all too common at FDA, as this fact sheet illustrates.

*Note: protecting yourself from the hazards of antibiotic resistant bacteria in meat requires the same kind of care as any other bacterial hazard in food:  wash your hands and any surface that comes into contact with meat thoroughly with ordinary soap and water, thoroughly cook meat before eating, avoid cross-contamination, and refrigerate food promptly.

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Comments

Jen SassMay 4 2011 03:57 PM

Excellent post, Avi. I like the part pointing out that if we keep pigs, and presumably other farm animals, in clean and healthy housing then they wouldn't need the drugs, and everyone would benefit. Animals would be healthier, and so would the farmers that work with them.

Paul ShapiroMay 4 2011 05:35 PM

I'm so glad NRDC is taking on irresponsible factory farming practices, misuse of antibiotics being just one of them. Eating less meat and ensuring that the animals who are being raised/killed for food are treated better would be an improvement for all of us.

Richard CarnevaleMay 5 2011 02:13 PM

If you insist on opining on this issue it would be good if you could do a little research before you blindly parrot inaccurate and misleading information. I will tell you straight up that I am a veterinarian that works for the companies that make animal medicines. I have been in both the Federal Government (FDA and USDA) and industry for over 35 years in food safety and animal health. The staph that was found on meat could have come from any environmental or human source it came in contact with. Staph is ubiquitous in nature, we all carry it and you might be surprised to know that 20% of people carry MRSA in their nose which does not come from meat or farm animals. Secondly, staph is not transmitted through food so there is very little risk you would get sick from meat that has been properly refrigerated. Unrefrigerated meat left for many hours can lead to staph food poisoning from a toxin but this has nothing to do with antibiotic resistance or antibiotic use in animals. And why don' t you do examine the 70-80% figures you throw out for animal use. Did you know that almost 50% of those figures counts antibiotics that are not used in humans and cannot even be associated with causing resistance to antibiotics that are used in humans? If you think I am lying just ask the authors of the 1999 Union of Concerned Scientists study that came up with those numbers. With Denmark did you also know that since the ban on low level antibiotics therapeutic high level use to treat the diseases that were being controlled before the ban has increased by over 100% (DANMAP)? This is rapidly causing overall antibiotic use to go back to previous levels--and to what end? There has not been a proven benefit to reducing human antibiotic resistant infections and even the Danes admit it! Why has there been no impact? Because the bacteria that present the greatest threat to humans from resistance problems do not come from animals! Go check out the top problems that CDC identifies--they are bacterial infections that are strictly human origin. Look, we can all have our opinions and I know that since you work for the NRDC you are prone to believe a lot of what you read that says the sky is falling. Before you blog about something you know so little about please do a little homework and check out the facts!

Steve RoachMay 6 2011 12:16 PM

@Richard Carnevale - A couple of facts. While the staph on meat could have come from any source it came in contact with, the paper (http://cid.oxfordjournals.org/content/early/2011/04/14/cid.cir181.abstract) makes very clear that this is unlikely. About 80% of the staph on turkey was the ST398 stain also known as livestock associated staph. The staph on the other types of meat was also different for each type indicating that it was the farm and not the food handlers that were the source. Once the farm is identified as the source resistance is not suprising.

20% of people do not carry MRSA. Its about 1.5% (http://jid.oxfordjournals.org/content/197/9/1226.long). Veterinairians have MRSA carriage around 18% and swine handlers even higher (20%-40%) (http://dels-old.nas.edu/ilar_n/ilarjournal/51_3/pdfs/v5103Weese.pdf).

As to the 80% of antibiotics being used in food production that number is from the FDA (http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm236143.html) not UCS. FDA did not provide the amount used in human medicine in that report but did provide the number to the Center for A Liveable Future (link is in the blog above). If you take out the ionophores which are drugs not used in human medicine you still get 74% of medically important antibiotics are used in human medicine. FDA collected but has not released data on how much of this was used in feed or water routes often used for nontherapeutic administration.

As Dr. Carnevale (of the Animal Health Institute) knows if it is indeed his post, it is unlikely that increases in therapeutic use 5 or 10 years after the ban are ban related. As the DANMAP reports make clear there have been other factors including the worldwide spread of immunosupressing viral diseases in swine that have resulted in increased therapeutic use around the globe including in the US. Even with the increase in therapeutic use antibiotic use in Denmark is well below levels before the ban.

As to the human health impact of the Danish ban, the clearest evidence of it public health benefit is the fact that meat produced in Denmark has less resistance than imported food and domestically aquired foodborne infections are less resistant than infections aquired abroad.

In the end, the question for U.S. consumers is whether we are willing to accept that are food is routinely contaminated with resistant pathogens or are we willing to demand our food producers to do better.

Avinash KarMay 8 2011 01:26 AM

@Steve Roach - Thank you for the excellent and informative commentary.

@Richard Carnevale - While it may be a difficult thing for the industry to accept, the evidence on animal agriculture’s contribution to the growth of antibiotic resistance is compelling, and we all need to face the fact that the regular use of subtherapeutic levels of antibiotics in animal feed is contributing to the global rise of antibiotic resistant bacteria. The American Medical Association, the World Health Organization (see blog above), the American College of Preventive Medicine, and many, many others in the scientific community are sounding the alarm. (http://www.kpihp.org/kpihp/frmContent.aspx?CMS_Entry_Id=301&Content_Type=H; http://www.who.int/world-health-day/2011/presskit/whd2011_fs4d_subanimal.pdf ; http://www.acpm.org/pol_comp_toc.htm#Antibiotic Resistance; http://www.keepantibioticsworking.org/new/resources_library.cfm)

The Institute of Medicine of the National Academies of Science said in 2003 about antibiotic resistance that “Clearly, a decrease in the inappropriate use of antimicrobials in human medicine alone is not enough. Substantial efforts must be made to decrease inappropriate overuse of antimicrobials in animals and agriculture as well.” (p. 207). (http://books.nap.edu/openbook.php?record_id=10636&page=207)

And it’s time for FDA to start listening and take meaningful action.

For more information about antibiotic resistance, see http://www.saveantibiotics.org/; http://www.tufts.edu/med/apua/; and http://www.keepantibioticsworking.org/new/index.cfm.

YvonneMay 12 2011 08:59 AM

First of all, really loving everything NRDC lately. Continue spreading awareness, folks. When I learned about antibiotics being used in meat many years ago I quit eating meat. When I learned about all of the toxins fish are swimming in recently, including issues with the BP Oil Disaster I quit eating fish. I felt the effects of mercury quite clearly...

Now I must help fight against the sickening, cancer causing pesticides that corporations are dumping on fruits and veggies. It is truly time to home grow my own food.......

Mandy Jo AnglebergerMay 13 2011 10:23 AM

If everyone only bought meat labeled "organic", then food companies would have to meet that demand by switching to natural methods or go out of business.

It's the consumers choice what meat company they want to support. We cannot sit around waiting for change, we must make it ourselves. One smart choice at a time.

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