Antibiotic resistance may mean some infections are untreatable in the future. To combat this bacterial evolution, new federal rules went into effect on January 1 that restrict the use of antibiotics in food animals, where the majority of US antibiotics are consumed. Critics worry the rules don’t go far enough. Experts on both sides of the issue discuss.
- Dr. David Wallinga, Senior Health Officer, Natural Resources Defense Council
- Dr. Ramanan Laxminarayan, Director, Center for Disease Dynamics, Economics and Policy and former member, White House antibiotics panel
- Dr. Liz Wagstrom, Chief Veterinarian, National Pork Producers Association
- Katie Roth, dairy farmer, Platteville, WI
Links for more info:
17-08 Antibiotics and Farm Animals: New Rules
Reed Pence: Since the 1940’s, antibiotics have revolutionized medicine. Today we don’t think twice about bacterial infections that would’ve been life-threatening 80 years ago. But there may be a time in the not too distant future when we can no longer take that for granted. According to the Centers for Disease Control and Prevention, at least 2 million people each year in the United States are infected with bacteria that are resistant to antibiotics.
Dr. David Wallinga: What people don’t really realize is how absolutely terrified the infectious disease doctors are about the future we’re facing. We’re basically running out of all the antibiotics that work. Things that we’re used to counting in medicine, like if we get an infection like pneumonia we want an antibiotic to work. But more and more, we are seeing and we’re going to be seeing, bacterial infections that we just can’t treat.
Pence: That’s Dr. David Wallinga, Senior Health Officer with the Natural Resources Defense Council.
Wallinga: There was a woman, a 70-year-old woman in Reno who passed away earlier last year and she had particularly nasty drug-resistant infections. They ended up trying 26 different antibiotics and that bacteria was resistant to every single one of them. So they literally could not find a drug that would work on her and she died. That’s kind of what we’re going to be seeing more and more of unless we take urgent and drastic action to reduce our overuse of these critical drugs.
Dr. Ramanan Laxminarayan: The ability of bacteria anywhere in humans and animals to evade antibiotics is now becoming a serious problem – both in developed and developing countries. In the United States, we have infections kill, very conservatively 23, 000 people each year, but probably far more than that.
Pence: Dr. Ramanan Laxminarayan is Director of the Center for Disease Dynamics, Economics and Policy in Washington D.C and has been a member of a White House panel advising the president on antibiotic policy.
Laxminarayan: The major drive for drug-resistant infections is the use of antibiotics. Where every time we use antibiotics, we kill off the sensitive bugs and let the resistant bugs remain. Now, where are most of these antibiotics used? In the United States, 80% of the antibiotics that are used are in animals and they use a lot for growth promotion or disease prevention. Therefore it really makes sense to really cut down the amount of selective pressure we’re placing on resistant bacteria to evolve and thrive because that has consequences for us getting infections that may then not be treatable with antibiotics and its safe to say its one of the biggest public health threats of our time.
Pence: That’s why when you go to the doctor you may not get an antibiotic when you want one. Doctors are much more careful with antibiotics than they used to be because every time we use one, at least a few of the most resistant bacteria survive. There may not be enough of them to make us sick, but if passed on to somebody else who repeats the process, and someone else and someone else – eventually the bacteria that are left are super-bugs. And that process it the same in farm animals as well and they are the biggest consumers of antibiotics in America.
Wallinga: So it doesn’t really matter whether you’re talking about the use in human medicine or the use on farms its all kind of one big ecosystem of bacteria. But we’re using and overusing antibiotics in both locations, so really the focus is on trying to reduce our overuse of antibiotics. Of the use in human medicine, about half is overuse and probably a similar number of even more of the use in livestock is overuse. That being said, if we just focus on the antibiotics that we’re most concerned about being overused – namely the ones that are used both in humans and in animals – and those are what we call “Medically Important Antibiotics” or human antibiotics those are 70% actually are sold for use in livestock, not people.
Laxminarayan: Two-thirds of antibiotics that go to animals are used for growth promotion or disease prevention, often its hard to separate out growth promotion from disease prevention because they’re administered to the animals in exactly the same way – mixed in with their food or water and the animals get some of this in small concentration for a very long period time, often for their entire life. Now giving antibiotics in small doses to animals, just seems to make them grow a little faster and save a few pennies on every pound of feed and is a standard practice in the United States and many other countries since the 1950’s.
Pence: Because of resistance, the FDA has been trying to regular antibiotic use in food animals since 1977. Finally, new rules went into affect on January 1st the same kind of rules that have existed in the European Union for more than 10 years. Laxminarayan says that it’s a process that’s ramped up over time.
Laxminarayan: A couple of years ago the FDA started by telling companies that made antibiotics for veterinary use that they should voluntarily withdraw the use of antibiotics for growth promotion. Now a lot of companies said that they would do that, but this was hard to monitor because they then came back and sold it as disease prevention. So growth promotion was banned or discouraged but who could argue with disease prevention, so that clearly does not work and antibiotic use in animals kept going up. So now the FDA’s come back and said, “look, if you want to use antibiotics in healthy animals, you have to do this under veterinary supervision.”
Dr. Liz Wagstrom: The new FDA regulations require that if an antibiotic that is used in human medicine or important to human medicine were to be used in a food animal, it can only be done when medically necessary to address a disease concern.
Pence: That’s Dr. Liz Wagstrom, Chief Veterinarian for the National Pork Producers Association.
Wagstrom: And when that medical necessary use is done, it can only be done under the direction of a veterinarian through either, what’s called a “veterinary feed directive order” or a prescription. So that means the bottom line is that these important antibiotics can no longer be used in healthy animals to help them grow faster and when they are used to prevent and control and treat diseases, they have to be used only when a veterinarian determines its appropriate and necessary.
Pence: However critics, such as the NRDC’s Wallinga say, that loopholes in the rules could render them less effective than supporters claim they will be.
Wallinga: It’s definitely good that veterinarians are gonna be more involved, but it’s not sufficient. Here’s why: private industries own claims growth promotion antibiotics only account for maybe 10% of the total use in livestock, so that kind of begs the question of where the other 90% happens. Now, we have other information that leads us to believe that the treating sick animals is again, a very small fraction, the majority of the use is probably for what’s called “routine disease prevention” – this is giving the antibiotics in the animal feed or drinking water in the name of keeping them from getting sick even though they’re not sick now. Because you think they might get sick in the future.
Pence: So what’s wrong with that? Platteville, Wisconsin dairy farmer Katie Roth says preventing disease is a lot better than treating animals that are already sick. Already under the new rules, she called in a veterinarian when a small part of her herd began developing pneumonia and she wanted to protect the rest.
Katie Roth: For us on our farms keeping animals healthy is a top priority and prevention is key, so anything we can do to prevent disease and illness, by keeping our cows comfortable, by keeping them in a health environment with good hygiene and vaccinations, that’s what we want. And antibiotics are, I consider them to be that last resort that last avenue for when we have animals that are at risk or are not healthy. From that aspect, not much will change.
Pence: However Wallinga believes that on some farms that have used antibiotics for growth, too little changing is exactly the problem. Low dose antibiotic use for an animal’s entire life could still happen.
Wallinga: The same products that were being put in animal feed for growth promotion can be used at the same dosage and in the same way in the name of disease prevention. So we’re really worried that’s what’s happening, or what’s going to happen is just kind of a switch and bait where the producers will continue to use these antibiotics, these important human antibiotics in the name of preventing disease in animals that aren’t even sick. But in fact, they’ll be using them in the same way that they’ve used in the past.
Pence: In other words, growth promotion by another name?
Wallinga: By another name, lipstick on a pig is what we’ve called it. Yeah.
Pence: But Wagstrom says vets cant OK administration for that.
Wagstrom: Once the labels are changed, antibiotics in feed by law can only be used as they are labeled. So if a farmer were to use it to improve growth or a veterinarian were to write a veterinary feed directive order for the purpose of improving growth – that’s against the law. So because antibiotics are not inexpensive, because we’re doing the things that Katie mentioned on the farm to try and prevent disease through other means such as vaccination or hygiene, the likelihood of prevention antibiotics being used inappropriately and as a loophole for growth promotion is very very slim.
Pence: Laxminarayan agrees. He believes that farmers won’t need to do anything to replace growth usages of antibiotics because they’re not needed. He says antibiotics provide a growth booster shot only in the absence of good hygiene and nutrition.
Laxminarayan: Animals today are very different than animals from 50 years ago, they’re generally well-fed, they generally come from good stock, they’re generally very hygienic condition, and herd help is generally quite good. So, the added value of antibiotics today is something not what it was a generation or two ago. Which means that, it is possible to raise poultry and hogs in the United States without using antibiotics, but simply by taking additional bio-safety/bio-security precautions, that might cost farmers just a little more money large producers like Purdue have already stopped using antibiotics in their poultry and its certainly possible for most of their industry to go that way. I don’t think that 60% of Americans’ antibiotic use needs to be replaced with anything; it just needs to be replaced with good hygiene and nutrition, which, in most cases, already happen.
Pence: Wallinga says keeping animals healthy with vaccines, good hygiene, and nutrition is exactly the path that agriculture should take. It’s disease prevention that cuts antibiotic use to the extent that happens, Laxminarayan says it will provide American farmers with a competitive advantage. He says the new rule is a push in the right direction.
Laxminarayan: Coming this far to even go after this is remarkable to anyone who is looked at the history of this. Is this the end? No. Will this solve all of the problems that we have with antibiotic use in animals? Certainly not. But I think this is a great first step to making sure that we take care of the antibiotics we have.
Pence: You can find out more about all of our guests through links on our website, RadioHealthJournal.net. You can find archives of our programs there as well. You’ll also find them on iTunes and Stitcher. I’m Reed Pence.
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