Cue the hosannas… maybe

From the New York Times:

The Food and Drug Administration announced the new rule Wednesday after trying for more than 35 years to stop farmers and ranchers from feeding antibiotics to cattle, pigs, chickens and other animals simply to help the animals grow larger. Using small amounts of antibiotics over long periods of time leads to the growth of bacteria that are resistant to the drugs’ effects, endangering humans who become infected but cannot be treated with routine antibiotic therapy.

At least two million people are sickened and an estimated 99,000 die every year from hospital-acquired infections, the majority of which result from such resistant strains. It is unknown how many of these illnesses and deaths result from agricultural uses of antibiotics, but about 80 percent of antibiotics sold in the United States are used in animals. [emphasis added]

Well, it’s about time… I think?

I have long considered it preposterous that I have to wrinkle my brow and decide which kid with the green gunk coming from her nose gets a prescription for antibiotics and which doesn’t, cogitating about whether it’s worth the risk of developing resistance, when a farmer can give the exact same antibiotic to every single one of his chickens.

But there are two concepts expressed in the highlighted sentence that push me toward separate conclusions.  Before I say anything more I should stipulate that I have precious little meaningful epidemiological training, so you should take what I say with a Buick-sized slab of salt.  That said, I find it difficult to believe that the creatures who receive 80% of the antibiotics in this country don’t contribute some form of resistance to those consuming the remaining 20%.  While it’s also quite easy to see how the multiple antibiotic exposures that occur in the hospital make that an ideal setting for resistance to develop and spread, it beggars credulity to think that agricultural overuse is not a contributor.

Yet I do wonder (assuming the reporter did the appropriate homework) why there aren’t more data, and I would hope that there’s something besides intuition behind the change in policy.  I think it’s great, but my preferences shouldn’t be informing United States farming policy.  (Please consider that an invitation for anyone with expertise in the area to weigh in in the comments; I would be genuinely grateful to learn.)  A quick scan through Google Scholar yields this article which calls the connection between agricultural use and human resistance into question, but it doesn’t look like there’s a particularly robust body of evidence either way.  Given that this policy is likely to have at least some impact on US agricultural output, is it naive to hope that there are data the reporter from the Times just didn’t find?

It’s disconcerting to see something one has long thought an appropriate change in policy come to pass, and then suddenly become ambivalent upon its passing.  Obviously, I think my own ideas are awesome, and ought to be adopted by right-thinking people the whole world round.  But when it comes to the policies of the FDA, I would be reassured to know that there are some numbers that align with my own best guesses, in the fleetingly rare chance that I might happen to be wrong.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

10 Comments

  1. I want to oppose stuff like this on principle (the people who get excited about this overlap with my enemies in the nutrition-world), but I actually think that intuition may be enough here. The downsides are making meat a little more expensive, I’d guess. The upside is not screwing up the enormous gift of antibiotics.

  2. Antibiotic resistance is one of my biggest concerns. Not as in, “it’s the thing that keeps me up at night,” but as in, “among the top 5 problems our society will face in my grandchildren’s generation.”

    But let’s recognize the potential unintended consequences here. One of the reasons antibiotics are used so regularly in agriculture is because the animals are kept in such close proximity. Waiting until an animal is evidently ill to treat it can mean it’s already exposed a lot of other animals.

    This can mean more than just a mild increase in meat prices. The only way to prevent this problem may be to keep the animals a lot more segregated from each other. From one perspective that’s good, since many people object to how crowded animals often are in industrial scale agriculture (poultry in particular). But some animals are social, and if it becomes necessary to too drastically limit contact between them that’s also not good for their psychological health. It also means potentially dramatically fewer animals per operation, which could mean not a small but a large increase in meat prices. I can afford that increase. Not everyone can, and those who can’t are the poor. They will bear the economic brunt of this policy.

    But perhaps the long range effect is that we shift away from a reliance on meat in our diet, not because the state requires it and not because of environmentalists’ moral suasion, but as an economic choice. That would be environmentally beneficial.

    The long-run benefits of this policy are, I think, very good. The short-run could be some serious disruptions, with costs borne primarily by smaller agricultural operations and poor consumers.

    • Your comment gets to the crux of my concerns, James. I am strongly inclined to support the policy on its presumed merits, but I hardly think its a no-cost change. I have a very good friend (who incidentally works as a consultant helping state legislators draft policy) who raises goats on a small farm, and I’ve heard her argue convincingly for being able to treat her animals with antibiotics at her own discretion. While I think antibiotic resistance is a potentially huge problem that it’s far better to prevent than correct, I also suspect there will be many more ramifications from this policy change than appear on the surface.

  3. In the arms race started by Lister and Pasteur, the bacteria have the advantages of both numbers and adaptability. The soundest strategies for defeating biological infection implement the duh-level tactics of handwashing and sterile instruments.

    Current animal husbandry is driven by a numbers game and the big ranchers are not particularly good mathematicians. Cattle and chickens raised in reasonably clean circumstances don’t require all these antibiotics. The worst offenders in the meat game are the disgusting feed lots. Filthy operations, hundreds of cattle standing around in filthy mud which would make a World War 1 trench look like a surgical theater. We’re feeding corn to a grass-eaters. They don’t process it very well. We’re trying to pack more fat onto these animals in an effort to put weight on them but it’s the wrong kind of fat. The tasty stuff is marbled into the steaks and roasts. This feedlot fat is just rind, stuff you’ll just trim off anyway.

    Boy howdy, a half hour on a cattle feed lot will make a vegetarian out of anyone.

    Antibiotics in poultry is pretty much nonsense. Packing thousands of chickens into one barn is an epidemiologist’s nightmare: they all get sick within a few hours and all those chickens will die. No amount of antibiotics will save such chickens from infectious bronchitis, it’s a virus anyway, antibiotics are of no use and every chicken in that barn will get it at once. Best to keep many smaller barns with populations at 200 chickens, contains epidemics. Chickens can be raised off the ground so their droppings fall down onto a washable concrete surface. No excuse for the current state of affairs. Salmonella is endemic to chickens, easily managed by sanitary conditions. We’ve got E Coli in our guts, the reason we don’t routinely die of coliform bacteria is as obvious as your toilet, shower and sink (and soap and clean towel).

    The practice of routinely feeding antibiotics to farm animals was always unwise and should have been stopped many years ago.

  4. One of the simplest methods to avoid using antibiotics is to keep the herd/flock healthy. Typically free ranging is a good method. Occasionally you will have an epidemic take a fair slice out of the population, but if your smart you keep many of the survivors to replenish. Feed lots and poltry producers slaughter everything, they will seldom see any benefit in natural immunity. Its can be good business though. Much cheaper to go to the big producers and buy hundreds at a time compaired to the local free rangers selling a few dozen here and there.

    About the only thing my fore fathers would do is hit the critters with some typical anti parasitics.

  5. This is a very, very overdue development. Facilitating large-scale factory farming simply isn’t worth the creation of drug-resistant bacteria. There’s a limit to how fast scientists can keep coming up with new cures.

    If it leads to a decline in factory farming generally, and an increase in smaller operations and ones that give animals a bit more space, that’s also a plus in my view.

    The costs of meat might rise, but that’s preferable to the long-run costs of continuing our present course. We don’t want to end up back at the pre-penicillin days.

  6. I imagine it is hard to get statistically significant results without a number of assumptions that would be regarded, at the other end, as gaming the question.

    Robust scientific research in the agribusiness sector is very difficult as the big players are largely privately held companies and they have zero interest in allowing any data to get outside the door.

    I would bet somewhere in the bowels of the Monsanto research division there’s a longitudinal research project going on attempting to do this, with rigor, hoping that the results come out one way. If it comes out the other way, in the bowels it will remain.

  7. I would say that doc shouldn’t lose a wink sleep one way or another, and probably is a case by case basis on humans. The same epidemics that run through herds or flocks will occasional thin out the human population.

    Even the dread of the Plague if taken in context of its highest kill rate could chew its way through the earth population and leave approx. a billion standing strong. Captain Trips is a wuss.

  8. Antibiotics are the one class of drugs I think should be controlled by government. Their misuse creates public health risks, and since they don’t make you high the risk of a black market forming is minimal.

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