Three things we need to stop the downward spiral with antibiotics

At dinner the other night, my four-year old son was listening to my husband and me talk about my day at work. He asked what we were talking about, and I explained that there are people who want to feed antibiotics to healthy pigs, chickens, and cows, instead of to sick people. His response was “That is a waste. You should only give medicine to sick people and sick animals. Not to healthy people and healthy animals.” 

There it is, neatly explained by a four-year old. Antibiotics should be for sick kids, not healthy animals.

And despite consensus by the world’s leading medical groups that the misuse of antibiotics on animals that are not sick could lead to the next antibiotic resistance pandemic, industrial farms continue this dangerous practice without regard for human health. The overwhelming majority of antibiotics sold in this country (80%) go to raise meat and poultry, largely dosing animals that aren’t sick, routinely at low-levels day after day.. That practice creates the perfect environment to breed antibiotic resistant bacteria, which can escape the farms and contaminate our communities.

At least 2 million Americans get sick every year from antibiotic resistant bacteria, with at least23,000 people dying as a result of those infections. Every major medical group has warned us that we are rushing headlong into a world where our miracle drugs may no longer work to make sick people healthy again. To prevent us spiraling into a post-antibiotic future, we need to end the misuse and overuse of antibiotics in factory farms now.

In July, the Second Circuit Court of Appeals overturned NRDC’s lawsuit victory on antibiotics, and ruled that the FDA does not have to consider eliminating the non-therapeutic use of antibiotics despite the fact that the agency itself determined almost 40 years ago that these uses were not safe to human health. Without the court mandate to act, we don’t expect that the FDA will take the necessary steps to address this crisis.

So with bated breath, we await an announcement from the White House about its plan to tackle antibiotic resistance.

A group of scientists advise the President on various technical issues, and they are called the President’s Council of Advisors on Science and Technology, or PCAST for short. The PCAST will be releasing its report on antibiotic resistance. Based on their comments at a recent public meeting, I suspect that the report will acknowledge that the misuse of antibiotics in agriculture is contributing to the problem and that we need to act.

I hope it will also advance critically-needed steps to keep our antibiotics working for sick humans.

Here are the three things that need to happen – and what our government is currently doing about them.

1. Stop using antibiotics on healthy animals as a crutch.  

“Disease prevention” uses of antibiotics provide a crutch for industrial farms. They routinely feed antibiotics to healthy animals to compensate for the dirty, crowded conditions. The reliance on antibiotics means these industrial farmers don’t have to clean up the manure, don’t have to give the animals room to move around, and don’t have to give them fresh air to breathe.

In December, 2013, the Food and Drug Administration (FDA) published a voluntary guidance to pharmaceuticals companies, encouraging them to voluntarily remove the “growth promotion” claims from their labels.

While most of the companies have agreed to do it, my colleague Avi Kar has an entire blogpost about why this guidance doesn’t amount to much at all. In a nutshell, here’s why the guidance isn’t going to help:

  • It’s voluntary. So even though companies say now that they will follow the guidance, they could change their minds at any time.
  • Abuse continues under another name: It allows the factory farms to continue using antibiotics as a crutch under the guise of “disease prevention” meaning antibiotic use will not go down.

2. Give us better data.

Aside from the corporations running the industrial farms, no one has any good information about how much these antibiotics are used. We have sales data that provides us with the only picture we have about antibiotics sold in the U.S. – but more information is important. How much is used on each type of animal? How many of those are sick animals and how many are healthy?

The FDA acknowledges that it is important to get data so that they can document change in use of antibiotics to track whether their guidance is working. The problem is that the FDA has not even proposed any ways to collect that data. These companies have said that this guidance will not affect their business. How long will we have to wait to see if this voluntary guidance plan has helped or – as the companies and we predict – hasn’t made a difference at all?

The FDA needs to develop and implement a plan to get these vital data and make them publicly available. Properly functioning antibiotics are critical to all of our health – and information about how they are being abused must be provided to the public.

3. Get the veterinarians more involved.

When a child gets sick, a parent doesn’t walk to the local drugstore, grab a bottle of antibiotics, and hope that it helps. The pediatrician examines the child and determines the best course of action based on her illness. Same should be true of animals. Before they are fed antibiotics to treat an illness, a veterinarian should examine them  and determine how best to treat it.

But that is not how FDA wants it to work. The FDA has proposed eliminating the requirement that veterinarians have a relationship with their patients before giving them antibiotics through their feed. It is cutting off the last line of defense to the overuse of antibiotics on industrial farms. Check out very detailed comments on the FDA’s proposal.

We need stronger and faster action from every level of leadership. It will be too late if we wait until we are in a post-antibiotic era to start figuring out how to fix this ever-worsening antibiotic resistance crisis.