Taking (live)stock
Taking (Live)stock:
Antibiotic resistance, farm antibiotic use, & what we can do about it
Antibiotic resistance is a topic that is increasingly in the news and on the minds of our patients, providers, and even our government. We all know we need to try to decrease inappropriate antibiotic use. But according to the CDC's now-infamous Threat Report 2013 on antibiotic resistance and its ensuing morbidity and mortality (23,000 attributable deaths yearly), and notwithstanding all that we know about our own antibiotic overuse, we physicians (and allied clinicians) are only at best half of the problem. Of course we are far from innocent. Unnecessary antibiotic use for viral infections has in some areas even increased in the past 20 years and efforts to decrease antibiotic overuse and increase stewardship are more needed than ever. But in fact as much as 70% of all antibiotics in this country are given to livestock.
Farm antibiotic use can be divided into two categories: treatment, given by veterinarians for animals who are actually sick; and low-dose constant use in feed, given to prevent infections or bacterial overgrowth and (reportedly) ensure the health and fitness of animals grown in overcrowded factory-farm conditions. It has been shown in study after study that use of low-level antibiotics leads to the emergence of resistant bacteria. While there may be less direct evidence that all of these organisms can and do transfer to humans, we are all familiar with problematic foodborne outbreaks, and there are certain specific cases like this one of farmers contracting resistant infections from animals. If we care about antibiotic resistance overall and in particular the spread of these infections in humans, we need to do something about unrestricted antibiotic use in animals.
Our generation is not the first to cry foul about antibiotic use on farms but given the increase in antibiotic resistance overall, furor over it has risen to new, appropriate, heights. And the FDA is listening...faintly. In December a new regulation required veterinarians to more strictly oversee antibiotic use and advised (non bindingly) drug companies to state on the label that the antibiotics are not for growth promotion. But this new guideline probably does not go far enough; low-level antibiotics to prevent disease are still allowed. And there is little legal recourse against drug companies or farms that don't comply.
So what can we do? Many large agribusiness companies and their lobbyists claim reducing antibiotics will lead to increased costs in order to house animals in ways that prevent disease (they point to pricier organic meat and poultry). But in Europe, stricter regulations have already landed in some countries and in The Netherlands, Dutch farmers are already removing antibiotics (other than to treat the sick) from their animal husbandry methods with, if anything, increased profits from the healthier, larger animals that result from improved conditions. But many US lawmakers are unaware of such success stories. And they are often still unaware of the horrors resistant organisms can wreak. And many, many patients are unaware of it all. And that's where we come in.
Pediatricians, and our constituent organizations like the AAP, are nothing if not advocates for our patients and their families:
- Every visit we can nudge our patients towards using antibiotic-free or organic milk, meat, or poultry is a visit we may be able to reduce their exposure to resistant organisms.
- For those who used to avoid going to AAP lobbying days—'what would I say?', now we can go and discuss antibiotics and farms with our state legislator, representative, or senator.
- Many of us sit on hospital safety and quality committees—raise the issue of having your institution only purchase antibiotic-free meats and related products. Some of you have already done so.
This is a fixable problem but it will take hard work by people who know about and care about the problem and those it affects. We can and should be among those working to fix it.