As soon as antibiotics were discovered and developed for medical use, bacteria began a Darwinian “arms race,” with pathogens developing resistance to antibiotics, necessitating continual development of new types of medications.
Experts have been warning that humans are starting to lose more of these battles every year. The specter of untreatable and virulent outbreaks, local or pandemic, increases with each decade; as a review in the journal Pediatrics put it, “Antimicrobial resistance has reached crisis stage in human medicine.”
Physicians have been educated and urged to be judicious in antibiotic use for many years now, with increasing success. But 70 to 80 percent of all antibiotics produced are used in farm animals to get them to market quicker and bigger; this continual, low-level use is a perfect way to breed resistant strains, which can then find their way into humans. Reports on this potential threat appeared as long ago as 1976, and government panels set up to make recommendations on the threat have been tainted by industry-linked scandal from the start.
Much leadership on this topic has come from the Bay Area. A decade ago, a coalition of concerned medical and public health organizations, including Commonweal in Bolinas, convened a meeting at the San Francisco Medical Society. Spurred by a medical society-initiated policy adopted by the American Medical Association urging less use of antibiotics in agriculture, the group developed a strategy to move such policy forward. We weren’t just outsiders to agriculture; the editor of California Farmer, the state’s leading agriculture journal, attended the meeting and later editorialized: “We call on producers and vets to stop overuse of all antibiotics… Antibiotic resistance is a wake-up call that ag must answer.”
The intentional obfuscation of the issue by those seeking profits is an uncomfortable reminder of the long and ongoing battle to regulate the tobacco industry, with similar dismaying exercises in political and public relations lobbying, and even scandal. As with tobacco control, science and health concerns should take precedence over profit in regulating the overuse of antibiotics in the production of meat and other agricultural products. Antibiotics do have a place on farms, but the benefits of their use can likely be preserved while minimizing harm.
We need to learn more about the extent of risk, but the delay tactic of allowing current practices to continue while more research is conducted is unacceptable. Enough is already known to justify a more cautious, preventive approach.
Based on growing scientific evidence, the European Union banned the use of non-therapeutic antibiotics in livestock production in 2006. Alas, that science-based approach has remained elusive in the United States—but not for scientific reasons. It comes down to political power and the marketplace. The pressure consumers can add certainly helps, but broader and stronger regulations are necessary for real change.
Still, big institutions can lead the way; locally, the University of California, San Francisco Academic Senate Coordinating Committee; the School of Pharmacy Faculty Council and the School of Medicine Faculty Council unanimously approved a resolution to phase out the procurement of meat and poultry raised with non-therapeutic antibiotics at UCSF. The resolution also encourages all University of California campuses to do the same.
Rep. Louise Slaughter, the only microbiologist in Congress, has four times introduced the Preservation of Antibiotics for Medical Treatment Act, and did so again just after the Centers for Disease Control sounded an “alarm on deadly, untreatable superbugs” this March. The act would ban non-therapeutic uses of medically important antibiotics in food animal production.
Recently a group of medical and public health leaders, including Kaiser Permanente’s chief of infectious diseases, wrote to political leaders to “require stronger reporting requirements for livestock antibiotic sales and distribution that can help illustrate current use patterns, explain resistance trends, and monitor progress in assuring responsible livestock antibiotic use. Such reporting would provide critical information to help track progress in reducing the inappropriate use of antibiotics and help target attention where it is needed.”
The battle to reduce agricultural use of antibiotics continues. The stakes are high—and may be even higher than before, as evidence that even the low-level antibiotics in our food and water can alter our gut flora—our “microbiome”—in unhealthy ways. The power of big money, both pharmaceutical and agricultural, makes for a prolonged battle, as the profits in the status quo are huge. But if science loses in this case, humanity’s fate may indeed be to end, as T.S. Eliot warned in another context, “not with a bang, but a whimper.”
Robert Gould is a professor and president of Physicians for Social Responsibility. Steve Heilig is a director of programs at the San Francisco Medical Society and at Commonweal in Bolinas. This is a revised version of a piece published in the current edition of San Francisco Medicine, the journal of the San Francisco Medical Society, available online at www.sfms.org.