Overuse of antibiotics: Follow the money (part 1)

Unlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.

The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the only thing that creates antibiotic resistance. Is there irrefutable scientific evidence that the overuse of antibiotics in raising livestock, for example, is harmful to human health? It’s not easy to prove direct cause and effect. If you feed a pig a steady diet of antibiotics, can you irrefutably prove that this results in the illness or death of someone who later eats that pig?

Follow the money

The speed with which we address the increasingly urgent problem of antibiotic resistance will depend on financial interests, not just scientific evidence or common sense. Just as with climate change, we can follow the money to identify the opponents. Who has a financial interest in convincing the public — and in turn politicians — that the overuse of antibiotics is not a problem?

It’s not the medical profession, which understands that overprescribing antibiotics contributes to the increase in antibiotic resistant bacteria. The financial interests of doctors are a little complex here. Unfortunately, because the public is not well educated about the subject, doctors find they need to satisfy the demands of their patients by offering prescriptions. Otherwise patients would simply take their business elsewhere. It takes time for doctors to educate their patients, and today’s doctors are very short of time. This is not sufficient grounds, however, to say that doctors have a financial incentive to overprescribe. Although doctors practicing today have no personal memory of the pre-antibiotic era, they are certainly among the first to appreciate that practicing medicine would become a nightmare without antibiotics.

Pharmaceutical companies aren’t really the problem either, since they’re not interested in selling or developing antibiotics. These drugs are not sufficiently profitable. This is a problem in itself, since the world desperately needs new antibiotics. Although drug companies might like to see more antibiotics prescribed and sold, this is such a small part of their overall business that there’s little motivation for them to question the dangers of overuse.

Where we can expect pushback is from the agricultural industry. This is a battle that’s just beginning to heat up. Katie Couric did a story on the CBS Evening News in February that got some attention: “Animal Antibiotic Overuse Hurting Humans?” There were congressional hearings (PDF) on the issue in April.

Well, maybe it’s a problem, but maybe it’s not. So there.

Publications that serve the livestock community – the beef, chicken, and hog industry – have been following the issue closely. It was interesting to see what a balanced approach Voice of America took on the issue.

Over-use in animal husbandry is not the only source of antibiotic resistance. Health experts point to doctors over-prescribing antibiotics, and patients misusing them, as another part of the problem.

And the growth-promoter ban [a Danish ban on drugs used as growth promoters] does not appear to have made much difference in the overall rates of resistant infections in people, says Rich Carnevale with the U.S. industry-sponsored Animal Health Institute. He says Denmark may have over-reacted.

He says, “They saw resistance. They said, ‘Well, it could be due to use of drugs in animals. And certainly some of that resistance was. But the real question is, was it harming humans? And to this day, they have not been able to really conclude that it’s actually harming humans.”

This is where opposition to attempts to reduce the use of antibiotics reminds me of those who oppose climate change legislation.

Continued in part two.

Update 7/3/10:

FDA recommends new limits on livestock drugs (Reuters)

[T]he U.S. Food and Drug Administration recommended on Monday [6/28/10] that livestock farmers use the drugs solely to cure or prevent disease in animals, phasing out their use to promote growth.

Antibiotics in Animals Need Limits, F.D.A. Says (The New York Times)

Federal food regulators took a tentative step Monday toward banning a common use of penicillin and tetracycline in the water and feed given cattle, chickens and pigs in hopes of slowing the growing scourge of killer bacteria.

But the Food and Drug Administration has tried without success for more than three decades to ban such uses. In the past, Congress has stepped in at the urging of agricultural interests and stopped the agency from acting.

Antibiotics and Agriculture (The New York Times editorial)

The Food and Drug Administration is taking some long overdue but still too timid steps to rein in excessive use of antibiotics in American agriculture. For years now industrial and many smaller-scale farmers have routinely fed antibiotics to their cattle, pigs and chickens to protect them from infectious diseases but also to spur growth and weight gain while using less feed. That may be good for agricultural production, but it is almost surely bad for the public’s health.

Jolley: Five Minutes With Dr. Scott Hurd & Agriculture’s Drug Problem (CattleNetwork)

To hear the FDA and numerous health experts, our very survival as a species is at stake as the future potency of antibiotics for humans begins to falter. The feds unequivocally state that drugs like tetracycline and penicillin transfer from farm animals to the people who consume their meat and overuse of such drugs create new ‘franken’-strains of antibiotic-resistant superbugs. …

Wow. Death is knocking at my door and laughing at penicillin because I gave a feverish pig a shot? Better let that porker die so that I may live.

Resources:

Photo source: Outdoor webshots

Katie Couric, Animal Antibiotic Overuse Hurting Humans?, CBS Evening News, February 9, 2010

Helena Bottemiller, Debate Over Antibiotic Use Continues, Food Safety News, April 19, 2010

Henry A. Waxman, Memorandum on the Subcommittee Hearing on Antibiotic Resistance, Committee on Energy and Commerce, April 26, 2010 (PDF)

Steve Baragona, Use of Antibiotics in Livestock Debated, Voice of America, May 13, 2010