Comments on: FDA Moves to Reduce Antibiotic Use in Livestock

FDA Moves to Reduce Antibiotic Use in Livestock

MonkeyToes — Tue, 26 Jun 2012 19:32:32 -0800

Worried about the widespread use of antibiotics used in the raising of steer, pigs and poultry, and fearing the rise of antibiotic-resistant illness, the U.S. Food and Drug Administration began the process of withdrawing its approval for the non-medical use of penicillin and tetracyclines (scribd, posted by Wired magazine's Maryn McKenna in conjunction with one of her posts on this issue). That was in 1977. The FDA stopped pursuing the process, and antibiotics have continued to be given in feed. But a recent court order may allow the FDA to oversee a major change to the system.

In the last few years, 80 percent of all antibiotics sold in the U.S. have been purchased for agricultural purposes, says a report from the FDA. Given to healthy animals, the drugs reduce the time it takes to get them to market weight and can prevent disease arising as a result of their living conditions; consequently, most of the meat and poultry in the U.S. food supply have been raised on antibiotic-laden feed. Sick animals receive extra antibiotics. These practices are common and widespread, even in the wake of a confirmed antibiotic-resistant, feed-related staph germ that may affect half of the American meat supply. In late March of 2012, Judge Theodore H. Katz of the Southern District of New York issued an order that potentially cleared the way for the FDA to rescind its approval of animal feed containing antibiotics, and to continue the process it began in 1977. (More about the lawsuit at issue here. You can read the order here; McKenna's Scribd posting, as above). The FDA may now compel feed makers to justify the safety of antibiotics, or it may rescind its approval for their use. A few weeks later, the FDA confirmed its stance: "Because it is well established that all uses of antimicrobial drugs, in both humans and animals, contribute to the development of antimicrobial resistance, it is important to use these drugs only when medically necessary." In the same press release, it also explained its new proposed actions on antimicrobial resistance: the implementation of "a voluntary strategy to promote the judicious use in food-producing animals of antibiotics that are important in treating humans." It also published three documents in the Federal Register, in order to help agricultural producers understand its recommendations: "A final guidance for industry (.pdf), The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals, that recommends phasing out the agricultural production use of medically important drugs and phasing in veterinary oversight of therapeutic uses of these drugs. "A draft guidance(.pdf), open for public comment, which will assist drug companies in voluntarily removing production uses of antibiotics from their FDA-approved product labels; adding, where appropriate, scientifically-supported disease prevention, control, and treatment uses; and changing the marketing status to include veterinary oversight. "A draft proposed Veterinary Feed Directive regulation (.pdf), open for public comment, that outlines ways that veterinarians can authorize the use of certain animal drugs in feed, which is important to make the needed veterinary oversight feasible and efficient." As far as shoppers are concerned, this may be an idea whose time has come. Consumers Union, which is the advocacy arm of Consumer Reports, recently issued the results of its survey (.pdf) on "what consumers think about reducing antibiotic use in meat and poultry production." Among the findings: "[A] majority of respondents (86%) agreed that customers should be able to buy meat and poultry raised without antibiotics at their local supermarkets... "The majority of respondents (see table) were extremely or very concerned about issues related to the use of antibiotics in animal feed." It's worth noting that medicated feed isn't new. Dr. LeGear's Poultry Prescription is one early example. Found, oddly enough, on the FDA's Flickr stream (and, as the FDA notes under this photo, "Dr. LeGear's labeling of this veterinary drug from the early 1920s perhaps learned from the experience of its Hog Prescription, seized several times in 1920 for misbranded claims to cure cholera and other diseases.").

By: hippybear

hippybear — Tue, 26 Jun 2012 19:54:53 -0800

Probably unrelated to the content of this most worthwhile and meaty post full of information, but the rise and spread of basically non-curable gonorrhea is alarming and by end up being a defining moment in the evolution of sexual mores in the early 21st Century.

By: Defenestrator

Defenestrator — Tue, 26 Jun 2012 19:55:20 -0800

It's about time, although I'll be happier when all of these words translate into practices actually changing on the ground. Stricter requirements on antibiotic use not only mean less risk of mass death by strange antibiotic resistant diseases but better (although still deplorable, I'm sure) conditions for the animals.

By: hippybear

hippybear — Tue, 26 Jun 2012 19:55:21 -0800

...and MAY end up being....

By: Ruki

Ruki — Tue, 26 Jun 2012 20:27:40 -0800

As someone who has (non-life-threatening) allergic reactions to certain antibiotics. I can't believe I've never thought of this before... but shouldn't it be publicized, for human health reasons, what antibiotics the animal has been given?

By: Panjandrum

Panjandrum — Tue, 26 Jun 2012 21:27:20 -0800

Worth also noting is that prophylactic use of antibiotics in livestock leads to a great deal of it actually being excreted into nearby water sources, thereby helping to select for anti-microbial resistance in a wide variety of bacteria. > A draft proposed Veterinary Feed Directive regulation, open for public comment You can comment here, and read other comments while you're at it. These kind of rule changes are typically widely disseminated through professional channels, so it's mostly professionals commenting, but when they say "open for public comment" the Feds really do mean it. FYI, the comment section closes July 12, 2012 and the regulation to search for is FDA-2010-N-0155. The proposed changes are to 21 CFR 558 (Title 21 of the Code of Federal Regulations is the section the establishes the rules for the FDA).

By: three blind mice

three blind mice — Tue, 26 Jun 2012 21:31:09 -0800

"Because it is well established that all uses of antimicrobial drugs, in both humans and animals, contribute to the development of antimicrobial resistance, it is important to use these drugs only when medically necessary." OK, but doesn't this pearl of wisdom only apply to antibiotics which are still somewhat effective? Penicillin was discovered by Fleming in the 1920s, it has long since lost it's punch (due most likely its profligate use in the 1950s and onwards, but still): In the 1970s, strains of the bacterium that causes ear infections and meningitis in children (Haemophilus influenzae) and the bacterium that causes gonorrhea (Neisseria gonorrhoeae) developed almost complete resistance to penicillin. It would seem to me that continued, repeated exposure to penicillin is going to have no effect on bacteria which are already resistant to penicillin. The cow's out of the barn, so to speak, with penicillin so why not feed it to cattle? What about feeding tetracycline to teenagers for its non-antibioric effects on acne? Is this not also a similar problem?

By: parudox

parudox — Tue, 26 Jun 2012 22:10:38 -0800

The cow's out of the barn, so to speak, with penicillin so why not feed it to cattle? Agribusiness is not entirely stupid - they do their research and feed livestock antibiotics that actually do something. The problem is that the agribusiness interest (especially the pharmaceutical portion) is not shared by the public, especially if that interest is to fit within an average investor's horizon of caring.

By: R343L

R343L — Tue, 26 Jun 2012 22:14:07 -0800

three blind mice: That's actually discussed. This commentary (on a paper in the same issue) discusses some of these issues.

By: George_Spiggott

George_Spiggott — Tue, 26 Jun 2012 22:15:12 -0800

The cow's out of the barn, so to speak, with penicillin so why not feed it to cattle? That doesn't make a lot of sense: if you're feeding it to cattle for any remaining antibiotic effect it may still have, then you will rapidly eliminate that effect. If it doesn't have any remaining antibiotic effect then why would you feed it to cattle? We need to protect whatever remaining tools we have; there are not an unlimited number of antibiotic effects these drugs can exploit; when one antibiotic is ruined by pathogen, it takes an entire class of related antibiotics with it: often all antibiotics that produce a particular effect on bacteria. Eventually you end up with pathogens that don't have susceptibilities to low doses of anything in quantities that are nonpoisonous to humans.

By: Panjandrum

Panjandrum — Tue, 26 Jun 2012 22:15:51 -0800

> only apply to antibiotics which are still somewhat effective Bacterial resistance develops in response to how a whole class of antibiotics work and there really aren't that many classes of antibiotics. Each drug may have a particular target, but the same drugs in a class will target the same thing (if in different ways) and may therefore be susceptible to the same resistance factors. Penicillin, for instance, is a beta-lactam antibiotic. At its simplest level, it prevents bacteria from making cell walls, which basically causes them to burst open and die. It does this by basically shoving part of itself in the middle of the cell wall instead of what is supposed to be there. Imagine the inner and outer layers of the cell wall as two people who want to calmly whether they the merits of pork vs. beef BBQ. A beta-lactam is basically the guy who jumps in and says "I like BBQ chicken," thereby derailing the whole conversation and preventing the inner and outer wall from having any sort of meaningful connection. This derailing assholery is the basic premise for all beta-lactam drugs. The BBQ loving bacteria have two ways of fighting this: - Make beta-lactamase that cuts the beta-lactam core of the antibiotic apart ("Chicken isn't BBQ, so fuck off chicken-sucker.") - Alter the proteins that the antibiotic binds too ("We were actually talking about the depiction of BBQ in the latest Cannes Film Festival winner.") Either way, any drug you see that ends with -cillin has a beta-lactam core that is gunning for a bacterial cell wall. All the various permutations of penicillin and it's derived compounds may be tailored to avoid some defense mechanism of a bacterium, but they all target the same thing. Penicillin may be broadly useless because it is easily countered, but the use of it's derivative compounds continues to select for bacteria that can counter its basic mechanism.

By: Panjandrum

Panjandrum — Tue, 26 Jun 2012 22:18:55 -0800

On not-preview, what R343L said.

By: R343L

R343L — Tue, 26 Jun 2012 22:19:20 -0800

Also, if you're curious, you can actually read up on some of the papers showing problems with antibiotics and agriculture yourself. I posted about antibiotic resistance and whether humans actually get resistant infections via agricultural sources. It turns out the evidence is surprisingly more indirect than I expected but also somehow more convincing. Am I allowed to self-link like that? I did a lot of work for that post that isn't obvious just by the word count. But it's very relevant!

By: Phalene

Phalene — Tue, 26 Jun 2012 22:29:24 -0800

It would seem to me that continued, repeated exposure to penicillin is going to have no effect on bacteria which are already resistant to penicillin. No, but removing exposure to the drug lets other competing bacteria build back up- ability to resist one drug is being selected for, but other strains still exist or will mutate back when you remove the selective quality.

By: Mike Mongo

Mike Mongo — Tue, 26 Jun 2012 22:39:17 -0800

Here's what I am seeing in Key West and nearby islands. Infections and super-infections which I previously was unaware of being a problem suddenly exacerbating into chronic and even fatal conditions. It is worrisome to me in that I am seeing the same things happening over and over. And that is seemingly insignificant injuries (cuts, scratches, minor surgeries) blowing up into full-scale mortally threatening hospitalizing events. Now I am conscious to tell any friend with a cut, breech or injury, "Stop. Act now. Don't look back and wish you had." Because it may be that infections are evolving resistance to antibiotics but whatever it is some trend is happening you may wish not to be a part of.

By: en forme de poire

en forme de poire — Tue, 26 Jun 2012 22:51:34 -0800

To piggyback on Phalene's comment, usually being resistant to a drug actually has a fitness cost (e.g.). If the selective pressure were lifted (i.e., people stop prescribing antibiotics), antibiotic resistance would therefore tend to disappear, because the resistant forms are, in general, slightly worse at growing than their sensitive counterparts. You would think that wouldn't be much use in the near term, but actually there is some encouraging evidence that reserving antibiotics for the most serious cases (plus more aggressive tracking and screening for MRSA) can be really effective.

By: homunculus

homunculus — Wed, 27 Jun 2012 00:47:07 -0800

Poll: Americans Don't Want Antibiotics in Their Meat

By: homunculus

homunculus — Wed, 27 Jun 2012 00:55:01 -0800

Poisoning Workers at the Bottom of the Food Chain: Pesticides sicken more than 10,000 farm laborers annually. What's being sprayed is often a mystery. And complaining can mean getting fired or deported.

By: tommyD

tommyD — Wed, 27 Jun 2012 03:28:57 -0800

Expect Big Farmer and Big Pharma to pour massive amounts of cash into armies of PR flacks, truckloads of television commercials, platoons of lobbyists, squadrons or radio talk show hosts and flocks of viral email and youtube campaigns, all designed to remind the American People that the legacy of freedom to continually dose our livestock with shovelfuls of antibiotics is what made our country great. Those polls you cite will shift quickly. Sorry, I woke up pessimistic this morning.

By: eriko

eriko — Wed, 27 Jun 2012 05:31:53 -0800

Penicillin may be broadly useless because it is easily countered, but the use of it's derivative compounds continues to select for bacteria that can counter its basic mechanism. For example, the combination of amoxicillin and clauvanic acid. The amoxicillin is a β-lactam antibiotic, and clauvanic acid inhibits the production of beta lacatamase, which lets the amoxicillin be effective against some β-lactam resistant bacterium. Interestingly enough, it's banned for use in feed in the US and most of Europe (with the big exception being the UK.)

By: gilrain

gilrain — Wed, 27 Jun 2012 06:48:06 -0800

tommyD: Sorry, I woke up pessimistic this morning. I had steak last night and woke up penicillic this morning.

By: VTX

VTX — Wed, 27 Jun 2012 06:52:39 -0800

By: wintermind

wintermind — Wed, 27 Jun 2012 07:41:40 -0800

We also should talking about how the proposed ban will increase the cost of animal protein in human diets. I'm not arguing against the proposed change. If nothing else, consumers will eventually demand it, regardless of what the science says. The demand for animal protein is still increasing, and rising feed (hello, ethanol subsidies) and fuel prices are increasing costs to the consumer. It's prudent to take a longer-term view of things and consider future human health impacts. But it's important to be aware that this is not all upside and no downside for individuals.

By: saulgoodman

saulgoodman — Wed, 27 Jun 2012 07:57:32 -0800

It's prudent to take a longer-term view of things and consider future human health impacts. Just to be clear here, this issue is not about being "prudent" and taking "a longer-term view." The emergence of antibiotic resistant pathogens from these practices is already very much underway and is already costing us a lot in ways that sticker prices on meat at the grocery don't reflect. The researchers estimate that 20,000 people in the United States die each year from MRSA, and treating MRSA can range from $3,000 to more than $35,000 per case. Taking the average of that low and high cost figure puts the costs of treating just those Americans who eventually die each year from antibiotic resistant bugs (that is, ignoring the costs of treatment for the many more who don't die) at about $19,000 a pop, over a population of 20,000--or $380,000,000.00 dollars. But you know, more importantly, real people are getting sick and dying just to help the meat industry shave a few points off its operating margins.

By: saulgoodman

saulgoodman — Wed, 27 Jun 2012 08:32:53 -0800

(To be fair, also because some doctors prescribe super doses of antibiotics for the sniffles, but the point stands...)

By: 4midori

4midori — Wed, 27 Jun 2012 08:46:07 -0800

It's amazing that with all the hand-wringing from conservatives about excess regulation, we have inaction from the FDA since the 1970s on this. I believe conservatives eat meat too.

By: Blue_Villain

Blue_Villain — Wed, 27 Jun 2012 08:51:33 -0800

On the other side of the coin, TommyD, I assert that public opinion has already passed the tipping point and the pro-antibiotic feed PR campaign will simply push more Americans to buy more antibiotic free meat faster. I just see it as an indication of a high demand, and that producers/distributors/retailers will just increase the markup on their best cuts and label it as "antibiotic free" regardless of whether or not it actually is. You know, sorta like they do with organic stuff.

By: George_Spiggott

George_Spiggott — Wed, 27 Jun 2012 10:13:24 -0800

(To be fair, also because some doctors prescribe super doses of antibiotics for the sniffles, but the point stands...) Also the widespread, illegal practice of selling doses of antibiotic over the counter as a magic bullet for whatever a customer is complaining about.

By: TedW

TedW — Wed, 27 Jun 2012 10:27:48 -0800

We also should talking about how the proposed ban will increase the cost of animal protein in human diets. If meat gets more expensive, perhaps many people will replace some portion of the meat in their diets with healthier alternatives. And less demand for meat means fewer factory farms which in turn means less waste, less energy use, and better conditions for the animals. Im still not seeing a downside there.

By: George_Spiggott

George_Spiggott — Wed, 27 Jun 2012 10:59:33 -0800

We also should talking about how the proposed ban will increase the cost of animal protein in human diets. Need to be careful that your definition of cost encompasses everything; not just the price a consumer pays at the cash register. The billions spent on pharma development in the antibiotic race, on rising treatment costs, to say nothing of the human cost in suffering and mortality for less-treatable and untreatable infections, is borne by everyone. Additionally, meat production is already directly and indirectly subsidized in all kinds of ways, not just obvious ones, like grain subsidies and grazing permits priced below market value and even below publicly-borne management costs; but also in the short-sighted permissiveness that spares meat producers the expense of land stewardship, watershed and water quality protection, and humane treatment, to name but a few things. Cheap meat is very expensive indeed if all we're doing is hiding the real price tag from ourselves.

By: oneirodynia

oneirodynia — Wed, 27 Jun 2012 11:20:15 -0800

The demand for animal protein is still increasing, and rising feed (hello, ethanol subsidies) and fuel prices are increasing costs to the consumer. The average American consumes 170 pounds of meat annually. I don't think it will be hugely problematic for rising prices to put a dent in that amount.

By: Renoroc

Renoroc — Wed, 27 Jun 2012 13:09:24 -0800

The Onion was ahead of the curve on this topic.

By: homunculus

homunculus — Sun, 15 Jul 2012 15:00:48 -0800

How Your Chicken Dinner Is Creating a Drug-Resistant Superbug: Continuing to treat urinary tract infections as a short-term, routine ailment rather than a long-term food safety issue risks turning the responsible bacteria into a major health crisis.