Editor and General Manager
By now you are well aware of the threat. You may have even contributed to its growth. Should you worry? Task forces have been formed. There are government agencies on the case and executive orders pushing action. There is a wealth of intelligence and further studies are being conducted. Yet people are dying and the enemy gathers in strength and numbers daily. Costs in the U.S. run into the billions every year. All this despite there being well-known and successful strategies that are bringing the problem under control elsewhere in the world.
The enemy in this case is antibiotic-resistant bacteria (ARB). The CDC estimates 28,000 yearly deaths in the U.S. from these infectious agents, and implicates them as a contributing factor in thousands of other deaths. Two million people are infected with ARB annually. Grim numbers indeed. As most of us are aware, the scientific advances that have protected people from bacterial infection for decades are being squandered through continued overuse and misuse of antibiotic drugs.
We are all pretty clear on how it happened. The long-term use of antibiotics and their analogues has become an entrenched part of agricultural practice, because, for reasons that are not yet understood, administering antibiotics seems to cause livestock to gain weight. Combine agricultural practices with the overprescribing of antibiotics for human patients, and patients who fail to follow protocol when being treated with antibiotics, and what you end up with is a widespread loss of therapeutic benefit.
How widespread? As the FDA’s Janet Woodcock noted in testimony before Congress as far back as 2010, “As of today, antimicrobial-resistance mechanisms have been reported for all known antibacterial drugs that are currently available for clinical use in human and veterinary medicine.” The United Kingdom’s Prime Minister, David Cameron, commissioned a Review with the mandate of delivering a set of recommendations he hopes will be adopted internationally by the summer of 2016. Meanwhile, the Review has published its first paper, “Antibiotic resistance: tackling a crisis for the health and wealth of nations,” which explains why failing to address the crisis will cause 10 million deaths a year and cost $100 trillion by 2050.
Various proposals from regulatory agencies, suits and countersuits in federal courts, congressional hearings and other government initiatives have so far led to inaction, or, more accurately, a series of actions and reactions that in the end amount to inaction.
Things are different in Europe, where Denmark has taken the lead in fighting these trends. Over the past two decades, the Danes have eliminated the nontherapeutic use of antibiotics in livestock. They have found that, not only does this lead to a reduction in antibiotic-resistant strains in animals, it leads to a reduction in those strains in humans as well. Resistance to antibiotics has decreased throughout the country (as it has throughout Europe, where similar policies are being implemented).
While the economic concerns of farmers (pharmers?) and, subsequently, consumers, seem to be on many minds in the U.S., what would be the consequences of stopping this assault on bacteria? One of the most telling aspects of Denmark’s transformation in agricultural policy is that eliminating routine antibiotic use has had almost no impact on the nation’s pork industry. And Danish hams are big business. From 1992 to 2008, antibiotic use per kilogram of pig raised in Denmark dropped by more than 50%, while overall production increased at nearly the same rate. Pig mortality did increase temporarily beginning in 1994, but then started falling and by 2008 was similar to 1992 levels. As for economics, the overall cost to raise a pig has increased by about one euro per animal for its entire life.
It seems the only place any economic pain would be felt is in pharmaceutical companies. While they sell these drugs in volume, they do so at commodity pricing. Any concerns that farmers may have about the consequences for their stock are not grounded in reality, at least not in the long term.
Why move so slowly? Or rather, why keep finding ways to not move at all? It is hard to conceive of any reason worth mentioning when the costs to society as a whole, and to a large number of individuals specifically, are so high. The ability of legislators and regulatory bodies in the U.S. to ignore (or worse, suppress; or worse still, to counter with dubious reports from industry) the advice and wisdom of scientists should no longer be surprising. While this is a drum I beat with regularity, it is a tune I am continually invited to play. In the end, one suspects that those who resist are looking out for their own interests. Indeed, serving dinner made of cuts from antibiotic-resistance breeding grounds does not serve their constituents well at all.
Steve Ernst is editor and general manager, American Laboratory/Labcompare; [email protected].