Why does the FDA tell me one thing about overuse of antibiotics as a farmer and another as a physician?

The big question is—which is more nauseating, meat laced with methicillin resistant staph or the fecklessness of the FDA in failing to protect us against drug resistant bacteria?  Actually there is no reason to chose, because the FDA is serving up both fecklessness and resistant bacteria in one package.  After 40 years of inaction in the face of dire warnings from every human public health entity that deals with the problem, the FDA has decided to………….do nothing.

Ok, let’s be fair. They did as close to nothing as possible. Yesterday, the FDA yesterday decided to ban 3/1000ths of the antibiotics used in livestock. That’s 0.0032 of the 29 million pounds of antibiotics given to livestock that we eat in the USA. (Yes, that’s 29 million pounds.). And these antibiotics are not being used to treat sick animals, but rather to make animals fatten faster, and meat a little cheaper.  The FDA’s landmark cave-in banned the use of the antibiotic group called cephalosporins.

Overuse of antibiotics creates “superbug” bacteria that are not able to be killed by the antibiotics. The strong bacteria survive and develop mutations in their DNA that give them chemical resistance to the antibiotics. These bacteria move back and forth between animals and people. So even if the resistant strain of bacteria starts in livestock it jumps to humans.  That’s why pig farmers, who gave massive quantities of antibiotics to their hogs— were found to have  760 times the rate of carrying the very, very nasty germ MSRA (methicillin resistant staph aureus). And research by Dr. Tara Smith, the courageous University of Iowa epidemiologist, show retail meat in Iowa contaminated with strains of MRSA that originated in livestock.

So, even though the strain of MRSA starts in livestock, the germ can infect, and kill people. And it does, according the CDC's recent report of a girl with a fatal lung infection caused by drug resistant staph of livestock origin.  Perhaps the FDA should pick up the phone and call over to the CDC and have a conversation about protecting human health.

So, it looks like all those physicians, me included, obsessing about limiting antibiotic use to only situations where it’s absolutely necessary, are being played for fools. Turns out physicians only control a small fraction of the antibiotics used, about 20%, and that overuse represents a smaller fraction of this 20% they give to their human patients.

Silly me, during those 25 years practicing medicine, trying my best to not prescribe antibiotics unless absolutely necessary, to avoid creating superbugs. Having many times dealt with the very nasty impact of drug resistant bacteria, I did my best to play my part in limiting this carnage.  I saw too much—-families dressed like space travelers to avoid contact with loved ones being treated for life threatening methicillin resistant staph in hospital isolation rooms; formerly ‘routine’ urinary tract infections with E. coli untreatable as outpatients because of resistance to Cipro and other quinolones;  kids with formerly routine pneumonia, now resistant to penicillin, unheard of a couple of years earlier. This all makes physicians very nervous.

The folks at the CDC must feel pretty dumb inveighing against overuse, telling us in a cute video, Don’t Give In and Give Those Antibiotics! A few hundred milligrams here and there in humans seems to warrant a full court press.

All I had to do was become a farmer of cattle, as I did 9 years ago, and suddenly it was ok ‘give in and give those antibiotics’, and sling them by the pound. It seems that getting cattle fat faster is much more important those foolish little public health instructions that were pounding me as a physician. Perhaps I’m a stickler for coherence, but having one set of rules for humans and a completely different set of rules for cattle is not really working.

This is what the FDA said in 2010, in their well titled Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals.

the public health concerns associated with the use of medically important antimicrobial drugs in food-producing animals has been the subject of scientific interest for the past 40 years. FDA has reviewed the recommendations provided by the various published reports and, based on this review, believes the overall weight of evidence available to date supports the conclusion that using medically important antimicrobial drugs for production purposes is not in the interest of protecting and promoting the public health. (bold type added)

Pretty good summary of the public health consensus. Now, with further deliberation, and massive pressure from drug manufacturers and industrial, feedlot agribusiness the FDA says “Whatever”, and opts for the trivial. Are we surprised, when 80% of the antibiotics used in the US go to livestock in industrial settings to fatten them faster.

Take a look at the numbers. This chart is from page 3 of the FDA’s (long delayed) report of the weight of antibiotics used in food producing livestock. Off the 29,000,000 pounds, 87% are from “medically important” classes of antibiotics that the FDA has chosen to ignore  (Ionophores at  13% of  the total are only used in livestock).  I’ve placed info on cephalosporins in bold type.

2009 Sales and Distribution Data Reported by Drug Class Antimicrobial Class

So I don’t give antibiotics to my cattle. They don’t need antibiotics. It’s that simple. They’re not sick. And we don’t confine them or feed them in a way that makes them sick. They may gain weight a little more slowly, but they still get fat.  How much would it cost to protect the public?  Even agribusiness researchers who have quantified the cost of protection report only $5/pig, which amounts to less than 5 cents a pound for retail pork.

It turns out that as a farmer, by not giving my cattle antibiotics, I’ve probably played a bigger role in preventing resistant bacteria than in all those years trying to be a careful physician. But what I do won’t really matter unless the FDA does its job.