The invisible epidemic – Giving voice to the faceless victims of antibiotic overuse

Overusing antibiotics has spurred a crisis in antibiotic resistance.

Since their advent in the 1940s, it’s been no secret that the more you use antibiotics, the quicker bacteria get resistant to them.
What’s newer is the realization of the scale of antibiotic overuse, at least in agriculture. Since 2010, the FDA has collected data from pharmaceutical companies definitively showing that more than 80 percent of all U.S. antibiotics – some 29 million lbs per year– are sold for use in livestock or poultry. Ninety percent of these are put at low doses into livestock feed or water for flocks or herds, often to spur growth or economic gain and not to treat a diagnosed disease.

What’s also new is that bacteria generally now have the capability to become resistant to most if not all antibiotics quite quickly. More and more now, people are getting sick and dying from infections that no longer respond easily to antibiotics. Some, like MRSA, have become household names. Others are less known, though often no less deadly.
But most resistant infections still take place in hospitals. Inside those walls, the impact is huge: Patients with resistant infections get sicker, stay in the hospital longer, and die more frequently than do patients with non-resistant bugs. The economics are scary, too. Resistant hospital infections cost $18,000 to $29,000 per case to treat, causing a cumulative $20 billion price tag for the nation.
Precisely because the victims of highly resistant infections typically land in the hospitals, however, they remain largely invisible. Due to patient confidentiality, their stories are little told. heir pictures fail to make their way into newspapers. Families may know their loved ones died of a bad infection, but not appreciate the role that resistance has played. It’s uncommon for the words “antibiotic resistant” to work their way into obituaries, or for pictures of victims to be so identified in news stories. Out of sight, out of mind.
The irony is that with an estimated 900,000 cases of resistant infections per year, there must be plenty of folks out there with personal experience. Yet it is a nearly faceless epidemic. And that simple fact works against mobilizing support for changes to farm policy that could help turn this situation around by making sure antibiotics are used only when necessary. Help us turn that around.
At IATP’s Healthy Food Action, we have long worked to collect some of these stories. Farmers, farmworkers – even veterinarians – are at greater risk from antibiotic resistant infections. Some of their stories, like this one from Kim, can now be found at Keep Antibiotics Working, where, as co-founders, we’ve served on the executive committee for the past 12 years.
“I was working on a local CAFO caring for 1200 hogs, 8 hours a day. Getting them fed was a big enough undertaking let alone administering B-12 shots and antibiotics as a routine part of their care. If they weren’t eating well I would medicate them. If they had a small wound or a runny nose I would medicate them. In fact, medicating the hogs was mandatory protocol at every farm I’d ever worked. Now, I’m not a veterinarian or even close—but, unlike human medicine that requires a licensed professional to prescribe and dispense drugs, Penicillin, Tylan or Lincomax were abundantly available to those of us who cared for the hogs. Antibiotics were considered a “fix all” for everything — starting at birth, giving newborn piglets a shot of penicillin, and continuing medication, even in their feed, throughout their short lives…..
Early in March a small bump appeared on the back of Dale’s left thigh. I noticed it, but thought nothing of it. Two days later Dale had noticed it as well since it had grown in size and color. Thinking it might be a spider bite we made a trip to the ER and sure enough, that was the diagnosis. An antibiotic was prescribed and we were sent home. The following evening the “bite” had grown to silver dollar size so we headed to the ER again. A couple hours and blood tests later it was confirmed that Dale had methicillin-resistant Staphylococcus aureus, or MRSA. This time we headed home with an antibiotic drip. By the next morning, Dale was rushed into surgery because it had grown another inch and half to the size of a tennis ball and they were cutting the flesh-eating disease out of his leg.
That very same day I noticed a small bump, identical to Dale’s, on my daughter’s leg. I immediately rushed her to the ER and requested she be tested for MRSA. Just as I feared, it came back positive…..
On my doctor’s recommendation, I stayed home from work a few days. With time on my hands, I obsessively set my mind on learning everything I could about MRSA….. I was shocked to learn that hog farmers who handle an abundance of antibiotics are a main carrier of MRSA. The idea that I brought this home to my family plagued me. I could not wait to return to work so I could alert everyone else to the dangers of this issue.”
Share these stories, with your friends, your colleagues, your members of Congress. Help us make them aware of the critical connection between the resistance epidemic, and the huge overuse of antibiotics in agriculture.
Help us create more stories. Contact me with your own, @Food_dr on Twitter, or at dwallinga@iatp.org. Or if you have had patients suffer from resistant infections connected by science to agriculture, especially including drug-resistant Salmonella, Campylobacter, resistant UTI and other E coli infections, MRSA and any resistant infection in farmers or farmworkers, think about sharing their stories as well (with their permission, of course).

Inaction persists at FDA in restricting antibiotics use in livestock production

By David Wallinga, M.D., Senior Advisor on Science, Food and Health, Institute for Agriculture and Trade Policy

July was an important month for saving antibiotics, and a busy month for IATP’s Healthy Food Action. Here’s what’s happened.

FDA data show 90 percent of the more than 29 million pounds of antibiotics given to food animals each year are put into animal feed or water. Mostly, this is to promote growth or to compensate for the crowded, factory-style conditions in which they’re raised, inducing an unnecessary disease risk. There’s consensus that the huge farm overuse is helping create and transmit resistant infections to humans, where they lead to more illness, more death and rising health costs.
FDA’s never taken one of these approved feed antibiotics—including penicillins, tetracyclines, erythromycins and other important human drugs—off the market. Earlier this year, federal courts decided against the FDA on the first of two legal claims. In effect, the decision said that FDA was unreasonable in putting a 35-year-old decision on the backburner and continuing to allow the addition of penicillins and tetracyclines to animal feedan—an unnecessary risk to public health. FDA appealed that ruling, and asked for a stay in implementing the decision.
Just a few days ago, the court ruled again. It refused the FDA’s request for a stay, saying, in effect that despite the appeal, the FDA could delay no longer. It must begin a process to withdraw approval for use of penicillin and tetracycline in animal feed unless drug manufacturers prove in regulatory hearings that such uses are safe for people. Finally.
Seven and 13 years ago, U.S. citizens also had petitioned the FDA to withdraw feed approval five other classes of antibiotics important to humans, in addition to penicillins and tetracyclines—the FDA denied those petitions. In the second legal decision that went against the FDA, in June 2012, the court directed the FDA to reexamine its grounds for doing so. If the FDA does nothing—that is, if the agency just lets this second decision stand, without appeal—the process can move forward to restore a more sane policy of using antibiotics for animals only when necessary.
That’s the ask that IATP made in a letter sent to FDA Commissioner Hamburg, herself a physician, last month. Seven partner organizations, with more than 9 million combined members, added their voices to this call.
Outside the courtroom, the FDA has been touting a “sea-change” in its approach to the overuse of antibiotics in livestock, but as suggested in comments filed by IATP and more than 50 other groups, including the American Academy of Pediatrics, the Pediatric Infectious Disease Society, American College of Preventive Medicine, American Osteopathic Association, American Public Health Association, Association of State and Territorial Health Officials, Association for Professionals in Infection Control and Epidemiology, Boston Public Health Commission, National Association of County and City Health Officials, March of Dimes and others, the FDA’s new approach could fall well short of the mark. Not least because at its core, the FDA’s approach asks pharmaceutical companies to volunteer to act against their own financial self-interest, by walking away from pharmaceutical sales in the short term.
If we’re going to convince FDA to get off the dime, it’s going to take a whole lot more people power, and health professionals are key. That’s why we asked you to weigh in, to tell FDA to do better and be more proactive to protect public health. More than 500 of you responded. You joined 270 chefs, and 44 hospitals, and about 219,000 citizens in asking the same.

Chicken, Life-threatening UTIs and Women’s Health

With 6-8 million cases per year, urinary tract infections (UTIs) primarily impact women. As many as 85 percent of UTIs are caused by E. coli bacteria, most often a specific form of E. coli known as ExPEC. ExPEC are believed to cause up to 40,000 deaths from bloodstream infections each year. As they get more resistant to antibiotics, ExPEC infections and resulting deaths will rise. It’s a troubling trend, given that these infections are already becoming more antibiotic resistant. This webinar focuses on the new, compelling science showing that women are contracting ExPEC infections from eating contaminated chicken. What’s more, we are now finding that chickens raised in environments where antibiotics are routinely added to chicken feed for growth promotion has helped create this problem.

Our speakers include Dr. Lance Price, a microbiologist doing cutting-edge research on how food, agriculture and resistant infections are linked and Susan Vaughn Grooters, MPH of STOP Foodborne Illness who will talk about the experiences of victims of drug-resistant UTIs, including an announcement of a new patient-based registry for resistant pediatric UTIs.

Co-sponsors:

American Holistic Medical Association
Washington State Nurses Association