Medicine Should Be For Sick People
There’s a new advertising campaign under way in Metro taking aim at the routine use of antibiotics in commercial poultry- and livestock-raising enterprises:
Photo by Eric Goldman
For all the same reasons that antibiotics can be helpful to sick people they can also be helpful to sick animals. Or, in the minds of America’s industrial farmers, they can be given out routinely as a prophylactic measure so as to make it possible to raise animals in unhealthy and unsanitary environments, while also feeding them cheap corn that makes them ill. Unfortunately, as Eric Goldman emphasizes, this helps breed antibiotic resistant bacteria with dire health consequences for people.
The specific talking point that this increases health care costs is a cute way of piggybacking on the current political debate. In reality, I doubt that the actual contribution to health care inflation is especially large as the biggest costs are associated with chronic conditions or end-of-life situations. On the other hand, it is true that this is an important public health issue. Antibiotic resistant bacteria is, at the moment, a somewhat problematic situation. But the really scary thing is the prospect that it could become much worse. We’ve invented a lot of new antibiotics over the years, but there isn’t any guarantee that an infinite range of antibiotics are out there just waiting to be invented. In principle, we could wind up backing ourselves into some extremely problematic situations in the future, and making chicken slightly cheaper isn’t a good reason to be doing it.
14 Responses to “Medicine Should Be For Sick People”
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June 10th, 2009 at 3:45 pm
We may have invented a lot of antibiotics over the years, but we haven’t invented very many in recent years.
And this is a very real problem. Staph aureus is a common skin bacterium. Almost everyone is a carrier. This makes the development of multi-resistant staph aureus (MRSA), the famous “flesh-eating bacteria” a very big problem.
The future is here, it just isn’t fully distributed.
June 10th, 2009 at 3:45 pm
Or, in the minds of America’s industrial farmers, they can be given out routinely as a prophylactic measure so as to make it possible to raise animals in unhealthy and unsanitary environments, while also feeding them cheap corn that makes them ill.
Right, but what is needed is a systemic solution, such as legislation, because each of those industrial farmers is only following profit, not some malicious desire to pump animals full of antibiotics.
June 10th, 2009 at 3:54 pm
We give medicated feed to our three chickens in order to stave off coccidiosis, which is close if not the number one cause of mortality in pullets, and we’d like to keep our chickens alive, thanks. However, we intend to move off medicated feed once they get a little older and more robust, and my understanding is that commercial chicken operations are permanently on medicated feed, because it’s a lot cheaper.
On the other hand, it’s not quite true to say that medicated feed for chickens is a crutch to make up for ‘unhealthy and unsanitary environments’. Even chickens in quite humane, quite sanitary conditions are at a very high risk of contracting it. Have a chat with your local organic, free-range chicken farmer about coccidiosis sometime. Cows, swine, etc may be a different matter.
June 10th, 2009 at 3:56 pm
Don’t forget that some of us are allergic to the some of the new antibiotics.
I suppose we can simply die when the infections resistant to older antibiotics become prevalent.
June 10th, 2009 at 5:18 pm
I’d like to clarify two things (I teach microbiology, fyi).
1) MRSA is not “flesh eating bacteria”. Flesh eating bacteria is really a disease called necrotizing fasciitis, which was caused by streptococci in the outbreak in the 1990s, and some cases caused by MRSA have been identified recently – in other words, some MRSA can cause “flesh eating disease” but they are not identical.
2) MRSA stands for “methicillin resistant staphylococcus aureus” not multi-resistant, although they are, and some people do use it in that mistaken way. There is a real and important distinction here.
3) treating your chickens for coccoidosis prophylactically not what matt or others are talking about. Sub-clinical doses of tetracycline and other drugs are given to livestock, not to prevent disease, but to improve growth rate of the animals – maybe by altering the bugs in their guts. This has NO effect on their chances of getting an infection (coccoidosis is caused by a fungus, anyway).
June 10th, 2009 at 5:19 pm
sorry, I meant coccidiosis, obviously
June 10th, 2009 at 5:22 pm
Arrgh! sorry again, coccidiosis is a protozoan disease – I was thinking of coccidiomycosis, which is fungal (that’s what mycosis means). Apologies (the original point stands).
June 10th, 2009 at 5:27 pm
Paul Orwin,
Thanks for your comment. I’ve read a little bit about animal nutrition, though I’m not a microbiologist. Your point 3) matches what I’ve read. Quick question: I did know that these are sub-clinical doses that work to increase growth rate, but I wasn’t aware that altering the gut flora was the mechanism- is that established?
I would assume that sub-clinical doses of antibiotics still serve as a selective pressure that selects for antibiotic resistance, right?
June 10th, 2009 at 6:20 pm
While appreciating Paul Orwin’s input, it’s still important to remember that the game has been raised to a new level, and that includes cost and complexity.
What should happen now is that hospitals should screen incoming patients for staph and isolate patients appropriately. For many hospitals this would be difficult, because many of their rooms are two-patient rooms. In Washington state hospitals and some epidemiologists were initially very resistant to new standards until they realized what a public relations disaster this could be.
And, meth or multi resistant, the bottom line is often prolonged hospital stays, which naturally increases the likelihood that the infection will get out of the isolation and infect others.
Outside, in the real world, we’re all walking around with tons of bacteria for which our bodies have evolved defense mechanisms. When you start breeding superbugs (and the amounts of medication found in treated wastewaters are also a concern here) things can spiral out of control.
June 10th, 2009 at 7:38 pm
Antibiotic use is a perfect experiment for our current evolutionary model: punctuated equilibrium. What this means is that evolution is more pronounced with adverse conditions, only a few individuals survive a serious change in the environment. Those who survive find an environment in which the competition has been eliminated.
You can create this experiment by stopping to take your antibiotics after a few days. You have killed most of the germs, but those who survive will have added resistance.
June 10th, 2009 at 8:45 pm
Outside, in the real world, we’re all walking around with tons of bacteria for which our bodies have evolved defense mechanisms. When you start breeding superbugs (and the amounts of medication found in treated wastewaters are also a concern here) things can spiral out of control.
Well, no. Superbugs are, in general, still the same “bugs” that we have developed defense mechanisms against – antibiotic-resistance does not make germs less susceptible to our natural defenses. Overuse of antibiotics is not producing new, more deadly strains of bacteria, it is just making the antibiotics less effective against them.
In fact, antibiotic-resistant germs are generally weaker than non-resistant ones, which is why the non-resistant germs were dominant in the first place; non-resistant germs were more competitive in the absence of the antibiotic.
June 10th, 2009 at 9:29 pm
It would help if people would stop using anti-bacterial products at home. Learn how to clean and wash hands properly. Use a thermometer in the kitchen. If you washed your hands properly with antibacterial hand soap you would likely have sores on your hand. Plain soap is sufficient.
This is a pet peeve of mine. Cleaning is the mechanical removal of soil—not spraying and wiping. Disinfectants are only effective when used on a clean, dry surface and left for the appropriate contact time.
Soap and water is enough for most tasks. Antibacterial products might be effective if used only in the case of a bacterial illness being present, but as it is, people are just giving bacteria immunity by providing them small doses of antibacterials in the film that is left by spray and wipe “cleaning”.
What is called “cleaning” in many homes, restaurants, and public places is the sorry result of advertising. We could probably save ourselves billions by teaching people how to clean and use disinfectants properly.
June 11th, 2009 at 12:55 am
Re:
Overuse of antibiotics is not producing new, more deadly strains of bacteria, it is just making the antibiotics less effective against them.
In fact, antibiotic-resistant germs are generally weaker than non-resistant ones, which is why the non-resistant germs were dominant in the first place; non-resistant germs were more competitive in the absence of the antibiotic.
This is true, but beyond antibiotics/resistance, there’s another facet to factory farming that’s could make for much nastier bugs.
In most cases, virulence should work against the spread of a disease; if it’s too deadly, it kills the hosts before they have much chance to spread it. And even if it’s not deadly, if a disease is just particularly nasty, carriers are going to be avoided and isolated. You’re a lot more likely to get sick from a coworker with a cold than one with ebola, because you’ll care a lot about one and not the other.
But that all gets thrown out the window in factory farms, where thousands of animals are crowded together. Avoidance of diseased animals isn’t possible, so the incentives are reversed: transmission rates should be increased not in milder strains but in those that can just make the most copies of themselves – thus, the most virulent strains of any given disease.
On top of what’s been discussed above, this is a double-whammy.
June 11th, 2009 at 1:12 am
In reply to Hector, the idea about gut flora modification is still in something being explored, but there is some basis for it in preliminary work (it hasn’t been established that these doses are having this effect, but it has been shown that 1) various env factors can change gut flora and 2) gut flora can alter growth and health in livestock). It’s a pretty tough problem, and there maybe isn’t an investor with a strong interest in finding this answer.
In reply to serial catowner, please don’t misunderstand me, I was just trying to correct some factual errors, not disagreeing with the point that antibiotic resistant bacteria are a big problems. The term “superbug” is probably overused, and I think we probably have a ways to go before we run out of potential antimicrobials, but it becomes more difficult to find them (the low hanging fruit have been plucked) and there is certainly a disconnect between the clinical need and the financial incentives. I also agree that routine screening is a good idea, especially in areas (like parts of Washington state) where community acquired MRSA is rampant. However, it’s not cheap (yet).