Bad Bugs Biting Back

"Centers for Disease Control sounds alarm on deadly, untreatable superbugs,"
- USA Today, March 2013

"Study shows bacteria moves from animals to humans"
- New York Times, March 2013

"California Adopts Strict Limits on Antibiotic Use in Food-Producing Livestock"
- California Healthline, October 2015

California Governor Jerry Brown has signed into law the nation's most stringent restrictions on the use of antibiotics in the production of meat. Is this a good thing? It certainly is - perhaps a crucial step in our survival, in fact - and I am not prone to exaggeration of such things. Now our state's new policy must become that of the entire nation.

Way back in my undergraduate years, I was worriedly casting about for an honor's thesis topic in biology and environmental studies when I read a small news story about the mass feeding of antibiotics to farm animals, not so much to protect them from diseases as to make them grow faster so they could be slaughtered and sent to market (why antibiotics speeds growth remains to this day a somewhat mysterious process). It seemed clear to me even then that prolonged, low level exposure of bacteria to antibiotics was an ideal way to cause "unnatural selection" and breed stronger, antibiotic-resistant strains of pathogens. So I spent months researching and writing a 100-page report titled "Bad Bugs Bite Back.

Little did I know that years later I would become enmeshed in the high-stakes professional effort to curtail this threat. And now, many years later, that effort has finally resulted in some positive action - landmark action, it will likely turn out to be. And it's about time, for some very good scientists believe that the increasing invulnerability of disease-causing bacteria and viruses is likely the biggest threat to humanity in the future.

As soon as antibiotics were discovered and developed for medical use, bacteria began the Darwinian "arms race" that has been fought ever since, with pathogens developing resistance to antibiotics, necessitating continual development of new types of medications and increasingly difficult infect agents arising with increasing regularity. Some of the most informed experts have been warning that humans are now starting to lose more of these battles every year. The specter of untreatable and virulent outbreaks, local or pandemic, increases with each decade; as a review put it a decade ago,"Antibiotic resistance has reached a crisis state in human medicine."

Physicians have increasingly been educated and urged to be judicious in antibiotic use for many years now, with increasing success. But as it turns out, up to 70-80 percent of all antibiotics produced — certainly more than half, at a minimum — are in fact used in farm animals. The drugs are added to feed in mass "subterapeutic" dosing - ie, not to treat disease, but for other reasons. As it also turns out, this continual, low-level use is indeed a perfect way to breed resistant strains, which can then find their way into humans. Reports on this potential threat appeared as long ago as 1976 in the New England Journal of Medicine - and government panels set up make recommendations on the threat were tainted by industry-linked scandal from the start. Turns out there is a lot of profit involved, on both the "big pharma" and farm sides of the status quo. <http://www.ncbi.nlm.nih.gov/pubmed/581708>

Fifteen years ago, a coalition of concerned medical and public health organizations convened a meeting at the San Francisco Medical Society, co-chaired by two health living legends, UCSF Chancellor Emeritus and foprmer US secretary of health Philip Lee, and the late Lester Breslow, Dean of the UCLA School of Public Health and past-president of the American Public Health Association. I had just drafted a policy statement on this adopted by the AMA, urging less use of antibiotics in agriculture, that was national news. The assembled group developed strategy to move such policy forward. We weren't only "outsiders" to agriculture; even the editor of California Farmer, the state's leading agriculture journal, attended the meeting and then editorialized: "We call on producers and vets to stop overuse of all antibiotics ... Antibiotic resistance is a wake-up call that ag must answer."

Lee, Breslow and I subsequently editorialized in the Western Journal of Medicine that:

Leading experts unequivocally state that our current practices of feeding antibiotics to animals goes against "a strong scientific consensus that it is a bad idea" and that the long stalemate on this issue constitutes a "struggle between strong science and bad politics."

The intentional obfuscation of the issue by those with profit in mind is an uncomfortable reminder of the long and ongoing battle to regulate the tobacco industry, with similar dismaying exercises in political and public relations lobbying and even scandal. As with tobacco control, science and health concerns should take precedence over profit in regulating the overuse of antibiotics in the production of meat and other agricultural products. Antibiotics do have a place on farms, but the benefits of their use can likely be preserved while minimizing harm. We need to learn more about the extent of risk, but the delay tactic of allowing current practices to continue while "more research" is conducted is unacceptable. Enough is already known to justify a more cautious, preventive approach.

The United States has lagged behind some other regions on this topic. Based on the growing scientific evidence and policy statements such as the AMA's, the European Union recommended a ban on the use of non-therapeutic antibiotics in livestock production in 2006, a policy still being implemented. Over here, national legislation has been defeated politically numerous times, even though a key sponsor, Rep. Louise Slaughter, is the only trained microbiologist in among all elected officials.  One might hope that our legislators might listen to the true experts among them, but that might be too much to ask.

It comes down to political power and the marketplace. Some of the pressure "consumers" can add by buying only meat produced without antibiotics will certainly help, but it should be admitted that broader and stronger regulations will still be necessary for real change. Still, big institutions can lead the way; locally, the University of California, San Francisco (UCSF) Academic Senate Coordinating Committee, the School of Pharmacy Faculty Council, and the School of Medicine Faculty Council unanimously approved a resolution to phase out the procurement of meat and poultry raised with non-therapeutic antibiotics at UCSF. The resolution also encourages all University of California campuses to do the same.

But again, beyond consumer pressure, much better regulation is warranted. Rep. Louise Slaughter (D-NY), the only microbiologist in Congress, has four times introduced national legislation along the lines of what California just approved, and each time been defeated by political lobbying. Hopefully, in this regard as in some others, "as California goes, so goes the nation." California's new law is a landmark, but bugs know no boundaries and national - and international - regulations are required. The stakes are high. The power of big money — pharmaceutical and agricultural - makes for a prolonged battle, as the profits in the status quo are huge.

But if science loses out to profits and politics in this case, humanity's fate may indeed be to end, as T.S. Eliot warned in another context, "not with a bang, but a whimper."