Saving Antibiotics For The Sick

Cow

The FDA wants to curb the use of antibiotics on livestock. The drugs are heavily used because they increase animal growth for reasons not fully understood. McArdle supports the move:

Antibiotic resistance is a growing problem that endangers many of the medical miracles we now take for granted. Antibiotics are effectively a scarce resource; we should be husbanding them to cure disease, not to make our steak 15 percent cheaper. That said, don’t think that this solves the problem. When I wrote a piece about antibiotic resistance for the Atlantic, I expected to get easy quotes from experts on the scurrilous waste of feeding penicillin to pigs. But none of the experts I talked to were willing to say that this was a huge part of the antibiotic-resistance problem. Most resistance isn’t evolving on farms, where very few of us spend any time; to be sure, we eat meat from those farms, but cooking should kill off most of the resistant bacteria. Most cases of antibiotic-resistant bacteria come from hospitals, people who have been in hospitals, or tuberculosis patients who stop taking their drugs as soon as they feel better.

Kent Sepkowitz makes related points:

Though admirable, the FDA’s action should not distract from the larger issue at hand: yes, we are giving too much antibiotic to pigs, but the real issue is that humans have been so piggish about prescribing and requesting and gobbling antibiotics—in hospitals and doctor’s offices and drive-through urgi-centers and through the mail. We are addicted as a nation not just to opiates but to antibiotics—and as with other addictions, sooner than later, the party always ends.

Maryn McKenna notes that the FDA’s announcement has no teeth:

This plan is not legislation, nor a regulation; it is entirely voluntary. (Hence the “shoulds” above rather than “musts.”) If you look at the Guidance document itself, it is prominently labeled “Contains Nonbinding Recommendations,” and also says: “This guidance … does not create or confer any rights for or on any person and does not operate to bind FDA or the public.” Companies have 90 days to signal to the FDA whether they agree to follow this plan. Could they defy the agency and continue to sell their products for growth promotion? Probably they could; but the FDA has promised to make transparent which companies sign up and don’t, apparently counting on public pressure to get companies to move.

Dina Fine Maron is pessimistic about compliance:

The bigger news today is that FDA also issued a proposed rule that would force animal producers to obtain veterinary oversight to use certain antibiotics. Essentially, farms would need a prescription to use these drugs in animal feed. It would be a step in the right direction – if it survives the comment period intact.

Tom Philpott weighs in:

[T]here’s little distinction between giving animals small daily doses of antibiotics to prevent disease and giving them small daily doses to make them put on weight. The industry can simply claim it’s using antibiotics “preventively,” continuing to reap the benefits of growth promotion and continue to generate resistant bacteria. That’s the loophole.

But the document released Wednesday delivers five pretty specific guidelines on how “prevention” should be defined, including that antibiotics prescribed preventively should be “targeted to animals at risk of developing a specific disease,” i.e., not given willy-nilly to “prevent” the theoretical possibility of some hypothetical disease. It adds: “FDA would not consider the administration of a drug to apparently healthy animals in the absence of any information that such animals were at risk of a specific disease to be judicious.” That’s the strongest statement I’ve seen from the FDA on the prevention loophole.

(Photo  by Jeroen Bennink)