Since the time of the Egyptians, humans have understood that certain molds and other natural substances can stop the spread of infection. But medical researchers only harnessed the awesome infection-fighting power of these substances during the early 1900s. Since that discovery, antibiotics have saved millions of lives.
For many Americans, that happy era of near-total protection from deadly bacterial infections has passed. Thanks to the profligate use of antibiotics in both human medicine and meat production, drug-resistant bacteria now kill an estimated 23,000 Americans each year, according to the CDC.
"Antibiotic resistance is one of the world's most pressing public health problems," says Jean Whichard, who leads the CDC's National Antimicrobial Resistance Surveillance Laboratory. "Illnesses that were once easily treatable with antibiotics are becoming more difficult to cure and more expensive to treat."
The World Health Organization agrees, and calls antibiotic resistance "one of the biggest threats to global health."
"Before antibiotics, a lot of children died from infections that started from minor injuries, like scraped knees, and young women died from untreatable bladder infections," says Lance Price, a professor of environmental health at the Milken Institute School of Public Health at George Washington University and founder of GW's Antibiotic Resistance Action Center. "We may be going back to that."
Price points out that the CDC's 23k estimate is already four years old, and is likely "super conservative." The actual number of deaths caused by antibiotic-resistant bacteria is likely much higher—and about to skyrocket. "We're at 23,000 deaths when we're still lucky enough to have antibiotics that work for virtually all infections," he says. "When we get bacteria that are resistant to everything, that number's going to shoot up."
Note that he says "when," not "if." The way meat producers, drug makers, and federal regulators continue to operate when it comes to the use of antibiotics in food production all but guarantees the rise of so-called "superbugs" and the illness and death they will cause. "We spend billions of dollars fighting terrorism and invisible demons, but this demon is here, and we aren't stopping it because it's a matter of business," Price says.
To wrap your head around the problem, it's important to understand that infection-causing bacteria are living things, and are able to mutate and evolve in order to avoid extinction. The more these bacteria are exposed to an antibiotic drug—whether in people or in animals—the faster they develop new ways to skirt that drug's defenses.
A prime example is tuberculosis, a deadly airborne disease that scientists once hoped to eradicate. Since drug-resistant TB first appeared in the 1980s, those hopes have vanished. Worldwide—and especially in parts of Asia and Africa—rates of infection from drug-resistant TB are on the rise. And most public health experts agree it's a matter of time before the problem escalates in the US.
A recent CDC report names 18 different bacteria—from TB to strains of Candida and Salmonella—as threats to develop further antibiotic resistance. Many of these bacteria are found on and around beef-producing cows, 30 million of which are packed into US feedlots, per USDA estimates. Once those bacteria develop antibiotic resistance, they can make their way into your system via meat you bring home from the store (among other ways). Here's how the CDC explains it:
"We know the more we use antibiotics, the more resistant bacteria will emerge and the faster our antibiotics lose efficacy," Price says. "But we keep using them anyway." Why do we do this? Treating livestock with antibiotics keeps animals free of disease even when their living conditions are unsanitary. Antibiotic treatment has the added benefits of making animals grow faster and fatter on less feed.
As of January 2017, FDA guidelines call on American food producers to stop treating cows and other livestock with antibiotics solely for the purpose of supercharging the animals' growth. To call these regulations overdue is a bit of an understatement. Experts have been shouting for years about the dangers of using antibiotics in food-producing animals. And while the regulations are welcome, some health officials say they don't go far enough.
The new guidelines aim to restrict the use of antibiotics in livestock to disease treatment and prevention. But Price calls the disease-prevention clause a "massive loophole" that will allow for the continued use of antibiotics on farms and feedlots.
"I talk against using a low dose of antibiotics to protect animals from infection, and some people groan and say, what, you want animals to suffer?" he says. "But what we have now is a system where we're cramming animals into terrible, unsanitary conditions and using antibiotics when they get sick instead of improving the conditions so antibiotics aren't necessary."
The meat industry isn't the only big business that profits from the current arrangement. Drug companies that produce antibiotics often make far, far more money selling their stuff to food producers than to hospitals or health systems. "When you're talking about humans needing antibiotics, you might need to take one every few years for three to 10 days," Price says. That doesn't keep pace with the volume of antibiotics required to treat livestock.
To be fair, use of antibiotics for meat production is only part of the problem. Doctors and clinicians continue to prescribe antibiotics for people who don't really need them. The use of medically important antibiotics in livestock is also an issue overseas. Some of the scariest drug-resistant bacteria have recently turned up in China.
But if a country like the US isn't willing to overhaul its practices and take a leadership role on antibiotics and livestock, the prospect of getting the worst offenders to fall in line is a non-starter. "We understand what's happening, and as a society we have a responsibility to do something about it," Price says. What are his solutions?
Here in the US, Price says he's not for banning the use of all antibiotics in animal production. "We just need surveillance and enforcement, and people saying, 'OK, this farm has treated this herd three cycles in a row, so let's get an extension agent in there to see what's going on," he says. Countries like Denmark and the Netherlands have systems like this already in place.
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On a broader scale, he says the US needs to band together with other nations to set up a fund that would pay drugmakers to discover and develop new antibiotics. "There are probably a lot of other antibiotics out there, and drug companies are best equipped to bring those to market," he says. "But it's incredibly expensive, and there are very few companies interested in [antibiotics] because there's so much more money to be made in drugs people take every day for a lifetime—like heart disease or diabetes medications."
Finally, one of the best ways the average American can end the use of antibiotics in livestock is to "vote with your dollars," and buy meat from animals raised without antibiotics. "Be vocal at your grocery store and at restaurants," Price says.
Some national restaurant chains—Chick-fil-A and McDonald's among them—have moved away from chicken treated with antibiotics. (Pork and beef are another story.) Chipotle and Panera Bread are industry leaders on the no-antibiotics front. Among grocery store chains, Whole Foods has long been a champ when it comes to banning antibiotics in meat. "If the label says 'raised without antibiotics' or 'organic,' that's what you're looking for," Price says.
"As far as imminent threats to human health go, I'd put antibiotic resistance second only to global warming," he says. "But in terms of timelines, climate change is down the line a bit, and for 23,000 people, this apocalypse is already here."
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