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Doctors across the county are witnessing the rise in the spread of drug-resistant superbugs. In fact, each year the Centers for Disease Control estimates that drug-resistant bacteria make 2 million people in the United States sick, and cause 23,000 deaths.
The antibiotic resistance crisis is particularly devastating in hospitals and long-term care facilities, where such infections often strike the most vulnerable patients with weaker immune systems or chronic diseases. High-risk groups include the elderly, cancer patients, diabetics, individuals who have undergone recent surgery and those who are fighting for their lives in the intensive care unit. These drug-resistant bacterial strains can cause bloodstream infections (sepsis), pneumonia, intestinal disease, urinary tract infections or skin and wound infections. Indeed, the World Health Organization recently issued a bulletin highlighting the “urgent threat” of antibiotic resistance, which unless we respond forcefully as a society, could foreshadow the unspeakable — a “post-antibiotic era” that would cripple modern medicine as we know it.
This phenomenon is a direct consequence of our overuse of antibiotics.
When bacteria are exposed to an antibiotic, most of them will be susceptible to the drug and die. Some of them, however, contain genes that allow them to survive and, left without competition for food from their more vulnerable counterparts, they multiply very quickly. Thus, the more antibiotics that are used, the more opportunities bacteria have to develop resistance.
Recognizing this threat, the medical community seeks to limit its use of antibiotics only to people who are sick.
Animal farms, however, do not deploy this same judicious use. Remarkably, 70 percent of antibiotics in the United States are sold not for humans, but for use in livestock production, and the vast majority of these drugs go to animals that are not sick. The drugs are typically added to feed in order to make animals grow faster, or to prevent disease caused by unhealthy and unsanitary conditions.
An alarming consequence of this overuse is the spread of resistant bacteria that can make their way to humans through contaminated food, air, water and soil. Recently, genetic detective work revealed that new clones of the superbug methicillin-resistant Staphylococcus aureus (MRSA) that originated in livestock had switched and adapted to people, then spread in epidemic form to establish themselves in human populations across the globe.
Recognizing the threat of resistance to both their human and animal populations, other governments are taking action. By 1999, the world’s leading pork exporter, Denmark, completed a process that banned the use of antibiotics in animal feed to make animals grow faster. The policy also banned the use of antibiotics for many types of disease prevention. As a result, antibiotic use in Denmark’s animal farms has dropped by 50 percent without a loss in productivity. Many Danish farmers have employed other techniques such as allowing piglets to cohabitate with their mothers longer, which fortifies their immune system against infection.
Despite the success of such international measures, California has yet to fully confront this public health crisis.
This year, the state Legislature enacted weak rules that are unlikely to lead to a decrease in use of antibiotics in livestock production. The new regulations do not ask farms to end all the misuse on their farms. In fact, they only ask drug manufacturers to stop labeling and marketing antibiotics for growth promotion, and do not address those used to prevent future disease. In practice, these uses can be very similar, and both threaten human health. Thus, restricting the use of antibiotics on factory farms for growth promotion and not for disease prevention could ultimately lead to very little appreciable decrease in antibiotic use.
Drug manufacturers, in public statements to their stockholders, have themselves expressed confidence in such loopholes to maintain the status quo. The Animal Health Institute, an industry trade group, for instance, said of such guidelines: “Growth uses of medically important antibiotics represent only a small percentage of overall use, so even if all other factors are static it’s unlikely overall use would be greatly affected.”
Such half-measures are inadequate to protect public health. We applaud members of the Assembly who did not vote in support of the bill. Next year, the Legislature should act to ban the use of antibiotics on animals that are not sick. In doing so, we will take a significant step toward preserving the effectiveness of these “miracle drugs” for generations to come.
Nizet, M.D., is professor of pediatrics and pharmacy at UC San Diego. Rusch is executive director of the California Public Interest Research Group.
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