To Slow Down Drug Resistance in Health Care, Buy an Antibiotic-Free Turkey for Thanksgiving

I thought it might be time to switch away from Ebola and catch up with other disease problems that continue to occur in the world. (If you miss Ebolanoia, though, I’m still collecting instances at my Tumblr. The latest: Indian authorities have force-quarantined in an airport a man who returned from West Africa with a clean bill of health and negative blood tests. They say they will not allow him to leave until his semen tests negative for Ebolavirus. Yes, they are insisting on samples.)

So: How can healthcare workers contribute to slowing down antibiotic resistance? A healthcare nonprofit suggests they commit to buying an antibiotic-free turkey for Thanksgiving.

If it feels like the problem in one sphere, medicine, doesn’t have much to do with the other, agriculture, then you are the perfect target for this pledge. (Even if you don’t actually work in health care.)

Here’s the backdrop to the campaign, created by Health Care Without Harm,the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative, and the Pediatric Infectious Disease Society (PIDS):

Health Care Without Harm takes seriously the injunction in the Hippocratic Oath — “first, do no harm” — and works to improve the  industry’s impact on patients, workers and the environment. Among other things, the group has encouraged large healthcare organizations to use their institutional food-purchasing power to support production of sustainable meat and produce. Recently, they have been encouraging hospitals to commit to buying meat from animals raised without the routine use of antibiotics, and a lot of hospital systems have signed on.

Their new pledge asks health care workers to make the problem personal, by choosing an antibiotic-free turkey for Thanksgiving — arguably the meat-animal purchase that gets the most attention out of all the holiday meals in the year. They say:

Antibiotic resistance is a growing problem that more and more patients and providers are facing each day, and antibiotic overuse is a major contributor to this problem. While as many as 50% of antibiotic prescriptions may be overly broad or even unnecessary, animal agriculture uses four times the amount of antibiotics as human medicine, and mostly in healthy animals for growth promotion or disease prevention on crowded farms…

We are advocating for a broader concept of antimicrobial stewardship.

This is actually pretty genius, for several reasons. First, because it gives people a concrete action to perform — something they can do immediately, not “the next time I shop for meat” or “the next time my kid gets an ear infection.” Second, because it lends economic support to an alternative to conventional turkey, which tests have found to be a persistent source of antibiotic-resistant bacteria.

And, third and maybe best of all, it  makes the case that combatting antibiotic overuse should be what an ethicist might call a seamless garment: something to be undertaken not just in medicine, or just in agriculture, but across all the situations where inappropriate use threatens antibiotic effectiveness. And it is making that case among people who by virtue of their jobs are more likely to encounter the reality of antibiotics no longer working well, and therefore more likely to want to take action — and to encourage others to follow their lead. (The pledge also asks the signers to explore whether their hospitals are serving antibiotic-free meat, and to press them to change buying patterns if not.) Members of the SHARPS collaborative explain to other physicians why they should care in this thoughtful post.

Mind you, this is not the first time that activists have urged buying antibiotic-free turkey as a Thanksgiving observance. NRDC, which has been suing the Food and Drug Administration for failure to curb farm antibiotic overuse, proposed the same last year. And Farm Forward, which works to combat intensive confinement raising, urges people to buy one of the scarce heritage turkeys raised in only a few places in the US.

But the plea to health care workers to contemplate how shopping for an iconic meal connects back to their work lives is unique to my knowledge, and smart. Not coincidentally, the pledge has gone live during a week of observances that focus attention on antibiotic resistance: Get Smart About Antibiotics Week in the US, which is sponsored by the Centers for Disease Control and Prevention, and European Antibiotic Awareness Day. The CDC and its counterpart, the European Centre for Disease Prevention and Control, use the week (and day) to push out earnest, detailed, important information on the need for combatting resistance — but outside the expected audiences, I’ve never seen the week’s campaigns get much traction. This one might.

(Thanks to Dr. Saul Hymes for bringing the pledge to my attention.)