Maryn McKenna

Journalist and Author

Resistance: The Movie That Will Make You Care About Antibiotic Misuse

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A few years ago I happened to get introduced to a pair of filmmakers, Michael Graziano and Ernie Park, who were starting to explore the topic of antibiotic resistance. They had the same questions about resistance that I obsess over, and the same shock about how enormous the problem is: according to a recent estimate, 700,000 deaths every year, likely to rise into the millions if nothing is done.

They recognized their disbelief as the creative spark for a project, and three years later, have brought out Resistance, a documentary now available on iTunes. LV Anderson just said about it, in Slate:

Regardless of your preexisting interest in public health or food politics, once you learn a little about antibiotic abuse, you won’t be able to stop caring about it. Without antibiotics, many of the medical treatments that we take for granted would be impossible, and the speed and carelessness with which we squander these important drugs — on people who don’t need them and on livestock that really don’t need them — is downright infuriating…  In talking-head interviews with well-chosen, highly articulate experts, Resistance explains the fundamental reason the incorrect use of antibiotics is so dangerous: Every time we use antibiotics, we give bacteria another chance to develop resistance to it.

I think Resistance is a fantastic exploration of the problem, but I am likely to be biased, because I am in it. But I realized as I watched it that there was a lot about the documentary that I didn’t know: how it came to be, why the stories within it were chosen, and whether making it changed the filmmakers’ life.

Here’s an edited chat with Michael Graziano about making the film.

Maryn McKenna: Your previous film, Lunch Line, was about school lunch and nutrition. Antibiotic resistance seems a long way from that. What got you interested?

Michael Graziano: I was hoping to get rich as quickly as possible. I calculated that if I spent three years making a film about science and public health the money would start pouring in.

Turns out my calculations were wrong.

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White House Actions on Antibiotic Resistance: Big Steps, Plus Disappointments

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Roman Boed (CC), Flickr

Roman Boed (CC), Flickr

The United States government proposed several important steps last week that, if accomplished, will significantly change how this country attempts to counter the advance of antibiotic resistance, bringing us within reach of the more complete programs which exist in Europe. But as significant as it is, the new program has some perplexing gaps that left experts attending to the issue disappointed.

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What the Forthcoming White House Report on Antibiotic Resistance Will Ask For

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e-Magine Art (CC), Flickr

e-Magine Art (CC), Flickr

Among the groups that work on awareness of antibiotics resistance — which include major medical and public health organizations as well as nonprofits trying to direct attention to antibiotic misuse in medicine and agriculture — there has been a lot of anticipation of a forthcoming report by the President’s Council of Advisors on Science and Technology. The report, which has been in the works for months, will be published shortly, possibly as early as next week. Today, the council — known as PCAST for short — held a public meeting to discuss the report’s contents and vote as a group to accept or rejected. The meeting was webcast, and as far as I could tell, the vote was unanimous.

Though the report itself won’t be out for a bit, the meeting gave a good sense of what the report will say. For accessibility, PCAST runs live voice-recognition transcription of its meetings; so while the meeting was proceeding, I grabbed a transcript to review later. Here’s what seems to be coming.

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Denmark: Three Deaths from Drug-Resistant "Pig MRSA"

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ICStefanescu (CC), Flickr

Image: ICStefanescu (CC), Flickr

A troubling and also kind of odd story came out of Denmark this weekend. In a court proceeding, a microbiologist has disclosed that three residents of the country who had no known connection to farming died of MRSA infections caused by ST398, the livestock-associated strain of drug-resistant staph that first appeared among pig farmers in the Netherlands in 2004 and has since moved through Europe, Canada and the United States.

If the report is correct — and sources have told me it is, but I’ve seen no data to confirm it — it reinforces the concern that bacteria which become resistant because of antibiotic use on farms can move off farms and affect the health of people who have no connection to farming.

Livestock MRSA has always one of the best cases for establishing that, because the drug to which it showed the greatest resistance, tetracycline, wasn’t used against human MRSA in the Netherlands, but was used routinely on farms — so the only place the strain could have picked up its unique resistance pattern was in pigs. (Here’s my long archive of posts on pig MRSA, dating back to my book Superbug where the story was told for the first time.)
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Antibiotic Overuse on Farms: Is the Opinion Tide Turning?

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USDA Photos by Lance Cheung/Flickr

It’s been a busy few weeks here at Casa Superbug — including some conference appearances, more on them later — so the first thing I’d like to do is point out some things that appeared while I was offline. Notably: In editorials, three newspapers recently challenged the way antibiotics are used on farms and asked why we can’t do better.

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Shutdown Salmonella Outbreak Continues. CDC Food Safety Chief: 'We Have a Blind Spot.'

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Image: Ben Husmann, (CC), Flickr

We’re 11 days now into the federal shutdown and four days since the announcement of a major foodborne outbreak in chicken that is challenging the shutdown-limited abilities of the food-safety and disease-detective personnel at the Centers for Disease Control and Prevention, Food and Drug Administration and Department of Agriculture. Here’s an update.
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CDC Threat Report: Yes, Agricultural Antibiotics Play a Role in Drug Resistance

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Campylobacter bacteria. Image: CDC

The grave assessment on the advance of drug resistance, released Monday by the US Centers for Disease Control and Prevention, contained some important observations about the relationship between antibiotic use in agriculture and resistant infections in humans. Those observations, combined with remarks made yesterday by the director of the CDC and also with testimony given in the past by other CDC personnel, ought to put to rest what seems like a persistent meme: that the CDC has never said, or doesn’t believe, that agricultural antibiotic use plays a role in the advance of resistance.

This is important because it puts the CDC in line with a substantial body of research pointing to agricultural use playing a role in the emergence of resistance outside farm properties. With the CDC agreeing — plus, to some degree, the Food and Drug Administration — surely it’s time to move on to whether there are things that could be done to curb the risks posed by some ag practices, while respecting the role that livestock-raising in particular plays as a substantial economic sector, and as an engine in feeding the world.

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Two Former FDA Commissioners Agree: Ag Antibiotic Policies Must Change

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source: Anselm (CC), Flickr

This is an ICYMI (“in case you missed it”) post, twice over. Last week, former Food and Drug Administration Commissioner Donald Kennedy, Ph.D., wrote a piece for the Washington Post in which he urged that the FDA change how it regulates antibiotics that are used in agriculture as part of meat production.

His prescription is notable, not just in itself, but because it marks the second time in a few months that a former commissioner of the FDA used a major paper’s op-ed page to criticize his former agency’s conduct on farm antibiotic use. David A. Kessler, M.D., did the same thing, hitting many of the same points, in the New York Times in March.

Kennedy was FDA Commissioner from 1977 to 1979, just as scrutiny of antibiotic use in livestock-raising was beginning. (There’s a timeline in this post.) Kessler was Commissioner from 1990 to 1997, during the time in which the FDA began to look for, and find, antibiotic-resistant bacteria on retail meat. There were almost 20 years between their tenures — and 16 years from Kessler to now — and yet almost nothing has changed.

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More on MRSA on Farms and in Farm Workers, and the Arguments for and Against

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Photo: ROIrving/ Flickr

In my last post I promised to catch up on some of the other research that has been published on the flow of MRSA (and other resistant organisms) between farm animals and farm workers as a result of farm antibiotic use.

Before I do that, though, I want to nod toward two other great pieces published on this. First, Mark Bittman  examined this issue closely at the New York Times. And Clare Leschin-Hoar also covered the new research at Take Part. (Bonus: Don’t miss her dissection of the news that a National Geographic photographer was arrested in Kansas after taking pictures of a feedlot — from the air.)

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"Pig MRSA" Carried by Workers from North Carolina Intensive Hog Farms

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Pig farms from the air. Maryn McKenna, Creative Commons License

I saved this post until today to allow everyone to get their holiday hot dogs guilt-free. Now that’s over: An important study has just been published which makes a close connection between the emergence of antibiotic-resistant bacteria, and the use of antibiotics on large-scale conventional hog farms. Bonus: It involves the resistant bacterium MRSA ST398 (known in shorthand as “pig MRSA”), which is widespread in Europe but up to this point has been found mainly in only one state in the US, Iowa. With this paper, the count rises to two(see Update): The study subjects in this paper are hog-farm workers in eastern North Carolina.

A quick explanation of why this is important: “Pig MRSA” is a particular strain of drug-resistant staph that is slightly different from the hospital and community (sports, gym) varieties. It was first spotted in the Netherlands in 2004, in the toddler daughter of pig farmers and in the family’s pigs. Since then, it has spread widely across Europe, not just in agriculture, but in healthcare and in everyday life, and has also been found widely in retail meat.

The question of whether livestock production’s use of antibiotics causes antibiotic-resistant bacteria to move into the wider world is much argued-over, and pig MRSA, or ST398 to be polite, is crucial to that dispute. That’s because, unlike most resistant bacteria, it has a genetic signature that makes an inarguable link back to farm drug use. More on that below. (If you want more, here’s an archive of my posts on ST398; the story of its emergence in 2004 and what happened afterward is told in my 2010 book SUPERBUG.)

Now, the study. Quick summary, with more unpacking to follow: Researchers checked livestock-farm workers in North Carolina to see whether they were carrying staph, and also drug-resistant staph. The workers formed two groups: one group worked at conventional hog operations, which routinely use antibiotics, and the other group at antibiotic-free farms. Both groups carried staph and also drug-resistant staph, which would be expected; about 30 percent of the population carries sensitive staph and about 4 percent carries the drug-resistant form. But, the key difference: Workers from the conventional, antibiotic-using farms were many times more likely to carry staph with the specific signature of farm-drug use.

That illuminates a potential occupational risk to the workers — and it also suggests that the workers could be a channel for that farm-influenced bacterium to move off the farm.

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