Maryn McKenna

Journalist and Author

More On Court Ordering FDA Hearings on Farm Antibiotics

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Since I posted last night on the judge’s order that the Food and Drug Administration examine the safety of farm antibiotics — via hearings that the Food and Drug Administration scheduled, but never held, back in 1977 — a lot has happened. Here’s a round-up.

The Natural Resources Defense Council, lead plaintiffs in the suit (with the Center for Science in the Public Interest, Food Animal Concerns Trust, Public Citizen and Union of Concerned Scientists) has put up a press release/explainer, accompanied by a blog post written by lead attorney Avinash Kar.  (Correction: The lead attorney is Jen Sorenson.) Key quote from Kar:

The judge’s opinion makes it clear that FDA’s voluntary approach—letting the industry police itself—does not satisfy its legal obligations. FDA must schedule hearings to let drug manufacturers make their case, and if the drug manufacturers cannot prove that the use of antibiotics in animal feed is safe, FDA must withdraw approval for those drug uses.

Kar’s comment to me: “We think this is a great step forward for public health. For 35 years, FDA has basically sat on the sidelines, mostly letting the industry police itself. In that time we have seen a massive rise in the occurrence of antibiotic-resistant bacteria. This means we now will ensure that we preserve these lifesaving medicines for those who need them most.”

I asked the press office this morning at the Center for Veterinary Medicine, the FDA division named in the order, if the agency has a response yet. They said: “We are studying the opinion and considering appropriate next steps.”

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Breaking News: Judge Orders FDA to Examine Safety of Ag Drugs

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Here’s breaking news that I’ve learned about. The significance is going to unfold over the next 24 hours and more, and when it does, I will update. (Update: Overnight, a lot came out about this, so I’ve wrapped it all into a new post here.)

Here are the basics:

A district judge in New York has ruled in favor of a coalition that sued the Food and Drug Administration in order to compel the agency to follow through on its 35-year-old attempt to exert control over antibiotics in animal feed known as “growth promoters” — tiny doses of antibiotics delivered in feed and water that are believed to stimulate the evolution of antibiotic-resistant organisms.

Technically, Magistrate Judge Theodore H. Katz has granted the groups’ motion for summary judgement, and denied the FDA’s request that the suit be dismissed.

The decision, filed this afternoon, does not compel the FDA to ban growth-promoter (or “feed efficiency”) use of antibiotics. What it does appear to do, though, is require the FDA to follow through on a process that it began in 1977, when the agency was so concerned over the safety of using penicillin and tetracycline drugs in livestock feed that it called hearings to examine withdrawing its approval of using the drugs in animals.

Because of pressure, largely from certain Congressmen, those hearings were never held.

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What You Get From Your Pet, 3: This One Is Sad

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Twice in the past year I’ve written about diseases that people can pick up from their household animals. They remain my highest-traffic posts (here and here) and also my most contentious. So knowing that readers respond to that topic, this recent paper caught my eye. It’s another account of what you can, possibly, catch from your pet — but for any pet owner (which includes me), it’s terribly sad.

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High Levels of Resistant Bacteria on Meat (Again)

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A new report is out from the federal collaboration that monitors antibiotic resistance in animals, retail meat and people, and the news is not good.

The full title is the 2010 Retail Meat Report from the National Antimicrobial Resistance Monitoring System. This report is issued by the Food and Drug Administration; the humans one comes from the Centers for Disease Control and Prevention and the animals one from the US Department of Agriculture. It reports the results of testing on 5,280 meat samples collected in 2010 in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee, and Pennsylvania. (Those are sites of state labs participating in a federal surveillance network, FoodNet, plus one volunteer lab, Maryland.)

The report — which is broken down first by foodborne organism and then by meat type — notes a number of instances where either the percentage of bacteria that are antibiotic resistant, or the complexity of the resistance, is rising. Quoting from the report:

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Early Sneak Peek: Resistance the Film

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A fantastic pair of producers named Ernie Park and Michael Graziano, who jointly make up a company called Uji Films, are working on a documentary about antibiotic resistance called, appropriately, Resistance. (Among their previous works: the fantastic Lunch Line about the U.S. School Lunch Program.) They asked if I would be taped for it, I was thrilled, and here’s a rough-cut sneak peek.

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Also Receiving Antibiotics on Factory Farms: Shrimp

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Tom Philpott of Mother Jones had a great post earlier this week looking at the vast environmental damage caused by shrimp farming in South and Southeast Asia. He takes off from a presentation at the annual meeting of the American Association for the Advancement of Science by J. Boone Kauffman of Oregon State University, which examined the destruction of coastal mangrove forests that allows shrimp farms to be established and found that shrimp’s carbon footprint is 10 times higher than that of beef cattle. Tom says:

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Moving Beyond Factory Farms: Pastured Poultry

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It’s astonishing what you can not know about the place where you live. Me, for instance: I live mostly in Atlanta. I’ve lived here twice, once for 10 years as a newspaper reporter, and now — after a four-year break — for 15 months so far as a writer (and trailing spouse, which is how I got back here). Between working for one of the (formerly) largest papers in the country, liking long drives, and regularly indulging my ungovernable curiosity, I thought I knew Georgia pretty well.

I was wrong. Here’s what I learned about Georgia on Thursday:

  • It raises more meat chickens than any other place in the United States, about 1.4 billion of them a year.
  • That’s 15 percent of all the animals raised in confinement agriculture in the United States. Not just 15 percent of the chickens; 15 percent of everything.
  • All those chickens produce 2 million tons of poultry manure and litter a year, one-fifth of what the entire U.S. poultry sector produces.
  • That waste is applied on land — including land where other food crops are grown — from which it can run off and contaminate water supplies.
  • 40 to 80 percent of gut bacteria recovered from confinement chicken-houses are multi-drug resistant.
  • Caring for foodborne illness from organisms carried on chicken, and making up for lost productivity when people are made sick, costs about $2.4 billion per year.
  • Chicken catchers, who cage the birds on their way to slaughter, may lift 5,000 pounds in an hour. Slaughterhouse line workers may perform the same repetitive cutting motions 20,000 to 30,000 times in a work shift.
  • Slaughterhouses in Georgia kill 1 million chickens per week.
  • Poultry is exempt from humane slaughter regulations.

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Goodbye, Magic Bullet: Hello, Highly Resistant Gonorrhea

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One hundred years and some months ago — on March 16, 1911 — a publication called the Boston Medical and Surgical Journal printed a description of the treatment of 20 men at Walter Reed General Hospital in Washington, D.C. The men were members of the U.S. Army. Because medical privacy rules were a lot looser 100 years ago, we know most of their names, because the journal gave them: Cornwell, 22 years old; Smith, 24; Randall, 29; Simerly, 27; Brown, 23; Davis, 26; Waits, 22; Allen, 19; Kimmitt, 27; Megee, 29; Laird, 40; Brinson, 34; Franklin, 29; Clements, 34; Johnson, 24; Lorah, 23; and Crabbe, 27.

The men were in Walter Reed, which we now know as Walter Reed Medical Center, because they all had the sexually transmitted disease syphilis. A century later, it seems absurd to be hospitalized for an STD — but in the years before antibiotics, syphilis and gonorrhea were fantastically destructive of productivity. The men’s records, excerpted by the journal, capture that: They had arthritis, ulcerated skin, heart-valve failure, necrosis of the skull. Cornwell had been “on sick report” — unable to report to duty — for 4 months and 10 days; Simerly, for 5 months and 23 days; Kimmitt, for 11 months; Johnson, for 1 year.

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Drug Resistance in Pork: More Going On Than Appears

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A paper released recently, by the University of Iowa team that is the lone US research group tracking “pig MRSA” ST398, caused a ripple. (It came out while I was at ScienceOnline and it’s taken me a while to catch up.) The paper compares the occurrence of MRSA, drug-resistant staph, on various cuts of retail pork from pigs that were raised either conventionally in confinement, with routine use of antibiotics, or in an alternative rearing scheme with no antibiotics. (NB: Not “organic,” despite what some headlines said; that’s a separate issue of USDA licensure.) The team found that both conventionally raised and antibiotic-free meat carried MRSA, both the human-associated kind and the pig-adapted kind.

The TL;DR over the past week has been: There’s just as much resistant bacteria on drug-free meat as there is on conventional meat, so why spend the money — or raise the alarm over farm antibiotic use?

My interpretation is a little more nuanced. But my takeaway is that, in its underlying data, the study proves what campaigners against ag antibiotic use keep saying: that once you use antibiotics indiscriminately and drive the emergence of resistant organisms, you have no way of predicting where that resistance DNA will end up.

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TDR-TB: The Indian Government Denies It

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An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

Because, of course, that’s going to keep a disease from spreading.

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Totally Drug-Resistant TB: A Patient Is Missing

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There was a lot of interest in  in TDR-TB Friday; both The Leonard Lopate Show on WNYC and Science Friday kindly asked me to be on to talk about it. While I was waiting for the phone link to Science Friday to become live, an alarming bulletin arrived in my e-mail. The early-warning list ProMED reported that the existence of two additional cases of TDR-TB have been disclosed, in Bangalore, 600 miles from Mumbai where the first known Indian cases were identified. The patients, a 56-year-old man and a 29-year-old woman, had been coming to a hospital for directly observed administration of their TB for more than two years; they were initially recognized as MDR-TB patients, with disease that was highly resistant but not untreatable, but were not getting better. For the past two weeks, though, the man has not shown up, and no one appears to know where he is.

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Totally Resistant TB: Earliest Cases in Italy

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A follow-up to Monday’s post on the recognition in India of totally drug-resistant tuberculosis, TDR-TB: The fantastic early-warning list ProMED points out that the earliest recorded cases of TDR were not the current 12 known cases in Mumbai or the 15 cases in Iran in 2009, but rather two women from Italy who died in 2003 after  being sick for several years.

It’s a sad story that was briefly recounted in 2007 in the journal EuroSurveillance, published by the European Centre for Disease Prevention and Control (ECDC).

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India Reports Completely Drug-Resistant TB

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Well, this is a bad way to start the year.

Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases, which just about everyone missed, including me. (But not, thankfully, the hyper-alert global-health blogger Crawford Kilian, to whom I hat-tip.) That letter describes the discovery and treatment of four cases of TDR-TB since last October. On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.

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More News: FDA Curbs One Class of Farm Drugs

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Here’s a bookend to the Food and Drug Administration’s disappointing Christmas Eve notice that it will cease trying to regulate the largest classes of growth-promoter antibiotics. Today, the agency announced that it is forbidding certain uses of a different class of drugs, cephalosporins.

To those who are concerned about antibiotic overuse in agriculture, though, this is good news — though it may be more good news-bad news-bad news-good news.

The dialectic looks like this:

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News: FDA Won't Act Against Ag Antibiotic Use

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With no notice other than a holiday-eve posting in the Federal Register, the US Food and Drug Administration has reneged on its long-stated intention to compel large-scale agriculture to curb over-use of agricultural antibiotics, which it had planned to do by reversing its approval for putting penicillin and tetracyclines in feed.

How long-stated? The FDA first announced its intention to withdraw those approvals in 1977.

From the official posting:

The Food and Drug Administration (FDA or the Agency) is withdrawing two 1977 notices of opportunity for a hearing (NOOH), which proposed to withdraw certain approved uses of penicillin and tetracyclines intended for use in feeds for food-producing animals based in part on microbial food safety concerns.1 … (1FDA’s approval to withdraw the approved uses of the drugs was based on three statutory grounds: (1) The drugs are not shown to be safe (21 U.S.C. 360b(e)(1)(B)); (2) lack of substantial evidence of effectiveness (21 U.S.C. 360b(e)(1)(C)); and (3) failure to submit required reports (21 U.S.C. 360b(e)(2)(A)).)

There is a lot of background to this, but here is the takeaway: For 34 years, the FDA has been contending that administering small doses of antibiotics to healthy animals is an inappropriate use of increasingly scarce drugs — a position in which it is supported by organizations as mainstream as the American Medical Association. With this withdrawal, it backs away from the actions it took to support that assertion — which may indicate there will be no further government action on the issue until after the 2012 election.

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Antibiotics: Connected to Obesity, Diabetes and Stroke?

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In consideration of your glaze-eyed tryptophan coma — at least among those who weren’t frightened off by the MRSA-in-turkey news — today’s post is mostly composed of brightly colored pictures. (Also, speculation. You’ve been warned.)

About a week ago, a nonprofit research group called Extending the Cure published the latest in a fantastic series of maps they have been producing for several years, based on public and privately collected data. Earlier iterations have looked at the incidence of various resistant organisms over time. This time, they decided to look instead at the major drivers of resistance, and focused on national data about antibiotic prescriptions, broken down by drug type and by state between 1999 and 2007.

The graphics they produced document both a troubling growth in the use of some precious (because still effective) antibiotic classes, and also a surprising differential in the amounts of antibiotics prescribed in different parts of the country. The rate of use of antibiotics, measured by outpatient prescriptions per 1,000 inhabitants, varied from a low of 533 in Alaska to a high of 1,214 in West Virginia. [Read more…]

More MRSA Found In U.S. Retail Meat (Turkey, Too)

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There are two new studies out that confirm, once again, that drug-resistant staph or MRSA — normally thought of as a problem in hospitals and out in everyday life, in schoolkids, sports teams, jails and gyms — is showing up in animals and in the meat those animals become.

The strain of staph that shows up in farm animals, known as “livestock-associated” MRSA or MRSA ST398, first emerged in pigs in the Netherlands, and has been widely identified in retail meat in Europe. (You can find a long archive of posts on ST398 here, and more here.) But that same strain has been difficult to identify in the United States. That may be due in part to the U.S. having a uniquely massive epidemic of community-associated MRSA, far larger than in any other country, which likely both obscures any animal epidemic from detection, and possibly also fills the ecological niche that livestock-associated staph might otherwise occupy. But, it must be said, there’s also remarkably little political will to look for livestock-associated MRSA (though the U.S. Department of Agriculture has now funded a study).

Nevertheless, individual investigators keep trying, and when they look for the pathogen, they find it, such as in these studies from May and this one from April. Now, two other teams have as well.

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Running Out of Antibiotics: Europe Gets It

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In the United States, it’s been “Get Smart About Antibiotics” Week this past week, an annual observance in which the Centers for Disease Control and Prevention and its medical and public health partners try to raise awareness of antibiotic resistance. The real action this week though was in Europe, where individual researchers and the EU’s version of a CDC — the European Centre for Disease Prevention and Control — are speaking out about the problem with unusual candor.

Here’s the short version: In Europe, according to the ECDC, 25,000 people each year die as a result of multi-drug resistant infections, causing an additional cost to society of 1.5 billion Euros ($2.02 billion): 938 million Euros ($1.27 billion) in hospital and outpatient medical costs, and an additional  596.3 million Euros ($806 million) in lost productivity.

Dr. Marc Sprenger, director of the ECDC, said Friday:

This certainly is an underestimate of the true economic impact of antimicrobial resistance. In particular, the figures were based on data for just five multidrug-resistant bacteria.The estimate was also based on a conservative figure for the cost of a day in hospital… We think the real cost of treating a patient with a multidrug-resistant infection would be higher than this. My take home message is that antimicrobial resistance is one of the most serious public health challenges that we face.

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EU Parliament Votes To Oppose Most Farm Antibiotic Use

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A quick post, because I’m on a ferocious deadline, but still can’t let this news go by. In a vote that’s non-binding but high profile and influential, the European Parliament has resolved to end “prophylactic use” of antibiotics in farming, and to prevent any “last resort” antibiotics from being used in animals, in order to keep resistance from developing so that the drugs will still be effective in human medicine.

This is a significant development. The European Union has already banned “growth promotion,” the use of micro-doses of antibiotics that cause meat animals to fatten more quickly. What the Parliament is doing here is asking the European Commission, the EU’s law-making body, to add “disease prevention” use to the ban. That’s the delivery of treatment-strength doses of antibiotics to all animals on a farm in order to prevent their becoming ill as a result of the confinement conditions in which they are held. It accounts for a substantial portion of the antibiotics used in agriculture, and is a major driver of the emergence of antibiotic-resistant organisms.

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Government Health Agency Agrees Mega-Farms Are A Health Risk (In The UK)

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It’s very odd sometimes watching how the same issues play out in different parts of the world. The French environment ministry confidently ascribes the growth of seaweed choking its beaches to farm runoff. The European Parliament denounces the establishment of very large-scale “meat factories.” China (China!) enacts a ban on growth-promoting uses of antibiotics in agriculture.

Here in the United States, on the other hand, the government gropes unsuccessfully for a way to put controls on confinement agriculture, despite evidence of its environmental harm, while at the same time those farms grow by an estimated 4,600 hogs and 5,800 broiler chickens per day.

For more of that difference between Europe and the US, look this week to England, where the Health Protection Agency has just rejected the zoning application for a hog farm that was small by US standards, with a plan for only 2,500 sows producing about 20,000 piglets. The HPA said:

… those living up to 150 meters downwind of an intensive swine farming installation could be at risk of adverse human health effects associated with exposure to multi-drug resistant organisms. (this .pdf, p.30 of 44)

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