Maryn McKenna

Journalist and Author

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Can Antibiotics User Fees Force Down Drug Mis-Use and Overuse?

January 7, 2014 By Maryn Leave a Comment

image: NeilT (CC), Flickr

Happy new year, constant readers. Here’s the most urgent thing I have to say today: Stop reading and go set your DVRs for 8pm ET tonight. The fantastic The Poisoner’s Handbook, written by Wired colleague and dear friend Deborah Blum, has been adapted by PBS and airs tonight on The American Experience. It’s going to be superb.

Back? OK, on to business. Just before the holidays, the Food and Drug Administration finalized its long-aborning plan to ask the meat-production industry to reduce its use of routinely administered antibiotics. (My posts on the move here and here.) The FDA’s guidance to industry, as it is called, is not a regulation but rather a request for voluntary action on the part of veterinary-drug companies. It has met with skepticism and concerns that manufacturers will redefine the uses of their drugs in such a way that nothing will change.

The FDA action is aimed at the routine use of antibiotics for what is called growth promotion — causing animals to gain muscle faster than they would without the drugs being used — and is modeled on a ban on growth promoters enacted by the European Union in 2005. The goal, as in the EU, is to reduce the drugs’ use, and therefore the antibiotic-resistant bacteria that use stimulates.

In a recent New England Journal of Medicine, University of Calgary economist Aidan Hollis suggests though that a ban may not be the most useful or practical approach to the problem of drug overuse. In its place, he suggests the pocketbook persuasion of having to pay a fee.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, drug development, FDA, IDSA, Resistance, Science Blogs, stewardship

Re-Examining the FDA Antibiotics Decision: Banning Growth Promoters Won't Be Enough

December 27, 2013 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

In my first take on the news of the FDA finalizing its request to agriculture to stop using growth-promoter antibiotics, I promised to come back for a more thoughtful reaction. And then this happened, and this happened, and the holidays happened, and, well, it’s been a busy few weeks.

So, finally getting back to it: When the news broke, a number of people, including me, said that this was a long-awaited first step on the part of the FDA, but of uncertain ultimate impact because it asks for voluntary action and does not address whether the drugs simply can be relabeled. I still agree with both those points, but think the possibly most important issue — which I raised briefly in the first post  — is that merely removing antibiotics, without changing the system in which those antibiotics have been administered, may cause significant animal-welfare problems, without having any real effect on human health.

(If you’d like the short version of this, listen to my chat with NPR’s Weekend All Things Considered.)

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: animals, antibiotics, FDA, food, food policy, food safety, growth promoters, Resistance, Science Blogs

Drug-Resistant Bacteria on Chicken: It's Everywhere and the Government Can't Help

December 19, 2013 By Maryn Leave a Comment

image: Thousand Robots (CC), Flickr

Two important, linked publications are out today, both carrying the same message: The way we raise poultry in this country is creating an under-appreciated health hazard, and the government structures we depend upon to detect that hazard and protect us from it are failing us.

The two pubs are:

  • A long piece that will be in the Feb. 2014 edition of Consumer Reports but has been placed online today.
  • A companion report by the Pew Charitable Trusts, addressing some of the systemic problems raised by the Consumer Reports story.

Short version: Independent tests show that multi-drug resistant disease-causing bacteria are widely present on chicken, and the US Department of Agriculture’s Food Safety and Inspection Service (FSIS) has insufficient personnel, or legal authority, to change that.

Both these assertions are important, because foodborne illness, and especially drug-resistant foodborne illness, are also under-appreciated — for how serious the disease can be, and how long-lasting the after-effects are. (For more on those: Here’s a piece I wrote for The Atlantic about how drug-resistant bacteria on chicken are causing an epidemic of urinary tract infections, and one for Scientific American about the lifelong cost of foodborne illness.)

It’s worth emphasizing also that we are right now in the middle of an outbreak of Salmonella on chicken that has been going on for about a year. The Centers for Disease Control and Prevention posted an update just this morning: 416 people since since last February, in 23 states and Puerto Rico, 39 percent of them hospitalized, linked to a single producer’s brand of chicken.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: animals, antibiotics, chicken, food, food policy, food safety, NARMS, poultry, Resistance, Science Blogs

FDA Scrutinizes Antibacterial Products for Hormonal Disruption, Bacterial Resistance

December 16, 2013 By Maryn Leave a Comment

Image: Jim Belford (CC), Flickr

More news today out of the Food and Drug Administration — so while I’m still writing my follow-up to last week’s news on growth promoters, I want to toss this up first. The latest: The FDA has announced that it is formally reconsidering “antibacterial” soaps and other personal-care products, charging that the antibacterial ingredients confer no benefit over regular soap and water while carrying extra risks.

In a draft rule that will be published Tuesday in the Federal Register, the agency calls for manufacturers of consumer antibacterial products to begin providing data that shows the ingredients are both safe for daily use, and also more effective than plain soap and water. Deep in the 137-page rule, it also raises the issue that’s most interesting to me: whether the routine use of these products causes bacteria to develop resistance against the active ingredients, and against antibiotics as an unintended side effect.

Antibacterial products are a vast market; according to the FDA there are more than 2,000 currently for sale to consumers. (NB: This rule does not cover antibacterial hand-sanitizers; neither does it include the kind of washes and wipes used in healthcare.) The announcement today opens a 6-month comment period that ends next June. It will be interesting to see where this goes.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, EPA, FDA, Resistance, Science Blogs

FDA Finally Imposes Some Controls on Agricultural Antibiotics. Sort Of.

December 11, 2013 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

This morning, the US Food and Drug Administration dropped some long-awaited-but-still-big news regarding the use of antibiotics in meat production. Tl;dr: The FDA asked (but did not compel) the livestock industry to stop using the micro-dose “growth promoter” antibiotics that are widely believed to contribute to increase in antibiotic resistant bacteria in animals, food and humans.

With exquisite timing, they happen to have picked a day when I am traveling, in order to get to my end-of-semester evaluation tomorrow for my  MIT fellowship. So I’m going to do what curation I can on this, and point to some important reactions and analyses. I’ll come back for a deeper look, probably on the weekend.

So here are the basics.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: animals, antibiotics, FDA, food policy, food safety, growth promoters, Resistance, Science Blogs

MRSA in UK Turkeys Raises Questions of Communication, Transparency and Risk

December 2, 2013 By Maryn Leave a Comment

Image: OZinOH (CC), Flickr

Two years ago, I celebrated Thanksgiving here on Superbug by announcing some new studies on resistant bacteria being found in turkey meat in the US. That did not go over well; so this year, I saved the bad-turkey news for the post-holiday week. And here you go:

Just in time for our Thanksgiving — and in the ramp-up to English Christmas, for which turkey is a traditional dish — the UK’s Animal Health and Veterinary Laboratories Agency announced that livestock-associated MRSA, drug-resistant staph, has been found in UK poultry for the first time. From their not-very-informative press release:

The Animal Health and Veterinary Laboratories Agency (AHVLA) has identified the presence of Livestock-Associated Meticillin Resistant Staphylococcus Aureus (LA-MRSA) in poultry on a farm in East Anglia… Once the poultry have been slaughtered and sold the owner will carry out cleansing and disinfection of their accommodation to ensure the next birds do not become colonised when they arrive on site. The AHVLA will revisit the farm after depopulation and thorough cleansing and disinfection to determine whether LA-MRSA is still present.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, food policy, food safety, foodborne, Resistance, Science Blogs, ST398, Turkey, UK

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

October 10, 2013 By Maryn Leave a Comment

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.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, antibiotics, CDC, FDA, food policy, food safety, Resistance, salmonella, Science Blogs, Shutdown

CDC Threat Report: Yes, Agricultural Antibiotics Play a Role in Drug Resistance

September 17, 2013 By Maryn Leave a Comment

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.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, animals, antibiotics, CDC, E. coli, FDA, Resistance, salmonella, Science Blogs

CDC Threat Report: 'We Will Soon Be in a Post-Antibiotic Era'

September 16, 2013 By Maryn Leave a Comment

Image: CDC

The U.S. Centers for Disease Control and Prevention has just published a first-of-its-kind assessment of the threat the country faces from antibiotic-resistant organisms, ranking them by the number of illnesses and deaths they cause each year and outlining urgent steps that need to be taken to roll back the trend.

The agency’s overall — and, it stressed, conservative — assessment of the problem:

  • Each year, in the U.S., 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics;
  • Each year, out of those illnesses, 23,000 deaths;
  • Because of those illnesses and deaths, $20 billion each year in additional healthcare spending;
  • And beyond the direct healthcare costs, an additional $35 billion lost to society in foregone productivity.

“If we are not careful, we will soon be in a post-antibiotic era,” Dr. Tom Frieden, the CDC’s director, said in a media briefing. “And for some patients and for some microbes, we are already there.”

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, CRE, IDSA, Resistance, Science Blogs

Two Former FDA Commissioners Agree: Ag Antibiotic Policies Must Change

August 27, 2013 By Maryn Leave a Comment

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.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, animals, antibiotics, FDA, food, food policy, food safety, growth promoters, Resistance, Science Blogs

Antibiotic Use in Chickens: Responsible for Hundreds of Human Deaths?

August 9, 2013 By Maryn Leave a Comment

Flickr: Thousand Robots, CC

In the long back and forth between science and agriculture over the source of antibiotic resistance in humans — Due to antibiotic overuse on farms, or in human medicine? — one question has been stubbornly hard to answer. If antibiotic-resistant bacteria do arise on farms, do they leave the farm and circulate in the wider world? And if they do, how much damage do they do?

A multi-national team of researchers recently published their answers to both questions. Their answer: In Europe, 1,518 deaths and 67,236 days in the hospital, every year, which would not otherwise have occurred.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: animals, antibiotics, cephalosporins, E. coli, food, food policy, food safety, poultry, Resistance, Science Blogs

'Nightmare Bacteria' Attack an ICU and Close a Burn Unit

August 1, 2013 By Maryn Leave a Comment

Flickr: Denis Bocquet, CC

I thought I was done for the time being with “nightmare bacteria” (the US CDC’s characterization of disease organisms resistant to the last-ditch antibiotics called carbapenems), but there are two stories today that deserve to be called out as examples of how rapidly and dangerously these pathogens are spreading.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Acinetobacter, antibiotics, carbapenems, CRE, CRKP, KPC, NDM-1, Resistance, Science Blogs

More on 'Nightmare Bacteria': Maybe Even Worse Than We Thought?

July 30, 2013 By Maryn Leave a Comment

Flickr: CelesteH, CC

In my last post I talked about the under-appreciated emergence of “nightmare bacteria” (those are the Centers for Disease Control and Prevention’s words, not mine) that are widely distributed in hospitals and nursing homes around the world and do not respond to a last-ditch small family of antibiotics called carbapenems. That seemed dire enough, but new research suggests the problem, bad as it looks, has been understated.

There’s an ahead-of-print article in Antimicrobial Agents and Chemotherapy whose authors include David Shlaes, a physician-researcher and former pharmaceutical executive, now consultant, and Brad Spellberg, an infectious disease physician on the UCLA medical faculty and author among other books of Rising Plague, about antibiotic resistance. In a commentary examining the Food and Drug Administration’s promised “reboot” of antibiotic development rules, they analyze privately gathered data on resistance in the United States and conclude the incidence of highly resistant bacteria is greater than the CDC has estimated.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CMO, CRE, CRKP, drug development, FDA, KPC, NDM-1, Resistance, Science Blogs

Where 'Nightmare Bacteria' Came From, And How Our Inattention Helped Them Emerge

July 25, 2013 By Maryn Leave a Comment

Zebbie (CC), Flickr

Cast your minds back a few months ago, to when the director of the US Centers for Disease Control and Prevention announced, “We have a very serious problem” with “nightmare bacteria,” and the chief medical officer of the United Kingdom backed him up a few days later, describing a “ticking time bomb” that threatens national security as seriously as terrorism.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CMO, CRE, CRKP, KPC, NDM-1, Resistance, Science Blogs

How Do You Know Which Chicken to Buy? This Kickstarter Might Help.

May 31, 2013 By Maryn Leave a Comment

 

There’s a project I’ve been watching on Kickstarter and I’m a little surprised it hasn’t gotten more traction, so I thought I’d call it out. TL;DR: You know those wallet cards and apps that help you make good choices about buying seafood: what’s endangered, what’s overfished, what’s responsible to eat? This effort, BuyingPoultry.com, hopes to do the same for chicken — but it’s only halfway to its goal.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, animals, antibiotics, chicken, Kickstarter, NARMS, poultry, Resistance, Science Blogs

News Round-Up: Food, Foodborne Illness, And Antibiotic Resistance In Food

May 5, 2013 By Maryn Leave a Comment

OK, still catching up. Today: food, foodborne illness, and antibiotic use and resistance in food — lots of news in a multi-item rundown. (Under normal circumstances, I’d give each of these items a post of its own; but since they all happened in the past few weeks, it seems better to note them and move on.)

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, consumer reports, E. coli, EIS, food, food policy, foodborne, Resistance, salmonella, Science Blogs, Turkey

News From The Road: No Drugs, Few Strategies, But A Little Good News On Antibiotic Resistance

April 28, 2013 By Maryn Leave a Comment

So, hi, constant readers. Sorry, didn’t mean to disappear for quite that long. I’ve been on the road, first teaching for a week at the University of Wisconsin as their Science Writer in Residence, and then in New York to attend the annual meeting of the American Society of Journalists and Authors, where I received the June Roth Memorial Book Award for Superbug. (Plus, in between those two, I recorded an episode of the Virtually Speaking Science podcast with Tom Levenson, which you can find here, about the looming post-antibiotic disaster; and an episode of Skeptically Speaking with Marie Claire Shanahan, which you can find here, about the emerging story of H7N9 flu; and got tangentially involved in the Boston bomber manhunt.)

While I was offline, a far amount of news happened. In the next few days, I’ll do my best to catch up. Here’s a start, all on infections and antibiotic resistance.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, HAI, IDSA, Iowa, MRSA, Resistance, Science Blogs

Gene Sequencing Pinpoints Antibiotic Resistance Moving From Livestock to Humans

March 28, 2013 By Maryn Leave a Comment

The antibiotic era was barely 20 years old when people started raising concerns about using the new “miracle drugs” in agriculture. Penicillin first entered use in 1943, streptomycin in 1944, tetracycline in 1948 — and by 1965, the United Kingdom’s Agricultural Research Council was hearing testimony that organisms common in food animals, especially Salmonella, were becoming resistant to the antibiotics being used on the animals while they were alive. By 1969, the UK government had compiled an official report outlining the danger, and by 1973, a task force of the US Food and Drug Administration had concurred, and concluded the only safe action was to withdraw approval to use antibiotics in animals. (At which, as we now know, they would never be successful.)

The policy difficulty regarding this long-recognized problem has never been the emergence of resistant bacteria on farms; no one seriously disputes that resistance emerges whenever antibiotics exert selective pressure on bacteria, killing the vulnerable and opening an ecological niche into which the surviving not-vulnerable can expand. The  sticking point has been the difficulty of proving that those resistant bacteria depart from farms, cross to humans, and cause resistant illness in them. Stuart Levy demonstrated it in 1976, on an experimental farm plot he set up just to make the proof. Most of the rest of the research, though — and after decades, there are hundreds of pieces of research — has been observational and retrospective: Looking at the drugs administered to populations of animals (about which we have very little data), measuring the antibiotic-resistant illness that arises in the human population, and making increasingly sophisticated backward matches between the resistance factors that show up in humans and the drugs that are deployed primarily on farms.

Demonstrating the bacterial traffic prospectively and experimentally, as Levy did, is challenging not just logistically but also ethically. It is difficult to imagine a study design that could trace specific animals, their meat, and their eaters in a large group of free-living humans; and unless you have volunteers, as Levy did, the study would push ethical boundaries as well. But having that lack of definition in the middle of the animal-to-human bacterial flow permits uncertainty — which proponents of continued ag antibiotic use exploit.

A new study of Danish farmers and their livestock may have ended that uncertainty. It is still retrospective, but its observations — using whole-genome sequencing — are so fine-grained that their tracing of the bacterial traffic seems to me to be difficult to challenge.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, animals, antibiotics, food, food policy, MRSA, Resistance, Science Blogs, ST398

'Catastrophic Threat': UK Government Calls Antibiotic Resistance a 'Ticking Time Bomb'

March 11, 2013 By Maryn Leave a Comment

On the heels of the director of the U.S. Centers for Disease Control declaring emerging antibiotic resistance a “nightmare,” the U.K.’s Chief Medical Officer released a report today in which she calls resistance a “catastrophic threat” which poses a national security risk as serious as terrorism. In an interview published overnight, she warns that unless resistance is curbed, “We will find ourselves in a health system not dissimilar to the early 19th century” in which organ transplants, cancer chemotherapy, joint replacements and even minor surgeries become life-threatening.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, Resistance, Science Blogs, UK

'We Have a Limited Window of Opportunity': CDC Warns of Resistance 'Nightmare'

March 6, 2013 By Maryn Leave a Comment

It’s not often that you get to hear a top federal health official deliberately deploy a headline-grabbing word such as “nightmare,” or warn: “We have a very serious problem, and we need to sound an alarm.”

Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, said both Tuesday, during a press conference announcing new CDC statistics on the advance of the highly drug-resistant bacteria known as CRE. His language — plus the fact that he conducted the entire press conference himself, instead of just making a brief opening statement — seem to me a clear signal that the CDC is taking this resistance problem seriously, and hoping we do too.

And we should. Here’s what the CDC announced Tuesday:

  • Healthcare institutions in 42 states have now identified at least one case of CRE.
  • The occurrence of this resistance in the overall family of bacteria has risen at least four-fold over 10 years.
  • In the CDC’s surveillance networks, 4.6 percent of hospitals and 17.8 percent of long-term care facilities diagnosed this bug in the first half of 2012.

Those are dire reports.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, CRE, CRKP, KPC, NIH, Resistance, Science Blogs

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