The Preservation of Antibiotics for Medical Treatment Act

Yes, this is old news.  I've written about it before, as have
numerous other progressive scientifically-oriented bloggers.  But
now that there is an opinion piece featured prominently in the New York
Times, perhaps the issue is gaining momentum.

on Drugs


Published: April 17, 2010

NOW that Congress has pushed through its complicated legislation to
reform the health insurance system, it could take one more simple step
to protect the health of all Americans. This one wouldn't raise any
taxes or make any further changes to our health insurance system, so it
could be quickly passed by Congress with an outpouring of bipartisan
support. Or could it? ...

This sort of thing is politically unpopular, because the people who
would benefit, do not have an strong lobby unified on the issue. 
And the people who would have to adjust their operation, do have such a
lobby.  It could cause some short-term difficulties for those who
make a living by raising and selling livestock and poultry.  We
need to acknowledge that some of those folk already are
struggling.  But the industry would adapt and rebalance. After
all, they do have a product that people want, and the people still are
ready, willing, and able to buy. 

The use of antibiotics in farming operations clearly leads to the
development of antibiotic-resistant pathogens. This causes problems
when those antibiotic-resistant pathogens get into people.  It
also costs a lot of money:

Antibiotic resistance is an expensive problem. A person who
cannot be treated with ordinary antibiotics is at risk of having a
large number of bacterial infections, and of needing to be treated in
the hospital for weeks or even months. The extra costs to the American
health care system are as much as $26 billion a year, according to
estimates by Cook County Hospital in Chicago and the Alliance for the
Prudent Use of Antibiotics, a health policy advocacy group.

The argument would be strengthened if we knew what fraction of that $26
billion was attributable to agricultural use of antibiotics.  That
apparently is not known, and it is not obvious to me how it could be
determined.  Even so, the figure does suggests that the economic
benefits of of the legislation could offset, at least partially, the
losses in the agricultural sector.  Furthermore, I suspect that
this legislation could provide a boost to smaller agricultural
operations.  This would be good.  Unfortunately, the small
operators don't have a powerful voice in Washington.

More like this

Wouldnât this assume that countries with centralized, politically powerful, PMed oriented, health care systems could, and would, limit the use of agricultural antibiotics?

If thatâs true in say, Sweden, or The UK, could we compare populations?

Or if those systems have had no effect of the use of antibiotics, we might ask ourselves; why not?

The use of antibiotics in farming operations clearly leads to the development of antibiotic-resistant pathogens.

So does the use of antibiotics in human medicine. The only attempt at modeling I've seen shows that while animal use has an important effect, it is relatively minor in comparison to the effect of over prescription in human medicine (Smith et al., 2002). Furthermore, I've read several reviews(Phillips et al., 2004; Phillips, 2007; Casewell et al. 2003) pointing out the ineffectiveness the EU ban has had on human antibiotic resistance, which supports the model put forward by Smith et al. (2002).

In essence the EU ban was instituted based on the Precautionary Principal, which is used when insufficient evidence is available and the potential risks are large enough to err on the side of caution. That was fine at the time, but over a decade has lapsed in the intervening time and there is no evidence that the ban has been effective at improving Human antibiotic resistance levels, only those on the farm.

As most review paper on the issue will freely admit, direct evidence of causation between antimicrobial use in livestock and a specific strain of antibiotic resistance in human medicine is very difficult to acquire due to the complex nature of the issue. However, there should be some evidence of the ban's efficacy by now, and when comparing resistance levels in the US and the EU who have such different policies I have difficulty seeing any evidence that the EU ban did anything positive.

My reading of the evidence is that the EU banned antibiotics to be safe, but it turns out the ban was unhelpful at attaining the stated goal, and in fact may have had a net negative impact on both agricultural production AND human health. Just because a connection is possible and makes logical sense, is not a substitute for scientific evidence gathering, and does not guarantee that the potential link is meaningfully large.

Casewell, M., C. Friis, E. Marco, P. McMullin, and I. Phillips. 2003. The European ban on growth-promoting antibiotics and emerging consequences for human and animal health. J. Antimicrob. Chemother. 52:159-161.

Phillips, I., M. Casewell, T. Cox, B. De Groot, C. Friis, R. Jones, C. Nightingale, R. Preston, and J. Waddell. 2004. Does the use of antibiotics in food animals pose a risk to human health? A critical review of published data. J. Antimicrob. Chemother. 53:28-52.

Phillips, I. 2007. Withdrawal of growth-promoting antibiotics in Europe and its effects in relation to human health. Int. J. Antimicrob. Agents. 30:101-107.

Smith, D. L., A. D. Harris, J. A. Johnson, E. K. Silbergeld, and J. G. Morris. 2002. Animal antibiotic use has an early but important impact on the emergence of antibiotic resistance in human commensal bacteria. Proc. Natl. Acad. Sci. U. S. A. 99:6434-6439.

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