Inside D.C.

The arrogance of ignorance

This week all kinds of players have waded into the issue of antibiotic resistance and the use of antibiotics on farms and ranches, and unless I’m missing something, it’s tough to identify any one of these very loud voices as knowing much about antibiotic use in human medicine or agriculture.

The latest noise comes from a gaggle of investment funds putting pressure on fast food companies, bars and restaurant chains to reduce antibiotic use.  For them it’s about money, and I understand that, and yes, I understand how cynical that statement is.  However, we also have six Senators who wrote a letter to FDA Commissioner Robert Califf essentially telling him he can’t trust farmers or veterinarians to follow the law, so he needs to crack down on agriculture’s use of antibiotics.  This is disturbing.

Any producer or veterinarian understands herd and flock animals get sick and by virtue of their behavior, illness can spread rapidly, no matter how well the animals are managed.  The judicious use of antibiotics in feed and water – at an FDA-approved rate of grams per ton – can prevent a disease from establishing itself in a herd or flock and, if caught early, can treat and prevent the spread of the disease.  The prudent use of these important medicines enhances not only animal welfare and food safety, but preserves the producer’s investment in his/her animals, as well as their income.

The issue of antibiotic resistance is very real and very serious.  By their nature, bacteria, when their existence is challenged, mutate to resist the challenge.  Antibiotics when used in human medicine or in agriculture present such a bacterial challenge so overuse in either sector leads to an increase in bacterial resistance and can render routine antimicrobial treatments ineffective.

The federal government has long identified antibiotic resistance as a major human health challenge.  Yet the attention paid to how best to manage and reduce resistance through prudent antibiotic use has always focused disproportionately on the use of these medicines in agriculture to prevent and treat disease.

FDA, the Centers for Disease Control (CDC) and USDA have monitored resistance and on-farm antibiotic use for over a decade — FDA sets the rules on use; USDA and FDA inspect meat and dairy any even a hint of residue — yet similar oversight of human medical use of these same medicines has not reached nearly the same level of priority.  I guess it’s because on a tonnage basis, the majority of antibiotics produced in the U.S. are used in agriculture; then again, there are 9 billion farm animals versus 300 million human beings.  Maybe it’s because agriculture is considered the “easy” target for political action, the lowest hanging political fruit in the war against antibiotic resistance.

FDA’s Center for Veterinary Medicine (CVM), the agency center in charge of all things animal drug and animal food, embarked a few years back on a “cooperative” plan with industry to reduce antibiotic use on farms.  The first step was to request drug company sponsors abandon antibiotic label claims for growth promotion/feed efficiency; all drug sponsors agreed.  Second, CVM proposed to move all antibiotic use, particularly for those with critical human medical applications, under the oversight of a veterinarian and the use of what’s called a Veterinary Feed Directive (VFD).  Vet groups, feed groups, producer groups all agreed.  The whole shebang is 100% operational by the end of 2016.

Research demonstrates and experts confirm the greatest overuse/misuse of antibiotics occurs in human medicine, either at the doctor’s office or in the hospital.  However, political attention, whether from Congress or activist groups, is focused like a laser on agriculture, yet none of the inflammatory rhetoric and allegations tossed around by on-farm antibiotic critics is directed at the human medical community.  I’ve yet to hear any politician advocate federal oversight of physicians’ prescription habits, nor even a whisper about regulating that authority.  It seems a doctor’s pledge to “voluntarily” cut back on over-prescription or inappropriate prescription of antibiotics is sufficient; doctors, can be trusted because, I guess, they’re doctors.  I had a former deputy commissioner of FDA – a pediatrician – say as much to me during a meeting on this issue when he questioned, “How do you know your farmers are doing what they say they’re doing?”  My response: “The same way you’re confident doctors who say they’re doing the right thing, in fact, are doing the right thing.”

Farmers and vets are not so noble, it seems, at least according to the Senate letter.  Signed by Sens. Elizabeth Warren (D, MA), Dianne Feinstein (D, CA), Kirsten Gillibrand (D, NY), Richard Blumenthal (D, CT), Ed Markey (D, MA) and Corey Booker (D, NJ) – PETA’s “hottest vegetarian Senator” and now a declared vegan – the letter alleges some producers continue to include antibiotics in feed and water to promote growth even though feed efficiency/growth promotion label claims are no longer allowed.  The Senators say these producers claim they’re using the medicines for disease prevention.

“We are highly concerned with FDA’s assertion that the agency will rely on stakeholders, including organizations representing veterinarians and animal producers, to promote compliance with these criteria,” they wrote, referring to FDA’s existing cooperative program with industry.  “This is problematic because some of these stakeholder organizations have questioned the link between antibiotic use in agriculture and antibiotic-resistant bacteria.”

So, if you disagree with these six lawmakers about agriculture’s role in the growth of antibiotic resistance or the most effective way to control resistance, ipso facto, you can’t be trusted to obey the law.

The arrogance of ignorance is astounding.