Inside D.C.

White House Plays Catch-Up on Antibiotics in Ag

The White House is set to release today (March 27) a report called by Reuters “ambitious,” a 60-page plan to “slow the growing and deadly problem of antibiotic resistance.”  While the report focuses on taking down so-called “superbug” infection rates over five years, one chunk of the report contains instructions to FDA and USDA to “further curtail” the use of “medically important” – read: antibiotics used in human medicine – for growth promotion in livestock and poultry.

There’s a significant point to be made here:  FDA has already done/is doing exactly what the White House’s “ambitious” report instructs it to do, and has been doing it for a number of years.

The goal of the report is laudable.  Antibiotic resistance is a health problem.  Whenever medicine attacks a bacteria, the bacteria defends itself by mutating, morphing into a creature resistant to the antibiotic being used.  This bacterial defense mechanism renders the antibiotic useless, i.e. it has no effect on the bacteria, and another is tried given the bacteria is “resistant” to the original antimicrobial.

The White House task force report is the work of a team populated by administration agriculture, defense and health executives, and at least two of the three components of the group should be aware FDA – not USDA since its job is to test for residues and cooperate in resistance monitoring – regulates the use of any antimicrobial in livestock and poultry feeds or water.

Three years ago, FDA’s Center for Veterinary Medicine (CVM), which regulates animal drugs and animal foods, embarked on a cooperative effort with industry to reduce the use of antibiotics broadly, while placing some uses under the supervision of veterinarians.   The first step was to ask drug makers to abandon any and all approved label claims for feed efficiency and/or weight gain, i.e. “growth promotion.”  Every animal drug company holding such label approvals agreed, and enjoyed the broad support of farmers, ranchers, feed companies, meat processors and others in this decision.   No growth promotion uses of antibiotics are allowed by FDA at this time.   All antibiotics can be used only for disease prevention and/or treatment.

The second step in this cooperative effort is to take prevention/treatment antibiotics and restrict their use to the order of a veterinarian.  This is going to be handled through what’s called a “veterinary feed directive (VFD),” a tool available for a number of years, but rarely used until now.  Under the VFD, the vet makes an evaluation/diagnosis, decides whether antibiotics are needed, writes an order to the farmer and his/her feed company on which antibiotic should be mixed into which feed at which rate to achieve which animal health outcome.  All of this cooperation will be finalized by December, 2016, well before the 2020 deadline set by the White House task force.

Critics ballyhoo, “70% of antibiotics sold in the U.S. are given to livestock and poultry.”  Reuters quotes this figure provided by U.S. PIRG Stop Antibiotics Overuse.  To compare the amount of antibiotics sold for use in agriculture with the percentage sold for human medicine is a pointless exercise.  There are roughly 300 million people to whom medicines can be given; there are roughly 8.5 billion farm animals.  A 600-lb. animal requires roughly three times the dose of a 200-lb. man.  Even I can do the math.  It’s also important to know that industry data shows only about 13% of approved antibiotics were ever used in animal agriculture for “growth promotion.”

But it begs the question:  Why do activists – and misinformed/misguided members of Congress who champion them – target so stridently antibiotic use in agriculture and not overuse or misuse of these same medicines in human treatments?

According to “Meat Mythcrushers,” a project of the North American Meat Institute (http://www.meatmythcrushers.com/), the Centers for Disease Control & Prevention (CDC) released a September, 2013, report called “Antibiotic Resistance Threats in the United States.”  CDC Director Dr. Thomas Frieden said at that time, “Right now the most acute problem is in hospitals.  And the most resistant organisms in hospitals are emerging in those settings because of poor antimicrobial stewardship among humans.”  According to the report, says the Meat Institute, 50% of all the antibiotics prescribed by doctors for people are unnecessary or are not optimally effective.  This is because patients demand from their doctors – and a good percentage of doctors capitulate – a prescription for antibiotics to treat viruses, the common cold and other diseases and conditions for which the antibiotic was never meant and can’t treat.

I guess once again, animal agriculture is deemed the low-hanging political fruit, easier to assail than organized medicine.