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Eco-Justice Notes
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Avoiding The Post-Antibiotic Future
distributed 2/20/15 - ©2015

I've just become more concerned about a public health issue. An article by Maryn McKenna -- a chapter in an anthology of recent science and nature writing that I received as a Christmas gift -- helped me to "Imagine the Post-Antibiotics Future". What she described wasn't pleasant.

Antibiotics came into widespread use during World War II, saving countless lives. The man who discovered penicillin recognized the danger of resistance from the start. Accepting the 1945 Nobel Prize in Medicine, he said: "It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them ... There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant."

Underdosing happens when the doctor prescribes 10 days of pills, but the patient feels better after 5 days and stops taking them. And underdoing is widespread in agriculture, when livestock are given constant low-level antibiotics as "growth promoters" (more on this below).

A similar problem comes with overuse -- where pervasive applications of antibiotics of many kinds wipe out weak strains of microbes, and leave growing populations of resistant strains. When a kid has a cold (caused by a virus), and the doctor prescribes antibiotics (which have no impact on the virus) because parents demand them, the pool of resistant bacteria is strengthened. Resistance also emerges in hospitals and nursing homes, where antibiotics are in widespread appropriate use.

Bacteria are adept at mutating, and some resistance has emerged to almost every form of antibiotic -- often within just a few years of the drug's release. As those resistant strains become more common, the wonder-drugs become less effective. The director of the US Centers for Disease Control and Prevention said, "If we're not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there."

So what does that post-antibiotic future look like? Conditions and treatments that we now see as routine become unworkable. McKenna runs through several implications.

  • Without viable antibiotics for cancer patients, "chemotherapy or radiation treatment would be as dangerous as the cancers they seek to cure."
  • Surgery on body parts with high bacteria counts -- intestines and the urinary tract -- would become much more dangerous.
  • Implantable devices like pacemakers can't be used without ongoing antibiotics. Synthetic prosthetic materials -- joints, vessels, heart valves -- do wonders, but without effective antibiotics, it is estimated that one out of every six recipients of new hip joints would die.
  • Our everyday lives become much riskier. Before antibiotics, "one out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. ... In a post-antibiotic era, would you mess around with power tools? Let your kid climb a tree?" Or get a tattoo?

Both underdosing and overuse are moving us toward that post-antibiotic future -- perhaps within 20 years if current trends continue. So it is essential that those trends change.

President Obama's proposed 2016 budget has several provisions to combat antibiotic-resistant bacteria. The Pew Charitable Trusts name three kinds of action that are needed to address this crisis.

  • Spur the creation of new antibiotics by removing the regulatory, economic, and scientific obstacles that impede antibiotic discovery and development. Developing new drugs is incredibly costly, and pharmaceutical companies haven't found it a profitable business strategy in recent years. The Promise for Antibiotics and Therapeutics for Health (PATH) Act is one legislative step in this direction.
  • Establish stewardship programs to ensure that antibiotics are prescribed only when necessary in human health care settings. Physicians and pharmacists are cracking down on inappropriate use. Consumer products like soaps with the antibacterial ingredient triclosan need to be taken off the market.
  • End the overuse of antibiotics in food animals. This is a huge problem that I wrote about in Notes in 2013 ("Pearls Before Swine").

Amazingly, 80% of the antibiotics used in the United States are given to poultry and livestock -- and only a small bit of that is used to actually treat disease. Low-level doses are used to promote weight gain, and to address the unsanitary conditions of CAFOs (confined animal feeding operations). This agricultural use creates a huge breeding ground for antibiotic resistant bacteria that is easily spread to humans. (National Geographic has some good infographics.)

Agricultural and pharmaceutical industries have fought long and hard against restrictions on livestock antibiotics, writes McKenna, "alleging that agricultural antibiotics have no discernible effect on human health." The widespread use of drugs in agriculture are obviously very profitable to the drug companies. Livestock producers claim that their costs would increase if they had to curtail antibiotic use. The Union of Concerned Scientists, though, refers to a study which estimates "that a ban on nontherapeutic use (that is, any use in livestock that are not sick) would increase per capita costs by about $5-10 per year. That is a price most people would willingly pay to preserve a robust arsenal of medicines against infectious disease."

Since "Big Ag" has been unwilling to make voluntary cuts in antibiotic use, a legislative mandate is necessary. Bills have been presented in both the US House and Senate for many years -- and have failed to get a serious hearing in the face of corporate lobbying. Food and Water Watch is one of the activist groups working to build support for this legislation -- with a form you can use to send a message to your legislators. (For citizens in our home state of Colorado -- a special push is being made to have Sen. Michael Bennet co-sponsor the Preventing Antibiotic Resistance Act (PARA). FWW has an email form directed specifically to his office.)

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Maryn McKenna -- a journalist who specializes in public health and food policy -- was compelling in her exploration of a post-antibiotic future. Once my awareness and concern were ratcheted up, I've seen more news reports of resistant-disease outbreaks (including one today about UCLA).

I urge you to be diligent in your own use of antibiotics. Use them only when necessary, and take the full set if they are needed. Don't use antibiotic soaps.

Follow the links above to urge legislative action on the widespread over-use of antibiotics in agriculture.

And -- if you or your family have a personal story about "superbugs" -- share your story to help educate and motivate the public to this danger.

Shalom!

Peter Sawtell
Executive Director
Eco-Justice Ministries

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