Agricultural Antibiotic Overuse

1. Agricultural Antibiotic Overuse Profits Before Public Health Martin Donohoe

2. Am I Stoned? A 1999 Utah anti-drug pamphlet warns: “Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

3. Food Safety/Food Justice • Poverty and hunger • Food waste • Environmental Degradation • Climate change, loss of arable land, water shortages, soil erosion, pesticides, indoor smoke exposure from biomass

4. Food Safety/Food Justice • War • GMOs, biopharming • Hormones in the meat and milk supply (rBGH, others)

5. Problems with the Integrity of the Food System • Other food-borne infections • Vegetables and produce (esp. sprouts) • Raw milk • 39% of seafood sold in US mis-labelled • Pink slime • NH4OH-treated beef trimmings

6. Problems with the Integrity of the Food System • Horsemeat in UK, EU • Multiple food recalls • Almost 9 million lbs of meat and poultry recalled in 2010 • 37 fruit/vegetable recalls in 2011 (2 in 2005) • Inspection system woefully underfunded/understaffed

7. Agricultural Antibiotic Overuse • Non-theraputic use – Livestock: 71% • Use up 50% over the last 15 years • Therapy – livestock: 8% • Other (soaps, pets, etc.): 10% • Therapy – humans: 15%

8. Agricultural vs. Human Antibiotic Sales

9. US Leads the World in Agricultural Antibiotic Use (WHO, 2012)

10. Agricultural Antibiotic Use • Almost 9 billion animals per year “treated” to “promote growth” • Given in feed for cows and pigs, in water for poultry • Claim: Larger animals, fewer infections in herd • 84% of beef cattle, 83% of pigs, and 40-50% of poultry given non-therapeutic antibiotics • 50-75% of antibiotics end up in waste stream (then soil and water)

11. Antibiotic Class – Feed Additive Antibiotics • Penicillins - Penicillin • Tetracyclines - Chlortetracycline, Oxytetracycline • Aminoglycosides - Apramycin • Streptogramins - Virginiamycin • Macrolides - Erythromycin, Oleandomycin, Tylosin • Clindamycin (Lincosamide class) - Lincomycin • Sulfonamides - Sulfamethazine, Sulfathiazole

13. Antibiotic-Resistant Human Infections “Antibiotic use in food animals is the dominant source of antibiotic resistance among food-borne pathogens.” (CDC)

14. Antibiotic-Resistant Human Infections • CDC: 48-76 million people suffer foodborne illnesses each year in the U.S. • 325,000 hospitalizations • 3,000 - 5,000 deaths • Increased risk of autoimmune disorders (GI, rheumatic diseases) • > $156 billion/yr in medical costs, lost wages, and lost productivity

15. Antibiotic-Resistant Human Infections • Associated with longer hospital stays, treatment with second- and third-line antibiotics that may be less effective, more toxic, and/or more expensive • High risk groups • Very young • Seniors • AIDS, cancer, transplants, immunosuppressants

16. Agricultural Antibiotic Overuse May Lead to Alterations in Human Microbiome • Changes linked to: • immune system development and function • autoimmune and allergic conditions • hormonal and reproductive disorders • diabetes • Autism • cancers

17. Consequences of Agricultural Antibiotic Use • Campylobacter fluoroquinolone resistance • Campylobacter = most common food-borne infection in US • 2.5 million case of diarrhea and 100 deaths per year • Increased dramatically in 1990s and 2000s • 2009: Campylobacter found in 62%, Salmonella in 14%, and both in 8% of store-bought chickens

18. Fluoroquinolone-Resistant Campylobacter Infections • Animal Use • Sarafloxacin (Saraflox) – Abbott Labs – voluntarily withdrawn from market (2001) • Enrofloxacin (Baytril) – Bayer – FDA withdraws approval (7/05) • Human Use • Ciprofloxacin (Cipro) and moxifloxacin (Avelox) - Bayer

19. Consequences of Agricultural Antibiotic Use • Vancomycin-resistant Enterococcusfaecium (VREF, due to avoparcin use in chickens) • Synercid-resistant infections (agent of last resort for vancomycin-resistant bacteria; due to Virginiamycin use) • Gentamycin- and Cipro-resistant E. coli in chickens • Linked to E.coli UTIs in humans

20. Consequences of Agricultural Antibiotic Use • Methicillin-resistant Staph aureus (MRSA) in pork, chickens • 49% of pigs and 45% of pig farmers harbor MRSA • MRSA carriage higher in those living near cattle and pig farms • One study found 30% of US grocery store pork cuts tainted with MRSA • MRSA from animals thought to be responsible for more than 20% of human MRSA cases in the Netherlands

21. Regulatory Advances • FDA bans fluoroquinolone use in poultry (2005) • EU bans use of all antibiotic growth promoters (2006) • FDA bans off-label use of cephalosporins in food animals (2008); further restrictions (2012) • 2010: FDA urges phasing out antibiotic use • 2012: FDA issues voluntary guidelines to reduce antibiotic use

22. Regulatory Advances • FDA considering banning PCNs and tetracyclines in food animals (2012/13) • Preservation of Antibiotics for Medical Treatment Act – awaiting vote in Congress • AMA, AAP, APHA, IDS, UCS, Consumers’ Union, others all oppose non-therapeutic antibiotic use in livestock

24. Agricultural Antibiotics • Three years after a Danish ban on routing use of antibiotics in chicken farming, the prevalence of antibiotic-resistant bacteria in chickens dropped from 82% to 12%

25. Antibiotic Use in Seafood • 91% of US seafood imported • Most from Asia • FDA inspects 2% at most • Antibiotic overuse • Klebsiella resistant to up to 8 different antibiotics in 1/5 of Thai shrimp (largest importer) (FDA, 2012) • Nitrofurans (carcinogenic, banned in US) found in 1/5 of Asian shrimp (FDA, 2008) • Vietnamese shrimp with traces of fluoroquinolones • Antibiotic-resistant land-based pathogens increasingly found in marine organisms

26. Alternatives to Agricultural Antibiotic Use • Organic farming • Decrease overcrowding • Better diet/sanitation/living conditions • Control heat stress

27. Alternatives to Agricultural Antibiotic Use • Vaccination • Increased use of bacterial cultures and specific antibiotic treatment in animals when indicated • Vegetarianism • Ban on non-therapeutic antibiotic use in US would increase per capita costs by $5-10 (National Research Council), but would decrease health care costs and other economic losses (likely by much more)

28. We

29. WHO Director-General Dr Margaret Chan (2011) “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”

30. Factory Farming • Large CAFOs make up 5% of livestock operations but produce more than 50% of food animals • CAFOs increasing, small family farms decreasing • 11,000 CAFOs in U.S. • Flourished thanks to indirect federal subsidies • Not subject to Clean Air Act Standards • Have replaced industrial factories as the # 1 polluters of American waterways

31. Factory Farming • 1.4 billion tons animal waste generated/yr in U.S. (13 billion tons worldwide) • 130 x human waste (in U.S.) • 1 hog farm in NC generates as much sewage annually as all of Manhattan

32. Factory Farm Waste • Most untreated • Ferments in open pools • Seeps into local water supply, estuaries • Kills fish • Causes human infections - e.g., Pfisteria pescii (Chesapeake Bay)

33. Factory Farm Waste • Foul odors and contaminated water reduce property values in surrounding communities by an estimated $26 billion • Widely disseminated by floods/hurricanes

34. The Bad News • Agricultural antibiotic use in China dramatically increasing (pork), unregulated • “Ag-Gag” laws (aimed at preventing employees, journalists, and activists from exposing illegal or unethical practices) • “Right to Farm” Acts – to prevent lawsuits by neighbors of factory farms (for air and water pollution, property devaluation)

35. Corporations • Internalize profits • Externalize health and environmental costs

36. Corporate PR tactics • Characterize opposition as “technophobic,” anti-science,” and “against progress” • Portray their products as environmentally beneficial despite evidence to the contrary • Public Relations (Greenwash) • Sponsored educational materials • Co-opting academia • Lobbying, political donations

37. Agricultural/Biotech Companies • Many major agricultural biotech companies also pharmaceutical companies (*): • Novartis Seeds* • Aventis CropScience* • Bayer CropScience* • BASF* • Dow* • Syngenta • Dupont/Pioneer

38. Pharmaceutical Industry • Influence over physicians through control of CME, gifts, research funding • Conduct seeding trials to alter prescribing patterns • Secrecy, statistical torturing of data sets, selective publication • Data mining of prescribing practices for marketing purposes

39. Pharmaceutical Industry • The largest defrauder of the federal government (as determined by payments made for violations of the federal False Claims Act) • Accounted for 25% of all FCA payouts between 2000 and 2010 • Defense industry – 11%

40. Pharmaceutical Industry • $240 million dollars spent on lobbying in 2011 • 1,228 lobbyists (2.3 for every member of Congress) • Revolving door between legislators, lobbyists, executives and government officials

41. Pharmaceutical Industry • Effectively lobbied and threatened trade sanctions against developing countries in order to prevent production and importation of much cheaper, generic versions of life-saving anti-AIDS drugs • Sneak patent extensions / carve-outs into Congressional measures • Bayer/Cipro/Anthrax

42. Solutions • Public Education • Legal • Legislative • PAMTA, etc.

43. Günter Grass “The first job of a citizen is to keep your mouth open.”

44. African Proverb If you think you are too small to have an impact, try going to bed with a mosquito in your tent

45. Contact Information and References Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org