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What Do We Do When the Antibiotics Stop Working?

05/23/2013 12:17 EDT | Updated 07/23/2013 05:12 EDT
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Antibiotic drugs being tested to see how resistant they are to bacteria

Gonorrhea, tuberculosis, staphylococcus -- you didn't want to get them before, and you definitely don't want them now. These are some of the not so pretty faces of today's antibiotic resistance, of today's untreatable diseases.

And worse is yet to come, say prominent experts. They warn of a post-antibiotic world, a health care equivalent of climate change, where today's easily treated infections becoming tomorrow's common causes of serious illness and death. Suddenly, tonsillitis could be a big deal again, pneumonia a big killer, routine surgery no longer so routine given the risk of deadly infection.

Estimates suggest that tens of thousands of people already die each year in the European Union and North America alone due to bacteria we can no longer treat. And we doctors are definitely part of the problem. Nothing says "thank you, come again" like an antibiotic prescription; nothing is faster at getting a patient out the door. Undeniably, more needs to be done to reduce the use, the misuse, the overuse of antibiotics in health care.

But another source of the problem lies far away from the clinic or the hospital, antibiotics used on farms. Evidence suggests the laissez-faire agricultural use of antibiotics is putting their usefulness at risk. Some are used for treatment, some for prevention, but a large proportion, shockingly, are used just to promote growth; to make more animals, at a faster rate.

It is actually agriculture that consumes the vast majority of antibiotics today. The US Food and Drug Administration (FDA) estimates that nearly 80 per cent of antibiotics sold in the United States are for animal use. In Canada, that number reaches almost 90 per cent.

Growth promotion antibiotics are used to make meat cheaper, to make producers more competitive in a world of global commodities where margins can be thinner than America's Next Top Model. And though we can't ignore the pressures to raise livestock as cheaply as possible, and we don't want to make farmers' lives even harder, the broader impacts of antibiotic overconsumption are too important for us to do nothing.

Despite the complexities of trade barriers and subsidies, the European Union has already jumped ahead and banned the use of antibiotics for growth promotion. Surely, monster agricultural companies like Smithfield and Tyson, Hormel, and Swift, given their dominance in the market, can do the same.

How do farm antibiotics hurt human health care? Some of the same antibiotics needed in health care, like tetracyclines, are used on farms. Others are similar enough that they can create resistance in the antibiotics we need to save lives. And the way antibiotics are used for growth promotion -- low dose and long-term -- is surely the worst way to use the drugs. Every medical student learns that under-treating bacteria is the best way to create resistance.

The World Health Organization (WHO) is calling for an end to growth promotion use and for the oversight of veterinarians for all farm antibiotics. They also want an "only when really necessary" designation for critical human antibiotics like the "floxacins" and the later generation penicillins.

The WHO is not alone. Even Codex Alimentarius, the intergovernmental (and corporate) body that creates standards for the global food trade, says that using antibiotics for growth promotion is not what they consider, um, "responsible use" if it has the potential to impact human health care, and Codex is far from being a radical critic of big agriculture or the food industry.

The US Food and Drug Administration is a believer now as well, and the United States was a few hundred lobbyists away from a law. We're left with guidance unfortunately, with suggestions and recommendations, with no guarantee anything will get done.

We need a world-wide push to reduce the use of antibiotics, and at the core of that push needs to be an end to antibiotics for growth promotion. In part it's just competition gone awry, the unnecessary use of antibiotics made necessary because one's rivals are using them. If livestock companies would together agree to lay off the juice they could change the game. It is time our leaders brought them to the table.

We may not be able to completely prevent a global antibiotic crisis, if that is where we are heading, but we need to do more, and quick. Growth promotion antibiotics have got to go, to protect the health care we have now, and the health care of tomorrow.

Kapil Khatter is a family physician who writes about health and corporate accountability, here and at illgotgains.com.