'Catastrophic Threat' of Antibiotic-Resistant 'Superbugs

Monday, March 11, 2013 by Common Dreams
UK's chief medical officer warns of deadly threat of untreatable infections in face of mutated bacteria
- Lauren McCauley, staff writer


Antibiotic resistant "superbugs" pose a "catastrophic threat" as untreatable infections may prove lethal, Britain's top health official warned in a new report published Monday.

Interaction of MRSA (green bacteria) with a human white cell. The bacteria shown is strain MRSA252, a leading cause of hospital-associated infections in the United States and United Kingdom. (Photo: NIAID via Flickr) "Antimicrobial resistance poses a catastrophic threat. If we don't act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can't be treated by antibiotics," cautioned Sally Davies, England's chief medical officer.

"Routine operations like hip replacements or organ transplants could be deadly because of the risk of infection," she added.

The pervasiveness of antibiotics—due to over-prescription, the systemic abuse of the drugs in industrial food supplies and subsequent leaching into the environment—is causing increased resistance, challenging bacteria to mutate and leaving current drugs ineffective against these new bacterial diseases.

Davis' statement comes less than a week after the Centers for Disease Control and Prevention (CDC) announced an alarming rise in antibiotic resistant, deadly "nightmare bacteria," carbapenem-resistant Enterobacteriaceae (CRE).

The Guardian reports, "there has been an alarming increase in other types of bacteria including new strains of E coli and Klebsiella, which causes pneumonia."

Reuters adds:

One of the best known superbugs, MRSA, is alone estimated to kill around 19,000 people every year in the United States - far more than HIV and AIDS - and a similar number in Europe.

And others are spreading. Cases of totally drug resistant tuberculosis have appeared in recent years and a new wave of "super superbugs" with a mutation called NDM 1, which first emerged in India, has now turned up all over the world, from Britain to New Zealand.

Last year the WHO said untreatable superbug strains of gonorrhoea were spreading across the world.

During her statement, Davies calls for international "anti-biotic stewardship," which includes increased surveillance of drug-resistant superbugs, prescribing fewer antibiotics and making sure they are only prescribed when needed. She added that, with no new antibiotics in the "pipeline," there is an urgent need for research and development to fill a drug "discovery void," to counter the swift rise of these emerging, mutating infections.

Scientists Cry Fowl Over the FDA's Regulatory Failure

Friday, April 27, 2012 by the Guardian/UK
Overuse of antibiotics in factory farming kills thousands every year, yet the industry is force-feeding chickens pharmaceuticals
by Richard Schiffman


In 2005, the antibiotic fluoroquinolone was banned by the FDA for use in poultry production. The reason for the ban was an alarming increase in antibiotic-resistant campylobacter bacteria in the meat of chickens and turkeys – "superbugs", which can lead to a lethal form of meningitis that our current antibiotics are no longer effective against.

Antibiotic-resistant infections kill tens of thousands of people every year, more than die of AIDS, according to the Infectious Diseases Society of America. This problem is on the rise because antibiotics are recklessly overused, especially in the commercial livestock industry, where 80% of all antibiotics manufactured in the US end up.

Fluoroquinolone used to be fed to chickens primarily to stimulate their growth. But why did the banned substance show up recently in eight of 12 samples of "feather meal", the ground-down plumage leftover from commercial poultry production?

This was just one of the mysteries uncovered in a study conducted jointly by the Johns Hopkins Center for a Livable Future and Arizona State University. The research, published last month in the journal Environmental Science & Technology, uncovered a whole slew of other drugs in the feather meal that the scientists had not expected to find there.

Traces of the arsenic compound Roxarsone, for example, were present in almost all of the samples. Farms administer arsenic to chickens to turn their flesh just the right shade of pink that consumers find attractive. Yet, in June 2011, the FDA gave Pfizer 30 days to discontinue selling Roxarsone, a proven carcinogen. So why is it still showing up in our chickens?

Other substances that the scientists found include acetaminophen, the active ingredient in Tylenol, Benadryl, an antihistamine, even Prozac, an antidepressant. Farms feed chickens these mood-altering drugs to reduce their anxiety. Chickens are anxious because they are bred on overcrowded and filthy factory farms. Stressed-out birds develop meat that is tough and unpalatable, so they need to be sedated. Yet, chickens on tranquilizers sleep all the time and do not eat enough. So they are given high doses of caffeine (which was also found in the feather meal) to keep them awake at night to feed and fatten up.

So, here is the deal. We create hellish conditions for our livestock, then we drug them to keep them numb. Then we drug them again to wake them from their pharmaceutical stupor. Then we drug them to grow faster. Then we drug them so their flesh will look healthier. Then we drug them to withstand the disease epidemics that our overcrowding has created.

Then, of course, we drug ourselves every time we take a bite of factory-farmed poultry.

"We were kind of floored," Keeve E Nachman, a co-author of the study told the New York Times. "It's unbelievable what we found." While Nachman says that the levels of arsenic and the witches' brew of other drugs and chemicals in the chicken samples may not be high enough to harm humans, he is not betting his own health on it.

"I've been studying food-animal production for some time," the researcher said, "and the more I study, the more I'm drawn to organic. We buy organic [in my family]."

"So, here is the deal. We create hellish conditions for our livestock, then we drug them to keep them numb. Then we drug them again to wake them from their pharmaceutical stupor. Then we drug them to grow faster. Then we drug them so their flesh will look healthier. Then we drug them to withstand the disease epidemics that our overcrowding has created... Then, of course, we drug ourselves every time we take a bite of factory-farmed poultry."Organic chickens are bred without artificial growth hormones and antibiotics. They are fed organically grown vegetable foods rather than the ground-up animal products – bones, feathers, blood, excrement, fishmeal and diseased animal parts – which their conventionally grown brethren receive. They are also raised free-range with plenty of space, sunlight and opportunities for exercise to keep them healthy. A 2001 study conducted at the University of Perugia found that chickens produced this way actually taste better than conventionally bred birds.

Yet, organic poultry is a lot more expensive to raise. While the market is growing steadily for organic birds, it still comprises less than 1% of the poultry sold in the US today (pdf). So, food scientists argue that the standards for conventional chickens and turkeys need to be strengthened.

"We strongly believe that the FDA should monitor what drugs are going into animal feed," Keeve Nachman urged, adding that, based on what the researchers discovered, they had little confidence that the animal food production industry could be left to regulate itself.

Earlier this month, the FDA announced what looked at first glance like sweeping new guidelines on the use of antibiotics in livestock. The new rules, however, are strictly "voluntary", and, while they do recommend restricting the use of antibiotics to stimulate growth, they would still allow them to be prescribed by a veterinarian for animals that are "either sick or at risk of getting a specific illness".

Critics contend that the words "at risk of getting a specific illness" provide factory poultry farms a loophole big enough to drive a truck through. Margaret Mellon, senior scientist at the Union of Concerned Scientists, said in a press statement:


"The outlined process appears to give the companies the opportunity to relabel drugs currently slated for growth promotion for disease prevention instead. Such relabeling could allow them to sell the exact same drugs in the very same amounts."

Public interest groups like the Union of Concerned Scientists say the time has come for the FDA to stop proposing half-measures and demonstrate that it is serious about preventing a looming public health disaster. It needs to ban dangerous antibiotic use in the raising of livestock, and to conduct rigorous on-site inspections to insure that the ban is enforced.

FDA Draws Criticism After U-Turn on Antibiotics in Animal Feed

Thursday, December 29, 2011 by The Guardian/UK
Environmental groups dismayed after agency drops long-held plan to regulate use of human antibiotics fed to healthy animals
by Karen McVeigh

Environmental and consumer groups have condemned the US Food and Drug Administration's move to renege on its long-held policy to regulate the use of human antibiotics in animal feed.

Last week, the agency quietly announced it was withdrawing its plan to limit the use of antibiotics fed to healthy livestock intended for human consumption.

Critics say the U-turn, which comes amid the FDA's own stated concerns over food safety, is at odds with its obligations to protect the public.

The groups also criticized the timing of the announcement, which was made during the holiday season and disclosed only in the federal register.

The use of low doses of antibiotics in agricultural animal feed contributes to drug-resistant superbugs, according to food and health experts.

One leading food policy writer described the policy reversal as "pathetic" and "dismaying."

"It's dismaying, and obviously something they felt sheepish about, otherwise it wouldn't have been released this week," Michael Pollan, author of the Onmivore's Dilemma and Food Rules: An Eater's Manual, told the Guardian.

"When Margaret Hamburg became the head of the FDA, she indicated this was a high priority for them and that she realized how much of a problem the profligate use of antibiotics was. She said she was going to treat this issue as if her hair was on fire. This isn't the way someone acts when their hair is on fire."

Pollan said there was "no question" that meat could be produced without human antibiotics, as the EU has already banned them.

The FDA first acknowledged in 1977 that the overuse of antibiotics in healthy livestock for growth promotion and disease prevention was unsafe and could promote antibiotic resistant bacteria that could infect people. An advisory committee at the time recommended that the FDA immediately withdraw approval for two drugs, penicillin and tetracycline, for subtherapeutic uses of the drugs in livestock.

Last week, in a statement in the Federal Register, the FDA says it plans instead to allow the industry to self-regulate and "focus its efforts for now on the potential for voluntary reform and the promotion of the judicious use of antimicrobials in the interest of public health".

The problem, said Pollan, boils down to a lack of political will in the face of powerful industry interests. "There's a lot of corporate money in politics these days," he said. "Here you're going up against not just one powerful industry, but two. This administration has had enough trouble going after individual powerful industries. That they would prevail against two of them joined together was too much to hope for."

Livestock consume about 80% of the antibiotics sold in the US.

The FDA's decision comes after a number of high profile meat recalls. In August, 36m lbs of turkey meat were found to have been contaminated with drug-resistant salmonella that caused one death and 76 people to become ill.

When approached by the Guardian, a spokesman for the FDA could not provide anyone for comment.

A statement, taken from the Federal Register, said: "FDA continues to view antimicrobial resistance as a significant public health issue. Today's action should not be interpreted as a sign that FDA no longer has safety concerns about the use of medically important antibiotics in food-producing animals, or that FDA will not consider re-proposing withdrawal proceedings in the future if necessary."

But Avinash Kar, an attorney with the Natural Resources Defense Council (NRDC), described the move as a "step backwards" for the FDA.

Kar believes the move is an attempt to get around a lawsuit filed by the NRDC to force the FDA to withdraw approval for the practice of mixing human antibiotics into animal feed. The lawsuit, filed in May, asked the court to declare that the FDA had violated federal law by failing to withdraw approval of using penicillin and tetracycline in animal feed when animal health is not at stake.

"This action by the FDA is a response to our lawsuit" said Kar. "The findings in 1977 were included in the notice for opportunity for a hearing, and they think they can get around the lawsuit by withdrawing the notices for opportunities for a hearing. But we will not allow the FDA to ignore public health."

In response to the FDA's reliance on voluntary regulations, Kar said: "We don't believe that the industry will voluntarily regulate itself, because for the last 33 years the approach has been voluntary and the use of antibiotics in livestock has not gone down but – based on estimates – has gone up."

"The science has only gotten stronger."

Stephen Roach, of the Food Animals Concern Trust, a group also involved in the lawsuit against the FDA, said he believed the FDA was putting public health at risk.

"It is totally at odds with their mission to protect the public. This month we had a salmonella outbreak in the north-east that was resistant to penicillin and the drug that replaced penicillin, cephalosporin. We are going to continue to have multi-drug resistant salmonella outbreaks and E.coli drug-resistant outbreaks."

Roach said the use of low doses of antibiotics in animals over a long period of time created the ideal conditions for bacteria to develop drug resistance.

A growing number of scientific and medical institutions have urged action on antibiotic resistance. The World Health Organization devoted a WHO day to microbial resistance.

In September, several institutions, including the American Medical Association, the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society, wrote a letter to Congress, calling for them to to reiterate the link between antibiotic resistance and the overuse of antibiotics in food animals. Some of the same health groups took ads out in Politico and The Hill.

"Hundreds of scientific studies conducted over four decades have shown that feeding low doses of antibiotics to healthy food animals leads to drug-resistant infections in people," they wrote in the ad. "In fact, America's leading medical, scientific and public health organizations have been warning of the danger for years."

Politicians also expressed dismay at the FDA's move.

In a statement on her website, Democratic congresswoman Louise Slaughter, the author of the Preservation of Antibiotics for Medical Treatment Act (PAMTA), a legislative framework aimed at tackling antibiotic resistance, said: "Every year, 100,000 Americans die from bacterial infections acquired in the hospital and this is just the tip of the iceberg. Seventy percent of these infections are resistant to drugs commonly used to treat them. I wonder how many lives could have been saved if these proposals were adopted in 1977 as they should have been.

"We need to get our head out of the sand and start taking public health advice from scientists rather than industry lobbyists."

What the USDA Doesn't Want You to Know About Antibiotics and Factory Farms

— By Tom Philpott  | Fri Jul. 29, 2011| Mother Jones

Here is a document the USDA doesn't want you to see. It's what the agency calls a "technical review"—nothing more than a USDA-contracted researcher's simple, blunt summary of recent academic findings on the growing problem of antibiotic-resistant infections and their link with factory animal farms. The topic is a serious one. A single antibiotic-resistant pathogen, MRSA—just one of many now circulating among Americans—now claims more lives each year than AIDS.

Back in June, the USDA put the review up on its National Agricultural Library website. Soon after, a Dow Jones story quoted a USDA official who declared it to be based on "reputed, scientific, peer-reviewed, and scholarly journals." She added that the report should not be seen as a "representation of the official position of USDA." That's fair enough—the review was designed to sum up the state of science on antibiotic resistance and factory farms, not the USDA's position on the matter.

But around the same time, the agency added an odd disclaimer to the top of the document: "This review has not been peer reviewed. The views expressed in this publication do not necessarily reflect the views of the United States Department of Agriculture." And last Friday, the document (original link) vanished without comment from the agency's website. The only way to see the document now is through the above-linked cached version supplied to me by the Union of Concerned Scientists.

What gives? Why is the USDA suppressing a review that assembles research from "reputed, scientific, peer-reviewed, and scholarly journals"?

To understand the USDA's quashing of a report it had earlier commissioned, published, and praised, you first have to understand a key aspect of industrial-scale meat production. You see, keeping animals alive and growing fast under cramped, unsanitary conditions is tricky business. One of the industry's tried-and-true tactics is low-level, daily doses of antibiotics. The practice helps keep infections down, at least in the short term, and, for reasons no one really understands, it pushes animals to fatten to slaughter weight faster.

Altogether, the US meat industry uses 29 million pounds of antibiotics every year. To put that number in perspective, consider that we humans in the United States—in all of our prescription fill-ups and hospital stays combined—use just over 7 million pounds per year. Thus the vast bulk of antibiotics consumed in this country, some 80 percent, goes to factory animal farms.

For years, scientists have worried that the industry's reliance on antibiotics was contributing to the growing problem of antibiotic resistance. The European Union took action to curtail routine antibiotic use on farms in 2006 (taking Sweden's lead, which had banned the practice 20 years before).

But here in the United States, the regulatory approach has been completely laissez-faire—and the meat industry would like to keep it that way. The industry claims that even though antibiotic-resistant bacteria have been found both in confined animals and supermarket meat, there's simply no evidence that livestock strains are jumping to the human population.

Here is where we get back to that now-you-see-it, now-you-don't USDA research summary, which reads like a heavily footnoted rebuttal to the industry line. Assembled by Vaishali Dharmarha, a research assistant at the University of Maryland, the report summarizes research from 63 academic papers and government studies. Here are few of her findings:

• "Use and misuse of antimicrobial drugs in food animal production and human medicine is the main factor accelerating antimicrobial resistance."

• "[F]ood animals, when exposed to antimicrobial agents, may serve as a significant reservoir of resistant bacteria that can transmit to humans through the food supply."

• "Several studies conducted by the Centers for Disease Control and Prevention (CDC) on antimicrobial-resistant Salmonella showed that [antibiotic resistance] in Salmonella strains was most likely due to the antimicrobial use in food animals, and that most infections caused by resistant strains are acquired from the consumption of contaminated food."

• "Farmers and farm workers may get exposed to resistant bacteria by handling animals, feed, and manure. These exposures are of significant concern to public health, as they can transfer the resistant bacteria to family and community members, particularly through person-to-person contacts."

• "Resistant bacteria can also spread from intensive food animal production area to outside boundaries through contact between food animals and animals in the external environment. Insects, flies, houseflies, rodents, and wild birds play an important role in this mode of transmission. They are particularly attracted to animal wastes and feed sources from where they carry the resistant bacteria to several locations outside the animal production facility."

Naturally, such assertions didn't please the meat industry—and the fact that they were backed up by dozens of peer-reviewed science papers no doubt only sharpened the sting. In the trade paper National Hog Farmer, a National Pork Producers Council official lashed out. Perhaps lacking factual ammunition, the official resorted to an attack on the researchers' credentials:

"We find it very disappointing that a research assistant at a university, who is not an Agricultural Research Service scientist, can develop and post such a review without it going through an agency or peer review process."

Well, the pork producers can rest a bit easier. The researcher, Dharmarha, has been silenced. Not only has her report been erased from the USDA site, but she has been forbidden to talk to media. I reached her by phone Thursday. She told me that she didn't know why the report had been taken down, and that she could make no further comment. She referred me to her superior, Tara Smith of the USDA's National Agriculture Library. Smith has yet to return calls or emails.

But Dharmarha's report remains available, due to the the miracle of Google search's cache and the diligence of the Union of Concerned Scientists' staff, and what it's telling us is disturbing: In addition to mountains of cheap product, the food industry is churning out a major public-health menace. And instead of informing the public about it, the USDA seems intent to keep it on the down-low. Justin Tatham of the Union of Concerned Scientists, who has been observing the drama since it started in June, put it to me like this: "As a science-based group, we're concerned about how the USDA is withholding this information from the public."

For me, what's even more disturbing is that government regulators know that serious trouble is brewing from antibiotic abuse on factory farms and seem incapable of acting to stop it.

Dharmarha's heresies are not the first time a government-associated person has bluntly held forth on the topic. In 2009, Josh Sharfstein, then deputy commissioner of the FDA, delivered damning testimony before the US House of Representatives. He opined that routine use of antibiotics on farm animals should be severely restricted—banned outright for non-medical uses like growth promotion and used only "under the supervision of a veterinarian" to treat sicknesses.

But by January of this year, Sharfstein had resigned from his post. The FDA maintains its official stance that antibiotics should be used "judiciously" on factory farms, and it leaves it to the industry to define what that means.

The Overuse of Antibiotics

One of the Three Most Serious Health Risks of the 21st Century
By RALPH NADER

Reading a recent issue of Public Citizen's excellent Health Letter titled "Know When Antibiotics Work," I recalled the recent tragic loss of a healthy history professor who was rushed to a fine urban hospital, with a leading infectious disease specialist by his side. No antibiotics could treat his mysterious "superbug." He died in 36 hours.

Wrongful or overuse of antibiotics has a perverse effect—causing the kinds of bacteria that these drugs can no longer destroy. The World Health Organization has cited antibiotic resistance as one of the three most serious public health threats of the 21st century.

The Centers for Disease Control and Prevention (CDC) notes that just in hospitals, where between 5 and 10 percent of all patients develop an infection, about 90,000 of these patients die each year as a result of their infection. This toll is up from 13,300 patient deaths in 1992. Some percentage of these people have problems because of antibiotic resistance.

No matter how many national and global public health organizations warn about this silent, deadly epidemic, no matter how many official recognitions and definition of the problems and demands for local and international action, the fatality toll and the economic costs keep growing.

As Dr. Sidney Wolfe, editor of the Health Letter says: "We've known about this problem for and the needed solutions for well over 30 years but almost nothing is being done about it!" The drug companies keep pushing these drugs while investing too little in truly new antibiotics that can overtake resistant bacteria. Too many doctors still prescribe antibiotics for viral infections that should not be treated with antibiotics. They don't work on viruses. These include, says Dr. Wolfe, "colds, flu—in the absence of bacterial complications, most coughs and bronchitis, sore throats (except those resulting from strep throat) and some ear infections.

Doctors say that patients demand antibiotics—its part of the culture. But doctors should be there to inform patients in those instances when antibiotics are inappropriate.

The CDC states that "many infectious diseases are increasingly difficult to treat because of antimicrobial-resistant organisms, including HIV infection, staphylococcal infection, tuberculosis, influenza, gonorrhea, candida infection and malaria."

Dr. Wolfe writes that "drug resistant infections also spread in the community at large. Examples include drug-resistant pneumonias, sexually transmitted diseases (STDs) and skin and soft tissue infections."

Let us pause for a puzzling question. How many elected representatives, whose chore they say is America's safety, spend any time on this devastating taking of lives because of preventable antibiotic resistant infections, compared to the daily focus on terrorism and the trillions of dollars spent on arms, surveillance, searching of tens of millions of Americans (at airports, for example) and sending soldiers all over the world to kill and be killed?

"Smart use of antibiotics," says Dr. Wolfe, "is the key to controlling the spread of resistance. Too many types of bacteria have become stronger and less responsive to antibiotic treatment when it is really needed. These antibiotic resistant bacteria can quickly spread to family members, schoolmates and co-workers—threatening the community with a new strain of infectious diseases that is more difficult to cure and more expensive to treat."

The veterinary medical community as well is showing a growing concern of too many antibiotics in domesticated animals which enter the human food supply.

"Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria," says the Public Citizen Health Letter, adding that bacteria that survive an antibiotic change so as to "neutralize or escape the effect of the antibiotic" then multiply rapidly.

There are lots to be done by many participants in the production, prescription, sale and use of these drugs. You can start by questioning your doctor and not buying soaps, handwipes and cleaning agents whose vendors lure you with the label "antibacterial."

For more about what you can do, visit citizen.org/hrg.