The following opinion piece was published Thursday, December 19 in the Omaha World Herald.
Midlands Voices: With antibiotics comes responsibility
By Richard Raymond, M.D.
The writer, of Windsor, Colorado, is the former chief medical officer for Nebraska and former U.S. undersecretary of agriculture for food safety.
I’m among the 97 percent of doctors a recent Consumers Union poll found are alarmed by the rise in illnesses caused by bacteria that are resistant to antibiotics. And I’m part of the 93 percent who are concerned — or at least have questions — about the use of antibiotics in animal agriculture.
To be sure, doctors are under a lot of pressure when it comes to prescribing antibiotics now that the Centers for Disease Control and Prevention has said that overprescribing to people is the leading cause of antibiotic resistance in humans.
I can say from experience that it’s tough to tell an upset mother she needs to wait a few more days before I prescribe antibiotics for her child’s ear infection, and it’s equally hard to tell a businessperson on his way to Asia that his sinus headache is caused by a virus and only time will help.
Perhaps that’s why we’re tempted to ask our counterparts in animal agriculture — veterinarians — to restrict their use of antibiotics so we can reserve them for human use. The fact is, all doctors, whether they have M.D. or DVM after their names, need to be responsible in their use of antibiotics. The CDC made that point, too.
Despite that, though, Consumers Union is calling for wholesale changes in antibiotics use only among the farmers and veterinarians trying to keep their animals healthy, citing its poll as evidence that the medical community is almost unanimously behind the demand that there be a ban on using antibiotics for promoting growth — they do by killing bad bacteria — and preventing disease.
But Consumers Union apparently didn’t tell the doctors it polled that antibiotics for growth promotion are being phased out and that the role of veterinarians in prescribing antibiotics that are important to human medicine is being expanded. Those doctors also likely weren’t told that 30 percent of antibiotics used in animal agriculture are in a class that aren’t approved for use in human medicine.
And I’m thinking those doctors may not realize that, because the U.S. Food and Drug Administration is doing its job, two of the top four classes of antibiotics they prescribe — critically important cephalosporins and flouroquinolones — make up only 0.3 percent of antibiotics used in animal agriculture.
Perhaps if they knew these facts they would be a little less concerned about antibiotics use in livestock and poultry.
Consumers Union said its poll found “85 percent of doctors report that one or more of their patients have had either a presumed or confirmed case of a multi-drug-resistant infection in the past 12 months.”
That’s terribly misleading.
I graduated from medical school in 1972. For most of my practicing lifetime, I cultured urine, blood, pus and sputum, asking for bacterial identification and antibiotic sensitivities so I could make the correct antibiotic choice. Those results often would show resistance but not resistance that necessarily threatened my patients’ health.
Multi-drug resistance is only important if the commonly used antibiotics won’t work.
Consumers Union also reported that “antibiotic use in livestock production increased 16 percent between 2009-2012,” but it omitted an even more important fact: Antibiotic use in human medicine increased by 36 percent from 2000 to 2010, according to a report from Princeton University released in July 2014.
Furthermore, the CDC in its September 2013 report on antibiotic resistance noted that “up to half of the antibiotic use in humans … is unnecessary or inappropriate.”
Antibiotic resistance is a very serious and complex issue. Organizations that point the finger only at animal agriculture aren’t fostering an atmosphere where science and facts can be presented and used to promote policies that address the problem. They’re creating a problem through fear-mongering and half-truths that advances only their agenda.
