The Antibiotic Dilemma
Issues over the use of antibiotics have been raging on for years. The scientific data is complex, the economic implications are vast and public opinion is continually being molded through public relations efforts. When discussing antibiotic resistance, no one argues the phenomenon of microevolution and the impact that selection pressure has on development of resistance. No one would debate that it is important that we have medications available to treat disease. We, however, enter a grey area when discussing solutions. Disagreements on how to interpret current data, conflicting information concerning success of programs in Denmark and increasing public attention has only increased frustrations and created additional questions.
- Will removal of animal antibiotics have an impact on resistant infections in people?
- How will removal of antibiotics impact the economics of animal agriculture in the long term?
- How will removal impact animal welfare?
The list of questions goes on.
I have been fortunate to hear a great deal of discussion on this issue during the first three weeks of my externship at AVMA. I attended a Health and Human Services listening session, a House Energy & Commerce Health Subcommittee hearing on “Promoting the Development of Antibiotics and Ensuring Judicious Use in Humans,” and meetings with AASV and AABP for their day in DC. I have also had lengthy discussions with representatives from HSUS and the PEW Charitable Trust concerning the topic.
I could go on at length about each of these experiences, but I’d like to touch briefly on the House Energy & Commerce Health Subcommittee hearing. This meeting, held in the Rayburn House Office Building, served as a reminder to me that our physician colleagues are also coming under considerable pressure for their use of antibiotics. Here are a few of the highlights from the hearing that are important to animal agriculture:
- Each expert admitted that there is a current overuse of antibiotics in the medical industry.
- Animal agriculture was sited as a source of antibiotic resistance, due to use in sub-therapeutic levels, by the AMA, IDSA and Rep. Diana DeGette (D-Colorado).
- Off label use became a topic of lengthy discussion during Q&A. Discussion centered on off label use in humans, but this topic is also of high importance in veterinary medicine.
- In human medicine, the highest use of antibiotics is in children. This is important to note as one of the most important antibiotic uses in veterinary medicine is in newly weaned animals.
- Lack of economic incentives, difficulty getting drugs passed by FDA and relatively little funding for research for new antibiotic discoveries has led to no novel antibiotics being approved in over 20 years.
- Definitive diagnoses are often difficult to determine before antibiotic regimen begins. Antibiotics are employed to prevent possible septicemia and progression of disease.
Main solutions proposed
- decrease the inappropriate use;
- increase product in pipeline through incentives, such as extending market exclusivity and tax exemptions;
- prevent initial bacterial infections and spread of infection through increased vaccine development;
- increase number of quick and accurate diagnostic tests to find definitive diagnosis before initiation of treatment;
- utilize more OTC for symptomatic treatment; and
- mandate that hospitals keep infection data.
Currently there is more discussion than action on this topic. Still, there is concern by many in the animal agriculture community that PAMTA (Preservation of Antibiotics for Medical Treatment Act) could be added as an amendment to the Food Safety Modernization Act (S. 510).
The debate on how to curb antibiotic resistance rages on and it’s exciting to be a part of the discussions. My schedule continues to be extremely full, and not a day has gone by where I’ve said that I’m bored. After all, who could be bored when you have an opportunity to combine the arts of science, law, economics and public relations?