Can we kick our habit in time?

| 02 Dec 2016 | 12:04

We are recklessly courting a post-antibiotic era. Meet the resistance.

By Emily Kahoud

We are at war with resistant microbes. Whether or not we’re paying attention, we’ve reached a breaking point for preserving antibiotic efficacy, estimated to have extended life expectancy by approximately 20 years. In the past months, not one but two Americans have been found to be infected with a superbug whose arrival could herald the end of modern medicine as we know it. We stand on the brink of a post-antibiotic era, in which childbirth, routine procedures, and minor wounds may become what our grandparents and great-grandparents knew to be negotiations with death.

This superbug – E.coli bacteria harboring the mcr-1 gene – was first discovered in the USA this spring, in a urine sample of a 49-year-old Pennsylvania woman who walked into a clinic on April 26 with a urinary tract infection. The second case was a patient in a New York hospital. The gene makes bacteria resistant to even our last resort antibiotics, and worse still, can be transferred between bacteria. With the arrival of a new class of truly pan-drug resistant bacteria, the post-antibiotic era could become a nightmare turned real.

Does that sound over the top? In late September, antibiotic resistance was the focus of a historic day-long United Nations meeting in New York, culminating in 193 nations signing a declaration to combat superbugs.

“Resistance to antibiotics is considered the greatest and most urgent global risk requiring international and national attention,” the UN said afterwards. Not Ebola. Not HIV. Not Zika. AMR, or antimicrobial resistance, is the scariest thing coming down the pike.

At least two million people get infected with antibiotic-resistant bacteria each year in the United States, 23,000 of whom consequently die, estimates the CDC.

Not only can these infections cost a literal arm and leg, but collectively, they cost a figurative one, too. The CDC tallies the direct cost of antibiotic-resistant infections at an estimated $20 billion, with an additional loss of $35 billion in productivity.

Yet all the while, the following scenario plays out in doctors’ offices across the country.

Doc: What you have is most likely viral. A prescription won’t help that.

Patient: But Doc, I feel awful. I can’t wait this one out. Can’t we just try the antibiotic?

[The good Doc, feeling pressured by patient expectations, as well as time, calls in the script.]

One in three antibiotic prescriptions is unnecessary, the CDC reported this spring, after analyzing data from doctors’ offices and ERs. Scripts are being filled for respiratory conditions caused by viruses – common colds, bronchitis, sinus and ear infections – which don’t respond to antibiotics.

Irresponsible, yes, but what’s in our medicine cabinets comprises a slim 20-30 percent of the problem. The vast majority of what’s driving antibiotics to the brink is its inappropriate use in agriculture.

In 2014, 33 million pounds of antibiotics were sold in the U.S. for use in food animals. Why? For growth promotion, and to prevent infections and contamination stemming from overcrowded and high-stress conditions of industrialized agriculture. In livestock antibiotic consumption, we are outgunned only by China.

Way back in 1986, Sweden eliminated the use of antibiotics for fattening livestock. It took 30 years, but Europe eventually followed suit with an EU-wide ban. Meanwhile, we’re pumping more antibiotics every year into the animals we eat. From 2009 through 2014, domestic sales and distribution of medically important antimicrobials for use in food producing animals jumped 23 percent, the Food and Drug Administration reported. Even after the FDA unveiled its 2013 “plan” to phase out the use of medically important antimicrobials in food animals (spoiler alert: it relied on voluntary compliance), that number continued to march upward.

Science comes down on one side, but the prophylactic use of antibiotics has two irrepressible cheerleaders: Big Ag and Big Pharma.

“Congress and the U.S. Food and Drug Administration have moved toward regulation, but for political reasons they’ve been unable to go the distance,” said Dr. Carl Nathan, Weill Cornell professor of microbiology and immunology.

“The argument is that it will raise costs and lower production – but in parts of Europe that have banned using antibiotics relevant to human medicine in healthy animals for food production, those fears were not realized.”

While Congress lollygags, other players large and small have taken up the mantle. Even McDonald’s has transitioned all its chicken off antibiotics important to human medicine (they still use another class of antimicrobials called ionophores) — and seven months ahead of schedule. Hospitals, where millions of Americans contract superbugs each year, have climbed aboard the bandwagon, harnessing their hefty buying power to move antibiotic-free food toward the mainstream.

“This is something we need to do something about. Fast food can’t be ahead of [hospitals] on public health; it’s not good business,” said Kyle Tafuri, senior sustainability advisor at The Deirdre Imus Environmental Health Center at Hackensack University Medical Center. Tafuri was just named to the website GreenBiz’s list of 30 under 30 emerging young leaders in business sustainability. He’s basically a professional thorn in the side of hospital management, asking questions, questions, and more questions. Like, is it okay for McDonald’s to be beating us on getting antibiotics out of its meat? And is it cool if we put a couple beehives on the roof? (Answers: no and yes.)

“I do kind of stick my nose, stick my foot in the door whenever I can,” he said.

After a year of threatening to leave suppliers, and convincing the bosses that the heftier price tag was worth it, Tafuri has scored a major victory. The meat at the 775-bed hospital is now 85 percent antibiotic-free, and was on the verge of becoming 100 percent antibiotic-free when we spoke in late September. They were just waiting on deli turkey.

“It’s the one inititiative I’ve done where I got killed by budget issues, but it was unanimously supported and it went through.,” Tafuri said. “When we talked to the physicians they were like, ‘Yeah, antibiotics in food are the dumbest thing ever.’”

More than 400 U.S. hospitals are working toward making 20 percent of their meat purchases antibiotic-free, and sourcing more food locally, according to healthcare nonprofit Practice Greenhealth.

“When you back what you’re preaching with your dollars, these companies will move,” said Tafuri.

Tafuri has resorted to unconventional tactics, like putting his head together with the CEO of Shake Shack to find a distributor of antibiotic-free pork.

“It takes effort and a couple bottles of aspirin, because the companies are tough to deal with,” he said. But if hospitals are “serious about public health and wellness, this is the easiest damn thing to do.”

What does a farm look like that can satisfy demand on an institutional scale, while raising animals in the kind of environment that keeps them healthy?

Up in Pennsylvania’s Amish country, Murray’s Chicken provides an example of such a farm. Headquartered in Fallsburg, NY, Murray’s actually contracts with about 75 chicken farmers, clustered within a certain radius of the company feed mill in Shamoken, PA. The mostly Mennonite or Amish chicken farmers each have between one and four chicken houses, containing a total of between 15,000 and 80,000 birds. About half of Murray’s chickens end up in grocery stores, and half in food service establishments like restaurants, country clubs and hospitals. Although Murray’s skinless chicken breast costs nearly twice as much as Perdue’s, demand keeps going up.

“Shoot, when we first started up we were doing literally a handful of birds a day. Now we average about 40,000 per day,” said Dean Koplik, Murray’s chief operating officer.

Murray’s chickens are Certified Humane Raised and Handled, which means, among other things, that the birds don’t get medicated feed, have more space than on a conventional farm, and have access to “toys” like perches to climb on. It takes seven weeks for Murray’s chickens to reach maturity, as opposed to five weeks for your conventional broiler. The slower growth, said Koplik, puts less stress on the animals.

About 98 percent of Murray’s chickens make it to slaughter without being given antibiotics. If a flock needs medicating, it would not be not sold as Murray’s.

One thing Certified Humane doesn’t mean is that chickens get to go outside the barns, which are each about half the size of a football field, featuring a pair of metal silos and a red sign reading, Stop: Biosecure area.

“We don’t permit the birds outside, and more importantly we don’t permit anything inside. Our concern is the spread of disease,” said Koplik. “Giving wild ducks, sparrows, and rodents a way indoors only makes the challenge of growing antibiotic free chicken more difficult.”

Is it the scene you imagined? Maybe not. But it is a step in the right direction.

“Our ability to raise birds without the use of antibiotics, at the end of the day just comes down to good husbandry practices. It’s not necessarily brain surgery,” said Koplik. “Not that there’s not science that goes into it, ‘cause there is, but a lot is common sense. If you’re going to crowd birds, they’re going to get sick.

“The use of antibiotics can overcome some shortcuts.”

The hardy chicken, known as the “gateway animal” for its tendency to turn unsuspecting hobbyists into farmers, may be our gateway once again — this time, to getting antibiotics off our dinner table. Even the industry behemoths are changing course.

“You have the top chicken companies — large, integrated, powerful companies like Perdue, Tyson, the really top players in the industry — already saying they are raising almost all their chickens without reliance on routine antibiotic use, or they’re going to be there within the next few years,” said Sasha Stashwick. Stashwick is (take a deep breath) the senior advocate with the Natural Resource Defense Council’s Energy & Transportation and Food & Agriculture programs.

“They’re doing it successfully, cost effectively, and I think we’re seeing that their customers are really rewarding them for it,” she said. “They’re responding to what people want.”

Forty percent of the chicken industry is either raising chickens under a good antibiotics policy, or is committed to do so in the next few years, Stashwick estimates. The NRDC, an environmental advocacy nonprofit, is hounding the “iconic chicken giant,” KFC, to get with the program.

“If KFC makes this commitment, it will tip the chicken industry over that 50 percent mark,” she said.

Fast food’s move to antibiotic-free chicken makes clear that the price is not seriously prohibitive. Still, there’s no denying that raising healthy animals does cost more, at least in the short-term, and the price goes up in direct proportion to the humanity with which the animals were reared.

Farmer Georgia Ranney, of Kinderhook Farm in Ghent, NY, was disheartened when a customer commented via Facebook that she couldn’t afford Kinderhook’s free range chicken.

“I can totally understand that,” Ranney said. Her heritage broilers ring in at $6 a pound, about quadruple what you’d pay for conventional meat. “However, I don’t think we can afford this cheap chicken. I don’t think people understand what it means when it’s that inexpensive.”

Beyond the problems with antibiotics, conventional farms are inhumane places, Ranney said.

“It’s just the way the animals and the human beings who care for them are treated, as if they are not living creatures.”

All told, she said, her $6 chicken seems “pretty darn cheap.”

Additional reporting by Becca Tucker