Penicillin was mass-produced for the first time during World War II, when pharmaceutical companies were enlisted by the federal government to fight life-threatening infections, then a leading cause of death at home and on the battlefield.
Buffalo native Lauren Belfer wrote about those times – when a knee scrape could become a life-threatening infection – in her critically acclaimed 2010 novel, “A Fierce Radiance.”
What Belfer learned while researching antibiotics has her worried about their effectiveness in the future.
“In the roughly 60 years since antibiotics became widely available, these medications have been so successful that they’ve become simply part of the background of our lives, always there when we need them. Because of antibiotics, nowadays we presume our children will survive into adulthood, and that adults generally will survive into old age,” Belfer said. “As I learned during my research, however, this presumption is false. Due to overuse, more and more antibiotics don’t work, and infectious bacteria are becoming increasingly resistant to medications.”
Belfer’s concern about the growing ineffectiveness of antibiotics is shared by the U.S. government.
A report released in September from the Centers for Disease Control and Prevention called the overuse of antibiotics a “crisis,” with more than 2 million Americans sickened and 23,000 deaths annually from antibiotic-resistant infections.
Demand from the public for antibiotics to treat viral infections, which they’re ineffective for, is partly to blame for the development and spread of resistant organisms. But the subtherapeutic use of antibiotics on industrial-scale factory farms is far and away the biggest culprit.
Some 80 percent of antibiotics sold for use by people and livestock are given to animals, according to Food and Drug Administration sales data for food animals and private sales data for humans published in 2010. That widely repeated statistic drops to 70 percent when subtracting a particular antibiotic not used to treat humans.
The FDA in 2011 reported nearly 30 million pounds of antibiotics were sold for use in food animal production, compared to less than 8 million sold to treat sick people, according to data compiled by IMS Health, a health care company.
“Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, antibiotics should be used in food-producing animals only under veterinary oversight, and only to manage and treat infectious diseases, not to promote growth,” the CDC said.
The latest alarm bell over antibiotic overuse was rung in October by a panel of experts convened by Johns Hopkins University. The panel called for changes to the factory farm model – long criticized as inhumane for limiting the movements of animals – so overstressed chickens, hogs and cows raised for beef don’t need food laced with antibiotics.
Despite the urgent public health risk, the report said, the powerful agricultural and pharmaceutical lobbies have crushed meaningful reform for decades, and are likely to do so into the future.
‘Alarm and inflame’
The animal agriculture industry says the science that links overuse of antibiotics with resistance is still unclear, and its impact on human health is sometimes exaggerated.
“Words like subtherapeutic dosing and multi-drug resistant bacteria that are tossed around are meant to alarm and inflame the American public, yet they’re simply misinforming and misusing these terms,” said Richard Raymond, formerly of the U.S. Department of Agriculture’s Food Safety Inspection Service and a member of the Animal Agriculture Alliance lobby, an industry advocacy group.
Raymond argues 40 percent of all antibiotics used in animals are not approved or allowed for use in humans. Another 42 percent represent the tetracycline class of antibiotics, which were popular decades ago but, he said, ultimately were replaced by more effective and efficient options in human medicine, and only rarely prescribed as a second choice.
“That leaves only 18 percent of the antibiotics used in animal health having any potential significant overlap with human medicine,” Raymond said.
Steve Ammerman, spokesman for the New York Farm Bureau, said farms are getting a bad rap.
“Most farmers act responsibly to ensure the food people eat is healthy and nutritious. Antibiotics are not just given willy-nilly on a farm as some people might think,” Ammerman said.
He emphasized there are government-required checks and balances to protect public health.
“There are prescribed FDA waiting periods before sick cattle can be taken to slaughter for beef, plus they are tested for antibiotic residue. It’s even more stringent for milk.”
Dairy farming is king in New York State, where the 5,400 milking farms dwarf other animal agricultural industries. Nearly 90 percent of the farms are family operated and have fewer than 200 cows.
One of the larger ones, with 1,000 mature dairy cattle and 850 younger stock, is in North Collins.
Dave Phillips grew up on that farm, and can trace his family’s lineage in dairy back to a farm operated near Albany by ancestors in the 1700s. His farm is also part of an Erie County cooperative that doesn’t allow cows to be given hormones to boost production, which some consumers object to.
On a recent day, a dozen Holsteins being treated with antibiotics – all but one suffering from mastitis, an inflammation that affects lactating cows – were in a barn, isolated from the general population. Unlike chickens, whose value is negligible, dairy cows are an expensive investment and are given individual and sometimes expensive antibiotic treatments to return to health.
The cows that are sick are milked separately, and the milk is discarded, Phillips said. All the milk from the farm is tested for safety when it comes from the cow, in the storage tank and after it arrives at the Sorrento Cheese plant in Buffalo. Computerized records on antibiotic dosage and duration on each cow are also maintained.
“We give the cows a roof, a clean, dry place to lie down, we give them fresh water and fresh feed every day, and that’s the number one thing that we do. That helps us minimize the use of antibiotics,” Phillips said.
As he spoke, about 600 cattle quietly fed on a diet that included corn silage, hay and concentrates of grade corn and soybean meal.
“A cow that isn’t alive is a cow that isn’t productive,” Phillips said. He added: “We don’t like to see sick cows, or cows that get so sick that they pass away, so we take care of them, and that includes using antibiotics to get back to better health.”
Dr. Joe Tashjian, a Springville veterinarian who tends Phillips’ herd, said subtherapeutic use of antibiotics is rare in the dairy farms he visits in Western New York.
The bigger problem he occasionally sees are farmers who, without consulting a veterinarian, administer the wrong antibiotic or without a proper diagnosis.
“Animal agriculture gets blamed for bacteria that’s resistant to antibiotics. I don’t think if it’s used the way it’s supposed to that it will result in the kind of resistance we have to worry about,” Tashjian said.
The ‘wonder’ cure
It’s not unusual for parents to expect to leave the doctor’s office with a prescription for antibiotics, even if it’s for a viral infection or the common cold, which they are ineffective for.
“It’s fairly common,” said Dr. Fred D. Archer III, a pediatrician at Women & Children’s Hospital. “We all feel the pressure. There’s a public perception that antibiotics can cure almost anything.”
More than 50 million unnecessary antibiotic prescriptions are written each year for patients outside of hospitals, according to the CDC.
It’s no wonder, Archer said. “Antibiotics were so revolutionary that when they came in, they changed how people were treated and responded to illnesses. They became a wonder cure for almost anything.”
Richard Vienne, Univera Healthcare’s chief medical officer, said another problem occurs when patients stop taking antibiotics after they start feeling better, rather than finishing the full regimen as prescribed. That also contributes to antibiotic resistance, because the worst bacteria isn’t killed.
The rise of “superbugs” – infectious organisms increasingly resistant to existing drugs, and often known by acronyms such as MRSA and VRE – is a growing concern.
The CDC report cited 18 superbugs that pose significant threats to public health and are usually passed on in hospitals. CRE, which people often come down with when they’re getting treatment for other conditions, resists virtually all bacteria, and MRSA sickens 80,000 people annually.
Making matters worse is the lack of new antibiotics. Thirteen were introduced between 1935 and 1968 – but just two since.
At Chipotle Mexican Grill, people eat tacos, burritos and quesadillas from animals that haven’t been fed antibiotics. The chain, with 1,100 locations in 40 states, has been a trailblazer in the fast-food industry.
“I would say probably half our customers know about it, and the other half know it’s delicious,” said Adam Reisdorf, the general manager of the Cheektowaga restaurant.
Debora Frank, who was waiting with a friend to eat her meal on the stainless steel table that’s part of Chipotle’s contemporary design, said it was an important factor in going there. “We come because a lot of the food is organic and doesn’t require antibiotics, and because the animals are treated better,” she said.
James McDermott, who was with his wife and son, also said it was important. “One of the reasons we come is definitely the lack of antibiotics used in the meats. Sustainable living is important to me,” he said.
It’s also important to people who shop at Lexington Cooperative Market, since the grocery store sells only cuts of meat free of antibiotics.
“Every year, more and more people come to us asking questions about what the animals are fed, if they’re humanely treated and whether they are given antibiotics,” said Tim Bartlett, the store’s general manager.
Forestville farmer Tim Grant supplies grass-fed beef to the food co-op. He said the animals rotationally graze in the summertime and have a forage diet in winter, reducing the kind of stress on immune systems found in cramped and unsanitary indoor conditions.
“There [are] a lot of fixes in conventional agriculture that I think stem out of wanting the highest performance. A lot of it comes out of a good place, but produces a bad result for the environment and us. There are real challenges that farmers face and you can’t ignore them,” Grant said.
The Humane Society of the United States is sharply critical of the use of antibiotics to spur growth, which began in the chicken industry in the 1950s, and the conditions on factory farms that breed antibiotic use.
“When we cram together thousands of animals in these filthy football-sized sheds to live beak to beak, or snout to snout, atop their own waste, it becomes a breeding ground for disease. Under those unhygienic conditions, the antibiotics are necessary for the animals to thrive,” said Dr. Michael Greger, director of public health and animal agriculture for the Humane Society.
“The reason they dose beef cattle with antibiotics is because they are placed on a feedlot for the last months of their lives and fed grain. Because it’s such an unnatural diet, it puts strain on their system and they develop liver abscesses. Cows on pasture don’t develop this problem.”
Greger said it’s frustrating to see common-sense solutions stymied on Capitol Hill.
“When you have the combined might of two of the most powerful lobbies in the Beltway, you can see that even if every human health organization is against it, there is no movement on this issue,” Greger said.
Two years ago, the American Medical Association, American Academy of Pediatrics, Center for Science in the Public Interest and other medical groups issued a call to action: “The evidence is so strong of a link between misuse of antibiotics in food animals and human antibiotic resistance that the FDA and Congress should be acting much more boldly and urgently to protect these vital drugs for human illness.”
The FDA has been reluctant to act for decades, despite first acknowledging the overuse of antibiotics on factory farms in 1977. But in April, the agency announced a voluntary plan that would phase out nonmedical uses of more than 200 antibiotics in animals over three years.
Because it’s not compulsory, critics, including Rep. Louise Slaughter, D-Fairport, predict it will accomplish little. Slaughter, the only microbiologist in Congress, has led the battle on Capitol Hill for years to ban subtherapeutic use of antibiotics for farm animals. Since 1999, she has unsuccessfully sponsored legislation to do that, while allowing for the treatment of sick animals and protecting eight classes of antibiotics for use in human health.
Slaughter, whose district once included part of Buffalo, says the public will need to speak louder on this issue if it wants to be heard.
“Factory farming has to be addressed, but agribusiness is much stronger than all of us. The European Union is looking to do away with antibiotic use. What it’s going to take, in all candor, is for the public to be aroused enough to say, ‘we demand you stop it,’ ” Slaughter said.