White House Acknowledges Health Risk Of Antibiotics Overuse; Critics Say It Fails To Fully Address Problem

In a new White House report on antibiotic resistance, the Obama administration acknowledges the serious public health risk posed by the over-prescription and overuse of antibiotics, and details multi-agency plans to combat the problem. However, many critics of the report say that these plans fail to close a loophole that will allow farmers to continue using medically unnecessary antibiotics on farm animals (who consume 80% of all antibiotics sold in the U.S.) primarily for the purpose of growth promotion.

This morning, a White House official claimed that the newly released National Action Plan for Combating Antibotic-Resistant Bacteria [PDF] is the “most aggressive and most transparent” plan yet from the federal government on the issue.

Indeed the plan does not attempt to sugarcoat the problem, directly stating that “the emergence of drug resistance in bacteria is reversing the miracles of the past eighty years, with drug choices for the treatment of many bacterial infections becoming increasingly limited, expensive, and, in some cases, nonexistent.”

According to the Centers for Disease Control and Prevention, more than 2 million people fall ill to drug-resistant pathogens every year in the U.S. alone, with some 23,000 of these illnesses resulting in death. Those numbers are only expected to grow if doctors and hospitals continue to over-prescribe antibiotics and if farmers continue to use the drugs in animal feed with the goal of raising larger cows and pigs.

One White House official points out that if we can no longer rely on antibiotics to fight infections, it will reverse a century’s worth of medical advances. No more organ transplants or artificial replacements, as patients would likely fall victim to post-surgery infections that are currently treated with antibiotics.

“Inaction is only going to compound what is already a growing problem,” said the official.

To that end, the plan includes several new stewardship, education, and monitoring programs for the use of antibiotics on human patients at hospitals and in doctors offices. For example, the administration aims, over the next five years, to reduce inappropriate antibiotic use by 50% in outpatient settings and by 20% in inpatient settings.

As a 2014 study published in the Journal of the American Medical Association showed, 70% of U.S. physicians are still prescribing antibiotics for patients with acute bronchitis, an illness that shouldn’t be treated this way.

The White House plan also seeks to establish state-level programs in all 50 states to monitor regionally important multidrug resistant organisms.

But as mentioned above, use of antibiotics on humans only accounts for less than 20% of all antibiotics sold in the U.S. The vast majority of these drugs is sold to farmers for use on livestock.

And while the White House plan acknowledges that something must be done about this overuse of antibiotics in farm animals, the report seems to accept that simply taking “growth promotion” off the label of of acceptable uses for these drugs will do the trick.

In late 2013, the FDA — after decades of doing nothing on the issue — released voluntarily guidance to the pharmaceutical industry asking drug companies to remove growth promotion as an allowable use for their antibiotics and to require that farmers only use these drugs for disease treatment or prevention.

The drug companies weren’t terribly bothered by this guidance, saying at the time that it wouldn’t hurt their bottom line (and it didn’t, as their stock prices continued to rise). And though growth promotion was taken off the label as a use for these drugs, some companies continued to market the fact that you’d get a fatter pig by using their antibiotic over the competition’s.

This is because the farmers are still allowed to use these drugs for the vague purpose of “disease prevention,” meaning that they only needed to change their reason for using the drugs, not the amount of antibiotics being used.

Mae Wu, attorney for the Natural Resources Defense Council, says the White House “tries to draw a false distinction between growth promotion uses and disease prevention uses – a distinction not recognized by bacteria. Both uses often involve routine, low doses of antibiotics given to large groups of animals for long periods of time – ideal conditions for breeding drug-resistant bacteria.”

Critics also wonder why the White House plan sets specific targets for reducing frivolous uses of antibiotics in humans, but makes no attempt to set a goal for similar reductions in agricultural antibiotic use.

“This means that the only measure of success will be whether or not companies remove growth claims from the labels – even if on-farm antibiotic use continues to rise,” says Steven Roach, senior analyst for Keep Antibiotics Working. “All the other actions in the National Action Plan – including research, outreach to producers and veterinarians, and improved monitoring – will be wasted as long as the target to be reached falls so short of what needs to be done.”

Rep. Louise Slaughter of New York, a trained microbiologist who recently re-introduced legislation aimed at curbing the use of antibiotics in farm animals was critical of the White House plan.

“Once again, the administration has fallen woefully short of taking meaningful action to curb the overuse of antibiotics in healthy food animals,” said Slaughter in an e-mailed statement. “The U.S. is already a decade behind European nations in combating antibiotic resistance, and it will become a major trade issue when our foreign counterparts stop accepting U.S. meat raised with medically-important antibiotics.”

In response to these critics, a White House official said this morning that “We recognize this is an area where we need better data than what we have now.”

He explained that more species-specific data is needed before further determinations can be made.

“We need to have the evidence that will allow us to target the species that are most susceptible,” said the official.

With regard to criticism that the removing growth-promotion as an acceptable use is ineffective, the official pointed out that it would now be illegal for a farmer to then use that drug solely to get fatter animals.

But that’s only if the farmer admits that their sole reason for using the drug is growth-promotion, which none of them will do publicly. Farmers and their associated veterinarians have repeatedly stood by the defense that they need to put these drugs in animal feed for prophylactic reasons to prevent disease. However, as noted above, this sort of frequent, low-dose use of antibiotics only helps to encourage the development of drug-resistant pathogens.

“Antibiotics were never meant for prevention of disease,” explains Slaughter, “they were meant for treatment of disease. Using them at sub-therapeutic levels for prevention has just made bacteria stronger and is rendering antibiotics ineffective.”