Media coverage of the controversies connected with antibiotic resistance is one of the most frustrating aspects of contemporary journalism.
First and foremost, there are no clear-cut answers to the challenge of dealing with microbial pathogens resistant to mainline antibiotics — nor are the causes of what has become a troubling phenomenon nailed down to the point that a straightforward campaign can begin to reverse this curse.
Virtually every story arguing over the causes or connections among animal agriculture, clinical medicine and bacterial physiology repeats the same statistic: “According to the Centers for Disease Control and Prevention, resistant strains of bacteria claim roughly 23,000 American lives each year.”
While that estimate is more or less accurate, the backdrop to that number is never explained. Truth is, the majority of those deaths are not due to otherwise healthy people falling prey to superbugs, but more so because many elderly and immune-compromised hospital patients are so weakened by disease and debilitation they can’t fight off a serious bacterial infection, even when given the most powerful antibiotics available.
The reality is that modern medicine hasn’t conquered the infections that cause sickness and death; those infections have only been somewhat contained. But that’s not what most people believe, and it’s not what very many physicians bother to explain.
The Source of Superbugs
Consider a recent opinion piece written by Dr. Joseph Perrone, the chief science officer for the Center for Accountability of Science. He addressed the dilemma squarely:
“Since penicillin’s discovery, Americans have understandably regarded antibiotic treatment as the panacea for medical ailments,” he wrote. “But the drugs’ extraordinary ability to fight infection rapidly led to their overuse. A Journal of the American Medical Association study estimates about a third of all outpatient prescriptions, and half of those for respiratory ailments, are unnecessarily issued.
“Doctors and patients alike believe antibiotics might help and won’t hurt, and thus liberally request and prescribe them.”
And therein lies the problem.
It’s easy to lash out at “irresponsible” producers who use sub-therapeutic regimens of antibiotics to maintain animal health and promote weight gain. Most people have no clue how or why such usage is indicated, and the proliferation of antibiotic-free meat and poultry products in the marketplace lends credence to the notion that the livestock industry is primarily responsible for the problem of resistant infections.
That belief leads to the conclusion that if only FDA would ban the use of low-level antibiotics in food animals, the resistance problem would be greatly mitigated, if not eliminated.
It’s tempting to choose such a simple and seemingly effective path toward solving the problem.
Unfortunately, it won’t work.
“Antibiotic prescription abuse, not responsible use by the meat industry, is the paramount contributor to our modern resistance epidemic,” Dr. Perrone wrote.
Why is that? For one, the for-profit healthcare system often incentivizes physicians on the basis of patient satisfaction surveys. Who wants to jeopardize their potential earnings by antagonizing patients who insist on receiving antibiotics, even if it’s the right call medically?
Theoretically, that system could change over time, but for now, not many physicians whose compensation depends on how patients perceive their treatment are willing to take the high road.
Second — and this is a problem even more difficult to control — far too many patients who receive an antibiotic prescription cease taking their medications once their symptoms subside. Instead of completing the full course of treatment, they basically knock down, rather than knock out, the population of pathogenic bacteria — which amounts to a highly effective way to select for resistant strains that will be that much better equipped next time around to fight off an antibiotic dosage even more aggressively.
Both of those complications ensure that even the most ethical, responsible policymakers have their hands tied on the issue of antibiotic resistance. Banning the use of such drugs in animal agriculture doesn’t solve the problem, but it sure feels better than doing nothing. And it makes for some tough-talking rhetoric about how much the senator or representative cares about his or her constituents.
In contrast, how do you mandate patient compliance with the instructions that come with antibiotic prescriptions? If doctors knew the answer to that one, they’d have put it into practice decades ago.
So on one hand, the public sees a bunch of money-grubbing producers recklessly dosing animals with drugs they don’t need, just to fatten their livestock and their bottom lines.
On the other hand, the political and scientific establishment sees a multi-faceted set of human behavioral challenges that, if they could somehow be corralled, would significantly reduce the threat of antibiotic-resistant pathogens.
Only they can’t be corralled – not until somebody comes up with a medication that compels people to think, speak and behave responsibly.
And if such a drug were ever developed, I guarantee it would be administered just as unevenly and illogically as our current crop of antibiotics.
The opinions expressed in this commentary are solely those of Dan Murphy, a veteran food-industry journalist and commentator.