(Photo: REUTERS / Joshua Roberts)
Chickens drink water next to calves on a farm near Poolesville, Maryland, October 19, 2005. Experts say the misuse of antibiotics for farm animals is helping to create superbugs.
The philosopher Frederick Nietzsche once famously said, "That which does not kill me, makes me stronger."
That may or may not be true for human beings. It is certainly true for bacteria. The superbugs are among us and they are not leaving. Indeed, they are growing stronger.
"The incidence of drug-resistant infections is a national and global problem, in both the civilian and military world, and has grown dramatically over the past decade in civilian hospitals," said Rep. Vic Snyder, D-AK, at a House subcommittee hearing Wednesday on what the military is doing to deal with multi-drug resistant organisms, aka superbugs.
The military, according to the military physicians who testified to the House Armed Services Subcommittee on Oversight and Investigations, has ramped up anti-infection measures over the past few years in the areas of prevention through standardized practices, detection through screenings and surveillance, and control through isolation, sanitization and the targeted use of antibiotics.
The military has had some success.
"While considerable progress has been made in controlling infection, the problem has not been solved," Congressman Snyder said. "New outbreaks will be a continuing challenge."
In July of this year, Dr. Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine, and a world-renowned expert on superbugs, appeared before another House subcommittee.
"We are not gaining ground in the struggle against antibiotic resistance," Levy said. "All of us - you, me and your constituents - are at ever greater risk of contracting a resistant bacterial infection and even one that is untreatable."
Levy explained to lawmakers "the paradoxical nature of human engagement with antibiotics."
"On the one hand, these miraculous drugs are pillars of modern medicine, helping us to manage and prevent dangerous bacterial infections and save lives. On the other hand, the widespread use - and misuse - of antibiotic drugs has spawned the evolution of life-threatening bacteria that render our current antibiotics useless," he said.
While the military physicians in their testimony this week, and the military branches in their efforts over the past several years, concentrated on prevention and control of superbugs, Levy took aim at the root cause of the problem - the overuse and misuse of antibiotics.
"Some progress has been made in developing protocols and encouraging more judicious use of antibiotics in human medicine," Levy told lawmakers in July. "But there has been precious little progress with regard to stemming the spigot of antibiotics flowing into animal agriculture."
Kathleen Young is the executive director of the Alliance for the Prudent Use of Antibiotics, a worldwide organization founded by Levy.
"The problem is that the animal agriculture industry makes massive use of low-dose antibiotics for growth promotion and in place of effective infection prevention methods," Young said, adding that the farm animal population is much larger than the human population.
The low-dose antibiotics do not kill the disease. They make the disease stronger, more resistant to those and other antibiotics. The animals - the cattle, pigs and chickens - thus treated become superbug factories. The diseases stay in them and they wash off them to infect the surrounding environment.
"The diseases are not only spread around. The superbugs propagate, making more superbugs," she said.
On the human side, antibiotics are still widely misused, Young said.
"Often, the diagnostics used to determine what bacteria is ailing a person are not precise," she said. "So the doctor, out of convenience, will use a broad spectrum antibiotic."
But a broad spectrum antibiotic - the popular Cipro, for example -- may not kill the specific bug, making it stronger.
Superbugs get into hospital settings, propagate and spread. When a patient actually needs an antibiotic in, say, a serious operation to stem infection, the antibiotic may not work. The physician goes to another type of antibiotic. That also may not work. The superbug is resisting. Another type of antibiotic is tried, if the patient is still alive for the trial.
Not only is there the threat to health and life, costs rise as more antibiotics are used to lesser and lesser effect, Young said.
Levy and Young say that the animal agriculture industry, and the pharmaceutical industry that supplies the antibiotics, have not responded to the outcry of professionals to curb non-therapeutic antibiotic use.
"The solution requires a multi-dimensional, multi-stakeholder approach," Young said. "The animal farming industry and Big Pharma do not want to cooperate."
Levy pointed out that the Food and Drug Administration has made plain to the animal farming industry that their use of antibiotics for growth promotion is dangerous to the public health. But FDA's guidance has no clout, and .the industry ignores it.
"Agribusiness has fought efforts to curtail overuse of antibiotics every step of the way," Levy said. "We've given moral suasion, medical urgency, scientific study and voluntary guidance its chance and the problem has only grown worse. We can't wait any longer. Congress must act."
Congress has at least begun to act. In July 2009, Rep. Louise Slaughter, D-NY, introduced the Preservation of Antibiotics for Medical Treatment Act, and the late Sen. Edward Kennedy, D-MA, sponsored the Senate version of the bill.
Slaughter's bill would phase out the use of the seven classes of medically significant antibiotics that are currently approved for nontherapeutic use in animal agriculture and, so people will better know what's in their chicken and burgers and pork chops, require producers of agricultural antibiotics to report the quantity of drugs they sell and information on the claimed purpose.
The bill is idle in a House committee. Young, however, said there is still interest in the bill and has hope that it will move in the future.
"Its provisions are similar to those of a law passed by the European Union that bans antibiotics for food animals and orders surveillance of the use of all antibiotics," she said. "We need to move in that direction."
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