Family physician separates fact from fiction about antibiotic resistance
By Doug Rich
Antimicrobial resistance is complex enough without all of the misconceptions and half-truths surrounding this issue. Dr. Richard Raymond, a former rural family physician from Nebraska who now consults, speaks, and writes about food safety, separated fact from fiction during a recent presentation in Kansas City, Mo.
Raymond was a moderator as well as a speaker at the “Bridging the Gap” symposium on antimicrobial resistance sponsored by the National Institute for Animal Agriculture. The symposium brought together leaders from animal agriculture, public health, and consumer advocacy groups to discuss the science around this important issue.
Raymond noted that while foodborne illnesses are down 29 percent in the past decade, media hits for foodborne illnesses are up 150 percent and media hits for food recalls are up 250 percent over that same time period.
“It is no wonder that the American public thinks we are letting them down with our food safety efforts,” Raymond said. “There is a misconception that we are doing badly.”
PulseNet, which was introduced by the Centers for Disease Control and Prevention in 1996, is partly to blame, according to Raymond. PulseNet compares the DNA fingerprint of bacteria from patients to find clusters of disease that might represent unrecognized outbreaks of foodborne illness. This network can link isolated cases of foodborne illnesses across the country and help locate the source of an outbreak.
“When you find a source you have a recall,” Raymond said. “When you announce a recall you have a criminal or a culprit in some people’s minds. If you can name a culprit you have people who will want to read about and that sells newspapers.”
The most recent such outbreak involved poultry from Foster Farms in Kirkland, Wash. Salmonella-tainted chicken from Foster Farms made more than 300 people in 20 states and Puerto Rico sick.
“We eat 1.6 million servings of chicken a day in this country and when 300 people get sick it is suddenly the worst thing that ever happened,” Raymond said. “We have to keep things in perspective when we talk about the way we raise animals in this country.”
Raymond said the public has a perception that concentrated feeding operations are bad and create increased risk for foodborne illnesses. The facts tell a different story. Raymond said chickens raised in free-range conditions have a higher rate of salmonella in their feathers than chickens raised in confinement operations. The number of E. coli illnesses reported in 2012 was the lowest it has been since the U.S. began tracing the disease.
The most recent report from the Food Safety Inspection Service stated that only 2.7 percent of young chicken carcasses tested positive for salmonella.
“When I was with USDA it was 16 percent,” Raymond said. “I don’t think confined feeding operations are making our chickens more contaminated with salmonella.”
Raymond said he does not like the term subtherapeutic as it applies to antibiotic use. He said it gives people the misconception that producers are under dosing their animals.
“I believe those words are used to give the misconception that the animal ag industry is exposing us to a greater risk of antimicrobial resistance because we are using subtherapeutic doses,” Raymond said. “These doses are used for prevention and control and are doses approved by the Food and Drug Administration for those purposes.”
“Which is the greater risk, a low dose given to an entire herd to prevent a disease or infection at a time when they are most vulnerable like at weaning, or treating 10 percent of that herd with a full dose when they get sick because we did not prevent the disease or infection?” Raymond said. “Which one causes the most resistance?”
There is no antibiotic guaranteed to kill 100 percent of the pathogens that make people sick. They get treated, they get well, and they go home. Not all of the pathogens have been killed, there are just not enough to make a person sick. Some of the pathogens have developed resistance to the antibiotic.
“We have created resistance by treating with the right drug, at the right dose, for the right length of time,” Raymond said.
Raymond said 82 percent of the all antibiotics sold for use in animal medicine are of little or no use in human medicine and 68 percent of the total volume of antibiotics sold for humans has little or no use in animal medicine.
“The animal ag industry is being painted as irresponsible and inappropriate users of massive amounts of antibiotics given to healthy animals when in fact the current uses and doses of antibiotics used in animal health have all been approved by the FDA as appropriate,” Raymond said.
The debate over the number of antibiotics sold or used in just diversionary, Raymond said. It is not the main issue in the public health debate over antibiotic resistance. The issue should not be the amount or frequency of microbials used, instead it is the judicious use of microbials and their impact on human health.
Doug Rich can be reached by phone at 785-749-5304 or by email at firstname.lastname@example.org.