Superbugs in Meat
A perspective for health care on antibiotics in
Eighty percent of antibiotics sold in the U.S. are used for animal agriculture. Most of these antibiotics are used for non-therapeutic purposes, such as feed additives, to compensate for the overcrowded and unsanitary living conditions of animals in our agricultural system. Many of these antibiotics are medically-important, like penicillin and macrolides, and used to treat illnesses in humans.
The Food and Drug Administration’s (FDA) 2011 Retail Meat Report, released earlier this year, found that 12 percent of the retail chicken it sampled contained salmonella, and of those samples, about 75 percent were resistant to one or more antibiotics. A growing body of research is now linking antibiotic-resistant bacteria in retail meat to the overuse of antibiotics in animal agriculture, and even to antibiotic-resistant infections in humans. In a March 2013 editorial in the New York Times, former commissioner of the FDA, David A. Kessler, identified this issue as a major public health threat. More than 300 organizations, including the American Medical Association and the American Public Health Association, have advocated ending the non-therapeutic use of medically-important antibiotics as feed additives.
Yet, antibiotic use in animal agriculture is increasing. Since 2001, use in the agricultural sector has risen from an estimated 24.6 to 29.9 million pounds per year.1
The policy landscape
Based on the available data, there is a strong case for federal policy to ban the use of medically-important drugs in animal agriculture, particularly for non-therapeutic purposes.
However, there have been minimal policy gains in this arena. To date, the only public policy in place guiding use of antimicrobials in animal agriculture are FDA Guidance #209 and #213, released in 2012, which advise more prudent use be undertaken by livestock producers—yet, this is just voluntary.
In 2008, small but significant improvements in antibiotics data collection were gained through the reauthorization of the Animal Drug User Fee Act (ADUFA). Congress amended the Federal Food, Drug, and Cosmetic Act to require that the FDA collect and report annually on antimicrobial sales in animal agriculture. ADUFA is up for reauthorization in Congress this year, but is unlikely to contain more data reporting requirements.
The most comprehensive policy under consideration is the Preservation of Antibiotics for Medical Treatment Act (PAMTA) which has been reintroduced by Representative Slaughter from New York three times since 2007. PAMTA would ban eight classes of medically-important antimicrobials from non-therapeutic use in animal agriculture.
The role of health care
The power of the health care sector to drive systemic change was seen clearly in the anti-tobacco movement. Like the case of tobacco, addressing the overuse of antibiotics in animal agriculture will require the health care sector to take a moral and scientific stand in the face of entrenched economic interests.
Hundreds of hospitals and clinicians have already contacted the FDA and Congress to express the need for legislation that allows us to both gather adequate data on use of antibiotics in animal agriculture and to restrict that use in order to protect antibiotics for human health. Numerous hospitals across the country have also begun to take proactive measures in their own facilities. HCWH’s Healthy Food in Health Care Program works with over 90 hospitals that are reducing the amount of meat they serve on their menus, and/or procuring more sustainable meat.
This year, as Congress considers the issue of antibiotics use in animal agriculture, clinicians and health care facilities can play a crucial role in urging greater vigilance and enforceable action. The following are some resources that can help with sustainable procurement, education, and advocacy:
- Learn how clinicians can communicate their concerns about industrialized agriculture to their communities, patients, and policymakers through HCWH’s Food Matters program: www.healthyfoodinhealthcare.org/foodmatters.resources.php
- Learn how hospitals can balance their menus by reducing the amount of meat they serve in their facilities, and by communicating their sustainable food preferences to their suppliers and distributors, by checking out the initiatives on HCWH’s webpage: www.healthyfoodinhealthcare.org/initiatives.php
Case Study: Tom Newman, MD, University of California-San Francisco Medical Center (UCSF)
Newman, who is a professor at UCSF, a National Board member of Physicians for Social Responsibility (PSR), and a member of the Steering Committee of the San Francisco Bay Area chapter of PSR, is addressing issues of sustainability in his hospital by working with the UCSF Academic Senate to transition a Sustainability Task Force into a full-fledged standing committee within the Senate. Newman expects that the Sustainability Committee will be approved and launched by the whole Academic Senate in September 2013. The committee will then identify ways to integrate material on sustainability into the medical and nursing school curricula.
The nascent committee already has its plate full. With Newman as Chair, the group passed a resolution in January to ask UCSF to phase out the procurement of meat raised with non-therapeutic antibiotics. The resolution calls on all University of California campuses to do the same. Thanks to the work of the group, the UCSF’s Academic Senate Coordinating Committee, the School of Pharmacy Faculty Council, and the School of Medicine Faculty Council unanimously passed the resolution in April. The Nutrition and Food Services Department at UCSF is collaborating with the Sustainability Task Force to find more sustainable meat.
Case Study: Fletcher Allen Health Care, Burlington, Vermont
Fletcher Allen has 562 licensed beds (excluding its nursery). In 2011, it served over two million meals to patients and in its five retail areas. Its 2012 food budget was just over $3.8 million. About $560,000 was budgeted for meat, fish, and poultry, not including dairy.
In 2010, 35 percent of Fletcher Allen’s meat and poultry purchases were raised without the routine use of antibiotics. Diane Imrie, Director of Nutrition Services at Fletcher Allen speculates that this number is over 50 percent now, since Fletcher Allen has added a line of pork and chicken that is raised without the routine use of antibiotics since 2010. Fletcher Allen’s staff routinely discusses its meat preferences with its distributors and suppliers.
Five years ago, Fletcher Allen created a long-term antibiotics reduction plan, which included finding organic sources of meat produced without the routine use of antibiotics. According to Diane Imrie, “that was at a point where there was a lot of public awareness of MRSA [a methicillin-resistant Staphylococcus aureus bacteria], and we were seeing it at the hospital, and it just didn’t make sense.”
Imrie estimates that her budget rose by $75,000 when Fletcher Allen switched to chicken raised without the routine use of antibiotics. Imrie also points out, however, that the cost of treating a MRSA infection in a human patient is not far off.
The increased cost of beef produced without the routine use of antibiotics, while higher compared to conventional beef, is not as marked. “There’s a variance of maybe 10 to 20 percent with our cost,” says Imrie. Additionally, Fletcher Allen has been creative with its beef purchases, to reduce costs. “We use flank, top round, and we use ground beef. We offer a Caribbean Jerk dish that’s marinated flank steak or a top round with a nice salsa on the side with rice. That’s not what you would normally see on a hospital menu, but it’s tasty and delicious,” shares Imrie.2
1 FDA. 2011. Annual Report on Antimicrobials Sold or Distributed for Food-Producing Animals in 2011. www.fda.gov/downloads/ForIndustry/UserFees/AnimalDrugUserFeeActADUFA/UCM338170.pdf. 2 Health Care Without Harm.2012. Health Care’s Commitment to Sustainable Meat Procurement: Four Case Studies from Health Care Without Harm. http://www.noharm.org/lib/downloads/food/ HC_Commitment_Sustainable_Meat_Procurement.pdf