By Joseph Perrone
This week, U.S. activist groups delivered a petition signed by 350,000 people demanding that Yum Brands, parent company of Kentucky Fried Chicken, stop using chickens routinely treated with antibiotics. The demand comes on the heels of a McDonald’s announcement that its own chicken is officially free of antibiotics important to human health. Faced with vocal opposition, the meat industry is clearly bowing to significant pressure to change its practices.
While the aversion is real — resistant strains of bacteria claim roughly 23,000 American lives each year — are livestock practices really to blame?
Antibiotic use in livestock is often criticized, despite the Food and Drug Administration (FDA) already prohibiting meat containing antibiotic residues from ever entering the food supply, and the vast majority of the antibiotics used by farmers and veterinarians aren’t regularly prescribed for humans.
No, I would venture to place the blame much closer to home.
Antibiotic prescription abuse, not responsible use by the meat industry, is the paramount contributor to our modern resistance epidemic. The severity of this public health risk demands a forthright conversation about our own role ushering in the age of resistant microbes.
Since penicillin’s discovery, Americans have understandably regarded antibiotic treatment as the panacea for medical ailments. 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.
Additionally, over half of patients stop taking their antibiotic course once they begin feeling better, rather than following the full regimen as prescribed to ensure the infection’s complete elimination. This mentality has driven bacteria to resist antibiotics faster than we can develop new drugs to fight them.
Observant doctors warn that unless today’s overuse is reined in, incurable infections will become the norm rather than the exception. The emergence of resistant bacteria presents a “trolley problem” of modern medicine — prescribe to the sick child in front of you as a precautionary measure and risk contributing to eventual resistance, or reserve prescriptions only for the most medically necessary cases in order to preserve future efficacy.
The latter choice — though more sensible — is easier said than done.
Dr. Ranit Mishori of Georgetown University’s School of Medicine notes that when faced with patients demanding a particular treatment, and pressured to see new ones every few minutes, doctors often have neither the patience nor the communication skills to explain why they won’t prescribe antibiotics. Others have acknowledged the rise of patient satisfaction surveys dictating a clinician’s salary has incentivized doctors to prescribe the drugs to avoid complaints from disgruntled patients who weren’t given the antibiotics they believe they “deserved.”
This often translates to doctors taking the path of least resistance by prescribing inappropriately.
Jesse Goodman, the former head of the FDA, suggests antibiotic stewardship must be achieved with cultural change. Patients must “think differently about antibiotics so they can affect the demand side, and physicians and health systems have to think differently about it so that we behave differently.”
Improvements may include a push for better diagnostic tools to differentiate between bacterial and viral infections, since antibiotics do not kill viruses.
We can look to the Swedes for guidance. With stricter diagnostic criteria and educational campaigns, Sweden issues nearly a third fewer antibiotic courses per 1,000 people as compared to regions in the United States. As expected, the country also has very low rates of antibiotic-resistant infections.
Comparatively, last month the American Society for Microbiology reported the first clinical presentation of a colistin-resistant strain of E. coli in the nation. Colistin is a powerful antibiotic not widely used on livestock — suggesting that the problem extends far beyond pig pens.
Colistin is a last-line-of-defense against resistant infections, and if what we are seeing is the beginning of its ineffectiveness, the calls to reconsider antibiotic overuse could not have come at a more apt time. While the rise of widespread colistin resistance isn’t necessarily imminent, its consequences are far too severe not to take action now.
Change doesn’t have to be drastic. For most Americans, responsible antibiotic use can start by simply following the doctor’s orders.
Dr. Joseph Perrone is the chief science officer at the Center for Accountability of Science.
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