How many times do we small animal types hand out a vial full of antibiotics, urging our clients to administer every last pill on schedule, only to have them decline: “No need. We have a bunch left over from last time. Remember Fluffy’s UTI last year?” Our clients’ chronic failure to comply with our antibiotic drug recommendations means we’re contributing to the development of antimicrobial resistance. In which case it won’t be our patients’ health alone that suffers, but eventually ours, too. We stress over this as we try to devise and recommend new delivery methods, hedging against poor client compliance with long-acting injectables, expanding our indications for pre-drug selection culture and sensitivity and generally employing more conservative antibiotic protocols. The standard of care in veterinary medicine is rapidly evolving to address how our antimicrobials are acting––or rather, failing to. No longer does that spay go home on a week’s worth of cephalexin just because. Nor do we base our antibiotic decisions on the nicely laminated, paint-by-numbers wall charts our drug reps recommend. This evolution in daily practice comes courtesy of the science underlying microbial mutation: Chronic or episodic exposure of bacteria to antimicrobials leads to the selection of those whose random mutations have conferred one or more advantages. Such wiliness allows them to evade their antimicrobial tormentors thorough a mechanism we’ve dubbed “antimicrobial resistance.” This we know, right? We also know antimicrobial resistance is a threat that’s accelerated in recent decades. The rise of the MRSAs, MRSIs and ESBLs we’re now so familiar with has chastened those who would deign to overprescribe, misuse or otherwise abuse antimicrobial drugs. Which is why physicians, veterinarians, patients and their families have all been put on notice: Overuse antibiotics at the public’s peril. Yet that hasn’t stopped most of our industry-oriented colleagues from staunchly defending the non-therapeutic use of antimicrobial drugs in agriculture species. Aimed at promoting growth and preventing disease in an industrial setting, the use of antibiotics in farm animals has been a boon to animal agriculture. Our protein now grows bigger and faster on less feed in less space. It succumbs to fewer diseases. Our dependence on therapeutic drugs that might necessitate long withdrawal times is reduced. For the public this might seem a slam dunk. Not only is our protein cleaner, but since animals cost less when we raise them on antimicrobials, supermarket-sized chunks of them cost less, too. In fact, feeding an American family a diet rich in animal proteins has never been as inexpensive as it is today. But at what cost? That’s what the Obama administration has been pointedly asking over the past year in its quest to enact a ban on the non-therapeutic use of antimicrobials in our agriculture species. Industrial animal agriculture doesn’t need the drugs to treat disease, the presidential powers-that-be argue. Rather, it needs them to feed a system artificially inflated by drugs; drugs best reserved for therapeutic indications so that we all (humans and animals) may continue to benefit from them. Indiscriminate use of antibiotics leads to antimicrobial resistance. Feeding antimicrobials to our livestock only accelerates the onset of a healthcare crisis the vast majority of the medical establishment agrees is looming. Indeed, this issue has been decades on the dissection table, meandering through public Senate subcommittee hearings and closed-door FDA sessions alike. Books have been written. Papers peer-reviewed and published. White papers authored. Commissions formed. In the mid-’90s I participated in AVMA Government Relations Division roundtables in Washington, D.C., taking in the talk of macrolides and fluoroquinolones along with reps for the NCBA. Yes, even 15 years ago we were scooping, digesting and spinning this stuff like a plate of high-priced tartare. Here’s how the issue’s historically been served: The AVMA and the big producers on one side of the table, the less well-organized, antimicrobial naysaying consumer advocates on the other. Over the past decade, however, the issue has gained purchase among the better organized public health and human medical communities, which suddenly translates into political traction now that we’ve replaced a self-styled Texas rancher with a suburban hobby farmer. In large part, this about-face is thanks to the Pew Campaign on Human Health and Industrial Farming. (Check it out at SaveAntibiotics.org.) Published last year, this report argues that the 40 to 70 percent of U.S. antibiotics we employ non-therapeutically in animal agriculture are essentially used to “offset crowding and poor sanitation.” It finds that “Food-borne bacteria are more dangerous in their antibiotic-resistant forms” and that “food contaminated by dangerous pathogens and bacteria such as Salmonella and E. coli ... are increasingly becoming antibiotic resistant.” A ban on non-therapeutic antimicrobials is clearly in order, it concludes. But the AVMA vehemently disagrees. Here’s an excerpt from its position statement on the subject. (Click here to read more) “This type of broad based ban is contrary to the practice of veterinary medicine and is not risk-based. As legislation concerning the use of antibiotics in animal agriculture is considered by Congress, it is imperative that decisions be made based upon the science supporting the issue.” To which I’ll now add my three pennies: No. 1: The AVMA refutes the Pew findings based on their contrariness to the practice of veterinary medicine because they’re not “risk-based.” However, how can the use of antimicrobials on healthy animals be “risk-based” given that healthy animals are the target? . No. 2: If “It is imperative that decisions be made based upon the science,” then the AVMA should know that the vast majority of the medical community strongly deplores the use of arbitrarily distributed, chronically dosed antimicrobials to an entire population in the absence of an indicated infection. Veterinary medicine should be based on the science that addresses an individual animal’s needs, not on empirical findings that merely demonstrate weight gain and lower morbidity. . No. 3: I’ll concede that the Pew findings are not based on the actual science that proves a direct link between antimicrobial resistance and agriculturally employed drugs. There is no smoking gun … yet. How much evidence do we need? How irrefutable does it have to be? In enacting this ban, says the AVMA, we would be surrendering animal and public health to a lose-lose proposition: A decline in animal welfare and a threat to our food supply will result. Trust us. This is within our expert purview. It’s something neither our companion animal compatriots nor any laypeople can possibly understand. Yes, the AVMA would have you believe that ours (as veterinarians) comprises the final word on the subject of science in the interest of animals. Yet all major animal welfare organizations applaud a ban on the non- therapeutic use of antimicrobials. And the AMA supports an antimicrobial ban, too. The AVMA lays no special claim to the hearts and minds behind the welfare or the science here. Indeed, the AVMA is increasingly alone on this one. It’s times like these when I can’t help but wonder how both industrial animal practitioners and the rest of us managed to graduate from the same institutions. Is there a varying interpretation of science that emerges after being employed by big agriculture? Somehow, I can’t help but think the mindset is relegated not to the bulk of our food animal colleagues but to a mouthy few. Which only makes me want to question the AVMA’s stance all the more. After all, as an AVMA member it’s my reputation as a rational thinker—and yours—that’s at stake here, too. <HOME> Patty Khuly, VMD, MBA, is a small-animal practitioner in Miami and a passionate blogger at Dolittler.com. This article first appeared in the May 2010 issue of Veterinary Practice News
