Pearls at Swine
Agriculture and the growing antibiotic crisis
by Charlie Angus

HighGrader Magazine January/February 2000
It has been likened to a man falling out of a building. As he passes each floor he tells himself, "well so far, so good." The free fall in question is the developed world's overuse of antibiotics. Every year over 235 million doses of antibiotics are given out to patients in the United States alone. Up to half of those doses may be medically unnecessary.
The medical overuse of antibiotics are dwarfed by the millions of kilos used every year in the agricultural industry. Some of these antibiotics are used to prevent the spread of disease on large factory-style farms. But by far the greatest use is simply as a fattener for pigs, cattle and broiler chickens.
In the fruit industry, antibiotics are regularly used in sprays to prevent blight. In certain segments of the food industry, antibiotics are used as a preservative.
Antibiotics have become a cheap and quick fix to everything from bruised apples to children's earaches. This casual overuse has, perhaps, overshadowed the very vital role antibiotics play in keeping Western mortality rates low. All that may soon change. Like the man in free-fall, we are rapidly moving towards a state where our antibiotic arsenal may be exhausted by the rise of resistant-hardened strains of bacteria.
Last year, for example, 70,000 people in the United States hit the pavement hard victims of fatal hospital-acquired infections. Thirteen thousand of those deaths were attributed to a golden staph bacteria, known as MRSA: Multi-resistant Staphylococcus Aureus.
In the 1970s, only 2% of staph were able to withstand the antibiotic powerhouse Methicillin (and other beta-lactam antibiotics). Now that number has jumped to 50%. In large American and European hospitals MRSA has become a constant and grim companion picking off the weak, the old and the very young.
And the death rates, as shocking as they are, tell only part of the story. Take for example, the case of Roger Pudney who entered a hospital in Melbourne, Australia to be treated for an abscess caused by a spider bite. As related in the Australian television show Quantum, Mr. Pudney went into shock after having the abscess drained. His temperature rose dangerously high and he was put into strict quarantine.
After six months of failed antibiotic therapy, doctors had to resort to amputating his leg in the hopes of stemming the spread of the MRSA bacteria. Seven years after the initial infection, he remains on heavy doses of morphine, has undergone a total of four amputations and his personal and professional life are in tatters.
Compare this medical quagmire with the rosy picture presented by the first use of penicillin half a century ago. The antibiotic was cheap to produce and remarkably effective in quickly eradicating a wide array of infections. Now penicillin barely gets to first base.
This has resulted in the skyrocketing cost of mixing and matching antibiotics with increasingly powerful strains. Nearly 130,000 people are infected with MRSA in the United States every year. One American study puts the cost of managing these antibiotic infections at anywhere from $100 million to $10 billion a year.
MRSA is still being held in check by the use of Vancomycin, sometimes called the antibiotic of last defense. In 1988, however, doctors in Europe encountered a form of enterococcus that was not only able to survive Vancomycin, it seemed to thrive on the antibiotic. Within two years, VRE (Vancomycin Resistant Enterococcus) had spread to numerous hospitals across the U.S. and Europe.
The spread of illnesses like VRE and MRSA has brought home the realization that the "bugs" are developing resistance much faster than our researchers are able to develop antibiotics. "Superbugs" and "plagues" have become part and parcel of our millennial taste for apocalyptic visions (global warming, mass animal extinction, stray asteroids, ozone holes, etc.). The question that needs to be addressed, however, is what can we do to redress the balance?

Breach in the Wall
Dr. David Groves, President of the Canadian Association for Clinical Microbiology and Infectious Diseases, has been paying very close attention to the rise of MRSA and VRE. Speaking from his office in Hamilton, he explains the state of antibiotic defenses in Canada.
"The party line is that we are in deep trouble and the truth is probably somewhere close to that."
Groves points out that we just aren't keeping up with the ability of strains to mutate into resistant forms.
"There are not too many antibiotics coming down the pipe and a significant fraction of strains are resistant to the antibiotics we do have. We now find ourselves in a situation where we have to balance how many antibiotics we use in a population and just how much we want to cure an individual patient."
Groves says fortunately Canadian hospitals have yet to be plagued with the high rates of infection seen in the larger American hospitals.
During the Reagan years, public health in many American cities took a serious kicking. It didn't take long for a number of diseases like tuberculosis to make a virulent comeback.
Says Groves, "The Americans made some public health mistakes and we have learned from them. They had a lapse where they weren't putting money into infection control and the monitoring of resistant organisms. We, however, have been putting the money into these areas."
Still, Groves admits that at best we have been given a little extra breathing room.
"Right now MRSA and VRE come and go in our hospitals. We don't have to deal with them as an endemic problem yet."
Groves points out that the plague imagery doesn't really apply to MRSA and VRE. "These are not particularly pathogenic strains. They don't cause infections very easily. What we try to do is to make sure they don't spread to the general hospital population."
While they may not rank up there with Ebola, antibiotic-resistant staph infections take a serious toll on sick, weak and elderly patients.
"Most of these illnesses do not cause infections in healthy people. The problem with the reduction in health care dollars is that the people who are in hospitals now tend to be very sick and they are susceptible to the spread of these illnesses."

Feeding the Pigs
The rise of Vancomycin Resistant Enterococcus has led to some serious finger pointing about who is to blame for the overuse of antibiotics. Little wonder as the prospect of losing Vancomycin as a reliable treatment would put modern doctors on par with their pre-antibiotic counterparts.
Although in use among humans since the 1950s, Vancomycin was first introduced to the agricultural industry in the early 1970s under the name Avoparcin.
Although it was never used in North America, because of concerns over carcinogenic properties, Avoparcin certainly made a dent in Australia and Europe. The Aussies, for example dumped over 60,000 kilos of Avoparcin a year on pig and poultry operations (as compared with less than 600 kilos for human use of Vancomycin). There is evidence, as well, that Avoparcin was illegally used in some North American farm operations.
Avoparcin-resistent bacteria began appearing in European farms in the 1980s. And Vancomycin-resistance appeared in humans shortly after.
The agricultural industry and agricultural veterinarians hotly deny any links between Avoparcin-resistance and VRE. They maintain that there is no similarity between the kinds of antibiotics used in animals and corresponding antibiotic resistance in humans.
Steve McOrist of the Edinborough Veterinary School maintains that the agricultural industry is being made the fall-guy. As quoted in the New Scientist, McOrist maintains that "Blaming animal use of antibiotics of animals is a soft option. Medics should be looking at the infection control procedures in hospitals that allow the spread of resistant strains between patients."
Dr. George Khachatourians of the University of Saskatchewan's School of Agriculture has just completed a major study of the issue for the Canadian Medical Journal (download the article at http://www.cma.ca/cmaj/vol-159/issue-9/1129.htm).
Speaking from Saskatoon, Dr. Khachatourians says that there is little point arguing about whether or not Avoparcin is responsible for the rise of VRE.
"Antibiotic resistance isn't a theory. It's happened. It doesn't matter how you got it; what matters is cleaning it up."
Khachatourians maintains that there is simply no escaping the fact that antibiotic resistance is directly related to the rise of antibiotics in the general environment.
"It's all related to use. If antibiotics were not present in nature, there would be few instances of antibiotic-resistant bacteria. We can't be frivolous in our use of antibiotics. We have to learn to be judicious. Antibiotics need to be used rarely because in nature they occur rarely."
Khachatourians' research found that the use of agricultural antibiotics is widespread (anywhere from 100 to 1000 times that used in humans). Over 8 million kilos are used annually in the U.S. in farm feeds and 22,000 kilos in the spraying of fruit trees.
Most staggering, however, is the fact that up to 90% of antibiotic use is simply to provide weight gain for animals bound for the market. The fatteners of choice are penicillin and tretracyline-based antibiotics, the same base of medicines that have helped eradicate so much illness in humans. They are routinely added to every bag of feed.
By providing a steady diet (35-100 mgs per head per day) of antibiotics like penicillin, streptomycin, virginiamycin and chlortetracyline, farmers can see a 3 to 5% gain in weight in market-bound animals.
The industry maintains if antibiotics were outlawed as a fattener, the productivity of today's farmers would seriously be impeded. An EU report puts the cost at upwards of $750 million a year in lost productivity for European farmers.
Khachatourians says the argument is misplaced. "If we compare the cost of putting someone on antibiotic treatment (with the cost of changing agricultural practices), all arguments disappear."
Certainly the cost to hospitals of maintaining strict isolation for every patient infected with VRE is sending health care costs through the roof.
As well, the costs of bringing new antibiotics onto the market have risen dramatically.
Says Khachatourians, "The new drugs cost $15 to 18 a crack whereas the old antibiotics cost pennies to produce. These are not trivial drugs."
Both critics and defenders of the industrial use of antibiotics in agriculture point to the experience of Sweden which banned the use in the 1980s.
Critics point to the fact that within a year of the ban, death rate in hogs had risen by 50,000. Other studies, however, maintain that the losses have levelled out and the industry has managed to find alternative weight enhancers.
Khachatourians, however, believes that the issue is already being decided for us. He points to the loss of penicillin from the medical arsenal.
"If it wasn't for penicillin we would have lost millions more in the last war. There would have been a whole generation lost. And yet, now after fifty years, we can no longer use penicillin. We have, in effect, gone back fifty years in health."
So far, Canada seems to be maintaining a "prove it first" attitude (perhaps out of fears of one of those pesky trade wars). And yet Khachatourians believes that there has been some positive moves amongst the agricultural industry to address the problem.
"Every time humans face a crisis there is a reaffirmation of the future. I think we will be forced to think more clearly about what we use in nature and how we use it. These really are sacred drugs. And we must learn to treat them as sacred."

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