Antibiotics made modern farming possible. By abusing them, we risk everything
And the craziest food you ever ate?
The question arrives, like clockwork, halfway through the dinner party. So I offer what guests might expect to hear from a food writer: The fried grasshoppers in Oaxaca, Mexico. The Tasmanian possum in Launceston, Australia (now that was tough to swallow, after watching the hairless creature get thrown around in a converted washing machine to tenderize it). The fried goat’s brain in Toronto. The whale bacon I chewed and chewed at a stall at the Tsukiji fish market in Tokyo, trying to quell the revulsion I felt from eating a creature nearly as intelligent as I. The blowfish I ate sitting cross legged on the floor of a restaurant a few hours from the Japanese capital, while a snowstorm howled outside. That dish really scared me: a slip of the knife could have caused the neurotoxin-laden liver to shut down my nervous system.
But the craziest food? Hands down, it was the chicken I had eaten a few days before that in Tokyo. We had consumed nearly every part of the bird that night—heart, gizzard, feet—before the chef sent out his pièce de résistance: glistening pink slices of chicken sashimi. To swallow the raw chicken, I had to trust the cooks who prepared it, the abattoir that slaughtered it, the farmers who raised it. I had to trust that it was free of the many pathogens that are routinely present on a chicken carcass in the supermarket.
Naturally, I thought of the toilet in my hotel room. It was one of those high-tech jobs, with a control board of buttons, that could clean every inch of my backside and, if I pressed the wrong button at the wrong time, every inch of the bathroom. Hygiene standards in Japan, of course, are famously high. I’d already watched a nude Japanese woman make a kind of citizen’s arrest at an onsen, pouncing on an equally naked tourist who had not properly scrubbed herself down before slipping into the spa waters. If I were going to eat raw chicken anywhere, Tokyo was surely one of the safer places to do it. (This is the kind of reasoning you follow when you’re jet lagged and several cups into a bottle of sake.)
Now, you might say that anyone who eats chicken sashimi is engaging in high-risk behaviour; but eating is always an intimate act, and, like most acts of intimacy, it requires you to trust your partner. Somebody—more often than not a stranger—has created something that will end up inside you, part of you. This fact seems obvious in the face of strange new food; less so when the most pervasive economic and social system on the planet requires us to place our faith in the faceless, nameless people who produce what we eat daily, whether at a poncey restaurant in Tokyo or KFC in Kingston.
In The Ethical Canary: Science, Society and the Human Spirit, the contrarian philosopher Margaret Somerville considers the common perception that trust is a “rapidly decreasing feature of our relationships with one another and our societal institutions.” But, she argues, the way we engage with the food system would suggest just the opposite. Two hundred years ago, a pioneer might have had to trust only a few producers to put breakfast on his plate if he didn’t grow the oats himself. “Today, our grapefruit may have come from one continent, the grain for our cereal from another and the bacon from yet another,” she writes. “Thousands of people had access to these products, but we trust that they are safe to eat.”
Or maybe, as with me and my chicken sashimi, we just hope they are.
The thing that scared me about the raw chicken scallop draped over my chopsticks was the possibility that it contained bacteria that would make me sick. Salmonella, E. coli, and campylobacter can, under the right conditions, kill us—or at least make us wish we were dead. At the same time, hundreds of species have co-evolved to live peacefully with us, and even benefit us. “Bacteria are as much a part of us as we are ourselves,” says Jim Hutchinson, an expert in medical microbiology in Victoria, who has spent much of his career studying the epidemiology of infectious diseases. Even the most germophobic among us host hundreds of species of bacteria; for every human cell, we shelter ten microbial ones. Each of us is host to an entire community of microbes.
This is also true of the animals in our lives—the pets we own, the livestock we raise. Bacteria move easily from one species to another, especially through the food system. “We are intertwined from a microbiological perspective,” says Hutchinson. What happens on the farm can affect us in the kitchen and at the dinner table. Yet aside from the occasional People for the Ethical Treatment of Animals horror video or friendly exchange with an organic farmer at a market, most of us have no idea what actually goes on inside those unmarked locked barns that sit a few hundred metres off the highway. It’s easier not to think about where our food comes from, or the risks it carries.
The idea that there is a connection between our health and that of other animals is not new. Sir William Osler, one of Canada’s most admired physicians and a father of modern medicine, is also considered a father of veterinary pathology. He believed that his students, whether medical or veterinary, should study the anatomy and pathology of both human beings and animals. When Osler delivered the inaugural address at the Montreal Veterinary College in 1876, he titled it “The Relations of Animals to Man,” and told students it would not be long before “you find out that similarity in animal structure is accompanied by a community of disease and that the ‘ills which flesh is heir to’ are not wholly monopolized by the ‘lords of creation.’ ” Back then, in lecture halls at the Faculty of Comparative Medicine and Veterinary Science at McGill, veterinary students sat alongside medical students.
Today, such crossover training would be highly unusual. Most doctors have little to do with animal medicine, unless they’re taking the family pet for a checkup. Likewise, vets rarely take more than a personal interest in human medicine. Each profession keeps to itself, and each tends to collect and analyze its own data separately, making it difficult to share information and identify cross-species health risks. And in the case of zoonotic diseases—those that move from animals to humans—there can be a tendency, between the professions, to develop an us-versus-them mindset. Vets are concerned with their own patients’ health, and doctors with theirs.
We segregate these disciplines at our peril. Most of the emerging and re-emerging infectious diseases that have plagued humans in recent decades—including Lyme disease, H1N1, and Ebola—began in animal populations, and were first transmitted to human beings either directly or through our shared environment. Consequences can be devastating, as in the case of plague, which emerges periodically from animal reservoirs. As Hutchinson says, “We are all swimming in the same pool.” That pool has changed significantly in the last sixty years. Or, to be more precise, we changed the pool when we declared open season on bacteria, and began killing them off with antibiotics.
Nowhere is the division between human and veterinary medicine more evident—or more significant—than in the way we govern antibiotic use. Imagine what health care might be like if the doctor prescribing you antibiotics for a skin infection was also the sales rep for the manufacturer of that drug, and earned a commission each time he wrote a prescription. This is what happens in most provinces when a vet prescribes antibiotics to livestock—if she writes a prescription at all.
Canada is one of the few Organisation for Economic Co-operation and Development countries to allow over-the-counter sales of antibiotics for animals. This makes it easy for farmers to obtain and abuse antibiotics; it also makes it difficult for scientists and regulators to track their use. Under an “own use” provision—designed to allow travellers to bring in three months’ worth of medicine after filling a prescription in, say, Florida—farmers can bring in unregistered, unregulated drugs from anywhere in the world, as long as they don’t sell them. A farmer with 90,000 chickens can go through a lot of antibiotics in three months. He can also import active pharmaceutical ingredients and compound his own medicines.
Jean Szkotnicki, who heads the Canadian Animal Health Institute, an animal drug manufacturing lobby group, estimates that about 13 percent of the drugs used on animals come into the country through these loopholes and are never approved by Health Canada. Warren Skippon, who recently developed antibiotic prudent-use guidelines for the Canadian Veterinarian Medical Association, says, “We are the only industrialized country in the Western world that has such voids.”
Data on antimicrobial use in Canada is hard to obtain—so difficult, in fact, that Rebecca Irwin, who heads a nationwide surveillance program designed to monitor antimicrobial resistance in the food system, once complained that she had no way of knowing whether the CVMA’s prudent-use guidelines were making any difference. A 2007 report from Health Canada estimated that about 200,000 kilograms of antimicrobials are used in human medicine each year. More than 1.6 million kilograms are used in animals (and that does not include the antibiotics that farmers import directly). Measured by weight of active ingredient, nearly 90 percent of antimicrobials sold in Canada are used for animals, including companion animals like dogs and cats. Even more alarmingly, two-thirds of those medications are considered important for human use.
Robert Tauxe, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, studies the way changes in human behaviour can affect microbial evolution. In a 2014 lecture, part of the Massachusetts Institute of Technology’s Knight science journalism program, he cheerfully describes food-borne outbreaks as “prime learning opportunities.” He explains that the CDC was established to control malaria during World War II; the US Department of Defense wanted to protect its soldiers on army bases. Within a few years, it had eradicated the disease throughout the country, without even meaning to. Polio took longer to quash, but by 1979 it, too, had disappeared from American soil. In 1949, the CDC began tackling its third challenge, salmonella.
He pauses for effect: “It turned out to be more durable than we originally thought.” Rates of salmonella infection are stable in the US and Canada, despite improvements in food safety standards, livestock management practices, and surveillance. And the infections salmonella causes are now more resistant to treatment than ever. Salmonella heidelberg is one of the top causes of gastroenteritis in humans; it’s also one of the top strains found in broiler chickens on the farm. Though the bacterium doesn’t affect chickens, it can cause severe illness in human beings—extra-intestinal infection, septicemia, myocarditis. It can kill you.
Bacteria such as S. heidelberg are successful in part because they are, as several scientists told me, “very promiscuous.” Shape-shifters capable of exchanging bits of genetic information and reproducing in minutes, they can refashion themselves with new bits of code that make them more resilient than their predecessors. In ideal conditions, they can survive for months, even years. And because salmonella microbes don’t usually bother chickens—and aren’t easily detected—farmers have little incentive to get rid of them. Farmers do, however, have plenty of incentives to inadvertently generate microbes resistant to antibiotics.
A decade or so ago, Health Canada began to monitor S. heidelberg and other food-borne pathogens. Irwin and her colleagues formed the Canadian Integrated Program for Antimicrobial Resistance Surveillance and collected isolates from both livestock and humans. Since they didn’t have access to farm samples (on-farm surveillance is only now being piloted in chickens), they collected bacteria from the animals’ intestines at abattoirs—samples, they reasoned, that would still accurately reflect the farms’ microflora. Staff also shopped for meat at grocery stores in numbers that reflected how many Canadians live in cities and rural areas, and how many of us buy our meat at supermarkets and butcher shops. CIPARS researchers were hoping to better understand the link between animal and human health, and whether resistance in one species leads to resistance up the food chain. Their project was unprecedented in Canada, both in scale and scope. What they uncovered has found its way into textbooks and PowerPoint presentations around the world.
At the time, broiler chicken hatcheries were injecting eggs with ceftiofur and gentamicin to prevent and control E. coli infections. Then gentamicin became unavailable, and by 2004 all the Quebec hatcheries surveyed were using ceftiofur. Even the scientists were surprised by what they found. There was a direct correlation between the ceftiofur injected into the eggs and the resistance in S. heidelberg to the class of antibiotic that includes ceftiofur. Moreover, the hard-to-treat bug was turning up on chicken in stores—and in patients in hospitals, first in Quebec and then in Ontario. “We didn’t expect to see such a strong linkage,” recalls Irwin. The evidence was so convincing that producers voluntarily stopped using the antibiotic. But a few years later, they quietly reintroduced ceftiofur, and CIPARS again noticed an uptick in human S. heidelberg isolates.
Scientists already knew that using antibiotics on farm animals could elevate resistance levels in food-borne pathogens. An influential report by the molecular biologist Michael Swann, published in 1969, caused the United Kingdom to rethink the way antibiotics were being used in agriculture. Then in 1975, Stuart Levy, an American microbiologist, established a family farm outside Boston and introduced two groups of chickens hatched from pathogen-free hens. One group received low doses of antibiotic-laced feed; the other did not.
Thirty-five years later, in 2010, Levy appeared before the US House of Representatives Energy and Commerce Committee to argue, once more, for the prudent use of antibiotics. “The findings were striking,” he recalled. “Within twenty-four to forty-eight hours, the chickens given the oxytetracycline-laced feed began to excrete tetracycline-resistant E. coli.” Within a week, almost all of the E. coli in the chickens’ guts was tetracycline resistant. After three months, the chickens were excreting E. coli that was also resistant to many other drugs: sulphonamides, ampicillin, streptomycin, and carbenicillin. Levy published his findings in The New England Journal of Medicine and in Nature. The study, he said, “demonstrated the ecologic and environmental impact of an antibiotic”—not only for the animals on the farm, but also for the humans who lived there. Family members also showed a change in their microflora; they were carrying more and more fecal E. coli that was resistant to more than one antibiotic.
By the mid-1990s, the wider medical community began noticing that the antibiotics that had served so well for decades were no longer as effective. Doctors would try one type of antibiotic; when that didn’t work, they’d try another. It gradually became clear that some bacteria had developed a resistance to a variety of antibiotics, making them almost impossible to treat. Dubbed superbugs , these multi-resistant bacteria (including strains of methicillin-resistant Staphylococcus aureus and E. coli) began showing up both in hospitals and on farms. To this day, Dutch hospitals routinely isolate and screen livestock workers if they are carrying MRSA.
Bacteria become resistant through random mutation and gene exchange; each time we use antibiotics, we increase the odds for resistance to them. Any bacteria able to survive our antibiotic onslaught will produce more resistant bacteria. And salmonella and E. coli can share resistance genes, facilitating the spread of drug resistance across the species that colonize the intestinal microbiota.
“There is essentially no gene in any bacterium that cannot be moved to another bacterium,” writes John Prescott, the bacteriologist at the University of Guelph in Ontario who literally wrote the book on Antimicrobial Therapy in Veterinary Medicine. Create superbugs that live on chickens, and they can travel easily through the food chain—from the farm, to the abattoir, to the supermarket, to the dinner plate. The phenomenon is self-perpetuating. Once resistant bacteria are established, they can move from animal to animal—humans included—without the aid of any additional antibiotics.
Each year, roughly one in eight Canadians—4 million people—gets sick from food-borne illnesses. (The vast majority are never identified, but researchers estimate twenty-six cases exist for every salmonella case that is actually reported. By this measure, Canadians may suffer as many as 2.3 million cases of salmonella in a given year.) The Public Health Agency of Canada estimates the total annual cost of food-borne illnesses, accounting for health care and lost productivity, to be as much as $3.7 billion. Already, some of those illnesses involve resistant pathogens, which lengthen hospital stays, complicate treatments, and at least double the cost of treating a bacterial infection. Plus, we could die. According to the World Health Organization, patients with MRSA are 64 percent more likely to die than those infected with non-resistant S. aureus.
Forget curing cancer, says Jim Hutchinson, who now heads up an antimicrobial stewardship program on Vancouver Island. Antibiotics have done more to extend our life expectancy than any other drug we use to treat disease: pneumonia, skin infections, and even urinary tract infections can be fatal without them. A December 2013 editorial in The New England Journal of Medicine suggests that the use of antibiotics extends life expectancy by as much as ten years. Put another way: if antibiotics no longer work, our lives end much sooner.
Medical professionals around the world warn of a post-antibiotic era, when bacteria will be resistant to all the drugs we can throw at them. The prospect is scary enough to be called a “crisis” (by the WHO), a “nightmare” (by the CDC), and a “catastrophic threat” (by UK chief medical officer Sally Davies). Yet the issue hasn’t commanded the attention it deserves. Some scientists compare antimicrobial resistance to climate change: it’s caused by human activity and we’ve known about it for a long time, but the problem is so complex, and involves so many players in so many places, that a solution seems beyond reach. Meanwhile, scientific reports demonstrating the link between antibiotic use (in both humans and animals) and cross-species resistance continue to be published, and recommendations urging prudence keep piling up.
The role that agriculture plays in antimicrobial resistance in humans has long been the subject of acrimonious debate. In this way, too, the issue of resistance resembles that of climate change: it’s easier to point fingers than to fix the problem. Doctors write scathing editorials in The New England Journal of Medicine laying blame at the feet of farmers and griping that “agricultural industry groups, in line with their short-term financial interests, argue that there is no conclusive proof that the antibiotics used in agriculture harm human health.” The Canadian Medical Association Journal, meanwhile, complains, “Agriculture plays a major role in promoting antibiotic resistance, even after accounting for other factors such as over-prescribing of antibiotics by physicians and suboptimal adherence by patients.”
Even John Prescott—who is sharply critical of the abuse of antibiotics by many farmers and vets, and of the regulations that permit it—acknowledges that agriculture’s direct contribution to human resistance could be as low as 6 percent. But a direct contribution may be only the tip of the iceberg. The epidemiologist Amee Manges and her colleagues at the University of British Columbia have been analyzing community-acquired urinary tract infections. DNA fingerprinting suggests that some of these infections may have been picked up from E. coli in supermarket chicken. Such infections are a common complaint among women; they become particularly worrisome when they do not respond to antibiotic treatment and persist for months.
In their defence, farmers point to the many studies that suggest overuse of antibiotics in human medicine is the worse offender, and many doctors, including Hutchinson, agree. On a global level, there is great concern that many countries don’t even regulate over-the-counter sales of human medications. Still, no one denies that agricultural antibiotics contribute to resistance, and that reforms to the way we distribute drugs in Canada are long overdue. Antibiotics are what Levy calls “societal drugs”: administer them to one individual (whether feathered or not) and you may affect resistance in other individuals. Ignoring their use in one part of the food chain, or one part of the world, imperils us all.
On February 7, the Canadian Federation of Agriculture will celebrate Food Freedom Day—the day on which most Canadians will have earned enough at their jobs to pay for a year’s worth of groceries. This is nothing short of miraculous. Each decade seems to bring us cheaper, more plentiful plates of food, and there is no greater success story than chicken, the protein that ends up on our plate more often than any other. About 2,700 Canadian farmers produced a staggering 1 billion kilograms of chicken in 2012. It looks like a good-news story—a chicken in every pot!—and in some ways it is.
In 1950, farmers spent eighty-four days raising their birds; today, most chickens are slaughtered after thirty-eight days. Farmers can now produce a kilogram of meat using less than half the feed and in less than half the time. Such efficiencies help explain why the typical Canadian eats 31 kilograms of chicken a year—21 kilograms more than we ate in 1965.
The average broiler farmer today is in his or her forties, while the average for all Canadian farmers is fifty-four. Improved breeding stock and equipment, and more sophisticated management techniques, help to make chicken farming more lucrative and attractive to the next generation. “Our farmers are like businessmen,” says Lisa Bishop-Spencer, communications manager with Chicken Farmers of Canada. “They wear suits and control feed and water and temperature by pressing a button.”
Prices drive chicken production choices, and in this sense production is governed by market forces. Yet because raising chickens falls under supply management, you could argue that the farmers have a social responsibility: under the Farm Products Agencies Act, they “have been granted a social licence to manage the supply of chicken in the interest of producers and consumers”(italics mine). What happens when the interests of producers are at odds with those of consumers?
Antibiotics help broiler farmers maximize yield while minimizing cost. Pathogens flourish in a 10,000-square-foot barn housing 10,000 birds. Warm, littered, and (by the time the birds reach their 2.2-kilogram slaughter weight) extremely crowded, a broiler barn is almost perfectly designed to promote the growth and transmission of germs. And, like toddlers in a daycare, the chickens pick up nearly every infection they’re exposed to. “A young intestine is very dynamic,” explains Prescott. “It takes time to settle the gut.”
Because of the likelihood of disease, antibiotics are used not only as you or I use them, to control an infection that has taken hold; farmers also routinely administer them in low doses to prevent infection. At least, that’s what we think happens. We can’t say for sure, since most of the drugs used on the farm do not require a prescription (i.e., paper trail) from a veterinarian (except in Quebec and Newfoundland and Labrador), and many are administered through feed and water.
Farmers also use antibiotics to promote faster growth. As early as 1946, it was observed that animals put on weight faster when they were given low doses of antibiotics. This strategy is especially effective in intensive livestock farming, where infections would otherwise reduce yield. In a paper for the UN’s Food and Agriculture Organization, Peter Hughes and John Heritage, microbiologists at the University of Leeds in the UK, suggest that “the effects of growth promoters were much more noticeable in sick animals and those housed in cramped, unhygienic conditions.” In 1995, the Animal Health Institute estimated that if the livestock industry stopped using antibiotics in this fashion, the US alone “would require an additional 452 million chickens, 23 million more cattle and 12 million more pigs to reach the levels of production attained by the current practices.”
Amazingly, we still don’t know why antibiotics promote growth. One hypothesis is that they suppress bacteria in the intestines. Energy that chickens might otherwise devote to fighting off (or perhaps just feeding) the gut’s microflora can instead be used to put on weight—anywhere from 1 to 10 percent more per day. It’s possible that something similar is happening in humans. “Underweight children used to be given tetracycline,” says Prescott. And new research is looking into the possibility that the widespread use of antibiotics—and the altering of the microflora of the human gut—may play a role in the obesity epidemic in North America.
On the Friday before Thanksgiving, I visited a chicken farm in southwestern Ontario. It was sunny and brisk, and the nights were cold, though not yet cold enough to have shocked the trees into peak blaze. As I drove along the highway, farmers were moving equipment from one field to another. Horse-drawn Mennonite buggies marked with giant reflective yield triangles on their backs stayed close to the shoulder. Green combines wider than a highway lane, with tires taller than my car, were moving as fast as I was.
I was on my way to meet Derek Detzler, the very incarnation of a modern-day chicken farmer. He can run six barns and produce about 540,000 birds a year—or 90,000 per cycle—with the help of just one hired hand, a farm manager who visits each barn two or three times a day. Detzler’s hands are soft, his nails clean; he is able to maintain a full-time job as the global program manager for an animal health and nutrition company, travelling the world to sell his fellow chicken farmers alternatives to antibiotics, including vaccines and organic acids to help them fight the never-ending war on bugs. His unhurried, folksy way of talking—“You and I are gonna get along just fine”—probably serves him well in this role. He was just back from China and heading to Brazil the following week. His eyes, he jokes, are blue when they’re not bloodshot from travelling.
Detzler, like a handful of other large-scale chicken farmers across the country, has been grappling for more than a decade with how to control infection in broiler flocks without resorting to antibiotics. Two worrisome diseases plague chicken flocks: One is coccidiosis, an intestinal infection caused by a protozoan parasite, which is nearly ubiquitous in modern chicken coops. If it isn’t managed properly, mortality rates begin to climb when chicks are twelve days old. The other is clostridium, which in Canada causes necrotic enteritis.
“Nothing works as good as a working antibiotic,” says Detzler, who trained as an engineering technologist and began his farming career at a large processor. Later, he took a job in hatchery sales and spent much of his time visiting farmers and advising them on managing chick health. (In Canada, large processors work closely with chicken farmers, awarding them contracts to grow a certain number of chickens per cycle, according to sales projections.) Across the industry, chicken mortality rates were on the rise, and, in a mirror of what was happening in our hospitals, the antibiotics used to fight disease didn’t seem to be working as well as they once did. Detzler’s boss, afraid of losing his competitive edge, charged him with finding an alternative: “He used to say, The best time to attack resistance is before it develops.” What Detzler learned, through trial and error, informed his own flock management when he took over his dad’s 324-hectare operation six years ago.
The farm is a ten-minute drive from Walkerton, the town that made national headlines in 2000 when agricultural runoff contaminated the water supply with 0157:H7 E. coli and infected half its population of 5,000. It’s the town where Detzler and his family went in 2000 for a Mother’s Day brunch. Everyone ordered a pop. Everyone, that is, except the Detzlers’ four-year-old daughter, Madison, who drank the water and ended up in the intensive care unit in nearby London with kidney failure.
Detzler has always taken an interest in animal health; when he was younger, he wanted to go to vet school. It’s taken the better part of six years, he says, to figure out how to manage infections and mortality without antibiotics. He’s still learning. Sitting at a long, polished granite island in his shiny stainless-steel kitchen (the house was previously owned by a bank vice-president), he explains that resistance wasn’t much of a problem in the 1970s and 1980s because so many new drugs were coming on the market. Farmers would move to a new antibiotic before bacteria developed significant resistance to the last one. Part of the reason there were so many options was that veterinary drug registrations were easier to obtain, and companies researching human medications would try to find an animal application for anything that didn’t get approval for human use. It was a way for the companies to recoup their costs.
When drug registration became harder to obtain (ironically, because of concerns about antimicrobial resistance), fewer drugs made it to market, at least through the usual channels. (These regulatory hurdles may have also driven farmers to exploit the own-use loophole to import unregulated supplies of cheaper, more readily available antibiotics.) With fewer drugs in their arsenal, farmers began using the same drugs over and over—giving bugs more opportunities to develop resistance.
Detzler compares bacterial control to weed control, explaining that he manages coccidiosis without the use of drugs by “seeding” his barns with a pre-resistant strain of coccidiosis, which dominates over the strains that have developed resistance to the anticoccidial vaccine. It is then relatively easy to vaccinate against the coccidiosis used to colonize the barns. It took him a long time, and much experimenting, to figure this out. “It hurt a lot,” he says of the early days of trial and error. “Mortality would skyrocket, and we wouldn’t know why.” His mortality rates are still a bit higher than those of conventional farmers (he would not be specific), and his chickens take a few more days to reach slaughter weight. But he can charge a premium for them, since they get sold as antibiotic free.
A lot of the work he does off the farm nowadays involves advising and troubleshooting with producers who want to reduce or eliminate the use of drugs. Still, he understands why they don’t want to switch production methods: it’s a difficult road. Even his own father was skeptical when he first phased out the miracle drugs. “You have to love to do it, because it’s harder,” says Detzler. But love won’t be enough to change a business model that currently earns $2.3 billion in annual farm-cash receipts.
A few years ago, John Prescott, who has organized three national conferences on antibiotic use, appeared before a parliamentary committee in Ottawa to talk about regulating antibiotics. The transcript does not reveal his tone of voice, but his frustration fairly leaps off the page. He drew the chair’s attention to the thirty-eight recommendations made in a landmark report on antimicrobial use to Health Canada in 2002. “Most of the recommendations have not been acted upon,” he said. “Currently, I think nobody in the federal government is in charge, just the resistant bacteria.”
One of the arguments against changing the way we regulate antibiotic use is that Canadian farmers need a level playing field in North America. But there is another, more fundamental obstacle that needs to be addressed. “Bacteria change easily to resistance,” Prescott said in his first email to me, after I told him I was pursuing this story. “But people are resistant to change; Canada especially has a constitution that resists change.” The loopholes that allow farmers to use unregulated antibiotics are yet another mess that goes all the way back to the British North America Act. While the feds oversee the approval and sale of drugs, it’s up to each province and territory to regulate their use. This is why Quebec and Newfoundland and Labrador require prescriptions for all antibiotics, while the other provinces and the territories do not.
Last March, the US Food and Drug Administration announced new “guidance for drug companies to voluntarily revise” labels to remove growth-promoting claims and “add, where appropriate, scientifically-supported disease treatment, control or prevention uses.” It also pledged to bring over-the-counter supplies of antibiotics under “veterinary oversight and consultation.” In response to these changes, Jean Szkotnicki approached Canada’s Veterinary Drugs Directorate and volunteered to change labels on her members’ drugs, too. So last April, Health Canada posted a vague “notice to stakeholders,” urging them to remove “growth promotion and/or production claims of medically-important antimicrobial drugs” and to develop “options to strengthen the veterinary oversight of antimicrobial use in food animals.”
A month later, the Chicken Farmers of Canada added its own set of promises, taking restrictions a step further. They promised to eliminate the preventive use of what Health Canada classifies as Category I drugs, the medically important ones such as ceftiofur, which has been linked to resistance in human beings.
These are promising steps, but small ones. Removing growth-promotion claims from labels doesn’t actually mean a lot. Farmers and vets who once used those drugs to promote growth can simply cite a different justification for using them: disease prevention. And even a promise not to use the drugs for prevention can be converted into claims for therapeutic use. Do you call it prevention if you decide to treat an entire flock with a drug because you’ve found an infection in a few of your 10,000 birds?
While a prescription-only system makes it easier for scientists and regulators to track antibiotic use, it probably won’t do much to change the behaviour of vets, unless they’re held accountable for their prescriptions. That’s the case in Denmark, where egregious use of the drugs triggers an interview to find out why the vet has been prescribing so many.
Expecting prescriptions to change antibiotic use “assumes vets do everything to benefit public health, rather than to benefit themselves or the animals they’re treating,” says Scott McEwen, co-author of the 2002 report that made those thirty-eight recommendations to Health Canada (and led to the creation of CIPARS). McEwen, who teaches public health at the University of Guelph, thinks this assumption is flawed. “In human behaviour, we tend to do things we are rewarded for and avoid things we are punished for.” A vet is not penalized for contributing to resistance, but she will be penalized for not managing an infection at the farm. “The default is to consider animal health interests, not public health interests.” (A similar argument applies to medical doctors seeking to manage the infection—and expectations—of a sick patient on a gurney. The physician may not stop to consider the public health implications of prescribing a course of pills.)
Michael Taylor, the deputy commissioner of foods at the FDA, puts it this way: “There are very few bad guys, but there are lots of economic constraints and incentives for violating food safety.” Perhaps it’s not the people we should distrust along the food chain, but this system we’ve built for ourselves.
The creation and maintenance of CIPARS (even in the face of cutbacks in both funding and opportunities to talk to the media) remains the single best thing our government has contributed to the discussion of how to manage antimicrobial resistance. Data collection is key. If we don’t know what’s going on in animal and human health, we can’t prepare ourselves for the pathogens—and resistance—that are emerging.
But this is only the first step. We must change the way we think about and use these life-saving drugs. Countries such as Denmark and the Netherlands have already done so. Following bans in both countries on the non-therapeutic use of antibiotics in livestock, resistance to some drugs dropped by half. Meanwhile, production costs and supermarket prices have done what many thought impossible: they have remained stable.
If chicken farmers, and producers in general, stopped using antibiotics tomorrow, our food system would be thrown into chaos. While the bulk of antibiotics is used in livestock, an editorial in The New England Journal of Medicine notes these drugs are also “dropped to salmon in cages in the seas, sprayed on fruit trees, and even embedded in marine paint to inhibit the formation of barnacles.” Even honeybees—which produce a sweetener with naturally antimicrobial properties—get treated with the stuff.
Prudent-use discussions, in both animal and human medicine, often promote the principle of stewardship. Levy calls antibiotics “societal drugs” because their use by one individual affects us all. We could also think of them as a common resource, like water, that must be protected. “Use is a privilege, not a right,” says Warren Skippon, “whether we’re talking about a livestock producer or the parent of a small child with an ear infection.”
Farmers were among the earliest stewards of the earth; if they didn’t carefully attend to the health of the soil and their animals and their crops, a community would starve or die of disease. For them, the idea of “One Health” was obvious. But most of us live in cities now, and apart from answering that antiquated question when we cross an international border—“Did you visit a farm within the past two weeks? ”—most of us give very little thought to the possibility that our health, and the health of our microbiome, might be connected to that of the animals we come in contact with.
Eating chicken sashimi makes for a good story, but it’s one of the stupidest things I’ve ever done. I was younger then, and a little drunk, and I felt immortal. I am pretty sure no CIPARS researcher would feed a child raw chicken; the bar graphs listing the bacteria that the birds carry, and the bacteria’s resistance to dozens of drugs, are as chromatic as a Missoni pattern. Nor would the Detzlers; they know too much.
Bacteria, like us, are just trying to survive. They predate us by millions of years, and will probably outlast us by millions more. But they are even less visible than the chickens our farmers raise behind locked doors, which means they are even easier to forget. Rather than forget them, though, we could learn from them. During our interview, Prescott, who recently retired, allowed himself a moment of pessimism: he worried aloud that it was all too little too late, and that rumours of regulatory change would never translate into concrete action. Then he quickly recovered.
“Bacteria can change,” he said. “But so can we.”
This appeared in the January/February 2015 issue.