A discussion paper newly released by the National Academy of Medicine–Antibiotic Resistance in Humans and Animals–marks the 40 year anniversary of the first definitive evidence that antibiotic usage in livestock results in the direct spread of antibiotic-resistant bacteria to humans. In releasing the report, the authors pull no punches:
Thus, we have known definitively for more than 40 years that antibiotic usage in livestock results in the direct spread of antib
iotic-resistant bacteria to humans. The complete failure of our society to address this concern in the United States is profoundly disappointing and alarming to providers who increasingly struggle to care for patients infected with antibiotic-resistant bacteria. Apologists abound. Excuses are rampant. As alluded to by the British report, “more science” is the often-heard refrain. Those who espouse the need for yet further study before action can be taken typically have close links to farms that continue to use antibiotics. Yet we are past the scientific tipping point.
The issue at hand is one of policy. All policy issues are matters of choosing between pros and cons, risks and benefits. Policy makers almost never have a perfect understanding of all variables at play, nor is it necessary for them to have such precision of information to make choices. Waiting for perfect science is not possible either, because science is constantly in a state of evolution of knowledge based on changing research. Thus, we seek here to summarize the state of the problem in human terms and to inform policy makers of the risks and benefits of taking action or not.
This report joins the increasingly urgent public calls for global collective policy action to address the threats posed by antimicrobial resistance to worldwide public health. A World Health Organization (WHO) report released April 2014 called for action against the “serious threat” posed by antimicrobial resistance, a threat that is “happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance—when bacteria change so antibiotics no longer work in people who need them to treat infections—is now a major threat to public health.”
The report is timely as well as urgent. Earlier this year, scientists discovered the first United States cases of a gene that renders infectious bacteria resistant to the “last-resort” antibiotic drug colistin, a Centers for Disease Control and Prevention (CDC) official testified last week during a congressional hearing on the danger posed by “superbugs”. Although the NAM report focuses on livestock antimicrobial use as a top priority, antimicrobial use in humans is still an important focus, especially in light of a report last month finding that at least 30 percent of antibiotics prescribed to humans in the United States are unnecessary.
Marion R. Sills, MD, MPH 