IN SOIL, WATER, FOOD, AIR
The Star Ledger, Amy Ellis Nutt, December 08, 2003
Pocomoke City, Md. -- Inside the long, aluminum chicken houses that checker the Delmarva Peninsula, even the darkness tastes sour. Saturated with ammonia and thick with the dust of feed and feces, each breath feels like sandpaper scraping against the lungs. A half-dozen men wade into a snowdrift of 20,000 plump white chickens and begin grabbing them by their feet, shoving them into the drawers of 6-foot-high crates. The men can catch more than 6,000 birds in an hour and by the end of the day about 70,000 birds will have been taken to a nearby processing plant, then trucked to supermarkets across the Northeast and elsewhere. Moving from one chicken house to another, the catchers barely have time to stop and eat a sandwich or even freshen up. Wherever they walk their boots kick up whirlpools of powder and when they emerge at dusk, after 10 or 12 hours, they shimmer in the pale ash that covers them from head to foot.
For William Scarborough and the other chicken catchers, there is no escaping the finely ground particles that blanket the farms and saturate the air of Delmarva. It's no wonder they are chronically ill. For years, scientists have issued warnings that mixing antibiotics into animal feed may be creating drug-resistant bacteria that are being passed on to humans. Now, for the first time, studies are supporting their theory. "Antibiotic-resistant organisms are ubiquitous," says Stanley Katz, professor of biochemistry and microbiology at Rutgers' Cook College. "Wherever you look -- in the soil, the water, the food, the air -- you'll find antibiotic-resistant germs. ... And there's only one place to start in addressing the problem. We have to look at minimizing the use of antibiotics in the agriculture industry." If not, Katz says, the immediate future is ominous. Put bluntly, "I see a lot of unnecessary deaths, that's what I see."
Building resistance
Every year, 8 billion domestic food animals --chicken, turkey, cattle, hogs and sheep --are raised for human consumption in the United States. Antibiotics have been added to their feed since the 1950s. At first, the drugs were used to prevent disease, but it was coincidentally discovered by farmers that antibiotics seem to help animals grow fatter, faster. The drugs appeared to improve animals' digestion, not only shortening the time it takes to get them to market weight, but also making the process more efficient and less costly.
The result? In 1954, 2 million pounds of antibiotics were manufactured for human and animal use. Today that number is 50 million. "It comes down to a matter of weighing the risks," says William Hueston, the director of the Center for Animal Health and Food Safety at the University of Minnesota's College of Veterinary Medicine, "the potential of an antibiotic to create resistance vs. the benefit to production by lowering the cost. A lot of people see only the first part as being about public health, but the abundance and affordability of food is another part of the public health equation. ... There are risks, trade-offs, no doubt about it."
The problem cited most frequently by those who want to ban animal antibiotics is that many of these drugs, such as penicillin, bacitracin, erythromycin and tetracycline, also are used to treat human diseases. In addition, when antibiotics are used as growth promoters they are administered in what's called "subtherapeutic" doses --strong enough to produce the desired growth, but not strong enough to kill an infection. That's the worst possible use of an antibiotic, say scientists, because at that level the drugs will eliminate some bacteria, but create many more resistant germs.
Though the Federal Drug Administration first proposed eliminating the subtherapeutic use of penicillin and tetracyline in animals 26 years ago, the agency has yet to outlaw a single animal antibiotic already in use -- even while it approves, on average, about 10 new animal antibiotics every year. Despite the mounting evidence that lacing animal feed with drugs is a danger to public health, the animal food industry continues to do so virtually unrestricted. Not even the growers who are paid to raise the birds for the poultry companies, know what antibiotics -- or how much -- is contained in the feed. The manufacturers determine the formulas and they are not required to share that information with growers, consumers or even the federal government.
In the past three years, hundreds of scientists and organizations, including the American Medical Association, the American Public Health Association and the New England Journal of Medicine, have stated their opposition to the use of growth-promoting antibiotics in animals. Two bills have been introduced into Congress asking for restrictions. Last year, Representative Sherrod Brown, a democrat from Ohio, introduced legislation that would phase out the use of eight classes of antibiotics used as growth promoters in the animal food industry. In July, a similar bipartisan bill was introduced to the U.S. Senate by Democrat Edward Kennedy of Massachusetts and republican Olympia Snowe of Maine. Neither bill has come up for vote.
The National Chicken Council, the primary lobbying group for the poultry industry, contends that animal antibiotic use has been greatly reduced over the years. However, spokesman Richard Lobb could not estimate how much or identify which drugs are involved. "There's little usage of growth promoters," he says. "Medicated feed is used to prevent disease in birds and a number of different compounds are used. And then there is the therapeutic use, used only when there is an actual disease outbreak in the flock. ... As for antibiotic resistance, there has never been a single human case traced to chickens."
Ellen Silbergeld, a professor of environmental health sciences at the Johns Hopkins Bloomberg School of Public Health in Baltimore, sees this argument as nothing more than the animal food industry slipping through a giant loophole. "It's easy to say you're giving chickens an antibiotic to prevent disease when you're actually giving it to them to promote growth," she says. "We've repeatedly asked for the exact compounds they use and they will never say."
Down on the Farm
The Delmarva Peninsula is a 180-mile-long and up to 71-mile-wide swath of land along the East Coast, encompassing Delaware and parts of Maryland and Virginia. It is the fifth-largest poultry-producing area in the United States. About 650 million chickens are grown each year on Delmarva's farms, according to Maryland's Department of Agriculture and Natural Resources, and most of them are for some of the country's top poultry producers, such as Perdue, Foster and Tyson. While it is impossible to estimate how many chickens actually have been given antibiotics, what is known is that as much as 80 percent of the antibiotics that are fed to the birds go unmetabolized. And the drugs end up in chicken feces, or litter, in highly concentrated amounts and much of that waste ends up as fertilizer on nearby fields.
According to the Delmarva Poultry Justice Alliance, a nonprofit advocacy group for workers in the chicken industry, a large majority of the thousand or so catchers on the peninsula have experienced significant health problems. Silbergeld believes many of these illnesses may be due to supergerms created by the antibiotic- laced meals that are fed to the chickens. E. coli, salmonella and campylobacter jejuni live in the guts of animals. The germs don't sicken livestock, but they can bring down humans in a flash.
A professor of environmental health sciences, Silbergeld has spent the past two years commuting from her lab in Baltimore to the chicken farms of Delmarva, studying antibiotic resistance in poultry workers and tracking germs from the catchers, to their families and into the community. In an initial study, which she is now expanding, Silbergeld tested 34 poultry and non-poultry workers and found that more than half of processing plant employees and more than 40 percent of chicken catchers, tested positive for campylobacter, which causes cramping, diarrhea, abdominal pain and fever. And all nine community members who participated in the study also tested positive for the bacterium. Earlier this year, Silbergeld announced that the campylobacter germs infecting the study's participants were resistant to several antibiotics, confirming her suspicion that the recurrence of infections in the workers was the result of the bacteria becoming "supersized," that is, better able to fight off the antibiotics. She is expanding her study, which now includes more than 100 poultry workers, and hopes to announce the results next spring. "Food has been industrialized for a very long time in the U.S. and it is not a pretty picture," says Silbergeld. "There have been a lot of stupid things we've done as a species over the course of human history, but this (giving animals antibiotics) has to be one of the most stupid. After spending centuries looking for a treatment to human infection, what do we do? We give it to chickens."
Food's Revenge
While antibiotic resistance only now is being studied, food-borne bacteria have been tracked by the government for years. The Centers for Disease Control estimates that there are about 76 million cases of food poisoning every year, 70 percent of which, says the U.S. Department of Agriculture, can be traced to contaminated meat. In January, Consumer Reports released a study of antibiotic resistance in store-bought chicken. It tested 484 fresh, whole broilers bought at supermarkets and health food stores in 25 cities nationwide. Drug resistant campylobacter jejuni was present in 42 percent of the chickens, down from 63 percent in a 1998 Consumer Reports study. However, 66 percent of the campylobacter germs were resistant. Antibiotic-resistant germs can be passed from animal to human in several ways: direct contact, ingestion of undercooked food or contamination of kitchen appliances by the juices from raw meat. About 1.4 million cases of food poisoning in the U.S. every year are due to salmonella infections, mostly in children and the elderly, and about 600 are fatal.
The potential lethality of drug-resistant salmonella was made dramatically clear in the summer of 1998 when a 62-year-old Danish woman, suffering severe diarrhea for nine days, was diagnosed with salmonella food poisoning. She was put on Cipro, but the powerful antibiotic was ineffective. Not only did the infection worsen, it essentially punched a hole through the woman's colon, spreading bacteria throughout the rest of her body. She went into septic shock and, one by one, each of her organs failed. She died four days after admission. Genetic sleuthing by a microbiologist at the Danish Veterinary Laboratory traced the Cipro-resistant strain of salmonella to a single herd of swine.
On the Delmarva Peninsula, most of the antibiotic-contaminated dust comes from chicken waste -- more than 750,000 tons of it each year. According to the Sierra Club, that's enough to fill 11,560 railroad boxcars, the equivalent of a train with its engine in Philadelphia and its caboose in Washington, D.C. "The ammonia rises up from the manure and it takes your breath away," says Kevin Harmon, a 32-year-old chicken catcher from Exmore, Va., who works with Scarborough's crew. "I used to throw up a lot; cough a lot, too. I have diarrhea all the time. ... The chicken dust, it gets in your eyes, up your nose and in your mouth. ... Even lunch tastes like chicken dust."
Farm food animals produce close to 3 trillion pounds of waste matter every year, according to a 1998 U.S. Senate Agriculture Committee report. That's equal to about 5 tons for every single American. Typically the manure gets watered down and flushed into giant, man-made lagoons and then, essentially untreated, is used to fertilize crops. This creates two problems. Because feces are 90 percent bacteria, all those germs either end up in the soil or as runoff in rivers, lakes, and even oceans. Second, because so much of an antibiotic goes undigested, the manure also is laced with the drugs that create resistance. Sweden banned all animal antibiotics for use as growth promoters in 1986. Denmark followed suit in 1998. And in 1999, the entire European Union banned growth- promoting use of four antibiotics also used to treat human infections.
Risk Factor
In the United States, it's a different story. The oversight agencies for the nation's agriculture and drug industries can't agree on the severity of the problem or what to do about it. The Food and Drug Administration, which approves antibiotics for food-producing animals, and the Environmental Protection Agency, which approves drugs for produce and plants, have established maximum allowable residue levels for antibiotics in animals and crops. The USDA, among others, runs a program that monitors antibiotic resistance in both animals and crops. While all three agencies agree that the use of antibiotics in agriculture has contributed to resistant strains of bacteria in humans, all have expressed caveats. The FDA and EPA believe more research is needed, and the USDA worries about balancing the risks of animal antibiotic use against the economic benefits to agriculture.
However, the U.S. Department of Health & Human Services does not equivocate. In a 1999 response to a draft report by the General Accounting Office on the health implications of agricultural antibiotics, June Gibbs Brown, the department's inspector general wrote: "Overall, we find that the draft report oversimplifies the public health issues. ... We believe that preventive action is needed now, not at some time in the future."
The FDA has been aware of antibiotic resistance since as early as 1977, when it asked Congress to restrict the use of penicillin and tetracycline in the food animal industry. Congress refused, but solicited the National Academy of Sciences to study the problem. The NAS agreed with Congress that there was no impending crisis. A second study was done in 1999, and although the Academy found a "link between the use of antibiotics in food animals, the development of bacterial resistance to these drugs, and human disease," it decided there was no immediate risk to public health.
Ron Phillips, spokesperson for the Animal Health Institute, a trade organization that represents manufacturers of animal health care products, agrees that in theory there could be a link. But because scientists have only recently begun tracking it, he contends resistance really could have existed all along. "The absence of resistance (to Cipro in 1990) does not mean it was zero," he says. "It just means it wasn't really measured (before 1990)."
"Action should be taken (to remove an animal antibiotic from use) only after a risk assessment has been taken. Let's do the science and get answers," says Phillips. "Otherwise we run the risk of unintended consequences. The European Union ... withdrew animal antibiotics and the result has been increased problems with animal diseases and therefore increased therapeutic use of antibiotic drugs. So we're putting the wrong selective pressure on this."
While Congress has failed to act on restricting animal antibiotics, some companies are feeling the pressure from consumer groups to do so voluntarily. Last year, several fast-food chains, including Wendy's and Popeye's, volunteered to stop buying meat and poultry products where growth-promoting antibiotics were used. And McDonald's ordered its chicken and cattle suppliers to stop using antibiotics that also are used to treat humans. Three months after McDonald's move, the FDA announced a new drug review procedure. The guidelines are meant to help the agency determine, on a case-by-case basis, which animal antibiotics should be rejected, based on risk to public health. Critics, however, say the guidelines are not formal rules and there is no timetable for the review.
Contaminated Water
"The problem is that we just don't really know what's out there," says Margaret Mellon, director of the food and environment program for the nonprofit public policy organization, the Union of Concerned Scientists. "The drug manufacturers are not required to report how many antibiotics they sell and the government doesn't have a system for making that information available. And people who use drugs are not required to report usage. ... The real question is why isn't the government getting the answer?"
The government is trying. In 1996 the Food and Drug Administration, the U.S. Department of Agriculture and the Centers for Disease Control created a national surveillance program to track resistant strains of salmonella, campylobacter, E. coli and shigella. In 2001, the CDC, FDA and National Institutes of Health chaired a task force on antimicrobial resistance and produced a public health action plan that recommended a more coordinated national surveillance system of supergerms, better detection and a more comprehensive monitoring of both antibiotic use and resistance.
"The FDA has been working on this since 1992, (but) most of their work has been focused on new drugs -- taking new drugs off the market," says Mellon. "We want them to focus on existing drugs. That's the 800-pound elephant in the living room."
Silbergeld believes the reason the government has failed to act on banning animal antibiotics is because of a lack of independent oversight. "The real tragedy is that most of the research on the problem is done at the (agriculture) schools and the ag schools are beholden to the ag industry for the money to do their research." [See: http://www.rpaforall.org/tenthousandfactsheet3.html and http://cspinet.org/integrity/ ]
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Diana Aga, a chemist at the University of Buffalo who specializes in environmental pollutants, has been studying the problem of animal antibiotics and fecal contamination for several years, using hog farms in Nebraska as her base of research. Her worry, like that of other scientists, is that resistance genes, which can be transferred from one organism to another, will jump from an animal bacterium to a human one, turning it pathogenic. "We found a lot of antibiotics persisting in the soil," she says, "and now it's five months later and they're still being detected."
Already there is evidence that antibiotics, as well as antibiotic-resistant bacteria, have made their way into the nation's water system. Last year the U.S. Geological Survey's Toxic Substances Hydrology Program published the results of a study that searched for pharmaceuticals in 139 streams in 30 states, including New Jersey. Fourteen antibiotics used in both human medicine and animal agriculture were found in 48 percent of the waterways. Ho-Ho-Kus Brook in Bergen County had the highest concentration of erythromycin -- a favored treatment for strep throat -- among the 139 streams tested nationwide. "There are papers going back to the'70s that said (pharmaceuticals) would be found in the groundwater," says Dana Kolpin of the USGS. "The surprise is that we found so many." While the USGS was conducting its two-year study, Ronald Ash at Washburn University in Topeka, Kansas, was sampling waterborne bacteria from 15 U.S. rivers, including the Colorado, Mississippi and Ohio. Ash tested the bacteria against ampicillin, a popular synthetic antibiotic in the penicillin family. At every site he found ampicillin-resistant bacteria.
Antibiotic Float
Antibiotics and antibiotic-resistant germs also are finding their way into unexpected places, such as nonfood animals. In 1999, Monica Tischler, a professor of biochemistry at Benedictine University in Lisle, Ill., headed a research project looking at the bacteria carried by wild Canada geese in suburban Chicago. "We weren't expecting to find antibiotic-resistant bacteria, but we did. A lot of it. It was astonishing," Tischler says. "These birds have virtually no contact with farms or with humans, so they shouldn't have had any exposure to antibiotics at all. ... The grass here grows right down to the water level, which hints that the geese were acquiring the antibiotic resistance from the environment ... perhaps picking it up from people, in the waste passing through the sewage treatment system."
Only 2.6 percent of the water on the face of the Earth is potable, and yet each time a toilet is flushed, between two and six gallons of polluted water is launched into the world. While the water is cleaned of pesticides and certain other toxins at sewage treatment plants, organic waste contaminants, such as antibiotics, pass through undetected and untreated. The EPA estimates that 50 to 90 percent of the pharmaceuticals humans ingest make their way into the nation's waterways in their original, biologically active form.
Thirty years ago, most sludge was dumped, untreated, far out to sea. The federal Clean Water Act, established in 1972, required cities to treat their waste by filtering out the sludge from the water and detoxing the water of pesticides and other pollutants. But where to put all the sludge that remained? The least expensive solution was to spread it onto fields and pastures. In October, 73 environmental groups petitioned the EPA for a national ban on the use of sludge as a fertilizer. The agency has until the end of the year to respond. Two years ago Perdue came up with an alternative to dumping chicken waste into the environment by building a $20 million facility on Delmarva to process the manure into fertilizer. Last year, 48,000 tons of poultry litter were removed from Perdue farms, preventing nearly 7 million pounds of surplus nitrogen and phosphorous from entering the waterways of Chesapeake Bay and Delaware and Maryland inland waterways. The downside: Some of the litter was shipped raw to mushroom farms in New Jersey and Pennsylvania, according to Trise Lewis at Perdue's AgriRecyle plant in Sussex County, Del.. The rest was processed into pellets and shipped by truck and rail to farms and golf courses in the Northeast, Midwest and South.
Hueston believes there are other alternatives, other ways to balance the interests of agriculture and public health. "I agree fluoroquinolones (antibiotics most useful against campylobacter and salmonella)should be restricted," he says, "but do we really want to ban them altogether? We might be able to minimize the risk, instead, by processing last those animals that have been treated for disease with fluoroquinolones. That way we can ensure the least amount of contamination (in the plant). Or we could require that those animals be cooked first before they're shipped[?]. Or we could make sure to destroy the litter from those treated chickens. What we need to do is agree on a shared interest in helping animals[?], in a safer food supply and in minimizing the environmental impact. ... There are no zero risks, but there are multiple strategies we can use."
The Chicken Man
Scarborough has had a long day, the third in a row on Sammy Hall's place in Princess Anne. His team and several others finally have emptied all the chicken houses of nearly 200,000 birds. "When I started, back then it was all closed off, there was no ventilation in there," he says. "We got head colds all winter. You feel your sinuses draining. If you're in there every day, you cough up stuff. The ammonia would be so strong you'd get water come pouring out of your eyes. I knew it was the ammonia making me sick." Because of illness, Scarborough switched a few years ago from chicken catching to driving the forklift. As he backs out of one of the sheds, Scarborough pirouettes the machine around and in one graceful movement, lifts the stack of crates that are poised on the forklift's two front blades, and gently nudges them into place on the back of the flatbed. When the last one has been stacked, Scarborough dismounts, leaving the machine right where he stopped it. A fuzzy halo of ash clings to his knit cap. He watches as the driver of the flatbed climbs into the cab of his truck, 6,000 chickens crated behind him, and heads out to the processing plant in Salisbury. Feathers drift out from the sides of the flatbed like cherry blossoms in a springtime breeze. It's 6 in the evening, and the setting sun is slowly turning the sky into a bruise of black and blue. Scarborough is talking about the time he was laid up with a lung infection. He took a lot of medicine, he says, and it still took him two weeks at home -- and out of work -- to get rid of the bug. "The doctor didn't have to tell me where I got it from," he says, shaking his head. "I got it right here."
Neil Fishman, director of the antimicrobial management program at the University of Pennsylvania Medical Center, understands Scarborough's plight. "I think there are many reasons for antibiotic resistance," he says. "And they're all coming together now. "It's the perfect storm."
IN SOIL, WATER, FOOD, AIR
The Star Ledger, Amy Ellis Nutt, December 08, 2003
Pocomoke City, Md. -- Inside the long, aluminum chicken houses that checker the Delmarva Peninsula, even the darkness tastes sour. Saturated with ammonia and thick with the dust of feed and feces, each breath feels like sandpaper scraping against the lungs. A half-dozen men wade into a snowdrift of 20,000 plump white chickens and begin grabbing them by their feet, shoving them into the drawers of 6-foot-high crates. The men can catch more than 6,000 birds in an hour and by the end of the day about 70,000 birds will have been taken to a nearby processing plant, then trucked to supermarkets across the Northeast and elsewhere. Moving from one chicken house to another, the catchers barely have time to stop and eat a sandwich or even freshen up. Wherever they walk their boots kick up whirlpools of powder and when they emerge at dusk, after 10 or 12 hours, they shimmer in the pale ash that covers them from head to foot.
For William Scarborough and the other chicken catchers, there is no escaping the finely ground particles that blanket the farms and saturate the air of Delmarva. It's no wonder they are chronically ill. For years, scientists have issued warnings that mixing antibiotics into animal feed may be creating drug-resistant bacteria that are being passed on to humans. Now, for the first time, studies are supporting their theory. "Antibiotic-resistant organisms are ubiquitous," says Stanley Katz, professor of biochemistry and microbiology at Rutgers' Cook College. "Wherever you look -- in the soil, the water, the food, the air -- you'll find antibiotic-resistant germs. ... And there's only one place to start in addressing the problem. We have to look at minimizing the use of antibiotics in the agriculture industry." If not, Katz says, the immediate future is ominous. Put bluntly, "I see a lot of unnecessary deaths, that's what I see."
Building resistance
Every year, 8 billion domestic food animals --chicken, turkey, cattle, hogs and sheep --are raised for human consumption in the United States. Antibiotics have been added to their feed since the 1950s. At first, the drugs were used to prevent disease, but it was coincidentally discovered by farmers that antibiotics seem to help animals grow fatter, faster. The drugs appeared to improve animals' digestion, not only shortening the time it takes to get them to market weight, but also making the process more efficient and less costly.
The result? In 1954, 2 million pounds of antibiotics were manufactured for human and animal use. Today that number is 50 million. "It comes down to a matter of weighing the risks," says William Hueston, the director of the Center for Animal Health and Food Safety at the University of Minnesota's College of Veterinary Medicine, "the potential of an antibiotic to create resistance vs. the benefit to production by lowering the cost. A lot of people see only the first part as being about public health, but the abundance and affordability of food is another part of the public health equation. ... There are risks, trade-offs, no doubt about it."
The problem cited most frequently by those who want to ban animal antibiotics is that many of these drugs, such as penicillin, bacitracin, erythromycin and tetracycline, also are used to treat human diseases. In addition, when antibiotics are used as growth promoters they are administered in what's called "subtherapeutic" doses --strong enough to produce the desired growth, but not strong enough to kill an infection. That's the worst possible use of an antibiotic, say scientists, because at that level the drugs will eliminate some bacteria, but create many more resistant germs.
Though the Federal Drug Administration first proposed eliminating the subtherapeutic use of penicillin and tetracyline in animals 26 years ago, the agency has yet to outlaw a single animal antibiotic already in use -- even while it approves, on average, about 10 new animal antibiotics every year. Despite the mounting evidence that lacing animal feed with drugs is a danger to public health, the animal food industry continues to do so virtually unrestricted. Not even the growers who are paid to raise the birds for the poultry companies, know what antibiotics -- or how much -- is contained in the feed. The manufacturers determine the formulas and they are not required to share that information with growers, consumers or even the federal government.
In the past three years, hundreds of scientists and organizations, including the American Medical Association, the American Public Health Association and the New England Journal of Medicine, have stated their opposition to the use of growth-promoting antibiotics in animals. Two bills have been introduced into Congress asking for restrictions. Last year, Representative Sherrod Brown, a democrat from Ohio, introduced legislation that would phase out the use of eight classes of antibiotics used as growth promoters in the animal food industry. In July, a similar bipartisan bill was introduced to the U.S. Senate by Democrat Edward Kennedy of Massachusetts and republican Olympia Snowe of Maine. Neither bill has come up for vote.
The National Chicken Council, the primary lobbying group for the poultry industry, contends that animal antibiotic use has been greatly reduced over the years. However, spokesman Richard Lobb could not estimate how much or identify which drugs are involved. "There's little usage of growth promoters," he says. "Medicated feed is used to prevent disease in birds and a number of different compounds are used. And then there is the therapeutic use, used only when there is an actual disease outbreak in the flock. ... As for antibiotic resistance, there has never been a single human case traced to chickens."
Ellen Silbergeld, a professor of environmental health sciences at the Johns Hopkins Bloomberg School of Public Health in Baltimore, sees this argument as nothing more than the animal food industry slipping through a giant loophole. "It's easy to say you're giving chickens an antibiotic to prevent disease when you're actually giving it to them to promote growth," she says. "We've repeatedly asked for the exact compounds they use and they will never say."
Down on the Farm
The Delmarva Peninsula is a 180-mile-long and up to 71-mile-wide swath of land along the East Coast, encompassing Delaware and parts of Maryland and Virginia. It is the fifth-largest poultry-producing area in the United States. About 650 million chickens are grown each year on Delmarva's farms, according to Maryland's Department of Agriculture and Natural Resources, and most of them are for some of the country's top poultry producers, such as Perdue, Foster and Tyson. While it is impossible to estimate how many chickens actually have been given antibiotics, what is known is that as much as 80 percent of the antibiotics that are fed to the birds go unmetabolized. And the drugs end up in chicken feces, or litter, in highly concentrated amounts and much of that waste ends up as fertilizer on nearby fields.
According to the Delmarva Poultry Justice Alliance, a nonprofit advocacy group for workers in the chicken industry, a large majority of the thousand or so catchers on the peninsula have experienced significant health problems. Silbergeld believes many of these illnesses may be due to supergerms created by the antibiotic- laced meals that are fed to the chickens. E. coli, salmonella and campylobacter jejuni live in the guts of animals. The germs don't sicken livestock, but they can bring down humans in a flash.
A professor of environmental health sciences, Silbergeld has spent the past two years commuting from her lab in Baltimore to the chicken farms of Delmarva, studying antibiotic resistance in poultry workers and tracking germs from the catchers, to their families and into the community. In an initial study, which she is now expanding, Silbergeld tested 34 poultry and non-poultry workers and found that more than half of processing plant employees and more than 40 percent of chicken catchers, tested positive for campylobacter, which causes cramping, diarrhea, abdominal pain and fever. And all nine community members who participated in the study also tested positive for the bacterium. Earlier this year, Silbergeld announced that the campylobacter germs infecting the study's participants were resistant to several antibiotics, confirming her suspicion that the recurrence of infections in the workers was the result of the bacteria becoming "supersized," that is, better able to fight off the antibiotics. She is expanding her study, which now includes more than 100 poultry workers, and hopes to announce the results next spring. "Food has been industrialized for a very long time in the U.S. and it is not a pretty picture," says Silbergeld. "There have been a lot of stupid things we've done as a species over the course of human history, but this (giving animals antibiotics) has to be one of the most stupid. After spending centuries looking for a treatment to human infection, what do we do? We give it to chickens."
Food's Revenge
While antibiotic resistance only now is being studied, food-borne bacteria have been tracked by the government for years. The Centers for Disease Control estimates that there are about 76 million cases of food poisoning every year, 70 percent of which, says the U.S. Department of Agriculture, can be traced to contaminated meat. In January, Consumer Reports released a study of antibiotic resistance in store-bought chicken. It tested 484 fresh, whole broilers bought at supermarkets and health food stores in 25 cities nationwide. Drug resistant campylobacter jejuni was present in 42 percent of the chickens, down from 63 percent in a 1998 Consumer Reports study. However, 66 percent of the campylobacter germs were resistant. Antibiotic-resistant germs can be passed from animal to human in several ways: direct contact, ingestion of undercooked food or contamination of kitchen appliances by the juices from raw meat. About 1.4 million cases of food poisoning in the U.S. every year are due to salmonella infections, mostly in children and the elderly, and about 600 are fatal.
The potential lethality of drug-resistant salmonella was made dramatically clear in the summer of 1998 when a 62-year-old Danish woman, suffering severe diarrhea for nine days, was diagnosed with salmonella food poisoning. She was put on Cipro, but the powerful antibiotic was ineffective. Not only did the infection worsen, it essentially punched a hole through the woman's colon, spreading bacteria throughout the rest of her body. She went into septic shock and, one by one, each of her organs failed. She died four days after admission. Genetic sleuthing by a microbiologist at the Danish Veterinary Laboratory traced the Cipro-resistant strain of salmonella to a single herd of swine.
On the Delmarva Peninsula, most of the antibiotic-contaminated dust comes from chicken waste -- more than 750,000 tons of it each year. According to the Sierra Club, that's enough to fill 11,560 railroad boxcars, the equivalent of a train with its engine in Philadelphia and its caboose in Washington, D.C. "The ammonia rises up from the manure and it takes your breath away," says Kevin Harmon, a 32-year-old chicken catcher from Exmore, Va., who works with Scarborough's crew. "I used to throw up a lot; cough a lot, too. I have diarrhea all the time. ... The chicken dust, it gets in your eyes, up your nose and in your mouth. ... Even lunch tastes like chicken dust."
Farm food animals produce close to 3 trillion pounds of waste matter every year, according to a 1998 U.S. Senate Agriculture Committee report. That's equal to about 5 tons for every single American. Typically the manure gets watered down and flushed into giant, man-made lagoons and then, essentially untreated, is used to fertilize crops. This creates two problems. Because feces are 90 percent bacteria, all those germs either end up in the soil or as runoff in rivers, lakes, and even oceans. Second, because so much of an antibiotic goes undigested, the manure also is laced with the drugs that create resistance. Sweden banned all animal antibiotics for use as growth promoters in 1986. Denmark followed suit in 1998. And in 1999, the entire European Union banned growth- promoting use of four antibiotics also used to treat human infections.
Risk Factor
In the United States, it's a different story. The oversight agencies for the nation's agriculture and drug industries can't agree on the severity of the problem or what to do about it. The Food and Drug Administration, which approves antibiotics for food-producing animals, and the Environmental Protection Agency, which approves drugs for produce and plants, have established maximum allowable residue levels for antibiotics in animals and crops. The USDA, among others, runs a program that monitors antibiotic resistance in both animals and crops. While all three agencies agree that the use of antibiotics in agriculture has contributed to resistant strains of bacteria in humans, all have expressed caveats. The FDA and EPA believe more research is needed, and the USDA worries about balancing the risks of animal antibiotic use against the economic benefits to agriculture.
However, the U.S. Department of Health & Human Services does not equivocate. In a 1999 response to a draft report by the General Accounting Office on the health implications of agricultural antibiotics, June Gibbs Brown, the department's inspector general wrote: "Overall, we find that the draft report oversimplifies the public health issues. ... We believe that preventive action is needed now, not at some time in the future."
The FDA has been aware of antibiotic resistance since as early as 1977, when it asked Congress to restrict the use of penicillin and tetracycline in the food animal industry. Congress refused, but solicited the National Academy of Sciences to study the problem. The NAS agreed with Congress that there was no impending crisis. A second study was done in 1999, and although the Academy found a "link between the use of antibiotics in food animals, the development of bacterial resistance to these drugs, and human disease," it decided there was no immediate risk to public health.
Ron Phillips, spokesperson for the Animal Health Institute, a trade organization that represents manufacturers of animal health care products, agrees that in theory there could be a link. But because scientists have only recently begun tracking it, he contends resistance really could have existed all along. "The absence of resistance (to Cipro in 1990) does not mean it was zero," he says. "It just means it wasn't really measured (before 1990)."
"Action should be taken (to remove an animal antibiotic from use) only after a risk assessment has been taken. Let's do the science and get answers," says Phillips. "Otherwise we run the risk of unintended consequences. The European Union ... withdrew animal antibiotics and the result has been increased problems with animal diseases and therefore increased therapeutic use of antibiotic drugs. So we're putting the wrong selective pressure on this."
While Congress has failed to act on restricting animal antibiotics, some companies are feeling the pressure from consumer groups to do so voluntarily. Last year, several fast-food chains, including Wendy's and Popeye's, volunteered to stop buying meat and poultry products where growth-promoting antibiotics were used. And McDonald's ordered its chicken and cattle suppliers to stop using antibiotics that also are used to treat humans. Three months after McDonald's move, the FDA announced a new drug review procedure. The guidelines are meant to help the agency determine, on a case-by-case basis, which animal antibiotics should be rejected, based on risk to public health. Critics, however, say the guidelines are not formal rules and there is no timetable for the review.
Contaminated Water
"The problem is that we just don't really know what's out there," says Margaret Mellon, director of the food and environment program for the nonprofit public policy organization, the Union of Concerned Scientists. "The drug manufacturers are not required to report how many antibiotics they sell and the government doesn't have a system for making that information available. And people who use drugs are not required to report usage. ... The real question is why isn't the government getting the answer?"
The government is trying. In 1996 the Food and Drug Administration, the U.S. Department of Agriculture and the Centers for Disease Control created a national surveillance program to track resistant strains of salmonella, campylobacter, E. coli and shigella. In 2001, the CDC, FDA and National Institutes of Health chaired a task force on antimicrobial resistance and produced a public health action plan that recommended a more coordinated national surveillance system of supergerms, better detection and a more comprehensive monitoring of both antibiotic use and resistance.
"The FDA has been working on this since 1992, (but) most of their work has been focused on new drugs -- taking new drugs off the market," says Mellon. "We want them to focus on existing drugs. That's the 800-pound elephant in the living room."
Silbergeld believes the reason the government has failed to act on banning animal antibiotics is because of a lack of independent oversight. "The real tragedy is that most of the research on the problem is done at the (agriculture) schools and the ag schools are beholden to the ag industry for the money to do their research." [See: http://www.rpaforall.org/tenthousandfactsheet3.html and http://cspinet.org/integrity/ ]
]
Diana Aga, a chemist at the University of Buffalo who specializes in environmental pollutants, has been studying the problem of animal antibiotics and fecal contamination for several years, using hog farms in Nebraska as her base of research. Her worry, like that of other scientists, is that resistance genes, which can be transferred from one organism to another, will jump from an animal bacterium to a human one, turning it pathogenic. "We found a lot of antibiotics persisting in the soil," she says, "and now it's five months later and they're still being detected."
Already there is evidence that antibiotics, as well as antibiotic-resistant bacteria, have made their way into the nation's water system. Last year the U.S. Geological Survey's Toxic Substances Hydrology Program published the results of a study that searched for pharmaceuticals in 139 streams in 30 states, including New Jersey. Fourteen antibiotics used in both human medicine and animal agriculture were found in 48 percent of the waterways. Ho-Ho-Kus Brook in Bergen County had the highest concentration of erythromycin -- a favored treatment for strep throat -- among the 139 streams tested nationwide. "There are papers going back to the'70s that said (pharmaceuticals) would be found in the groundwater," says Dana Kolpin of the USGS. "The surprise is that we found so many." While the USGS was conducting its two-year study, Ronald Ash at Washburn University in Topeka, Kansas, was sampling waterborne bacteria from 15 U.S. rivers, including the Colorado, Mississippi and Ohio. Ash tested the bacteria against ampicillin, a popular synthetic antibiotic in the penicillin family. At every site he found ampicillin-resistant bacteria.
Antibiotic Float
Antibiotics and antibiotic-resistant germs also are finding their way into unexpected places, such as nonfood animals. In 1999, Monica Tischler, a professor of biochemistry at Benedictine University in Lisle, Ill., headed a research project looking at the bacteria carried by wild Canada geese in suburban Chicago. "We weren't expecting to find antibiotic-resistant bacteria, but we did. A lot of it. It was astonishing," Tischler says. "These birds have virtually no contact with farms or with humans, so they shouldn't have had any exposure to antibiotics at all. ... The grass here grows right down to the water level, which hints that the geese were acquiring the antibiotic resistance from the environment ... perhaps picking it up from people, in the waste passing through the sewage treatment system."
Only 2.6 percent of the water on the face of the Earth is potable, and yet each time a toilet is flushed, between two and six gallons of polluted water is launched into the world. While the water is cleaned of pesticides and certain other toxins at sewage treatment plants, organic waste contaminants, such as antibiotics, pass through undetected and untreated. The EPA estimates that 50 to 90 percent of the pharmaceuticals humans ingest make their way into the nation's waterways in their original, biologically active form.
Thirty years ago, most sludge was dumped, untreated, far out to sea. The federal Clean Water Act, established in 1972, required cities to treat their waste by filtering out the sludge from the water and detoxing the water of pesticides and other pollutants. But where to put all the sludge that remained? The least expensive solution was to spread it onto fields and pastures. In October, 73 environmental groups petitioned the EPA for a national ban on the use of sludge as a fertilizer. The agency has until the end of the year to respond. Two years ago Perdue came up with an alternative to dumping chicken waste into the environment by building a $20 million facility on Delmarva to process the manure into fertilizer. Last year, 48,000 tons of poultry litter were removed from Perdue farms, preventing nearly 7 million pounds of surplus nitrogen and phosphorous from entering the waterways of Chesapeake Bay and Delaware and Maryland inland waterways. The downside: Some of the litter was shipped raw to mushroom farms in New Jersey and Pennsylvania, according to Trise Lewis at Perdue's AgriRecyle plant in Sussex County, Del.. The rest was processed into pellets and shipped by truck and rail to farms and golf courses in the Northeast, Midwest and South.
Hueston believes there are other alternatives, other ways to balance the interests of agriculture and public health. "I agree fluoroquinolones (antibiotics most useful against campylobacter and salmonella)should be restricted," he says, "but do we really want to ban them altogether? We might be able to minimize the risk, instead, by processing last those animals that have been treated for disease with fluoroquinolones. That way we can ensure the least amount of contamination (in the plant). Or we could require that those animals be cooked first before they're shipped[?]. Or we could make sure to destroy the litter from those treated chickens. What we need to do is agree on a shared interest in helping animals[?], in a safer food supply and in minimizing the environmental impact. ... There are no zero risks, but there are multiple strategies we can use."
The Chicken Man
Scarborough has had a long day, the third in a row on Sammy Hall's place in Princess Anne. His team and several others finally have emptied all the chicken houses of nearly 200,000 birds. "When I started, back then it was all closed off, there was no ventilation in there," he says. "We got head colds all winter. You feel your sinuses draining. If you're in there every day, you cough up stuff. The ammonia would be so strong you'd get water come pouring out of your eyes. I knew it was the ammonia making me sick." Because of illness, Scarborough switched a few years ago from chicken catching to driving the forklift. As he backs out of one of the sheds, Scarborough pirouettes the machine around and in one graceful movement, lifts the stack of crates that are poised on the forklift's two front blades, and gently nudges them into place on the back of the flatbed. When the last one has been stacked, Scarborough dismounts, leaving the machine right where he stopped it. A fuzzy halo of ash clings to his knit cap. He watches as the driver of the flatbed climbs into the cab of his truck, 6,000 chickens crated behind him, and heads out to the processing plant in Salisbury. Feathers drift out from the sides of the flatbed like cherry blossoms in a springtime breeze. It's 6 in the evening, and the setting sun is slowly turning the sky into a bruise of black and blue. Scarborough is talking about the time he was laid up with a lung infection. He took a lot of medicine, he says, and it still took him two weeks at home -- and out of work -- to get rid of the bug. "The doctor didn't have to tell me where I got it from," he says, shaking his head. "I got it right here."
Neil Fishman, director of the antimicrobial management program at the University of Pennsylvania Medical Center, understands Scarborough's plight. "I think there are many reasons for antibiotic resistance," he says. "And they're all coming together now. "It's the perfect storm."
IN SOIL, WATER, FOOD, AIR
The Star Ledger, Amy Ellis Nutt, December 08, 2003
Pocomoke City, Md. -- Inside the long, aluminum chicken houses that checker the Delmarva Peninsula, even the darkness tastes sour. Saturated with ammonia and thick with the dust of feed and feces, each breath feels like sandpaper scraping against the lungs. A half-dozen men wade into a snowdrift of 20,000 plump white chickens and begin grabbing them by their feet, shoving them into the drawers of 6-foot-high crates. The men can catch more than 6,000 birds in an hour and by the end of the day about 70,000 birds will have been taken to a nearby processing plant, then trucked to supermarkets across the Northeast and elsewhere. Moving from one chicken house to another, the catchers barely have time to stop and eat a sandwich or even freshen up. Wherever they walk their boots kick up whirlpools of powder and when they emerge at dusk, after 10 or 12 hours, they shimmer in the pale ash that covers them from head to foot.
For William Scarborough and the other chicken catchers, there is no escaping the finely ground particles that blanket the farms and saturate the air of Delmarva. It's no wonder they are chronically ill. For years, scientists have issued warnings that mixing antibiotics into animal feed may be creating drug-resistant bacteria that are being passed on to humans. Now, for the first time, studies are supporting their theory. "Antibiotic-resistant organisms are ubiquitous," says Stanley Katz, professor of biochemistry and microbiology at Rutgers' Cook College. "Wherever you look -- in the soil, the water, the food, the air -- you'll find antibiotic-resistant germs. ... And there's only one place to start in addressing the problem. We have to look at minimizing the use of antibiotics in the agriculture industry." If not, Katz says, the immediate future is ominous. Put bluntly, "I see a lot of unnecessary deaths, that's what I see."
Building resistance
Every year, 8 billion domestic food animals --chicken, turkey, cattle, hogs and sheep --are raised for human consumption in the United States. Antibiotics have been added to their feed since the 1950s. At first, the drugs were used to prevent disease, but it was coincidentally discovered by farmers that antibiotics seem to help animals grow fatter, faster. The drugs appeared to improve animals' digestion, not only shortening the time it takes to get them to market weight, but also making the process more efficient and less costly.
The result? In 1954, 2 million pounds of antibiotics were manufactured for human and animal use. Today that number is 50 million. "It comes down to a matter of weighing the risks," says William Hueston, the director of the Center for Animal Health and Food Safety at the University of Minnesota's College of Veterinary Medicine, "the potential of an antibiotic to create resistance vs. the benefit to production by lowering the cost. A lot of people see only the first part as being about public health, but the abundance and affordability of food is another part of the public health equation. ... There are risks, trade-offs, no doubt about it."
The problem cited most frequently by those who want to ban animal antibiotics is that many of these drugs, such as penicillin, bacitracin, erythromycin and tetracycline, also are used to treat human diseases. In addition, when antibiotics are used as growth promoters they are administered in what's called "subtherapeutic" doses --strong enough to produce the desired growth, but not strong enough to kill an infection. That's the worst possible use of an antibiotic, say scientists, because at that level the drugs will eliminate some bacteria, but create many more resistant germs.
Though the Federal Drug Administration first proposed eliminating the subtherapeutic use of penicillin and tetracyline in animals 26 years ago, the agency has yet to outlaw a single animal antibiotic already in use -- even while it approves, on average, about 10 new animal antibiotics every year. Despite the mounting evidence that lacing animal feed with drugs is a danger to public health, the animal food industry continues to do so virtually unrestricted. Not even the growers who are paid to raise the birds for the poultry companies, know what antibiotics -- or how much -- is contained in the feed. The manufacturers determine the formulas and they are not required to share that information with growers, consumers or even the federal government.
In the past three years, hundreds of scientists and organizations, including the American Medical Association, the American Public Health Association and the New England Journal of Medicine, have stated their opposition to the use of growth-promoting antibiotics in animals. Two bills have been introduced into Congress asking for restrictions. Last year, Representative Sherrod Brown, a democrat from Ohio, introduced legislation that would phase out the use of eight classes of antibiotics used as growth promoters in the animal food industry. In July, a similar bipartisan bill was introduced to the U.S. Senate by Democrat Edward Kennedy of Massachusetts and republican Olympia Snowe of Maine. Neither bill has come up for vote.
The National Chicken Council, the primary lobbying group for the poultry industry, contends that animal antibiotic use has been greatly reduced over the years. However, spokesman Richard Lobb could not estimate how much or identify which drugs are involved. "There's little usage of growth promoters," he says. "Medicated feed is used to prevent disease in birds and a number of different compounds are used. And then there is the therapeutic use, used only when there is an actual disease outbreak in the flock. ... As for antibiotic resistance, there has never been a single human case traced to chickens."
Ellen Silbergeld, a professor of environmental health sciences at the Johns Hopkins Bloomberg School of Public Health in Baltimore, sees this argument as nothing more than the animal food industry slipping through a giant loophole. "It's easy to say you're giving chickens an antibiotic to prevent disease when you're actually giving it to them to promote growth," she says. "We've repeatedly asked for the exact compounds they use and they will never say."
Down on the Farm
The Delmarva Peninsula is a 180-mile-long and up to 71-mile-wide swath of land along the East Coast, encompassing Delaware and parts of Maryland and Virginia. It is the fifth-largest poultry-producing area in the United States. About 650 million chickens are grown each year on Delmarva's farms, according to Maryland's Department of Agriculture and Natural Resources, and most of them are for some of the country's top poultry producers, such as Perdue, Foster and Tyson. While it is impossible to estimate how many chickens actually have been given antibiotics, what is known is that as much as 80 percent of the antibiotics that are fed to the birds go unmetabolized. And the drugs end up in chicken feces, or litter, in highly concentrated amounts and much of that waste ends up as fertilizer on nearby fields.
According to the Delmarva Poultry Justice Alliance, a nonprofit advocacy group for workers in the chicken industry, a large majority of the thousand or so catchers on the peninsula have experienced significant health problems. Silbergeld believes many of these illnesses may be due to supergerms created by the antibiotic- laced meals that are fed to the chickens. E. coli, salmonella and campylobacter jejuni live in the guts of animals. The germs don't sicken livestock, but they can bring down humans in a flash.
A professor of environmental health sciences, Silbergeld has spent the past two years commuting from her lab in Baltimore to the chicken farms of Delmarva, studying antibiotic resistance in poultry workers and tracking germs from the catchers, to their families and into the community. In an initial study, which she is now expanding, Silbergeld tested 34 poultry and non-poultry workers and found that more than half of processing plant employees and more than 40 percent of chicken catchers, tested positive for campylobacter, which causes cramping, diarrhea, abdominal pain and fever. And all nine community members who participated in the study also tested positive for the bacterium. Earlier this year, Silbergeld announced that the campylobacter germs infecting the study's participants were resistant to several antibiotics, confirming her suspicion that the recurrence of infections in the workers was the result of the bacteria becoming "supersized," that is, better able to fight off the antibiotics. She is expanding her study, which now includes more than 100 poultry workers, and hopes to announce the results next spring. "Food has been industrialized for a very long time in the U.S. and it is not a pretty picture," says Silbergeld. "There have been a lot of stupid things we've done as a species over the course of human history, but this (giving animals antibiotics) has to be one of the most stupid. After spending centuries looking for a treatment to human infection, what do we do? We give it to chickens."
Food's Revenge
While antibiotic resistance only now is being studied, food-borne bacteria have been tracked by the government for years. The Centers for Disease Control estimates that there are about 76 million cases of food poisoning every year, 70 percent of which, says the U.S. Department of Agriculture, can be traced to contaminated meat. In January, Consumer Reports released a study of antibiotic resistance in store-bought chicken. It tested 484 fresh, whole broilers bought at supermarkets and health food stores in 25 cities nationwide. Drug resistant campylobacter jejuni was present in 42 percent of the chickens, down from 63 percent in a 1998 Consumer Reports study. However, 66 percent of the campylobacter germs were resistant. Antibiotic-resistant germs can be passed from animal to human in several ways: direct contact, ingestion of undercooked food or contamination of kitchen appliances by the juices from raw meat. About 1.4 million cases of food poisoning in the U.S. every year are due to salmonella infections, mostly in children and the elderly, and about 600 are fatal.
The potential lethality of drug-resistant salmonella was made dramatically clear in the summer of 1998 when a 62-year-old Danish woman, suffering severe diarrhea for nine days, was diagnosed with salmonella food poisoning. She was put on Cipro, but the powerful antibiotic was ineffective. Not only did the infection worsen, it essentially punched a hole through the woman's colon, spreading bacteria throughout the rest of her body. She went into septic shock and, one by one, each of her organs failed. She died four days after admission. Genetic sleuthing by a microbiologist at the Danish Veterinary Laboratory traced the Cipro-resistant strain of salmonella to a single herd of swine.
On the Delmarva Peninsula, most of the antibiotic-contaminated dust comes from chicken waste -- more than 750,000 tons of it each year. According to the Sierra Club, that's enough to fill 11,560 railroad boxcars, the equivalent of a train with its engine in Philadelphia and its caboose in Washington, D.C. "The ammonia rises up from the manure and it takes your breath away," says Kevin Harmon, a 32-year-old chicken catcher from Exmore, Va., who works with Scarborough's crew. "I used to throw up a lot; cough a lot, too. I have diarrhea all the time. ... The chicken dust, it gets in your eyes, up your nose and in your mouth. ... Even lunch tastes like chicken dust."
Farm food animals produce close to 3 trillion pounds of waste matter every year, according to a 1998 U.S. Senate Agriculture Committee report. That's equal to about 5 tons for every single American. Typically the manure gets watered down and flushed into giant, man-made lagoons and then, essentially untreated, is used to fertilize crops. This creates two problems. Because feces are 90 percent bacteria, all those germs either end up in the soil or as runoff in rivers, lakes, and even oceans. Second, because so much of an antibiotic goes undigested, the manure also is laced with the drugs that create resistance. Sweden banned all animal antibiotics for use as growth promoters in 1986. Denmark followed suit in 1998. And in 1999, the entire European Union banned growth- promoting use of four antibiotics also used to treat human infections.
Risk Factor
In the United States, it's a different story. The oversight agencies for the nation's agriculture and drug industries can't agree on the severity of the problem or what to do about it. The Food and Drug Administration, which approves antibiotics for food-producing animals, and the Environmental Protection Agency, which approves drugs for produce and plants, have established maximum allowable residue levels for antibiotics in animals and crops. The USDA, among others, runs a program that monitors antibiotic resistance in both animals and crops. While all three agencies agree that the use of antibiotics in agriculture has contributed to resistant strains of bacteria in humans, all have expressed caveats. The FDA and EPA believe more research is needed, and the USDA worries about balancing the risks of animal antibiotic use against the economic benefits to agriculture.
However, the U.S. Department of Health & Human Services does not equivocate. In a 1999 response to a draft report by the General Accounting Office on the health implications of agricultural antibiotics, June Gibbs Brown, the department's inspector general wrote: "Overall, we find that the draft report oversimplifies the public health issues. ... We believe that preventive action is needed now, not at some time in the future."
The FDA has been aware of antibiotic resistance since as early as 1977, when it asked Congress to restrict the use of penicillin and tetracycline in the food animal industry. Congress refused, but solicited the National Academy of Sciences to study the problem. The NAS agreed with Congress that there was no impending crisis. A second study was done in 1999, and although the Academy found a "link between the use of antibiotics in food animals, the development of bacterial resistance to these drugs, and human disease," it decided there was no immediate risk to public health.
Ron Phillips, spokesperson for the Animal Health Institute, a trade organization that represents manufacturers of animal health care products, agrees that in theory there could be a link. But because scientists have only recently begun tracking it, he contends resistance really could have existed all along. "The absence of resistance (to Cipro in 1990) does not mean it was zero," he says. "It just means it wasn't really measured (before 1990)."
"Action should be taken (to remove an animal antibiotic from use) only after a risk assessment has been taken. Let's do the science and get answers," says Phillips. "Otherwise we run the risk of unintended consequences. The European Union ... withdrew animal antibiotics and the result has been increased problems with animal diseases and therefore increased therapeutic use of antibiotic drugs. So we're putting the wrong selective pressure on this."
While Congress has failed to act on restricting animal antibiotics, some companies are feeling the pressure from consumer groups to do so voluntarily. Last year, several fast-food chains, including Wendy's and Popeye's, volunteered to stop buying meat and poultry products where growth-promoting antibiotics were used. And McDonald's ordered its chicken and cattle suppliers to stop using antibiotics that also are used to treat humans. Three months after McDonald's move, the FDA announced a new drug review procedure. The guidelines are meant to help the agency determine, on a case-by-case basis, which animal antibiotics should be rejected, based on risk to public health. Critics, however, say the guidelines are not formal rules and there is no timetable for the review.
Contaminated Water
"The problem is that we just don't really know what's out there," says Margaret Mellon, director of the food and environment program for the nonprofit public policy organization, the Union of Concerned Scientists. "The drug manufacturers are not required to report how many antibiotics they sell and the government doesn't have a system for making that information available. And people who use drugs are not required to report usage. ... The real question is why isn't the government getting the answer?"
The government is trying. In 1996 the Food and Drug Administration, the U.S. Department of Agriculture and the Centers for Disease Control created a national surveillance program to track resistant strains of salmonella, campylobacter, E. coli and shigella. In 2001, the CDC, FDA and National Institutes of Health chaired a task force on antimicrobial resistance and produced a public health action plan that recommended a more coordinated national surveillance system of supergerms, better detection and a more comprehensive monitoring of both antibiotic use and resistance.
"The FDA has been working on this since 1992, (but) most of their work has been focused on new drugs -- taking new drugs off the market," says Mellon. "We want them to focus on existing drugs. That's the 800-pound elephant in the living room."
Silbergeld believes the reason the government has failed to act on banning animal antibiotics is because of a lack of independent oversight. "The real tragedy is that most of the research on the problem is done at the (agriculture) schools and the ag schools are beholden to the ag industry for the money to do their research." [See: http://www.rpaforall.org/tenthousandfactsheet3.html and http://cspinet.org/integrity/ ]
]
Diana Aga, a chemist at the University of Buffalo who specializes in environmental pollutants, has been studying the problem of animal antibiotics and fecal contamination for several years, using hog farms in Nebraska as her base of research. Her worry, like that of other scientists, is that resistance genes, which can be transferred from one organism to another, will jump from an animal bacterium to a human one, turning it pathogenic. "We found a lot of antibiotics persisting in the soil," she says, "and now it's five months later and they're still being detected."
Already there is evidence that antibiotics, as well as antibiotic-resistant bacteria, have made their way into the nation's water system. Last year the U.S. Geological Survey's Toxic Substances Hydrology Program published the results of a study that searched for pharmaceuticals in 139 streams in 30 states, including New Jersey. Fourteen antibiotics used in both human medicine and animal agriculture were found in 48 percent of the waterways. Ho-Ho-Kus Brook in Bergen County had the highest concentration of erythromycin -- a favored treatment for strep throat -- among the 139 streams tested nationwide. "There are papers going back to the'70s that said (pharmaceuticals) would be found in the groundwater," says Dana Kolpin of the USGS. "The surprise is that we found so many." While the USGS was conducting its two-year study, Ronald Ash at Washburn University in Topeka, Kansas, was sampling waterborne bacteria from 15 U.S. rivers, including the Colorado, Mississippi and Ohio. Ash tested the bacteria against ampicillin, a popular synthetic antibiotic in the penicillin family. At every site he found ampicillin-resistant bacteria.
Antibiotic Float
Antibiotics and antibiotic-resistant germs also are finding their way into unexpected places, such as nonfood animals. In 1999, Monica Tischler, a professor of biochemistry at Benedictine University in Lisle, Ill., headed a research project looking at the bacteria carried by wild Canada geese in suburban Chicago. "We weren't expecting to find antibiotic-resistant bacteria, but we did. A lot of it. It was astonishing," Tischler says. "These birds have virtually no contact with farms or with humans, so they shouldn't have had any exposure to antibiotics at all. ... The grass here grows right down to the water level, which hints that the geese were acquiring the antibiotic resistance from the environment ... perhaps picking it up from people, in the waste passing through the sewage treatment system."
Only 2.6 percent of the water on the face of the Earth is potable, and yet each time a toilet is flushed, between two and six gallons of polluted water is launched into the world. While the water is cleaned of pesticides and certain other toxins at sewage treatment plants, organic waste contaminants, such as antibiotics, pass through undetected and untreated. The EPA estimates that 50 to 90 percent of the pharmaceuticals humans ingest make their way into the nation's waterways in their original, biologically active form.
Thirty years ago, most sludge was dumped, untreated, far out to sea. The federal Clean Water Act, established in 1972, required cities to treat their waste by filtering out the sludge from the water and detoxing the water of pesticides and other pollutants. But where to put all the sludge that remained? The least expensive solution was to spread it onto fields and pastures. In October, 73 environmental groups petitioned the EPA for a national ban on the use of sludge as a fertilizer. The agency has until the end of the year to respond. Two years ago Perdue came up with an alternative to dumping chicken waste into the environment by building a $20 million facility on Delmarva to process the manure into fertilizer. Last year, 48,000 tons of poultry litter were removed from Perdue farms, preventing nearly 7 million pounds of surplus nitrogen and phosphorous from entering the waterways of Chesapeake Bay and Delaware and Maryland inland waterways. The downside: Some of the litter was shipped raw to mushroom farms in New Jersey and Pennsylvania, according to Trise Lewis at Perdue's AgriRecyle plant in Sussex County, Del.. The rest was processed into pellets and shipped by truck and rail to farms and golf courses in the Northeast, Midwest and South.
Hueston believes there are other alternatives, other ways to balance the interests of agriculture and public health. "I agree fluoroquinolones (antibiotics most useful against campylobacter and salmonella)should be restricted," he says, "but do we really want to ban them altogether? We might be able to minimize the risk, instead, by processing last those animals that have been treated for disease with fluoroquinolones. That way we can ensure the least amount of contamination (in the plant). Or we could require that those animals be cooked first before they're shipped[?]. Or we could make sure to destroy the litter from those treated chickens. What we need to do is agree on a shared interest in helping animals[?], in a safer food supply and in minimizing the environmental impact. ... There are no zero risks, but there are multiple strategies we can use."
The Chicken Man
Scarborough has had a long day, the third in a row on Sammy Hall's place in Princess Anne. His team and several others finally have emptied all the chicken houses of nearly 200,000 birds. "When I started, back then it was all closed off, there was no ventilation in there," he says. "We got head colds all winter. You feel your sinuses draining. If you're in there every day, you cough up stuff. The ammonia would be so strong you'd get water come pouring out of your eyes. I knew it was the ammonia making me sick." Because of illness, Scarborough switched a few years ago from chicken catching to driving the forklift. As he backs out of one of the sheds, Scarborough pirouettes the machine around and in one graceful movement, lifts the stack of crates that are poised on the forklift's two front blades, and gently nudges them into place on the back of the flatbed. When the last one has been stacked, Scarborough dismounts, leaving the machine right where he stopped it. A fuzzy halo of ash clings to his knit cap. He watches as the driver of the flatbed climbs into the cab of his truck, 6,000 chickens crated behind him, and heads out to the processing plant in Salisbury. Feathers drift out from the sides of the flatbed like cherry blossoms in a springtime breeze. It's 6 in the evening, and the setting sun is slowly turning the sky into a bruise of black and blue. Scarborough is talking about the time he was laid up with a lung infection. He took a lot of medicine, he says, and it still took him two weeks at home -- and out of work -- to get rid of the bug. "The doctor didn't have to tell me where I got it from," he says, shaking his head. "I got it right here."
Neil Fishman, director of the antimicrobial management program at the University of Pennsylvania Medical Center, understands Scarborough's plight. "I think there are many reasons for antibiotic resistance," he says. "And they're all coming together now. "It's the perfect storm."
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