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who is to blame for antibiotic resistance

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Doctors, Mothers Responsible For Antibiotic Resistant Bugs

Yes, that headline is provocative. But it’s also true…up to a point. And the gulf between the headline’s truth and its half-truth illustrates several realities that the beef industry [3]must continue to deal with.

First, let’s set the record straight. No, doctors and mothers are not totally (emphasis on the word totally) responsible for antibiotic resistance. On the other hand, however, yes, mothers and doctors are responsible for antibiotic-resistant bugs. But only partly.

So are you. And no, animal agriculture is not totally (emphasis on the word totally) responsible for antibiotic-resistant pathogens, as some would have us believe. The completely accurate headline is this: Everyone Is Responsible For Antibiotic Resistance [4]. To quote Steven Solomon, director of the Centers for Disease Control (CDC) Office of antimicrobial resistance, and co-chair of the federal interagency taskforce on antimicrobial resistance, “There is not a time when you put antibiotics into this ecosystem that it does not contribute to resistance in some way. “

And, please, don’t misunderstand. I’m not casting aspersions at mothers or doctors. They are only doing what they think they need to do. Mothers especially. I know this from first-hand experience and many years of close observation. I have three mothers to deal with—the one who birthed me, the one who birthed our children, and the child who birthed my granddaughter. 

Now, to get to the point, which is that antibiotic resistance is everyone’s problem. And it will only be managed if everyone—human health, animal health and consumer advocates—work together.

The first of the realities that my not-quite-totally-true headline illustrates is that provocative headlines have always sold newspapers.

I’ll spare you the numbers, but we scribes have mere seconds to capture your attention and convince you to click on an article. Right or wrong, and the editors at BEEF would argue more on the wrong side than the right, provocative headlines have always been a fact of life. Now, in this post-print, neuvo-modern, digital-electronic, fast-news world we live in, the pressure to write provocative headlines is even more intense.

It made you look, didn’t it? And if you’re still with me, you are among the minority of readers who clicked on this editorial.

Here’s the second reality, and the partial truth behind the headline [5]. When a mother takes her sick child, or you take your sick self, to the doctor, she and you expect to be given something that will make it better. Period.

Mothers are going to behave like mothers, both individually and collectively. That is perhaps one of the most powerful forces on earth, and one reason for concern among human health professionals about antibiotic overuse in human medicine.

Likewise, when you have a sick animal [6]and call the veterinarian, or more likely go to the feed store and buy a bottle of antibiotic, you expect that it will make things better. If it doesn’t, what do you do? Give it another shot, probably of the same stuff. This would be an appropriate time to recall Einstein’s observation on insanity.

And that’s where things regarding antibiotic-resistant bacteria [7]get complicated. I’ll give you two quotes to back up that claim:

  • “If you think you understand antibiotic resistance, it hasn’t been adequately explained to you.” Guy Loneragan, veterinary epidemiologist and professor of food safety and public health, Texas Tech University.
  • “Antibiotic resistance may be the single most complex problem in all of public health.” Steven Solomon, CDC.

Thus, I’m not going to explain antibiotic resistance in this editorial. I spent three fascinating days last month at a symposium where some really smart people from both human and animal health discussed the issue. If you want to delve deeper into the subject, I encourage you to go to the National Institute of Animal Agriculture (NIAA) website. [8]

What I am going to do is emphasize the point made any number of times during the symposium. And that is this: everyone—human doctors and human patients, veterinary doctors, (and this very much includes small-animal vets) along with their animal and human patients—all have an important role in dealing with antibiotic resistance.

We’re not going to stop microorganisms from becoming resistant to antibiotics. The bugs have too much of a head start, Solomon says, by several billion years. But there are things we can do to keep the problem from growing beyond the ability of technology as we know it today to deal with pathogens.

 

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The first is to use antibiotics judiciously [6]and only when needed. Just because you have a sick calf doesn’t mean you need to give it a shot of antibiotic. Antibiotics are useless against viral infections. See Solomon’s quote above about what happens when you use an antibiotic where it isn’t needed. How do you tell the difference? That’s where using your veterinarian as a herd health consultant instead of an EMT who comes screeching up to the scene of the wreck is really, really, really (that’s three reallys, which means it’s really important) important.

Bottom line—how we (which means you) use antibiotics will partly determine how they can be used and obtained in the future, and how many antibiotics animal agriculture will have at its (meaning your) disposal.

The second point is this: we can’t let the discussion about antibiotic use and antibiotic resistance devolve into a shouting match. My recent editorial on horse slaughter [10]shows very well what happens when an issue becomes so heated and polarized that civil discussion becomes impossible.

For the first time that I’m aware of, at least in a public setting, the NIAA symposium brought consumer groups, animal agriculture and human medicine into the same room, all talking about antibiotic resistance, and all doing so in a very civil and professional manner.  Representatives from the Center for Science in the Public Interest (CSPI), Pew and the Natural Resources Defense Council attended the symposium, and the CSPI representative was one of the presenters. NIAA is to be commended for that.

That dialogue absolutely must continue. Animal agriculture needs antibiotics. It is at its core an issue of animal welfare [11]and humane animal stewardship. But we need to figure out ways to use those antibiotics judiciously and to seek alternatives to antibiotics in our animal health protocols. That means that every livestock owner must have, at some level or another, a relationship with a veterinarian.

Human medicine needs antibiotics. It is at its core an issue of delivering both the absolute best clinical health and public health systems that we can humanly do. If society must choose between antibiotic use for humans and antibiotic use for animals, guess who wins.

And we all need to tone down the rhetoric. Polarizing this issue serves only to ensure that the problem of antibiotic-resistan [4]t bacteria will get worse. Should that happen, everyone who truly cares about humans and animals alike will lose.

 

 

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