Sunday, March 7, 2010

First do no harm!

You know the conventional wisdom:   Taking antibiotics unnecessarily (over-use) leads to superbugs - bugs that develop resistence to antibiotics.  So most doctors no longer give out prescriptions prophylactically.  They wait until a viral thing would have passed, or they do a culture.

A New York Times OpEd piece, posted to facebook by my friend Suzanne Pickett Martinson, focused me on what should have been rather obvious - our doctors' safety measures barely make a dent in the problem.  Compare the occasional human request for antibiotics to the widespread use of antibiotics by the food industry.   The difference in impact is exponential, due to the routine prophylactic use of antibiotics in livestock feed.  While doctors have taken a vow to do no harm, the livestock industry has no similar mandatory compulsion.  The thing is, the upside for agribusiness to use antibiotics is immediate, while the downside to society is delayed.  Way before regular bugs morph into superbugs, the food industry has made a profit from the use of the offending antibiotics. 

There is always a proof problem when the detrimental impact of an action is not immediate.  The time delay creates a situation where it is often difficult to follow a chain of causation from the original event (over-use of antibiotics, in this case) to the outcome event (superbugs).  Other intervening factors can and sometimes do influence the outcome, making the original event's degree of impact difficult to measure.  By way of illustration, two similarly time-delayed issues are cigarettes' lung cancer (and other) repercussions, and carbon dioxide's impact on climate change.  This causal disconnect gives the perpetrator a window of opportunity to exploit the offending technology, while waiting for society to figure out the connection and find the damning proof.  Until after regulators discover the causation and jump through political and legal hoops to prove it up and achieve regulatory authority, no law says the offender has to figure it all out and come clean - even when the offender has some idea of the implications of his actions. 

And unlike cigarettes, it would be wrong of me not to point out that there are and have been significant benefits to human health and the availability of food to the public from the use of antibiotics, not just the potentially devastating problems associated with the overuse of antibiotics.

But we cannot downplay the latter, as the CDC has now concluded that the use of antibiotics in food animals is the dominant source of antibiotic resistance among foodborne pathogens,  One obvious compromise is the reduction of routine administration of antibiotics, and in many cases perhaps, the restriction the use of antibiotics in food animals to therapeutic use - the same way our doctors have now restricted its use for humans.

Back to the OpEd, written by Nicholas D. Kristoff.  This is not a science article, although there's enough science to be explanatory.  It's a political article, and the following line will explain all you need to know about why I want you to read it:

"Routine use of antibiotics to raise livestock is widely seen as a major reason for the rise of superbugs. But Congress and the Obama administration have refused to curb agriculture’s addiction to antibiotics, apparently because of the power of the agribusiness lobby."

You can find the rest of the article here.  Even though you already have enough to worry about - we all do - this business about cow-towing to big business has got to be brought under control.  Please take a few minutes to read Kristoff's piece:

By the way, I lifted the fun graphic from a great science blog called Both Brains & Beauty,", by Teri Baker.  Definitely check out her blog, or follow her on facebook!  I'm going to.

And here is a great speech by an Arizona icon, Morris Udall, on the effects of cigarettes on human health:  Running across this is one of the lucky accidents of doing blog research.

And this website on tobacco history.  May sound boring, but trust me, it's fabulous. Did you know that cigarettes were initially banned around 1900, putting smaller companies out of business while the big ones were able to live through (and get around) the ban?

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