by
Bruce Barrett and Eric Uram
If there is one thing agreed on by all sides of the current debate over health care, it is that medical costs are rising to unsustainable levels. Politicians looking for the lowest-hanging fruit have pointed to the prevention of serious disease as a means of controlling costs, as this approach is cheaper than later treatment.
It is surprising, therefore, that greater attention has not been afforded to antibiotic-resistant diseases.
An article published this month in the peer-reviewed journal Clinical Infectious Diseases concluded that the combined hospital and societal costs from 188 patients with antibiotic-resistant infections at just one hospital amounted to more than $13 million, using conservative estimates.
Antibiotics were considered miracle drugs when they were discovered in the previous century. Today, they are already losing their ability to treat disease, and once-fatal diseases are increasingly becoming impervious to drug treatment again.
The way drug resistance develops is fairly simple: Antibiotics kill targeted bacteria, except a small percentage that have a mechanism that allows them to survive. These surviving bacteria - so-called superbugs - multiply, passing along their immunity to future generations. Because of the ease with which antibiotic resistance emerges, the medical community is learning to be judicious about administering antibiotic treatments.
But antibiotics are not being doled out so carefully in other places. According to the Union of Concerned Scientists, an estimated 70% of the antibiotics and related drugs used in the United States are added to the feed and water of livestock and poultry that are not sick. The antibiotics are used not to treat diagnosed disease but to promote growth and to compensate for the overcrowded, stressful, unsanitary conditions in confined animal feeding operations.
Numerous studies have associated these practices with the emergence of antibiotic-resistant superbugs such as salmonella, E. coli and even methicillin-resistant Staphylococcus aureus (MRSA) - a bug previously known to occur almost exclusively in hospital settings.
Doctors treating these diseases must resort to multiple rounds of treatment, using ever more expensive antibiotics with more serious side effects, while patients are incurring higher medical bills and greater suffering. In many cases, patients die.
The science demonstrating a link between farm practices and human illness is becoming increasingly difficult to refute. Earlier this year, researchers at the University of Iowa tested two hog production systems in Iowa and Illinois and found a recently identified strain of MRSA in 70% of pigs at one of the two sites.
More alarming, more than half of workers tested at that facility were colonized with the identical superbug strain, suggesting a possible route of transmission of the strain from pigs to farm workers and perhaps to the wider community. Humans also can acquire antibiotic-resistant diseases through meat or by environmental contamination.
Leaders in the House and Senate have introduced legislation to address this problem in a common-sense way. The Preservation of Antibiotics for Medical Treatment Act would authorize the Food and Drug Administration to restrict the use of antibiotics that are important for treating human infections from being used as livestock feed unless it can be proven by the drugs' manufacturers that such uses do not cause resistance.
This legislation would not affect the ability of producers to treat sick animals. Similar measures have been adopted in Europe; in Denmark, the world's top pork exporter, a ban on using antibiotics for growth promotion led to a 50% decrease in overall antibiotic use with no harm to animal health, and consumer prices have not increased.
Ending the overuse of antibiotics in the feed and water of animals is an obvious step we can take to keep antibiotics working for future generations, while helping to rein in runaway health care costs today. National groups such as the American Medical Association, the American Public Health Association and the Sierra Club have joined together to call on Congress to pass the Preservation of Antibiotics for Medical Treatment Act.
It's time for Wisconsin's congressional delegation to get behind this critical piece of legislation.
Bruce Barrett, M.D. and PhD, is an associate professor in the University of Wisconsin Department of Family Medicine and a member of Physicians for Social Responsibility. Eric Uram is vice chairman of the John Muir Chapter of the Sierra Club.Milwaukee Journal Sentinel
