John
M Balbus, MD, MPH, FACP, Director, Health Program,
Environmental Defense
|
|
Physicians
and medical centers are the front lines of the battle against
antibiotic resistance in infectious bacteria. Government agencies,
professional organizations, and health care corporations have
developed various directives and control mechanisms to help guide
physicians toward prescribing practices that minimize the development
and dissemination of antibiotic resistance. But as Jeffrey Ritterman,
MD, points out in "Preventing Antibiotic Resistance:The Next
Step," (page 35) the quantity of antibiotics routinely administered
to livestock and poultry as feed additives appears to dwarf human
use. The evidence that using antibiotics as feed additives contributes
significantly to the problem of antibiotic resistance in humans
has been acknowledged by the major medical associations, including
the American Medical Association, American Academy of Family Physicians,
American Academy of Pediatrics, and dozens of others, leading
them to call for an end to this practice.
Physicians
have taken many necessary steps to curtail unnecessary uses of
antibiotics in humans, but what can they do about antibiotic practices
on farms? Plenty.
Doctors
provide a trusted, authoritative voice to the public. Greater
awareness of this misuse among physicians can translate into greater
awareness and concern among their patients. And an educated, mobilized
public can help counter industry denial and government inaction.
Just
as important is the role physicians play as leaders within medical
centers and other large health care institutions. Medical centers
have an impact on society that goes well beyond the health services
they provide. They are universally among the largest employers
in any given region: Kaiser Permanente (KP), as an example, has
been the largest private sector employer in Los Angeles County
for the past three years. Over the past decade, medical centers
have recognized their significant role and responsibility in broader
environmental and societal issues through organizations like Health
Care Without Harm (HCWH) and Hospitals for a Healthy Environment
(H2E). These organizations are reducing the health care industry's
environmental footprint and changing markets by getting medical
centers to adopt standards and purchasing policies to minimize
use of toxic materials, such as mercury. With 140,000 employees,
30 medical centers and over 8 million enrolled patients, KP's
actions and policies will influence the nation's economy.
And
among health care institutions, KP is known as a pioneering leader.
KP's adoption of a purchasing policy that minimizes use of antibiotics
in agriculture would help educate other hospitals, food services,
and members of the public about the need to take similar steps.
The
adoption of purchasing policies that curtail antibiotic overuse
in food animals--notably use of medically important antibiotics
as feed additives--is already affecting the market. Environmental
Defense has helped McDonald's (the world's largest meat purchaser),
as well as Compass America and Bon Appetit (two of the nation's
largest food-service companies) craft policies that restrict certain
antibiotic uses in chicken. The Compass America policy also addresses
the use of antibiotic feed additives in pork.2 While
these policies are only first steps, they are having some real
impacts. Indeed, earlier this year USA Today1
reported that several of the nation's largest chicken producers
had dramatically cut their overall antibiotic use; Tyson's reported
a drop of 93%. However, it's not clear to what extent similar
steps have been taken throughout the chicken industry, and there
is still much to be done in reducing antibiotic use in pork, cattle,
and other food animals.
It's
possible that we are approaching a tipping point on this issue,
but we are not there yet. Moreover, there are no regulatory or
legislative guarantees that any of the progress made so far in
reducing nonessential antibiotic use will be maintained. This
is why it's so important for the medical profession and the health
care sector to put their money where their mouths are, so to speak,
and join these major food companies in setting purchasing policies
to move the market away from routine uses of antibiotics in food
animals. No economic sector is as directly affected by the challenge
of antibiotic resistance as the health care sector. And no other
sector's action has the same authority and influence on this issue.
As comedian Marty Feldman has said, "the pen is mightier
than the sword and much easier to write with." Physicians,
while restraining their pens from writing unnecessary antibiotic
prescriptions, should employ them to help move the food industry
away from unnecessary antibiotic use in food animals.
References
-
1. Weise E. "Natural" chickens take flight: Four top
producers end use of antibiotics. USA Today. 2006 Jan 24; Sect
D;5.
-
2. Hold the antibiotics, please! Food service giant helps keep
antibiotics working by limiting their use in pork [monograph
on the Internet]. New York: Environmental Defense; 2005 Aug
2 [cited 2006 Jul 13]. Available from: www.environmentaldefense.org/article.cfm?contentID=4636.
|
