Physicians tried different drugs, but at first nothing seemed to work.
Blame the overuse of antibiotics in livestock, according to the doctors familiar with their cases.
“These kids had some really highly resistant bacteria that they clearly had not picked up in a hospital,” said Jason Newland, director of the Children Mercy’s antibiotic stewardship program.
Newland and other doctors believe those infections are part of the price we are paying for a half-century of overusing antibiotics in cattle and other meat animals in the United States.
“If you look at tonnage, 80 percent of the total of all the antibiotics we use in the states is used in meat animals,” Newland said.
As in humans, bacteria growing inside animals that are given antibiotics can develop a resistance to the medicines, Newland explained. That resistant bacteria can then be transferred to the soil through animal waste.
During severe storms, such as the EF5 tornado which killed 161 people in Joplin, that contaminated soil can end up in open wounds, and even modern medicine is challenged in combating the serious infections that can occur.
“We are increasingly treating kids with antibiotic-resistant infections who were at the last antibiotic we could possibly use on them,” Newland said. “In the next 20 years will we see antibiotics resistant to everything?”
A yearlong investigation by The Kansas City Star found a multimillion-dollar-a-year pharmaceutical arms race in the beef industry is not just about curing sick cows.
It’s also about fattening cattle cheaply and quickly, driven in part by efforts to maximize profits, according to food safety advocates. In fact, the same number of cattle today are producing twice as much meat as they did in the 1950s because of genetics, drugs and more efficient processing.
Despite decades of warnings, the federal government has failed to pass meaningful regulation of animal drug use, failed to adequately monitor the harmful residues they leave behind, and failed to stop the consumption of meat contaminated with such substances.
Last year, an Arizona lab discovered a strain of antibiotic resistant MRSA in meat that can infect humans. MRSA is the potentially fatal staph infection that sometimes races through hospitals.
Mexico rejected contaminated meat that U.S. rules allow Americans to eat. A shipment of U.S. beef in 2008 contained high levels of copper, a byproduct of industry and antibiotics, which can damage kidneys. The U.S. Department of Agriculture, which hasn’t set allowable amounts of copper in meat, couldn’t stop it from distribution in the United States.
Until it tightened monitoring this year, the government couldn’t even stop the sale of meat containing arsenic, one of the residues found in cattle treated with antibiotics. High levels of the poison can cause vascular disease and hypertension in humans. Many U.S. veterinarians who specialize in treating cattle said in a recent survey that they were concerned about the overuse and improper use of antibiotics and other drugs. Some blamed salesmen intent on making more money. Based on sales data alone, the amount of drugs used in livestock is increasing, and beef samples are showing greater numbers of antibiotic-resistant pathogens.
In its investigation, The Star examined the largest beef packers including the big four — Tyson Foods of Arkansas, Cargill Meat Solutions of Wichita, Kan., National Beef of Kansas City, Mo., and JBS of Brazil — as well as the intertwined network of feedlots, processing plants, animal drug companies and lobbyists who make up the behemoth known as Big Beef.
Today’s ever-larger feedlots use an intensive antibiotic regimen, even though the USDA reports that such practices contribute to antibiotic-resistant bacteria in humans.
But Big Beef maintains that concerns about antibiotic overuse in livestock are overblown. The Animal Health Institute, the lobbying arm of the animal pharmaceutical industry, said there’s not enough data to compare antibiotic use in animals and humans, citing a Food and Drug Administration statement that said it is “difficult to draw definite conclusions.”
The industry said antibiotics are needed for the humane treatment of sick and suffering animals and added that there is no “provable connection” between the cases in Joplin and livestock antibiotic use.
Before cattle are slaughtered, they’ve been fed, tagged and injected with millions of dollars of hormones, growth promoters and antibiotics.
Every year, about 29 million pounds of antimicrobial drugs are used on cattle, pigs and poultry, government data show.
But the government doesn’t make public how much of those drugs are used in cattle, or any other meat animals, because it considers that information a “trade secret” and its release might give one meat producer a competitive advantage over another.
A public interest group, however, sued the FDA on Wednesday to force the release of additional data on antibiotics used in food animals.
“How can we truly know the extent to which these drugs are causing harm if we can’t even access the information,” said Amanda Hitt, director of the food integrity campaign at the Government Accountability Project, a whistle-blower protection group.
GAP sued when FDA refused to release the data under a Freedom of Information Act request.
The Animal Health Institute said that data it collected until 2007 showed that about one-third of the compounds used in food animals are not used in humans and therefore “cannot in any way contribute to the burden of antibiotic resistance in humans.”
Which means two-thirds of those used in food animals are used in humans. So why does Big Beef keep using them?
Cattlemen have known for decades that antibiotics cause digestive changes in cattle that help them efficiently convert corn into added weight.
And that saves money.
Before the 1950s, most cattle primarily ate grass until they were slaughtered. But after World War II, farmers learned they could feed large numbers of cattle on less acreage by using more corn instead of grass.
However, there were unintended consequences.
Animals in confined spaces spread diseases. Cattle on high rations of corn develop acid buildup, which can deteriorate the gut lining — similar to an ulcer in humans — and cause gas, bloating and lameness.
Corn can eat away part of a cow’s stomach, said Allen Williams, a former feedlot owner and cattle specialist at Mississippi State University.
“They actually discharge a mucusy, dull, reddish-brown substance through their rectums,” that is part of their stomachs, Williams said.
Big Beef soon discovered antibiotics controlled both problems.
Not only do such drugs help control diseases among closely confined cattle, they also counteract the acid buildup from corn. They relieve bloating, allowing cattle to eat more.
Beef industry officials said they had no research to back up that claim. But Cargill acknowledged that antibiotics are used in part to treat liver abscesses in cattle that result from high concentrations of corn they are fed.
Williams, who now consults with grass fed beef producers, said pressure to keep using higher levels of antibiotics and other drugs on cattle is all about bigger profits.
“It’s pressure from pharmaceutical companies. They are making money … and they don’t want it to stop,” he said.
That’s inaccurate, industry officials contend. “Farmers and ranchers have complete freedom to purchase or not purchase products based on animal needs,” according to the Animal Health Institute.
Improved genetics along with antibiotics, hormones and growth promoters allow the beef industry to raise a calf to slaughter weight in a little more than a year, half the time it used to take. Studies also show that animal drug residues in the beef people eat, and in cattle waste runoff that occasionally enters public water systems, can cause human illnesses.
Yet both sides in the debate over limiting the use of animal antibiotics remain entrenched and cite scientific studies to back up their point of view.
“There’s no question that routinely administering non-therapeutic doses of antibiotics to food animals contributes to antibiotic resistance,” said Donald Kennedy, former commissioner of the FDA and president emeritus at Stanford University.
Not true, said Mike Apley, a veterinarian and Kansas State University professor.
“We have zero data to say that growth-promoting uses of antibiotics in animals is a major contributor to the overall problem of antibiotic-resistant bacteria,” said Apley, who acknowledged that some of his studies are funded by pharmaceutical companies.
Some concerned ranchers aren’t using antibiotics anymore, at least for growth promotion. And meat packers, including some of the largest ones, offer antibiotic-free beef.
Bill Haw, a former banker who grazes his herds in the Flint Hills of Kansas, doesn’t use antibiotics in feed.
“Given the problems, it is crazy to do so,” Haw said.
Veterinarians who specialize in cattle also are speaking out against antibiotic overuse.
When the American Association of Bovine Practitioners surveyed its members in March, they tapped into a deep vein of frustration. Of the 389 veterinarians who anonymously answered the survey, 344 said they want guidelines for the judicious use of drugs in cattle.
Some ranchers have begun relying on free advice from “roving veterinarians” who sometimes ride shotgun with drug distributors.
“There is tremendous pressure from pharmaceutical companies to push different products through rebates,” said Ken Winter, who operates a feedlot in Dodge City, Kan. “They cater to big outfits and give away discounts, vests, cowboy hats and boots.”
Those kinds of practices, according to many veterinarians surveyed, contribute to the misuse of some drugs.
“Illegal performance of veterinary procedures and sale of prescription supplies are rampant in the industry,” said one veterinarian. Stopping such practices “would be a benefit to the veterinary food animal industry,” he added.
Human antibiotics are not as freely dispensed as antibiotics are to cattle, wrote another veterinarian, adding physicians “also don’t write blanket prescriptions to include every family member, and we should not either.” The survey showed that cattle veterinarians want a clearer definition of their role in modern day beef production, said Gatz Trudell, the American Association of Bovine Practitioners’ executive director.
He added that some of the practices, such as drug company veterinarians writing whole-herd prescriptions, are questionable.
“Some of our members are frustrated over marketing channels for products that don’t require a veterinarian,” Trudell said, including what he said are some Internet pharmacies that provide prescription-only drugs without a script.
“Veterinarians and beef producers have an obligation to provide the safest product we can, and given their schooling, veterinarians should be part of the animal health distribution scheme,” he pointed out.
The Animal Health Institute said their drug company members “focus on educating veterinarians and their clients on how to use products for the optimal health and well-being of individual animals.
“Our member companies generally have codes of conduct that guide how to interact with medical professionals with integrity,” they added.
Today, there is overwhelming evidence that non-therapeutic use of antibiotics in food animals contributes to antibiotic resistance, according to Stuart Levy, a world-renowned expert who co-authored a study last year at Tufts University.
The World Health Organization also is worried, warning that the speed at which antibiotics are becoming ineffective outpaces the development of replacement drugs.
“One of the most powerful measures globally to prevent antimicrobial resistance has been the ban of the use of antibiotics as growth promoters in livestock in the 27 European Union countries since 2006,” the WHO said last year.
Numerous strains of antibiotic-resistant bacteria already have begun cropping up. Earlier this year, a lab in Arizona discovered a strain of antibiotic-resistant MRSA in retail meat. MRSA, a staph infection, can cause abscesses and lesions.
The lab, the Translation Genomics Research Institute, published a study that showed that bacteria jumped from humans to livestock and back.
“Our findings underscore the potential public health risks of widespread antibiotic use in food animal production,” the study noted.
In Joplin last year, 13 of the 900 people injured in the deadly tornado suffered from fungal and other infections after contaminated dirt and debris was blown into their wounds, according to a study published Thursday in the New England Journal of Medicine. Five of the 13 died, and three of those deaths listed fungal infections as a “primary or contributing cause,” the study said.
Two survivors, a 16-year-old boy and a 13-year-old girl, were treated at Children’s Mercy Hospital in Kansas City for multiple injuries and multiple antibiotic-resistant infections, not just those related to fungi.
Both are subjects of another article by Children’s Mercy doctors and others published in The Pediatric Infectious Disease Journal in June.
The children were not named, but the boy is Steven Weersing, whose story appeared in The Star after his injury.
Weersing, who dropped to 106 pounds during his treatment, said he was not aware of the findings in the journal article before being contacted by The Star. He said he now has three titanium ribs as a result of his injuries and will be undergoing more surgery at Children’s Mercy in March.
According to the Pediatric Journal article, the antibiotic-resistant bacteria found in both children were linked to “agricultural antibiotic use, release of heavy metals, organic pollutants and spillage of fecal and pathogenic microorganisms.”
“What’s different about our patients is that they were impaled with foreign bodies, similar to what has been reported in tsunami victims,” explained Mary Anne Jackson, chief of the pediatrics disease section at Children’s Mercy who contributed to the Journal article. “We were pulling gravel and dirt and other foreign material from their wounds weeks after their injuries.”
But she said doctors’ efforts also were hampered by antibiotic-resistant infections in those wounds.
“These were not typical organisms; they were many in number and they were strikingly resistant (to antibiotics),” Jackson said.
The most compelling explanation for that, she said, given the kinds of infections found and the level of cattle production in that area, is that the use of antibiotics in livestock production may have led to soil contamination with antibiotic-resistant bacteria.
Some of the world’s largest cattle feedlots are a few hundred miles west of Joplin, and the town is home to one of the nation’s largest cattle auction centers.
Dirt from those areas could easily have blown into Joplin over the years, according to a meteorologist at the federal storm prediction center in Norman, Okla. The tornado disturbed that dirt and suspended it in the air, he said.
But the Animal Health Institute says it’s all mere speculation.
“The article states that the infections were caused by a soil fungus,” Animal Health Institute officials said after reviewing it. “ … the antifungal medicines used for the patients’ treatment are not approved for use in beef cattle production. … In this instance, the speculation about food animal sources is quickly discarded once data driven analysis is applied.”
Jackson said the Animal Health Institute oversimplified the findings in the article, and she added that antibiotic use in cattle and other meat animals can have broader consequences beyond just one drug.
Newland said that he and other doctors also are seeing more children with antibiotic-resistant salmonella, which is found in beef and other foods.
“This has to be from the animal industry and their antibiotic use,” Newland said. “And the thing about it is that if a 5-year-old child gets a salmonella infection that becomes invasive, then you need antibiotics to treat it, and that’s where it gets a little scarier for us.”
Numerous studies have found antibiotic-resistant strains of foodborne pathogens in meat.
However, “so-called antibiotic resistance from eating meat has not been scientifically linked,” Cargill officials told The Star. “Overuse of antibiotics in humans may pose greater human health risks than anything associated with eating meat.”
But Newland and Jackson aren’t alone in their concerns.
In July, 45 hospitals and medical societies, as well as 359 doctors and other health care professionals, urged the FDA to finally take action to limit antibiotic use in animals.
Rep. Louise Slaughter, a New York Democrat and the only member of Congress who is a microbiologist, has felt the power of Big Beef’s lobbyists.
Slaughter has been pushing legislation for years that would limit agricultural uses of seven antibiotics considered critical in humans, including penicillin.
Her bill, the Preservation of Antibiotics for Medical Treatment Act, has never passed.
Pharmaceutical trade groups and other agricultural lobbies have staunchly opposed it.
They argued that Slaughter’s bill would prohibit veterinarians from preventing disease in livestock and “would ultimately harm animal welfare, animal health, food safety, and food security.”
Slaughter isn’t buying it.
In February, she tried another approach. Slaughter sent a letter to 60 fast-food companies, producers, processors and grocery chains asking them to disclose their policies on antibiotic use in meat production.
Big Beef processors replied that they opposed stricter regulations and maintained that the industry would be better off continuing to police itself.
One of the big four, Tyson, wrote to Slaughter: “We respectfully disagree with the premise of your position on antibiotic use in animal agriculture.”
Margaret Mellon, a scientist who has been battling for antibiotic restrictions far longer than Slaughter, conceded that it’s nearly impossible to overcome industry lobbying.
“They kick butt on (Capitol) Hill and they have blocked every single effort at oversight,” said Mellon of the Union of Concerned Scientists.
“They would prefer that the public not know the quantities of antibiotics they are using and for what purposes, which is why they also oppose more data collection by the government,” she added.
The Animal Health Institute said that Mellon is forgetting that it collected data from members on a voluntary basis and made it public until 2007. The lobbying group said they stopped doing so when Congress mandated that the FDA collect more of that data.
In the Kansas City area alone, various animal health firms account for nearly 32 percent of the $19 billion global animal health market, which includes drugs for pets.
The Animal Health Institute spent more than $850,000 on lobbying in the last decade on a range of issues, including opposition to Slaughter’s proposal. Individual animal pharmaceutical firms also lobby and make campaign contributions on a range of issues, including drugs used in animals.
For example, Bayer AG, a German company whose Bayer Animal Health division is based here, contributed more than $408,000 to politicians in 2011-12, according to the Center for Responsive Politics.
The company spent another $10 million on lobbying in the last two years alone.
Bayer makes about 100 different drugs for livestock and pets. Some of them, including Baytril 100, its antimicrobial for bovine respiratory disease, are made at its Shawnee manufacturing plant.
Another area pharmaceutical firm is St. Joseph, Mo.-based Boehringer Ingelheim Vetmedica, a division of CH Boehringer Sohn of Germany. The parent company made more than $231,000 in campaign contributions in 2011-12.
The company spent more than $4 million on lobbying in the last two years, but the lobbying was directed at animal and human business.
Pharmaceutical companies also spend lavishly entertaining potential customers. Bayer, sponsored “Cowboy’s Night at the Opry and Barn Dance” this year at the National Cattlemen’s Beef Association convention in Nashville.
And Bayer and Boehringer Ingelheim Vetmedica are among five animal health companies that are “gold level sponsors” in the cattlemen group’s Allied Industry Partners program, contributed $500,000 to the group.
Neither company, however, discussed their activities at length.
The National Cattlemen’s Beef Association said there is nothing unusual about that kind of financial support. “Companies that support NCBA support many state and national organizations,” an official said.
The Star asked both companies for information and tours of their manufacturing facilities early this year. The newspaper also submitted questions about antibiotic resistance.
After several additional inquiries, Bayer sent a short letter and a copy of an industry-sponsored book about the history of U.S. animal pharmaceutical firms.
Eventually, Bayer also sent a written statement indicating they “strongly support the responsible use of antibiotic medicines and the involvement of a veterinarian whenever antibiotics are administered to food producing animals.”
Boehringer also said it believes veterinarians also have an “important role to play in the wellbeing of herds.”
After years of pressure, the FDA in April finally took limited action on animal antibiotics. But instead of the mandatory limits long advocated by public health groups, the federal agency sought voluntary reductions.
The beef industry was pleased they didn’t go further.
“We are pleased that FDA has resisted unscientific calls to completely ban the use of antibiotics and antimicrobials in cattle and other livestock species,” said Tom Talbot, chairman of the National Cattlemen’s Beef Association’s Cattle Health and Well-Being Committee.
Talbot said he remains concerned, however, that regulatory actions could eventually “set the precedent to take animal care and health decisions out of the hands of veterinarians.”
Specifically, the FDA asked cattle feeders to voluntarily stop using antibiotics to enhance growth or feed efficiency.
That “guidance” specifically refers to “medically important” antibiotics, especially those used to fight increasingly antibiotic-resistant foodborne pathogens found in meat.
Medical use of the drugs for sick animals would not be affected, except that the agency is urging greater veterinarian oversight on those “therapeutic” uses as well. The FDA won’t evaluate the latest efforts until 2015, at which time it “may” consider further action.
But one bovine veterinarian said he was “conflicted and cynical about (voluntary efforts)” in his comments on this year’s survey by the American Association of Bovine Practitioners. “I am afraid as long as these drug use issues are all voluntary, there will never be adequate compliance.”
Public health groups and environmentalists also are dubious. As a result, they took their battle to court last year, where a federal judge took more action in a few months than the FDA has in decades.
The National Resources Defense Council, the Union of Concerned Scientists and others sued the FDA in March 2011 to force it to go beyond a voluntary effort and actually ban the use of antibiotics as growth promoters.
Research has shown for years, their lawsuit noted, “that the use of antibiotics in livestock leads to the development of antibiotic-resistant bacteria that can be … transferred from animals to people through direct contact, environmental exposure, and the consumption and handling of contaminated meat and poultry products.”
Earlier the judge in the case ordered the FDA to withdraw approvals for penicillin and tetracyclines in animal feed, unless drug manufacturers can prove they are safe.
In August, the court also ordered the FDA to “stop dillydallying” and hold regulatory hearings about the use of those drugs in livestock production.
The agency appealed those rulings. A decision is expected soon.
Critics contend Americans can’t depend on the government to ensure the meat on their plate is free of residues from antibiotics and other drugs because the monitoring system is hopelessly broken.
Even the USDA’s own audits agree.
“The national residue program is not accomplishing its mission of monitoring the food supply for harmful residues,” according to a 2010 USDA audit.
Federal agencies charged with monitoring harmful substances in meat have failed to set limits for pesticides and heavy metals such as copper and cadmium, which can be left behind by veterinary drugs, according to the USDA’s inspector general.
The audit found that has resulted in contaminated meat being distributed to the public.
Mexico has tolerances for harmful substances that aren’t covered by U.S. rules.
In 2008, the audit said, Mexico rejected a shipment of U.S. beef because it contained high levels of copper, which can cause renal dysfunction. The USDA had no tolerance levels for copper and couldn’t stop the meat from distribution here.
That same year, according to the inspector general, a producer voluntarily withheld beef from the U.S. market after it tested positive for arsenic, which his cattle “mistakenly” ingested. Consequently, if the producer hadn’t come forward on his own, the inspector general said the government would have been powerless to stop the meat from being distributed.
Even when federal regulators set tolerances and find harmful residues, they don’t always prevent consumers from eating it.
Between July 2007 and March 2008, for example, the USDA found meat from four carcasses had higher-than-allowed levels of veterinary drugs. Even though the residues could cause stomach, nerve, or skin problems, the agency took no action.
Under federal law, recalls are voluntary on the part of meat packers. In order to pressure a plant to do so, the USDA has to prove that a single serving is likely to make someone sick.
“The audit was an impetus to improve a lot,” one top official of the USDA’s Food Safety and Inspection Service, told The Star. In July this year, more than two years later, the department announced reforms.
Officials said they shifted toward “a more public health-based sampling approach” that includes more screening for veterinary drugs and pesticides, including some forms of arsenic. The agency, however, still is not testing for copper.
The inspector general’s office hasn’t scheduled a follow-up audit, but told The Star, “it is a topic that (the agency’s watchdog group) will consider … for additional review.”
The consequences of antibiotic overuse in humans and animals — and the residues they leave behind — are dire, warned Margaret Chan, the director general of the World Health Organization.
If something isn’t done soon, Chan said it could mean “the end of modern medicine as we know it … and things as common as strep throat or a child’s scratched knee could once again kill.”
By Mike McGraw - The Kansas City Star (MCT)
©2012 The Kansas City Star (Kansas City, Mo.)
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