One of the greatest medical discoveries of the 20th century happened by accident.
In 1928 scientist Alexander Fleming found mold growing in one of his petri dishes—then noticed that the bacteria all around it had been destroyed. That bacteria-killing mold was the first form of penicillin—and we as a society embarked on a brave new world in medicine. Suddenly, deadly diseases such as tuberculosis, scarlet fever, bacterial meningitis, and diphtheria could be cured with a pill. Surgery for heart disease and organ transplants, as well as chemotherapy, could succeed because those miracle drugs wiped out the infections that arose after treatment.
But less than 100 years after that breakthrough, antibiotics are losing their lifesaving effectiveness. Their overuse has allowed bacteria to evolve so that they are almost impervious to the drugs. That has led to the rise of “superbugs”—which include methicillin-resistant staphylococcus aureus (MRSA) and bacteria resistant to three or more types of antibiotics. And as the number of superbugs increases, the development of new antibiotics to kill them has lagged. At least 2 million Americans fall victim to antibiotic-resistant infections every year; 23,000 die. “The antibiotics we’ve relied on for decades are becoming less effective—and we risk turning back the clock to a time where simple infections killed people,” says Tom Frieden, M.D., M.P.H., director of the Centers for Disease Control and Prevention.
Over this past year, Consumer Reports has investigated the dangers of antibiotic overuse in hospitals and doctors’ offices. But nowhere are the drugs more inappropriately employed than in the meat and poultry industries. About 80 percent of the antibiotics sold in the U.S. are given to animals raised for food—including hogs, cattle, chickens, and turkeys. The most recent data from the Food and Drug Administration show that more than 32 million pounds of antibiotics were sold for use in food animals in the U.S. in 2013—up 17 percent from just four years earlier.
Recently, several meat and poultry producers, such as Tyson, and restaurant chains, like McDonald’s and Subway, have pledged to reduce the production or sale of meat or poultry from animals raised with antibiotics. “But whether such measures will end up significantly reducing antibiotic use remains to be seen,” says Gail Hansen, D.V.M., who has more than 25 years of experience in veterinary public health and infectious disease.
“In the last few years we’ve witnessed some of the bacteria most commonly found in food—germs such as salmonella and campylobacter—become increasingly resistant to some important antibiotics,” says Robert Tauxe, M.D., M.P.H., deputy director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. Those resistant strains can cause infections that are “more severe, longer lasting, and harder to treat,” Tauxe says. In fact, our calculations using data from the CDC show that about 20 percent of people sickened by an antibiotic-resistant bug don’t pick it up in the hospital or from another person—they get it from their food.
More From Consumer Reports
Read parts 1 and 2 of our series: "The Rise of Superbugs" and "How Your Hospital Can Make You Sick." Plus, check our special report "How Safe Is Your Ground Beef?" and antibiotic resistance guide.
Superbugs in Your Meat
Four years ago, Ruby Lee of Sandy, Ore., wound up fighting for her life against a superbug. She was only 10 months old when her parents rushed her to the emergency room with severe diarrhea and a high fever. “Ruby was so sick the first five days that she barely moved,” says her mother, Melissa Lee. “We were terrified of losing her.” Doctors eventually determined that Ruby’s illness was part of a salmonella Heidelberg outbreak involving ground turkey that sickened 135 other people in several states. That bacteria was resistant to several antibiotics, but luckily Ruby’s doctors found one that still worked.
Even just handling contaminated meat poses a risk. Ken Koehler, 55, always cooked his burgers to well-done. But he still got sick during a 2011 outbreak of salmonella typhimurium linked to ground beef. Public health officials told him that he may have gotten the resistant bacteria on his hands when shaping the raw meat into patties. Bedridden for weeks, the Old Orchard Beach, Maine, resident counts the experience as one of the worst of his life. Antibiotics tackled the infection, but recovery was slow. “It was a month before I could eat a full meal,” he says. “My digestive system is still not back to normal.”
Ruby and Ken’s stories aren’t isolated incidents. Information on cases like these is often incomplete, but according to data from the CDC, at least six multi-state outbreaks of food poisoning involving antibiotic-resistant bacteria have occurred since 2011. The largest one, linked to Foster Farms chicken, began in spring 2013 and continued through summer 2014, infecting 634 people in 29 states. About 40 percent were sick enough to be hospitalized—double the usual percentage in salmonella outbreaks.
“Antibiotic-resistant bacteria are all too prevalent in our meat supply,” says Urvashi Rangan, Ph.D., executive director of the Food Safety and Sustainability Center at Consumer Reports. “Multistate outbreaks get a lot of attention, but the data underestimate the total number of illnesses because there are many more that occur at the local level.” For example, this past August, pork contaminated with salmonella immune to four antibiotics sickened 152 people in Washington state. “Over the years, we’ve tested hundreds of packages of supermarket meat, poultry, and shrimp, and found multidrug-resistant bacteria in samples from every type of animal,” Rangan says.
Why Animals Are Drugged
The practice of feeding drugs to animals dates back some 70 years. Thinking it would be easier to study nutrition in “sterile” chicks, a group of researchers fed them antibiotics with the intent of wiping out their gut bacteria. The “rather unexpected result,” according to the 1946 study, was that the chicks grew faster. By 1950, researchers had discovered that when given antibiotics, animals reached market weight sooner while consuming less feed. “At the time, they didn’t know why the animals grew faster,” Gail Hansen says. “We still really don’t.” But the profit advantage seemed clear, and adding the drugs to feed became standard practice. But research from the past 15 years suggests that today, antibiotics probably don’t work well to promote growth, at least in some animals. According to Hansen, that may be because animals farmed today differ genetically from those of yesteryear or because any effect from the antibiotics declined as bacteria grew resistant to the drugs.
The other reason producers give healthy animals low doses of antibiotics is to keep them from getting sick. Under pressure from large processors, over the past few decades small to midsized farms have increasingly been replaced by industrial-scale farms and feedlots that confine thousands of animals together, according to a recent analysis of Department of Agriculture farm census data by Food & Water Watch. In such crowded conditions disease can spread rapidly.
These days farmers often have little say in how their animals are raised. “The majority of food animals now are raised under contracts with major meat-producing companies that require farmers to use feed supplied by the company that may be premixed with antibiotics,” Hansen says. “Many have no idea how much and what kind of drugs their animals get.” Most of the antibiotics given to animals are in the form of drug-laced feed or water, according to the FDA.
Why Resistance Is Risky
Antibiotics do have their place on the farm: to treat sick animals. When the drugs are used in therapeutic doses, antibiotic resistance is less likely to occur. But the low doses given to animals routinely are problematic. “The combination of frequent antibiotic use and the conditions the animals are raised in creates a hospitable environment for superbugs to develop and proliferate,” Rangan says. The drugs can kill off weaker bacteria in the animals’ digestive tracts, leaving a few hardy survivors to multiply. Those bacteria, as well as certain antibiotic residues, are excreted in manure, which is the perfect medium for antibiotic-resistant bacteria to grow. Over time, you wind up with colonies of almost indestructible superbugs. “On industrial farms, the animals are literally surrounded by their own waste,” Rangan says. So those bacteria get on the animals’ hides and skin, and can contaminate the meat we eat when the animals are slaughtered. And, Rangan says, the bacteria continue to reproduce and spread resistance to other bacteria in the animal waste and can get into our environment if the waste is not well-managed.
The problem doesn’t just lie with the bacteria that cause foodborne illness. Once resistant bacteria are in the environment, they can mingle with other bacteria and share genetic material, which could contribute to additional antibiotic-resistant infections in hospitals and communities.
What has experts most concerned is the use of antibiotics that are important in human medicine or similar to ones that are. For example, tetracyclines are used in people, but certain types are used primarily in animals. If bacteria develop resistance to the animal drugs, they may also become resistant to the human tetracyclines. When resistant infections occur, doctors have limited options to treat them. For example, the strain of salmonella that sickened Ken Koehler was resistant to nine of the 15 antibiotics the CDC tested it against while investigating the outbreak.
Animal-only antibiotics are also a concern. A group of antibiotics called ionophores that are fed to animals are not generally important in human medicine. But there is a possibility that their long-term use could lead to problems with human drugs. And their use helps make it possible to continue to raise livestock and poultry in crowded conditions, where bacteria can quickly reproduce.
Trade groups representing the meat and poultry industry mostly say that the drugs are not widely overused and that they do not put human health at risk. “An important point that’s often missing in this discussion is that antibiotics are really needed to both ensure animal health and welfare as well as food safety,” says Christine Hoang, D.V.M., assistant director of animal and public health at the American Veterinary Medical Association. Hoang says that the industry is already phasing out use of antibiotics for growth promotion and that drugs used for disease prevention are necessary. As for antibiotic resistance, she says the jury is still out. “The science that is available is unclear on how use of antibiotics in animals relates to human health and resistant infections in the community,” Hoang says. The association has gone on record as saying that the use of the drugs in food production “plays an extremely small role.” Other organizations that represent the animal agriculture industry echo that view. For example, the Animal Agriculture Alliance says that “layers of protection have been put in place to ensure that animal antibiotics don’t affect public health.”
Lance Price, Ph.D., a professor of environmental and occupational health at George Washington University in Washington, D.C., categorically disagrees. “As a microbiologist, I have dedicated my career to studying bacteria, and I know that those notions are false,” he says. “Studies dating back to the 1960s have repeatedly shown how antibiotic use in food-animal production contributes to the growing crisis of antibiotic-resistant infections in people.”
Consumer Reports’ tests show that, in general, meat and poultry from animals raised without antibiotics are less likely to harbor multidrug-resistant bacteria than meat from animals that get the drugs routinely. For example, in our most recent tests, we found that ground beef from conventionally raised cows was twice as likely as that from cows raised without antibiotics to contain superbugs. “Those results suggest that farming practices can profoundly affect the safety of our food,” Rangan says.
What happens on the farm also has implications for our health overall. Research shows that resistant bacteria bred on the farm wind up reaching people in a surprising number of ways. For example, farm workers can pick up antibiotic-resistant bacteria handling animals and manure; even if the germs don’t make them sick, they can still pass them along to other people.
Disposing of the more than 700 billion pounds of manure generated by industrial farming creates a health hazard as well. Some is used as commercial fertilizer and can spread superbugs to crops and taint streams and groundwater. Studies also suggest that resistant bacteria can be picked up and transmitted by flies and spread by the wind. In one study, for example, rural Pennsylvania residents living near fields fertilized with manure from pig farms were up to 38 percent more likely to develop MRSA infections than others in their community.
In 2013, the FDA announced a voluntary plan to change the way veterinary antibiotics are labeled and sold. The plan is voluntary, the FDA says, because “it is the fastest, most efficient way to make these changes.” People need a prescription for antibiotics, but currently almost all of the drugs are available over the counter for use in food animals. By the end of 2016, though, the FDA’s plan calls for requiring a veterinarian’s approval before feeding animals antibiotics that are important in human medicine. And those drugs will no longer be labeled for use for growth promotion.
But that doesn’t mean food producers will immediately cut back on antibiotics. Under the FDA plan, they can continue to use them by saying they’re to prevent disease. “That’s a pretty big loophole,” says Laura Rogers, deputy director of the Antibiotic Resistance Action Center at George Washington University’s Milken Institute School of Public Health. “In fact, it has the potential to make the FDA plan meaningless.” What’s more, producers are free to use other drugs to promote growth.
Indeed, for certain veterinary antibiotics, label directions—the dosages used and the way they are administered—for preventing disease are the same as those for promoting growth, according to a 2014 analysis by The Pew Charitable Trusts. What that means is that “the spigot of drugs can keep flowing,” says Rogers, who at the time of the study directed Pew’s campaign on human health and industrial farming.
Government actions have been “weak baby steps,” according to Price. “Until we take a stronger stand, we’re not leading the world in protecting important antibiotics,” he says. “We are just supporting an industry trying to maximize profits at the expense of causing drug-resistant infections in people.”
Progress on Poultry
If you’ve read the headlines about companies pledging to reduce antibiotic use over the past year, you might think that the marketplace is solving the problem, even without tough regulations. Last spring, for example, McDonald’s announced that it would move toward serving chicken raised without antibiotics important to human medicine within two years, Tyson said it would phase out those drugs in chicken, and Wal-Mart called on its vast chain of suppliers to adopt guidelines for “responsible use of antibiotics.” And in the fall, Subway pledged to stop all antibiotic use, starting with poultry but expanding to other animals within 10 years. But a closer look reveals a lot of wiggle room in the way some of those pledges are phrased. “When a company says it will stop selling or producing meat or poultry with antibiotics important in human medicine, it can mean they simply switch to using other drugs like ionophores for disease prevention,” Rangan says. “That can increase our exposure to bacteria because it allows animals to continue to be raised in conditions that promote the bugs’ growth and spread.” And, she adds, claims such as “sustainable” and “responsible antibiotic use” aren’t regulated. Companies are free to define them as they see fit. “Moreover, some of these changes won’t take place for many years.”
Much of the progress in reducing antibiotic use has been in chicken, not in other animals. Certain chicken producers, including Perdue and Tyson Foods, have pledged to reduce their use of antibiotics and are already making changes. For example, Perdue says that 96 percent of its chickens are not given antibiotics used in human medicine; more than half receive no antibiotics ever. To achieve that, the company had to “relook at virtually everything,” says Bruce Stewart-Brown, D.V.M., senior vice president of food safety, quality, and live production at Perdue. Changes include constructing cleaner hatcheries, using probiotics (which may help foster the growth of healthy bacteria) in the birds, and expanding the use of vaccinations to prevent disease.
Even when it comes to chickens, though, Rogers points out that not every pledge involves eliminating all antibiotics. “When people say, ‘Good job, you’re almost there,’ I say, ‘Whoa, we’re so far from almost there,’ ” she says. “There’s been a lot of ‘me too’ on chicken, but until it’s verified to be raised without antibiotics and there is movement when it comes to turkey, pork, and beef, it’s far from time to raise the victory flag.”
“It’s good that change is taking place, but it’s moving too slowly,” Rangan says. “Ideally not only would all meat be raised without any routine antibiotics, but we also would raise animals for food differently. Crowded conditions and unsanitary practices on factory farms are a big part of what makes daily antibiotics and other drugs necessary in the first place.
Consumers as Change-Makers
The biggest driver of change, the CDC’s Tauxe says, is likely to be consumer demand: “It comes down to millions of consumers making choices every day about what food to buy and the level of safety they want for their families.”
More than one-quarter of Americans report that they are buying meat and poultry raised without antibiotics more often than they did a year ago, according to a nationally representative survey of 1,008 adults from the Consumer Reports National Research Center in September 2015. Almost half said that they check products for a “no antibiotics” claim.
And it is becoming easier to find those products. The percentage of labels on meat and poultry packaging with claims about animals raised without antibiotics more than doubled between 2011 and 2014, according to a recent report from the market research firm Mintel. Meat and poultry sold at Whole Foods, for example, never comes from animals treated with antibiotics, but Consumer Reports’ shoppers have also found a wide selection of no-antibiotic products at chains across the U.S., including Giant, Hannaford, Publix, QFC, Ralphs, and Trader Joe’s.
But consumers don’t always know what they’re buying in their quest for no-antibiotic meat. “We also see quite a bit of confusion about what claims mean,” says Julia Gallo-Torres, a senior analyst at Mintel. The report found that one of the top factors people consider, for example, is whether a product is “all natural.” But that claim doesn’t indicate anything about how an animal is raised or whether drugs are used. Two reliable claims to look for: “organic” and “no antibiotics administered.”
Some argue that changing current farming practices to make antibiotics unnecessary would make meat prohibitively expensive for the average consumer to buy. But that assumption is not always true. A 1999 report from the National Research Council (the most recent data available) found that if all routine use of antibiotics were eliminated, the cost to consumers would be about $10 per year—around $14 in today’s dollars.
Farms in the U.S. and around the world are proving that it’s possible to raise all types of livestock without the excessive use of drugs. For example, Niman Ranch, one of the largest suppliers of sustainable meat in the U.S., eschews factory farming. Instead it relies on a network of more than 700 family ranchers and farmers that supply the company with meat raised according to its strict standards, which include never using antibiotics. “If your animals are living in a healthy environment—they are given enough space and not stressed—and you vaccinate them against routine diseases, then antibiotics aren’t needed,” says Paul Willis, a hog farmer who was one of the founders of Niman Ranch. Willis says that sick animals would still be treated with antibiotics, but their meat could not be sold under the Niman Ranch label. But he says that rarely happens. “We take care of our animals,” Willis says. “I haven’t had a really sick pig that needed antibiotics for years.”
Scandinavian countries are modeling how it can work on a large scale. For example, Denmark stopped the use of antibiotics for growth promotion in broiler chickens and pigs about 15 years ago without harming the animals’ health or the farmers’ incomes. And in 2009, the Netherlands, one of the world’s largest meat exporters, set a goal of halving the amount of antibiotics farmers use in four years; it met that goal a year early.
“Europe has no more disease in livestock than we have here. They haven’t seen a difference in animal growth,” Hansen adds. “That experience proves that it is possible to maintain a thriving agriculture industry using far less drugs.”
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