Badger Drugs!

Let me just throw this out there to get the ball rolling. I wrote it two years ago. I'm gonna copy and paste. It's not well written. It needs to be updated, and I'm working on that.

Antibiotic resistance is going down, not up

By Shaun Evertson

Western Harvest, May, 2014

Readers may be wondering if that headline is a typo or misprint. It’s not. According to the CDC, in 2005, 190,320 cases of antibiotic resistance were reported in the U.S., causing 29,940 deaths. In 2011 (the most recent year for which data are available), the number of reported cases of antibiotic resistance had fallen to 163,406, with 19,480 associated deaths.

Simple subtraction shows that the number of cases/year has fallen by 26,914 and the number of deaths/year by 10,460 over seven years. The morbidity of antibiotic resistant infection – that is, the percentage of the entire population affected – have gone down even more than the absolute numbers imply, for the total population has grown. In 2005 there were 295 million Americans, in 2011 there were 312 million.

These facts are most certainly not being reported as part of the antibiotic resistance story. Newspapers, television and radio news programs, and an exhaustive list of government agencies consistently, authoritatively and confidently report that antibiotic resistance is a growing epidemic, and that antibiotic resistant superbugs are an existential threat to humanity.

The stories, fact sheets and fact sound-bites which are most commonly (and almost exclusively) reported are false. The story most commonly told is in fact the opposite of reality. Government agencies and the media report a growing epidemic, while the facts reveal extraordinary success in treating and reducing the effects of antibiotic resistance. The data collected by the very agencies reporting the so-called crisis do not support the assertions they make. The mismatch between the data and the commonly reported story is striking.

The Centers for Disease Control (CDC), the Food And Drug Administration (FDA), the United States Department of Agriculture (USDA), the White House, both Houses of congress, and every state and local health department and agency are quite busy reporting on the superbug/resistance epidemic. Every single newspaper and news organization in the land is reporting on the superbug/resistance epidemic. Even NASA, the National Weather Service, and the Bureau of Land Management are reporting on the superbug/resistance epidemic.

Most of the reports say something like this: “Antibiotic resistance is one of the world’s most pressing public health problems. The overuse of antibiotics in food animals and the over-prescription of antibiotics in humans has caused the development of antibiotic resistant superbugs which no longer respond to traditional methods of treatment. Antibiotic resistance is now an epidemic.  In the U.S. alone, 23,000 people die each year from superbug infections. If this epidemic is not controlled immediately, antibiotics will soon no longer work and humanity will face unprecedented death and destruction.”

Let’s deconstruct that statement. As to the first sentence, an assertion is made but is not supported by any facts or data. Of the hundreds of similar news stories and dozens of fact sheets read in preparing this story, no data or cited data were found which support the assertion.

In the second sentence, the assertion is that over-prescription of antibiotics is forcing pathogens to evolve into resistant strains. Again, there is no data cited or presented in support of the assertion. Nor are readers likely to find such data in extant news reports or fact sheets. The assertion is based upon the hypothesis that when pathogens are exposed to antibiotics, the weak gems die but the strong germs survive and develop resistance. This is one of the tenets of evolution, and it’s a very intriguing theory. However, when it comes to the development of antibiotic resistance, the numbers do not provide any proof that the theory is true. In fact, those numbers provide good evidence that the antibiotic-exposure-leads-to-antibiotic-resistance theory is unsound.

The third sentence is a bold assertion with no proof. There simply is no superbug epidemic, and the number of antibiotic resistant cases is going down, not up.

The fourth sentence asserts that 23,000 Americans die from superbug infections each year. This oft-repeated number is inflated. There were in fact about 19,500 deaths in 2011. What the assertion does not explain, however, is that in 2005 that number was nearly 30,000. Both deaths and infection rates from these so-called superbugs have been going down each and every year.

The final sentence is not supported by evidence.

The pseudoscience of over-prescription

Leaving aside the question of why, the fact is that government and the media are reporting the opposite of what is actually happening. What makes the reports seem reasonable at first glance is that they are embellished with pseudoscientific jargon which seems like it might be reasonable. In addition, readers tend to believe information from government and media sources. Readers have a hard time imagining that such sources would willfully mislead them.

One example of pseudoscientific jargon is the assertion that exposure to antibiotics is forcing all pathogens to evolve into resistant strains. This assertion sounds good because it is generally in line with the theory of evolution. But evolution is more complex than simple “survival of the fittest.” Exposure to antibiotics does appear to have caused some pathogens to develop resistance, but it has not caused all – or even most – pathogens to do so. The vast majority of disease causing bacteria still respond to first generation antibiotics such as penicillin, sulfa, and tetracycline. Fewer than one percent are completely resistant to first generation antibiotics.

The reader may ask, “Why then does my doctor give me a more sophisticated antibiotic?” Fair question. Today’s new formulations (such as the Z-Pac) are easier to take and are effective against multiple pathogens. It makes sense to use them. But that does not mean that the pathogens being treated are resistant to the older generations of antibiotics.

If the pseudoscientific “survival of the fittest” theory was actually in effect here, then after more than 70 years of antibiotic use and untold trillions of generations of bacterial evolution, no earthly pathogenic bacteria would today be susceptible to first generation antibiotics. In reality, more than 99 percent of pathogens remain susceptible.

The theory and the assertion that over-prescription of antibiotics is causing an epidemic of antibiotic resistance is simply not supported by the evidence.

Given the facts, the assertion that antibiotic resistance is a major public health problem is simply absurd. We’re doing an outstanding job at addressing disease caused by resistant pathogens. That should be the major story. Why is it not?

The pseudoscience of overuse in livestock production

The assertion that overuse of antibiotics in livestock production is causing the development of antibiotic resistance and superbugs is largely based on the same evolutionary forcing hypothesis. As with the over-prescription theory, the evidence does not support that assertion. As in humans, the vast majority of livestock pathogens continue to respond to first generation antibiotics. Newer antibiotic formulations are used for the same reason they are used in humans – they are easier to employ and they treat more diseases.

Furthermore, although some diseases and pathogens affecting livestock are the same pathogens and diseases that affect humans, the vast majority are different. Likewise, while some antibiotics are used in both livestock and humans, the vast majority of animal antibiotics are not used in humans and vice-versa.

There are other factors cited in the livestock-causation theory. One is the use of growth promoting antimicrobials. The theory claims that such antimicrobials apply the same pressure as antibiotics and thus force pathogens to evolve into resistant strains. The evidence, however, disproves this assertion. The rates of antibiotic resistance in livestock pathogens are no different than in humans. Antibiotics are simply not forcing evolutionary development of resistance.

Another assertion is that because of “horizontal gene transfer” between bacterial species, antibiotic resistance can be passed from bacterial species to bacterial species without being evolutionarily forced by exposure to antibiotics. Again, this seems like a sound theory at first glance, however, there is simply no evidence to support the hypothesis. While it’s possible that horizontal transfer could, in theory, increase antibiotic resistance, after more than 70 years of use there should be evidence that his has occurred. Such evidence is simply not there.

An example of misinformation

One of the most widely repeated assertions regarding the livestock-caused theory holds that antibiotic use in livestock is causing an increase in MRSA, or methicillin-resistant Staphylococcus aureus. This is the widely-reported “flesh eating bacteria” most readers have heard a lot about.

MRSA is most often contracted in hospitals or medical clinics. In 2011, of the 80,461 cases reported, 63,901 were contracted in the medical arena and 16,560 in the non-medical arena.

Television reporter Katie Couric insisted in a 2010 report that new strains of  MRSA were showing up in hogs and workers on farms in Iowa and Illinois where antibiotics were used. On farms where no antibiotics were used, Couric claimed, no new MRSA strains were discovered.

Dr. H. Scott Hurd, then an Associate Professor of Veterinary Diagnostic and Production Animal Medicine at Iowa State University (who, sadly, passed away in March), responded almost immediately to Couric’s claims.

Hurd noted that the hogs which tested positive for MRSA were not diseased (did not have MRSA infections), but had rather been contaminated by workers who acquired MRSA infections from other humans. Hurd added that the assertion that antibiotic use in hogs was forcing new strains of MRSA to develop was completely misleading. Since hogs are not treated with methicillin, and methicillin has never been used to treat livestock in the U.S., exposure to methicillin could hardly be prompting resistance in these cases.

Couric asserted that “Drug resistant infections have sky-rocketed over the past two decades, killing an estimated 70,000 Americans last year alone. Antibiotic resistance is an emerging health crisis that scientists say is caused not only by the overuse of antibiotics in humans, but in livestock as well.”

Hurd noted that “The drug-resistant infections referred to here have little-to-no relationship to any antibiotic use in animal agriculture…according to the FDA, resistance in food-borne illness is stable to declining over the last several years.”

As we’ve shown previously, Couric overstated the number of deaths (by 50,000) caused by antibiotic resistant infections, and reported that infection rates were “skyrocketing” despite the fact that she had every reason to know that just the opposite was happening.

Couric went on to claim that “the bottom line on antibiotic use is this: no one is really monitoring it.”

To which Hurd replied, “The U.S. Food and Drug Administration (FDA) regulates antibiotic use in both humans and animals. The FDA inspects the feed mills that produce medicated feed. The agency also evaluates the safety of antibiotics used in animals for human safety. And, the FDA works with the USDA to conduct tests in processing facilities to make sure those regulations for antibiotic use are followed. It’s clearly a highly regulated practice.”

Likewise, in a 2011 report the Pew Commission on Industrial Farm Animal Production (PCIFAP) asserted that “nearly half” (47 percent) of samples collected from supermarket meat and poultry were contaminated with Staphylococcus aureus, and that 52 percent of those bacteria were resistant to at least three classes of antibiotics. Furthermore, they reported that DNA testing indicated food animals “as the major source” of the contamination.

As it turned out, PCIFAP was fibbing about the source of the contamination. According to Drs. Elizabeth Wagstrom and Peter Davies of the University of Minnesota College of Veterinary Population Medicine, the MRSA strains found in the study were human types. The meat was contaminated by workers in the supply chain or by consumers in the supermarkets.

Moreover, according to Dr. Ellin Doyle of the University of Wisconsin's Food Research Institute, Staphylococcus aureus is found in over half of human nasal passages. The incidence of MRSA is much lower – estimates by CDC indicate that only about 1.5 percent of people in the general population carry MRSA. Doyle added that only two foodborne outbreaks of MRSA have been identified, and both were attributed to food handlers contaminating food – not to the food source itself.

Ongoing misinformation

A close reading of news stories and fact sheets claiming an ongoing epidemic of antibiotic resistance reveals several troubling problems with such reporting. Firstly, actual data is rarely cited. When data is cited, close reading of the cited data will show that it does not in fact support the assertions made. Secondly, experts quoted in such stories and fact sheets give opinions about their “fears” of “what might happen,” but they never cite verifiable data, nor do they ever make a factual-based argument which shows that antibiotic resistance is a worsening epidemic.

Such stories argue mightily that something awful is happening. However, no real-world facts, data or evidence are ever produced in support of the argument. Arguments and evidence given in support of the epidemic thesis are invariably irrational, invented, incomplete, and/or out of context.

The misreporting on antibiotic resistance does nothing educate or inform the public. Such misreporting almost certainly causes harm through promoting fear.

Antibiotics are a vital tool in combating disease. They allow humans to survive diseases which were, in many cases, nearly universally fatal less than a century ago. The treatment of infectious disease is today better than it has ever been. The complete and unvarnished story of disease and antibiotic use in America clearly shows that modern medicine is constantly improving. Antibiotics are becoming more effective, and disease is becoming less prevalent.

Those supporting the antibiotic resistance epidemic thesis argue that in animal and human medicine, over-prescription of antibiotics is causing an increase in the development of antibiotic resistant disease pathogens. They cannot, however, support that argument with facts. The morbidity and mortality numbers for disease caused by antibiotic resistance are trending sharply down, and no amount of pseudoscientific posturing can change that fact.