“When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I guess that was exactly what I did.” These were the words of Dr. Alexander Fleming, the man who ushered in the age of antibiotics. In doing so, he revolutionized the field of modern medicine. Now, not even a century after Fleming’s discovery, medicine is approaching the end of the antibiotic era.
Penicillin and other antibiotics have saved countless lives. The discovery of antibiotics has enabled doctors to treat previously fatal infections without complications, and many of us have experienced the wonders of antibiotics ourselves. Antibiotics are used to treat common bacterial infections, such as strep throat, and is also used to prevent infection in various surgical procedures. But the drugs upon which we have relied for so long are losing their efficacy due to the rise of antimicrobial resistance (AMR)—a threat fueled by the overuse of antibiotics in medicine and, most significantly, in agriculture. This microscopic threat is not as salient as global terrorism or as heavily debated as recent elections, but it is unmatched as a threat to American health. A report commissioned by the former prime minister of the UK, David Cameron, found that the annual death toll of AMR could reach ten million by 2050 – greater than that cancer today. The same report revealed that AMR causes around 700,000 deaths globally each year; it is clear that this is not merely an issue for future generations to be concerned with. Nor will national borders provide protection against the growing threat; America is not exempt from the impacts AMR will have on public health. The Centers for Disease Control and Prevention (CDC) estimates that two million Americans are infected by resistant bacteria each year, around 23,000 of them perishing as a direct result.
In some cases, resistance merely means that drugs are less effective than usual, but sometimes it causes them to fail completely. Last month, a report revealed the story of a Nevada woman who had died of an infection resistant to all 26 kinds of antibiotics available to doctors in America. The woman had broken her leg on vacation, and when the infection spread to her hip, doctors tried one antibiotic after another without effect.
The problem of antimicrobial resistance also has economic roots. One aspect of this issue is the lack of new antibiotics on the market. Since the discovery of penicillin in 1928, pharmaceutical companies have attempted to invent new drugs faster than resistance evolves. However, in recent decades, the pipeline of new antibiotics has been drying up. This is because there is little economic incentive for companies to develop new antibiotics rather than other types of drugs, as antibiotics are used only once by each consumer as needed.
A far more pressing issue is the overuse of the drugs we already have. When drugs are used to kill bacteria, natural selection occurs among bacteria populations. Just as Darwin’s Galapagos Island finches evolved beaks suited to their food sources, bacteria will survive and reproduce until the most resistant strains are the most prevalent. For this reason, there is a clear relationship between use of antibiotics and the emergence of resistant bacteria. Reducing the use of antibiotics is crucial in assuaging this impending public health crisis. Too often, physicians prescribe antibiotics when they are not required. Antibiotics fight bacteria, not viruses (like the common cold) for which doctors frequently prescribe them. Regardless of which ailments antibiotics are used to fight, their overuse leads bacteria to develop resistance to the drugs.
Even if the medical community moves to reduce the excessive prescription of antibiotics, there will still be cause for concern. The overuse of antibiotics in agriculture is a more pressing issue for its magnitude: 70% of the medically important antibiotics sold in the U.S. are used on livestock, not on humans. Antibiotics can be used to treat sick animals, but often they are used on animals that are not even sick. This is done to make them grow faster or to prevent diseases that can be common in unsanitary, crowded conditions. Antibiotic use in agriculture is concerning because resistant bacteria can spread easily from animal to human. Antibiotics cannot be preserved for future generations unless the reckless use of the medicine is stopped.
The most obvious solution would appear to be to regulate the use of antibiotics. Unfortunately, national initiatives have thus far been underwhelming. FDA guidelines that took full effect on January 1st prohibit the use of antibiotics for growth promotion but allow for their use in disease prevention in otherwise healthy animals. This sounds reasonable, but data on the effects of similar regulation in Europe suggest this distinction allows farms to circumvent regulations and continue in their misuse of antibiotics for purposes other than disease treatment. If the FDA intend to pursue their stated goal of “assuring the safety, efficacy, and security of human and veterinary drugs,” stricter regulations are long overdue.
Despite the FDA’s insufficient action, some states have shown promise with recent legislative strides towards solving the problem. In 2015, California passed a statewide bill that goes beyond the FDA’s lackluster national restrictions. The bill only allows for the use of medically important antibiotics in cases when animals are sick, or for preventive use in instances of “elevated risk.” Maryland has also introduced a similar bill pushing in the same direction as California.
While these are important steps in the right direction, there is more to do. To prevent this impending health crisis, the market for meat production must shift away from the routine use of antibiotics. This lies in the hands of the consumers, who vote with the dollars they spend and have the power to move the marketplace. Increased public awareness has already had a positive effect on the food industry. Major restaurant chains like Panera Bread and Chipotle have led the way, while Subway and McDonald’s have followed suit with promising initiatives last year. Tyson Foods and Perdue, two of the country’s largest meat producers, have also agreed to cut back on the use of ‘medically important’ antibiotics.
These companies should be lauded for their commitments while being held accountable to their promises. In the meantime, it is equally important that other chains are urged to make similar commitments to the conservation of public health. If a chain like Kentucky Fried Chicken, the world’s largest chain of fried chicken-selling restaurants, would commit to an ambitious policy on antibiotics, it would be a significant stride towards preserving the efficacy of crucial medicine.
“When major chains make serious commitments to stop the overuse of antibiotics the benefit is two-fold,” Matthew Wellington, Field Director of the U.S. Public Research Interest Group’s Antibiotic Program, told The Politic. “The marketplace shifts change the way the industry uses these life-saving medicines, and also build momentum toward a strong policy solution at the federal level.”
After discovering penicillin, Fleming said: “The thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted.” Despite his warning, society is approaching this evil at an alarming rate. Antimicrobial resistance already counts its casualties by the hundreds of thousands and, if current trends continue, the medical field will soon find itself without a fundamental tool required for everyday procedures. The threat may be formidable, but the milestones necessary to avert catastrophe are reachable. Immediate action by legislators and consumers alike, done correctly, has the potential to curb the rise of antimicrobial resistance.