June 8, 2015

CLF Week in Links: Free Lunch, Ag-Gag, White House on Drugs

Robert Lawrence, MD

Robert Lawrence, MD

Director Emeritus

Johns Hopkins Center for a Livable Future

school lunchFree food for Baltimore students. I’ll start off this post with some nice news: as of one week ago, June 1, all Baltimore City students may eat breakfast and lunch for free. While the majority of City students are already enrolled in the free-and-reduced-meals program, and breakfast is already provided free for all, this move by the school system is important for a couple of reasons: (1) it reduces stigma and bureaucracy by no longer requiring that students enter a PIN number when they want a free lunch, and (2) it reduces the burden on low-income families to provide the paperwork necessary to be declared eligible for free or reduced meals. This effort is being done in conjunction with the USDA. And while I’m talking about free breakfast, which is a national program, I’d like to give a nod to the Black Panther Party for its dedication to inner city school children: the Black Panthers spearheaded free breakfast programs 45 years ago in Oakland, California, at a time when I, as young physician just finished with my training, was engaged in a project in rural North Carolina funded by the Office of Economic Opportunity (OEO), part of Lyndon Johnson’s “war on poverty.” The Nixon administration was beginning to dismantle OEO, but through some effective political maneuvering, the Democratic congress was able to transfer the health centers program to HRSA (Health Resources Service Administration) within the Department of Health and Human Services. Federally funded community health centers are alive and well today and serving many of our poorest neighbors.

Jillian in Jeju. We were fortunate to have one of our project directors, Jillian Fry, attend the World Aquaculture Society Conference in Jeju, South Korea. The conference’s audience is primarily composed of entrepreneurs seeking to expand the aquaculture industry. Jillian offered these business leaders a public health perspective on aquaculture, which you can read about in her blogpost.

A new low for North Carolina. A couple of weeks ago I wrote about what was going on with the ag-gag bill in the North Carolina legislature. Both the house and senate had passed the ag-gag bill, and then on May 29, Governor McCrory vetoed the bill, saying that if passed, it would not adequately protect or give clear guidance to honest employees who uncover criminal activity. In return, the legislature voted to override the governor’s veto; now the ag-gag bill will become law, turning whistleblowers into criminals. Here’s the story. As noted above, North Carolina was the place where my post-training professional life began so I feel a special sense of disappointment and outrage at the collective stupidity of the majority party in the house and senate.

Summit on antibiotic use. Last week the White House held a summit to endorse the responsible use of antibiotics (story here). Reuters reports that “Among the topics under discussion [was] developing guidelines and recommendations to control the overuse of antibiotics in hospitals and curtail their use in food animals.” Food Safety News reports on the 8 steps outlined in the forum. One of those steps is the development of animal-only antibiotics, which might sound like a good idea, but given what we now know about the “resistome,” that effort might be more of a fool’s errand than sound science. The resistome refers to the fact that resistance genes occurring through spontaneous mutations can confer resistance to different classes of antibiotics, and bacteria have several methods of swapping genes between different species of bacteria. So, an animal-only antibiotic might create a favorable ecologic niche for bacteria with a mutant gene conferring resistance to the animal-only antibiotic but this mutant gene might also convey resistance to a different class of antibiotics important in human medicine. What is needed – and what scientists, farmers, and policymakers in Holland and Denmark agreed on years ago – is to eliminate the use of low-dose antibiotics for disease prevention.

FDA and drugs. Right around the same time as the White House summit, FDA’s Mike Taylor announced that a new rule will require veterinarians to play a bigger, more judicious role in deciding which animals may receive antibiotics. His announcement also said that the agency will push to obtain data that goes beyond drug sales and distribution data, advocating for more information about drug use in species, dosage levels and duration. Here’s the announcement. The current reporting of gross sales is insufficient for epidemiologists and others to study the dynamics of how much of which antibiotic is administered to what species of food animal leading to what problems of antibiotic resistance. Only with this more detailed data will it be possible to have an adequate surveillance system to identify the hot spots in the epidemic of industrial food animal production induced antibiotic resistance in pathogens of importance to both animal and human health.

Foster Farms follow suit. Like so many other poultry producers of late, Foster Farms recently announced that it will reduce its use of antibiotic use in chicken production. At the risk of sounding like a broken record, I will say what I said about this move when announced by similar companies: reducing and even eliminating the use of antibiotics important to human health is a fine thing, but it is not enough to eliminate the misuse of “human” antibiotics. The misuse of antibiotics that are used in animals only can contribute to antibiotic resistance among classes of drugs used in humans. I wish it weren’t so, but it is. As noted above the use of low-dose antibiotics of any type for growth promotion or disease prevention allows resistance genes occurring through spontaneous mutations to flourish. And these resistance genes can be swapped between different species of bacteria, including species that cause human disease.

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