- Because the vast majority of the roughly 30,000 people
who took Cipro in the anthrax scare were treating fear rather than
exposure,
the effectiveness of the bestselling drug was undermined even as its sales
were skyrocketing. The more people who don't have bacterial infections
take antibiotics, the less effective the drugs are when treating real
problems,
including TB, pneumonia, and bad colds.
-
- Strangely enough, being partner to human overuse is not
the only way Cipro-maker Bayer is at once reaping benefits from antibiotics
and eroding their power. Bayer's drug Baytril--a super-antibiotic virtually
identical to Cipro that is fed to more than 128 million chickens each
year--is
so clearly responsible for hundreds of Cipro-resistant infections in humans
that the Food and Drug Administration has begun the process of withdrawing
its approval.
-
- Shortly after the FDA started its effort to ban potent,
Cipro-like poultry pharmaceuticals last year, Abbott Laboratories
voluntarily
withdrew SaraFlox, Baytril's only competitor. Bayer instead appealed the
agency's move, fighting to keep selling a drug that treats chicken
respiratory
infections--and pulls in an estimated $150 million worldwide each year.
Cipro dominates the human antibiotic market, but Baytril is the market
for chicken super-antibiotics. (In 1999 alone, 38,000 pounds of such
super-antibiotics
were fed to animals, according to the Animal Health Institute.) The FDA
is expected to decide by the end of December whether to ban Baytril
outright
or to allow Bayer a hearing to defend it.
-
- The agency bases its own case against Baytril on rising
antibiotic resistance in human cases of food poisoning from a bacteria
called campylobacter, which causes vomiting, diarrhea, and--in about 1
percent of cases--death. When such cases are extreme, Cipro is often the
treatment of choice. Though people have had access to such powerful
antibiotics
since 1987, when Cipro was approved, resistance to them "did not
increase
among campylobacter organisms until 1996 and 1997, soon after the approval
and use of these drugs in poultry," according to an FDA entry in the
federal register.
-
- When confronted with Baytril, bacteria in chicken
experience
a sort of quick, mini-evolution; while most die from the drugs, those with
genetic differences that make them invulnerable go on to reproduce--and
pass the mutations on. People can pick up these bacterial infections from
eating undercooked chicken or juice from uncooked chicken.
-
- When Baytril was approved in 1995, farmers began feeding
it to entire flocks, even if only one bird was sick. Since then, the
percentage
of drug-resistant campylobacter infections in humans has shot up from about
1 percent to almost 20 percent, with more than 9000 Cipro-resistant cases
reported in 1999 alone, according to a national database of food-borne
infections.
-
- While Baytril is used only on sick chickens and
turkeys--and
the other birds in their flocks--less powerful antibiotics are routinely
also fed to healthy animals. Indeed, 70 percent of all antibiotics in this
country are used to fatten up the profits by making commercially raised
animals bigger, according to estimates by the Union of Concerned
Scientists.
Today, virtually all of the 8 billion chickens slaughtered each year are
exposed to antibiotics at some point in their lives. (The roughly 36,000
antibiotic-free, certified-organic chickens provide the only
exception.)
-
- The dangers of the resulting antibiotic resistance are
obvious. Take the case of Baytril: Most people with chicken-borne food
poisoning won't require treatment, but for those who do, Cipro is less
and less likely to work. As a result, experts say, the number of
drug-resistant
cases of campylobacter and salmonella, another chicken-borne bacteria,
are shooting into the hundreds of thousands, while about 700 people now
die each year from these bugs.
-
- Even as the direct casualties are increasing, Tamar
Barlam,
a physician and infectious-disease specialist who directs the
antibiotic-resistance
project at the Washington-based Center for Science in the Public Interest
calls them "just the tip of the iceberg." She worries about
infections
that may develop unnoticed as other bacteria--including some that aren't
the intended target of the antibiotic--develop drug resistance.
-
- An article in the October 4 New England Journal of
Medicine
points to just that sort of silent epidemic. The study traced
drug-resistant,
urinary tract infections in women to a single strain of E. coli the authors
think was passed through infected meat. After finding the drug-resistant
infection in California, the researchers looked for it in Minnesota and
Michigan. "They found it in each of the states they
investigated,"
says Barlam. "And I truly believe the more we look the more we're
going to find."
-
- Nevertheless, agricultural trade groups defend the
widespread
use of antibiotics in healthy chickens. "It improves the gut health
of the bird and its conversion of feed, what we call the feed efficiency
ratio," says Richard L. Lobb, spokesperson for the National Chicken
Council. Without drugs, poultry producers say, chicken prices would go
up. As for Baytril, Lobb argues that a connection between the drug and
antibiotic-resistant infections in humans hasn't yet been proven. Lobb
also supports the industrywide practice of putting Baytril in an entire
flock's food and water, saying, "It's useless to try to treat a single
bird."
-
- Bayer did not comment, but its press release about
Baytril
states that the number of campylobacter infections attributed to eating
chicken has been overestimated and that "there is no evidence that
withdrawal of the product would . . . have a meaningful impact on resistant
campylobacter infections in humans."
-
- As Lobb sees it, antibiotics make chickens and turkeys
healthier all around. "And if we are what we eat, we're healthier
if they're healthier."
-
- Many advocates are arguing just the opposite, of course,
decrying the drugs that permeate the entire meat industry. In a recent
study by the federal Center for Veterinary Medicine, researchers found
that one in five packages of supermarket meat and poultry was infected
with microbes, and 84 percent of the bugs were resistant to at least one
antibiotic. Most were resistant to several.
-
- The recent threats of bioterrorism have turned this wave
of ever bolder microbes from a scientific curiosity into a real public
health threat. Anthrax has yet to become resistant to Cipro, but other
bacteria have been foiling antibiotics for decades. These drugs, which
have vastly increased the safety of everything from surgery to childbirth,
may no longer work the way we want them to. And in the wake of September
11, there are untold ways we really may need them.
-
- The Centers for Disease Control and Prevention has
renewed
its focus on sloppy medicine--like using antibiotics, which kill bacteria,
to treat viral infections--which it says accounts for fully one-third of
the 150 million prescriptions written for antibiotics each year. And big,
mainstream groups including the American Medical Association and the World
Health Organization have joined in the call to stop the use of antibiotics
in healthy farm animals.
-
- If Baytril is forced off the market, the ban could mark
the end of the shortsightedness that's made antibiotics a staple of chicken
at the expense of people. "Why the hell aren't we giving a lot more
careful thought to using critical human drugs in animals in the first
place?"
asks David Wallinga, a physician who directs the antibiotic-resistance
project for the Institute for Agriculture and Trade Policy, an advocacy
group based in Minneapolis. "We know that once these drugs lose their
effectiveness, we're out of luck."
-
- Click here for a list of New York restaurants that serve
antiobiotic-free meat and a list of organic poultry producers.
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