Jolley: Five Minutes with EWG and the invasion of superbugs

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If you’ve ever driven across Kansas or ventured very far to the East of Oakland, Calif., you’ve seen those giant wind farms; acres and acres of huge wind turbines cranking out gigawatts of electricity when the wind blows.  The hills near the Inland Empire and the flatlands of central Kansas rarely lack for a freshening breeze. 

DawnDawn Undurraga Imagine the accumulated meadow muffins from all the cattle in Texas being tossed against those fan blades.  Now you have some idea of the controversy created recently by the publication of Superbugs Invade American Supermarkets, a ‘scholarly’ treatise by the Environmental Working Group and partially funded by Applegate, a company that sells organic and antibiotic-free meat.  It was based on data collected in 2011 by the National Antimicrobial Resistance Monitoring System (NARMS), a joint program of the Food and Drug Administration, the United States Department of Agriculture and the Centers for Disease Control and Prevention. It shows an increase in the amount of meat contaminated with antibiotic-resistant forms of bacteria like salmonella, E. coli and campylobacter.

To accurately report the contents of the NARMS report, I contacted Richard Raymond, former Undersecretary for Food Safety, U.S. Department of Agriculture (2005-2008) and a food safety and public health consultant. He supplied me with these facts:

  • Ampicillin resistance in Salmonella is increasing
  • Ciprofloxacin resistance is down from 29% to 18% since FDA banned its use in 2005
  • Resistance to Vancomycin or Linezolid in enterococci was not found
  • Nalidixic Acid (a Quinolone) resistance in E coli dropped from 10% to 1% in ground turkey
  • Macrolide resistance in Campylobacter remained low at 4.3% for C coli and 0.5% for C jejuni
  • No samples of E coli showed resistance to Ciprofloxacin
  • Multi-drug resistance (MDR) increased in Salmonella while remaining very rare in Campylobacter

“Superbugs” caused eyebrows to pop at the Food and Drug Administration’s Washington office.  Alarm bells sounded at every FDA office across the land.  FDA officials, often accused of watching Alaskan glaciers thunder by as they hem and haw over every little word in the shortest press release, responded immediately.

The FDA could find almost nothing in Superbugs that was supported by anything they had published.  The gentle wording they chose said something like EWG had ‘over simplified’ a 2011 report.

In fact, the New York Times published a story shortly after Superbugs was released, quoting an unimpressed Dr. Randall Singer, Professor of Veterinary Science at the University of Minnesota. “The No. 1 misunderstanding about antibiotics in animal agriculture is that it is not understood well enough that antibiotics are used to keep animals healthy, period,” he said.

He noted sample size in the federal data, 480 samples each of ground turkey, pork chops, ground beef, chicken breasts, wings and thighs might be a little short of achieving statistical significance.

“We should not assume that when we find resistance to antibiotics in humans, it means it was caused by the use of antibiotics in animals,” was his parting comment.

So, in the interest of clearing the debris from those rotating California and Kansas fans, I contacted EWG and asked a few questions.  I contacted Sara Sciammacco, Environmental Working Group’s Director of Communications.  She agreed to the interview and asked Dawn Undurraga, the Superbug author, to reply to my questions.

Q. First, let’s talk about the Environmental Working Group. Who are you and what do you do?

A. Here’s our mission statement: “The Environmental Working Group is the nation’s leading environmental health research and advocacy organization. Our mission is to serve as a watchdog to see that Americans get straight facts, unfiltered and unspun, so they can make healthier choices and enjoy a cleaner environment. We use the power of information to create cutting-edge research and advocacy that transform government policies and the marketplace in order to conserve land and water, produce and use energy responsibly and ensure that food and consumer products are free of harmful chemicals. We investigate government subsidies that encourage wasteful practices, and we support policies that promote thoughtful stewardship of our land and natural resources.”

The lead author of Superbugs Invade American Supermarkets is Dawn Undurraga, MS, RD, nutritionist and registered dietitian (who also supplied the answers to these questions). Johanna Congleton, PhD, senior scientist, helped conduct the analysis, in consultation with Renee Sharp, MS, the director of research. Agricultural policy experts Brett Lorenzen, JD, from EWG’s Iowa office, and Kari Hamerschlag, MS, California office, served as content reviewers.

Q. You published Superbugs last week. The usual careful and slow-to-respond Food and Drug Administration quickly published a statement criticizing your report. The FDA accused you of oversimplifying the data from their 2011 Retail Meat Report, a joint project which included the Centers for Disease Control and Prevention and U.S. Department of Agriculture. Some people thought the headline bordered on sensationalism; others within the industry agreed that your report made statements not supported by the study. Just how prevalent and dangerous do you consider those ‘superbugs’ to be?

A. Anyone who regularly works with food animals or eats meat should take these antibiotic-resistant trends seriously. Workers are the canary in the coalmine—and are the first to contract dangerous infections, like multidrug resistant staph, that are hard to treat.

Consumers have the right to know that the percentages of antibiotic-resistant bacteria are on the rise. The percentage of Salmonella found in chicken is at a nine-year high. And the percentages of multi-drug-resistant Salmonella in chicken and turkey are up from a low of 20% in 2002 to more than 45% in 2011. Federal scientists routinely find Salmonella resistant to 6 or more antibiotic classes on chicken and turkey. That should be “superbug enough” even for the FDA.

Those same scientists found that 26 percent of chicken contained an antibiotic-resistant form of Campylobacter. That’s “prevalent” enough for me. Also on chicken, the percentage of Campylobacter resistant to two or more antibiotic classes is at a nine-year high.

This week the federal Centers for Disease Control and Prevention said that Campylobacter infections are on the rise, up 14 percent between the 2006-2008 period and 2011. EWG doesn’t think the FDA should wait until people are gravely ill with superbug infections to raise the alarm on this issue. Antibiotic-resistant bacteria readily share traits that allow them to defeat antibiotics. The development and spread of antibiotic resistance traits pose veryreal dangers to all of us.

Q. Most experts agree that some bacteria have a natural resistance to a few of the antibiotics and the normal course of treatment requires that the cause of an infection be determined and the appropriate antibiotic be selected. The FDA says it’s wrong to claim that pathogens resistant to one, or even a few, antimicrobials should be called “superbugs,” especially if they’re treatable by other commonly used antibiotics. Shouldn’t the alarm be sounded only after a certain strain of bacteria show newfound resistance and is that happening?

A. The FDA insists that only pathogens that are untreatable (or nearly so) should be called superbugs. But EWG believes that the development of resistance, even to only one antibiotic, is significant. It is well established that genes that confer the trait of antibiotic resistance readily transfer from one bacterium to others, that bacteria that develop resistance to one antibiotic can often withstand others, and that people can be allergic to entire classes of antibiotics, further limiting their options for treatment of infections.

It’s worth noting that FDA’s scientists screened out “natural resistance” patterns from the results. It is true that bacteria are showing newfound resistance. In 2011, for the first time, federal scientists looked for Salmonella resistance to azithromycin and found it. In addition, scientists found statistically significant upward trends in Salmonella resistance in chicken for amoxicillin/clavulanic acid, ceftiofur, ceftriaxone, sulfisoxazole, ampicillin, and tetracycline. All of these, except ceftiofur are also used to treat infections in humans.

Q. The loudest alarms seem to be sounding about the use of antibiotics in cattle and other livestock. With much of the medicines being used in agriculture different than those used for human health, do we really have a serious problem? And if so, how do you propose we treat illnesses in livestock?

A. With respect to treating sick animals, EWG’s position is, and always has been, that any animal deemed sick after examination by a veterinarian should be given whatever drugs the veterinarian determines are appropriate and safe. The use of individually-administered treatments is not, and has never been, a concern.

Our concern is driven by the use of antibiotics in feed and other herd-wide applications that do not involve treating animals individually. The vast majority of antibiotics used in animal agriculture are distributed in food and water – for the purposes of helping the animals endure the cramped conditions of modern factory farms, and as a growth promoter. Neither of these is a legitimate, or justifiable, use in our view.

Resistance to one drug can result in increased resistance to other drugs as well. In 1990, U.S. health agencies noted almost no human resistance to Cipro, the antibiotic used to treat Campylobacter in people. In 1996, the FDA approved the use of an antibiotic very close in design to Cipro, but considered distinct, in poultry feed. By 2001 Cipro resistance in human campylobacter cases had risen to 1 in every 5 cases.

Q. You stated that “Federal scientists routinely test for and find Salmonella resistant to six or more antimicrobial classes in poultry. We think the public deserves to know that antibiotic-resistant bacteria are in its meat now, and that the resistance in Salmonella in poultry is also at a nine-year high.”

Would you expand on that statement? What are the Salmonella strains and what are the antimicrobial classes?

A. I’m not sure the first thing that goes through people’s minds when they contract Salmonella is, “What strain and serovar did I catch? Is it Salmonella enterica enterica, serovar Typhimurium or Salmonella enterica enterica, servovar Enteritidis?” Scientists consider all strains of Salmonella enterica enterica to be disease-causing.

But if inquiring minds want to know, in chicken, the predominant Salmonellaserovar isolated was Typhimurium. Eighteen (or 27 percent) of the 66 strains found were resistant to 6 or more antibiotic classes, which included tetracyclines, penicillins, cephems, aminoglycosides, amoxicillin/clavulanic acid, and folate pathway inhibitors.

Q. In your Tips to Avoid Superbugs in Meat you make some scary claims, including a statement that the vast majority of meats are contaminated with superbugs and the safest resources for the public are “USDA Certified Organic, Animal Welfare Approved, Certified Humane.”

At a time when food borne illnesses traceable to meat is at an all-time low, isn’t your statement about contamination more frightening than real? And do you have data to support those ‘safest resources’ really are safer?

A. The CDC reports that the rate of E. coli O157 infections is steady compared to 2006-2008. We applaud the cattle producers who represent the one bright spot in the Retail Meat Report. Your food safety efforts are making a difference. In ground beef, E. coli resistance is down in 2011 to 21 percent from a high of 36 percent in 2002. In pork, E. coli resistance was down to 48 percent, still too high, but the right direction from a peak of 62 percent in 2004. EWG found that E. coli resistance in beef and pork was the only place where antibiotic-resistance was actually trending down. All other microbes tested in significant quantities showed increasing resistance.

Yes, buying from the resources listed in EWG's Tips to Avoid Superbugs in Meat really does make a difference in the prevalence of superbugs on the meat. Studies show that meat is still contaminated with bacteria that can make you sick, but organic, and other production practices that minimize the use of antibiotics, do contain fewer antibiotic-resistant bacteria.

Finally, we encourage more cattlemen and women to learn how they can transition to a more sustainable and healthful production model. EWG will continue to advocate for better farm bill policies that support farmers and ranchers who raise animals on pasture and employ practices that fortify health.

The opinions expressed in this column are solely those of Chuck Jolley, a veteran food industry journalist and columnist.

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Dr Dan    
Ohio  |  April, 27, 2013 at 10:39 AM

Did not respond with the data to back up claim for "safest" in last question. Also cipro is not used in animals but is the first choice by doctors in hospitals, talk about overuse that is one.

April, 29, 2013 at 09:23 AM

Dr. Dan, I see you noticed their 'artful dodge."

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