The debate over antibiotic stewardship gives me a real crisis of personal belief.
Generally, if you ask me whether I think more regulation is a good idea in any area of society, I'll tell you flat-out no.
I have three reasons for that:
- Regulations always distort and disrupt the marketplace, often in favor of the bigger, more powerful firms.
- Regulations give more power to people in bureaucratic positions, and such power is always, inevitably abused.
- Making money is the ultimate goal of business and it will winnow out a lot of foolishness in the end. Bureaucracy has no profit motive and so its ultimate goal becomes to perpetuate itself.
In fact, I'll go so far as to say a great deal of what's wrong with this nation today, including its ailing economy, has occurred because we ignored the wisdom of the framers of our Constitution and allowed the formation of excessive bureaucracy. Ultimately, we did this in the name of getting free cheese -- accepting "tax" money from the government after they took it from our neighbors. Our political forefathers warned us against that, as well.
Anyway, this whole thing with antibiotic stewardship has me in a knot because, although I despise regulations, the problem is not getting any better on its own.
Like most of us in the animal industries, I've seen most of the burden directed at our industry to "clean up our act" and reduce antibiotic use, supposedly thereby reducing antibiotic resistance in all bacterial populations.
That seems to be changing. I spent several days recently at the National Institute for Animal Agriculture (NIAA) in Atlanta, and heard several speakers from the Centers for Disease Control (CDC) talk about decreasing antibiotic misuse in the human population. Their methods employ public education and Medicare-based coercion of hospitals and doctors to clamp down on antibiotics usage.
I didn't know whether to stand up and cheer, or sit there and weep silently.
I thought a lot about the issue in years leading up to this meeting and I've been thinking a lot about the issue since I got home. In fact, I thought I would have written about it before now, but instead I'm struggling to formulate a belief about the way forward.
Perhaps instead I'll share with you my thoughts and then some of you readers may suggest a solution.
- Antibiotics were such a miracle in the past 70 years, and so many advances were made so rapidly, I think everyone got sloppy with them. It looked like a panacea, an end-all solution.
- In human and veterinary medicine, we simply came to depend on these friendly compounds; they seemed so able to solve all our sickness and infectious problems. In the end, we became lazy.
- Because antibiotics were easy to get, humanity used them for everything, many times for the wrong things.
- We didn't really understand resistance, which is a complex topic. We don't fully understand it now, but it has reared its ugly heads, showing us such tricks as getting exposure to one antibiotic compound and developing resistance to several more, or sharing multiple resistances across unrelated species of bacteria.
- Most antibiotics in the livestock industry will have to pass through veterinarians' hands as of Jan. 1, 2017.
- Most antibiotics in U.S. human medicine are controlled by doctors, but great amounts are prescribed annually for common colds and for bronchitis, two diseases medical researchers say are not treated/affected by antibiotics.
- Elsewhere, in the developing world, it is said you can walk into a clinic and get antibiotics for anything, anytime.
- Antibacterial hand soap is still a big seller at Wal-Mart and other major retailers.
- The great, gaping hole in the antibiotic resistance catch net may be sewage treatment plants, which have no requirements to test or treat for resistant bacteria. Research suggests they may release huge amounts of resistant bacteria.
- Resistance to any poison, including antibiotics, is a process of natural reaction within nature. The only variable is how quickly resistance progresses.
With these things in mind, I'm mumbling under my breath, "Maybe we need to crack down a little bit on human medicine and human usage."
Are we humans just too foolish and/or under-educated to manage something as complex as antibiotics?
Moreover, are the humans who are more educated than the bulk of the population more capable of slowing the advance of antibiotic resistance? Should they be given power to try? And do we have any way to measure that?