=======================Electronic Edition========================
RACHEL’S ENVIRONMENT & HEALTH WEEKLY #402
(formerly RACHEL’s HAZARDOUS WASTE NEWS)
—August 11, 1994—
News and resources for environmental justice.
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THE MAKING OF A PUBLIC HEALTH CRISIS
Policies of the U.S. Food and Drug Administration (FDA) appear to
be contributing to the development of a public health crisis.
FDA approval of a growth hormone (rBGH) for use in cows, and
approval of the Flavr Savr genetically-engineered tomato, both
may increase the number of antibiotic-resistant disease organisms.
Germs resistant to antibiotics are one of the medical community’s
worst nightmares. Diseases that we routinely cure with
antibiotics and ONLY with antibiotics –such as typhoid fever,
cholera, meningitis, pneumonia, gonorrhea, syphilis, and
tuberculosis –are now appearing in forms that resist
antibiotics. As the trend continues, we slip backward toward
conditions that existed prior to 1928 when Arthur Fleming
discovered penicillin, the first antibiotic. Prior to 1928,
infectious diseases killed Americans by the tens of thousands
each year. A simple wound or surgical incision could lead to
fatal blood poisoning; a child’s ear infection could turn into
lethal meningitis; common pneumonia often ended in death. For 50
years the world has enjoyed a reprieve from these brutal
conditions, all because of 100-or-so antibiotics.
According to agricultural experts, the use of synthetic growth
hormone (rBGH) in milk cows, to boost milk production, increases
the incidence of mastitis, an infection of the udder, which can
contribute pus to milk. [1] Pus in milk can reduce, or destroy,
the commercial value of the milk, so farmers fight mastitis by
treating their cows with antibiotics.
The widespread use of antibiotics in livestock is ALREADY causing
human disease germs, like salmonella, to develop resistance to
antibiotics. The chain, rBGH–> mastitis–> antibiotics, simply
promises to make an already-serious problem worse.
Consider the return of tuberculosis. A writer in SCIENCE said in
1992, “After a century of decline in the United States,
tuberculosis is increasing, and strains resistant to multiple
antibiotics have emerged…. The steadily declining incidence of
TB in the United States since 1882 has been reversed since 1985,
with 26,283 cases reported in 1991. To the trend of increasing
incidence one must add the ominous emergence of drug-resistant
strains that threaten our capability of controlling the disease.
One-third of all cases tested in a New York City survey in 1991
were resistant to one or more drugs.” [2]
TB was the leading cause of death in the United States until the
1950s when improved sanitation and antibiotics brought it under
control. TB spreads when TB victims cough, sneeze or even sing
and others nearby breathe their germs. Today, antibiotics are
our only reliable control for TB. The progressive loss of
antibiotics as a weapon against TB has health officials shaking
their heads in dismay.
The New York TIMES last month reported an epidemic of TB at
middle-class La Quinta High School in Westminster, California, 25
miles southeast of downtown Los Angeles. [3] Twenty-three percent
of the 1270 students at La Quinta tested positive for TB in 1993
and the number has risen since then. Twelve students are being
treated for active cases of multiple-drug-resistant TB (MDRTB)
and 70 other students known to have been exposed to MDRTB are
being monitored by x-ray examination of their lungs, the TIMES
said.
Tuberculosis is not the only serious human disease becoming
resistant to antibiotics. Others are pneumonia; streptococcus
(which causes “strep throat,” impetigo, scarlet fever, and
rheumatic fever [4]); staphylococcus (cause of “staph
infections”–serious blood infections common in hospitals);
shigella; salmonella; cholera; dysentery and others. [5]
According to the federal Centers for Disease Control (CDC), in
1992, 13,300 hospital patients died of bacterial infections that
resisted the antibiotics that doctors used against them. [6]
Earlier this year, at the annual meeting of the American
Association for the Advancement of Science, microbiologist
Alexander Tomasz of Rockefeller University warned that
antibiotic-resistant germs represent “nothing short of a medical
disaster.” [7]
Drug resistance occurs when a colony of bacteria is dosed with an
antibiotic. Most of the bacteria die, but a few hardy ones
survive because, by chance, they harbor genes that make them
immune to the drug. These hardy creatures thrive and
proliferate, passing their resistant genes to their progeny. (One
bacteria can give rise to 16,777,220 offspring in 24 hours.)
Furthermore, mutant bacteria can share their resistant genes with
unrelated bacteria. When two bacteria touch each other (say, in
the mud of a barnyard, in a hospital bed sheet, or in a human
stomach), they can exchange a loop of DNA called a plasmid –thus
transferring resistance from one organism to another. Even a
relatively benign bacteria, such as E. COLI, common in the human
gut, can develop antibiotic resistance and then pass that
resistance, via plasmid transfer, or by other means, to bacteria
that cause a fatal disease such as cholera or typhoid fever. [8]
Experts agree there are two causes of antibiotic resistance among
bacteria: overuse of antibiotics in humans and in farm animals.
Humans: Because patients have come to expect antibiotics from
their doctor, doctors now prescribe antibiotics for many ailments
that antibiotics cannot cure –such as viral infections like the
common cold. The result of such misuse is the development of
antibiotic-resistant germs. The World Health Organization (WHO)
calls it “a situation which is fast becoming a global public
health problem.” [9]
Even when an antibiotic is prescribed properly, if the patient
stops taking it (because he or she feels better after 2 or 3
days), this causes growth of drug-resistant bacteria. People who
save up antibiotics to self-medicate themselves later, and people
who take portions of other peoples’ prescription antibiotics,
worsen the problem of resistance.
Farm animals: Someone discovered in the 1950s that feeding low
levels of antibiotics to livestock will increase weight-gain.
Even today no one understands how this works, but for 40 years
farmers–urged on by drug and chemical companies–have fed
antibiotics to healthy animals to speed growth. An estimated 15
million pounds, about half of all antibiotics, are fed to farm
animals.
Ironically, the FDA (U.S. Food and Drug Administration)
recognized the public health implications of this problem 17
years ago, in 1977, and published a FEDERAL REGISTER notice
announcing its intention to curb the routine feeding of
antibiotics to livestock. Drug and livestock corporations
responded by bringing intense pressure on Congress, which
promptly ordered FDA to back off. Everyone agreed that using
antibiotics in livestock (cows, sheep, pigs and chickens) was
creating disease organisms resistant to antibiotics. But
corporate lobbyists argued then that no one knew for sure that
such organisms could infect humans. Since that time, definitive
evidence has come to light, [10] but FDA still has not acted.
Today there is no doubt that routinely dosing farm animals with
antibiotics is creating a serious public health problem for
humans. Some responsible officials are already calling it a
public health emergency. [5] Eleven years ago, in 1983, 300
scientists petitioned the FDA to control the use of antibiotics
on the farm. [11] But the FDA remains paralyzed and antibiotics
remain freely available without prescription.
In July of this year, we walked into Bowen’s Farm Supply in
Annapolis, Md., and purchased, off the shelf, a 100-milliliter
bottle of penicillin-G for $9.29. We also bought 6.4 ounces of
the Aureomycin brand of tetracycline for $3.49. Penicillin and
tetracycline are potent antibiotics. Also available was
tetracycline selling under the trade name Terramycin. The
Terramycin package insert said, “Terramycin used right after
birth gives them the protection they need… Starts them off
faster to more profitable gains.” The insert urged routine
treatment of cattle and calves, pigs and hogs, sheep, mink,
poultry and bees with tetracycline to prevent disease.
FDA’s failure to control antibiotic abuse is symptomatic of the
agency’s weakness in controlling the behavior of powerful
corporations. In justifying its decision to approve bovine growth
hormone (rBGH) in milk cows, FDA simply did not discuss the
problem of mastitis leading to increased antibiotic use which
promises to make a big public health problem bigger. [12]
Likewise, in its decision this year to allow Calgene’s Flavr Savr
genetically-engineered tomato onto the market, FDA did not
answer all the critics of the Flavr Savr. The Flavr Savr tomato
contains a gene that is resistant to the antibiotic kanamycin.
Some geneticists warned that the resistant gene can be
transferred to other bacteria in peoples’ stomachs and
intestines, creating new antibiotic-resistant germs with
potentially serious public health consequences. [13] FDA remained
silent and gave Calgene what it wanted.
Available evidence forces the conclusion that
antibiotic-resistant disease organisms are already threatening
public health in important ways, world-wide. What prevents
decisive action by responsible authorities is the unrestrained
political influence of certain corporations. It seems clear
that, until we learn to control the behavior of such
corporations, this public health problem will grow steadily
toward crisis proportions.
                
                
                
                
    
–Peter Montague
===============
[1] David S. Kronfeld, “Safety of Bovine Growth Hormone,” SCIENCE
Vol. 251 (Jan. 18, 1991), pgs. 256-257. And: T.B. Mepham,
“Public health implications of bovine somatotropin use in
dairying: discussion paper,” JOURNAL OF THE ROYAL SOCIETY OF
MEDICINE Vol. 85 (December 1992), pgs. 736-739. And see, Eleanor
Chelimsky and others, RECOMBINANT BOVINE GROWTH HORMONE: FDA
APPROVAL SHOULD BE WITHHELD UNTIL THE MASTITIS ISSUE IS RESOLVED
[GAO/PEMD-92-26] (Gaithersburg, Md.: U.S. General Accounting
Office, 1992).
[4] Karen Wright, “Bad New Bacteria,” SCIENCE Vol. 249 (July 6,
1990), pgs. 22-24.
[6] Sharon Begley, “The End of Antibiotics,” NEWSWEEK Vol. 123
(March 28, 1994), pgs. 47-52.
Descriptor terms: fda; bgh; rbgh; bovine growth hormone; flavr
savr; antibiotics; resistance; typhoid fever; cholera;
meningitis; pneumonia; gonorrhea; syphilis; tuberculosis; tb;
arthur fleming; penicillin; mastitis; farming; dairying;
agriculture; veterinary medicine; salmonella; new york city; nyc;
la quinta high school; westminster; ca; california;
streptococcus; strep throat; impetigo; scarlet fever; rheumatic
fever; staphylococcus; staph infections; nosocomial infections;
shigella; salmonella; cholera; dysentery; alexander tomasz; dna;
plasmid; world health organization; who; bowen’s farm supply;
annapolis; md; aureomycin; terramycin; tetracycline;
corporations; calgene; kanamycin;