The Drugs in my Food’s Food

Last Thursday, 150+ healthcare professionals and students gathered at Mt Sinai Hospital for the Screening of Resistance, an award-winning documentary on antibiotic resistance as part of the International Antibiotic Awareness Week. ICYMI, here are some highlights of the movie and a panel discussion starring some major players in the field:

• Dr Andrew Morris, General Internal Medicine/Infectious Diseases Physician and Medical Director of the MSH/UHN Antimicrobial Stewardship Program,
• Elizabeth Leung, Antimicrobial Stewardship Pharmacist at St. Michael’s Hospital and
• Harry Stoddart, Ontario livestock farmer and author of Real Dirt, An Ex-Industrial Farmer’s Guide to Sustainable Eating. 

Antibiotic resistance is a major threat to human health. The film opens on this premise: for decades we’ve been squandering one of our most precious medicine, our best weapon in the fight against deadly infections. If we continue our current misuse of antibiotics, we may soon enter a post-antibiotic era. What does that mean to you and me? For starters, transplants will be impossible, heart infections could be deadly, and giving birth will become a lot more dangerous.

What went wrong and why can’t we stop the threat?

• Overuse in the environment: today, many household products, sanitation products, kitchenware, and even  cosmetics contain small doses of antimicrobial that have been shown to cause resistance.
• Overuse in medicine: explained by the healthcare system’s inertia and the challenge of solidifying new best practices. The movie exposes the theory that doctors fear of being ineffective. They want to help their patients by doing something, anything, so they tend to prescribe antibiotics to cover the 5% chance that an infection is bacterial, than viral.
• Overuse in agriculture: the pressure of low profit margins in agriculture pushed farmers to raise more animals in less space, increasing sanitary issues. Antibiotics are routinely added to animal feed in order to prevent bacterial infections and promote – for some unknown reason – animal growth.
• Lack of new antibiotics coming to the market: antibiotics take a minimum 10 years and $1 billion to reach the market and the development of resistance can take as little as 5 years. It’s just not profitable for drug companies.

While antibiotic misuse in medicine is complex to eradicate because it depends on individual behaviour change, stopping overuse/preventive use of antibiotics in agriculture would be quite simple: we just need to forbid it. Denmark banned routine antibiotics is animal feed way back in 1992. The rest of Europe followed suit in 1999. In North America, not much has changed since the FDA warned in the 70’s about the danger of this agricultural practice. Today, the ban of antibiotics in animal feed is more a political will problem than a science problem. It has long been proven that misuse of antibiotics in agriculture creates resistance in human pathogens. We are facing a typical case of tragedy of the commons.

 

 

I won’t sugar coat it, this movie is a bit of a downer. The panel – 2 of which encounter antibiotic resistance on a daily basis – focused on the Canadian context and change strategies.

• Stewardship: In healthcare, we need to equip hospitals, community hospitals and family health team with the right tools, including better awareness and tools to educate patients. Still, stewardship is “a soft response” to a major problem.
• New tools: Elizabeth Leung mentions rapid diagnostic testing as the more timely tools we can use to help decrease over-utilization of antibiotics. New therapies were also mentioned: ever heard of phage therapy?
• Health policy: According to Dr Morris, the issue is clearly misrepresented/unrepresented in Canadian politics. It’s not even on the new health minister’s mandate, and funding for stewardship is very limited. In today’s political agenda, the senior strategy, assisted death policy, and marijuana legalization take priority.
• Agricultural policy: Harry Stoddart believes that antibiotic resistance is among the most pressing issues in agriculture, before bee health and way ahead of GMOs. It is surprising that the issues doesn’t create a strong response by the public. In 2014, a small move was made: the chicken industry has banned category I antibiotics (those for which there is no alternative) and has a plan to better monitor antibiotic use in agriculture. That’s nice, but a tiny drop in a very large bucket!
• Market: When problems are systemic, change is complex and political will is low, the “fastest route is the market” says Stoddart. It is not a surprise large food corporation are starting to pledge the use of antibiotic-free meat.

Here is my personal take: even if growth-promoting use of antibiotic were to be banned in Canada – and I really hope it will be as soon as possible – the cheaper, antibiotic-pumped meat will still come from elsewhere. We have a say as consumers, and our voice is where we choose to spend our dollars. Sure, our meat will be slightly more expensive, but we are already over consuming meat. Less meat/better meat is the way to go for those of us who choose the non-vegetarian route. The cows will thank you, and so will the patients.