antibiotics made modern farming possible. by abusing them
TRANSCRIPT
HEALTH
Antibiotics made modern farming possible. By abusing them, we risk
everything
BY SASHA CHAPMAN · ILLUSTRATION BY TAMARA SHOPSIN AND JASON FULFORD
FROM THE JANUARY/FEBRUARY 2015 MAGAZINE
agriculture · animals · antibiotics · bacteria · chickens · disease · farms · food · health · veterinary · Walkerton
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ND THE craziest food you ever ate?
The question arrives, like clockwork, halfway through the
dinner party. So I offer what guests might expect to hear from a
food writer: The fried grasshoppers in Oaxaca, Mexico. The
Tasmanian possum in Launceston, Australia (now that was tough
to swallow, after watching the hairless creature get thrown around
in a converted washing machine to tenderize it). The fried goat’s
brain in Toronto. The whale bacon I chewed and chewed at a stall at
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the Tsukiji fish market in Tokyo, trying to quell the revulsion I felt
from eating a creature nearly as intelligent as I. The blowfish I ate
sitting cross legged on the floor of a restaurant a few hours from the
Japanese capital, while a snowstorm howled outside. That dish
really scared me: a slip of the knife could have caused the
neurotoxin-laden liver to shut down my nervous system.
But the craziest food? Hands down, it was the chicken I had eaten a
few days before that in Tokyo. We had consumed nearly every part
of the bird that night—heart, gizzard, feet—before the chef sent
out his pièce de résistance: glistening pink slices of chicken
sashimi. To swallow the raw chicken, I had to trust the cooks who
prepared it, the abattoir that slaughtered it, the farmers who raised
it. I had to trust that it was free of the many pathogens that are
routinely present on a chicken carcass in the supermarket.
Naturally, I thought of the toilet in my hotel room. It was one of
those high-tech jobs, with a control board of buttons, that could
clean every inch of my backside and, if I pressed the wrong button
at the wrong time, every inch of the bathroom. Hygiene standards
in Japan, of course, are famously high. I’d already watched a nude
Japanese woman make a kind of citizen’s arrest at an onsen,
pouncing on an equally naked tourist who had not properly
scrubbed herself down before slipping into the spa waters. If I were
going to eat raw chicken anywhere, Tokyo was surely one of the
safer places to do it. (This is the kind of reasoning you follow when
you’re jet lagged and several cups into a bottle of sake.)
Now, you might say that anyone who eats chicken sashimi is
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engaging in high-risk behaviour; but eating is always an intimate
act, and, like most acts of intimacy, it requires you to trust your
partner. Somebody—more often than not a stranger—has created
something that will end up inside you, part of you. This fact seems
obvious in the face of strange new food; less so when the most
pervasive economic and social system on the planet requires us to
place our faith in the faceless, nameless people who produce what
we eat daily, whether at a poncey restaurant in Tokyo or KFC in
Kingston.
In The Ethical Canary: Science, Society and the Human Spirit, the
contrarian philosopher Margaret Somerville considers the common
perception that trust is a “rapidly decreasing feature of our
relationships with one another and our societal institutions.” But,
she argues, the way we engage with the food system would suggest
just the opposite. Two hundred years ago, a pioneer might have had
to trust only a few producers to put breakfast on his plate if he
didn’t grow the oats himself. “Today, our grapefruit may have come
from one continent, the grain for our cereal from another and the
bacon from yet another,” she writes. “Thousands of people had
access to these products, but we trust that they are safe to eat.”
Or maybe, as with me and my chicken sashimi, we just hope they
are.
HE THING that scared me about the raw chicken scallop
draped over my chopsticks was the possibility that it
contained bacteria that would make me sick. Salmonella, E. coli,
and campylobacter can, under the right conditions, kill us—or at
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least make us wish we were dead. At the same time, hundreds of
species have co-evolved to live peacefully with us, and even benefit
us. “Bacteria are as much a part of us as we are ourselves,” says Jim
Hutchinson, an expert in medical microbiology in Victoria, who
has spent much of his career studying the epidemiology of
infectious diseases. Even the most germophobic among us host
hundreds of species of bacteria; for every human cell, we shelter
ten microbial ones. Each of us is host to an entire community of
microbes.
This is also true of the animals in our lives—the pets we own, the
livestock we raise. Bacteria move easily from one species to
another, especially through the food system. “We are intertwined
from a microbiological perspective,” says Hutchinson. What
happens on the farm can affect us in the kitchen and at the dinner
table. Yet aside from the occasional People for the Ethical
Treatment of Animals horror video or friendly exchange with an
organic farmer at a market, most of us have no idea what actually
goes on inside those unmarked locked barns that sit a few hundred
metres off the highway. It’s easier not to think about where our
food comes from, or the risks it carries.
The idea that there is a connection between our health and that of
other animals is not new. Sir William Osler, one of Canada’s most
admired physicians and a father of modern medicine, is also
considered a father of veterinary pathology. He believed that his
students, whether medical or veterinary, should study the
anatomy and pathology of both human beings and animals. When
Osler delivered the inaugural address at the Montreal Veterinary
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College in 1876, he titled it “The Relations of Animals to Man,” and
told students it would not be long before “you find out that
similarity in animal structure is accompanied by a community of
disease and that the ‘ills which flesh is heir to’ are not wholly
monopolized by the ‘lords of creation.’ ” Back then, in lecture halls
at the Faculty of Comparative Medicine and Veterinary Science at
McGill, veterinary students sat alongside medical students.
Today, such crossover training would be highly unusual. Most
doctors have little to do with animal medicine, unless they’re
taking the family pet for a checkup. Likewise, vets rarely take more
than a personal interest in human medicine. Each profession keeps
to itself, and each tends to collect and analyze its own data
separately, making it difficult to share information and identify
cross-species health risks. And in the case of zoonotic diseases
—those that move from animals to humans—there can be a
tendency, between the professions, to develop an us-versus-them
mindset. Vets are concerned with their own patients’ health, and
doctors with theirs.
We segregate these disciplines at our peril. Most of the emerging
and re-emerging infectious diseases that have plagued humans in
recent decades—including Lyme disease, H1N1, and Ebola—began
in animal populations, and were first transmitted to human beings
either directly or through our shared environment. Consequences
can be devastating, as in the case of plague, which emerges
periodically from animal reservoirs. As Hutchinson says, “We are
all swimming in the same pool.” That pool has changed
significantly in the last sixty years. Or, to be more precise, we
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changed the pool when we declared open season on bacteria, and
began killing them off with antibiotics.
OWHERE IS the division between human and veterinary
medicine more evident—or more significant—than in the
way we govern antibiotic use. Imagine what health care might be
like if the doctor prescribing you antibiotics for a skin infection was
also the sales rep for the manufacturer of that drug, and earned a
commission each time he wrote a prescription. This is what
happens in most provinces when a vet prescribes antibiotics to
livestock—if she writes a prescription at all.
Canada is one of the few Organisation for Economic Co-operation
and Development countries to allow over-the-counter sales of
antibiotics for animals. This makes it easy for farmers to obtain and
abuse antibiotics; it also makes it difficult for scientists and
regulators to track their use. Under an “own use” provision
—designed to allow travellers to bring in three months’ worth of
medicine after filling a prescription in, say, Florida—farmers can
bring in unregistered, unregulated drugs from anywhere in the
world, as long as they don’t sell them. A farmer with 90,000
chickens can go through a lot of antibiotics in three months. He can
also import active pharmaceutical ingredients and compound his
own medicines.
Jean Szkotnicki, who heads the Canadian Animal Health Institute,
an animal drug manufacturing lobby group, estimates that about
13 percent of the drugs used on animals come into the country
through these loopholes and are never approved by Health Canada.
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Warren Skippon, who recently developed antibiotic prudent-use
guidelines for the Canadian Veterinarian Medical Association,
says, “We are the only industrialized country in the Western world
that has such voids.”
Data on antimicrobial use in Canada is hard to obtain—so difficult,
in fact, that Rebecca Irwin, who heads a nationwide surveillance
program designed to monitor antimicrobial resistance in the food
system, once complained that she had no way of knowing whether
the CVMA’s prudent-use guidelines were making any difference. A
2007 report from Health Canada estimated that about 200,000
kilograms of antimicrobials are used in human medicine each year.
More than 1.6 million kilograms are used in animals (and that does
not include the antibiotics that farmers import directly). Measured
by weight of active ingredient, nearly 90 percent of antimicrobials
sold in Canada are used for animals, including companion animals
like dogs and cats. Even more alarmingly, two-thirds of those
medications are considered important for human use.
OBERT TAUXE, an epidemiologist at the Centers for Disease
Control and Prevention in Atlanta, studies the way changes
in human behaviour can affect microbial evolution. In a 2014
lecture, part of the Massachusetts Institute of Technology’s Knight
science journalism program, he cheerfully describes food-borne
outbreaks as “prime learning opportunities.” He explains that the
CDC was established to control malaria during World War II; the US
Department of Defense wanted to protect its soldiers on army
bases. Within a few years, it had eradicated the disease throughout
the country, without even meaning to. Polio took longer to quash,
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but by 1979 it, too, had disappeared from American soil. In 1949,
the CDC began tackling its third challenge, salmonella.
He pauses for effect: “It turned out to be more durable than we
originally thought.” Rates of salmonella infection are stable in the
US and Canada, despite improvements in food safety standards,
livestock management practices, and surveillance. And the
infections salmonella causes are now more resistant to treatment
than ever. Salmonella heidelberg is one of the top causes of
gastroenteritis in humans; it’s also one of the top strains found in
broiler chickens on the farm. Though the bacterium doesn’t affect
chickens, it can cause severe illness in human beings—extra-
intestinal infection, septicemia, myocarditis. It can kill you.
Bacteria such as S. heidelberg are successful in part because they
are, as several scientists told me, “very promiscuous.” Shape-
shifters capable of exchanging bits of genetic information and
reproducing in minutes, they can refashion themselves with new
bits of code that make them more resilient than their predecessors.
In ideal conditions, they can survive for months, even years. And
because salmonella microbes don’t usually bother chickens—and
aren’t easily detected—farmers have little incentive to get rid of
them. Farmers do, however, have plenty of incentives to
inadvertently generate microbes resistant to antibiotics.
A decade or so ago, Health Canada began to monitor S. heidelberg
and other food-borne pathogens. Irwin and her colleagues formed
the Canadian Integrated Program for Antimicrobial Resistance
Surveillance and collected isolates from both livestock and
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humans. Since they didn’t have access to farm samples (on-farm
surveillance is only now being piloted in chickens), they collected
bacteria from the animals’ intestines at abattoirs—samples, they
reasoned, that would still accurately reflect the farms’ microflora.
Staff also shopped for meat at grocery stores in numbers that
reflected how many Canadians live in cities and rural areas, and
how many of us buy our meat at supermarkets and butcher shops.
CIPARS researchers were hoping to better understand the link
between animal and human health, and whether resistance in one
species leads to resistance up the food chain. Their project was
unprecedented in Canada, both in scale and scope. What they
uncovered has found its way into textbooks and PowerPoint
presentations around the world.
At the time, broiler chicken hatcheries were injecting eggs with
ceftiofur and gentamicin to prevent and control E. coli infections.
Then gentamicin became unavailable, and by 2004 all the Quebec
hatcheries surveyed were using ceftiofur. Even the scientists were
surprised by what they found. There was a direct correlation
between the ceftiofur injected into the eggs and the resistance in S.
heidelberg to the class of antibiotic that includes ceftiofur.
Moreover, the hard-to-treat bug was turning up on chicken in
stores—and in patients in hospitals, first in Quebec and then in
Ontario. “We didn’t expect to see such a strong linkage,” recalls
Irwin. The evidence was so convincing that producers voluntarily
stopped using the antibiotic. But a few years later, they quietly
reintroduced ceftiofur, and CIPARS again noticed an uptick in
human S. heidelberg isolates.
Scientists already knew that using antibiotics on farm animals
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could elevate resistance levels in food-borne pathogens. An
influential report by the molecular biologist Michael Swann,
published in 1969, caused the United Kingdom to rethink the way
antibiotics were being used in agriculture. Then in 1975, Stuart
Levy, an American microbiologist, established a family farm
outside Boston and introduced two groups of chickens hatched
from pathogen-free hens. One group received low doses of
antibiotic-laced feed; the other did not.
Thirty-five years later, in 2010, Levy appeared before the US House
of Representatives Energy and Commerce Committee to argue,
once more, for the prudent use of antibiotics. “The findings were
striking,” he recalled. “Within twenty-four to forty-eight hours, the
chickens given the oxytetracycline-laced feed began to excrete
tetracycline-resistant E. coli.” Within a week, almost all of the E.
coli in the chickens’ guts was tetracycline resistant. After three
months, the chickens were excreting E. coli that was also resistant
to many other drugs: sulphonamides, ampicillin, streptomycin,
and carbenicillin. Levy published his findings in The New England
Journal of Medicine and in Nature. The study, he said,
“demonstrated the ecologic and environmental impact of an
antibiotic”—not only for the animals on the farm, but also for the
humans who lived there. Family members also showed a change in
their microflora; they were carrying more and more fecal E. coli
that was resistant to more than one antibiotic.
By the mid-1990s, the wider medical community began noticing
that the antibiotics that had served so well for decades were no
longer as effective. Doctors would try one type of antibiotic; when
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that didn’t work, they’d try another. It gradually became clear that
some bacteria had developed a resistance to a variety of antibiotics,
making them almost impossible to treat. Dubbed superbugs , these
multi-resistant bacteria (including strains of methicillin-resistant
Staphylococcus aureus and E. coli) began showing up both in
hospitals and on farms. To this day, Dutch hospitals routinely
isolate and screen livestock workers if they are carrying MRSA.
Bacteria become resistant through random mutation and gene
exchange; each time we use antibiotics, we increase the odds for
resistance to them. Any bacteria able to survive our antibiotic
onslaught will produce more resistant bacteria. And salmonella
and E. coli can share resistance genes, facilitating the spread of
drug resistance across the species that colonize the intestinal
microbiota.
“There is essentially no gene in any bacterium that cannot be
moved to another bacterium,” writes John Prescott, the
bacteriologist at the University of Guelph in Ontario who literally
wrote the book on Antimicrobial Therapy in Veterinary Medicine.
Create superbugs that live on chickens, and they can travel easily
through the food chain—from the farm, to the abattoir, to the
supermarket, to the dinner plate. The phenomenon is
self-perpetuating. Once resistant bacteria are established, they can
move from animal to animal—humans included—without the aid
of any additional antibiotics.
Each year, roughly one in eight Canadians—4 million people—gets
sick from food-borne illnesses. (The vast majority are never
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identified, but researchers estimate twenty-six cases exist for every
salmonella case that is actually reported. By this measure,
Canadians may suffer as many as 2.3 million cases of salmonella in
a given year.) The Public Health Agency of Canada estimates the
total annual cost of food-borne illnesses, accounting for health care
and lost productivity, to be as much as $3.7 billion. Already, some
of those illnesses involve resistant pathogens, which lengthen
hospital stays, complicate treatments, and at least double the cost
of treating a bacterial infection. Plus, we could die. According to
the World Health Organization, patients with MRSA are 64 percent
more likely to die than those infected with non-resistant S. aureus.
ORGET CURING CANCER, says Jim Hutchinson, who now heads
up an antimicrobial stewardship program on Vancouver
Island. Antibiotics have done more to extend our life expectancy
than any other drug we use to treat disease: pneumonia, skin
infections, and even urinary tract infections can be fatal without
them. A December 2013 editorial in The New England Journal of
Medicine suggests that the use of antibiotics extends life expectancy
by as much as ten years. Put another way: if antibiotics no longer
work, our lives end much sooner.
Medical professionals around the world warn of a post-antibiotic
era, when bacteria will be resistant to all the drugs we can throw at
them. The prospect is scary enough to be called a “crisis” (by the
WHO), a “nightmare” (by the CDC), and a “catastrophic threat” (by
UK chief medical officer Sally Davies). Yet the issue hasn’t
commanded the attention it deserves. Some scientists compare
antimicrobial resistance to climate change: it’s caused by human
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activity and we’ve known about it for a long time, but the problem
is so complex, and involves so many players in so many places, that
a solution seems beyond reach. Meanwhile, scientific reports
demonstrating the link between antibiotic use (in both humans and
animals) and cross-species resistance continue to be published, and
recommendations urging prudence keep piling up.
The role that agriculture plays in antimicrobial resistance in
humans has long been the subject of acrimonious debate. In this
way, too, the issue of resistance resembles that of climate change:
it’s easier to point fingers than to fix the problem. Doctors write
scathing editorials in The New England Journal of Medicine laying
blame at the feet of farmers and griping that “agricultural industry
groups, in line with their short-term financial interests, argue that
there is no conclusive proof that the antibiotics used in agriculture
harm human health.” The Canadian Medical Association Journal,
meanwhile, complains, “Agriculture plays a major role in
promoting antibiotic resistance, even after accounting for other
factors such as over-prescribing of antibiotics by physicians and
suboptimal adherence by patients.”
Even John Prescott—who is sharply critical of the abuse of
antibiotics by many farmers and vets, and of the regulations that
permit it—acknowledges that agriculture’s direct contribution to
human resistance could be as low as 6 percent. But a direct
contribution may be only the tip of the iceberg. The epidemiologist
Amee Manges and her colleagues at the University of British
Columbia have been analyzing community-acquired urinary tract
infections. DNA fingerprinting suggests that some of these
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infections may have been picked up from E. coli in supermarket
chicken. Such infections are a common complaint among women;
they become particularly worrisome when they do not respond to
antibiotic treatment and persist for months.
In their defence, farmers point to the many studies that suggest
overuse of antibiotics in human medicine is the worse offender,
and many doctors, including Hutchinson, agree. On a global level,
there is great concern that many countries don’t even regulate
over-the-counter sales of human medications. Still, no one denies
that agricultural antibiotics contribute to resistance, and that
reforms to the way we distribute drugs in Canada are long overdue.
Antibiotics are what Levy calls “societal drugs”: administer them to
one individual (whether feathered or not) and you may affect
resistance in other individuals. Ignoring their use in one part of the
food chain, or one part of the world, imperils us all.
N FEBRUARY 7, the Canadian Federation of Agriculture will
celebrate Food Freedom Day—the day on which most
Canadians will have earned enough at their jobs to pay for a year’s
worth of groceries. This is nothing short of miraculous. Each
decade seems to bring us cheaper, more plentiful plates of food,
and there is no greater success story than chicken, the protein that
ends up on our plate more often than any other. About 2,700
Canadian farmers produced a staggering 1 billion kilograms of
chicken in 2012. It looks like a good-news story—a chicken in
every pot!—and in some ways it is.
In 1950, farmers spent eighty-four days raising their birds; today,
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most chickens are slaughtered after thirty-eight days. Farmers can
now produce a kilogram of meat using less than half the feed and in
less than half the time. Such efficiencies help explain why the
typical Canadian eats 31 kilograms of chicken a year—21 kilograms
more than we ate in 1965.
The average broiler farmer today is in his or her forties, while the
average for all Canadian farmers is fifty-four. Improved breeding
stock and equipment, and more sophisticated management
techniques, help to make chicken farming more lucrative and
attractive to the next generation. “Our farmers are like
businessmen,” says Lisa Bishop-Spencer, communications
manager with Chicken Farmers of Canada. “They wear suits and
control feed and water and temperature by pressing a button.”
Prices drive chicken production choices, and in this sense
production is governed by market forces. Yet because raising
chickens falls under supply management, you could argue that the
farmers have a social responsibility: under the Farm Products
Agencies Act, they “have been granted a social licence to manage
the supply of chicken in the interest of producers and consumers”
(italics mine). What happens when the interests of producers are at
odds with those of consumers?
Antibiotics help broiler farmers maximize yield while minimizing
cost. Pathogens flourish in a 10,000-square-foot barn housing
10,000 birds. Warm, littered, and (by the time the birds reach their
2.2-kilogram slaughter weight) extremely crowded, a broiler barn
is almost perfectly designed to promote the growth and
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transmission of germs. And, like toddlers in a daycare, the
chickens pick up nearly every infection they’re exposed to. “A
young intestine is very dynamic,” explains Prescott. “It takes time
to settle the gut.”
Because of the likelihood of disease, antibiotics are used not only as
you or I use them, to control an infection that has taken hold;
farmers also routinely administer them in low doses to prevent
infection. At least, that’s what we think happens. We can’t say for
sure, since most of the drugs used on the farm do not require a
prescription (i.e., paper trail) from a veterinarian (except in Quebec
and Newfoundland and Labrador), and many are administered
through feed and water.
Farmers also use antibiotics to promote faster growth. As early as
1946, it was observed that animals put on weight faster when they
were given low doses of antibiotics. This strategy is especially
effective in intensive livestock farming, where infections would
otherwise reduce yield. In a paper for the UN’s Food and
Agriculture Organization, Peter Hughes and John Heritage,
microbiologists at the University of Leeds in the UK, suggest that
“the effects of growth promoters were much more noticeable in
sick animals and those housed in cramped, unhygienic
conditions.” In 1995, the Animal Health Institute estimated that if
the livestock industry stopped using antibiotics in this fashion, the
US alone “would require an additional 452 million chickens, 23
million more cattle and 12 million more pigs to reach the levels of
production attained by the current practices.”
Amazingly, we still don’t know why antibiotics promote growth.
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One hypothesis is that they suppress bacteria in the intestines.
Energy that chickens might otherwise devote to fighting off (or
perhaps just feeding) the gut’s microflora can instead be used to put
on weight—anywhere from 1 to 10 percent more per day. It’s
possible that something similar is happening in humans.
“Underweight children used to be given tetracycline,” says
Prescott. And new research is looking into the possibility that the
widespread use of antibiotics—and the altering of the microflora of
the human gut—may play a role in the obesity epidemic in North
America.
N THE FRIDAY before Thanksgiving, I visited a chicken farm
in southwestern Ontario. It was sunny and brisk, and the
nights were cold, though not yet cold enough to have shocked the
trees into peak blaze. As I drove along the highway, farmers were
moving equipment from one field to another. Horse-drawn
Mennonite buggies marked with giant reflective yield triangles on
their backs stayed close to the shoulder. Green combines wider
than a highway lane, with tires taller than my car, were moving as
fast as I was.
I was on my way to meet Derek Detzler, the very incarnation of a
modern-day chicken farmer. He can run six barns and produce
about 540,000 birds a year—or 90,000 per cycle—with the help of
just one hired hand, a farm manager who visits each barn two or
three times a day. Detzler’s hands are soft, his nails clean; he is able
to maintain a full-time job as the global program manager for an
animal health and nutrition company, travelling the world to sell
his fellow chicken farmers alternatives to antibiotics, including
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vaccines and organic acids to help them fight the never-ending war
on bugs. His unhurried, folksy way of talking—“You and I are
gonna get along just fine”—probably serves him well in this role.
He was just back from China and heading to Brazil the following
week. His eyes, he jokes, are blue when they’re not bloodshot from
travelling.
Detzler, like a handful of other large-scale chicken farmers across
the country, has been grappling for more than a decade with how to
control infection in broiler flocks without resorting to antibiotics.
Two worrisome diseases plague chicken flocks: One is coccidiosis,
an intestinal infection caused by a protozoan parasite, which is
nearly ubiquitous in modern chicken coops. If it isn’t managed
properly, mortality rates begin to climb when chicks are twelve
days old. The other is clostridium, which in Canada causes necrotic
enteritis.
“Nothing works as good as a working antibiotic,” says Detzler, who
trained as an engineering technologist and began his farming
career at a large processor. Later, he took a job in hatchery sales
and spent much of his time visiting farmers and advising them on
managing chick health. (In Canada, large processors work closely
with chicken farmers, awarding them contracts to grow a certain
number of chickens per cycle, according to sales projections.)
Across the industry, chicken mortality rates were on the rise, and,
in a mirror of what was happening in our hospitals, the antibiotics
used to fight disease didn’t seem to be working as well as they once
did. Detzler’s boss, afraid of losing his competitive edge, charged
him with finding an alternative: “He used to say, The best time to
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attack resistance is before it develops.” What Detzler learned,
through trial and error, informed his own flock management when
he took over his dad’s 324-hectare operation six years ago.
The farm is a ten-minute drive from Walkerton, the town that made
national headlines in 2000 when agricultural runoff contaminated
the water supply with 0157:H7 E. coli and infected half its
population of 5,000. It’s the town where Detzler and his family
went in 2000 for a Mother’s Day brunch. Everyone ordered a pop.
Everyone, that is, except the Detzlers’ four-year-old daughter,
Madison, who drank the water and ended up in the intensive care
unit in nearby London with kidney failure.
Detzler has always taken an interest in animal health; when he was
younger, he wanted to go to vet school. It’s taken the better part of
six years, he says, to figure out how to manage infections and
mortality without antibiotics. He’s still learning. Sitting at a long,
polished granite island in his shiny stainless-steel kitchen (the
house was previously owned by a bank vice-president), he explains
that resistance wasn’t much of a problem in the 1970s and 1980s
because so many new drugs were coming on the market. Farmers
would move to a new antibiotic before bacteria developed
significant resistance to the last one. Part of the reason there were
so many options was that veterinary drug registrations were easier
to obtain, and companies researching human medications would
try to find an animal application for anything that didn’t get
approval for human use. It was a way for the companies to recoup
their costs.
When drug registration became harder to obtain (ironically,
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because of concerns about antimicrobial resistance), fewer drugs
made it to market, at least through the usual channels. (These
regulatory hurdles may have also driven farmers to exploit the
own-use loophole to import unregulated supplies of cheaper, more
readily available antibiotics.) With fewer drugs in their arsenal,
farmers began using the same drugs over and over—giving bugs
more opportunities to develop resistance.
Detzler compares bacterial control to weed control, explaining that
he manages coccidiosis without the use of drugs by “seeding” his
barns with a pre-resistant strain of coccidiosis, which dominates
over the strains that have developed resistance to the anticoccidial
vaccine. It is then relatively easy to vaccinate against the
coccidiosis used to colonize the barns. It took him a long time, and
much experimenting, to figure this out. “It hurt a lot,” he says of
the early days of trial and error. “Mortality would skyrocket, and
we wouldn’t know why.” His mortality rates are still a bit higher
than those of conventional farmers (he would not be specific), and
his chickens take a few more days to reach slaughter weight. But he
can charge a premium for them, since they get sold as antibiotic
free.
A lot of the work he does off the farm nowadays involves advising
and troubleshooting with producers who want to reduce or
eliminate the use of drugs. Still, he understands why they don’t
want to switch production methods: it’s a difficult road. Even his
own father was skeptical when he first phased out the miracle
drugs. “You have to love to do it, because it’s harder,” says Detzler.
But love won’t be enough to change a business model that currently
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earns $2.3 billion in annual farm-cash receipts.
FEW YEARS AGO, John Prescott, who has organized three
national conferences on antibiotic use, appeared before a
parliamentary committee in Ottawa to talk about regulating
antibiotics. The transcript does not reveal his tone of voice, but his
frustration fairly leaps off the page. He drew the chair’s attention to
the thirty-eight recommendations made in a landmark report on
antimicrobial use to Health Canada in 2002. “Most of the
recommendations have not been acted upon,” he said. “Currently,
I think nobody in the federal government is in charge, just the
resistant bacteria.”
One of the arguments against changing the way we regulate
antibiotic use is that Canadian farmers need a level playing field in
North America. But there is another, more fundamental obstacle
that needs to be addressed. “Bacteria change easily to resistance,”
Prescott said in his first email to me, after I told him I was pursuing
this story. “But people are resistant to change; Canada especially
has a constitution that resists change.” The loopholes that allow
farmers to use unregulated antibiotics are yet another mess that
goes all the way back to the British North America Act. While the
feds oversee the approval and sale of drugs, it’s up to each province
and territory to regulate their use. This is why Quebec and
Newfoundland and Labrador require prescriptions for all
antibiotics, while the other provinces and the territories do not.
Last March, the US Food and Drug Administration announced new
“guidance for drug companies to voluntarily revise” labels to
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remove growth-promoting claims and “add, where appropriate,
scientifically-supported disease treatment, control or prevention
uses.” It also pledged to bring over-the-counter supplies of
antibiotics under “veterinary oversight and consultation.” In
response to these changes, Jean Szkotnicki approached Canada’s
Veterinary Drugs Directorate and volunteered to change labels on
her members’ drugs, too. So last April, Health Canada posted a
vague “notice to stakeholders,” urging them to remove “growth
promotion and/or production claims of medically-important
antimicrobial drugs” and to develop “options to strengthen the
veterinary oversight of antimicrobial use in food animals.”
A month later, the Chicken Farmers of Canada added its own set of
promises, taking restrictions a step further. They promised to
eliminate the preventive use of what Health Canada classifies as
Category I drugs, the medically important ones such as ceftiofur,
which has been linked to resistance in human beings.
These are promising steps, but small ones. Removing growth-
promotion claims from labels doesn’t actually mean a lot. Farmers
and vets who once used those drugs to promote growth can simply
cite a different justification for using them: disease prevention.
And even a promise not to use the drugs for prevention can be
converted into claims for therapeutic use. Do you call it prevention
if you decide to treat an entire flock with a drug because you’ve
found an infection in a few of your 10,000 birds?
While a prescription-only system makes it easier for scientists and
regulators to track antibiotic use, it probably won’t do much to
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change the behaviour of vets, unless they’re held accountable for
their prescriptions. That’s the case in Denmark, where egregious
use of the drugs triggers an interview to find out why the vet has
been prescribing so many.
Expecting prescriptions to change antibiotic use “assumes vets do
everything to benefit public health, rather than to benefit
themselves or the animals they’re treating,” says Scott McEwen,
co-author of the 2002 report that made those thirty-eight
recommendations to Health Canada (and led to the creation of
CIPARS). McEwen, who teaches public health at the University of
Guelph, thinks this assumption is flawed. “In human behaviour,
we tend to do things we are rewarded for and avoid things we are
punished for.” A vet is not penalized for contributing to resistance,
but she will be penalized for not managing an infection at the farm.
“The default is to consider animal health interests, not public
health interests.” (A similar argument applies to medical doctors
seeking to manage the infection—and expectations—of a sick
patient on a gurney. The physician may not stop to consider the
public health implications of prescribing a course of pills.)
Michael Taylor, the deputy commissioner of foods at the FDA, puts
it this way: “There are very few bad guys, but there are lots of
economic constraints and incentives for violating food safety.”
Perhaps it’s not the people we should distrust along the food chain,
but this system we’ve built for ourselves.
The creation and maintenance of CIPARS (even in the face of
cutbacks in both funding and opportunities to talk to the media)
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remains the single best thing our government has contributed to
the discussion of how to manage antimicrobial resistance. Data
collection is key. If we don’t know what’s going on in animal and
human health, we can’t prepare ourselves for the pathogens—and
resistance—that are emerging.
But this is only the first step. We must change the way we think
about and use these life-saving drugs. Countries such as Denmark
and the Netherlands have already done so. Following bans in both
countries on the non-therapeutic use of antibiotics in livestock,
resistance to some drugs dropped by half. Meanwhile, production
costs and supermarket prices have done what many thought
impossible: they have remained stable.
F CHICKEN FARMERS, and producers in general, stopped using
antibiotics tomorrow, our food system would be thrown into
chaos. While the bulk of antibiotics is used in livestock, an
editorial in The New England Journal of Medicine notes these drugs
are also “dropped to salmon in cages in the seas, sprayed on fruit
trees, and even embedded in marine paint to inhibit the formation
of barnacles.” Even honeybees—which produce a sweetener with
naturally antimicrobial properties—get treated with the stuff.
Prudent-use discussions, in both animal and human medicine,
often promote the principle of stewardship. Levy calls antibiotics
“societal drugs” because their use by one individual affects us all.
We could also think of them as a common resource, like water, that
must be protected. “Use is a privilege, not a right,” says Warren
Skippon, “whether we’re talking about a livestock producer or the
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parent of a small child with an ear infection.”
Farmers were among the earliest stewards of the earth; if they
didn’t carefully attend to the health of the soil and their animals
and their crops, a community would starve or die of disease. For
them, the idea of “One Health” was obvious. But most of us live in
cities now, and apart from answering that antiquated question
when we cross an international border—“Did you visit a farm
within the past two weeks? ”—most of us give very little thought to
the possibility that our health, and the health of our microbiome,
might be connected to that of the animals we come in contact with.
Eating chicken sashimi makes for a good story, but it’s one of the
stupidest things I’ve ever done. I was younger then, and a little
drunk, and I felt immortal. I am pretty sure no CIPARS researcher
would feed a child raw chicken; the bar graphs listing the bacteria
that the birds carry, and the bacteria’s resistance to dozens of
drugs, are as chromatic as a Missoni pattern. Nor would the
Detzlers; they know too much.
Bacteria, like us, are just trying to survive. They predate us by
millions of years, and will probably outlast us by millions more.
But they are even less visible than the chickens our farmers raise
behind locked doors, which means they are even easier to forget.
Rather than forget them, though, we could learn from them.
During our interview, Prescott, who recently retired, allowed
himself a moment of pessimism: he worried aloud that it was all
too little too late, and that rumours of regulatory change would
never translate into concrete action. Then he quickly recovered.
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“Bacteria can change,” he said. “But so can we.”
Sasha Chapman is one of the magazine’s senior editors. She joined The Walrus in 2011.
Tamara Shopsin does artwork for the New York Times, Time, and The Walrus.
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