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Feedstuffs
AMA, which is the nation's largest and most powerful professional
organization for medical doctors, took the action during its annual meeting
in Chicago, Ill.
The action drew immediate praise from several consumer groups but criticism
from the Animal Health Institute (AHI), the trade association based in
Washington that represents companies that make veterinary medicines,
vaccines and feed additives.
AHI had asked for the withdrawal of the resolution, noting efforts by the
animal health industry to address resistance through research, education
and surveillance. Further, AHI said "many segments of the animal
agriculture industry are working with the American Veterinary Medical Assn.
to implement judicious use guidelines."
Despite the plea from the animal health industry to quash the resolution on
antimicrobial use and resistance, in floor action AMA launched its
three-pronged attack on resistance in a measure that included a $2 million
fiscal note. The measure originated with the California Medical Assn.
The final resolution, as amended, states that:
* AMA resolves to "work with other organizations to establish a national
program to counter antibiotic resistance in clinical practice similar to
the California Medical Assn. Foundation AWARE program;
* AMA is "opposed to the use of antimicrobials at non-therapeutic levels in
agriculture or as pesticides or growth promoters and urges that
non-therapeutic use in animals of antimicrobials (that are also used in
humans) should be terminated or phased out based on scientifically sound
risk assessments," and
* AMA urges "surveillance of antimicrobial use and resistance be funded and
instituted as recommended by the Institute of Medicine and American Society
of Microbiology."
That final language came following discussion in the AMA committee of a
more sweeping draft resolution dealing with livestock antibiotic use.
Originally, it would have included blanket opposition to "the use of
antimicrobials at less than therapeutic levels in agriculture, or as
pesticides, or as pesticides or growth promoters, and would urge that these
uses be phased out by regulation."
Committee notes provided to Feedstuffs by AMA showed that testimony in the
committee "was uniformly supportive of the resolution and noted that many
organizations are interested in this issue."
Those notes indicated, however, that both the Centers for Disease Control &
Prevention and the Food & Drug Administration provided alternative wording
for the section dealing with use of antibiotics in agriculture while
supporting the first and third parts of the resolution that dealt with
human clinical use and surveillance.
AMA reported that FDA "is already addressing the use in animals of
antimicrobials that have human therapeutic benefit.
FDA stated that it has no authority to ban the use of an antimicrobial and
can only regulate use based upon scientific evaluation. Consideration was
given to that information in amending the AMA resolution, the committee noted.
The draft resolution said "an estimated 16 million pounds of
antimicrobials, or 80% of all such usage in agriculture, are used
subtherapeutically; ... all low-level constant uses are likely to promote
the development of resistance."
However, AHI took issue with the usage data presented in the resolution.
Three consumer or environmental organizations immediately praised AMA's
action on antibiotics in agriculture.
In a statement, Dr. Tamar Barlam, spokesperson for the Center for Science
in the Public Interest, said subtherapeutic use in food animals can
"drastically shorten the life span of an antibiotic. Clearly it is
important to extend the lifetime of any drug that is effective against
human disease, especially because few new antibiotics will be available in
the near future."
AMA said its action is aimed at putting the brakes on the burgeoning
problem doctors are having with resistance to antibiotics used in the
treatment of human ailments.
Reports show it is a serious and growing medical problem. Just this month,
the American Society of Microbiology (ASM) cited research at the University
of Iowa College of Medicine that showed antibiotic resistance rates for
Streptococcus pneumoniae infections have been on the rise over the past
five years. Resistance increased as much as 10 to 16% in the case of some
commonly prescribed antibiotics, according to data reported in the June
2001 issue of the journal Antimicrobial Agents & Chemotherapy.
In the study, researchers "collected and tested more than 1,500 clinical
isolates of S. pneumoniae from 33 medical centers nationwide during the
winter of 1999-2000 for resistance to 32 antibiotics. The results were then
compared to a similar nationwide study conducted in 1994-95 with many of
the same medical centers participating," according to the ASM statement.
Over the last five years, resistance rates of S. pneumoniae have increased,
dramatically in some cases, with resistance to penicillin increasing more
than 10%, resistance to erythromycin increasing more than 16% and
multi-drug resistance increasing more than 13%.
"Despite awareness and prevention efforts, antimicrobial resistance with S.
pneumoniae continues to increase in the U.S.," said the researchers. S.
pneumoniae is the cause of many different diseases in humans, including
meningitis, ear infections and pneumonia. The first antibiotic-resistant
infection by S. pneumoniae in the U.S. was reported in 1974, and resistant
infections occurred at low levels in the 1980s. It wasn't until the early
1990s that resistance became widespread.
AHI agrees that resistance is a serious issue that is being addressed in
the livestock industry. However, AHI spokesperson Ron Phillips told
Feedstuffs that AMA's stand on agricultural antibiotics was "like using a
blunt instrument to do surgery instead of a scalpel."
He disputed data AMA used to reach its decision -- and, it's relevance to a
policy decision on resistance. "The amount of use is not an indication of
the contribution to resistance," he pointed out. "They are trying to make
this a numbers game when resistance is much more complicated."
He also criticized AMA's call to phase out antibiotics used as growth
promotants. "Most growth promotants are not used in human health," he said,
and "it shows the political rather than the scientific nature" of AMA's
position.
Phillips pointed out that, "Everybody's concerned about resistance; that's
why we have judicious use guidelines."
AHI said in a statement that it "is committed to working with public health
officials and those in the veterinary and agriculture communities to combat
antibiotic resistance. While we recognize the importance of antibiotics to
human health, the AMA resolution is far too broad and sweeping, confuses
therapeutic and subtherapeutic uses and is an ineffective solution to
addressing antibiotic resistance."
AHI said, "Many segments of the animal agriculture industry are working
with public health officials to implement judicious use guidelines for
antibiotic use in animals. At the same time, we have supported funding for
additional research into resistance and how it is spread and have supported
funding for additional monitoring, surveillance and data collection to
provide a robust information base for proposed management efforts."
AHI said "the best approach is for the human health and animal health
industries to work together on research, education, monitoring and
surveillance efforts ... . This resolution does not represent such a
cooperative effort."
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