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David Perlman,
To spread their message, leaders of the San
Francisco Medical Society held a conference of
experts Friday that examined the connection
between the widespread use of common antibiotics
on farms and evidence that their continued presence
in foods can make many common disease-causing
microbes resistant to the drugs designed to kill
them.
Said Dr. Philip R. Lee, former chancellor of the
University of California at San Francisco and
longtime scourge of the international pharmaceutical
industry: "There's no question that antibiotics used
so widely on huge factory farms are posing a real
threat to human health, and it's not a problem that
doctors can deal with in their offices."
Lee insisted that only the U.S. Food and Drug
Administration, spurred by Congress, can make a
"major contribution to human health" by doing what
the European Union already has done in its partner
nations -- controlling the use in animals of
"nontherapeutic" antibiotics that are important in
human medicine and banning four specific antibiotics
for use as animal growth- promoters.
According to Dr. Rolland Lowe, former president
of the California Medical Association, leaders of the
statewide organization already are mobilizing
doctors all over California as well as more than 60
community health organizations to spread
knowledge of two aspects of the problem:
unnecessary prescribing for minor illnesses and
overuse in the farm animal industry as "the
pharmaceutical industry overwhelms you with
confusing facts."
That the facts are indeed confusing was made clear
by wide disagreement between two groups of
advocates.
On one side, for example, was Margaret Mellon,
food and environment program director of the
Union of Concerned Scientists, who said her
advocacy organization estimates that the beef, swine
and poultry industries use more than 50 million
pounds of antibiotics a year, with more than 25
million pounds a year just to promote growth in
animals or for other "non-therapeutic" purposes.
On the other side, a recent survey by the
Washington-based Animal Health Institute, which
represents the major pharmaceutical companies
producing antibiotics and other veterinary drugs,
maintains that less than 20 million pounds of
antibiotics are used in animals, with 17 million
pounds for treating diseases and only 2.8 million
pounds for "improving feed efficiency and enhancing
growth."
Mellon conceded that all the figures are only rough
estimates, and while she insisted that the industry
numbers "have no basis in fact," she argued that
only government agencies such as the FDA or the
Centers for Disease Control and Prevention have
the power to ferret out the actual amount used.
However, Dr. B. Joseph Guglielmo, professor of
clinical pharmacy at UCSF, reminded the
conference that doctors themselves are prescribing
far too many antibiotics indiscriminately for treating
minor infections -- often because patients demand
them. Other physicians agreed that overprescribing
might still be a major contributor to bacterial
resistance to antibiotic drugs.
Dr. Randy Singer, an epidemiologist at the
University of Illinois College of Veterinary
Medicine, said "the harsh reality is that resistance to
antibiotics occurs because of overuse in humans,"
and that using antibiotics in animals raised for food
has proved important in keeping those animals
healthy.
"Antibiotics used to improve animal growth and
feed efficiency can reduce subclinical disease and
improve productive performance and overall
health," he said.
"There is definitely abuse of antibiotics in the
livestock and poultry industries," Singer said, "but
the question is: How do you balance the need for
animal health with the problem of persistence of
antibiotics in the environment, and the increase of
resistance to antibiotics?"
The San Francisco Medical Society, led by its
president, Dr. George P. Susens, recently
persuaded the California Medical Association to
pass a resolution condemning unregulated use of
antibiotics in the livestock and poultry industries.
And only three weeks ago in Chicago, the powerful
American Medical Association adopted the
California policy by voting for a resolution that
declared, in part: "The spread of bacterial resistance
arises not only from unnecessary clinical use in
human medicine, but also from massive use in
animal agriculture, with increasing evidence that
resistance developed in animals is spreading to
human pathogens."
The AMA also opposed use of the drugs in animals
except to treat or prevent diseases and declared
that nontherapeutic use in animals of antibiotics that
are also used in humans should be terminated or
phased out by regulation "based on scientifically
sound risk assessment."
Susens and Steve Heilig, the San Francisco Medical
Society's director of public health and education,
said the local organization plans a major national
conference to weigh all sides of the growing
problem and will work to spread public awareness
of the issues.
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