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"Worst thing I've ever had," he says. "That's for sure."
Coldbreath runs his family's horse farm near Nashville. He looks a little like Paul Bunyan. He tells the story as he and his wife give the horses their morning hay. He says it just hit him one evening—wham.
"I could drink a 12-ounce can of Coca-Cola and I would have to go to the bathroom five times within 15 minutes of drinking it," he recalls. "It would go right through you."
So Colbreath went to his family doctor and asked him what he thought was wrong.
"He really didn't say ... he said, 'You might have eaten something that disagreed.' And I said, 'Well, I haven't eaten anything.' He said, 'Well, you know, you'll probably be all right.' He gave me some kind of light antibiotic. He told me, 'Be sure and take them as prescribed, and take all of them,' " Coldbreath explains.
That antibiotic was CIPRO. It stands for ciprofloxacin. This antibiotic came on the market in the late 1980s and since then has become one of the most important drugs in the world because it can treat all kinds of serious diseases. But Coldbreath kept getting worse. He lost almost 20 pounds from diarrhea. By now, he was so scared he went to the hospital.
"And the minute I walked in the room and saw him in clinic, literally hunched over—his eyes are very sunken-looking, his face is sunken-looking—it was pretty clear that this gentleman was very ill," remembers Dr. Stacy Davis, a cardiologist at Vanderbilt Medical Center in Nashville. Coldbreath sees her occasionally for a heart condition.
Davis says she could see he was incredibly dehydrated. "But we didn't expect the next thing we found. The next thing we found was he was so dehydrated [that] his kidneys had virtually shut down. He was actually on the verge of kidney failure."
Davis says if he'd waited two more days to come to the hospital, Mike Culbreath might be dead. The lab tests show that he had a whopping infection that people often get from eating chicken. It's caused by a kind of bacteria called campylobacter. You probably know about salmonella, right? Federal researchers say campylobacter infections are actually the most common kind of food poisoning in America. They think roughly two million people get sick from it every year, and until recently, CIPRO easily cured it. Not this time.
"I mean, it was very clear to me that what he had been treated with wasn't working and he needed to use something else," says Davis.
Coldbreath put a face on a statistic. Government researchers are finding that almost 20 percent of the patients who get sick from campylobacter have infections now that are resistant to CIPRO. And here's one of the most troubling parts of this story: They predicted years ago that this was going to happen. Researchers warned that if farmers gave crucial drugs like CIPRO to their animals, people like Mike Culbreath could possibly die.
The Miracle of Antibiotics
It's easy to take antibiotics for granted. Stuart Levy knows that. He runs one of the most respected laboratories that studies them, at Tufts University in Boston. He says we tend to forget that scientists developed the drugs barely 70 years ago.
"What makes an antibiotic a miracle is first that this group of drugs has reversed deaths from pneumonias, septic events in surgery, cured urinary tract infections, skin infections, diseases of the brain—any tissue of the body. There has been antibiotics that could literally, in their heyday, have cured most, if not all, infections," Levy explains.
And back in the 1940s, farmers started using them to cure sick animals. Then researchers accidentally discovered that the drugs can work other miracles, too. If you feed them to pigs and chickens and cattle, they make the animals grow faster. Scientists still don't really know why, although they have theories. In any case, America's drug and meat companies have convinced farmers that you have to feed antibiotics to your animals almost every day if you're going to compete in this age of factory farming.
As Little Feed as Possible
To see why antibiotics have become so important, we've come to a chicken house in the hills of Cornelia, Georgia. A vet named John Smith leads us through a flock of 17,000 chickens. The birds are so densely packed that it looks like Moses parting the sea.
"As you can see, they're not pets," he tells us, "but they're not, you know, overly frightened, obviously."
Smith works for a poultry company named Fieldale. They sell more than three million chickens every week in supermarkets on the East Coast. His company calculates its costs and profits based on something they call feed conversion. They know exactly how many ounces of feed they need to give every chicken so the chickens reach the perfect weight in precisely 46 days. It's an assembly line.
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"We have a target market weight. These birds we want to weigh about 5.4 pounds when they go to market. Our marketing department gets upset with us if we don't provide that size bird," says Smith. "If they're too big or too little, we've got problems."
And Smith says if the chickens munch antibiotics almost every day like vitamins, they gain the same amount of weight in the same amount of time, but on a tiny bit less feed.
"Feed conversion is important, because we need to use as little feed as possible to get that 5.4-pound bird. And the cost of feed and the cost of all the other inputs is very important to us to remain competitive and to be a profitable company," he explains.
Creating Super Bugs
But almost ever since farmers began using antibiotics in animals, researchers like Stuart Levy have been warning that they can threaten your health. The problem is bacteria are amazing creatures.
"As a young investigator," Levy recalls, "I was fascinated by bacterial ingenuity, so to speak. They had this facility to resist, to find a way to get around these powerful antibiotics."
Levy started studying this problem back in the 1960s. He'd seen bacteria get resistant to penicillin. He'd seen bacteria shrug off tetracycline. Levy and his colleagues discovered that the more you douse bacteria with antibiotics, the more some of those bacteria transformed themselves like creatures from outer space, so drugs become powerless to kill them. Levy started wondering, how are doctors hurting the public's health when they prescribe too many antibiotics in their clinics? And then it hit him.
"What's happening on the farm if we're throwing at the animals these drugs?" he questions.
Drugs at the Dinner Table
Levy raised a bunch of chickens to find out, and sure enough, the bacteria in the birds that munched antibiotics got resistant almost overnight. Now Levy pictured a scenario: You sit down for dinner. You eat a chicken breast that's still got some resistant bacteria on it. Then you get sick and go to the doctor, but the antibiotics won't work.
Levy did this study back in the 1970s, and officials at the Food and Drug Administration got so alarmed that they decided to banish some of the main antibiotics from farms. But the meat industry went straight to Capitol Hill, and congressmen ordered FDA to back off.
Now here it is decades later. The nation's farms are using more drugs than ever. Doctors are seeing patients with infections like salmonella that half a dozen antibiotics can't treat. Levy says the problem could be affecting your family.
"I'd be amazed if a large proportion ... 20, 30 percent ... has not had, has not confronted an antibiotic resistance problem," says Levy. "Many, many people in the United States are suffering in one way or another, some worse. Some have untreatable infections; some have died in the United States."
Levy says doctors who prescribe too many drugs are still the biggest cause of the problem, but, he warns, "farms are definitely part of the problem."
And the officials who run FDA now say they want to go after antibiotics again. They say farmers shouldn't use the same drugs that are crucial for saving humans just to make animals gain weight or even to treat animals that are sick. And that brings us back to CIPRO. Remember Mike Culbreath in Tennessee? Remember how he got a campylobacter infection and the best-selling CIPRO didn't cure it? FDA says CIPRO's losing its power in people because farmers are using a version to treat chickens. FDA officials plan to hold public hearings later this year to begin to ban CIPRO on the farms.
The Animal Health Institute
"Well, I don't know what's motivating them," says Richard Carnevale, a drug company spokesperson. "The problem we've had with this issue for a long time: It's gotten very emotional."
Carnevale speaks for the country's leading drug companies, like Bayer, Pfizer, Monsanto. They have a coalition that promotes medicines on farms. They call it the Animal Health Institute. Carnevale says FDA can't prove that CIPRO or any other drug on farms actually ends up hurting people. He says that's circumstantial evidence, so he says public health officials who want to crack down on antibiotics must have personal motives.
"And I think there are some other agendas probably at work," Carnevale explains. "There's the whole idea that there are some people against the raising of animals for food. The vegetarians, the people that just don't like the whole practice of animal production, I think, could be driving some of it."
FDA officials agree that the evidence against CIPRO is circumstantial, but they say it's overwhelming. Until farmers started giving the drug to chickens only a few years ago, researchers almost never saw campylobacter infections that were resistant to CIPRO. Since then, a lot of campylobacter has become resistant, both in chickens and in the humans who ate them.
The Price of Precaution
Back on the farm in the rolling hills of Georgia, John Smith says he worries that these drugs might be affecting the country. Smith is the vet at the Fieldale Chicken Company, but he says maybe it all comes down to philosophy.
"I guess it's my fear that this is representative of a feeling that I see in our society in general. We've gone from ... a period in, I guess, the '50s and '60s where technology was our savior. And now technology is evil and bad until proven otherwise. And we're adopting this precautionary principle, 'Well, there might be a problem, so we'd better stop right now.' To me, that's a dangerous precedent."
And, of course, there's the question of money. The country's top science body, the National Academy of Sciences, asked a provocative question a few years ago. If farmers stop raising animals on antibiotics to make them grow faster, what will happen to the nation's economy? The study concludes that the drug companies will be hurt most of all. They sell more than $2 billion worth of drugs for food animals every year. And the study says that you will have to pay more for your meat. You'll pay an extra $9.72 per year to rein in drugs on the farms, or about the cost of a movie ticket.
Denmark Vows to Kick the Habit
Who would ever figure that Denmark could teach America and the rest of the world how to farm? The whole country is smaller than West Virginia. But come to this chicken house in the countryside a couple hours from Copenhagen and you'll discover why Denmark brags that its chickens are a lot better for you than most chickens in the United States. Today is market day.
The trucks have come to take these thousands of birds to slaughter. Back in America, they usually grab the chickens by hand, but it's all mechanized here in Denmark.
"It's an amazing machine, very easy and gentle for the chickens," one of the workers explains.
It looks like those scrubbers that roll around at a car wash, and they spin the chickens in a pirouette and fling them in crates on the truck. And Danes can tell you that this is the same spirit of progress that's pushed them to make their chickens safer. If you visit a typical American farm, you'll find that every chicken has spent its life munching antibiotics. The drugs make the animals grow faster on less feed. Medical researchers warn that those drugs threaten public health. It used to be like that in Denmark, but not anymore.
"Actually, most chickens now would be raised entirely without antibiotics," explains Henrik Wegener.
Wegener works for the Ministry of Agriculture, and he takes us to the meat section in a supermarket to reinforce what his country has accomplished. This is a typical supermarket. If you look past the sales signs in Danish, and ignore the million cans of herring, you could be at Safeway or Kroger. And meat's cheap. Chickens are around a dollar a pound. But then Wegener reads the label and it says what the American farm industry claims can't be done.
"It's standard labeling. You can see, now that you recognize the Danish, produced without antibiotic growth promoters. This one says, 'Produced without antibiotic growth promoters.' You cannot find any one that doesn't say that," says Wegener.
Five years ago, says Wegener, he could not have dreamed that this day would come so soon in Denmark. "No, not at all. Not at all."
Not Just Another Additive
One of the most surprising parts of this story is not just that Danish farmers have pretty much kicked the chemical habit; it's the fact that executives and their food industry pushed them to do it. Just about anybody can tell you exactly when people in Denmark decided that farmers had to change.
It was one night in spring in the mid 1990s; the country's leading television network broadcast this expose. They called it "A Pig of a Medicine." The program showed pigs literally wallowing in yellow powder made from antibiotics.
"It came as a shock to everyone that growth promoters were, in fact, antibiotics, because it had almost been forgotten," says Wegener. "I mean, even the farmers, even their advisers sometimes didn't know they were antibiotics. It was just another additive like vitamins, and no one thought about it as an antibiotic for many years."
Government researchers discovered that drugs on the farms were causing a dangerous chain reaction. First, farmers were giving their animals the same important antibiotics that doctors use in hospitals. Second, bacteria in the animals' intestines were getting resistant to those drugs. Third, people were getting infected with those resistant bacteria when they ate the meat. And finally, some people were getting sick and almost dying because the most powerful antibiotics didn't work anymore. Wegener told Denmark's leaders, 'We've got to start banning antibiotics on the farms.' Critics said he'd destroy the country's economy. Their single biggest export is pigs.
"Well, I mean, there were warnings from other scientists that this would create an animal health disaster, you know, that animals would die in thousands, that farmers would go bankrupt, that what we do can basically [is] make Danish agriculture, you know, go out of business," says Wegener. "And that is a strong argument in a country that is relying so heavily on its agriculture and especially its meat production. And even in the light of that, we could not defend to ourselves, to our children, our ancestors, not to act."
A Sobering Experiment
Back in the United States, public health officials have tried for years to yank antibiotics off farms, but the drug and meat industries have always blocked them. They argue there's no proof that drugs on the farms end up hurting people.
Here in Denmark, things were different. Chris Turkelson represents the big poultry companies, the Danish Poultry Meat Association. He says executives believed their government studies.
"So we was a little bit worried about using antibiotic growth promoters, because there could be a risk for the human health," says Turkelson, "and we can see that resistant bacteria was increasing, and that was really the reason why we say, 'Stop.'"
And Turkelson says executives also wanted to protect their business. A popular TV program broadcast a sobering experiment. They put signs on some of the meat in the supermarket that said, 'This comes from animals that were raised with antibiotics,' and then hidden cameras showed shoppers turning away. So when Danish leaders decided to ban only a couple of drugs on the farms, industry executives said, 'Let's get tougher,' and the meat companies told the nation's farmers, 'From now on, if you want to do business with us, you'll have to sign a contract swearing that you never use antibiotics to help your animals grow faster.'
"I think this was a very strong message given to the consumer," explains Turkelson. "We want the consumer to trust the product we put onto the market."
Cleaning Up After the Chickens
To see how Danish farmers are coping, we drive down a country road past wheat fields and cattle and farmhouses with thatched roofs.
"My name is Biara. I hope you will enjoy your stay here, and just ask me if you want to know something about my way of raising broilers."
Biara has got an impish smile, gray hair, and really blue eyes. He says when he took over his parents' farm 20 years ago, he proudly taught them to farm the modern way. So when the meat industry suddenly told him to stop using antibiotics, he and his neighbors couldn't believe it.
"Yeah. I, as a broiler producer, and some of my colleagues, were laughing, yeah. When I was in agriculture school," Biara recalls, "we were told that the animals got to have some antibiotics so they could have good health. So that was the way we was taught to do, and we do it."
But Biara says he's learned the secret of how to raise animals a more natural way. You have to take great care of them. For instance, it's harder to visit Biara's chicken house than the intensive care ward in a hospital. He raises his chickens, 45,000 chickens, in a huge brick shed that's longer than a football field. No windows. Before we step foot across the threshold, we have to put on disposable body suits with hoods. Then we have to lift each foot in the air and balance as we pull on a long, plastic boot, and then we carefully place that foot inside the doorway without ever brushing the ground outside. Biara's not protecting us; he's protecting his birds.
"I'm afraid you have some bacteria on you," he says. "Perhaps on your clothes. At least we don't want to take any risk that you'll bring bacteria inside my house."
At this point, we still can't get next to the chickens. He'll only let us view them through a sealed window. Some researchers in Europe and the U.S. say that antibiotics are like a crutch. They basically cover up a farmer's mistakes and they work best in animals that aren't perfectly healthy.
So Biara says he has to be meticulous. "First of all, we have the computer taking care of everything. It's connecting the feed barrel to the water."
Biara's computer sends his chickens just the right amount of feed, and he has to give them better feed now than he used to. The computer creates a soothing climate with perfect temperature and humidity. And Danish farmers say there's one more key to raising chickens without antibiotics. When you hear this, you might think it sounds so obvious that it's silly to even mention it. After farmers send each flock of chickens to market, they clean up.
On the day we visit Biara's farm, his birds are only halfway grown, so let's go down the road to another farm where they've just sent the flock to the slaughterhouse. Here's a quiz for you. When you take tens of thousands of chickens out of your chicken house, what have you got left? Answer: You have a chicken house full of feces and chicken litter and viruses and bacteria that can make your animals sick. And if you're a typical American farmer, you clean up all this stuff only once every two or three years. Danish farmers scour the chicken house every several weeks with high-pressure hoses and disinfectants.
Farmers here say they can't believe that American farmers don't do this. And now you know the Danish secrets of how to kick the drug habit. Biara says he's so determined to make it work that he goes to bed with his chickens, in a way. He's hooked up a video camera and microphone in his chicken house so he can monitor his flocks on his bedroom TV.
"On my TV I can have a look at my broilers inside the broiler house," he explains. "That's a part of my family, and I want to say good night. In the evening, I turn on my television, yes, that's why."
Can American Farmers Kick the Drug Habit?
Since Denmark began its crusade, farmers haven't totally stopped using drugs, but they've cut way back, by almost two-thirds. Government researchers are studying the effects. Some farmers say their pigs tend to get sick more often, although it hasn't caused major problems, and studies show that chickens have to eat a tiny bit more food to gain the same amount of weight. They figure it costs two cents more now to raise each chicken, but the farmers are selling their chickens for two cents more, so they're making as much money as ever. Of course, the main reason Denmark went after drugs was to protect the public's health. The latest government survey shows that most of the main kinds of bacteria on the farms the doctors worry about are already less resistant, which raises a question: Could American farmers kick the drug habit, too? Ask the government scientist who helped prod his country to change, Henrik Wegener.
"It is not rocket science," says Wegener. "If it can be done here, of course it can be done in the States. Whether they do it or the consumers do it for them, sooner or later they'll have to do it. And, of course, the advice they get may be 'Better not listen too much to those crazy Danes.' But I think they should try and listen to us. I think we've set a good example."
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