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FDA: 70 Percent of Antibiotics Sold in US are Used in Livestock, and That Number Continues to Rise

FDA: 70 Percent of Antibiotics Sold in US are Used in Livestock, and That Number Continues to Rise

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The Natural Resources Defense Council has called for individual states to step up in the face of ‘meaningful federal action.’

According to the latest report from the US Food and Drug Administration (FDA), released Friday, April 10, sales of medically important antibiotics for the treatment of livestock continue to rise.

This is despite repeated warnings from the FDA itself, the World Health Organization, hundreds of American physicians, and the Centers for Disease Control, which called antibiotic resistance one of the five greatest health threats facing the nation.

As we’ve previously reported, public health officials have continually warned against the use of human antibiotics on farm animals, abuses of which have been linked to increasingly resilient “superbugs,” including drug-resistant tuberculosis and gonorrhea.

The study, which looks at the sales of antibiotics in 2013, found that there was an increase of 3 percent in the use of antibiotics important to human medicine, from approximately 9,800 tons to nearly 10,140 tons, since 2012. Additionally, 95 percent of medically important antibiotics sold wound up in the food and water given to farm animals, up from 94 percent.

The FDA previously indicated that it would stop the routine use of antibiotics to increase growth, but not for disease prevention. According to the Natural Resources Defense Council, “Because ‘growth promotion’ and ‘disease prevention’ uses overlap significantly, stopping only growth promotion uses would allow the continued routine use of antibiotics at low doses in the feed and water of large numbers of animals that are not sick.”

Currently, the NRDC is working with California Senator Jerry Hill to close the FDA loophole that allows the use of those same antibiotics for disease prevention. The organization has called upon individual states, “in the absence of meaningful federal action,” to do their part to stop the proliferation of antibiotics in livestock.

Antibiotics in Agriculture

Because organic practices recognize and respect the powerful nature of antibiotics, organic practices protect human health in the long term. Organic practices prohibit the use of hormones, antibiotics or other animal drugs in animal feed for the purpose of stimulating the growth or production of livestock. If an antibiotic is used to restore an animal to health, that animal cannot be used for organic production or be sold, labeled or represented as organic. Thus, organic practices avoid the abuse of antibiotics that could have profound consequences for treatment of disease in humans, including the serious dangers of antibiotic-resistant bacteria.

The following highlight findings concerning the abuse of antibiotics in agriculture:

• The June 2009 issue of Environmental Health Perspectives includes a focus article entitled “The Landscape of Antibiotic Resistance.” Included are references to research showing that the practice of using antibiotics at sub-therapeutic levels in livestock feed and water has led to the persistence of these antibiotics in the environment and the possibility of antibiotic-resistant bacteria.
Source: Environmental Health Perspectives, June 2009 (

• Researchers at the Johns Hopkins Bloomberg School of Public Health have found evidence that driving behind trucks transporting broiler chickens from non-organic farms to slaughterhouse can exposure humans to antibiotic-resistant bacteria. The study showed increased levels of pathogenic bacteria, both susceptible and drug-resistant, on surfaces and in the air of cars traveling behind trucks that carry intensively raised poultry. The findings were published in the first issue of the Journal of Infection and Public Health.

• In a report released in April 2008, the European Food Safety Authority (EFSA) expressed concerns about the growing use of antimicrobial agents in food. Citing the potentially negative impact of these agents on human resistance to bacteria and other microbes, EFSA spokesperson Alun Jones told that “Antimicrobial resistance cannot be predicted—it comes from the mutation of existing bacteria…so we need to keep an eye on this issue and make sure that all the potential entry points into the food chain for such resistant bacteria are controlled.”

• Evaluating the impact of antibiotic feeding in livestock production on the environment, scientists at the University of Minnesota conducting a greenhouse study found that food crops can accumulate antibiotics from soils spread with manure containing antibiotics. Results from the study, published in the July-August 2007 issue of the Journal of Environmental Quality, showed that corn, lettuce and potatoes all take up antibiotics in the soil, with concentrations in plant tissue increasing correspondingly to the levels in the manure. Not only were antibiotics found in plant leaves, but also diffused in potato tubers, indicating that root crops that directly come into contact with soil may be particularly vulnerable to antibiotic contamination.
Source: Journal of Environmental Quality, July-August 2007.

• A study evaluating the levels of antibiotic-resistant bacteria inside, upwind and downwind from a confined animal feeding operation for swine found that bacterial concentrations with multiple antibiotic resistance were recovered both inside and at least 150 meters downwind at higher percentages than upwind. These concentrations were found within and downwind of the facility even after the use of sub-therapeutic antibiotics was discontinued. Researchers led by Shawn G. Gibbs of the University of Texas Health Science Center pointed out that these findings point to a potential health risk for those who work within or live near such facilities.
Source: Environmental Health Perspectives, Vol. 114, No. 7, July 2006, pages 1,032-1,037.

• A study conducted by a Johns Hopkins team of researchers has investigated possible antibiotic resistance in airborne bacteria in a swine concentrated animal feeding operation (CAFO). In the study, researchers collected air samples from a swine-finishing CAFO in the mid-Atlantic United States. Their conclusions: exposure to airborne bacteria from a CAFO can provide a potential pathway for transferring antibiotic-resistant bacteria from animals to humans.
Source: Environmental Health Perspectives, February 2005.

• The U.S. Food and Drug Administration has withdrawn approval for the use of Cipro-like antibiotics in poultry due to concerns it could lead to antibiotic–resistant bacteria in humans. The ban, first proposed by the Clinton Administration in October 2000, took effect in September 2005. As a result, conventional farmers will no longer be able to use the antibiotic Baytril, known generically as enrofloxacin, on poultry.

• Environmental Defense in June 2005 issued a report, “Resistant Bugs and Antibiotic Drugs,” which highlights state and county estimates of antibiotics in agricultural feed and animal waste. Among the findings: North Carolina and Iowa each are estimated to use three million pounds of antibiotics as feed additives annually, the same amount estimated to be used for human medical treatment nationwide of the total quantity of medically important antibiotics used as feed additives, the largest fraction is used in hogs (69 percent), compared to 19 percent in broiler chickens and 12 percent in beef cattle when all antibiotic feed additives are considered, hogs accounted for 42 percent, broiler chickens for 44 percent, and beef cattle for 14 percent.
Source: Environmental Defense, “Resistant Bugs and Antibiotic Drugs,” June 2005.

• A report by the U.S. Government Accounting Office notes that the U.S. Food and Drug Administration has determined that antibiotic resistance in humans resulting from the use of antibiotics in animals “is an unacceptable risk to the public health.” The study, entitled Antibiotic Resistance: Federal Agencies Need to Better Focus Efforts to Address Risk to Humans from Antibiotic Use in Animals, was requested by Senators Edward M. Kennedy (D-MA), Olympia Snowe (R-ME), and Tom Harkin (D-IA). Kennedy and Snowe were sponsors of a bipartisan bill (S. 1460) to phase out the routine use of medically important antibiotics in livestock and poultry that are not sick, and to provide funding to help farmers make the transition. Representatives Sherrod Brown (D-OH) and Wayne Gilchrest (R-MD) were sponsors of the companion bill (H.R. 2932) in the House of Representatives.
Source: U.S. Government Accounting Office, Antibiotic Resistance: Federal Agencies Need to Better Focus Efforts to Address Risk to Humans from Antibiotic Use in Animals, April 2004. Report posted at

• A report in Emerging Infectious Diseases (April 2004, has shown that the antimicrobial agent avoparcin, used extensively as a growth promoter in animal feeds, contains a cluster of intact genes that confer antibiotic resistance. Noting that many antimicrobial agents used as animal feed additives likely act as a carrier for resistance genes, authors Karen Lu, Rumi Asano and Julian Davies wrote, “Delivery systems provide the opportunity for resistant strains of bacteria to evolve and so create an enormous gene pool for antimicrobial resistance determinants in the environment.”
Source: Karen Lu, Rumi Asano and Julian Davies, in Emerging Infectious Diseases, April 2004.

• A Colorado State University study has found antibiotic drugs used to promote growth, prevent disease and increase feed efficiency in livestock are showing up in public waterways. Conducted on the Cache la Poudre River in Colorado, the study, funded by USDA and the university’s Agricultural Experiment Station showed that antibiotics used in livestock are finding their way into streams and rivers. Ken Carlson, principal investigator on the project, said future studies are needed to determine how the antibiotics made their way into public waterways, how long they stay in water and sediment, and to better understand potential dangers to aquatic life, animals and humans.
Source: Ken Carlson, Department of Civil & Environmental Engineering, Colorado State University, Fort Collins, CO.

• Research has shown waste from poultry raised in industrial chicken houses contains bacteria with antibiotic multi-resistance genes. Anne Summers and colleagues from the University of Georgia collected samples of chicken litter from Georgia chicken houses over a 13-week period. They then tested the litter for integrons (small DNA segments that assemble and express resistance genes) and associated antibiotic resistance genes.
Source: Proceedings of the National Academy of Sciences, April 19-23, 2004 online edition.

• In Letters in Applied Microbiology, Vol. 28, pages 197-205 (2004), researchers from the Institute of Food Research, Norwich, United Kingdom, reported that a probiotic diet makes chickens healthier and safer to eat, and could reduce the routine use of antibiotics.

• The World Health Organization in 2003 recommended that countries phase out the use of antibiotic growth promoters in animal feed. Basing its recommendation on a study conducted following a 1998 voluntary ban of such growth promoters in Denmark, WHO said the phase-out would help preserve the effectiveness of antibiotics for therapeutic use. According to the report, the cost of producing pigs in Denmark rose about 1 percent and antibiotic use to treat sick animals increased after the ban, but the overall amount of antibiotics used on Danish farms fell by about 50 percent. More important, the amount of resistant bacteria in pork and chicken declined substantially. For instance, before the ban, 60 to 80 percent of chickens had bacteria resistant to three widely used antibiotics. After the ban, that number had dropped to 5 to 35 percent of the birds.

• A German study of dust samples collected during two decades from a pig feeding operation revealed the presence of various antibiotics. Findings, published in the October 2003 issue (Vol. 111, No. 13) of Environmental Health Perspectives showed up to five different antibiotics in 90 percent of the samples. Warning that high dust exposure could expose farmers to inhaling dust contaminated with antibiotics, researchers from the School of Veterinary Medicine Hannover, Hannover, Germany, said their data provide evidence that dust can carry veterinary drugs in the environment.
Source: “Antibiotics in Dust Originating from a Pig-Fattening Farm: A New Source of Health Hazard for Farmers?” Gerd Hamscher, Heike Theresia Pawelzick, Silke Sczesny, Heinz Nau, and Jörg Hartung.

• Researchers at the University of Maryland School of Medicine, in collaboration with a researcher at the Veterans Administration Medical Center in Baltimore, MD, have found anitibiotic use in animals can affect the emergence of antibiotic resistant bacteria in humans. Reporting their findings in the April 23, 2002, Proceedings of the National Academy of Sciences, David L. Smith and colleagues concluded that “regulating early agricultural antibiotic use would likely extend the period that a drug can be used effectively in humans and reduce the demands for new antibiotics.”
Source: Proceedings of the National Academy of Sciences, April 23, 2002.

• Public health authorities have linked low-level antibiotic use in conventionally raised livestock directly to greater numbers of people contracting infections that resist treatment with the same drugs. Microbiologist Rustam Aminov and colleagues at the University of Illinois at Urbana-Champaign have discovered that bacteria in the soil and groundwater beneath farms seem to be acquiring tetracycline resistance genes from bacteria originating in pigs’ guts. Studying the environmental effects of antibiotics used as growth promoters on two swine farms, Aminov’s team analyzed samples from farm-waste lagoons and from groundwater reservoirs beneath the lagoons, and found that bacteria in the soil and groundwater carried tetracycline resistance genes.
Source: Applied & Environmental Microbiology, Vol. 67, page 1494 (2001). Also cited in New Scientist magazine, April 21, 2001.

• A preliminary survey of beef and poultry sold in U.S. supermarkets conducted by the U.S. Food and Drug Administration found relatively high levels of antibiotic-resistant bacteria, according to a report presented at the 101st annual meeting of the American Society for Microbiology in May 2001. FDA microbiologist Dr. David Wagner reported that investigators found “fairly substantial amounts of resistance to a number of drugs.”
Source: 101st annual meeting of the American Society for Microbiology, May 2001.

• The American Medical Association in June 2001 adopted a resolution opposing the use of antimicrobials at non-therapeutic levels in agriculture, or as pesticides or growth promoters, and urged that such uses be ended or phased out based on scientifically sound risk assessments.
Source: American Medical Association, 515 North State Street, Chicago, IL 60610, 312-464-5000. Resolution 508: Antimicrobial Use and Resistance (adopted as amended, June 2001).

• “The reason to buy meat without antibiotics is not because the antibiotics in the meat are transferred to the person, but because of how the antibiotics increase the number of antibiotic-resistant bacteria,” according to Dr. Stuart Levy, director of the Center of Adaptation Genetics and Drug Resistance at Tufts University Medical School, in a New York Times article by Marion Burros.
Source: Jan. 17, 2001, New York Times article by Marian Burros.

• Carol Goforth, the Clayton N. Little Professor of Law at the University of Arkansas, and Robyn Goforth, a biochemistry graduate student, have called for regulation of antibiotic use in livestock due to the growing problem of antibiotic-resistant infections in humans. In a paper in the Boston College Environmental Affairs Law Review, the Goforths cited the growing body of scientific literature linking sub-therapeutic doses of antibiotics in livestock to mutated, antibiotic-resistant bacteria and to outbreaks of antibiotic-resistant infections in humans.
Source: “Appropriate Regulation of Antibiotics in Livestock Feed,” by Carol Goforth and Robyn Goforth, in the Boston College Environmental Affairs Law Review, as cited in “The Cow & The Cure,” by Melissa Blouin, in University of Arkansas Research Frontiers, Spring 2001, pp. 28-29.

• In its report “WHO Global Strategy for Containment of Antimicrobial Resistance,” the United Nations’ World Health Organization (WHO) noted that farmers’ use of antibiotics to fatten livestock and poultry enables microbes to build up defenses against the drugs, jump up the food chain, and attack human immune systems. WHO urged farmers to stop the practice of using antibiotics for growth promotion if such antimicrobials are also used in humans.
Source: “WHO Global Strategy for Containment of Antimicrobial Resistance,” United Nations’ World Health Organization, September 2001 (

• Conventional farmers routinely feed antibiotics to livestock because flocks and herds tend to grow faster with their use. However, scientists, doctors, and government officials fear this is contributing to the rise of antibiotic-resistant “super-bugs.” Farm animals in the United States receive 24.6 million pounds of antibiotics a year, which may be fueling the rise of drug-resistant bacteria, according to the Union of Concerned Scientists (UCS). UCS noted that about 70 percent of all antibiotics made in the United States are used to fatten up livestock.
Source: “Hogging It: Estimates of Antimicrobial Abuse in Livestock,” by Margaret Mellon, Charles Benbrook, and Karen Lutz Benbrook, Union of Concerned Scientists, January 2001 (report available at

• Three studies published in The New England Journal of Medicine verified that antibiotic-resistant bacteria are widespread in commercial meats and poultry in the United States and also are found in consumers’ intestines. The studies show evidence that the routine use of antibiotics to enhance growth in farm animals can encourage the growth of drug-resistant bacteria, which may threaten people who undercook their meat or consume food or water contaminated by animal droppings. An accompanying editorial written by Dr. Sherwood L. Gorbach, an infectious disease specialist at Tufts University’s medical school, urged a ban on the routine use of low-dose antibiotics to aid animal growth and prevent infection because it sets up conditions for the emergence of resistant bacteria.
Source: The New England Journal of Medicine, Vol. 345: pages 1147-1154, 1155-1160, and 1161-1166, Oct. 18, 2001

• Water samples from the Ohio River and two of its tributaries contained trace amounts of commonly prescribed antibiotics, such as penicillin, tetraycline, and vancomycin. They were also present in area tap water. The results were from a science project undertaken by 17-year-old high school senior Ashley Mulroy.
Source: “Water Worries,” in Popular Science, May 2001, p. 42.

• Findings published in The New England Journal of Medicine indicate that the controversial practice of administering antibiotics to cattle may have led to the development of salmonella resistant to the antibiotic ceftriaxone. The study, led by Paul Fey of the Nebraska Public Health Laboratory, examined the case of a 12-year-old boy infected with salmonella.
Source: The New England Journal of Medicine, April 27, 2000

Organic practices offer a compelling alternative to to the overuse of antibiotics

• Researchers from the University of Florida and the Universities of Wageningen and Groningen in the Netherlands have developed a computer model called Coliwave that predicts the risk of E. coli contamination in manure. Their findings showed that the way manure is treated and stored has a huge impact on E. coli levels, with good organic practices more likely to produce foods less likely to be contaminated. However, it is still important for farmers to take measures, such as feeding a high fiber diet, to try to prevent E. coli from forming in cattle (from the March/Winter 2010 issue of The Organic Report).
• In a 2007 study for the Food Safety Consortium, researchers led by Daniel Fung, food science professor at Kansas State University, found that Jasmine tea or green tea with honey can be used to reduce pathogenic bacteria in meat. Treating turkey breast slices with combinations of Jasmine tea extract and wildflower dark honey reduced Listeria monocytogenes by 10 to 20 percent. Similar reductions were recorded when applied to hot dogs.
• In another 2007 research study funded by the Food Safety Consortium, a University of Arkansas-led team found that using bacteriocins—proteins produced naturally by other bacteria—can provide an effective way to get rid of pathogenic Campylobacter bacteria in turkeys. “If we can eliminate Campylobacter, we don’t have to worry about antibiotic resistance,” according to Dan Donoghue, a poultry science researcher at the University of Arkansas who led the project.
• A 2005 study conducted by the University of Guelph in Canada showed suppression of Fusarium in plants fertilized with Drammatic K fish hydrolysate. The findings are consistent with observations by organic growers, who have reported suppression of plant diseases when using fish hydrolysate.
• Researchers at the University of Santiago de Compostela in Lugo, Spain, have found significantly lower percentages of antimicrobial resistant E. coli isolates in organically raised poultry than in conventionally raised poultry. Conducting a comparison of antimicrobial resistance in E. coli, Staphylococcus aureus and Listeria monocytogenes strains in poultry, researchers studied 55 samples of organic poultry meat and 61 samples of conventional poultry meat.

“Accordingly with consumers’ beliefs, the statistically significant lower percentages of antimicrobial resistant E. coli isolates found in organically raised poultry support that the organic rearing of poultry may limit the presence of antibiotic-resistant intestinal bacterial in such animal foods,” the researchers concluded. Findings were published in the December 2008 issue of the Journal of Food Protection.

Other information related to antibiotic use:
• U.S. Representative Louise Slaughter (D-NY) in March 2009 introduced legislation to limit the use of antibiotics on industrial livestock farms to when the animals are sick. Proponents of the bill point out that the misuse of antibiotics in industrial farming contributes to the dramatic rise in antibiotic-resistant infections in humans. Organic farming does not allow the use of antibiotics.

• Check out this informative paper from Food and Water Watch on how antibiotic misuse on factory farms can make you sick.

This fact sheet was compiled by the Organic Trade Association, Fall 2010.

Food Safety

Are Growth Hormones Safe or Not?

You’ll find something else in the feed of grain-fed cows: hormones. Synthetic estrogen, testosterone and growth hormones are another way to help cows grow 15% larger, faster.

Going back to our first point, “you are what you eat”, when we eat beef that has been treated with hormones, we’re also ingesting those hormones. While there’s limited research to show the impact that synthetic hormones — specifically sourced from grain-fed meat — have on our health, it may not be ideal for those who are already susceptible to certain cancers or are suffering from hormonal imbalances to be ingesting them (6)(7).

A large percentage of grain-fed cattle are treated with hormones. However, it’s possible to find hormone-free conventionally raised beef.

Grass-fed beef are generally not exposed to hormones in their lifetime.

Antibiotics: 30 Million Pounds Used in Livestock

Think it’s common for Americans to take antibiotics? Some sources suggest over 70% of the antibiotics in the US are given to animals. In fact, over 30 million pounds of antibiotics were given to American livestock in 2011.

The danger of consuming antibiotics through meat is becoming more prevalent, as antibiotic use in livestock has recently been discovered as a leading cause of the rise in antimicrobial-resistant infections — leading to antibiotic resistance and increased mortality rates (8).

There’s no pretty way to say this: the feedlots on which grain-fed cows live aren’t the most sanitary environments. In fact, the ground the cattle stands on is basically a mix of bacteria, mud, dirt, and feces. These living conditions make the cows more susceptible to illness and disease, which is why they’re commonly treated with antibiotics.

While there’s no guarantee that a grass-fed cow won’t get sick and need a round of antibiotics in their lifetime, the living conditions of a pasture are far less of a threat to the cow’s health than a feedlot. That’s not to mention the greater amount of immune-boosting nutrients in a grass-fed diet versus a grain-fed diet — in which case, fewer (if any) antibiotics should be needed.

- LAND -

Animal agriculture contributes to species extinction in many ways. In addition to the monumental habitat destruction caused by clearing forests and converting land to grow feed crops and for animal grazing, predators and "competition" species are frequently targeted and hunted because of a perceived threat to livestock profits. The widespread use of pesticides, herbicides and chemical fertilizers used in the production of feed crops often interferes with the reproductive systems of animals and poison waterways. The overexploitation of wild species through commercial fishing, bushmeat trade as well as animal agriculture’s impact on climate change, all contribute to global depletion of species and resources. [XIX]

David Kirby on “The Looming Threat of Industrial Pig, Dairy and Poultry Farms on Humans and the Environment”

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We speak with David Kirby about his book Animal Factory: The Looming Threat of Industrial Pig, Dairy and Poultry Farms on Humans and the Environment. “We need more regulations, and we need enforcement of the regulations,” Kirby says. “These [food] companies are self-policing, and they are operating on the honor system. And consumers are obviously paying the price.” [includes rush transcript]

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AMY GOODMAN : As we talk about the largest egg recall in US history, at this point half a billion eggs, our guest is David Kirby. His book is Animal Factory: The Looming Threat of Industrial Pig, Dairy and Poultry Farms on Humans and the Environment.

Actually, David, we keep saying half a billion eggs have been pulled off the shelves. How do we know they’re pulled off the shelves?

DAVID KIRBY : Apparently they haven’t all been pulled off the shelves, because they’re still warning people to check the numbers when they get the eggs home from the market. This is a voluntary recall, which just illustrates the point that I was making before. We need more regulations, and we need enforcement of the regulations. These companies are sel- policing, and they’re operating on the honor system. And consumers are obviously paying the price. Salmonella can make you very, very sick.

AMY GOODMAN : I mean, we’re talking about more than thirty labels. You don’t see DeCoster. You know, you don’t &mdash- it’s not Hillandale. It’s not these -&mdash

DAVID KIRBY : These are market &mdash usually under supermarket brand labels. A lot of these were sold to restaurants and food service operations, as well.

AMY GOODMAN : Let’s talk about the two factory farms in Iowa, as an example, what they look like in the community.

DAVID KIRBY : These things, when you drive down the highway in Iowa, for example, you see them one after the other after the other. They’re often interspersed, poultry factory next to a hog factory, which of course increases the chance for interspecies mingling of influenza virus. If we thought swine flu was bad, we may get an avian swine flu hybrid from the close proximity of these factories. From the outside, they look fairly innocuous. You’ve probably seen them on TV, this row after row of those tall green buildings. It’s once you go inside that the horrors really become apparent.

These chickens are kept in tiny little cages stacked one on top of the other, crammed in by the hundreds of thousands &mdash same with pigs, oftentimes same with dairy cattle, crammed in by the hundreds into small confinements where the air is foul. They have to pump clean air at one end, and at the other end they push out all of the odors and gases and bacteria and ammonia and viruses and even antibiotics out into the atmosphere. These are not clean or sustainable operations. And without proper regulations, these kinds of diseases will keep coming.

AMY GOODMAN : What is salmonella?

DAVID KIRBY : Salmonella is a bacteria that can get into the intestine. It can get in the bloodstream. If not treated, it can cause all kinds of horrible problems, including arthritis, and it can even kill people, if it’s not treated in time.

AMY GOODMAN : How do you know if you’re affected by it? I mean, we’ve been saying now around 1,300 people. They say none have died. What symptoms are they coming down with? And how is it that the chickens contract them &mdash salmonella?

DAVID KIRBY : The symptoms are often masked as symptoms of flu, especially in the early stages, so people don’t even realize they have salmonella. And probably the case rate is much, much higher than what’s been reported. Usually persists longer than the average stomach flu, and the symptoms become more severe &mdash- cramps, diarrhea, fever, chills.

We still don’t know exactly how these chickens got the salmonella, but there’s widespread speculation either just from the filthy conditions in the barns or it was in the feed itself. And that’s something else that Americans don’t realize. We worry about what we eat, but we also need to worry about what we eat eats. And the quality of feed can be highly compromised in these factories, where the drive to lower costs and prices is so great, and the temptation to cut corners is there, and this is the result. And we have to remember that factory farming has produced not only salmonella, but also E. coli, also mad cow disease, also swine flu, I believe, and MRSA , the drug-resistant staph infection that now kills more Americans than AIDS .

AMY GOODMAN : You say, “Swine flu. Bird flu. Unusual concentrations of cancer and other diseases. Massive fish kills from flesh-eating parasites. Recalls of meats, vegetables, and fruits because of deadly E-coli bacterial contamination.” All as a result of animal factories, as you put them.

DAVID KIRBY : Correct. Now, those diseases could conceivably emerge in any farm, even the smallest, most sustainable farm, but they’re far more likely to emerge in these large industrial factories. And again, the scale is so much larger that when you have an outbreak, you have this massive problem that’s going to cost millions and millions of dollars, just in terms of the lost eggs and productivity.

And just to mention the workshops that you were mentioning earlier with the federal government, the Obama administration has vowed to try to even the playing field a little bit more, so that we have greater access to smaller, independently raised farms. And one way, I think, to do that is to address the subsidy issue. This farm got very cheap grain from a farmer who got millions, perhaps, of dollars in our money to lower the price of that feed. If DeCoster didn’t have access to that cheap feed, he wouldn’t be able to operate in this way, and that would provide greater access to the market for smaller producers.

AMY GOODMAN : And explain the significance of feed and what’s in it.

DAVID KIRBY : Well, feed is a huge issue. And for example, with the chickens that we eat, so-called broiler chickens, they often add arsenic into that feed to make the birds grow faster and to prevent intestinal diseases. Another thing we do in this country -&mdash

DAVID KIRBY : Arsenic, yes.

AMY GOODMAN : Isn’t that poison?

DAVID KIRBY : It is poison. Yes, it is poison.

AMY GOODMAN : And how does it affect humans? I mean, the chickens eat the arsenic. Why do they grow faster?

DAVID KIRBY : They don’t know. No one knows. The theory is that when you poison a chicken, it gets sick, so it eats and drinks more, consumes more, to try to get the poison out of its body. That makes a chicken grow faster, and it prevents intestinal parasites. The risk to humans, there have been studies done, and they have found residue of arsenic in some chickens. The real threat is in the litter that comes out the other end of the chicken. When that gets spread on farmland, people breathe in that arsenic dust. And there’s a town in Arkansas where cancer rates are just through the roof. There’s been over twenty pediatric cases in this tiny town of Prairie Grove with just a couple of thousand people.

AMY GOODMAN : Let’s go to Arkansas. Don’t &mdash let’s not shortcut this, because you have a very interesting book, where you look at families in several different communities. Arkansas &mdash describe what are the animal factories that are there and what happens to the people in the community.

DAVID KIRBY : Most of them are so-called broiler operations. Tyson chicken is from Arkansas. The big operators, they’re in northwestern Arkansas. It’s just &mdash it’s chicken country. And with consolidation, you’ve had the rise of these very large factory farms. And again, up until recently, Tyson was using this arsenic product in its feed, and the other companies were, as well. And around this little town of Prairie Grove, as an example, this stuff is dry spread &mdash- the litter is dry spread on the cropland. And where the school was -&mdash

AMY GOODMAN : You mean the chicken manure.

DAVID KIRBY : The chicken manure. And the dust has been found in the air filters of homes and schools in this town, and it’s been found with arsenic that has been traced back to the feed in the chicken.

Something else we feed chickens that people don’t realize is beef products. And when those chickens eat that beef product, some of it falls into their litter. Well, we produce so much chicken litter in this country, because of these factory farms, and it is so rich in phosphorus and nitrogen, its land application uses are limited. So you have surplus chicken litter and nothing to do with it. What do they do with it? They feed it to cattle. So we feed beef cows chicken crap. That chicken litter often contains bits and byproducts of cattle. So we are actually feeding cattle to cattle, which is a risk factor for bovine spongiform encephalopathy, better known as mad cow disease. We actually feed cattle products to cattle in three different ways: chicken litter, restaurant scraps, and blood products on dairy farms. And all the mad cow cases in this country came from mega-dairies where, when that calf is born, they remove it from its mother immediately, because that mother’s milk is a commodity, it’s worth money, so instead they feed that calf a formula that includes bovine blood products, and again increasing the risk of mad cow disease.

AMY GOODMAN : Now, that’s chicken factories. What about pig factories?

DAVID KIRBY : Pig factories, for me, were the hardest to witness and take in and see and hear and smell. Pigs are incredibly intelligent animals, about the same IQ as a three-year-old child, smarter than dogs. The breeding facilities, in particular, are just horrendous, where these pigs, these female sows, are kept in crates, gestation crates. They’re kept pregnant virtually their whole lives. And then, when they give birth, they’re moved into another crate where the piglets go under the bars so that the sow won’t crush the piglets. Their life is horrendous. And quite honestly, the piglets have it good, because they’re only going to live about four or five months before they go to slaughter. When you go into these facilities, they put the piglets in when they’re young, and by the time they’re done, they’re 250 pounds each, but they’re in the same space. So they’re now so big they can’t turn around. And I spent the night right across the street from a hog farm in Illinois kept up all night long &mdash-

AMY GOODMAN : Where in Illinois?

DAVID KIRBY : A little town outside of -&mdash I don’t remember, but not far from St. Louis in southwestern Illinois. Mendon. Mendon, Illinois. And at night, of course, people switch off the lights and leave. Nobody lives, typically, on a factory farm. It’s not a farm it’s a factory. And the racket, the screaming and squealing and crying of these pigs that were obviously attacking each other and fighting and biting each other and just miserable, crammed together &mdash they went on all night long. It sounded like a thousand children being tortured at once. It’s a sound I will never forget. And I saw and heard and smelled a lot in doing my research on this book.

AMY GOODMAN : And what happens to their manure?

DAVID KIRBY : Well, their manure is typically kept liquefied. In the Midwest, it’s kept in pits underneath where the pigs live. So they’re &mdash when they defecate or urinate, it just goes right down into these pits, which of course creates huge amounts of ammonia and methane and hydrogen sulfide. If those fans were ever to break down, those pigs would die within minutes. That’s how bad it is. That then gets flushed out into these giant waste lagoons, and then it’s sprayed onto fields. And usually, very often, it’s overapplied. Again, these farmers operate on the honor system. They may file a manure plan with the state, but nobody is out there regulating them. And I’ve gone up in airplanes, both in the Midwest and in North Carolina, where the real hog factories are just crammed in one after another after another, and I’ve seen the spray fields, and I’ve seen those farmers out there spraying directly into creeks, applying so much of this brown water onto the fields that it pools up and you see the little rivlets and you see it running off into creeks, that bloom red, orange, purple and green with algae from all of the nutrients, and then that goes on to &mdash we just saw a fish kill. That’s the number one cause of fish kills, including in the Gulf of Mexico every summer, a fish kill the size of New Jersey forms. That’s from agricultural runoff coming down the Mississippi River.

AMY GOODMAN : Wait, say that again. A fish kill the size of New Jersey forms where?

DAVID KIRBY : In the Gulf of Mexico, right off the coast of Louisiana, every summer. And it kills billions and billions of marine life. And we don’t hear about this. We hear about the Gulf spill. But this happens every year, and it’s almost entirely due &mdash largely due to agricultural runoff in the Midwest.

AMY GOODMAN : CAFOs, what are they?

DAVID KIRBY : A CAFO is the government designation for what we call a factory farm, concentrated animal feeding operation. It’s any operation that has more than what’s called 1,000 animal units. An animal unit is a beef cow. So it takes about fifty pigs to make an animal unit, young pigs. And the whole idea is to feed these animals and to get them to market as quickly as possible. Nothing wrong with a farmer wanting to get their animals to market quickly, but it’s the method by which we do it. It’s the mechanization. It’s the feed additives. It’s the antibiotic use, which we haven’t talked about. It’s the conditions &mdash-

AMY GOODMAN : Talk about it.

DAVID KIRBY : Well, it’s a very serious problem, and the FDA has been very lax and, I would say, asleep at the wheel, and continues to, as Patty said, offer recommendations without putting down strict rules on the overuse of antibiotics.

AMY GOODMAN : Well, FDA Commissioner Hamburg says they have very little enforcement power, unless Congress gives them -&mdash

DAVID KIRBY : They have more than they claim, and they do have the courts. And we do have Congress, as well, and the administration. Barack Obama campaigned on a bill called PAMTA to ban the use of non-therapeutic antibiotics in agriculture. They give them these drugs for the same reason as arsenic: it makes the animals grow faster, and it prevents disease. It’s used as a prophylaxis against disease, but at subtherapeutic levels, so it allows the microbes to mutate and get around these drugs and become resistant. That’s why we see MRSA emerging. Three percent of US pork sampled had &mdash fresh pork, had MRSA .

AMY GOODMAN : Explain what MRSA is.

DAVID KIRBY : MRSA is a drug-resistant form of staph bacteria. It’s extremely &mdash can be extremely dangerous. And it kills, like I said, more people than AIDS in this country. And lot of it is &mdash a lot of it’s from overuse of antibiotics in hospitals, but 70 percent of the antibiotics sold in this country are given to farm animals. And a farmer can walk into the feed store and buy a big barrel of tetracycline or some antibiotic without even a prescription, and there’s just &mdash there’s virtually no regulation at all. And it is leading to widespread antibiotic resistance that’s going to make salmonella look like a day at the beach, I’m afraid.

AMY GOODMAN : We’re talking to David Kirby. His book is called Animal Factory. David, you not only talk about the crisis of corporate farming, but the people who are fighting back, like &mdash well, describe the man in North Carolina &mdash-

AMY GOODMAN : &mdash- who’s taking on pig farming.

DAVID KIRBY : Sure. Yeah, my book is not really about animals, and it’s not even just about animal poop, although there’s a lot of poop in the book. It’s about the people who live near these farms, who have seen their communities overturned and, in times, destroyed, seen the water polluted, the air polluted, people like Rick Dove, who is a &mdash comes from a very conservative Republic background. He’s a former Marine, retired colonel, a retired Marine, a JAG , moved his family to the Neuse River, which is a beautiful river in North Carolina, pristine. And then the hog factories came in, and the river started to die. This dinoflagellates called Pfiesteria started to appear. Rick was trying to operate a fishing business, and all of a sudden the fish were showing up dead with open sores on their sides. And the fishermen themselves were getting disoriented from the toxins being released by this protozoa. And Rick took it upon himself to &mdash he went up in the air and saw these hog factories. And he’s still fighting them. He works with the Waterkeeper Alliance. And they are successfully suing a chicken company, Perdue, and a chicken grower in Maryland, and they’re suing some of the polluting hog farms down in North Carolina.

My other two main characters are Helen Reddout, who lives in the Yakima Valley of Washington, a cherry farmer, grandmother, and Karen Hudson, who lives in Elmwood, Illinois &mdash all three sort of bedrock conservative Americans from small town, farmers, fishermen, not your typical environmental activists, but they have become leading national spokespeople against factory farming, because they’ve learned firsthand what’s happened. In Yakima Valley, because of the mega-dairies, the nitrate levels in the drinking water, in the groundwater, are so high, EPA &mdash-

DAVID KIRBY : From the cow manure. There’s so much cow manure being applied to the land, and the lagoons themselves tend to leak, that it’s getting into the groundwater, contaminating people’s wells. And nitrates can cause spontaneous abortions, diabetes, blue baby syndrome. It can aggravate autism symptoms, etc. And they are finding the levels are so high -&mdash the EPA now &mdash they’re telling people not only to not drink your well water, but don’t even come in contact with your skin, don’t wash your hands with it. That’s how contaminated it is. And, of course, it’s always the poorest people who suffer the most, because they depend on well water.

AMY GOODMAN : Her home is covered in soot?

DAVID KIRBY : Well, it has been. It’s covered in odors. I describe the scene in the opening of the book. One summer night, she had the windows open and woke up, and she said it smelled like a thousand cows had crapped in her bed. And I hear this story over and over and over again. And that odor is unforgettable. And people run around trying to close all the windows in their house, but, of course, then you just end up trapping the odor in it. And the problem &mdash odor was the number one problem everywhere I went. And it smells terrible, and it’s completely unpredictable. You have these clouds of hydrogen sulfide and methane and ammonia sort of blowing around. And if it blows in your direction, you may be outside on a summer day with your laundry, having a lunch outside, and you have to literally pick everything up and run inside. It’s the unpredictability of the odors. But when I came back from Yakima Valley &mdash I went there two times &mdash and also in the Central Valley of California, I came back with what they call manure flu, from just breathing in this stuff and the viruses and bacteria that’s contained in it. You get a mild fever, achy, chills. And it’s really &mdash-

AMY GOODMAN : How consolidated is the farm industry in this country?

DAVID KIRBY : Highly consolidated. I would say chickens were the first to become consolidated, and virtually every chicken you buy in the store comes from a factory farm. Now we have the egg industry. In the ྌs and 󈨞s, the hog industry became consolidated. Dairy industry has now largely become consolidated, with big exceptions. There's still pasture-fed dairies, particularly in Wisconsin and Vermont. The beef industry is the least consolidated. Most beef growers are still independent operators who raise their cattle out on range, on pasture. But then, for the last two or three months of their lives, those cattle are sent to feed lots, which are essentially factory farms.

AMY GOODMAN : And now we have this latest news. Zemco Industries in Buffalo, New York, has recalled approximately 380,000 pounds of deli meat that may be contaminated with bacteria that can cause a potentially fatal disease. The products were distributed to Wal-Marts nationwide. The meats may be contaminated with Listeria monocytogenes, which was discovered in a retail sample that was collected by inspectors in Georgia.

DAVID KIRBY : Yeah, that, to me, sounds more like a problem of processing than production. But processing is such a big key part of this story. I mentioned -&mdash and if we reduce antibiotic use in these factory farms, if we reduce the amount of subsidies they were getting, it would level the playing field between the big operators and the small operators. It’s the processing plants that are the final blockade. We have so few of them now that it’s harder for independent producers to get their products to market. But the other problem is, because we have so few processing plants and they’re so huge, that when you have a contamination issue like this, then all of a sudden tons &mdash hundreds of thousands of tons of food is contaminated.

AMY GOODMAN : Finally, farmers’ markets, community farms, family farms, do they stand a chance now? Describe the movement.

DAVID KIRBY : Well, from what I understand, you can’t find fresh eggs at the farmers’ market anymore. People are lining up to buy them. So this type of story only feeds demand for those things. Yes, of course, they can. And if we allow those operators &mdash again, if we share some of these tax subsidies with them, if we ban antibiotics, if we create more processing plants so smaller producers can get into the market and get their product to market, that will level the playing field. That means we can bring prices of the smaller-produced items down. It may mean that the cheap stuff comes up a little bit and levels the playing field. So there’s great hope for independent producers.

AMY GOODMAN : David Kirby, I want to thank you for being with us. Animal Factory is his book, The Looming Threat of Industrial Pig, Dairy and Poultry Farms on Humans and the Environment. When we come back, we’ll look at the global picture of corporate versus community farms, and then we’re going to look at this precedent-setting federal court decision that bans federal funding for embryonic stem cell research.

Unhealthy conditions for farm animals are—no surprise—bad for humans, too

Last spring a man was admitted to Mt. Sinai Hospital in Brooklyn for surgery. A blood test revealed he was positive for the deadly antibiotic-resistant fungus, C. auris, and he was quickly quarantined. After three months of intensive treatment, he died. In order to eradicate traces of the germ from his room, the hospital had to acquire special cleaning equipment, rip out parts of the ceiling and floor, and get rid of some treatment tools. “Everything in the room was positive,” Dr. Scott Lorin, the hospital’s president, told The New York Times. The germ, deemed an “urgent threat” by the Centers for Disease Control and Prevention, has so far been found in two more states, New Jersey and Illinois.

Experts warn it’s only going to get worse. In 2014, the Review on Antimicrobial Resistance, commissioned by the UK Government and Wellcome Trust, estimated that 700,000 people around the world die each year due to drug-resistant infections. Without action, that number could grow to 10 million per year by 2050. A leading cause of antibiotic resistance? The misuse and overuse of antibiotics on factory farms.

Flourishing antibiotic resistance is just one of the many public health crises produced by factory farming. Other problems include food borne illness, flu epidemics, the fall out from poor air and water quality, and chronic disease. All of it can be traced to the current industrial approach to raising animals, which values “high stocking density” over safe working conditions and farm animal welfare. Oversight for the way factory farms operate and manage waste is minimal at best. No federal agency collects consistent and reliable information on the number, size, and location of large-scale agricultural operations, nor the pollution they’re emitting. There are also no federal laws governing the conditions in which farm animals are raised, and most state anti-cruelty laws do not apply to farm animals.

For example, Texas, Iowa and Nebraska have excluded livestock from their animal cruelty statute and instead created specific legislation aimed at farm animal abuse that makes accepted or customary husbandry practices the animal welfare standard. After New Jersey created similar legislation, the New Jersey Society for the Prevention of Cruelty to Animals (NJSPCA) sued the New Jersey Department of Agriculture (NJDA), claiming that “routine husbandry practices” was too vague. NJSPCA won, and as a result, the NJDA has created more specific regulations: tail docking of cattle is only allowed when performed “by a veterinarian for individual animals,” and debeaking of birds is only allowed if performed by a knowledgeable individual and in compliance with the United Egg Producers Animal Husbandry Guidelines for U.S. Egg Laying Flocks. In North Carolina, any person or organization can file a lawsuit if they suspect animal cruelty, even if that person does not have “possessory or ownership rights in an animal.” In this way, the state has “a civil remedy” for farm animal cruelty.

The general lack of governmental oversight results in cramped and filthy conditions, stressed out animals and workers, and an ideal set up for the rampant spread of disease among animals, between animals and workers, and into the surrounding environment through animal waste.


The problem: In 2017, nearly 11 million kilograms of antibiotics––including 5.6 million kilograms of medically important antibiotics––were sold in the US for food animals. Factory farms use antibiotics to make livestock grow faster and control the spread of disease in cramped and unhealthy living conditions. While antibiotics do kill some bacteria in animals, resistant bacteria can, and often do, survive and multiply, contaminating meat and animal products during slaughter and processing.

What it means for you: People can be exposed to antibiotic-resistant bacteria by handling or eating contaminated animal products, coming into contact with contaminated water, or touching or caring for farm animals, which of course makes a farmworker’s job especially dangerous. Even if you don’t eat much meat or dairy, you’re vulnerable resistant pathogens can enter water streams through animal manure and contaminate irrigated produce.

The CDC breaks down how routine antibiotic use on factory farms can lead to antibiotic resistance harming human health. Image source

Developments: The European Union has been much more aggressive than the US in regulating antibiotic use on factory farms, banning the use of all antibiotics for growth promotion in 2006. But the US is making some progress, too. Under the FDA’s new rules, which went into effect January 2017, antibiotics that are important for human medicine can no longer be used for growth promotion or feed efficiency in cows, pigs, chickens, turkeys, and other food animals. In addition, 95 percent of medically important antibiotics used in animal water and feed for therapeutic purposes were reclassified so they could not be bought over the counter, and a veterinarian would have to sign off on its use in animals. As a result, domestic sales and distribution of medically important antimicrobials approved for use in food-producing animals decreased by 43 percent from 2015 (the year of peak sales) through 2017, reports the FDA.

However, the FDA still allows routine antibiotic use in factory farms for disease prevention in crowded and stressed animals, so these new rules aren’t nearly enough, says Matthew Wellington, antibiotics program director for the US Public Interest Research Group Education Fund. "The FDA should implement ambitious reduction targets for antibiotic use in the meat industry, and ensure that these medicines are used to treat sick animals or control a verified disease outbreak, not for routine disease prevention," Wellington said in a statement to the Center for Infectious Disease Research and Policy.

National Resources Defense Council senior attorney Avinash Kar agrees. “We are seeing real progress, but the American meat industry continues to have a drug problem and the clock is ticking to solve it," she says. "Far more antibiotics important to humans still go to cows and pigs—usually when they're not sick—than to people, putting the health of every single one of us in jeopardy."


The problem: Livestock in this country produce between 3 and 20 times more waste than people in the US produce, according to a 2005 EPA report, or as much as 1.2–1.37 billion tons of manure a year. Some estimates are even higher. Manure can contain “pathogens such as E. coli, growth hormones, antibiotics, chemicals used as additives to the manure or to clean equipment, animal blood, silage leachate from corn feed, or copper sulfate used in footbaths for cows,” reports a 2010 report by the National Association of Local Boards of Health. Though sewage treatment plants are required for human waste, no such treatment facility exists for livestock waste.

Since this amount far exceeds what can be used as fertilizer, animal waste from factory farms typically enters massive, open-air waste lagoons, which spread airborne pathogens to people who live near by. If animal waste is applied as fertilizer and exceeds the soil’s capacity for absorption, or if there is a leak or break in the manure storage or containment unit, the animal waste runs off into oceans, lakes, rivers, and streams, and groundwater. Extreme weather increases the possibility of such breaks Hurricane Florence, for example, flooded at least 50 hog lagoons when it struck the Carolinas last year, and satellite photos captured the damage. Eight years ago, the EPA reported that 29 states identify animal feeding operations as contributing to water pollution. To offer some idea of what that looks like, the EPA reported in 1998 that factory farm runoff polluted 35,000 miles of river in 22 states.

Whether or not the manure is contained or spread as fertilizer, it can release 400 different types of harmful gases, including ammonia and hydrogen sulfide, as well as particulate matter comprised of fecal matter, feed materials, pollen, bacteria, fungi, skin cells, and silicates into the air. Manure is also an abundant source of nitrate, which seeps into groundwater and can be toxic at elevated levels.

Factory farms contain animal waste in massive open-air lagoons that run the risk of leaking and breaking, contaminating surrounding air and water. Image source

What it means for you: Pathogens can cause diarrhea and severe illness or even death for those with weakened immune systems, and gases like ammonia and hydrogen sulfide can cause dizziness, eye irritation, respiratory illness, nausea, sore throats, seizures, comas, and death. Particulate matter in the air can lead to chronic bronchitis, chronic respiratory symptoms, declines in lung function, and organic dust toxic syndrome. The CDC has reported that children raised in communities near factory farms are more likely to develop asthma or bronchitis, and that people who live near factory farms may experience mental health deterioration and increased sensitization to smells. Nitrates in drinking water have been connected to birth defects, miscarriages, poor general health. For infants it can mean blue baby syndrome and even death.

Developments: It is difficult to hold factory farms accountable for polluting surrounding air and water, largely for political reasons. The GOP-controlled Congress and the Trump administration recently excused big livestock farms from reporting air emissions, for instance, following a decade-long push for special treatment by the livestock industry. The exemption indicates “further denial of the impact that these [emissions] are having, whether it’s on climate or whether it’s on public health,” says Carrie Apfel, an attorney for Earthjustice. In a 2017 report from the EPA’s Office of the Inspector General, the agency admitted it has not found a good way to track emissions from animal farms and know whether the farms are complyimg with the Clean Air Act.

No federal agency even has reliable information on the number and locations of factory farms, which of course makes accountability even harder to establish. Two Stanford scholars are hoping to change that. Professor Daniel Ho and doctoral candidate Cassandra Handan-Nader published a paper in Nature Sustainability last month demonstrating how a new map-reading algorithm could help regulators identify CAFOs more efficiently. They retrained an existing image-recognition model to recognize large-scale animal facilities from publicly available satellite images. The researchers estimate that their algorithm can capture 95 percent of existing large-scale facilities using less than 10 percent of the resources required for a manual census.

Food & Water Watch has compiled data from the USDA Census of Agriculture to estimate the number and density of livestock operations in the United States. Factory farms don’t always need permits to operate, which makes it hard to know where they are located and how many there are. Image source


The problem: The United States has “shockingly high” levels of food borne illness, according to the Bureau of Investigative Journalism and The Guardian, and unsanitary conditions at factory farms are a leading contributor.

In a study of 47 meat plants across the U.S., investigators found that hygiene incidents occur at rates experts described as “deeply worrying.” One dataset covered 13 large red meat and poultry plants between 2015 and 2017 and found an average of more than 150 violations a week, or 15,000 violations over the entire period. Violations included unsanitary factory conditions and meat contaminated with blood, septicemic disease, and feces.

“The rates at which outbreaks of infectious food poisoning occur in the U.S. are significantly higher than in the UK, or the EU,” said Erik Milstone, a food safety expert at Sussex University interviewed by The Guardian. “Poor hygiene in the meat supply chain is a leading cause of food poisoning in the U.S.”

Poor sanitary practices allow bacteria like E. coli and Salmonella, which live in the intestinal tracts of infected livestock, to contaminate meat or animal products during slaughter or processing. Contamination occurs at higher rates on factory farms because crowded and unclean living conditions increase the likelihood of transmission between animals. It also stress out animals, which suppresses their immune response making them more susceptible to disease. The grain-based diets used to fatten cattle can also quickly increase the risk of E. coli infection. In poultry, the practice of processing dead hens into “spent hen meal” to be fed to live hens has increased the spread of Salmonella.

What it means for you: According to the CDC, roughly 48 million people in the US suffer from food borne illnesses annually, with 128,000 hospitalizations and 3,000 deaths each year. Salmonella accounts for approximately 11 percent of infections, and kills more people every year than any other food borne illness.

Developments: In January of 2011, President Obama signed The Food Safety Modernization Act (FSMA), the first major piece of federal legislation addressing food safety since 1938. FSMA grants the FDA new authority to regulate the way food is grown, harvested, and processed, and new powers such as mandatory recall authority. The FSMA “basically codified this principle that everybody responsible for producing food should be doing what the best science says is appropriate to prevent hazards and reduce the risk of illness," according to Mike Taylor, co-chairman of Stop Foodborne Illness and a former deputy commissioner for foods and veterinary medicine at the FDA. "So we're moving in the right direction." However, almost ten years later, the FSMA is still being phased in, due to a shortage of trained food-inspectors and a lack of funding. "Congress has gotten about halfway to what it said was needed to successfully implement" the act, Taylor said.

In 2011, President Obama signed The Food Safety Modernization Act (FSMA), the first major piece of federal legislation addressing food safety since 1938. Image source

The problem: Both the number and density of animals on factory farms increases the risk of new virulent pathogens, according to the US Council for Agriculture, Science and Technology. In addition, transporting animals over long distances to processing facilities brings different influenza strains into contact with each other so they combine and spread quickly. Pigs are susceptible to both avian and human flu viruses so they can serve as ground zero for all sorts of new strains. Because of intensive pig farming practices,“the North American swine flu virus has jumped onto an evolutionary fast track, churning out variants every year,” according to a report published in Science magazine.

What it means for you: These viruses can become pandemics. In fact, viral geneticists link the genetic lineage of H1N1 to a strain that emerged in 1998 in US factory pig farms. The CDC has estimated that between 151,700 and 575,400 people worldwide died from the 2009 H1N1 virus infection during the first year the virus circulated.


The problem: Factory farms in the US use hormones to stimulate growth in two-thirds of beef cattle. On dairy farms, 54 percent of cows are injected with recombinant bovine growth hormone (rBGH), a growth hormone that increases milk production.

What it means for you: The health effects of consuming animal products treated with these growth hormones is an ongoing international debate. Some studies have linked growth hormone residues in meat to reproductive issues and breast, prostate, and colon cancer, and IGF-1 has been linked to colon and breast cancer. However, the FDA, the National Institute of Health and the World Health Organization have independently found that dairy products and meat from rBGH-treated cows are safe for human consumption. Because risk assessments vary, the EU, Australia, New Zealand, Japan, Israel, and Argentina have banned the use of rBGH as a precautionary measure. The EU has also banned the use of six hormones in cattle and imported beef.

Developments: USDA guidelines allow beef products to be labeled with “no hormones administered” and dairy products to be labeled “from cows not treated with rBST/rBGH” if the producer provides sufficient documentation that this is true. Consumers can use this information to make their own decisions about the risks associated with hormone-treated animal products.

While the health risks of consuming animal products from livestock treated with hormones are up for debate, USDA guidelines allow beef and dairy products to be labeled as hormone-free, if it can be proven. Image source


You can vote for local initiatives that establish health and welfare regulations for factory farms, but only a tiny number of states, including California and Massachusetts, are even putting relevant propositions on the ballot. Another option is to support any of the nonprofits that are, in lieu of effective government action, taking these factory farms to task. The Environmental Working Group, Earthjustice, and Animal Legal Defense Fund are among those working hard to check the worst practices of these CAFOs. Another good organization is the Socially Responsible Agriculture Project (SRAP), which works with local residents to fight the development of factory farms in their own backyards.

Dr. Mark Post of Mosa Meats holds a ‘clean meat’ hamburger grown from cell culture. Clean meat is produced without the use of antibiotics and hormones and eradicates animal waste management and thus air and water pollution problems. Image source: The Good Food Institute

Buying humanely raised animal products from farms, and farmers, you trust is another way to push back against factory farming. Sadly, products from these smaller farms make up only a fraction of the total. In the US roughly 99 percent of chicken, turkeys, eggs, and pork, and 70 percent of cows, are raised on factory farms.

You can support “clean” burgers, chicken, and pork, by buying it once it becomes widely available. Made from animal cells, the process completely spares the animal and eliminates the factory farm. “The resulting product is 100 percent real meat, but without the antibiotics, E. coli, Salmonella, or waste contamination,” writes the Good Food Institute, a resource for many clean meat start-ups, which currently number 27. Says Paul Shapiro, CEO of The Better Meat Co., “this promising field will only continue to get bigger.”

In the meantime, you can register your objection to factory farming by doing your bit to reduce demand for their products. In short, eat less meat and dairy, and more plant-based proteins. Fortunately, the days when that meant forking in soy dogs and potato burgers are long gone. More than $13B were invested in plant-based meat, egg, and dairy companies in 2017 and 2018 alone, according to the Good Food Institute, and Beyond Meat’s IPO debut last week marked the most successful one since the year 2000. Lest you think that what you do on your own can’t possibly make a difference, consider one of the major drivers behind all this new investment: consumers are demanding change. Says Bruce Friedrich, executive director of Good Food Institute: “Shifting consumer values have created a favorable market for alternatives to animal-based foods, and we have already seen fast-paced growth in this space across retail and foodservice markets.”

Tia Schwab is a Stone Pier Press News Fellow and a senior at Stanford University, where she studies human biology with a concentration in food systems and public health.

From European to global reform

The effects of rising antibiotic use on global AMR were predictable. With antibiotic research stalling, 1980s experts renewed warnings of an imminent post-antibiotic era. In Western countries, bestsellers like Orville Shell’s Modern Meat (Schell, 1985), Jeremy Rifkin’s Beyond Beef (Rifkin, 1992), or Stuart Levy’s Antibiotic Paradox (Levy, 1992) led to fierce finger-pointing between medical, veterinary, and agricultural practitioners. Although public debates initially had little impact on policymaking among major antibiotic consumers, they led to significant reforms in Scandinavia.

Historically, the efficacy requirements of the ‘Nordic Welfare State’ had made Scandinavian countries very conservative when it came to antibiotic use in medicine (Lie, 2014). However, medical conservatism had not prevented rising antibiotic use in agri- and aquaculture. This changed during the 1980s. In Sweden, Swann-style AGP restrictions had been introduced in 1977. However, in 1981, newspaper articles and the influential children’s book author Astrid Lindgren began calling for further bans. In contrast to other countries, Swedish farmers reacted proactively and tried to improve their image by petitioning for a total AGP ban. Parliament reacted by banning all AGPs from 1986 onwards. Struggling to adapt production systems, some farmers, however, replaced AGPs with higher-dosed prophylactics. In 1987, public criticism of Swedish animal husbandry’s ongoing antibiotic-dependency was one of the factors leading to the passage of a comprehensive new animal welfare law designed to reform industry. Prime Minister Ingvar Carlson personally drove to Lindgren’s house to inform her of the so-called Lex Lindgren, which among other things mandated greater space requirements, increased weaning ages, and new straw and litter requirements for pigs (Wierup, 2001 Andersen, 2018 Kahn, 2016).

Other Scandinavian countries also reformed antibiotic use and rearing systems. In Norway, AMR concerns led to a review of antibiotics in aquaculture. While nearly 50 tonnes of antibacterial substances were used in Norwegian aquaculture in 1987, preventive measures like vaccines helped reduce consumption to below five tonnes in 1993 (Anon., 2016). Denmark also underwent a radical restructuring of non-human antibiotic use. Since the nineteenth century, Danish farmers had supplied global markets with pork and bacon. Organised in large integrated cooperatives, farmers had also adopted confined production systems and routine antibiotic use. Following similar detections in Germany and Britain, Danish microbiologists reported the isolation of vancomycin resistant enterococci (VRE) from healthy pigs and poultry in 1993. VRE detections were likely due to the extensive use of avoparcin. While ca. 22 kg of the reserve antibiotic vancomycin had been used to treat humans in Denmark in 1993, 19,472 kg of closely related avoparcin had been used as AGPs (Aarestrup, 1995). Following heated debates, farmers stopped using avoparcin voluntarily and Denmark banned avoparcin in 1995. Although it resulted in a temporary rise of therapeutic antibiotic use, Danish AGP consumption plummeted from 115,786 kg in 1994 to 12,283 kg in 1999 when producers voluntarily phased out AGPs altogether (Aarestrup et al., 2001 Kahn, 2016).

Scandinavian countries also lobbied for wider EU restrictions. In 1995, Denmark, the Netherlands, and Germany opposed a British request to license avoparcin for dairy cows. Footnote 29 A 1996 German avoparcin ban was followed by an EU-wide ban in 1997. Scandinavian pressure soon led to further restrictions. Concerned about having to abandon its stricter laws to comply with more permissive EU feed regulations after its 1995 accession, Sweden campaigned for wider AGP bans. The Swedish campaign profited from Britain’s mad cow disease (BSE) crisis and won the support of EU consumer organisations and medical experts. Ignoring industry protest and the EU’s Scientific Committee on Animal Nutrition (SCAN), member states banned four popular AGPs and established the European Antibiotic Resistance Surveillance System (EARSS) in 1998. Although a planned phase-out of coccidiostats was abandoned in 2003, the EU restricted remaining AGPs by 2006 (Kirchhelle, 2016 Kahn, 2016). Two years earlier, residue detections in honey had also led to a ban of routine streptomycin spraying against fire blight (Bundestag, 2008 Mayerhofer et al., 2009). Although European farmers retained access to higher-dosed therapeutic and prophylactic antibiotics via veterinary prescriptions and emergency spraying permits, the EU’s precautionary bans marked a significant victory for antibiotic critics. The EU’s perceived leadership and large protected market also placed significant pressure on other countries to reform—or at least to appear to reform—agricultural antibiotic use.

In the US, antibiotic reforms proved difficult. After failing to overcome industrial resistance to bans, FDA officials had stopped pushing for AGP restrictions and were battling allegations of inadequate enforcement following sulfamethazine detections in milk and reports of widespread noncompliance with existing antibiotic regulations on farms. The mood in Washington also dampened hopes for AMR-oriented reform. During the 1990s, Congress shortened FDA licensing periods and facilitated extra-label drug use in animal feeds. Under conflicting pressure to respond to rising AMR and reduce alleged market barriers, the FDA’s dilemma was particularly pronounced in the case of agricultural fluoroquinolone use. In 1995, FDA officials licensed two fluoroquinolone antibiotics for use in poultry feeds and water despite warnings about the drugs’ close relation to human reserve antibiotics. Officials reassured critics that AMR detections would lead to quick withdrawals. This promise proved difficult to keep. In 1997, the FDA reacted hesitantly to AMR reports by banning extra-label applications. After this measure proved toothless, officials launched formal withdrawal procedures in 2000. However, Bayer, the manufacturer of one of the fluoroquinolones (Baytril/enrofloxacin), resisted in court. Although Baytril’s similarity to Bayer’s reserve antibiotic ciprofloxacin became a national security matter in the wake of the 2001 anthrax letters, it took the FDA until 2005 to formally withdraw the drug (Kahn, 2016 Kirchhelle, 2019).

Concerned about their ability to ban substances, FDA officials also reacted hesitantly to contemporary EU AGP restrictions. Despite several Congressional initiatives for statutory restrictions of medically relevant antibiotics, the agency focused on developing voluntary guidances to phase out antibiotic growth promotion via label changes (Kirchhelle, 2019). Although US agricultural antibiotic use has recently declined (FDA, 2017), it remains to be seen whether reductions are due to voluntary FDA guidances or to shifting consumer demand and growing doubt about AGPs’ economic efficacy. Meanwhile, therapeutic and prophylactic antibiotic use in animal and plant production remain legal. Footnote 30

Regulatory change has also occurred in other high-income countries. In Japan, regulators reacted to EU reforms by banning avoparcin and orienticin feed additives in 1997. Residue problems in domestic and imported produce also led to a reduction of antibiotic tolerances (Morita, 1997). Although Japan continues to allow multiple AGPs, agricultural antibiotic consumption declined from ca. 1060 to 781 tonnes between 2000 and 2013. Japan has recently announced that it will cut overall antibiotic use by another third by 2020 ((Milanov et al., 2016 JVARM, 2013 Anon., 2017). In South Korea, AMR detections in 18 major food items sparked major public concern during the 2000s. Following 2005, over 45 antimicrobial feed additives were restricted to veterinary prescription. Although it remains high, antibiotic consumption declined from over 1500 to under 1000 tonnes between 2007 and 2016. Footnote 31

Middle- and low-income countries have similarly endorsed antibiotic reform. The 2015 mcr-1 episode triggered colistin bans in Brazil and China (Walsh and Wu, 2017 Davies and Walsh, 2018). In 2016, Vietnam announced that it would reduce the number of feed antibiotics to 15 and ban AGPs by 2020 (USDA, 2016). India has similarly developed an action plan for antibiotic reductions and has introduced drug withdrawal times for livestock production (Kahn, 2016). According to a 1997 report, Russian antibiotic consumption and AMR rates in farm-related organisms declined 1.5–3-fold following the collapse of the USSR. Only non-medical growth promoters like bacitracin, grisin, flavomycin, and virginiamycin remained permitted (Panin et al., 1997). Russia is also backing FAO-led efforts to promote food safety and prevent AMR in Central Asia and Eastern Europe (FAO, 2017). In reaction to new WHO initiatives, Bangladesh, Bhutan, Indonesia, Myanmar, Nepal, Sri Lanka, and Thailand have similarly announced agricultural antibiotic restrictions and national action plans (Goutard, 2017).

Access to Farm Programs Widened Since 2000

U.S. consumer demand for organic food has outpaced domestic production since the national standards were set in 2000. Public and private sector initiatives could further boost demand. In 2010, USDA set its first priority goal for organic agriculture: expanding the number of U.S. certified organic operations by 25 percent over a 5-year period. To facilitate transition to organic production, USDA developed new provisions in risk management, conservation, research, and other farm programs to widen access to these programs for organic and transitioning producers. USDA also expanded U.S. agricultural trade efforts to include bilateral negotiations to facilitate organic trade. In addition, Congress boosted funding for a number of organic programs in the 2014 Farm Act to assist producers with organic certification costs, expand organic research, and improve technical assistance and crop insurance.

USDA and congressional efforts to facilitate organic production include:

Cost-share assistance for organic certification. Organic certification is mandatory for all organic farmers and handlers with over $5,000 in annual organic sales. Certification costs include application fees, inspection costs, and travel costs and per diem expenditures for inspectors. Congress boosted total funding for USDA’s two organic certification cost-share programs in the 2014 Farm Act. Under these programs, USDA may reimburse producers and handlers up to 75 percent of their certification costs, up to a maximum of $750 per scope of operation certified.

However, more producers may now reach the coverage limit well before 75 percent of their certification costs are covered. Average organic certification costs have increased from $1,264 per farm in 2008 to about $1,517 per farm in 2015. Fewer than half of the certified organic farmers in 2015 were enrolled in a certification cost-share program. Beginning in 2017, this program will be administered by USDA’s Farm Service Agency to make producer participation easier. Producers that are transitioning to organic production will also be eligible to participate in the certification cost-share program beginning in 2017.

Environmental Quality Incentives Program (EQIP) Organic Initiative. EQIP provides technical and financial assistance for conservation practices and activities. The EQIP Organic Initiative created under the 2008 Farm Act targets funding for conservation practices related to organic production and transition. The Act, however, capped these payments at a lower level than payments from the regular EQIP.

USDA’s Natural Resources Conservation Service has also expanded its outreach on conservation assistance to organic and transitioning producers in recent years. In 2016, this agency established a field-level “organic champions” position in each state to improve assistance to organic and transitioning producers.

Federal crop insurance. In the Agricultural Risk Protection Act in 2000, Congress recognized that organic farming practices are good farming practices and extended crop insurance coverage to organic producers. Federal crop insurance was initially less attractive to organic producers because the program generally did not account for the higher prices that organic farmers would receive for their crops. USDA’s Risk Management Agency (RMA) subsequently published organic price elections for a substantial number of commodities. RMA also added a 2016 provision allowing certified organic or transitioning producers with a written contract from a buyer to insure their crop at the contract price.

Research on organic farming systems. Organic farming is based on detailed knowledge that is often specific to a region and crop. In 2002, Congress established the Organic Agriculture Research & Extension Initiative, the first major USDA grant program to support research projects that address the critical production challenges faced by organic farmers. The number of high-quality research applications for this competitive grant program has substantially exceeded the number that can be funded since the program’s inception in 2002. In the 2014 Farm Act, Congress set total mandatory funding at $20 million annually, just above its annual funding level under the 2008 Act.

Bilateral agreements to facilitate organic trade. The international organic market is characterized by numerous sets of regulations and standards that differ from country to country. After setting national organic standards, USDA began negotiations with a number of countries to develop bilateral trade agreements, called equivalency arrangements. These arrangements allow goods certified to either country’s organic standard to be sold as organic in both countries. Equivalency arrangements improve access to foreign markets by reducing the need for additional inspection, auditing, and other costs.

The United States entered into its first equivalency arrangement with Canada in 2009, and subsequently with the European Union (2012), Japan (2014), South Korea (2014), and Switzerland (2015). The United States also has unilateral arrangements with Taiwan, New Zealand, Israel, and India—and is expected to have a new equivalency arrangement with Mexico in 2017.

In addition to government efforts, the private sector is taking steps to encourage the adoption of organic farming systems in the United States. For example, General Mills has set goals for expanding the organic acreage for its ingredients and developed partnerships with the Organic Valley dairy cooperative, organic advocacy groups, university researchers, and others to encourage organic farming. Another example is food retailers, like Whole Foods and Costco, which have developed pilot programs to lend money to farmers for organic farming. Local and regional initiatives are also emerging as the interest in organic food and agriculture continues to expand.

Infectious Disease Roundup 2017 -- The Year In Review

Reflecting on the past year in infectious disease and global health news, these were some of the stories that particularly grabbed my attention.

Antibiotic resistance

Antibiotic resistance continues to be a huge problem prompting many of my consults on hospitalized patients. Because of resistance—and sometimes from incorrectly claimed drug allergies by patients—we are forced to use more toxic antibiotics than would otherwise be needed. This is also more costly, usually requiring placement of a long-term IV catheter (aka PICC line), which has its own risks, such as blood clots and additional infection.

There have been glimmers of good news, however.

Antibiotic use in agriculture is a huge driver of antibiotic resistance

Milken Institute School of Public Health at GWU

A dozen antibiotic resistance experts, supported by the Antibiotic Resistance Action Center at GWSPH and the Natural Resources Defense Council, issued recommendations in Combating Antibiotic Resistance: A Policy Roadmap to Reduce Use of Medically Important Antibiotics in Livestock .

The focus on livestock is because “70% of medically important antibiotics sold in the U.S. (i.e. those identical or belonging to the same class as antibiotics used in human medicine) are sold for use in food-producing animals, not people.” Further, the OneHealth concept is gaining attention, as “6 out of every 10 infectious diseases in people are spread from animals.” This is a recurrent message to keep in mind as we look at links between outbreaks—such as Yellow Fever and Ebola—and environmental destruction that places people in closer proximity to animal hosts.

There was recently a bit of good news from the FDA’s report on the Animal Drug User Fee Act (ADUFA)—there has been a marked decrease in antibiotic use for chicken, according to Michael Hansen at Consumer Reports and Lance Price at Milken Institute School of Public Health at GWU. Unfortunately, antibiotic use for beef and pork lag ways behind and is still high. Mounting pressure from consumers have led to the changes from the (fast-)food industry. Let’s keep it up.

Sexually transmitted diseases

STDs are likely to explode. Related to antibiotic resistance, and on the bad news front, is the rise in syphilis and gonorrhea. More than half of state and local STD programs have been cut, and in 2012 alone, 21 STD clinics closed⁠. Public health spending was 10% lower in 2013 than in 2009. Yet Congress just voted to further slash public health funding.

With Congress letting the Children’s Health Insurance Program (CHIP) expire, 9 million poor children⁠ and pregnant women have lost health coverage. This will no doubt increase the toll of syphilis and life-long problems for affected children and their families.

The American Public Health Association noted the recent tax legislation would include “the complete elimination of the Prevention and Public Health Fund and other mandatory spending over the next 10 years. The fund currently makes up 12 percent of the entire Centers for Disease Control and Prevention budget, and its elimination would cripple the public health workforce’s ability to respond to infectious disease outbreaks and continue critical prevention programs.

APHA executive director Georges Benjamin observed, "Like a game of high-stakes poker, Congress is gambling with public health by undercutting our ability to protect against infectious disease, stop the opioid crisis and tackle chronic conditions that are making Americans sick.”

The Trust for America’s Health also explained the importance of the Prevention Fund, including strict performance measures for grants. More than 500 signatories—ranging from the TFAH and public health organizations to patient advocacy groups, universities and local health departments sent a letter imploring Trump not to gut this essential program. The CDC outlined the impact of cuts, including on childhood immunization and lead poisoning prevention, noting that in FY 2016, PPHF accounted for over 12 percent of CDC’s total program funding. They also outlined the cost-effectiveness of the PPHF program, demonstrating that this cut is really not about saving money.

Speaking of children, CHIP, and public health disasters…didn’t anybody learn anything about the need for sound public health from the Ebola and Zika outbreaks?

Ebola was well-controlled in the U.S. through scientific, evidence-based, sound public health policy. Without that, there would have undoubtedly been far more panic and cases. Think back to then Governor Christie irrationally and needlessly quarantining Kaci Hickox, violating her civil rights. She subsequently sued Christie, with help from the ACLU. That suit was settled this summer. According to the Bangor Daily News, with an agreement outlining when and how quarantines can be imposed.

When there is a resurgence of Zika, it will be far more of a problem than before for several reasons—poverty and worsening infrastructure, as well as a warming climate, will likely lead to more mosquito-borne outbreaks in coming years. Public health funding is being devastated. While ineffective abstinence-only programs are being promoted instead of comprehensive sex ed, and anti-abortion laws are increasing, one does not need a crystal ball to see that there will be more babies born with microcephaly in future outbreaks. Poor women and women of color will be disproportionately affected and left in the lurch, given cuts in funding for CHIP and Medicaid. With CDC and NIH reportedly being told that controversial words like “fetus” will be flagged and the censorship at government agencies growing (a clear message, whether or not the precise language has been confirmed), how will evidence-based research to ensure the health of fetuses continue? Who will care for these children with devastating birth defects?

Counties with Aedes aegypti mosquitos that commonly transmit Zika

CDC/Entomological Society of America

Also, the CDC noted a 21% increase in A. aegypti, the main Zika vector, which also transmits Chikungunya and dengue viruses and also A. albopictus, a lesser source of zika, dengue, Chikingunya, West Nile, Japanese and Eastern equine encephalitis in counties where they are present. Who will continue to do surveillance and education with funding cuts and misplaced priorities?

Range of disease bearing mosquitoes

Vaccine preventable diseases - Measles and Polio

We have been tantalizingly close to eradicating polio, but several problems sabotage successes. Perhaps most tragically are the assassinations of polio workers. In part, we can thank the CIA for this legacy of mistrust from their using a hepatitis vaccination program to help track down Osama Bin Laden in 2011. Additional rumors that the polio vaccine is being used to sterilize Muslims contributes to the mistrust in the countries where polio persists—Pakistan, Afghanistan, and Nigeria. The result? Vaccine workers are routinely murdered and polio continues, as vaccinations were banned by the Taliban in Afghanistan and Pakistan.

Similarly, using an HIV prevention workshop as a pretense in 2014, the U.S. Agency for International Development sent young people undercover to Cuba to incite anti-government activism. At that time, Congresswoman Barbara Lee, co-chair of the Congressional HIV/AIDS Caucus, aptly noted, “This blatant deception undermines U.S. credibility abroad and endangers U.S. government supported public health programs which have saved millions of lives in recent years around the world.”

Fallout from these poorly conceived programs has continued, with similar mistrust fueling the Ebola epidemic, with attacks on health care workers in 2014.

A more recent problem with polio is the growing number (now 84) of cases of circulating vaccine-derived poliovirus cases, outnumbering the wild (natural) type. The oral polio is a very weakened but still live vaccine, which can be shed in stool. There have been a few cases of infection from this vaccine, especially in non-endemic countries. Most recently, this occurred in Syria and the Democratic Republic of the Congo, each with one case of paralysis. But without vaccination, the world remains threatened by a possible resurgence of polio.

Measles was eliminated from the U.S. in 2000, but had since made a large comeback because of vaccine refusers. Nearly 70 percent of the people with measles from January 2001 through December 2015 were unvaccinated. Per the CDC, 79% claimed personal belief exemptions ⁠ rather than a medical contraindication. The public health cost to the rest of taxpayers for these people’s “personal beliefs”? $2.7-5.3 million.

There were several large outbreaks, one at Disney, one among the Amish in Ohio, and, most recently, an outbreak among the Somali community in Minneapolis. Many Somalis were dissuaded from vaccination by people pushing the long-debunked assertion that vaccines cause autism.

That our tax-dollars, paid to ICE, fueled an epidemic in Arizona through a for profit prison, is particularly infuriating, as was their refusal to cooperate with local public health officials.

Measles is not a mild childhood rite of passage. Keep in mind that a number of children who are too young for the shots or are immunocompromised and cannot be vaccinated can be killed or disabled for life because of an infection. The argument over vaccinations for highly communicable diseases shows why we generally opt to do things for the good of the society it’s why we have basic laws an norms. It’s why most people support regulations to protect our communities from infections, pollution, and gun violence, understanding that individual “liberties” shouldn’t trump other people’s rights to a safe existence.

Shock and septic shock

I’ll end on this bit of good news, about Angiotensin II for treatment of shock.

Severe shock has a mortality of

50% despite all efforts to improve care over decades, and sepsis is a common cause. This ATHOS-3 study was small, but a “gold-standard” design, being multinational, double-blind (neither investigator nor patient knew which treatment they were receiving), randomized, controlled trial. This study showed that Angiotensin II, aka Giapreza, (La Jolla Pharmaceutical Company, NASDAQ: LJPC) was better than saline for improving blood pressure in these critically ill patients. It was given in addition to standard treatments with catecholamines (norepinephrine, or Levophed—known cynically as “leave-em-dead” or vasopressin , which have many nasty side effects, with a goal of reducing the dose of these toxic drugs that have to be used now.

It did not result in a higher mortality or more frequent adverse events than the saline placebo.

Note that while this study had limited endpoint—an elevation of blood pressure after three hours—it is an important start in finding an effective treatment for a deadly condition.

It’s been a mixed year in infectious disease news. We have made a bit of progress on antibiotic use in agriculture, particularly in chickens.

Outbreaks of various plagues—Yellow fever, Plague in Madagascar, Zika— have cropped up, but have been fairly well-controlled or have burnt themselves out.

We’ll face more challenges in the coming years due to recent legislative funding priorities. One potentially good thing coming is the formation of HHS Federal Tick Borne Disease Working Group, though they have a very difficult task ahead of them. More on that in the coming year.


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