Eideard

Home on the Range

Federal drug regulators announced Wednesday that farmers and ranchers must restrict their use of a critical class of antibiotics in cattle, pigs, chickens and turkeys because such practices may have contributed to the growing threat of bacterial infections in people that are resistant to treatment.

The medicines belong to a class of antibiotics known as cephalosporins and include such brands as Cefzil and Keflex. They are among the most common antibiotics prescribed to treat strep throat, bronchitis, skin infections and urinary tract infections. Surgeons also often use them before surgery to prevent bacterial infections.

The drugs’ use in agriculture has, according to many microbiologists, led to the development of bacteria that are resistant to the drugs’ effects, a development that many doctors say has endangered the lives of patients.

Antibiotics are often added to animal feed and are used routinely to encourage rapid growth of livestock, but officials at the Food and Drug Administration have been increasingly vocal in their concerns that overuse of antibiotics in agriculture is endangering human health. The agency proposed rules in 2010 to slow the use of penicillin, tetracycline and other antibiotics simply to promote growth or prevent disease in feed animals, but those rules have yet to be made final…

Perish the thought we offend a drug company or the owners of cattle feed lots.

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Medicines experts are calling for a review of the 50-year-old guidelines on prescribing antibiotics to children, warning that the rise in overweight and obese youngsters may mean that some get a less than adequate dose. While they stress that there is no evidence that children are suffering as a result of under-treatment, they say there should be better guidance than the rule of thumb that has applied for half a century.

Since the 1960s, doctors have worked on the principle that a big child is equal to half an adult, a small child is equal to half a big child and a baby is equal to half a small child, say a group of doctors and scientists in the British Medical Journal.

The problem lies with the prescription of oral penicillin, such as amoxicillin which is widely used against bacterial infections in children. They make up 4.5m of the total 6m annual antibiotic prescriptions for children…

If children get less than the dose they need, there is a possibility that their infection will not clear up easily. It also raises the risk of antibiotic resistance developing. If the bug is not successfully eliminated by the antibiotic, it may mutate into a new form that is resistant to the drug – and be passed on to other children.

Dr Paul Long, senior lecturer in pharmacognosy at King’s College London, who is one of the authors, said: ‘We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug. Children’s average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.

“It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and we want to reassure parents of that. But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose …

I’ve had this discussion with local physicians over the last couple of years. Mostly, it evokes mild – and short-lived – curiosity.

As practicing GP’s they haven’t the time for detailed and scientific studies. They’ll wait for the evidence and recommendations from peer-reviewed journals, medical associations. Still, it sounds as if it’s time for some serious research on the topic. Since we’re stuck into growing obesity as thoroughly as declining education.

Creil, the Netherlands — Modest farms, 90 acres or less, dot the region here, most of them raising grains and vegetables, some the occasional sheep or cow.

In the midst of this idyllic scene a few years back there appeared what residents now call “the pink invasion,” three huge hog barns each with 10,000 or more pigs in the fields that skirt the dike that protects the region from the Ijsselmeer, once known as the Zuiderzee.

“Some people don’t like the idea,” said Dick van Leeuwen, 65, who walks his dog Thor along the roads leading to the largest of the barns. Local people feared that the pig farms would stink, while bringing an unwanted increase in truck traffic, he said, delivering feed for the thousands of pigs or hauling away manure or grown hogs for slaughter. But their complaints fell mostly on deaf ears.

The Netherlands, a country of almost 17 million people, is home to a pig population of 14 million. Despite its status as one of the smaller countries in the European Union — about half the size of the state of Maine — the Netherlands has long been Europe’s leading exporter of pork and pork products, though that ranking has been contested in recent years by wurst-loving Germany.

Like pork producers everywhere, Dutch farmers are fighting rising costs by resorting to ever bigger herds and barns, a trend that is reinforced by the petite size of the Netherlands…As the big barns become more common, the government has begun to respond to public complaints about industrial farming and cruelty to animals. Officials are now discussing ways to curb the size of barns like those in tiny Creil, with its 1,600 people in trim brick homes, much to the chagrin of the new generation of farmers who see industrial-scale husbandry as their only means to compete…

Critics of the pork industry argue that enormous pig barns damage the environment because of the immense amounts of manure they produce, threaten people’s heath because of the antibiotics used liberally to avoid sickness among the animals and disregard the welfare of the animals by confining them to barns…

Pig farmers like Mr. Vowinkel insist that they can compete only if they keep costs and the price of their pork down. “Some disappear, others get bigger, to lower production prices,” he said. A fellow farmer, Sietse van der Meer, agreed. “You grow bigger, or you stop,” he said.

Politicians feel the pressure of the environmentalists and animal rights groups. In December, Parliament will begin discussing a possible restriction on the size of farms and a ban on antibiotics, two steps the farming region of Noord-Brabant, in the south, has already taken on its own.

RTFA. The arguments of the Pig Farmers Association seem specious to me. They argue that the diminishing number of pig farmers is proof of their inability to compete because of regulation. They sound like Wall Street Republicans. But, the enormous expansion of the size of farms, number of pigs produced at lower prices is as likely to be the cause for small farmers being forced out of business.

They’ll never be able to compete with pork produced in nations with an excess of arable land – from China to Brazil – and their natural market is the citizens of the Netherlands and Europe. The rest – especially reliance on antibiotics – is the same sort of propaganda we get from members of every greed-driven guild in the world.

Each year, federal inspectors find illegal levels of antibiotics in hundreds of older dairy cows bound for the slaughterhouse. Concerned that those antibiotics might also be contaminating the milk Americans drink, the Food and Drug Administration intended to begin tests this month on the milk from farms that had repeatedly sold cows tainted by drug residue.

But the testing plan met with fierce protest from the dairy industry, which said that it could force farmers to needlessly dump millions of gallons of milk while they waited for test results. Industry officials and state regulators said the testing program was poorly conceived and could lead to costly recalls that could be avoided with a better plan for testing.

In response, the F.D.A. postponed the testing, and now the two sides are sparring over how much danger the antibiotics pose and the best way to ensure that the drugs do not end up in the milk supply.

“What has been served up, up to this point, by Food and Drug has been potentially very damaging to innocent dairy farmers,” said John J. Wilson, a senior vice president for Dairy Farmers of America, the nation’s largest dairy cooperative. He said that that the nation’s milk was safe and that there was little reason to think that the slaughterhouse findings would be replicated in tests of the milk supply.

But food safety advocates said that the F.D.A.’s preliminary findings raised issues about the possible overuse of antibiotics in livestock, which many fear could undermine the effectiveness of drugs to combat human illnesses.

“Consumers certainly don’t want to be taking small amounts of drugs every time they drink milk,” said Caroline Smith DeWaal, food safety director of the Center for Science in the Public Interest, an advocacy group. “They want products that are appropriately managed to ensure those drug residues aren’t there, and the dairy farmer is the one who can control that.”

RTFA for the details. Poisonally, I trust the Dairy Farmers association as far as I can throw them uphill into a heavy wind. Maybe because everyone I hang out with in the cattle business are beef growers not milk growers. But, the evidence has been pretty clear that virtually all the instances of BSE getting into the mainstream originated with dairy farms.

And – the FDA is just beginning to get up on their hind legs and starting to fight for consumers. In past administrations, Democrat and Republican, the profit-takers have been the regulators as far as best practices were concerned. Things have only begun to change in the past two years. Yes – there’s that word the KoolAid Party hates, again.

Patients were misdiagnosed with pneumonia at an alarming rate when they were readmitted to the hospital shortly after a previous hospitalization for the same illness, according to two Henry Ford Hospital companion studies.

Researchers say the misdiagnoses led to overuse of antibiotics and increased health care costs. Pneumonia ranks second to congestive heart failure as the reason for readmission within 30 days of a previous hospitalization.

Led by Henry Ford Infectious Diseases physicians Hiren Pokharna, M.D., and Norman Markowitz, M.D., researchers found that:
72 percent of patients were misdiagnosed with pneumonia upon readmission to the same hospital.

African-Americans were twice more likely than Caucasians to be misdiagnosed with pneumonia…

72 percent of the misdiagnoses occurred in the Emergency Department.

Fewer than 33 percent of patients had any outpatient follow-up care prior to their readmission.

“This also points to the importance of using X-ray for ruling out pneumonia. And once pneumonia is ruled out, the antibiotics can be discontinued…”

Health care associated pneumonia is a newly recognized form of pneumonia in patients who had recent close contact with a health care system, either through a hospital, outpatient dialysis center, nursing home or long-term care facility. The classification was added with the shift from hospital-based care to home-based care.

Cripes. So, adding another human aspect to medicine seems to increase the likelihood of misdiagnosis. Or is it just reliance on ER treatment for people without healthcare insurance?

Not inspiring a lot of confidence here, folks.

US authorities have indicted 11 German and Chinese executives for conspiring to illegally import $40 million worth of honey from China. The executives were accused of being part of an operation which mislabelled honey and tainted it with antibiotics in an attempt to avoid import duties.

The case is part of a crackdown on illegal imports of substandard and counterfeit products.

Officials say it is the biggest food smuggling case in US history.

Ten of the suspects were senior executives at Alfred L Wolff, a German company, which allegedly bought cheap Chinese honey and, en route to the US, filtered out “pollen and other trace elements that could indicate that the honey originated from China”, according to the charge sheet.

A sales manager from the Chinese-based QHD Sanghai Honey was also indicted…

Those involved are alleged to have made 606 illegal shipments over six years, beginning in March 2002.

Senator Charles Schumer said he welcomed the fact that law enforcement agencies were taking “honey laundering” seriously.

Har!

Federal food regulators took a tentative step this week toward banning a common use of penicillin and tetracycline in the water and feed given cattle, chickens and pigs in hopes of slowing the growing scourge of killer bacteria.

But the Food and Drug Administration has tried without success for more than three decades to ban such uses. In the past, Congress has stepped in at the urging of agricultural interests and stopped the agency from acting.

In the battle between public health and agriculture, the guys with the cowboy hats generally win.

The F.D.A. released a policy document stating that agricultural uses of antibiotics should be limited to assuring animal health, and that veterinarians should be involved in the drugs’ uses.

While doing nothing to change the present oversight of antibiotics, the document is the first signal in years that the agency intends to rejoin the battle to crack down on agricultural uses of antibiotics that many infectious disease experts oppose…

Antibiotics are used in agriculture for three reasons: to promote animal growth, prevent illness and treat sickness. How antibiotics in feed and water help to fatten animals is not entirely clear.

The industrialization of animal husbandry has increased processors’ dependence on antibiotics because factory farm animals tend to be sicker and feed-lot diets can encourage bacterial infections.

The Union of Concerned Scientists estimated in 2001 that 84 percent of all antibiotics were used in agriculture and that 70 percent were used simply to promote animal growth, not to treat or prevent illness. The Animal Health Institute, a trade association, estimated that 13 percent of agricultural antibiotics were used to promote growth…

The distinction is important because F.D.A. officials said they were mostly concerned with the use of antibiotics to promote growth — not to prevent or treat illnesses. If the agency some day bans growth promotion as a use, there is a chance producers would simply relabel such uses as preventative.

There now is proposed legislation banning nontherapeutic uses of some classes of antibiotics on animals and poultry. I don’t think it’s even succeeded in getting out of committee.

Farmers who fear the removal of one of their more universal money-making schemes may become limited have the mid-term elections to look forward to. Nothing like moving Congress further to the Right to aid in ill health for our populace.

Beef containing harmful pesticides, veterinary antibiotics and heavy metals is being sold to the public because federal agencies have failed to set limits for the contaminants or adequately test for them, a federal audit finds…

The health effects on people who eat such meat are a “growing concern,” the audit adds.

The testing program for cattle is run by the USDA’s Food Safety and Inspection Service (FSIS), which also tests meat for such pathogens as salmonella and certain dangerous strains of E. coli. But the residue program relies on assistance from the Environmental Protection Agency, which sets tolerance levels for human exposure to pesticides and other pollutants, and the Food and Drug Administration, which does the same for antibiotics and other medicines.

Limits have not been set by the EPA and FDA “for many potentially harmful substances, which can impair FSIS’ enforcement activities,” the audit found…

Even when the inspection service does identify a lot of beef with high levels of pesticide or antibiotics, it often is powerless to stop the distribution of that meat because there is no legal limit for those contaminants.

In 2008, for example, Mexican authorities rejected a U.S. beef shipment because its copper levels exceeded Mexican standards, the audit says. But because there is no U.S. limit, the FSIS had no grounds for blocking the beef’s producer from reselling the rejected meat in the United States.

Terrific. Just another reminder why it took an election just to begin the process of turning federal agencies into something that must be responsible to the electorate – instead of corporate rubber stamps.

What good comes from mandatory vaccines, eh?

We all know that influenza vaccination helps prevent disease, but a new study from Canada suggests it may also prevent another public health problem: inappropriate antibiotic use. The findings come from a new study in the September 1, 2009 issue of Clinical Infectious Disease, which is now available online.

Starting in 2000, the Canadian province of Ontario introduced a universal immunization program offering free influenza vaccines to anyone 6 months of age or older. Other provinces continued to target only high-risk groups and their contacts for vaccination. The authors compared prescription rates for influenza-associated respiratory antibiotics before and after the Ontario program began, and compared the Ontario prescription rates with those of other provinces.

The broader immunization effort in Ontario was associated with a 64 percent decline in these antibiotic prescriptions compared with the other provinces that maintained targeted vaccination programs. Additionally, influenza-associated mortality fell 39 percent. Flu-related hospitalizations, emergency department use, and doctors’ office visits also fell an average of 52 percent.

Influenza and upper respiratory conditions account for a substantial number of antibiotic prescriptions, even though antibiotics don’t work against viruses such as the flu. The overuse of antibiotics and the development of antibiotic-resistant bacteria continue to be serious public health problems.

Here I am posting this in the United States where half the wingnuts in the nation still consider vaccination the work of the AntiChrist – and half the remainder think it may be an infringement on their liberty.

Our nation has the sense of science and logic of your average Stone Age sloth.

The Food and Drug Administration believes antibiotics should be used on livestock only to cure or prevent disease and not to promote growth, a common use.

Principal deputy FDA commissioner Joshua Sharfstein said restrictions on livestock use would reduce the opportunity for bacteria to develop resistance to drugs used by humans.

Critics of the heavy antibiotic use in livestock, such as the Union of Concerned Scientists, estimate 70 percent of all antibiotics sold in the United States are used on food animals, mostly in tiny doses that promote weight gain or more efficient feed consumption…

“Purposes other than for the advancement of animal or human health should not be considered judicious use” and not allowed, Sharfstein said in a statement for a House hearing. “Eliminating these uses will not compromise the safety of food.

“FDA also believes that the use of medications for prevention and control should be under the supervision of a veterinarian,” he said. This would mean no over-the-counter sales of antibiotics to farmers and ranchers.

Sharfstein told reporters afterward that his testimony was a statement of FDA principles. He said there was no administration or FDA position on a bill that would phase out nontherapeutic use in livestock of seven classes of antibiotics — penicillins, tetracyclines, macrolides, lincosamides, streptogramins, aminoglycosides, sulfonamides — and any other drug used to treat bacterial illness in people.

Identical phase-out bills were filed in the House and Senate on March 17 but have languished. The hearing on Monday by the House Rules Committee was the first in either chamber.

They’re still in the “my lobbyist said this” versus “your lobbyist said that” stage of considering legislation in Congress, of course.

Wouldn’t it be a pleasant switch if our Congress-critters considered our well-being to be as important as their after-Congress careers.