"Take two cheeseburgers and call me in the morning."
That's appallingly bad medical advice to give patients who may be suffering bacterial infections and requiring antibiotics. Still, you have to wonder about that prospect, if only imaginatively, when you consider the enormous amount of antibiotics pumped into our country's meat supply.
Indeed, according to the FDA, a whopping 29.9 million pounds of antibiotics were administered to our livestock in 2011 -- fourfold more than the 7.3 million pounds used to treat humans. Just imagine the greater appeal (for non-vegetarians) of spooning up chili-con-carne to treat pneumonia, compared to forking over $100 for some nasty-tasting antibiotic. Or feasting on lamb stew to cure cellulitis, rather than stewing over side effects from prescription antimicrobials.
But, clearly, that's not how things work. Livestock aren't inert containers that simply store all the antibiotics we dump into them. Instead, like humans, animals ingest, metabolize, and eliminate antibiotics from their bodies.
And, also like humans, animals naturally harbor millions of bacteria within their bodies, and those bacteria are affected by antibiotics consumed by the animals. Consequently, sensitive bacteria are killed off, while insensitive others proliferate. Some bacteria with Darwinian survival skills genetically mutate, gaining resistance against the antibiotics to which they've been exposed.
These antibiotic-resistant bacteria can cause problems up the food chain when susceptible humans ingest poultry or meat carrying them. Depending upon the scope of the bacteria's resilience, ensuing human infections with resistant strains of Salmonella, Campylobacter, or E. coli can prove notoriously difficult to treat. Overall, antibiotic-resistant bacterial infections pose a greater risk of patient mortality and hospitalization, as well as more prolonged, intensive, and expensive medical care.
Back at the farm, antibiotics administered to poultry and livestock rarely serve any therapeutic purpose. Instead, they're routinely provided to healthy animals in regular feed and water, in hopes of promoting animal growth and meat production. Antibiotic-doping of animals on the field and in the henhouse has become a worrying farm-aceutical epidemic.
Now at the supermarket, consider recent studies documenting the widespread prevalence of antibiotic-resistant bacteria within our meat supply. For example, in February, an FDA workforce monitoring foodborne illnesses published some rather unappetizing results. As analyzed and reported by the Environmental Working Group (EWG), data revealed that store-bought raw meat tested in 2011 contained antibiotic-resistant bacteria in 81 percent of ground turkey samples, 69 percent of pork chops, 55 percent of ground beef, and nearly 40 percent of chicken parts.
The FDA subsequently refuted EWG's interpretation of the data, claiming it to be oversimplified, misleading, and alarmist. But having examined both the FDA data and EWG's analysis, I believe the most optimistic possible view still warrants our serious concern.
Antibiotic doping of food animals has become so widespread that even Chipotle Mexican Grill announced last week it would allow antibiotic-treated beef in its restaurant offerings. Purportedly, Chipotle could no longer secure adequate supplies of the naturally-raised and antibiotic-free meat it had been touting for years.
Of course, our problem with antibiotic-resistant disease has roots beyond the farm. For too long a while, we doctors in clinics and hospitals have been contributing to the burgeoning crisis by misusing and over-prescribing antibiotics for our patients. A new study published last month in the Journal of Antimicrobial Chemotherapy also revealed that we tended to choose excessively broad-spectrum antibiotics when we prescribed. Furthermore, those antibiotics were pointless 25 percent of the time because the infections had been caused by viruses which don't respond to antibiotics.
In clinical settings, we've been witnessing the ominous spread of methicillin-resistant Staphylococcus aureus (MRSA), which now kills about 19,000 people each year in the U.S. alone. Antibiotic-resistant TB and untreatable gonorrhea continue their relentless trek across the globe.
If antibiotic resistance continues to worsen, we may someday lack a robust arsenal of effective antibiotics to contain even minor infections. Two months ago, the British Science minister urged fellow G-8 nations to impose restrictions on antibiotic use, deeming it "a global challenge that is up there with climate change, water stress and environmental damage."
In 2011, this warning appeared in the Journal of Antimicrobial Chemotherapy: "History could well regard the past 70 years as an era of immense profligacy, with a squandering of the world's finite resources, included among which must be antibiotics. It may become a reality that antibiotics were discovered and squandered within the living memory of a single lifetime; a startling achievement for mankind."
The good news is that the multifaceted challenges we face regarding antibiotic resistance provide us with multiple opportunities to intervene. We can become more responsible farmers and ranchers, more health-conscious consumers in markets and restaurants, more discerning doctors and patients, more dedicated public health advocates and policymakers, and more vocal citizens lending support to bills like the Preventing Antibiotic Resistance Act of 2013.
Lastly, in a common quest to restore healthy arsenals of effective antibiotics for the future, we can finally justify seeking "the path of least resistance."
Kate Scannell is a Bay Area physician and the author of "Death of the Good Doctor" and "Flood Stage."