Farmaceuticals: The drugs fed to farm animals and the risks posed to humans

Brian Grow, P.J. Huffstutter and Michael Erman, Farmaceuticals: The drugs fed to farm animals and the risks posed to humans. Reuters Investigates, Part One, 15 September 2014. Part Two, 4 December 2014. Part Three, 23 December 2014. Part One: “Documents reveal how poultry firms systematically feed antibiotics to flocks…. Pervasive use [of antibiotics] fuels concerns about impact on human health, emergence of resistant superbugs.” Part Two: “On American dairy farms, sharp rise in the misuse of a potent but risky drug…. The antibiotic ceftiofur is a wonder drug for dairy farmers. But its strength–and the frequency at which it’s used improperly in cattle–pose a threat to public health.” Part Three: “Veterinarians face conflicting allegiances to animals, farmers–and drug companies…. The FDA is counting on vets to curb antibiotic use, but not even the government knows which of the animal doctors has financial ties to the pharmaceutical industry.”

Part One:

Major U.S. poultry firms are administering antibiotics to their flocks far more pervasively than regulators realize, posing a potential risk to human health.

Internal records examined by Reuters reveal that some of the nation’s largest poultry producers routinely feed chickens an array of antibiotics – not just when sickness strikes, but as a standard practice over most of the birds’ lives.

In every instance of antibiotic use identified by Reuters, the doses were at the low levels that scientists say are especially conducive to the growth of so-called superbugs, bacteria that gain resistance to conventional medicines used to treat people. Some of the antibiotics belong to categories considered medically important to humans.

The internal documents contain details on how five major companies  – Tyson Foods, Pilgrim’s Pride, Perdue Farms, George’s and Koch Foods – medicate some of their flocks….

Reuters reviewed more than 320 documents generated by six major poultry companies during the past two years. Called “feed tickets,” the documents are issued to chicken growers by the mills that make feed to poultry companies’ specifications. They list the names and grams per ton of each “active drug ingredient” in a batch of feed. They disclose the FDA-approved purpose of each medication. And they specify which stage in a chicken’s roughly six-week life the feed is meant for.

The feed tickets examined represent a fraction of the tens of thousands issued annually to poultry farms run by or for major producers. The confidential information they contain nonetheless extends well beyond what the U.S. government knows. Veterinary use of antibiotics is legal and has been rising for decades. But U.S. regulators don’t monitor how the drugs are administered on the farm – in what doses, for what purposes, or for how long. Made public here for the first time, the feed documents thus provide unique insight into how some major players use antibiotics.

The tickets indicate that two of the poultry producers – George’s and Koch Foods – have administered drugs belonging to the same classes of antibiotics used to treat infections in humans. The practice is legal. But many medical scientists deem it particularly dangerous, because it runs the risk of promoting superbugs that can defeat the life-saving human antibiotics.

In interviews, another major producer, Foster Poultry Farms, acknowledged that it too has used drugs that are in the same classes as antibiotics considered medically important to humans by the FDA.

About 10 percent of the feed tickets reviewed by Reuters list antibiotics belonging to medically important drug classes. But in recent presentations, scientists with the U.S. Centers for Disease Control and Prevention said the use of any type of antibiotic, not just medically important ones, contributes to resistance. They said that whenever an antibiotic is administered, it kills weaker bacteria and enables the strongest to survive and multiply.

Frequent, sub-therapeutic use of antibiotics in low doses intensifies that effect, scientists and public health experts say. The risk: Any resulting superbugs might also develop cross-resistance to medically important antibiotics.

According to the feed tickets reviewed, low doses of antibiotics were part of the standard diet for some flocks at five companies: Tyson, Pilgrim’s, Perdue, George’s and Koch.

“These are not targeted uses aimed at specific bugs for defined duration. They’re multiple, repeat shotgun blasts that will certainly kill off weaker bugs and promote the stronger, more resistant ones,” said Keeve Nachman, director of the food production and public health program at Johns Hopkins University’s Bloomberg School of Public Health….

Poultry producers began using antibiotics in the 1940s, not long after scientists discovered that penicillin, streptomycin and chlortetracycline helped control outbreaks of disease in chickens. The drugs offered an added benefit: They kept the birds’ digestive tracts healthy, and chickens were able to gain more weight without eating more food.

Over the years, the industry’s use of antibiotics grew. Early on, independent scientists warned that bacteria would inevitably develop resistance to those antibiotics, especially when the drugs were administered in low doses. In 1976, a landmark study by microbiologist Stuart Levy showed that potentially deadly bacteria in poultry were developing resistance to tetracyclines and other antibiotics. The resistant bacteria, E. Coli, were then moving from poultry to people.

That is when the FDA first tried to rein in drug use in food animals. The agricultural and pharmaceutical industries resisted, viewing low-level antibiotic use as a way to produce meat more quickly and cheaply.

Today, 80 percent of all antibiotics used in America are given not to people, but to livestock.

About 390 medications containing antibiotics have been approved to treat illness, stave off disease and promote growth in farm animals. But the FDA has reviewed just 7 percent of those drugs for their likelihood of creating antibiotic-resistant superbugs, a Reuters data analysis found.

Each year, about 430,000 people in the United States become ill from food-borne bacteria that resist conventional antibiotics, according to a July report by the CDC. Overall, the CDC estimates that 2 million people are sickened in the United States annually with infections resistant to antibiotics. At least 23,000 people die….

All the poultry giants state publicly that they use antibiotics for the limited purpose of keeping chickens healthy.

But the feed tickets, which list the medications included in chicken feed, highlight a second effect of many of the drugs: bulking up the birds.

Some of the tickets reviewed for this article state that the antibiotics promote feed efficiency or weight gain in chickens. The FDA requires companies to list growth promotion on feed tickets whenever feed includes antibiotics that have been approved for that purpose….

Part Two:

The U.S. Food and Drug Administration cautioned in 2012 that ceftiofur could pose a “high public health risk,” in part because the drug belongs to a class of antibiotics considered critically important in human medicine. The warning is the FDA’s strongest kind. The concern is that ceftiofur in animals could spawn antibiotic-resistant bacteria, superbugs that can infect people and defeat conventional medical treatment, even when the drug is used as directed.

A Reuters analysis of government data indicates that the risks to human health may be more significant than previously known. Since last year, records kept by the U.S. Department of Agriculture show that traces of ceftiofur were found at illegal levels in slaughtered animals more frequently than with any other drug. In 2013, ceftiofur alone accounted for one-fourth of all residue violations logged by the USDA, the data show.

The ceftiofur residues are not themselves considered dangerous to people if ingested, because the government sets its standards well below hazardous levels.

But the traces serve as a warning sign that the drug was used shortly before the animal was killed, thus increasing the chances that the meat contains superbugs, said Guy Loneragan, a veterinary epidemiologist at Texas Tech University. Studies show that ceftiofur, more than most other drugs, can sharply increase the amount of antibiotic-resistant bacteria in an animal.

“It kills off weaker bugs and allows stronger ones to survive and multiply,” Loneragan said. The effect is especially pronounced soon after the drug has been used, studies show….

Those caught misusing veterinary antibiotics face light consequences. Penalties include condemnation of the animal. FDA inspectors review a violator’s practices, which can result in warning letters ordering farmers to change how they administer the medicines. Further action is extremely rare, an examination of regulatory and court records shows….

The World Health Organization called antibiotic resistance “a problem so serious it threatens the achievements of modern medicine.”…

The government tests fewer than 1 percent of cattle for antibiotic residue….

Part Three:

In 2016, a new U.S. Food and Drug Administration policy will give veterinarians a key role in combating a surge in antibiotic-resistant “superbugs” that infect humans. For the first time, the agency will require veterinarians, not farmers, to decide whenever antibiotics used by people are given to animals.

Medical doctors issue antibiotics by prescription only. Yet farmers and food companies have been able to buy the same or similar drugs over the counter to add to feed and water. The drugs not only help prevent disease but enable livestock to grow faster on less feed.

The new directive is meant to guard against the overuse of the drugs in American meat production. But by enlisting the help of veterinarians, a Reuters examination found, the FDA will be empowering a profession that not only has allegiances to animals, farmers and public health, but also has pervasive and undisclosed financial ties to the makers of the drugs.

The relationships between medical doctors and the pharmaceutical industry are subject to strict rules that require the public disclosure of payments for meals, trips, consulting, speaking and research.

No laws or regulations – including the new FDA directives –
require veterinarians to reveal financial connections to drug companies. That means veterinarians can be wined and dined and given scholarships, awards, stipends, gifts and trips by pharmaceutical benefactors without the knowledge of the FDA or the public….

Veterinary medicine is a little-regulated corner of the medical profession, more dependent on industry funding than its human counterparts, and Reuters found that drug companies support veterinarians at every stage of their careers….

The American Veterinary Medical Association, the non-profit organization that represents the nation’s veterinarians, also benefits from contributions from the pharmaceutical industry. The association’s ethics code calls on veterinarians to divulge all potential conflicts of interests. But only after Reuters asked did the group disclose that it has accepted $3.3 million from drug companies over the past four years. It declined to say which pharmaceutical companies contributed to the group….

Two new voluntary rules, effective in December 2016 and supported by drug makers, prohibit using antibiotics to promote fattening animals for food, and require prescriptions for all antibiotics used in both animal and human medicine. But the new guidelines still permit antibiotics to be used for disease prevention, a provision that some health advocates say will enable veterinarians to rationalize almost any prescription.

The FDA’s handling of the antibiotics issue itself illustrates the conflicts facing the industry and the government.

The agency’s Veterinary Medicine Advisory Committee, for example, discussed the use of antibiotics four times between 1999 and 2006. Among the 22 veterinarians who participated in those discussions, half had some sort of financial tie with one or more of the companies that sold antibiotics. In the two most recent meetings, an even higher percentage, seven of 10, had financial ties to drug makers….

In some cases, the relationships between veterinarians and drug companies appear at odds with the ethics code that the profession has embraced.

That code, adopted by the American Veterinary Medical Association, calls on veterinarians to disclose all potential conflicts of interest to clients. But neither the government nor the veterinarian association tracks or enforces the provision….

The pharmaceutical industry has strong ties to veterinary education across the United States, providing financial support to professors, researchers and students.

Zoetis, the world’s leading animal drug maker, has given $3.6 million in scholarships over the past five years to more than 1,100 U.S. veterinary students. The American Association of Bovine Practitioners, a beef veterinary group, provided $300,000 in grants and scholarships funded by Merck, Zoetis, Cargill and others this year….