Antibiotics made modern farming possible. By abusing them ...

HEALTH

Antibiotics made modern farming possible. By abusing them, we risk

everything

BY SASHA CHAPMAN · ILLUSTRATION BY TAMARA SHOPSIN AND JASON FULFORD

FROM THE JANUARY/FEBRUARY 2015 MAGAZINE

agriculture · animals · antibiotics · bacteria · chickens · disease · farms · food · health · veterinary · Walkerton

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ND THE craziest food you ever ate?

The question arrives, like clockwork, halfway through the

dinner party. So I offer what guests might expect to hear from a

food writer: The fried grasshoppers in Oaxaca, Mexico. The

Tasmanian possum in Launceston, Australia (now that was tough

to swallow, after watching the hairless creature get thrown around

in a converted washing machine to tenderize it). The fried goat’s

brain in Toronto. The whale bacon I chewed and chewed at a stall at


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the Tsukiji fish market in Tokyo, trying to quell the revulsion I felt

from eating a creature nearly as intelligent as I. The blowfish I ate

sitting cross legged on the floor of a restaurant a few hours from the

Japanese capital, while a snowstorm howled outside. That dish

really scared me: a slip of the knife could have caused the

neurotoxin-laden liver to shut down my nervous system.

But the craziest food? Hands down, it was the chicken I had eaten a

few days before that in Tokyo. We had consumed nearly every part

of the bird that night—heart, gizzard, feet—before the chef sent

out his pièce de résistance: glistening pink slices of chicken

sashimi. To swallow the raw chicken, I had to trust the cooks who

prepared it, the abattoir that slaughtered it, the farmers who raised

it. I had to trust that it was free of the many pathogens that are

routinely present on a chicken carcass in the supermarket.

Naturally, I thought of the toilet in my hotel room. It was one of

those high-tech jobs, with a control board of buttons, that could

clean every inch of my backside and, if I pressed the wrong button

at the wrong time, every inch of the bathroom. Hygiene standards

in Japan, of course, are famously high. I’d already watched a nude

Japanese woman make a kind of citizen’s arrest at an onsen,

pouncing on an equally naked tourist who had not properly

scrubbed herself down before slipping into the spa waters. If I were

going to eat raw chicken anywhere, Tokyo was surely one of the

safer places to do it. (This is the kind of reasoning you follow when

you’re jet lagged and several cups into a bottle of sake.)

Now, you might say that anyone who eats chicken sashimi is


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engaging in high-risk behaviour; but eating is always an intimate

act, and, like most acts of intimacy, it requires you to trust your

partner. Somebody—more often than not a stranger—has created

something that will end up inside you, part of you. This fact seems

obvious in the face of strange new food; less so when the most

pervasive economic and social system on the planet requires us to

place our faith in the faceless, nameless people who produce what

we eat daily, whether at a poncey restaurant in Tokyo or KFC in

Kingston.

In The Ethical Canary: Science, Society and the Human Spirit, the

contrarian philosopher Margaret Somerville considers the common

perception that trust is a “rapidly decreasing feature of our

relationships with one another and our societal institutions.” But,

she argues, the way we engage with the food system would suggest

just the opposite. Two hundred years ago, a pioneer might have had

to trust only a few producers to put breakfast on his plate if he

didn’t grow the oats himself. “Today, our grapefruit may have come

from one continent, the grain for our cereal from another and the

bacon from yet another,” she writes. “Thousands of people had

access to these products, but we trust that they are safe to eat.”

Or maybe, as with me and my chicken sashimi, we just hope they

are.

HE THING that scared me about the raw chicken scallop

draped over my chopsticks was the possibility that it

contained bacteria that would make me sick. Salmonella, E. coli,

and campylobacter can, under the right conditions, kill us—or at


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least make us wish we were dead. At the same time, hundreds of

species have co-evolved to live peacefully with us, and even benefit

us. “Bacteria are as much a part of us as we are ourselves,” says Jim

Hutchinson, an expert in medical microbiology in Victoria, who

has spent much of his career studying the epidemiology of

infectious diseases. Even the most germophobic among us host

hundreds of species of bacteria; for every human cell, we shelter

ten microbial ones. Each of us is host to an entire community of

microbes.

This is also true of the animals in our lives—the pets we own, the

livestock we raise. Bacteria move easily from one species to

another, especially through the food system. “We are intertwined

from a microbiological perspective,” says Hutchinson. What

happens on the farm can affect us in the kitchen and at the dinner

table. Yet aside from the occasional People for the Ethical

Treatment of Animals horror video or friendly exchange with an

organic farmer at a market, most of us have no idea what actually

goes on inside those unmarked locked barns that sit a few hundred

metres off the highway. It’s easier not to think about where our

food comes from, or the risks it carries.

The idea that there is a connection between our health and that of

other animals is not new. Sir William Osler, one of Canada’s most

admired physicians and a father of modern medicine, is also

considered a father of veterinary pathology. He believed that his

students, whether medical or veterinary, should study the

anatomy and pathology of both human beings and animals. When

Osler delivered the inaugural address at the Montreal Veterinary


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College in 1876, he titled it “The Relations of Animals to Man,” and

told students it would not be long before “you find out that

similarity in animal structure is accompanied by a community of

disease and that the ‘ills which flesh is heir to’ are not wholly

monopolized by the ‘lords of creation.’ ” Back then, in lecture halls

at the Faculty of Comparative Medicine and Veterinary Science at

McGill, veterinary students sat alongside medical students.

Today, such crossover training would be highly unusual. Most

doctors have little to do with animal medicine, unless they’re

taking the family pet for a checkup. Likewise, vets rarely take more

than a personal interest in human medicine. Each profession keeps

to itself, and each tends to collect and analyze its own data

separately, making it difficult to share information and identify

cross-species health risks. And in the case of zoonotic diseases

—those that move from animals to humans—there can be a

tendency, between the professions, to develop an us-versus-them

mindset. Vets are concerned with their own patients’ health, and

doctors with theirs.

We segregate these disciplines at our peril. Most of the emerging

and re-emerging infectious diseases that have plagued humans in

recent decades—including Lyme disease, H1N1, and Ebola—began

in animal populations, and were first transmitted to human beings

either directly or through our shared environment. Consequences

can be devastating, as in the case of plague, which emerges

periodically from animal reservoirs. As Hutchinson says, “We are

all swimming in the same pool.” That pool has changed

significantly in the last sixty years. Or, to be more precise, we


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changed the pool when we declared open season on bacteria, and

began killing them off with antibiotics.

OWHERE IS the division between human and veterinary

medicine more evident—or more significant—than in the

way we govern antibiotic use. Imagine what health care might be

like if the doctor prescribing you antibiotics for a skin infection was

also the sales rep for the manufacturer of that drug, and earned a

commission each time he wrote a prescription. This is what

happens in most provinces when a vet prescribes antibiotics to

livestock—if she writes a prescription at all.

Canada is one of the few Organisation for Economic Co-operation

and Development countries to allow over-the-counter sales of

antibiotics for animals. This makes it easy for farmers to obtain and

abuse antibiotics; it also makes it difficult for scientists and

regulators to track their use. Under an “own use” provision

—designed to allow travellers to bring in three months’ worth of

medicine after filling a prescription in, say, Florida—farmers can

bring in unregistered, unregulated drugs from anywhere in the

world, as long as they don’t sell them. A farmer with 90,000

chickens can go through a lot of antibiotics in three months. He can

also import active pharmaceutical ingredients and compound his

own medicines.

Jean Szkotnicki, who heads the Canadian Animal Health Institute,

an animal drug manufacturing lobby group, estimates that about

13 percent of the drugs used on animals come into the country

through these loopholes and are never approved by Health Canada.


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Warren Skippon, who recently developed antibiotic prudent-use

guidelines for the Canadian Veterinarian Medical Association,

says, “We are the only industrialized country in the Western world

that has such voids.”

Data on antimicrobial use in Canada is hard to obtain—so difficult,

in fact, that Rebecca Irwin, who heads a nationwide surveillance

program designed to monitor antimicrobial resistance in the food

system, once complained that she had no way of knowing whether

the CVMA’s prudent-use guidelines were making any difference. A

2007 report from Health Canada estimated that about 200,000

kilograms of antimicrobials are used in human medicine each year.

More than 1.6 million kilograms are used in animals (and that does

not include the antibiotics that farmers import directly). Measured

by weight of active ingredient, nearly 90 percent of antimicrobials

sold in Canada are used for animals, including companion animals

like dogs and cats. Even more alarmingly, two-thirds of those

medications are considered important for human use.

OBERT TAUXE, an epidemiologist at the Centers for Disease

Control and Prevention in Atlanta, studies the way changes

in human behaviour can affect microbial evolution. In a 2014

lecture, part of the Massachusetts Institute of Technology’s Knight

science journalism program, he cheerfully describes food-borne

outbreaks as “prime learning opportunities.” He explains that the

CDC was established to control malaria during World War II; the US

Department of Defense wanted to protect its soldiers on army

bases. Within a few years, it had eradicated the disease throughout

the country, without even meaning to. Polio took longer to quash,


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but by 1979 it, too, had disappeared from American soil. In 1949,

the CDC began tackling its third challenge, salmonella.

He pauses for effect: “It turned out to be more durable than we

originally thought.” Rates of salmonella infection are stable in the

US and Canada, despite improvements in food safety standards,

livestock management practices, and surveillance. And the

infections salmonella causes are now more resistant to treatment

than ever. Salmonella heidelberg is one of the top causes of

gastroenteritis in humans; it’s also one of the top strains found in

broiler chickens on the farm. Though the bacterium doesn’t affect

chickens, it can cause severe illness in human beings—extra-

intestinal infection, septicemia, myocarditis. It can kill you.

Bacteria such as S. heidelberg are successful in part because they

are, as several scientists told me, “very promiscuous.” Shape-

shifters capable of exchanging bits of genetic information and

reproducing in minutes, they can refashion themselves with new

bits of code that make them more resilient than their predecessors.

In ideal conditions, they can survive for months, even years. And

because salmonella microbes don’t usually bother chickens—and

aren’t easily detected—farmers have little incentive to get rid of

them. Farmers do, however, have plenty of incentives to

inadvertently generate microbes resistant to antibiotics.

A decade or so ago, Health Canada began to monitor S. heidelberg

and other food-borne pathogens. Irwin and her colleagues formed

the Canadian Integrated Program for Antimicrobial Resistance

Surveillance and collected isolates from both livestock and


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humans. Since they didn’t have access to farm samples (on-farm

surveillance is only now being piloted in chickens), they collected

bacteria from the animals’ intestines at abattoirs—samples, they

reasoned, that would still accurately reflect the farms’ microflora.

Staff also shopped for meat at grocery stores in numbers that

reflected how many Canadians live in cities and rural areas, and

how many of us buy our meat at supermarkets and butcher shops.

CIPARS researchers were hoping to better understand the link

between animal and human health, and whether resistance in one

species leads to resistance up the food chain. Their project was

unprecedented in Canada, both in scale and scope. What they

uncovered has found its way into textbooks and PowerPoint

presentations around the world.

At the time, broiler chicken hatcheries were injecting eggs with

ceftiofur and gentamicin to prevent and control E. coli infections.

Then gentamicin became unavailable, and by 2004 all the Quebec

hatcheries surveyed were using ceftiofur. Even the scientists were

surprised by what they found. There was a direct correlation

between the ceftiofur injected into the eggs and the resistance in S.

heidelberg to the class of antibiotic that includes ceftiofur.

Moreover, the hard-to-treat bug was turning up on chicken in

stores—and in patients in hospitals, first in Quebec and then in

Ontario. “We didn’t expect to see such a strong linkage,” recalls

Irwin. The evidence was so convincing that producers voluntarily

stopped using the antibiotic. But a few years later, they quietly

reintroduced ceftiofur, and CIPARS again noticed an uptick in

human S. heidelberg isolates.

Scientists already knew that using antibiotics on farm animals


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could elevate resistance levels in food-borne pathogens. An

influential report by the molecular biologist Michael Swann,

published in 1969, caused the United Kingdom to rethink the way

antibiotics were being used in agriculture. Then in 1975, Stuart

Levy, an American microbiologist, established a family farm

outside Boston and introduced two groups of chickens hatched

from pathogen-free hens. One group received low doses of

antibiotic-laced feed; the other did not.

Thirty-five years later, in 2010, Levy appeared before the US House

of Representatives Energy and Commerce Committee to argue,

once more, for the prudent use of antibiotics. “The findings were

striking,” he recalled. “Within twenty-four to forty-eight hours, the

chickens given the oxytetracycline-laced feed began to excrete

tetracycline-resistant E. coli.” Within a week, almost all of the E.

coli in the chickens’ guts was tetracycline resistant. After three

months, the chickens were excreting E. coli that was also resistant

to many other drugs: sulphonamides, ampicillin, streptomycin,

and carbenicillin. Levy published his findings in The New England

Journal of Medicine and in Nature. The study, he said,

“demonstrated the ecologic and environmental impact of an

antibiotic”—not only for the animals on the farm, but also for the

humans who lived there. Family members also showed a change in

their microflora; they were carrying more and more fecal E. coli

that was resistant to more than one antibiotic.

By the mid-1990s, the wider medical community began noticing

that the antibiotics that had served so well for decades were no

longer as effective. Doctors would try one type of antibiotic; when


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that didn’t work, they’d try another. It gradually became clear that

some bacteria had developed a resistance to a variety of antibiotics,

making them almost impossible to treat. Dubbed superbugs , these

multi-resistant bacteria (including strains of methicillin-resistant

Staphylococcus aureus and E. coli) began showing up both in

hospitals and on farms. To this day, Dutch hospitals routinely

isolate and screen livestock workers if they are carrying MRSA.

Bacteria become resistant through random mutation and gene

exchange; each time we use antibiotics, we increase the odds for

resistance to them. Any bacteria able to survive our antibiotic

onslaught will produce more resistant bacteria. And salmonella

and E. coli can share resistance genes, facilitating the spread of

drug resistance across the species that colonize the intestinal

microbiota.

“There is essentially no gene in any bacterium that cannot be

moved to another bacterium,” writes John Prescott, the

bacteriologist at the University of Guelph in Ontario who literally

wrote the book on Antimicrobial Therapy in Veterinary Medicine.

Create superbugs that live on chickens, and they can travel easily

through the food chain—from the farm, to the abattoir, to the

supermarket, to the dinner plate. The phenomenon is

self-perpetuating. Once resistant bacteria are established, they can

move from animal to animal—humans included—without the aid

of any additional antibiotics.

Each year, roughly one in eight Canadians—4 million people—gets

sick from food-borne illnesses. (The vast majority are never


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identified, but researchers estimate twenty-six cases exist for every

salmonella case that is actually reported. By this measure,

Canadians may suffer as many as 2.3 million cases of salmonella in

a given year.) The Public Health Agency of Canada estimates the

total annual cost of food-borne illnesses, accounting for health care

and lost productivity, to be as much as $3.7 billion. Already, some

of those illnesses involve resistant pathogens, which lengthen

hospital stays, complicate treatments, and at least double the cost

of treating a bacterial infection. Plus, we could die. According to

the World Health Organization, patients with MRSA are 64 percent

more likely to die than those infected with non-resistant S. aureus.

ORGET CURING CANCER, says Jim Hutchinson, who now heads

up an antimicrobial stewardship program on Vancouver

Island. Antibiotics have done more to extend our life expectancy

than any other drug we use to treat disease: pneumonia, skin

infections, and even urinary tract infections can be fatal without

them. A December 2013 editorial in The New England Journal of

Medicine suggests that the use of antibiotics extends life expectancy

by as much as ten years. Put another way: if antibiotics no longer

work, our lives end much sooner.

Medical professionals around the world warn of a post-antibiotic

era, when bacteria will be resistant to all the drugs we can throw at

them. The prospect is scary enough to be called a “crisis” (by the

WHO), a “nightmare” (by the CDC), and a “catastrophic threat” (by

UK chief medical officer Sally Davies). Yet the issue hasn’t

commanded the attention it deserves. Some scientists compare

antimicrobial resistance to climate change: it’s caused by human


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activity and we’ve known about it for a long time, but the problem

is so complex, and involves so many players in so many places, that

a solution seems beyond reach. Meanwhile, scientific reports

demonstrating the link between antibiotic use (in both humans and

animals) and cross-species resistance continue to be published, and

recommendations urging prudence keep piling up.

The role that agriculture plays in antimicrobial resistance in

humans has long been the subject of acrimonious debate. In this

way, too, the issue of resistance resembles that of climate change:

it’s easier to point fingers than to fix the problem. Doctors write

scathing editorials in The New England Journal of Medicine laying

blame at the feet of farmers and griping that “agricultural industry

groups, in line with their short-term financial interests, argue that

there is no conclusive proof that the antibiotics used in agriculture

harm human health.” The Canadian Medical Association Journal,

meanwhile, complains, “Agriculture plays a major role in

promoting antibiotic resistance, even after accounting for other

factors such as over-prescribing of antibiotics by physicians and

suboptimal adherence by patients.”

Even John Prescott—who is sharply critical of the abuse of

antibiotics by many farmers and vets, and of the regulations that

permit it—acknowledges that agriculture’s direct contribution to

human resistance could be as low as 6 percent. But a direct

contribution may be only the tip of the iceberg. The epidemiologist

Amee Manges and her colleagues at the University of British

Columbia have been analyzing community-acquired urinary tract

infections. DNA fingerprinting suggests that some of these


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infections may have been picked up from E. coli in supermarket

chicken. Such infections are a common complaint among women;

they become particularly worrisome when they do not respond to

antibiotic treatment and persist for months.

In their defence, farmers point to the many studies that suggest

overuse of antibiotics in human medicine is the worse offender,

and many doctors, including Hutchinson, agree. On a global level,

there is great concern that many countries don’t even regulate

over-the-counter sales of human medications. Still, no one denies

that agricultural antibiotics contribute to resistance, and that

reforms to the way we distribute drugs in Canada are long overdue.

Antibiotics are what Levy calls “societal drugs”: administer them to

one individual (whether feathered or not) and you may affect

resistance in other individuals. Ignoring their use in one part of the

food chain, or one part of the world, imperils us all.

N FEBRUARY 7, the Canadian Federation of Agriculture will

celebrate Food Freedom Day—the day on which most

Canadians will have earned enough at their jobs to pay for a year’s

worth of groceries. This is nothing short of miraculous. Each

decade seems to bring us cheaper, more plentiful plates of food,

and there is no greater success story than chicken, the protein that

ends up on our plate more often than any other. About 2,700

Canadian farmers produced a staggering 1 billion kilograms of

chicken in 2012. It looks like a good-news story—a chicken in

every pot!—and in some ways it is.

In 1950, farmers spent eighty-four days raising their birds; today,


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most chickens are slaughtered after thirty-eight days. Farmers can

now produce a kilogram of meat using less than half the feed and in

less than half the time. Such efficiencies help explain why the

typical Canadian eats 31 kilograms of chicken a year—21 kilograms

more than we ate in 1965.

The average broiler farmer today is in his or her forties, while the

average for all Canadian farmers is fifty-four. Improved breeding

stock and equipment, and more sophisticated management

techniques, help to make chicken farming more lucrative and

attractive to the next generation. “Our farmers are like

businessmen,” says Lisa Bishop-Spencer, communications

manager with Chicken Farmers of Canada. “They wear suits and

control feed and water and temperature by pressing a button.”

Prices drive chicken production choices, and in this sense

production is governed by market forces. Yet because raising

chickens falls under supply management, you could argue that the

farmers have a social responsibility: under the Farm Products

Agencies Act, they “have been granted a social licence to manage

the supply of chicken in the interest of producers and consumers”

(italics mine). What happens when the interests of producers are at

odds with those of consumers?

Antibiotics help broiler farmers maximize yield while minimizing

cost. Pathogens flourish in a 10,000-square-foot barn housing

10,000 birds. Warm, littered, and (by the time the birds reach their

2.2-kilogram slaughter weight) extremely crowded, a broiler barn

is almost perfectly designed to promote the growth and


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transmission of germs. And, like toddlers in a daycare, the

chickens pick up nearly every infection they’re exposed to. “A

young intestine is very dynamic,” explains Prescott. “It takes time

to settle the gut.”

Because of the likelihood of disease, antibiotics are used not only as

you or I use them, to control an infection that has taken hold;

farmers also routinely administer them in low doses to prevent

infection. At least, that’s what we think happens. We can’t say for

sure, since most of the drugs used on the farm do not require a

prescription (i.e., paper trail) from a veterinarian (except in Quebec

and Newfoundland and Labrador), and many are administered

through feed and water.

Farmers also use antibiotics to promote faster growth. As early as

1946, it was observed that animals put on weight faster when they

were given low doses of antibiotics. This strategy is especially

effective in intensive livestock farming, where infections would

otherwise reduce yield. In a paper for the UN’s Food and

Agriculture Organization, Peter Hughes and John Heritage,

microbiologists at the University of Leeds in the UK, suggest that

“the effects of growth promoters were much more noticeable in

sick animals and those housed in cramped, unhygienic

conditions.” In 1995, the Animal Health Institute estimated that if

the livestock industry stopped using antibiotics in this fashion, the

US alone “would require an additional 452 million chickens, 23

million more cattle and 12 million more pigs to reach the levels of

production attained by the current practices.”

Amazingly, we still don’t know why antibiotics promote growth.


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One hypothesis is that they suppress bacteria in the intestines.

Energy that chickens might otherwise devote to fighting off (or

perhaps just feeding) the gut’s microflora can instead be used to put

on weight—anywhere from 1 to 10 percent more per day. It’s

possible that something similar is happening in humans.

“Underweight children used to be given tetracycline,” says

Prescott. And new research is looking into the possibility that the

widespread use of antibiotics—and the altering of the microflora of

the human gut—may play a role in the obesity epidemic in North

America.

N THE FRIDAY before Thanksgiving, I visited a chicken farm

in southwestern Ontario. It was sunny and brisk, and the

nights were cold, though not yet cold enough to have shocked the

trees into peak blaze. As I drove along the highway, farmers were

moving equipment from one field to another. Horse-drawn

Mennonite buggies marked with giant reflective yield triangles on

their backs stayed close to the shoulder. Green combines wider

than a highway lane, with tires taller than my car, were moving as

fast as I was.

I was on my way to meet Derek Detzler, the very incarnation of a

modern-day chicken farmer. He can run six barns and produce

about 540,000 birds a year—or 90,000 per cycle—with the help of

just one hired hand, a farm manager who visits each barn two or

three times a day. Detzler’s hands are soft, his nails clean; he is able

to maintain a full-time job as the global program manager for an

animal health and nutrition company, travelling the world to sell

his fellow chicken farmers alternatives to antibiotics, including


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vaccines and organic acids to help them fight the never-ending war

on bugs. His unhurried, folksy way of talking—“You and I are

gonna get along just fine”—probably serves him well in this role.

He was just back from China and heading to Brazil the following

week. His eyes, he jokes, are blue when they’re not bloodshot from

travelling.

Detzler, like a handful of other large-scale chicken farmers across

the country, has been grappling for more than a decade with how to

control infection in broiler flocks without resorting to antibiotics.

Two worrisome diseases plague chicken flocks: One is coccidiosis,

an intestinal infection caused by a protozoan parasite, which is

nearly ubiquitous in modern chicken coops. If it isn’t managed

properly, mortality rates begin to climb when chicks are twelve

days old. The other is clostridium, which in Canada causes necrotic

enteritis.

“Nothing works as good as a working antibiotic,” says Detzler, who

trained as an engineering technologist and began his farming

career at a large processor. Later, he took a job in hatchery sales

and spent much of his time visiting farmers and advising them on

managing chick health. (In Canada, large processors work closely

with chicken farmers, awarding them contracts to grow a certain

number of chickens per cycle, according to sales projections.)

Across the industry, chicken mortality rates were on the rise, and,

in a mirror of what was happening in our hospitals, the antibiotics

used to fight disease didn’t seem to be working as well as they once

did. Detzler’s boss, afraid of losing his competitive edge, charged

him with finding an alternative: “He used to say, The best time to


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attack resistance is before it develops.” What Detzler learned,

through trial and error, informed his own flock management when

he took over his dad’s 324-hectare operation six years ago.

The farm is a ten-minute drive from Walkerton, the town that made

national headlines in 2000 when agricultural runoff contaminated

the water supply with 0157:H7 E. coli and infected half its

population of 5,000. It’s the town where Detzler and his family

went in 2000 for a Mother’s Day brunch. Everyone ordered a pop.

Everyone, that is, except the Detzlers’ four-year-old daughter,

Madison, who drank the water and ended up in the intensive care

unit in nearby London with kidney failure.

Detzler has always taken an interest in animal health; when he was

younger, he wanted to go to vet school. It’s taken the better part of

six years, he says, to figure out how to manage infections and

mortality without antibiotics. He’s still learning. Sitting at a long,

polished granite island in his shiny stainless-steel kitchen (the

house was previously owned by a bank vice-president), he explains

that resistance wasn’t much of a problem in the 1970s and 1980s

because so many new drugs were coming on the market. Farmers

would move to a new antibiotic before bacteria developed

significant resistance to the last one. Part of the reason there were

so many options was that veterinary drug registrations were easier

to obtain, and companies researching human medications would

try to find an animal application for anything that didn’t get

approval for human use. It was a way for the companies to recoup

their costs.

When drug registration became harder to obtain (ironically,


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because of concerns about antimicrobial resistance), fewer drugs

made it to market, at least through the usual channels. (These

regulatory hurdles may have also driven farmers to exploit the

own-use loophole to import unregulated supplies of cheaper, more

readily available antibiotics.) With fewer drugs in their arsenal,

farmers began using the same drugs over and over—giving bugs

more opportunities to develop resistance.

Detzler compares bacterial control to weed control, explaining that

he manages coccidiosis without the use of drugs by “seeding” his

barns with a pre-resistant strain of coccidiosis, which dominates

over the strains that have developed resistance to the anticoccidial

vaccine. It is then relatively easy to vaccinate against the

coccidiosis used to colonize the barns. It took him a long time, and

much experimenting, to figure this out. “It hurt a lot,” he says of

the early days of trial and error. “Mortality would skyrocket, and

we wouldn’t know why.” His mortality rates are still a bit higher

than those of conventional farmers (he would not be specific), and

his chickens take a few more days to reach slaughter weight. But he

can charge a premium for them, since they get sold as antibiotic

free.

A lot of the work he does off the farm nowadays involves advising

and troubleshooting with producers who want to reduce or

eliminate the use of drugs. Still, he understands why they don’t

want to switch production methods: it’s a difficult road. Even his

own father was skeptical when he first phased out the miracle

drugs. “You have to love to do it, because it’s harder,” says Detzler.

But love won’t be enough to change a business model that currently


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earns $2.3 billion in annual farm-cash receipts.

FEW YEARS AGO, John Prescott, who has organized three

national conferences on antibiotic use, appeared before a

parliamentary committee in Ottawa to talk about regulating

antibiotics. The transcript does not reveal his tone of voice, but his

frustration fairly leaps off the page. He drew the chair’s attention to

the thirty-eight recommendations made in a landmark report on

antimicrobial use to Health Canada in 2002. “Most of the

recommendations have not been acted upon,” he said. “Currently,

I think nobody in the federal government is in charge, just the

resistant bacteria.”

One of the arguments against changing the way we regulate

antibiotic use is that Canadian farmers need a level playing field in

North America. But there is another, more fundamental obstacle

that needs to be addressed. “Bacteria change easily to resistance,”

Prescott said in his first email to me, after I told him I was pursuing

this story. “But people are resistant to change; Canada especially

has a constitution that resists change.” The loopholes that allow

farmers to use unregulated antibiotics are yet another mess that

goes all the way back to the British North America Act. While the

feds oversee the approval and sale of drugs, it’s up to each province

and territory to regulate their use. This is why Quebec and

Newfoundland and Labrador require prescriptions for all

antibiotics, while the other provinces and the territories do not.

Last March, the US Food and Drug Administration announced new

“guidance for drug companies to voluntarily revise” labels to


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remove growth-promoting claims and “add, where appropriate,

scientifically-supported disease treatment, control or prevention

uses.” It also pledged to bring over-the-counter supplies of

antibiotics under “veterinary oversight and consultation.” In

response to these changes, Jean Szkotnicki approached Canada’s

Veterinary Drugs Directorate and volunteered to change labels on

her members’ drugs, too. So last April, Health Canada posted a

vague “notice to stakeholders,” urging them to remove “growth

promotion and/or production claims of medically-important

antimicrobial drugs” and to develop “options to strengthen the

veterinary oversight of antimicrobial use in food animals.”

A month later, the Chicken Farmers of Canada added its own set of

promises, taking restrictions a step further. They promised to

eliminate the preventive use of what Health Canada classifies as

Category I drugs, the medically important ones such as ceftiofur,

which has been linked to resistance in human beings.

These are promising steps, but small ones. Removing growth-

promotion claims from labels doesn’t actually mean a lot. Farmers

and vets who once used those drugs to promote growth can simply

cite a different justification for using them: disease prevention.

And even a promise not to use the drugs for prevention can be

converted into claims for therapeutic use. Do you call it prevention

if you decide to treat an entire flock with a drug because you’ve

found an infection in a few of your 10,000 birds?

While a prescription-only system makes it easier for scientists and

regulators to track antibiotic use, it probably won’t do much to


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change the behaviour of vets, unless they’re held accountable for

their prescriptions. That’s the case in Denmark, where egregious

use of the drugs triggers an interview to find out why the vet has

been prescribing so many.

Expecting prescriptions to change antibiotic use “assumes vets do

everything to benefit public health, rather than to benefit

themselves or the animals they’re treating,” says Scott McEwen,

co-author of the 2002 report that made those thirty-eight

recommendations to Health Canada (and led to the creation of

CIPARS). McEwen, who teaches public health at the University of

Guelph, thinks this assumption is flawed. “In human behaviour,

we tend to do things we are rewarded for and avoid things we are

punished for.” A vet is not penalized for contributing to resistance,

but she will be penalized for not managing an infection at the farm.

“The default is to consider animal health interests, not public

health interests.” (A similar argument applies to medical doctors

seeking to manage the infection—and expectations—of a sick

patient on a gurney. The physician may not stop to consider the

public health implications of prescribing a course of pills.)

Michael Taylor, the deputy commissioner of foods at the FDA, puts

it this way: “There are very few bad guys, but there are lots of

economic constraints and incentives for violating food safety.”

Perhaps it’s not the people we should distrust along the food chain,

but this system we’ve built for ourselves.

The creation and maintenance of CIPARS (even in the face of

cutbacks in both funding and opportunities to talk to the media)


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remains the single best thing our government has contributed to

the discussion of how to manage antimicrobial resistance. Data

collection is key. If we don’t know what’s going on in animal and

human health, we can’t prepare ourselves for the pathogens—and

resistance—that are emerging.

But this is only the first step. We must change the way we think

about and use these life-saving drugs. Countries such as Denmark

and the Netherlands have already done so. Following bans in both

countries on the non-therapeutic use of antibiotics in livestock,

resistance to some drugs dropped by half. Meanwhile, production

costs and supermarket prices have done what many thought

impossible: they have remained stable.

F CHICKEN FARMERS, and producers in general, stopped using

antibiotics tomorrow, our food system would be thrown into

chaos. While the bulk of antibiotics is used in livestock, an

editorial in The New England Journal of Medicine notes these drugs

are also “dropped to salmon in cages in the seas, sprayed on fruit

trees, and even embedded in marine paint to inhibit the formation

of barnacles.” Even honeybees—which produce a sweetener with

naturally antimicrobial properties—get treated with the stuff.

Prudent-use discussions, in both animal and human medicine,

often promote the principle of stewardship. Levy calls antibiotics

“societal drugs” because their use by one individual affects us all.

We could also think of them as a common resource, like water, that

must be protected. “Use is a privilege, not a right,” says Warren

Skippon, “whether we’re talking about a livestock producer or the


25 of 31 12/17/2014 9:59 AM

parent of a small child with an ear infection.”

Farmers were among the earliest stewards of the earth; if they

didn’t carefully attend to the health of the soil and their animals

and their crops, a community would starve or die of disease. For

them, the idea of “One Health” was obvious. But most of us live in

cities now, and apart from answering that antiquated question

when we cross an international border—“Did you visit a farm

within the past two weeks? ”—most of us give very little thought to

the possibility that our health, and the health of our microbiome,

might be connected to that of the animals we come in contact with.

Eating chicken sashimi makes for a good story, but it’s one of the

stupidest things I’ve ever done. I was younger then, and a little

drunk, and I felt immortal. I am pretty sure no CIPARS researcher

would feed a child raw chicken; the bar graphs listing the bacteria

that the birds carry, and the bacteria’s resistance to dozens of

drugs, are as chromatic as a Missoni pattern. Nor would the

Detzlers; they know too much.

Bacteria, like us, are just trying to survive. They predate us by

millions of years, and will probably outlast us by millions more.

But they are even less visible than the chickens our farmers raise

behind locked doors, which means they are even easier to forget.

Rather than forget them, though, we could learn from them.

During our interview, Prescott, who recently retired, allowed

himself a moment of pessimism: he worried aloud that it was all

too little too late, and that rumours of regulatory change would

never translate into concrete action. Then he quickly recovered.


26 of 31 12/17/2014 9:59 AM

“Bacteria can change,” he said. “But so can we.”

Sasha Chapman is one of the magazine’s senior editors. She joined The Walrus in 2011.

Tamara Shopsin does artwork for the New York Times, Time, and The Walrus.

RECOMMENDED LINKS

FIGHT OF THE BUMBLEBEE by Sasha Chapman

ENVIRONMENT · MARCH 2013

Honeybee colonies are collapsing around the world, putting food production in danger. We

may need Canada’s indigenous pollinators to save the day

MANUFACTURING TASTE by Sasha Chapman

FOOD · SEPTEMBER 2012

The (un)natural history of Kraft Dinner—a dish that has shaped not only what we eat, but

also who we are

A MATTER OF TASTE by Sasha Chapman

CUISINE · MARCH 2012

Mitchell Davis, vice-president of the James Beard Foundation, believes you can’t develop a

national cuisine until you create a public conversation about food

OUR WEEKLY BREAD by Peter Menzel

PHOTO ESSAY · DECEMBER 2006/JANUARY 2007

Around the world in many meals

THE FARMS ARE NOT ALL RIGHT by Chris Turner

FOOD · OCTOBER 2011

The growing gap between what they produce and what they earn is driving many farmers

off the land. The crisis in Canadian farming


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