Dispatch from APHA: Searching for the silver lining

Day two of the American Public Health Association meeting found me carting my breakfast (a poorly-executed bagel) to a hyper-air conditioned room to learn about bacteria on meat. Not the most ambient setting for food consumption, but I didn't mind: The panel promised to cover CAFOs and would be led off by David Wallinga, who directs the food and health program at the Minneapolis-based Institute for Agriculture and Trade Policy, one of my all-time favorite organizations.

And lead it off he did, with a riveting talk on the epidemic of antibiotic resistance. It has everything to do with the way we produce meat: Many CAFOs, which crowd hundreds or thousands of animals into a confined space, do their best to ward off the illness that can quickly sweep through the barns by feeding animals low doses of antibiotics throughout their lives. The industry and NGOs both estimate that around 30 million pounds of antibiotics are used in the livestock sector each year, including penicillin and other common human antibiotics. And an estimated 70% of that is fed to animals that aren’t sick.

The crazy thing is that although antibiotics are prescription-only for humans, CAFO operators have special over-the-counter access. “You really can just go to a feed store and buy a 50-lb. bag of tetracycline,” David lamented. And he should lament – he’s a doctor, and like many in the public health community, he’s seen antibiotic-resistant illnesses skyrocket in recent years.

How is antibiotic use in CAFOs leading to resistant illnesses in humans? David gave us a mini-lesson in bacterial evolution: It’s fast, it involves a lot of mutation, and given prolonged and repeated exposure to antibiotics, the most resistant bacterial strains tend to survive. They survive in manure, which gets into water sources; they survive on the animals as they're taken to slaughter; and they survive around the barns where workers come into regular contact with them. There’s a scientific consensus emerging, he said, that heavy antibiotic use in agriculture is contributing to the transmission of antibiotic resistance in the human population.

And here’s the gross thing: Although it can be transmitted through contaminated water or direct contact with animals, the most common route of transmission is through contaminated food. “Much of the meat we can buy in the grocery store has antibiotic-resistant bacteria on it,” he said. We’re talking resistant Salmonella, E. Coli, staph, and other superbugs. The FDA has estimated that over 150,000 U.S. residents develop Cipro-resistant campylobacter –- a nasty disease that causes severe intestinal distress and can lead to death -- from eating chicken contaminated with resistant bacteria.

Super stupid

Increasingly, doctors are seeing E. Coli superbugs that are resistant to the newest generations of antibiotics. “These are the biggest guns in the arsenal of an infectious disease doctor,” he said. “And E. Coli is beating them.”

Let’s say that again with feeling: In the interest of keeping CAFO livestock alive long enough to fatten them and bring them to slaughter, we are compromising the tools – new and old – that doctors use to fight common but potentially deadly human illnesses. And in case your inner technological optimist just reared its head, let's give it a whack: The discovery of new antibiotics is more and more rare these days, so it's by no means guaranteed that we'll be able to create a new tool out of thin air once the current box is empty.

Hogging the meds

David was followed by John Balbus of the Environmental Defense Fund, who built off the first presentation with a case study of MRSA (a staph infection resistant to methicillin, a newer form of penicillin) and its link to the industrial hog industry. Get this: A full 95% of the antibiotics fed to hogs are human-use drugs, and the oinkers wolf down over 10 million pounds of antibiotics each year.

MRSA has existed for quite a while, but was always isolated in hospitals, where the large number of sick patients and prevalence of antibiotics was prime breeding ground. But in 2005, MRSA was discovered on pig farms across Europe. Evidence suggests it’s evolving in the U.S. as well. (One study found it on 70% of pigs the researchers tested in Iowa and Illinois.) In the U.S., MRSA already has a higher death toll than AIDS.

So what can we do to stop the superbugs? More research, for one. No one’s really been looking at MRSA and hogs in the U.S., nor have we been looking for the presence of MRSA on pork we buy in the supermarkets -- but it’s there. And of course, we need to be investing in sustainable agriculture that avoids the use of antibiotics except when absolutely necessary. Cause really, if you need to jack up your animals to keep them alive, doesn’t that suggest there might be a problem with the system? (That was my editorial comment, not theirs.)

Milking the petroleum teat

The panel switched gears from antibiotic use to another way in which industrial ag is squandering the earth's resources: Fuel dependence. Ashley Winestrom, a PhD candidate at the University of Arizona, presented a study on the impact of peak oil on the agricultural sector. Survey says: Bad. Between fuel-intensive pesticides and fertilizers and the average 1500 miles food travels from farm to table, we currently use 10 calories of energy to produce 1 calorie of food. Failing to invest in less oil-intensive ways of producing food could lead to rising food prices and falling food production, which in the long-term could mean things like recession, increased hunger and malnutrition, conflict over agricultural resources, and large-scale migration. Soil degradation and climate change will -- guess what -- only exacerbate these problems. In her words, energy policy has officially become public health policy.

Finally, a glimpse of silver

Thank goodness it was Alison Gustafson, a North Carolina researcher, who finished up the panel. She shared the results of a community food assessment she carried out in Wayne County, NC, wisely noting that “a big function of how we eat is what food is available in our communities.” She surveyed and then mapped the food chain in Wayne County, from farms to processors to retail distributors, to figure out exactly what was available and what was possible. Looking at those maps was a definite highlight of the morning. (And way more palatable than the pictures of MRSA sores... ugh.)

The first map she showed pinpointed all of the livestock operations in the county: A whopping 200 hog farms, 70% of which were industrial-scale. Then she showed meat processing operations: A measly eight, all large and not interested in taking animals from the small farming operations. “That imbalance is an economic development opportunity for Wayne County right there,” she said. It's an opportunity to promote the type of meat production we want -- smaller scale and antibiotic-free -- by building the infrastructure so those farmers can get their product directly to local consumers. And you can bet that we'll all save gas by doing it this way.

There were hundreds of wheat, corn, cotton and tobacco farmers, many of whom supplied the livestock operations with feed, but there were only nine fruit and vegetable producers. Alison flagged another opportunity to re-localize: Incredibly, there were 37 schools located within 10 miles of those fruit and vegetable producers, an excellent opportunity for farm-to-school programs. As for retail, the only supermarkets were centered in the urban part of the county, while rural residents—as is common nationwide—had very little access to fresh food. More small-scale processing facilities and more farmstands could mean more access for rural residents, without having to drive miles for their supper.

This kind of mapping is a critical tool for researchers, advocates, and communities trying to build a more sustainable food system. As the saying goes, what gets measured gets improved. Visually representing the imbalance between meat producers and processors, for example, or the lack of fruit and vegetable farmers, can help planners and producers fill in those critical gaps.

I chatted with her afterward and recommended she check out Ken Meter’s work at the Crossroads Resource Center in Minnesota. It’s a cool complement to her mapping project: Ken has worked with communities around the country to calculate how much money they spend growing food they can’t eat (field corn, soybeans, cotton, tobacco) and how much they spend buying food that wasn’t produced locally. When you see the numbers, you realize how many economic opportunities are lost when we don’t take full advantage of local production and consumption potential.

I left thinking about new and better possibilities for healthy, low-energy local food systems and forgot about the MRSA-contaminated pork (at least for a little while). Thank goodness, cause it was lunchtime.

9 Responsesto “Dispatch from APHA: Searching for the silver lining”

  1. Charlotte says:

    My 97-year old grandmother turns out to be an asymptomatic carrier of the MRSA bacteria -- we found out when she had to have surgery a year ago, and wound up in isolation for *three months* while recovering. My aunt finally sprung her and hired home help and brought her back to our family farm. We've been in the horse business for generations, so I doubt she picked it up there -- but they eat absolutely conventionally. CAFO meat, processed food, etc ... if a 97 year old homebound woman can pick it up, well, then it has to be alarmingly ubiquitous.

  2. Kevin says:

    I live close to the Wayne County, NC border and we currently sell collards, mustard, and some kale to three places in Wayne, two grocery stores and a farm stand, in addition to several supermarkets elsewhere within an hour's drive.  It's promising to see people's response to the "locally grown" signs and not just the price, but there's still a lot that can be done to encourage and educate both producers and consumers about a local, sustainable agriculture.
    I rarely eat pork anymore, thanks in part to this website, which is unfortunate considering the importance it has in Southern cooking, but I don't approve of the way the majority of the pork in the stores is produced.  Then again, I don't approve of the way the majority of anything in the stores around here is produced either, but we'll take it one step at a time.

  3. Thanks for the long report from APHA; it's always a great meeting. For more on MRSA in meat specifically, you might take a look at SUPERBUG, where I've been covering the topic as part of research for a book. Most recent post, from the ICAAC meeting (which was scheduled against the APHA meeting; couldn't be at both) is here, on ST 398, the pig-MRSA strain, being found in New York City.

  4. Elanor- you should consider attending the November 20th Teach-In at San Francisco's Fort Mason Center titled, "Food Safety Gone Astray: The Misguided War on Wildlife- A Teach-In for Media, Decision Makers, and Stakeholders."  One of the topics will be CAFOs and the rise of pathogenic bacteria and antibiotic resistant bacteria, which is leading to unprecedented levels of contamination in our meat supply.  The leafy greens industry is wrongfully attacking wildlife and their habitats while staying silent about the source of pathogenic E.coli.  See more info. on this Teach-In at http://www.wildfarmalliance.org

  5. Emily says:

    In the U.S., MRSA already has a higher death toll than AIDS.
    May I ask...where did you get this stat? Is that annually, cumulatively (since when), in the US, worldwide...? This is mind-boggling, and I'd like to have my facts straight when I start telling all my friends. :)
     
     

  6. Elanor says:

    Rebecca, I just registered for this on Friday! I'm looking forward to it.

    Emily, the stat was provided by John Balbus of the Environmental Defense Fund. He presented it as an annual statistic comparing U.S. deaths from MRSA to U.S. deaths from AIDS (which, while still a terrible illness, has become largely managable with meds in the U.S. and causes far fewer deaths than it used to). I should emphasize, as he did, that the majority of MRSA infections in the U.S. still happen in hospitals, but that infections linked to the hog industry are a growing share of total infections. Hope that helps. I'm sure you could contact him directly if you had more questions.

  7. I'm an infectious-disease reporter and am writing a book on MRSA, so can help with this. The "kills more people than AIDS" estimate originates with a Centers for Disease Control study and editorial from the Journal of the American Medical Association from about a year ago. There is no national surveillance for MRSA, so what the CDC did was to analyze numbers they gathered from an existing program that runs intensive surveillance for bacterial diseases in 9 cities during 2005. They found that, for those 9 areas that year, the rate of invasive MRSA illness - that's pneumonia, bone infection, joint infection, etc, the kinds of MRSA that can kill you - and death from MRSA; then, using pretty robust and common statistical tools, they estimated what the rate of invasive illness and death would be if the denominator they were using was not the population in those 9 areas, but the whole US population. That's where the equivalency with AIDS deaths comes from. 
    The actual quote, from the editorial, is: "Klevens et al report that among 5287 patients hospitalized with MRSA during 2005, there were 988 deaths; based on these data, the authors estimate that were 18 650 deaths in patients with invasive MRSA in the United States in 2005. If their projection is accurate, these deaths would exceed the total number of deaths attributable to human immunodeficiency virus/AIDS in the United States in 2005."
    FWIW, it is not actually true that "the majority of MRSA infections in the US still happen in hospitals." There is a vast, vast amount of minor-to-serious MRSA caused by the community strain of the disease that has no relation to hospitals at all. (The community strain is what is causing illnesses in football players, for instance, and most of the kids you hear about who die suddenly of MRSA pneumonia.) What is true is that the CDC says that invasive MRSA is mostly due to the hospital strain manifesting in people either in the  hospital or after they leave — though there is a great deal of argument on that between community-strain researchers and the CDC.
    And, just to be really boring and pedantic and never get invited back again :->, the "pig strain" of MRSA (usually called ST 398) is just emerging in this country, largely because people just started looking for it. There isn't any evidence yet of ST 398 causing illness in people in the US, though it has done so in Scotland and the Netherlands. (Lots in the Netherlands.) But it has been found in pigs and their keepers in Iowa, and an enterprising group of TV stations just did an investigation for sweeps month and found MRSA in ground pork in the Pacific Northwest, though they didn't say which strain. If you'd like references on "pig MRSA" they are collected here.

  8. Elanor says:

    Maryn, thanks so much for this information. I just looked back at my notes and he was indeed talking about the invasive strain of MRSA when he mentioned that the majority of cases are still found in hospitals. Like you, he also emphasized the lack of research on MRSA from pigs-- there is a huge need for studies investigating this method of exposure.

    FYI, I came across a disturbing article today on the topic of MRSA infection via retail pork. "A few months ago," it notes, "a University of Iowa study found a virulent strain of MRSA in pigs. But in spite of that information, no one from the USDA is testing." So a network of TV stations in the Northwest purchased pork from a bunch of supermarkets, contracted a lab, and conducted its own studies. The lab found MRSA bacteria on pork purchased at grocery stores in California, Oregon and Idaho. Depressing quote: "Canada and several European countries already test pork in grocery stores for MRSA. We contacted the USDA and were told they have no plans for any testing." That's great. Just great.

  9. Elanor - yes, that's the TV investigation I was thinking of. The Soil Association in the UK (that country's premier organics lobby) did a huge, great report on MRSA in meat in 2007 and has been pushing for meat testing there, largely without success.