Bedside Reading

Maryn McKenna is the author of a new book released yesterday, "Superbug: The Fatal Menace of MRSA," on the hospital, community, and environmental dangers of methicillin-resistant Staphylococcus aureus. McKenna, a science and medical journalist with the University of Minnesota's Center for Infectious Disease Research and Policy, discussed the book yesterday on NPR's Fresh Air with Terry Gross. You can listen to the interview here or read the transcript online.

In the interview, McKenna discusses the increased complication in treating MRSA infections due to crossover between what were originally separate healthcare-associated and community-associated MRSA strains. Now, she says, strains that were typically isolated to the hospital or to community settings (prisons and locker rooms, for example) are showing up in unexpected places and behaving in unexpected ways. As a result, doctors are not sure what the drug-resistance pattern of a given infection is -- and as a result, rely on prescribing the most intense drugs available. She also explains the dangers of low-dose antibiotics in farm animals, and the possibility of MRSA being transferred from animals to humans. Although she acknowledges that preventing the spread of MRSA and the development of resistance in general is difficult given the overprescription and overuse of antibiotics, as well as MRSA's resilience as an organism, McKenna does recommend a few things people can do to protect themselves: wash your hands, make sure your kids shower after sports, and use antibiotics appropriately.

Image courtesy of www.npr.org

What's In My Meat?

It’s getting harder and harder to be an informed grocery shopper today, particularly when it comes to buying meat. Between “free range,” “organic,” and “natural,” options, it’s hard to know what kind of lives our chickens lived before they became thighs and breasts, or what hidden ingredients might be in our hot dogs. But behind these often vague labels are specific regulations that are monitored by the U.S. Department of Agriculture’s Food and Safety Inspection Service. What the label says about your meat:

Organic: Animals have been fed organic feed and raised without antibiotics or growth hormones using other management methods to minimize disease. They must be allowed access to the outdoors, but the amount of access is not specified under regulations. Organic farms are inspected by government-approved officials. Products labeled “made with organic ingredients” must be at least 70% organic; those labeled “organic” must contain at least 95% organic ingredients.

Natural: Meat has been minimally processed (in a way that does not “fundamentally alter the raw product”) with no artificial (synthetically- produced) ingredients.

Free range: Animals must have open-air access for at least five minutes a day. Other factors such as the density of animals are not specified.

Grass-fed: After weaning, animals are fed only grass and other forage, are able to engage in natural grazing behaviors, and can continuously access to a pasture during the growing season. However, at other times they may be confined and fed grass indoors. (See more on grass-fed beef in a recent New York Times blog post.)

Cage-free: Virtually all poultry raised for meat is “cage-free,” but egg-laying hens that are not cage-free are often kept in cages that greatly restrict movement. Cage-free animals do not have to have access to the outdoors.

Certified humane raised and handled: A non-governmental organization certifies farms that allow animals to engage in natural behaviors with sufficient space and that do not use antibiotics or hormones.

For the perpetually curious, the USDA also has a Meat and Poultry Hotline that accepts food-safety related questions.

Photo: Cage-free chickens
Image credit: www.yankeeacres.com

In the News: Antibiotics and Farm Animals

Is the use of antibiotics in farm animals contributing to resistance in humans? That depends on who you ask, but increasing evidence seems to be pointing towards a connection. The long-term, low-dose courses of antibiotics used in almost all farm animals in the United States create an ideal environment for the selection of resistant bacteria, which studies show can be passed to humans through food consumption and direct animal contact. After a ban on all antibiotic growth promoters was implemented in the European Union four years ago, U.S. regulators still waver on their policy stance - with much pressure from the food production industry to leave drug choices up to the farmers themselves.

The issue has been getting increased coverage in news outlets recently. Last month, Katie Couric reported on the link between antibiotic use in animals and human health and on the ban of antibiotic growth promoters in Denmark, the first of the EU nations to institute strict regulations on non-therapeutic drug use in animals. Couric quotes Stephen McDonnell, CEO of Applegate Farms, on the necessity of tighter restrictions on American food producers:

"We use too many antibiotics, we use too many growth promotants. The singular focus is to create cheap meat. That's not always the best thing for the health of the Americans who buy it. We think with some subtle changes - giving [farm animals] more space, feeding them a good diet, and not stressing them out by growing them too quicky - you don't even need to use antibiotics."

Response to Couric's reports was swift. H. Scott Hurd, Director of the WHO Collaborating Center for Risk Assessment and Hazard Identification in Foods of Animal Origin, picked apart her evidence with arguments against a ban on growth promoters. These opposing positions represent the back-and-forth that is behind a bill in the U.S. Congress, PAMTA, which would ban antibiotics as growth promoters. But both sides often suffer from the same lack of evidence: while antibiotic use and resistance surveillance is common in Europe, the U.S. does not monitor the amount of antibiotics fed to farm animals.

In the last week, national columnists have also chimed in on the issue. Nicholas Kristof of The New York Times recounted the story of a California executive stricken with antibiotic-resistant Escherichia coli and attributed increasing resistance to antibiotic use on factory farms, as well as overprescribing by doctors. Yesterday, veterinarian Patty Khuly published an op-ed in USA Today supporting a ban and justifying potentially negative economic and animal health consequences. Like many other experts, she sees overuse of antibiotics in food animal production as part of a larger problem:

"After all, antibiotic use in animal agriculture makes sense primarily because of how we crowd and transport creatures. Remove the antibiotics, and more animals will surely get sick in the short term. But long-term, that only means the industry will be forced to reform how it houses and ships its 'widgets.'"