Antibiotics Overuse: Why Healthcare Should Care about Agriculture Use October 7, 2010

Webinar sponsored by the American Medical Association, in partnership with Health Care Without Harm and Kaiser Permanente

Moderator: Preston Maring, M.D., Associate Physician-in-Chief, Kaiser Permanente Medical Center Oakland

Presenter: David Wallinga, MD. MPA directs www.HealthyFoodAction.org, a project of the Institute for Agriculture and Trade Policy, and serves on the steering committee of www.KeepAntibioticsWorking.org. He also is a Wm. T. Grant Foundation Distinguished Fellow in Food Systems and Public Health, University of MN. In his work, Dr. Wallinga uses a systems lens to shed light on the health impacts our food and agriculture practices and policies, including the Farm Bill. For a decade, his work has focused on antibiotics fed to healthy animals, arsenic used to grow chickens faster and mercury contamination of HFCS, among other topics. He has degrees from Dartmouth College, Princeton University and the University of MN Medical School.

Presenter: Diane Imrie, MBA, RD is the Director of Nutrition Services at Fletcher Allen Health Care. A Registered Dietitian, with 20 years in the field of nutrition and health care food service, Diane has facilitated the purchase and incorporation of local foods into the menu at Fletcher Allen. Those efforts resulted in Fletcher Allen receiving an honorable mention on the 2006 list of top ten Green Hospitals in America. Diane has spoken on the topic of sustainability at several national teleconferences, and Fletcher Allen has been recognized in many diverse publications, from Food Service Director magazine to the Maine Organic Farmer. She holds a Bachelor of Nutrition from McGill University, and an MBA from the University of Vermont.

Presenter: Robert Martin is a senior officer at the Pew Environment Group and previously was the Executive Director of the Pew Commission on Industrial Farm Animal Production, a two year study funded by The Pew Charitable Trusts by a grant to Johns Hopkins Bloomberg School of Public. The charge to the Commission was to recommend solutions to the problems caused by concentrated animal feeding operations in the areas of public health, the environment, rural communities, and animal welfare. The Commission’s final report, Putting Meat on the Table: Industrial Farm Animal Production in America, was release on April 28, 2008. OctoberOctober 7,7, 20102010

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Sources: Data on MN quinolone resistant C. jejuni from Smith KE et al. 1999. Other data on FQ-resistant C jejuni from NARMS. See Gupta A et al. 2004. TheThe imperativeimperative ““EmergingEmerging”” infectionsinfections…….MRSA,.MRSA, VRE,VRE, FQFQ--resres infectionsinfections

ƒƒ MethicillinMethicillin--resistantresistant S.S. aureusaureus − “Methicillin resistant” signals resistance to other clinically important β-lactam | antibiotics (penicillins, cephalosporins, and carbepenems) ƒƒ LeadingLeading causecause ofof hospitalhospital--associatedassociated infectionsinfections

– ~1.5% colonized with MRSA. J Infect Dis 2006, 193, (2), 172-9.

– 18,000 deaths, 94,000 infections from MRSA in 2005. J Infect Dis 2008;197:1226-34.

Image: http://trouble.philadelphiaweekly.com/archives/MRSA220207_400x379%5B1%5D.jpg FundamentalsFundamentals ResistanceResistance ←← AntibioticAntibiotic useuse ++ ReservoirsReservoirs

ƒƒ ExtentExtent ofof antibioticantibiotic useuse ƒƒ PrevalencePrevalence ((““reservoirsreservoirs””)) ofof resistanceresistance genesgenes

Levy S. Scientific American. March 1998

Darwin NaturalNatural selectionselection FundamentalsFundamentals ResistanceResistance genesgenes makemake thethe proteinsproteins thatthat protectprotect bacteriabacteria fromfrom antibioticsantibiotics

PhysicallyPhysically--linkedlinked resistanceresistance genesgenes FundamentalsFundamentals EcologicalEcological reservoirsreservoirs ofof resistanceresistance

“The exchange of genes is so pervasive the entire bacterial world can be thought of as one huge multicellular organism in which the cells interchange their genes with ease.” Levy S. 1998. Scientific American FundamentalsFundamentals EcologicalEcological reservoirsreservoirs ofof resistanceresistance Fish ponds Hospitals “The exchange of genes is so pervasive the entire bacterial world can be thought of as one huge Livestock multicellular organism in which farms the cells interchange their genes Communities with ease.” Levy S. 1998. Scientific American The human gut Food supply WhatWhat wewe knowknow aboutabout animalanimal antibioticsantibiotics

Widespread antibiotic use is integral to much (but not all) of the industrial-style food animal production that predominates, worldwide. =

Aarestrup FM, Wegener HC, Collignon P. Resistance in bacteria of the food chain: epidemiology and control strategies. Expert Rev. Anti Infect. Ther. 2008, 6(5):733-750. WhatWhat wewe knowknow ScienceScience consensusconsensus

August 30th Dr. Hugh Auchincloss, NIAID Principal Deputy Director, Letter to Keeve Nachman, PhD, Johns Hopkins University Bloomberg School of Public Health: “NIAID does find that the overall weight of evidence to date links antibiotic use in food animals with antibiotic resistance in humans.”

July 13th CDC Director Thomas Frieden, MD, MPH, Letter to Chairman Frank Pallone, Subcommittee on Health, House Energy and Commerce Committee: “To be clear, the Centers for Disease Control and Prevention (CDC) finds that there is a compelling body of evidence”… “to establish a clear link between antibiotic use in animals and antibiotic resistance in humans.” WhatWhat wewe knowknow ScienceScience consensusconsensus

Antibiotic use in animal agriculture DOES contribute to rising resistance transmitted to humans

www.KeepAntibioticsWorking.com/new/indepth_keyevid.cfm WhatWhat wewe knowknow ScienceScience consensusconsensus ƒ Aarestrup FM et al. Expert Rev. Anti Infect. Ther. 2008, 6(5):733-750. ƒ Price L et al. Env Health Perspect. 2007 ƒ Smith DL et al. PLoS Medicine 2005 ƒ Shea KM. Pediatrics 2004 ƒ Angulo FJ et al. 2004. J. Vet. Med ƒ Anderson AD. Microb. Drug Resist 2003 ƒ Wegener H. Current Opinion in Microbiology 2003 IncludingIncluding ƒ Joint FAO/OIE/WHO Expert Workshop on Non-Human Antimicrobial MRSA!MRSA! Usage & Antimicrobial Resistance, 2003 ƒ NAS/IOM. Microbial Threats to Health. 2003. www.KeepAntibioticsWorking.com/new/indepth_keyevid.cfm WhatWhat wewe knowknow Aarestrup FM, Wegener HC, Collignon P. Resistance in bacteria of the food chain: epidemiology and control strategies. Expert Rev. Anti Infect. Ther. 2008, 6(5):733-750.

Very large quantities of antibiotics are used in industrialized livestock. ⇓⇓ Industry,Industry, IOM,IOM, NGONGO estimatesestimates1,2,3 agree:agree:

≈≈ 2020 toto 3030 millionmillion lbslbs perper yearyear

1. Institute of Medicine (1998), Antimicrobial Resistance: Issues & Options, Forum on Emerging Infections. www.nap.edu 2. Animal Health Institute (2002), Press Release dated September 30, 2002, accessed at http://www.ahi.org. 3. Union of Concerned Scientists. (2001). Hogging It! Estimates of Darwin Antimicrobial Abuse in Livestock. www.UCSUSA.org WhatWhat wewe knowknow TherapeuticTherapeutic UseUse Example: Cephalosporins

:: ƒ Extended spectrum antibiotics (ceftriaxone, cefepime)

ƒ Important “last lines of defense” against severe, systemic Salmonella or

E coli infections, other resistant infections.

ƒ Widely used in food animals

− Ceftiofur = 3rd gen ceph widely used in cattle, poultry wordlwide − Cefquinome = 4th gen ceph, used in Europe U.S. Department of Health and Human Services, National Antimicrobial Resistance Monitoring System/Enteric Bacteria (NARMS/EB) Salmonella Annual Veterinary Isolates Data, U.S. Department of Agriculture, www.ars.usda.gov/Main/docs.htm?docid=6750&page=4, 2006.

TherapeuticTherapeutic UseUse Ceftiofur-resistant Salmonella in animals ::

WhatWhat wewe knowknow

TherapeuticTherapeutic UseUse ““NonNon‐‐therapeutictherapeutic””

ƒGrowth promotion / feed efficiency ƒProphylaxis / disease control 9 Non-rx 9 Healthy, non- exposed animals 9 “Just in case” cover What we know Abx. use by country can vary ≥10-fold BestBest estimatesestimates 71%71% ofof allall U.S.U.S. antimicrobialsantimicrobials areare fedfed routinelyroutinely toto beefbeef cattle,cattle, poultrypoultry && swineswine Percentage of Total US Antibiotic Use

71%

6% 8% 15%

Source: Union of Concerned Scientists, Hoggin’ It, 2001 WhatWhat wewe knowknow

Very large quantities of antibiotics are used in industrialized livestock. ⇓⇓ These antibiotics are often identical or belong to the same classes as human antibiotics. AboutAboutFDAFDA previouslypreviously ½½ ofof antimicrobialsantimicrobials approvedapproved manymany addedadded feedfeed toto additivesadditives feedfeed arearewithoutwithout ofof medicalmedical consideringconsidering importanceimportance thethe potentialpotential forfor resistanceresistance Human antibiotic class U.S.-approved feed-additive antibiotic(s) Penicillins Penicillin G procaine Tetracyclines Chlortetracycline, Oxytetracycline Amingoglycosides Spectinomycin Streptogramins Virginiamycin Macrolides Tylosin, Erythromycin, Tilmicosin, Oleandomycin Clindamycin (lincosamides) Lincomycin, apramycin

Polypeptides Bacitracin Sulfonamides Sulfanitran, Sulfadimethoxine, Sulfamethazine, Sulfaquinoxaline, Sulfathiazole, Neomycin sulfate Arsenicals Roxarsone, arsanilic acid, nitrarsone

Aarestrup et al. 2008; FDA Green Book 2006 AboutAbout ½½ ofof antimicrobialsantimicrobials addedadded toto feedfeed areare ofof medicalmedical importanceimportance Human antibiotic class U.S.-approved feed-additive antibiotic(s) Penicillins Penicillin G procaine Tetracyclines Chlortetracycline, Oxytetracycline Amingoglycosides Spectinomycin Streptogramins Virginiamycin Macrolides Tylosin, Erythromycin, Tilmicosin, Oleandomycin Clindamycin (lincosamides) Lincomycin, apramycin

Polypeptides Bacitracin Sulfonamides Sulfanitran, Sulfadimethoxine, Sulfamethazine, Sulfaquinoxaline, Sulfathiazole, Neomycin sulfate Arsenicals Roxarsone, arsanilic acid, nitrarsone

Aarestrup et al. 2008; FDA Green Book 2006 FDAFDA previouslypreviously approvedapproved manymany feedfeed additivesadditives withoutwithout consideringconsidering thethe potentialpotential forfor resistanceresistance

Human antibiotic class U.S.-approved feed-additive antibiotic(s) Penicillins Penicillin G procaine Tetracyclines Chlortetracycline, Oxytetracycline Amingoglycosides Spectinomycin Streptogramins Virginiamycin Macrolides Tylosin, Erythromycin, Tilmicosin, Oleandomycin Clindamycin (lincosamides) Lincomycin, apramycin

Polypeptides Bacitracin Sulfonamides Sulfanitran, Sulfadimethoxine, Sulfamethazine, Sulfaquinoxaline, Sulfathiazole, Neomycin sulfate Arsenicals Roxarsone, arsanilic acid, nitrarsone

Aarestrup et al. 2008; FDA Green Book 2006 WhatWhat wewe knowknow

Very large quantities of antibiotics are used in industrialized livestock. ⇓⇓ These antibiotics are often identical or belong to the same classes as human antibiotics. ⇓⇓ These conditions favor selection, persistence and spread of antibiotic-resistant bacteria capable of causing infections in both animals and people. Darwin AntibioticAntibiotic useuse inin foodfood animalsanimals transmitstransmits resistanceresistance toto peoplepeople viavia contaminatedcontaminated food,food, otherother routesroutes Antibiotics Via FOOD White et al., 2001. NEJM 345(16): 1147- 54 (salmonella in ground meat); Molbak et al., 1999, NEJM (fatal salmonella in Denmark); Johnson JR et al. J Infect Dis. 2006;194[1]:71-78) (food-linked UTI) HUMANS (General Animals Populace)

Bacteria AntibioticAntibiotic useuse inin foodfood animalsanimals transmitstransmits resistanceresistance toto peoplepeople viavia contaminatedcontaminated food,food, otherother routesroutes Antibiotics Via FOOD White et al., 2001. NEJM 345(16): 1147- 54 (salmonella in ground meat); Molbak et al., 1999, NEJM (fatal salmonella in Denmark); Johnson JR et al. J Infect Dis. 2006;194[1]:71-78) (food-linked UTI) HUMANS (General Animals Populace) Salmonella Antibiotic use in food animals may account for as much as 90% of Salmonella resistance. Angulo F et al. 2000; IOM 1989 Campylobacter FDA estimates: 153,580 Americans developed Bacteria fluoroquinolone (Cipro) resistant Campy from contaminated chicken. 66 FR 6623-6624 (01/22/01), using 1999 data E coli • Cipro-resistant E coli infections in humans may be imported from chickens. Johnson J et al. JID 2006 • A new, deadly (ESBL-producing) E coli strain now affects 30,000 British annually. One quarter of foreign retail chickens in UK supermarkets carry it. Collignon P, Aaerstrup. 2007 AntibioticAntibiotic useuse inin foodfood animalsanimals transmitstransmits resistanceresistance toto peoplepeople viavia contaminatedcontaminated food,food, otherother routesroutes Antibiotics Via FOOD White et al., 2001. NEJM 345(16): 1147- 54 (salmonella in ground meat); Molbak et al., 1999, NEJM (fatal salmonella in Denmark); Johnson JR et al. J Infect Dis. 2006;194[1]:71-78) (food-linked UTI) HUMANS (General Animals Populace)

Via WORKERS Levy 1976, NEJM, 295(11): 583- 588 (worker study); Lyons et al., 1980, JAMA 243(6): 546-7 (nursery outbreak). Price et al., 2007, Environ Bacteria Health Perspect 115:1738–1742. Smith TC et al., 2009, PLoS ONE 4(1) ƒ Dutch hog farmers 760X more likely colonized with MRSA than the public. Voss, A.; Loeffen, F., Bakker, J. et. Al. Emerg. Infect. Dis. 2005.

ƒ Human MRSA traceable to farm animals (hogs, cattle) from zero (‘02) → >20% (’06) Van Loo et al. Emerging Infectious Diseases, December 2007. AntibioticAntibiotic useuse inin foodfood animalsanimals transmitstransmits resistanceresistance toto peoplepeople viavia contaminatedcontaminated food,food, otherother routesroutes Antibiotics Via FOOD White et al., 2001. NEJM 345(16): 1147- 54 (salmonella in ground meat); Molbak et al., 1999, NEJM (fatal salmonella in Denmark); Johnson JR et al. J Infect Dis. 2006;194[1]:71-78) (food-linked UTI) HUMANS (General Animals Populace)

Via WORKERS Levy 1976, NEJM, 295(11): 583- 588 (worker study); Lyons et al., 1980, JAMA 243(6): 546-7 (nursery outbreak). Price et al., 2007, Environ Bacteria Health Perspect 115:1738–1742. Smith TC et al., 2009, PLoS ONE 4(1)

Via ENVIRONMENT Chee-Sanford et al., 2001. Applied Env. Microbiology. 67(4): 1494-1502 (tetracycline resistance genes in groundwater and soil bacteria). Chapin A et al., 2005. EHP. WhatWhat toto dodo CurbCurb antibioticantibiotic overuse,overuse, 19761976 →→ 20032003

“The rise in frequency of resistant organisms in our environment is the obvious result of antibiotic usage….. All areas of antibiotic usage deserve critical evaluation.” Dr. Stuart Levy, NEJM 1976; 295:583

““SubstantialSubstantial effortsefforts mustmust bebe mademade toto decreasedecrease inappropriateinappropriate overuseoveruse ofof antimicrobialsantimicrobials inin animalsanimals andand agricultureagriculture asas well."well."

Smolinski MS, Hamburg MA, Lederberg J, editors. Microbial threats to health: emergence, detection, and response. Washington: Institute of Medicine. 2003. WhatWhat toto dodo CurbCurb antibioticantibiotic overuseoveruse

ƒƒ SelfSelf--regulationregulation

ƒƒ MarketMarket--ledled changechange

ƒƒ PolicyPolicy optionsoptions

− Stricter regulation

− Federal legislation Curbing antibiotic use Quebec, 2005

Declining ceftiofur resistance in E coli and Salmonella bacteria in chickens, humans following withdrawal of extra‐ label use in Quebec hatcheries

Irwin R (Public Health Agency of Canada) Curbing antibiotic use Denmark (‘98-’99), Sweden (1986)

kg active compound 250,000 Total Antibiotic Use ⇓ 54%, 1994-2001 200,000

150,000

100,000

50,000

0 1990 1992 1994 1996 1998 1999 2000 2001 EliminatingEliminating thethe routineroutine useuse ofof anantibioticstibiotics inin livestocklivestock reducesreduces humanhuman healthhealthTreatment risksrisks withoutwithoutGrowth PromoterssignificantlysignificantlyTotal harmingharming Antimicrobials animalanimal 32 healthhealth oror farmersfarmers’’ incomes.incomes.Source: DANMAP 2001 WHO 2003. Wegener HC. Curr Opin Micro 2003. CanCan foodfood animalsanimals bebe producedproduced inin numbersnumbers withoutwithout routineroutine antibiotics?antibiotics? TheThe JourneyJourney ofof SustainableSustainable FoodFood atat FletcherFletcher AllenAllen

Diane Imrie, MBA, RD

ReductionReduction ofof AntibioticsAntibiotics Food Category 2008 Goal 2009 Goal 2010 Goal Poultry Purchase a minimum of 20% Purchase an additional 20%. Purchase an additional 20%. Status: sustainably raised poultry New source negotiated for target Achieve this through investigating Not achieved due to lack of quantity of chicken and turkey. ground turkey and raw chicken availability. breast. Beef Purchase 100% sustainable ground Evaluate other cuts of beef and Evaluate processed foods containing Status: beef. implement change as required. beef. Updated to finding a source Complete. Local source for all top round for stew beef. achieved. Next will be stew beef. Fish and Seafood Evaluate current supply, develop plan Complete implementation and Reassess menu for variety and add Status: and begin to implement. reassess plan as needed. north American sources of Complete and implemented. Will reassess with new renovation sustainable fish and seafood. menu for April. Complete. Eggs Evaluate options available. Implement changes depending on the Investigation of sources to continue. Status: Complete. analysis results. New option available and under investigation. Incomplete; not possible with this vendor. Cheese Research options and implement two Research options and implement two Research options and implement Status: rBst free (and local if possible) rBst free, local cheeses per year. two rBst free (and local if possible) cheeses per year. Purchasing new options available cheeses per year. Not achieved due to cost. from Cabot. Complete. Pork Reduce the amount of pork Reduce the amount of pork Evaluate options available for local, Status: purchased. purchased. sustainable pork products. Complete. Complete. Food Category Status of Sustainable Purchases Additional Comments Annual Cost Poultry All fajita and whole chickens - $70,000 Met our goal approximately 25 % Beef All beef tips, diced, cubes, and $48,000 Met our goal ground – approximately 80 % Fish and Seafood All fish and Seafood is what we None Met our goal consider a “green” rating Eggs No changes accomplished None Unsuccessful Cheese Only 1 major product is $2500 Unsuccessful currently in place – insufficient options in the market Pork Removed pork from the menu None Unsuccessful due to limited options SupportSupport forfor PAMTAPAMTA

OverOver 7070 FacilitiesFacilities NationwideNationwide „ Fletcher Allen Health Care, VT „ Porter Medical Center, VT „ Fairview Hospital, MA „ Covenant Health Systems, New England (14 facilities) „ Regis Care Center, NY „ Swedish Covenant, IL „ St. Luke’s, MN „ Sacred Heart Hospital, WI „ Mercy Medical Center, Baltimore , MD „ Oregon Health and Science University, OR „ Catholic Healthcare West, AZ , NV, CA (40 facilities) „ St. Joseph Health System - Sonoma County, CA (7 facilities) „ Union Hospital, Maryland

www. Protectantibiotics.org

Cost Versus Revenue

$5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 Total Volume $2,500,000 Revenue $2,000,000 Food Costs $1,500,000 $1,000,000 $500,000 $- 04 05 06 07 08 09 EducationEducation

TasteTaste ofof VermontVermont TheThe CenterCenter forfor NutritionNutrition andand HealthyHealthy FoodFood SystemsSystems TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

† The independent Pew Commission on Industrial Farm Animal Production (PCIFAP) was formed to conduct a comprehensive, fact‐based and balanced examination of key aspects of the farm animal industry. Commissioners represented diverse backgrounds and perspectives and came from the fields of veterinary medicine, agriculture, public health, business, government, rural advocacy and animal welfare. † In April, 2008 the Commission released the full report of findings with 24 recommendations in public health, the environment, animal welfare and community impact. † Banning all non‐therapeutic antimicrobial use in food animal production was one of the top recommendations from the Commission. TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

Commission definitions:

„ Therapeutic: The use of antimicrobials in food animals with diagnosed microbial disease. „ Non‐therapeutic: Any use of antimicrobials in food animals in the absence of microbial disease; any use of the drug as an additive for growth promotion, feed efficiency, weight gain, routine disease prevention in the absence of documented exposure or other routine purpose. „ Prevention: The use of antimicrobials in healthy animals in advance of an expected exposure to an infectious agent or after such an exposure but before onset of laboratory confirmed clinical disease as determined by a licensed professional. TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

The goal of the Pew Campaign on Human Health and Industrial Farming (HHIF) is to reduce antibiotic resistance in humans by phasing out the routine use of antibiotics in food animal production through legislative and/or regulatory action.

The Preservation of Antibiotics for Medical Treatment Act (PAMTA, H.R. 1549/S. 619) was introduced in March, 2009. ƒ PAMTA would withdraw the routine use of seven classes of antibiotics vitally important to human health from food animal production unless animals or herds are sick with disease or unless drug companies can prove that their routine use does not harm human health. TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

FDA Deputy Commissioner Joshua Sharfstein, M.D., House Energy & Commerce Sub‐Committee on Health, Hearing July 14, 2010. ƒ “FDA concludes that the overall weight of evidence to date supports the conclusion that using medically important antimicrobial drugs for production purposes is not in the interest of protecting and promoting the public health.”

The FDA has since initiated two actions:

ƒ FDA Draft Guidance “The Judicious Use of Medically Important Antimicrobial Drugs in Food‐Producing Animals.”

ƒ The guidance should be stronger and go further to protect antibiotics.

ƒ FDA Advance Notice of Proposed Rulemaking on the Veterinary Feed Directive.

ƒ Could result in a weakening of the oversight that was set up to help prevent unnecessary drug use and further development of bacterial resistance to antibiotics. TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

USDA Economic Research Service study, January 2009. ƒ “A heavy reliance on antibiotics for growth promotion and for disease prevention may spawn antibiotic‐resistant strains of bacteria, with human health risks.” ƒ Growth‐promoting antibiotics are more likely to be used on larger hog operations. ƒ Producers not reliant on growth promoting antibiotics utilize improved husbandry practices such as extensive testing and improved sanitary protocols to prevent disease and promote growth.

USDA Deputy Administrator John Clifford, DVM, House Energy & Commerce Sub‐Committee on Health, Hearing July 14, 2010. ƒ “USDA believes that it is likely that the use of antimicrobials in animal agriculture does lead to some cases of antimicrobial resistance among humans and in animals themselves, and we believe that we must use medically important antimicrobials judiciously.”

USDA Agriculture Secretary Tom Vilsack, September 15, 2010. ƒ “I’ve communicated to Rep. Slaughter, my support of the judicious use of antibiotics. The vast majority of producers do not abuse the use of antibiotics in livestock production. I told her you cannot ban this. It doesn’t make sense. USDA’s position is, and always has been, that antibiotics need to used judiciously and we believe they already are.” TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

Denmark.

ƒ Recognizing the potential for a health crisis, in 1998 Denmark began restricting the non‐therapeutic use of antibiotics in cattle, broiler chickens and swine.

ƒ Overall antibiotic use in swine dropped by more than 50 percent from 1992 to 2008.

ƒ Swine production increased by nearly 50 percent during the same period.

ƒ Adjustments made in husbandry practices allowing swine to be more productive

ƒ Antibiotic resistance in humans has decreased after implementation of the ban. TheThe PewPew CampaignCampaign onon HumanHuman HealthHealth andand IndustrialIndustrial FarmingFarming

www.SaveAntibiotics.org Laura Rogers, Project Director [email protected]