Drug-resistant superbugs have become a worry akin to climate change: an overwhelming but intangible threat that can be difficult to rally around.
Yet the post-antibiotic era is already here. It's on our dinner plates and in our hospitals. There are already a number of infections — gonorrhea and strains of tuberculosis — that don't respond to the drugs we have, and reasonable predictions suggest superbugs will kill 10 million people globally per year by 2050. That's more than the current death toll from cancer.
Despite the dire warnings, the issue is still abstract for many; industry has blocked efforts to tackle it; and legislation to address antibiotic resistance has repeatedly flopped.
Rep. Louise Slaughter, the only microbiologist in Congress, has been leading the push to stop the overuse of antibiotics on farms through the Preservation of Antibiotics for Medical Treatment Act (PAMTA). This is a hugely important aim: 80 percent of antibiotics in the US are used on animals. So far, Slaughter has met resistance at every turn. PAMTA has been re-introduced four times since she took it over in 2007, repeatedly dying on the house floor.
"We are frittering away the usefulness of one of the most important breakthroughs in medical science," she said during an interview in her office in the Capitol. Slaughter also talked to Vox about why lawmakers ignore the problem; what the FDA needs to do to curb drug resistance; and why the US lags behind other countries in our policies, even as evidence continues to mount that this is a problem that could literally undo us. What follows has been edited for length and clarify.
Julia Belluz: You wrote a college term paper about antibiotic resistance some 60 years ago. What did it say, and how have things changed since?
Louise Slaughter: At the University of Kentucky, my master’s thesis was on the overuse of antibiotics. That was just after the war, in the late '40s and early '50s, as penicillin was coming into effect. They put the antibiotic in mouthwash, toothpaste, and cosmetics. People were getting anaphylactic shock.
It wasn’t that I was far-seeing then that they were going to use antibiotics in agriculture. But I have worked on preserving antibiotics for decades. Now, the bacteria have evolved. When I was doing microbiology in college, Staphylococcus aureus was the most innocuous bacterium you would ever see. It was ubiquitous, on everything, and every now and then it might cause a cold. Now it has evolved to become methicillin-resistant, also known as MRSA, and it can kill you in 24 hours
JB: The issue of antibiotic resistance reminds me a bit of climate change: the scientific community has been sounding the alarm — all the way back to Alexander Fleming, who discovered penicillin — yet we do little about it. As the only microbiologist in the House, you've been working on this issue for some time — and we still have seen little progress.
LS: A couple of Congressional terms ago, I tried to get some information on the use of antibiotics in agriculture. That was in 2006. At the time, some members of the Agriculture Committee in the House went to Denmark, because everyone had heard that in Denmark farmers were raising poultry and livestock without antibiotics and doing well.
The conditions of the animals had greatly improved; they had not lost any money; they were saving money because of the cost of antibiotics. The report from the visit came back here, and it said that what Denmark had done made no difference.
JB: Was that true or did the Agriculture Committee purposely misrepresent what they were told in Denmark?
LS: That was the first time in my years of Congress that I heard from a government: the Danish government wrote to tell me [those members of the Agriculture Committee] were wrong, that their practice with antibiotics was working enormously well. We were by Denmark informed that information needed to be given to me, as the leader on that bill, and to the Speaker [of the House], that indeed [their antibiotic experiment] was working.
I delved more into the issue, and I found out the Food and Drug Administration had decided in 1977 that the use of the [antibiotics] tetracycline and penicillin in livestock was not a good move, but they never finalized the regulations. Nineteen-seventy-seven — that was way before Denmark — they knew overusing antibiotics was not good, that to use antibiotics as a defense against getting sick, instead of treating illness, just frittered away the antibiotics and created all these superbugs.
JB: As you point out, for a long time the FDA has taken what is very much a hands-off approach to regulating the use of antibiotics, with voluntary guidance for industry to reduce the use of the drugs. Of course they have the power to do much more. What would you like to see the FDA do?
LS: Stop using antibiotics. What our bill says is you must not use these eight classes of antibiotics because they are used for human diseases. And frankly, for the sake of the animal, we don’t want it fed antibiotics every day.
Over the years I worked on this, I determined that the FDA will not protect us. Neither will the Agriculture Department, and neither will the White House. We have 450 outside groups — every consumer group, scientific group, and medical group you can think of — supporting our bill. But 88 percent of the money spent lobbying on this issue lobbies against us.
JB: Why have we allowed the problem of antibiotic resistance to go on for so long?
LS: Because of corporations. This bill will never see the light of day. All the lobbying and money has been against the bill. Very few people have lobbied for it.
There was a case in the early 2000s in Texas called Supreme Beef vs. USDA. It was the first time the USDA wanted to shut down a plant because of E. coli. A plant owner went to court and the court put an injunction on closing it. On the face of it, it’s appalling to me that a judge would override the health agency charged with protecting the health and safety of citizens, that a judge could decide that’s not necessary. I am not certain that the fear of lawsuits has not been, partly, to blame, for the timidity they show in really standing up to the producers.
Even worse than that is what happens in [farm] inspections. The USDA has moved it up to inspecting 175 birds a minute. They practically give the inspections over to the plant owners, they go through so fast, and [the birds] have been treated with chemicals all the way through. The last thing they do with the chickens is soak them in a Clorox bath.
JB: The Preservation of Antibiotics for Medical Treatment Act (PAMTA) would push to conserve antibiotics for use only on humans and sick farm animals, and the Delivering Antimicrobial Transparency in Animals (DATA) Act would force industry to be more transparent, to report more data to the FDA about their antibiotic usage. You're going to put PAMTA forward again in March. What will the reception be like among your peers?
LS: They don’t know much about [antibiotic resistance]. It’s not anything that particularly interests them. [I'm] like the Grim Reaper coming in saying, "Ten years from now, strep throat can kill you." This seems impossible to a population brought up on antibiotics.
The White House [doesn’t] acknowledge the problem of overusing antibiotics in animals that are not sick. If they haven’t acknowledged that, they can make all the antibiotics on earth.
JB: So it sounds like it might be a while, to say the least, before we see any systemic changes in how we use antibiotics in agriculture. For now, what can concerned citizens do about this? Is it about voting with our dollars at this point?
LS: We need to engage the American people to demand that they are not going to buy a steak soaked in antibiotics; that they don’t want their chicken dipped in Clorox; that they want wholesome food for themselves and their children; that they want to save antibiotics for animals and people that are ill.
I haven’t bought any chicken since I read an article on the front page of the Washington Post on how chicken is inspected. I have not had a bite of chicken and it’s been over two years.
This is a critical issue. In 10 years, a cut on your hand could be fatal. You won’t be able to get any organ transplants, or any hip, knee or any replacements, any surgery at all. Because they’re all dependent on antibiotics.