Right now I am on a plane from New York to Colorado going to the Aspen Ideas Festival Spotlight Health, which is a medical spin off of the Aspen Institute conference. A team of us from Consumer Reports are coordinated to present and promote some Consumer Reports projects, including education about unnecessary health care and especially on preventing the development of bacterial “superbugs”. A superbug is bacteria which is antibiotic resistant. Consumer Reports has three major complaints about the use of antibiotics: in routine family health practice, physicians provide antibiotics to patients when they are not indicated; in livestock industry, the meat industry feeds huge amounts of antibiotics to livestock to boost meat production; and in the pharmaceutical industry, the company leaders who ought to be stewards for protecting antibiotics instead deny responsibility and maliciously promote the use of antibiotics in circumstances in which everyone agrees that they ought not be used for the sake of meager short term profit. In the short term, Consumer Reports is concerned with restricting the use of antibiotics by individual consumers to whenever there is a medical indication for them to use them; in other words, antibiotics should be used when a family doctor knows that they should be used. In the longer term Consumer Reports is concerned with curbing the evolution of superbugs, which are brought into existence by patient overuse and use in meat production. This is a big issue for me and I have come to have personal concern about this, even though I remember 1-2 years ago when this issue was presented to me I did not feel as strongly.
At Consumer Reports I am employed to share information on Wikipedia. The nonprofit mission of Consumer Reports is to empower the public to make informed decisions in the marketplace. Coming here from Seattle I already had adopted the relatively unusual perspectives of Cascadia activist culture. After having lived in New York, I have become aware that in the Pacific Northwest more people have time and interest to consider the relationship between individuals and corporations, and how when individuals and businesses have differing goals each one wants their own benefit. This is a trivial notion, but in practice has complicated implications in that the public creates an environment in which business is supposed to operate to benefit the world, but actually businesses frequently behave badly to their own end. There is a range of political discussion about the best way to govern society and the marketplace, and the problem which I address in my work is how to most efficiently deliver information so that better and more production discussion can happen among the public for the benefit of individuals whenever a business is promoting a product or service which is not good for a consumer to purchase.
In a capitalist marketplace the market will correct itself so that the best value products and services become more common. The problem is that this takes time, and as the products and services being offered continually change, corporations continually make offerings which no one should take. Corporations are aware that they do this, but because they have invested capital in outdated systems, they are entrenched in sustaining outdated marketplaces which harm all consumers and they invest in advertising and propaganda to manipulate consumer demand with intent to harm the public in exchange for profit and the promise of continued dominance in the marketplace.
I regret that in the case of misuse of antibiotics, too much of the blame is placed on consumers, when I feel that the responsibility for addressing the problem should more heavily lie on the more powerful and informed players in the chain of antibiotics delivery. The chain is pharma companies and government regulation at the top, then branches to livestock production on to consumers who eat meat, and in another branch to doctors on to consumers of personal antibiotics.
Most of the narrative about antibiotics in the meat industry is that consumers need meat and livestock producers should serve this consumer demand. All things being equal, I would leave this sector to its own, but actually, there is sufficient evidence to demonstrate that antibiotic use in livestock production is quickly (over 40 years or so) producing superbugs. The financial value of the entire meat industry is relatively small compared to the global healthcare value of antibiotics in health care, and the cost of producing new antibiotics is extremely high and not an option, so I feel that the economic value of protecting antibiotics outweighs the financial interest of the meat sector. I see it as a natural conclusion that antibiotic use should be regulated in the meat industry because there is no reason to expect that any market forces in that industry would make the stakeholders in that industry examine their impact on the domestic and global health market. The routine and intensive use of antibiotics in livestock production is not a sustainable practice. 70% of all antibiotics are used in meat production. The antibiotics are fed to healthy animals as a growth stimulant and as a counter to the diseases which breed in cheap, filthy conditions. Antibiotic use needs to be curbed in this sector. As an alternative, animals can take longer to grow naturally, they can be given more space and cleaner living conditions, and the price of meat can go up. I think that the public would enjoy learning more about antibiotic use in meat production and not enough media resources are presenting this social issue to people who wish to learn more about it.
In personal health care, Consumer Reports has campaigned that patients talk more with doctors about whether they really need antibiotics, and for doctors to not prescribe antibiotics when they know that they are not supposed to do this. There is a problem that patients perceive antibiotics to be safe and without side effects, when actually they carry risks which are uncommon in individuals but within society happen a lot because antibiotics are cheap and commonly prescribed. When patients have health problems which would not be improved with antibiotic treatment, they often still want antibiotics, and many doctors are comfortable giving antibiotics to patients because when they do not, that makes patients unhappy. The global effect of this is that excessive use of antibiotics creates or at least speeds the diminished efficacy of antibiotics.
We have been talking about how to explain antibiotic resistance more effectively to the public. It is a concept which a person has to consider for a while, and when they understand it, they begin to take it for granted. If I were to explain it I would say “evolution based on LD-50 natural selection” but I am not sure that is effective to create passion in others like I have it.