I seldom feel sorry for the leaders of the world’s largest pharmaceutical companies, where multimillion dollar compensation packages, corporate jets and unending expense accounts are the norm. But I’m starting to pity these poor souls. Why? Because their job — indeed their whole purpose — directly conflicts with the effectiveness of antibiotic medicines essential for all humanity. To be frank, I sometimes wonder how they can sleep at night.
Surely they must wake every day knowing their actions are basically destroying antibiotics for future generations, leading to the rise of untreatable diseases that will affect millions of lives. After all, this is the consensus among government agencies, public health organizations and scientists across the globe. It’s been the focus of major medical reports that have generated headlines.
The boards of the world’s pharmaceutical giants must also recognize that the only solution is to collaborate with their competitors, public health organizations and governments across the world to end the inappropriate use of antibiotics in human health care and also food animal production, which is the biggest area of abuse by far. Yet this presents them with a huge ethical dilemma: As officers of publicly traded pharmaceutical companies, how can they reconcile protecting the efficacy of these vital drugs with their corporate responsibility to boost market share and profitability?
All this got me thinking: Antibiotics are now “societal” drugs. Let me explain. If I misuse or abuse a medication prescribed by my doctor for blood pressure, that only hurts me. However, if I don’t take my full course of antibiotics as instructed, or if Big Ag’s boardrooms insist that all their contracted farmers use antibiotics in ways that lead to the development of antibiotic-resistant bacteria, that affects everyone.
If antibiotics are societal drugs, and, so, critical to the future of humanity, shouldn’t they be managed for the benefit of society as a whole? Sadly, the production, distribution and sale of these drugs has been left almost entirely to corporations and a free market based on volume, dominance and last quarter’s sales.
Antibiotics for people are almost always prescribed to treat actual illness. Preventative use is generally limited to things such as post-surgical care. We wouldn’t expect to fortify our food or water with antibiotics to prevent illnesses caused by unsanitary living conditions or eating an unhealthy diet. Instead, our first thought would be to improve sanitation or help people to eat better.
So I have two questions: Does the current corporate business model really protect antibiotics for the benefit of all? And is the free market really the right place for these life-saving medicinal tools?
Reconciling corporate needs with public health
To succeed as a chief executive of a major corporation, free market logic dictates that you must grow your company and your market. After all, a successful company is one that achieves market dominance and, where appropriate, continues to increase product sales.
So how do we reconcile the innate corporate need to increase antibiotic sales and market share with the widely acknowledged public health need to dramatically decrease the amount of antibiotics used in all sectors — but particularly in farming systems that are abusing antibiotics?
Some believe that the U.S. Food and Drug Administration’s recent introduction of voluntary guidelines on the use of antimicrobials in food animals shows that appropriate action is being taken. However, many commentators — myself included — strongly disagree. New York Rep. Louise Slaughter, who has campaigned to stop antibiotic misuse in industrial farming, says the voluntary initiative “falls woefully short of what is needed to address a public health crisis.”
Let’s also put the FDA’s voluntary guidelines into historical perspective: The FDA first acknowledged evidence of a link between antibiotic abuse in farming and the development of antibiotic-resistant bacteria in 1977. Yet more 30 years later it’s clear that little – if anything — has been done to control how antibiotic use in farming. In fact, the U.S. leads the world in the overuse of antibiotics in farming.
Despite mounting scientific evidence of the urgent need to act, the FDA and the USDA have been cowed by industry pressure on antibiotic control. Anyone who believes that Big Ag and Big Pharma — or any big industry for that matter — do not have a direct influence on the development and implementation of U.S. government policy is sadly mistaken. Corporations spend billions of dollars lobbying government to ensure favorable policy outcomes.
Bear in mind, too, the wider market realities here. In 2009 alone, 80% of all antibiotics produced in the U.S. were used for food animals — an incredible 28.8 million pounds out of the 36 million pounds produced. As the New York Times said in a recent editorial: “No new class of antibiotics has been discovered since 1987, largely because the financial returns for finding new classes of antibiotics are too low. Unlike lucrative drugs to treat chronic diseases like cancer and cardiovascular ailments, antibiotics are typically taken for a relatively short period, and any new drug is apt to be used sparingly and held in reserve to treat patients resistant to existing drugs.”
One could argue that the demand for antibiotics from intensive livestock systems represents a near perfect market for Big Pharma. Unlike humans, who normally get better after a single course of antibiotics, millions of livestock usually receive low-level daily doses to prevent disease or increase their lifetime growth. Unless farming changes in a big way, our insatiable demand for ever-cheaper animal protein means demand for these drugs isn’t likely to cease any time soon — even under the FDA’s voluntary guidelines to phase out antibiotics as animal growth promoters. Perhaps that’s why Juan Ramon Alaix, CEO of Zoetis — the world’s largest animal pharmaceutical company — recently told the Wall Street Journal that the FDA’s voluntary agreement “will not have a significant impact on our revenues.”
We have spent too many years hearing industry lobby groups and paid-up scientists and politicians deny any link between the rise of antibiotic-resistant bacteria and the routine abuse of low-level antibiotics for growth promotion and disease prevention in industrial farming. Time and again, we have watched the meat and pharmaceutical industry-funded lobbyists and front groups fight tooth and nail against any attempt to regulate antibiotic use in farming. The industry-funded U.S. Farmers and Ranchers Alliance, for example, insists “there has been no proven link to antibiotic treatment failure in humans due to antibiotic use in animals for consumption... ” If they still won’t accept any responsibility for antibiotic-resistant bacteria — despite massive scientific evidence to the contrary — what makes anyone believe these corporations are now suddenly willing to put public health ahead of corporate profit?
With no new antibiotics in the development pipeline, we must focus our combined energies on doing everything we can to protect the limited range of antibiotics we have. We need to accept that industrial livestock farming systems are unsustainable. Instead, we need to support the expansion of alternative livestock farming systems where antibiotics are used only as a last resort.
According to the Centers for Disease Control and Prevention, at least 23,000 people die each year as a direct result of antibiotic-resistant infections. We keep hearing about the need for better antibiotic stewardship in farming. But what exactly will it take to trigger regulatory intervention and enforcement: Tens of thousands more deaths each year? Maybe hundreds of thousands? How bad do things have to get before we realize that cheap meat is killing us, and that the time for the self-regulation of antibiotic production and use in farming has long since expired?