Washington Post: Maryland shows states how to save modern medicine (OpEd)

In a new Opinion Editorial in the Washington Post, Dr. Pat McLaine from UMD and the Maryland Nurses Association and David Wallinga from the Natural Resources Defense Council talk about the growing threat of antibiotic resistance and Maryland’s groundbreaking new law to protect public health and modern medicine. Please give it a read and share with your networks.

 

Maryland shows states how to save modern medicine

A growing scourge is threatening modern medicine as Americans know it. Each day, hundreds of us die or are maimed by infections caused by superbugs — a.k.a. drug-resistant bacteria — but often they’re not even named as a cause of those deaths.

New estimates suggest superbug infections are now the third-leading cause of death in the United States, behind heart disease and cancer, claiming up to 162,000 lives each year. That’s more people than are killed in all manner of accidents and more than double the annual deaths from opioid overdose.

About two-thirds of the kinds of antibiotics important for treating sick people are sold for use in livestock, not people. The vast majority aren’t even used as treatments for sick animals, but, rather, are added routinely to animal feed and drinking water as poor compensation for less-than-optimal practices and conditions on industrial farms. This practice can spur the animals’ normal bacteria to develop resistance to the antibiotics supplied. And that resistance can spread to bacteria in people.

To curb the epidemic of drug resistance, experts have long warned we need to stop squandering antibiotics when they aren’t needed. That means we must improve how meat is produced.

While Washington’s efforts to end this senseless waste have fallen short, Maryland is setting a model for other states. In late May, the state finalized a law that goes further than any other — and much further than the Food and Drug Administration’s federal rules — to prohibit this routine use of human-class antibiotics on farm animals, holding them in reserve instead for when animals are sick and when they need surgeries or other medical procedures. This follows the advice of medical and public-health institutions from the World Health Organization to the American Academy of Pediatrics. The new law also greatly improves the collection of data on the agricultural use of those drugs.

For nearly 80 years, we have taken antibiotics for granted. Already, bacterial infections are becoming harder to treat, and impossible in some cases. If antibiotics continue to lose their effectiveness, modern medicine as we know it will be in jeopardy. Many basic surgical procedures may no longer be feasible. When clinicians can no longer treat the infections that often complicate essential procedures such as dialysis, C-sections, joint replacements, organ transplants and cancer chemotherapy, these interventions will simply become unavailable. We would return to the pre-antibiotic era, when people died from a cut or minor injury that could not be treated. The result is likely to be longer hospital stays and increased pain, suffering and costs.

And yet ending routine antibiotic use in animals that aren’t sick is a step that continues to encounter stiff resistance from many farmers, meat producers and pharmaceutical companies. Perhaps that explains why for decades the FDA has refused to set national targets for reducing the enormous overuse of antibiotics on farms, even as other countries have set and then quickly surpassed targets for reducing the use of antibiotics in the livestock sector.

Or why, despite frequent recommendations to do so by the Government Accountability Office, the FDA has failed to create any farm-level system to collect comprehensive data on antibiotic use. “Out of sight, out of mind” is not the best strategy for stewarding our limited supply of antibiotics and keeping them effective into the future.

Fortunately, Maryland’s new law, co-written by Sen. Paul G. Pinsky (D-Prince George’s), Sen. Shirley Nathan-Pulliam (D-Baltimore County), a nurse, and Del. Sara N. Love (D-Montgomery), will be doing more than any other state to collect important, farm-level data regarding antibiotic use. Specifically, the law requires the authorizing veterinarians to report on these uses on a yearly basis. It is an essential complement to the restrictions on routine antibiotic use, helping to establish a baseline to measure and fine-tune progress. Together, these two provisions establish the new benchmark for sensible restrictions on livestock antibiotic use.

Maryland’s leadership comes at a critical moment for anyone who will rely on antibiotics at some point. With progress at the federal level stalled, we urge other states to follow Maryland’s lead and preserve the continued effectiveness of these miracle drugs for us and for our children, into the future.

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We did it!! Thank you to everyone!

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Today, Governor Hogan announced that he will allow the updated Keep Antibiotics Effective Act become law!

This couldn’t have happened without our tireless and amazing sponsors – Senator Pinsky, Senator Nathan-Pulliam, and Delegate Love. Thanks also to Delegate Robinson for sponsoring the original 2017 bill (and the iterations before it).

Thanks to everyone who traveled to Annapolis to testify and lobby in support of the bill!

Maryland now has the strongest law in the land protecting antibiotics thanks to the support of all the health care, public health, labor, business, and environmental organizations including: the Maryland Nurses Association, Maryland Public Health Association, Maryland Sierra Club, 1199SEIU United Health Care Workers, Elevation Burger, the Society of Infectious Disease Pharmacists, Fair Farms, Waterkeepers Chesapeake, Maryland Conservation Council, Maryland Votes for Animals, Natural Resources Defense Council (NRDC), Maryland PIRG, and Clean Water Action.

The bill makes the following clarifications and expansion of the law to address errors in the Maryland Department of Agriculture’s prior definitions in the regulations and to help ensure proper implementation:

  • Adds new definitions and clarifies definitions for key terms that will ensure that the law reduces unnecessary antibiotic use, including “administered in a regular pattern,” “Control of the spread of disease or infection,” “Elevated risk,” “Prophylaxis,” and “Treat a disease or infection.”
  • Adds a technical fix to exempt dairy farms with herd size of fewer than 300, to be in line with the small farm exemptions for poultry, pork and beef.
  • Adds a a requirement for veterinarians to report the use of medically important antibiotics on a yearly basis to ensure compliance with the law and track progress.

 

Thanks and watch the great hearings in the House and Senate on the Antibiotics Bill

We had two great hearings in both the House and the Senate on the antibiotics bills. (SB 471 and HB 652).

Thanks to the mighty group of witnesses who came to Annapolis to testify. Alex Smith, Edina Avdic, Rob Sprinkle, Michael Berger, Mae Wu, Emily Scarr, and Emily Ranson. 

2019 ABX Panel Maryland photo

Especial thanks to Rob, Alex, Mae, Emily S. and Emily R. for sticking around until 10:30 PM to testify in the Senate!

Senate hearing ABX Maryland 2019

And of course, huge thanks to the sponsors – Sen. Pinsky and Del. Love – for leading our panels!

The Senate hearing video is here (begins at the 7:30 mark) and the House hearing video is here (begins at the 1:19 mark). Enjoy!!

 

Good news/Bad news: FDA release on antibiotic sales

In December, the U.S. Food and Drug Administration released new data on the sales of antibiotics important to human medicine in livestock production. The good news: sales have declined. The bad news: the amount of antibiotics going to livestock is still alarmingly high.

Read more:

Livestock Antibiotic Sales See Big Drop. but Remain High: Natural Resources Defence Council

A great first step to protect antibiotics for the future, Washington Post Editorial Board

FDA reports major drop in antibiotics for food animals, Center for Infectious Disease Research and Policy

We must do more to stop the misuse of our lifesaving drugs on animals that are not sick. 

1000 Letters Delivered to Gov. Hogan

MDKAW Letter Drop Off

Yesterday, we delivered more than 1000 letters from Marylanders and a letter from local, state, and national organizations asking Governor Hogan to pass stronger regulations for antibiotics used in animal agriculture.

Emily Scarr from Maryland PIRG and Dr. Pat McLaine from the Maryland Nurses Association did a great job! And many thanks to everyone who braved the heat and humidity from Fair Farms Maryland, Maryland Votes for Animals, Maryland Sierra Club, Natural Resources Defense Council, Clean Water Action, in addition to Maryland PIRG and Maryland Nurses Association.

Here’s an article in the Southern Maryland Online about the event. And another one from the Cumberland Times-News. And another one from the Center for Infectious Disease Research Policy. And another one from the Annapolis Patch.

Here’s the video of the event from Maryland PIRG’s Facebook page.

 

Press Statement: Local, State, and National Groups call on Gov. Hogan to Strengthen Antibiotics Regulations

As public comment period ends, more than 1,000 say Hogan needs to do more to protect public health

Contact:
Emily Scarr, Maryland PIRG Director 859-221-4213
Kyanna Cadwallader, Maryland PIRG Campaign Organizer 386-972-2838

Annapolis – The Maryland Campaign to Keep Antibiotics Working delivered a letter from public health, labor, and environmental organizations and more than 1,000 public comments to Governor Hogan asking him to revise and strengthen long-overdue draft regulations to the 2017 Keep Antibiotics Effective Act.

The letter was signed by more than a dozen groups including Maryland Sierra Club, Maryland Nurses Association, SEIU 1199 United Health Care Workers, the Society of Infectious Disease Pharmacists, Waterkeepers Chesapeake, Maryland Votes for Animals, Natural Resources Defense Council, Maryland PIRG, and Maryland Clean Water Action. In the letter the groups called for two specific improvements of the regulations, saying, “We face and urgent global antibiotic resistance crisis, driven in part by widespread overuse of antibiotics in animal agriculture.”

Public health advocates warn that the proposed regulations fail to curb the overuse of antibiotics in animal agriculture and need to be fixed in order to protect Marylanders from antibiotic-resistant bacteria.

“Antibiotics are our last defense against life threatening infections,” said Dr. Pat McLaine, a registered nurse and member of the Maryland Nurses Association. “We need the Hogan Administration to do its due diligence in implementing this law to save our precious antibiotics for times when they are needed most.”

In 2017, the Maryland General Assembly passed the Keep Antibiotics Effective Act to curb the overuse of antibiotics in livestock by eliminating routine use of antibiotics in animals that aren’t sick. The bill became law without a signature from Governor Hogan. After more than a year, the Maryland Department of Agriculture (MDA) finally released draft regulations.

The public comment period on the draft regulations ends today, and the regulations could be finalized by Governor Hogan and the Maryland Department of Agriculture as soon as September 18th.

“We must act now to protect these life saving drugs for future generations,” said Maryland PIRG Director Emily Scarr, “Governor Hogan should strengthen the Department of Agriculture’s proposed regulations to ensure antibiotics are reserved for when they are needed most: for sickness and surgery.”

Before antibiotics, infections were the leading cause of death in America. Now, ending the routine use of antibiotics in agriculture has been identified by the World Health Organization, American Academy of Pediatrics, and other leading health groups as a key strategy to fight the growing crisis of antibiotic resistance. The Centers for Disease Control and Prevention estimates the number of antibiotic resistant infections in the country at approximately 2 million cases per year. Of those, 23,000 people will die as a result of the resistant infection. The annual cost in the United States of such infections exceeds $55 billion per year.

In the United States, 70% of antibiotics are sold for use on farms, not to treat sick animals but rather to compensate for a poor diet and cramped, unhygienic living conditions. This daily use of antibiotics accelerates the development of drug-resistant bacteria which can travel off of farms and into our communities through human-to-animal contact, contaminated food and through environmental factors like water run-off, dirt and airborne dust.

“Combating antibiotic-resistant bacteria is a national public health priority, and healthcare professionals work tirelessly to minimize inappropriate antibiotic use for patients,” said Emily L. Heil, PharmD, an assistant professor of pharmacy practice and science at the University of Maryland School of Pharmacy. “However, human stewardship efforts can help only so much because the vast majority of antibiotic usage occurs in food-producing animals. Strong regulations to carry out the Keep Antibiotics Effective Act will make Maryland a leader for other states in ensuring that antibiotics are used appropriately in agriculture.”

We got the law. Now we need strong regulations.

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Credit: Scott Brundage

In 2017, we were thrilled to watch the Maryland General Assembly pass the Keep Antibiotics Effective Act to prohibit the overuse of human antibiotics in animal agriculture.

More than a year after the bill became law, the Hogan Administration finally released draft regulations to implement the law, and unfortunately the regulations are so weak that the overuse of human antibiotics on Maryland farms will likely continue.

The Keep Antibiotics Effective Act was designed to be stronger than the U.S. Food and Drug Administrations loophole-ridden policy. But we have ended up back where we started, with the Hogan Administration wanting to allowed continued, routine use of antibiotics on animals that aren’t sick.

The public has an opportunity to share comments with the Administration and demand stronger regulations that actually protect the effectiveness of our antibiotics. Comments are due September 4, 2018.

You can go through one of our participating organizations’ action: Take Action with Fair Farms