The Washington PostDemocracy Dies in Darkness

Opinion Maryland shows states how to save modern medicine

A colorized scanning electron micrograph image from the Centers for Disease Control and Prevention shows the O157:H7 strain of the E. coli bacteria. (Janice Carr/Associated Press)

Pat McLaine is a professor of nursing at the University of Maryland and a member of the Maryland Nurses Association. David Wallinga is senior health officer at the Natural Resources Defense Council.

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.

Read more:

The Post’s View: A great first step to protect antibiotics for the future

Donald Kennedy: The threat from antibiotic use on the farm

Tobias Rees and Nils Gilman: The silent microbiome crisis

The Post’s View: A new superbug requires urgent attention