Extra Matter

Resistance is fudgeable

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Editing the recent podcast on Antibiotics in agriculture was far harder than I expected it to be, mostly because I had to cut away stuff that is important, but just didn’t fit. Much of that was about how, in time honoured tradition, antibiotic manufacturers and veterinarians sowed doubts about who was to blame for what. Here’s a bit of that. Claas Kirchhelle’s paper uncovers a lot more.

The Animal Health Institute is an organisation in the US that represents many manufacturers of veterinary products. If you go to the Animal Antibiotics section of the AHI’s website, you’ll find, among other things, a page on The Antibiotic Ban in Denmark: A Case Study on Politically Driven Bans. Given that everyone I’ve spoken to seems to regard Denmark as a shining example of how to regulate antibiotics in agriculture, I wanted to see what the AHI made of it.

Their conclusion:

Bottom line: A ban on AGPs in Denmark has not had the intended benefit of reducing antibiotic resistance patterns in humans; it has had the unintended consequence of increasing animal suffering, pain and death.

To back that up, the AHI helpfully publishes this graph.

This does show an increase in the therapeutic use of antibiotics, which exceeds the amount used before Denmark’s ban on antibiotic growth promotors came into force. Claas Kirchhelle said as much when we spoke. In fact, just a cursory look at the graph suggests that antibiotic use is much higher in 2009 than it was in the peak year of 1994. Which, of course, is exactly what the AHI would like you to think. There are, however, a couple of worrying things about that graph. First, why are the years across the bottom evenly spaced, when there are years missing? That’s always fishy. Much more importantly, why does the graph end in 2009, when here we are in 2017?

Bravely, the AHI provides a link to Denmark’s official report for 2009, so I didn’t have to hunt for it myself. And there, of course, is the official version of the same graph.

A couple of things to note.

  • The Danes do not skip years for which they don’t show data, so the slopes, which indicate how quickly things are changing, are more accurate.
  • For the years up until 1999, the Danes stack AGPs and therapeutic antibiotics on top of one another, showing total use of antibiotics in animals. So you can see that although therapeutic use has gone up, total use is quite a bit lower in 2009 than it was in 1994.
  • The Danish graph shows figures for the human use of antibiotics from 1997 onwards; it may be increasing slightly, and is about one-third the use in animals. AHI does not show these data at all.

These points all make me think that maybe the AHI redrew the graph not merely to inject colourful chart junk but also to hide the facts it represents. Looking at the official Danish graph for 2016, published just a week ago, makes me certain.

Well, would you look at that. Antibiotic use in animals started to decline in 2010 and has continued on a downward path. In humans it has gone up a little.

To me, this manipulation of the data (and a whole lot else on the AHI site, like the utterly ludicrous probabilities here) fully confirm my view that the AHI knows perfectly well that it hasn’t got a leg to stand on. Other organisations fighting tighter regulation of antibiotics and livestock are probably the same.

There’s more, much more, which is why editing the podcast was so hard. Like the evidence that in the UK the Association of the British Pharmaceutical Industry lobbied hard to have the editor of New Scientist magazine fired. Bernard Dixon, himself a microbiologist, was instrumental in drawing public attention to the very clear evidence collected by E.S. “Andy” Anderson of the Public Health Laboratory Service, connecting antibiotics on the farm with antibiotic resistance in bacteria and – most importantly – demonstrating that resistance could move from harmless bacteria to pathogenic ones.

Part of the industry’s argument against greater regulation of antibiotics is that because antibiotics are also used in human medicine, we can’t be sure how much resistance is the result of medical use and how much the result of use on the farm. In one sense, animals and humans actually receive about the same amount of antibiotics a year, if you measure antibiotics per kilogram per organism. But the total biomass of animals getting antibiotics is far, far greater than the mass of humans; overall something like 70–80% of antibiotics go to agriculture, not human medicine. Worse, in animals almost all antibiotics are given in sub-therapeutic doses, perfect conditions for selecting resistant bacteria.

Of course there are gaps in our knowledge; there always are. But that is not a good reason to block action. The final part of the McNeill report for the British government has this to say (p 10):

Where gaps in the evidence remain, they should be filled But given all that we know already, it does not make sense to delay action further: the burden of proof should be for those who oppose curtailing the use of antimicrobials in food production to explain why, not the other way around.

Podcasts

Antibiotics and agriculture Tackling the problem of antibiotic resistance at (one) source

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Podcast: Play in new window | Download (Duration: 22:01 — 17.9MB)

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In the past year or so there has been a slew of high-level meetings pointing to antibiotic resistance as a growing threat to human well-being. But then, resistance was always an inevitable, Darwinian consequence of antibiotic use. Well before penicillin was widely available, Ernst Chain, who went on to win a Nobel Prize for his work on penicillin, noted that some bacteria were capable of neutralising the antibiotic.

What is new about the recent pronouncements and decisions is that the use of antibiotics in agriculture is being recognised, somewhat belatedly, as a major source of resistance. Antibiotic manufacturers and the animal health industry have, since the start, done everything they can to deny that. Indeed, the history of efforts to regulate the use of antibiotics in agriculture reveals a pretty sordid approach to public health.

But while it can be hard to prove the connection between agriculture and a specific case of antibiotic resistance, a look at hundreds of recent academic studies showed that almost three quarters of them did demonstrate a conclusive link.

Antibiotic resistance – whether it originates with agriculture or inappropriate medical use – takes us back almost 100 years, when infectious diseases we now consider trivial could, and did, kill. It reduces the effectiveness of other procedures too, such as surgery and chemotherapy, by making it more likely that a subsequent infection will wreck the patient’s prospects. So it imposes huge costs on society as a whole.

Maybe society as a whole needs to tackle the problem. The Oxford Martin School, which supports a portfolio of highly interdisciplinary research groups at Oxford University, has a Programme on Collective Responsibility for Infectious Disease. They recently published a paper proposing a tax on animal products produced with antibiotics. Could that possibly work?

Notes

  1. The paper by Alberto Giubilini and his colleagues is Taxing Meat: Taking Responsibility for One’s Contribution to Antibiotic Resistance. He also wrote an article explaining why we should tax meat that contains antibiotics.
  2. Claas Kirchhelle’s paper on the history of antibiotic regulation in Britain will be published in the Bulletin of the History of Medicine. His prize-winning D.Phil thesis Pyrrhic Progress – Antibiotics and Western Food Production (1949–2013) will be published by Rutgers University Press.
  3. Reducing antimicrobial use in food animals, published in Science after I had talked to Alberto and Claas, has some interesting things to say about a tax on antibiotics and other ways to tackle antibiotic resistance.
  4. The UK government’s Review on Antimicrobial Resistance is a valuable source of information.
  5. Pig pill image from the National Academy of Medicine. Banner image of methicillin-resistant Staphylococcus aureus from the Wellcome Trust.

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Extra Matter

Mouldy salt

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It’s a scary headline alright:

Mold contamination in sea salts could potentially spoil food

I checked the press release, and yes, sea salts contained spores of some moulds that could conceivably result in food spoilage. A couple of things worried me though. Do other salts, and even the much vaunted kosher salt, also contain mould spores? And, although the spores are there, do they cause spoilage? I mean, if you swabbed my hands right now you might find potentially harmful bacteria, but are they actually going to make me ill? Probably not.

So I looked at the full paper. The first thing that struck me was that the one salt that isn’t made by evaporating sea water now, Himalayan salt — “labeled as a sea salt when in fact it was mined from an ancient sea salt deposit” — had by far the lowest level of fungal spores. So maybe “ordinary” salt would be similarly uncontaminated.

Sea salt may have contributed to food spoilage in cured meats before now, and the paper also identified some fungal species that produce toxins. Overall, through, there’s nothing in the paper to suggest why we should be more worried about sea salt than other kinds of salt.

I’m waiting to see the follow-up, where researchers use different salts to preserve meat or vegetables, taking all the usual precautions, to see whether the fungi survive once fermentation really gets going.

Extra Matter

Eat This Newsletter 63

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2 October 2017

  1. What will happen during the forthcoming avocado glut.
  2. I found about that from Marc Bellemare’s piece on avocadonomics, which contains the remakable words “In the process of preparing for my call with Kyle, I read a whole bunch about avocados, as they were a commodity I knew little about.” How many pundits do that?
  3. Partial closure on the case of The Codfather — 46 months in the slammer. The original story featured in ETN 051 in March.
  4. The Lancet looks forward to a world without hunger.
  5. I wonder what the domestic goddesses who taught Emily Gould how to be an adult think about world hunger. They’re against it too, I feel certain.
  6. Anti-science reaches a new nadir as Italians vandalise a field trial of Xylella-resistant olives.
Extra Matter

Crime and nourishment Some costs and consequences of the Supplemental Nutrition Assistance Program

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Talking to interesting people about interesting food-related things creates its own kind of treadmill. I often continue to read around a topic, which means that the amount of reading around I’m doing just keeps going up. But when I come across something new and interesting, I often think, “I’ve done that. Nobody wants to know more.” Lately, a few people have said I’m wrong, they would like to know more, and that I should write more. So, as I’m travelling, gathering material for future episodes, I’m going to try that. In future, if all goes well, maybe it’ll be in addition to, rather than instead of, an episode.

The Supplemental Nutrition Assistance Program (SNAP) is where the US government spends most of the money it dedicates to food for people who need help. SNAP has two, linked, goals; to reduce food insecurity and to get people to make healthier choices for their diets. It does both, to some extent, but there are also niggling doubts.

For a start, most people who get SNAP benefits have spent their allowance before the month is up. Half of all recipients have used up their SNAP benefits within two weeks of getting them. Furthermore, SNAP benefits represent a huge, regular injection of resources into poor communities. Researchers know that government transfers of cash are associated with crime spikes, probably because some people spend their grants on drugs and liquor or else rob people who haven’t yet spent their benefits. What about SNAP?

Crime

While SNAP benefits cannot be used officially to buy drink or drugs, they might free up other income for what have been called “complements to crime” — leisure, illicit drugs and alcohol. Other factors could also be in play. If people know that SNAP benefits arrive early in the month, recipients might be easy targets for crimes. Lean times at the end of the month might prompt people to steal food. Of course, lean times at the end of the month could also potentially reduce crime, if people can’t afford complements to crime. If people getting SNAP might be getting other benefits at the start of the month, maybe shifting SNAP benefits later would help them to smooth their consumption patterns so they don’t need to steal food at the end of the month. It’s clearly complex.

Luckily, although SNAP is a federal program individual states differ in how they distribute SNAP benefits. In Indiana, for example, people get SNAP benefits depending on the initial letter of their last name, so disbursements are more spread out. And on 16 February 2010 Illinois introduced a new policy; instead of two-thirds of SNAP benefits going out on the first of the month, they were shifted to the 4th, 7th and 10th day of the month. These two natural experiments allowed Analisa Packham at Miami University and Jillian Carr at Purdue University to begin to unpick the complexity. (SNAP Benefits and Crime: Evidence from Changing Disbursement Schedules)

Crime statistics in Chicago, Il, have been dropping anyway over time. However, the SNAP policy change has a clear additional effect. Crime and theft at grocery stores are 20-30% lower after the change in policy, equivalent to about 3 grocery store crimes a day across the city, but there is no change in other kinds of crime. There is also evidence that crimes around the 15th of the month — that is two weeks after disbursement, when half of all recipients have exhausted their SNAP payments — also fell after the change in distribution dates. Adding weight to the idea that it is changes in SNAP distribution policy that drive changes in crime rates, the effects are strongest in places that have above average numbers of SNAP recipients and SNAP retailers.

In Indiana, the researchers could match crime and arrest data to the perpetrator’s name and so to the day of the month on which they would have received SNAP benefits. Alas, they had no information on the detailed nature of the crime — grocery store vs other stores, for example — nor on whether the criminal was actually receiving SNAP benefits. Despite that, the analysis shows that crime falls by 4.3% in the 3rd week after SNAP disbursements, but increases in the final week of the benefit cycle. Given the limits of the data, this is probably an underestimate. There is also no evidence of an influence on drug crimes, so this is not just reckless behaviour after possibly receiving SNAP benefits.

What’s going on? One possibility is that recipients have exhausted their SNAP benefits by the 3rd week of the cycle and so don’t have the resources to spend on complements to crime. But they’re not robbing grocery stores either, it seems. There is, however, a tantalising suggestion that women do show a tendency to commit more crimes in the 3rd and 4th week after they might have received SNAP benefits. Perhaps they are providing for children.

So changing the timing of SNAP benefits can actually reduce the level of crime in grocery stories. Another niggling doubt, though, is whether the desire to encourage a healthier diet is thwarted by the higher cost of healthier choices? That was the focus of Eat This Podcast episodes earlier this year, asking Parke Wilde How much does a nutritious diet cost? and talking to Amanda Lee about Australia: where healthier diets are cheaper … but people spend more to eat badly.

After talking to Parke Wilde I concluded, more or less, that you can use SNAP benefits to buy a healthy diet, but you might not want to. Amanda Lee’s research reinforces that view. Healthy choices are less expensive, and also less desirable.

Nourishment

Now along comes the first study that looks directly at the cost of following the USDA’s MyPlate dietary guidelines and relates that to SNAP benefits. Kranti Mulik of the Union of Concerned Scientists and Lindsey Haynes-Maslow at North Carolina State University, looked at the cost of eating the MyPlate guidelines ((They also factor in the cost of labour in preparation, as 40% of the total cost of food.)) with three different scenarios for satisfying the fruit and vegetable requirements: all fresh, half fresh and half frozen, and one-third each fresh, frozen and canned. ((As an aside, the reason for looking separately at fresh, frozen and canned was because “it is likely that processed forms of produce are accompanied by changes in flavor quality, which can influence intake.” No mention of nutrition quality.)) That difference, in amount of frozen or canned food, makes no difference to the overall cost of following the MyPlate guidelines for any of the groups they looked at. ((The differences were all in the direction you might expect, but they were not statistically significant.)) With a few exceptions, though, most groups had to pay more to eat the MyPlate diet than they were getting in SNAP benefits.

In some cases, the differences were quite large. A family of four with older children would have to spend $626.95 more than they get in SNAP benefits to follow the MyPlate guidelines with all fresh fruit and vegetables. Vegetarian families get off more lightly. They need only an extra $497.07 a month.

Who wins? Senior women, over the age of 51, get $17.27 more in SNAP benefits than they need to follow the all-fresh MyPlate guidelines. Senior vegetarian men get $1.28 more than they need if they eat half of their fruit and vegetables frozen. Children under the age of 7 also generally get more than they need, unless they are being fed a vegetarian diet. That costs their parents about $60 a month more for children aged 2-4 and $26 a month more for children aged 5-7.

Mulik and Haynes-Maslow say they did their study to provide evidence to inform policy decisions. And the Union of Concerned Scientists, for which Mulik works, published a report that says “increased consumption of fruits and vegetables according to MyPlate guidelines could prevent over 127,000 deaths annually from heart disease, and the value of this increased longevity would exceed $11 trillion.”

The US government is currently thinking about cutting both the levels of SNAP support and eligibility. Will they pay any attention to either the affordability of a healthier diet or the impact of SNAP disbursements on crime?

P.s.