The "Trouble with Antibiotics" in U.S. animal agriculture production

Frontline last night had an excellent report, the Trouble with Antibiotics, on the plausible link between dangerous antibiotic resistant diseases and the overuse of antibiotics in U.S. meat production.

Poultry and hog producers use large amounts of antibiotics even in healthy animals, as a growth promoter and to prevent disease. As bacteria evolve to become resistant to these antibiotics, we lose important tools for treating deadly diseases in humans, including Methicillin-resistant Staphylococcus aureus (MRSA).

For readers who want to inspect the scientific evidence for themselves, here are some links to research mentioned in the Frontline report.

Jessica Rinsky, Lance Price (interviewed in the report), and colleagues found livestock-associated MRSA in workers from industrial livestock operations but not workers from antibiotic-free livestock operations.

Andrew Waters, Lance Price, and colleagues found that MRSA bacteria reaches meat on supermarket shelves.

Joan Casey, Brian Schwartz, and colleagues found in the Journal of the American Medical Association (JAMA) that antibiotic-resistant bacteria cases in humans were geographically associated with the proximity of nearby meat producers in Pennsylvania. The Frontline interviewer did a great job questioning the scientists and explaining both the strengths and limits of this type of geographic association.

Concerned about the Frontline story, the federal government's National Pork Board has been scrambling to persuade people not to worry about this issue. Reuters reports today that the NPB is funding an online public information campaign to defend antibiotic use. The most damning part of the Reuters report alleges that the NPB is using search engine optimization (SEO) tools so that web users seeking information about antibiotics are directed to industry-friendly web sources.

Both Reuters and the Frontline report describe the pork board as an "industry" association, but the National Pork Board is a semi-public checkoff program. The U.S. Congress created this board, the Secretary of Agriculture appoints its members from a slate of candidates suggested by the industry, and the federal government uses its powers of taxation to collect the "mandatory assessment" -- a tax -- that funds this public information campaign. This is not a voluntary industry association. All pork board messages must be approved by the federal government as its own "government speech," so our government is complicit in this public information campaign to rebut the Frontline report.

The industry representatives interviewed in the Frontline report didn't really dispute any of the facts, but they engaged in a rhetorical game of shifting the burden of proof. They argued that no further regulation is needed, because there is not yet certain proof that some of the research associations represent true cause and effect. Since nothing is ever certain in this type of research, the industry representatives can feel safe that no level of evidence would ever clear their hurdle.

One of the best passages in the Frontline report was an interview with FDA Commissioner Margaret Hamburg. The interviewer asked why FDA does not collect information about the quantity of antibiotics administered by meat producers. Though Hamburg squirmed under the question, she essentially confirmed that FDA wanted this information but could not get it because of industry opposition. In other words, the industry representatives say no action should be taken until we have certain proof, while simultaneously hindering access to the data needed to investigate the question.

The industry is pursuing some voluntary steps to reduce antibiotic use for the purpose of "growth promotion," but it has defined this term narrowly so that most antibiotic use even in healthy animals will still continue.

The Frontline report is strongly recommended. Now is the time for stronger measures to restrain the overuse of antibiotics in U.S. meat production.

Frontline, October 14, 2014.

NRDC shares inspection documents for Foster Farms

The Natural Resources Defense Council (NRDC) yesterday shared inspection documents for Foster Farms, the company at the center of a recent Salmonella outbreak that now appears contained.

From a blog post yesterday by Jonathan Kaplan, who is NRDC's director for food and agriculture (and by coincidence a childhood friend who grew up on the same block in Washington, DC, as I did):

Today NRDC posted hundreds of noncompliance reports written by USDA food safety inspectors at Foster Farms plants around the country between September 2013 and March of this year. Most of the violations found were incredibly unsavory and include more than 200 from two California plants linked by the Centers for Disease Control and Prevention (CDC) to an antibiotic resistant Salmonella outbreak. Although the outbreak now appears to be over, the pattern of violations at Foster Farms plants doesn’t leave us feeling warm and fuzzy about the company’s commitment to protecting public health. And we still have not received any response to our questions about antibiotic use at Foster Farms.

Food safety problems are fundamentally about lack of public information. If consumers had magic sunglasses that displayed the presence of Salmonella on chicken in the grocery store, there would be no need for government regulation. Immediately, faced with market consequences for distributing chicken with Salmonella, the companies would clean up their product.

The Foster Farms case shows how much better off we would be if the public had access to more of the information that appears routinely in inspection reports. Ironically, even companies might benefit from market incentives to reduce problems at the inspection stage rather than waiting for an outbreak (which can cause many more millions of dollars in loss of sales and reputation).

Thanks, NRDC, for helping to make such information available.

Next steps for preventing Salmonella in chicken ... and fresh produce?

After this year's Salmonella Heidelberg outbreak, which has caused more than 300 illnesses and an unusually high rate of hospitalizations, was linked to Foster Farms, observers were surprised that USDA's Food Safety Inspection Service (FSIS) did not ask the chicken processor to recall product that may have been contaminated.

Participants in a recent meeting with FSIS reported that agency officials seemed to take the position that they required proof of culpability before they could request a recall.  That cautious stance makes sense when an agency is bringing a criminal case, but not when an agency is deciding merely whether to recall contaminated chicken. 

In a Salmonella case that may be related, Costco has recalled rotisserie chicken sold at a store in California.  Why didn't FSIS ask for a recall of the Foster Farms chicken?  There may be several reasons.

• The agency may simply be satisfied with Foster Farms proposed remedial actions and may feel incapable of doing much good by chasing after the chicken that has already left the farm gate, so to speak.
• The agency may feel that Salmonella on chicken is a tolerable hazard, because consumers should be able to kill it by cooking at home.  The agency has a tolerance for the presence of Salmonella on whole chickens and tends to take action only if the rate of Salmonella contamination exceeds this percentage.  There is no specific tolerance established for chicken parts, as in the Foster Farms case, but the agency may feel that Foster Farms' rate of contamination is in line with the rest of the industry.

A coalition of consumer groups has asked for stronger action (.pdf), including a list of 7 specific steps the federal government could take.  For example, the government could declare antibiotic resistant Salmonella and Salmonella that has been linked to an outbreak in poultry as "adulterants," a legal term which triggers specific legal power to prohibit sale.  Also on the list, the government could require companies to revise their food safety plans.

The politics of such food safety regulations is complex, however.  Separate from this Salmonella outbreak in processed chicken, I have been following the very tough stance that some sustainable agriculture advocates have been taking against allowing new food safety rules under the Food Safety Modernization Act (FSMA) to be applied to foods produced locally and on small farms.  Salmonella contamination is much more common on chicken from processing factories than on small farm produce; still, when contamination occurs on fruits or vegetables, there is not even a "kill step" through consumer cooking at home, so the safety issues are quite serious.  Some small farm advocates say it would be too burdensome to have formal "HACCP" food safety plans and bacterial monitoring of on-farm water sources, in the same manner that poultry plants must do.

When the industry under discussion is chicken processing, it is tempting to say we should bear any cost necessary to protect food safety.  But I've noticed that when public-interest minded people think in a parallel fashion about both chicken and fresh produce, they tend to conclude that our society must find a sensible balance between food safety protection and the costs -- for farmers, manufacturers, and for the consumers who ultimately purchase the product.

Ractopamine and the proposed Chinese purchase of Smithfield Foods

Helena Bottemiller reported at the end of May for NBC News that the proposed purchase of Smithfield Foods by a Chinese company may be related to the fact that China has stricter standards than the United States does for a growth promoting drug:

The proposed $4.7 billion sale of Smithfield Foods, America’s largest pork producer, to China’s biggest meat processing company comes amid significant trade friction between the two countries over meat and livestock.

China bans ractopamine, a controversial growth-promoting drug that is widely used by U.S. livestock producers. Russia also bans the feed additive and both countries have recently stepped up residue testing in meat, worried about the health effects of the drug. The actions have constrained American meat exports.

Bottemiller's feature was supported by the Food & Environment Reporting Network.

Albany Law School professor Timothy Lytton has a new book, Kosher: Private Regulation in the Age of Industrial Food.  A key point is that this topic is more broadly relevant than one might think, because kosher food is just one of many examples of food regulation systems that can be adopted by the private sector.

Lytton was interviewed on the What is Your Food Worth? blog.

As a general matter, private food safety audits and industry-sponsored nutrition labeling schemes have been a great disappointment. Behind most major food-poisoning outbreaks is some private auditing firm that gave the food producer a phony five-star rating. And when nutritional rating schemes give high marks to sugary cereals and full-fat ice cream, you have to wonder.

As a kosher-observant Orthodox Jew, I realized that kosher certification offers a 2000 year old example of private food certification. My initial suspicion was that kosher certification was full of price gouging and unnecessary, super-stringent standards. As I began to get into my research, however, I found that, although fraud and corruption were rampant a century ago in kosher meat production, today’s kosher system is highly reliable. My book tells the story of how, within the span of a century, kosher certification became the one of the most reliable systems of private certification in the food industry, indeed, perhaps in any industry.

National Food Policy Conference, April 15-16, Washington DC

The Consumer Federation of America's National Food Policy Conference is an always-fascinating annual tradition. 

For 36 years, the National Food Policy Conference has been a Washington institution and a unique collaboration between consumer advocates, the food industry and government.  The conference is organized by the Consumer Federation of America and is a key national gathering for those interested in agriculture, food and nutrition policy.

This year’s conference will explore an array of important food policy issues facing consumers and the food industry. The conference will explore how immigration reform might impact our food supply and discuss the future of food shopping. Speakers and panelists will examine timely food policy topics including the debate on sugar sweetened beverages, the impact of changing animal welfare standards, an update on implementation of the Food Safety Modernization Act, the opportunities and challenges of sodium reduction, and priority setting in a time of reduced resources.

Register today using the registration tab.  Reduced registration fees are available for college and graduate students. 

Check back here for the latest conference updates and information.Follow us on Twitter and join the conversation at #FPC2013.

A few years ago, I enjoyed participating in a debate about agricultural subsidies at this event, as part of a panel including former U.S. Rep. Charlie Stenholm, the Environmental Working Group's Ken Cook, and Bread for the World's David Beckmann, and hosted by NPR's Dan Charles.

Choices Magazine examines lean finely textured beef ('pink slime')

A recent theme issue in Choices Magazine, a publication of the Agricultural and Applied Economics Association (AAEA), examined lean finely textured beef (LFTB), an ammonia-treated beef filler product widely known as 'pink slime.' 

To some extent, the authors of the theme overview, J. Ross Pruitt and Joshua D. Detre, share the beef industry's view that the long controversy over this beef product is unfair to the industry.

The use of the moniker “pink slime” is an example of how calling into question the safety and/or quality of a food product/production practice can do irreparable damage to the faith in the U.S. agricultural supply chain. As prices and markets continue to adjust due to the inability of ground beef suppliers to use LFTB, consumers are paying more per pound for ground beef. The LFTB case has impacts beyond the market price of ground beef, especially for the employees of BPI who lost their jobs and the communities who benefitted from the presence of BPI. While it is not yet clear if longer-term adjustments to the beef cattle industry will be tied back to the media scare over LFTB, it is evident that educating consumers about food production is a challenge not to be ignored.

At the same time, the theme issue includes plenty of grounds for thinking the industry could have handled this matter better.  For example, Erika K. Eckley and Roger A. McEowen review the history of the food disparagement laws, which BPI, the company responsible for LFTB, is using to sue ABC News following a feature story last year that criticized the product.  This review makes these food disparagement laws look like awful public policy, and the authors doubt BPI will succeed.

A long time-line of the history of 'pink slime,' on the Food Safety News website, recounts many low moments for this product, including a shipment of contaminated product that was the subject of an unsuccessful recall (apparently the product was sold before it could be recovered) and an occasion when the product generated complaints from food service workers because of strong ammonia smells.  Important early coverage included this article by Michael Moss at the New York Times in 2009.

The Council on Food, Agriculture, and Resource Economics (C-FARE), an AAEA outreach organization (for which I am a board member), is jointly sponsoring a media event and discussion on February 15 with the Federation of Animal Science Societies.

FDA urged to make public information about antibiotic use

The Johns Hopkins Center for a Livable Future and the Government Accountability Project have spent a couple years asking the Food and Drug Administration (FDA) to release information about the amount of antibiotic use in farm animals.  Overuse of antibiotics in farm animals may lead to the evolution of more dangerous drug-resistant strains.

FDA releases some summary data each year, but denied the request for more detailed tabulations,citing an exemption in freedom-of-information law that applies to commercial information and trade secrets.  This seems wrong.  Misuse of antibiotics is an important public health issue, and the aggregated data requested were not firm-specific.

In response, the Center for a Livable Future and the Government Accountability Project brought a lawsuit this month.  The Center's director Robert Lawrence explains this week:

Since 2008, when the Animal Drug User Fee Act (ADUFA) began requiring drug companies to report basic information about antibiotic sales to FDA, the agency has released limited summaries of these data to the public. Sadly, though, the FDA conceals most of what gets reported by the drug companies. This concealment protects the producers and the drug companies, both of which make tidy profits from injudicious dosing of food animals.

In the meantime, the Center's staff has done some clever sleuthing, exploiting a glitch in FDA's annual release of summary data, which was followed by a correction to the agency's numbers.  The Center tracked down the source of the change in order to conjecture about the amount of antibiotics used in one particular category called arsenicals.

FDA is missing deadlines for implementation of complex food safety rules

The Food and Drug Administration (FDA) has been missing the implementation deadlines that Congress set in 2009 as part of the landmark FDA Food Safety Modernization Act (FSMA). 

Food safety advocates have sued the agency because of the delays.  In a legal motion to dismiss (.pdf) filed today, FDA argues that the courts should not hold the agency liable for this failure to implement the law:

The sole remedy available for an unreasonable agency delay claim is for the court to compel agency action, such as by issuing an order requiring the agency to act, without directing the substantive content of the decision....  Although FDA has been unable to meet the aggressive statutory timelines for the seven new rules, there is no indication that Congress believed that strict adherence to those timetables is more important than careful consideration and development of these complex regulations to create an effective and modernized food safety system, provide clear guidance to the industry, and minimize later challenges or revisions to hastily adopted regulations. Accordingly, judicial intervention is not warranted at this time.

There is a certain sad logic to this argument! The courts should mind their own business, because the only possible punishment is to order the very same achievements that FDA already is failing to achieve.

I considered disputing FDA's claim about there being "no indication" of Congressional intentions for adherence to timetables.  After all, Congress did write these timetables into law.  On the other hand, Congress has not given FDA sufficient funding to meet all of its food safety objectives in the past year, and of course the next year looks even more bleak.  Although food safety advocates are unimpressed with the agency's excuses, FDA really does seem justified in implying that Congress has sent mixed signals about prioritizing food safety implementation.

I think we'll just have to be patient ... and go easy on the peanut butter.

Pretty much everything you read about cancer from authoritative sources is likely to be worth taking seriously

Here is my paraphrase of the most important results from a study by Schoenfeld and Ioannidis in the current issue of the American Journal of Clinical Nutrition:

• Meta-analyses do fairly well at correctly stating their conclusions.  Meta-analyses are quantitative literature reviews that combine results from across studies, essentially increasing the sample size and breadth.
• For example, Schoenfeld and Ioannadis looked at 9 meta-analyses showing an association between consuming particular foods (I think of foods such as fruits and vegetables) and reduced risk of cancer. For all 9, the results were statistically significant at conventional levels (p<.05).
• Schoenfeld and Ioannadis looked at 4 meta-analyses showing an association between consuming particular foods (I think of foods such as processed meats) and increased risk of cancer.  For 3 of the 4, the results were statistically significant at conventional levels (p<.05).
• While the meta-analyses did well at reporting results, individual studies sometimes report results in their abstracts even when they were not statistically significant.  Some of these reported results may be attributed to random happenstance rather than real cancer effects. This is why it is unwise to change eating habits with every new study.  It is wiser to rely on the balance of scientific evidence connecting particular foods to cancer risks and benefits.

Based on these results, you may be interested in the excellent collections of meta-analyses and systematic literature reviews available from a well-respected source such as the World Cancer Research Fund and the American Institute of Cancer Research. The new paper by Schoenfeld and Ioannadis reflects fairly well on the type of research posted by the WCRF and AICR.

But, journalists will report the conclusions of the new study to say something completely different from the above.  In the endless search for novelty, journalists write each day that everything you previously believed about diet and health is mistaken.

For example, Sarah Kliff at the Washington Post's Wonkblog writes today under the headline: "Pretty much everything you eat is associated with cancer. Don’t worry about it." 

Food industry public relations folks will love this message.

To make things worse, Kliff garbles the statistical material (see the comments to the Wonkblog post):

Don’t panic yet, though: The vast majority of those studies, Schoenfeld and Ioannidis found, showed really weak associations between the ingredient at hand and cancer risk. A full 80 percent of the studies had shown statistical relationships that were “weak or nominally significant,” as measured by the study’s P-values.

This description seems to ignore the meta-analyses and also it seems to describe perfectly fine statistically significant results (p<.05) as if they were "weak or nominally significant."

Perhaps the authors share some of the responsibility.  Kliff quotes the author:

“I was constantly amazed at how often claims about associations of specific foods with cancer were made, so I wanted to examine systematically the phenomenon,” e-mails study author John Ioannidis ”I suspected that much of this literature must be wrong. What we see is that almost everything is claimed to be associated with cancer, and a large portion of these claims seem to be wrong indeed.”

As with climate change skepticism, people twist genuine heterogeneity in scientific results to cast doubt on both marginal claims and widely accepted claims alike.  I wish that neither journalists nor authors would cavalierly say that most of the literature is wrong, when even the new study shows quite trustworthy results for the authoritative meta-analyses that actually merit attention from the public.

Just for example, the balance of scientific evidence from WCRF and AICR suggests that fruits and vegetables reduce risk and that red meats and processed meats increase risks of certain cancers.  Such conclusions based on meta-analyses fare well in the new AJCN study.

New data from USDA about international food safety audits

USDA's Food Safety Inspection Service (FSIS) this week began posting more information than ever before about foreign food safety audits.

Helena Bottemiller at Food Safety News, who had been pressing for greater transparency, reports today that USDA has been conducting fewer of these audits in recent years:

During the Bush administration, in-country audits generally happened annually, but, according to data provided to Food Safety News by FSIS earlier this month (which were posted online Wednesday), the number of in-country audits has dropped dramatically under the Obama administration.

Online documents show that from 2001 to 2008 FSIS inspectors were routinely evaluating, in-person, the foreign plants processing meat for American consumers. The number of countries audited annually, with only one exception (in 2006 there was a large drop in audits), was between 25 and 32, so FSIS was auditing an average of 26.4 countries per year. From 2009 to 2012, however, the number of countries audited annually dropped to between 3 and 20, so FSIS was auditing an average of 9.8 countries per year.

Food Safety News has released an interactive illustration of the data.  Hover over a particular year to see the countries audited that year.

Powered by Tableau

Three views of ractopamine in pigs

Helena Bottemiller this week writes a thorough summary of the international trade controversies over U.S. exports of pork from pigs that have been treated with the growth promoter ractopamine hydrochloride.  This animal drug is allowed under U.S. rules, but banned in many other countries, so U.S. trade negotiators have been pressing hard to get other countries to relent and allow small residues of the drug in imported pork.

Bottemiller describes the history of testing by the drug's manufacturer, Elanco, in terms that could leave a reader quite concerned:

The FDA ruled that ractopamine was safe and approved it for pigs in 1999, for cattle in 2003 and turkeys in 2008. As with many drugs, the approval process relied on safety studies conducted by the drug-maker — studies that lie at the heart of the current trade dispute.

Elanco mainly tested animals — mice, rats, monkeys and dogs — to judge how much ractopamine could be safely consumed. Only one human study was used in the safety assessment by Elanco, and among the six healthy young men who participated, one was removed because his heart began racing and pounding abnormally, according to a detailed evaluation of the study by European food safety officials.

When Elanco studied the drug in pigs for its effectiveness, it reported that “no adverse effects were observed for any treatments.” But within a few years of Paylean’s approval, the company received hundreds of reports of sickened pigs from farmers and veterinarians, according to records from the FDA’s Center for Veterinary Medicine.

USDA meat inspectors also reported an increase in the number of “downer pigs” — lame animals unable to walk — in slaughter plants. As a result of the high number of adverse reactions, the FDA requested Elanco add a warning label to the drug, and it did so in 2002.

The company also received a warning letter from the FDA that year for failing to disclose all data about the safety and effectiveness of the drug.

Some of the research literature is available on the USDA website, including this 2003 article by Marchant and colleagues, which indicates why there might be concern.

We found that there were differences in 24h behavioral time budgets, with the ractopamine-fed pigs being more active and alert and taking longer to lie down after being disturbed. However, these differences were only apparent during the first 2 weeks. In contrast, ractopamine pigs remained more difficult to handle over the entire 4-week period. At the end of the 4-week period, they also had higher heart rates than control-fed pigs and higher levels of circulating stress hormones.

We conclude therefore, that feeding ractopamine to pigs does affect behavior and physiology. Pigs that are more difficult to move are more likely to be subjected to rough handling and increased stress during transportation, implying reduced welfare, increased workload for the handlers and, potentially, poorer meat quality. However, for this conclusion to be applicable to the finishing pig population in general, other genetic lines should be tested.

I have been spending some time recently thinking about what makes many Wikipedia articles excellent, and also about the limitations of the free encyclopedia approach. Interestingly, the Wikipedia article on ractopamine is highly technical, as if written by an animal science expert, and generally downplays the safety concern. Although the Wikipedia article includes the Bottemiller article as one recent reference, its summary of the animal safety issue seems to contrast both with her article and with the Marchant article cited above. Here is the section in full:

Target animal safety

Ractopamine is safe for finishing pigs heavier than 240 pounds when administered in the diet at concentrations up to 10 ppm and fed for up to 35 days. However, there was an increase in the number of ractopamine hydrochloride-treated animals exhibiting signs of injury during the final drive to slaughter. (FDA)

I suppose the second sentence captures the animal health issues sufficiently? Of course, the great thing about Wikipedia is that articles are constantly changing and commonly improving.

NYC shares restaurant inspection information online

New York City last year introduced an online data utility that provides great detail about health inspections of restaurants. The application cleverly combines Google Maps with data from health inspector reports.

It has always been the case that health inspectors could shut down restaurants that failed to meet a certain threshold for adequate hygiene.  The most distinctive thing about this "report card" approach is that it provides consumers with greater information about inspections that found some problems, but not enough problems to shut down the restaurant.  In economic terms, this approach remedies an "information asymmetry," in which the consumer lacks some key information about food production practices. 

Perhaps the most interesting thing to do on this site is to visit "advanced search" and then browse the worst-scoring restaurants that were not shut down.  For example, the restaurant "La Trattoria" in the screen shot below was not closed.  Here are the recorded violations:

Violations recorded in the following area (s) and a Notice of Violation issued at the reinspection conducted on 09/02/2011.

Tip! "Critical" violations are displayed in red.

Violation points: 79 Sanitary Violations 1) Hot food item not held at or above 140º F. 2) Appropriately scaled metal stem-type thermometer or thermocouple not provided or used to evaluate temperatures of potentially hazardous foods during cooking, cooling, reheating and holding. 3) Evidence of mice or live mice present in facility's food and/or non-food areas. 4) Hand washing facility not provided in or near food preparation area and toilet room. Hot and cold running water at adequate pressure to enable cleanliness of employees not provided at facility. Soap and an acceptable hand-drying device not provided. 5) Toilet facility not provided for employees or for patrons when required. 6) Food not protected from potential source of contamination during storage, preparation, transportation, display or service. 7) Food contact surface not properly washed, rinsed and sanitized after each use and following any activity when contamination may have occurred. 8) Facility not vermin proof. Harborage or conditions conducive to attracting vermin to the premises and/or allowing vermin to exist. 9) Accurate thermometer not provided in refrigerated or hot holding equipment.

New York's effort is the latest in a series of similar innovations around the country.  In the past, we described similar but lower-tech health inspection report cards in Los Angeles.