Published in the Washington Post

I began working on health policy as legislative staff in the Maryland House of Delegates in 2008. Since that time I earned a MSPH in Health Policy from the Johns Hopkins Bloomberg School of Public Health and have spent nearly a decade working to implement the Affordable Care Act so as to improve perhaps one of the most vexing and convoluted policy quagmires facing our nation today.

We need health policy experts in the Maryland House of Delegates. I'm running to serve as a public health champion in our state legislature. To that end I have analyzed recent legislation that was passed through the Maryland General Assembly that left open a wide loophole that severely hampers the statute from meeting legislative intent. That's why I wrote an op-ed on the topic, co-authored by MacArthur "Genius" Fellow Dr. Ellen Silbergeld, and why The Washington Post chose to publish it. 

Antibiotic Legislation Falls Short in Maryland

On October 1, 2017 a number of health-related bills in Maryland came into effect that have unfortunately fallen short of where we need to be. The Keep Antibiotics Effective Act of 2017 has taken a step in the right direction by attempting to limit the prophylactic use of antibiotics in livestock, fish, and poultry so as to arrest the spread of antibiotic resistant strains of bacteria and to thereby prolong the efficacy of our antibiotic drugs. Unfortunately this bill does not require confirmation of an actual disease in a herd or flock in order for the animals to be treated with antibiotics and it will therefore be ineffective at addressing the legislative intent behind this statute.

The legislation is to be commended for prohibiting the use of antibiotics in livestock, fish, and poultry to promote weight gain or to improve feed efficiency. However there is a loophole in this legislation large enough for a battleship to pass through pertaining to the prophylactic use of antibiotics based on the judgment of a veterinarian. At first blush this sounds like a reasonable approach that would balance animal welfare and productivity. Unfortunately this bill does not require confirmation and identification of an actual disease in a herd or flock in order for the animals to be treated with antibiotics.

In order to select effective treatments, it is equally important to administer the proper class of antibiotics to animals and thus prolong the effectiveness of antibiotics for subsequent use by both humans and animals.  As a result, this legislation will not be as effective in addressing the legislative intent behind this statute as it might have been had this loophole been eliminated. The World Health Organization opposes this sort of loophole since, given the crowded conditions characteristic of factory farms, it would not be too difficult for a veterinarian to conclude that every animal stands a reasonable risk of contracting a disease. This situation is analogous to how a pediatrician might conclude that every child who attends daycare should take antibiotics on a daily basis throughout childhood simply because they have an increased risk of contracting the common cold.

The most compelling argument for closing this legislative loophole is that without these changes we will continue to erode the efficacy of our limited armory of antibiotics for use in medicine.  While all uses of antibiotics contribute to the diminishment of their effectiveness, the volume of antibiotic use in food animal production is greatly accelerating, which in turn increases antibiotic resistance in bacteria that cause human disease. Humans who consume meat from animals that received prophylactic antibiotics are exposed to strains of bacteria that have evolved to survive the effects of the antibiotics administered to livestock, fish, and poultry. In effect, our demand for cheap and abundant meat has led to our careless use of prophylactic antibiotics in animals that in turn has exponentially reduced the efficacy of antibiotics for human use. The results are shocking.

Widespread antibiotic resistance has become a crisis on a global scale in urgent need of redress.  The CDC indicates that Marylanders endure a rate of healthcare-associated infections that are higher than the national baseline. We incur large costs associated with antibiotic-resistant strains of bacteria that infect hospitalized patients.  This results in extended hospital stays, increased complications, increased costs born by payers (and subsequently by all policy-holders through increased premiums), and increased loss of life. Some of the most well-known culprits, sometimes referred to as “Super Bugs,” are Methicillin-Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C. Diff). These bacteria have developed resistance to many different antibiotics.

This crisis is exacerbated by the lack of new antibiotic molecules.  This issue is recognized but it is a time consuming process to develop and test new antibiotics. While we wait for these new discoveries we need to protect the antibiotics that we have by prohibiting the administration of sub-effective and inappropriate prophylactic doses of antibiotics in industrial food animal production.

We support the actions of the Maryland legislature in developing the Keep Antibiotics Effective Act of 2017. There is much that is good in this legislation but, in failing to prevent the abuse of prophylactic antibiotic uses in livestock, fish, and poultry, we will fall short of accomplishing its intent of protecting the health of Marylanders.

Jordan Cooper has been involved with the implementation of the Affordable Care Act at the Maryland House of Delegates, Johns Hopkins Hospital, Kaiser Permanente, and in DC Medicaid. He has a master's degree in health policy from the Johns Hopkins Bloomberg School of Public Health. Ellen Silbergeld is a recipient of the MacArthur Foundation “genius grant,” the author of “Chickenizing Farms and Food,” is a special consultant to the World Health Organization Food Safety Program, and is a Professor of Environmental Health at the Johns Hopkins Bloomberg School of Public Health.