AVMA debates profession's role concerning antimicrobials in livestock

July 11, 2009
By: Jennifer Fiala
For The VIN News Service

Seattle — The issues range from fish tossing to ear cropping. But when it comes to controversy, two words dominate this year’s American Veterinary Medical Association (AVMA) House of Delegates agenda — antimicrobial resistance.

At the forefront was a resolution to nix seven words from a single sentence in AVMA’s Judicious Therapeutic Use of Antimicrobials Policy, which would have called for practitioner oversight every time a producer administers antimicrobials to a food-producing animal. Striking “when under the direction of a veterinarian” left the following statement: “Judicious use of antimicrobials should meet all requirements of a veterinarian-client-patient relationship” (VCPR).

At first glance, the change might appear simple. But omitting those seven words closes a big loophole in AVMA policy that gives a pass to livestock producers who buy antimicrobials from distributors and feed stores and administer them to animals, with no direction from a DVM.

The mere suggestion that there should be more veterinarian control over antimicrobials used in livestock incited hours of debate during the July 9-10 annual gathering in Seattle. That's because just beneath the suface lies one big question: Should all antimicrobials require a prescription?

So rather than vote on the resolution's merits, the House punted it, referring the topic to the Executive Board with instructions to create a task force to thoroughly study the entire Judicious Therapeutic Use of Antimicrobials Policy for a possible overhaul by next summer’s annual meeting in Atlanta.

The House’s failure to amend AVMA’s policy appeared to disappoint some, including a representative with the Food and Drug Administration’s Center for Veterinary Medicine (FDA-CVM).

“Clearly antimicrobial resistance continues to be a big public health concern and there’s general recognition that the use of antimicrobial drugs is a contributing factor driving resistance,” announced Dr. William T. Flynn, CVM’s senior advisor for science policy, before the House floor. “So from that standpoint, I think FDA feels it’s very important that veterinarians be involved in the decision-making process" when it involves the use of medically important antimicrobial drugs.

To some, that argument might seem like a no-brainer. But the issue concerning whether or not producers should be able to buy antibiotics and administer them at will is as complex as the scientific evidence published on livestock-related antimicrobial resistance. There’s pressure from the public to throttle back on the use of antibiotics in food animals and some practitioners who want to throw a blanket policy over all antimicrobial usages, stating that it must be done in accordance with oversight from a DVM.

Yet at the same time, there exists a delicate relationship between food-animal veterinarians and the industry they serve — producers who for years have relied less and less on veterinarians to care for their animals. Dr. Gatz Riddell, head of the American Association of Bovine Practitioners, stated during the meeting that if veterinarians pressured producers to go to them for scripts, their need for DVMs would become obsolete.

“By taking this out (seven words), we may be on the line,” he said. “If we begin to mandate VCPR, our relationship with industry is going to suffer. It has the opportunity to make us irrelevant to them.”

Arguing that requiring scripts for the therapeutic use of antimicrobials would be a hindrance to a profession with a dwindling number of large-animal practitioners, Riddell added: “You can’t have a veterinarian look at every animal.”

What’s more, many food-animal practitioners and some high-ranking executives within AVMA believe that science fails to back a link between antimicrobial resistance in humans and the use of such drugs in livestock. On July 8, the AVMA Executive Board voted to not lend its support to a federal bill designed to strengthen antimicrobial resistance surveillance by creating an office to study and track it within the U.S. Department of Health and Human Services.

According to Dr. Christine Hoang, assistant director of AVMA’s Scientific Activities Division, HR 2400, known as the Strategies to Address Antimicrobial Resistance Act, “has the potential to add another layer” to FDA’s already cumbersome drug-approval process and makes “inappropriate and inaccurate statements and findings, including inferences in the role of animal agriculture in antibiotic resistance.”

That stance follows congressional testimony made in June 2008 by Dr. Lyle Vogel, AVMA assistant executive vice president, in which he told lawmakers, “The AVMA Guidelines for the Judicious Therapeutic Use of Antimicobials were developed to safeguard public health by emphasizing prudent and judicious therapeutic use of antimicrobials.”

That’s an overstatement, critics say, considering that the policy only applies to those already working with a veterinarian and gives a free pass to producers.

To be clear, AVMA policies contain no legal teeth. But the resolution’s supporters, including its author, New Jersey delegate Dr. Robert Gordon, believe that a clear statement from the House would put AVMA at the forefront of a movement already underway. On Monday, a federal bill seeking to limit the use of antimicrobials in food animals is expected to go to hearing before a House committee. If passed, the Preservation of Antibiotics for Medical Treatment Act of 2009, would require the Secretary of Health & Human Services to deny new animal drug applications unless it can be demonstrated that there is a reasonable certainty of no harm to human health resulting from antimicrobial resistance. Additionally, the bill requires the withdrawal of a nontherapeutic use of such drugs in food producing animals two years after the date of enactment unless certain safety requirements are met.

“To me this resolution is nothing more than this profession having the pride to say when it comes to therapeutic use, a VCPR must be present,” Gordon said. “There may be lay people who have experience and are knowledgeable, but they have no accountability because they do not have a licenses. We’re the ones who earned that professional standing.”

Last April, the Pew Commission released a $3-million study titled Putting Meat on The Table: Industrial Farm Animal Production in America, publicized as the nation’s first in-depth, comprehensive review of U.S. agricultural practices. In it contained a recommendation to ban the non-therapeutic use of antimicrobials in animals entering the human food chain. Producer groups railed against the report, and AVMA officials have since authored a response to it, targeted for release in early August.

In the meantime, the Pew Trust is spending a fortune on ads in the D.C. area to stop antibiotic use in food animals, said Dr. John Sanders, branch chief for food defense and preparedness coordination in the Department of Homeland Security’s Office of Health Affairs.

“That’s what Congress sees,” Sanders told delegates. “We can argue among ourselves about whether we’re going to hurt industry and our profession … but we’re going to wake up and Congress is going to act by banning antibiotics altogether or making the MDs write the scripts.”

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