Farm pens and prescription pads.

Physicians and medical centers are the front lines of the battle against antibiotic resistance in infectious bacteria. Government agencies, professional organizations, and health care corporations have developed various directives and control mechanisms to help guide physicians toward prescribing practices that minimize the development and dissemination of antibiotic resistance. But as Jeffrey Ritterman, MD, points out in “Preventing Antibiotic Resistance: The Next Step,” (page 35) the quantity of antibiotics routinely administered to livestock and poultry as feed additives appears to dwarf human use. The evidence that using antibiotics as feed additives contributes significantly to the problem of antibiotic resistance in humans has been acknowledged by the major medical associations, including the American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, and dozens of others, leading them to call for an end to this practice. No economic sector is as directly affected by the challenge of antibiotic resistance as the health care sector. Physicians have taken many necessary steps to curtail unnecessary uses of antibiotics in humans, but what can they do about antibiotic practices on farms? Plenty. Doctors provide a trusted, authoritative voice to the public. Greater awareness of this misuse among physicians can translate into greater awareness and concern among their patients. And an educated, mobilized public can help counter industry denial and government inaction. Just as important is the role physicians play as leaders within medical centers and other large health care institutions. Medical centers have an impact on society that goes well beyond the health services they provide. They are universally among the largest employers in any given region: Kaiser Permanente (KP), as an example, has been the largest private sector employer in Los Angeles County for the past three years. Over the past decade, medical centers have recognized their significant role and responsibility in broader environmental and societal issues through organizations like Health Care Without Harm (HCWH) and Hospitals for a Healthy Environment (H2E). These organizations are reducing the health care industry's environmental footprint and changing markets by getting medical centers to adopt standards and purchasing policies to minimize use of toxic materials, such as mercury. With 140,000 employees, 30 medical centers and over 8 million enrolled patients, KP's actions and policies will influence the nation's economy. And among health care institutions, KP is known as a pioneering leader. KP's adoption of a purchasing policy that minimizes use of antibiotics in agriculture would help educate other hospitals, food services, and members of the public about the need to take similar steps. The adoption of purchasing policies that curtail antibiotic overuse in food animals—notably use of medically important antibiotics as feed additives—is already affecting the market. Environmental Defense has helped McDonald's (the world's largest meat purchaser), as well as Compass America and Bon Appetit (two of the nation's largest food-service companies) craft policies that restrict certain antibiotic uses in chicken. The Compass America policy also addresses the use of antibiotic feed additives in pork.2 While these policies are only first steps, they are having some real impacts. Indeed, earlier this year USA Today1 reported that several of the nation's largest chicken producers had dramatically cut their overall antibiotic use; Tyson's reported a drop of 93%. However, it's not clear to what extent similar steps have been taken throughout the chicken industry, and there is still much to be done in reducing antibiotic use in pork, cattle, and other food animals. It's possible that we are approaching a tipping point on this issue, but we are not there yet. Moreover, there are no regulatory or legislative guarantees that any of the progress made so far in reducing nonessential antibiotic use will be maintained. This is why it's so important for the medical profession and the health care sector to put their money where their mouths are, so to speak, and join these major food companies in setting purchasing policies to move the market away from routine uses of antibiotics in food animals. No economic sector is as directly affected by the challenge of antibiotic resistance as the health care sector. And no other sector's action has the same authority and influence on this issue. As comedian Marty Feldman has said, “the pen is mightier than the sword and much easier to write with.” Physicians, while restraining their pens from writing unnecessary antibiotic prescriptions, should employ them to help move the food industry away from unnecessary antibiotic use in food animals.