Antibiotics: call for real change.

![Figure][1] CREDIT: ALVAREZ/ISTOCKPHOTO (MODIFIED BY G. GRULLON/ SCIENCE ) In his Editorial “Time to Deal with Antibiotics” (15 November 2013, p. [777][2]), D. Kennedy mentioned our assessment of the impact of the Pew Commission on Industrial Farm Animal Production (IFAP) ([ 1 ][3]). We support his call to end the misuse of antibiotics in animal agriculture. We believe, however, that finalization of the U.S. Food and Drug Administration (FDA) guidance documents will not have a meaningful impact on the way these life-saving drugs are administered to animals; thus, they will not slow the contribution of IFAP to our rapid progression toward a postantibiotic era. These guidances—nonbinding pleas for the cooperation of drug companies—do not call for an end to the use of antimicrobials in the absence of a microbial disease or documented disease exposure, as recommended by the Commission ([ 2 ][4]). Instead, they would effectively rebrand uses currently labeled “growth promotion” as “disease prevention.” Like growth promotion, prophylactic uses entail low, subtherapeutic doses and can span much of the animal's life span. They apply continuous selective pressure for antibiotic resistance and may even induce new resistance-conferring mutations ([ 3 ][5]). Furthermore, the FDA's proposal for veterinary oversight would eliminate the federal requirement that a valid “veterinarian-client-patient relationship” exist before veterinarians order the use of antibiotics in feed, allowing veterinarians to prescribe antibiotics for use at operations they have not visited recently for administration to animals they have never seen. The head of a large drug company recently told The Wall Street Journal that the guidances will not substantially affect revenues ([ 4 ][6]), implying that minimal changes to antibiotic sales are expected. This explains why companies support voluntary limits on their products: The limits will have little practical effect. We share Kennedy's assessment of the problem, but instead would call for meaningful regulation—comparable to what he attempted as FDA commissioner almost four decades ago—to curb irresponsible antibiotic use. If such efforts fall short, legislative relief is needed. 1. [↵][7] Johns Hopkins Center for a Livable Future, Industrial Food Animal Production in America: Examining the Impact of the Pew Commission's Priority Recommendations (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2013); [www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/\_pdf/research/clf\_reports/CLF-PEW-for%20Web.pdf][8]. 2. [↵][9] Pew Commission on Industrial Farm Animal Production, Putting Meat on the Table: Industrial Farm Animal Production in America (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2008); [www.ncifap.org/_images/PCIFAPFin.pdf][10]. 3. [↵][11] 1. D. C. Love, 2. M. F. Davis, 3. A. Bassett, 4. A. Gunther, 5. K. E. Nachman , Environ. Health Perspect. 119, 279 (2011). [OpenUrl][12][PubMed][13][Web of Science][14] 4. [↵][15] 1. P. Loftus , Zoetis chief leads animal-health firm following split from Pfizer, Wall Street Journal (2013); [1]: pending:yes [2]: /lookup/doi/10.1126/science.1248056 [3]: #ref-1 [4]: #ref-2 [5]: #ref-3 [6]: #ref-4 [7]: #xref-ref-1-1 "View reference 1 in text" [8]: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/_pdf/research/clf_reports/CLF-PEW-for%20Web.pdf [9]: #xref-ref-2-1 "View reference 2 in text" [10]: http://www.ncifap.org/_images/PCIFAPFin.pdf [11]: #xref-ref-3-1 "View reference 3 in text" [12]: {openurl}?query=rft.jtitle%253DEnvironmental%2BHealth%2BPerspectives%26rft.stitle%253DEnvironmental%2BHealth%2BPerspectives%26rft.aulast%253DLove%26rft.auinit1%253DD.%2BC.%26rft.volume%253D119%26rft.issue%253D3%26rft.spage%253D279%26rft.epage%253D283%26rft.atitle%253DDose%2Bimprecision%2Band%2Bresistance%253A%2Bfree-choice%2Bmedicated%2Bfeeds%2Bin%2Bindustrial%2Bfood%2Banimal%2Bproduction%2Bin%2Bthe%2BUnited%2BStates.%26rft_id%253Dinfo%253Apmid%252F21030337%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [13]: /lookup/external-ref?access_num=21030337&link_type=MED&atom=%2Fsci%2F343%2F6167%2F136.1.atom [14]: /lookup/external-ref?access_num=000287926700013&link_type=ISI [15]: #xref-ref-4-1 "View reference 4 in text"