Doing what the FDA won't

I haven't written about the FDAs new voluntary relabeling of antibiotics for livestock use because I don't expect it to have much effect. It is a positive step in the sense that it acknowledges the problem of antibiotic overuse in livestock production, but that's about it.

The Netherlands tried a similar approach in the 2000s, banning the use of antibiotics as growth promoters. The "therapeutic" use of antibiotics promptly expanded to the point where overall consumption of antibiotics remained unchanged. The result for public health? Being a pig farmer classifies you as a presumptive carrier of MRSA in Dutch hospitals, which are otherwise nearly free of MRSA.

So that didn't work out so well there, and I expect the results of the FDAs action to be about the same here. The tell is that the antibiotic manufacturers are going along with it, not squealing too loudly, you might say. Thus they expect little disruption to their business model.

Ideally we might follow the lead of Denmark, which has instituted an effective ban, and had no trouble maintaining or increasing their production of pork and chicken. But that sort of edict is not likely to happen here - the political power of of rural constituencies and drug suppliers is much greater than that of public interest regulators.

Raising the cost of antibiotics would be the most effective way to ensure that they are put to the highest-value uses. A tax on antibiotics would discourage indiscriminate use. If the proceeds were rebated to producers on a per-pig basis, farmers would be incentivized to minimize use of antibiotics. In effect, the antibiotic-free producers would get a subsidy. They would be the winners, helping to split political opposition to the tax. The heavy users of antibiotics and the pharmas who manufacture and sell them would be the losers. However, given the power of the status quo in American governance, they would likely be able to block change.

Like it or not, some mechanism to preserve pharma profits will have to be found. This could come in the form of a "floor" on antibiotic prices, much like price supports for milk and other commodities. A floor would allow margins to go up as volume goes down, preserving profitability.

This sort of solution is ugly - it basically amounts to bribing farmers and pharmas to not endanger public health. But it would actually result in reduced usage of antibiotics in livestock. That's something that the FDA is unlikely to ever do on its own.

 

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