If You Try To Eat, I’ll Tax Your Meat – Antibiotic Resistance, As Sung By The Beatles?

“If you drive a car, I’ll tax the street; if you try to eat, I’ll tax your meat…” Apologies to The Beatles for flagrant misuse of “The Taxman” lyrics, yet as reported in The Conversation based on this study, taxing conventionally-produced meat* is the newest solution proposed to tackle antibiotic resistance.

At first glance, the premise seems like a logical solution. If somebody’s individual choice confers a societal cost, e.g. person A’s decision to eat meat raised in a system where antibiotics are used increases the risk that person B will incur negative health consequences because drugs do not effectively treat bacterial infection, then it is logical to suggest that person A should be morally responsible for that economic cost. Taxing conventionally-produced meat and using the tax to fund research into alternative treatments therefore appears to make sense.

However, the first and most obvious issue arising from this premise is that we have not yet been able to accurately quantify the comparative impacts of humans, companion animals and livestock on antibiotic resistance. Indeed, a recent paper in Royal Society Open Science concluded that curtailing antibiotic use in livestock would have little impact on the level of resistance in humans. Therefore, although there is consensus that shared-class antibiotics (those used in both human and animal medicine) should be phased out of livestock production and that any reduction in antibiotic use can potentially have mitigating effects, we cannot state with any degree of certainty the relative impacts of completing (or, more seriously, not completing) one course of human antibiotics, compared to treating a bacterial infection in a cat or using antibiotics to treat a lame cow.

The study authors suggest that people who buy conventionally-raised meat are morally responsible for antibiotic resistance. This is rather a stretch, especially given the knowledge gaps around human/companion animal/livestock impacts described above. Does this mean that children treated for throat or ear infections are morally responsible for cases of antibiotic-resistant Staphylococcus aureus in elderly people? Tax those toddlers immediately! 

The tax mechanism has not been implemented elsewhere, at least not in the UK under the National Health Service. For example, patients who are morbidly obese or contract lifestyle-related diseases (e.g. smokers with lung cancer) do not pay a greater economic cost towards healthcare than those who have breast cancer or require a hip transplant. Without a precedent for this type of action, the hypothesis remains entirely theoretical.

Although dairy consumption is relatively inflexible with regards to economic cost, taxing meat has been shown to cut consumption. Placing a tax upon conventionally-produced meat would therefore not necessarily generate the billions of pounds required to develop new drugs or treatments. Cutting consumption might reduce antibiotic use simply as a consequence of fewer animals being raised, but also penalises those people who have lower incomes – should they be forced to forgo meat simply because they cannot afford it? If ethical and moral responsibilities are the major issue, how do we justify removing high-quality protein that demonstrably improves cognitive development and scholastic achievement  from the diets of growing children, particularly those in developing countries where animal protein consumption is already significantly below nutritional targets?


There is no realistic all-or-nothing solution to antibiotic resistance. Demanding that all antibiotics used in livestock production are banned instantly is not a viable solution on a national nor a global basis, nor is continuing with present levels of antibiotic use. However, the paper’s authors underestimate the potential for improvements in disease surveillance and livestock management to cut antibiotic use, without incurring additional costs to the producer. Building upon existing initiatives by groups including RUMA,  NOAH, academics at the University of Bristol, and animal health companies; and working with farmers to discover, disseminate and adopt practices that allow antibiotic use to be reduced or eliminated while maintaining and improving livestock health and welfare is essential for ensuring human, animal and food safety, and can be achieved without putting food security at risk.

*The Conversation refers to “meat that contains antibiotics” several times. This is a misnomer that really needs to be addressed as strict withdrawal periods exist for antibiotics used in livestock production to ensure that residues are not present in either milk or meat.

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Got Ebola? Just Take Some Vitamin C.

Ebola

It appears that the lunatics are taking over the asylum. This is another post about “things that irritate me” – just a short rant this time about bad science and fear-mongering. The current irritant is the Alliance for Natural Health (ANH; as publicized by the Organic Consumers Association), which claims that Ebola can be prevented and treated naturally, but that these remedies are being (gasp!) “ignored by doctors and the government”.

If you’re really concerned that you may catch Ebola, the easiest way to avoid it is not to have intimate contact with an infected person’s bodily fluids; but never fear, if you do, the ANH have a list of “proven” natural remedies that will stop Ebola dead in its tracks. For example, Ebola is selenium-dependant, making people who’re already selenium-deficient more vulnerable to the disease, so if you just load up with mega-doses of selenium, you’ll be fine. Equally, both silver and vitamin C are antiviral, so add these to your selenium cocktail and you won’t just be fine, you’ll be invincible!

There’s just one problem – none of these miracle remedies have actually been tested against Ebola, which ANH claim is because of government/big drug conspiracies. It’s true that increasing your intake of selenium and vitamins C, D and E should boost your immune system to a degree, but you can’t then have a long smooch with somebody who’s infected with Ebola and expect to be immune. More importantly, given the ANH’s claims of natural “treatment”, there is zero evidence that any of these purported remedies provide a cure.

Most worrying of all is the final tagline: “Alert! Write to both FDA and Congress. Ask them to review natural treatments for Ebola without the lengthy drug approval process“. This lengthy drug approval process exists to ensure that drugs are safe, efficacious and do not cause unexpected or severe side-effects. It costs drug companies millions of dollars to get a single drug to market through this process, which is required for every new drug in order to protect our health. Furthermore, “natural” chemicals are not safe or effective simply because they exist in nature. Arsenic, cyanide and mercury are all inherently natural, as are deadly nightshade and death cap mushrooms. The “action alert” above is an example of bad science and fear-mongering at its worst – a dangerous remedy that will do nothing to halt the spread of the disease – and will probably hasten the patient’s death in the process.

One In Five Children Who Contract Diphtheria Die – Are Anti-Vaccination Activists Dangerous, Or Simply Misinformed?

vaccine1I had the pleasure of speaking in the plenary session at the 2014 AAVLD/USAHA Annual Meeting this week, where, among other topics, we discussed risk. One of the other panelists made the best point that I’ve heard in a long time – activists hate denominators.

Think about the last few scare stories you’ve seen – there’s no doubt that it is frightening to read that 3,000 people die from food poisoning each year, or that, to date, 4,546 people have died from Ebola (one in the USA). Yet if we put this into context, one person out of 315 million in the USA dying from Ebola is a tiny tiny fraction, and a correspondingly tiny risk.

Activists hate denominators because they provide us with context, a way to assess whether we’re really in danger. Statistically speaking, you’re  more likely to die from a traffic accident (one in 71 deaths), flu (one in 1,642 deaths), or syphilis (one in 55,866 deaths) than Ebola (one in 2,515,458 deaths). Which brings me to my current favorite activist, anti-vaccine zealot and proponent of “well-researched” bad science, Modern Alternative Mama (MAM). Thus week, she’s been promoting what she optimistically calls a “risk:benefit analysis” of the DTaP (diphtheria, tetanus and pertussis) vaccine.

Interestingly, she appears to consider all vaccine risks equal: death is no more of a minor inconvenience than redness at an injection site, and she earnestly notes that there is “no known benefit to getting diphtheria“. That sentence alone causes the mind to boggle. On a positive note, she does use valid CDC data, reporting that there were 3,169 adverse effects attributed to DTaP in 2011, which she claims is an underestimate of up to 9-fold.

So let’s run the numbers. Each year, approximately 3.95 million babies are born, of which 82.5% are given the DTaP vaccine. Between birth and 6 years of age, 5 doses of DTaP are recommended, so each year, 5 x 3.95 million x 82.5% = 16,293,750 doses are given (note that babies will have three each in that year, but older children (18 months and 4-6 years) will also receive a dose). Let’s give MAM the benefit of the doubt and assume adverse vaccine events are actually 5x the cited CDC number, at 15,845 events. The CDC classifies 10% of these events as “serious”, which equals 1,585 serious events per year.

So what is your child’s chance of having a serious reaction to the DTaP vaccine? 1,585/16,293,750 = 0.0000973, or one in 10,277 children will have a serious reaction to DTaP.

By contrast, we could take our chances in not vaccinating and hope that our child doesn’t contract diphtheria, which carries a risk of death of up to 20% in children under five years old. That means one in five children who contract diphtheria will die.

Given MAM’s antagonism towards vaccines, it’s not altogether surprising that she concludes “Although diphtheria is serious, it appears that the risk from the vaccine is much greater.” Yet let’s be realistic about this. One in 10,277 children will have a serious reaction to DTaP (serious reactions does not mean death, although that is one possible outcome) versus one in five children who will die after contracting diphtheria.

Admittedly that’s assuming that all unvaccinated children will get diphtheria. They won’t, but even if only 5% do, the risk is still overwhelmingly lower in the vaccine category (one in 10,277 suffering a serious reaction to the vaccine vs. one in 100 dying from diphtheria).

The site carries a disclaimer that writers are neither education professionals nor providing medical advice, yet the suggestion (by the author herself) that this is a well-researched, scientific post will no doubt cause some parents to congratulate themselves on their choice to not vaccinate.

This pseudoscientific scaremongering is dangerous, potentially lethal. All parents are concerned for their children’s health and welfare, but propounding nonsensical “risk:benefit analyses” that do not consider the denominator but simply the total adverse effects does not allow any parent to make a rational and well-considered decision. If my child is the one in 10,277 who suffers a serious DTaP vaccine reaction, I’m unlikely to care whether she is one of few or many, but at least I can make the decision whether or not to vaccinate (my answer is an overwhelming “yes”) based on risk. We all want our babies to grow up healthy and happy – in this case, it’s time to be a mainstream vaccinating Mama, rather than a “modern alternative” one.

Hyperbole, Hysteria, and a Sample Size of One – Where’s the Science?

IMG_9219I often describe this blog as a place where I write about things that irritate me. Today, is a case in point. There’s a new princess of technology paranoia on the block: move over Jenny McCarthy, because Modern Alternative Mama (MAM) is out to smother your crown with homemade liver pills and tweak it off your head. Billed as “a community of supportive people and well-researched information” the site is full of useful hints and tips on how to keep your children healthy – which in this case means unvaccinated, with unbrushed teeth and breast milk squirted up their noses to cure congestion. I wish this were my hyperbole – it’s not.

One of the common themes in the litany of anti-vaccination posts is the fact that vaccine scientists need funding to do experiments  (gasp!) and that such funding comes from companies that manufacture vaccines (gasp!). Obviously these scientists are the epitome of corporate shilldom and would sell their first-born child for a microscope and box of latex gloves. Best not to trust their pesky peer-reviewed science.

Don’t worry though, MAM is here to do the research for you and write about in a balanced and fair way. This translates roughly as: “Science (pesky corporate shills) shows there is no harmful effect of X, but if you allow the dastardly medical profession to force it on your defenseless bundle of joy they have a 756% increased risk of <insert scary disease here>, will be in therapy (blaming YOU) till they’re 45, and will never pass third-grade algebra. Oh, and did we mention that X has been linked to leukemia/childhood obesity/autism/type II diabetes/ADD/teenage pregnancy/atheism/voting Republican (delete as appropriate)“. They helpfully highlight the scary messages on the website in bold, so that you don’t miss them.

As with so many anti-technology sites, science is the enemy…unless it’s happy touchy feely science that backs up whatever theory is being propounded this week. Which is why it’s so funny to see them reporting that Baltic amber necklaces “really work” for preventing teething issues in babies.

One of the bloggers was sent a necklace by an amber company. She put it on her baby at 3 months of age (too early to teethe). 5 months and 5 teeth later  – no loss of sleep, no cranky baby, no teething problems whatsoever. Hooray! It’s a miracle! In her words: “Baltic amber is a win!” For the moment, let’s gloss over the fact that the necklace was provided free of charge and that the blogger was compensated for her post (ahem, Baltic amber shill).

So let me compare this to my experience. My baby is now 8.5 months old and also has 5 teeth. We’ve had no loss of sleep, no crankiness, no problems whatsoever with teething….and no amber necklace! Hooray! It’s a miracle! Wearing stripy Rainbow Brite-style leggings and pointing excitedly at next door’s dog (my daughter’s current favorite activity) are a win! Or maybe it’s the cucumber that she often eats for dinner! Or the fact that she can see the mountains from her crib! Or… some babies just teethe better than others.

Billions of children have been given vaccines that prevent disease with no ill-effects whatsoever, which the anti-vaccination activists appear to consider irrelevant. Yet one child given an amber necklace, with no control group or latin-square experimental design to test it’s efficacy – it’s a win! Baltic amber works! For goodness sake, try and be consistent MAM – you wouldn’t consider a sample size of one (my daughter for example, who has experienced no adverse effects from vaccines to date) to be proof that vaccines are ok – why do it with other issues that affect children’s health and wellbeing?

I’m not suggesting that teething pain is on the same scale of importance as the provision of vaccines, but let’s be realistic. If you’re going to this site (or others like it) for unbiased, sound information about vaccines or child health, just take a look at the other posts and products that are being promoted. Would I take cardiac advice from a surgeon who offered me three leeches and a tincture of wormwood to cure cancer*? No – and neither should you.

*Or eating tumeric and avoiding wearing a bra to avoid getting breast cancer, as MAM suggests

Is Our Modern, Chemical-Laden, Twinkie-Guzzling Lifestyle Killing Us?

Burger4How often do we hear that we’re so much more unhealthy than our ancestors? That our modern chemical-laden diet is responsible for the fact that in 2010, the top three causes of death were heart disease, cancer and chronic airways disease? That if we only ate like our ancestors did (if you can’t pronounce it, it shouldn’t be in your food…) we’d have the secret to eternal life?

Let’s take a trip back to 1900 – the US contained 70 million US inhabitants, McKinley was president, and the first Hershey bar was introduced. Life was so much simpler without those pesky whipper-snapper millenials on social media and everybody lived till they were 95, passing with a smile on their face surrounded by their 17 children…or did they?

It’s a beautiful image – and an absolute fallacy. Life expectancy at birth in 1900 was 47.3 years. To put that into context, Michelle Obama, Keanu Reeves and Elle McPherson would already be dead, and Julia Roberts, Matt LeBlanc and Will Ferrell would be enjoying their final days of celebrity life. The low life expectancy was skewed by the high rates of infant mortality in 1900 – premature birth was the #11 most-common cause of death and up to 10% of infants died before their first birthday. Any child that made it past 5 years old had a pretty good chance of surviving – as long as disease didn’t set in – the top three killers in 1900 were pneumonia/flu, tuberculosis and heart disease.

Hold on… heart disease? Surely that’s a consequence of our modern, slothful, twinkie-guzzling lifestyle? Let’s move on to 1950, when most food was still organic, high-fructose corn syrup hadn’t yet been invented and the majority of beef and dairy cattle were grazed on pasture. Top three killers: heart disease, cancer, stroke.

There’s a reason why Mark Twain’s saying “lies, damned lies and statistics” gets quoted so often. In this case, the data is true. However, when we look at the statistics, i.e. the % of people killed by heart disease or cancer, those have indeed gone up. Why? Because very few people die of pneumonia, flu or TB. If we express something on a percentage basis, a decline in one factor means an increase in another. Simple 3rd-grade math. I hate to point out the obvious, but we’re all going to die – and there will always be a cause.

Many enthusiasts for the “Paleo” diet like to suggest that it must be a healthy lifestyle, because the average lifespan for our ancestors was the same as it is now – providing that they didn’t die in accidents, war or from infection. Way to go for those few ancestors who stayed in their cave and didn’t get attacked by a wildebeest! All that actually suggests is that a human body has a genetic potential for life of 75-80 years. Europeans who died from the Black Death in 1348-1350 weren’t genetically programmed to live shorter lives, they were just unlucky enough to run up against the microorganism Yersinia pestis. We can’t eliminate specific causes of death that don’t suit our theory to “show” that one lifestyle is more healthy than other – everything that we do, every single day will have some positive or negative effect on our eventual lifespan.

We’re lucky enough to live in a society where we have effective sanitation, a wide variety of nutritional choices, antibiotics, vaccines, x-rays and prenatal vitamins. In the US, nowadays only 6 babies die per 1,000 births compared to ~100 per 1,000 births in 1900. Average life expectancy is 78.1 years. If I were to follow the activist “correlation = causation” logic I could point out that in the past 114 years we’ve seen the introduction of cell phones; nuclear bombs; GMO-crops; rbST for dairy cattle; implants and antibiotics for beef cattle; and corn-fed beef… so these technologies must make us live longer!! Hooray!! Instead, I’ll just be thankful that I will be giving birth within the next week in a world where we have a safe, effective food supply and that my baby will have a far better chance of surviving than her great-grandparents did. Thank goodness for technology.

Scare Tactics – Why Do So Many “Public Health Experts” Promote Fear vs. Food?

pork chop 1How many of us are motivated by fear every single day? We’d like to think that we’re lucky enough to live in a society where we don’t feel afraid. In contrast to inhabitants of many war-torn regions we are unlikely to be shot as we drive to work; when we’re sick we have the luxury of modern medical attention (Obamacare not withstanding); and we can buy almost any food we fancy, at any time of year and feel safe in our food choices… or can we?

Food safety is an underlying assumption of dietary choice within the USA. We buy food based on three major factors: taste, price and nutrition. Safety isn’t a defining factor in choosing between the cheese quesadilla, the chef’s salad or the T-bone steak because most of us have rarely experienced significant negative health effects as a consequence of food choice (aside from the annual Thanksgiving food coma).

Yet so many food commentators, self-proclaimed experts (I read Michael Pollan therefore I am…) or bloggers appear to exist for the sole purpose of instilling consumer fear. Take this recent article in Salon – 9 reasons why we should fear eating steak – apparently it’s riddled with antibiotics, full of heavy metals and likely to give us all mad cow disease. I’m not going to turn this blog post into a thesis, so today will simply address one of the issues raised in the article, and examine the others in future posts.

I’m a scientist by training. In my career to date, I’ve learned that the more controversial the topic, the more important it is to base claims on sound data that is peer-reviewed and published in order to gain trust. If I present data that challenges perceptions, the first questions are always “Is this published in a peer-reviewed journal? Who funded it? How do I know it’s correct?” That is not to say that science is the only way to communicate – it’s not. Yet when making claims, it’s important to have science, or at least logical and biologically-feasible arguments, to back them up.

Yet, if we’re asking a question, even if it’s a loaded question that may instill fear or doubt into the reader, apparently scientific foundation is redundant. Could combining coffee and bagels in the same meal cause impotence? Is breast cancer caused by the rise in popularity of household pets sleeping on their owners’ beds? Is your tiredness really the result of too little sleep, or could it be all the chemicals that “big food” uses every single day? Hey, I’m just asking! Not making a claim, not saying that X + Y = Z, just throwing the thoughts out there. But having read them, how many of us now are thinking about our sexual performance, the potential ill-effects of Fluffy the cat, or how we really do seem to be more tired nowadays? (note that these really are examples that I have invented, I know of no scientific foundation for any of them).

Possibly the most damaging line in the Salon article contained no data. No scientific foundation. Just a question:

Could Ractopamine, added to the food supply in 1997 with little public awareness1, be contributing to skyrocketing rates of obesity and hyperactivity in children?

The FDA approved the use of Ractopamine in swine in 1999. It’s added to the diet of finishing pigs, improving feed efficiency and partitioning more feed nutrients into lean meat rather than fat (as demanded by today’s consumer). Effectively it allows us to produce more pork using fewer resources, but it has been linked to behavioral changes in pigs.

Most of us are aware that childhood obesity is a huge issue (pardon the pun). Many of us know children that have been diagnosed as having attention deficit hyperactivity disorder (ADHD). So does Ractopamine cause these? It’s as likely as suggesting that eating alfalfa hay is going to make us lactate like dairy cows.

Maximum residue limits (MRLs) exist to make sure that there are no human physiological effects of veterinary drugs in meat, milk or eggs from treated animals. Regulatory bodies including CODEX assess potential human effects of a drug residue in animal products by multiplying the average residue level in food by the average intake. For example, if the residue level is 2 micrograms per 100 grams and the average person eats 300 grams of that food each day, the intake would be 6 micrograms. This intake is then compared to the acceptable daily intake (ADI) – the quantity that could be eaten every day for a lifetime without human health risk. This is usually the intake that would have a physiological effect, divided by a safety factor of one hundred. The MRL for Ractopamine in meat is 0.25 parts per million (0.00000025 grams per gram) with an ADI of 1.25 micrograms per kg of bodyweight per day.

If we examine the average pork intake for a 10 year old child in the USA (detailed calculation below) we see that they’d have to eat 13.3x more pork than the daily average to even equal the ADI – remember that’s the intake at which we would expect no physiological effect. For Ractopamine to have a physiological effect, the ADI would have to be increased one-hundred-fold. So the average 10-year old child would have to eat 1,330x more than the average child’s intake of pork, equivalent to 35 lbs of pork per day, every single day (the average adult only eats 48 lbs of pork in a year), for Ractopamine to have a health effect. My little nieces adore pork sausages, but they are pushed to eat two (approx 2 oz) in a day, let alone 35 lbs worth!

Still think that we can link Ractopamine use to obesity and ADHD? We can’t prove a negative, but it’s as tenuous a link as suggesting that we could drown in a single drop of water. So why are public health “experts” like Martha Rosenberg using fear tactics to scare us rather than extolling the positive contributions that high-quality animal proteins make to the human diet? Surely there’s no agenda there….is there?

1Note that all the data relating to this is freely-available on the internet – the “little public awareness” line is simply more fear-mongering.

Details of Ractopamine calculation

Let’s examine an average child’s intake. The average 10-year-old boy in the USA weighs 32 kg (71 lbs) and needs 34 grams of protein each day. In the USA, meat contributes about 40% of protein intake and about 21% of that comes from pork. That means, on average, a 10-year-old boy would eat about 12 g of pork per day (2.9 g protein).

If Taylor eats 12 g of pork each day at the maximum residue limit of Ractopamine (note that this would be unusually high), he’s consuming 12 g x 0.25/1,000,000 = 0.000003 g Ractopamine. His ADI = 1.25 micrograms x 32 kg bodyweight = 40 micrograms, or 0.00004 grams. That’s 13.3x higher than his intake. So a child could eat 13.3x more pork than average, every single day, and not be expected to have any physiological effects. For ingested Ractopamine to have a physiological effect he would have to eat 100 times that amount – 16 kg, or 35 lbs of pork per day. To put that into context, the average adult eats 48 lbs of pork in a year.