Resources: Articles

Covering use of antibiotics in medicine and agriculture Date: 09/15/17

By Bara Vaida

Overuse and misuse of antibiotics in medicine and agriculture has led to a rise in the number of people infected with antibiotic resistant bacteria. In the U.S., about 2 million people annually are sickened by antibiotic resistance and 23,000 of them die. If nothing changes, more than 10 million people globally could die from antibiotic resistance bugs in 2050.

Award-winning journalist and AHCJ board member Maryn McKenna digs deep into this frightening trend with her new book “Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats.

In the following Q & A, McKenna explains her reporting and writing process for the book, published on Sept. 12.

Q: What led you to begin reporting on this book? How did it come about?

Maryn McKenna

A: This is my third book. I went freelance about 10 years ago [after working for many years as a staff writer at the Atlanta Journal-Constitution] and I felt that I needed to do something big to establish myself in the freelance marketplace, so I wrote [my second book] “Superbug” to describe the expansion of antibiotic resistance by telling the story of MRSA [methicillin-resistant staphylococcus aureus]… and [as I worked on that book] I learned that we give antibiotics not only to cure people but to promote animals putting on weight. Four times as many antibiotics go into livestock as people in the United States. That was stunning to me…. That was counterintuitive to me, so that is why I started working on this book. I wanted to understand everything about what I was hearing about the connection between antibiotic resistance [and farming].

Q: What was the most surprising thing that you learned?

A: Most of the antibiotics that are given to animals are not for therapeutic uses. There is a role, of course, for using antibiotics to make sick animals well. No one critiques that. It just happens that is a small portion of antibiotic use. Most of it is non-therapeutic and consumed by animals [in food] and it goes through their digestive system and ends up in their guts where … the bacteria becomes resistant because of exposure in animals’ guts. The animals are destined to be killed and some of that [antibiotic resistant bacteria] ends up on the meat and then in the home or restaurant kitchen. Or, while the animal is alive, the [antibiotic-resistant] bacteria passed out of the animals in their manure, and into the  ...lagoons maintained on pig farms, or the wood shavings and feathers raked out of chicken houses. And then it ends up spread onto fields, or washed off into storm water or carried off by the wind. The antibiotic resistant bacteria can also be carried off by insects, or on the clothing and skin of farm workers, who bring it into their homes.

Q: How long did it take you to write the book?

Maryn McKenna

A: It took four years to do this book, which wasn’t what I had planned. I signed the contract for the book in the summer of 2013 and I thought it would be an exposé that nothing had been done on this [by U.S. government officials]. I could see a clear narrative of how the European and Scandinavian governments were working on this and how America was doing it wrong. Then in December 2013, the U.S. Food and Drug Administration announced its first action against agricultural antibiotics – the first since 1977. So then my concept was blown up. What the story turned out to be was a chronicle of cultural change…. a portrait of all the ways reform [of agricultural antibiotic use] is happening and places where reform still has to happen. While I was writing this, a huge consumer movement arose around antibiotic use in animals, which resulted in big companies changing their minds.

Q: What was your biggest challenge reporting on this book?

A: I was constantly racing to catch up with changing news. I had to rewrite the last third of the book three times and the epilogue brings it as close to present day as I could, which is a meeting at the United Nations in September 2016. Staying up with a moving target was one end of the challenge. The other was trying to figure out what had happened at the very beginning of when antibiotics first were used in farming….it turns out there were advocates [in industry] from the very beginning who advised against the use of antibiotics in farming, but they were over-ruled. Another difficulty was trying to establish the richness of the story. I spent a ridiculous amount of time on PubMed [a free database of medical and life sciences articles and studies run by the National Library of Medicine]. I had to track down lots of old conference proceedings from the 1950’s that were only available in old book dealers’ back rooms. I spent a lot of money there.

Q: What advice would you have for someone on how to report a book like this, or a story on antibiotic resistance?

A: I wish had some fancy secret to impart, but a lot of what I try to do are “lost episodes,” historical episodes that illuminate a current situation. I am a fanatic reader of footnotes and I step my way backward through publication history until I get to the first instance of what people are talking about. That is how I found the old conference proceedings.

Q: What are some of the best resources you use regularly to cover antibiotic resistance as story?

A: I read lots of scientific journals like, Clinical Infectious Diseases, the Journal of Infectious Diseases, Environmental Health Perspectives, Emerging Infectious Diseases, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. I also regularly read the Lancet, the Lancet Infectious Diseases, Science, Nature, Infection Control and Hospital Epidemiology, Antimicrobial Agents and Chemotherapy, and the Center for Infectious Disease Research and Policy.

Q: You’ve been covering this topic for so long. Were you surprised by any particular findings?

A: A thing that was surprising, and maybe I was naive to be surprised, is how much this battle over the use of antibiotics was like the battle over tobacco. The science was clear for a long time. There wasn’t a lack of clear science. It was economic imperatives and political advantages that outweighed the science. As I moved to the modern day and looked at what people were saying who did not want antibiotic use to change, they took from the tobacco playbook. They said there wasn’t clear data, that more research was needed, when in fact more research wasn’t needed. It was better political will that was needed. Amazingly, we got that. I think one of the notable legacies of [President Barack] Obama’s administration will be that they created the first national strategy on antibiotic resistance.

Q: Might President Trump roll back the Obama administration efforts on antibiotic resistance?

A: It is clear this administration doesn’t have the same interest in the topic, but the people I talk to think agriculture and the pharma companies have committed to this and have now moved on. The moment is gone for interference. Consumers want it. People are hopeful it won’t be reversed.

Q: What other advice might you have for someone trying to write a book such a complicated topic like this?

A: I benefited from there being some nonprofits and advocacy groups who had been thinking for awhile about on how to elevate the issue, so that it would catch the attention of the average mother and father buying meat and going to the doctor. So I had people who could help me understand the complexities of this topic. I would tell reporters to find someone who knows the landscape of your topic and help you find your way through it. Find someone who has the long view, who may not be your best quote, but can be the reliable resource for background.

Q: Any advice for reporters who want to localize the story of antibiotic resistance?

A: Find a farmer. Preferably a big farm, because what they do has more significance for the market. Or someone who has come to farming from something else, because they will have fresh eyes on old practices. Or go to groups involved in the slow food movement, or go to your farmer’s markets. Go to your local infectious disease doctors and ask them about antibiotic resistant infections and foodborne illnesses.

Maryn McKenna is an independent journalist who specializes in public health, global health and food policy. She blogs for Wired and is a columnist for Scientific American and a long-form and investigative writer for Self, the Atlantic, the Guardian, Nature, and other publications in the United States, Europe and Asia.  She serves on AHCJ's Freelance Committee. You can follow her at @MarynMcK.