Medical Journal Forgets Own Warning

By Steven J. Milloy
Copyright 2000 Junkscience.com
May 21, 2000

Shame on the New England Journal of Medicine. It opted to inflame rather than inform the public about the controversy surrounding the use of antibiotics in farm animals. Journal editor Marcia Angell, seems to have forgotten her own clarion call for more "scientific thinking."

Angell editorialized in June 1996, "Many people have become alienated from science and scientific habits of thought -- at a time when we need science more than ever to help us find our way through an increasing number of serious and complicated questions involving risks to health and safety."

Resistance to antibiotics possibly resulting from antibiotic use in animals is such a "serious and complicated" issue. Still, Angell permitted the Journal become "alienated from science."

A study in the Journal reported recently "evidence that antibiotic resistant strains of salmonella in the United States evolve primarily in livestock." The researchers concluded "the circulation of highly resistant strains in livestock constitutes a potential public health threat, especially to farmers, ranchers and animal handlers."

The study involved a 12-year-old Nebraska farm boy who suffered salmonella poisoning. The salmonella strain identified was resistant to a number of antibiotics including ceftriaxone, the antibiotic of choice for invasive salmonella disease.

Cattle from boy’s farm and three other local herds were tested for salmonella. The boy’s salmonella strain reportedly matched the strain of salmonella from one of the tested herds. The researchers concluded the boy’s infection was acquired from one of the herds.

The media dutifully parroted the researchers’ conclusion. "The controversial practice of giving antibiotics to cattle apparently led to the development of salmonella resistant to the antibiotic Ceftriaxone," reported Reuters. The Associated Press reported, "the Nebraska child... caught the salmonella from infected cows that apparently had been given antibiotics."

But the study has gaping holes preventing these conclusions from being reached.

The researchers could not determine how the boy became infected with salmonella. There was no evidence he consumed contaminated meat or came into contact with contaminated animal feces.

Although the salmonella strain isolated from the boy matched a strain in one herd, the match was apparently not from the family’s herd. The researchers reported the boy did not accompany his father on visits to the other herds during the two-week period before his illness. So how the boy became infected with salmonella is a mystery.

The researchers could not rule out that "unknown environmental factors" were the source of the resistant salmonella. Cattle can acquire salmonella from birds or other wildlife. There wasn’t even any evidence the cattle were treated with ceftriaxone, the antibiotic in question, or any other antibiotics.

And despite the researchers’ alarmism, cetriaxone resistance among salmonella remains low according to the National Antimicrobial Resistance Monitoring System (NARMS).

None of this prevented the researchers from pronouncing the use of antibiotics in livestock should be restricted or that such use was a public health problem.

The fault for exposing the public to this misinformation lies squarely with the New England Journal of Medicine. Studies should be peer reviewed by independent experts before publication. It is difficult to believe that was the case here.

It seems as if the study was published as a matter of convenience -- it fit neatly into an issue containing three other studies on infectious disease and an editorial titled "Emerging Infections - Another Warning."

There is no doubt infectious disease is a serious public health matter or the use of antibiotics in animals has become controversial. Alarmists at the Center for Science in the Public Interest and Public Citizen already have decided antibiotic use in animals is a public health problem. But cooler heads aren’t so sure.

The Food and Drug Administration is developing a riskbased process for evaluating the microbial safety of antibiotics drugs intended for use in livestock. But unlike the researchers in question, the media, the alarmists and the New England Journal of Medicine, the FDA is not jumping to unwarranted conclusions.

In her 1996 editorial, Angell cited as a warning Carl Sagan’s comments of his darkest vision: "It’s a foreboding I have -- maybe ill-placed -- of an America in my children’s generation or my grandchildren’s generation... when clutching our horoscopes, our critical faculties in steep decline, unable to distinguish between what’s true and what feels good, we slide almost without noticing, into superstition and darkness."

What’s to prevent Sagan’s vision from coming true if our most prestigious medical journal fails to enforce the principles of sound science?

Steven J. Milloy is an adjunct scholar at the Cato Institute and editor of Junkscience.com.