Caged battery hens in a chicken farm in Catania, Sicily. Photograph: Fabrizio Villa/AFP/Getty Images
Antibiotics do not create blandness, but they created the conditions that allowed chicken to be bland, allowing us to turn a skittish, active backyard bird into a fast-growing, slow-moving, docile block of protein, as muscle-bound and top-heavy as a bodybuilder in a kids cartoon. At this moment, most meat animals, across most of the planet, are raised with the assistance of doses of antibiotics on most days of their lives: 63,151 tons of antibiotics per year, about 126m pounds.
Farmers began using the drugs because antibiotics allowed animals to convert feed to tasty muscle more efficiently; when that result made it irresistible to pack more livestock into barns, antibiotics protected animals against the likelihood of disease. Those discoveries, which began with chickens, created what we choose to call industrialized agriculture, a poultry historian living in Georgia proudly wrote in 1971.
Chicken prices fell so low that it became the meat that Americans eat more than any other and the meat most likely to transmit food-borne illness, and also antibiotic resistance, the greatest slow-brewing health crisis of our time.
For most people, antibiotic resistance is a hidden epidemic unless they have the misfortune to contract an infection themselves or have a family member or friend unlucky enough to become infected.
Drug-resistant infections have no celebrity spokespeople, negligible political support and few patients organizations advocating for them. If we think of resistant infections, we imagine them as something rare, occurring to people unlike us, whoever we are: people who are in nursing homes at the end of their lives, or dealing with the drain of chronic illness, or in intensive-care units after terrible trauma. But resistant infections are a vast and common problem that occur in every part of daily life: to children in daycare, athletes playing sports, teens going for piercings, people getting healthy in the gym.
And though common, resistant bacteria are a grave threat and getting worse.
They are responsible for at least 700,000 deaths around the world each year: 23,000 in the United States, 25,000 in Europe, more than 63,000 babies in India. Beyond those deaths, bacteria that are resistant to antibiotics cause millions of illnesses 2m annually just in the United States and cost billions in healthcare spending, lost wages and lost national productivity.
It is predicted that by 2050, antibiotic resistance will cost the world $100tn and will cause a staggering 10m deaths per year.
Disease organisms have been developing defenses against the antibiotics meant to kill them for as long as antibiotics have existed. Penicillin arrived in the 1940s, and resistance to it swept the world in the 1950s.
Tetracycline arrived in 1948, and resistance was nibbling at its effectiveness before the 1950s ended. Erythromycin was discovered in 1952, and erythromycin resistance arrived in 1955. Methicillin, a lab-synthesized relative of penicillin, was developed in 1960 specifically to counter penicillin resistance, yet within a year, staph bacteria developed defenses against it as well, earning the bug the name MRSA, methicillin-resistant Staphylococcus aureus.
After MRSA, there were the ESBLs, extended-spectrum beta-lactamases, which defeated not only penicillin and its relatives but also a large family of antibiotics called cephalosporins. And after cephalosporins were undermined, new antibiotics were achieved and lost in turn.
Each time pharmaceutical chemistry produced a new class of antibiotics, with a new molecular shape and a new mode of action, bacteria adapted. In fact, as the decades passed, they seemed to adapt faster than before. Their persistence threatened to inaugurate a post-antibiotic era, in which surgery could be too dangerous to attempt and ordinary health problems scrapes, tooth extractions, broken limbs could pose a deadly risk.
For a long time, it was assumed that the extraordinary unspooling of antibiotic resistance around the world was due only to misuse of the drugs in medicine: to parents begging for the drugs even though their children had viral illnesses that antibiotics could not help; physicians prescribing antibiotics without checking to see whether the drug they chose was a good match; people stopping their prescriptions halfway through the prescribed course because they felt better, or saving some pills for friends without health insurance, or buying antibiotics over the counter, in the many countries where they are available that way and dosing themselves.
But from the earliest days of the antibiotic era, the drugs have had another, parallel use: in animals that are grown to become food.
Eighty percent of the antibiotics sold in the United States and more than half of those sold around the world are used in animals, not in humans. Animals destined to be meat routinely receive antibiotics in their feed and water, and most of those drugs are not given to treat diseases, which is how we use them in people.
Instead, antibiotics are given to make food animals put on weight more quickly than they would otherwise, or to protect food animals from illnesses that the crowded conditions of livestock production make them vulnerable to. And nearly two-thirds of the antibiotics that are used for those purposes are compounds that are also used against human illness which means that when resistance against the farm use of those drugs arises, it undermines the drugs usefulness in human medicine as well.
Caged chickens in San Diego, California. California voters passed a new animal welfare law in 2008 to require that the states egg-laying hens be given room to move. Photograph: Christian Science Monitor/Getty Images
Resistance is a defensive adaptation, an evolutionary strategy that allows bacteria to protect themselves against antibiotics power to kill them. It is created by subtle genetic changes that allow organisms to counter antibiotics attacks on them, altering their cell walls to keep drug molecules from attaching or penetrating, or forming tiny pumps that eject the drugs after they have entered the cell.
What slows the emergence of resistance is using an antibiotic conservatively: at the right dose, for the right length of time, for an organism that will be vulnerable to the drug, and not for any other reason. Most antibiotic use in agriculture violates those rules.
Resistant bacteria are the result.
Antibiotic resistance is like climate change: it is an overwhelming threat, created over decades by millions of individual decisions and reinforced by the actions of industries.
It is also like climate change in that the industrialized west and the emerging economies of the global south are at odds. One quadrant of the globe already enjoyed the cheap protein of factory farming and now regrets it; the other would like not to forgo its chance. And it is additionally like climate change because any action taken in hopes of ameliorating the problem feels inadequate, like buying a fluorescent lightbulb while watching a polar bear drown.
But that it seems difficult does not mean it is not possible. The willingness to relinquish antibiotics of farmers in the Netherlands, as well as Perdue Farms and other companies in the United States, proves that industrial-scale production can be achieved without growth promoters or preventive antibiotic use. The stability of Masadour and Lou and White Oak Pastures shows that medium-sized and small farms can secure a place in a remixed meat economy.
Whole Foods pivot to slower-growing chicken birds that share some of the genetics preserved by Frank Reese illustrates that removing antibiotics and choosing birds that do not need them returns biodiversity to poultry production. All of those achievements are signposts, pointing to where chicken, and cattle and hogs and farmed fish after them, need to go: to a mode of production where antibiotics are used as infrequently as possible to care for sick animals, but not to fatten or protect them.
That is the way antibiotics are now used in human medicine, and it is the only way that the utility of antibiotics and the risk of resistance can be adequately balanced.
Excerpted from Big Chicken by Maryn McKenna published by National Geographic on 12 September 2017. Available wherever books are sold.
Plucked! The Truth About Chicken by Maryn McKenna is published in the UK by Little, Brown and is now available in eBook @14.99, and is published in Trade Format @14.99 on 1 February 2018.