Two weeks ago, the Food and Drug Administration (FDA) announced that it would ban certain off-label uses of cephalosporin antibiotics in animal agriculture, asserting that these uses posed an undue risk of selecting for antibiotic-resistant bacteria. Many of us who follow this issue closely recognized FDA's move for what it was: a distraction from the fundamental need for change. The cephalosporin announcement came just two weeks after FDA refused to restrict the use of two other important antibiotics in food animals. It looked to be a thinly veiled effort to deflect criticism of this refusal.
With the occasional exception, like cephalosporins, FDA has failed for decades to take meaningful action on the misuse of antibiotics in food animal production -- misuse that directly contributes to the selection of antibiotic-resistant bacteria and compromises our ability to treat bacterial infections.
In 1900, the three leading causes of death in the United States were pneumonia, tuberculosis, and enteritis -- all infectious diseases. A century later, heart disease, cancer, and stroke -- all chronic, non-infectious diseases -- had replaced these at the top of the list. The shift in leading causes of death from infectious to chronic diseases is partly credited with raising average life expectancy by over 30 years. Much of this increase has been attributed to massive reductions in infectious disease mortality, which disproportionately impacts the young. These shifts have come to be known as an "epidemiologic transition," perhaps the most notable achievement in the modern history of public health.