Today I am very excited to share our interview with Maryn McKenna. Maryn is an independent journalist and author who specializes in public health, global health, and food policy. She is the author of Big Chicken, a book about the evolution of animal agriculture through antibiotics, and received the 2018 Science in Society Award for the book. Maryn has also done a TedTalk about the emergence of antibiotic resistant bacteria and its healthcare impact. After this interview you will know:
Ahmed Khan: Big Chicken is one of the two books that you’ve written about the emergence of antibiotic resistance. How did you first become passionate about this field and how did that take you toward chicken?
Maryn McKenna: For most of my career, I have worked on public health as my journalistic subject. As a newspaper reporter, I was assigned to cover the US Centers for Disease Control and Prevention, which meant going to the agency in Atlanta, Georgia, day after day after day and talking to people, calling people, and emailing people. Trying to figure out what was coming out that was interesting with the goal of writing newspaper stories about them.
Part of my job was to go to as many disease outbreak investigations as possible. I went to an outbreak of MRSA [an antibiotic-resistant strain of Staphylococcus aureus] that was being investigated in Los Angeles. It was what we would now call community MRSA. The people who have picked it up were very, very sick. They had really severe, very large lesions that, in many cases, required hospitalization and surgery.
I never had really been aware of antibiotic resistance outside the confines of hospitals and learning about the impact of community MRSA, and how widely it had spread, was really shocking to me. That happened to be the same year that a pair of influential papers were published. They said explicitly that the toll of MRSA year-to-year was beyond the toll of HIV in the United States.
HIV had been such a touchstone for infectious disease public health for so long. I found that really shocking. That really led to my book, “Superbug”, which is my chronicle of the emergence of antibiotic resistance using the lens of MRSA to explain where antibiotic resistance just came from, what social practices furthered it, and why we're in such trouble.
In the process of reporting that book, I realized that there was a really significant portion of the antibiotic resistance problem that had nothing to do with human experience, really. Neither human experience in healthcare nor human experience in acquiring these organisms in the community outside of medical care. And that was the question of how much will agriculture play.
“There is nothing else and never will be anything else like antibiotics. They are precious to medicine and we should protect them.”
I began to dig into this question of how much agricultural use of antibiotics over decades contribute to the antibiotic resistance problem. As I started looking into that, I realized that that story, the emergence of antibiotic use in agriculture, is really bracketed by the story of the rise of industrial chicken, because chickens were the first animals to get experimentally what we now call growth promoter antibiotics.
I could see that, as I was telling this story of how antibiotic use in agriculture emerged, I was also really telling the story of how poultry first set the stage for misuse of antibiotics. How it effectively taught the rest of agriculture how to choose antibiotics, and how, after fifty years, it is reversing that historic mistake, and that holds out the hope that the country might teach the rest of meat agriculture how to come back from misuse of antibiotics as well.
Ahmed: Was there anything that really surprised you while you were researching Big Chicken relating to animal agriculture and their usage of antibiotics?
Maryn: I was really shocked when I went back to all the original papers that upheld the use of antibiotics in agriculture at the start at how incurious they were about the long-term effects of using antibiotics routinely in animals.
From 1948 up to about 1965, there are hundreds and hundreds of scientific papers written about this fantastic new use of antibiotics to disrupt the gut microbiome of animals and cause them to put on weight faster. That’s what growth promotion is.
Almost none of those papers ever ask whether there are going to be a larger longer-term consequence.
The most that they considered is that if a gut bacterium they’re affecting with growth promoters turns towards resistance, the scientists assumed that the power of growth promotion is going to go away. But it never occurred to them to consider that those drug resistant bacteria are going to leave the animal. They assumed they’re going to stay with the animal and that’s as far the problem is going to go.
"I know there are people who say that cellular ag will solve the problem. I think that is very much an open question."
But, in fact, we know now that large scale farms that routinely use antibiotics are nodes in a network for distribution of antibiotic resistant bacteria via food and into the environment.
It never seems to have occurred to the scientists that those drugs were going to move away from animals and move away from farms. I find that lack of foresight really kind of shocking.
Ahmed: Were there any scientific papers that were initially concerned and against antibiotic usage?
Maryn: There are a few people early on who raised concerns about this very issue.
It takes about less than 10 years for the first human health effect to be perceived in the United Kingdom. That is the first outbreak anywhere in the world of a drug resistant, foodborne illness, which is the thing that just has never existed in the world before.
One particular scientist in the British public health system is a guy named Ephraim Saul Anderson, known to everyone as Andy Anderson. He does some quite smart lab work that links particular outbreaks of drug resistant salmonella and E. coli back to particular farming practices. In one particular case, back to one particular farm and demonstrates that meat has become a vehicle for the transport of antibiotic resistant foodborne bacteria away from farms and animals and into the wider society. Into the system by which we distribute food from growers to middlemen to wholesalers to retailers and then either to home kitchens or restaurant. That system for distributing food is now becoming an assistant for distributing antibiotic resistant bacteria as well.
Anderson's work is so powerful that it leads to the first government-supported ban anywhere in the world for growth promoter antibiotics in food animals. It was passed by parliament in 1971. His work inspired an American scientist, Stuart Levy, who is still on faculty at Tufts University, to do similar work and a really elegant experience that’s published in 1976. Levy’s work inspires an unsuccessful ban in the United States that is proposed but not ever actually active in 1977.
“I don’t think that concern for what is in the meat that people eat has ever gone away.”
The work of those two pioneering scientists really begin to get the ball rolling with alarm over antibiotic use. It also immediately demonstrates how differently different nations are going to take this threat because England and the European Union move forward with bans on antibiotic usage in agriculture and the United States does not for another 40 years.
Ahmed: One thing that really surprised me in the US about antibiotic usage was a practice called ‘Acronization’. This underlined the first public outcry against antibiotic usage, where the public was furious at food producers. How did the poultry producers justify this practice at the time?
Maryn: That's a really interesting story. I’m quite proud of the acronization sections of the book, because, as far as I can tell, no one has ever written about this before. I had to put the story together by doing some real primary source research in old conference proceedings and then by scouring local newspapers in various databases.
To define the term, acronization is a process by which meat and fish, after they are butchered and before they are packaged, are dipped in a solution of antibiotics. The idea being to create a film of active antibiotics on the surface of the meat that would retard the growth of spoilage organisms.
Like a lot of things in this early history, this is done mostly with good intentions though there's no question that there's also a sales motive to it as well. All the animals whose meat is being acronized have previously been treated with antibiotics from these companies. By promoting acronization, which is one of several tradenames, the companies managed to sell one more dose of their drug for every animal.
Beyond that sales motivation, the point is also to be able to ship fresh meat around to more places less expensively than ever has been possible. If you acronize a piece of meat so that it will last without spoiling for a month instead of a week, you can then send it over long distances by less expensive transit.
But, as with growth promotion, no one seems to have considered that flinging antibiotics around in this free matter was undoubtedly going to create, to stimulate, the development of antibiotic resistant bacteria, and that, in fact, turns out to be true.
One particular clinician, as so often happens in these stories, noticed the development of antibiotic resistant illness in a particular class of people in the Pacific Northwest. In slaughterhouse and packaging house workers.
His work doesn't really lead to ban, it just started to raise awareness. What actually leads to a ban in this case is consumer power, because acronization exists for about ten years from the mid-1950s to the late 1960s.
“It's my belief that we can trace the change in policy around antibiotic use in meat animals to consumer pressure”
By the late 1960s, consumers in the United States are beginning to be very concerned about food additives of all kinds. This is the point where they're talking about hormones being given to cattle, the variety of artificial sweeteners that are available, and whether any of them are carcinogens. Against that setting, adding raw antibiotics to your meat suddenly seems no longer like a good idea.
I found all these letters to the editor in small local newspapers, with people questioning whether acronization had been a smart idea and committing themselves to buying only un-acronized meat. By 1968, the practice is completely gone away.
Ahmed: This seems to be one of the first times the public was furious at food producers. Was this the emergence of public distrust in the integration of the latest science and food production? What could companies working on future food technologies learn from this?
Maryn: Acronizing is one of the first moments I believe, along with the other things being considered at the same time. That is definitely one of the moments in the 1960s when consumers begin to think about what is going into their foods.
At the same time, “Silent Spring” is published in 1962. In the United Kingdom, an equally influential book called “Animal Machines”, which is specifically against industrial-scale farming, is published. That starts to lift the curtain on the way that meat animals are produced.
I don’t think that concern for what is in the meat that people eat has ever gone away.
In fact, in the United States, it's my belief that we can trace the change in policy around antibiotic use in meat animals to consumer pressure, because the United States doesn't actually change its policy at the federal level until 2017. But big companies come out, starting in about 2014.
“Meat has become a vehicle for the transport of antibiotic resistant foodborne bacteria away from farms and animals and into the wider society.”
Big poultry companies, beginning with Perdue Foods, committed themselves to antibiotic-free raising of poultry. The reason they do that is very explicitly because they're getting pressure from consumers who want to spend their dollars on meat that is raised without routine antibiotic use.
Before Perdue makes that move in 2014, there are some earlier movers. There has been a health foods movement since the 1970s. There are companies like Chipotle and Whole Foods dating back to the 1990s that are selling antibiotic-free meat.
The power of consumers to speak directly to food production companies, I think, is really evident in the years starting about 2000. Big institutional buyers, like universities and school systems and medical centers, started saying directly to the food production companies that we’re not going to spend our catering budget on your product anymore. Then they're followed by individual moms, chefs, and so forth.
So, what is the lesson in that thing going forward? I think there is no going back on transparency.
Consumers now are sufficiently empowered about what goes into the things they’re spending money on. Food companies just have to take it, if they want their sales to continue to rise.
They have to take transparency as basic value because consumers just aren't going to accept any less. And when consumers find that the transparency has been violated, that something has been kept from them, that really doesn't go well for companies. It's a really lasting injury in the market place that they should avoid if they can.
Ahmed: Has the idea of cellular agriculture emerged during your research as an alternative to conventional animal agriculture?
Maryn: I think there are 2 questions on the table for cellular ag companies as they move forward. This is within the envelope of mandatory transparency. They’re just not going to get away without it.
The first question is really how are antibiotics going to be used? In the first test of cellular meat, the Maastricht burger, antibiotics were used in the growth medium.
While antibiotics may not have been used in the prototype for subsequent companies, there remains a real question: as these companies scale up to industrial scale production, how are they going to keep their growing media sterile? If they're not going to use antibiotics, how are they going to solve the problem of growing at scale? Because antibiotics is a really tempting way to address the problem of using a sterile growth medium.
If they're not going to do that, not going to be using antibiotics, then they've got a great selling point. I have not done an in-depth study, but I think that is one [question] that the companies are going to have to address. You can get away without using antibiotics when you’re doing a prototype, but I think the question of scale is a really important one.
The second question, which is not actually specific to antibiotics but it’s fairly illuminated by the rise of industrial chicken, is that poultry around the world is intellectual property (IP).
As birds were hybridized and crossbred to make the modern industrial chicken, chicken became no longer an open-source food. It became entirely intellectual property owned by, really, only two companies now.
Whether you are a giant producer, like Perdue, or a small producer in France, you are buying your chicks time after time from those companies that hold the genetics of chicken. At this point, cattle and pigs are still open source. There are certainly breeds and varieties, and there is some degree of wanting to keep those breeding varieties true, but they are not IP.
“If it can stay away from antibiotics, it may be that cellular ag solves the problem of satisfying the appetite for meat in an antibiotic-free way.”
I think the larger philosophical question that consumers are going to ask: is cellular meat IP, and do consumers actually want that? Do they want all their food to be owned by big corporations?
It’s IP that’s going to make cellular ag worth doing. That is a really profound communications challenge in front of the companies as they move forward to scale. I think it's a question a lot of consumers are going to ask. I think that companies ought to be thinking about that now.
Ahmed: I was under the impression that the ‘discovery’ of excessive antibiotic usage was relatively recent, based on how widespread that concern appears to be. Yet, your book makes it seem that the dangers of antibiotic resistance were known for a while, yet there was little policy action against it. What were the reasons for the lack of action in the US?
Maryn: The easy answer is that the agricultural sector, which is really the agriculture sector and the veterinarian pharma sector, have more sway in American politics than it did in British politics. Therefore, more ability to influence the political factor away from doing regulation on this.
After all, that first very seminal experiment done in the United States, which demonstrated that resistant bacteria arise in animals given antibiotics and then move through the environment to other animals and human beings, was funded by a trade food that was pro antibiotic use.
It wasn't academic science that funded that experiment is one of the great ironies. It was actually funded by someone who wanted a negative result. They wanted a result that would endorse their practices and what they got was something that instead jump-started the science of agricultural antibiotic resistance research in the United States.
So easy answer was politics.
The more complex answer is that the difference in what happened in the United Kingdom and the European Union and what happened in the United States is a fundamental difference in how those societies approach policy making. The European Union fundamentally bases policy decisions on the precautionary principle. If something looks like a bad idea, like it may have a negative effect, they generally don't do it. And that is a matter of policy making.
In the United States, they're much more empirical. You're much more likely to create a policy, put something into action and then evaluate afterwards whether that was a good or a bad idea. That's what the two models show in how to approach antibiotic use in agriculture.
Because of that attitude, it takes a lot longer in the United States to unwind these things. It also takes a particular administration to do it.
Ahmed: You’ve written about how antibiotic use has literally created our modern agricultural system, using chicken. Where do you now see the future of animal agriculture going?
Maryn: I don’t think there’s one answer to this question.
I hope that we will move towards a day when antibiotics are used in animal agriculture only in the way that they are used human medicine, which is to cure instances of disease. At the moment, most antibiotics use in animal agriculture is not for that.
I hope we will move to that because that will slow down the emergence of resistant bacteria, and that’s the real reason to care about this. Beyond the concerns about concentration of agriculture and animal welfare, the fundamental reason to care about this is that it undermines the actions of antibiotics around the world.
There is nothing else and never will be anything else like antibiotics. They are precious to medicine and we should protect them.
I think that the success of companies like Perdue in keeping up there their animal agriculture at scale while relinquishing antibiotics shows that it’s possible to delink the two. We don't have to have antibiotic use in animal agriculture.
In order to do that, you have to do certain other things. You have to improve hygiene, improve animal welfare, and have to improve some of your raising practices. I know there are people who say that cellular ag will solve the problem. I think that is very much an open question.
"As I was telling this story of how antibiotic use in agriculture emerged, I was also really telling the story of how poultry first set the stage for misuse of antibiotics.”
I feel very cautious about whether cellular ag is going to be pulled down the path of antibiotic use as traditional animal ag was. If it's not, if it can stay away from antibiotics, it may be that cellular ag solves the problem of satisfying the appetite for meat in an antibiotic-free way.
But to do that, it can't be a boutique product in the way that heritage animals are a boutique product. It has to be a product that is priced for the mass market and that again is a question that has to be answered by the industry in the future. I don't think there's an answer to it yet.
Ahmed: Do you have plans to write any more books in your future plans?
Maryn: I think I may be done with antibiotic resistance now because I have written two books on it. I remain as my core identity as a journalist in public health and food policy. I have an idea for another book but I’m pretending to myself that I don’t yet, so that I can hold it at arm’s length.
I think my next book will have something to do with food production, but beyond that, it’s a little early to say.