By Sophie Kevany for Sentient.
Broadcast version by Roz Brown for New Mexico News Connection reporting for the Sentient-Public News Service Collaboration

It's a well-known fact that factory farms rely on antibiotics to treat animals raised in cramped, unsanitary conditions. Lesser known is the rising quantity of antibiotics needed to do just that. Sales of medically important antibiotics for use in U.S. livestock farming rose over four percent in 2022, compared to a year earlier, and show an overall upward trend since 2018, risking greater human mortality from antibiotic-resistant infections.

Medically important antimicrobials - a broader term for drugs, including antibiotics, that kill microorganisms - are those considered essential for treating human disease. Globally, the livestock industry fed an estimated 99,502 metric tons of antimicrobials in 2020 to the billions of cattle, sheep, chicken and pigs raised for food that year.

Such widespread antimicrobial use has been linked to the development of resistant bacteria and other organisms like fungi. Infection from antimicrobial-resistant organisms is described as a "growing crisis" by the American Public Health Association and other health professionals and scientists.

People and animals infected by resistant organisms are harder to cure. In the U.S., the Centers for Disease Control estimates there are over 2.8 million antibiotic-resistant infections every year. Of those, over 35,000 people eventually die. Globally, one study found there were an estimated 4.95 million deaths associated with bacterial antimicrobial resistance.

Factory Farms Depend on Antibiotics to Raise Billions of Animals

The Food and Drug Administration data show sales of medically important antimicrobials approved for use in farm animals rose 4.3 percent to 6.25 million kilograms in 2022. The 2022 figure is a significant decrease on the 8.36 million kilograms sold in 2016, the earliest year shown in the data. But the 2022 figure is higher than all other years since 2016, indicating a more recent trend in the wrong direction.

Thomas van Boeckel, an expert in global antimicrobial usage and resistance in farm animals, fish and humans, says the upward swing indicates that "unlike some European and Asian countries ... the U.S. is clearly not on a trend that shows its commitment to sustainably reduce antimicrobial use in animals."

The data, he adds, shows the problem is "mostly a pig and cattle issue" and reveals "a dependence" by the livestock sector on antibiotics that has "potential consequences on the continued development of resistance."

Prior to 2016, the use of medically important drugs for livestock was even higher, says Steven Roach of the Food Animal Concerns Trust. To control the problem, federal rules were tightened in 2017 to prevent farmers using the drugs for growth promotion.

By species, the administration's data shows 2022 sales of medically important antibiotics for cattle were up 4.3 percent to 2.57 million kilograms, higher than any other year since 2016. For pigs, sales rose almost 5 percent to 2.66 million kilograms, again higher than any year since 2016.

Treating Healthy Animals Has Deadly Consequences for Humans

Farmers use antimicrobials in three ways, Roach says. "Treating a sick animal, which everyone supports. Treating a particular group of animals, for example if there is a risk of infection from one sick animal, which we also support," he says.

The third use, which Roach opposes and is prohibited in Europe, is treating healthy animals to prevent disease, a practice known as prophylaxis. For example, Roach says, months of preventative treatment of cattle can happen in feedlots where the animal's weight promoting, high energy diet produces a bacteria that can infect their livers. To prevent liver problems, medically important antimicrobials called macrolides are used, Roach says.

Most antimicrobials are fed to livestock via their feed and water. Research has linked the addition of antimicrobials to water with the faster breeding and spread of resistant bacteria between animals and feedlot workers.

The FDA data, Roach added, does not "tell us the percentages of how much of each antimicrobial is used for which category," making it hard to know the level of preventative use.

Not only does Roach agree that the U.S. livestock sector is falling behind other countries in using more, not less, medically important antimicrobials, he says the government appears uninterested in the problem.

"We can't even get anyone in the U.S. government to say that there is a need to reduce medically important antimicrobials in food animals," he says, blaming livestock industry lobbying for the current predicament.

Roach hopes the FDA "will realize it has to act and follow the EU and prohibit the use of [the drugs] for disease prevention." He adds, "the FDA could also set a public health goal to reduce their use, say by 50 percent by a certain year, which is what other countries have done."

Absent government action to prevent prophylactic use of the drugs, Roach says the most successful route to reducing their use in livestock is consumer pressure. "We have had good luck getting big meat buyers to put pressure on companies. The good news is in chicken, it is going down and part of that was pressure on the companies [to reduce their use of medically important antimicrobials] and a choice by Tyson and Perdue to quit using them."

Some companies are avoiding antibiotics altogether. "[Our] family farmers and ranchers prove every day that routine antibiotic use is not necessary when animals are provided a low-stress environment with extra space, fresh air and humane animal care," says Chris Oliviero, who leads the Niman Ranch network of independent meat producers. Niman Ranch animals that must be treated with antibiotics are not sold as meat.

FDA and American Veterinary Medical Health Association Push Back

Neither the National Cattlemen's Beef Association nor the National Pork Producers Council replied to Sentient Media's requests for comment.

Answering the criticisms raised here, the Food and Drug Administration said in an email that it is "committed to the judicious use of antimicrobials in food-producing animals" and that it continues to take "many actions to promote judicious use, reduce inappropriate use .... [and] try to curb the development of antimicrobial resistance (AMR) that could stem from antimicrobial use in food-producing animals."

Those actions, it said, include rules that now ensure "all medically important antimicrobials for food-producing animals are only available under the supervision of a licensed veterinarian."

Asked about policies to restrict antibiotic use on factory farms elsewhere in the world, the email said U.S. laws and livestock population "are not the same as that of the EU or other countries. The FDA's initiatives to promote judicious use and reduce AMR were devised specifically for the U.S."

It added that there are "many factors to consider" when analyzing antimicrobial sales data. These include sales volume fluctuations "in response to various factors, including changing animal health needs or changes in animal populations that may make certain antimicrobial drugs more medically important at various times."

The American Veterinary Medical Health Association also replied, arguing that antimicrobial sales data is "a valuable indicator of market trends" but that it "does not necessarily reflect the actual use of antimicrobial drugs." Pointing to more detailed biomass data, which includes animal weights, the association further suggested that higher animal numbers might be a factor saying that "... overall, animal populations have been growing annually since 2016 ... [which would] impact the amount of antimicrobials sold and could be one factor contributing to an increase in antimicrobial sales."

Yet according to FACT's Steven Roach, a closer look at the data suggests sales may be even higher. "If you look at the more detailed biomass data referred to by the AVMA it shows that animal numbers were down in 2022 compared to 2021 so when corrected for biomass the [medically important anti-microbial] sales increases are even larger."


Sophie Kevany wrote this article for Sentient.


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In the aftermath of Hurricane Helene, many dentists in Western North Carolina faced devastating losses, from damaged practices to destroyed homes. The North Carolina Dental Society Foundation is stepping in to help them. The group launched an emergency relief grant program to help dentists get back on their feet.

Dr. Ruma Simhan, former president of the North Carolina Dental Society Foundation, said the recovery efforts are about more than rebuilding practices; they're about restoring vital oral health services to communities that need them most.

"A lot of dentists we hear from, their practice is damaged or lost altogether, and they're trying to find a way to go back to their community and serve their patients," she explained. "And so they just really need help getting back on their feet."

She added that the goal is to make sure that critical health care gets back to communities where access was already limited.

Simhan said the foundation isn't stopping at grant funding. Through partnerships with local organizations, it launched an oral hygiene supply drive, collecting more than 25,000 items such as toothbrushes, toothpaste and floss for impacted residents. Collaborations with Valley Strong Disaster Relief and Blue Ridge Tae Kwon Do helped transform community spaces into relief centers, while dental associations across the country sent donations to expand support efforts. Simhan said these initiatives are helping ensure oral health remains a priority.

"Oral health is truly important to one's overall health. And it cannot be stated enough that if one part of the state struggles for access, has dentists that cannot work in the area then that really affects that community to obtain its optimal health," she continued.

The foundation is still accepting grant applications and donations to support recovery efforts. Simhan said with rural communities in Western North Carolina already facing limited access to dental care, getting these practices back up and running is critical. More information is available on the foundation's website.

The Community Health Provider Alliance improved health care quality and saved $17.3 million in taxpayer money that would have been paid out by Medicare in 2023.

Brandi Apodaca, chief operating officer with Community Health Provider Alliance, said nearly half of the money saved will go to support community health centers that treat all patients regardless of their ability to pay. That's good news for clinics struggling with a steep increase in uncompensated care after more than half a million Coloradans were dropped from health insurance rolls.

"As Medicaid dollars have decreased to the community health centers due to the Medicaid unwind, these dollars are coming at a critical time to really support the integrated work that community health centers are doing," she said.

Medicaid coverage was automatically maintained during the COVID public health emergency, but that ended in the spring of 2023. Nearly half of enrolled Coloradans, including thousands who still qualified for coverage, lost their health insurance.

Over the past five years, the alliance has helped save $70 million for the Centers for Medicare and Medicaid Services. Apodaca said improving the quality of care - for example, by bringing more people in for their annual wellness visits - creates better health outcomes for patients, and keeps costs down by reducing expensive emergency room visits and hospitalizations.

"By doing things like managing chronic conditions and getting engaged into primary care - which should be your number one source of health care - we're going to control costs," she continued.

Nationally, the Medicare Shared Savings Program saved a record $5.2 billion in 2023. Program participants get to keep a portion of those savings. Apodaca says in Colorado, the money will help ensure that community health centers can continue to deliver high-quality coordinated health care.

"They not only provide physical health, they are also integrated with dental and behavioral health. So when you show up at a community health center, we're going to be able to provide services for all of your health care needs," she concluded.


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Some anesthesiologists hope this is the year Tennessee passes legislation to allow Certified Anesthesiologist Assistants to practice in the state.

Assistants are authorized to work in 20 states but not in Tennessee.

Sasi Duggirala, certified anesthesiologist assistant and managing partner at Harmony Anesthesia in Atlanta, a former Tennessean, said the state's shortage of anesthesiologists as well as Certified Registered Nurse Anesthetists delays surgeries. He is advocating for licensure of certified assistants to increase the number of anesthesia providers, saying it would ultimately improve patient care.

"After coming out of COVID, there's been just a huge backlog on necessary procedures and surgeries that need to be done," Duggirala pointed out. "The mid-level anesthetist coming only from CRNA pool is just not enough to fill that gap."

Last year, Senate Bill 453 would have allowed certified assistants to practice in Tennessee but the bill stalled in the House. Some Tennessee Certified Registered Nurse Anesthetists opposed it, claiming the assistants lack the comprehensive training of nurse anesthetists. Backers want to see the bill reintroduced.

David Ryan Diehl, certified anesthesiologist assistant at Diehl Anesthesia in Atlanta, explained his son was born with a congenital disorder requiring prosthetics. The family receives support from the Jordan Thomas Foundation in Nashville. Diehl said new legislation would allow him to practice anesthesiology in Tennessee.

"Legislation needs to be passed that allows us to practice there, to bill insurance, Medicare, Medicaid, all those types of things, and for the groups to be reimbursed," Diehl outlined. "Also for us to be insured there as well, to practice."

Dr. Richard Duncan, orthopedic surgeon and medical director of the Center for Advanced Bone and Joint Surgery at Watauga Orthopedics in Johnson City, Tennessee, pointed out both Certified Registered Nurse Anesthetists and Certified Anesthesiologist Assistants can administer anesthesia during surgeries. He highlighted their extensive training, and suggested Tennessee institutions could offer such training as an additional educational benefit.

"A Certified Anesthesia Assistant is a person that has a bachelor's degree with some prerequisites that they have to have, and testing that they do," Duncan explained. "Once they're admitted into their training, it's 24 to 28 months of didactic training, and then clinical training."

Duncan added the critical shortage of anesthesia providers affects hospitals, surgery centers and patient care across the board.


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