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John Carr

What is your experience with Antibiotic Resistance?
I qualified as a veterinarian 40 years ago. Antibiotic Resistance (ABR) was discussed in the sense that ABR needs to be very clearly defined as bacterial resistance to chemicals. At the moment, ABR is very poorly defined, which poses a huge problem. Each country has different definitions to achieve antibiotic-free farming. For example, antibiotic-free pig farming means no antibiotics from the pigs’ birth to the slaughter. As a consequence, farmers will massively dose the piglet’s mother. The mother’s milk is full of antibiotics which causes the piglets and weaners to also be supported by antibiotics. But, the piglets did not receive the dose!

As a veterinarian for four decades, I have never run into clinical problems of ABR. There are two reasons. The first is that if a pig has bacteria resistant to my treatment protocol, the pig will unfortunately die and the resistant bacteria will likely die with the pig. If a pig is worth $100 and its treatment is $101, then it isn’t cost-effective for me to treat it as its monetary value isn’t enough. Besides, if the pig does not respond quickly to treatment, farms cannot afford to start picking different antibiotics, which could increase the chance of resistance. The second reason is adequate training around which bacteria are naturally resistant to certain antibiotics and which are not. For instance, Mycoplasma is always resistant to penicillin because the bacterium does not have a cell wall and penicillin functions in the cell wall. Therefore, it is important to be educated about naturally resistant bacteria and to accept this, rather than try to find multiple antibiotics and further increase resistance. Animal health professionals are aware of bacteria who pose problems with antibiotics, such as Brachyspira hyodysenteriae (swine dysentery), but they cannot use effective medication reserved for mankind and must, therefore, allocate antibiotics where bacterial strains are known to be resistant. Thus, resistant strains in animals persist and propagate.

We understand that you consider ABR a philosophical problem. Could you explain?
You are a customer at the supermarket. You buy cheese or pork. How much do you want to pay? Every day, 46% of the protein that human beings eat is pork. With 7.6 billion people on this planet, we feed almost half the planet every single day with their daily protein. My number one concern is children. If we can produce healthy children, they will develop into healthy adults, and healthy people tend to need fewer antibiotics. Consumers expect the pig industry to produce extremely high-quality, extremely nutritious, and extremely cheap food. Plus, the food must be and has been antibiotic-free for decades. But mankind has to ask itself the following question—are you willing to pay for healthy food? What has a higher value for you, healthy food or affordable food? Farming without antibiotics is easy. But consumers must want to pay for it.

Today, the health of the human race is healthier than it's ever been. This is not because of medicine, it is because of good quality and safe food. If we are going to have safe food, then animals must be healthy. Therefore, the second philosophical question is—what am I supposed to do with a sick animal? Do you want me to treat it with antibiotics or do you want me to shoot it because I can't allow it to suffer? Over the past few decades, I have witnessed the animal health profession move towards our pets. One of the problems with this is that we spend more money on the well-being of our cats and dogs than on the animals that we eat.

Do you think the experience with Covid-19 could in some way lead us to reconsider how we deal with antimicrobials?
In the framework of Covid-19, the world has been here before. If you look towards history, we had the Black Death and the 1918 Spanish influenza. Each generation, we seem to have nature telling us that we are not the dominant power on this planet. We have to start to be humble. I can assure you that within two years of Covid-19 ending, we will have forgotten all about it and the next crisis will come eventually.

Fungi have been at war with bacteria for more than 500 million years producing antibiotics. I find it very odd that we primates consider ourselves more intelligent than 500 million years of evolution. What frightens me about ABR is that if the current antibiotics we have do not work, this means a world where we cannot do abdominal surgery. This means that if I am gardening this afternoon, and I cut my hand on a splinter of wood, I may die of sepsis. The issue at hand is that mankind may need to go back to its natural ways.

How do you assess today’s health system around antibiotics?
There are two problems with our health system today. First, medical training seems to teach health professionals that when you give a patient an antibiotic, you will kill all the bacteria. This to me is when you get resistance. Say you have 100 bacteria, and one of them is naturally resistant to an antibiotic, and you prescribe a massive dose of antibiotics, then you have just killed 99% of the bacteria (good or bad) leaving the one that is resistant.

The second problem is that no one is allowed to die. Say my daughter needs a kidney transplant, she is put onto immunosuppressive medicines, given a kidney from somebody else, and lives. Then, she stabs her toe and gets an infection in her nail. She is rushed to the hospital and the first antibiotics don't work. Then the second ones don’t work, and even after the third try of antibiotics, the physicians refuse to admit defeat. And so, antibiotics are prescribed, even if they don’t work. But the patient is my daughter, therefore, she must not die.

The reality today is that when you produce a tonne of penicillin, only a fraction is used for treatment. This results in huge amounts of waste. What do you think is done with the waste? The waste runs through our rivers and water supplies. The birds eat it, or the landfill receives it. People need not forget how antibiotics are made and what is done to the environment throughout the process.

In your view what is the role of Big Pharma regarding antibiotic resistance?
I wrote a paper on ABR and antibiotic-free farming. The journal took nearly five years to publish. Why? Because Big Pharma told the journal that they would stop funding. For three years, my publication sat on the shelf. When the case received attention from my lawyers, in fear of a court case, the journal published it. But, they published the article with a Proviso that the paper was not peer-reviewed, and that it was an opinion piece, merely, “John's thoughts”. This was after it had been peer-reviewed and accepted. This occurred because Big Pharma did not want a discussion about how to farm with antibiotic-free treatment.

In 1982, I was in university training as a veterinarian. We had cancelled lectures and were allowed to choose which courses we would like to be taught. So, we submitted homoeopathy and herbal medicine as topics. We wanted to understand and be trained around non-therapeutic medicine. However, the university apologized saying we would not obtain these types of courses. What happened was that the pharmaceutical companies threatened the school that we were going to get lectures on alternative medicine. So, what did we do? My classmates and I found lecturers that could teach us everything about herbal medicine. We took extra night classes and paid for them ourselves. The school eventually found out and was furious that we would have the audacity to try and train ourselves.

I will end with this, we are in the hands of pharma. We can all relate to Covid-19, so here is one final example. Pfizer’s Covid-19 vaccine is in vials of five. Doctors found that they can get a sixth dose out of the five vials. So, Pfizer charged the government for six doses of vaccines instead of five. Rather than saying, “Oh, that's fantastic! We can vaccinate more people with our product!”, they do not want to be ripped off. They are interested in their shareholders.

- John Carr (BVSc, PhD, DPM, DiplECPHM, MRCVS) Worldwide Consultant to the animal production industry, Australia