1. Factory Farms, Antibiotics and Anthrax: Putting Profits Before Public Health Martin Donohoe, MD, FACP

2. Outline Factory Farming Agricultural Antibiotics Cipro and Anthrax Bayer Conclusions

3. Factory Farming Factory farms have replaced industrial factories as the # 1 polluters of American waterways Large CAFOs make up 5% of livestock operations but produce more than 50% of food animals 1.4 billion tons animal waste generated/yr –130 x human waste

4. Factory Farming Cattle manure 1.2 billion tons –16kg livestock feces and urine produced for every 0.3kg steak Pig manure 116 million tons Chicken droppings 14 million tons

5. Factory Farm Waste Overall number of hog farms down from 600,000 to 157,000 over the last 15yrs, while # of factory hog farms up 75% 1 hog farm in NC generates as much sewage annualy as all of Manhattan

6. Factory Farm Waste Most untreated Ferments in open pools Seeps into local water supply, estuaries –Kills fish –Causes human infections - e.g., Pfisteria pescii, Chesapeake Bay

7. Factory Farm Waste Creates unbearable stench –Foul odors and contaminated water caused by CAFOs reduce property values in surrounding communities an estimated $26 billion nationally Widely disseminated by floods/hurricanes

8. Risks to Farm Workers Antibiotic-resistant infections Carriage of antibiotic-resistant organisms Aerosolized pig brains associated with immune polyradiculoneuropathy (progressive inflammatory neuropathy) in pork processing plant workers –?Other similar illnesses?

9. Agricultural Antibiotic Use Agriculture accounts for 70% of U.S. antibiotic use –Use up 50% over the last 15 years Almost 8 billion animals per year “treated” to “promote growth” –Larger animals, fewer infections in herd

10. Agricultural Antibiotic Use 84% of beef cattle, 83% of pigs, and 40- 50% of poultry given non-therapeutic antibiotics Arsenic used in chicken and pork feed (banned in Europe; Poison-Free Poultry Act pending in U.S. Congress)

11. Consequences of Agricultural Antibiotic Use Campylobacter fluoroquinolone resistance –Infections/carriage by swine farmers associated with inflammatory neuropathies VREF (due to avoparcin use in chickens) Gentamycin- and Cipro-resistant E. coli in chickens 2009: Campylobacter found in 62%, Salmonella in 14%, and both in 8% of store-bought chickens

12. Consequences of Agricultural Antibiotic Use MRSA in pork, chickens –49% of pigs and 45% of pig farmers harbor MRSA –MRSA from animals throught to be responsible for more than 20% of human MRSA cases in the Netherlands H1N1 carriage rates very high in CAFO workers

13. Antibiotic Resistant Pathogens CDC: “Antibiotic use in food animals is the dominant source of antibiotic resistance among food-borne pathogens.” CDC: 76 million people suffer foodborne illnesses each year in the U.S. –325,000 hospitalizations –5,000 deaths –> $152 billion/yr in medical costs, lost wages, and lost productivity

14. Antibiotic Resistant Pathogens EU bans use of all antibiotic growth promoters effective 1/1/06 FDA bans off-label use of cephalosporins in food animals (2008) Preservation of Antibiotics for Medical Treatment Act – awaiting vote in Congress

15. Alternatives to Agricultural Antibiotic Use Decrease overcrowding Better diet/sanitation/living conditions Control heat stress Vaccination Increased use of bacterial cultures and specific antibiotic treatment in animals when indicated

16. Alternatives to Agricultural Antibiotic Use: Vegetarianism ↓ water/grain needs ↓ animal fecal waste ↓ rendering/mad cow disease ↓ rBGH (→ ↑IGF-1 in milk) Health benefits Meatpacking = most dangerous job in US

17. Agricultural Antibiotics Three years after a Danish ban on routing use of antibiotics in chicken farming, the prevalence of antibiotic-resistant bacteria in chickens dropped from 82% to 12%

18. Agricultural Antibiotics 2008: USDA allows E. coli-tainted meat to be sold as pre-cooked hamburger patties, taco meat, pizza toppings, etc. Multiple other food recalls since

19. Agricultural Antibiotics 2010: AMA, AAP, APHA, IDS all oppose non-therapeutic antibiotic use in livestock 2010: FDA urges phasing out antibiotic use

20. Campylobacter Most common food-borne infection in US 2.5 million case of diarrhea and 100 deaths per year

21. Campylobacter Resistance to Fluoroquinolones Increasing 13% in 1998, 18% in 1999, 20-80% currently Fluoroquinolone use up dramatically Continues to increase FDA proposed ban on fluoroquinolone use in poultry –Supported by APHA, PSR and others

22. Fluoroquinolones Animal Use –Sarafloxacin (Saraflox) – Abbott Labs – voluntarily withdrawn from market –Enrofloxacin (Baytril) – Bayer – FDA withdraws approval (7/05), ban effective 9/05 Human Use –Ciprofloxacin (Cipro) - Bayer

23. Anthrax Cipro – patent expired 2004 Doxycycline – generic Penicillin - generic Huge potential profits –300 million Americans, others –20-25% increase in Cipro sales one month after 2001 anthrax mailings, per the nation’s largest PBM

24. Cipro Was best selling antibiotic in the world for almost a decade Sales down since off patent, lower than levofloxacin and moxifloxacin Gross sales (first quarter of 2008) = $242 million

25. Bayer and Cipro 1997 onward – Bayer pays Barr Pharmaceuticals and two other competitors $200 million not to manufacture generic ciprofloxacin, despite a federal judge’s 1995 decision allowing it to do so –Ultimately absolved of wrongdoing: “anticompetitive effects … were within the exclusionary zone of the patent, and thus could not be redressed by federal antitrust law.”

26. Cost of Cipro Drugstore = $4.50/pill 2002: US government agreed to buy 100 million tablets for $0.95 per pill (twice what is paid under other government-sponsored public health programs) A full course of ciprofloxacin for postexposure prophylaxis (60 days) would then cost the government $204 per person treated, compared with $12 per person treated with doxycycline

27. Cost of Cipro US government has the authority, under existing law, to license generic production of ciprofloxacin by other companies for as little as $0.20/pill in the event of a public health emergency –It did not, but it cut a deal with Bayer to reduce the price of Cipro Canada did override Bayer’s patent and ordered 1 million tablets from a Canadian manufacturer

28. Why? Weakening of case at WTO meetings that the massive suffering consequent to 25 million AIDS cases in Sub-Saharan Africa did not constitute enough of a public health emergency to permit those countries to obtain and produce cheaper generic versions of largely unavailable AIDS drugs

29. Other Consequences Opens door to other situations involving parallel importing and compulsory licensing Threatens pharmaceutical industry’s massive profits –the most profitable industry in the US

30. Other Consequences Weakens pharmaceutical industry’s grip on legislators –$110 million dollars spent on lobbying in the first half of 2010 –1,228 lobbyists (2.3 for every member of Congress) –Revolving door between legislators, lobbyists, executives and government officials

31. Bayer Based in Leverkusen, Germany 107,000 employees worldwide (2008) Revenue: €31.16 billion (2009) Pre-tax profits: €6.47 billion (2009) US = largest market

32. Bayer Consists of Bayer HealthCare, Bayer MaterialScience, and Bayer CropScience Pharmaceuticals World’s leading pesticide manufacturer One of world’s largest seed companies

33. Bayer Number one biotech company in Europe (after 2001 purchase of Aventis CropScience) Controls over half of genetically-modified crop varieties up for approval for commercial use Risks of GMOs

34. History of Bayer Trademarked heroin in 1898 –Marketed as cough syrup for children “without side effects”, despite well-known dangers of addiction Patented acetylsalicylic acid as aspirin in 1899

35. History of Bayer WW I: invented modern chemical warfare; developed “School for Chemical Warfare” WW II: part of IG Farben conglomerate, which exploited slave labor at Auschwitz, conducted unethical human subject experiments (including funding Mengele) Manufactured and supplied Zyklon B (without usual odorant) to the SS for use in gas chambers

36. History of Bayer 24 board members and executives indicted in Nuremberg Trials –13 received prison sentences –Longest sentence to Fritz Meer Convicted for plunder, slavery, and mass murder Released from prison in 1952 Chairman of supervisory board of Bayer 1956- 1964

37. History of Bayer Early 1990s – admitted knowingly selling HIV-tainted blood clotting products which infected up to 50% of hemophiliacs in some developed countries –US Class action suits settled for $100,000 per claimant –European taxpayers left to foot most of bill

38. History of Bayer 1995 onward - failed to follow promise to withdraw its most toxic pesticides from the market Failed to educate farmers in developing nations re pesticide health risks 2 to 10 million poisonings / 200,000 deaths per year due to pesticides (WHO)

39. History of Bayer 1998 –pays Scottish adult volunteers $750 to swallow doses of the insecticide Guthion to “prove product’s safety” –Sued the FDA to lift moratorium on human- derived data 2000 – cited by FDA and FTC for misleading claims regarding aspirin and heart attacks/strokes

40. History of Bayer 2000 – fined by OSHA for workplace safety violations related to MDA (carcinogen) exposures 2000 – fined by Commerce Dept. for violations of export laws

41. History of Bayer 2001 – FDA-reported violations in quality control contribute to worldwide clotting factor shortage for hemophiliacs 2002 - Baycol (cholesterol lowering drug) withdrawn from market –Linked to 100 deaths and 1600 injuries –Accused by Germany’s health minister of failing to inform government of lethal side effects for 2 months

42. History of Bayer 2006: Bayer CropScience genetically- modified, herbicide-tolerant “Liberty Link” rice contaminates U.S. food supply –Bayer keeps contamination secret for 6 months, then US government takes another 18 days to respond –Places $1.5 billion industry at risk

43. History of Bayer “Liberty Link” rice contamination: –9/06: 33/162 EU samples tested positive for Liberty Link contamination –EU initially requires testing of all imported rice, then stops in response to US pressure –Japan ban imports of US rice –Over 1,200 lawsuits

44. History of Bayer 2007: Member of rubber cartel fined $356 million by European Commission 2007: Bayer suspends sales of Traysol (aprotinin) 2 years after data show increased deaths in heart surgery patients (Bayer withheld data) 2008: FDA warns Bayer re unapproved marketing claims for Bayer Women’s Low Dose Aspirin plus Calcium and Bayer Heart Advantage

45. History of Bayer 2008: Explosion at Bayer CropScience plant in Institute, WV, kills 2 workers Above-ground storage tank that can hold up to 40,000 lbs of methyl isocyanate) located 50-75 ft from blast area –Underground storage tank at plant site can store an additional 200,000 lbs

46. Comparison: Bhopal 50,000 to 90,000 pounds of methylisocyanate released in Union Carbide Bhopal, India explosion –7000-10,000 dead within 3 days, 15,000- 20,000 more over next 10 years; tens of thousands injured –Persistent water and soil contamination

47. History of Bayer 2009: $4 million settlement reached re 2006 release of chemical odorant propyl mercaptan and organophosphate pesticide Mocap from Bayer Cropscience plant in Alabama in 2006, which caused 2 deaths 2009: Sued by CSPI for false claims about selenium in its “One A Day Men’s Health Formula” multivitamin reducing prostate cancer risk

48. History of Bayer 2009: Bayer ordered by FDA and a number of states attorneys general to run a $20 million corrective advertising campaign about its birth control pill Yaz 2009: Oregon taxpayers on hook for ¾ of cleanup costs for one of Oregon’s most contaminated dump sites (pesticides)

49. History of Bayer 2010: FSA orders Bayer to stop misleading advertising re its IUD Mirena 2010: Cited by Political Economy Research Institute as #1 toxic air polluter in the U.S. 2010: Loses cases to Dow AgroSciences LLC and Monsanto over patent infringement cases involving genetically- modified crops

50. History of Bayer 2010: Fire at BayerCropScience Plant in india caused by leaking ethoprophos (toxic pesticide ingredient) kills one worker Late 1990s - 2010s: Bayer pesticides spirotetramat, imidacloprid, and clothianidin implicated in (honeybee) “colony collapse disorder”

51. Bayer’s Corporate Agenda Bluewash: signatory to UN’s Global Compact Greenwash: “crop protection” (pesticides) Promotion of anti-environmental health agenda: “Wise Use,” “Responsible Care” movements

52. Bayer’s Corporate Agenda Corporate Front Groups: “Global Crop Protection Federation” Harrassment / SLAPP suits against watchdog groups –e.g., Coalition Against Bayer Dangers

53. Bayer’s Corporate Agenda Lobbying / Campaign donations / Influence peddling: –Member of numerous lobbying groups attacking “trade barriers” (i.e., environmental health and safety laws) –Spent $8,498,512 for lobbying in 2009 –Gave $319,482,000 to federal candidates in the 2008 election through its PAC, 42% to Democrats, 58% to Republicans

54. Bayer Fortune Magazine (2001): one of the “most admired companies” in the United States Multinational Monitor (2001, 2003): one of the 10 worst corporations of the year

55. Conclusions Triumph of corporate profits and influence- peddling over urgent public health needs Stronger regulation needed over: –Agricultural antibiotic use –Drug pricing Stiffer penalties for corporate malfeasance necessary (fines and jail time) Important role of medical/public health organizations and the media

56. Reference Donohoe MT. Factory farms, antibiotics, and anthrax. Z Magazine 2003 (Jan):28- 30. Available at http://zmagsite.zmag.org/Jan2003/donoho e0103.shtml http://zmagsite.zmag.org/Jan2003/donoho e0103.shtml

57. Contact Information Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org