Health Story Archives - Page 16 of 21 - West Virginia Public Broadcasting

How Does Women's Health Fare Under Trumpcare?

The House Republican health care proposal to replace the Affordable Care Act could have a profound impact on women’s health care coverage.

The ACA reformed several insurance provisions that affect women, including requiring coverage of no-cost birth control, not allowing insurance companies to charge women more than men and expanding coverage of pre-pregnancy care. Changes to these provisions would impact all women, but especially low-income women.

According to the Kaiser Family Foundation, one in three low-income women receives birth control from family planning clinics like Planned Parenthood while three quarters of higher-income women receive birth control from a doctor’s office.

President Trump has proposed major cuts to federal funding that support family planning clinics – a move that could disproportionately affect low-income women’s access to family planning services. Anti-abortion advocates have long supported defunding Planned Parenthood due to its role as an abortion provider. House Speaker Paul Ryan has said he supports redirecting women’s health resources from Planned Parenthood to federally qualified health centers, which, he said, will allow women to get the services they need without the controversy.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Halting Traffic: Truckers, Survivors, Fighting Human Trafficking

Note: Some readers may find this subject matter disturbing.When Beth Jacobs was 16 years old, she needed a ride home. She had missed her bus after work…

Note: Some readers may find this subject matter disturbing.

When Beth Jacobs was 16 years old, she needed a ride home. She had missed her bus after work again after promising her father she was responsible enough not to make it a habit. She asked a man she thought was a friend to give her a lift. He offered her a drink from his car’s cup holder. She took a sip and woke up in a parking lot hours later.

“And he was like, ‘Baby do you know what I am?’” Jacobs recalled decades later. “He said, ‘I’m a pimp.’ I reached for the door, and he grabbed my hair and he said, ‘I own you now.’”

The pimp told Jacobs if she didn’t cooperate he would kill her and her father. Jacobs believed him. “He had taken me home before, he knew where I lived.”

The pimp told her she was going to sleep with a man in a truck. “The driver raped me,” Jacobs said. The driver asked the pimp for some of his money back. “Because I cried too much.”

A collage created in art therapy by a human trafficking victim.

Jacobs was then beaten openly for others to see, and they did nothing.

“People kind of watched it happen, and they didn’t help, so I felt like I kind of had to go with him,” she said.

Jacobs went from being an average 16-year-old to a human trafficking victim. Later she was convicted of prostitution, an offense that would prevent her from securing a job as a human trafficking investigator with the state of Arizona.

Jacobs contacted every legislator she could to explain that the conviction had become a life sentence. The state listened, and now others across the U.S. are working towards implementing legislation that targets “vacatur convictions” — bills to help survivors of human trafficking clear their criminal records of non-violent crimes they were forced to commit during their exploitation. Removal of such convictions paves the way for fewer obstacles in hiring or financial or housing aid.

Today, at 53, Jacobs is among the small but dedicated group of former victims of trafficking and abuse who are working to find solutions. Jacobs works with Truckers Against Trafficking, or TAT, a non profit that trains truck drivers to recognize and report instances of human trafficking.

Fast-Growing Trade

The FBI refers to human trafficking as today’s slave trade and says the numbers are increasing every year.

Estimates place the number of domestic and international victims in the millions, mostly females and children enslaved in the commercial sex industry for little or no money, according to an FBI Law Enforcement Bulletin. The International Labour Organization estimates that there are 20.9 million victims of human trafficking globally.

Crimes associated with human trafficking and sex slavery are often associated with places outside of the U.S., such as Eastern Europe and Southeast Asia. But borders simply don’t stop trafficking that can take place via the air, across state lines, or from one backyard to another. It happens everywhere, including the Ohio Valley region.

In 2016 the Polaris Project, an organization that runs the National Trafficking Hotline, reported 375 human trafficking cases in Ohio. Kentucky had the second highest in the region, reporting 89, and West Virginia the least with 19. Most states also only record cases that involve minors, so data on adult trafficking victims is only reported through calls to the hotline.

The rankings clearly correlate to population, but they are also related to how active a state prosecutor’s office is with increasing awareness. Both Ohio and Kentucky have a Human Trafficking Task Force, and West Virginia has started to gain momentum in organizing stakeholders to increase public awareness.

Education among law enforcement is critical, according to Allyson Taylor, Director of the Kentucky Office of Child Abuse Exploitation Prevention.

“What I really think you are seeing across the state is that law-enforcement has not really identified trafficking cases as trafficking cases,” she said.

Truckers against Trafficking aims to make drivers “Knights of the Roads.”

For instance, Taylor said the state sees a lot of parents or caregivers who will trade sex with their kids for drugs. “We see that all over the state,” she said. Under the law, that’s human trafficking.

But Taylor says officers will typically see that instead as a sex crime.

“So things like that we are still trying to get law enforcement to wrap their heads around,” said Taylor.

Not only does this affect data associated with human trafficking cases, it also prevents funds set aside to aid the victims.

“Our state law also has a $10,000 penalty per conviction,” she said, and that money could go toward a human trafficking victims fund.

At present, the account is empty.

“I think it is just lack of education.” Taylor explained.

“Human Trafficking is the fastest growing human enterprise in the world,” Kentucky Attorney General Andy Beshear said.

“One of the ways that we can best educate people,” Beshear said, “is that, in Kentucky there is no such thing as a child prostitute. That child is being human trafficked.”

Until 2013, minors picked up for prostitution in Kentucky would essentially lose their childhood in the eyes of the law. Rather than recognizing the child as a victim, the child would be treated as a criminal. Safe Harbor Legislation helped to change that. According to a Protected Innocence Challenge report, 2016 is the first year that all 50 states have laws specifically criminalizing child sex trafficking.

Beshear and other AG officials around the country have teamed up with TAT as well.

Driving Change

Ohio and Kentucky have programs to train truckers. Before drivers can receive a commercial license they have to train with a TAT video.

Kendis Paris founded TAT along with her mother. The organization began as an initiative of Chapter 61 Ministries in 2009 and became its own non profit two years later.

“It was my mother, Lynn Thompson, who came up with the original idea,” said Paris.

Her parents owned a hotel when she was a child and truck drivers were some of their frequent customers. So when Paris and her mother decided to fight human trafficking, Paris said the answer was right in front of them.

“One of the things we knew we needed right away was something to go to all the places we couldn’t go,” she said. There are hundreds of thousands of trucking companies in the U.S., and most of them operate fewer than 20 trucks. “So how are you going to get this information into the hands of the industry?”

Click here to see federal laws that address human trafficking >>

Paris said the answer was to turn to the drivers, whom she now calls the “Knights of the Road.” Equipped with TAT training and an information card that fits into a wallet, drivers can better identify problems and connect victims with help in every state across the country.

The Road to Help

The TAT training includes contact information for the National Human Trafficking Hotline, run by the Polaris Project. Almost 27,000 calls were made to the hotline in 2016, a 35 percent jump in cases over the previous year.

Polaris attributes the increase to people spreading awareness of human trafficking and the hotline. While sex trafficking has the highest numbers, labor trafficking is second and increasing at almost 50 percent since last year.

The hotline connects victims to resources such as shelters and detox facilities — places to get off the streets and start over.

These services are critical not just as a safe place for victims to sleep at night, but to help them deal with trauma and often drug abuse. Ohio’s Anti-Human-Trafficking Coordinator, Elizabeth Ranade Janis, said human trafficking adds demand on facilities already strained by the opioid epidemic. Detox facilities are in short supply of beds, and they are almost always full.

To get a sense of the state available treatment resources, consider Amy Nace-DeGonda’s job. She’s an outreach coordinator for the Human Trafficking Program at Catholic Charities, located in Louisville. She estimates that statewide, approximately 45 beds are available for human trafficking victims at various times throughout the year. Polaris reports that Kentucky had at least 89 human trafficking cases in 2016, That would means more than half the victims calling could be turned away.

Personal Perspective

Kellie Russell is a co-founder of Victory Through Grace Ministries, a home and counselling center for female human trafficking victims in Paducah, Kentucky. Russell brings a personal view to the work when she offers a room to a victim.

“I was also sexually abused and trafficked,” she said.

The home has five beds. Russell wants to add more, but that takes money that isn’t readily available.

“We network with several different organizations, so they all know when we are full,” she said. Fluctuations in demand make it hard to predict, but Russell said the three beds she wants to add would quickly be filled.

Russell said it is important to her that her facility is not a shelter. Her personal experience in and out of facilities over the years made her realize that the more home like a place can be for the victims, the quicker they become empowered to stay and work through their struggles.

“I went through a couple places, like a 30-day program,” she said. “It felt like I was on lockdown, so I left.”

Art on the wall at a center for trafficking victims.

Acts of Kindness

Occasionally an act of kindness triggers enough courage for a victim to seek help. But if they have nowhere to go, then they usually end up back on the streets. When Beth Jacobs is conducting one of her training sessions, she says it is important not to promise something you can’t guarantee, like a place to stay.

“I tell them it’s just the random acts of kindness, you know, listen to them,” she said “If they look scared and hungry, feed them, ask them if they want a drink of water.”

That little bit of kindness can plant a seed of trust, she said, and if it happens often enough, a victim might eventually reach back for help.

Ohio County Deputies to Carry Opioid Overdose Antidote

Ohio County sheriff’s deputies are soon going to start carrying antidotes for opioid overdoses.

WTRF-TV reports that the Ohio County commission on Tuesday announced their approval for deputies to carry Naloxone, which reverses the symptoms of an opioid overdose.

All deputies with the sheriff’s office will receive training on how to administer the medication and how to identify the symptoms of an opioid overdose.

U.S. Attorney William Ihlenfeld says it is especially important for the Ohio County deputies to have the antidote because the county is in a rural area and deputies are oftentimes the first to the scene.

Federal funding will be used for the start-up costs.

After Obamacare: Thousands Of Jobs Hinge On Affordable Care Act Decisions

As Congress considers repealing the Affordable Care Act, health professionals in Kentucky, Ohio, and West Virginia grapple with what that might mean for a…

As Congress considers repealing the Affordable Care Act, health professionals in Kentucky, Ohio, and West Virginia grapple with what that might mean for a region where many depend on the law for access to care. This occasional series from the ReSource explores what’s ahead for the Ohio Valley after Obamacare. See more stories here >>

Since the expansion of Medicaid under the Affordable Care Act the health care sector has grown by more than 19,000 jobs in the Ohio Valley region. And some economists who focus on health care policy are warning that many of those jobs could well hang in the balance as Congress considers changes to the Act.

One of the ACA’s effects in the Ohio Valley region has been to sharply reduce costs for what’s called uncompensated care — that’s the cost of caring for the uninsured.

Dustin Pugel is an economist at the Kentucky Center for Economic Policy, a nonpartisan research center. He said in Kentucky’s rural hospitals there’s been about a $150 million decrease in uncompensated care costs just in the first quarter after Medicaid expansion. He worries that if the ACA is repealed more people will lose their health insurance, and hospitals will have to cover that cost again.

“We would definitely see hospitals getting squeezed more and more, and that would be devastating for their budgets,” Pugel said.

Pugel said Medicaid expansion payments more than made up for the loss of what are known as disproportionate share hospital payments — the other method by which hospitals were reimbursed for charity care. Those payments from the federal government used to make up for the cost of caring for the uninsured but largely were phased out when more people became insured.

Pugel said even when those payments went away hospitals were still better off because they were getting more money from newly insured patients.

Those changes to hospital finances allowed them to expand programs and add personnel.

“In the first few years of medicaid expansion in Kentucky there were 13,000 hospital jobs alone that grew in the state. Whereas before it was flatlined,” Pugel said.

Pugel said if the ACA is repealed a lot of those people will likely lose their jobs. Kentucky could have the second highest rate of job loss, with estimates of almost 56,000 jobs being eliminated. West Virginia could lose 16,000 jobs by 2019. Ohio stands to lose more than 50,000 jobs if the ACA is repealed.

Kat Stoll is with the West Virginia Center on Budget and Policy. She said West Virginia doesn’t have the room in its state budget to pick up the cost of covering hundreds of thousands of people who would lose their health insurance if Congress moves forward with the repeal of the ACA. She said sick people still get sick, but without insurance they will put off seeking care until it is an emergency, which is usually more costly.

“People will die and the people who do get treatment will put a tremendous burden on our hospitals and providers in our rural state,” Stoll said.

West Virginia gained about 6,500 healthcare jobs since the state expanded medicaid in 2014.

A number of competing plans have emerged in Congress that might replace some or all of the ACA. Stoll said the replacement plans she has seen leave a lot to be desired.

Troubled Waters: A Coalfield County Loses Trust In Water And Government

On any given day in Martin County, Kentucky, the water system loses more water to leaks than it delivers to paying customers through their faucets.The…

On any given day in Martin County, Kentucky, the water system loses more water to leaks than it delivers to paying customers through their faucets.The water system is under a state investigation for the third time since 2002. Customers complain of frequent service interruptions and discolored water, and their bills come with a notice that drinking the water could increase the risk of cancer.

This is the state of infrastructure in a county that’s mined many millions of dollars worth of coal since the early 1900s, providing the power required for America’s industries and modern comforts. As with many coalfield communities, all the profit and advances the area’s laborers and natural resources made possible haven’t left much to show for in the local economy and infrastructure.

Opening a tap is an exercise in trust which most of us take for granted. But in Martin County it’s just one more reason for residents to feel let down by the powers that be; one more chapter in the long story of how the people have lost faith in their government.

Dirty Water and Distrust

Josie Delong lives in Warfield, Kentucky, which is one of Martin County’s bigger towns with a population of 269. Because it’s across a ridge line from Martin County’s water intake near Inez, the county seat, Warfield has had some of the worst recent water struggles in Martin County.

“We drink nothing but bottled water,” Delong said. “I even put bottled water in my kids’ bathroom when they brush their teeth.”

A lot of people in Martin County won’t drink the tap water. Peggy Newsome, a clerk at the local Save-A-Lot supermarket, estimated that at least 75 percent of the people she checks out buy bottled water.

Delong said the water has long had a chemical smell and she worries that it might be contributing to her health problems, including bleeding ulcers.

“So I go to my doctor and the first thing he says is, ‘Contaminated water. How’s your drinking water?’” she said. “Is it caused by the water? I can’t say that 100 percent, but my belief — it is.”

Josie Delong with a sign used as part of her advocacy for cleaner water.

Delong is among many residents who say they have seen water service cut off at times with little or no notice.

The service interruptions relate to the system’s inability to meet peak demands for water. For example, when the temperature drops below freezing, many people leave their taps open to make sure pipes don’t freeze. That creates peak demand on the water system, and last winter in Warfield, it was enough to drain the water tanks.

That left Joe Hammond with a dilemma. Hammond is the public face of the Martin County Water District. He said the lack of water would force the local school to close.

A still image from a video of foul water in a Martin County home

“At night they would shut it down so that they’d have water for schools,” Hammond said.

Before you use water after a loss of service, it’s best to flush the pipes to get out any dirt that’s seeped inside in the meantime. But you can only do that if you know your water’s been cut off.

Hammond said it was a quick decision late at night to shut down water to the Warfield area and that explains why a notice, known as a boil water advisory, didn’t go out until until the next morning.

Delong and others say they never heard anything about a notice, not for that night, or for any of the following nights when the water was again cut off.

The problem with stopping water flow to a section of pipes is that there’s no longer any water pressure to keep out contaminants. That’s especially true in Martin County, where the pipes are so leaky that the water-loss rate has consistently been over 50 percent.

Joe Hammond of the Martin County Water District took questions at a hearing on water problems.

Last June, Martin County State Senator Ray Jones called in several top state officials for a public meeting to address the county’s drinking water issues. The water district’s Hammond tried to explain the county’s system for calling customers affected by a cutoff or boil water advisory. But he was cut off by angry audience members. One man said he’d never heard of anyone getting such a warning. “I’m done with it, it was a lie!” the man shouted and stormed out of the room.

Sewage Stressing System

The other top issue at the public meeting was concern over two disinfection byproducts, Trihalomethanes and Haloacetic acids. Since 2002, these have been showing up on notices sent to customers of the Martin County Water District. The notices inform customers that their water has exceeded maximum contaminant levels, and that long-term exposure can increase the risk of cancer, especially for the elderly, infants, and anyone with a compromised immune system.

According to Joe Burns of the Kentucky Rural Water Association, disinfection byproducts aren’t an issue for most U.S. water systems that draw from groundwater. In Kentucky and the Ohio Valley region, however, many systems draw water from rivers and streams, which opens up more possibility for contamination that needs to be treated with chlorine.

The disinfection byproducts are the result of chlorine interacting with organic molecules. Much of the organic molecules come from what are commonly known as “straight-pipes”. In Martin County, like much of the coalfields, there’s a serious shortage of wastewater infrastructure, which means sewage often gets piped straight into the nearest stream.

Martin County’s water intake on the Tug Fork River.

Gail Brion directs the University of Kentucky’s Environmental Research and Training Laboratories and has worked on water treatment issues for decades. She calls the amount of sewage in this region’s watershed “as close as I could come to Third World conditions without a passport.”

More sewage in the water source means more chlorine is needed. Nina McCoy, a retired biology teacher, has been testing water around Martin County for nearly 25 years. She said the frequent violations for high levels of disinfection byproducts is an indication of the poor quality of the water coming out of the county’s water treatment plant.

“We’re constantly being told, this is basically your own crap,” McCoy said.

Officials have tried to reassure the public that disinfection byproducts shouldn’t make them afraid to drink their water.

Peter Goodman, the Director of the Kentucky Division of Water, was in attendance at the June meeting in Martin County. He tried to reassure the crowd that they’re not at any great risk. He said the levels are just a little over the standard, that the standard is very conservative, and that since it was recently strengthened many water districts are dealing with the issue.

At the Martin County Water District Office, Hammond shared a handout that emphasizes that the risk of cancer from disinfection byproducts is small, and a worthwhile trade-off if the alternative is water that could potentially make you sick right away.

Coal’s Contamination

Martin County’s major industry has also caused massive contamination of surface waters.

The Martin County Coal slurry spill in 2000.

Leaks and spills from coal mines and gas drilling operations are common. Many are minor, blackening a stretch of stream or producing mysterious, short-lived slicks. Other spills are disastrous.

That was the case on October, 11, 2000, when a massive coal slurry impoundment, or sludge pond, broke through an old mine shaft underneath. Wolf Creek and Coldwater Creek ran black with sludge, overflowing their banks by up to seven feet, and the millions of gallons of sludge forced the closure of drinking water intakes along miles of downstream rivers.

A decade later, residents could still find residue of the sludge along streams just a few inches below the surface.

The spill and the way it was handled by authorities has further eroded people’s trust in both the county’s water and its leaders.

Some residents complained that there was little warning for residents at the time of the disastrous spill, and a mine safety investigation of the incident was mired in scandal and accusations of a cover up to protect the coal company.

A War on Poverty Battlefield

Now, Martin County is in a really tough situation. Forty percent of the county’s residents live in poverty. Only thirty percent are in the workforce. The coal industry has been laying off workers as it competes with cheaper natural gas, depletes the best coal seams, and relies more on machines.

Hard times here are nothing new. Martin County has been facing many of the same challenges of economy and infrastructure for decades and was a highly visible part of one of the country’s most famous efforts to address poverty.

In 1964, President Lyndon Johnson visited Martin County as he launched the War on Poverty. A government film described it as “a trip to the root of Appalachian poverty” and noted that the area’s economic hardship was “attributable primarily to a general lack of industrialization, and losses in the coal mining industry.”

President Lyndon Johnson on the porch of a Martin County home in 1964, as he launched his “War on Poverty.”

The War on Poverty did lead to significant investment that had measurable benefits, but many have lamented that Johnson’s program did not have the impact it aspired to.

“Here’s the thing, in 1964 LBJ kicked off the War on Poverty,” said Gary Ball, editor of Martin County’s weekly newspaper, The Mountain Citizen. “Here we are, over 50 years later and we can’t even get decent drinking water.”

Tight Budgets

Coal’s decline has had an enormous impact on county budgets across Central Appalachia.

Judge Kelly Callaham, the top elected official In Martin County, said the the local government has been forced to make a lot of cutbacks. He said the county is now getting less than a quarter of the tax revenue from coal that it got as recently as three years ago.

“If somebody’d looked at me when we was getting $800,000 a quarter and said, ‘Judge, you’re not gonna get but $150,000 three years down the road’ I’d say you’re crazy man,” Callaham said. “But that’s what happened.”

That drastic loss of income makes it harder to pay for water system improvements.

The Judge said the quick change in coal tax revenue surprised him, but some in the community expressed unhappiness with how the county has handled its funds. Newspaper editor Gary Ball said that the county’s leadership should have been better prepared and made better decisions. He pointed to the county’s recent investment in a $10 million government center as money that could have been better spent improving the county’s water system.

Judge Callaham said he wouldn’t have supported building the courthouse if he’d known how much tax revenue the county would soon lose. He also argued that the old courthouse needed to be replaced because it had issues with lead and asbestos that he suspects caused his health problems.

The new $10 million government center (right) beside the old courthouse (left)

The dispute over spending priorities is just one more example of the strained relationship between residents and officials. “People just aren’t trustful of their political leaders,” Ball said. “And when you think about it, the leaders haven’t given them a whole lot to win that trust.”

Some Improvements

Martin County’s water district is getting help from the Kentucky Rural Water Association, thanks to the state’s Division of Water. The association has sent in technicians to train and assist the county on detecting and repairing leaks.

Joe Hammond said he’s hopeful that this will help the county’s water loss rate continue to drop— it’s approaching 50 percent after previously topping 60 percent. However, Hammond said there isn’t enough money to make the kinds of fixes that are really needed and the patches being made are short-term at best.

“If you have a hole already, it’s just going to get bigger,” he said.

Martin County relies on a water treatment plant that was built in 1968.

Hammond has a list of prospects for funding. Two options come from the state government— the Kentucky Infrastructure Authority and the Department for Local Government. Those are unlikely to provide the large amounts needed to renovate the treatment plant and start replacing pipes that have been in the ground for as long as fifty years. But they are becoming more plausible, now that the water district has submitted the required financial audits.

Hammond and others in the community seem to have their hopes most firmly set on money from the federal Abandoned Mine Land fund. A proposal pending in Congress, the RECLAIM Act, would allow spending from that trust fund for projects in the region that improve economic possibilities.

Gail Brion has experience with federal funding for water systems from her time working at the Environmental Protection Agency. She says the EPA used to provide a lot more federal money for water systems in places like Martin County, but there was a fundamental shift in how the agency approached funding during the Reagan administration, when she describes the EPA as having gone through a “great dismantling.”

Brion said she’s bothered by how America’s priorities have changed when it comes to water systems and other infrastructure.

“These water systems were established with federal money,” Brion said. “That money has now become a revolving fund that has to be paid back. And when you can’t pay for your services to begin with, how are you going to pay back a loan to make those services better?”

Brion said she’s hopeful that there’s a growing consensus about the importance of investment in the country’s infrastructure. But she’s not sure that will include things such as water systems.

Gail Brion directs the Environmental Research and Training Laboratories at the University of Kentucky.

Fighting for Change

Sadly, the issues in Martin County aren’t that exceptional. Counties across the coalfields and in other rural areas face similar challenges of poor infrastructure, lack of investment, declines in the industrial job base, and polluted watersheds.

Despite the many problems with its drinking water, Martin County doesn’t stand out as a worst case. In 2016 the Martin County Water District reported ten water quality violations and nineteen boil water advisories. That puts the county below average compared to other Kentucky water systems and the number of reported advisories.

Where Martin County does stand out is in its community of hell-raisers: The Mountain Citizen highlights water issues week after week; Josie Delong formed a Martin County Water Warriors Facebook community; and many other outspoken local activists are making noise.

So while there’s still a lot that needs to be done for the people of Martin County to regain trust in their leaders and their water, one thing is certain: The county has an active community fighting for change, and for clean water.

Stopping Superbug: A New Farm Rule Targets Antibiotic Resistance

A recent report from the Centers for Disease Control offers a stark example of the declining power of medicine’s most important weapons against infectious…

A recent report from the Centers for Disease Control offers a stark example of the declining power of medicine’s most important weapons against infectious disease. The CDC noted that a patient who died at a Nevada hospital last year had an infection that was resistant to 26 different antibiotic treatments. That’s essentially the entire antibiotic arsenal doctors had.

There’s an antibiotic problem in the U.S. Some just aren’t working anymore as resistant bacteria, so-called “superbugs,” are growing. Part of the problem lies with farms, where massive amounts of antibiotics have been used on livestock, including animals that aren’t even sick.

A new regulation from the Food and Drug Administration taking effect this month aims at decreasing the agricultural use of medically-important antibiotics — the ones also used to treat people. The rule has raised questions in farm country and sparked debate among public health advocates who worry that the new mandate doesn’t do enough.

Path to Resistance

Dr. Rusty Ellis is an acute care physician at Baptist Health Hospital in LaGrange, Kentucky. Patients come in with staph infections, urinary tract infections, and sepsis. But the antibiotic quick fix for infections isn’t as easy as it used to be. He’s seeing a lot of patients with strains that resist antibiotics.

“This is Leviquin,” Ellis said, holding an intravenous sack of antibiotics. “It still works in some instances, but it’s become fewer and fewer pathologies we use this in.”

This story on antibiotic resistance hit close to home for ReSource reporter Nicole Erwin, who has firsthand experience of the illness that these bacterial strains can cause.

That’s because Leviquin has lost some of its effectiveness. Leviquin was also once widely used on livestock before the FDA banned its use on animals more than a decade ago.

“Whatever you’re giving your cows, those bugs can become resistant,” he said. “It’s not any different from us.”

Take enough antibiotics, and your system can build resistance. And those bugs can hop from person to person. The same thing can happen with livestock on farms. Over half of the antibiotics sold for livestock use in 2015 were also of the types used in human medicine, and a strain that becomes resistant in animals won’t necessarily stay down on the farm.

Read more about Nicole Erwin's experience here

It’s such a problem that the World Health Organization held its first summit on the subject last fall. The W.H.O. says resistant strains of bacteria can increase the likelihood of death and make people sicker for longer.

Ellis can’t make a direct link between resistant bacteria cases he sees in the hospital and the antibiotic use on farms in the surrounding county. But he knows resistance can arise with any indiscriminate use of antibiotics, and he knows the pressures doctors face to prescribe them.

“I had a patient that I didn’t have a reason to give them an antibiotic and that person got really upset with me,” Ellis said.

It’s hard to say no to a patient. Doctors wrote 47 million prescriptions in 2015 for antibiotics that were medically unnecessary, according to the Centers for Disease Control and Prevention. “You want to please the person that’s spending the money to come see you, because this is a service-based industry.”

Veterinarians face similar pressure. Many farmers have become accustomed to easy access to antibiotics mixed with animal feed to promote growth and prevent disease among healthy animals. The new FDA rule restricts that use and requires a farmer to get a vet’s prescription for preventative use.

Patrick Butaye, a professor and vet at Ross University on the Caribbean island St. Kitts, teaches a lot of students going into work on farms in the U.S. He doesn’t think antibiotics should be used on healthy animals and he tries to teach his students that. But he knows that with this regulation in place vets will have to make some tough decisions.

“When they go into the field, and the farmer wants this and the farmer wants that. We have to work on consciousness,” Butaye said. “The situation is going from bad to worse and it won’t change until we start using less.”

If doctors are known to give into patients begging for an antibiotic, who’s to say vets won’t do the same with farmers?

Bacteria that gain resistance to antibiotics in livestock can leave the farm via manure runoff, human contact, or vehicles and equipment.

Vetting the Vets

“Antibiotic resistance should be a concern for everyone,” said Lucky Pittman, director of the Breathitt Veterinary Center. “But I think food animal production is unfairly targeted.”

The center provides diagnostic data to aid veterinarians in making appropriate treatment decisions. Pittman has a unique perspective on the matter. He is a scientist, veterinarian, and a cattle farmer. He said the new regulation means people will no longer be able to “just go buy tetracycline and feed it willy-nilly.”

But he also thinks it will be burdensome to both farmers and vets because of the paperwork it will generate.

Veterinarian and rancher Lucky Pittman thinks animal production is being unfairly targeted.

Pittman said vets and producers alike will be required to keep all paperwork associated with any antibiotic orders for two years. This implies that a regulator might use the information gathered to perform an audit.

FDA spokesperson Juli Putnam said implementation of the rule will involve “risk-based general surveillance, as well as for-cause inspection assignments.” If an offender is caught, Putnam said the FDA would “collaborate with state regulatory partners and state boards of veterinary medicine” to enforce compliance, which could involve a fine or revocation of a vet’s license.

Some public health advocates are concerned that enforcement may be weak. However, some trends already underway in the industry show a willingness to move away from antibiotic use.

No Antibiotics – Ever

Nancy Butler still works on the Calhoun, Kentucky, farm where she was born. Back then, the family grew tobacco and soybeans. Now she raises chickens, one of the biggest agriculture money makers in this region. For the past 20 years Butler has contracted her two chicken houses to Perdue. Butler describes herself as a small producer, even though each of her houses holds 25,000 chickens per contract. Here’s the remarkable thing about those chickens: not one of them is raised with antibiotics.

Farmer Nancy Butler raises her thousands of chickens without any antibiotic use.

“So many people are making that choice, to go antibiotic free, because we have a lot of sickness in this country,” Butler said. “I believe it can be remedied if we would just be more vigilant in what we are consuming.”

Perdue started moving away from antibiotics 14 years ago, well before the newest government regulation. Butler said the switch hasn’t been a problem. She can still meet the pressure to produce bigger birds at a cheaper rate.

“These chickens grow really fast,”she said. “It’s the conditions. The right air, the right temperature, the right feed, the right clean water.”

Butler’s farm shows that chickens can be produced efficiently and humanely without antibiotics.

“It has been a long journey,” Perdue senior vice president Eric Christianson said, explaining his company’s “No Antibiotics Ever” approach. “Fundamentally the challenge was: if we can raise healthy chickens and healthy animals without using antibiotics, then why wouldn’t we?”

Perdue growers do things public health advocates say the chicken industry should do in order to prevent disease.

“We have loosened up our flocks so the density is not as tight,” Christianson said. He admits that those practices lower efficiency somewhat. “But the trade-off is that you’re raising healthier chickens. We’re not trying to be a factory farm. We’re trying to do things the right way.”

For decades, many healthy chickens were routinely fed antibiotics to prevent disease outbreak and to promote rapid growth.

This is where the industry is divided. Some want to end all use of antibiotics, as public health advocates urge. Others say some medically-important antibiotic use — as the new FDA rule allows — is okay. For instance, Tyson Foods will comply with the regulation, but that’s as far as they and their farmers will go.

Christine Daugherty is Tyson Food’s vice president of sustainable food production. She said that by the end of this year Tyson will no longer use antibiotics used in human medicine.

“We know those are the ones that are the most sensitive and we want to try to eliminate those in our broiler chicken,” Daugherty said.

Too Little?

Public health advocates are urging industry to go further than the new FDA regulation, which they fear will not do enough to prevent the rise of superbugs.

“Our highest priority is to eliminate the routine use of medically important antibiotics on livestock and poultry because of the threat it poses to human health,” said Matt Wellington, a public health advocate with the environmental group PIRG.

Wellington said the new rule’s allowance for preventive use means medicines important for human treatment will still be used on animals that aren’t sick, potentially contributing to resistant strains that can easily escape a farm.

“They can spread from contaminated water off of farms, so from manure, and once they’re out there, they’re out there,” he said.

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PIRG and other public health groups are putting pressure on the big buyers such as restaurants and fast food chains.

“We want them to commit to only buy from farms that don’t use this routinely, only for sick animals,” Wellington said.

So when activists from the Natural Resources Defense Council visited various KFC locations last year, they weren’t out for an 8-piece meal. NRDC’s creative campaign used an advocate in a chicken costume covered with giant pills — that’s right: a chicken on drugs.

“We’ve been drugged enough!” the chicken character squawked in a video shot in front of a KFC store.

An NRDC activist uses a chicken costume to call attention to KFC’s use of animals raised with antibiotics.

The campaign generated a petition urging KFC to publicly commit to sourcing chicken raised without routine antibiotics.

Other industry leaders have already moved in that direction, including McDonald’s, Subway, and Chick-fil-A. KFC issued a written response: “Our position on antibiotics is currently being reviewed to determine the viability for our suppliers to go beyond the FDA guidelines for antibiotics usage.”

KFC wouldn’t provide the ReSource with any information regarding where they purchase chicken and many food companies protect information about where they buy or sell products.

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Large fast food chains may also buy meat from more than one company, making it more difficult for a concerned consumer to make an informed choice.

Perdue did identify one partner, Chick-fil-A. “They are very committed to [no antibiotics] and they’ve gone on record saying that,” said Perdue executive Christianson.

Less Rotten in Denmark

The US is not the first country to tackle this problem, and the experience of one other country offers a lesson. Denmark took action 20 years ago with a rule similar to the one the FDA just adopted. Karl Pedersen at the National Veterinary Institute in Copenhagen said the consumption of antibiotics on farms has decreased.

“Maybe the reasons for using these growth promoters were more on tradition, that there was really not the need for it that the industry had thought,” he said.

More than half the antibiotics used on livestock are drugs also used to treat people.

And the best news, Pedersen said, is that the prevalence of resistant bacteria has gone down in Denmark since that rule took effect.

Of course farms aren’t the only source of the problem. Over-prescription and improper use of antibiotics by people also contribute to resistant bacteria. So whether we’re doctors or patients, farmers or foodies, we all have a role to play in stopping superbugs.