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Animal Antibiotic Use and Human Health: No Expert Judgment is Needed to Determine that Reducing Cases Reduces Risk


* Cox Associates, 503 Franklin Street, Denver, CO 80218-3623, USA; tel: 303-388-1778; fax: 303-388-0609;


In his comments on our Rapid Risk Rating Technique (RRRT), Dr. Claycamp states that “Cox and Popken were silent on the pivotal expert judgment subsumed in their method: quality weights for illnesses caused by antimicrobial-resistant and antimicrobial-sensitive microbes are tacitly assumed to be equal.” However, contrary to this comment, we explicitly provide separate quality weights for antimicrobial-resistant and antimicrobial-sensitive illnesses (with different values, based on QALYs lost per illness, illustrated in our article). Thus, our model already addresses Dr. Claycamp's central concern. Moreover, since withdrawing macrolides and fluoroquinolones from use as animal antibiotics is projected to cause more of both types of illnesses—antimicrobial-resistant and antimicrobial-sensitive—than continuing to use them would, our conclusion that such withdrawals would be poor public health policy is completely robust to changes in the quality weights. Our human health impacts assessment is therefore indeed immune from the “expert judgments in risk management” discussed by Dr. Claycamp.