Management Over Medication Field Day

October 26, 2021

Michigan State University will host a virtual field day focusing on responsible use of antimicrobials . This virtual field day event will feature leading researchers and outreach specialists representing Michigan State University and Kansas State University, and include local farmers and retail businesses who will describe why sound antimicrobial stewardship is critical to the future of livestock production and provide practical advice on how it can be implemented effectively on farms of any size. 

Speakers will offer insights on the effectiveness of meat and dairy industry efforts to encourage responsible use of antimicrobials following Veterinary Feed Directive guidelines implemented in 2017 as well as other, commodity-specific, initiatives.  They will describe strategies promoting responsible use of antimicrobials, how they benefit the health and well-being of both animals and humans, and how consumers value responsible use of antimicrobials. The event will include a discussion on the future of antimicrobial use in food animals and offer attendees opportunities to ask questions around this topic. 

Video Transcript

 Lets Go!  Well good morning everyone and thanks for joining us today. We're here today to talk about Antimicrobial Stewardship in food animal production and why it's important. It's been five years, I think now since the US food animal industry implemented the Veterinary Feed Directive and the VFD is a set of guidelines designed to help preserve the effectiveness of antimicrobials used to treat diseases that affect livestock and people. Most of us would agree, I think, that that meat and dairy producers have done a good job with stewardship program since VFD was implemented. But as we approach its five-year anniversary, we thought it would be a good time to learn about, how leading experts view responsible antimicrobial use today and how it might evolve in the coming years. We also wanted to share the perspective of farmers and animal product retailers whose daily activities have been affected at multiple levels by Antimicrobial Stewardship Programs. Our program today will lead off with an overview by Professor Pamela  Ruegg from MSU, who will describe some key foundations of antimicrobial stewardship and how it's practiced in the US. Then we're going to go to dairy, to the Black Locust Dairy in Stanton Michigan. Where Phil Durst and Ciarra LaHuis from MSU will interview farmer Jack  Jepson and they'll discuss how this farm is practicing some stewardship. From there we'll go Southwest, I think about 40 miles to Grand Rapids, Michigan to Louise Earl Butcher Shop where owner Matt Smith will talk about how he selects farms to partner with, to meet the healthy local food preferences of his customers. And then finally, we'll call on Professor Mike Apley at Kansas State University, who will share his perspective on Antimicrobial Stewardship and how current recommendations might be tweaked going forward. There will be a couple of brief technology checks following the second and  fourth talks. And we'll hope you use that time to answer a couple of questions that we'll pose to you. Shelby Warner will explain in a minute how to ask questions. Panel members will answer questions that you pose following their presentations or during the next speakers talk. Sometimes there'll be a bit of a lag there, but we'll have time during the open discussion to answer other questions. If you intend to apply for continuing Ed credits, instructions will be provided to you at the end of the very brief survey following the open discussion. Now Shelby, I will say a few words about how to ask questions on Zoom before we get to Professor Ruegg. Shelby. Hi there everyone. So today for our Zoom webinar, we'll be answering questions through the Q & A feature. You'll find this feature at the bottom of your screen in your little Zoom toolbar. You just click on that Q&A icon and then you type in your question and click the send button and it will send it our way. If your having any audio or other technical trouble  throughout the presentation, please give our help desk a call. The phone number is 800-500-1554. We also will have the chat open. So in case you have any comments or other things that you would like to notify us about, you can send us a message through there. That wraps up our tech for today. Well, thank you, Shelby. Without further delay, then it's my pleasure to introduce Professor Pamela Ruegg, the Ellis chair of Antimicrobial Resistance at MSU, will describe how animal agriculture can benefit from antimicrobial stewardship programs. Professor Ruegg, are you there? Hello, I'm Dr. Pamela Ruegg, I am fortunate to be the inaugural holder of the David J. Ellis Chair in Antimicrobial Resistance and Large Animal  Clinical Sciences in the College of Veterinary Medicine. Some of you may remember Dr. Ellis as he was an esteemed veterinary practitioner who had a big impact on the swine industry in the state. And I'm proud to tell you he was one of my teachers when I was a student here. So today I'm going to be talking about a very important and practical subject today that is influencing all of our, all of our animal commodities, And that's the subject of antimicrobial stewardship on our farms. The subject of my talk today is how we in animal agriculture can actually benefit from antimicrobial stewardship programs. And this is a little bit different take on this because I think we often look at these antimicrobial stewardship programs as something that's being imposed on us. But I'd like everybody just to maybe suspend that thought for a minute and think about the good that can happen when we in animal ag engage in these programs. You know, one of the things that is very true regardless of which type of animal protein we're producing today, is that consumers get competing messages about antibiotic usage and animal agriculture. You just look at these two slides, these two pictures, these two pieces of news that I've got up today. One on your left is a report from the Center for Infectious Disease Research and Policy, which you know who really knows who that is. And it says, US pigs consume nearly as many antibiotics as people do. That's one message that gets transmitted. And then on the other side is a message in the National Hog Farmer that says, US pork producers are committed to responsible antibiotic use daily. And both of these messages are messages which are competing for space within our consumers. I'm going to be referring, you know, I work primarily in the dairy industry and the issues in the dairy industry and swine and all of animal ag are the same. And I'm going to show you a little bit of data from the dairy industry as well. This is from a study we published this year called, Quantification of Antimicrobial use each in adult cows and preweaned calves and this, this quantification across 40 large Wisconsin dairy farms. What this graph shows is on the horizontal axis, we've got 40 farms, data from 40 farms. And on the vertical axis is the average daily dose per 1,000 animal days of antibiotic use. Then it's not important that you understand the metric. What I want you to take a look at here is the tremendous variation. Our lowest using farm, this farm that I've labeled number 1, used about 5, defined doses 1,000 animal days. Whereas our farm number 40 used approximately 40 animal daily doses per 1,000 animal days. We see this kind of large variation among farms regardless of commodity. And part of the reason we see this variation is not many of us have a good context for what normal antibiotic usage is. And the same thing applies to measures that have been done in the swine industry. Lots of variation. This is kind of a messy slide, but this is a study that's titled Variation in Use of Antibiotics Among Swine Farms in 2016 and 17. It came out in 2020 with Davies & Singer. And you really don't want to have to understand the details of this, you just need to look at kind of the pictures. Let's look at 2016. Those colors are all different types of antibiotics and let's just contrast farm A and farm C. You can see farm A used 70% of their usage was Tetracycline. Farm C, approximately 35% was farm D, almost 90%. This isn't volume, but it just shows you how much variation there is in usage among farms. And this reminds me, very early in my career when we're trying to figure out some of our other metrics like what's the right amount of certain diseases. We just start collecting this data, understanding it, and trying to understand what was achievable before we could make progress. And I think the same thing applies to our use of antibiotics. And when we start understanding and benchmarking this data, then at some point we'll be able to on individual firms make decisions about, hey, do we need to work on certain areas of improving antibiotic usage? Okay, So with that background of all this variation that we see out there in farms, I want to just introduce the subject of what is antimicrobial stewardship, and it just all commodities right now, in response to these societal pressures, have statements about what antimicrobial stewardship is and why those of us producing animal protein are interested in it. And the National Pork Board has a policy on antibiotic usage in pork production. And I'm sure many of you are familiar with this. And these statements are very similar. They say things about using antibiotics, responsibly prevention of disease, reducing the use of medically important antimicrobials. And following guidelines to make sure that antimicrobial usage or antibiotic usage on farms is done in a responsible manner. So this is some of the pork producers. We agree to implement the following guidelines to demonstrate our values. Advocating objective, scientifically rigorous studies and risk assessments. Engaging with veterinary oversight, promoting stakeholder education. Demonstrating compliance with regulatory requirements and treatment records such as in PQA Plus, and encouraging transparency. These are all really good things. And I'm really an advocate of these. But I also want to point out that when we start looking at antimicrobial stewardship at the farm level, there's beneficial things for us that actually can improve the efficiency of our agricultural units and the welfare of our animals. And you see this a little bit in the American Association of Bovine Practitioners definition of antimicrobial stewardship. Which says that they're committed to reducing the need for antimicrobial drugs by preventing infectious disease and when antimicrobial drugs are needed, using them in an optimal way. And the thing I kinda like is that this antimicrobial stewardship is introduced as a cycle, a bacterial disease management. And that's where I think we need to be moving toward, is kind of just incorporating the fact where we need to diagnose our bacterial disease. Think about non antibiotic alternatives. When we do have to use antimicrobials, think about the least amount  we need to use. And then after we're finishing up with our disease management, are bacterial disease management, re-evaluating the need for antimicrobials in future cases. That's a little bit different spin on it, because now we're moving directly in, are we optimally managing bacterial diseases? That's a really important concept for us to understand. Antibiotics are for bacterial diseases. And they help the animal's immune response successfully eliminate bacterial pathogens. And so when we think about antibiotics, we should be thinking about bacterial diseases. And when we think also about the value of antibiotics, we have to understand that the value of that antibiotic is the marginal difference between the spontaneous cure rate and the treatment cure rate. So let's just take a, take a look at this little graph I've put up here to illustrate this. So let's say we have a viral disease. And you can see this green bar. Antibiotics don't help at all. So if we have 100 animals affected with a viral disease and 50% of the time the cow, the animal's immune response can effectively eradicate that the spontaneous cure rate itself is what is helping that animal. Now let's move into bacterial disease A. We've got bacterial disease A, which is the middle one here, where we've got 50%   spontaneous cure. And we're going to use an antibiotic that has 50% efficacy. It, and that's the other important thing to understand. Antibiotics themselves rarely have a 100% efficacy. So if we treat a 100 animals and 75 of them get better, 50 of those were spontaneous cured. The antibiotic actually cured 25. What we see as cure is the combined amount of the spontaneous cure plus the treatment cure. So it's important for us to understand which bacterial diseases this can respond to the antibiotic and which bacterial diseases can't, and which bacterial diseases have high spontaneous cure rates if the other animals are otherwise immunologically competent. And these are the things you need to be working with your veterinarian on in achieving bacterial diagnoses. So one of the things I want to introduce today is the concept, that we need to do a better job of measuring antimicrobial usage. Because if we don't measure it, we can't manage it. And this article that I'm showing you here is an article called Antimicrobial use in wean to market pigs in the United States, assessed via voluntary sharing of proprietary data. And this is a fairly recent article that came out this last year by Davies and Singer. And what you're seeing across the horizontal axis is individual farms labeled with A, B, C, D, E, and F. And then the vertical axis is simply showing the proportion of antibiotic usage on these farms, that is critically important. Highly important. or Not important. And this critically important category, these other drugs that the FDA and the World Health Organization has said, Hey, we need to reserve the use of these for human diseases when possible. And you can see that in this data on just these few farms, farm C about almost 50% of their antibiotic usage is these critically important antimicrobials. They probably don't know this. They probably don't know that they're using more than other farms because we haven't done enough benchmarking. And so we have to start thinking about this antimicrobial stewardship management cycle on our farms benchmark and assess the usage of our  antibiotics. Develop farm specific goals for usage. Assign actions to members of the farm treatment team to, to reach those goals and then assess the results of actions. So I'm proposing we move from antimicrobial stewardship as something that's imposed upon us that we have to reduce antimicrobial usage, into a management cycle where we're looking at understanding how and why we're using antibiotics. And then ways to optimize that use to, to ensure the welfare of the animals we're dealing with. So to do that, we have to understand the different types of antimicrobial usage. The easiest to defend and the one we need the most is Therapeutic usage, and that's treatment of disease. So that would be, for example, treatment of pigs showing signs of respiratory disease. And then the Prophylactic in the Metaphylactic, they kind of merge together a little bit. Prophylactic usage is the treatment of antibiotics for prevention of disease. That would be, for example, if you treat pigs in the same pen with other ill pigs.  Then this Metaphylactic  usage. This is often the most problematic from the consumer side, where we're using antibiotics to minimize the effects of an expected outbreak. And that would be, for example, if we treat pigs housed in the same building, same building with ill pigs. If you look at this NAHMS data, you can see that this Metaphylactic use, treat all pigs in entire room with clinically ill pigs is pretty common, about 50% of farms do that. And that's one of them that's the hardest to justify when we think about judicious usage of antimicrobials. So there's some criteria for justifiable antibiotic usage and these criteria are listed here. And this is from a book called Antimicrobial Stewardship in Animals, or from a chapter in a book. So here is the six criteria we need to think about. We need to have the local veterinarians developing and assessing protocols. We need to make sure animals are examined before antibiotics are used. That's coming back to, is this a bacterial disease that requires the use of antibiotics to achieve a cure? So there should be a reasonable benefit that a bacterial infection is present. We should target that bacterial infection with the narrow-spectrum drugs. We should use as short a duration as possible. That's it That's one that in my career we've gone from short to long, back to short duration recommendations. And we should avoid extra label usage when possible. So I want to just kind of spend the next maybe five minutes to conclude here talking about some practical ways to do that. And that's the 5-R Principles of Stewardship. Responsibility. We need to have a treatment team who's engaged. Reduction. We need have focus on preventive practices. Replacement. Are there things other than antimicrobial usage that we can do? Refinement. We want to evaluate the quality of antimicrobial usage.  And Review. Monitor the outcomes of those treatments. So assessing quality of antimicrobial usage, want to make sure we're treating bacterial infections. We want to make sure that we're following approved protocol that the local vet is engaged in and that we're using the right dosage duration and route. So putting this into action, responsibility and leadership, our goal is to create accountability. We can do that by regular training of an approved treatment team, prescription and drug purchase process review and assessment of a recording system. The benefit for the farm is increased competency of employees in a defined chain of command for animal health decisions. Secondly, how about reduction in need for antibiotics? Our goal, and this is a common goal on virtually all farms, is to prevent bacterial diseases. Are, actions are to determine the incidence of the most common, let's say the big five bacterial diseases. And review your detection, diagnosis or reporting criteria and make an action plan focused on one disease. Are benefit is to reduce disease rates and increase production efficiency. Third, replacement. Our goal is to use non antimicrobial interventions when possible. So let's re-evaluate and re-examine our vaccination programs. Let's consider non- antimicrobial interventions when we have chronic diseases. And our benefit is reduce morbidity and mortality losses. Refinements, number 4. And that's to improve our quality of antibiotic usage. So we need to read the labels of the antibiotics. We need to evaluate the diagnostic criteria for bacterial diseases, review our antibiotic choices, and evaluate our rationale for duration. Our benefit is we're going to preserve the efficiency and efficacy of antibiotics used on your farms. And we're going to reduce usage, probably of this critically important and medically important antimicrobials. And then finally, we need to review.  Are our current treatment protocols effective? We defined the outcomes, evaluate the cost, benchmark usage if you've got multiple farms, compare them. Address why there's higher use on some farms then others, and we're going to come up with better treatment results. So to conclude, antimicrobial stewardship simply means better management of bacterial diseases. It's good for the farm. It's similar to the other things that we do to, to make incremental improvement. We've got to have bench marking goals, actions, and assess our results. Thank you. Thank you, professor Ruegg, That was excellent. We did have a few good questions come in. It looks like you were able to answer them in real time, but we've got a couple of minutes, if you would like to say say a few words about these questions and what your answers were. Maybe beginning with the question around how many farms currently practice disease cycle of management properly and what are the key barriers to implementing a program like that? Yeah, I think that was  really an excellent question,  I don't actually have data on exactly what people are doing. But I would say in my experiences more than 35 years as a working in animal agriculture is a veterinarian. I think that it, it's the goal of most farms to to minimize bacterial diseases. To maximize  animal health, and I think are  key barriers, are the barriers we have on many of our farms where resource limited. We don't have enough people on farms. People are always have more tasks than they can complete. And then I think especially when we look at this antimicrobial stewardship in it kind of optimizing the use of antimicrobials. We don't have enough data to figure out how we're doing on farm A, as compared to the general population, I think that's something we really need to strive to improve. Thank you and one more that I like the question and I'll paraphrase a little bit here. Do we know what other management strategies were used by the low antimicrobial dairies were health and milk production is high and the low antimicrobial farms as it was on the high antimicrobial farms in that Wisconsin study? Yeah, that's a great question. In fact, we have at least two more papers coming out of that dataset. I've got people working on them right now. but I can't answer that question. Um, I don't know. You know, this was a USDA funded study, we made one visit to these farms to collect the data. We have extensive, these farms shared their computerized, animal health software,  but we don't have actually enough data to do a risk assessment. We only have 40 herds. And I did a previous study looking for risk factors of animal health on organic versus conventional dairy farms, and we required 300 herds to be able to answer that question. So we just don't have a sample size big enough to do that. But I will say these farms were not random. We recruited farms that had outstanding animal health records. And because of that, these farms, I would say in general would be at the upper echelons of overall management. Okay, great. Thank you. Yeah, that'll be interesting to see how those data come out, when we have larger numbers included so that we can monitor disease and performance in addition to, or correlate with antimicrobial use. Thanks again,  Professor Ruegg. And if you're able to stay online now, we'd like to have you. I'm sure there will probably be a few other questions come in. I think we'll, we'll move ahead then, Shelby to our next speakers. And I think Phil Durst from MSU Extension and Ciarra LaHuis are going to beem  in from the dairy in Stanton , if our  connections are good. It looks like they've got a good sunny day there. So, Phil are you and Ciarra there? Yes. Hi, I'm Phil Durst with Michigan State University Extension. Hi, I'm Ciarra LaHuis, I study cows in the Department of Animal Science at Michigan State.  And we're here, with Jack Jeppson,  with partners of Black Lucas farms. Jack, ah,  it's great to be here with you. Thanks a lot for having us out. Tell us a little bit about the dairy operation you have here. Our dairy operation was started in 1923 by our grandparents. I'm in a partnership now with my brother, it's a limited liability company and we're milking  about 240 through the parlor every day. We've got close to 30 or 40 dry animals. And then we also have our young stock.  We're running probably close to 220 young stock, from baby calves all the way to breed heifers. So if I did the math right, that's about 500 head of cattle on the farm? Yep, and 500 head of cattle that that that you want to keep healthy. Correct, Yeah, we we put a lot of effort into keeping our animals healthy in different different ways of doing it. So you put a lot of effort into keeping your cattle healthy. In a lot of different  ways. Lets just talk about some of those ways. What are what are some things that you do specifically for animal well-being and health? Sure. We have several different fields that we look at. Ventilation is one in the summertime and in the wintertime you want to keep their flowing with them. Hense the fans right here, that we shut off for the video, right. Yep, yep, Right. Yeah. Barnes have curtains on them. We open the curtains up as much as we can to keep the ventilation and the air flowing. The sanitary, we try to keep the stalls as clean as we can and I'm sure, you know, we could do better, but we do the best we can with the manpower we've got. Nutrition is a big thing. Let me just fall back, just for a minute on the ventilation and the stalls, and the sanitation, because we know that there's bacteria that,   and viruses that do get, that  are environmental and, and some of them  are  even in the air. So ventilation is moving outside air in, inside air out to get those bacteria out of here. Dryness and cleanliness obviously reduces the life of bacteria. And so those things really keep animals healthier because it's getting bacteria away from them and therefore lowering the exposure. Right. Yep, yep. Yep and some of the the lactating animals, we bed on sand, which is a non-organic bedding, which organisms can't live that well and in that kind of an environment. So again its about reducing exposure, even in choice a bedding. So then I interrupted you at nutrition. You'll talked about that yet. Nutrition, we feel that you've got to have a good balanced diet for your animals to keep them healthy. We work really close with our nutritionist. She comes maybe once every two weeks, looks at the feed. We keep feed samples up to date and balance, a good balance diet through our nutritionist.  Yeah. In speaking in terms of nutrition, and with your nutritionist  coming, would you say that you work with a large team to help you know, improve overall health? Yeah, good question. Actually, today we are having our, I call it our consulting team. Our nutritionist is involved, are veterinarian is involved. We have some agronomist people. Phil usually comes. We've got grad students and things like that that come. So yeah, we've got a really good team of professionals that we deal with. And what we do at those meetings is we, we talked about the progress of the operation. We look for ways the operation could improve. And we identify things  that are going well and things that maybe aren't going as well as possible and lay out a course of action. Right. Yeah, and another thing, well maybe I'm getting ahead of myself here a little bit, but we've talked about different fields that we use for health of the animal. This last spring, we made an investment on the, on our dairy, with a program called cow manager. And some of the animals have orange tags in their ears and they're transmitters. And we've got a mode on that transmitter that is a health mode. Okay. So if a cow is starting to get sick, It will relay a message to our phones. Then we need to go out and then track that animal down and see just what her problem is. Right and the way that's doing it is, it's by monitor monitoring her behavior, monitoring her rumination. It's it's saying this animal is not normal and her behavior not normal, rumination and therefore she may,  she may be sick, I think monitors her temperature too. Right. Yep, yep. Yeah. So it's a great way to pick up disease problems early. And as you say, an ounce of prevention is worth a pound of cure. Yeah, absolutely. So what we want, what you do here on the farm is, is a lot of the ounces of prevention. Right. You pile on the prevention. Because that's worth a whole lot more than just coming back and trying to cure things. Yep, And if the animals aren't  healthy, that affects our bottom line tremendously because right now the margin and dairy is very tight. And so you want to keep your animals good and healthy, so you don't have to buy into antibiotics, which there is a place for antibiotics on every farm. If you can't keep them healthy with your nutrition and all your other practices, then you have to refer back to an antibiotic. Right. So the first, the first course of action for health is of course all the prevention stuff we do, you got good management of taking care of the animal and the environment the animals in and reduce exposure to pathogens. But at times in any population of individuals, whether it's humans or whether it's animals, individuals get sick. Correct. And, and when an animal is sick? Well. We talked about detection, early detection that's really important. And when an animal is sick, you can do nothing or you can, you can do something. Right. And we don't use, our philosophy is that we don't use anymore antibiotics, anymore drugs then we absolutely have to to keep our animals going in the best health that they can and it's just added cost, and with the, the profit margins were there at, you just can't spend the money foolishly. So you have setup with your veterinarian, a plan for dealing with sick animals. Right. We've got a game plan with our vet, on different ways to go about treating animals, and what kind of drugs to use and such as that.  Yep, and that relationship with your vet is, is really an important relationship. We call that the, the the VCPR, the veterinary client patient relationship. And that's something that you really do a lot with here. Yeah. You have a really good relationship with your veterinarian and she's very familiar with your with your management and their recommendations are are tailored to your operation. Yeah. Yeah. We've got the owner of the clinic and then two of her co-workers or her workers, we're real close with them. They actually come out every week. We do our herd health every week. They check the animals, look them over. Check for pregnancies and in such as that and if they need to have some treatments, then we go ahead and treat them. And she joins us here at these consulting meetings to, to meet with the overall team  and discuss overall welfare of the animal. Right. We have,  our vet is real good at looking over our records along with the rest of our team and they crunch numbers and we find out where we gotta do better at. And I think that's an important point to bring up is that records is a part of management. And you use your records not just, you  just don't keep records, but you use your records, you look at, has the animal been treated before? You look at, you know, what what sickness  the animal has had and what have we done in the past to the animal. And so as your veterinarian sits down and looks over your records and consults with you, those records become a management tool as well. Right. Yeah. And, you know, other areas that we look at too , for the herd health is we have a hoof trimmer that comes once a month to make sure the animals I have good feet underneath them. If they don't have good feet to be up on to eat, to go through the parlor, they're usually laying down and if they're laying down they're not eating what they should be. And then they can turn sick that way. So a lot of things that you do to, to to keep animals well. When you use antibiotics, what are the safeguards that would keep that antibiotic from ever getting into the milk? Real good question. If we treat an animal that's lactating, usually we put leg bands on them. So whoever is milking can actually see the animal that's been treated and her milk will be discarded, goes down the drain, doesn't get anywhere near the, the tank, the actual milk that's sold. And then after the withdrawal period from the, the antibiotic, we usually test the animal individually and she has to clear the test on the farm before her milk goes into the tank. Once the milks in the tank, every day the milk truck  picks the milk up, take samples, and then they go to the dairy. And when when the truck gets to the dairy, the truck is sampled. As long as the truck is good with no antibiotic showing, than the milk is processed for the consumer. If the truck is tested positive for antibiotic, then they go back to each one of the individual samples from the farm and then they find out who the person is that contaminated the truck. But we've in the past we have um. Every farm is not perfect and we're one of them. We have had a sample of the tank that we felt was positive antibiotic. Because there was a cow that was misidentified or they got in the group and she milked into the tank. And nobody caught it in time. Correct. Until she was milked into the tank. Correct. In that instance, we have our milk  co-op, they come out and take a sample of the tank, and if it is positive tank, then we usually dump that milk down the drain and it gets nowhere near the, the milk that goes to the consumer. So you go to great lengths. I mean, dumping a tank load of milk down the drain is not something that we want to do. No, No it's not. But it's, it's so important that we ensure that the milk supply is is wholesome and antibiotic-free that your willing to do that. This the milk on our farm, I would drink it before it would go to the consumer any day. It's, it's the most pure product that you can get. So consumers can have confidence that that there's not going to be antibiotics in the milk. And the antibiotics are used responsibly. I think that's one of the things that consumers that have really shifted now to say, okay, we believe the milk is safe, but are the antibiotics being use responsibly  on the farm? And your response to that would? Sure. You know our vet prescribes certain drugs and she puts confidence in us to use them the way she's prescribed them. You know and if something happens and we don't and we get caught and then, you know, we have a consequence to pay, but no, we're responsible for drugs that we get. So when we talk about stewardship of antibiotics of steward, we talk about stewardship. And I came out and I say are we being good stewards of the antibiotics and you tell me Yes. But also we're being good stewards of the cows to. Yeah. How does that plan out? You can see our animals behind us. Some of them are pets. We've sold some animals before that, they went out the driveway and my gosh, I didn't think it would ever bother me to see one of them go  down the road. And when she went out the driveway, it's kinda like, wow, that was pet that just went down the road so, you know, as baby calves, you treat them good and usually they turn into pets once they get older. Yeah. And you know  its obviously it's important that that calves being, that we be good stewards of antibiotics and calves as well too. And first of all, again, we go back to the prevention part because prevention is critical. And we were just looking at the calves in the hutches and that's, that's great environment for violation standpoint. They're fed well, there on a  higher plan of nutrition so that they again have the ability to fight off disease. And we know that, that sometimes calves get sick, but you know, it's been a good steward of antibiotics and yet being a good steward of the animals as well. Right, Yeah. That's a that's a good good point. When the new baby calves are born. There's three things that we do to them as soon as possible. Actually, I guess there's four. We dip their navels with the iodine solution. They get an injection of a, I guess it's called Bo-Se It's selenium and selenium, yeah. And then they get a bolus of another type of stimulate for their, their immune system in like that. And then they actually, as soon as we can, we  get colostrum or a colostrum substitute into them, to get, to get them up and going as fast as we can because colostrum has antibodies that the mom was carrying And then we get those into the calf right away and that's just a  great way to  protect the calves health. So we need to try to get it into them within four hours of birth because they don't get the total benefit from the, the immune, the immune globulins. They're I screwed that up, didn't I? Immunoglobulin. There you go. Yeah. That but yeah. So we take good pride in our calves. We take as much good care of them as we can. So what I'm hearing is, is that you as represented the dairy industry today. Because  we're talking about other farmers as well to. That management is so important in health and the health is a cornerstone of the dairy. Right. You know, it's, it's, just a critical aspect. Antibiotics or tool that we use. But they're used in a, in a way that is, is responsible and judicious and certainly not overused because that just doesn't make any sense from anybody's point of view. And the antibiotics is one of the last sources that we want to use just because of the costs and such. But if it gets to the point where we do treat the animal and the animal ends up doesn't make it if the animal does die. A lot of times we go to Michigan State University to actually see what the disease or what the culprit was of them dying and we work close with MSU. Actually our dairy farm right now is in a couple studies that they're pretty in-depth studies. The one has been going on for about 5, 6 years, something like that. We just started a couple new ones this last year. So you're involved in health-related research, animal health  research And that's great. It's a great way to learn, Its great way to be able to have more information to managed with. And I feel that whatever we can do here on our farm will help the whole dairy industry as a whole. You know, that's, that's what we're here for is to help everyone else out in the dairy industry. Yeah, One of the things I really appreciate about the dairy industry is a sense of community. The farmers are part of a community of farmers and they, they feel the link to each other and their responsibility, if you will, to each other as well. Jack. Thank you very much. It's been great talking with you and looked forward to meeting  you this afternoon. Thank you. Phil and Cierra that was a great. Thank you. And please thank Jack for us. We did have a couple of good questions. Come in, Phil, you'd probably see them on your screen, but if you didn't, I think I can paraphrase them here. First question was, have VFD restrictions lead to more or less disease on the Michigan dairies you're familiar with? That's an excellent question and it kind of parallels a question that was asked previously to Dr. Reugg about the use of antibiotics and maybe the reduced use of antibiotics and the level of disease. We did a survey of, of producers across all animal types couple of years ago. Results were not published. But we did a, we did a question survey to  animal producers. We had a number responses. One of the questions we asked them was about this very thing. Has the VFD caused your animals to be healthy or unhealthy. And certainly there are some producers for whom the, the restrictions, the VFD, which, which did restrict them in some ways, create those restrictions, did cause animals to suffer consequences of health problems. However, what we also heard and this was more response. What we heard was that people made management changes that reduced the prevalence of disease on farm. They increase the monitoring, they increase the prevention, they increased, they improve the environment. And so that, that when, when VFD,  came into effect, they responded by, by actually improving the management so that there was less need for antibiotics and so that animals were healthier. And so I think that we have to say, that that's the kind of response that we're looking for from from all farmers, whether the dairy or any animal tag. So there was probably a transition during that first year, but things have settled down. They're figuring out what they need to do. Which is a good segue to the next question, I think that was sent in. And that is what is the greatest barrier to sound antimicrobial stewardship on the dairies you visit? That's another great question and I think that I'll  answer off the top my head on this. But I think it's going to be time. I think that that Dr. Reugg mentioned the fact that everybody is busy and the time to to sit down and thoughtfully, As she said, benchmark, set goals, take actions, and assess the results. That hasn't, that's so hard to carve out that time for. It really takes time to do that. One of the things that the VFD rules created for us was was really pushing the veterinary client patient relationship. And on some farms where where that relationship really wasn't there, it caused the veterinary have to be more involved in the operation. I think that's a very positive thing because it does then give the opportunity for, for producers to sit back and say, Okay, what are we supposed to be doing and what are we doing? And how's it going? But I would say the greatest barrier is, is time. Dr. Reugg has initiated project in which in which Ciarra and I are being involved in which we will sit down with a team on a the farm. And we're going to be doing this through  the winter. but it's going to take some time on the farm to really benchmark, to set goals, to take actions to assess. And, um, and that's a time commitment that some producers are willing to make and that's going to be a great investment of time on their part. Sounds like a great study. When will that be ending By the way? We will be initiating that actually this month and it will go for about six months, and we'll have data from that certainly by this time next year. Great, We look forward to seeing the results from that. Thank you. Thank you Phil and Ciarra. And again, please Thank Jack for his time. I'm Shelby, I think we'll move then to our first tech check. Just two quick questions. Mainly to make sure that the technology is working for everyone. But it's useful information as well. So if Shelby, if you can call up the first, the first panel with the tech check questions. We're getting a black...I'm I'm seeing a black area in front of it. So there we go. Okay question number 1. Which of the following is an essential, an essential component of sound antimicrobial stewardship? And there's three options there. A. Using only vaccines and probiotics to manage disease on your farm. B. Moving to injectable antimicrobials exclusively. And then C. Include careful diagnosis of bacterial disease In you're herd before using  antimicrobials. So it looks like answers are coming in. Looks like that's good. People were able to vote at least somewhere. And I think this is the correct answer,(C is Correct) Professor Reugg. And then the second question. What aspects of cattle management impact health and should always be on the mind of a farmer? And the options are A. Ventalation B. Cleanliness and sanitation. C. Good nutrition. D. Monitoring animal performance. and then E. All of the above.(E is the Correct Answer) And it looks like, yeah, I can't see the full screen, Shelby, but it looks like people did very well on both questions. This was, we  know these were softballs, they were easy. They were meant to be easy to just check to make sure that you're able to to get on and ask questions when you need to. So I think Shelby to stay on schedule, we'll move on then and hear from Matt Smith from Louise Earl  Butcher, who's going to describe this morning his views on retail advocacy and consumer support. And we're really happy to have someone who's out at the front lines meeting with and talking to our end users, our customers. And Matt  has a lot of experience with that and we thought would be a good change of pace to hear some of his views on that. So Matt if you're there, take it away. My name is Matt Smith. I am the owner of Louise Earl Butcher we're located in Grand Rapids on the south east side. And we're a whole animal artisan butcher shop that supports local farmers. Want to thank MSU for inviting me to be a speaker today in the Management over Medicine seminar. And I'm going to kind of give my perspective from the retailer to the consumers. And, and kind of how we come into play on this whole topic. What I'd like to do is kind of start off, I, hear in the shop we have a lot of kind of sayings that we refer to, to kind of sometimes remind us or inspire us as to what we're doing and why we're doing it. And the first one that I wanted to reference is "The food you eat can either be the safest, most powerful form of medicine or the slowest form of poison". And that was from Ann Wigmore and  she was a holistic practitioner early in the century. And so, you know, one of the things that we sometimes think about is that food can be medicine. That's kind of one of the reasons why we open this shop, almost six years ago We opened January 16, and we really wanted to offer the public some better choices. And at the same time support our local farmers. And, and, and we'll talk a little bit about how that plays into this topic. As I mentioned, we opened in 2016. My wife Cindy, who works here in the shop also, we've kinda been in and around food, for basically our whole lives. Passionate about food and wanted to share that passion with our community and bring some better choices to the area. We, we subscribe to supporting our local farmers. And, and I want to talk a little bit about what that means. We have all of our animals coming from farms that are within 60 miles of the shop. We have pastured lamb, pastured chicken, heritage breed pork, 100% beef, 100% grass-fed and finished beef. And how does this play into management over medicine in the animals that we buy for the shop and sell to the general public here in Grand Rapids. To give you an example, the, the pork farmer, the hog farmer that we deal with in a Coopersville when we first met them. They were, at the time three generations into farming hogs had largely been involved in commercial hog farming in the past. And we're just dipping their toe into some heritage breed hogs, and we kind of encourage them to get heavier into that. And the same time kinda change some of their practices that they used for the commercial commodity style farming in the past. Which means we encourage them to switch their diet over to a non-GMO diet. At first, the farmer really thought that was going to be challenging. And as he put a little effort into it, found that there were a lot of options out there for non-GMO. As that program started to develop and be successful. He then actually started to raise his own grain, non-GMO grain, on the farm. And my understanding is that less than 5% of all the farms in the United States actually raise the grain that they feed to the livestock. And so by us supporting that farmer, he's been able to make better choices, we think in the practices that he uses to raise the hogs. I think also the chicken scenario is one dimension as kind of a success  story. Our farmer started to raise pastured  chickens for us, also raises pastured, laying hens for our eggs. And same kind of success. That program has grown immensely. He's growing the grain for his heritage breed chickens that actually took on the responsibility, built his own processing plant on farm. And so the only thing that our farmer doesn't do is hatched the birds, But he grows the birds, grows the grain and process of the birds, all right, on the farm. The reason I bring these things up is that, management over medicine. When, when these farmers are using practices that create more of a regenerative versus extractive farming practice. It makes the ground healthier, it makes the animal's healthier. And there's much less need for any medication. Because when we start with, in this case, the ground,  than the animals follow, ensue and are much healthier and do not need medications to mitigate any problems that may come up. So those are some examples of how the product that we bring in here starts out. Something else that I would kinda like to reference as far as the saying goes, is the bitterness of poor quality remains long after the sweetness of low prices are forgotten. Sometimes people ask us, you know, how are you doing as far as the product that you sell here? It is a product that compared to commodity products, is a little bit higher price. But we often like to reference the first saying about people's health. And, and people being more conscientious about what they're putting into their bodies these days is something that we see more and more people being conscientious of. And so while the product, maybe a little more than a commodity product, something from a grocery store. The reception has been tremendous and we've actually here in the butcher shop, experience double digit growth every year since we've opened up. My notes here. As I mentioned, who are the customers? You might think that just because people are being more health conscious, it might be a demographic that is more affluent. But that's not actually always the case. In fact, when we looked for a location to put our butcher shop, we we spent a lot of time. In fact, it's almost two years find a building to open the business in. And that was because we were very specific about wanting this location to be demographically in the most diverse and crossroads area we think that Grand Rapids offers. So to give you an example, to the east, we have East Grand Rapids very fluent, wealthy area. But just to the south of us Baxter neighborhood. Is probably one of the poorer areas of Grand Rapids. Heritage Hill. The hill districts are just to the north of us and then downtown to the West. And so what we've actually seen is that people who are concerned about their health, what they're putting in their body and consuming or providing for their family. Come, come from all different diversities, demographics. And so we certainly have affluent customers who budgets are not maybe an issue. But we also have people that use EBT and food assistance programs that we accept here. And so I think that just speaks to the fact that when it comes to better food, better health, it's not something that is specific to one demographic. And that's another reason why we kind of do what we do here in the shop at Louis Earl Butcher because we're trying to provide a better product to anyone who's interested in it. And we think that kind of starts with the farmer. We do the best we can to just translate that product to the end consumer. And so that's kind of what we're all about here at Louise Earl Butcher. And how we support the farmers that try to practice the management over medicine thought process and mentality. And so thanks everyone for again, inviting me and listening to what we have to say from kind of a retail perspective and look forward to continuing to support MSU and all the farmers and people who are involved in this movement. Thank you Matt, that was excellent, and we've had a couple of good questions come in if you'd like to answer them in real time, maybe you've answered them privately already. But I think they're good questions and I think the broader audience would be interested in hearing your responses. The first one, and I'll, I'll paraphrase. Is there a single quality and a local farm that your customers are seeking? Do they mention and seemed understand responsible use of antimicrobials in your discussions with them? Sure. Yeah. I think that we get a lot of questions, refreshingly, we get a lot of questions from people really wanting to understand. Number one, where the products are coming from. I think people are really focused on local. And then what are the practices that the farmers are using? And I think that that kind of translates to people wanting to understand what am I putting into my body? What am I consuming? And if those animals had been raised in a method that falls in line with their ideals, then they're going to be happy and that's what we try to really promote here is, the story of the farmers transparency on how the animals are raised so that the consumer can have that confidence. And that's, the second question is, how should a local farmer approach a shop like yours? What it, what information do you consider when a new farmer would come to you and say Matt were interested in working with you and providing, lamb or chicken or beef, what what factors weigh your decision? Sure. That's you know, that's, it can be a deep question. We're, we're always happy to have a conversation with a new farmer who's looking to kind of walk down this path. We like to, we're, we're happy to share with them the standards that we're looking for. In oftentimes, when people start to get into that game, we want to kinda understand what, what practices they're subscribing to. And so for example, maybe a beef farmer comes to us and says, Hey, I got some really great beef, we raise it like this , are you interested. we oftentimes will ask for things like, Loin pictures from a hanging carcass. Or if it's somebody who's maybe smaller farmer, that's raising  lamb or chicken. If it's a local farmer, we may asked to visit their farm and really kind of get to know them, get to understand and see what kind of practices they're, they're using. So that again, we can reference back to that in, and provide the confidence to our consumer that we've actually done the work we've already set foot on the farms to really understand what they're all about and we can trans, trans, transfer that story onto the end consumer. Thank you. Well, I think we're right on time. And I saw that Professor Apley was able to join us. Thank you Matt.  I saw that Professor Apley was able to join us. For those of you who, maybe probably few of you who don't know Professor Apley, he comes to us from Kansas State University. And I was, I was very happy to see that his Bobcats won on Saturday. So he should be in a good mood today. And Professor Apley is going to talk today about the future of antimicrobials in food animal production. So, Professor, Apley if you're there, take it away. Hello everyone I'm Mike Apley from Kansas State University. I teach production medicine and Clinical Pharmacology here at Kansas State. Today I'm going to be talking about the future of antimicrobials in food animal medicine. I struggled a little bit with exactly what context to put this in, But I went back to the basics of clinical pharmacology, being a clinical pharmacologist and put it in the four basic components of clinical pharmacology that I think describes how we as veterinarians, and food animal producers are going to be addressing antimicrobial use in the future. And that's can I  do some good? Can I do some harm? Can I get any animal? And what does it cost? And of course,  Can I get it in the animal means do I have reasonable regimen I can use? So when we break down, can I be some good? We're talking about welfare and conservation of animal resources. Which one of the things in our veterinary oath. Then when we talk about can I do some harm? In the past, a lot of times we've just thought about direct toxicity, but also regulations, residues and market chain access. Today we have different market chains with very specific requirements. And by recommending or using an antimicrobial or a drug and a certain manner, we could make it impossible for our client to sell into the market chain for which they prepared the animals. And again, the practical regimen. We're going to come back to about different ways of looking at the cost. So when we start breaking out, can I do some harm before we talk about direct toxicity of the drug, regulatory harm residues, market chain access. And of course, regulatory would include having a viable residue at slaughter. But today we include considerations such as the microbiota and the environmental resistome alteration. What could we be doing in the population of bacteria that are not necessarily associated with our direct pathogen of interest. And that leads also to resistance development indirect pathogens through the animals, and  foodborne pathogen. That's really a tough, tough part of the equation to get a handle on with direct evidence. A friend of mine has told me that if you understand antibiotic resistance, it hasn't been adequately explained to you. And I think that's a very astute observation that's incredibly complicated. And the fact of the matter is we're going to move on in the next decade without having a lot of that settled. Which makes it difficult to include that in parts of our equation. And then maybe cost isn't just about the price of the drug. The costs could be in resistance, the cost could be in market chain access. There are a lot of things in there that are externalities, different costs that aren't necessarily related to science. If we're going to talk about the future of antimicrobials, we need to talk about the past. So if we look way back in 1910 in 1912, we basically had arsenical compounds that the goal of these compounds was to kill the bacteria, slightly before it took you out. So they weren't very friendly drug but they were the best we had. In '35, the first sulfas came out for use in '42, we got benzyl penicillin, which is procaine PNG, as we know it, tetracyclines in '48. And then here they came in the 40's and 50's We had all these first members of our groups. And it was really fascinating to see these all come in. And then by the '85 we get the carbapenems and then it started to slow down and we'd get to linezolid. Remember the ox's only been known in 2000  and 2003 daptomycin, one of the cyclic peptide. If you look at the ones that we use in food animal medicine, the last year we got a new drug group that is a direct action antibiotic that we use in food animal medicine, it was 1978. So we're more than,  we're along ways in, way over 40 years. Since we had the last new group, we've had new members of the groups, but they're the same basic chemistry. We now have some new novel compounds are being developed on the human side, there's over 40 compounds in development worldwide, but only about 4 of them are new, actual unique classes, unique mechanisms of action. This just illustrates that in food animal medicine, we're not going to have a whole lot of new tools. We have, the ones that we have, we need to move forward and be sure to conserve those. And it's all wrapped up and antimicrobial stewardship. And I was glad to see the AVMA, but significant time into developing an antimicrobial stewardship definition. In one of the really big things is that as a profession, we are obligated to preserve the effect, effectiveness and availability of antimicrobial drugs. And we have to utilize responsible medical decision-making and safeguard animal public and environmental health. It's a great definition. Sometimes get down into the details can be a little challenging. They have gone forward with some further breakouts, but coordinated interventions and proven major the appropriate use of antimicrobials, so that measures a big part that's in our future. And looking at the optimal regimen dose duration of therapy and route of administration. We use a lot of single administration antimicrobials in food animals. We're very fortunate there. But in our daily administer drugs through the feed or through the water and some injectables. And also in the human medical field, we are woefully under supported in how we make a reasonable decision on duration. The duration of therapy supporting data just isn't there us and in my way of thinking, as we look towards the future of antimicrobial use, we really need to sort that out. We want the optimal clinical outcomes, minimize toxicity with these costs, limited selection for antimicrobial resistant strains. And there's another component. We can definitely use more research. But so much of what's going to happen in the next decade is going to evolve around what we know, what we think we know, and what we're scared we don't know the unknown unknowns in relation to selection for antimicrobial resistant strains. And some parts of the world dealt with that with the precautionary principle. Were unless you can prove it, say its out, we haven't gone there yet in the United States. But when you, when you're worried about what you don't know to be worried about. Sometimes we get awfully, awfully conservative. Conservative meaning being very reluctant to allow much use of these compounds. If we look at stewardship, this again defines our future. The first thing is we have to be using reasonable and appropriate diagnostics and have very accurate and functional case definition, That is the classic partnership between a veterinarian and their client. And without those, we can't move forward and claim that we are using these drugs within stewardship and in a judicious manner. This number 2 part is there a non- antibiotic alternative. This is one of the biggest parts of our future, is looking for reasonable non antibiotic alternatives that will prevent control or treat the disease challenge. We already see prevention with antimicrobials prohibited in at least one state. You have other states considering that the boundary between prevention and control is sometimes rather fuzzy. And of course, individual animal treatment is something we'd all agree we need to do. We'd also agree we need to do everything possible to not have to treat those. So this non-antibiotic alternative component of stewardship is going to continue to become more and more into the forefront as we move forward in this next decade. And that selecting an antibiotic which has been demonstrated as safe and effective for this purpose. That's safe and effective is going to continue to take on a new meaning. And the safe part is not only going to be direct toxicity to the animal or toxicity by passing the residue through the food chain. It's now going to continue to be more and more focus on that somewhat nebulous concept of, What might we be doing to select the resistance and pathogens of concern for veterinary species? And also what impact might we have on immune therapy? In this fourth part to me is how I truly tell if the veterinarian has a VCPR. If they can tell me whether people are following their protocols they come up together with, then I know whether or not they have a VCPR. You can have all the printed written out VCPR agreements you want all the written protocols that everyone signed. But unless we really know how they're being followed, me, I'm not sure we really have the VCPR established. And this is also a tough part of figuring out whether that antibiotic intervention still necessary. And I think that's one of our biggest challenges. But in the future, we're going to have to double up on going back and making sure that, any antibiotic interventions we've established in prevention or control are actually still necessary. And then no, you stop. Yes, you go back looking for that non-antibiotic alternative. Somebody look at this and think it's a little Pollyanna, a little academic. But I think it defines the steps we're going to have to be engaged in. And we're going to be watched as to how we're engaging the steps. So when we talk about those antibiotic alternatives, when you recommend or prescribe, and would a client  adopt an alternative which possibly raises the cost of production. Requires an alteration in production practices. Results in a detrimental effect on animal welfare or risks you losing the client or incurring liability, losses. Those are the hard questions. Right there. We can talk about considering resistance. That resistance can be a far off concept over the horizon, where immediate concerns or cost of production maintain production, staying in business, et' sedere. How we balance that is going to be a major debate in a major focus in this next. And what would be an incentive to adopt such an alternative. If we have something that could be an antibiotic alternative with lower-cost and same or improved efficacy. Not going to be a problem putting that in. The market access if people are willing to pay a regulatory penalties, preservation of  antimicrobial efficacy, that last one is really difficult to quantify, it could look like. So here's the core questions that comes down to, do you believe your actions as a veterinarian or a producer in your use, have any effect on the future efficacy of antimicrobials in animals. And if yes, are you willing to take any personal risk in an attempt to minimize the effects of your antimicrobial use of prescribing? Those are the hard questions and frankly, we have a hard time answering them with some of the data we have. If you look at what antibiotics were using, it's really clear that we have a large emphasis on macrolides and tetracyclines and a Cylance use quite a little bit, a lot of it and turkeys orally in water. But the macrolides and tetracycline cyclins dominate in both cattle and swine. Wanted to make you aware of or recent set of pilot studies through a cooperative agreement with the FDA Center for veterinary medicine, where we quantified antimicrobial use in 22 US beef feedyards is one of the papers. And if you look at it, this is milligrams per kilogram of live way. You can also look at it, regiments, parental year, and the study of how metrics affect your view of antimicrobial use is really important. And if you go through these papers, there's a lot of really good explanations in there from the different species that the insets just magnify the use for control of respiratory disease, an individual animal treatment for all diseases because its so low. So you can look at the different antimicrobials, but here's the actual values. And you can see that in feed use dominates and in milligrams per kilogram of lightweight. If you add up the macrolides in green, and the purple color is the tetracyclines. If you add those up your at about 95% of the milligrams of drug use per kilograms lightweight. If you drop it down to regiments per animal year, these two categories would make up about 85%. Which emphasizes that are in feed and in water use, to groups of animals are going to be a focus in the next few years as to why we're using them and the ramifications of using them. So we talked about resistance. This is the integrative conjugative element that we find in Mannheimia haemolytica. It carries multiple different antimicrobial resistance genes on this integrative conjugative element called the  ice. And it can be passed back and forth between our three main respiratory pathogens as well as  e. coli in the lab. And this is a paper that I look at that to me illustrates what we're going to have to continue to consider in relation to resistance such as that. This is a paper out of Iowa State where they looked at  isolates coming into the diagnostic lab and looked at records for how many times the animal was treated and correlated that with resistance. And what we found was they found was that if they were treated none, Once, twice or three times, the percent of resistant isolates went up and it went up across all drugs due to that integrated conjugative element. Possibly being in there and causing multiple drug resistance. And it just shows that as we put more and more pressure in those animals with therapeutics, we can bring out those resistance subsets. So this is something to me that really shows we have an issue to deal with. So those FDA CVM cooperative agreements were made publicly available in a free access special edition and can be accessed. I think we'll close with the FDA's view of what's going to happen in the next, well, this will end by 2022 or 23, but their five-year plan currently in effect. And the most important parts to me are, that we're going to have a very clear emphasis on duration and a very clear focus that over-the-counter antimicrobial use is going to be gone by the end of 2022. Those are the things that strike me as the biggest components of explaining to us what we're going to be doing over the next decade or so, there's going to be a huge emphasis on what we're doing with antimicrobials in relation to selecting for resistance in their own pathogens and possibly having an effect on therapeutics in people. And the transparency through initiatives such as antimicrobial use monitoring are going to continue to increase. Putting us more and more in the public arena for our use. With that I'll look forward to questions. Thank you, Professor Apley, that was really nice. We did have a few really good questions come in. I'm not sure if you've seen them, but if it's okay, we'll answer them live, and I'll  paraphrase them. First question was that after five years, how satisfied is the FDA with the outcomes of VFD? Well, the Veterinary Feed Directive is clearly, well, okay. It's a temporal association. There were some changes right away for our use of tetracyclines, cut almost in half. In beef cattle, the Tylosin use macrolide use went up because we've been using less than the stated grams per ten, to stay in milligrams per pound range on the label. And once that was realized, we've got a letter FDA saying until that straightened out, Use the grams per ton you need to, to stay within the milligrams per pound range. So those were two things that happened. If you look at global vetlink, the vast majority of VFDs being written are for beef cattle. There's quite a few for swine also, but beef cattle, especially with things like anaplasmosis, control claims. And we went through a period of really having to work to get some of the nuances ironed out the details of writing you VFDs, making sure they were legal. I would say this right now except for a couple of smaller areas for we still have some areas that need clarification. It's worked pretty well. I don't think they went into this with an idea that this was specifically going to decrease sales quantity that they monitor every year, but rather to increase the interaction between veterinarians and their clients related to these in- feed uses that previously did not require that. I could tell you that this has and it's from my personal communication as a veterinarian producers, it's led to a whole lot of conversations about what really needs to be used and how it's best used, which I think was the goal for that. You know I can't speak for them, but I would say that many of us feel that that ability to have those conversations, that's led to a lot of consideration of exactly which one of these uses is really doing us good. But on aggregate, it does look like the, the, the VFD did stimulate a net reduction in use of medically important antimicrobials across the industries. Yeah. Yeah, maybe from the end-user's perspective. And we'll ask Matt to comment in a minute. But maybe for, for the meat buying customers, actually reducing the amount was an important endpoint to achieve. but Mike you, you and answer that first and then we'll give Matt a chance if we got to. I think one of the things about that is we have to be real careful on the denominator because we've got our, all of our use data, we have in this  country is without a denominator and the  FDA's worked on that. And then also the uses related to disease, events that cause  disease. So there's a lot of things confounding there where I'm, I could talk about what's happened since the VFD labels went in effect, basically five-years ago. I'm pretty careful to put cause and effect. Very cautious of talking cause and effect. Matt? Matt you have to turn the mute off If you want to comment on this. If you want to think about it a little bit more we can bring it back up in the discussion in a few minutes. It's up to you. Yeah, not, not something that I have a great degree of knowledge on and it's something that I would say I haven't heard a lot from our customers on this particular item. And so from our perspective on the retail end of the business, probably not a big focus item. Maybe people just in general consumer population, haven't heard enough or don't know enough about it. Mike, Another question that came in. I like, does the US have a defined target for reduction of drug resistant strains in the environment? How are they testing for that? No, they don't have a defined target that I'm aware of. There are, there is talk about more testing. One of the really controversial aspects about testing would be the ability to go on farm and collect samples on farm, especially with follow-up. So is everyone listening here would know that we tend to be rather independent minded in ag. Both veterinarians and producers, there's been push back on that. The other thing about the environmental sampling is, you know, assigning causation to it. You know can be problematic, but they are as I'm aware, there is more of a push to be able to go collect the samples and see what's going on with at  least some  indicator organisms. Thank you. Mike, we had a few other questions that we'll come back to during the discussion, but to stay on task, I think Shelby will go ahead and take that second tech check. Which will be very, very quick. And there's two questions again. The first question is many consumers across demographic groups understand how animals are raised affects their, the animal's, health, and why this is worth investing in from a human nutritional perspective. This is a true, false, or need more information question. So one that people are having to think about a little bit and hopefully are hopefully our question or are responds tool is still working? Shelby? You do have to answer both questions to be able to get in their responses. Oh, you do. Okay. Okay. I'm sorry I  didn't realize that. So. They might be stuck on  on that first one. Thank Shelby. So the second question is Two likely areas that FDA will focus on going forward,  in terms of building on antimicrobial stewardship gains achieved since implementation of FDA guidelines in 2017 are: A. Adding ionophores and probiotics to the list of products requiring veterinary oversight. B. Limiting duration of therapy and over-the-counter availability of antimicrobials. And C.  Neither A nor B above are correct. So I can't see the response to that Shelby.  I suspect. Okay. Yes. So most people that answered got or getting that correct, limiting the duration of therapy and over-the-counter. And Professor Apley, how confident are you that those will be two areas that will be focused on? I know you're privy to a lot of information. So you want me to go ahead and answer number two? Yeah. Yeah. The first one I would see is incredibly remote. There's been discussion on the probiotics and what resistance genes they might harbor, but certainly not a VFD veterinary oversight issue. The limited duration of therapy and over-the-counter availability by microbial. Definitely. The limiting duration of therapy is let me say definitely to the over-the-counter availability by microbials. They put out a guidance document and It is clear that by well, the timing is approximate, but probably fourth quarter 2022, first-quarter 2023. We will probably see all over-the-counter medically important antimicrobials removed. As far as limiting duration of therapy, they have pointed out and said, we need to evaluate that. How do we evaluate that? But for actually limiting it yet I'd say we're still in the process of evaluating that, but duration of therapy is really a focus. Thank you. Matt, I think it's interesting that the opinion was pretty well divided regarding the question before that, many consumers across demographic groups understand how animals are raised affects their, their health and why it's worth investing in from my human nutritional perspective? There's really two parts to that question, at least maybe more, but I think I think it has a fair question for you, how many and maybe your customers are more sophisticated than, than, than the average customer. But how educated do you think they are about issues around antimicrobial use? Yeah, that's a  good question. I would say that the general population probably isn't too highly focused on it. Yes, probably our customer here in the shop maybe is a little bit more tuned into it. But I would, I would say that we are niche. You know, we're a very small player, were real small shop, if you compare it to the big box retailers. And so probably the people that shop with us are a little bit more in tune with how the animals are raised, what kind of methods are being used. But we're, we're a small percentage of that market, I would say. Thank you. I think I think what we'll do then to stay on track as we'll move to the what really be the next to last part of our program this morning. And that'll be a panel discussion. And I think Shelby and I came up with a few questions that came that came up multiple times. Most of them didn't get answered. That there are questions that didn't get answered. But Shelby, Do you have that slide that has the questions that we scrambled together here? Okay, great, Thank You. Can everyone see these? And I think what we'll do is we'll ask Professor Reugg maybe to take number one. And we'll kind of split things up a little bit, at least to get the, the responses going. And so Professor Reugg, the the question was, what are the, the most important but often missed opportunities in terms of management practices available to farmers for approving antimicrobial microbial stewardship on their farms? Where are they missing out now? Where could they realize some significant bang for their buck that based on your observations, they're not seeing? You're on mute. Professor Reugg. Gotta unmute here, I was talking to myself. You know you'd think after a year and a half we'd have that figured out. I think one of the biggest opportunities, and I think this is both an economic opportunity for the farmers in a sustainability is engaging with their local veterinarians to really discuss evidence to base guidelines for their current existing treatment protocols, using antimicrobials. And so I think that engagement, is often taken for granted. But I think what often is really going out at us. People may have had a discussion a few years back about a particular treatment protocol. And then it sits there and there's drift that occurs on the farms and things change. And so I think one of the biggest things I was intrigued by Dr. Apleys comments about duration and things like that. You know, that in my field, especially in dairy, the duration of treatment needs a lot of definition. We really use a lot of the products off-label. Or if they've got a flexible label at the maximum or close to the maximum. And as we're learning more about having an actual diagnosis, knowing what the actual pathogen is. Learning more about with what randomized clinical trials that are negatively controlled tell us. We're learning, we don't necessarily have to treat as long as possible. So they, you know that engagement where and that focus on evidence-based treatment is an area we could improve in. Thank you. I see Phil Durst turned his picture and sound back on, which means he he's dying to comment on that. Yeah, Thanks Dave, I appreciate that. So you know, I really think it's important for farmers to, to react aggressively when an animal gets sick or when an animal dies. And to find out why the animal got sick. Why the animal, or why the animal died. You know, I, I've been on too many farms where you know sometimes an animal is sick and or an animal dies and they say, well, you know, it happens sooner or later, your going to have one sooner or later. But the problem is, it happens again and it happens again. And they're concern level starts to ratchet up. But what I want to encourage farmers to do is be concerned on that, on that very first case. If we're going to prevent problems, we have to react quickly and aggressively when we find out that there's an animal that sick. Because if there's an animal that's sick it's most likely going to be a herd problem that's being experienced. Whether it's environmental or whether it's nutritional, the animal has become vulnerable. The exposure level is there. So those things need to be investigated, need to be promptly understood so that we can prevent a death or we can prevent the next one from getting sick. And when we do that, then that's, that's the whole start of stewardship is to be able to, to prevent. And so I think that finding out why an animal is sick, finding out why an animal dies is a critical step that we got to be more aggressive on. Thank you, Phil. I'm going to give Mike a chance to comment on that if he would like to. And then I'm going to ask Dr. Benjamin who just joined us, who has some expertise in that particular area to comment if she will. So Mike. Well it kind of blends into number two below, but I think the real missed opportunities are routine interaction between the veterinarian and the producer towards that goal of reducing the disease, the disease pressure. I think there's a lot of things that we have opportunities to look at environmental. It doesn't have to be through a needle into the information we're getting on genetics and their contribution to disease to me is fascinating, I just am learning enough to know how much I don't know about that, but I'm really tuned into what opportunity's we find and Looking at genetics among many other things. So a lot opportunities that come up through routine interaction. Thank you, Mike and Madonna Benjamin, I I know is an expert in remote sensing and she, she's actually been in the barn all morning working on a study this morning. So she didn't have time to shower, but that's okay. But Madonna maybe you'd like to comment, if you will, on the potential you see for remote sensing and monitoring for early detection of disease and other conditions that might eventually provide another tool for farmers, in terms of their efforts to achieve high levels of antimicrobial stewardship. Thanks Dave for  that opportunity. I just I want  to go back and Dr. Apley shared a publication. And thank you all speakers. And if Dave gives me any credit, he's lying, he he did all the work he and Shelby did all the work. True. But anyway, the Mike had presented a paper where the number of doses of treatment was correlated with resistance. And,  I, my thought on that was I wonder, I wonder what the timing was, you know, kinda fitting in with what Phil was saying about early detection, early treatment, and making decisions. And we have SOPs in many of the barns where someone is responsible for, for oftentimes for walking around and and observing animals and and marking them to be treated, order treated. But I wonder what would happen if we were to increase our opportunity for observations. So whether that would be by having both morning and night and then the person who is responsible, for example, for euthanasia would then follow up and do that or the treatments. Or that a different view. And this is what kind of what we're leading to alluding to in precision livestock farming. Because with precision livestock farming, what I've noticed is when I use computer vision and I show the stock person the image, they will make a comment on her state. And what that tells me is that they're looking at it from a different pair of eyes. May we become accustomed. There's that old adage of the, that the gorilla in the middle of the pathology slide and 50% of the pathologists missed the gorilla because they were so focused on the fact that this was a specific type of cell. And I think that happens for our stock people too, is that they're, they're doing what they need to do, doing what they need to do. Perhaps the body condition score of an animal is low, and that may be due to cachexia. You know, she's losing weight because of illness. But it's something they've seen before and so it doesn't really register. And I look forward to precision livestock farming. Our computer imaging or the other senses such as accelerometers or sound. And then that interface that we present, to the stock person or the, the, the farmer that shows them what that animal looks like or sounds like, only with a different pair of eyes, slash ears. So thanks Dave. I think that I think that might improve our detection and it may improve our opportunities for response. In our last comment is that people need the tools to be able to respond and the permission to respond quickly and make a decision about an animal. Thank you. So continuing to, Thank thank you, Madonna. Continuing to build those relationships with the veterinaries veterinarians who serve them. And then going it forward, animal monitoring, going to become very important to really probably improve early detection and then allow more individual pig care. Which you both benefit. Dave. Yes, Bill. That was one of the things to Jack Jeppesen mentioned on their farm is of course the ability to monitor cows, temperature, activity, rumination, and to be able to use that to detect animals that aren't feeling well. So they were in the early stages. I think that there'll be improvements of that. But technology has a real place to help us to identify animals that, that for some reason or just off. And, and, and to understand why, why it is so that we can care for them quickly and, um, and also prevent further cases of it. Madonna, you thank you Phil. Madonna you  had a comment to that. No, she she's pushed her. Okay. My my comment is, I think these are excellent points, but veterinarians can be fairly expensive and monitoring equipment can be fairly expensive. And I think that's fine for the large producer, but what about the small producer? I mean, would you recommend the same for a small producer, a small dairy men, a small farmer that keeps pigs or chickens? How, where's the break-even point for that expensive professional advice that that that the that you're recommending  Yeah. Yeah. Go ahead. Go ahead. So I'm not sure what number of cows that you can justify having that system. But, but let me just also say that in diary we have a real advantage. Our cows are coming into a parlor two or three times a day. We have we have people there that are seeing our calves. We have people there that are feeder our calves. And I think that the greatest challenge is also in training our workers to identify animals that are, are not feeling well. So to identify animals as normal or to identify animals as not normal. As we have employees with weather or family members or employees, they need to be able to identify those animals before they're, they're just dead out, sick. And we need to train people who are working with the animals to identify that. That's, that's cheap monitoring, that's,  eyeball monitoring. And that's the first level that we need to make sure that we're doing is have the ability to pick up on the fact that an animal was not feeling well today and understand why. Thank you. Phil. We had a few questions come in that we didn't get to around poultry today. And I'm going to kind of tweak the two or three that came in on poultry and ask Matt to comment and then the panel to comment. The questions were around. Why didn't we talk about poultry today? Why didn't anybody really mentioned poultry in and and there's a second part of the question was, was it because there isn't very much way of antimicrobial used in poultry today. The other question was around, do consumers consume more poultry? Is poultry continuing to increase in the amount of consumption and at least in the US? In part because consumers are savvy enough to understand that a lot of poultry is raised with very little antimicrobial. Is that enter into the equations like I think, we'll, let Matt answer that part first and then we'll come back to poultry and what's going on with poultry. And I will probably ask Mike to comment first on that after Matt. Yeah. You know think for for our farmer who raises all of our chickens. And we have a couple of different breeds we work with on top of also having laying hens. You know, I had a little discussion with the farmer about this topic that we're, that we're discussing today. And he really pointed towards the health of the land that he pastures the birds on as kind of where he can kind of avoid having to deal with a lot of antibiotic treatments and that type of thing. And so, you know, from, from my farmer's perspective, that's kind of what he says, is where he really concentrates on is the health of the land, which translates to the health of the animal. Thank you. And Mike, would you like to comment on that? So when we talk about poultry, there's an entire range of intensity farming operations to backyard poultry, to pastured poultry, which Matt just mentioned. So we have to be careful about lumping them all together. So this is my understanding of working with people like Randy Singer, that about 60% of the poultry in the supermarket today is produced under some kind of no antibiotics ever or antibiotic-free system. Which in many cases still allows the use of chemical coccidiostats but not a medically important antibiotic, in some cases, not even a ionophores. And so if you want an idea of what's going on with antibiotic use in poultry, the paper I mentioned where we did the feedlot study as a companion papers by Dr. Singer and his group on turkeys and broilers and well over 90% of the antibiotic use of antibiotic use in about 90% plus of the broiler population the United States is characterized  in his paper and about 75% of the turkey production and they're working on bringing laying hens online. So you can go, those are free access. The saying of reference, those of my talk where they can go see what's going on with that. There's also papers out there that deal with the welfare implications of that in intensive systems even with some alterations with the welfare implications are that so it's just like all things to do stewardship and antibiotic use. It's really hard to make it overall lump statement because there's such a spread of different activities management styles and uses and disease pressures throughout. Thank you Mike and Professor Reugg if you'd like to comment on poultry at all before we move into the final phase. I'm completely unqualified to comment on that. I doubt that, but it's it, I'll tell you, Matt, I haven't had lunch yet today and I had a light breakfast and seen those, those beautiful steaks on Matt's slide are really making my mouth water here So I want to, I want to close by thanking our audience for sticking with us. I want to thank the panel for doing a great job, great presentations, and really enjoyed the discussion afterwards. But, but I really want to do is let you know that it is my birthday today. I have a bet with my boss that we will get 100% of our participants, both panel members and, and people who phoned in to complete our post program survey. We are the university, we measure every single little thing we do. And we get in big trouble if we don't get good measurements. So please take just a few minutes, if you will, And make my birthday Happy one and make my boss happy, and take our poll before you leave. The last question on the poll is ask you whether you need to have a certificate, course completion for two hours of continuing Ed credits. And for that you just need to say yes and then give us an email to send your certificate too. Thanks everyone. Please stay on to take the poll and safe travels for those that are traveling and have a great day. Thank you so much.

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