Evidence for the Efficacy of Udder Health Therapies on Organic Dairies

1. Evidence for the Efficacy of Udder Health Therapies on Organic Dairies Linda L. Tikofsky, DVM Quality Milk Production Services Cornell University

2. What is the evidence? Very limited

3. Overview • Farmers’ motivation • What conventional practices are allowed for udder health? • What is Complementary and Alternative Therapy? • Udder Health Therapies • Our role in Extension

4. Farmer’s motivation—What is organic production? • Holistic system relying on a symbiosis between soil health, crop health and animal health • To use preventive health care is the key to reducing reliance on treatments

5. Farmer’s motivation: What organic dairying is not • Input substitution: Cannot simply substitute alternative therapies for conventional ones • Farming by benign neglect: Organic rule requires that animals be treated

6. Farmer’s motivation: The National Organic Program Requires that the farm establish preventive health care practices that address: • Suitability of the species to the site • Adequate ration • Appropriate housing, pasture and sanitation to minimize disease • Access to exercise and stress reduction • Provides vaccination as needed

7. Farmer’s motivation: The National Organic Program • Disallows the administration of treatments without disease • Disallows the use of hormones, routine deworming and administration of antibiotics and other restricted drugs to animals whose products will be sold as organic

8. Farmer’s motivation: The National Organic Program BUT… Requires that no farmer withhold treatment from a sick animal just to preserve its organic status. All appropriate medications must be used to restore health

9. Farmer’s Motivation • Consumers: Interested in products without antibiotics and hormones. • Farmer’s Pride: Keep cows healthy through management and prevention rather than relying on synthetics as a band-aid for poor management (Vaarst et al., JDS 89, 2006)

10. Udder Health Practices • Prevention: Maintaining a healthy immune system • Four of the NMC’s Five Point Plan(teat dipping, culling, equipment maintenance, management of clinical mastitis) • Nutrition: Vitamin E, selenium, other trace minerals • Breeding for resistance (it’s not black & white….)

11. Udder Health Practices • Pasture • Washburn, et al. 2004: Confined cows had more clinical mastitis than pastured cows • Waage, et al. 1998: Heifers on pasture were at lower risk for clinical mastitis than confined heifers • Goldberg et al. 1994: Grazed herds had lower total bacteria counts than confined herds during grazing season. Trend toward improved udder health on pastured herds.

12. Udder Health Therapies Conventional therapies: • Fluids, glucose • Hypertonic saline • Aspirin • Vaccinations • Chlorhexidine • Frequent milkout • Udder liniments

13. Udder Health Therapies Complementary and Alternative Therapies

14. Complementary and Alternative Medicine (CAM) • Usually not therapies that are traditionally taught in medical or veterinary schools • Lack mechanisms of action that can be explained by traditional science • Controversial • No published milk/meat withdrawals

15. Complementary and Alternative Medicine (CAM) • Becoming more commonly used by the public • US Medical schools offering coursework in CAM: 77(including Johns Hopkins and Harvard) • National Center for Clinical and Alternative Medicine (NCCAM) • NIH member • Research CAM therapies and integrate into conventional medicine where proven • Budget (2006): 122,692,000

16. Complementary and Alternative Medicine (CAM) • Acupuncture • Chiropractic • Botanicals • Homeopathy • Immune Modulators

17. Why little evidence for veterinary efficacy? • Love of Evidence-Based Medicine • Fear of the unknown • Lack of funding • Farmer treatment without veterinary/extension involvement

18. Botanicals (Phytotherapy) • One of the oldest form of therapy • Until the 20th century, often the most commonly used medicine • Still used extensively in non-Western and indigenous populations • Natural substances basis for modern synthetics • Dosages: older veterinary texts • Toxicity can be a problem

19. Commonly used botanicals in udder health • Garlic (allicin) • Ginseng • Sage • Cayenne • Liniments: Peppermint Belladonna-Phytolacca Calendula-Echinacea

20. The Evidence …Garlic • Sulfide compounds (allicin) • in vitro efficacy against yeasts and fungi Shams-Ghahfarokhi, 2006 • Antimicrobial activity of fresh garlic paste against E. coli H1:O157 Gupta and Ravishankar, 2006 • Effect of garlic extract on MRSA Cutler and Wilson, 2004

21. Garlic and Bovines • Calves fed milk replacer containing either oxytetracycline or Enterogard (probiotic with allicin) had similar weight gain, fecal scores and feed efficiency Donovan et al., 2002 • Allicin did not alter fecal scores or weight gain of calves infected with Cryptosporidia although second part of study showed promise for prophylactic administration of allicin Olson, et al., 1998

22. The Evidence…Ginseng • Ginsenosides: anti-inflammatory, anti-oxidant and anti-cancer (Kiefer and Pantuso, 2003) • Ginseng increased production of Interleukin-12 by monocytes (Larsen, et al. 2004) • Ginseng reduced number of cold, recurrences, duration and severity (Predy, et al., 2005)

23. Ginseng and Bovines • Ginseng treated cows (chronically infected with S. aureus) had increased phagocytic and oxidative burst activity (Hu, et al., 2001) • Cows were injected with S. aureus bacterin alone, with crude ginseng extract and bacterin or purified ginsenoside and bacterin. Ginseng compounds acted as adjuvants and increased antibody production and lymphocyte proliferation (Hu, et al., 2003)

24. Evidence….Sage (Salvia) • Essential oils of certain spices and herbs had potent antimicrobial effects (Kalemba and Kunicka 2003) • Solvent extracts of sage exhibited anti-oxidant, anti-malarial, antimicrobial and anti-inflammatory effects (Kamatou, et al. 2005)

25. Evidence…..Cayenne • Antimicrobial effects of capsicum on L. monocytogenes (Leuschner and Ielsch, 2003);E. coli(Molina-Torres, et al. 1999); bacillus and clostridial spp (Cichewicz and Thorpe, 1996) • Clemson Study: control heifers, heifers on diatomaceous earth and natural wormers (garlic and cayene or ration with tannins. Both treatment groups had decreased FEC over control group (Bertrand, 2004)

26. Evidence….Calendula • Calendula ointment applied to venous leg ulcers improved healing over control (Duran, et al. 2005) • Calendula extract decreased post-radiation dermatitis in breast cancer patients (Pommier, et al. 2004)

27. Homeopathy • Samuel Hahneman: German botanist, chemist and physician • Early 1800’s • One of the most controversial sectors of CAM • Attempts to stimulate the body to heal itself rather than treat symptoms

28. Law of Similars • Like treats like • Find the single substance that, if given to a healthy person, would cause the same symptoms seen in the sick person • The more dilute a substance is, the more potent its healing effects

29. Homeopathic remedies • May be diluted 10 times, 100 times or 1000 times • After each dilution, the solution is shaken or ‘succussed’ to activate the energy • Holistic approach: assesses not just the symptoms but personality and behavior

30. Homeopathy in Cattle • Administer usually in the mouth or the vulva • Because it is designed for individualized treatment, can it be effective at the herd level?

31. Common Homeopathic Remedies for Udder Health • Pulsatilla: Thick, creamy discharge • Apis: hard, swollen quarter • Bryonia: mastitis in fresh cows, firm quarters • Belladonna: hard quarter, off-feed, fever

32. Evidence…..Homeopathy Comparison of homeopathic treatment, placebo and antibiotic 57 cows in 39 Norwegian herds; measured both acute and chronic changes Homeopathy did not differ from placebo or antibiotic But… Low cow numbers in each group Inordinate amount of S. aureus cows were randomized to the antibiotic group (Hektoen, et al. 2004. J Vet Med A 51)

33. Evidence…..Homeopathy • Evaluated effect of homeopathic nosode on subclinical mastitis • 250 cow English dairy, cows were randomized to two groups • Treated for six milkings and sampled 3 days before tmt and six times in the subsequent month • No significant difference in SCC between the two groups (Holmes, et al. 2005. Vet Rec 156)

34. Evidence…..Homeopathy • Compared effect of homeopathy (Phytolacca, phosphorus, Conium maculatum) with placebo • 13 cows in each group, treated over 30 days • Homeopathy cows had lower CMT scores than placebo cows after treatment (Searcy, et al. 1995. Br Homeo J. 84)

35. Evidence….Homeopathy • Evaluation of Homeopathic nosodes for mastitis vs. placebo • Mastitis nosode created from common mastitis pathogens • No differences between treated and control • ?Herd homeopathy? McCrory and Barlow, 2000

36. Evidence…..Homeopathy Evaluation of homeopathic metaphylaxis vs antibiotic metaphylaxis • 1440 piglets on one farm; medication groups of 20; homeopathy, placebo or antibiotic • Homeopathic treatment was better than placebo at preventing respiratory disease and slightly better than antibiotic at prophylactic doses. • Only when antibiotic was increased to therapeutic doses did it outperform homeopathy (Albrecht and Schutte, 1999. Alt Ther Health Med. 5)

37. Immunomodulators • Vaccines • Colostral-Whey Products • Immunoboost® • Hyperimmune Serum

38. Immunomodulators • Activate the innate immune system • Non-specific stimulation • Macrophages • Neutrophils • Killer Cells • Complement • Acute phase proteins

39. Immunomodulators • Colostral-whey products from hyperimmunized cows • Biocell-CBT • Crystal-Whey • IMPRO H.Karreman

40. Evidence….Immunomodulators Enhancement of neutrophil function by ultrafiltered bovine whey • Evaluated whey in vitro on neutrophils from normal and immunosuppressed cows and in vivo in periparturient cows • Results: • increased neutrophil random migration and cell-mediated cytotoxicity • No change in WBC counts in vivo but increased neutrophil iodination (bactericidal mechanism) (Roth, et al. 2001. JDS 84)

41. Evidence….Immunomodulators Effects of colostral whey on WBC from cows +/- S. aureus mastitis • Increase in WBC cells, increase in random migration • Increase in S. aureus shedding in infected cows • No adverse effects (Kerhli, et al. 1989 Vet Immuno Immunopath. 20

42. Evidence…Immunomodulators • Evaluation of effect of Mycobacterium cell wall fraction stimulant on diarrhea in bull calves • 200 neonatal bull calves on calf ranch received product or assigned to control • No difference between treated or control calves (Kirk, et al. 1998. JAVMA. 213)

43. Evaluation of an Alternative Treatment Regimen for S. aureus • To evaluate the efficacy of a recommended treatment protocol for contagious mastitis • To better characterize S. aureus mastitis epidemiology on New York organic dairy farms.

44. Materials and Methods Herds: Known history of S. aureus Owner willingness to participate Herd Two 300 Holstein Friesian Freestall-Double Six 3X milking Organic since 2000 Herd One 100 Holstein Friesian Round the barn pipeline 2X milking Organic since 1998 Herd Three 70 Holstein Cross 100% pasture, NZ dbl 10 2X milking Organic since 1998

45. Materials and Methods • Cow selection: Hx of S. aureus infection or two of past three DHIA LS > 4.5 • Randomized in blocks of fifteen by farm Ten treated, five controls per block • Cows were quarter sampled weekly 3X before treatment and biweekly 3X post-treatment for aerobic culture(NMC, 1999) and SCC(Fossomatic methods) • Cure rates (Fisher’s Exact test) Change in LS pre and post treatment (ANOVA)

46. Results • Herd Three dropped out after 2nd day of treatment • 32 S. aureus quarters and 80 non-aureus quarters • Most cows infected in one quarter • Five quarters “cured” • No effect on quarter level LS

47. So, What works? (at least for now….) • Prevention • Good management • Healthy animals • Motivation and attention to detail • Botanicals • Immunomodulators?

48. What do We Need From Extension and Universities? • More clinical research on CAM • Scott Haskell (Maine): looking at in vitro and in vivo efficacy of alternative mastitis treatments • Danish Agriculture Institute: will explore efficacy of botanicals and homeopathics

49. Questions?