development and daily management of an explicit …orgprints.org/13776/1/13776.pdfdevelopment and...

J. Dairy Sci. 89:1842–1853 American Dairy Science Association, 2006.

Development and Daily Management of an Explicit Strategy of Nonuseof Antimicrobial Drugs in Twelve Danish Organic Dairy Herds

M. Vaarst,*1 T. W. Bennedsgaard,* I. Klaas,* T. B. Nissen,† S. M. Thamsborg,‡ and S. Østergaard**Department of Animal Health, Welfare and Nutrition, Danish Institute of Agricultural Sciences, P.O.Box 50, DK–8830 Tjele, Denmark†Danish Association of Organic Farming, Frederiksgade 72, DK–8000 Arhus C‡Danish Centre for Experimental Parasitology, The Royal Veterinary and Agricultural University, 100 Dyrlægevej,DK–1870 Frederiksberg C, Denmark

ABSTRACT

Promotion of animal health and well-being at theindividual animal and herd level is an important goalin organic farming. At the same time, chemical productsaffecting the natural balance among living organismsare prohibited in all areas of the organic farm. Froman animal welfare point of view, however, no animalmust suffer. Therefore, veterinary drugs are allowedunder the European Union’s regulations for organicfarming, despite the fact that they are powerful celltoxins affecting both pathogenic and necessary bacte-ria, and as such in organic terminology, are regardedas “chemical” or “artificial” products. In this article, wepresent and discuss interviews with 12 Danish organicdairy producers who claim that minimized use or non-use of antimicrobial drugs is an explicit goal. The dairyproducers were at different levels with regard to re-duced antimicrobial treatment. An explicit strategy ofno antimicrobial treatments is based primarily on along-term effort to improve herd health, and second-arily, on finding alternative treatments for diseasedanimals. Improved hygiene, outdoor access, use of nurs-ing cows, and blinding of chronic mastitis quarters werethe main techniques in developing a strategy of notusing antimicrobial treatments in the herd by dairyproducers. Producers’ perception of disease changedfrom something unavoidable to a disturbing break inthe daily rhythm that often could have been avoided.Change toward a nonantimicrobial strategy was grad-ual and stepwise. All dairy producers in this study de-sired to preserve the possibility of using antimicrobialdrugs in emergencies.Key words: nonantimicrobial treatment strategy,mastitis treatment, organic dairy farming

INTRODUCTION

Organic farming is characterized by several goalsthat are expressed in daily practices and in standards.

Received May 30, 2005.Accepted November 30, 2005.1Corresponding author: [email protected]

1842

Some of the important goals for organic production sys-tems are naturalness, harmony on all levels of produc-tion, local recycling of resources, and the principle ofprecaution (Anonymous, 2002). When focusing on theherd, goals for organic farming concerning naturalnessand harmony are met by giving the animals opportuni-ties to perform natural behavior and achieve harmonywithin the group, and to favor freedom of the animalsto make as many choices as possible (Alrøe et al., 2001;Lund and Rocklingsberg, 2001; Vaarst et al., 2004; Ver-hoog et al., 2002, 2004). The production system is notsustainable if animals show evidence of pain, disease,or distress because of an inadequate system or dishar-mony between the animals and the system. Health andwell-being should be promoted in each animal in or-ganic husbandry systems (Lund, 2002; Thamsborg etal., 2004; Verhoog et al., 2004).

A prerequisite for success in any animal productionsystem is the responsibility for maintaining animalhealth and welfare, managing various crisis and de-mands, and taking responsibility to intervene whennecessary and at the first sign of disharmony. Whenintervention is necessary to prevent sick animals fromsuffering, we face potential conflicts and paradoxeswithin organic animal husbandry. First, many drugscan be regarded as strong toxins disturbing the balanceamong living organisms (e.g., diarrhea induced by anti-microbial treatments in calves; Rollin et al., 1986). Useof chemical products affecting the natural balanceamong organisms is prohibited in most areas of theorganic farm, except in the animal herd. Justificationfor their use is the concern for animal welfare: individ-ual animals are not allowed to suffer from disease andmust be treated responsibly. This leads to the nextrelevant discussion: what is a responsible treatment? Inthe light of the increasing problems with antimicrobialresistance (Aarestrup, 2000), the discussion of responsi-bility takes several directions that should be addressed.With regard to the animal, overall prognosis of antimi-crobial treatments can be discussed in terms of theprognosis for each type of treatment case (e.g., chronicor acute mastitis) and the experience among dairy pro-

OUR INDUSTRY TODAY 1843

ducers and veterinarians with each antimicrobial prod-uct. A relevant example in a dairy herd is mastitis casesinvolving Staphylococcus aureus bacteria. These casesare reported to have a very poor prognosis for lastingcure even when treated with antimicrobial drugs (Er-skine, 2001). Thus, the next obvious question is to deter-mine what else could be done.

Consumers, on the other hand, have expressed theirexpectations that organic products should be of highquality, including a low risk of drug residues or bacteriathat may either cause infection or transfer antimicro-bial resistance. They also expect animals to have im-proved welfare compared with conventional herds(Harper and Makatouni, 2002; Gambelli et al., 2003;Milne, 2003; Midmore et al., 2005). In the UnitedStates, the food safety issue is met in a very radical way.According to the National Organic Standards (USDA,2003), food products from animals treated with anyantimicrobial medicine cannot be sold as organic. If ananimal receives an antimicrobial treatment in case ofa severe disease, it is then removed from the organicfood chain. This provision gives a clear signal that or-ganic production has a strong focus on the animal foodproduct and the concerns of consumers regarding a po-tential risk of being exposed to a product containingresidues. In Europe, a similar intention is only ex-pressed through prolonged withdrawal time after treat-ments and a restriction on only 3 medical treatmentsper lactation for dairy cows [Council Regulation (EEC)No 2092/91 and No 1804/1999, CONSLEG:1991R2092 – 01/05/2004].

The discussion of an explicit strategy of nonuse ofantimicrobial drugs has reached organic dairy produc-ers in Denmark. Consequently, a pilot study was initi-ated with the purpose of describing motivations andcircumstances under which organic dairy producershad to work when applying an explicit antimicrobialnonuse strategy. Twelve organic dairy producers wereinterviewed in qualitative research interviews. Theyhad expressed viewpoints about antimicrobial nonusestrategy in their herds, ranging from growing interestbut no attempt or experience in practice to reach thisgoal to several years of experience with active diseaseprevention and so-called alternative (nonbiomedical)strategies of disease handling. In this article, the re-sults of those interviews are presented and discussedwith a focus on relevant questions concerning a strategyof nonuse of antimicrobial agents in the dairy sectorbased on the case of Danish organic dairy producersand their specific conditions.

MATERIALS AND METHODS

Selection and Presentation of Herds

For economic reasons, an interview study of only 12dairy producers was planned in connection with a proj-

Journal of Dairy Science Vol. 89 No. 5, 2006

ect investigating the risk of antimicrobial resistance inorganic dairy farming. A questionnaire was sent to themembers of the Association of Organic and BiodynamicDairy Farmers (100 dairy producers), in which theywere asked to express their interest and experience, ifany, in phasing out antimicrobial medicines from theirdairy herds. Forty-two dairy producers responded to thequestionnaire and expressed interest in participating inresearch activities exploring conditions and conse-quences of limited use of antimicrobial treatments.

To have as much diversity as possible, the 12 dairyproducers were selected according to their location, yearof conversion to organic methods, and duration of timethat reduction of antimicrobial use had been an explicitgoal. Six herds had very low antimicrobial use at thetime of selection. The other 6 herds used differentamount of antimicrobials, but expressed interest in lim-iting their use of antimicrobials. Some herd characteris-tics are presented in Table 1. Each farm was connectedto a veterinary practice; however, none of the dairyproducers was associated with the same veterinarypractice. To evaluate the health status of the selectedherds, the main health indicators were calculated forwhat can be regarded as a control of 76 organic dairyherds selected because they participated in other proj-ects at the Danish Institute of Agricultural Sciences.

Interviews

All dairy producers were interviewed by means of aqualitative, semistructured research interview in Sep-tember 2003. All interviews were performed by thesame 2 persons (first and fourth authors) and recordedon tape. Interviews lasted approximately 90 min, andthe interview followed a 30-min walking tour of thefarm. The qualitative research interview is a researchmethod that aims to explore and describe a spectrumof attitudes and experience within a certain field, ratherthan presenting a representative sample of opinions orquantifying opinions or experience among a group ofpeople (Strauss and Corbin, 1990; Kvale, 1996). Inter-views were structured according to a number of the-matic questions (Figure 1). The interviewee was encour-aged to speak and direct the course of the interview.Interviewers followed up on his or her questions, ex-plored apparently self-contradictory statements, andasked for further examples. The interviewers took re-sponsibility for keeping to the point and the theme ofthe interview. Thematic questions were weighted dif-ferently in the various interviews and were partly di-rected by the focus of the farm and the interviewee. Forexample, if homeopathic treatment was widely used inone herd, but not used at all in another, this theme

VAARST ET AL.1844

Tab

le1.

Sel

ecte

dke

ypr

odu

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nfi

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s(f

rom

2003

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rth

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part

icip

atin

gda

iry

her

ds

Her

d(y

ear)

1

AB

CD

EF

GH

IJ

KL

(198

3)(1

995)

(199

5)(1

998)

(198

8)(2

000)

(199

5)(1

995)

(199

5)(1

991)

(199

5)(1

999)

Ave

rage

Bre

ed2

Jers

eyS

DM

Cro

ssS

DM

Cro

ssS

DM

SD

MD

RH

SD

MS

DM

DR

HJe

rsey

—N

o.of

cow

s/yr

4490

6812

329

5912

556

109

142

7866

82A

nn

ual

EC

M/c

ow6,

300

8,13

08,

000

9,30

07,

318

8,47

78,

323

7,57

25,

915

7,50

08,

239

7,81

77,

741

Bu

lkm

ilk

SC

C3

(×10

00)

179

232

183

263

478

214

144

243

545

344

218

226

272

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dou

tdoo

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stem

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275

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5320

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3528

3529

3926

2930

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received respectively more or less focus and time duringthese 12 interviews.

Interview Analysis

Each interview was taped and a written summarywas made and sent to the farmer for confirmation. Quo-tations of what the farmer said were included in thissummary. This approach was chosen to confirm thoseconclusions and statements of individual dairy produc-ers that were regarded as important. Further, a fulltranscript was difficult to read and did not contain anyinterpretation. Overall themes were described acrossthe interviews in an approach modified from Straussand Corbin (1990). After the themes were described andanalyzed, a farmer workshop was held in which theunderstanding of the relationships among, and the con-flicts within, these themes were discussed and con-firmed among participants.

Quantitative Data

Herd data were obtained from the central DanishCattle Database. Data from monthly or bimonthly milkcontrol were available from all herds. Disease treat-ments by the veterinarians were reported in the data-base. Treatments were counted as 1 treatment whenthey were administered within 9 d of the first treatmentof the disease. Differences between years were analyzedby using procedure GLM with herd and year in themodel (SAS Institute, 1999).

RESULTS

Facilitating Nonantimicrobial Treatment Strategies

Focus on Improving Herd Health Rather ThanEliminating Antimicrobial Use. Seven dairy produc-ers said that they had had the goal of phasing out anti-microbial treatments in their herds for at least 1 yr (oneof whom had considered himself inexperienced withstrategies of nonuse of antimicrobial agents). Thesedairy producers strived to improve health conditions intheir herds and create a dairy production system thatpromoted animal health and welfare and enabled thedairy producer to manage effectively and intervenewhen necessary. At a certain point in this develop-mental process, they realized that, as the number ofdisease treatments decreased, their awareness and mo-tivation to improve the living conditions in the herdincreased. All dairy producers emphasized that theavoidance of antimicrobial treatment was a herd goal,but not the first priority compared with generally im-proved herd health. In Figure 2, we present factors that


Figure 1. The interview guide used in interviews with farmers/producers to determine their goals and practical handling of the herd,individual animals, and disease cases.

the dairy producers cited as important for improvingherd health.

Improved Control of Individual Cows and Hous-ing. Because of making a strategy of antimicrobial non-use an explicit, distinct goal for the herd, the dairyproducers had begun to examine their own choices ofdisease treatments. They had systematically evaluatedwhich disease cases they had treated by going throughlists from the central cattle database and their ownlogbooks. In doing so, they had reflected upon the re-sults and whether something else could have been done.The veterinarian had normally not been involved in thisreflection process. Dairy producers gradually startedchecking certain cows (e.g., fresh cows) with the Califor-nia Mastitis Test (CMT) and bacteriological culturingof milk samples in collaboration with the veterinarian.


For up to several years (some of the dairy producersstill found themselves in this phase), they graduallychanged their responses to a disease case from immedi-ate disease treatment to immediate intense follow-upand frequent checking of the diseased animal. Theyclosely followed up on mastitis cases treated by theirveterinarian (in Denmark, veterinarians are allowed totreat organic dairy cows with veterinary drugs), andthose they had treated with alternative methods. Thechoice of how to handle mastitis cases varied amongdairy producers and partially depended on producers’individual goals. Some dairy producers expressed theview that their goal was to avoid time-consuming treat-ments; therefore, they would never focus on alternativetreatments, but would blind a quarter in case of achronic problem. Others saw it as a goal to avoid cows

VAARST ET AL.1846

Figure 2. Important health factors as indicated by the participating dairy producers that reflected their perception of a healthy herd.

with blind quarters, and therefore were willing to puteffort into a combination of alternative treatment anda culling strategy that matched the goals of the herdconcerning bulk tank SCC. Some dairy producers usedcows with high SCC as nurse cows for calves less than3 mo of age. Furthermore, collaboration with the veteri-narian was also important (e.g., when sampling andmaking bacteriological cultures of suspected mastitis


cows). In most cases, the farmer exclusively made thedecisions and the veterinarian was involved only toperform the bacteriological culturing and to treat thecows, if the farmer decided to use antimicrobial drugs.In 2 cases, the veterinarian was the driving force withregard to homeopathic treatments, but was not directlyinvolved in other decisions on the individual or herdlevel.


Gradually Increasing Skepticism and StepwiseReduction of Antimicrobial Agent Use. Dairy pro-ducers who began an antimicrobial nonuse strategy ex-perienced a gradual and stepwise change. As explainedabove, the goal itself evolved over time, and once becom-ing a goal, it was still achieved in a stepwise way andinvolved sporadic antimicrobial treatments in cases inwhich they were considered necessary. Improvementsin the herd were increasingly focused on eliminatingthe need for disease treatment. Parallel to the realiza-tion that treatments in the herd were reduced dramati-cally over time, the farmer often described increasingskepticism about antimicrobial treatments because oftheir disappointing results in the herd and the appar-ently reduced need for them. The dairy producers alsodescribed an increasing consciousness of generally un-satisfying treatment results (reduced milk production,chronic changes in the udder, or permanently elevatedSCC despite treatment), and said that this had sup-ported the change toward a strategy of nonantimicro-bial treatment.

Use of Antimicrobials Should Always Be An Op-tion. All dairy producers indicated that they would notadvocate general prohibition of antimicrobial agent usein organic farming. Regardless of their own personalgoal of not using it or needing it in their own herds,use of antimicrobial treatments should be an option.The idea of selling or transferring cows to another herdbecause they were treated once with antimicrobialdrugs did not make sense as expressed by farmer E:

“If you just cull the cows and get rid of them,well, then you push the problem away fromyourself and onto somebody else. If you seeit all in a more overall perspective, then Ishould be able to—within this closed area,which is my farm—make things work. Andif I cannot, then I have to use the tools avail-able ... Because, in reality, this cow still ex-ists. Whether she lives here in my herd orwith a conventional farmer, well ... this cowwas born here, and has had a good life here,and so she should stay here for the rest ofher life – that is my principle.”

Daily Disease Management Followinga Nonuse Strategy

Outdoor Access, Improved Bedding Hygiene,and Milking as Key Management Routines. Out-door access or open housing systems with plentiful freshair was a management factor that the dairy producerspointed to as important for an environment with lowrisk for developing infectious diseases, such as mastitis.In all herds, a big effort was made to keep the bedding


clean by cleaning them 2 or 3 times every day, veryoften in relation to milking. Straw bedding was usedin all herds, and all the dairy producers stressed thatmanaging bedding was a major daily routine.

Milking was a third key area that dairy producersemphasized as an essential element of generally goodhealth status. In all herds, the same person was in-volved in milking, and milked at least once every day.Dairy producers considered this a major advantage,because it ensured monitoring every development ofeach cow in the herd. Further, maintaining the samemilking routines over time as well as between milkingswas important. In some herds, such as herds F and I,daily herd management was performed by one personalmost exclusively, namely the farmer himself; he per-ceived this as leading to a good “feel” for current herdstatus. In other herds, such as herd J, where 2 or 3persons milked cows, a clear system of communicationwith spray colors on the udder was developed, so that allmilkers were aware of cows that needed extra attention.

Characteristics of the Mastitis Cases. All herdsexperienced mastitis cases that were relatively uncom-plicated and did not lead to any serious risk to the lifeor general health of cows. A“typical” mastitis case wasdescribed to involve clots in the milk and one or moreslightly swollen quarters, in which appetite was unaf-fected. Most cows had problems with mastitis in connec-tion with drying off and calving. Drying off as well ascalving management differed among herds.

Measuring Mastitis and Follow-Up on Individ-ual Cows. Most of the dairy producers interviewedused control measures such as CMT, premilking stripcup, and collected samples for bacteriological cultures.Using a strip cup was often done in relation to all milk-ings, and most producers used the monthly SCC mea-sures to select cows for CMT and to identify affectedquarters. Dairy producers D and H only had bimonthly,instead of monthly SCC measures, partly to encouragemore intensive use of CMT, and because they consid-ered the CMT more informative and valuable than themonthly cow-level SCC. As explained earlier, measur-ing SCC indirectly by the CMT was most widely done inthe first part of the process, in which improved controlcontributed to “replacement” of immediate treatment.These cases were not ignored, but intensely followedup by the farmer, instead of just treating the cow imme-diately after having noticed some signs of disease with-out further evaluation or reflection.

Disease Treatment was a Time-ConsumingBreak in the Daily Routine. One major reason foravoiding disease rather than considering replacementof antimicrobial treatments with alternative treat-ments was to reduce disruptions in the daily work rou-tine. Dairy producers making this argument touched

VAARST ET AL.1848

on both the lack of being able to plan a rational, efficientday and the psychological distress from being con-fronted by diseased animals and the decision as to howto handle the situation. Dairy producers pointed to thefact that the housing or handling facilities did not alloweasy intervention. Cows were housed in large groupsand in loose-housing systems, and it was time consum-ing to catch a single cow for treatment or extra care.One farmer did not reduce antimicrobial treatment dur-ing the first year after the interviews, but emphasizedthat treatment by the veterinarian was the first choicein mastitis cases, because other ways of handling dis-ease were too time consuming. In contrast, farmer Bexpressed the view that a production system that iswhat he called “robust” (meaning promoting the ani-mals’ health and welfare and at the same time flexibleto work with and easy to overview for the farmer) makesthe resources for crisis management available:

“We normally have plenty of time in our dailylife, and there is plenty of time to take careof our animals in this system, because it isrelatively simple – so, we have extra time incase of need for an extra effort – and you canspend that time for a limited period, but webasically do not want to go on for a longertime.”

Alternative Disease Treatments. Widely differentattitudes and approaches were taken to alternativetreatments of mastitis cases. Most dairy producers usedpeppermint ointment for udder massage in mild cases,and did some extra stripping in connection with milk-ing. Farmer F estimated that he used an extra 15 minat every milking for taking care of cows that demandedspecial care. Some dairy producers, such as dairy pro-ducers D and C, expressed complete lack of interest inalternative treatments and in the idea of paying somuch attention to treating diseased cows. They referredto health promotion as their main interest, with thegoal that disease should not be allowed to absorb energyand attention. Therefore, when a cow reached the pointwhere it should be treated, they preferred to have ittreated with antimicrobial drugs, because that was theeasiest approach. Some dairy producers had sporadi-cally tried various alternative products, mostly homeo-pathic complex remedies, with different levels of suc-cess. A few others had developed a treatment practicewith homeopathic remedies in collaboration with a vet-erinarian or other dairy producers.

Suckling as an Alternative to Handling Cowswith High SCC. Five of the 12 dairy producers hadsuckling systems, in which cows nursed 3 to 4 calveseach, either in separate pens (1 cow with her calves)or common pens. Suckling systems worked in different


ways, but a common feature in 4 herds was that patient,old “good nursing cows” stayed with the newborn calveson a more permanent basis, and developed a bond withthem. In some cases, this permanent stay lasted for the3-mo milk-feeding period. Nurse cows were normallythose having elevated SCC, and they often were des-tined to leave the herd after the nursing period. Parallelto this system, another system was applied in 2 herdswith older and more robust calves that were used tonurse a cow. This system was typically more of a short-term treatment involving cows having elevated SCC orclinical changes in their milk or udders. These cowscould remain with nursing calves perhaps 4 to 7 d andthen return to the milking herd.

Drying Off Quarters as a Strategy. Chronic casesof mastitis were often handled by drying off the quarter.In most cases, milk yield from the affected quarter wasvery small, and in a sense, the cow dried off the quarterherself. Nevertheless, in some cases the farmer had tomake an active effort to gradually dry off one quarterby hand milking while machine milking the other quar-ters. In some herds, such as herd C, up to 33% of thecows had blind quarters. In many herds, cows havinga blind quarter were still inseminated to stay in theherd. In other herds, a blind quarter was a reason forculling. Some dairy producers had experience withblind quarters becoming completely normal again afterone calving.

Collaboration with the Veterinarians. Farmer Adescribed a gradual development of common under-standing and mutual respect between himself and hisveterinarian:

“We have been using the same veterinarypractice all these years, and we have devel-oped a good way of collaborating, in particu-lar with one of the vets, so that when hecomes to the herd, he may drive away againwithout having treated any cow, and then Ithink you have come a long way.”

Some dairy producers, such as dairy producers F andH, very specifically said that they used their veterinar-ian only for treatments when they themselves found itnecessary, and that the veterinarians were not inter-ested in advisory service, and had no interest in thedairy producers’ goals or to the fact that they wereorganic. Farmer J felt that he himself normally had agood feeling for the disease situations, and that he hadthe same knowledge as the veterinarian:

“Without really saying anything negativeabout the veterinarian, I claim that in morethan 90% of disease cases, we know as wellas the vet what is wrong, ... and in the re-


maining 10%, well, he cannot always do any-thing anyway, so if we run into a case likethat, we hope that the cow will recover; other-wise we will have to shoot her.”

Doubts and Feelings of Insecurity Among DairyProducers Who Have Not Yet Started the Process

Dairy producers G, K, and L were interested in anonantimicrobial treatment strategy because they hadbeen confronted with the idea and heard it discussedat meetings, but had not yet started the process. Inthe case of farmer L, the veterinarian had inspired histhoughts about this goal, including the attempt to reachit by herd improvements. This farmer and his veterinar-ian focused primarily on the treatment strategy andhow to prevent disease. To varying degrees, the dairyproducers expressed concern about animal welfare incases of disease when antimicrobial treatment was ex-cluded as a treatment possibility. At the same time,they expressed an increasingly critical and self-examin-ing consciousness about the motivations for using anti-microbial agents as expressed by farmer K:

“Sometimes it is your own bad consciencethat is the true object of treatment ... andyou are told that if antimicrobials do notwork, then nothing will work – and then itis a damned easy solution.”

One characteristic of herd K was favoritism for cer-tain cows that had received the majority of treatments.Farmer K realized this favoritism, but did not want tocull these cows because he liked them and they hada high milk yield. He chose antimicrobial treatmentsrather than alternative treatments, because he foundthat they produced the best prognosis.

Indicators of Herd Health During the FirstYear After Interviews

Indicators of herd health for the 1-yr periods beforeand after the interviews are shown in Table 2. Thesmall number of herds in the study meant that onlyvery large differences in the variables could be expectedto show statistical significance. Frequency of mastitistreatments was smaller (P < 0.05) in the herds withlimited use of antimicrobial agents than in the herdsphasing out antimicrobial drugs in 2003, and the con-trol (other organic herds) in 2003 and 2004. Reducingmastitis treatments seen in the herds phasing out anti-microbial drugs did not differ from control organicherds. Reducing mastitis treatments occurred in 40 to75% of 4 of 6 herds, an 80% increase in 1 herd, but nochange in the last herd (see Table 1).


Calculated bulk tank SCC was smaller (P < 0.05) inthe herds phasing out antimicrobial drugs than theherds with limited use of antimicrobials during bothyears.

DISCUSSION

Amount of Mastitis and Treatmentsin Organic Dairy Herds

As seen from the herd characteristics in Table 1, thedairy producers indicating they wanted to phase outuse of antimicrobial drugs were clearly very far from thegoal of an antimicrobial nonuse strategy. For example, 1herd had 55 treatments per 100 cow-yr. Furthermore,the SCC data indicated that most herds struggled tomaintain good udder health, regardless of how fre-quently farmers used antimicrobial treatments.

Mastitis has been identified as the main disease prob-lem in organic dairy herds in most European countries.In many studies, the amount of mastitis in organicherds is similar to or greater than in conventional herds(Krutsinna et al., 1996; Spranger, 1998; Hovi and Rod-erick, 1999; Weller and Bowling, 2000; Sundrum, 2001;Thamsborg et al., 2004). In Scandinavian countries,generally less mastitis has been found in organic herds(Ebbesvik and Løes, 1994; Vaarst and Enevoldsen,1994; Vaarst, 1995; Hardeng and Edge, 2001). In or-ganic herds in England and Wales, a large amount ofdry cow mastitis has been reported (Hovi and Roderick,1999). Dry cow therapy is widely used in dairy herds,often as a preventive measure, and as such, used foreach cow in the herd at dry off (Hovi, 2003). In Den-mark, use of any medical inputs for disease preventionhas been prohibited since 1995. This means that drycow therapy, as a preventive measure, cannot be per-formed in any herd, conventional or organic. In morerecent Danish studies, only a few old organic herdsdiffered from the conventional herds with regard tofrequency of treatments and SCC (Danish CattleHealth Advisory Board, 1998; Bennedsgaard et al.,2003). Vaarst (1995) found a very small incidence oftreatments as well as relatively little mastitis (basedon reduced SCC, few clinical signs, and fewer bacterio-logical findings) in 15 organic Danish herds that partici-pated in a study of organic farming. At that time, theyrepresented about 25% of Danish organic dairy cows.These results were achieved by consistent and strictmanagement routines, and immediate interventionafter observing signs of mastitis. These interventionsinvolved hand stripping, udder massage using pepper-mint ointment, and other nonmedical treatments. InDanish studies, this picture is no longer seen, becauseorganic dairy producers generally do not report making

VAARST ET AL.1850

Table 2. Udder health in 6 herds having limited antimicrobial use, in 6 herds working to phase out antimicrobial use, and in 76 organicdairy herds not involved in the research project

Based on monthly recordingsof individual milk yield and SCC

Mastitis Cows with Cows withNo. treatment Calculated chronic acuteof Herd size per 100 bulk tank elevated elevated Culling rate

Group herds (cow-yr) cow-yr SCC SCC, % SCC, % per yr

Limited use of antimicrobialdrugs for > 1 yr2003 6 75 (29–142)1 3 (0–5)a 324 (180–550)b 14 (2–40) 3 (1–4) 29 (16–46)2004 6 77 (30–162) 0 (0–1)a 281 (144–479)b 22 (2–39) 4 (1–5) 35 (22–39)

Expressing interest in phasingout antimicrobial drugs2003 6 90 (56–125) 37 (22–55)b 221 (140–260)a 14 (3–15) 3 (1–3) 31 (22–39)2004 6 87 (56–124) 26 (7–58)ab 214 (180–220)a 15 (9–18) 3 (1–4) 39 (24–57)

Other organic herds2003 76 105 45b 292 30 3 342004 76 107 41b 270 29 3 35

a,bMeans having different superscript letters within columns differ (P < 0.05).1Numbers in parentheses are minimum and maximum values.

any extraordinary effort (Bennedsgaard et al., 2003;Vaarst et al., 2003).

Focus on Improving Herd Health

All dairy producers expressed interest in avoidingantimicrobial treatments. Nevertheless, those whoseemed to have nearly achieved that goal focused onimproving herd health as a prerequisite for eliminatingthe need for antimicrobial treatments. The historyabout stepwise and gradual change in perception ofthese dairy producers is an interesting contrast to theconcerns and doubts of those dairy producers whoseinterest in eliminating antimicrobial treatment wasraised at farmer meetings, but where the idea was rela-tively new and less integrated into the other strategiesfor the herd. They focused on eliminating treatmentsinstead of avoiding disease as a primary goal. The onlyfarmer that did not succeed in reducing antimicrobialtreatment during the first year after the interviewsdiffered from this scenario in emphasizing that treat-ment by the veterinarian was the first choice in mastitiscases, inasmuch as other ways of handling disease weretoo time consuming.

All 12 dairy producers interviewed said that theywould like antimicrobial treatments to remain an op-tion in emergency cases such as cesareans, severe clawdisorders, and severe mastitis. This focus seems rele-vant and appropriate for finding a balance betweenthe basic ideas of organic farming and the concern foranimal welfare (i.e., minimize unnecessary suffering).


Disease Management Following an AntimicrobialNonuse Strategy

Some statements made by the dairy producers sug-gested that they associated an explicit strategy of non-antimicrobial treatment with taking responsibility. Inparticular, the responsibility is to keep the cow healthy,as described by farmer E:

“You push the problem away from yourselfand onto somebody else.... You should be ableto ... make things work. And if I cannot, thenI have to use the tools available.”

The diseased cow is defined as a failure and as some-thing that the farmer has not handled well enough.How far you can take this argument is a valid question.In a well-working, balanced housing system with a goodration and management focusing on animal welfare,the amount of disease is very low. Some cases can,however, be explained by cow characteristics and a com-bination of unfavorable conditions. Thamsborg et al.(2004) mentioned feeding and housing as potential riskfactors for mastitis. They emphasized that growing evi-dence exists that mastitis can be controlled under or-ganic production conditions, but it is also the majorchallenge in organic dairy farming. Vaarst (1995) con-cluded that the markedly small amount of mastitis com-pared with conventional herds in the early 1990s wasnot related to the organic production system in general,but to individual dairy producers’ willingness and abil-ity to make an extraordinary effort in their herds. Thiseffort can be claimed to be a characteristic of organicfarming in the ideal, but it is definitely not guaranteed,


and the fact that herd size has been consistently in-creasing during the past decade in Denmark also raisesthe question of how to ensure routines in which extracare is provided to cows.

Disease Treatments: An Easy Solutionor a Disturbing Break?

As explained in more detail below, the following state-ments became a crucial part of the conclusions of thisstudy. A disease treatment (which in practice was oftena treatment with antimicrobial drugs) can be viewedas meeting 2 completely contrasting objectives. Somedairy producers see disease treatments as an annoyingand disturbing event that interrupts daily routine. Oth-ers perceive disease treatment as an easy solution afterhaving done all within herd resources. Still others relyupon the judgment of the veterinarian rather thanthemselves.

Questioning the Necessity of Medical Treatment.In many herds, disease treatments have become partof daily herd management and are not questioned. Themajor change in several herds in this study seemed tocome when the farmer questioned the option of treatingdisease. Some of the dairy producers (those who madelimited progress in their nonuse strategy) describedbiomedical disease treatments (i.e., natural sciencetreatments or so-called western medicine) primarily as“easy solutions.” When doing so, their starting pointwas still that disease is a condition that must be ac-cepted. Gradually, incidences of disease seemed to be-come an increasingly disturbing phenomenon, and ev-ery time it occurred, the producers were aware thatperhaps it could have been avoided. They begin to viewdisease as something that should not occur. When dis-ease is viewed that way, all efforts connected to diseasetreatments are regarded as disturbing breaks in every-day routines, and many of the everyday routines aretargeted at health promotion. Disease should still bereacted to, when present, but the situation could havebeen avoided, leaving time and peace for the normalmanagement routines. The interviews reflect this de-velopment that, of course, is gradual and stepwise.

What is a “Responsible” Disease Treatment? Nomatter whether a disease is treated with veterinarymedicine or in any nonmedical way, it still requiresfarmer resolution. The next relevant question is whatconstitutes responsible treatment. The earlier state-ment of farmer K:

“ ...sometimes it is your own bad consciencethat is the true object of treatment...”

suggests that some treatments may be performed pri-marily to ease the conscience of the farmer. Treatments


with antiobiotics seem to be used when not indicatedand when no known efficacy for their use has beendemonstrated scientifically. Thus, many such treat-ments, whether farmer- or veterinarian-directed, areoften “feel-good” treatments of the user (i.e., they makethe farmer feel like he has done something for the coweven though treatment was a waste of time andproduct).

The question is whether antimicrobial treatment isthe most appropriate way of intervening in case of dis-ease. In Sweden, Ekman et al. (1995) recommended useof antimicrobial drugs based on critical criteria andrecommended that all chronic cases not be treated withantimicrobial drugs because it is well documented suchtreatments have a poor prognosis. Mastitis treatmentsaccount for the majority of disease treatments in theseherds, and in Danish dairy herds in general.

Potential Consequences of Limiting TreatmentStrategy. It is not recommended to keep cows withchronic disease of any kind, and particularly not if thegoal is to reduce the frequency of disease treatments.This means that a limited treatment strategy to someextent is in conflict with the idea of keeping favoritecows—farmer K expressed interest in eliminating theuse of antimicrobial drugs from his herd, but wantedto keep his favorite cows. Strategies such as dryingoff infected quarters raise similar potential conflicts inrelation to some farmer definitions of good managementand healthy cows (Vaarst et al., 2002).

Collaboration with the Veterinarians

The local veterinarians were involved in differentways in this process in the 12 herds. In some herds,veterinarian involvement was nearly absent. Somedairy producers regarded veterinarians as technicianswho did the bacteriological culturing. In Denmark,many veterinarians do bacteriological cultures of milkas part of their daily routines. This has been a majorhelp in the decision-making process for dairy producers.Veterinarians have regularly expressed concern that agoal of a limited disease treatment, as in organic animalhusbandry, can lead to poor animal welfare (Anony-mous, 1998). These interviews show that the dairy pro-ducers want to eliminate the need for antimicrobialtreatments primarily by improving the managementand environment of cows. This approach probablyshould be acknowledged and supported by many veteri-narians. Nevertheless, working actively and positivelywith dairy producers toward these goals demands open-ness, honest dialog, and a desire to understand theintentions behind this goal and what it means for theherd management, daily routines, and choices. Vaarstet al. (2003) showed in an interview study of newly

VAARST ET AL.1852

converted organic dairy producers that they used theirveterinarians in relation to biomedical disease treat-ments, but only to a very limited extent when makingdecisions about health promotion and disease preven-tion, as well as regarding any alternative treatmentmethods. The same seems to be true in this study. Thegoal of dairy producers in the present study is clear:they wanted to eliminate the need for antimicrobialtreatments through improved animal health, and theywanted support and guidelines to handle diseased cowsin a responsible way that did not compromise animalwelfare. They wanted advice on how to achieve thisgoal, and advisors and veterinarians could be relevantpartners in the general improvement of the herd aswell as daily sparring partners when any critical situa-tion must be handled. The basic goals of the organicdairy producers should not be questioned, but the waysto reach these goals are appropriate to question. Profes-sional knowledge, interaction, and dialogue seemed tobe lacking. It is important for the advisor to make aneffort to understand the goals of the dairy producerand find acceptable solutions together. Andersen (2004)discussed the competencies of an advisor, and empha-sizes the importance of basing all dialogue and adviceon the empathetic understanding of the producer, serv-ing as a reflective practitioner and listener, and contrib-uting with professional knowledge and skills where rel-evant and agreed upon. Hegelund (2004) has discusseddifferent models of clinical decision making from hu-man medicine, including informed decision making,shared decision making, perfect agent, and paternal-ism. His study mostly dealt with the disease treatmentsituation and was based on a case study of a Danishveterinary practice. He concluded that veterinariansoften use their superior position (in terms of “scientificknowledge” and their role as expert) to impose theirpreferences and choice of treatment and managementchanges upon dairy producers. Zwald et al. (2004) foundthat organic dairy producers tended to seek advice fromother producers, whereas conventional dairy producersgot their advice from veterinarians. The dairy produc-ers may choose not to spend their resources in seekingadvice from veterinary professionals, and this may beexplained by the general lack of innovativeness andopen-mindedness toward organic farming among veter-inarians. This was also expressed by some of the dairyproducers in this study and in a previous study of or-ganic dairy herds (Vaarst et al., 2003).

CONCLUSIONS

The following conclusions are drawn from results de-rived from a small sample of Danish organic dairy farm-ers, who produce under the conditions of the European


organic production systems, in which use of antimicro-bial drugs is allowed, but followed by increased with-drawal time. Further limitations are invoked in USorganic production systems. A gradual long-term effortto improve herd health status must be the basis ofan explicit antimicrobial nonuse strategy to meet theintent of acceptable animal welfare within the organicfarming concept. All dairy producers in our study saidthat they would like to have the option of using antimi-crobial drugs in emergencies. Despite the effort, thedescriptive statistics from participating herds indicatedthat SCC could be improved greatly, and that mostdairy producers who have expressed interest in an anti-microbial nonuse treatment strategy still had a longway to go 1 yr after interviews were conducted. Im-proved hygiene, outdoor access, use of nursing cows,and drying off infected quarters with chronic mastitisproblems were the main strategies used to develop anonuse treatment strategy. More information on dairyproducer attitudes and perceptions in relation to treat-ment of diseased animals is needed to achieve the goalsof high health status and reduced use of medicines.

ACKNOWLEDGMENTS

The study was conducted by members of 2 projects,the first funded by the Danish Research Centre forOrganic Farming (DARCOF; “Use of antimicrobials andoccurrence of resistance in organic dairy herds”), andthe second by the Directorate for Food, Fisheries andAgro Business Fund for Organic Farming Research(“Networking for health in organic dairy herds”). Theauthors are grateful to the participating dairy produc-ers for the knowledge and experience they shared withus in an honest and open minded way. We gratefullyacknowledge Willie Lockeretz, Tufts University (Bos-ton, MA) for very valuable comments and suggestionsregarding this manuscript.

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