Well, good afternoon, everybody. Thanks for this opportunity to speak to. We talked yesterday about the afternoon being the graveyard slot, and this is the final event.
There's two things. First of all, in the current weather and the climate crisis, I think it's the crematorium slot rather than the graveyard one, but it's also luckily for you going to be very, very, very short. Anthony gave me the topic of treating pets prophylactically.
Do we need a rethink? Well the answer is yes. So thank you very much for your time.
If any questions. And I also have another bone to pick with Anthony because I think this is potentially an oxymoron actually because I think treatment and prophylaxis is something completely different. Now how does this work right here we go.
So treatment is the management and care of a patient to combat disease, injury or a disorder seems fairly straightforward. Whereas prophylaxis is an attempt to prevent disease, and these, I think, are not the same. Prophylaxis is, is very laudable, something we should really be dedicating our lives to in, in, in all sorts of ways.
And but for the purposes of this talk, I'm going to talk about the meds, the way that we use medicines to try and prevent disease and specifically parasiticides and in mostly most of like pets, and those of you with a working knowledge of French will also know that the word prophylactic is another word for a condom. I don't think that's quite what Anthony had in mind for this talk. So I spent, I've been a vet for about 40 years.
I spent most of that in, in, in clinical practise. And in my latter years of practise, a sort of a late middle age crisis, I started looking at thinking about some of the work that we spent an awful lot of our time doing and trying to figure out whether this was really, it was really evidence-based or whether it was just perhaps eminence-based. And and I looking at these things and they won't get too bogged down in here, but, but annual booster vaccinations, which we used to do, we never used to do them when I first qualified, we did them for some diseases, but not for everything, and the goalposts keep changing, and we did some work with Michael Day at Bristol looking at at serology for for vaccine protection and .
Dogs and found that over 90%, 95% of dogs actually had a very long standing immunity from single vaccines for distemper, hepatitis, and pa. So that's one area I wasn't sure about the evidence and juvenile neutering is up for discussion again at the moment a lot of papers coming out suggesting that there's quite significant downsides to neutering animals, particularly in youth diet. It's, it's a big topic, BPA actually, we, we've got a working group going now to to look at some of the elements of that, but right there is parasite treatment.
No. I was concerned here that the level of treatment that we were using that we were being encouraged, recommended, and advertised to. The level of treatment we were being suggested we should be doing seemed to see a little bit out of sync with the actual level of disease that I was seeing.
I mean, . We've all seen We know that in young animals in in the wormy puppy, the wormy kitten, the the kittens that come in with ear mites, we know that with those we need to treat. But it seemed to me that we were actually treating quite a lot of animals that appeared to me to be entirely healthy, and we certainly weren't testing most of them.
So I thought, well, what are we dealing with ill health, so ill health, so these animals are just talked about, they're symptomatic and they test positive. You can see the ear mites, they're passing worms, and that's a fairly straightforward situation and relatively rarely we might see an animal with lung worm, although that's rarer than perhaps the advertising might tell us. But then we got infection.
Now that's not the same thing, and we may have lots of animals who come to us who maybe have microorganisms, they may have what could be an infection, they could have an E. Coli, they could have all sorts of things, but they're not necessarily symptomatic and lots of my gut is full of bacteria. I don't take antibiotics to clear out all the all the bacteria.
So we talk about everybody's familiar with the idea of the gut biome, and the fact that we're very dependent upon a population of bacteria in our guts. But there's been some recent work coming out and this is possibly a little bit left field, but I'm gonna say it anyway cos it's on the slide. People are talking about the parasitome and whether in fact there are benefits from parasites.
So this is a quote. And it's from therapeutic advances in in gastroenterology from last year. Until a few years ago, parasites were always considered harmful, but accumulating evidence of parasite screening studies reveal several protozoans and helmets previously thought to be pathogenic, are in fact highly frequent in the gut microbiome of healthy individuals.
Evidence to show a direct correlation exists between the loss of parasite colonisation and a rise in autoimmune diseases such as IVD and IBS. In the individuals in developed countries, and I should preface this, but all I'm talking about is on the basis of work in this country because the circumstances are very different in other places. So this is interesting.
I'm not going to get distracted, but there are questions being asked about this now, just this week. In New Scientists, I don't know if you saw it, there was an intriguing article there about ants and a certain particular type of ant that has a life cycle of about a year normally unless they happen to be infected with a certain tapeworm, and if they're infected with that tapeworm, the life expectancy is not 1 year, but it's 35, or even 7 years. I think it's a field that we're going to hear a lot more about in the future.
So going back then, we've got this, we've got ill health, animals that are symptomatic and they test positive for parasites, but we've also got an infected animal which tests positive for parasites but it's completely healthy, but what we seem to be doing. Is the 3rd 1. We're treating a perceived risk of infection, and that seems to me to be something different.
So just winding back a bit, when I I I'm no longer in clinical practise and when I when I did leave, I became involved in a number of projects around wildlife biodiversity and the environment in general, and I started to read more about this and I came across the World Biodiversity intactness Index, which is developed by the Natural History Museum and I'm much quoted by RSPB and so on and so forth. And this is where we stand, and I find this a little bit alive. I was really shocked by this.
So the UK is in the lowest 12% of global countries in terms of our biodiversity and tactness. This immediate area here is probably slightly better than that, but as a country, we're not great. We're bottom of the list of the G7 countries, right?
And and and and and and third from the bottom of all European countries. And what this means we we're that low because our biodiversity is only 50% intact. 65% in France, 67%, 89% in Canada, Go Canada.
Alright, so so much for the green and pleasant land. You know, we drive around this country and it looks fantastic. I mean look at it at the moment, it's full of birds, it's all lovely, but actually it's not.
We're really in, we're really in trouble. This one here, the ogs Matter survey looked at the flying insect population in this country, down 60%. In the last 20 years, sorry, between 2004 and 2021.
They call the windscreen phenomenon, which when you're as old as me, you remember what windscreens used to look like on the summer's evening you go out and you have a bucket of water to try and clear all the insects off that and then the number plate is just not happening anymore. And population decline, and this a lot of this may be very familiar. This is a very recent paper from the Proceedings of the National Academy of Sciences in the states looking at bird populations across Europe.
So bird populations in European farmland are down 57%. And urban bird populations down 28%. And they, the paper specifically identified.
Fertilisers and pesticides as being the primary issues here because of their effect on disrupting the food chain, a lot of which was flying insects, which is the food source for all the birds and so on and so forth. And the secondary effects were loss of forest cover, urbanisation, and climate change. So right up at the top, pesticides and fertilisers, a major problem.
The ornithologists amongst us will know the list of birds where the populations in the UK have dropped so dramatically tree sparrows, corn buntings, willow tits, spotted flycatchers, woodcocks, starlings, turtle doves, song thrus, bullfinches, scarlets, cuckoo. It's not a great list. Now I'm not saying at this point.
That there is a confirmed connection. Between this and our professions. Shall we say potentially profligate use of parasiticides.
Which are after all pesticides. And the fact that we use them mostly on entirely healthy animals. Because we're worried about the perceived risk of infection.
But wouldn't it be ironic if we, the vets of the world, the self-appointed guardians of the animal kingdom, actually had anything to do with what's going on in the world around us simply because some of the stuff we were using might possibly have leaked out into the environment. So what is going on? .
Well, here we go. The seminal paper that two of the authors are here with us today alerted me to the idea that we have fried all over the place. 66% of the samples, river samples, had indiclorad in them.
99% firia that's I found pretty alarming. So I went, I had a contact with Imperial College and went along to talk to them and said, is anybody else in the non-veterinary world looking at these parasiticides that we're using? And they said, Well, which ones are you particularly interested in?
I said, well, it's I mean how about imidocloprid and fipronil? And the response was immediate, sort of, oh my God, yes. And these are immitogloin particularly is very high.
It's consistently at the top of the list of chemicals of concern being picked up in rivers in the UK and the EU, and sorry, that wasn't to happen. No, no, go on, sorry, forget all this. I've just been pressing the wrong button.
I told you they quit talking, yes, exactly. Very good. So that's, that's, that's pretty, hang on, that's, pretty alarming figure, so I'll go into a little bit more detail on that in just a second.
So this is what these guys at Imperial would come up with. And they looked they were looking at 98 contaminants of emerging concern detected in London's rivers and imidocloprid. Of highest and increasing urban risk.
Despite a ban on agriculture in 2018. So everybody knows, I'm sure in this room, particularly the mitocloprid is a mere nicotinoid the pesticide banned for outdoor agriculture use in 2018. Because of its potential impact.
Oh dear, I'm doing it again. Because of its potential impact consider impact on bees and pollinators, so to find out how much of this stuff is being used, how much is out there, the people who are selling it were not particularly keen to tell us because obviously commercially sensitive to know what the sales figures. We put in a Freedom of Information request to the VMD to find out and before the agricultural ban.
There's 2.7 tonnes of immidilo year being sold in the UK into the agricultural trade, and 2.7 tonnes doesn't sound like a vast amount over an entire country apart from the fact of its level of toxicity.
Which the LD 50, so the lethal dose of 50% of the population is 132 nanograms. You might be asking, well, how many, what are we talking about here, how many nanograms in, or how many 132 nanograms in 2.7 tonnes?
Well, it's enough to kill 500 million beehives full of bees. And this country has quarter of a million beehives. So it's 2.7 tonnes is a gargantuan amount of an incredibly toxic pesticide.
So, it's no longer sold to the agricultural trade, which is fantastic, sales in that market is 0, but what has been allowed to happen is a drift into the small animal, the pet trade. And the latest figures we have are how much immidiloprid is now being sold into the pet trade either through the veterinary profession or through directly over the counter in some cases, and guess what, it's about 2.7 tonnes.
So exactly back to where we were. Beforehand and it is in the form. But these products might be familiar with some of them, advocate, advantage and not pointing any fingers.
But these are here, and, and I, I guess the most concerning, I don't have exact sales figures, but this one here, you can buy just over the counter. The Data for this now, so this is a slide. That looks at the patterns of detection, this is information that came from the Environment Agency.
And so on the left there you got the the ones for imidolopid on the right for fipronil. And this is where it's being detected and the size of the bubble on each one is a measure of the concentration that's being found. So there's two things that are important to that.
Firstly, it has a very strong what we call urban signature. So this is not in agricultural areas. This is not the farms.
This is not the wild. This is where the centres of population are, which is where the centres of pet population are too, and actually the peak levels are being found. Just downstream from the outlets from wastewater treatment works.
So Some of it will be coming, as it says in the data sheets from Don't let your dog swim and all the rest of it, but the but the significant majority of this looks like it's going straight down the plug hole from at home. And this is happening because you put the front line or whatever it is on the or the the the advocate or advantage on your dog, you get them on your fingers, what do you do, you wash your hands, of course you do. And then it dries off on your dog's coat, you stroke the dog, more of it comes off in your hands.
The dog sit or the cat sits on your lap, it gets onto your clothes, it gets on the sofa, it gets on their bedding, gets in their hair, and the evidence looks like it's it's being lost from that pet for up to a month, possibly even more than that. So you've got this continuous loss, and it all, every time you wash the pet's bedding, your hands, your clothes, it's going down the drain. It's being found also in house dust, so every time you hoover, if you check the dust in your vacuum cleaner at home, you've probably got imidolopri sitting in that as well if you're using any of these products.
It's also being found in. Hair, animal hair in lining the nests. In fact, there's a number of different pet parasiticides that are being found there.
The other thing that's important on this one, if we look at the size of the bubbles on there, the range that we're talking about here is between 0.25 and 1 mcg per litre, and here we're talking about several orders of magnitude above. The level that is expected to have a toxic effect on invertebrates.
So this is not a minor effect at all. This is very significant quantities and. In addition, so most of what I'm talking about here is these two products, immitoclori and fibril, but actually samples of a foxolana, floralana have also been found in animal hair in birds' nests, and these, these are forming.
Not only an issue in the waterways and the wild, but it's also in our homes, and the medics are increasingly worried about the sort of cocktail or chemical contaminants. You can't see, you can't smell, maybe the things you're using to clean the house or all the stuff in this cocktail of medicines that are being linked specifically now to the developed ferment of some allergies and autoimmune disease. So that's the good part.
These are some of the routes that we're talking about on the on the bottom left there was where it used to be coming in from primarily from agriculture into the waterways, but now the top boxes there that the root looks like the primary route is coming in down the domestic drain hole. So how common are the diseases we're trying to treat or how common is the perceived risk of diseases that we're trying to treat? So here we go.
This is a paper from Dan O'Neill, the RBC on data from Compass, so they looked at 22,000 dogs from 784 different clinics to try and figure out how common are these things. Fleas 2%, so that's about 1 in 50 dogs presented at the vet clinic have fleas at any one time. Which is, you think, 01 in 50, well, it's maybe quite a lot, but actually the Corolla that is 49 out of 50 didn't have fleas.
So for ticks, 1 in 143. Dogs presenting at the clinic had ticks, so 142 out of 143 didn't have ticks. Paris flea allergic dermatitis again it's about 1 in 200 cases walking through the vet's door.
Parasite infestation overall, we reckon is about 3.8% of this survey of 22,000 dogs from 784 clinics. Now, which suggests that 96 out of 100 did not have any evidence of parasite infection.
Although we don't know because as a profession, we're not really doing very much testing. There are also other other surveys that have been done. The European Medicines Agency did survey which they reported in the mid teens, and they found 0.69%, so 1 in 150 animals had signs of some sort of parasite infestation.
SAN did a report also in the mid teens, and they found that 1 in 170 pets came in with a tick on them. Somebody did a survey looking at poo bags, poo bags in poo bins. That's a nice task for a sunny day, but taking poo bags out of the poo bins in the parks and going and doing faecal egg counts on those to see what happened.
98 out of 100 had a negative faecal egg, and the 2% that did have a positive faecal egg count mostly had very low counts. So for me it raises the question. I'm not sure what we're doing here, we're treating these animals that really actually don't have many parasites, so the astute amongst you will be saying, well, that's because we're treating them all.
That's why parasite levels are so low, and you might be right, but. We did this work, so that on the left there is a list of the 11 commonest parasiticide elements by sales volume in the UK. And what we tried to figure out is, well, what's the average dose for say a 15 kg dog and a 4.5 kg cat and roughly roughly how many animals would be getting their full allocation 12 months of treatment from that amount of sales, and these are our best estimate.
On this column here, and you can't quite see the figure at the bottom, but that's 577,000, call it 6 million. The sales of parasiticides are enough to treat 6 million cats and dogs. But there's actually 25 million dogs and cats and dogs in this country or thereabouts, so it means that all these parasite desires are actually probably treating between 20 and 25% of the pets in this country, probably not enough to reduce the parasite burden in the entire population.
So, you're treating a bit of a non disease at this point, but the other argument that we see a lot about in particularly articles in some of the popular veterinary press is about zoonosis. So how common are the zoonosis? Toxocara lava migrants obviously makes all our children go blind and everybody gets cat scratch fever apart from the fact it doesn't.
This is the zoonosis in Veterinary Public Health Quarterly report for the 1st 3 months of this year. So the first thing, the toxic larva migraines is so common it's actually not even recorded on the zoonosis list. Now there is some controversy about this because we don't know whether some people are actually being affected subliminally by toxicara or not, but my feeling would be.
If it was such a big health problem, you might wonder whether they might be looking at it in a little bit more detail. So anyway, it's not recorded. Bartonellosis for cat scratch fever also not recorded.
Hdaidosis, zero cases recorded in the last 3 years. So what about money? The veterinary industry is estimated about 6 billion a year in the UK.
According to NOAA, the National Office of Animal Health, medicines revenue is about 745 million, of which 63% is companion animals, of which 35% is parasiticides. So that's about 178 million pounds a year is what it's worth to. The pharmaceutical companies and just interestingly with somebody we were talking about the use of antibiotics a little bit earlier on, well, the pet parasiticide market is worth 3 times the veterinary antibiotic market, so it's it's quite a big chunk.
A major route for these volumes of sales is through the pet health scheme. Now somebody has already raised the issue of a pet health scheme for pets quite match up with what a health scheme for farm animals might look like. So this is figures from the CBS annual report last year.
470,000 people signed up, 40% of their database signed up onto their pet health scheme. Which includes vet prescribed flea and worm treatment, and she thought that was. Bad pets at home, they have 1.5 million people signed up on their pet health scheme, right, generates them 120 million pounds a year out of their 1.6 billion turnover, by the way, but it includes advantage.
Oh, that's idoclorid on defence, that's footprintal front line, that's footprintil. So that's 1.5.5 million animals.
I've not worked at pets at home, but my experience in veterinary practise is that not many of these animals are actually getting what we would call a full parasite assessment. Let alone testing. So that doesn't look great.
Now, to their credit, the BVA and BSAVA and BVZS are changing our position on this. So our leaders are giving us good policy guidance when saying that . And I quote, Veterinary professionals should avoid blanket treatment and instead risk assess the use of parasiticides for individual animals, taking into account animal, human and environmental health risks in addition to lifestyle factors, which is great.
That's absolutely the way we should be going. But my sense from vets in practise is that they want more. We need more guidance to make sure that vets in practise don't get caught out when it comes to it.
And our friends at SA, the European. And Scientific council for companion annual parasite has always been very strongly in favour of routine parasite treatment with a great irregularity. It's they're changing their position on this a little bit more recently.
So the guide a quote from the guidelines, I just get you SAP. They do have very, very extensive guidelines for the control of parasites, which is great, but there's this very, very strong emphasis on the health risk to pets and people. I'm not convinced that actually matches up with the data that is out there if you start looking for it, and the website is full of things, so welcome to happier, safer, safer parasite free pets.
Assisting both veterinarians and impaired donors to successfully control ectoparasiticide infection, these are diseases which actually are not as common as this would imply. SAP of course, is heavily sponsored by Elanco MSD and Zatis. So a new development is these parasite assessment risk apps, which is fantastic.
That's brilliant. So that means as a client, as a pet owner, you can actually run your data of your pet through this or that can do it and figure out well what's actually the risk of parasite infection to my pet. This could be a great answer.
And Somebody did some work on this to have a look at what happened if you put your pets through this thing, so 68% of cats that were put through one of these assessment apps. 68% ended up in the highest risk category, requiring full treatment all the time. And for dogs, 97% of dogs ended up in the highest risk category and actually none.
Ended up in the in the low risk category at all. So it's possible that this is skewed a little bit towards treatment. I'm not sure.
I couldn't comment. Now advertising, yeah, I don't know if you do you remember this one? Did anybody else see this one?
It was interesting. It was out last year. So this is from Elanco, it's to the general public, so it's not advertising .
To the profession, I saw this actually on a billboard on the roadside in London a couple of things I thought a bit peculiar about. One is slugs on the face of the person I'm not quite sure what the link to canine lung worm is on that would be one thing. Secondly, and it does the tagline 22,997 cases already reported.
Well, I did ask them about that and they then admitted, well, that's over a 17 year period. So actually that means it's 156 cases a year out of a population of 12.5 million.
Which if the cases were evenly geographically distributed, which they're not, any individual dog has about a 1 in 75,000 chance of getting lung worm in any given year. Now the medics classify anything less than 1 in 10,000 as being very rare, so 1 in 75,000. That's pretty rare.
What this is suggesting, oh, and by the way, it is brought to you by the manufacturers of advocates, so it doesn't break VND's rules about not advertising prescription only medicines to the general public, so that's fine. Well that's actually suggesting. Is that 12,499,844 dogs should be treated every month throughout their entire lives to stop 156 cases, and that would be fine.
If it were not for the fact that imidocloprid, which is one of the components of Advocate, is actually spilling out down our drains, going out into the rivers and is at between 10 to 100 times the toxic dose in our rivers right now all the time. I don't wish to cast any. Aspersions or blame will be, but I think that's grossly irresponsible.
There you go, I see it. Just the veterinary time, I don't know anybody here reads the Veterinary Times. It seems to be turning into the sort of the House Journal for SCAP at the moment, and the, the large scale adverts throughout the whole, this is just the last couple of weeks.
Of adverts for parasite treatment. Anyway, I'm nearly done, I'm just gonna close this with another fascinating article I'm beginning to feel like, have I got news for you this week's guest publication. Is guide to the advances in the control of gastrointestinal roundworms in sheep, and there were 4, I thought, rather good quotes.
I don't know anything about sheep. I've I've only treated 2 sheep in my life and that's another whole story, but . What I can say is they both survived, and that's a bloody miracle.
So guide to advances in the control of gastrointestinal gastrointestinal rambles and sheep, May 2033. So four quotes to finish. One, the aim of prevention, the aim is prevention of disease, not the prevention of infection.
I think this is really, really important. 2, there is a level of gas gastrointestinal nematode challenge that can be tolerated by sheep without negative impacts on health and productivity. 3, all attempts to eliminate gastrointestinal nematode populations from sheep populations have failed.
Sheep that's amongst us might dispute that, but there it is. And the final one. A new approach is needed which requires considerably more humility in the face of the natural world and a greater appreciation of the complex systems we are attempting to steward.
When we farm sheep. So just to close, I'm not against the treatment of parasites when those parasites are causing health problems in the animals that we treat. But I do really question the wisdom of treatment for a perceived risk of infection.
When so few of those animals are actually sick and so few of them actually have any evidence of parasite infestation. We do know that we are having a very we are in a biodiversity crisis. A lot of the discussion has been about this in the last few days, and as a veterinary community, I think we need to be much, much more circumspect in what we're doing in this field.
So to go back to the very start of the lecture, do we need a rethink? Yeah. Thank you very much.