ways using less water. a lot of them are using new technology and some of them may be using gene those and others are using the kinds of things. so it is really important that we recognize in this whole area of our centers are not just the fda, usda, epa and seed companies. this is becoming a very decentralized issue, food. that other sectors have. the high-tech world and everything else. are regulated system has to cope with a much more diverse group of players. and that's something i hear when you go, these young guys getting out of silicon valley or harvard or mit saying we see food as a dramatic new opportunity. we don't make sure there is a regulatory system that is consistent speed up we are seeing a grain of the boundaries between food and drugs as welcome what our nutraceuticals

iso- but also as we learn more about human biology, as learn more about relationship between nutrition and health. we are seeing products and approaches that no longer fit within the way we use to organize food and drug related activities, and the legal regulatory structure that supports the. it's a whole new era. hopefully it will be a science driven one, and i think, we haven't talked much about nutrition, a special with michael jacobson sitting there -- >> he scares us. >> would also to talk about how we can change our system, regulatory but importantly food production so that we can produce foods that actually will support health, not increase

risk. >> that leads me to my next question. if you watch tv in the morning, you see a constant barrage of ads for breakfast cereals to kids. most of the cereals are mostly sugar and fat, may be sprayed with some vitamins so they say they can have vitamins in them. and as commissioner hamburg knows, there's been all sorts of efforts that congress has aborted to draw up guidelines, nutritional guidelines for food products that are advertised directly to children. and we know that in many of these food products, sort of negative nutritional value. what's the right approach to this? congress passed the ftc, fda, cdc of the department of agriculture to come up with voluntary standards for foods marketed directly to kids. we did. somehow commissioner hamburg

avoided it but i was a piñata at a major congressional hearing which is really unique because i was beaten up by both democrats and republicans. the old after bipartisanship i think that's taken place in the last eight years -- only. how do we crack through this? you talk about nutritional standards. how do we make sure origin people are actually getting foods that are nutritious and we can start curbing some of the direct marketing to kids, which is only getting more intense now that they're on the internet all the time. and brands like coke laura kids to their sites with fun games. but that message is to drink more coke. >> i think i would start, one of the things i learned when i got to the clinton foundation was president clinton and the clinton foundation and our spinoff, the alliance for a healthier generation, they are private sector initiatives that are going on all across this

country we have 37,000 schools to the alliance which have taken out all of the sugar drinks from the machines. in fact, they have been so successful that president clinton told me a story. he was at a hillary clinton rally at one of these schools. he was so excited to be mythical but someone fainted at the rant around rent around to the machines and they couldn't find a sugar-based drink any of the machines. he called me up and said we are killing people. i explain to them it was the unintended consequence of good public policy. [laughter] at any rate so we had some orange juice and they took care of the person that had fainted. that are private sector initiatives, things going on and we did many o of these things wl be to conduct about the industry. and that is the our schools across the country that have removed the sugary drinks from the machines in their schools. 37,000 that we personally have been assaulted with our alliance

with our healthy schools progr program. in addition to that we've done exercise programs and worked with a lunch and breakfast programs in those schools. that's having tremendous impact. the president come clinton, got a lot of criticism because he cuts these deals with things like mcdonald's. mcdonald's longer markets for their kids meals, french fries and coke. if you order a mcdonald's keep me in this country you get milk and apple slices off with a hamburger. so we've gone part of the way they are committees been criticized because he's not a purist about these things. anything we can do, instead of% of mcdonald's kids meals are now bought with milk and its low-fat milk if i remember correctly, and with apple slices. we can do things voluntarily

with the private sector, with not-for-profit organizations like the clinton foundation, the alliance for a healthier generation. the are 50 of these or positions working with schools and working with kids. we did it with tobacco. we did some regulatory stuff but at the end of the day, organizing the states and not-for-profit organizations, so there's lots of things we can do outside of the regulatory framework i thin think the leftt as great impact in getting it repaired much. our biggest strategy has to focus on low-income neighborhoods in which they don't have access to healthy foods. we've got to find an imaginative way of doing that. in haiti we are sinking kids home from school -- sending -- whether a bag of apples or whether it's a bag of vegetables. we got to find a way in this country to get healthier foods to the families. and it could be the solution is

amazon. we haven't even started to think imaginatively about ways to deliver to low income families healthy foods. i would argue that we are just going to do work outside the government framework complementary. meanwhile, while we are taking on all of the regulatory burdens and the politics at the same time. >> secretary glickman? >> i agree with much of what donna said. when i was at the motion picture association we were involved in the ratings movies. most fun things i ever had in life was to look at this movie and kind of hope that others make a decision. we went to this thing where we added smoking as a factor in the ratings of movies. that when you see a movie it is rated and they give the descriptors it was a gratuitous smoking are accessible to. at almost will always come almost always caused the movie to be rated r if there is lots

of spoke a committed group of people, from a nutrition professor we want any movie that shows high fat foods to have an r-rated movie in a. and i said i don't think we can do that. because of the foods are not inherently unhealthy. smoking is inherently unhealthy. it depend depends on how give ef foods and all that stuff. to just talk about the complexity of the situations spirit and portion control in the movies? [laughter] speakeasy tom cruise eating a half piece of pizza and i would be pg-13. a couple of things. med one michelle obama and the devastation has done a lot in the school meals area to try to reduce fat content and improve the nutritional quality of program that's gotten some controversy. but i think it will have some real, real impact. the medical community needs to do much more. donna and i talk about this.

at the bipartisan policy center, we did a study that was just astounding, find out how to medical students get any training in nutrition. none or zero our primitive united states. we saw a nice alternative to the university of miami but if you have your primary health people and that is have to be doctors can it can be physicians assistants owners assistants who don't have a background in health or nutrition, if somebody comes to them with a profit of the people don't know anything about it, it's a gigantic gap in our society. the are some medical schools trying to do that because the health community needs to be trained and they within of the business and corporate and insurance communities. a lot of companies are changing their insurance model for the people are healthier. they get benefits in terms of either cost reductions on address or other kinds of benefits as well. the pentagon which is the largest single of were in the united states has a healthy base

initiative where they've got all the service is working on a pilot program to increase health and nutrition and physical activity as part of the training of recruits. maybe that's another thing. i agree with donna. a lot of this will have to come from these outside forces. press from consumers who are demanding it as well as from the medical command as a. there are also some other things in the farmers market initiative. my former colleague at fda josh schumacher has got double up box communities and the ability to get fresh fruits and vegetables as part of her snack benefits or wic program benefits. the wic program is a profoundly significant program in this area. got to make sure that doesn't get cut because it is not an appellate poker. it's an appropriate program and provides basically prenatal through i guess two years old. whatever it is, five company

what it is largely based on specific foods that have direct nutritional impact for small children. it's going to take a combination of some government engagement like school meals together with the private sector and things that donna has talked about. >> my favorite one is at the university of miami i was going to get we can stop the kids running across the street to fast food on the weekends at night, late at night. they get back from a party. we started late night dining. at the university of miami, free for the students from 10:00 until 3 a.m. you can go to one of the dining halls and get much healthier food. while we reduce the income of the fast food operations around the anniversary, it actually gave us an opportunity to make occupation to good nutrition for our students because that was the one time when they ate fast food. because the students are very

oriented towards, college students are very oriented towards healthy foods but they did have access to them on the weekends late at night. it took somebody to convince people to run a diagram from 10:00 at night until 3 a.m., but my own view of universities they are organized for untold hours, hourscome not for kids hours and just give think about their hours if you really want to affect their behavior. >> nutrition education which is part of all r&d in terms of food and agriculture, is the public is in large part confused about the messages they get. they see all the ads on tv. most of those are highly laura, dense foods. window to the old days you would see, face a healthy. but you see the dancing strawberries or blueberries based on these kinds of programs that farmers could support self-help. but that's a rare. almost, all the messages people

are seeing, i watch a lot of television. i mean, i'm not telling i'm proud. i watch it morning, noon and night when i am home. and this is not just a problem for people who are five or six or seven years old. this is a problem for everybody. there is virtually nothing advertised that's healthy. not very much. and, because commodities are not advertised. there's no money in that. you advertise when you in which the this to win due process the foods. this is intending that the couple still do good work in this area. they are offering their products. we are being encouraged to eat more fresh fruits and vegetables. this is a generic problem for the whole society about how we deal with this cacophony of messaging that's coming. some of hamburgers i've seen are so big it would take an elephant to put in your mouth. that's what's being advertised. on television and it looks good

and quite frankly after i see it i want one. [laughter] spent i don't have much to add but i will just speed you were watching television early in the morning. >> i do watch television, but probably not quite as much as you got what you described. but i do just want to, on a couple of the important roles of government. i agree it's going to take change that occurs at many different levels and is reinforced in education and in the community behavior, and in healthy behavior in response to consumer demand. some of the activities the fda really are important and negative is that i mentioned the nutrition facts label that was just announced the update. this update does address every concern but it is going to make with a redesign calories more prominent which really matters

to its going to include added sugar which i think is very important in terms of people really understanding the sugar that is just empty calories added to so many products. and it's going to hopefully clarify some other aspects of nutritional content to make it easier for consumers to know what's in the products and make informed choices. the work that's been done on menu labeling which is a component of come little recognized of the affordable care act, one which a joke when i first learned this was an fta responsibility and the bill, i thought this a big pretty straightforward. internet to be incredibly complicated determine what in the spotlight establish a was. in all honesty it was one of the areas that almost quit over because of fights around whether movie theater food should receive menu labeling.

>> can i stop you? i was involved in directly with that because a movie theater will get the vast majority of the revenues from the food that they serve, not from the tickets they sell. so that's why they were effected. >> and they have menu boards and they frankly have food that the public should know how calvary, fat and sodium and sugar dense they are. it actually -- >> if they don't, michael wilson remind them. >> movie theaters were in the final, so delighted about that. but also fda does play an important role in terms of what is in processed food. for example, a move to reduce to the greatest degree possible trans fat in foods which is linked to serious disease and heart disease is a leading cause of preventable death and disability in this country.

yesterday or the day before i guess, finally the voluntary sodium guidelines were announced, that reflects a very science-based, very thoughtful effort within the fda within different categories of foods establish very reasonable, achievable targets for sodium reduction in the american food supply. because consumers are often challenged that they want to make changes in their diet but it's hard if the foods there in the marketplace and that it the and in some cases can afford, have more sugar, more sodium, more fat than they need. so i think that all is or import-the role of fda and actually calling companies to task when they are making false

claims about the nutritional value of foods. all of these areas that the activity, again have to underscore dramatically underfunded, and fda i think could move more quickly and more robustly, but it does make a difference i think for consumers and for health. >> we have about 10 minutes left at like to invite members of the audience to ask questions. there are microphones in either i'll. please identify yourself. you will be on tv. we need to know who you are. and please short questions. no speeches, just short questions. [inaudible] >> could you make an argument for or against moving the dietary guidelines from the usda to perhaps the institute of

medicine, cdc or the national academy of sciences? >> they are actually joint between hhs and usda. at in my case the assistant secretary for health negotiated them with usda. we did not have a disagree with you every once in a while they would bring something up to dan and i, but they were science-based, although the of negotiation, more on how they look than what was in them. but i didn't come of all the problems we had, that was not one of them in terms of joint working. i don't know, peggy, whether you had a different -- >> no. i think that is true. i do think it does play an important role in terms of providing science-based input in the nutrition area.

and many other areas as well around policy development and in the nutrition space it has historically rooted the ever important part speak we consulted with them. we read the report. we consulted with the other health agencies and the department including the cdc and the national institutes of health to see whether there was some other aspect. philip we manage that process for me. but i don't think that was an area where i felt the need for kicking it someplace else because of the way the process worked. and, frankly, the two sectors that i chance to work with, we just always left it to the scientists in our departments, and the public health people to come to us with any recommendations. >> nonetheless and i would agree, nonetheless interest groups including commodity

groups into the process to offer their views. sometimes very, very intensely. as the people in the public health community. does a prospective by the meat industry or somebody that's not part of classic nutrition science community, do they have a role in what the final decided in a political process? probably. i wouldn't tell you that there was total purity in a situation but you're going to get that whatever you put this function in. this is a pretty transparent place to have it. spent so let's move onto the next question. >> thank you. i'm the professor at the law school at a faculty director of the food law initiative. commissioner hamburg, i was excited to hear you say out loud that agriculture is one of the leading causes of environmental degradation because that's so awful it out of these kinds of conversations.

so my question for the whole panel is about. meaningful regulation in that area for the whole history of environmental law has been such a nonstarter. will but your advice be for the next administration if they wanted to take on this issue to try to break the logjam speak with i think agriculture and food production were probably, no one. but it's important look at that whole ecosystem. this is hardly my area of expertise. but as a citizen of the world i think it's something we really need to address that i think it's starting to address an interesting some of the big conversation or decisions -- conservation purposes our grading programs in these arenas to work with governments and industry to find ways to reduce the burden on the environment. big part of it is understanding.

i mean, i had been working the food arena for it while without appreciating the seriousness of this problem. and it was brought to my attention, and when i sat and looked at the data, i thought wow, and i thought frankly i need to start to educate myself and start to do work in this arena. so education really matters. and i think they're starting to be models for how to manage situations, you know, don't destroy the rain forests in indonesia to grow palm oil with our other strategies to produce the necessary and perhaps healthier oils, and you can maintain the rain forest. there are other ways to do agriculture that are less water intensive. but i have to say it's not my area of expertise but i think it's a problem with osha little

about and care about. >> this is an area in which the nature foundations are working with small farmers all over the world. american farmers have gotten this a long time ago. my family, which lives in north dakota and my brother-in-law and sister are north dakota wheat farmers among other things. my brother-in-law and sister are so sophisticated on this issue because has to do with her livelihood. and their inability to to market their products. around the world so that major foundations, but it's gates or rocketrocket the event the clinn foundation working africa are all consciously working in agriculture and, of course, rockefeller has been working agriculture for a very long time. so there's a lot of things going on in addition to the international organizations that are working, government

organizations. >> i agree with what peggy said this is food and agriculture. windage is agriculture and it's got to be about farmers, the grain growers and the cow produces. that's just not true. is all part of a big industry. second of all politically it is true a lot of farmers in this country believe they are being persecuted by the latest from washington who come down with regulatory approaches that are dramatically impacting the ability to produce. most of the newer farmers understand they have to be part of the solution and not part of the problem. the our problems. methane emissions from cows for example, is a big problem. it's less when you grasp the the the animal and when you grain feed the animal. pesticides leaching and fertilizing leeching our big problems as well. but politically we have to work together to solve these problems, rather than look at production agriculture like it

is a tar baby, the cause of all these things. that's what a couple of things, new technologies, precision agriculture, helping farmers are exactly where they need to put their inputs on and what they should and other inputs on. finding new ways to feed animals with feed or other fee to products that produce less of a belching effect, for example. r&d has a lot to do with is the uri, agriculture has a big part to play in the environmental world but it has to be done sensibly and went to do this bringing the farmers and producers into the solution as well. >> next question. >> i'm michael jacobson for the center of public sites. two quick comments that any question -- >> no, no, no. just a question. >> okay. i think all three of you basically buried the issue of government reorganization. fight like to ask dr. hamburg a

quick question about the organization. some people on the outside have expressed concern that the commission of the fda is largely focused on drugs and medical devices and that the foods division is kind of a stepchild. those people have suggested breaking the fda in two. have a foods division at a drugs and medical devices, i don't know about tobacco. what do you see as the pluses and minuses of breaking the fda up and still reporting to hhs leading congressional oversight the same? >> my first wish would be to have fda be an independent right of the agency. but it is a concert that i think it's rare to the commissioner that actually has had experience across all the debates of fda activities. i actually in retrospect realized i was the unusual in

that i came in from having both done drug and vaccine research and development issues and as commissioner of health in new york city been very involved with food safety and restaurant inspections and other things. so both were familiar to me. when i get the fda it was clear that a commissioner could not really bring both the expertise and the day-to-day oversight that was missing across all the domains of activity that was what i did a reorganization to create a deputy for foods and a deputy for medical products and tobacco. you look at the fda today as commissioner certainly does not have a lot of depth of experience on the food side, but we have a deputy for foods and outgoing mikey taylor who was among the most expert around and now steve who also was just

years and years of experience on food safety and nutrition issues. so i think that your concern is a real one, but it can be addressed within the structure of the fda but again i think if you tried to divide it up you actually do harm to the day-to-day work. it would be very hard to increase the expenses of the agency that you have to create parallel administrative and other support systems. as i mentioned that is i think a growing need to look across areas of fda in terms of food, nutrition and health and the medical products site. so i don't see the would be huge benefits. again if i were starting from scratch, what i've done it this way? i'm not completely sure but i think it can and does work, but it needs to constantly be

addressed to make sure that the organization within fda and expertise within fda is supporting the needs of the program. and again, i hate to be a broken record, but funding issues matter. the food side has always been underfunded in comparison to the medical product site. i don't think that is something that really should be accepted as a norm. we need to keep fighting for more food, for more money for the food and nutrition side of the house. >> i am sorry but we have run out of time. for those with questions, i'm sure our panelists will stay around for a couple of minutes. please join me in thanking, this is a just a terrific panel. thank you so much, everyone. [applause] >> please be back here at 10:45.

[inaudible conversations] [inaudible conversations] >> a brief break ever gave on coverage of this look at food law posted by georgetown university law center. up next to be a discussion on use of antibiotics in livestock and the future of for me. that starts in about 15 minutes here on c-span2.

while we wait remarks now from commerce secretary penny pritzker. she quoted pope francis. like the pope she says they should all challenge themselves to a greater meaning in life in the agency chains for their community. community.[inaudible conversations]

[inaudible conversations] [inaudible conversations] >> and now to those reports from commerce secretary penny pritzker two new georgian university graduates. [applause] thank you. thank you very much for this honor. and thank you very much for your extraordinary words. it's really an honor to receive this degree.

it's also wonderful to be here with our esteemed graduates on what feels like the first nice d.c. day in weeks. the world that i entered when i graduated from business school 25 years ago was a bit different than the one that all of you are entering. i understand one of the new classes offered to you as a student is strategic management of social networks. when i was in business school, mark zuckerberg had not been born yet, and the closest thing that i had to a social network was my rolodex. so trust me, you are very lucky that you have missed the era when business operated at the speed of fax machines, pagers, and while you were out sticky notes. so while the business world has

changed a great deal since then, the keys to success are largely the same. each of you has earned an mba from one of the most prestigious business schools in the country. a school whose mission is to turn you into, and i quote, ethically responsible and effective business leaders. you should take pride in the hard work that brought you to this moment. but you would not be here today without your support system. so let's take a moment to give your parents, your families and your friends a big round of applause. [applause] georgetown has armed you with a strong foundation and the

personal network required to succeed. but whether or not you will be an ethically responsible and effective business leader will ultimately depend on the choices that you make over the course of your working life. do you have the integrity and the awareness that every decision you make will impact your reputation? do you have the vision to understand the long-term needs of your company, and the courage to overcome your mistakes in pursuit of that vision? are you using your influence as a business leader to be a force for good in your community? when i started in business, both my grandfather and my mother told me, there are only two things you take with you throughout your life.

your education and your reputation. nothing else is guaranteed. when you receive your diploma today, your formal education is completed. but your reputation, that is something you will have to nurture your entire life. think of your reputation as your biggest asset. in today's increasingly digital world where mistakes and triumphs are all like, are immortalized on social media and in your google search history, managing that asset is harder than ever. as you begin your careers, you need to start building your reputation from day one. there is no honeymoon. i'm not just referring to obtain the law, but the way you treat people and how you behave.

if you conduct yourself with integrity and kindness, i promise you, your reputation will serve as the bedrock on which you build your career, and you will have control of your narrative. today i want to tell the two stories about the power of choice and how the choices you make will shape your life. let me begin with the story of my first business which i started when i was 27, two years after i graduated with a jd mba. both of my parents had passed away and i was responsible for taking care of my grandmother. one day i realized that there must be people like me all over the country who now don't have to care for an aging family member, but with the added challenge of raising children. so i am a data person and i did

my research, and they discovered that a product is missing. so with a lot of help i started a company called feed senior living. sounds like a recipe for success, right? unfortunately i made every mistake in the book. some of the early product development was not precisely right. i hired people who did not share my work ethic or my values and vision for the company. and the savings and loan crisis in the late 1980s made it hard for our customer to sell their home and afford our product. so things were not going well, and i was absolutely terrified. i went to my uncle who was my mentor and the chairman of the company, and i said, this is not going to work. we should liquefy the company. you know, you have learned in business school.

but my uncle, in all of his wisdom, told me not to panic and to look at the long-term prospects. he understood the big picture. we were about to undergo a massive demographic shift in our country as the baby boomers move into their 70s and beyond. so we retooled our approach, revised the product and hired better talent whose values are more in line with the mission of the company. for changing our approach, it was not easy. it was really hard. it took just the recognition that we need to pivot, but the perseverance to make the significant shifts. and today it's an innovative leader in senior living in the lessons that i learned from that experience have informed my entire life. like me come over the course of

your careers, you are going to make mistakes. big mistakes. don't panic, be confident. if your ideas are good, don't let it be derailed by the missteps you will inevitably make along the way. my experience with vi catawba to look beyond the immediate challenges, beyond the quarterly earnings report and take the long view. i also learned that business is a team sport, that you must be intentional about the talent you choose. to get it right, first you need to know yourself, to know your strengths and your weaknesses. for example, i'm good at numbers, sales and tactics. but i struggle with marketing, branding and strategy.

so find a team who feels in your gaps and complements your talents. because the people you surround yourself will be the key to your long-term success. this brings me to my second story. a good friend of mine is the ceo of a fortune 100 company. and like many companies in today's economy, his business has a large number of job openings, but too few people that have the specialized skills needed to fill those positions. he told me a couple of weeks ago, we were together having breakfast and he said, i am constantly approached about hiring people who need jobs. but they don't have the skills needed to succeed. and my friend knew that it might be charitable to offer those folks jobs, in the short term,

but that would not end well and it would not be sustainable either for his company or for the people he hired. and he understood though that his community needed more than charity. it made thoughtful, entrepreneurial solution to a system that problem. so the ceo is considering setting up an academy to give people in his community, not only the skills they need at his company, but the skills needed for long-term success. he wants to build this academy in the poorest apart of the city, he plans to invite other companies in this sector to participate. now, you heard me. keep in mindcompanies talking about working together with businesses to which every day he competes, who are all fighting for the same market share and the same new hires.

and yet my friend wants to bring everyone to the table to develop a holistic solution that actually works for both the businesses and the workers. i met a lot of business leaders in my life and the ones who i admire and the ones that i remember are those who are committed to their communities. so make no mistake, being committed to your community is not inconsistent with being extraordinarily successful business leader. in fact, it enhances your reputation, the bedrock of your success. so as you move up the ladder, you're going to find yourself becoming more and more responsible for the well being of your neighborhood, your city, and your region. and as a business leader you will have the power to become a

force for good. the question is what you choose to do with that influence. just look at what happened in georgia earlier this year when governor deal the code a so called religious liberties bill following pressure from disney, time warner, salesforce, and others. whether you spend your entire career in the private sector or take a detour into the public sector, as i did, you will have the ability to not just affect our economy but to affect the very fabric of our nation. as a famous jesuit you might have heard of and one of my personal heroes has said, and let me quote pope francis, business is a vocation, and a noble vocation.

provided that those engaged in it see themselves challenged by the greater meaning in life. challenge yourself to the greater meaning in life. become a force for good. seize the opportunity afforded to you as a business leader to change your country and our world for the better. so congratulations to the georgetown university mcdonough school of business class of 2016. i wish you all the success in the world. [applause] >> those recent remarks from penny pritzker to graduate of georgetown university.

we are live this morning with a daylong coverage of a look at food law hosted by georgetown university law center. there in the midst of a short break, and when that ends there will be a discussion on the use of antibiotics in livestock in the future of farming. that i should start in just a moment live here on c-span2. [inaudible conversations] [inaudible conversations]

>> if folks could grab their seats and we will go ahead and get started. so let me just start by thanking georgetown and the o'neill institute. my name is scott faber, i'm a really poor substitute for professor lisa what i will do my best to channel lisa. i among other things teach a foreign law and policy class here in the spring. i know a couple of students are here and i can say right now the answer is no. no on the extensions. [laughter] the first panel did a great job of teeing up will be about to talk about, antibiotics, antibiotic use in animal agriculture and certainly the recent news about the effectiveness of the last resort antibiotic making the conversation really timely. because of the subject matter of

this whole day, i think we're all hopeful that this issue and other issues will be part of the conversation as we are having our national elections this fall. so we have three terrific experts. i'm not going to go over their bios. they are in your packets, but we have the experts with deep experience with all aspects of this issue, whether it's the role of fda, the role of animal agriculture from the role of veterinarians and the role of public health groups. some going to dive right in and ask karen, give us a quick overview of what we know about the link between antibiotic use in animals and antibiotic resistance. >> absolutely. thank you. we at pew advance -- where we focus on improving the end of

the audits in as animals settings. and by fostering the development of new drugs. i lead a part of antibiotics in animals and the nudity because antibiotics can it's a public global health crisis we were talking about 2 million infections, accurate and the u.s. every year that leads to more than 23,000 deaths. we know every time we have the risk of developing resistance. that is why we are trying to minimize the inappropriate or unnecessary use of antibiotics where ever it occurs in humans as well as animals settings. as we heard this morning, regarding the relevance of antibiotic use in animals for antibiotic resistance there's a lot of data to support of that. we have a lot of studies. we have control studies, clinical trials in animals. with a lot of other evidence in studies. as we also heard, this link is

really well accepted. the president's advisory council on science and technology are links -- i've been the president advisory committee on combating bacteria took one hell approach. the reason they did that because they recognize effective federal of and about accused in animals as well as humans. globally as we heard today, the world health organization program that really depends on what is called -- that is, the collaboration between the world health organization, the with the authorization for animals, and the food and drug, food and agricultural organization of the united nations. really emphasize how important antibiotic use in animals is to the problem. in fact the world health organization for animals just last week signed off on their

strategy on how to combat resistance. so there's no doubt in antibiotic use in animals contributes to resistant to the thing we don't quite know yet is just how much of the overall burden of antibiotic resistance is caused by used in human settings as well as animals settings. the reason we don't know that because antibiotic resistant is very a complex topic at the a lot of resistance can find its way from the farm to humans. that can be through direct contact with infected animals, -- [inaudible] and actually promiscuous. they can share genetic materials but that means if there's bacteria and in the gut of an animal that he felt antibiotic resistance, that resistance might find its way to a human pathogen and will be difficult to trace back exactly where the resistance was from.

there's research ongoing target the exact numbers are what the contribution of and about accused in human settings, hospitals, outpatient settings, veterinary settings is for the overall contribution of and about resistance but we know for a fact that antibiotic use in animals contributes to the problem. and we know there are antibiotic use in forms that are not judicious. what that means is that there used to but don't directly contribute to the wealth and health of the animal or food safety. we heard about food production -- that is giving antibiotics to help the animal not to protect thefrom disease but to make it w faster. fda has taken very good strides in reining in that practice, and i'm sure bill will talk about that later this morning. spent and made we did go to the.

bill, can you give folks a summary of what is th fda doingo redefine what judicious use immediately opened up groundwork for folks were watching or who are here with us, what does that term mean? what will it mean? and what is fda doing to ultimately limit the use of antibiotics to the guidance is that have been issued in recent years. >> so it was mentioned in the earlier session that certain this is by no means a new issue, and really it's been a subject of debate and scientific debate really for decades. the thing that is really significant in terms of the steps that fda has initiated and is ongoing now is fighting for the first time and this really goes back to some guidance, documents and policy documents really that fda issued in 2012 and 2013, which really for the first time the fda took a very clear position to say that there

are certain uses of particularly these antibiotics that have human medical importance, antibiotics that we currently rely on in human medicine for managing disease in humans, that there are certain uses of those are taken antibiotics that really are not appropriate and not consistent with our current thinking about judicious use our good about stewardship. and really took a very clear position that these medically important antibiotics should not be used for purposes in animals that really are not tied to managing the health of the animal. and i think that's the real key distinction with using these drugs for growth promotion is that the intent is to enhance the growth. even the science on how those drugs exert that activity is still not completely clear. but in any case the primary driver for those uses was

enhanced growth. it wasn't directed at specific disease or managing specific diseases. i think the view that we took was given that we need to do everything we can to be using these drugs as judicious as possible, and that's really based on the signs that we understand that using antibiotics in all different settings, animals, humans are other applications that used itself as a part of resistance to you select for resistant pathogens by the greater use of these products, the greater the risk is that we drive resistant. we need to look critical of those uses that are out there to make sure all the really necessary. i think the point, because he was is that message to be using this critically important antibiotics that are important for human medicine for growth promotion purposes. that was one key policies data we made.

the second was we need to make sure any remaining uses of those antibiotics for therapeutic uses in animals are brought under the oversight of that energy. i think that's a significant in my mind of the step of eliminating growth promotion is hto really come is to bring thoe uses under budgetary oversight that it does to key actions that we laid out and initiated a strategy in 2013 -- veterinarian oversight. >> in food producing animals for production type purposes, purposes that are intended to enhance growth or improved efficiency. and that's really focused on the drugs that are used, those drugs are primarily delivered to animals either through feed or drinking water. of course, which is another risk factor into since by the we are delivering those drugs, you can effectively administer the drug

to large numbers of animals and have a greater risk insurance from an exposure potential of driving resistant. one, we want to take that step, second is to bring the remaining therapeutic uses of those drugs to either treat, control or prevent disease under the oversight of licensed veterinarian. those of the two key changes. we implement a three-year strategy in 2013 to bring about those changes in these products. our target is not done by the end of this year. >> and i think would help folks understand that you can no longer, the guidance strongly discourages producers from using antibiotics indeed or water to promote growth but they can still use it to prevent disease as a prophylactic measure. i think one question i know lisa would ask if she were here is how much will antibiotic use decline? is this a change in the rationale or the label indication? ..

not binding requirement. but i think there was a very concerted decision around taking that approach because what we were trying to do was, again, seek cooperation and collaboration from all the stakeholders that are involved here. we are talking upon decades upon decades of practices of how antibiotics are being used in variety of agriculture sectors. it represents a significant shift. we felt it would be a more effective approach if we were to bring folks on board to be part of the solution.

i think doing it there this three-year plan, and the thing that's voluntary about it is we are asking the pharmaceutical companies that market these products to voluntarily come to fda and work through the process of modifying the labeling, the underlying of approved conditions of these products to make those two key changes. once the changes are made, they're not voluntary anymore. once the labeling has been changed at the end of this year, it will be illegal to use these products for growth, production purposes or use them without the authorization of a licensed veterinarian and the point concerns about, you know, i mean, there's two levels to this. one is there's from a compliance standpoint a concern that, well, clearly these have been practices have been ongoing for many, many decades and so there is that sort of tension of how

do you shift folks away from there standard practices that they have in place and is there concern even if we make changes people will continue to do what they have been doing for years. that was a concern of ours and a key reason why we felt it was absolutely critical in conjunction with eliminating the growth hormone uses. i think that's the other key gap that has been missing. veterinary embalmment is out there, this really changes the dynamic significantly in terms of how producers, farmers, ranchers will be able to access these products. you know, when we reach january of this coming year, they won't be able to just go to their supplier and obtain them the way they did before. they will have to obtain authorization from the a license vetneraria, in the veterinarians

and the professions generally is now responsible for making decisions about and the extent to which these products are used and authorized is now on their shoulders and so i think that is a significant and component of this because the veterinarian is -- does play and i think we are looking for them to play an important role in advising producers about how they're using antibiotics and clearly means also that you need to make decisions about not only when you're using antibiotics appropriately, but do you need to use one to begin with and is there an alternative practice or change that would eliminate for you to reach for antibiotics. i think those are really critical things. a slightly different aspect of

this is, you mention it had -- mentioned the concerned about prevention use. while these are important in changes, is by no means, the -- we are not done. i think we can't just say, okay, success and we can move onto other things at the end of the year. we need to continue to look critically as to how the drugs are being used and use for additional opportunities where additional changes and improvements to be made. clearly we do you believe that using these antibiotics for that prevention use of antibiotics in animal agriculture setting has a role in terms of managing disease, having said that, we need to make sure that we are looking critically as how those are being used for prevention and are we doing everything we can to make sure that it is, in

fact, based on risk and targeted as it can be and it doesn't become simply a routine practice that -- and that we are looking at other opportunities in which we can manage this condition and not rely on antibiotics. we know that some of the products that we are dealing with today under the current strategy have prevent uses on their label, intention not to eliminate prevent uses. going forward from here, 2017 and beyond, one of the other issues that's clearly on a priority for us is to look critically at those prevention uses and make sure that they are aligns with what today's currency key is on issues. i guess my message is, we are not done, there's going to be work to be done and continue to focus on and build on, i think, you know, the improvements and the change that is we are making today.

>> it would be great if you could provide perspective of a company and how you've responding to the guidances around and growth production and role of veterinarians. >> you bet. i think this is as karin started off it's a critical issue and complex issue and one that's going to be solved by multiple stakeholders in what we call the value chain, if you will, around food production and so i think, you know, from an animal health perspective, number one is we've been strong supporters of the fda guidance that they put in place. i think the thing we understood there has to be strong commitment not only from animal health industry, farm -- pharmaceutical manufacturers and all play a key role as we work

through the transition that dr. flynn talked about. we've been very much proactive in terms of moving forward with those voluntary guidelines. we've got a milestone at the end of the coming month in which we will come in with the proposed kind of label changes and previsions that are outlined in those guidances. the other thing that we have done as a company in some cases like in europe, these -- these guidelines are fairly similar, right, we don't have growth promotion uses in europe for similar products. we have actually taken that outside of the united states and europe, as a company, as policy, we've got, i think, 70 to 100 labels across the global in which would fall into this medically important classes of

antibiotics in which they allow uses, we are pulling that away voluntarily. again, because i think it's an evolution of what we understand around use and around stewardship of antibiotics and the criticalness of that. the other role, i think, that we play and have done so in conjunction with a number of industry players is around education. this is a huge industry that produces the food that we eat here in the u.s. and around the world. it's a complex and fragmented industry and just the nature of getting that message out and helping people understand that things will change, that they're going to need a veterinarian to play a more critical role in their operation, in some cases veterinary access is a concern. how do we work through that? the role that we have been playing as an industry and company individually is to do a lot of round education informing people of the changes that are coming.

in addition trying to provide the right context for them in terms of why. we heard from some of the earlier panel. sometimes transition of policy from washington to places where animals are raised doesn't always occur seamlessly, trying to help people understand why and the critical role that we all play in terms of maintaining long-term access and long-term effectiveness of antibiotics both for humans and animals is a key part of that. we've worked around stewardship guidelines, we've educated people from the food companies all the way down to the producer level at what these changes mean and how that will impact them and why ultimately at tend of the day that these are the right things to do. so those are some of the things as an industry trying to push forward and be proactive around. the one other thing is for us to talk about, we talk about the human health implications around this which is absolutely critical.

i guess i represent, you know, kind of the voice of the animal, if you will. not to overlook the long-term effectiveness and use of antibiotics for treating animal diseases. if you look globally despite how advanced we have become in terms of disease prevention, 20% of livestock estimated globally is lost before the productive end of those livestock and largely due to disease pressure. we need that emerging diseases continue to come up. we are dealing with that all of the time. as much as long-term preservation of effectiveness as antibiotics as a tool, not the only tool, so that's the key component, i think. and in the last point that i would make really is we try today tried to frame this in terms of the health concept,

which has been alluded to but not called out. the interplay between people and animals where that has often been, the contribution of disease that has potential to move to humans is a critical part of that. the other piece of that is the environmental side of that, the healthy planet. we talked some of the environmental aspects from the other panel. when you think about animal health and the things that we do to maintain that, it touches all of those from food safety, obviously from well willing and well-fair standpoint but also environmental impact. for every animal that has to replace has implications in terms of food, water and waste and all of the things that we know. so one health is the light lens to look at this through and we feel that it's a critical issue and trying to play as much leadership role and proactive role as much as we can.

>> and we heard from both of you that veterinarians are going to play the critical role, sort of on the front lines of ultimately implementing these guidances and assessing on a case-by-case basis whether or not a producer should be able to use antibiotic for particular use. how does that change the relationship between veterinarians and the people -- animal veterinarians and the people that they have been traditionally been serving and are there conflicts of interest? help us understand that dynamic. i know at least two of you worked as animal veterinarians with producers, so it'll be helpful for folks to understand whether that's likely to be an effective relationship. >> i can start, perhaps. i think certainly that is going to be a challenge for the veterinarian profession. i would say that in many cases

veterinarians, producers, farmers, ranchers have been utilizing the services of veterinarians and of course, veterinarians can provide a variety of services on these farms. you know, this is sort of pointing in on a very specific service and i think because of the fact that right now while some antibiotics are limited to prescription status or iv status, meaning they cannot be accessed by a producer unless they get authorization, the vast majority of product that is we are talking about are affected here under the strategy, of course, right now that are used in water are not subject to that. so it's really outside the control so to speak of the veterinarian. now the veterinarian may be

advising the producer on some of those use practices or disease-control issues, but have limited leverage because the producer can just purchase them without that authorization. so i think it's going to challenge some folks and veterinarians in certain settings that the decision now will be on them to consult with their producer and, you know, advise whether it makes sense to use a particular antibiotic in a certain way and, you know, i would expect there are probably going to be situations where there may not be agreements. i think those are challenges that the profession is going to have to face. i think were encouraged by the fact that -- you know, we are getting very positive signals from the veterinarian profession in terms of stepping up, the different veterinary

associations including the ema, american veterinarian association which has been supportive. so i think that's why in my mind the veterinarian oversight piece is, i think, been a little bit underappreciated, so to speak in terms of what the impact will be. i think there's been focus, rightfully so on eliminating growth production, that goes back decade, debating whether that practice should continue and good news we are on a path to eliminate it. maybe underscope of what the significance is and i do believe that's going to have a significant impact in terms of changing dynamic in terms of how products are being used. >> i could not agree more. actually the foundation together with fda organized work to

inform of one of the new tools that will be necessary to implement the policies in regards to authorizing drugs. they took the opportunity to do a little survey to get an understanding how they feel about the role of veterinarians and what they found that there's a huge disconnect. veterinarians as the adviser and making animal decisions on the farm. producer side based on that survey, that was not necessarily the case. so i think it's a tremendous opportunity having the veterinarian being required to authorize these drugs, having veterinarian on the farm, great opportunity to build new relationships, to become involved in the health and management on the farm. >> and karin, maybe you can talk about how important antibiotics are for animal health and animal mortality. what are other alternatives that

would be deployed on the farm that might use for medically antibiotics? >> that's a very good point. to really reduce we have to tackle inappropriate use, fda guidance but we also have to find other ways of doing things so in the long run we don't need antibiotics. broadly, there's a lot to do as alluded today giving more space to animals, et cetera. there are real products that can be used. most people familiar with vaccines that have been effective against bacterial diseases. we know that some antibiotics are used against viruses either because of misdiagnosis or secondary infectionses, et cetera.

probiotics in yogurts that can be used. so there are a lot of products out there that are promising but more research needs to be done to make sure that they work effectively and have a good understanding of how they can actually be implemented as part of animal health plan, health of the animal and how can we get them healthy as well as their life. >> secretary allude today this, density and reducing the density of animals. how much efforts to give animals a little bit more room ultimately reduce also presumably which are addressing animal welfare concerns help reduce the need for medically important antibiotics? do we have a good sense of that? obviously there are lots of laws being passed in the state level to change how hens are raised.

are those laws likely to impact how much we use antibiotics? do we know? >> i'm not sure we know but it's important to view animal health as a holistic concept. there are a lot of components that can impact how well animals are doing. things like rainfall and climate can have an impact. it's not looking at just one piece but what can we do to minimize the need that they get sick and reduce use of antibiotics. >> i think you raise a good point about the interconnectiveness. a lot of us i don't think we fully understand. one thing we do know, i know from firsthand experiences that farmers and producers, livestock growers are extremely ingenuous. they are focused on driving

change and efficiency and so we will figure out what changes have to be made and perdue was mentioned this morning, there's lots of companies already that are looking at alternatives to antibiotics, both to man taken health but also the other critical piece to maintain the efficiency of production, maintain the low cost ultimately of food that we are producing. so that, i think, in time we will -- in ten year's time we will see things very different than what we see today in terms of how some of those practices are employed. i think the challenge around, you know, what does the short-term effect or long-term effect have is really, really real. again the data is not necessarily all conclusive but you brought up the issue about cages with hens and there's evidence that shows that if you

-- if you move from traditional cage-type laying system to modified or free-range type programs that you can see impact on mortality and i think a lot of that -- a lot of that comes from the fact that it's implementing a change to practice that we have become very accustom to and understand how to manage it. i think that doesn't necessarily provide us a silver bullet to health and again comes back to the long-term kind of access and importance of all kinds of tools that we have to manage health. but that's something that i think, if we think about what more is needed, what more researcher, the systemic evaluations and how we can optimize from a health perspective is an area that presents great opportunity for us to refine a lot of the practice that is we have used over the last 50 years that have been effect i have to this point but may need to be reevaluated as we go forward. >> how do we know whether we are

making progress? i know fda released a rule in may along reporting by species by species basis. how do we know the steps we are taking are effective? >> that's a critical issue that we are struggling with, i think. i mean, first again, i think there's sort of an expectation issue that we need to, you know, try to manage here in terms of recognizing that this is a long-term effort that we are -- we need to be committed to stick with it and that it, again, all the issues that we know need to be addressed, you know, aren't going to be resolved this year. that there's more work that needs to be done and which does mean that we need to be particular if we recognize we are in it for the longer haul, we need to make sure that we have a way of collecting

information over a span of period of time so we can understand whether or not we are actually, you know, moving a needle here in terms of making a difference, and i think that's -- that's a critical thing. i think, you know, we -- we held a public meeting on that issue last fall in september in collaboration with usda and fvc on that issue on what kind of information should we be looking at and do we have all the data that we need to adequately assess the progress that's being made. and i think certainly one factor is simply looking at, you know, quantity of product that is actually going into distribution channels for use in animals. the concern that we have is that -- i think that doesn't give us the entire picture of what's happening and we need to look at it more holistically than that or look a broader set of information to understand what's

going on. ultimately our desire is to impact behaviors on farm -- and again we are talking specifically about animal agriculture. i want to reiterate the one health aspect of this is we need to look across all the different sectors and identify things that we can be doing to implement, you know, that will help support the goal of minimizing resistance, keeping to the idea that the objective is trying to take steps that are going to have positive effect on resistance but measuring is a challenge and so i think it is a need to make sure we are looking at a broad set of information as -- that includes a variety of things. you mentioned the fact that fda does collect and farm -- farm

>> that data comes into us and we report out an annual summary report and we have been doing that since 2009. it's a fairly detailed report although, again, there's limits with that because that represents what's being sold, what's going into the distribution pipeline so to speak, it doesn't necessarily tell us specifically what's actually being used at the end user at the farm, there's limits in terms of information and one of the changes recently made was requiring that pharmaceutical companies provide us estimates of a breakdown of that sales data by species. that's one of the other challenges dealing with the animal side of the equation. there's more than one species. we have many species to deal with and many of the products marketed are marketed with uses for more than one species. so if you're looking at sales data, it's aggregated for all those species.

that was one change that would break down. that's one piece of information. our belief is you can't look at that in isolation. there's other information we need to look at. there's the narms in place, food-born pathogens. that's another piece that's information. one additional piece is that we feel it would be helpful to have information about actual use at the farm level and resistance tie today that use so that we have sort of the other end of the pipe, so to speak, understanding better in terms of what's happening at the farm level. and right now i think that's where the gap we are hoping can be filled and, again, speaking of, you know, inner agency

collaborations that were mentioned earlier, usda that's not here on the table is playing a critical role and we are working very closely with them particularly as a role as they play in terms of farm-management practices and the history they've had in terms of collecting types of information about production practices and one of the things we are looking at ways in which we can work with usda to leverage some of those existing infrastructure to gather information on farm practices and also that usda plays a key role in looking at the issue we just talked about, which is, you know, alternatives to management practices. i think it's important that we look critically at what are the drivers of antibiotic use. why do farmers and producers need to rely on antibiotics in certain circumstances? what are the disease, conditions that they try to manage?

so again, the antibiotics is an important tool that they have to have access to, you know, we want to shift away from them always reaching to that as the first option. are there other ways that we can manage the diseases, conditions that are driven by a number of different production prices, not only housing but how the animals are fed and other factors that can be risk facts factors for animals. and was mentioned earlier are we putting enough emphasis on the fundamental work that needs to be done to better understand factors so that we can make necessary adjustments to take pressure off of antibiotic use. >> karin, maybe you can talk about it. can you talk about what are the benchmarks you're looking for in order to measure whether or not

the guidances are making progress or not making enough progress? >> i do think that the guidance is recommendable to step in the right direction. assayed earlier, we are not there yet but we need to make sure that we really have an impact on antibiotic use and that's actual use of antibiotics on farms. we need to have data to understand how they're used on the farm and understand why they use and we need to understand target research on better interventions, we need to get a better understanding. we see in the sales data antibiotic use fails but we don't understand why, we don't understand which indications, so we need better data to understand, remaining areas that need to be addressed and where do we need to target our

resources. .. is having on antibiotic use and how much should consumers trust the pledges that are being made by companies that are sometimes making pledges of different timelines. it's hard to know how they plan to enforce the pledges they are making, so it easier to start talk about the role that consumers are playing in influencing these companies and whether these pledges are meaningful. >> absolutely pure he-- we have unique situations where consumer

demand has more policies being put in place. where we see in this sector, a move away not just-- in fact pretty much independent of antibiotics, but having a huge shift in how antibiotics are used with market demand and consumers carried about how the meat is raised and caring about antibiotics. it is true that there are different copies out there with a lot of different pledges out there with different timelines and they mean a lot of different things. i think it became clear this morning, it is a complicated issue and very difficult for consumers to understand what individual company policies mean. are they talking about all antibiotics, are they talking about all uses, so it's very

confusing to the consumer. it's a question of how are these policies actually verified. some companies for instant use it usda approved systems where usda inspectors verify that the criteria laid out is adhered to in other companies vary in how it is enforced. we recognize the importance of consumer demand and we develop for a chicken-- [inaudible] >> we chose yesterday because they are have a lot of trust in their programs and we decided to go with them, but there are differences with the different company programs out there and i understand it's confusing to customers. >> we talked to food companies

lot and they are caught in a position in which they are fundamental purposes to serve their consumers, serve their customer and that's what they continue to do. at the same time, they tell us, we feel like we are asked to be a regulator in some sense and we don't necessarily feel comfortable with that role, so i think one of the things first to think that is how does that balance work and the role of the fda and the role of other regulatory agencies that establish safe guidelines and those types of things and there is consumer choice, which is obviously something that we need to be supportive of and cognitive of. one of the things that i think is important is we spend a lot of time looking at consumer market research, monitoring social media and all those things work the antibiotic conversation is not top of mind for the vast majority of

consumers out there. the conversation is increasing and concerns are increasing and it's a concern of around public health. what role do i plate and how do my decisions affect some of this, but the antibiotic conversation is less than 2% of the overall social media conversation around food and we can get very granular to where that is being driven and where it's being driven, but i think that is one of the important aspects and with that said these food companies do feel increasing pressure to provide choice to consumers that want to do that. so, you see a range of policies. ec policies and fermented, cheerfully as an example where it's antibiotic free policy, that mcdonald's implemented. they did a global stewardship policy outlining with their standards are relative to how there and biotics used globally and regulatory bodies and experts and third-party

references all a long and it in their us policy applied to the poultry production in which they said medically important and about x would be phased out and so you have a range of what those policies have actually said. i think one of the critical things that we have to make sure we understand is, antibiotic free maybe a choice for some and it may be something people desire and if that is the case that is great. i think the confusing part of that is how does that perception of how this impact my thoughts around food safety, so there are rigorous standards and others could speak much more to that need around ensuring that food does not have harmful residues of antibiotics when consumed regardless of how it tastes, so antibiotic free type of label conflates that a little bit and confuses that. the other factor when you look at-- take mcdonald's for example, as they have a

requirement around no antibiotics use that are important in human medicine, you have scenarios where disease optics occur and so you have to to -- of a choice, one choice or the other end that is to allow the birds to suffer and die or treat those birds with an anabolic and if you treat those birds with an antibiotic yet to figure out several else in the supply chain that those birds can go and as long as we have choice in a model that allows conventionally raised an antibiotic free that works well, but when you move toward scenario with 100% anabolic free that ceases to work, so there's a number of things around that that i think are critical. i think the supply chains are taking it seriously that have made the commitments as karana said there are third-party or quit i would love to see is more of the labeling not around and about a free or raised without, but raised under stewardship guidelines or principles and if you have a great opportunity to expand how we label and

communicate and educate around what that means see next zero, if i am a consumer and to simplify this a bit for folks who are here watching and i go into a mcdonald's and i very a chicken sandwich there and there's an antibiotic claim of some kind and then i go across the street and buy a chick lit-- chicken sandwich at chick-fil-a and there is a different story told, those stories might appear to me to be the same thing, but they probably mean something different. is that the case and is there a role for fda or usda government in some way in a clarifying what those claims mean? i guess that is the question a lot of folks might have. >> well, i think to the general, i mean, to the general notion i think clearly marked its factors have playing an important role lately in terms-- and i think overall and is looking at this

issue in the context of the last 40, 50 years i think a significant shift has occurred in the last five or six years and more sort of positive motion has happened in this last five years and probably happened in the past several decades, so i think-- and there may be a number of reasons for that and some of which were talked about in the session this morning and changes in consumer views and and other market factors also driving it and also actions that federal agencies take, so i think the good news is that has shifted at least from my vantage point the narrative has changed a bit and i think a positive way a way of how we are dealing with the industry and agriculture community generally where there is more emphasis turned from sme

prior to this time a lot of emphasis was placed on the narrative around is there really a basis to making change and is there sufficient evidence to to justify changing practices and i think installed our ability to move forward in a positive way. my senses we have shifted off of that is more now rather than focusing on that it's focusing on how can we move forward and what are ways in which we can now adopt changes. clearly there are practical challenges, but at least the focuses more on the how part of it rather than the doing part. to the notion of, do i think the market factors have been important in terms of additional push to move change along? i think the challenge we have with whether we are talking about products that meet organic standards, which there are standards established or antibiotic free standards and

those all provide different options in terms of choices for consumers, but going to having the notion that we are going to be able to obtain an antibiotic free uniformly across all animal production is frankly unrealistic. it doesn't diminish the fact that having choices and finding situations where and about a can be attained and which companies like tyson or purdue who may be getting there with grower production, that is great. the challenge may be it's one thing to be able to institute those kinds of changes in the context of raising chickens who have very short lifespans in a controlled environment to a fine not to other sectors of the industry and be able to maintain animal health, so it's important factor, but it provides choices for consumers, but it's not

necessarily going to be the solution. i agree with brady's comment that a significant element also needs to be focused on encouraging standards around the notion of appropriate use or judicious use and that consumers can have confidence that the products they are purchasing are coming from farms that are applying good stewardship principle in terms of the use of antibiotics select so, we have microphones open if folks have questions that they would like to ask. modeling gets the first question. >> thank you to the panelists. appreciate your presentation. i am from forever view farms and we run livestock in central virginia and alabama. we have never used antibiotics and we never will. my question revolves around the project goals, the business on farm impact of this product conversation, which i think it's absolutely critical.

how, when we look at the business challenge particularly for younger producers, how do we match the difficulty that they face from a capital sampling-- standpoint against this imperative around the use of antibiotics because you made it clear, why do producers use antibiotics, scale, efficiency, that is it, but if i have a five goats per acre imperative to maintain a level of what we consider to be responsible stewardship, at rates of reproduction, we know what they are here: a subnet six to $10000 an acre you could see what happens to my capital structure 30 quickly. so, for younger producer or point producer that isn't necessarily able to handle that

kind of capital intensity, how should we begin to think from a broader policy perspective and i would ask each of you to discuss beyond your expertise, how do we think about the broader aspect of aiding younger producers while meeting that imperative we talked about here to related tooth-- relative to antibody clinic i guess i will start. i think-- one, a think clearly we believe that producers, large or small still need to have access to these products, antibiotics for managing disease. that is clear that that's important to be able to manage health of animals and it goes to the discussion around being able to continue to have-- meet our needs in terms of food production, so i think it really

does go to more fundamentally looking at building into or looking at the operations and how the animals are being raised to try to maximize or optimize the use of those antibiotics and try to identify ways in which they can limit their use. again, our focus here is primarily on those antibiotics that have seen the medical importance, so the change that is occurring is to eliminate the use of medically important and phonics for growth promotion bring this products under oversight. there are classes of antibiotics that we don't consider medically important. i will give you an example, a fairly large class of antibiotics that do have antimicrobial activity, so they do fall under the category of being antibiotics, but there are

no uses in human medicine and there is little evidence to suggest that this use of this drug contributes to resistance that the public health concern, so there are other alternatives. some of this comes down to making choices about how they are meeting their production meet-- needs and our desire is that they are not reaching for an import antibiotic for production purposes, let's look to other options whether management or other non- important, non- medically important products to address those issues-- anyway, not sure that answers your question. the other factor here is that the challenge we are facing is the past diversity of the agriculture industry in the us

and the changes we're making are impacting small backyard operations, 4h kids that are raising handful of animals, from that scale all the way up to the multistate integrator and everything in between, so clearly there is a challenge to try to apply standards that can cut across that broad swath and be able to call it a-- accommodate all the practical implications, which there is no denying that these are going to -- these changes are going impact and there are adjustments that producers will be struggling through as we complete the transition. >> maybe one comment. i completely share the concern and awareness of the challenge

of younger producers starting and i do a lot with young agriculture students and those maybe that are teetering on the verge of al gore engineering or something else and i'm very passionate about the growth of the industry from that standpoint. i think i would answer may be from this lens much like we saw many other problems and challenges that we had in the past is around innovation and that may be a simple answer, but i think the-- one of the great values and strings of american agriculture is the diversity of it, so which you describe, and what doctor flynn has described and in effect continued investment in innovation that matches that diversity and allows us to bring new practices and allows us to do more with less in terms of input output standpoint is critical going forward. we have recently got a novel product and i think it's now in four continents for dairy

production. one of the most significant places where we use shared class and abroad ex in their is the treatment of mastitis, a critical issue in a disease challenge any technology that they not out of iraq that actually helps to reduce the need for treatment of mastitis and i think it is something the industry has to look at, so talk about alternatives. so, it's products, it's practices and a whole host of things, but i think if we truly feel like we can address the challenges that secretary glickman talked about in terms of meeting this need of doubling food, the key piece around that is continuing to focus on innovation and bringing products to new practices and new things to the farmers that you described. >> i would add that important sharing lessons learned and education for that marion's and education of the farmers.

we have seen producers that have been trying to phase out antibiotics and they have gone through a learning curve and there are opportunities to learn from others and figure out how to do things better and there really is an important piece of sharing lessons learned to making sure you don't have to innovate and re- figure out things multiple times. >> thank you. so, this may be a bit of an unpopular question, but i'm curious to ask anyway. obviously, this is a comp located problem that requires a multipronged solution and one potential prong that we have not talked about yet it all today is efforts to reduce the amount of meat that people eat and i say reduce, not eliminate, but we eat a lot of meat and it seems to me that one valuable way to contribute to solving this problem would be to reduce that, so it to what extent do you think that should or could be

part of the conversation? >> i think from our perspective and i'm no nutritionist. i'm not a human nutritionist. i stutter cattle nutrition, which they don't eat a lot of meat. [laughter] >> i mean, i described to the view that protein in a diet is critical part of that and animal -based protein is a critical part of a diet. i think when you look outside of the us and you spend time in the developing world and you see the evolution of diets and the socioeconomic ability for people to select diets, animal -based protein is one of the first things that comes into the picture, so i think the reality is that we look at the global perspective that protein will continue to play an important

role and i think that we have to figure out how do we-- do all the things we talk about to be able to bring that to bear in a way that is most and are mentally responsible, most responsible from an animal welfare standpoint, from human health standpoint, so i guess i see that as kind of the outlook from my seat from our chair we really feel like animal protein pieces a critical parts, especially as you look at the diets developed around the world >> do either of you want to weigh in on that? >> i don't have anything to add. i'd think a twist on was question, what are some of the investments that congress ought to make to measure success and to help farmers transition, animal producers transition to systems of raising animals that might reduce the need for medically important antibiotics?

i promise it won't be anything more that has already been permitted to be suggested, but if you are keen for the day and you are writing the next farm bill or the appropriations bill, what are the sorts of investments we are not making now that we ought to be making? >> i can take a stab at that. i think the critical role of having good data and has been mention a couple times already, but i think it is really critical and i cannot emphasize enough how important it is to make sure we have this data. understanding the correlation between how antibiotics are used in farms. research and really making sure that we have alternative innovative ways of reducing the need to use antibiotics in the long run. >> i think echoing secretary glickman meant earlier this

morning about if we are not to the broader issues related to food production, that we are not putting enough priority and resources towards it and there is sort of is a disconnect where we identify as a high-priority issue, but doesn't seem to be getting the resources it needs. you know, really dive into some the critical issues pick coming effect if we do feel there is some important changes being made that affect how we produce food including from food producing animals, there really needs to be resources put to stimulate and be able to foster innovation and change at the farm level to bring about those changes and the resources don't seem to be there to do that. so, supporting the developer and of those alternatives.

closer to home for fda and i think we again work closely with usda on this issue. our request for dollars we requested for the fy 16 budget to support efforts in this area were not appropriated and so there were no new resources for fda or usda frankly to support some of these efforts related to this antibiotic resistance issue and fy 16, so that has the factor of slowing down progress. i mean, we are looking forward to hopefully funding in future budgets, but certainly it set us back into the fact that we did not get some of the increases we asked for for this year. >> i think the most has been discussed, but from our perspective i think metrics and surveillance as has been

mentioned and focusing on those areas critically important, resistance again, doctor flynn pointed out that is the issue we are try to address is so whatever actions we take away dressing that. i think from the five or six most critical areas-- ensuring we have the right funding a process set up for that is critical in the second one is around public research, so increasingly and i don't have the statistics for this, increasingly the private industry has more and more of the burden of agricultural research and that's just if you go to land-grant universities are a country you see that evolution of the last 25 years and i think with this one approach, the impact on human health, on public safety, food safety, the environment, all of those things are so pivotable around agriculture and food

production that i think we need to continue to look at how do we drive our research. the last one i would say that maybe congressional, maybe regulatory as i think the under secretary has commissioned some work to look at incentives and disincentives that exist today around new drug or new alternative development and i think addressing some of those incentives or disincentives in the system that would spur more integration of the state process and if we are really concerned about bringing alternatives had we expedite and how do we prioritize. had we often devise in some ways that's development and efforts. i think economics, companies, investors, biotech will respond to those types of incentives. >> we have run out of time, so please join me in thanking our experts, they will be here if

you have other questions. thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> for those of you leaving the room, you're making a tremendous mistake and i urge you to come back immediately. i'm a professor here at georgetown law school and i'm deeply honored today to introduce doctor sonja angel as our keynote speaker doctor angel is one of the unheralded heroes

of the public health movement and she is certainly a hero to me. i met doctor angel nearly a decade ago when we were both appointed to an expert panel convened by the national academy of science to divide strategies to reduce sodium intake in the us diet. from the moment the committee met it was clear that doctor angel was not only the smartest person in the room, but also had the best ideas about how to get things sound. the fda announced this week that it was started to implement strategies to reduce stomach-- sodium intake. well, that's a decade after the new york city health department with sonja angel at lead was already taking positive and important steps to achieve the same and. one of the things that struck me , i still remember this conversation vividly was during our first meeting she was describing how she and her colleagues at the new york city

health department were working with baker's in the city, in and around the city to reduce the sodium content of bread. she was also taking steps to use new york's enormous peak your met the silly to change composition of the food being provided to services. she was already working on getting trans- fats out of foods she was already championing the idea that we needed strategies to reduce sugar consumption, particularly among vulnerable children and she wanted us all to know about the calorie and sodium content of the food that we. she pioneered many calorie information years before anyone was thinking about the affordable care act, and if you go to new york in the next couple of months you'll see on restaurant menus not just calorie labeling, which has been there for a while, but also

warnings about salt. you will get this little note on your menu saying you could eat this, but this is your month along, you know, dose. so, she has been the driving force behind many of the most important modern public health initiatives this nation has seen , but because she plays on a local and national stage people don't know about doctor sonja angel, so when we are plans covers-- outside washington dc in the first panel this morning made crystal clear it's very hard to accomplish anything in washington dc. political inciting, budget cuts, bureaucratic short-term, massive industries-- interest group lobbying often derails the best ideas. washington, many say, is a place where good ideas come to die, but that is not true in cities and states that often can move

more effectively and more quickly than the federal government and we in washington need to be on guard for federal initiatives that preempt or place obstacles in the path of state and local government from acting