November 2, 2017

The Resistance is Coming

By Matt Kuhn

Some of the best experiences afforded to us as Externs on the Hill are completely spontaneous. As I looked at my twitter feed two weeks ago, I noticed a posting by the USDA advertising a live-stream for an upcoming conference on the National Antimicrobial Resistance Monitoring System (NARMS). As I looked into the event, I noticed the conference itself was being held at none other than USDA Headquarters, a ten-minute metro ride from our AVMA GRD office.

NARMS is a system formed jointly by the FDA, CDC, and USDA in 1996 to monitor isolates of bacteria from sick humans (CDC), retail meats (FDA), and farm animals (USDA) to detect and track the spread of antibiotic resistance. It has been one of the most successful inter-agency collaborations in the US government and has maintained its high regard from the scientific community through the years by continuing to be innovative and transparent, providing much of their raw data directly to the public to spur further research. Having such a unique event so close by was very fortunate, so I took advantage of the two days of presentations and discussions revolving around various topics effected by NARMS.

Over the course of the conference, a couple of trends emerged from those speaking, representing not only the three sponsor organizations, but others from academia, animal and plant trade organizations, and other governmental entities. The first trend was an emphasis on whole-genome sequencing. Previous to the mass use of whole genome sequencing, studying antibiotic resistant organisms relied heavily on phenotypic responses, meaning how an isolate of bacteria responded to treatment with various antibiotics. With whole genome sequencing, we can begin to match those phenotypic responses with specific genetic changes. This allows NARMS to track the spread of specific genes, cluster outbreaks based on similar genetics, and better predict how, when, and where future outbreaks may occur. Much of the first day delved deep into this topic as its full potential is only beginning to come to light.

Another obvious motif of the conference was the need to better measure and track antibiotic use to understand its impact on resistance. Currently, one of the tasks of the FDA is to collect antibiotic sales data from industry, which is many times used in a negative light against animal agriculture. The current means of measuring antibiotic use is based upon a total mass of product sold, which does not consider potency of the drug nor how it was used, both of which make it difficult to tie these data to any substantial conclusions about their impact on resistance. Further, antibiotics sold for human medicine are not reported in the same manner making comparisons between the two industries indirect and problematic.

Everyone at the conference agreed that we can do better when it comes to preventing antibiotic resistance, but almost all emphasized that this does not mean straightforward decreases in antibiotic use or further use restrictions as many law-makers not well-versed in science have proposed. Reducing resistance means using antibiotics judiciously. Using them after culture and susceptibility rather than as a means of diagnosis. Following the correct dosage, route, and duration of therapy. And this is not all confined to food animals. Speakers voiced concerns over more strict employment of these methods in companion animal and human healthcare as well.

Agriculture Secretary Sonny Perdue was kind enough to stop by and leave us with some kind words. He emphasized the great advances made in antibiotics over the past eighty years as well as the recognition and fight against antibiotic resistance there since. While he held everyone in the room and within our field in very high regard, we all can still improve and must improve on our antibiotic use and resistance monitoring if we hope to continue our dependence upon these antimicrobials into the future.

Sonny NARMS

 

 

 

 

 

 

 

 

October 26, 2017

Pride for Michigan

By Matt Kuhn

These past two weeks, I finally had the opportunity to meet with my senators, Debbie Stabenow and Gary Peters. Senators certainly have their hands full with their constituents, taking on their entire state rather than the smaller portions that the house members represent. This can make finding time to meet with them considerably, and understandably, more difficult. Fortunately, each of my senators have a ‘Morning with the Senator’ event each week that the senate is in session. I’ve noticed that many other members of the senate from across the country hold this event or one of a similar nature as a means to set aside specific time to meet with their constituents.

It really is a rarity, on either side of The Hill to be able to personally meet a representative or senator and have time to talk about the issues that concern you most. Most conversations pertaining to political matters occur through a member’s staff member, or ‘staffer,’ on behalf of the congressman or congresswoman. I’ve become well acquainted with these meetings during my externship and in past visits to The Hill, so being able to actually meet the person with their name on the door really means a lot. Now I can imagine that much of the year their mornings are much busier than late October, well past DC’s peak tourism season, so my experience may have been a little more laid back than most.

Stabenow PicturesI’m very lucky to have one of my senators as the ranking member of the Senate Agriculture, Nutrition, and Forestry Committee. Senator Debbie Stabenow has not only been a powerful member of the senate for many years, but a strong supporter of veterinary medicine and agriculture. In fact, she is a sponsor of the Veterinary Medical Loan Repayment Program Enhancement Act (VMLRPEA) that I spend most of my time advocating for. Our meeting was a nice change of pace as her office’s views parallel those of the AVMA for the most part, giving me time to thank her for all she has done.

This is not to say that Senator Peters has been anything but helpful as well; he simply has a different committee assignment and thus different priorities. That’s why it’s my job as a constituent to bring to light important topics such as the VMLRPEA and student loans related legislation. I was extremely appreciative of his and his aids’ attentiveness throughout the morning and active engagement over my concerns. I look forward to continuing to work with Peters Photohim and his staff in the future to continue to garner his support for Michigan’s agriculture and veterinary communities.

Prior to my meetings, I have been very proud of both of my senators. They are both fellow alumni of Michigan State University, both very passionate about protecting Michigan and the Great Lakes, and are both willing to stand up for their constituents and work side by side for the sake of our state. After these meetings, and their willingness to take to heart my message and worries, my pride has only grown.

At a time when congress needs to hear the wants and needs of their constituents the most (not to mention entering an election year), taking advantage of opportunities to meet with our national representatives is very important to keeping Washington grounded. I strongly encourage anyone visiting the DC area to always check ahead of time and see when these events are being held. Even if you don’t have a specific bill to talk about, find something that you are passionate about. Their job is to represent you and the only way they can do so is to understand what fires you up, what gets you out of bed in the morning, and what concerns you have.

October 26, 2017

Now say it five times fast

By Matt Kuhn

The Extern on the Hill program is multifaceted. During our brief stint in DC, part of the externship is to network and meet many veterinarians and scientists in the area, which I touched on in a previous blog post. Another aspect that we spend a significant amount of time on is meeting with congressmen and congresswomen from our home state, and at times other states, to discuss some of the topics and bills that are impactful to veterinary medicine.

At the moment, one of the most opportunistic bills to discuss is the Veterinary Medicine Loan Repayment Program Enhancement Act (VMLRPEA). My externship coincides with a very pivotal time in the course of this bill, as it has been introduced in several sessions of congress now, not yet having the support or timing to get passed through each house. As a well-supported, bi-partisan bill introduced in both the house and senate, it has the potential to be moved along and with tax reform and the 2018 Farm Bill both looming on the horizon, there are potential vehicles to do so. This is a moment where both support and timing come together to give a bill the best opportunity possible to become law. The key for me, at this opportune moment, is to bolster the support side of the equation.

The VMLRPEA looks to improve a program that has been successful in bringing primarily food animal veterinarians to areas of rural America that need them most. Currently, this program identifies regions in each state that are in critical need of food animal veterinary services and entices veterinarians to come and fill those voids through a $75,000 loan repayment program paid out over three years. The program is a win win for all those involved. Veterinarians have a means to pay off a portion of their student loans and receive a stable position in the community while farmers and their animals receive the veterinary care they desperately need. While hundreds of veterinarians have taken advantage of this program, there are still many unfilled positions every year, and not due to lack of applications. One of the reasons for this is a 39% tax that is placed upon the award given to veterinarians. Thankfully, the United States Department of Agriculture (USDA) who runs the program picks up this tax so that veterinarians may still receive their full loan repayment amount. The pitfall to this is that of the money appropriated to the USDA for the VMLRP, over a third of it is now going straight back to the government and limiting how many positions can be awarded.

My home state of Michigan has been fortunate enough to have several of our critical areas of need filled through this program over the past few years. That being so, several slots have also been applied for but remain unfilled; the same story told over and over again in every agricultural state. This bill is good for veterinarians, good for farmers and ranchers, and most importantly good for the animals, who deserve proper veterinary care.

If you would like to support this effort yourself, I encourage you to visit the AVMA’s Congressional Advocacy Network page to learn more about the this bill and the AVMA’s efforts in its passage. Additionally, information on how to contact your representatives is available on this website. If you would like to make it more personal, write a hand-written letter or better yet, meet them in person; all representatives have offices in their home state and are always happy to meet with constituents when in town.

October 17, 2017

It’s not what you know…

By Matt Kuhn
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We’ve all heard the phrase “It’s not what you know, but who you know.” I can’t imagine a city where this phrase holds true more than Washington, D.C. I heard an adage related to this saying this past week that goes “It’s not what you know, but who you know, and not necessarily who you know, but who knows you.” It’s easy to have contacts, but harder to have relationships.

A significant portion of our time as Externs on the Hill is spent meeting with other veterinarians and scientists on The Hill and surrounding area. Building relationships with those whose path we hope to emulate is likely more important than learning the nuances to policy and legislation in DC. This past week I had several meetings with veterinarians whose names you have likely heard before if you read this blog regularly, and some who have not been mentioned before.

20171005_151031731_iOSDr. Sarah Babcock was the first veterinarian I was fortunate enough to meet. A fellow Spartan and also a lawyer, she has been involved with animal law and a relief veterinarian for a number of years. Much of her sage advice stemmed from how to make the transition from a university into city life and simply, how to live. It’s a silly thing to read, but so much of our time is spent thinking about how we may do our jobs, sometimes we forget about the other half of our lives and how we balance the two.

Next was Dr. Eric Deeble, a legislative assistant for Senator Gillibrand of New York. Eric emphasized the advantages to becoming involved in politics at a local level. To become comfortable being an extrovert and having discussions about politics with everyday people. After Eric was Dr. Rachel Cumberbatch who hails from the Animal Health Institute and had great advice as to how to grow writing skills, an asset in a city that lives and dies by the memo and white paper. Additionally, she was a valuable resource regarding talks, discussions, and presentations relating to science that are held around the city every day when you really start to look for them.

At the Department of Homeland Security, I met Roxann Motroni, a program manager for agricultural defense research. She, like me, comes from an educational background based in food animal medicine. Roxann had many pieces of advice on how to stay sharp as a veterinarian and where to find relief work with food animals around a city devoid of agriculture. Lastly, Dr. Elise Ackley now works with Pew Charitable Trusts, a non-partisan organization helping humans and animals around the world through policy. Elise expressed the bond that veterinarians share around DC and across the country. With relatively so few veterinarians in non-traditional careers, it become close-knit a very close-knit community.

Each meeting with a past AVMA Fellow had similar themes; ways to prepare for application to a fellowship program, advice for on working on The Hill, tips for living the ‘DC Life,’ and yet each one carried its own spin. Each fellow had little bits of advice that were unique with thoughts I had never considered before. Each offered insights to the nuances of politics and how legislation is carried out in Washington. Each meeting was invaluable and could not be replaced by any other. I think that is what makes building relationships so valuable in this city. The little differences we all carry with us are what make each person fit a different niche. Everyone I spoke with was a DVM, yet each had developed a very different approach to influencing policy and infusing science into politics. This is what makes this externship so valuable. No other experience in veterinary medicine opens you to meeting so many successful, non-traditional, veterinarians who are so willing to open up and invite you into their world. I truly hope each of them known how valuable their opinions are to the students they speak with.

Remember to follow @AVMACAN on twitter for updates about what you can do to influence policy and @MattKuhnDVM18 for more on my externship here in DC.

October 10, 2017

An Ounce of Prevention is Worth a Pound of Cure

By Matt Kuhn

This past week I had the opportunity to see past Senate Majority Leader Tom Daschle speak as a part of the Blue Ribbon Panel on BioDefense (BRPB). The BRPB began in 2014 as a privately funded, bipartisan, entity with panel members composted of former Representatives, Senators, and Governors among other high ranking federal positions. The goal of the panel was to evaluate the ability of the United States to prevent, detect, and respond to biological outbreaks, whether they be natural or by way of bio-terrorism. Their findings suggested that the United State is woefully unprepared to detect bio-threats in a timely manner nor to appropriately respond to such threats. Their conclusions reveal the underappreciated fragility of the American economy and nuanced ramifications faced by Americans due to foreign pathogens causing disease outbreaks.

20171004_021346738_iOSThe AVMA, alongside several veterinary and agricultural-trade organizations, have recognized this insufficiency in American agri-defense for many years and have recently bolstered their pressure on the federal government to establish a national animal vaccine bank with a priority on Foot and Mouth Disease (FMD)  to protect American livestock. Speaking purely from a monetary standpoint, creating a vaccine bank is more than worth the expense. Consider this: the current ask of the federal government is 750 million dollars for the establishment of the vaccine bank and coordination of vaccine production. Compare that to the 34.5 billion dollars the United Kingdom economy lost due to the islands FMD outbreak back in 2001. If an outbreak in the UK can disrupt an economy to that scale, it is hard to put in perspective what could happen to the US.

Despite this strong argument, there is many more aspects to this discussion than purely maintaining economic stability. As I mentioned previously, there are many nuances to a disease outbreak that are hard to account for. As a veterinary student having worked with those in the agricultural sector for many years, the concern that I have from an outbreak is not the cost to the American economy, but the direct impact on animals and those that care for them. Without the ability to manage disease outbreaks with vaccination, we are left with depopulation; the approach taken by the UK in 2001 and found to be devastating.

When managed depopulation is carried out, farmers are forced to go against everything they’ve ever learned and worked for. While they may be compensated to a certain extent by the federal government for losses, the reimbursement will never make up for the true costs of such an undertaking, such as years of on farm genetic selection, young and growing stock’s future potential, and an abrupt cessation of likely their only income for a long period of time. This significant loss of livelihood would be the end of the road for many of our countries small family farms. And more difficult even than this, many of these caregivers must face the reality of euthanizing their animals, their life’s work. Farmers and ranchers put their heart and soul into their animals. They are their lifeblood and such action would take an incalculable emotional tole.

As negotiations over the 2018 Farm Bill continue, it is ever important that our nation’s decision makers fully understand the consequences of potential bio-threats facing our country today. In Tom Daschle’s closing remarks, he pressed for the need for leadership in Washington. Leadership willing to stand up for bio-defense and for the protection of our people and animals. The AVMA and those representing beef and pork industries have certainly taken a leading role in this regard, now it is time for congress to listen. As Benjamin Franking said “An ounce of prevention is worth a pound of cure.”

October 4, 2017

The Name Game

By Matt Kuhn

It’s fairly standard procedure to begin each new rotation during clinics with a little round robin of names, future interests, and probably a fun fact or two with your rotation mates and new clinicians. I’ll start off this rotation with all of you in lieu of my peers.

My name is Matt Kuhn. When I grow up, I want to work in public policy focusing on advancing science based legislation and regulation. I have a four-year-old pit bull who is a blood donor and has now donated almost two gallons to the university hospital. And it took me 24 years of life to finally see the movie Hocus Pocus.
And unlike most students who’s follow up questions revolve around their fun facts, I consistently get the question, “you want to go into what?”

From day one of veterinary school, students are told about various non-traditional careers for veterinarians and yet we become so entrenched in clinical medicine that many students, veterinarians, and the public never think about the other opportunities open to veterinarians. The skill set we acquire during our didactic and clinical years makes veterinarians a jack of all trades, able to quickly adapt to any number of careers. We are educated not only in medicine, but basic biology, epidemiology, research principles, and food safety, all with a one health perspective. We are taught to be leaders, yet work well within a team. In talking with clients and peers, we learn to speak to a broad range of audiences, allowing anyone, from scientist to laymen, to follow the conversation. Some of these skills can simply be taught, but many of them are the soft skills. Skills that can only be gained with experience and practice. Skills that are very sought after in a city that runs on communication and influence.

This opens the door for veterinarians to fill positions in almost every sector of government from the obvious, in the USDA or FDA, to more unknown roles, such as those in the Department of Defense or White House. While veterinarians working in government do so across the United States, there is a reliable need for them on The Hill. Now, more than ever, we need to bring science back into policy. Decisions need to be made based upon peer-reviewed research and widely accepted basic understandings of science. Specific to veterinary medicine, those with a non-science background need to be informed of the threats facing our country and its food supply and how legislation they pass (or don’t pass) can impact veterinarians both large and small, as well as farmers, ranchers, and pet owners.

Over the next six weeks, I will be meeting with a number of individuals who have taken on non-traditional careers as veterinarians as well as others actively involved as non-veterinary scientists on The Hill. I am elated to be able to hear their stories and share their experiences; to learn from their mistakes and emulate their successes. I hope that you can follow along with me and not only learn about careers open to veterinary studentsFirst Post Pic but what you can do right now to influence legislation both nationally and in your own state. Make sure to follow @AVMACAN on twitter for updates on legislative priorities and me @MattKuhnDVM18 for updates on my externship, animal health, and upcoming blog posts.

October 3, 2017

The Hill Has Ayes

By Derecka Alexander

My first experience with Robert’s Rules of Order was when I was a citizen at the American Legion Auxiliary’s Louisiana Girls State program. That was a great introduction but no where near the level our Congress People work through markups on the hill.

A markup is the process by which a U.S. congressional committee debates, amends, and rewrites proposed legislation. Markups are open to the public, however, depending on how popular the bill is, you might want to get there way sooner than when the doors open. The first markup I attended was for the Fiscal Year 2018 Labor, HHS, Education Appropriations Bill. The other extern Jacob and I stood in line for over thirty minutes waiting to get in. I usually don’t do waiting in lines, especially when I have on heels, but I knew this learning experience was not the time for me to be boujee. Lesson learned.

The next markup session I attended was for 7 bills in review by the House Natural Resources Committee. Chairman Rob Bishop, R-Utah,  had no problem enforcing Robert’s Rules in a swift manner. Other markups were scheduled to happen right after and some markup meetings overlapped other ones. So much important legislation, like the healthcare bills, were being discussed and amended in preparation for the day they hit the floor for voting. Trying to keep up with the discussions, the ayes versus the nays and the constant request for roll call votes was more than I expected and kind of gave me an adrenaline rush. Then towards the end of this markup, I finally understood why the Moms Demand Action for Gun Sense in America group was present at the full committee markup for a committee concerned with natural resources issues. It went down during discussions around the SHARE Act. I’m not here to sway people to the left or right, however, I do find it strange for legislation removing silencers from the National Firearms Act to be important to the heritage of American sportsmen and women.

My Hill meeting with Mr. Peter Hunter from Representative Cedric Richmond’s staff will hopefully lead to an aye for the Veterinary Medicine Loan Repayment Program Enhancement Act. Mr. Hunter and I discussed why this bill is needed and how important it is to agriculture states like Louisiana. He said it’s straightforward legislation that is requesting the same kind of treatment other health professionals working in underserved areas get. Definitely expecting that co-sponsorship and a big AYE from Representative Richmond!

I really enjoyed meeting a couple of members of Congress who also practiced veterinary medicine! Dr. Kurt Schrader is a representative for the state of Oregon who wears the coolest cowboy boots everyday to work. Florida Representative Dr. Ted Yoho is definitely a U of F Gators fan and didn’t hold back his southern hospitality when he offered Jacob and me a couple of small bottles of Tropicana Florida orange juice.

Being on the hill and experiencing the process of law making was a great experience. Washington D.C. is home to many vets who play major roles in developing and implementing legislation. The profession has only a few who take on the challenge of traveling down the non-traditional path. For those who do, the reward of working for the greater good of this country is something they cherish. I am looking forward to my future experiences and to continuing to break down barriers while showing the world what veterinarians have to offer.

The Hill Has Ayes 4 The Hill Has Ayes 3 The Hill Has Ayes 2 The Hill Has Ayes 1

October 3, 2017

Louisianians Love LunchMEATings

By Derecka Alexander
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The Carving Room is where lunch meetings turn into lunch MEATings. Today, I met Dr. Will McCauley and Dr. Rachel Cumberbatch, two veterinarians following the unbeaten path with their current employer the Animal Health Institute (AHI). I was under the impression that AHI is a consulting firm, and I was wrong. AHI is a non-profit membership organization that represents companies with an interest in veterinary health. It’s considered a trade association and participates in public relations activities, with a focus on collaboration between clients and the governmental agencies regulating their clients’ activities.

Both Dr. McCauley and Dr. Cumberbatch started out their veterinary careers in private practice. After five years, Dr. McCauley decided he wanted a change and was led to AHI where he serves as the Director of Regulatory Affairs and Veterinary Biologics. Dr. Cumberbatch was a AAAS Science Policy Fellow for the EPA and a AAAS/AVMA Congressional Fellow for Senator Al Franken’s office. She’s now the Regulatory Affairs Manager for AHI where she integrates clinical expertise and policy experience to protect the health of humans, animals and the environment. These vets work together with other teams at AHI uniting stakeholders in the pet, agriculture, veterinary and public health communities with the common goal of addressing issues at the center of human and animal health.

I asked them about what skills they thought are helpful for jobs like the ones they have. They stressed that their work is based mainly on the use of soft skills rather than the technical stuff vets work so hard on mastering before graduation. The work they do has a heavy focus on the regulatory side of the Legislative branch. They spend a large portion of their time monitoring CFRs and communicating changes to clients via memos. Much like how a vet has to break down complicated cases to pet owners, the vets at AHI have to soup the issues important to their clients and translate that information to team members and clients who may not have a strong science background. For them, the balancing of key interests is crucial; so, negotiation skills definitely help them serve as liaisons between regulatory bodies like FDA or USDA and stakeholders. There’s a lot of human to human interaction taking place when you’re working in the middle of manufacturers of veterinary health products and the governmental agencies that regulate them.

I think what the vets do at AHI is super cool! I would never have heard any of my professors talk about doing this kind of work. Listening to them talk about their super cool jobs had me wonder about how a vet can position his/herself into getting this kind of job. Then Dr. Cumberbatch talked to me about creating good elevator speeches. She said that if I can’t translate what I want to do at a job for a boss or a family member to understand, then I’ll miss out on amazing career opportunities.

I would like to thank Dr. Cumberbatch and Dr. McCauley for introducing me to a cool lunch spot. Good food mixed with great throwback 90’s hip hop/pop music is always a good time. Y’all know this Louisiana girl loves good food and music! I’m so grateful that the vets in D.C. take time out of their busy schedules to talk to vet students like me who are searching for a “that something different” kind of career in veterinary medicine.

 

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October 3, 2017

The Jive Inside the Hive

By Derecka Alexander

One Health is not a brand new concept, but it is still going through some growing pains as the concept gains some traction in the mainstream. Under the One Health umbrella, different disciplines work together to figure out how to maintain optimal health for people, animals, and the environment. At the One Health Academy in D.C., health professionals interested in One Health dialogue and social engagement meet monthly to discuss issues. I took the opportunity to attend this month’s meeting that featured Dr. Terry Kane, DVM, MS, who talked about the wonderful world of bees.

Confession: I am afraid of bees! I’ve never been stung, but I am too melodramatic about suffering the same consequence the character Thomas J sufferers in the movie My Girl.

Dr. Kane went from private practitioner at a feline veterinary hospital to AVMA Congressional Fellow to currently working as the “A2Bee” vet. Reporters around the country have media outlets talking about how the pollinators of this country are in trouble. It was nice to hear the veterinary perspective on this.

That night, I learned that beekeeping has been in practice for millennia. The Egyptians are recorded as the first beekeepers (shout out to the Motherland, Africa). Scientists know that pollination is essential for an ecosystem’s survival. Farmers rely on pollinators for over 100 different kinds of crops. A threat to bees can lead to a threat to our nation’s food supply and have major effects on a multi-million dollar industry!

Dance is considered a universal language that transcends different cultures and animal species. Despite my fear, I found myself slipping into a space where I envisioned bees busily buzzing around in a synchronized manner. I let my guard down and allowed my love for animals to grow through the connection of dance. Bees dance y’all!

Dr. Kane talked about how uncoded bits of RNA produced by plants are picked up by bees and are used to create their waggle dance. Bees have an internal GPS that allows for them to create coordinates through the form of dance. This waggle dance communicates to the other bees where the flowers are. Researchers are using computer analysis techniques to uncode the waggle dance and figure out where these flowers are, too. All of this is done in hopes of understanding and treating the colony collapse disorder, which is a global issue.

Important research like this is needed to help vets understand how to treat bees on a bee farm. It’s great knowing that there are veterinary schools currently incorporating the latest bee information into curricula to help prepare the vets of tomorrow. I don’t think any veterinarian everThe Jive Inside the Hive- Bee Talk of BEEcoming a vet for bees. This profession never ceases to amaze me.

October 3, 2017

SOAP-ing on the Hill

By Jacob Froehlich, PhD

Every veterinary student knows the acronym “SOAP.” Subjective. Objective. Assessment. Plan. You don’t receive a DVM without writing at least 500 SOAPS (and that number is probably generously low).

Soap1 soap2During one of my meetings with the three veterinarians in Congress – Rep Kurt Schrader, DVM (D-OR-5), Rep Ted Yoho, DVM (R-FL-3), and Rep Ralph Abraham. DVM. MD (R-LA-5) – the Congressman remarked that the SOAP can be applied to Congress and the legislative process. First, when confronting any patient or problem, one needs to first subjectively characterize that patient or problem. Is the patient a three year old castrated male Doberman Pinscher? Is he bright, alert, and responsive? Is the problem that the United States must currently shares its food-and-mouth disease (FMD) vaccine bank with Mexico and Canada? As you continue reading, note that I will be using FMD and the need for a vaccine bank to illustrate the SOAP process of thinking here.

Subjective: Shared foot-and-mouth disease vaccine bank appears inadequate to quickly respond to any future FMD outbreak.

The objective portion of the SOAP is next. Here, the facts are stated. What is the patient’s heart rate? What is the patient’s temperature?  How many vaccines are available? What is the response time for FMD vaccine deployment in the event of an outbreak in the United States?

Objective
O1. FMD vaccines available: 14 strains, with a few million doses each.
O2. Location: Plum Island, NY.
O3. Vaccine manufacturing finished overseas. 
O4. Deployment time: approximately 4 days

Now, with any patient or problem, one must make assessments in order to formulate a plan.

Assessment
A1. FMD not reported in USA since 1929. 
A2. FMD vaccine bank shared between USA, Mexico, and Canada.
A3. Inadequate number of doses, strains available: rule out (r/o) international North American sharing v. poor federal funding v. no apparent need 
A4. Poor response, vaccine deployment time: r/o overseas manufacturing v. international North American sharing v. antiquated disease 

Based on one’s assessment, the patient’s problem list (or, in this case, the issue’s problem list) is then used to formulate a plan. In my example of foot-and-mouth disease prevention and outbreak response, there are currently 60 strains of FMD and 24 known vaccines to provide immunological coverage for those strains. While FMD has not been identified in the United States since 1929, it’s impact on animal health, welfare, and production would be catastrophic, should it reappear after finding its way back into the country. Hundreds of thousands of animals would be slaughtered and burned, and US exports of animal products would slam closed overnight, wreaking financial havoc on ranchers’ bottom lines and our economy as a whole.

Lastly, as foreshadowed above, a plan is made to address the various assessments and rule-outs associated with those assessments in order to make a positive impact on the patient’s health or the issue at hand.

Plan
P1. Request that Congress create a foreign animal disease (including FMD) vaccine bank for exclusive United States use.
P2. Request that Congress direct the vaccine bank to expand the vaccine strains on hand and the numbers of those vaccines available for use. 
P3. Request that Congress fund this vaccine bank adequately in the next Farm Bill.

As you can see from this very simple (but important) example, subjectively and objectively characterizing a problem, assessing that problem, and generating a plan for that problem is not too far removed the process veterinarians use every single day to treat animal patients. As I am sure the Congressmen which whom I met would agree, perhaps Congress would function more efficiently and in a more bipartisan manner if they – the 435 Representatives, 6 Delegates and Resident Commissioner, and 100 Senators – were required to write SOAPs for every problem they faced, just like every veterinary student and veterinarian does for every one of their patients.

Thank you, Congressmen Schrader and Yoho, for taking time out of your very busy days to meet with Derecka and me!