Saturday, November 27, 2010

Large Animal Industries Scream for Medical Attention (While Committing Suicide?)

I recently read a November article in the Washington Post entitled "Vet Students Choosing Pets Over Farm Animals." It described how an AVMA survey of 2010-graduating vet students found that only 2% intended to work with large "non-pet" animals once in practice. According to the article, from 1998 to 2009, the number of small animal veterinarians increased from 30,255 to 47,118 while the number of farm animal vets dropped from 5,553 to 5,040. Three possible reasons for the small animal preference were mentioned in the article: the average companion animal salary is slightly higher, there is risk of greater physical injury in large animal medicine, and drives to farm call appointments are time-consuming.

The Post article explains how the large animal veterinarian shortage is being called a "food safety crisis." For this reason, pending federal legislation seeks to bolster the field of large animal medicine. In addition, at least some vet schools have changed admissions criteria in order to increase the number of students with large animal interest.   

I should point out that none of the large animal medicine disadvantages listed in the article represents the primary and simple reason most students have no intention of working in this field. It's because they were not raised on or near farming operations; that is the main determinant, because modern agribusiness has its own culture-specific view of those animals that's completely disparate from that in companion animal medicine. 
In small animal medicine, most patients are regarded as non-verbal family members; it's a stone's throw from human pediatrics. In large animal medicine, on the other hand, the animals are viewed mainly (if not entirely) as production units, meat, or soon-to-be pieces of meat. In general, the purpose of  large animal medicine isn't to interact with and enjoy animals; it's to ensure the most cost-effective, herd-preserving course of action that creates maximum animal productivity and economic gain.
And in this age of factory farming, concern for and interaction with individual animals is less than ever - it's rarely like this any more. So if Farmer John and Bessie the cow are being replaced with "giant agribusiness operation" and "heifer #706", can we really expect the James Herriot-appeal of large animal medicine to persist? 

It's silly to paint a picture in the media or elsewhere that large animal medicine is just like small animal medicine, except that the animals are larger. For the most part, small animal veterinarian "types" do not just become large animal veterinarian "types"; the cultural and value backgrounds are so incongruous, it's like expecting a Democrat to transform into a Republican or vice versa just because both are politicians.
Seeing this Post article made me flash back to a time not long ago when I was a vet student writing articles for the Student AVMA journal Vet Gazette. Of the 3 animal protection articles I submitted, only the one regarding farm animals was not published. I bring this up because I wrote it in response to this Vet Gazette "student forum" question:

"The need for food animal veterinarians has become an important topic within our profession and our nation. Why do you think graduating veterinarians are moving away from this field and how can this issue be addressed? What would convince you to become a food animal veterinarian if you were inclined towards a different field?"

Here are some excerpts from my response, just dug up from the dark, crowded depths of My Documents and re-read by me for the first time since its submission years ago. (My middle school English teacher would have yardstick slapped me for using that passive voice.) I've taken the liberty of inserting an "OUCH!" after each statement. Reading them now, I still stand by all of these statements, even if some seemed very direct.

Value conflicts between the worlds of food animal and small animal medicine are ever- increasing. As small animal medicine continues to move forward almost equally with the advances of human medicine and medical technology, large animal practice is appearing less like medicine and more like a specialized form of animal production consulting. (OUCH!)

I have also observed time and time again a tendency (of large animal veterinarians and producers) to attack evolving values of society if they interfere with economic gain. This habit is not helping the image of the food animal world. The more agribusiness moves toward ‘factory farming’, the less veterinary students will show interest in working with these animals. Interaction with animals, a huge part of the profession’s appeal, is severely  restricted by the nature of modern agribusiness and its confinement practices. (OUCH!)

In a typical swine confinement facility, the environment usually reeks of urine, and sows packed into gestation stalls are unable to turn around or even move much at all. They remain that way for months on end with no relief... these animals are often orthopedic nightmares and display stereotypical behaviors caused directly by the production environment. While few veterinary students are actively promoting animal welfare reforms to change these production methods, even fewer students are considering switching careers to swine medicine. Unfortunately, its practices can be repulsive to compassionate, animal-loving people who have not been conditioned from an early age to accept them. (OUCH!)

Making an effort to recruit more students with food animal interest and offering financial assistance may bring more food animal veterinarians into the profession. However, it will not change the larger problem, which is that veterinary medicine has the very real potential to become a house divided against itself. (OUCH!)

I knew that the SAVMA Vet Gazette did not want to hear about the larger issue, and that my view would not be published. But look at this, ladies and has been published elsewhere.

Until next time... here is some interesting advice.

Tuesday, November 16, 2010

Declawing Bans Also Passed in the Face of Veterinary Opposition

Prop B's success prompts me to mention another animal protection effort that succeeded despite fierce opposition from its state veterinary medical association. Legislation to ban cat declawing passed last year in San Francisco and 6 other California cities even though the CVMA publicly expressed disapproval. Now, before you make that cliche quip that San Francisco is not representative of anything but itself,  know that upwards of 25 countries have also outlawed declawing and labelled it an act of animal cruelty.

Declawing has become an ethics poster issue for veterinarians. In a way, that's unfortunate, because declawing is a problem created by veterinarians for veterinarians. In other words, the veterinary community winds up quibbling internally over its own issue when it could be weighing in on other issues that cause massive animal suffering elsewhere in society.

As a person who repeatedly comes face to face with severe animal abuse and neglect, I would not place outlawing declaws high on my list of priorities for practical animal protection, even though I will not perform them. It is true that declawed cats can still have a relatively good quality of life. It is true that I would rather be a declawed housecat than a starving stray, a dogfighting dog, a puppy mill breeder, a circus elephant, a battery caged hen, a gestation crated sow, a male dairy calf, or a pit bull mix in a high-kill shelter.

However, even if declawed cats don't typically suffer as badly as some other animals, declawing is ethically significant. It's significant that doctors can be paid to amputate an animal's digits when the procedure has no medical justification. People do not bring their toddler into a doctor's office and appeal to their physician because little Joey's fingers keep picking up crayons and scribbling on the walls. A "real doctor" would never even consider amputating Joey's distal phalanges for that reason. Especially when there will always be other potentially destructive body parts that cannot be amputated.

We know declawing doesn't contribute to animal welfare as a whole or to the health of the individual animal. On the contrary, it induces pain; cats don't get a consolation prize weeklong supply of happy juice for nothing. Declawing also puts cats at greater risk of injury, predation or death if they do escape outside.

Because declawing jeopardizes the natural interest and well-being of the patient, it follows that any veterinarian performing it needs to have a "but it is in the best interest of the patient"-type statement ready in order to justify it.You already know what The Statement is, because it's uttered in automaton fashion whenever and whereever the declawing issue comes up: "I would rather declaw a cat than risk having the owner relinquish it to a shelter, dump it somewhere, or worse!" There's also this occasional addendum to The Statement:  "I've had clients be threatening." 

You don't have to be a psychologist to recognize The Statement for what it is: a weak attempt at rationalization based on a relatively improbable scenario. It does not justify the overwhelming majority of declaws, which are performed even when possible relinquishment is not a factor. 

The Statement's addendum about clients being threatening is even more improbable. I've had numerous people of all different values and walks of life approach me about the possibility of declawing their cat. Not one of them has shot through the hospital door with an uzi, assaulted the first person wearing a stethoscope, and said, "Let me pay you hundreds of dollars to cut off my cat's toes, or I'm droppin' her at the pound... where she'll surely be killed!" It's not that dramatic, and we know it. If it was, we'd be trained in self-defense as well as surgery. Even if a client did act this way, we're not here to give in to and reinforce people's bad behaviors; we're here to set an example for society's treatment of animals. It is possible to deal with bad behaviors gracefully.

What normally happens when clients ask about declawing is just that...they ask about it. So I tell them the known facts. I tell them that declawing involves amputating bone, that it's a procedure with a significant amount of postoperative pain, and... most people stop me right there (has anyone had this experience?) to say they thought only the claw was removed and they are not actually interested in doing that to their cat. In terms of analogy, they thought declawing was to nail trims what waxing is to shaving. No, not's more like cutting off your legs so you don't have to worry about waxing or shaving.   

Even clients who assert their wish to declaw rather than inquiring about it seem to change their minds when I state that I do not personally perform them and explain why. I've never once been forceful with my opinion nor have I needed to be. I don't question my mechanic when he recommends changing my timing belts at a certain mileage. Do you?
But obviously, not all veterinarians discourage declawing and some are upset that non-medical people (i.e. lawmakers) are now "telling them what to do medically." But, again, whether or not to declaw a cat is not a medical issue when it induces pain, alters an animal and there is no medical reason to do it. It's an ethical issue. Lawmakers, activists and the general public are increasingly overruling the veterinary profession on ethical issues. It's deja-vu of many other animal protection vs. veterinarian battles out there (see all my previous blog posts). Perhaps veterinarians need to start re-evaluating what we condone. Again, these are ethical issues.

But for those who prefer to jam a square peg into a round hole by debating declawing on scientific rather than ethical grounds, I'll talk about research studies. A large case-control study published in JAVMA back in 1996 found in its multivariate analysis that declawed cats were 89% more likely to be relinquished to animal shelters. (That's a large percentage, but part of the study did contradict what was found in the univariate model, making it "difficult to interpret.") In this same study, inappropriate elimination was found to be 80% more likely in declawed cats. There have been other studies since that have found an increase in unwanted behaviors after declawing. The most recent retrospective study I know of to date found 18% of cats developing increased biting and 15% developing inappropriate elimination (two potential causes of shelter relinquishment) after being declawed.

However, the AVMA has this political statement on its website: "There is no scientific evidence that declawing leads to behavioral abnormalities when the behavior of declawed cats is compared with that of cats in control groups." Studies like the 1996 case-control study and the retrospective study aren't mentioned by the AVMA, allegedly because they are case-control and retrospective.  However, researchers cannot ascertain development of behavioral problems in a household or whether shelter relinquishment occurs using the same type of study used to determine something like whether or not catecholamine levels rise post-op. Who is going to relinquish cats in a controlled experiment to a shelter? The scientists? And here is my answer to the AVMA regarding whether or not case-control studies should be left out of mention in the future:

British physiologist and epidemiologist Sir Richard Doll and other researchers after him used large case-control studies to demonstrate a statistically significant association between tobacco smoking and lung cancer. Opponents dismissed these studies for many years, insisting that it did not prove causation. Technically, it didn't prove causation, but the correlation was so strong researchers would have been foolish to ignore it. Cohort studies subsequently proved that tobacco smoking is the cause of almost 90% of lung cancer mortality in this country.

My point is that declawing may actually even increase a cat's chances of ending up dumped, euthanized or in a shelter. I hope you will consider that the next time you hear a veterinarian utter The Statement.

This was a long post and you're a trooper if you made it through. In the words of my hero Rod Serling.... thank you and good night.

Friday, November 12, 2010

In Memory of an Ethical Veterinarian: Dr. Dean Wyatt

Sadly, this past weekend we lost a true member of the ethical veterinarian community. The President of the Humane Society of the United States recently gave a beautiful tribute to Dr. Dean Wyatt, the federal veterinarian who courageously testified last year against USDA slaughter plant inspection practices. Dr. Wyatt's tips to the Humane Society years earlier led to a slaughterhouse investigation that incited major calls for reform within the industry.

Here is an article from last year discussing Dr. Wyatt's testimony before the US House Oversight and Government Reform Committee. He was quoted as saying:

"I truly believe that the USDA inspector is the only advocate animals have in slaughter plants. When we turn our backs on the helpless, when we fail to speak on behalf of the voiceless, when we tolerate animal abuse and suffering, then the moral compass of a just and compassionate society is gone."

The humane world and community of ethical veterinarians honor Dr. Wyatt and thank him for devoting his life to the well-being of people and animals. He serves as an inspiration to us all.

Sunday, November 7, 2010

*It Happened in the Hospital* Part 1

In celebration of Missouri Prop B's dramatic, down-to-the-wire, 51% of the vote-gaining victory, today we'll indulge in some hospital stories. Because I have enough of this material to fill an encyclopedia-sized tome, I'll stick to only what I saw this past week.

*A lady told me that her very large dog had a tendency to bite when examined, so I might want to nuzzle him. I may be a dog whisperer, but I don't think so.*

*A very sweet elderly lady told me that when she first got her cat as a stray, she picked all eighty-five fleas off him. "Eighty-five?" I asked, "Did you count them?" She said, "Oh yes. Eighty-five."
All right then. She probably did it in less than an hour eat your heart out, competition!  *

*While I was standing in the lobby writing up my records for a previous appointment, the door to Exam Room 1 kept opening a crack, closing again, opening a crack, and closing again. It was odd, but I just assumed the client was eavesdropping on my conversation with the other doctor. (Clients get a kick out of me talking about non-medical things, like my quarter mil of educational debt or former prostitutes running for NY governor.) However, when I stepped into Exam Room 1, I became immediately aware that this woman's obese, gremlin-faced Boston Terrier was trying to intentionally suffocate her via creation of a noxious gas chamber. Hence her need for intermittent ventilation.
The dog's buggy eyes said to me, "This is what she gets for taking me to the doctor!"  I slickly avoided palpating his abdomen, so as not to worsen our ambiance.  The woman had made the appointment partly to gain weight loss insights for the dog, but confessed that her husband had just given him a lion's share of Italian dressing-marinated pork chops. If for no other reason, it's good to avoid this kind of feeding in order to improve one's own air space.*

Until next time...
Remember to treat the underlying cause.