MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
ON THE VETERINARY PROFESSION Matthew Watkinson
“We have all traded on the sentimental attachment owners
have for their pets…” Nick Henderson BSc MRCVS SUMMARY •
Question everything.
INTRODUCTION (NB This is an expanded version of an article that appeared in Dogs Monthly Magazine in the first half of 2010.) How many of you suspect that your dog’s welfare isn’t always a veterinary surgeon’s main priority? Some? All? None? Judging by what I have read elsewhere, I’m pretty confident it won’t be none, but is this scepticism justified? Is it really possible for people in such a caring profession to lose sight of the welfare of the animals they have sworn to protect? “Veterinary surgeons, both in perception and potentially in reality, face two conflicts of interest: a. The conflict between the income they derive from correcting faults and their duty to advise against breeding practices that cause such faults to proliferate. b. The conflict between what they should advise their client to do and what their client wants to do.” Sir Patrick Bateson, Independent Inquiry into Dog Breeding (http://bit.ly/9sNYce)
Yes. It is unfortunately, although not always for the greedy reasons you might imagine. Yes, there are greedy vets who won’t think twice about recommending the most lucrative treatment options... “Some vets are carrying out costly, non-essential procedures, which could be leading to increased premiums for pet owners, a leading insurer has said…Mr Price, head of animal insurance at Direct Line, told 5 Live costs were rising because although vets were seeing fewer animals, some were recommending non-essential and costly treatments to make up for the shortfall in earnings…‘What we see is a tendency to select more expensive and elegant forms of diagnosis over something more pragmatic,’ said Mr Price.” BBC (http://ht.ly/31ReS)
...and yes, there are some who will find problems where none seem to exist... “Chris Price, from Direct Line, told BBC Radio 5 Live the company had received claims for treatment that its consultant vets considered unnecessary.” BBC (http://ht.ly/31ReS)
but the vast majority of vets are incredibly hard working and extremely compassionate people who truly believe they’re doing the right thing. “We evolved to manipulate both nature and other people – and then deceive ourselves about our motives.” Jay Hansen
Unfortunately however, the right thing isn’t always that obvious and therein lies the problem. Is it right for the owner for example (who pays the bills after all)?
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MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
“However you look at it, [vets] are privately funded and cannot exist without the support of the public. That support can only be achieved by offering services that ultimately benefit people.” Mark Holmes BCVS MRCVS
Is it right for the vet (who, to be perfectly frank, does need to make a living)? “While half of vets claimed to be stressed this was not due to their long hours, but rather due to the inadequacy of the income they received...how much is a stress free [veterinary] work life worth a year? £85,000 is the magic number. Earn that much are you are almost guaranteed to be stress free!” Carlos Michelsen, Managing Director of VetsPanel
Is it right for the dog (how does anybody really know what the dog is thinking?)? In fact, the deeper you look the more complex the situation becomes and it’s easy to see how the dog’s themselves can get left out of the final decision altogether. The dog’s welfare must come first however, so it’s time for a fresh perspective.
ETHICS What everybody needs to remember is that ethics is a very small part of any vets training. As far as I can remember for example, my ethical training was limited to one afternoon with a vicar in five years and that’s nowhere near enough to cope with the intense pressures created by the need to make money out of welfare problems you’d rather you weren’t seeing at all. There just isn’t enough time to teach everybody about the growing number of diseases and treatment options as well as the ethical implications of being able to do something to everything that walks through the door, even though the welfare of all of them is intractably linked with the answer to the following puzzle: I know we can do it, but does that necessarily mean we should do it? There probably is no easy answer to that by the way, but whatever vets will or won’t do for whatever reasons, I do know that welfare is about minimising suffering rather than maximising life, I’m pretty convinced that animals focus on quality of life rather than quantity “When considering an animal’s interests, should quality or quantity of life take priority? Dr Dorothy McKeegan [Lecturer in animal welfare at the University of Glasgow] believed quality of life was more important, and pointed out that this was supported by animal welfare legislation, which considered only quality of life.” Suzanne Jarvis, Where do you draw the line on treatment? Veterinary Record
...and I’m quite sure that nature would rapidly cull struggling animals without a second thought: “It may metaphorically be said that natural selection is daily and hourly scrutinising, throughout the world, the slightest variations; rejecting those that are bad, preserving and adding up all that are good; silently and insensibly working, whenever and wherever opportunity offers, at the improvement of each organic being in relation to its organic and inorganic conditions of life.” Charles Darwin
I realise this isn’t a workable solution in the real world of course, and that the compromise is clearly somewhere in the middle, but I will say this: don’t ever feel bad about putting a dog to sleep if you think it’s suffering, or if you would rather it didn’t have major surgery, or if you don’t think months in a cage is all that kind etc. etc. While your dog is healthy that’s fine, but when it isn’t, don’t let cultural ethics, or veterinary pressure or indeed anything other the current or potential suffering of your animal get in the way of a focused decision.
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MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
PLANNING To help with this I would recommend that everybody with a healthy dog decides what they will and won’t do right now. Don’t wait until you‘re an emotional wreck in a vet surgery. Decide now what your dog needs to be happy and then what you’re prepared to do when these needs have been compromised. Decide now whether you will pay thousands of pounds for a few extra months, or put a dog in a trolley; Decide now whether you will authorise brain surgery, or a limb amputation (some vets will even recommend double limb amputations where necessary). Decide now whether you think it’s worth opening a dog’s chest to manually pump the heart if it stops, or whether you will put it through painful hip replacement surgery. Do it with your vet as well. Find out what they think about extreme surgery and how far they think you should take things. Find out whether their priority will be your happiness or the dog’s welfare when it comes to the really tough decisions. And then tell them what you would like done long before it ever gets to that point. If you don’t want to be given a huge list of possible solutions when you have already made a decision about euthanasia, tell them. If you do want all the options, but you don’t trust yourself to make the right decision, tell them. Get them to make a note of it on the clinical notes as well. For whatever reason, whether greed or client loyalty, vets won’t always make the best decision for your dog and you must get ready for that. “Those of you working away in practice, whether farming or small animal, will have been feeling the draught over the past few months and beginning to wonder when your next big pay day is coming.” Nick Henderson MRCVS, President of the Veterinary Marketing Association (VMA), Veterinary Times
MONEY Money may add an extra dimension to these treatment decisions as well, but if you can’t afford a treatment option, don’t feel bad about that, especially if there will be significant amounts of suffering even if you could. Animals get seriously ill and not everybody is a millionaire. Just make sure they have a good death and march proudly on knowing that you made a tough decision that didn’t involve any extra suffering. Conversely, if you can afford to do everything possible to save your dog’s life, that doesn’t necessarily mean you should. Indeed, unlimited money can be a disaster sometimes. As can insurance. “High claims inflation continues to be a concern for insurers, keeping profit margins low. Claims costs were estimated to have grown by 10.6% in 2008…Veterinary costs continue to be the main driver behind higher claims costs.” Datamonitor (http://ht.ly/31RGC)
Both can free vets to recommend all sorts of fancy operations and treatments – escalating insurance premiums are no coincidence – even though neither should be an excuse for anybody to go all out for life at all costs. “I do the most that can be done – but qualify it with something like: “But I’m a vet and major surgery is fairly day-to-day for me....” Gareth Cross BVSc MRCVS, Veterinary Times
I have seen ancient dogs scream in agony just because amputation may yield a few extra months; I have seen mildly sick dogs opened up just because of insurance; I have seen dogs lying paralysed for months because everybody is thinking about the options available rather than the suffering at stake, and lots of money was the key to all these situations.
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MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
“...we should accept that between 2005-2008, when petrol prices doubled, veterinary fees trebled. It can cost more to treat an animal than a human being and many pet owners are finding this out to their cost.” Ross Tiffin, Veterinary Business Journal
The nursing care is often incredible by the way, but that doesn’t mean the dogs are feeling any better and they must be the priority. Yes, vets should be able to guide you away from such counter-productive options, but no, they don’t always do it (as the mere existence of extreme treatments conclusively proves). They are emotional people and many get caught up in the desire to push the frontiers of veterinary science or do whatever it takes to preserve life, even though the dogs themselves think about their quality of life now, rather than the length of their life in the future. “As a profession, we owe a great deal to our pharmaceutical suppliers and surgical instrument manufacturers. Their progress has helped ours, and we have an array of products with which to ply our trade and encourage the world to love us.” Nick Henderson BSc MRCVS, Veterinary Times
Don’t get me wrong, I think insurance can be a great idea, but not when it’s used like a blank cheque to recommend extreme life-saving treatments that side-line the immediate condition of the dog itself. “Mr Price, head of animal insurance at Direct Line, told 5 Live costs were rising because although vets were seeing fewer animals, some were recommending non-essential and costly treatments to make up for the shortfall in earnings.” BBC (http://ht.ly/31ReS)
It should always be about the dog, never ever about the professional freedom of people who like getting really fancy. “Is your motivation pure, that is, not for ego, money or science?” Professor Noel Fitzpatrick, Veterinary Record
BREEDING "Some of the peculiarities characteristic of the several breeds of the dog have probably arisen suddenly, and, though strictly inherited, may be called monstrosities." Charles Darwin
Fancy and expensive treatments that make use of devoted owners or generous insurance limits are particularly inappropriate when, and this is where I am really going to get challenging (I have been much harsher about this subject elsewhere and I will make no apologies for that), they’re used to help some of the breed related diseases survive and perpetuate. “Its only the ready availability of modern veterinary medicine that has permitted some conditions…to become widespread.” Independent Inquiry into Dog Breeding (http://bit.ly/9sNYce)
As harsh as this may sound, dogs couldn’t care less what they look like and diseases that exist simply because of our sentimental attachments to certain appearance traits clearly have nothing to do with the dogs themselves. “It appears that ‘just liking them’ is a very powerful motive for breeding and buying particular breeds and that this, rather than function, economics or other reasons in the list above, may often be the major factor. If this is the only factor, the question becomes does ‘just liking them’, with whatever human welfare benefits this may bring, justify continued breeding where it is known that there is a risk of poor welfare due to hereditary disease as a result? If animals were to be bred, for scientific purposes rather than as companion animals, where there was a known likelihood that the welfare of some of the offspring would be compromised, this would be permitted only under licence under the Animals (Scientific Procedures) Act 1986, and only where the Home Secretary was persuaded that the benefits outweighed the welfare costs. It seems very
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MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
unlikely that ‘just liking’ something would ever be accepted as a justification for causing poor animal welfare in this context.” Companion Animal Welfare Council, Approaches to tackling genetic welfare problems in companion animals (http://ht.ly/31RQv)
Our reaction to their appearance is about us, not them and I am obliged to challenge everybody to seriously consider this issue. I realise that many of you will never have thought about it that way, and that some of this will be a real shock, but the reality is shocking and we should not try and avoid that. There are no Kennel Club recognised dog breeds without an associated inherited disease for example, and that means something has gone seriously wrong. Indeed, according to a survey by the Royal Veterinary College, the fifty most popular breeds of dog share an incredible 322 inherited diseases between them. This is unacceptable and it’s time for everybody to take a long hard look at their motivation for owning pedigree dogs. Do you like dogs because of the way they look... “Pedigree breeds are meant to cause division of opinion, because if we left dogs free to procreate at will, we’d just have an homogenous mass of collies crossed with staffs…Now, where would the fun be in that?” Oli Viner BVetMed MRCVS, Veterinary Times
...or do you just like dogs? "There has been a great drive for novelty amongst companion animal breeders." Companion Animal Welfare Council (CAWC), Breeding and Welfare in Companion Animals Source » http://www.cawc.org.uk/sites/default/files/CAWCModifications.pdf
If it is the former... “...even those varieties of the dog which have been bred into grotesque deformity by the dogfancier are in good faith accounted beautiful by many. These varieties of dogs—and the like is true of other fancy-bred animals—are rated and graded in aesthetic value somewhat in proportion to the degree of grotesqueness and instability of the particular fashion which the deformity takes in the given case.” Thorstein Veblen, The Theory of the Leisure Class
...you need to remember that many of these inherited diseases are part of that. If it is the latter, then you truly love dogs. For all those who managed to emerge from the previous paragraph without reaching for a big glass of indignant rage, the next issue is the solution to these breed related problems and that is another area that requires veterinary scepticism. “Veterinarians also bear some responsibility for the welfare situation of purebred dogs. In fact, the veterinary profession has facilitated the evolution of purebred dogs. ‘Breeds’ that would not normally be sustainable are propagated by the compliance of veterinarians to breeder wishes.” Koharik Arman, A new direction for kennel club regulations and breed standards(http://ht.ly/31RYd)
Breed issues are lucrative after all, and an unhealthy dog population has obvious financial benefits for the profession: “Due to the way in which the animals have been bred to be more desirable, they are more susceptible to certain conditions that other dogs might not be, meaning the possibility of more trips to the vet." Sainsburys Pet Insurance (http://ht.ly/31RZx)
Now, I don’t think many vets have realised that, but that doesn’t mean it’s wrong and it’s the dogs themselves that matter most. So, for the long-term improvement of the general health of British dogs I would like to offer a radical solution: we must not breed from any dog with any genetic or conformational health issues.
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MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
“In the breeding of domestic animals, the elimination of those individuals, though few in number, which are in any marked manner inferior, is by no means an unimportant element toward success.” Charles Darwin
Forget all the expensive tests and fancy screening procedures... "Genetic testing is alwasy held up as the Holy Grail. Actually, as I will show you, that is not always true. Things that we thought were fairly simple in their genetics have turned out to be far more complex when we have actually had a genetic test. Waiting to do something until we have a genetic test is head in the sand stuff. We can do an awful lot just by looking and seeing." Mike Herrtage (Professor of small animal medicine at Cambridge University)
...that will inevitably recommended by the veterinary profession (of course they want to perform more expensive tests etc.): “...we welcome the practical recommendations for a database, an independent body and the increased use of health screening. However, funding remains a major problem and we hope that Defra and the breed societies recognise the importance of financing these measures." Professor Bill Reilly, Former President of the British Veterinary Association
If you’re worried at all then the risk is too high... “Grapes are not gathered from thorn bushes nor figs from thistles.” The Bible, Matthew 7:16
...and the most responsible course of action must be to eliminate that animal’s genetic proclivities from the gene pool. "...hardly any one is so ignorant as to allow his worst animals to breed.” Charles Darwin
They must be neutered. I know it sounds harsh, but you must never forget that nobody should ever breed from animals with problems they don’t actually want. "The inheritance of good and bad qualities is so obvious." Charles Darwin
That’s the exact opposite of basic breeding logic and it’s time to remember that. What you do after a dog has been neutered has been discussed earlier in the article, but we must not threaten the long-term health of the dog population any further because of the way we want them to look, especially while there are so many hybrid mongrels out there in desperate need of a home.
CONCERNS “What happens behind the scenes at your veterinary practice? It’s difficult for you to be sure…” RCVS
Anyway, back to the veterinary ethics and, in particular, what you should do if you’re not comfortable. Severe concerns should be reported to the RCVS obviously (indeed you guys are the only people checking them at the moment so this is essential), but this should never be done maliciously and without great thought. Most vets are trying to do an extremely difficult job and you must never forget that it is impossible to predict how every patient will respond. Indeed, predicting disease responses is like predicting the weather and it would be extremely unfair to threaten a vet’s career because of an unlucky result. However, there are bad eggs and you are the only people searching for them at the moment. Legitimate concerns could be of extreme value therefore and they should be reported. Beyond the cowboys there are more mild concerns and your solutions to these must be a second opinion. You must be honest with the second vet however. Tell them you are there for a second opinion and be very suspicious if they belittle the other vet in any way. Their assessment may be 6
MATTHEW WATKINSON • WEB: http://www.fishsnorkel.com • TWITTER: http://twitter.com/fishsnorkel
perfectly accurate, but they may also be exploiting your desire to hear a different opinion and that should concern you. What they should do is contact the previous vet to share information and then give you a professional second opinion. They should fight not to criticise the other vet, even if it is perfectly clear that the other vet was wrong, and, if that’s what they do, they’re probably worth trusting.
QUESTION EVERYTHING Having said that, I truly believe that everybody should remain sceptical whatever happens. There is simply no way of really understanding somebody else’s knowledge limits and personal motivations and it is perfectly acceptable to question everything that anybody tells you therefore. Your loyalty is to your dog’s welfare, not your vet and, even if it involves ignoring their advice, you must do whatever it takes to protect this. © Dogs Monthly (www.dogsmonthly.co.uk)
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