Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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a dogs view
- Jeffery C McILwain (23 February 2007)
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Dog Bites - The Blue Dog Programme
- Ray L Butcher (26 February 2007)
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Dogs and Human Health - parallel debate in the Veterinary Record
- Mr Matthew D Clarke, Katherine M Clarke (27 February 2007)
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Need for science rather than politics for progress on dog bites
- Daniel S Mills (27 February 2007)
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Inaccurate figures and statement
- Hugh.D. CORYN. (7 March 2007)
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Primum non nocere
- Tommaso Siciliano, Brian McNicholl (10 March 2007)
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Re: Dogs and Human Health - parallel debate in the Veterinary Record
- Rachel E J Besser (15 March 2007)
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Human bites
- Andrew A Gardiner (28 March 2007)
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Dog Bites: A Better Alternative Than Breed Bans
- Tamara A. Follett (22 November 2008)
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Jeffery C McILwain, Consultant, Clinical Risk Management St Helens & Knowsley NHS Trust, Merseyside L35 5DR
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I read the article by Ms Besser with a deal of interest. As an owner of a rescue greyhound I can concur with most of what she writes. Dogs are descended from wolves and so will retain some of these vulpine traits. Yet how often are parents cajoled by little Wendy “to have one of those fluffy puppies” as seen nightly advertising toilet tissue. Most people forget that puppies grow up, require looking after for food and toilet and have teeth. Interestingly a set of teeth is called ‘canine teeth’ in humans! So indeed it is rarely the dog’s fault when it is hungry and then disturbed with “its kill” by little Wendy pulling its ears or tail. Yet, some form of control is possible. One can limit the breeds so more aggressive breeds are not bred or are more heavily controlled by legislation. Many rescue centres do routinely neuter the dogs and chip them as well as vetting potential owners. It is also worth remembering how much dogs have given humans aside form work dogs. Greyhounds in the 1960’s and 70’s who failed on the track in Belfast were taken for medical research. The development of cardiac defibrillators was part of this. The energy damage was assessed on living greyhounds to ascertain the energy of shock that heart muscle could withstand without further damage. However, aside from rescue centres it is humans who profit from dogs. Greyhounds make money for their owners, trainers and some punters, yet, when they fail a race they are either discarded or murdered at the track (the human euphemism of “being put down” is used); similarly dog breeders make a handsome profit from each litter, up to £350 for a Labrador pup. A rescue greyhound, neutered, chipped and vaccinated comes in about £100. Further, aggression can be bred out of dog breeds, as happens with greyhounds, to prevent competitiveness on the track. Greyhounds prefer to sleep for 20 hours a day and require x3 walks a day – not miles of running. As to dog free parks and muzzles, this situation is occurring in Manchester whereby the proposal is for a £80 fine for a dog off the lead, despite the fact that 50% of park users are dog walkers and who also pay Council Tax to maintain the park for the teenage drinkers who seem to inhabit them. I reckon few could afford such a fine which is £20 more than driving a car with a mobile phone to one’s ear. Rather than dog free parks, why not dog zones that are fenced off so that dogs can exercise off lead and away from the public – safer for the dog and safer for the humans. Finally, as to ‘fouling’ responsible owners do pick up dog faeces and bin it (if ever one can find a bin) yet the faeces of feral cats and urban foxes remains well below the radar of City Councils in their ‘pest’ control. Ms Besser is correct, it is to humans one must look to resolve dog issues. Dogs do what comes naturally to them and perhaps too many children see too many toilet paper advertisements and so forget, or are unadvised, that they are playing with the descendants of wolves, some of whom have given much to human medical research. Competing interests: None declared |
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Ray L Butcher, Veterinarian Wylie Veterinary Centre RM141TD
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Dear Sir Ref: Dog Bite articles in BMJ / Blue Dog Programme I was very interested to read the paper (Morgan & Palmer) and comment (Besser) in the recent BMJ on dog bite incidents and treatment.. As the authors rightly point out, dog bites are a serious issue causing not only distress to the unfortunate victim, but also a financial drain on the NHS. Understandably, the really serious incidents receive much media hype, and sadly the “knee jerk” reaction of the authorities is to blame specific breeds. Available data shows this is not the real problem, as most bites occur in children within their own home by their own dog. A comment in the BMJ article even suggests a ban on all dogs!!! However, having a pet dog has been shown scientifically to enhance the health of the owners as well as helping with child development. Dogs are being increasingly used in therapeutic settings, especially in relation to older people. The challenge therefore is to devise a way of retaining all the benefits of pet ownership yet reducing the risks. I am a veterinarian in practice in Upminster Essex, but I am also the secretary of the BLUE DOG TRUST. This has developed by collaboration between professionals of multi disciplines (veterinarians, pediatricians, dog behaviorists, educational psychologists, teachers, graphic artists) to devise an appropriate educational tool for young children to help address this problem. Valuable lessons were learnt from the changing emphasis in other accident prevention programmes (eg Road Traffic accidents), where it has been shown that teaching children to recognize risk situations is more effective than simply providing them with a list of rules. Accordingly, an interactive CD ROM with a parent guide has been developed. It is hoped that the child will learn to recognise risk situations while enjoying the CD as a game (so called “edutainment”). Its efficacy as a learning tool has been assessed by Dr Kerstin Meints at the Child Psychology Department at the University of Lincoln. Since the launch of the program at the World Small Animal Veterinary Association Congress in October 2006, we have had fantastic feedback from vets throughout the World. Translation of the parent guide into many languages is now under way. We are currently trying to make inroads into the teaching profession within the UK. It is also essential to involve the medical profession. A multi-discipline group is already being set up in Belgium, and it would be good to have a similar group within the UK. I would be keen to hear from medical colleagues with an interest in this problem. Further details can be found on our website: www.thebluedog.org or contact me on: ray.butcher31@tiscali.co.uk The project is managed by THE BLUE DOG TRUST, which is registered as a non-profit making organisation. All surpluses made from royalties received from the sale of the product will be used to fund further research and development. This research can be broadly classified into: 1. Further investigations into the efficacy of the existing CDROM and Parent guide 2. Investigations into aspects of child behavior that might trigger bites 3. The study of the trigger factors that initiate bite incidents in other cultures and the development of appropriate educational tools for these situations. This has special relevance to rabies control programmes, and the developing world and the BLUE DOG TRUST has formed a partnership with the Alliance for Rabies Control (ARC) for this specific purpose. Yours sincerely Ray Butcher MA VetMB MRCVS (Secretary BLUE DOG TRUST, 196 Hall Lane, Upminster Essex RM14 1TD) Competing interests: Secretary of BLUE DOG TRUST |
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Mr Matthew D Clarke, Consultant Surgeon Friarage Hospital Northallerton DL6 1JG, Katherine M Clarke
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Dear Sir, As a veterinary surgeon I picked up my husband’s copy of the BMJ dated 24th February 2007 with interest. The dramatic front cover drew my attention to the article on page 425 titled “Managing Dog Bites”. After reading the review I felt saddened at them author’s attitude towards dogs and was surprised to read that she was a life long dog owner. I would be the first to admit that a dog that has bitten, especially a child is in many cases best destroyed and I would not hesitate to euthanase such an animal. However to tar all dogs with the same brush and to suggest a dog ban to prevent biting is unfair. The negative opinions in this article contrast with the positive impact of dog ownership on human health described in editorial published in the Veterinary Record this very week [1]. The Record cites research showing that dog owners tend to be fitter, have lower blood pressure and cholesterol and a greater level of physiological well being [2]. The NHS should weigh up the cost saving implications of the above with the cost of treating dog bites. Let us also not forget the life enriching work carried out by the Guide Dogs For The Blind, Hearing Dogs For The Deaf, and Dogs For The disabled. These charities must save the NHS thousands of pounds in carers fees. Education of dog owners is the key to reducing dog bites but I disagree with Ms Besser’s suggestion that vets do little to advise owners. Animal behaviour makes up a significant part of the veterinary undergraduate curriculum and veterinary practices are very conscious about the need to spend time with owners of new dogs especially puppies discussing dog behaviour. Indeed many will run puppy socialisation and training classes. To suggest neutering all dogs would solve the bite problem is naïve. Dogs bite for many reasons. Neutering with behavioural therapy can reduce the incidence of dominance aggression but it can have an adverse effect in anxious dogs and make them more prone to displays of nervous aggression. Mrs Kate Clarke MRCVS 1 Benefits of dog ownership on human health. The Veterinary Record, vol 160 issue 7 p 209, February 17 2006. 2 Wells, D.L. (2007) Domestic dogs and human health: an overview. British Journal of Health Psychology vol 12, pp145-156. Competing interests: None declared |
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Daniel S Mills, Professor of veterinary behavioural medicien University of Lincoln LN2 2LG
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Sir, The Review of Morgan and Palmer (BMJ 2007:334:413-7) is a timely reminder of some of the dangers associated with dogs, in light of the recent tragedy of Ellie Lawrenson, but should not obscure the enormous benefits dogs bring to a society, which increasingly seems to see banning or exclusion as a solution. Unfortunately the more we remove ourselves from those with whom we share common space the more we are likely to provoke further misunderstandings and violence as a consequence. As Morgan and Palmer point out, most attacks are “apparently unprovoked” and this is more a reflection of our ignorance than the true nature of the problem. Dogs rarely, if ever, bite without reason, it is just that they see the world differently to us. What might seem innocuous or friendly to us might be seen as potentially threatening or intimidating to another which uses a different communication system. It is a shame that in the UK, in contrast to some other European countries, it is increasingly difficult for owners to fully incorporate their dogs into their lives as “No dogs allowed” seems to become the norm. As a result people do not understand normal canine behaviour and we must seek to educate them accordingly. There are a number of excellent recent research-informed, initiatives in this direction, in addition to the Blue Dog programme (www.thebluedog.org) for young children mentioned by Besser (BMJ 2007:334: 425) which seeks to teach appropriate behaviour rather than precautionary behaviour around dogs, (the outcome of the “Prevent-a-bite” scheme in Australia). These include the text “The canine commandments” by Kendal Shepherd, who is also developing an educational package compatible with Personal, Social and Health Education requirements within the national curriculum for older children, which is being supported by the Association for the Study of Animal Behaviour. However, there is a need for further research and funding for such initiatives. At present there is a dearth of knowledge concerning the circumstances of most attacks, simply because we don’t ask the right questions. With this in mind, I would like to propose an initial scoping meeting to identify research priorities for prevention and would be delighted to hear from colleagues willing to contribute to an initial discussion. Yours sincerely, Daniel S. Mills BVSc PhD CBiol MIBiol Dip ECVBM-CA MRCVS
Competing interests: None declared |
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Hugh.D. CORYN., MRCVS Retired CO6 3AP
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Figures for German Shepherds (Alsatian) take no account of the significant number of legitimate bites by Police and other Security services whilst dogs are detaining suspects who have run off. The modern GSD has a much improved temperament. I know of no study which would back up the statement that neutering would ultimately solve the problem. Hugh D.Coryn MRCVS Competing interests: None declared |
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Tommaso Siciliano, Accident and Emergency Staff Grade Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Brian McNicholl
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Sir We welcome the publication of the clinical review Dog Bites (1) as a valuable source of evidence for those involved in either pre-hospital or in- hospital care. However, we do not agree that cervical spine immobilization is required in all head and neck bites in children. The application of the collar is technically difficult, it causes agitation in small children and it may restrict expansion of neck haematomas causing airway compression. This is more likely to occur if inexperienced staff apply the collar. It also demands a stretcher and an ambulance, which may not be required. A search of the relevant literature (Ovid Medline 1990-2007, Pubmed 1990-2007) reveals only one case of cervical spine injury due to dog attack in a 2-year-old child, while blood vessel and airway injury are more common (2). We recommend that dog bites to the head and face in children be treated as any wound in this area, based on the mechanism of injury and severity, always honouring the Hippocratic primum non nocere! Pre-hospital providers should take spinal immobilization precautions according to local protocols. Other carers should use the SAFE approach (3) as minimize agitation may be the best form of cervical spine immobilization. References 1. Morgan M, Palmer J (2007). Dog bites. British Medical Journal. 334: 413-417 2. Mitchell RB, Nanez G, Wagner JD et al (2003). Dog bites of the Scalp, Face and Neck in Children. Laryngoscope. 113: 492-495 3. Advanced Paediatric Life Support Group (2001). ALSG BMJ Books Competing interests: None declared |
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Rachel E J Besser, Paediatric specialist registrar London Deanary
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Dr Clarke has missed the point of my Personal View regarding dog bites (1,2). Careful reading of my article would have highlighted my view that education to dog owners, parents and children as key to preventing further bites and hospital admissions. In addition I have not dismissed vets as educaters, but suggested that doctors, vets and schools need to work together. Dr Clarke has rightly pointed out the vital work carried out by organisations such as Guide Dogs for the Blind. Of course these dogs, and most importantly their owners, are thoroughly trained. I am sorry that Dr Carke appears to have missed the irony in my suggestion of neutering all dogs since, by implication, if all dogs were neutered, dogs would soon cease to exist. As a lifetime dog owner and paediatrician, I have seen first-hand the positive influence that owning a dog can bring. Clearly current education is not working at some level, otherwise hospital admissions due to dog bites would not have doubled in the last decade despite no increase in dog ownership. Dr Rachel E J Besser BSc MBBS (Hons) MRCPCH. (1) Besser R.Dog attacks:it's time for doctor's to bite back BMJ 2007;334:425 (2) Clarke K. Education of dog owners is key to reducing attacks BMJ 2007;334:489 Competing interests: None declared |
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Andrew A Gardiner, Veterinarian Edinburgh EH8 9RF
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It would be interesting to know, for comparison, the numbers of human bite cases (on humans) seen in accident and emergency departments. Also whether many vets have seen dogs bitten by humans - I remember one case of this. Other forms of deliberate trauma towards animals are of course much commoner. I think in general vets are more aware of potential problems in this area and most at least try to make appropriate recommendations for referral. The hardest thing is sometimes ensuring owners are aware there is indeed a problem that needs taken seriously and intelligently with adequate follow up, preferably at an early stage because to the experienced eye there are plenty warning signs. Problem dogs cannot be dealt with in the absence of owner commitment and involvement. In effect, the owner has to be taught to be their own pet's animal behaviourist - that takes time and effort. Competing interests: None declared |
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Tamara A. Follett, President/CEO of Dog-Trax Napanee, Ontario, Canada
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In 2004, an investigation tasked with finding a solution to the escalating incidence of dog bites was launched in Canada. Three years later we resurfaced, with an evidence-based series of corrective actions identified through a formal risk assessment and entitled the "7-Step Dangerous Dog Risk Mitigation Protocol". It, and the rest of our research, is available at no cost on: www.PreventDogBites.com and www.PreventDogBites.ca. This 7 Step Protocol consists of the specific corrective actions needed to eliminate the problem of dangerous dogs, without breed bans, and without infringing on the rights of responsible owners. Once fully implemented, these controls are projected to reduce the incidence of dog- human attacks and Dog Bite-Related Fatalities by as much as 90%. (We determined this through a standard Failure-Mode Effects Analysis, whereby quantified risks are broken down into their component exposures, one or more corrective actions identified to address each exposure, and the probability of the exposure occurring in light of implemented controls is recalculated.) We are currently seeking a researcher interested in analyzing the results of a year-long 2009 pilot of Dog-Trax. (The risk assessment indicated that implementation of just one control -- the tracking of problem dogs and owners-- could result in as much as a 70% reduction in dog bites.) If readers are aware of any researchers that might be interested in participating in the study, please alert them to this need. This system was developed in Canada, but was designed for global application, so running a pilot in the UK is feasible. Thanks for any assistance you can provide. Competing interests: Designer and Owner of the Dog-Trax database and the PreventDogBites websites |
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