Human and veterinary medicine
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7496.858 (Published 14 April 2005) Cite this as: BMJ 2005;330:858
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Sir,
As a veterinarian, I was interested in the editorial ‘Human and veterinary medicine’ on the value of collaboration between the two professions. The prevention of dog bites is an area that might benefit from more collaboration.
Dog bites represent a serious health issue. For example, in Belgium each year approximately 1% of the general population needs medical attention following a dog bite [1]. Epidemiological data indicate that 50% of bites are not reported to medical or legal authorities [2].
Children appear to be more at risk of being bitten by a dog than any other age group [3]. In children less than 16 years old, the incidence is estimated at 2.2% each year [2]. Injuries in children are often to the face and neck, and may be life threatening [4].
Most dog bites happen at home, and involve the family pet [5]. At the same time, dogs remain very popular as pets, and there is growing evidence for the physical, psychological and social benefits of dog ownership [6,7]. Data from pet food companies indicate that about one third of families in Europe, and more than 5 million families in the UK, own a dog [8]. Therefore prevention of dog bites is an important issue.
A dog’s tendency to bite depends on several interacting factors, including genetics, early socialisation, learning experiences, education, physical health, mental health and the behaviour of the victim [9]. Because so many factors are involved, measures such as breed specific legislation, as adopted by some governments, are inappropriate [5,9,10]. Instead, tackling the problem requires a multifactorial, multidisciplinary approach [3,9,11].
In 2001, I was involved in a collaborative study with paediatricians in Belgium into the circumstances surrounding dog bites incidents in children, both at home and in public places [5]. One of the findings was that the majority of bites at home were triggered by an interaction from the child towards the dog. Many of these incidents might have been prevented if the parents and children had been more aware of how dogs react in these situations. This suggest that much could be achieved through improved parent/child education [3,5,9]. On the basis of these findings, interactive educational material is being developed for use by children and their parents in families who own dogs.
More collaborative studies are needed to better understand the causes of dog bites, and to develop a coordinated, evidence-based approach to prevention.
References
1. Gisle L, Buziarsist J, Van der Heyden J, Demarest S, Miermans PJ, Sartor F, Van Oyen H, Tafforeau J: Health Enquiry by Interview, Belgium, 2001 , Epidemiology Department, 2002; Brussels ; Institute of Public Health, IPH/EPI Report N° 2002 – 22
2. Kahn A, Robert E, Piette D, De Keuster T, Lamoureux J, Levêque A , Prevalence of dog bites in children.A telephone survey. European Journal of Pediatrics 2004; 163: 424
3. Love M, Overall K, How anticipating relationships between dogs and children can help prevent disasters. Journal of the American Veterinary Medical Association 2001; 219:446-452
4. Demunnynck K, Van de Voorde W, Forensic approach of fatal dog attacks: a case report and literature review. International Journal of Legal Medicine 2002; 116(5):295-300.
5. Kahn A, Bauche P, Lamoureux J and the Members of the Dog Bites Research Team, Child victims of dog bites treated in emergency departments. European Journal of Pediatrics 2003; 162:254-258
6. Poresky, R.H, Companion animals and other factors affecting young children’s development. Anthrozoos 1996; 9:159-168.
7. Triebenbacher SL , Pets as transitional objects: their role in children's emotional development. Psychological Reports. 1998 ;82 :191-200
8. http://www.pfma.com/public/petownership_stats.htm
9. American Veterinary Medical Association, A community approach to dog bite prevention. Journal of the American Veterinary Medical Association 2001;218:1732-1749.
10. Overall K, Love M Dog bites to humans – demography, epidemiology, injury and risk. Journal of the American Veterinary Medical Association 2001; 218:1923-1934
11. Bond LA, Hauf AM, Taking stock and putting stock in primaru prevention: characteristics of effective programs. The Journal of Primary Prevention; 2004; 24 (2):199-221
Competing interests: None declared
Competing interests: No competing interests
Sir, The avian `flu threat indicates the importance of links between the medical and veterinary professions, but the debate needs to extend further still--into the hidden costs of current food policy. Food policy is still excessively reliant on market efficiencies, by minimizing price and maximizing choice [1]. Although the obesity epidemic has brought the Food and Agriculture Organization (FAO) and World Health Organisation (WHO) together on the socio-economic costs of the nutrition transition [2], the associated animal health and welfare costs are easily overlooked. In 2003, the WHO and FAO stressed the adverse health impact of cheap, convenient, energy-dense foods that are high in fats [2,3], but drew back from the implications for the meats and dairy fats industries. The point was not lost on industry, however, which funded defensive economic assessments [4].
Historically, there was a good public health case for reducing the price of foods, particularly meats. Vets have helped deliver that policy. Today, vets help farmers control the diseases and other welfare concerns that intensive farming inadvertently promotes. Doctors, in turn, deal both with farmers’ health, as farmers struggle to remain in business, and with the public’s health, damaged by the modern diet. So, should vets and doctors join together to examine the case for radically reforming current food policy? Certainly, the links between reduced human health and farm animal welfare are matters of public interest that lie across and within the professions’ respective purviews. There is also considerable cultural pressure to rethink food policy, not least to internalize the public health costs of industrialized food processing and distribution systems [5]. Moreover, many consumers now tend to associate good human health with good animal welfare [6], and the health professions are being asked to encourage a dramatic shift in national diets [3]. Thus, the time is right for joint veterinary and medical debate about food policy, and even a shared position.
This position should not be simplistic. While a new balance is needed between consumers and the animals they consume, it depends on complex psychosocial, economic, and political factors. A joint position would be timely, however, because agricultural policy is currently a ‘hot’ issue in the World Trade Organisation negotiations; a rethink is needed of the 1994 Sanitary and Phytosanitary Standards agreement – for one – because it prevents human health or animal welfare from being allowable trade barriers. The public deserves better than such minimalism. It is time to raise the game.
References
1. Lang T. What is Food and Farming For? - The (Re)emergence of Health as a Key Policy Driver. In: Frederick H. Buttel and Philip McMichael, eds. New Directions in the Sociology of Global Development, New York: Elsevier. Forthcoming 2006, 123-145.
2. Popkin BM. An overview on the nutrition transition and its health implications: the Bellagio meeting. Publ Health Nutr 2002; 5:93-103.
3. WHO & FAO. Diet, nutrition and the prevention of chronic diseases. Report of the joint WHO/FAO expert consultation. WHO Technical Report Series, No. 916, Geneva: World Health Organisation and Food and Agriculture Organisation, 2003.
4. Irz X, Shankar B, Srinivasan C. Dietary Recommendations in the Report of a Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (WHO Technical Report Series 916, 2003): Potential Impact on Consumption, Production and Trade of Selected Food Products: report for the International Federation of Agricultural Producers & Institute for European Food Studies: 59. Reading: University of Reading Dept Agricultural and Food Economics, 2003.
5. Pretty JN, Ball AS, Lang T , Morison JIL. Farm costs and food miles: an assessment of the full cost of the UK weekly food basket. Food Policy 2005; 30: 1-20
6. Harper G, Henson S. Consumer Concerns about Animal Welfare and the Impact on Food Choice (EU FAIR CT98-3678). Brussels: EU; c. 2005 [cited 2005 Aug 9]. 2001. Available from: http://www.europa.eu.int/comm/food/animal/welfare/index_en.htm
Competing interests: None declared
Competing interests: No competing interests
THE COMPARATIVE CLINICAL SCIENCE FOUNDATION
It is particularly interesting that, at this juncture, the British Medical Journal (BMJ) and the Veterinary Record have jointly decided to publish theme issues to explore how vets and doctors can collaborate in the future.
To say that it is foolhardy for someone who is not a scientist, a doctor or a vet to venture to comment in a specialist journal on this subject would be an understatement. However, I do so, emboldened by a number of happy years chairing the Council of The Royal Veterinary College and as the Chairman of the recently established Comparative Clinical Science Foundation (CCSF).
The United Kingdom is strong in veterinary science. Ever since Martin and Irvine pioneered the use of bibliometric indices to assess our scientific performance, our standing in this field has consistently been rated as strong. Indeed, the performance of both the institutes and the veterinary schools in their respective assessments supports that view.
However, the same reassuring state of affairs does not obtain in one area in particular: Comparative Clinical Science. The Selborne report (published in 1997) said that British comparative clinical science suffered from lack of a strategic funding focus and that output was not of a high enough quality. The British Veterinary Association (BVA) has suggested that the first of these weaknesses could best be addressed by using the Medical Research Council as a channel for funding. Incidentally, the Americans reached a similar conclusion when their Pew Report proposed using the National Institutes for Health (NIH) for a similar purpose.
In 2000, therefore, the Medical Research Council (MRC) agreed to establish a Comparative Clinical Science Panel, using new funds, for an initial trial period of 5 to 7 years. The reason for the trial period was to protect the MRC from any possible criticism that it was 'diverting' funds away from human research and to accumulate the evidence for the benefits for human medicine which could result from collaborative research in comparative clinical science. Now, the Comparative Clinical Science Foundation has been established, in order to raise the first £25 million towards the MRC starting this project. Leading medical and veterinary organisations have generously contributed the working capital to establish the appeal. Those organisations include: The Royal College of Physicians, The Royal College of Pathologists, the Royal College of Physicians and Surgeons of Glasgow, The Royal College of Veterinary Surgeons, The British Veterinary Association, The British Small Animal Veterinary Association, various specialist and territorial divisions of the British Veterinary Association, as well as individuals. This is, in itself, a tribute to the importance both professions attach to the project.
Furthermore, the project has now received the personal support of Lord May, former Government Chief Scientific Officer and now President of the Royal Society, and of Lord Winston.
In recent years, what I am told are known as "minimally invasive quantitative techniques" have strengthened the relationship between comparative medicine and comparative clinical research, especially by using the spontaneous disease models encountered in veterinary medicine. Moreover, it seems these are particularly useful for the modelling of multifactorial diseases, such as hypertension or chronic renal failure, or the assessment of novel therapies, e.g. for cancer, before they finally reach human patients. Veterinary patients thus gain the benefit of innovations far sooner than hitherto and which can then be used in human medicine.
The MRC Panel will attach particular importance to collaborative projects involving veterinary clinicians based in practice, as well an institutes and schools, both medical and veterinary. This will have a number of advantages. It will ensure large and representative populations of patients, rather than the small groups available to single establishments and will maximise the cross fertilisation between basic and clinical science and between human and veterinary medicine. Such research will also deliver a number of other benefits. It will raise the quality of veterinary clinical research and provide the evidence base essential for the future credibility of veterinary medicine. Perhaps, most interestingly of all, it will encourage practitioners to become involved in clinical research, reducing the traditional damaging division between a career in practice and a career in research.
The veterinary schools are often criticised for receiving the cream of the biologically-motivated school leavers, but failing to attract many to a career in research. Many graduates are deterred by the difference in material prospects and career continuity, but they also love the everyday contact with their patients that a career in practice brings. However, clinical research is what young and enthusiastic clinicians can do for the patients of tomorrow. If the intellectual cream are skimmed into practice - and large practices, in particular, have the range and volume of caseload of a district general hospital - it is essential that able practitioners are not lost to collaborative research. The panel will, therefore, favour projects based on collaboration between practice-based researchers and those in veterinary and medical institutes or schools.
Many feel that the new MRC Comparative Clinical Science Panel represents the most important development for veterinary clinical science for over 60 years. It will serve to maximise collaborative studies between veterinary and medical clinical scientists interested in the same diseases; to exploit the opportunities to draw lessons concerning the causes, diagnosis, prevention and treatment of human diseases by studying the equivalent diseases among veterinary patients; to enhance the quality of veterinary clinical science and strengthen the evidence base for veterinary medicine. It will, in short, benefit animal patients, as well as their owners.
We are able to give a new impetus to collaborative research in comparative medicine because the subject has been transformed by the advance in molecular biology and molecular genetics during the last 10 to 15 years. Until then, animal models of disease were just that; models, imitations, recognisably similar, but not identical. My scientific friends and colleagues are daily demonstrating that the receptors, the mediators and the relevant genes underlying similar diseases in humans and animals are, in fact, identical. From now on, we can study disease in one species to the benefit of most creatures, man included. Our knowledge of diseases and thus our ability to treat them will vastly increase and, incidentally, the amount of suffering we inflict in order to make progress, will decline significantly.
It is interesting that, after centuries of division, human and animal medicine are coming together. I hope that those interested in promoting scientific progress will support the CCSF, as the Veterinary and Medical Professional bodies have done. In particular, animal charities, which have led the way in animal welfare, have large funds at their disposal. I hope it would not be too impertinent to suggest that their support could achieve an immense amount for animal welfare, over and above what they do already.
Robert Salisbury
The Marquess of Salisbury
Chairman, Comparative Clinical Science Foundation
Competing interests: None declared
Competing interests: No competing interests
EDITOR – The BMJ 16 April 2005 editorial ‘Human and veterinary medicine’ showed the British Medical Association in a united front with the British Veterinary Association and the Pet Food Manufacturers’ Association. We believe this was an unforeseen mistake requiring urgent correction.
For many years we have kept pet dogs and cats and for many years we fed processed pet foods and held veterinary surgeons in the highest esteem. But when we read Raw Meaty Bones www.rawmeatybones.com the peer-reviewed, fully referenced exposé on the processed pet-food industry/veterinary profession alliance we saw things in a different light. Nowadays we run a website www.ukrmb.co.uk and campaign against what we regard as a major scientific and consumer scam with major implications for animal and human health.
In December 2004, 55 Members of Parliament signed the Early Day Motion:
PROCESSED PET FOODS AND VETS
(http://edmi.parliament.uk/EDMi/ EDMDetails.aspx?EDMID=26858)
"That this House deeply regrets the professional endorsement of processed food for domestic dogs, cats and ferrets by some members of the veterinary profession; is concerned at the level of incidence of malodorous gum disease and associated diseases of the kidneys, liver and other organs amongst the domestic pet population; recognises that their health and welfare is best served by foods, such as raw meaty bones, that reflect the full range of nutritional need; applauds and recommends the work of veterinary surgeon Tom Lonsdale and others in this field; recognises also that vets in the UK are trusted and independent advisers on the health of our pets; is therefore concerned by the nature of the relationship between some vets and producers of foods that cause illnesses in pets; and calls upon the Royal College of Veterinary Surgeons to make a definitive statement on the active endorsement and promotion of processed pet foods by vets."
We at United Kingdom Raw Meaty Bones consider ourselves fortunate. We discovered our mistake, swallowed our pride and now dispense dietary advice with medicinal effects. Respectfully we call upon the BMJ to do likewise. An editorial correcting and balancing the record could go a long way towards safeguarding the health and welfare of patients, whether they walk on two legs or four.
Jackie Marriott (Mrs)
United Kingdom Raw Meaty Bones
Support and Action Group
www.ukrmb.co.uk
www.rawmeatybones.com
e.mail: info@ukrmb.co.uk
Competing interests: None declared
Competing interests: No competing interests
EDITOR - The British Medical Journal and the Veterinary Record are to be congratulated with respect to their editorial suggesting a more complete integration of human and veterinary medicine(1).
Although over the years differences between the two disciplines have narrowed, particularly with respect to therapeutic options within ubiquitous economical constraints(2), physician responses to present day sophistication of veterinary medicine can sometimes border on the condescending. The fundamentals of medical physiology and pathophysiology are the same, and many disease syndromes are similar enough to warrant numerous animal models for human conditions. The consequences of this can be profound when, as Drs. Alder and Easton point out, the medical fates of humans and animals can be inextricably entwined through emotional bonds, economic necessity and/or zoonotic potential.
Because of contemporary challenges outlined in the editorial perhaps medical and veterinary schools should facilitate combined programs for certain motivated individuals. Given the universal underpinning of medicine this should be no more or less challenging than combined medical/dental or research degrees and probably much more rewarding: a program for physarians perhaps!
Hadley Bagshaw
Staff Veterinarian
Red Bank Veterinary Hospital,
Red Bank, New Jersey 07724
Roger Bagshaw
Anesthesiologist
Hospital of the University of Pennsylvania,
Philadelphia, PA 19104
1. Alder M, Easton G, Human and Veterinary Medicine. British Medical Journal 2005;330:858-59.
2. Brown JP, Silverman JD, The current and future market for veterinarians and veterinary medical services in the United States. Journal of the American Veterinary Medical Association 1999;215:161–183.
Competing interests: None declared
Competing interests: No competing interests
British Veterinary Association Policy Brief
EDITOR — The British Medical Journal (BMJ) editorial of 16 May 2005, Human and veterinary medicine, contemplated ‘ways in which doctors and vets can work together’.(1) Midway through the article readers are directed to the Pet Food Manufacturers’ Association (PFMA) website:
‘Half of all households in the United Kingdom own a pet (www.pfma.com/public/petownership_stats.htm), and many pets are just as important as a family member or friend, sometimes more; for them, the same level of health care is expected . . . Doctors may not fully appreciate the importance of the relationship between owners and their animals.’
Before becoming engaged in a threesome with the veterinary profession and the PFMA it might be prudent for members of the British Medical Association (BMA) to consider the 12 October 2005 British Veterinary Association (BVA) Policy Brief reproduced below.
BMA members might also like to consider that:
• Confectioners Mars and Nestlé are the global giants of the junk pet -food business.
• The BVA Policy Brief refers to ‘an ongoing debate within the veterinary profession’ when in fact apathy, censorship and suppression prevail.
• The book Raw Meaty Bones provides a fuller discussion of the evils of a daily diet of junk food for pets, the implications for human health, national economy and natural environment.(2)
• A rebuttal of the BVA ‘Key facts’ is posted at www.rawmeatybones.com and www.ukrmb.co.uk
Tom Lonsdale, veterinarian and author
Email: tom@rawmeatybones.com Web: www.rawmeatybones.com
1. Alder M, Easton G, Human and Veterinary Medicine. British Medical Journal 2005;330:858-59
2. Lonsdale T, Raw Meaty Bones: Promote Health 2001 Rivetco P/L, Windsor DC, Australia ___________________________________________________________
BRITISH VETERINARY ASSOCIATION POLICY BRIEF (12 Oct 2005)
Raw Meaty Bones Lobby
An ongoing debate within the veterinary profession. A small lobby group proposes that pet dogs and cats should be fed a ‘natural diet’ of raw meat and bones rather than commercially prepared diets. The group is active in their criticism of the commercial manufacturers of pet foods. This criticism has recently been extended to the university veterinary schools, which have been accused of teaching undergraduate veterinary nutrition in a biased fashion in return for financial support for research and clinical work within the schools.
Key facts:
• Dogs are omnivorous animals whilst cats are obligate carnivores. Both species require a balance of essential dietary nutrients (e.g. vitamins, minerals and essential fatty acids) for optimal health and longevity.
• Commercially prepared pet foods have been scientifically formulated to contain the optimum balance of essential dietary nutrients for each species. Some commercial pet foods have been designed to satisfy the requirements of specific breeds or the specialised dietary needs of animals with a range of illnesses. The use of such diets over the past decades likely accounts for the increased health and longevity of companion animals.
• These commercial diets are based on extensive research, performed both ‘in-house’ and in collaboration with veterinary schools. Much of this research is published in the peer-reviewed scientific literature. By contrast, there is no scientific evidence base to support the benefits of feeding raw meat and bones.
• Dogs and cats may be fed with home-prepared ‘natural diets’, but it is difficult to achieve the optimum balance of requisite nutrients in this fashion.
• The feeding of raw meat and bones to companion animals carries particular risks, including infection with pathogenic bacteria associated with uncooked meats (e.g. Salmonella, Campylobacter) and injury (e.g. intestinal perforation) caused by bone fragments. The BSAVA (the BVA’s relevant specialist division) advises against the feeding of raw meat or bones to companion animals for this reason.
• The RMB lobby proposes that the feeding of bones is beneficial to oral health (teeth and gums). Similar benefits may be achieved by feeding of purpose designed kibble food or dental chews, without the attendant risk of damage (e.g. fractures) of the teeth.
Main Contacts BVA: Dr Freda Scott-Park [BVA President], BSAVA: Mark Johnston
PFMA: Nicole Harrison 20 Bedford Street, London, WC2E 9HP Tel: (020 7379 9009) Fax: (020 7379 8008) Email: nicole@pfma.org.uk
BVA Press Office: Chrissie Nicholls E: chrissien@bva.co.uk Nadin Sajakow E: nadins@bva.co.uk Helena Cotton E: helenac@bva.co.uk T: 0207 636 6541 Out of hours: 07810 433 730 07929 620 325
Additional Resources • Pet Food Manufacturers Association Information Paper on Raw Meat and Bones Discussions. PFMA, January 2005.
Date last edited: 11 October 2005
Competing interests: Author: Raw Meaty Bones: Promote Health, Work Wonders: Feed your dog raw meaty bones
Competing interests: No competing interests