Dog ownership has unknown risks but known health benefits: we need evidence based policyBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4081 (Published 17 July 2014) Cite this as: BMJ 2014;349:g4081
All rapid responses
Thank you to everyone that has taken the time to respond to this letter so far. I hope that my comments below will address some of the points made in those responses.
To Steve Chaplin:
It is true that the risk of dog bites is a real one, but in order to know if policies designed to reduce that risk are effective, we must first quantify the problem. I don’t deny that dog bites can result in serious physical and mental trauma, and I am certainly not advocating withholding measures that are evidenced to reduce the risk. However as no such measures are used on a national basis in the UK, I am advising against the use of reactionary measures that satisfy the need for the government to be seen to be acting, and therefore take the place of measures that could be more effective.
As it stands, the UK government is relying on a punitive law, which by definition does not protect against dog bites, rather than implementing nationwide policies to reduce the occurrence of dog bites. Formulating a solution to the problem in consultation with the relevant scientific literature would be a more appropriate course of action, but even this would need to be measured in terms of its effectiveness to ensure that it offers a solution rather than a ‘pseudo-solution’ to the problem at hand.
To Jukka Lindeman:
Thank you for your contribution. One of the purposes in writing this letter was to point out that dog risks must be considered alongside dog owning benefits.
To Gee Yen Shin:
Thank you for your response. I recognise that whether or not an anti-dog culture is perceived depends upon the cultural sphere examined. In this letter I was referring to remarks made by authors of other articles in this journal, and to the propagation of anti-dog messages by the news media, in particular by tabloid publications.
I agree, as previously stated, that a better classification system would benefit the situation. Indeed HSCIC reports do already contain some very specific categories of injury. For example, the W58 category is used for injuries caused by a crocodile or an alligator (three were reported in the 2012-2013 report). Recording the dog breed responsible would be a step in the right direction in terms of data collection, but breed is only part of a very complex picture involving the interaction of behaviour between two different species. By solely focussing upon breed, we risk ignoring the range of complex factors that can affect a dog’s behaviour.
Incidentally, there is a code for human bites. Suarez’s victim, had he been hospitalised overnight in the UK, would have been categorized as a W50 patient. Unless, of course, he was truly accidentally bitten, in which case he would be assigned to the W51 category. If separate categories based on intentionality were also afforded to dog related injuries, we would perhaps see a very different set of numbers in the news media.
To Christopher J. Mannion, Kendal Shepherd and Danielle Greenberg:
Thank you for your considered response to my letter. Again, it was not my intention to hide the problem of dog bites. I believe I made this clear in my letter, as I am calling for appropriate data collection so that the efficacy of measures to reduce dog bites can be assessed. I would like to reiterate here that HSCIC data cannot be relied upon as a measure of dog bite occurrence. Interpreting it as such, or repeating these interpretations from other sources is to be discouraged. Using tabloid publications as a reflection of public opinion is also to be discouraged, as they have their own political agenda. I have recently been involved with a qualitative project aimed at gathering the views and experiences of dog owners and professionals on aggressive behaviour and dog ownership. Hopefully this research will lead to more systematic assessment of the views of the public with regards to this issue.
I would be very interested to know the response you obtained form the various MPs you have contacted and the House of Lords. I am also looking forward to reading your submitted paper ‘Dog Bite Injuries: What Can We Do?’ It is encouraging to know that others are promoting the use of evidence based strategies to address the problem.
In reference to the expense incurred by the NHS as a result of dog bite injuries, again no valid figure is available, and the approximation mentioned by Ian Lavery in the House of Lords debate on Responsible Dog Ownership was based on the very figures I have discredited in the course of this letter. It is important that accurate data collection is prioritised if we are to accurately quantify the problem and know if measures implemented to curtail it are successful.
1 Legislation.gov.uk. Dangerous Dogs Act 1991.http://www.legislation.gov.uk/ukpga/1991/65/contents
2, 3 HSCIC. Hospital Episode Statistics, Admitted Patient Care, England - 2012-13 http://www.hscic.gov.uk/searchcatalogue?productid=13264&q=title%3a%22Hos.... Published November 5, 2013
4 Parliament.co.uk. Minutes from ‘Responsible Dog Ownership’. http://www.publications.parliament.uk/pa/cm201213/cmhansrd/cm130226/hall.... Published 26 Feb 2014
Competing interests: No competing interests
We welcome the recent view by Orritt (BMJ 2014; 348:g4081) regarding dog ownership and the problem of dog bites. The author rightly highlights the issues of inaccurate use of statistics and reporting associated with dog bite injuries (DBI) especially by the media. Yet, this does not hide the fact that a very significant clinical problem exists (Mannion CJ, Mills DS. Injuries sustained by dog bites. Br J Oral Maxillofac Surg 2013;51:368-9).
As a surgeon, I see on an almost daily basis, wounds caused by DBI. Ask any GP, Emergency Department doctor or Maxillofacial and/or Plastic Surgeon and you will hear a similar story. Not only does this problem affect the general public, but I am also increasingly seeing a large number of veterinary surgeons who are being bitten and severely injured which is specifically recorded.
There is a wealth of research data that documents the differences in anatomy and locations of bites, the differing patient ages and socioeconomic groups, regional variations and even variations between countries regarding DBIs (Mannion CJ. Graham A. Shepherd K. Greenberg D. Dog Bite Injuries: What can we do? Submitted to BJOMS July 2014).However, there is little or no data relating to the number dogs euthanized each year due to dog bites (at vast expense to the public purse). It is therefore too simplistic merely to discuss dog bites without understanding the context of the bite injury. All too frequently, this information is not collected and investigated. Breed is equally poorly discussed or properly documented.
Certainly this is a public health issue where the Medical and Veterinary professions can truly demonstrate inter professional working and collaboration (Mannion CJ, Shepherd K. One Health approach to dog bite prevention. Vet Rec. 2014 Feb 8;174(6):151-2.).It is documented that the 10% most deprived areas of England had 3 times higher admissions with bite and strike injuries compared with the 10% least deprived areas (BMJ 2014;348:g2991). Could social deprivation or/and poor human (antisocial) behaviour lead to poor canine behaviour and aggression. A recent newspaper article highlighted this: ‘Why I hate arrogant dog owners who can’t keep their mutts under control’.(Daily Mail, page 15 July 24, 2014). Therefore to fully address this problem, further agencies should also be involved including the Police and Social services and local authorities.
Perhaps what is most striking is a clear lack of any coherent public health policy and strategy in addressing this issue. With this in mind, my colleagues and I have presented our concern to MPs including the shadow public health minister, and also to the House of Lords.
Thus in our proposal we suggest approaching this problem with the following:
• Collaboration and strategies with veterinary colleagues to thoroughly investigate those DBI presenting to hospital (Medical centres etc.), together with clear documentation of the injury sustained and treatment required. Specifics relating to the animal and the context of the bite need to be understood.
• The development of an ‘after bite injury’ pathway, with appropriate support from both medical and veterinary professionals. The aim is to prevent further injuries and provide support from appropriately trained professionals.
• A clear and coherent education programme for dog owners and the general public, especially families with young children, to improve awareness of dog owners of potential signs of aggression and how their own actions may trigger it.
• Introduction of simple interventions (for example at puppy vaccination appointments) to give informal advice and tips on good dog control and behaviour from an early age.
• Clear documentation of injuries to the Veterinary profession secondary to DBI, nationally documented numbers of euthanized animals due to DBI, and data pertaining to reasons for this.
This strategy is outlined in our recently submitted paper ‘Dog Bite Injuries: What can we do?’.
We will be presenting on this issue from a truly collaborative perspective by jointly addressing the British Veterinary Behaviour Association in Telford (October, 2014) and FECAVA Eurocongress in Munich (November, 2014). Support or interest at these events from the Medical profession and clinicians would be greatly appreciated.
Let us not forget that the NHS affords vast sums each year to this (www.Parliament.co.uk: Minutes from ‘Responsible Dog Ownership’; 26 Feb 2014). A proper and coherent approach would deliver significant rewards to the public with a reduction in DBI, together with financial savings to the health service.
C. J. Mannion (Consultant Maxillofacial Surgeon)
K. Shepherd (Veterinary Surgeon and Qualified Canine Behaviourist)
D. Greenberg (Veterinary Surgeon)
Competing interests: No competing interests
I do not perceive the “prevailing anti-dog culture” that Orritt describes. There is certainly public anxiety about a small number of certain dog breeds such as pitbull terriers and other breeds listed in the Dangerous Dogs Act 1991. However, examples of peaceful and affectionate “dangerous dogs” like pitbull terriers abound on well-known social media websites.
I agree that it is obviously important to have accurate data on which to base Government/public policies. Orritt describes what appears to be an unsatisfactorily imprecise reporting code for dog-related physical injury “W54” . This W54 code does not differentiate between dog bites and dog strikes e.g. fall due to an over-enthusiastic dog greeting.
Surely, it is not beyond the wit of Man to sub-divide the W54 code into W54a, W54b etc. so that the statisticians and the authorities can differentiate between dog bites and dog strikes? In addition, the dog breed involved should be carefully recorded. As these incidents cause harm to humans, it may well be that the relevant local Public Health authority may take an interest in such a re-classification.
It is not only dogs who bite people as we saw recently in the 2014 FIFA World Cup. I don’t suppose there is a code or database for those kinds of bites – yet.
 Dangerous Dogs Act 1991. http://www.legislation.gov.uk/ukpga/1991/65/contents
 Orritt R. Dog Ownership has unknown risks but known health benefits: we need evidence based policy. BMJ 2014;349:g4081 http://www.bmj.com/content/349/bmj.g4081
 Luis Suarez bite: Fifa charges Uruguay striker with biting Giorgio Chiellini during World Cup clash. The Independent newspaper online 25th June 2014: http://www.independent.co.uk/sport/football/worldcup/luis-suarez-bite-ur...
Competing interests: I work for Public Health England but am writing in a personal capacity. The views expressed are my own and not those of my employer. I support the Dogs Trust registered charity.
The conclusion 'A holistic view, incorporating the risk of dog bites, balanced against the health benefits of dog ownership, is appropriate' might seem fair but I find it challenging to expose my child to the risk of a dog bite for the benefit of someone else's health. And the risk, for all that we're unable to quantify it, is real. I know of one 5 year-old who was bitten 6 weeks ago by a dog believed to be tolerant of children. I have been cornered by aggressive dogs three times - on one occasion, the owner blamed me for the dog's behaviour.
No-one is talking about dogs or no dogs, as the tone of this article implies but a lack of statistics is no justification for withholding proportionate measures that can protect children. Examples include measures that increase owners' responsibilities, such as training as a condition of ownership, stringent licensing to make it easier to trace owners, chipping all dogs, and banning owners of dogs that bite from keeping dogs.
Competing interests: No competing interests
Besides psychological benefits of dog ownership there is an observation of possible protective effect on immune defensive system:
Virtanen SM et al.
Microbial Exposure in Infancy and Subsequent Appearance of Type 1 Diabetes Mellitus–Associated Autoantibodies. A Cohort Study.
JAMA Pediatr. Published online June 23, 2014.
"Among the 9 early microbial exposures studied, only the indoor dog exposure during the first year of life was inversely associated with the development of preclinical type 1 diabetes. This finding needs to be confirmed in other populations."
Competing interests: No competing interests