Dog ownership has unknown risks but known health benefits: we need evidence based policy

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)

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.