Despite, and in part because of advances in the biomedical sciences, the health and welfare of companion animals have been on the decline over the past two to three decades, as has that of farmed animals due principally to competitive economic pressures in the livestock and poultry industries. This statement may seem outlandish, if not offensive to those many veterinarians dedicated to improving the health and well-being of animals under their care. But as this review will document, the veterinary profession has become as much a victim of these forces and trends as the animals themselves.
The advent of CAPOs—confined animal production operations —has meant increased reliance on vaccines and drugs to control disease and to maximize production and profits in livestock and poultry husbandry systems that are highly stressful, immuno-compromising and create consumer and worker health and safety problems. . A percentage of animal morbidity and mortality—and associated suffering—is accepted as the price of doing business ‘economically and efficiently. CAPOs have also decimated rural communities and that meant the demise of the ‘mixed’ veterinary practice, a return to which some advocate, not out of nostalgia but from a sense of community renewal and sustainability.
Except as a provider of drugs and vaccines and monitor of zoonotic diseases, the food-animal veterinarian is limited in what can be done economically beyond being merely a service provider to the industry. Food animal veterinarians have knowledge and skills that are rarely applied because they add to production costs of CAPOs, the exceptions being with valuable foundation and breeding stock, small farm and ranch operators, and organic and livestock and poultry producers whose husbandry practices are more challenging and usually more humane than CAPOs.
The veterinary bioethical principle of the One Health (where human health=animal health=environmental health) is undermined by the economic pressures on CAPOs managers who are forced ‘to seek greater efficiencies’ to quote from the editorial comment in the British Veterinary Association’s Veterinary Record (1).
There has been much recent discussion about recruitment of veterinarians into the food animal medicine sector, and what the future may hold for new graduates. Heather Lyons Narver, VMD, in her Commentary ‘Demographics, moral orientation, and veterinary shortages in food animal and laboratory animal medicine’ (2) raises some pertinent concerns. Aside from the current predominance of women in veterinary colleges in the US, the shortage of both men and women in the food animal and laboratory animal medicine sectors may reflect a convergence of gender-linked differences in moral philosophy. This is with respect to animals being treated ‘as an economic commodity’ and ‘as an intellectual commodity’ to use Dr. Narver’s terms, in these respective sectors.
There is limited employment opportunity for veterinarians in CAPOs. For economic reasons, veterinary services and compassionate care are short-changed in the CAPOs of the main-stream food and drug industries that accept a percentage of animal loss from stress, injuries and disease. Any percentage of disease loss when those diseases are indicators of bad husbandry, (also termed production-related, or domestogenic diseases) is ethically questionable. The veterinary mission to control and prevent these indicator diseases reflective of pathogenic conditions and unsound husbandry and breeding practices is not as laudable as it once was, now that the cost-justified suffering of animals in CAPOs is evoking more public concern as well as the ‘carbon footprint’ and other hidden costs of ‘cheap’ meat.(3 ). The long predicted (4) development of antibiotic resistant strains of bacteria such as MRSA and MRSP (methicillin resistant Staphylococcus aureus and Staph. psuedointermedius) in livestock infecting humans, and of CAPOs becoming the epicenters for human pandemics like avian and swine flu have come to pass, further underscoring the inherent flaws in the livestock industry that will not be rectified simply by treating animal produce with isotopic irradiation, (that causes brain damage when fed to cats). Freeze-drying and hydrostatic pressure food treatments may be less hazardous alternatives.
What then are veterinary colleges and these animal-based industries doing to fill this lack of food animal veterinarians that could mean lower standards of animal health, consumer safety/public health, animal welfare and animal protection oversight? To possibly help rectify the shortage of veterinarians in the food animal sector the multinational drug company Pfizer Animal Health has teamed with the American Veterinary Medical Foundation to award $2,500 scholarships to more than 225 veterinary students in the US ( 5).
Both production-enhancing drug and vaccine addicted livestock and poultry industries, and the petrochemical and pesticide addicted, gene-engineering human food and beverage, and livestock feed industries, create enormous volumes of sometimes hazardous waste by-products that are recycled very profitably into pet foods, livestock feeds, fertilizer and human supplements, cosmetics and toiletries and a host of other secondary consumables. The safety of these secondary consumables, many imported from third world countries by US manufacturers, are too complex and costly to effectively police. This is what the heads of government agencies like the USDA and FDA say at every Congressional hearing on some major E.coli hamburger or contaminated spinach recall, or massive pet food recall as at the Senate Sub-committee hearings in 2007.
The animal and human health benefits of prebiotics and probiotics, along with biologically appropriate diets, which nurture beneficial gut bacteria, parallel organic farming practices that benefit soil microorganisms essential to crop health and nutrient content. Both gut and soil bacteria are respectively harmed by agrichemicals, antibiotics and GM (genetically modified) crops and foods. Dysbiosis, imbalane
Advances in the biomedical sciences have lead to more costly, if not more accurate, diagnostic technologies and procedures as well as treatment options. This means financial hardship for many pet owners who are encouraged, if not coerced into buying into a pet health insurance scheme. The alternative, especially when there are few general practitioners willing to risk cost-containing best-guess treatments for fear of law suits for malpractice and instead send clients to see veterinary specialists, means no adequate veterinary care being available for many sick dogs and cats whose owners cannot afford more than basic care and making the animal as comfortable as possible. Aside from the suffering, owner anguish, and rise in premature euthanasia requests and loss of veterinary clients, there is the issue of public health. Sick companion animals receiving no proper veterinary care become a major reservoir for zoonotic diseases.
Based on some legitimate concerns, the American Veterinary Medical Association has lobbied against law courts levying damages for emotional loss in cases of veterinary malpractice involving the death of a companion animal. If this were to become commonplace as it is in human medical practice, client costs would escalate since veterinarians would have to find ways to offset malpractice insurance expenses. Client costs would escalate further with no guarantee of improved pet health care and treatment with liability-conscious veterinarians placing greater emphasis on defensive rather than preventive and evidence based medicine. This would entail conducting costly and often unwarranted diagnostic procedures, for example, the non-execution of which would be grounds for a malpractice suit, frivolous as it may be, in the hands of an experienced ‘ambulance-chasing’ attorney representing an emotionally traumatized pet owner.
It is ironic that it is on the basis of a strong human-companion animal bond and the related emotional investment of pet-owning clients that people will spend their savings on securing what they believe to be the best veterinary treatment for their animals. This makes them vulnerable to exploitation by unscrupulous practitioners who are adepts at emotionally blackmailing their clients into feeling guilty for balking at certain tests and procedures that may do little but prolong an animal’s life and suffering; and who are incapable or unwilling to broach the choice of euthanasia that in many cases is the ethical, humane decision and not a reflection of professional incompetence or failure.
The veterinary bioethical principles of integrative and preventive medicine (6, 7) that include right breeding, right nutrition, right environment and right understanding (including socialization and animal communication) are undermined by multiple factors in small animal/companion animal veterinary medicine. Even though these animals are treated as family rather than as commodities or intellectual property, the veterinary profession is challenged by the high incidence of genetic anomalies and diseases of hereditary origin in most pedigreed/pure-breed and ‘designer’ varieties of dogs and cats. These problems are magnified by commercial breeders who treat their animals like mere commodities.
British physician Dr. Des Spence (8) writes :
‘Large animal vet practice has all but perished, along with many farming communities. But it is veterinary care insurance for small animals that has fundamentally changed practice—in a way all too familiar to us GPs. Costs have spiralled, and investigations, referrals, bogus conditions, and chemotherapy are now all standard.— Vets deal not with animals’ ill health but with dependent health seeking behaviour from owners with distorted health beliefs.
And specialisation is undermining the status of the “generalist.” Expensive branded drugs are being peddled by big pharma representatives. Corporations are moving in, buying up practices; and big business dictates “total billing,” with the flogging of “scientific” diets, dog collars, and toothbrushes’.
Rhetoric aside, it is noteworthy that veterinarians in the UK must earn annual hours of accredited CPD (Continued Professional Development), and can do so by attending seminars by drug companies, like those offered at no cost for 3 hours accreditation by Pfizer drug company’s ‘Academy’, pitching the benefits of Trocoxil ( mavacoxib) to treat osteoarthritic dogs, (as per their premium advertising spot in the Oct 31, 2009 Veterinary Record.) This class of drugs includes some Cox 2 inhibiting drugs that have been recalled from human use because of harmful side effects. Similar continuing education credit hours under the American Association of Veterinary State Board’s RACE (Registry of Approved Continuing Education) are dominated by pharmaceutical companies.
It is unlikely that veterinarians would receive RACE credits for attending a seminar on the role of nutrition in canine osteoarthritis and the use of safer and effective dietary supplements, nutraceuticals and herbal preparations widely used for this and related conditions by veterinarians practicing integrative medicine (9). This is unlikely at the present time since organized veterinary medicine in the US, as in the UK, accepts the ‘science’ behind the drug companies and pet food manufacturers products and calls for the same kind of science that is not applicable or feasible, other than an evidence-based medicine/treatment documentation, for many alternative therapies and treatment protocols.
The debacle of cats and dogs born from genetically defective parents is compounded when the parent animals are fed manufactured pet foods that make them prone to developing diabetes and kidney stones for example. Until recently, the genetic components of many companion animal diseases have been little studied, and those of known hereditary cause have yet to be effectively eradicated. These problems have added to the demands of companion animal practice for more advanced and costly diagnostic procedures and treatments, often with ‘off label’ human drugs, and new drugs, as to fight cancer and prevent organ rejection in cat kidney transplants in the US.
Many kidney and urinary tract diseases, diabetes, skin and enteric problems and a host of other cat and dog ailments— the bread and butter of the companion animal health care industry— can be prevented and many cured by taking the animals off the highly processed manufactured ‘’junk’ pet foods. Uninformed and trusting owners are sold these manufactured foods by far too many veterinarians who gain considerable income from the generous profit margins the manufacturers seduce them with. When health problems develop, they are then sold ‘therapeutic’ pet foods that are very expensive (and even more profitable for veterinary businesses). No data have yet been published to my knowledge on secondary health problems arising after these ‘scientifically formulated’ prescription diets given to hopefully correct for the deficiencies and imbalances in the animals’ original processed food and beverage industry byproduct-based diet, (10). Many animals find them wholly unpalatable like the corn starch and egg byproduct, sucrose-laced prescription diet sold by one company to dissolve struvite uroliths in dogs. Because of genetic differences between breeds, the one-diet –fits all notion, has been supplanted by nutritional genomics that will have limited clinical validity until the epigenetic effects of parental diets on offspring are addressed.
Dogs play a significant public health role in third world villages by eating human infant and adult feces, the feces of nursing kids and calves, and in consuming/ removing carrion and garbage they help reduce the fly population—the main vector of enteric diseases. Dogs have evolved to be semi-carnivore hunter-scavengers, since they can supplement their natural animal-based diet of live-kills and carrion with protein and energy sources of vegetable origin, especially cooked or processed left-over human foods. Until recently these were minimally processed whole-food ingredients, not highly refined food and beverage industry by-products.
One might call dogs adaptable opportunist omnivores, up to a point. But the cat, domesticated for only a few generations compared to the dog, is still, with some individually adapted exceptions, an obligate carnivore. The cat has not yet evolved genetically and metabolically to thrive like a dog can on a diet high in plant-derived nutrients. On such a diet many cats do not adapt but rather, succumb to obesity, diabetes, osteoarthritis, and other easily preventable diseases. Yet high corn, soy, and cereal-containing cat foods are still widely sold to trusting clients by far too many pet health insurance and ‘preventive’ medicine program marketing veterinary business operations as part of the ‘package’ of ‘ science-based’ companion animal care.
Should companion animal practice exclude offering to perform cosmetic surgeries such as ear-cropping of dogs and de-clawing/onychectomy of cats for ethical reasons, income generation not withstanding? The resistance to changing vaccination protocols is a case in point, where benefits to the business outweighed documented risks to the patients under the guise of long established preventive medicine protocol. Recent arguments by veterinarians opposing legislation to prohibit routine feline onychectomy in domestic cats (already prohibited under US federal law for big cats) on the grounds that it is a life-saving procedure because otherwise many cats would be euthanized for being destructive in the home, is the kind of emotional blackmail and rationalization to justify such animal mutilation that I find professionally reprehensible. Why not remove dogs’ teeth in case they might bite someone and then have to be euthanized?
As the percentage of veterinary college graduates seeing advanced training increases, the DVM/VMD degree is being seen as an ‘entry- level degree’ (11). And as more graduates work toward certification in various specialty fields, particularly in the companion animal sector, we may find there is an increasing shortage of general practitioners, a recognized regional problem in human health care industry. Increasing service costs to clients could mean fewer companion animals receive adequate veterinary care. The net result of new DVM graduates feeling inadequate and compensating for a lack of practical clinical experience through mentorship and internship programs by electing instead to work toward board-certification in some specialty such as internal medicine or dermatology, aside from the promise of higher incomes (11) remains to be seen. Veterinarian Jeffrey A. LaCroix (12) calls for a limited licensure where veterinary students would elect to specialize in either companion animal or food animal medicine, for example, at the start of their education rather than investing in subsequent postgraduate specialization. ‘In the current economic climate, there are even fewer pet owners willing and able to pay for this (specialist-referral0 level of care. In this scenario, the specialist may find many more colleagues sharing a smaller pie.”
There are surely veterinary students who would like to work with wild animals but not in a laboratory or conventional zoo and circus setting, or with farmed animals under organic and other humane husbandry systems, especially in the aid programs for ‘developing’ countries. But funding is often lacking in these non-commercial sectors, and having to pay off hefty student loans can leave veterinary graduates with few options outside of the commercial and animal research industry sectors, especially in developing and testing new drugs, vaccines, and high-tech diagnostics and therapies.
Many epidemiologists and other biomedical scientists contend that more research should be done in-field, and not in laboratories trying to simulate various animal diseases, often with considerable difficulty without violating animal protection laws and institutional animal research protocols. Focusing on the ecology of animal disease and health, many veterinary students would enroll in a farmed/food animal or wildlife specialty. Others could specialize in veterinary immunology, genetics and pathology that would better serve the new wave of organically certified and humane animal production systems and wildlife and biodiversity conservation fields rather than the end goals of CAPOs and the increasingly dysfunctional global food industry. Better to address the root causes of dysfunction than to develop yet stronger pesticides, vaccines, and veterinary medicines for ever more CAPOs that are the antithesis of humane animal husbandry, and are seen by many communities, health and environment experts, as destroying all hope for a more viable and fulfilling future.
I see grounds for hope when veterinary schools develop and offer degree programs, postgraduate internships and residencies, as well as advanced degrees which enable students to work in these emergent sectors that are calling for veterinarians to help with animal health and welfare problems, and also wildlife preservation and habitat restoration. These emergent sectors are notably in extensive, organic and other less intensive animal husbandry (including aquaculture) systems, and in wildlife medicine where veterinary expertise can be crucial in efforts to save endangered species and other wildlife and their habitats as well as addressing new ‘emerging’ zoonotic diseases. Specializing in ‘exotic’ animal medicine to serve those who keep various wild species as ‘pets’ or as a hobby, and who support the often illegal market trade in wildlife, is an ethically questionable professional pursuit.
Perhaps all first year veterinary students should take a basic introductory clinical course in applied bioethics (13) with an emphasis on the ecology, ethics, and economics of domestic and wild animal diseases that tie in with sustainable and healthful food production, water and other resource management, conservation and preservation practices, and especially with genetic preservation in terms of the biodiversity of both seed-stock and breed-stock. Such a course could be revisited in the final year to help give clarity and resolution to their future professional goals. Learning the elements of indigenous wisdom especially concerning sustainable agricultural practices, medicinal and food plants, and the adaptive and productive traits of rare breeds and their inherent biological value—ethnoveterinary medicine—would broaden the vision of students if not also their future career choices and opportunities.
Real progress in veterinary and human medicine will come not in correcting the problems of dysfunctional and often over-capitalized, energy-consuming, life and nutrition-degrading, and environmentally damaging systems and industries, but in client education, and in the creative anarchism and paradigm shift toward a more holistic, integrative approach to health care and maintenance, rather than profiting from treating disease and suffering, and in the process simply preserving the status quo. Informed consumers vote with their dollars when there is freedom of choice that monopolistic oligopolies abhor. For companion animal veterinary business enterprises to have to sell products and services that are at best ethically questionable and at worse do more harm than good, in order to stay in business, would be an unethical pursuit for any reasonably intelligent and rational life form*.
Acknowledgement
I appreciate the critical input of Minnesota veterinary practitioner Ron Gaskin, DVM, who notes; “We make more money doing services like nutrition, pet care consults, and dentistry—relieving pain and preventing disease than we do selling yearly vaccines and working for the vaccine manufacturers or selling RX foods or doing declaws. But DVM’s need to see and believe to take the leap of faith. The rewards for a medical service based on the wellness of the pet and quality of life is immediately rewarding. We enjoy our follow-up calls to our clients.”
The day I finished this review, The UK Mail Online, Dec.1st, 2009, published an article written by veterinarian Matthew Watkins who practiced for 8 years before dropping out to write about animals and his perceptions of veterinary practice. (http://www.dailymail.co.uk/news/article-1232217/Why-Im-ashamed-vet-shocking-expose-profession-puts-pets-painful-unnecessary-treatments-fleece-trusting-owners.html). While many of his concerns I also express in the above review, I take exception to many of his over-statements, such as blaming veterinarians for the health problems of bulldogs and other breeds of dogs and cats associated with selective breeding for abnormal physical traits. His failure to acknowledge the role of alternative medicine and a more holistic, integrative approach to animal health and well-being affirms the truism that it is easier to criticize than to offer constructive solutions for the good of all.
Veterinarians’ Well-being: At Risk from Empathy?
According to a Feb 13th 2015 Centers for Disease Control & Prevention Weekly Morbidity and Mortality Report Vol 64, p 131-132 by Randall J. Nett and associates, “Veterinarians are believed to be at increased risk for suicide compared with the general population.” They sent out a questionnaire that “asked respondents about their experiences with depression and suicidal behavior, and included standardized questions from the Kessler-6 psychological distress scale that assesses for the presence of serious mental illness…. Approximately 6.8% of male and 10.9% of female respondents were characterized as having serious psychological distress… compared with 3.5% of male and 4.4% of female U.S. adults, respectively.”
That they found almost one in 10 U.S. veterinarians might suffer from serious psychological distress and more than one in six might have experienced suicidal ideation since graduation makes me deeply concerned and wonder why. The challenges of diagnosing, treating and preventing various animal maladies coupled with financial constraints in a culture with a schizoid attitude toward animals (ranging from treating them as family members to mere commodities) may be overwhelming at times: And frustrating seeing the same conditions day after day with no significant advances in the prevention of illness and suffering. But above all I believe that veterinarians are generally more empathetic toward animals than most people in the general population. They, along with others on the front lines of animal protection such as animal sheltering and in-field animal rescue and wildlife conservation, take the brunt of society’s use and abuse of animals. This burden of empathy, combined with veterinarians’ clinical knowledge and greater understanding of how their animal patients can suffer, calls for greater public recognition and respect for the many contributions this profession provides for the good of the animals and society both at home and abroad.