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Vet Talk

Zoobiquity: the Intersection of Human and Non-human Animal Medicine
July 23, 2012 (published)

Editor's note: Read a Q&A with Zoobiquity author Dr. Barbara Natterson-Horowitz by the VIN News Service


Photo courtesy of Knopf

After years of surreal conversations with physician friends and family members – usually involving the comment “You guys do that for animals, TOO?” I was surprised and pleased when a review copy of a book written by a human cardiologist that actually addressed the parallels between human and non-human animal diseases and medicine crossed my desk. ‘Finally,’ I thought. ‘Someone gets it! We do the same things.’

The fabulous Dr. J and I have both alluded, in other posts here on VetzInsight, to the fact that veterinarians are – among other things – human. In general, most veterinarians have a pretty good sense of security (and humor) about what we do. But there are a few things that occasionally stick in the collective veterinary craw. One of the headlining craw-stickers is what seems to be a general ignorance of veterinary medical training. When we hear things like “Why didn’t you become a real doctor?” or comments that imply that our version of medicine involves 8-hour days of puppy and kitten snuggling with the occasional spay or neuter tossed in, we tend to get a bit testy, especially at the end of a 12-hour day involving very little snuggling but plenty of challenging medicine and surgery.

Given that veterinary education spans a wide range of medical disciplines and species, veterinary minds often become curators of an extensive collection of seemingly obscure medical knowledge.

Keeping all of this in mind, it is perhaps not surprising that when the publicity surrounding the release of Zoobiquity by cardiologist Barbara Natterson-Horowitz, MD, and science writer Kathryn Bowers hit the airwaves, Internet, and newspapers, the response from veterinarians who took notice was well… mixed…and human.

Comments such as those shown below, made on the National Public Radio website in response to NPR’s interview with Natterson-Horowitz and Bowers, reflect some of the frustration felt by veterinarians.

  • The shocking part for me (as a veterinarian) listening to this story, was the [sic] the author (a human doctor) was shocked to discover that some disease processes are common or comparable between animals and humans. How does someone get through medical school without learning that so much medical research is done first on animal models before being tried on humans? How would this be possible if many of these disease processes weren't the same? The American Veterinary Medical Association has been on top of this issue for years now with their One Health initiative that seeks to explore the common bonds between human health, animal health, and our common environment. This book seems to have been born out of surprising naivity [sic] and many of the examples and conclusions mentioned in this story also seemed a bit naive to me. 
  • Perhaps the good human doctor would also be "intrigued" to learn that there are veterinarians who specialize in cardiology, too? I'm happy that Dr. Natterson-Horowitz had her eyes (and mind) opened to the wonderful world of animal behavior and medicine; however, I hope that she realizes that her revelations aren't news to everyone. I strongly suspect that fellow veterinarians (i.e. Doctors of Veterinary Medicine) and scientists that study, treat and care for pet and wild animals alike can only shake our heads at her naivity [sic] for our professions. 
  • Wow. She acts like this is some big medical breakthrough [sic]. I learned all this in vet school, no big shocker here. Guess I would be AMAZED at her "revelation" if I were a "real doctor." This is incredibly frustrating as a veterinarian that was educated on the principles that animal behavior, animal diseases and animal research are the cornerstones for learning about human disease and behavior.
          I strive to educate my clients on the correlation of stress and related animal behavior, as well as the similarities in human and animal disease. I guess all of the specialists/diplomates in veterinary medicine had absolutely no idea about diseases that commonly occur in both animal and human medicine. I will remember that the next time I refer one of my patients to a cardiologist, neurologist, oncologist, etc.

On the other hand, some veterinary practitioners responded to the book in much the same way that I did – if something, regardless of the source, increases awareness of the importance of a cross-species approach to medicine, so much the better.

If there is one trait all medical practitioners share – regardless of the number of legs, ribs, vertebrae, stomachs, toes, or chromosomes possessed by their patient species – it is the ability to dig past the subjective parts of a situation and get to the verifiable data. In this case, to me, the best means of analyzing the value of the book was to examine it, as I would a patient, from head to toe (or cover to cover), in depth, and report my findings.

My “patient summary” (in the form of a book review) is below:

Yet here were the human doctors in early 2000 trumpeting the finding, savoring the fancy foreign name, and making academic careers out of a “discovery” that every vet student learned in the first year of school. These animal doctors knew something we human doctors had no clue existed. And if that was true…what else did the vets know that we didn’t? What other “human” diseases were found in animals? – Zoobiquity, by Barbara Natterson-Horowitz, M.D., and Kathryn Bowers

Like most of her colleagues in human medicine, UCLA cardiologist Barbara Natterson-Horowitz, M.D., had spent the bulk of her career focused on the ailments of one species: Homo sapiens. Until collaboration with the veterinarians at the Los Angeles Zoo pointed her toward the similarities between cardiac failure subsequent to capture myopathy in animals and a stress-induced heart condition in humans known as takotsubo cardiomyopathy, Natterson-Horowitz had given scant attention to the diseases of non-human species, or to the professionals that study and treat these species.

In the early 21st century, takotsubo cardiomyopathy was the new darling diagnosis of human cardiologists. Natterson-Horowitz was astounded to learn that “for nearly four decades (and probably longer) veterinarians had known this could happen to animals – that extreme fear could damage muscles in general and heart muscles in particular. In fact, even the most basic veterinary training includes specific protocols for making sure animals being netted and examined don’t die in the process.” For Natterson-Horowitz, “The key point wasn’t the overlap of the two conditions. It was the gulf between them.”

She found herself asking a question that she had never previously considered. “Why don’t we human doctors routinely cooperate with animal experts?” This question led her to make some uncomfortable discoveries about her own training, the gulf between the veterinary and human medical professions, and the lost opportunities for expansion of both human and animal health.

Natterson-Horowitz was humbled to learn that others had asked the same questions before her, and that a number of collaborations between human and non-human medicine had been attempted over the decades, culminating most recently with the One Health Initiative.

A collaboration between Natterson-Horowitz and science writer Kathryn Bowers, Zoobiquity brings the concepts of the One Health Initiative into a publicly accessible forum. Full of lively, yet intensively researched anecdotes and examples, Zoobiquity pulls no punches in its exploration of the divide between the veterinary medical community and the medical establishment devoted to the treatment of the human animal.

Crediting veterinarians with the innate and academically-instilled drive to reach beyond species barriers and keep current on human medical literature, Natterson-Horowitz is less complimentary toward the open-mindedness of her own profession. According to her, “Most physicians see animals and their illnesses as somehow ‘different’” from those of the human animal.

Natterson-Horowitz and Bowers were surprised to learn that this separation between the medicine of human and non-human animals had not always existed. “We used to. In fact, a century or two ago, in many communities, animals and humans were cared for by the same practitioner – the town doctor, as he set broken bones and delivered babies, was not deterred by the species barrier.” The authors go on to explain that modern medicine – human and veterinary – followed a common path, sharing even “founding fathers” until increasing urbanization shifted the balance of monetary value between human and non-human medicine.

The book references efforts such as the One Health Initiative as positive steps toward the greater cooperation of physicians, veterinarians, biologists, and ecologists, but laments the fact that those participating in the conversation are “still the rare exception.”

While comparative medicine is scarcely a new concept to veterinarians, and while even most lay people are aware of the contributions of animal research to human medicine, Zoobiquity aims at, and largely reaches, a broader goal of educating the public to the merits of a species-spanning approach to medicine and bridging the gap between veterinary medicine and non-veterinary health professionals. “This approach is based on a simple reality: animals in jungles, oceans, forests, and our homes sometimes get sick – just as we do. Veterinarians and biologists see and treat these illnesses among a wide variety of species. And yet physicians largely ignore this. That’s a major blind spot, because we could improve the health of all species by learning how animals live, die, get sick, and heal in their natural settings.”

Species-spanning medicine is limited in its efficacy if the approach is limited to one profession (veterinarians) and a handful of others (public-health and zoonotic disease specialists). With Zoobiquity, Natterson-Horowitz and Bowers appear to be speaking less to the veterinarians and biologists who use the approach daily and more to physicians and a public who tend to view the human animal as an entity beyond the natural world.

Chapters such as “Zoophoria,” addressing addiction, and “The Koala and the Clap,” which tackles the subject of STDs in human and non-human animals, show how treating humans as one of many species that face these ailments can help remove stigmatization that impairs treatment of these conditions. Other chapters such as “Scared to Death” and “Jews, Jaguars, and Jurassic Cancer” explore ways in which further investigation of ailments common across multiple species could impact understanding of risks and management of these conditions.

Though an engaging and entertaining read, Zoobiquity is clearly well-researched and pulls information from multiple sources including a wide array of scientific literature and field interviews. Without over-simplifying or bogging down in explanation, the book is equally accessible to both the scientist and the lay reader.

While the examples of animal disease occasionally begin to feel repetitious, Natterson-Horowitz and Bowers liberally season the serious with enough obscure or titillating cases to retain interest.

Zoobiquity is best viewed as an attempt to both explain some facets of the medical world to a lay public and as an opening gambit in a critically needed dialogue between physicians, veterinarians, and biologists. Natterson-Horowitz has expanded her outreach efforts beyond the writing of the book to co-chairing a Zoobiquity Conference. Jointly sponsored by the UCLA School of Medicine, the UC Davis School of Veterinary Medicine, and the Los Angeles Zoo and Botanical Gardens, the conference brings veterinarians and human physicians together with case studies that illustrate the parallels between the fields.

3 Comments

Matt Toia
August 13, 2012

We, as Veterinarians, allow the M.D.'s to care for only one species of animal!  We take care of all the rest!

Srinivasan Ramanathan
August 9, 2012

We veterinary doctors who treat multiple species (unlike our human counterparts who limit to one species) always understood that there is only one health, one medicine and one planet  that we all share and interact with.So it is no surprise to us but it is a great revelation to many of the "Real Doctors". This is one of the problems of super specialization that had permeated the human field and it is easy to forget that the finger you are treating is connected to the hand and in turn that hand to arm and that arm to the shoulder and so on...,There is a definite need for collaboration among the oth professionals and the sooner one realizes this truth they will be able to better serve their patients and their environment also.

TAM
August 6, 2012

Real doctors treat more than one species :)



 
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