Marian C. Horzinek, DVM, Dr DDr h c
The WSAVA International Award for Service to the Profession
I shall attempt to present an old--though still prevailing--problem, and focus on two facets of the same topic:
The devastation and desolation of our intellectual landscape by irrational ideologies, and
The challenge for veterinary schools to teach young avid, committed students the difference between belief and knowledge--to prepare them for their professional life, where they should never sell quackery disguised as knowledge to their clients.
This is my credo, as a citizen and a scientist. If we want our profession to gain prestige it should also become a veterinary credo.
In The Structure of Scientific Revolutions, Thomas S. Kuhn (1922-1996) describes science as the result of an interplay between phases of normal, daily, continuous research routine and sudden revolutions of insight, which result in paradigm changes. The paradigms of theories that are separated by a revolution are 'incommensurable', i.e., they cannot be measured with the same gauge--like the geocentric with the heliocentric view of our solar system, Aristotle's physics with Galileo's, humoral pathology as Hippocrates has preconceived it with the medical insights since the Renaissance.
Kuhn's rather historical approach should be viewed together with Sir Karl Popper's (1902-1994) proposals, which are at the core of modern research work. Veterinary students should not only have heard about them in passing, they should have been intrinsically educated in Popper's world of thought. His 'critical rationalism' defines science as the methodical approach through conjectures and refutations--coarsely paraphrased: of trial and error. It must be the researcher's ambition to generalize and refine his hypotheses and theories, to underpin them with experimental evidence. And the ambition is not to corroborate them, but to find out about their weaknesses, so they can be replaced by other, better hypotheses and theories. Popper is not interested in the verification of presumed regularities in accumulated data, he rather intends to falsify hypotheses that had been formulated through a process of deduction. Consequently, experiments must be designed with the objective to disprove, not to prove. Only theories that continue to defy falsification offer a chance to reflect objective reality. This is what distinguishes science from ideology: the tentative nature of insight, the continuous pursuit, the corrective measures. Both Kuhn's and Popper's ideas are still valid, and can be found in the philosophical literature, in many flavours and variants.
The inane statement: '...there is a difference between theory and practice...' I hardly ever hear from scientists, rather from practitioners, as an implicit justification of veterinary measures that are evidently wrong, but are nevertheless taken. In other words: measures that disregard the state of the art--which is defined as the highest level of development of a device, technique, or scientific field achieved at present. In the medical professions, it is the standard of care, a set of rules adopted on the basis of scientific evidence and expert opinion; they must be followed, if only to avoid malpractice suits. In industry research, the GLP (good laboratory practice) and GCP (good clinical practice) acronyms refer to internationally recognized rules for performing clinical studies, which take ethical, legal and scientific aspects into consideration. For the daily veterinary practice, it should be a matter of course that any intervention, any measure is preceded by a rationale, any therapy or prophylaxis by a diagnosis.
In theory, there is no difference between theory and practice. But, in practice, there is (pun intended). Thus many a cat will get her leukemia shot without having been tested for FeLV antigen in her blood before. Every vet student knows that a viraemic animal cannot be immunized; nevertheless, this is common and ubiquitous. After all, the test is about as expensive as the vaccine, and so you rather inject than take a blood sample, which also may be a tedious procedure. In this reasoning, the veterinary surgeon follows the 'practical' ideas of the lay client and refrains from defending a solid scientific theory. There are two possible verdicts:
Either the vet knows that the vaccine does not work in a viraemic animal and sells it nevertheless--which is unethical.
Or the vet believes that the vaccine will work in a viraemic animal and sells it therefore--which is quackery.
We are making a mistake in veterinary education and in professional life when we attribute a superior role to actions, manipulations, interventions, and use knowledge but as a scientific fig leaf. Once veterinary medicine has learned to sell insight--in addition to the admittedly demanding physical procedures--it will eventually lose that farmyard smell. And veterinary surgeons will send an invoice just for a consultation, as an intellectual service rendered, like any lawyer, consultant, broker, censor, psychologist, counselor...