Earlier this year, a study out of the University of California-Davis showed higher rates of certain cancers and musculoskeletal disorders among neutered Golden Retrievers, compared with rates among sexually intact Goldens. The findings challenge what is essentially an article of faith within the U.S. veterinary profession: Thou shalt spay or castrate cats and dogs.
Unlike in many parts of Europe, where elective gonadectomy is seen as unethical and the procedure is rare, most owned cats and dogs in the United States are spayed or castrated before 1 year of age.
Veterinarians and humane organizations alike support neutering as a population management tool that can also improve pet health and curb unwanted behaviors.
Belief in the advisability of spaying and neutering was called into question this past February when the online journal PLOS ONE published the UC-Davis study linking neutering to the increased occurrence of certain adverse health conditions in Golden Retrievers. While it isn't the first study to challenge widely held assumptions about neutering, it garnered a great deal of attention, possibly because of the Golden Retriever's standing as one of America's most popular dog breeds.
As part of the study, UC-Davis researchers analyzed medical records for 759 Golden Retrievers treated at the Veterinary Medical Teaching Hospital for hip dysplasia, cranial cruciate ligament tear, lymphosarcoma, hemangiosarcoma, and mast cell tumor—conditions to which the breed is predisposed. The dogs were privately owned, were of both sexes, and ranged from 1 to 8 years of age.
Of males castrated early—defined in this study as before 1 year of age—10 percent had hip dysplasia, double the occurrence among sexually intact males. Cranial cruciate ligament tears were not diagnosed in any of the sexually intact males or females, but in the early age-neutered males and females, prevalences were 5 percent and 8 percent, respectively. Lymphosarcoma was diagnosed in almost 10 percent of males castrated early, three times the rate in sexually intact males.
Additionally, researchers found the percentage of females spayed at 1 year of age or later that developed hemangiosarcoma (about 7 percent) was more than four times the percentages of sexually intact and early age-neutered females that developed hemangiosarcoma. None of the sexually intact females developed mast cell tumors, but nearly 6 percent of females spayed at 1 year of age or later did.
“Understandably, we see plenty of push back, along with lots of compliments like ‘thank goodness someone is finally doing something about the issue, especially the very early neutering’,” acknowledged Dr. Benjamin L. Hart, the study's lead investigator and a distinguished professor emeritus at the UC-Davis School of Veterinary Medicine.
Dr. Ann F. Hubbs is chairwoman of the Golden Retriever Club of America's Health and Genetics Committee. The GRCA, comprising more than 4,500 members, has long been concerned with issues regarding the health effects and optimal timing of neutering. The club welcomes the findings of the UC-Davis study.
“Studies such as this may help owners and veterinarians make neutering decisions together that balance numerous factors and are tailored to the individual dog's health, the owner's goals, and the overall circumstances,” Dr. Hubbs said.
Critics of the UC-Davis study claim a retrospective analysis won't produce any meaningful insights into the complex physiological changes brought on by gonad removal. Others fault the study for being limited to Golden Retrievers and say the data cannot be extrapolated across dog populations. Still others insist the study only confirms what they had already suspected about the health risks of neutering.
Veterinarians, Dr. Hart said, have two concerns about delaying neutering. One is an increased risk of mammary cancers in females, and the other is an increased risk of problem behaviors, such as aggression, in males. With regard to mammary cancer, he pointed to a recent meta-analysis that concluded there is only a weak link, if any, between sexually intact females and an increase in the rate of mammary cancer. Research done at their center and cited in their paper shows that neutering males in adulthood, after the onset of problem behavior, is as effective in changing the behavior as neutering before puberty is in preventing the problems.
The UC-Davis study on Golden Retrievers is part of a growing body of evidence indicating elective gonadectomy can adversely impact an animal's health.
Numerous studies published in peer-reviewed scientific journals, including the JAVMA, have reported the health benefits neutering can impart. Spayed and castrated cats and dogs tend to live longer and are less susceptible to reproductive tract diseases and hormone-associated disorders than are those left sexually intact.
Throughout the past three decades, however, the same journals have also published data showing the opposite to be true. Researchers have reported higher incidences of musculoskeletal and endocrinologic disorders, obesity, and urinary incontinence in neutered mixed-breed and pedigreed cats and dogs, compared with incidences in sexually intact animals.
“We change animals when we spay and castrate them, both in good and bad ways,” explained Dr. Margaret V. Root, a professor of small animal theriogenology at the University of Minnesota College of Veterinary Medicine.
“There is little to help us understand cause and effect of surgery and disorders prevented or apparently promoted by this surgery. There also are few studies specifically addressing whether or not age at the time of surgery has an effect on development of problems.”
The American Society for the Prevention of Cruelty to Animals is one of the most widely recognized humane organizations working to control the overpopulation of unwanted dogs and cats, in part by advocating for the neutering of all cats and dogs, except those that are part of a responsible breeding program or for which neutering isn't medically viable.
Moreover, the ASPCA supports neutering animals as soon as they reach 2 months of age and weigh 2 pounds. The AVMA likewise endorses pediatric or “early-age” spay and neuter to manage dog and cat overpopulation, and advises veterinarians to use their best judgment in deciding at what age the surgery should be performed.
Dr. Jed Rogers, senior vice president of Animal Health Services for the ASPCA, acknowledged there is a lack of scientific evidence proving that neutering has helped reduce the number of unwanted cats and dogs. The consensus within the shelter community, however, is that neutering has contributed to a substantial decline. It is estimated that, some 30 years ago, upward of 70 million shelter animals were being euthanized annually. Today, that number is thought to have dropped to fewer than 5 million.
“We know that an animal that has been spayed or neutered is less likely to be relinquished to shelters. We know that spay-neuter conveys health benefits with respect to certain types of cancers. There are some risks that we all know about, such as obesity and urinary incontinence in female dogs.”
While commending the UC-Davis study for offering new insights on the effects of neutering on the health of Golden Retrievers, Dr. Rogers said the findings are too limited in scope to spur a review of his organization's policies and initiatives.
To help practitioners sort through the mixed messages, the Humane Society VMA this past September hosted a webinar summarizing the research on the health benefits and risks associated with neutering cats and dogs.
The webinar was presented by Dr. Philip A. Bushby, a professor of humane ethics and animal welfare at the Mississippi State University College of Veterinary Medicine. What many people ignore, he says, is this key statement in the UC-Davis analysis: “An important point to make is that the results of this study, being breed-specific, with regard to the effects of early and late neutering cannot be extrapolated to other breeds, or dogs in general.”
“These data are real, the issue is there, but the numbers are real small,” Dr. Bushby said.
Dr. Bushby believes the decision to neuter a cat or dog should be based, in part, on the animal's ownership status. Before neutering an owned animal, a veterinarian should also take into account the pet's breed and its genetic predisposition to particular diseases.
Similar to Dr. Bushby, Dr. Root believes that, given the millions of unowned cats and dogs and the research on neutering, shelter animals and pets should be treated differently when it comes to spaying and castrating. Veterinarians, she added, owe it to their clients to make sure they understand the pros and cons of neutering so they can make the best choices for their pets.
Finding calm amid the chaos
It's no secret that the veterinary profession can be rough on individuals. There's the stress of getting into veterinary school, performing well, and standing out among peers, followed by years or decades of long hours, demanding clients, and heavy workloads.
What isn't discussed as freely is what happens when those stresses become overwhelming or when mental illness develops as a result. The good news is that more people are pushing for dialogue about this topic, in the hope of preventing these situations from developing or finding ways to help when they do.
For many veterinarians, the stigma associated with mental illness is an important barrier not just to accessing mental health services but to even discussing the topic in the first place. According to the results of a 2012 study of U.K. veterinarians with a history of suicidal thoughts or behavior, half the participants had not talked with anyone about their problems, because they felt guilty or ashamed (Soc Psychiatry Psychiatr Epidemiol 2012;47:223–240).
Whether veterinarians are actually more prone to suicide and other mental health issues than the general population remains unclear.
A fairly recent structured review by Dr. David J. Bartram and others (Veterinary Record 2010;166:388–397) found that the veterinary profession has around three to four times the rate of suicide that would be expected in the general population, and around twice that reported for other health care professionals. Although the review focused on the U.K. veterinary population, the study's list of risk factors for suicide sounds familiar: characteristics of individuals entering the profession; negative effects during undergraduate training; work-related stressors; ready access to, and knowledge of, means; stigma associated with mental illness; professional and social isolation; and alcohol or drug misuse. Attitudes about death and euthanasia, and suicide contagion (due to direct or indirect exposure to suicide of peers) are other possible influences.
Yet, the study in Social Psychiatry and Psychiatric Epidemiology, titled “Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review,” found little evidence that veterinarians have particularly poor mental health or suffer from an exceptionally high degree of stress.
That said, female veterinarians, young veterinarians, and those working alone were identified in the study as being more at risk for suicidal thoughts, mental health difficulties, and stress.
Those findings mirror what is seen by the Veterinary Benevolent Fund, a U.K. charity that provides support to those in the profession who need mental health services. The VBF's services include the Vet Helpline, an anonymous, confidential support service.
In 2012, 60 percent of calls to the Vet Helpline were from individuals age 30 or younger, said VBF director Dr. Rosie Allister, at the Veterinary Professional Wellness Summit, held Sept. 17 during the World Veterinary Congress in Prague. The summit was sponsored by the International Veterinary Officers Coalition.
Citing additional results from the 2012 study, Allister also stated in her talk that veterinarians may be most likely to first experience suicidal thoughts during the transition from training to practice. Barriers to seeking help included concerns regarding the potential for adverse effects on career prospects, an inclination toward self-reliance, and a perception that support was of no value because it could not change circumstances, Dr. Allister said.
Kathleen Ruby, PhD, director of counseling and wellness at the Washington State University College of Veterinary Medicine, recently met with fellow counselors and mental health professionals who work with veterinary students and reflected on what is different now from 25 years ago.
For one thing, she said, all universities are noticing much higher usage of their health centers, as mental health care has become more accepted in the past 20 years. This has allowed more students to enter college, even though they might have a moderate condition.
Mental health care isn't always readily available for U.S. veterinarians because of a spotty network of support services at the state and local levels.
Many state VMAs, including those in Michigan, South Carolina, and Texas, rely on recovery programs that assist all health professionals with substance abuse and other issues. A few states have their own programs for veterinary professionals, such as Alabama's Veterinary Professionals Wellness Program, which provides confidential evaluation and treatment for veterinarians, veterinary technicians, support staff, and families.
Further, no dedicated rehabilitation facilities exist solely for veterinarians, although there are a handful of successful ones for health professionals. One of the first to be created was the Ridgeview Institute in Atlanta, after which many others are modeled.
Dr. Jerome B. Williams, director of the Alabama veterinary wellness program and a speaker at the International Veterinary Officers Coalition wellness summit, told JAVMA News that some of the better facilities will be cost-prohibitive for veterinarians, charging up to $50,000 for treatment. By the time most veterinarians get to the point where they need treatment, they have exhausted all resources, he said.
He advocates for state VMAs and state boards of veterinary medical examiners to provide more mental health resources. The way these boards are set up now, Dr. Williams said, “is their actions tend to be punitive rather than therapeutic, because most people don't realize (mental illness, such as) addiction is a disease and it needs to be treated as such.”
At the veterinary student level, a 2012 study showed that most U.S. veterinary colleges—22 of the 26 that participated—directed students to their university counseling centers for mental health services. Nine of these colleges had a designated counselor for veterinary students, but even those colleges typically had only a single individual available to provide services. The amount of time these counselors provided to veterinary programs varied greatly, from five hours per week to full time (JVME 2012;39:83–92).
The topic of mental health and wellness seems to be gaining more attention in the profession following relevant presentations at veterinary conferences, including the 2012 Ban-field Summit and the IVOC wellness summit this past September. In addition, The Ohio State University College of Veterinary Medicine recently hosted its first Health and Wellness Summit, Sept. 25–26. The event drew 60 attendees from 22 veterinary colleges in the U.S. and Canada, including deans, associate deans, and mental health professionals from these institutions. It was sponsored by the AVMA and Zoetis.
The summit came about after Dean Lonnie J. King of OSU's veterinary college led a discussion on the topic at the Association of American Veterinary Medical Colleges' Deans Conference this past January in Naples, Fla.
OSU summit attendees agreed that a task force of veterinary mental health professionals should be created to develop recommendations for veterinary colleges on best practices for mental health and wellness. These could be used not only by veterinary programs but also integrated into the curriculum or incorporated into state VMA programs.
A meeting is being considered for the AAVMC Annual Meeting in March, Dr. Ruby said.
Online business training courses created for practitioners
Veterinarians can strengthen their business knowledge and skills, thanks to a new Internet-based program.
Five courses with a total of 25 video modules are being offered online, with the assistance of the large animal continuing education site Animal Care Training on the following topics: budgeting, recruiting and hiring new employees, improving client satisfaction, personal financial management, and sales forecasting. The program targets veterinarians in rural areas.
The National Food Animal Veterinary Institute, based at Missouri Western State University in St. Joseph, created the program through a collaborative effort with Kansas State University and its colleges of business, veterinary medicine, and agriculture as well as Iowa State University, the University of Nebraska-Lincoln, Oklahoma State University, and the University of Missouri-Columbia.
The program, titled “Best Practices Business Model for Rural Veterinarians,” is anticipated to help veterinary practices stay in business and turn a profit so that they can grow and hire more people, said Bruce J. Prince, professor of management at KSU's business college, in an Aug. 19 press release.
Each course costs $75.
The NFAVI, supported by the Department of Agriculture's Rural Development and a handful of state departments of agriculture, was created in 2010 to foster the development of food animal practitioners. It emphasizes regulatory and continuing education as well as best practices business models for rural veterinarians.
A new center in Texas is aiming to become a global leader in adult stem cell research, organ transplantation, and personalized medicine.
Gov. Rick Perry announced on Sept. 13 a $3 million investment through the Texas Emerging Technology Fund to create the Center for Cell and Organ Biotechnology in collaboration with the Texas A&M University College of Veterinary Medicine & Biomedical Sciences and Texas Heart Institute.
Texas A&M's veterinary college is home to the Michael E. DeBakey Institute for Cardiovascular Sciences. The institute is known for its biomedical research programs in vascular studies and cardiovascular devices.
The new center will be co-located at the existing laboratories in Houston and College Station, and will take a multifaceted approach to chronic disease for both human and veterinary health care, looking at cell and organ failure. It will be led by Dr. Doris Taylor, director of regenerative medicine research at THI, whose concentration is on the adult human stem cell field. Scientists, engineers, physicians, veterinarians, and business managers from THI and Texas A&M will be a part of the center.
Proposal would focus AVMA mission statement on members
The AVMA House of Delegates will consider an amendment to the AVMA Bylaws that would revise the Association's mission statement to focus on the membership of the Association.
The current mission statement is: “The mission of the Association is to improve animal and human health and advance the veterinary medical profession.”
The proposed mission statement is: “The Mission of the AVMA is to serve, support, and advocate on behalf of its members, in order to advance the veterinary medical profession and, thereby, improve both animal and human health.”
The Vermont VMA submitted the proposed bylaws amendment along with seven other state VMAs and the American Animal Hospital Association, American Association of Feline Practitioners, and American Society of Laboratory Animal Practitioners.
“Our profession is facing a period of unprecedented uncertainty and turbulence,” according to the statement about the proposal. The statement continues later: “Our members and our profession need and demand a very strong association focused on their concerns, their issues, and their future. We need an association that makes the members its primary focus and not just an implied suggestion.”
The proposal also would revise the objective of the AVMA to focus on members.
The House of Delegates will consider the proposed bylaws amendment during its regular winter session, Jan. 11 in Chicago. Proposals going to the delegates are available at www.avma.org/about/governance under “House of Delegates.” AVMA members can find contact information for their delegates by visiting www.avma.org/members and clicking on “My AVMA Leaders.”
New online diversity resources available
New online resources from the AVMA and other sources aim to help veterinarians make the phrases “cultural competency” and “inclusive environment” more concrete in their daily lives.
The online community Access and Opportunity in Veterinary Medicine was launched Sept. 30 on LinkedIn, a career-oriented networking website.
Modeled after the AVMA Early Career Online Community on Facebook, this is a closed LinkedIn group for AVMA and Student AVMA members interested in expanding access to, and opportunity in, the veterinary profession in general—and to AVMA leadership specifically.
Dr. Beth Sabin, AVMA associate director for international and diversity initiatives, anticipates that it will bring together veterinarians and veterinary students interested in discussing ideas and, potentially, developing related projects. She will moderate the group.
Topics may include reaching out to individuals underrepresented in veterinary medicine, enrolling in leadership courses, and finding Spanish language classes for large animal practitioners.
The Association also introduced its own Diversity and Inclusion in Veterinary Medicine website area Oct. 15, dedicated to providing information about efforts to increase diversity in the profession. Links to relevant books and news articles, continuing education opportunities, U.S. Census Bureau information, materials produced by the AVMA Future Leaders Class of 2012–2013, and other online resources will be available.
A joint initiative led by the Purdue University College of Veterinary Medicine with input from the Association of American Veterinary Medical Colleges and AVMA was also launched this fall, the Center of Excellence for Diversity and Inclusion in Veterinary Medicine.
The center plans to host an online certificate program for faculty, staff, and students at veterinary colleges beginning in fall 2014. This program will later be expanded to meet the needs of all veterinary professionals. For more, visit http://vet.purdue.edu/humancenteredvetmed.
Be part of the dialogue
One way that AVMA members can voice their views on veterinary issues and collaborate on efforts to advance veterinary medicine is through service on a council, committee, or other AVMA entity or as a liaison.
These entities help develop AVMA policy and influence such important areas as animal welfare, clinical practice, and food safety.
Nominations are being invited for 68 upcoming vacancies.
AVMA President Clark K. Fobian has found service in organized veterinary medicine to be “every bit as gratifying as administering to the needs of animals.” He said, “It's another way to make a difference in the lives of animals and those who care for them.”
Dr. Fobian noted that a personal request and encouragement from a colleague, mentor, or friend was what prompted the involvement of most veterinarians who have volunteered for AVMA activities and entities.
The Executive Board will fill at least 54 vacancies on AVMA committees and other bodies at its meeting April 10–12, 2014. It will also appoint or reappoint one of the two North American councilors to the World Veterinary Association and a liaison to the Pan-American Association of Veterinary Sciences Directive Council. Nominations are also invited for an AVMA Political Action Committee Board member, who will be appointed by the House (of Delegates) Advisory Committee in July 2014.
Nominations may be made by AVMA members on their own or another's behalf, by local or state veterinary associations, by organizations represented in the HOD, by a specific organization to be represented by the nominee, or as otherwise stated in the entry description.
Council members will be elected by the HOD, which will fill at least 14 vacancies when it convenes in July 2014 in Denver. Council nominations may be made by organizations represented in the HOD or by petition of 10 AVMA voting members.
The AVMA Office of the Executive Vice President must receive nominations for committee and trust seats and liaison positions by Feb. 24, 2014, and nominations for councils by April 1, 2014.
Nominations open for 2014 Excellence in Veterinary Medicine Awards
The AVMA and American Veterinary Medical Foundation are accepting nominations for the 2014 Excellence in Veterinary Medicine Awards, which recognize contributions to the profession.
The awards will be presented at various venues, including the AVMA Annual Convention, July 25–29, 2014, in Denver, and the 2014 Merial–National Institutes of Health Veterinary Scholars Symposium.
The AVMA and AVMF are accepting nominations for the following: The AVMA Award, AVMA Meritorious Service Award, AVMF/AKC Career Achievement Award in Canine Research, AVMF/Winn Excellence in Feline Research Award, AVMA Advocacy Award, AVMA Animal Welfare Award, AVMA Humane Award, AVMA Lifetime Excellence in Research Award, AVMA Practitioner Research Award, AVMA Public Service Award, and AVMA XIIth International Veterinary Congress Prize.
Like the public insurance exchanges, the private insurance exchange from the AVMA Group Health & Life Insurance Trust got off to a slow start in October. By November, the exchange for AVMA members was selling health insurance in most of the states.
Dec. 15 is the deadline to apply for medical coverage to take effect Jan. 1, 2014.
The GHLIT exchange is at www.avmaghlitcare.org, and the phone number is (877) 473-6017. As of Nov. 4, the exchange had received about 2,000 calls, provided more than 1,000 quotes, submitted 334 applications, and issued 198 policies. In addition, many GHLIT policyholders have been purchasing new health insurance through their agents.
The Trust will stop offering health insurance for 17,500 AVMA members and their dependents at year's end because it cannot find an underwriter. Underwriters are no longer willing to take on medical coverage for association plans because of challenges of complying with provisions of the Patient Protection and Affordable Care Act.
Among other provisions, the Affordable Care Act requires individuals to purchase health insurance starting in 2014 or pay a penalty. The enrollment period runs through March 31, 2014. Public and private insurance exchanges provide marketplaces for purchasing a plan.
As of Nov. 4, the GHLIT exchange was selling insurance via the website in 27 states and by phone in 42 states. The exchange is a free service for all members of the AVMA and Student AVMA, not just GHLIT policyholders, and offers plans from A-rated carriers.
The GHLIT exchange offers not only a marketplace for health insurance, but also a one-stop shopping experience for the insurance plans that the Trust continues to offer. These plans include life, dental, vision, hospital indemnity, disability, and professional overhead insurance.