Comments on foreign veterinary school accreditation

In regard to the May 15, 2010, JAVMA News article “Speaking different languages,”¹ I believe that accreditation of US veterinary schools should be done by an independent body. The AVMA Council on Education could maintain this function but should do so as a stand-alone entity, unaffiliated with the AVMA. In addition, there should be a separate, independent organization that reviews foreign graduates, just as the Educational Commission for Foreign Veterinary Graduates does so today.

The precedent for this is already set by medical schools. The Association of American Medical Colleges is a nonprofit organization involved in the accreditation of medical schools in the United States. There is a separate organization, the National Committee on Foreign Medical Education and Accreditation, that reviews the standards used by foreign countries.

In my opinion, the AVMA should represent the interests of US veterinarians and not be in the business of accreditation at all, especially not accreditation of foreign schools. The AVMA should take a leadership role in helping to define global standards under the auspices of the World Organisation for Animal Health. In addition, the AVMA can form consulting committees to reach out to developing countries to improve their training of local veterinarians.

On a side note, I am one of 43,000 people who participate on the Veterinary Information Network (VIN). I am not a follower of Dr. Paul Pion, VIN's founder. I participate in VIN to communicate with and learn from an international group of fellow veterinarians, all striving to help animals and improve our profession.

Michael Goldmann, dvm

Nanuet Animal Hospital, Nanuet, NY.

The May 15, 2010, JAVMA News article “Speaking different languages: foreign veterinary school accreditation stirs debate”¹ builds on the increasingly inflammatory rhetoric of the debate between leaders of the AVMA and some members of the Veterinary Information Network (VIN) regarding accreditation of foreign veterinary schools by the AVMA Council on Education (COE). I am disappointed that what seems to me to be attacks of a personal nature were printed, but more troubling is that this debate is fostering an unhealthy divide between two institutions that should hold similar goals and ideals for the veterinary community. Much of the backlash appears to have roots in the lack of transparency as to why certain schools meet COE standards and others do not and in concerns about undue influence by Banfield. What is clear is a lack of complete and open communication. This rancor must yield to a more objective and respectful dialogue.

The AVMA has stated that JAVMA News is an independent news source. However, the appearance is that the two are intimately entwined, raising questions as to whether JAVMA News can act as an impartial voice in reporting on the AVMA. As an example, the statement in the article that “[t]he AVMA and COE also haven't taken Dr. Pion and his followers' criticism lightly” appears to me to belittle the members of VIN by portraying them as unthinking subordinates and to suggest a degree of bias on the part of JAVMA News.

The editors and reporters for JAVMA News may be objective, but the potential for bias, no matter how subtle or unintentional, can have poisonous results, so even the appearance of conflict is dangerous. As a subscriber to The Washington Post, I admire this news organization for many reasons, not the least of which is their employment of an ombudsman to act as an internal critic and represent readers who have concerns or complaints about possible bias, racism, sexism, and conflicts of interest. To my mind, the autonomy given to the ombudsman that allows him to speak and write freely strengthens the paper's journalistic integrity. Thus, I believe the JAVMA News would be well-served to hire an ombudsman, ideally someone from outside the veterinary community, who can foster a healthier debate and shine a fair and honest light on issues of contention.

Mike Karg, dvm

Frederick, MD.

I am writing in response to the May 15, 2010, JAVMA News article “Speaking different languages.”¹ I share many of the concerns voiced by Dr. Pion in the article and think many JAVMA readers do as well.

I believe that accreditation of the Universidad Nacional Autonoma de México Facultad de Medicina Veterinaria y Zootecnia is likely to have a substantial economic impact on US veterinarians. If 200 to 300 new graduates with no educational debt gain easier access to the US veterinary job market, how could that not affect starting salaries for our graduates? I worry that Banfield intends to hire many of these graduates in its clinics, thus lowering their employment costs and increasing their profit margins. If so, will that not alter the face of veterinary medicine in the United States as well?

The AVMA Council on Education has made it clear that it intends to make its accreditation decision without considering any of the possible economic ramifications. Dr. Pion is simply questioning why the AVMA would permit that. Isn't one of the roles of our professional organization to advocate for private practices and improve their fiscal health? Doesn't AVMA promote itself to members as such an organization? Is this accreditation in the best interests of most AVMA members? Is it what most dues-paying members want? If not, how do we resolve this conflict of interests?

I hope that our leaders in the AVMA can recognize the legitimate concerns that many members have about this issue. An open, honest dialogue is needed to determine the best course of action.

Ruth C. Beismer, dvm

Magnolia, Ky.

Dr. Granstrom responds:

Many of the concerns raised by the letter writers were addressed in a May 15, 2010, JAVMA News article.¹ However, I would like to make a few points.

First, confidentiality is an integral part of the accreditation process for all of the health professions, including nursing, human medicine, and dentistry, not just veterinary medicine. The Council on Education (COE) pledges to the colleges that all materials, discussions, and decisions of the COE regarding accreditation will remain confidential. This is in keeping with best practices advocated by the Association of Specialized and Professional Accreditors (ASPA). In addition, strict observance of confidentiality by the COE promotes full and uninhibited disclosure of information by the colleges and open discussion of concerns during COE deliberations, thus protecting the objectivity and integrity of the accreditation process. Importantly, although information regarding the accreditation decision for any specific college is confidential, the entire accreditation process is described in detail in the COE Manual, which is publicly available on the AVMA website. Of note, the US Department of Education recently issued new regulations governing the recognition of accrediting agencies and, for the first time, included a requirement that accreditors provide a summary of the reasons for an adverse accreditation decision. The COE amended its published policies and procedures to comply with this new requirement.

Second, professional accrediting bodies for the health professions are commonly sponsored by their respective professional associations. In fact, the Liaison Committee on Medical Education is jointly sponsored by the American Medical Association and the Association of American Medical Colleges. The Commission on Dental Accreditation is sponsored by the American Dental Association. Both the US Department of Education and the Council on Higher Education Accreditation recognize the value that professional associations can provide to accrediting bodies, so long as procedures are in place to ensure that accreditation decisions are made with complete independence.

Third, the COE is a member in good standing of the ASPA and adheres to that association's code of good practice.² In this regard, the COE is obligated to make accreditation decisions strictly on the basis of a college's adherence to the established standards of accreditation.

Fourth, the Executive Board created a task force in 1998 to study the accreditation process for veterinary colleges outside the United States and Canada, and in 1999, the Board voted to resume accepting applications from such colleges. The task force noted that “global economics, expansion in the trade of animals and animal products, and the continued emergence and spread of diseases without respect for national borders mandates an increased role for the AVMA and its members.” In the years since then, such concerns have only intensified, further highlighting the critical need for improving the quality of veterinary education around the world. Accreditation of foreign veterinary colleges by the COE is one means to accomplish this.

Finally, only nine veterinary colleges outside the United States and Canada have been accredited by the COE since 1973, and so far as I am aware, there has been no rush of non–US citizens immigrating to the United States following COE accreditation of these colleges. Importantly, any foreign veterinarian wishing to work in the United States would still be required to comply with all current immigration and labor laws and pass both the national and state veterinary licensing examinations.

David Granstrom, dvm, phd

Director, AVMA Division of Education and Research, Schaumburg, Ill.

Restrictions on antimicrobials in food-producing animals

In their recent letter to the editor,¹ Drs. Tarpley and Buttke invoke the vague term “mounting evidence” to single out particular uses of antimicrobials in food-producing animals as worthy of bans and restrictions. They point to results from Nordic countries to suggest that such bans have curtailed the “…introduction into the environment of resistant organisms that could threaten animal and human health…” and that “…animal welfare has been served by improving living conditions for production animals.”

In Europe, where bans on the use of antimicrobials for growth promotion in animal agriculture have been adopted to limit on-farm antimicrobial use, there has been little evidence of improvements in public health. In fact, although the bans have had no impact on the prevalence of antimicrobial resistance in people, they have had adverse effects on poultry health and productivity and have resulted in substantial increases in the use of antimicrobials for therapeutic purposes.^2–4 In Denmark alone, antimicrobial use for treatment of food-producing animals has increased 152% following implementation of the bans, from 48,000 kg in 1996 to 121,100 kg in 2007.³ In reference to animal welfare, the countries cited still use large-scale industrial practices and no studies I am aware of demonstrate improved welfare or improvements in living conditions for production animals, compared with conditions for animals raised under conventional practices in other countries.

Subtherapeutic uses of antimicrobials can minimize shorter-duration use of antimicrobials in livestock and poultry. When administration of subtherapeutic dosages for longer durations is permitted, veterinarians are less compelled to use more of the antimicrobials important in human medicine at higher dosages to treat diseases. Such negative outcomes, including the documented increase in use of more highly important drug classes also used in humans, followed the 1999 European Union bans.^2,3

The US National Antibiotic Resistance Monitoring System was implemented in 1997 to specifically monitor antimicrobial resistance in humans and animals.^5,6 Data in recent reports show that the frequency of single and multiple resistant Salmonella isolates and other pathogens had either declined or remained stable for well over a decade; thus, there appears to be no mounting evidence of increasing resistance trends relevant to classes of antimicrobials used in feed or water in the United States. Resistant Salmonella isolates and other pathogens have remained problematic in European countries despite previous wholesale bans.⁴ This evidence from actual resistance data suggests that animal feed and water uses are not uniquely implicated in bacterial resistance of public health importance.

Antimicrobials are important tools for production agriculture but should be used judiciously and according to label directions. Most approved in-feed and in-water uses are for disease prevention, treatment, and control, not growth promotion.⁷ Allegations of overuse and mounting evidence of problematic resistance exclusively coming from one particular type of use (ie, in-feed use) have not been substantiated.

Steven Clark, dvm, dacpv

West Jefferson, NC.

Questions conclusion of intervertebral disk disease study

I read with interest the report by Dr. Joaquim et al¹ regarding a study performed in Brazil comparing the outcomes of decompressive surgery versus acupuncture for the treatment of thoracolumbar intervertebral disk disease (IVDD) in dogs.

The conclusion was that acupuncture alone resulted in better clinical outcomes than did decompressive surgery for the treatment of dogs with thoracolumbar IVDD when surgery was delayed > 48 hours after loss of deep pain perception.

My comment is that from the results of the study, we cannot say whether acupuncture has any benefit over doing neither decompressive surgery nor acupuncture, because there was no control group containing dogs in which neither acupuncture nor surgery was performed.

While it is interesting to note that in this study, surgery was shown to be of no benefit if delayed beyond 48 hours after deep pain loss, I would have liked to have seen a control group of untreated dogs to determine whether performing acupuncture showed any benefit to not performing acupuncture.

Joshua Lincoln, vmd

River Cove Animal Hospital, Williston, Vt.

The author responds:

In regards to the comments by Dr. Lincoln about our study¹ comparing the outcomes of decompressive surgery versus electroacupuncture (EAP) for the treatment of thoracolumbar intervertebral disk disease (IVDD) in dogs, I would like to point out that the outcome for dogs that underwent EAP was better than the outcome for dogs that underwent surgery, suggesting that EAP was beneficial for dogs with long-standing, severe neurologic deficits resulting from thoracolumbar IVDD. We did not include a group of untreated dogs because this would not have been ethical.

Importantly, the idea of our study was not to criticize surgery, which is the gold standard treatment for IVDD, but to show that in dogs with long-standing deficits, EAP may be an option.

Jean Joaquim, dvm, msc, phd

Bioethicus Institute, Botucatu, SP, Brazil.