Additional views on the costs of feral cat control

This letter concerns the JAVMA News article “Economic study estimates costs of feral cat control,”¹ which summarized findings of an economic study commissioned by Best Friends Animal Society. According to the article, the study concluded that “[c]atching and euthanizing… is less effective at population control than are trapneuter-and-return programs….”

First, the study did not evaluate control in terms of effectiveness and did nothing to show that trap-neuter-and-return (TNR) programs are more effective than catch-and-euthanize programs. Rather, the study only assessed the relative costs of these programs. The study estimated that it would cost $15.7 billion to eliminate all feral cats in the United States and $14 billion to include all feral cats in TNR programs. However, the former would remove all feral cats and the latter would remove no cats, leading to a profound difference in short-term efficacy. Both types of programs would be challenged long term by resupply of the feral cat population from the owned cat population.

Second, the marked cost difference between the two types of programs highlighted in the second paragraph of the news article is based on veterinarians and others volunteering their services to support TNR programs. However, the article fails to point out that $7.9 billion of the cost for catch-and-euthanize programs is for sheltering, feeding, and testing cats that are subsequently euthanized. Substantial program savings (50% of the total) would be realized by capturing and immediately euthanizing feral cats. Further, volunteering of capture and euthanasia services could theoretically drive the cost to near zero.

Brent Martin, dvm, daclam

Senior Veterinarian, Lab Animal Veterinary Consultants, LLC, Toledo, Ohio.

Thank you for alerting veterinarians to the economic study commissioned by Best Friends on the economics of trap-neuter-and-release (TNR) programs.¹ As a feline practitioner, I expect that my clients will find out about it, and I will have opportunities to discuss the issue with them.

I visited the website mentioned in the story (www.bestfriends.org) and found the study assumes costs of $250/cat to trap and euthanize cats and $220/cat for traditional TNR programs and assumes discounted services and volunteerism will decrease TNR program costs to $100/cat. The study reports there are 84 million feral cats in the United States. If we estimate $15 of the $100/cat will go for the nonveterinary portion of each cat's care, veterinarians would expect reimbursment of $85/cat. If we were to subtract $85 from the nationwide average cost of a feline neutering and multiply this by 84 million, we would obtain an estimate of the cost to veterinarians to participate, as suggested by this study. We could then divide that total cost by the number of practicing small animal practitioners to determine the amount of subsidized services expected from each of us. Because it is unlikely that feral cat breeding will be 100% controlled, we can expect requests to provide some ongoing level of subsidized services until our retirement. It is possible that my guess as to the percentage going toward the veterinary versus nonveterinary portion of the program is not correct, but this information was not provided by the website.

As someone who donates a few thousand dollars each year to my favorite animal-based charities (as I expect many veterinarians do), I cannot help but be offended when I am also expected to subsidize many thousands more for feral cat control. The website also touts the savings to state and local governments of discounted TNR programs. I question the appropriateness of expecting private businesses to assume these costs.

An honest attempt to control the feral cat population would not require billions of dollars of subsidized services from practicing veterinarians. Our professional organizations need to keep this in view of the public, and TNR proponents should be challenged to find appropriate funding for services. The old saying is “put your money where your mouth is.”

Minta Keyes, dvm

Cat Hospital of Tucson, Tucson, Ariz.

Poultry veterinarians' perspectives on antimicrobial resistance

In response to the May 15, 2010, letter to the editor by Drs. Tarpley and Buttke,¹ mounting evidence regarding the development of antimicrobial resistance does indeed provide veterinarians with an opportunity regarding our professional services to animal agriculture—specifically, the poultry industry in my case. That opportunity must keep the following facts in mind, and veterinarians must make sure that the public understands what is at stake and what is known and what is not.

First, the last new class of antimicrobials for use in poultry was cleared in the late 1970s. We are left with the pharmaceutical armamentarium of 30 years past. How this contributes to the relatively recent increase in antimicrobial resistance among human pathogens is not clear to me, especially given that these antique pharmaceuticals still function as well in agricultural medicine as they ever did. Newer classes function better through better bioavailability and tissue targeting. The fluoroquinolones were superior to sulfonamide compounds and tetracyclines in the treatment of fowl cholera for those reasons, not because sulfoamides and tetracyclines had become less effective over the years.

Second, animal agriculture is indeed a revenue-enhancing business. Consequently, we do not use ingredients that are not cost-effective because they do not enhance the revenue stream (ie, make money). That is the reason “antimicrobial-free” products cost more and that not everyone is producing them. Not using these antimicrobials for their labeled claims of improved feed efficiency wastes resources and is therefore not sustainable. If feed efficiency deteriorates by 0.05 lb of feed/lb of live weight, over 450,000 acres of corn and soy cropland will be needed for the additional feed and over 600,000 gallons of diesel fuel will be needed to haul the finished feed required for current US poultry production, given conservative assumptions.

Third, Drs. Fauci and Frieden admitted at a recent Congressional hearing that no definitive link exists between the use of antimicrobials in agriculture and antimicrobial-resistant infections in humans in the United States.² This is meaningful since this issue has been under study for > 30 years and there still are no case reports of human clinical treatment failures attributed to antimicrobial-resistant infections acquired from USDA-inspected products. The speculative risk has existed for years; the actual risk appears quite ethereal. The often-remarked-upon Danish experiment has not yet resulted in any improvement in human health.

Perhaps it is time to admit that this issue remains speculative and unsupported by the available clinical information and concentrate on appropriate patient care and infection control in both human and veterinary medicine. Veterinary supervision of antimicrobial use, either by consultation or on-staff veterinarians, has been the rule in poultry medicine for many years. I cannot speak for other areas of agriculture.

Eric Gonder, dvm, phd, dacpv

Goldsboro, NC.

Misinformation in the May 15, 2010, letter to the editor by Drs. Tarpley and Buttke¹ makes clear the need for the poultry industry to educate non–food animal veterinarians and consumers on its mission, practices, and outcomes. The primary goal and mission of the poultry industry is to provide safe, affordable, high-quality protein for human consumption. Concerns regarding human and bird safety and welfare are a top priority, including antimicrobial resistance in both birds and humans. To ensure best practices, the industry relies on the experience of board-certified poultry veterinarians who are experts in the use of antimicrobials for disease prevention and treatment. Flock health decisions are based on science (eg, gross pathological examination, bacterial culture, antimicrobial susceptibility testing, serologic testing, and microscopic examination), experience, and the scientific literature. The industry adheres to strict antimicrobial withdrawal periods as required by the US FDA. Data are critically evaluated in light of human and bird health and welfare. Changes and improvements in the poultry industry have been made on the basis of concerns for human and bird health and welfare and affordability of food for consumers.

For health, welfare, and economic reasons, intensive rearing of birds is standard practice in the poultry industry. Even though strict biosecurity and best management practices are in place, enteric diseases such as necrotic enteritis may occur in flocks as a result of the natural foraging activities of poultry. For > 30 years, the combination of best management practices and addition of low-level concentrations of antimicrobials (eg, virginiamycin and bacitracin) to the feed has been successfully used for maintenance of intestinal health in poultry. In contrast to the suggestion by Drs. Tarpley and Buttke, such low-level concentrations of antimicrobials in feed are used primarily for enteric disease prevention. Although virginiamycin is not a human drug, it is in the same class of streptogramins as a relatively new combination, quinupristin and dalfopristin, used in people to treat nosocomial vancomycin-resistant Enterococcus faecium infection. Concern emerged over the development of resistance in humans from the use of virginiamycin in poultry. However, when these theoretical concerns were investigated, the results showed extremely low risk to humans.² Of further concern is the increased use of therapeutic antimicrobials in food-producing animals in Europe following the ban on use of antimicrobials in the feed, with no corresponding improvement in antimicrobial resistance in humans.³

Antimicrobial resistance is monitored in flocks, and antimicrobials are alternated to ensure the longevity of their efficacy. Further, the industry works to ensure that minimal environmental contamination with microorganisms occurs. Litter composting substantially reduces the numbers of microorganisms, and litter is reused, decreasing the amount used to fertilize agricultural fields. Pathogen reduction procedures in poultry processing plants minimize bacterial counts in raw meat products. Although USDA-inspected meat is not sterile, microorganisms are eliminated by proper cooking.

The poultry industry seeks and implements new and innovative practices to reduce preventative uses of antimicrobials. Two important, active areas of research are in the promotion of intestinal health through the use of direct-fed microbials and in the development of vaccines against pathogenic microorganisms.

Becky Tilley, dvm, dacpv

Goldsboro, NC.

Bridging the gap between education and the needs of the profession

Dr. Eyre's commentary, “The time has come…,”¹ is an impassioned treatise focusing, chiding, and imploring the profession to work together in educational reform. We forget that the practice of any profession is, in reality, a business, wherein despite expertise and professionalism, the bills still need to be paid. Consumers have distinct needs in what they want and how they expect to receive it. And their needs as consumers are constantly changing, sometimes by the intervention of regulation and laws and sometimes by the availability of factors to make an offering more accessible. Business is practiced in the 21st century² with transparency, communication, flexibility, adaptiveness, innovation, risk taking, and experimentation. Veterinary medicine must adapt to the needs of its market, the very market for which its services, expertise, research, and innovation have been crafted. Dr. Eyre cites the travails of engineering education reform. Another example is the MBA degree, once considered the hallmark of a business resume. Business education was considered a trade school until the Carnegie and Ford Foundation reports of the 1990s, when it became clear that business schools had to become relevant to the needs of the business community by establishing rigor. Research abounded creating the theoretical grounding necessary to provide credibility to business disciplines. However, the schools ended up graduating individuals with MBA degrees who were fully knowledgeable about the theory of business but had no knowledge of how to apply it, a problem referred to as the knowing-doing gap. Major MBA programs have gotten the message and refurbished their programs to instill real-world knowledge in their offerings.^3,4 They adapted to the needs of the market. Why, then, shouldn't veterinary medicine change its educational paradigm to meet the needs of its ever-changing market?

As Dr. Eyre points out, archaic licensure criteria, rigorous and relatively inflexible curricula, the antiquated concept that every graduate must be all things to all species, and entrenched self-interests of faculty all represent impediments to change. This once proud and vigorous profession is rapidly losing its relevancy. While schools are highly individual and often influenced by local interests and funding sources, changes to the approach to education, pedagogical delivery, and learning outcome assessments (including licensure) can and must be made.

Just as engineering and business educational programs have changed, so can veterinary education. It will take leadership, common understanding, and a clearly articulated vision for the future. Most importantly, it will take a willingness to do what is right, not for self-interest, but for the profession at large. The AVMA is the advocacy body representing veterinary medicine in all of its dimensions. As such, it has an obligation to ensure that a coordinated effort is crafted to provide the leadership required to craft agreements among schools, specialty boards, licensing agencies, and the practice community to effect the required educational changes. To leave it to each individual school to try and craft their own solution is to court failure once again.

Edwin J. Andrews, vmd, phd, dacvp, daclam

Project Management Institute, Newtown Square, Pa.

Abortifacient vaccines and bovine herpesvirus-1

A peculiarity of veterinary medicine in this country is the extraordinary abundance of commercially available vaccines to protect animals against infectious agents, particularly vaccines labeled for use in food animals. For bovine viral diarrhea virus, for instance, there are > 150 products. An optimist would say this reflects a competitive marketplace. A skeptic would say it is too much of a good thing and cite the apparent ease with which companies can obtain licenses from the USDA for nearly identical biologic products. This becomes an important issue when producers use abortifacient, modified-live virus (MLV) vaccines in pregnant animals.

In our work as veterinary diagnosticians, we currently are seeing an increase in the number of abortions in cattle resulting from bovine herpesvirus-1 (BHV-1) infection, either with or without concurrent bovine viral diarrhea infection. We make the diagnosis by detecting BHV-1 with fluorescent antibody tests, immunohistochemical staining, and PCR assays. In some but not all cases, histologic herpetic-type lesions are present. Often, there is a history of modified-live BHV-1 vaccine use in the 2 to 8 weeks prior to abortion. Our laboratories are generally unsuccessful isolating a causative agent because most fetuses infected with strains of BHV-1 are autolyzed. As a result, antigens and DNA may be preserved but infectious virus is not. Diagnosis is hampered by the lack of published genetic sequences for BHV-1 strains in specific vaccines. Some producers appear to use modified-live BHV-1 vaccines in pregnant animals without realizing they must first use specific products before the cattle are bred. Given the timeline and the fact that we consistently cannot isolate BHV-1, we suspect that vaccine strains are responsible for these abortions.

From the manufacturers' point of view, these iatrogenic abortions are the fault of the producers or their veterinarians. Given the confusing range of products on the market, the small warning on the box, and producer access to multiple abortifacient MLV vaccines, vaccine-induced abortions seem inevitable.

This problem can be addressed in several ways. Our preference, as it is the simplest, is to withdraw abortifacient MLV vaccines designed for use in pregnant cattle, particularly when they contain BHV-1. It is unlikely the USDA's Center for Veterinary Biologics will take this step. Weak postmarketing surveillance in the United States ensures the Center for Veterinary Biologics rarely knows the extent of vaccine-induced problems until they are widespread or, in individual episodes, responsible for high morbidity rates. Thus, we suggest that vaccine companies applying for a USDA license should be required to provide genetic sequence information to allow distinction of vaccine from field strains. This information should be available to diagnosticians so they can identify vaccine-induced abortions. In addition, the warning on the box about abortion risk should be made larger and more explicit. Companies should be encouraged to alert producers to the fact that vaccines intended to prevent abortion may also cause them. Lastly, abortifacient vaccines should be sold only by veterinarians and in situations where a veterinarian-client-patient relationship exists.

Donal O'Toole, mvb, phd

Wyoming State Veterinary Laboratory, University of Wyoming, Laramie, Wyo.

Hana Van Campen, dvm, phd

Veterinary Diagnostic Laboratory, Colorado State University, Fort Collins, Colo.

Expectations and rewards of veterinary practice

Any attempt to superimpose upon today's graduates the same practice paradigm that worked for those of us who graduated 45 years ago is a waste of time. There are vast attitudinal and financial differences between that time and the present. Any attempt to compare the two in terms of expectations and rewards on the part of the employer and the newly hired veterinarian is practically impossible. There are, in my view, however, axiomatic principles that transcend these differences and constitute the essence of a satisfying and productive career in veterinary medicine.

To new veterinary graduates, then, I would say that it is not unreasonable to expect you to be a productive employee from day one. Your veterinary degree is prima facie evidence of some expertise in clinical medicine and surgery. At a minimum, this should include the ability to perform spays, neuters, and uncomplicated soft tissue surgeries. New graduates shouldn't expect to be mentored on those clinical tasks they learned in veterinary school.

Also, forget about clock-watching. If your job requirements include 10-hour work days, 5 days a week, so be it. In today's economic climate, be grateful you have a regular job. Weekend and after-hours work have always been part of veterinary practice. In those areas with emergency clinics, most night calls have been eliminated. However, not every community has the luxury of being served by a facility that ensures veterinarians an uninterrupted night's sleep. The practice of veterinary medicine has not and probably never will be a 9-to-5 occupation.

Finally, always attempt to display the love for animals that brought you to the profession in the first place. This caring attitude covers a multitude of sins. If the owner of a beloved pet on your examination table can sense this, your job will be a lot easier. If this quality is missing, all your technical knowledge will not suffice. A lasting bond between you and your clients is built on a feeling that treating their pets is more than just a routine and impersonal chore. After a very short while, you will find that your clients' response to a caring attitude is the greatest reward of your profession.

Richard H. McCormick, dvm

Miami, Fla.