Discussion continues on foreign veterinary school accreditation

This letter is in response to a series of previous letters^1–3 concerning AVMA Council on Education (COE) accreditation of foreign veterinary schools. Although the letter writers are well-meaning, they demonstrate a concern for economic factors affecting veterinarians that appears to be shortsighted and may have lost the vision of AVMA as a global leader in veterinary medicine. In tough economic times, there is always the tendency to regard immigrants as a potential threat, particularly when illegal immigration is considered. However, any graduates from a COE-accredited foreign veterinary school entering the job market in this country would not be illegal immigrants and would have to meet legal immigration requirements. The United States has accepted legal immigrants through good and bad economic times, and this should continue.

The benefits of and reasons for foreign veterinary school accreditation were addressed in a recent AVMA Executive Board meeting and include “…global recognition of AVMA COE standards, leadership in international educational initiatives, expanded opportunities for U.S. veterinarians, enhanced ability to address public health concerns, collaborative efforts that ultimately help prevent and fight emerging and zoonotic diseases, and improved health and safety in the global food chain.”⁴

It has been said that animal-based diseases account for 75% of newly emerging infectious diseases. Health problems and their solutions are transboundary both geographically and among the health professions. The solutions to global infectious disease challenges can be found through research, education, global outreach, and application of disease control at the animal-human interface. Strong international partner institutions are needed to accomplish these goals.

The 42 veterinary colleges accredited by the COE are located in the United States (28), Canada (5), Australia (3), Scotland (2), England (1), Ireland (1), New Zealand (1), and the Netherlands (1). Only about 500 million people live in countries with COE-accredited veterinary colleges. The remaining 6.4 billion people in the world live in other countries, including many developing countries. The standards of veterinary education worldwide need to be raised to control and prevent infectious diseases at the animal-human interface.

As to transparency regarding COE requirements for accreditation, they are spelled out clearly in the council's policies and procedures manual.⁵ These standards are specific and stringent enough that most North American veterinary colleges spend weeks and months preparing for a visit from the COE. Members of the COE do their homework and generally know more about a given school than most faculty at the school during their visit. As with any respectable doctor-client relationship, the results (with reasons) are shared with the client but not broadcast to the general public. Not secrecy, just confidentiality

Our fellow veterinarians are entitled to philosophical differences regarding the role of the AVMA in accrediting foreign veterinary schools. Accreditation of veterinary colleges located overseas would bring international recognition to their teaching and research programs. This recognition would facilitate international collaboration in research and active participation in global efforts to control and prevent many infectious and zoonotic diseases, resulting in a more healthy and prosperous society. It would also encourage people-to-people contact between the United States and other countries, improve global food security, and perhaps even decrease global conflict and enhance world peace. Several countries have looked to the COE to provide leadership regarding standards of veterinary education. Through the process of accreditation, we have a tremendous opportunity to improve the quality of veterinary medicine worldwide. We should accept this awesome responsibility with gratitude and humility and strive to improve the quality of veterinary medicine for the good of animals and humans throughout the world.

Bonnie Buntain, dvm, ms, dabvp, dagvpm

Faculty of Veterinary Medicine

University of Calgary

Calgary, AB, Canada

Jorge Hernandez, mvz, mpvm, phd

Department of Large Animal

Clinical Sciences

College of Veterinary Medicine

University of Florida

Gainesville, Fla

S. W. Jack, dvm, phd

Department of Pathobiology and

Population Medicine

College of Veterinary Medicine

Mississippi State University

Mississippi State, Miss

David McKenzie, dvm, ms, mph, dagvim

Department of Large Animal

Medicine and Surgery

School of Veterinary Medicine

Tuskegee University

Tuskegee, Ala

Mushtaq A. Memon, bvsc, phd, dact

Department of Veterinary

Clinical Sciences

College of Veterinary Medicine &

School for Global Animal Health

Washington State University

Pullman, Wash

Mo Salman, bvms, mpvm, phd, dacvpm

Animal Population Health Institute

College of Veterinary Medicine and

Biomedical Sciences

Colorado State University

Fort Collins, Colo

Haroldo Toro, dvm, phd

Department of Pathobiology

College of Veterinary Medicine

Auburn University

Auburn, Ala

More on the economics behind feral cat control

This is in response to the letter by Dr. Keyes in the August 1, 2010, issue of JAVMA.¹ As a veterinarian who provides low-cost services to trap-neuter-and-release (TNR) programs, I have a contrasting view of the economics involved.

Importantly, it should be stressed that the costs of trapping and euthanizing feral cats are borne entirely by the municipalities having animal control facilities. Conversely, the cost of TNR programs is covered by rescue groups and individuals willing to donate their time and money (including donated, raised, and personal funds) to the cause. Thus, although government funds are used with the trap-and-euthanize approach, which has been shown to ultimately fail, no government funds are used with the TNR approach, which has been shown to succeed. In addition, TNR programs remove unhealthy and adoptable animals from the population and return healthy, nonreproducing, vaccinated ones, which receive ongoing care.

Bemoaning the income lost by practitioners who provide services to TNR programs is like looking at a half-empty glass. My current charges are $116 for males and $166 for females (with an additional $20 for pregnant females). I consider this additional income for relatively stress-free and minimally time-consuming procedures, rather than lost income, as well as practice for recent graduates and a chance to gain the unending gratitude of clients who know that I care.

Finally, no one is forced to donate their services. I suspect there are plenty of other veterinarians who are similarly happy to participate in this worthwhile and rewarding endeavor.

Jan Rottenberg, dvm

Just Cats Veterinary Care

Edison, NJ

Sensitivity versus specificity of PennHIP as a screening test for osteoarthritis

I appreciated reading the recent study by Powers et al,¹ which compared hip scores from the Orthopedic Foundation for Animals (OFA) with PennHIP distraction index (DI) values in dogs. It was interesting that such large percentages of dogs with excellent or good OFA scores were found to have DI values that would classify them as susceptible to osteoarthritis.

As a general practitioner with an interest in reproduction, I often help my clients choose quality dogs to breed. Depending on breed, multiple variables go into this decision, including radiographic appearance of the hip and elbow joints and vertebral column, results of a complete ocular examination, thyroid gland function, specific markers of genetic diseases, temperament, familial reproductive efficiency, and conformation. Many of my clients spend thousands of dollars determining which dogs are best inclined to pass on their genetic phenotype.

I am interested in the conclusion in the report that OFA scores “…underestimated susceptibility to osteoarthritis in dogs….” I am intrigued by the possibility that PennHIP DI values may in fact designate many normal nonarthritic dogs as dysplastic. Reliance on DI values would, therefore, take many normal dogs with otherwise desirable phenotypes out of the breeding pool. I also wonder whether there are any studies that have examined the percentage of dogs labeled dysplastic on the basis of PennHIP DI values that turned out to have grossly and radiographi-cally apparent arthritis at a later age. It would be great to see a follow-up study in which dogs that had a DI ≥ 0.30 yet were classified by OFA as being phenotypically normal were evaluated 2, 4, and 6 years later.

Jesse A. Sondel, dvm

Spring Harbor Animal Hospital and

Reproductive Center

Madison, Wis

The author responds:

Thank you for your comments on our manuscript. Your concerns give us the opportunity to clarify some common misconceptions. Underlying these concerns are two basic assumptions. First, that dogs are either positive or negative for canine hip dysplasia, and second, that there exists a gold standard method for identifying dogs with hip dysplasia against which the accuracy of a diagnostic test can be assessed. Neither of these assumptions is valid.

Canine hip dysplasia is not a “pass-fail” disease. It is a quantitative trait, meaning that many genes or gene loci act in concert with environmental influences to cause phenotypic expression of the genotype, that being overt clinical or radiographic signs of osteoarthritis (OA). As a disease, hip dysplasia is more akin to cancer or to diabetes. These diseases require a certain set or frequency of alleles in combination with certain environmental factors (eg, cigarette smoking or obesity) that increase susceptibility for tumor formation or insulin in-sensitivity. Not everyone susceptible to cancer will necessarily develop it in a lifetime, but they may pass on the susceptibility to their offspring. Similarly, in selecting dogs for breeding, the genetic goal is not only to eliminate the overt clinical expression of the disease (ie, OA) but also to decrease the susceptibility to OA. Research has shown that the PennHIP distraction index (DI) is a continuous metric that quantifies hip joint laxity, which in turn correlates strongly with susceptibility to develop the OA characteristic of hip dysplasia.^1,2 Dogs with the tightest hips (DI < 0.3) have a near zero probability of developing the OA associated with hip dysplasia.³ Dogs with DIs ≥ 0.3 are susceptible to developing OA, with the likelihood of doing so increasing as DI increases.^2,a Because PennHIP is not a “pass-fail” screening system, PennHIP scoring does not remove dogs with desirable phenotypes from the gene pool, as suggested in your letter. Rather, a dog is ranked on the basis of its individual susceptibility to develop OA (as determined by the DI) relative to other dogs of the same breed. Systematic genetic progress is made through applying selection pressure by breeding dogs having DIs lower than the mean for the breed. These are time-tested, proven principles of quantitative genetics.⁴

Although there is no gold standard for the diagnosis of hip dysplasia in dogs, the long-term outcome studies you request in your letter are essential, whether referring to the PennHIP method or the OFA method. Fortunately, a long-term study (involving 48 Labrador Retrievers followed up over their entire lifetimes) has yielded some critical answers.^5,a The results are striking. Twenty-four of the 26 (92%) Labrador Retrievers that received excellent, good, or fair OFA scores at 2 years of age went on to develop histologic signs of OA, and 16 of 29 (55%) developed radiographic signs. By contrast, all 48 dogs had DIs ≥ 0.3 and 44 of the 45 (98%) dogs evaluated both radiographi-cally and histologically went on to develop radiographic or histologic signs of OA. This further reinforces our conclusion that the high proportion of false-negative diagnoses associated with OFA hip scoring impedes genetic progress.

Gail K. Smith, vmd, phd

Director of PennHIP

University of Pennsylvania

Philadelphia, Pa