Veterinary medicine in the global community

I feel compelled to respond to the recent letters to the editor by Drs. Bruce Max Feldmann¹ and Chris Frye² regarding the commentary by Dr. Robert Marshak published in the November 1, 2011, issue of JAVMA discussing veterinary school accreditation.³ It is clear that the commentary by Dr. Marshak has touched a nerve within our profession, and I expect that there will be debates on the topic for years to come.

In particular, I am concerned that the letter by Dr. Feldmann may leave readers with the impression that foreign-trained veterinarians—myself included—are somehow less capable or less driven, compared with veterinarians trained in North America. This is, in my opinion, misguided. In point of fact, Dr. James Law, who trained the first American-degreed veterinarian (Daniel Salmon) at Cornell University, was a foreign-trained veterinarian. I believe that this unfavorable attitude toward foreign-trained veterinarians holds us back as a profession and decreases our collegiality. Isn't this the age of diversity and inclusion? Shouldn't that include foreign-trained veterinarians?

The letter by Dr. Frye expresses concerns about a potential oversupply of veterinarians and suggests that this “may lead to ever more veterinarians facing low incomes and high debts.” Of course, these fears are understandable given the ongoing increase in the student debt—to—income ratio, but they should be examined in light of the demand for veterinary services. Dr. Frye's own alma mater, Cornell University, recently opened a satellite veterinary specialty hospital in Stamford, Conn. Would the university have done so if the new facility wasn't filling a need?

Like it or not, competition is what created the free-market society we live in. Competition is all around, be it from national chains, the new clinic opening around the corner, or veterinarians trained outside of the United States. These changes will continue in a market-driven economy. I hope that our profession can move forward while still remaining collegial and providing the same respect to all veterinarians, regardless of the university name on their diploma.

Matthew Panarella, dvm

Hampton, NJ

In response to the recent commentary¹ by Dr. Robert Marshak on veterinary school accreditation and the subsequent letters to the editor, I wanted to say that I applaud the AVMA for extending the accreditation process beyond the borders of the United States and Canada. As Dr. Francisco J. Trigo points out in his letter,² we should be embracing global veterinary medicine rather than excluding ourselves from it.

For those of us fortunate enough to be acquainted with our esteemed colleagues and neighbors to the south and elsewhere in the global veterinary community, it is not difficult to realize the importance of aligning ourselves with these outstanding veterinary colleges. Across the planet, veterinarians are playing ever more important roles in a variety of complex issues, including issues relating to food supply, human and animal health, and environmental and conservation concerns, to name just a few, and I hope that those of us in the veterinary profession would not seek to isolate or distance ourselves from a world full of surprises, creativity, and differences. For myself, I would like to sincerely welcome the addition of these highly regarded institutions, along with their esteemed faculty and graduates, into the AVMA network and global veterinary community.

I think the quote from the Mexican writer Paco Ignancio Taibo I is very apropos:

“La cualidad más fascinante de las cosas es que cambian tan rápido que uno sigue pensando en ellas como eran antes” (roughly, “The most fascinating quality of things is that they change so fast that one continues thinking of them as they were before”).

David Hoffman, dvm, ms

Belle Fourche, SD

Concern regarding application of exclusion criteria in PPA study

We read with much interest the recent retrospective study of phenylpropanolamine (PPA) toxicosis in dogs.¹ The authors are to be commended for compiling information regarding overdosage of this commonly used medication. However, we are concerned that the authors apparently did not follow their exclusion criteria when they decided which PPA cases to omit from the study. Specifically, it was stated that cases in which multiple toxic agents were involved or medical records were incomplete were to be excluded. Yet, the one dog in the study that died was “exposed to multiple medications, including PPA, in the garbage….” Furthermore, for this dog, “additional information regarding decontamination, treatments performed, and specific clinical signs was not obtained.”

The desire to provide clinical information on the one observed death in the study is understandable. However, including this dog in the study calls into question whether other cases for which the exclusion criteria were not rigidly applied were included in the statistical analysis. If so, then the conclusions of the study may be less definitive. Perhaps it would have been better to exclude this dog from the statistical data set, but still describe in the Discussion section the clinical observations that occurred for this case.

Paul A. Eubig, dvm, ms, dabt

Michael L. Biehl, dvm, phd, mba, dabt

Duncan C. Ferguson, vmd, phd, dacvim, dacvcp

Department of Comparative Biosciences

College of Veterinary Medicine

University of Illinois at Urbana-Champaign

Urbana, Ill

The authors respond:

Thank you for your comments regarding our manuscript. The single fatality was included in our analysis, even though other medications were ingested, to underscore the potential for development of severe clinical signs, up to and including death, that may occur with phenylpropanolamine ingestion. In this case, although the other medications were not documented during the initial consultation, they were not considered by the attending veterinarian to be associated with the dog's clinical signs. We agree that on the basis of our exclusion criteria, it may have been more prudent to include this dog's information in the discussion and exclude it from the statistical analysis.

In reviewing data for this case and all other cases in the study, we identified an additional 18 cases that were inadvertently included in the analysis but should have been excluded because of possible ingestion of other medications (eg, multivitamins, thyroid hormone, and antimicrobials). Inclusion of these cases was an oversight and not an attempt to mislead readers or misrepresent our study population, and we apologize for this error. Recalculation of median ingested doses following removal of these 19 cases resulted in minor changes in the values but did not alter our conclusions. After removal of these 19 cases, median ingested dose for the remaining 151 dogs was 30 mg/kg (13.6 mg/lb), median ingested dose was significantly (P < 0.001) higher for the 92 dogs that developed clinical signs (39.0 mg/kg [17.7 mg/lb]) than for the 59 dogs that did not develop clinical signs (18.3 mg/kg [8.3 mg/lb]), median ingested dose was significantly (P < 0.001) higher for the 121 dogs evaluated by a veterinarian (36.7 mg/kg [16.7 mg/lb]) than for the 30 dogs monitored at home (11.4 mg/kg [5.2 mg/lb]), and median ingested dose was significantly (P < 0.001) higher for the 108 dogs that were hospitalized (41.9 mg/kg [19.0 mg/lb]) than for the 13 dogs that received outpatient treatment (19.0 mg/kg [8.6 mg/lb]).

We appreciate your noting this error and apologize for not more prudently excluding cases that met our exclusion criteria.

Katherine L. Peterson, dvm

Justine A. Lee, dvm, dacvecc

Lynn R. Hovda, rph, dvm, ms, dacvim

Pet Poison Helpline Bloomington, Minn