The father of veterinary public health

I read with interest the recent JAVMA News story¹ on Dr. James H. Steele, “The father of veterinary public health.” I have always deemed it an honor and privilege to have known Dr. Steele during the early phases of his career and remember when he first visited me at Colorado State University, where I began my career in academia.

The 1940s to 1970s was a golden era for veterinary medicine and the biomedical sciences, when giant leaps forward were made by many pioneers, including Dr. Steele. Both he and I were extremely fortunate to have been selected as veterinary medical students by Dr. Ward Giltner of Michigan State University, who was the dean of the College of Veterinary Medicine from 1923 to 1947. Dr. Giltner was an outstanding educator and important mentor in shaping our careers.

Nicholas H. Booth, dvm, phd

Jacksonville, Fla

Impact of free-ranging cats on wildlife

It was good to see the recent JAVMA News article¹ on the impact of free-ranging domestic cats on wildlife, but I don't believe veterinarians needed a study demonstrating the destruction of wildlife by feral cats. Veterinarians own cats, treat cats, and speak to owners of cats and know that once outdoors, cats can be effective predators that often kill wildlife.

Feral cats have negative effects on wildlife and the people who enjoy wildlife. Equally important, cats, being domesticated and nonnative, are poorly equipped to survive in the wild, facing hunger, disease, and attack from other animals. Feral cats also raise public health concerns related to zoonotic diseases and parasites.

As a practicing veterinarian in southern Florida, I would not neuter a Burmese python and release it into the wild and believe we should not do so with any house pet, including cats. It seems to me that the more the public knows about feral cats and feral cat colonies, the less acceptable they will become.

Mark S. Mathusa, dvm

Sanibel, Fla

We would like to compliment the JAVMA on the publication of its recent news story on the impact of free-ranging domestic cats on wildlife.¹ We are aware that the issue of free-ranging domestic cats is controversial, as it seems to pit cat lovers against wildlife conservationists, and we know the study by Loss et al² described in the news report has elicited protests from feral cat advocacy groups. But this isn't simply a matter of cats versus wildlife.

One critique of the Loss et al² study raised by detractors is that the authors extrapolated from small datasets, making their conclusions suspect. Their methods, however, were the same as those used to evaluate other major causes of death for people and animals. More importantly, whether the number of birds and mammals killed by free-ranging cats is in the billions or merely the hundreds of millions is beside the point. Clearly, free-ranging cats kill birds and small mammals, lots of them native, on a massive scale. Many other studies support this conclusion and essentially none refute it. Most people's own observations and common sense also confirm it. Cats are effective killers of native species, and although they kill some pests, having evolved with rats and mice, they are an inefficient and environmentally damaging method of rodent control.³

Feral cats are also an important human health risk because they can carry a variety of zoonotic pathogens, regardless of whether they are vaccinated.⁴ One can argue about the comparative scope and magnitude of the risk, but it is real and it results in human sickness and, occasionally, death as well as in the regular expenditure of public health dollars.^5,6 When feral cats are concentrated, the cats themselves, their feces and urine, and any leftover food may pose a risk to owned pets, degrade property values, and cause conflicts with neighbors.

Finally, feral cats generally live shorter and less healthy lives than do cats that don't live outdoors.⁷ They die or are hurt as a result of car and other accidents, malicious human activities, dog and coyote attacks, severe weather, and starvation.^8,9

In sum, feral cats kill vast numbers of birds and small mammals, create public health risks, and have shorter and less healthy lives. In our opinion, therefore, managing feral cats outdoors is not consistent with a one health approach. We can do better for cats and for wildlife.

David A. Jessup, dvm, mpvm, daczm

Royal Oaks, Calif

Michael Hutchins, phd

Silver Springs, Md

Doxycycline for veterinary use during shortage

For a variety of reasons, there currently is limited availability of commercial formulations of doxycycline hyclate and doxycycline monohydrate,¹ and the cost of those products that are available has markedly increased. There are, however, some alternatives that can be considered until such time as these products are again available.

Doxycycline as the monohydrate salt is approved for use in dogs and cats in other countries, and doxycycline monohydrate is a reasonable substitute for doxycycline hyclate, although the incidence of gastrointestinal upset may be greater with doxycycline monohydrate. Compounded formulations of doxycycline may be available, but because some compounded forms of doxycycline are unstable, being characterized by a short beyond-use date,² assurances should be obtained from the pharmacy preparing any compounded doxycycline formulation that the product will retain potency up to the labeled beyond-use date.

In humans, minocycline is an acceptable alternative to doxycycline. However, although breakpoint concentrations for minocycline and doxycycline have been established for human isolates, none have yet been established for veterinary isolates. Importantly, breakpoint concentrations for human isolates may not be equivalent to the breakpoint concentrations for canine and feline isolates. The Clinical Laboratory Standards Institute Veterinary Subcommittee may establish interpretive criteria for these drugs in the future. No data are available regarding treatment of Wolbachia spp and other rickettsiae with minocycline, although activity similar to that of doxycycline is anticipated on the basis of mechanism of action and tissue penetrability. Regarding pharmacokinetics, minocycline is cleared more rapidly than doxycycline in dogs and more rapidly in dogs than in humans. Pharmacokinetic studies following oral administration of minocycline are limited, but half-life and recommended dosing intervals are anticipated to be similar to those for doxycycline in dogs. Although minocycline is less likely to bind to food, the oral bioavailability of minocycline may be less than that for doxycycline, leading to higher recommended oral dosages (10 mg/kg [4.5 mg/lb], q 12 h, or 20 mg/kg [9.0 mg/lb], q 24 h). Only a small percentage of minocycline is excreted in the urine, and minocycline, therefore, is not recommended for treatment of urinary tract infections. Regarding safety, oral administration of minocycline at a dosage of 30 mg/kg (13.6 mg/lb) daily for 30 days was well tolerated in dogs, but adverse events were reported at a daily dosage of 40 mg/kg (18.2 mg/lb). In contrast, IV administration of doses ≥ 5 mg/kg (2.3 mg/lb) was not well tolerated, and IV administration is not recommended. Adverse events that occur with administration of minocycline in dogs or cats should be reported to the FDA Center for Veterinary Medicine.³ No data are available regarding the use of minocycline in cats at this time.

Dawn Merton Boothe, dvm, phd, dacvim, dacvcp

College of Veterinary Medicine

Auburn University, Ala

Benefit versus cost of recent AVMA moves

At various times over the past several years, we have disagreed with some of the decisions made by the AVMA Executive Board and Executive Vice President and wondered whether these decisions best serve the needs of the general AVMA membership.

For example, last year, the AVMA created a new staff position, associate director for international and diversity initiatives.¹ It appears to us that this position substantially overlaps with a volunteer position that already exists within the AVMA Committee on International Veterinary Affairs. According to a report² prepared by the AVMA in late 2012, projected expenses for all international activities conducted by the AVMA during 2012 were $615,918, while projected income associated with international activities was $598,400. Executive Vice President Ron DeHaven has stated that this net loss is necessary because, “As they say, you either need to have a seat at the table or you may find yourself on the menu. … Even at such a modest cost, we have a prominent seat at the table.”³ We do not understand how the AVMA's international activities are of sufficient value to the membership to justify the creation of this new position, which contributes substantially to the $615,918 price of AVMA's international engagement.

Similarly, in late 2010, the AVMA launched MyVeterinarian.com “as a free resource to help members market their clinics on the Web”⁴ and as a way for members to reach prospective clients. The service is in our opinion clunky for both participating practices and potential clients. We believe promoting member clinics via freely available, public search engines such as Google that are more familiar, more user-friendly, and more comprehensive would be a better alternative.

Despite the recent redesign of the AVMA website, the Network of Animal Health (NOAH), the portion of the website devoted to discussion forums, remains sparsely populated, while the Veterinary Information Network (VIN) appears to be the overwhelming choice for veterinarians looking for online discussion forums. A review of the NOAH forums directory showed 784 posts on 164 topics in 27 forums for the 6-month period from July 12, 2012, to January 31, 2013,⁵ whereas during the same time period, VIN reportedly had 638,296 posts on 56,480 topics in 60 forums.^a We believe that the membership would be better served by discontinuing NOAH and partnering with VIN to provide an AVMA members–only area.

Finally, the AVMA Executive Board recently approved spending up to $178,000 to design and implement a new logo for the association, an amount equivalent to the dues for nearly 600 members. Although various explanations of the need for a new logo have been given,⁶ we question the timing of this effort.

While the AVMA performs some critical functions well, some members are questioning the value they receive for the dues they pay. As long-established member benefits such as health and liability insurance become more available elsewhere, the AVMA may have a difficult time sustaining the vital functions we need it to continue providing if members decide to leave because of a perceived lack of value. The current economic climate demands a tangible return on investment, and we do not believe that the money and resources spent by the organization on these example initiatives can be justified by the benefit provided to members.

Eden Myers, dvm, ms

Mount Sterling, Ky

Ryan G. Gates, dvm

Cuyahoga Falls Veterinary Clinic Inc

Cuyahoga Falls, Ohio

James F. Wilson, dvm, jd

Priority Veterinary

Management Consultants

Yardley, Pa

The AVMA responds:

I want to thank Drs. Myers, Gates, and Wilson for their comments. Member input such as theirs helps shape and provide direction for the AVMA as we continue our mission of improving human and animal health and advancing the veterinary medical profession. I would make a few points, however.

As indicated, the AVMA's international activities are effectively cost neutral for AVMA members. Yet, those activities have a far-reaching impact. As travel and trade between countries increases, activities elsewhere are having a greater and greater impact here at home. Thus, it is vital that the AVMA remain engaged internationally. A thorough review of the AVMA's international activities and the reasons for them is available on the AVMA website.¹

Currently, > 13,500 practices (of the approx 24,000 to 26,000 in the United States) have registered with MyVeterinarian.com, providing these practices an additional online presence at no cost to the practice. Technological advances are indeed needed to improve this resource, but feedback we have received indicates that many members are pleased with the visibility MyVeterinarian.com provides for their practices.

While it is true that use of the Network of Animal Health (NOAH) is not yet as widespread as we would like, it clearly is a valuable resource for many AVMA members and is available to all members at no additional cost. Importantly, NOAH is just a part of the AVMA's online community, which includes social media outlets such as Facebook and Twitter, the AVMA@work blog, the AVMA YouTube channel, and a variety of electronic newsletters.

Finally, other members have shared their concerns with the AVMA Executive Board's decision to spend up to $178,000 to design and implement a new logo for the association. The AVMA's logo has been the same since 1971, and since that time, technology has changed, communication methods have evolved, and member demand for public outreach has increased dramatically. Our current logo design, text size, and style hinders our ability to make an effective impact, particularly in the online world. In addition, our involvement with the Partners for Healthy Pets initiative, which will include a substantial investment in public outreach, makes this an ideal time to move forward with a redesign. While the cost may seem high, a large part of that cost will be spent to ensure we have broad input from AVMA members.

Dr. Myers, Gates, and Wilson are quite correct that today's economic climate demands a return on one's investment, and the AVMA encourages members to evaluate what they are getting for their dues dollars. That said, the AVMA is working and continues to work in many ways big and small to help members build their businesses and careers, promote and protect the veterinary profession, and help veterinarians stay connected. Given the great diversity in the veterinary profession, we do not expect that every member will find every resource to be of benefit to that person individually. But, we do believe that every member will find value. By exploring the information and resources available from the AVMA, members can come to understand the benefits, both tangible and intangible, of their membership.

Kevin Dajka, dvm

Director, Membership and Field

Services Division

AVMA Schaumburg, Ill