Further thoughts on possible discrimination against LGBT veterinarians

Like Dr. Keri Jones,¹ I read with interest the JAVMA News story on health concerns of lesbian, gay, bisexual, and trans-gender veterinarians.² However, I took away a different message. My interpretation of the statement from Dr. Michael Chaddock that LGBT veterinarians have a greater likelihood of mental health and substance abuse issues (compared with other practitioners) is that the factors listed may contribute to an increased likelihood, but do not automatically mean that members of this group will develop such issues. Dr. Jones does make a good point that more study is needed before reaching any conclusions, especially given the large number of factors that could lead an individual to develop mental health or substance abuse issues.

I understand Dr. Jones’ concern that employers might be unwilling to hire LGBT veterinarians if the employers were convinced that LGBT veterinarians were at risk for developing mental health or substance abuse issues. However, I fail to see how an employer would even know a job candidate's sexual orientation, as asking about sexual orientation during a job interview is illegal. The job candidate would have to volunteer this information. In my experience as an employer, a potential employee bringing up lifestyle details during an interview that are irrelevant to job performance is not a good idea.

John Parker, dvm

Novi, Mich

Disputing strong claims of acupuncture's effects

I was troubled when reading the article by Teixeira et al, “Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture,”¹ because the authors ignored the results of their statistical analyses that showed no significant treatment effects. Instead, they based all of the conclusions on a few results from the large number of within-group comparisons (analyses that do not involve comparison of a treatment group to a control group and that are not appropriate in this context²) that were performed and used these invalid comparisons to claim the existence of a treatment effect that was not substantiated by their data.

Disconcertingly, results of the direct comparisons between treatment and control groups were not addressed in the discussion and were given a single sentence in the results section: “For the HD [hip dysplasia]-affected dogs, there was no difference in the HCPI [Helsinki Chronic Pain Index], CPBI [Canine Brief Pain Index], and VAS [visual analogue scale] data among the 3 treatments at any time point.” Unfortunately, instead of accepting the implications of these results, the authors attempted to discount them by testing for significant (ie, P 0.05) changes over time. This P value cutoff is valid when performing a single comparison, but given that there were 6 owner assessments (total CBPI score, CBPI pain severity subscore, CBPI pain interference subscore, HCPI, VAS for pain, and VAS for locomotion), 3 treatment time points (2, 4, and 6 weeks), and 3 baselines (-2 weeks, 0 weeks, and both), it appears a total of 54 comparisons were performed within the acupuncture group alone. The use of 3 baselines increased the number of within-group comparisons for each group from 18 to 54. This in turn increased the odds of obtaining at least one false-positive result (1 − 0.95ⁿ) from 60.3% to 93.7%, much higher than the false-positive rate implied by a P value cutoff of 0.05.

Within-group comparisons evaluate changes over time. They are not controlled measures of treatment effects and are highly prone to producing false-positive results.³ The fallibility of this method is illustrated by the puzzling claim that “[t]he VAS for pain revealed that only owners of the acupuncture-treated dogs perceived a reduction (P = 0.008) in their dog's pain intensity at week 6, compared with findings at week -2 (Figure 3),” when Figure 3 shows that the reduction was less in the acupuncture group than in the control group. If a measurable effect existed (which was not the case, given that the authors did not identify any differences between the acupuncture and control groups at any time), then acupuncture actually prevented dogs from improving as much as the control treatment over the 8-week interval.

I am troubled also that the review process allowed inclusion of the conclusion in the abstract that “[a]cupuncture and carprofen reduced the degree of subjectively evaluated lameness, and acupuncture was associated with a decrease in validated chronic pain scores,” as this strong statement is in no way supported by the data presented. More disturbing still is that this wholly unsubstantiated strong claim of treatment effect is now part of the searchable scientific database.

Ben Hale, dvm, phd

Hinesburg, Vt

The authors respond

In his letter regarding our study “Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture,”¹ Dr. Hale writes that “the authors ignored the results of their statistical analyses that showed no significant treatment effects” and “used invalid comparisons to claim the existence of a treatment effect that was not substantiated by their data.”

The hypothesis of our study was that both acupuncture and carprofen would reduce signs of pain and lameness and improve symmetry indices derived from kinetic evaluation of the hind limbs in dogs with hip dysplasia. And, we indeed did not observe any differences in Helsinki Chronic Pain Index, Canine Brief Pain Index (CBPI), or pain and locomotion visual analogue scale data among the 3 treatments at any time point, a finding that was not omitted from the report.

However, as mentioned in the results section, the percentage of dogs with at least a 30% improvement in CBPI score, compared with baseline score, was significantly (P = 0.034) higher for dogs treated with acupuncture (13/15) than for dogs treated with a placebo (7/16), although not significantly (P = 0.446) different from the percentage for dogs treated with carprofen (11/16), suggesting that there was a difference between acupuncture and placebo.

Dr. Hale asserts that, as suggested by Allison et al,² within-group comparisons that do not involve comparison of a treatment group to a control group are not appropriate. But, the authors believe that the situation for our study was different from the one discussed by Allison et al. The Friedman test used in our study is a classic statistical test that, when combined with the Dunn test for multiple pairwise comparisons, has been frequently used for within-group comparisons.³ Nevertheless, we thank Dr. Hale for his observations regarding our statistical methods and intend to consider his suggested approach for future studies.

However, the authors do not agree that our conclusion is not supported by the data presented in the study and we feel confident in our conclusion that acupuncture may be a viable option for dogs with hip dysplasia.

Stelio P. L. Luna, dvm, phd

Department of Veterinary Surgery and Anesthesiology

Faculty of Veterinary Medicine and Animal Science

São Paulo State University

Botucatu, Brazil

Clarifying the mission of no- or low-cost clinics

The “Back to basics” JAVMA News story¹ describing efforts to help underserved populations of pet owners afford veterinary care made some excellent points. I've seen both sides of the issue, having practiced quality, for-profit small animal medicine for close to five decades and been involved with a nonprofit, low- or no-cost spay-neuter clinic for pets of low-income owners for nearly a decade.

Our nonprofit clinic provides care for pets owned by a segment of the population that could not otherwise afford veterinary care. We don't advertise, relying on word-of-mouth recommendations, and have strict income requirements. Unlike some other nonprofit clinics, we only provide neutering, pain control, and rabies vaccination and do not perform any elective procedures.

Lower-cost alternatives may be perceived by the public to provide the same level of service, but they often do not. And, it is only through the generosity of donors and fundraising that we are able to provide these services. We cannot provide preanesthetic screening or some of the other services that are standard in for-profit clinics. That said, we have an experienced surgeon and surprisingly few issues.

Perhaps the profession needs to do a better job of informing pet owners about who we in the private sector are and what we are capable of providing. There will always be a place for reduced-cost services or even charity work. Those clients troubled by the cost of veterinary care who go to nonprofit clinics when they could afford for-profit services need a healthy dose of education.

William C. Skaer, dvm

Wichita, Kan