Letters to the Editor

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Changing how we think about one health

The AVMA's recent efforts lobbying Congress to support a bill requiring federal agencies to adopt a one-health approach to zoonotic disease outbreaks, as reported in JAVMA News,1 strikes me as a poor use of member-funded resources.

Legislation requiring federal agencies to work together is notoriously ineffective. In my nearly 13 years’ experience working in or with the federal government, I have found that agencies will often pay little more than lip service to statutory requirements to collaborate if they are not already inherently incentivized to do so. The health needs of humans, animals, and the planet are so broad and deep that the answers will not be found in a framework requiring officials to talk to each other. Legislation mandating such collaboration primarily succeeds in enabling members of Congress to demonstrate to their constituents that they are taking action of some kind.

Moreover, “one health” has become a perpetually veterinary-dominated endeavor characterized by relatively less interest from the other sectors so relevant to making its goals a success. Both lead sponsors of the House version of the Advancing Emergency Preparedness Through One Health Act of 2019 are veterinarians, even though 14 members of the House of Representatives are physicians and dozens of others have degrees or experience in areas of science such as climate change, ocean science, and mathematics—all foundational to advancing holistic health solutions. This only serves to further brand one health as a veterinary initiative and diminish its reach.

Despite the frequent talk of one health in our profession these days, it is not a new concept. An understanding of the connectivity of human, animal, and environmental health was present in ancient Greece and Rome. Examples of successful interdisciplinary health interventions abound in modern US history, from the eradication of Texas cattle fever to the wildly successful rabies interventions of the 20th century. Expansion and specialization of government agencies have indeed led to the inadvertent development of problematic siloes, but the solution to this governance problem lies not in legal dictates but in advancement of interdisciplinary and interagency funding vehicles, open-access information-sharing platforms, and collaborative educational experiences for health and science students of all fields.

Students increasingly seek advice from me on pursuing careers in one health. This is the generation that will become the doctors, scientists, health officials, and policymakers who will address the world's growing health challenges. Instead of viewing one health as a discipline or career unto itself, I urge these students to instead master a specific skill set and apply it to health problems in collaboration with other professionals. This is one health.

Ellen P. Carlin, DVM

Washington, DC

1. Legislation would create one-health response to outbreaks. J Am Vet Med Assoc 2020;256:15.

The AVMA responds:

We agree that one health is complicated, with no simple solution to ensure interdisciplinary health interventions when dealing with zoonotic diseases. But, whereas legislation will not singlehandedly solve one-health challenges, we have no doubt it is a step in the right direction.

Currently, one-health activities are conducted at many different federal agencies. Examples include the One Health Office within the CDC, antimicrobial resistance-related projects at the USDA, and the Emerging Pandemic Threats program at the US Agency for International Development. It only makes sense to ensure these agencies are coordinating their work to maximize their success, which is exactly what this legislation would do.

At the same time, one-health legislation offers an opportunity to educate the public and elevate one health at the highest levels of government. It is true that many nonveterinarians are not familiar with one health, but this is why it is all the more important to have a national conversation about one health and to use legislative options to expand use of the one-health approach.

The AVMA will continue to educate Congress on the importance of one health, without sacrificing our effective lobbying efforts on all of the diverse issues affecting veterinary medicine, including health care, rural veterinary care, prescription mandates, and more. We are excited to seize every legislative opportunity to advance veterinary medicine.

John Howe, DVM

President AVMA Schaumburg, Ill

Pet allergies in veterinary medicine

We read with interest the JAVMA News article “Allergic to work: veterinary professionals see pet allergies as hurdle, not barrier”1 and appreciate the opportunity to provide clarification and some additional information on human allergies to cats.

We were intrigued by the 2009 study2 in which 39% of Western Canadian veterinarians reported developing an allergy during their career. The study did not differentiate which allergens were most problematic, but cats are the second-most common animal source of indoor inhalant allergens after house dust mites.3 Globally, as many as 1 in 5 adults are allergic to cats.4 The major cat allergen is Fel d 1, which accounts for up to 95% of human sensitization to cats.5 It is primarily produced in the salivary and sebaceous glands and is distributed on the hair and skin as the cat grooms.5 All cats produce Fel d 1, but the amounts produced can vary widely between cats as well as within the same cat over the course of the year.4,5 For many allergic humans, this helps to explain why exposure to some cats causes minimal reactions but exposure to others sparks an immediate, more severe response.

When presented with cat-allergic patients, allergists typically recommend removing the cat from the home to reduce the allergen load.4 However, few cat owners are willing to comply with this recommendation. Similarly, most veterinarians in the Canadian study2 did not alter their practice because of allergies. Although immunotherapy has been considered successful for managing many allergies, there is less evidence for its efficacy in managing allergies to cats.6

The exact function of Fel d 1 in cats is currently unknown; therefore, the health and welfare impacts of ceasing or altering its production in cats are also unknown.5 For this reason, a new approach was developed to neutralize the allergic potential of Fel d 1 after its production but before its introduction into the environment. Coating a dry cat food with an egg product containing anti-Fel d 1 IgY antibodies neutralizes active Fel d 1 in the cat's saliva. Once the antibodies bind to active Fel d 1, it is neutralized and no longer recognized as an allergen. When the cat grooms, it distributes the neutralized Fel d 1, reducing the amount of active (allergenic) Fel d 1 on the cat's hair and thus reducing the amount of active Fel d 1 shed into the environment. A series of peer-reviewed publications has documented the efficacy and safety of the approach, and a recent supplement to the journal Allergy5 provides an in-depth summary of these manuscripts.

We encourage all veterinarians with allergies to consult an allergist to establish an individualized management plan. For cat-allergic cat owners and veterinarians, this new feline-friendly approach offers another tool for allergen load management.

Andy Sparkes, BVetMed, PhD

Simply Feline Veterinary Consultancy Shaftesbury, England

Ebenezer Satyaraj, PhD

Nestlé Purina Research St Louis, Mo

H. James Wedner, MD

Division of Allergy and Immunology Department of Medicine Washington University School of Medicine St Louis, Mo

  • 1. Mattson K. Allergic to work: veterinary professionals see pet allergies as hurdle, not barrier. J Am Vet Med Assoc 2020;256:2226.

  • 2. Epp T, Waldner C. Occupational health hazards in veterinary medicine: zoonoses and other biological hazards. Can Vet J 2012;53:144150.

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  • 3. Bonnet B, Messaoudi K, Jacomet F, et al. An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen. Allergy Asthma Clin Immunol 2018;14:14.

    • Crossref
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  • 4. Dávila I, Dominguez-Ortega J, Navarro-Pulido A, et al. Consensus document on dog and cat allergy. Allergy 2018;73:12061222.

  • 5. Satyaraj E, Wedner HJ, Bousquet J. Keep the cat, change the care pathway: a transformational approach to managing Fel d 1, the major cat allergen. Allergy 2019;74(suppl 107):517.

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    • Search Google Scholar
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  • 6. Dhami S, Agarwal A. Does evidence support the use of cat allergen immunotherapy? Curr Opin Allergy Clin Immunol 2018;18:350355.

Is talk tricky?

The recent JAVMA News story1 on the unknowing use of microaggressions by veterinary professionals made some interesting points. However, I noticed that in describing microaggressions, the story did not discuss intentional versus nonintentional statements. This distinction is important and needs more discussion. An intentionally made offensive remark is much different from and should be viewed differently than an innocent remark taken as offensive.

There are, of course, statements made with no offensive intent that are taken as offensive. I don't think, however, that we should necessarily default to the notion that the speaker is always at fault for such offense. The article quoted Dr. Stacie Gallenstein from the North Carolina State University College of Veterinary Medicine, whose comment that former President Obama was an amazing speaker was taken the wrong way by some of her students. I find it curious that a statement such as “President Obama was an amazing speaker” could be taken as offensive, but I can certainly see that in some contexts, a seemingly objective statement could be taken the wrong way. On the other hand, however, and in a different context, any offense might be taken as the listener being overly sensitive. I would posit that conversation partners share responsibility for the appropriateness of their statements and their corresponding responses.

The article seems to suggest that it is the responsibility of speakers to anticipate what may or may not be offensive to their listeners. As well, there seems to be a suggestion that we all should be continually evaluating our statements to seek out signs of microaggressions. Yet, there is no suggestion that individuals examine themselves for areas where, because of their own biases, they might be overly sensitive to things they hear.

Communication is a two-way activity. As much as people should be careful not to give offense, people should be careful not to take offense if it is not clearly meant. I have yet to meet a veterinarian who has not been asked whether they were a “real doctor.” I also have yet to be asked that question by someone who intended it to be offensive.

Talk isn't that tricky if we follow the Golden Rule and assume the best intentions in others.

John S. Parker, DVM, MBA

Briarpointe Veterinary Clinic Novi, Mich

1. Mattson K. Talk is tricky. J Am Vet Med Assoc 2020;256:158159.

The looming crisis in rural practice

As we rush toward the end of yet another academic year, we should take a moment to acknowledge a looming crisis: new veterinarians are overwhelmingly taking positions in urban and suburban practices, with few looking to make a career in rural practice.

Urban and suburban practices can only absorb so many new veterinarians before over-supply starts to drive salaries down. Meanwhile, rural practices are closing their doors, taking what jobs they had offered with them.

Right now, rural practices are selling at reasonable prices. As a solo practitioner or practice partner, you have the ultimate control over your own life-work balance.

Perhaps encouraging extern-ship programs in rural areas would show veterinary students, especially those deeply in debt, that they can make a living there. Possibly, rural counties could come together and build a public practice that would hire veterinarians on a contract basis, shifting the cost of property, materials, equipment, and staff away from the veterinarian. Private veterinary practice is still the largest sector of veterinary medicine, and innovative financing arrangements and hospital organizations are potential ways to keep veterinarians in rural environments.

Fred Philips, DVM

Animal Hospital of Rushville PC Rushville, Ind

  • 1. Legislation would create one-health response to outbreaks. J Am Vet Med Assoc 2020;256:15.

  • 1. Mattson K. Allergic to work: veterinary professionals see pet allergies as hurdle, not barrier. J Am Vet Med Assoc 2020;256:2226.

  • 2. Epp T, Waldner C. Occupational health hazards in veterinary medicine: zoonoses and other biological hazards. Can Vet J 2012;53:144150.

    • Search Google Scholar
    • Export Citation
  • 3. Bonnet B, Messaoudi K, Jacomet F, et al. An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen. Allergy Asthma Clin Immunol 2018;14:14.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Dávila I, Dominguez-Ortega J, Navarro-Pulido A, et al. Consensus document on dog and cat allergy. Allergy 2018;73:12061222.

  • 5. Satyaraj E, Wedner HJ, Bousquet J. Keep the cat, change the care pathway: a transformational approach to managing Fel d 1, the major cat allergen. Allergy 2019;74(suppl 107):517.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Dhami S, Agarwal A. Does evidence support the use of cat allergen immunotherapy? Curr Opin Allergy Clin Immunol 2018;18:350355.

  • 1. Mattson K. Talk is tricky. J Am Vet Med Assoc 2020;256:158159.

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