Letters to the Editor

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Animal agriculture and global food security

I would like to expand on Dr. Gwendolen Reyes-Illg's letter1 related to veterinary medicine and global food security.1 The growing Western market for plant-based meat alternatives is all very well and good but we should not ignore the urgent need for improved veterinary services, particularly those related to disease prevention and surveillance, in poor rural communities around the world. Farmed animals are vital to local economies and the nutrient needs of the people, providing food, labor, capital resources, and fertilizer and fuel from manure.

Regrettably, in many developing countries, veterinary services are under state or local government authority and are primarily directed to large producers and confined animal feeding operations that supply urban communities with eggs, poultry, dairy products, beef, and pork, with some for export. Poor rural communities are thus underserved and cannot afford private veterinary services unless subsidized by charities and donors. Also, government services can be rife with corruption, falsifying vaccination numbers, not maintaining vaccine refrigeration, and not effectively monitoring livestock, poultry, and wildlife for potentially epidemic zoonotic diseases.

This deficiency in rural veterinary services creates hotspots for diseases, such as foot-and-mouth disease and African swine fever, that can pass from smallholders' animals to wildlife and ultimately to large confinement operations with the potential to spread to the United States and other countries through the export of infected animal products.

Many concentrated animal feeding operations are government subsidized and can themselves be the sources of zoonotic diseases. In addition, such operations can displace small local producers and farming communities and any financial losses are often passed on to contracted farmers.

In contrast, the adoption of traditional and innovative farming practices involving freshwater fish, such as tilapia, and local varieties of more disease-resistant and adaptable ruminants (bovine, ovine, and caprine) and pig and poultry breeds has become a ray of hope in many countries.

Michael W. Fox, bvetmed, phd, dsc

Golden Valley, Minn

1. Reyes-Illg G. Veterinary medicine and global food security (lett). J Am Vet Med Assoc 2020;256:1203.

Justifying the importance of livestock in achieving global food security

I applaud the commentary by Kelly et al1 on the role of the veterinary profession in global food security. However, I wanted to address Dr. Reyes-Illg's2 subsequent letter to the editor on this subject, in which she appears to suggest that global food security and climate change can be mitigated by switching to plant-based food sources. I believe this notion is misguided and may divert veterinarians from a worthy cause.

I agree there is a case for moderating the consumption of animal-source food (ASF) in the developed world, where we are accustomed to the luxury of food security and almost unlimited food source choices. However, the commentary was particularly referring to the developing world, where available and affordable sources of plant-based nutrition frequently cannot meet energy and nutrient requirements, particularly in young children.3 A recent global analysis of 49 countries showed consumption of ASF was strongly, negatively correlated with stunting, a primary indicator of chronic undernutrition.4 Yet ASF consumption has actually decreased in sub-Saharan Africa in recent decades and 30% of children under the age of 5 in this region continue to suffer from malnutrition.5,6 Livestock farming not only helps alleviate malnutrition, it can also help lift smallholder farmers and others in the supply chain out of poverty, another sustainability goal.7 Indeed, there are many regions of the world where the only viable agricultural practice is pastoralism.

Our role as veterinarians then should not be to blindly advocate for the adoption of plant-based diets. Instead, we need to recognize the divergent nature of global populations and understand that ASF from livestock will continue to be vital to many populations for the foreseeable future. Dr. Reyes-Illg rightly cites increasing greenhouse gas emissions, water pollution, biodiversity loss, and animal welfare as specific concerns. However, advances in breeding, nutrition, and husbandry alongside environmental waste management could reduce global greenhouse gas emissions from livestock by an estimated 30%.8 Veterinarians can play key roles in the future development of sustainable and ethical livestock management systems under the umbrella of one health while avoiding environmental and welfare mistakes that have previously been made in industrialized livestock farming. Society does indeed look to veterinarians as experts. Should we choose to heed or ignore this calling?

Rudy T. Kirkhope, vetmb, msc

Phoenix, Ariz

  • 1. Kelly AM, Galligan DT, Salman MD, et al. The epic challenge of global food security: a compelling mission for veterinary medicine. J Am Vet Med Assoc 2020;256:643645.

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  • 2. Reyes-Illg G. Veterinary medicine and global food security (lett). J Am Vet Med Assoc 2020;256:1203.

  • 3. Adesogan AT, Havelaar AH, McKune SL, et al. Animal source foods: sustainability problem or malnutrition and sustainability solution? Perspective matters. Glob Food Secur 2020;25:100325.

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  • 4. Headey D, Hirvonen K, Hoddinott J. Animal sourced foods and child stunting. Am J Agric Econ 2018;100:13021319.

  • 5. Robinson TP, Pozzi F. Mapping supply and demand for animal-source foods to 2030. Animal Production and Health Working Paper. No. 2. Rome: Food and Agriculture Organization of the United Nations, 2011.

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  • 6. United Nations Children's Fund (UNICEF), the World Health Organization, International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: key findings of the 2020 edition of the joint child malnutrition estimates. Geneva: World Health Organization, 2020.

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  • 7. United Nations. Sustainable development goals. Available at: sustainabledevelopment.un.org/topics/sustainabledevelopmentgoals. Accessed Jun 15, 2018.

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  • 8. Gerber PJ, Steinfeld H, Henderson B, et al. Tackling climate change through livestock—a global assessment of emissions and mitigation opportunities. Rome: Food and Agriculture Organization of the United Nations, 2013.

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Reporting effect sizes

The table in the recent review article by Johnson et al1 on nutritional management of osteoarthritis in dogs and cats is an excellent summary of information that veterinarians can easily use to aid nutritional decision making. That said, however, we encourage editors and reviewers to ensure that authors of primary research and reviews of the literature include measures of estimated treatment effects along with their confidence intervals in their data summaries. For example, in the column “Main outcomes” in this table, the authors report for the second study listed that “ [d]ogs fed the test diet had significantly increased ability to rise.” However, statistical significance alone is not enough to allow readers to make the types of informed decisions advocated by the authors, and measures of the estimated effect size and the variability of that estimate are needed to evaluate the clinical importance of any differences between treatment groups. The term effect size may not be familiar to all veterinarians, but simply refers to the size of the effect of the intervention.

Consider, for instance, a study cited by Johnson et al2 in which the study diet increased weight bearing by a statistically significant mean score of 0.33 on a scale from 1 to 4 after dogs were fed the diet for 90 days. This was based on the difference between scores for the study (mean, 1.73; SEM, 0.12) and control (mean, 1.40; SEM, 0.10) groups. This effect size might be meaningful to owners if it impacts function. However, an effect size of 0.33 means that dogs with an initial mean score of 3.73 would on average have a mean score of 3.40 after being fed the study diet and would likely still be quite lame. Therefore, comprehensive evaluation of the intervention requires both the intervention effect size and the baseline used for comparison. With this information, veterinarians can explicitly consider whether an expected mean difference in score of 0.33 is worth the cost and effort of feeding a novel diet.

Estimates of the effect size (sometimes also called the treatment effect) and its confidence interval should be required in all reports of controlled studies, whether observational or experimental, and reviews about such studies.3,4 We know that veterinarians are busy and use reviews as a rapid way to stay up to date. Therefore, authors of reviews should provide the most useful summary data, which should include at a minimum the effect size and, if possible, the reference group's data. Veterinarians could then in fact “make informed decisions to recommend which approaches may be best for the patient and client.”

Virginia R. Fajt, dvm, phd

Texas A&M University College Station, Tex

Annette O'Connor, bvsc, mvsc, dvsc

Michigan State University East Lansing, Mich

Jan Sargeant, dvm, mvsc, phd

University of Guelph Guelph, ON

  • 1. Johnson KA, Lee AH, Swanson KS. Nutrition and nutraceuticals in the changing management of osteoarthritis for dogs and cats. J Am Vet Med Assoc 2020;256:13351341.

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  • 2. Fritsch D, Allen TA, Dodd CE, et al. Dose-titration effects of fish oil in osteoarthritic dogs. J Vet Intern Med 2010;24:10201026.

  • 3. Wasserstein RL, Lazar NA. The ASA statement on p-values: context, process, and purpose. Am Stat 2016;70:129133.

  • 4. Sargeant JM, O'Connor AM. Scoping reviews, systematic reviews, and meta-analysis: applications in veterinary medicine. Front Vet Science 2020;7:11.

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Science and democracy

Many years ago, when I was studying for my PhD, I discovered a remarkable essay by the distinguished early 20th century physiologist Ralph W. Gerard.1 Throughout my career, this essay has shaped my thinking about the structure of science. The following reflects some of Dr. Gerard's ideas, which are still valid today.

Those of us fortunate enough to serve as medical science professionals in the United States and Canada owe our careers to the many freedoms offered by democratic forms of government. Science and democracy are kin: Truth and freedom are fundamental, but neither should be taken for granted.

Once upon a time, science was the hobby of amateurs. Now and then, a true genius would emerge (eg, Leonardo da Vinci, who was born in 1452); however, science and scientists generally remained obscure and unimportant until the development of experimentation and rationalism in the 17th century.1

Today, science is inextricably tied to government, industry, and society. Science will forever influence the shape of things to come; its rational experimental approach will in time supply answers to questions that are beyond our present grasp. Scientific exploration cannot be for itself alone, however. The aim of research is to generate not just more facts, but more facts of strategic value.1 Scientists must act wisely on the knowledge they have created, understanding that along with freedom of enquiry comes the responsibility to serve the public interest.

The COVID-19 pandemic provides an important opportunity for science and politics to collaborate in global health security. Currently, there are numerous conflicts regarding the prevention and treatment of COVID-19 infection,2 and although numerous drug and vaccine candidates are being developed, we still have a long way to go. It seems likely that COVID-19 may never completely disappear, so drugs and vaccines will be essential for future management of the disease. Global awareness together with genuine political and scientific cooperation will be necessary for success.

Science has given us an abundance of knowledge of immense value to society. Scientific exploration also provides the means to better understand both the natural world and ourselves as part of it. We must act wisely on the knowledge that science provides.

Peter Eyre, DVM&S, bvms, bsc, phd

Professor and Dean Emeritus Virginia-Maryland College of Veterinary Medicine Virginia Tech Blacksburg, Va

  • 1. Gerard RW. The organization of science. Ann Rev Physiol 1952;14:113.

  • 2. Special report: the coronavirus pandemic. Scientific American 2020;322(6):2425.

Parvovirus and the impact of COVID-19

During the current COVID-19 pandemic, BluePearl Specialty and Emergency Pet Hospital, one of the largest providers of emergency and specialty care in the United States, has observed alarming increases in the number of confirmed cases of parvoviral enteritis and the number of hospitalizations attributable to it. In fact, across the BluePearl network of > 90 pet hospitals, we have seen a 70% increase in the number of parvovirus emergency admissions so far this year, compared with numbers during the same periods for 2015 through 2019.

Although we are still in the early stages of analyzing these data to determine epidemiological risk factors for this increased incidence of parvoviral enteritis, it is likely that multiple factors have contributed. Still, COVID-19 and the response to it may be playing a role. For instance, during the time that stay-at-home orders were in effect, many practices instituted protocols restricting appointments to those patients requiring emergency care. This may have disrupted the timing of vaccine administration for puppies or prevented puppies from receiving a full prophylactic vaccine series, resulting in incomplete immunity.

Also, as a result of state quarantine orders, many socially isolated people turned to animals to provide companionship, resulting in the fostering and adoption of large numbers of shelter animals.1 Some of these shelter animals may have been released prior to completion of their vaccination series. Meanwhile, these same stay-at-home orders may have prompted people to spend more time outdoors, including visiting dog parks, which may have increased environmental exposure.

The effects of COVID-19 were also felt within the labor market, bringing about widespread financial hardship for millions of Americans, including job losses and pay cuts.2 Because of this, owners may have prevented or delayed seeking veterinary services like routine vaccinations, including both puppy vaccinations and booster vaccinations for adult dogs.

If the United States continues to experience a prolonged plateau or second wave of COVID-19 cases, this may exacerbate these trends and greatly harm the health and well-being of our patients. It is important for the profession to continue to advocate for the critical public health role of veterinary medicine during this time of crisis. Companion animals serve not only as invaluable sources of emotional support, but also as sentinels and potential vectors of infectious disease. Parvovirus outbreaks endanger our pets but skipping routine vaccinations could also jeopardize human health through the risk of rabies exposure.

We must ensure that veterinary hospitals and related businesses continue to be recognized as essential services, stress the importance of preventative care to the general public, and make sure that state and federal governments recognize the value of investing in veterinary medicine and public health. The implications of an increase in parvovirus cases and other preventable companion animal diseases may be far-reaching.

We look forward to the publication of an in-depth analysis of our data and sharing these findings with the veterinary community and clients to broaden the understanding of a one-health approach to health care.

Lenore Bacek, dvm, ms

Andrea Monnig, dvm

Teresa Lightfoot, dvm

BluePearl Specialty and Emergency Pet Hospital Tampa, Fla

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