Monday, July 16, 2012

Zoobiquity With Horowitz and Bowers

This new book Zoobiquity makes the pitch for far greater collaboration between human and animal medicine. The most compelling argument though is that there are many prospective animal models to work with in terms of developing healing protocols. We need to be taking advantage of this fact.

There are plenty of curative protocols out there that are presently been self administered with significant effect that begs for a proper animal study to establish efficacy. It also makes it far easier to acquire the data itself which is no small thing in medical research.

The book itself is an exploration of the interface that exists between the two disciplines.

Zoobiquity: What Animals Can Teach Us About Being Human by Barbara Natterson Horowitz and Kathryn Bowers – review

Would it be healthier for humanity if doctors were more like vets?

The Observer, Sunday 1 July 2012

Shared experience: the authors of Zoobiquity point out that stallions, like human males, can suffer from psychosomatic sexual dysfunction. Photograph: Marilyn Newton/AP

We all know that, biologically speaking, Homo sapiens is just another animal. Yet we seem to have been remarkably slow in coming to terms with the implications of this truth. One example of this is summed up in the joke that a doctor is just a vet who can treat only one species. This is actually quite a recent development, as cardiologist Barbara Natterson Horowitz points out in one of the many fascinating asides that light upZoobiquity, written with the journalist Kathryn Bowers. Before Darwin decisively quashed the myth of an essential difference, "a century or two ago, in many communities, animals and humans were cared for by the same practitioner".

Horowitz's central claim is that this failure to make connections between animal and human medicine is robbing us of vital insights that could improve health and even save lives. "Zoobiquity" is the cheesy neologism given to the approach that makes just that link.

Horowitz and Bowers give several striking examples of why this link is needed. For instance, the reluctance in 1999 of the US Centres for Disease Control and Prevention to listen to the counsel of a veterinarian led them to falsely conclude that a mysterious disease that had broken out in New York was St Louis encephalitis, when it was West Nile virus. The delay this caused almost certainly cost lives.

Something else vets know, and doctors ought to, concerns the phenomenon of capture myopathy. This is when animals caught by predators die of a sudden surge of adrenaline. Unfortunately, this reaction can also be triggered when they are held by well-intentioned vets. Even more unfortunately, in humans the same mechanism can lead to injury, complications and death when patients are restrained in hospitals; and possibly also when infants experience a shock while lying on their stomachs, which is considered a likely cause of sudden infant death syndrome.

The book is stuffed full of examples of overlaps between human and other-animal pathology. Cancer, for example, is not just a modern disease caused by bad diet and environmental toxins but something found all over the animal kingdom, even in dinosaurs. Wherever there is replicating DNA, there is the potential for harmful as well as adaptive random mutation.

Animals too suffer from psychosomatic sexual dysfunction. In stallions, "fear and confusion can all lead to vastly decreased libido and sometimes an inability to breed", says equine expert Jessica Jahiel. And the evolutionary advantage of rapid insemination suggests that what we call premature ejaculation is not a medical pathology at all, which perhaps explains why a third of men of all ages are affected by it.

Interesting though these examples are, the book rarely delivers on its promise that bridging the animal-human divide will reap major health benefits, offering instead a promissory note for future developments. The pay-off for people is often simply a cold comfort that we are not alone in our suffering, allowing "a human stress eater [to] better understand his own candy binge" and making the bewildering behaviour of adolescents "slightly more bearable". Zoobiquity also overuses the trope of describing what seems to be a familiar human situation and then revealing that – da-daaa! – the case in point is actually that of a nonhuman animal.

But these small irritations are far outweighed by the pleasures provided by this pacy, readable and entertaining manifesto for a zoobiquitous approach to health and wellbeing, to be welcomed by vets and other human animals.


 Dr. House, Meet Doctor Dolittle

 Redefining the Boundaries of Medicine

 In the spring of 2005, the chief veterinarian of the Los Angeles Zoo called me, an urgent edge to his voice.

Uh, listen, Barbara? We’ve got an emperor tamarin in heart failure. Any chance you could comeout today?

I reached for my car keys. For thirteen years I’d been a cardiologist treating members of my own species at the UCLA Medical Center. From time to time, however, the zoo veterinarians asked me to weigh in on some of their more difficult animal cases. Because UCLA is a leading heart-transplant hospital, I’d had a front-row view of every type of human heart failure. But heartfailure in a tamarin 

a tiny, nonhuman primate? That I’d never seen. I threw my bag in the car and headed for the lush, 113-acre zoo nestled along the eastern edge of Griffith Park.

Into the tiled exam room the veterinary assistant carried a small bundle wrapped in a pink blanket.

This is Spitzbuben,‖ she said, lowering the animal gently into a Plexiglas-fronted examinationbox. My own heart did a little flip. Emperor tamarins are, in a word, adorable. About the size of kittens, these monkeys evolved in the treetops of the Central and South American rain forests.Their wispy, white Fu Manchu style mustaches droop below enormous brown eyes. Swaddled inthe pink blanket, staring up at me with that liquid gaze, Spitzbuben was pushing every maternalbutton I had.

When I’m with a human patient who seems anxious, especially a child, I crouch close and openmy eyes wide. Over the years I’ve seen how this can establish a trust bond and put a nervous patient at ease. I did this with Spitzbuben. I wanted this defenseless little animal to understandhow much I felt her vulnerability, how hard I would work to help her. I moved my face up to thebox and stared deep in her eyes animal to animal. It was working. She sat very still, her eyeslocked on mine through the scratched plastic. I pursed my lips and cooed.

Sooo brave, little Spitzbuben.

 Suddenly I felt a strong hand on my shoulder.

Please stop making eye contact with her.

I turned. The veterinarian smiled stiffly at me. You’ll give her capture myopathy.

 A little surprised, I did as instructed and got out of the way. Animal-human bonding would have to wait, apparently. But I was puzzled. Capture myopathy? I’d been practicing medicine for almost twenty years and had never heard of that diagnosis. Myopathy, sure that simply means a disease that affects a muscle. In my specialty, I see it most often as cardiomyopathy, a degradation of the heart muscle. But what did that have to do with capture?

Just then, Spitzbuben’s anesthesia took effect. Time to intubate, the attending veterinarian instructed, focusing every person in the room on this critical and sometimes difficult procedure. I pushed capture myopathy out of my mind to be fully attentive to our animal patient.But as soon as we were finished and Spitzbuben was safely back in her enclosure with the other tamarins, I looked up capture myopathy. And there it was in veterinary textbooks and journals going back decades. There was even an article about it in  Nature, from 1974. Animals caught by predators may experience a catastrophic surge of adrenaline in their bloodstreams, which can poison their muscles. In the case of the heart, the overflow of stress hormones can injure the pumping chambers, making them weak and inefficient. It can kill, especially in the case of cautious and high-strung prey animals like deer, rodents, birds, and small primates. And there was more: locking eyes can contribute to capture myopathy. To Spitzbuben, my compassionate gaze wasn’t communicating, You’re so cute; don’t be afraid; I’m here to help you. It said: I’m starving; you look delicious; I’m going to eat you.

 Though this was my first encounter with the diagnosis, parts of it were startlingly familiar.n Cardiology in the early 2000s was abuzz with a newly described syndrome called takotsubocardiomyopathy. This distinctive condition presents with severe, crushing chest pain and a markedly abnormal EKG, much like a classic heart attack. We rush these patients to an operating suite for an angiogram, expecting to find a dangerous blood clot. But in takotsubo cases, the treating cardiologist finds perfectly healthy, ―clean‖ coronary arteries. No clot. No blockage. No heart attack. On closer inspection, doctors notice a strange, lightbulb-shaped bulge in the left ventricle. As the pumping engines for the circulatory system, ventricles must have a particular ovoid, lemonlike shape for strong, swift ejection of blood. If the end of the left ventricle balloons out, as it does intakotsubo hearts, the firm, healthy contractions are reduced to inefficient spasms floppy and unpredictable. But what’s remarkable about takotsubo is what causes the bulge. Seeing a loved one die can do it. So can being left at the altar or losing your life savings with a bad roll of the dice. Intense, painful emotions in the brain can set off alarming, life-threatening physical changes in the heart. This new diagnosis was indisputable proof of the powerful connection between heart and mind. Takotsubo cardiomyopathy was tangible evidence of a relationship many doctors had considered more metaphoric than diagnostic. As a clinical cardiologist, I needed to know how to recognize and treat takotsubo cardiomyopathy. But years before pursuing cardiology, I had completed a residency in psychiatry at the UCLA Neuropsychiatric Institute. Having also trained as a psychiatrist, I was captivated by this syndrome, which lay at the intersection of my two professional passions. That background put me in a unique position that day at the zoo. I reflexively placed the human phenomenon side by side with the animal one.

 Emotional trigger . . . surge of stress hormones . . . failing heart muscle . . . possible death
. An unexpected ―aha!‖ suddenly hit me.

Takotsubo in humans and the heart effects of capture myopathy in animals were almost certainly related

 perhaps even the same syndrome with different names.

But a second, even stronger insight quickly followed this ―aha.‖ The key point wasn’t the
overlap of the two conditions. It was the gulf between them. For nearly four decades (and probably longer) veterinarians had known this could happen to animals that extreme fear could amage muscles in general and heart muscles in particular. In fact, even the most basicveterinary training includes specific protocols for making sure animals being netted and examined don’t die in the process. Yet here were the human doctors in early 2000 trumpeting thefinding, savoring the fancy foreign name, and making academic careers out of a ―discovery‖ that every vet student learned in the first year of school. These animal doctors knew something we human doctors had no clue existed. And if that was true . . . what else did the vets know that wedidn’t? What other human‖ diseases were found in animals?

 So I designed a challenge for myself. As an attending physician at UCLA I see a wide variety of maladies. By day on my rounds, I began making careful notes of the conditions I came across. Atnight, I combed veterinary databases and journals for their correlates, asking myself a simple question: Do Animals Get [ fill in the disease]?

 I started with the big killers. Do animals get breast cancer? Stress-induced heart attacks?Leukemia?How about melanoma? Fainting spells? Chlamydia?And night after night, condition after cond ition, the answer kept coming back ―yes.‖ The similarities clicked into place.

Jaguars get breast cancer and may carry the BRCA1 genetic mutation that predisposes many Jews of Ashkenazi descent and others to the disease. Rhinos in zoos get leukemia. Melanoma hasbeen diagnosed in the bodies of animals from penguins to buffaloes. Western lowland gorillas die from a terrifying condition in which the body’s biggest and most critical artery, the aorta, ruptures. Torn aortas also killed Lucille Ball, Albert Einstein, and the actor John Ritter, and strike thousands of less famous human beings every year. I learned that koalas in Australia are in the middle of a rampant epidemic of chlamydia. Yes, that kind sexually transmitted. Veterinarians there are racing to produce a koala chlamydia vaccine.That gave me an idea: doctors around the United States are seeing human chlamydia infectionrates spike. Could the koala research inform human public health strategies? Since unprotected sex is the only kind koalas have (my searches for condom use by animals came up short), whatmight those koala experts know about the spread of sexually transmitted diseases in a population that practices nothing but ―unsafe‖ sex?

 I wondered about obesity and diabetes two of the most pressing health concerns of our time. I burned midnight pixels investigating questions like: Do wild animals get medically obese? Do animals overeat or binge-eat? Do they hoard food and eat in secret at night? I learned that yes,they do. Comparing animal grazers, gorgers, and regurgitators to human snackers, diners, and dieters transformed my views on conventional human nutritional advice and on the obesity epidemic itself. Very quickly, I found myself in a world of surprising and unfamiliar new ideas, the kinds I’d never been encouraged to entertain in all my years of medical training and practice. It was,frankly, humbling, and I started to see my role as a physician in a whole new way. I wondered:
Shouldn’t human and veterinary doctors be partnering, along with wild- life biologists, in the field, the lab, and the clinic? Maybe such collaborations would inspire a version of my takotsubo moment, but for breast cancer, obesity, infectious disease, or other health concerns. Perhaps they would even lead to cures. The more I learned, the more a tantalizing question started creeping into my thoughts: Why don’t we human doctors routinely cooperate with animal experts?And as I searched for that answer, I learned something surprising. We used to. In fact, a century or two ago, in many communities, animals and humans were cared for by the same practitioner — the town doc- tor, as he set broken bones and delivered babies, was not deterred by the species barrier. A leading physician of that era named Rudolf Virchow, still renowned today as the father of modern pathology, put it this way: ― Between animal and human medicine there is no dividing line nor should there be. The object is different but the experience obtained constitutes the basis of all medicine.

 However, animal and human medicine began a decisive split around the turn of the twentieth century. Increasing urbanization meant fewer people relied on animals to make a living. Motorized vehicles began pushing work animals out of daily life. With them went a primary revenue stream for many veterinarians. And in the United States, federal legislation called the Morrill Land-Grant Acts of the late 1800s relegated veterinary schools to rural communities while academic medical centers rapidly rose to prominence in wealthier cities. As the golden age of modern medicine dawned, there was simply more money, prestige, and academic reward to be had in pursuing human patients. For physicians, this era all but erased their tarnished image as the leech purveyors and potion makers of times past. But veterinarians enjoyed little to none of this skyrocketing social status and its accompanying wealth. The two fields moved through the twentieth century for the most part on divided, yet parallel, paths.

Until 2007. That’s when a veterinarian named Roger Mahr and a physician, Ron Davis, arranged a meeting in East Lansing, Michigan. They compared notes on similar problems they encountered in their animal and human patients: cancer, diabetes, the adverse effects of secondhand smoke, and the explosion of ―zoonoses (diseases that spread from animals to humans, like West Nile virus and avian flu). They called for physicians and veterinarians to stop segregating themselves based on the species of their patients and start learning from one another. Because Davis was president of the American Medical Association (AMA) and Mahr headed the American Veterinary Medical Association (AVMA), their meeting carried more weight than the handful of previous attempts to reunify the fields. But the Davis-Mahr announcement received little notice in the popular media, or even among medical professionals, especially physicians. True, One Health (the favored term for this movement) has got- ten notice from the World Health Organization, the United Nations, and the Centers for Disease Control and Prevention.† The Institute of Medicine, which is the health arm of the National Academy of Sciences, hosted a One Health summit in Washington, D.C., in2009. And veterinary schools, including those at the University of Pennsylvania, Cornell, Tufts, UC Davis, Colorado State, and the University of Florida, have embarked on One Health collaborations in education, research, and clinical care. Yet, the truth is that most physicians will go through their entire careers never interacting with veterinarians, at least not professionally. Until I started consulting at the zoo, the only time I even thought about animal doctors was when I brought my own dogs in for an exam or vaccination. My veterinary colleagues tell me they regularly read human medical journals keep up on the latest research and techniques. But most physicians I know including myself, until recently would never dream of consulting an animal-focused monthly, even one as highly respected as the  Journal of Veterinary Internal Medicine.

I think I know why. Most physicians see animals and their illnesses as somehow different.‖ We humans have our diseases. Animals have theirs. And I suspect there’s another reason. The human medical establishment has an undeniable, though unspoken, bias against veterinary medicine. While most physicians have many laudable attributes tireless work ethics, the desire to help others, a sense of duty to the community, scien- tific rigor we have some dirty laundry I must reluctantly air. Doctors, it may or may not surprise you to learn, can be snobs. Ask your (non

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