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.
CHAPTER ONE
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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