Criticism Justified?
In a Horse & Hound article last year, veterinary surgeon Dr Sue Dyson is quoted as saying:
"We don't know yet what causes navicular disease. We now think there are several pathological processes taking part in the bone, so it is probably not correct to say that it is a single disease.
“It is astonishing what we have learned (using MRI scanning). I always believed we would find a number of soft tissue injuries in the foot, but 70% of horses believed to have navicular problems actually have soft tissue injuries, so navicular syndrome is much rarer than we thought."
A rather enlightening statement from someone working in an establishment that was once at the centre of navicular disease research. As one of those who have always expressed scepticism of the significance of navicular syndrome, it is no consolation to be proven right, neither can it provide succour to any owners whose horses were condemned as incurable sufferers, or those who were obliged to carry the expense of a treatment which was clearly pointless.
Perhaps apologies are forthcoming to all?
The second issue emerging from the development of MRI scanning is that we are moving too quickly into new diagnoses which are frequently proving to be unsustainable. Thus, desmitis (ligament pathology) is the new ‘in’ diagnosis and horses are being subjected to treatments (including surgery) that are in danger of becoming fashionable rather than curative.
As this website tries to emphasise, there is a great deal of obscure lameness in ridden (and driving) horses of all types that is not being properly diagnosed. Various techniques, which should not be condemned outright, lead to faulty conclusions. Thus, thermography misses very significant chronic lesions (where there is no heat) – and why shouldn’t it when the essence of its capacity is to locate areas of active inflammation (where there is)? Be warned, there are serious deficiencies with this system, frequently leading to conclusions that are unsustainable.
And so it goes for other techniques as well. All very fine when there is a positive finding, like a fracture, not so when results are negative or inconclusive.
As a consequence of this type of situation, it has been customary for some time to inject hocks that have no external signs of inflammation and show no abnormality on x-ray. The same happens to other joints (like the coffin joint, in the foot) and it has to be asked: why, and where is the logic?
While positive findings are always important, it would appear that clinicians are under pressure to find answers when the source of lameness is obscure and impossible to pinpoint with nerve blocks and where there is no conclusive result from any kind of diagnostic test or scan.
A long hard look needs to be taken at this ‘progress’.
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Professional Charges
As a recent after-dinner speaker to the Veterinary Practice Management Association, a former president is quoted as saying ‘My serious worry is that too many senior members of my profession, in positions of authority, appear to support the views held by some animal owners and client groups that:
veterinary practice fees and charges are expensive;
veterinary practice, generally, is highly profitable;
it should be prepared to make significant reductions in its charges to clients; and,
it can readily afford to cover the increased costs of professional bureaucracy.’
While this is obviously a sweeping statement, and there are many angles to the argument, visitors will have varying viewpoints and are invited to submit them to newspage@petergray.org.uk .
News Page appreciates that costs have risen, especially considering property, equipment and labour increases over the years. There has also been a move away from farm/home visits to in-clinic or hospital consultation, which has meant added costs for time and travel.
There is, therefore, room for two viewpoints. Life does become more costly by the day; but, is there excessive charging? An objective study could be warranted by the profession to evaluate the situation. It might ask if there is a tendency to over-use equipment and techniques that are expensive only in order to pay for the cost of providing them, rather than measuring what is in the best interests of the animal and its owner. Are the costs of running a hospital justifiable economically, in every situation? While it may be argued that this is part of providing a service, where precisely are the benefits and is the animal any better off than it was twenty years ago?
These are commercial and materialistic times. But is there a tendency to be swayed by perceived legal necessity and is it possible that the unseen requirements of a court are dictating what is, and what is not, good medicine? Visitors are invited to comment.
Several related points bear comment:
· International statistics indicate that the benefit of ultrasound scanning to equine fertility over twenty years has not significantly improved the percentage of live foals born.
· The direct consequence of introducing this technology has been that veterinary surgeons causing the death of a horse while conducting a rectal (or vaginal) examination have no liability to the animal owner. This can hardly benefit anyone other than veterinary insurers and is a sad reflection on professional progress. The incidence of such events has risen and the courts have, so far, decided there is no liability on the operator because of an ‘element of risk’ – which is possibly eliminated with experience.
· Legal requirements dictate the need for evidence in cases where negligence is alleged, meaning vets are disinclined (as many doctors) to express clinical opinions rather than rely on laboratory or other cost-creating results. A scan or blood test is evidence to produce in court. A clinical opinion is not.
Peter Gray |
