July 24, 2012
Can MDs and DVMs bridge the cultural divide?
By: Edie Lau
For The VIN News Service
Editor’s note: From the New York Times to Fox News, the Daily Mail to The Daily Beast, the popular media is keen on the new book Zoobiquity. Co-authored by Barbara Natterson-Horowitz, M.D., a cardiologist at the University of California, Los Angeles (UCLA), and science writer Kathryn Bowers, Zoobiquity examines myriad diseases and disorders that afflict people and animals alike, laments the separation between human and veterinary medicine and urges closer collaboration between the disciplines.
Photo by Joanna Brooks
Pointing to the many diseases that humans share in common with other animals, Barbara Natterson-Horowitz, M.D., advocates that physicians cross the culture gap in medicine to collaborate with and learn from veterinarians.
To veterinarians, the concept of common ground in animal and human health isn’t new. Comparative medicine is an established field in veterinary education, and recent efforts to unite human and veterinary medicine have taken shape in an initiative called One Health.
But Natterson-Horowitz and Bowers deliver the science in a manner especially friendly to a general audience. They explore fainting, cancer, sexuality, getting high, heart attacks, weight gain, self-injury, eating disorders, sexually-transmitted diseases and adolescent risk-taking with a conversational “hey, didja know?” approach that has captured public attention.
In interviews with the VIN News Service by telephone and email, Natterson-Horowitz laid out the idea of a ‘“zoobiquitous” approach to medicine and reaction to the book so far. Here is an edited transcript.
Question: Let’s start by reviewing the genesis of “zoobiquity," a term you and your co-author coined.
Answer: I was working at UCLA as a cardiologist seeing patients, teaching medical students and reading echocardiograms. And then I had the wonderful opportunity, as part of the zoo’s medical advisory board, to consult for the Los Angeles Zoo, to assist with cardiac imaging. While I was hanging out helping, listening to the veterinarians and watching them practice, I had an actual “aha” moment. I was exposed for the first time to a very familiar, almost parallel, universe that I knew almost nothing about. It was not just the practice of veterinary medicine, but the content. The diagnoses.
I was excited about this and began quizzing my friends and colleagues in the cafeteria and on rounds. “Did you know that a rhinoceros could get leukemia?” Et cetera. None of my colleagues knew. They’re like, “You’re kidding.” And these are all smart people. This is a huge continent of ignorance for physicians. I became engrossed in an exploration of this gulf between physicians and veterinarians — its history, extent and scientific cost.
My co-author Kathryn Bowers was a part of this from the beginning. She really saw the broader perspective that, in general, it’s not good for one field to be contained and cut off from another. She pushed us to the broader implications.
Q: Why did the Los Angeles Zoo call a human cardiologist rather than a veterinary cardiologist?
A: They wanted to do cardiovascular exams on great apes using transesophageal echocardiography (TEE), a technique and procedure I have a great deal of experience with. Most of the help I have offered the zoo has been to perform TEEs and instruct the veterinarians there in doing them.
Q: Are you surprised by the attention the book has received in
the popular press? What kind of response are you getting from general
Reviews, reader comments, excerpts and articles about Zoobiquity
A: In some ways yes, and in others, no. I think there’s a
tremendous amount of interest in the connection between animals and
humans. The attention (to Zoobiquity) speaks to the level of
ignorance, frankly, on the part of physicians ... and also patients.
Unless a dog or cat owner has had a pet with breast cancer or lymphoma
or diabetes or seizures — or whatever the condition — they may not know
(that animals naturally get these diseases).
A strong connection point for human patients is to know that they’re not
alone. Human patients suffering from disturbances like cutting or
addiction or eating disorders are often full of guilt,
self-recrimination and shame. I think it’s very powerful for patients
struggling with a condition like that to know it’s not uniquely human,
it’s not something that’s bad, not (caused by) something they did. That
may be what’s resonating.
We also cover sexuality pretty heavily in the book. (The chapter)
“Roar-gasm” is somewhat provocative and titillating. ... They say sex
Q: The book is pitched to lay readers and told entertainingly.
There’s sex, as you say, and also drugs. All that’s missing is rock ‘n’
roll. What are the benefits of writing a medical book for a general
A: We really wanted a book that people would read and enjoy. We could have called the book Contemporary Clinical Applications of Comparative Medicine and Evolutionary Biology but if we had, I don’t think we’d be having this interview.
Our editor felt that the voice should be accessible but whenever there
was any question, to lean toward the science. That’s why it’s highly
cited. It’s pitched to be funny and readable, and it reads like a guilty
pleasure, maybe. But to accomplish the goal, it has to be scientific.
It has to be relevant. If you want to catch the attention of physicians
and patients, you’ve got to hit them where they live.
Q: How does the knowledge that animals share medical
conditions with humans change the ways physicians approach disease?
A: In each chapter, we have tried to develop new
hypotheses that would not be possible without the collaborative
perspective. An example is obesity. We as physicians talk to our
overweight patients with a series of recommendations and reprimands that
are all about what they as individuals need to do.
Frankly, that approach isn’t working very well.
In discussions with wildlife experts and veterinarians, we learned of
overweight in a variety of animal populations. Wildlife biologists, when
looking at a population of animals that are gaining weight, don’t think
about what the individual animal is or isn’t doing. They ask, what is
going on in the environment? When they’re confronted with abundance and
ready access, animals over-consume.
Seeing obesity as a disease of the environment could have significant implications for the human obesity epidemic.
Q: How have physicians responded to the book? Do they agree with or take offense to the premise that MDs have a big blind spot on the universal nature of disease?
A: The best part of writing the book is having colleagues read it. I’m getting really wonderful feedback. A number of major figures in medical education are reaching out (to me) about what they can do to help facilitate interdisciplinary activities.
So far, no one’s taken offense. But then, the book is only now getting into the hands of many people. It’s only five weeks old.
Q: Some veterinarians have been surprised by the media attention to the book and feel insulted by the notion that the connection between human and animal medicine is a new discovery. What’s your thought about this feedback?
A: I was at first surprised, but I’ve since reflected on this issue quite a lot.
Some of the veterinarians who heard the press but didn’t read the book, I think, really missed the point. Much of the book is a reprimand of my own profession for its narrow-mindedness, ignorance, and even snobbishness when it comes to animal medicine. Maybe the fuller story didn’t come through ... On the other hand, many veterinarians have read the book and have sent some really nice emails.
I think some parts of the veterinary community don’t know how ignorant some parts of the medical community are about this. I’ve spent many years now talking to physicians and saying things like, “Did you know that cats get kidney diseases and some are on dialysis?” Occasionally there’s a physician who was raised on a farm or has some specific animal knowledge, but (overall), everyone’s fascinated and their jaw drops when you share the most basic things.
From the deepest and most humble part of my heart, I have to say, it is new to the human side.
I studied the history of science as an undergraduate and graduate student at Harvard and know a lot about the history of comparative medicine. Comparing animal and human anatomy and pathology is at least centuries old. What is new is the possibility of putting comparative medicine into the hands of clinical practitioners.
In 25 years of clinical rounds as a medical student, resident, fellow and attending (physician), I cannot think of a single time a colleague presented a comparative animal case as part of the clinical discussion.
So we use this zippy term (“zoobiquity”), and maybe it’s a little bit of L.A. and a little bit of marketing, but since the book’s release, we’ve managed to create a national conversation about comparative medicine.
Ironically, I see the book in some ways as a love letter to veterinarians and the veterinary approach.
Q: If this book had been written by a veterinarian, do you suppose it would have attracted the same attention?
A: I don’t know. We intentionally tried to connect all of these issues to key human medical concerns, and to ask how human medicine could benefit from an expanded perspective. The book is not just about comparing diseases, it’s really about, how does this matter? It’s told as a physician’s journey: “Working with veterinarians made me a better doctor.”
Q: Tell me about common misperceptions among physicians about veterinary medicine. For example, you write how “strikingly similar” veterinary rounds are to rounds with human patients. Before you saw veterinary rounds, what did you imagine happened, or was it just not something you thought about?
A: I didn’t think a lot about it. My pets would go to the vet on occasion but fortunately, they’ve been pretty healthy. I don’t think I knew any veterinary subspecialists.
Q: What pets do you have?
A: I have two dogs right now, a little bichon-poodle mix named Nellie who’s adorable and pretty. I’ve read Zoobiquity out loud to her several times.
My other dog is Bongo, an 8-year-old Havanese. Bongo’s had some orthopedic issues. He dropped off of our high table in the kitchen, had a meniscus tear and had to have some orthopedic surgery, but is otherwise very healthy.
Q: Has your relationship with your dogs’ veterinarian changed since you began thinking zoobiquitously?
A: Yes. I now relate to veterinarians as subspecialists. As a cardiologist I relate to lots of subspecialists: orthopedists, gynecologists, pulmonologists etc. I think of veterinarians along those lines.
I get a kick out of noticing what veterinarians are able to do that we physicians aren’t. For example, it’s rare these days to see a physician who does surgeries, his own anesthesia, pediatrics, obstetrics and more … but the zoo veterinarians do it all — and on many different species!
Q: Even though the separation between human and veterinary medicine is relatively new, as you outline in the book, it seems to run deep. What are ways to close that separation on a day-to-day basis?
A: I think everything starts with relationships. Have medical and veterinary students work together, find out they have things in common, become friends. Developing relationships at an early stage is crucial.
If a physician is in an academic medical center, he should consider inviting veterinarians to join grand rounds. Subspecialty medicine is an ideal place for these kinds of engagements.
I want to encourage the human side to visit the veterinary literature; to remember that first of all, these diseases are not unique to humans. We’re not talking about (conditions induced in) lab animals, we’re talking about spontaneously occurring fill-in-the-blank. And attending a veterinary conference where a topic that’s of interest to you clinically as a physician is being presented.
The voyage Kathryn and I have taken ... has been possible largely thanks to the collegiality of veterinarians who helped us along the way. I don’t want to be putting my own field down, but I’m not sure the same level of collegiality would have been extended to a veterinarian showing up at human medical meetings, rounds and conferences.
I hope Zoobiquity helps change that. Since the book was released, I’ve had many emails from physicians who would like to engage with veterinarians in their community. They’re asking how.
Q: Do you see this as a two-way street? What can veterinarians learn from working more closely with physicians?
A: Absolutely. Veterinarians should also reach out to physicians in the community. Many already have physician-clients and physician-friends. I’d encourage discussion of cases, casually or through formal programs.
Q: Besides veterinary medicine, the work of other scientific disciplines is reflected in the research you summarize in the book. Should a zoobiquitous approach include collaboration with wildlife biologists, zoologists, entomologists and any number of other ologists? Logistically, is that doable?
A: The broadest perspective of zoobiquity is that we should be interdisciplinary and integrating of all approaches. What’s doable is to have an open mind and to have an expanded perspective of where information can come from.
I hope leaders in human medicine who read Zoobiquity will recognize how funding research about animal health directly helps human health. We share the same disorders and environments. We can’t afford any more to be narrow.
We write about the possibility of adding a simple question to NIH (National Institutes of Health)-funded studies of human disease: “What animals get (xyz disease)?” This cost-free query ... (could) quite possibly improve the quality of investigation.
Q: Before Zoobiquity the book, there was Zoobiquity the conference. Can you talk a bit about the first conference and what you’ve got planned for the next gathering?
A: The first one we held (in 2011) at UCLA. We had a number of (veterinary school) faculty from UC Davis participate, as well. We covered heart disease, cancer, behavior and infectious diseases. A veterinarian presented the disease in an animal patient and a physician presented the disease in a human patient and they talked about clinical presentation, treatment, problems in treatment, investigations and opportunities.
We featured cases of glioblastoma, Lyme disease, Salmonella, tuberculosis and behavior — obsessive-compulsive disorder and separation anxiety.
Part of the goal of the Zoobiquity conference is to gently and compellingly show my colleagues on the human side that, “Hey guys, we have these colleagues on the veterinary side,” so it had to be not just scientific but social. After the morning didactic sessions, the doctors were given box lunches and jumped on buses for a field trip. We went on rounds at the LA Zoo. Curtis Eng, the chief veterinarian at the zoo, walked us around. Steve Ettinger (a veterinary internal medicine specialist and cardiologist with California Animal Hospital Veterinary Specialty Group in Los Angeles) did a wrap-up. We had a cocktail party. We had (veterinary) students from UC Davis and Western (University of Health Sciences).
Coming up on September 29th, we’re doing Zoob II, and we’re going to do fertility, breast cancer, self-injury and bullying. We can have 185 registrants, and are hoping to have 50 percent veterinarians and 50 percent physicians.
By the way, I’d love to partner with any vets interested in having a “zoob” conference where they are.
Q: It sounds like zoobiquity could become a movement.
A: I don’t think of zoobiquity as a movement per se, just a push toward greater awareness ... The timing is right for our fields to come closer together. We humans are gradually acknowledging that we exist with animals on a spectrum, not on two sides of a canyon.
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