Above is the Marriott at the San Fransisco 2018 AAEP meeting. I was on the 35th floor overlooking all of downtown.
Veterinarians are smart people and well-educated scientists. They may love horses and have compassion for their health and care. Unfortunately, they have been trained to fix things without really understanding why they have occurred. Let’s look at what I have seen so far in the 2 days here.
The first egregious lectures were presented at 6:45 in the morning by manufacturers and had no educational credits associated with them because they were agenda-driven. The two I attended were given by international feed companies (Cargill and Purina) and each had a Ph.D. nutritionist as their presenter. They knew their stuff well and smoothly presented to the 50 to 70 veterinarians who ate the free food as they listened. Many took the slick material and several either took notes or photographed the slides on the screen. Few saw the gaping holes in their story.
Cargill’s talk was on the repair of a poor top line which involved feeding their feeds including Top Line Extreme and ProAdd. They discussed amino acids and the quality of protein being fed. What they never discussed was the reason for the chronic protein loss showing as loss of the top line muscle. Adding their feed was said to resolve top lines. They didn’t say that they change the formulations of their feed this year to include inflammatory ingredients nor did they talk about medications that prevent the absorption of proteins.
Purina’s talk was about their new ulcer-preventing additive to their feed called Outcome. Their research trials created more questions than answers which is a sure sign that the research is agenda driven. For example, this presentation only focused on gastric (stomach) ulcers and ignored colon (hindgut) ulcers. In fact, at the very end, they gave a blanket statement that these colon ulcers are “poorly understood” which is not true. It was never mentioned that ulcers in humans are now associated with dysbiosis (abnormal gut bacteria). Worse, the whole purpose of their additive is to increase the pH of the stomach (less acidic) which is very disruptive to the bacteria normally living in the stomach. Further, an acid environment in the stomach kills bad bacteria and dissolves proteins into absorbable peptides and amino acids – both essential to the good health of the horse.
What shocks me the most is that the attending veterinarians allowed the spoon-feeding of unchallenged information. Both of these companies are huge supporters of the AAEP. Way too many complications for my comfort level.
The keynote speaker was a human physician who now writes books (and gives talks) about doctors (and veterinarians) who spend more time on lab results and diagnostic tests and far less time listening to the patient. He used the famous painting of the late 1600s of an obviously dying child in a blanket laying on cushioned chairs in the living room of a house. To the right of the child and in the shadows were the parents, the mother with her head down in prayer and the father assuring her with his hand but gazing upon the doctor on the other side of the child. The doctor sitting in a chair by the window with sunlight was in deep thought and focused on the child. There are no diagnostic tools in the painting such as a stethoscope and thermometer and this was done on purpose. The painting resonated with viewers wherever it was displayed and crowds formed around it because it represented the faith of people in doctors and their compassion for healing.
I wrote about this doctor-patient connection many years ago and included two photos of paintings celebrating 100 years of veterinarians caring for horses for 100 years. The first painting was of a barn scene 100 years ago and all eyes of the people and the dog were on the veterinarian who was focused on the horse. The second painting depicts veterinary care today and it had all the people looking at the ultrasound screen while no one, not even the dog, was looking at the horse.
Is anyone seeing this disconnect with the patient at their barn? Maybe you have experienced it personally as I did when my son was in the hospital with a life-threatening illness. Few doctors and nurses had a connection with him as he lay there scared and confused with few answers coming from the experts. He was given numbers they read from their computers. I am grateful that the AAEP is addressing this concern of owners that veterinarians are not connecting with their patients. But cynically I don’t think it will make a difference because the selection of students for vet school excludes most horsemen while focusing on diagnostics.
The main speaker today was Dr. Virginia Reef (Univ of Penn), the world’s expert on heart disease in horses. Last year it was Dr. Paddy Dixon (Edinburgh Univ) on dentistry and the evolution of the horse. Before that, it was Dr. Norm Ducharme (Cornell) on laryngeal function and Dr. Tom Divers (Cornell) on liver function. These speakers are worth the price of admission as the in-depth discussion is very fascinating.
In the case presentations on heart disease given today, there was again no mention of root causes or any epidemiological studies (looking at factors that may cause the disease) that would help horse owners prevent heart disease. Excluding congenital defects (birth defects), why do horses get disease of the heart muscle and valves? The primary answer was “age.”
I get confused. Is heart disease more prevalent now because we now have diagnostic tools able to discover these diseases? Or is it more evident because we are caring for them differently than 50 years ago? Are feeding programs to blame or is it the constant stress from shipping and competing? The Purina speaker said there was a study showing horses stabled with talk radio playing had a higher incidence of gastric ulcers than if music was played. They did not mention if these programs were political or educational.
All of this does give me the thought that what we are doing today may not be working as far as giving our horses optimal care. But as long as horses continue to get sick, veterinarians will have work and feed dealers and supplement makers will have a market. And as long as I have state licenses that need continuing education requirements I will attend these meetings. It gives me perspective and on occasion, I meet another like-minded veterinarian. That gives me hope.