At this year's Discussion Forum
we will be debating whether uncontrolled treatment innovations are detrimental to animal welfare. As the range of treatments available to our pets becomes more extensive year on year and often increasingly invasive, we want to ask, can this ever be justified?
One of our speakers is Professor Dan Brockman, Director of the Cardiothoracic Surgery Service at the RVC which has performed over 60 open heart operations in the last 12 months. We recently sat down with him to find out what drew him to speaking at the debate and his own feelings on treatment innovation.
: How did you become interested in your field of work and what made you decide to pursue it?
: I became interested in heart surgery when I worked at the University of Pennsylvania between 1990 and 2000. I became interested in surgical treatment of mitral valve disease during this time (approximately 1994/5) because it is the most prevalent heart disease in dogs. In humans, surgical treatment is the gold standard treatment for mitral valve disease. Thus, if surgical treatment of mitral valve disease could be demonstrated to be successful, theoretically, this could benefit a great many dogs.
AWF: Can you tell us how your experience applies to the topic you will be discussing at the Discussion Forum?
Open-heart treatment of the diseased mitral valve requires a big team effort and is highly technical in nature and the required skills take some time to master. The learning curve is long, success rates are typically poor at the beginning, the cost to the clients is high and sometimes the cost to the dogs is high.
Ultimately, the rewards are huge for both the dogs and their owners. Preliminary information on both pet and owner quality of life, suggests that the impact is substantial.
How any team gets from the beginning of this process to the position where they can offer a reliable and durable treatment for mitral valve disease is the difficult question. Do the ends justify the means? Whom should pay for the development phase of such a programme? How are patients (and owners) selected?
: Why is this topic particularly relevant now and what do you predict will happen in this area in the next 5 years?
With the trend towards a distributed model of clinical training for veterinary students (potentially signalling the end of University teaching hospitals) and the proliferation of private referral practices, a big question is: who will “sponsor” such innovation in veterinary clinical science, and where will these innovations happen?
: What is the biggest challenge in this topic area at the moment?
For surgical management of mitral valve disease specifically; acceptance of the therapy, cost of therapy and expanding capacity. “New” centres are likely to develop and ideally, these centres should not have to start from the very “bottom” of the learning curve, now that knowledge exists.
AWF: Is there anything you think we should share with the audience to get them thinking in advance of your discussion?
Developing a heart surgery programme has been a professional goal that has taken 25 years to realise. It has taken a team that was familiar with open-heart surgery three years to become “good” at mitral valve repair; survival rate following surgery can be in excess of 95%. The cost remains high but the dogs that survive typically return to normal cardiac life free of medications and the owners are typically free of worry (although most of them continue to worry!!).
Who decides where such a complex therapy should be undertaken? i.e. how should innovations like this be regulated? The potential is for such a therapy to be a strong revenue generator for any group that master the required skills but the initial cost in terms of a “lost leader” and in terms of animal welfare could be very high.