We live in times of rapid change, with recent years and decades bringing huge amounts of progress in every field. However, all progress comes with its good and bad parts.
India and England are vastly different countries, but looking at how they’ve progressed, many similarities can be seen. We can all see how the smart phone has allowed everyone to have the world at their fingertips, but we also know its negative side. I was astonished to find that the general population of India appear even more preoccupied with their phones than Westerners. Dinner dates are had with both parties staring at their phones in both countries, and train rides involve the majority of passengers staring at their phones whilst music or videos blare out. Many question how good phones are for our brain function, as we have no need to remember things that would have been essential before, as we can just look it up. With fewer computers amongst the general population in India I feel the phone has made more of an impact, both for the good and the bad. Suddenly masses of the population, who could only access books before, have found the world at their fingertips with all the knowledge and possibilities the internet offers. Also a huge leap in ease of communication. The negative side is that a lot of what is seen on the internet, as we know is social media, where how you look and what you’re doing seem the most important things to share. Indians have truly taken selfies to heart, I would say even more so than other Eastern countries. Not a day goes by where you don’t see hundreds of Indians taking hundreds of selfies, or get asked for a selfie by what seems like every other visitor at an attraction. So they have seen the great benefits and downfalls of mobile phones.
In other areas, such as the environment, they have progressed quicker than many western countries, though over a shorter time. Over the last 4 years (when my partner Joe last visited) their littering problem has vastly improved, with signs all over discouraging littering and single-use plastics (although I won’t pretend it isn’t still a huge issue, with litter being posted out of train & bus windows, or piling up around corners). The smell of burning plastic is only occasionally smelt, rather than around every street corner. In terms of energy supply, I believe they will become 100% renewable quicker than many western countries. They have both the advantage of progressing this way later than the west, and so more advanced technology is available, plus they have more readily available resources - huge hydro-electric plants have taken over some Himalayan valleys, solar fields have cropped up on arid land, wind farms on hilltops, and solar water heaters and panels dot many rooftops in the cities. Yet, as a country, they still have huge issues with poverty, and a gigantic poverty gap between their richest and poorest. So progress brings many benefits, but has its pitfalls and difficulties too, for it is easier to change the energy supply of a nation, than the habits of its people, as countries the world over are finding.
In the veterinary industry, like many medical fields, things have progressed rapidly over the last decades too. We have a huge plethora of diagnostic and treatment options available, that wouldn’t have been dreamt of before. Not only are they now available, but often quite readily, with CT & MRI scanners being commonplace, even if only one day a week as they travel around, and even prosthetic limbs being offered for animals. Veterinary medicine, as we know from James Herriot, used to depend a lot on the ingenuity, knowledge and resourcefulness of the vet, as the number of treatment and diagnostic options was low. Although these are obviously fantastic progressions for animal health and welfare, there are drawbacks. All new treatment and diagnostic options tend to be expensive, at least initially. In fact the price of pet insurance has been rising rapidly, to the point where the number of insured pets is dropping. Many people simply can no longer afford to insure their pets, and many insurance companies have so many restrictions and exclusions, including making owners pay an additional fee to visit a referral centre that isn’t on their ‘list’, that many deem it not worthwhile. These owners are tending towards simply saving what would have been their monthly payment in a pet bank account for their own insurance. Could we be moving towards an era where the cost of pet ownership means that pet welfare could drop due to an inability to afford treatment?
Another potentially detrimental progression in the industry is that towards corporate practice. Almost 70% of veterinary practices are now owned by corporate companies, meaning that profit-driven businessmen and women hold the practice reins, instead of practicing vets, who understand all aspects of the business. I can see some possible advantages to corporate practice - more money in the industry could mean more investments for research and scientific advancement, as well as more widespread availability of resources, such as diagnostic equipment. However, with profit driving decision-making, will the research be done for the good of the pet population, or for the good of the practice pocket? Some corporate practice groups are also making partnerships with different companies, such as the Linnaeus group with PetPlan, the insurance company. Until this point, as vets, we’ve never been allowed to specifically recommend insurance companies, so times really are changing. Others are making their own brands of supplements, or restricting what they sell to specific drugs or foods. Are pet owners to be penalized by their vet practice for wanting to make their own choices about what food or insurance to choose? And are vets to face these same restrictions when trying to offer pet owners the full array of options?
This brings me to the Gold Standard. In medical terms, this is the treatment or diagnostic protocol that has been found, through scientific study and/or experience, to be the best available option for a given disease or condition. The advancements in medical fields are constant so the gold standard does change, and over recent decades will have changed innumerable times. Medical advancements have no doubt saved many lives, human and animal. For humans, these advancements can give the patient more choice, accuracy and efficacy in their diagnosis and treatment of disease. For animal owners, who have to make decisions on behalf of their pets, I think it can leave some feeling confused and uncertain. Most human and animal patients depend on the knowledge and advice of their doctor or vet to help with these difficult choices. For some this is a huge help, but for others, as I have seen, it can leave them feeling even more lost. Many vets are fantastic at explaining all the treatment and diagnostic options available, with pros and cons for each, ensuring owners can make a fully informed decision. Others, due to time or energy pressures, practice protocols, or personal preferences, can fall short of this ideal. In this regard, I fear the gold standard can sometimes do more harm than good.
There is no doubt about it, gold standards save lives. All over the world right now gold standard protocols are being rolled out to try to minimize the spread of the novel coronavirus, originating in Wuhan, China. These may save many lives, with their successes and failures helping new gold standards to be drawn up. In every disease condition, if there is a gold standard option, it should always be offered and/or discussed - I do not question that. The thing that distresses me, and many pet owners I have met, about the gold standard is that it isn’t always ‘holistic’, and some vets seem only happy offering this option, as it is considered the ‘best one’.
As I wrote in my previous blog post, holistic means to take into account all parts of the patient, and to find the option that suits them as an individual, in themselves and in how they are expressing their disease. For animals, the owners’ lifestyles, working hours, ability to administer medication and finances must also be taken into account when choosing a protocol. We’re very lucky in the UK to have the NHS, removing cost from most human medical decisions. In veterinary medicine it must always be considered, even in insured cases as insurance policies vary hugely. In my personal experience, cost, pet personality, and owners’ ability to mediate (either issues of timing/repetition of medicating, or physical ability) most frequently influence options chosen. For example, an older owner, who lives alone and off their pension, is unlikely to be able to afford or administer an expensive tablet 3 times a day to a fractious fussy cat! It may well be the gold standard treatment, but for this cat and owner it is not suitable. Similarly an anxious and aggressive dog, that needs sedation for anything more than a cursory check, may not suit a weekly day admission to a vet hospital for intravenous chemotherapy. Many owners are also influenced by previous experience - if a pet of theirs died under, or recovered poorly from, an anaesthetic when unwell, the option of a long surgical procedure may be the last thing they want, if it isn’t already at the life or death stage (e.g. a twisted spleen, or intestinal foreign body).
Unfortunately, I have seen many cases where owners have been offered the gold standard treatment, or the option of taking their pet home, with pain relief if needed, and waiting for them to decline or die, whilst being made to feel guilty for not choosing the gold standard option that doesn’t suit them. This is by no means the norm, and I suspect other holistic vets see more of these cases than regular vets, as it is often to the alternatively-minded that these owners turn for help. I have seen similar happen with diagnostic options, where the owners are offered hundreds or thousands of pounds worth of tests, often with neither an offered option of a treatment trial, nor the 1 or 2 most useful tests within their budget. They are then made to feel terrible if they can’t afford it, or don’t want to put their pets through invasive procedures, which may or may not give them answers. Again this isn’t commonplace, but with the growth of corporate practices and profit-driven decision making could it become so?
Luckily, the majority of vets love to explain to owners all the options available, and so allow them to make their own informed choice, whilst still maintaining high levels of animal welfare. This way the ‘gold standard’ for that particular patient and owner can be chosen with all sides feeling happy with the choice made. I find the holistic consult style, used for herbal medicine, homeopathy and acupuncture, to be particularly good for this. The length and requirement for the collection of detailed information into all areas of the patients life, and their owners desires for treatment, tends to allow the vet to know their client and patients better, allowing comfortable discussions, often about uncomfortable subjects.
In a lot of chronic disease, from a conventional perspective, there are often few treatment options available, so if an owner refuses one it can leave the vet feeling at a loss as to what to offer. For example: Cancer cases that don’t want chemo, surgery or steroids; heart disease cases without symptoms, whose owners are reluctant to just wait for them to appear; early renal failure cases that have yet to reach a severity requiring medication; or joint problems in young animals whose owners are reluctant to start a lifetime of drugs. As a pet owner myself, I couldn’t bear to just watch and wait for my pet to decline. I would feel helpless. It is these owners that regularly end up at the door of a holistic vets, and find there the help and understanding they need to make their decisions. Herbs, homeopathy, acupuncture and diet can all be used, alone or in combination with each other, or with conventional drugs, to help relieve symptoms, support organ and body system function, and so improve the health and happiness of diseased pets, and so their owners too. Many conventional vets are becoming more and more interested in nutraceuticals (nutritional supplements, often containing one or more herbs), physical therapies, and acupuncture, making them more readily available around the country. However, I have heard from colleagues that some practice owners discourage this usage, and the RCVS statement on complementary therapies was hardly encouraging. So again I worry that we could be entering an era of restricted choices for pet owners, when in reality we have never been blessed with more options.
With this in mind, my advice to pet owners the world over is this:
Find a vet you trust, and can have open honest discussions with; look outside the box and research things for yourself as well as listening to your vet - we can’t know everything! And remember, your vet is always trying to do their best by your pet, based on the knowledge they have, however it may seem. We do this job because we love animals and want them to be as happy and healthy as possible. Also, remember that your pet is under your guardianship, so unless their welfare is compromised, the decisions are always yours. Never feel pressured into making a decision that feels wrong for you and your pet. Gold standard or no, the decision is yours.
For me, India is a constant inspiration in working with what you have available. Give them a problem and they’ll find a solution, or way of sorting it, using whatever resources they have. Their solutions may be so far from the gold standard that it can be almost laughable, but you know what? They work! Maybe not perfectly, and maybe not for long, but they demonstrate the ingenuity and resourcefulness of human nature. We should all remember that progress can be great, and the gold standard important, but there are many colours duller than gold, yet just as beautiful to some, if not others. Choose your own colours, in life & health.
“If he is indeed wise he does not bid you enter the house of his wisdom, but rather leads you to the threshold of your own mind.” - from The Prophet, by Khalil Gibran
