You may share many things with your family pet — your food, your bed, your vacation. But are you ready to share your medical appointments? That could be part of the One World, One Health, One Medicine concept imagined by a group of veterinarians, physicians and public health leaders.
Led by past president of the American Veterinary Medical Association Roger Mahr and president of the American Medical Association Ronald Davis, these people are looking at ways of integrating animal and human medicine. They’ve formed the One Health Initiative Task Force, which is considering collaborations ranging from health surveillance to laboratory testing to preventing the spread of diseases between species.
The forming of family practices that include vets and MDs might be a part of this new world. You may suspect Fido has a zoonotic disease (a disease that can be transmitted from animals to humans). You could make an appointment to see your doctor and another for Fido to see his vet at the same practice. If he’s got it, you may have it, too.
The boundary between animal and human medicine has always been a bit flimsy. Even today, veterinarians may treat people in crisis situations. For instance, Marguerite Pappaioanou, director of the Association of American Veterinary Medical Colleges and a member of the task force, said vets are sometimes called upon in the Alaskan bush to suture human wounds when MDs aren’t available. She sees the shoe fitting on the other foot as well: MDs could be trained in treating serious animal diseases such as hoof and mouth disease.
Davis is taking a lead in reaching out to the other side. He is the lead researcher in a study of second-hand smoke on household pets.
John Thompson, dean of Iowa State College of Veterinary Medicine, imagines rural areas that have difficulty attracting both MDs and vets, being served by a veterinarian who has also been trained as a physician’s assistant.
Many ideas are being considered, but findings and recommendations have not yet been formulated. The task force expects to release them at a June meeting.
Veterinarians have long seen the need for a more collaborative approach to treating humans and their animal companions, but it’s only been in the last few years that the concept has attracted a wider community.
Zoonotic diseases are the main impetus. Some 75 percent of all diseases emerging worldwide are zoonotic, and of the 35 new diseases that have struck since 1980, most are zoonotic, including avian flu, Ebola virus, mad cow disease, monkey pox, West Nile virus, SARS and HIV/AIDS.
And as the world becomes smaller, pandemics, bio-terrorism and environmental “hot spots” all get closer to home.
Pappaioanou noted that the anthrax scare could have been resolved sooner had veterinary labs been able to help in the analysis of suspected contaminated articles. She noted that there also is a need for integrated disease surveillance to assure sharing of information between human and animal medical providers.
Food safety concerns are clearly at the forefront of issues related to interactions between species. Mahr, past president of the AVMA and the leader in developing the One Health Task Force, cited avian flu to illustrate the need for addressing human and animal health within the context of a global environment.
Leonard Marcus, a member of the task force who is both an MD and a veterinarian, noted that veterinarians have been more likely to understand the One Health concept because they are trained to look at “herd health.” They have to consider if the way they treat one patient just protects the individual or if it also prevents transmission to other individuals and other species, he said.
Marcus recently retired from a practice that focused on advising and immunizing people who travel to tropical and Third World countries — and treating those who returned with an exotic disease.
He earned his veterinary degree first and became interested in human medicine while serving in the U.S. Public Health Service. There he assisted MDs in research on comparative cardiovascular disease, where animal models of human heart disease were studied. He said he’s always thought of himself as “a vet who happened to specialize in the human species.”
Although he believes the One Health Initiative is greatly needed, Marcus said it will take a “sea change” in attitude before ideas such as jointly schooling vets and MDs in core medical courses take hold.
There are general principles in the basic sciences of physiology, biochemistry and pathology across all species lines, but Marcus said it doesn’t take long before the similarities cease. “The devil is in the details,” he said. “The cow has an entirely different diet than a human or a cat or a dog. They all get tumors, but the drug that can treat a cancer could be markedly different from one species to the next.”
Marcus added that other barriers include “surmounting walls between schools in a university” and subtle psychological barriers. He took a basic pathology course at the University of Pennsylvania in the 1960s while studying to be a veterinarian that was attended by both veterinary and medical students. “It was not particularly well received by either the vet or medical students,” he said. There is so much to learn in both fields that students found it difficult when the course went from general to specific.
He said a common attitude among medical students was, “I’ve got enough to learn — why should I care how this affects a dog?” And vice versa for the students studying animal medicine.
Still, he sees similarities between vets and MDs as vast — from dealing with disease to political and business issues.
Mahr cited the commonality of many diseases between animals and humans, noting that many are treated with the same pharmaceuticals, each tested and licensed independently. He said diabetes, heart disease and joint disease are commonly shared across species and pointed to the possibility of addressing one of the main health concerns for both humans and their furry friends: obesity.
Many health professionals, including the U.S. surgeon general, are saying it’s time to pay attention when Fido comes to you with a leash in his mouth. And although the global environment is the focus of the task force, some issues remain close to home.
