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Dog health needs a decision-making revolution: “Best of Health” July 2020

Ian J Seath ♦ July 21, 2020

The recent furore about the Dutch government’s legislation affecting 12 brachycephalic breeds has seen yet more polarisation of views on both the definition of the problem and the potential solutions. In summary, the legislation uses a single measurement; the craniofacial ratio to specify which dogs can be bred from. Consequently, the Dutch KC has said it will no longer issue full pedigrees for puppies from those breeds that don’t meet the criterion for the length of nose to skull.

The resulting conversations from interested parties have, perhaps, generated more heat than light. Meanwhile, in a parallel Covid19 universe, we have been told regularly that our government is “following the science”. The question I want to consider in this month’s article is “how can evidence be used more effectively to support decision-making for breed health improvement?”.

We know, from years of observation, that there are many problems with the way evidence is used (or abused). Policy-makers in government often talk about evidence-based policy but the reality is that politicians often simply want to be seen to do something. The result is (usually) flawed policies and ineffective legislation, often with unanticipated consequences that actually make things worse. We also know that, in some breeds, people have cherry-picked data from research studies either to support their own case or to try to undermine other people’s arguments. Scientists value sound methodologies and are trained to develop well-designed studies and to look for robust evidence. Readers of their studies may not have that expertise and, to be fair, many researchers make little effort to make their results accessible for the lay reader.

Since we’re unlikely to develop more dog people with scientific training (in the short-term), we clearly need some other options to enable us all to have better, evidence-based, conversations about the problems and solutions. 

Horizon scanning

Breed clubs often work reactively and get caught out when new studies are published or sensational stories appear in the media. In contrast, researchers regularly do “horizon scanning” to identify emerging issues. This might be as simple as a literature search for papers published in a particular area of interest. This probably isn’t a very practical option for breed clubs but it’s certainly something that Breed Health Coordinators do. In our BHC Facebook Group, we share newly published papers, regularly. These may cover breed-specific health conditions, general canine topics such as husbandry, behaviour and temperament, and genetics. The Kennel Club is also helping breeds to do this horizon scanning with the development of Breed Health and Conservation Plans, each of which includes an extensive literature survey of papers relevant to a breed.

Diverse perspectives

If decision-makers restrict themselves to their historical range of responses to a problem, they may overlook better options. We see this all too frequently in canine health projects; an assumption that yet more “education” or a “better website” will make a difference and change people’s behaviours. Campaigners can fall into this trap as well, with an assumption that “more legislation” or “bans” will solve a long-standing problem. We know from human behaviour change research that solutions based on compliance or punishment are far less likely to have the desired effect than incentive-based and positive-reinforcement options. We also know that successful behaviour change in areas like obesity and smoking often requires 10 or more, different interventions (single, simple interventions just don’t work).

So, in breed health improvement we do need to listen to a range of perspectives on the problem (and ways of solving the problem) because we know that diversity of thinking helps to generate new ideas for solutions. I probably shouldn’t mention Dominic Cummings but there is something to be said for his call for more “assorted weirdos” to be recruited! He was talking about the civil service; maybe we need the same on our breed club committees.

Ready access to data

It’s often hard for breed clubs and BHCs to get hold of research papers and published evidence in a timely way, to inform their decision-making. Finding and storing relevant papers is much easier these days with the various online tools that are available. You can set up a Google Scholar search for any papers containing keywords (e.g. “canine”, “genetic diversity”, “Dachshund”) and you will get regular notifications with links to the papers. Free tools such as Microsoft OneNote or Evernote are then great for storing, indexing and retrieving the papers of interest to you. Increasingly, BHCs are summarising key messages for their breed club members, buyers and owners in the form of infographics using free tools like Canva.

Not all “evidence” is created equal

I have written previously about the Trust Triangle which describes the different types of information you might come across and the levels of trust that can be associated with each. At the bottom of the Trust Triangle are non-experts with opinions. Facebook and social media are awash with these! Journalists and experts with a commercial interest also fall into this category. Next comes expert opinion; these are people who are widely acknowledged to be experts in their field. Many of them will know an awful lot about a very narrow field of science. They too come with their biases and personal agendas but, mostly, they will have years of experience and scientific data to back up their opinions. Moving up the Trust Triangle, we find primary scientific research. This is made public via “papers”, the best of which will be peer-reviewed, rigorous, well-reported and independent. At the pinnacle of trustworthy published scientific research are papers that present systematic reviews of multiple other studies. These publications dissect and critique a set of primary research papers in order to arrive at “the best evidence” to support a particular case (or to disprove it).

We all need to get better at understanding the quality of evidence presented to us, including issues such as bias, chance and risk. We have seen over the past few months that many people are completely hopeless at understanding risk. We see it in canine health screening too; people may not understand what a screening grade means in relation to a decision to breed or not, and the risk of producing “affected” puppies.

A final part of the revolution we need in breed health improvement is to make more use of collaborative group decision-making processes. Different groups lobbing data, opinions and solutions over the fence really isn’t conducive to transparency or consensus-reaching.

Returning to my opening comments about the brachycephalic issue, in 2016 I wrote one of these articles where I said “Overall, the good news is the problem is moving into solution mode” with the formation of the Brachycephalic Working Group. In 2020, we’ve got more than enough data; we still need more improvement.

“You can’t change the bricks, and together, you still have to build a wall.”

Chris Hadfield, Astronaut

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Culture eats strategy for breakfast – my June 2020 “Best of Health” article

Ian J Seath ♦ June 19, 2020

I’m not overly persuaded by the many comparisons of Covid19 testing and death rates in different countries. Statisticians David Spiegelhalter and Sylvia Richardson said recently:

“…it’s tempting to link a country’s statistics to the measures they have taken to control the virus: for example, has Sweden’s more relaxed policy been as effective as lockdown? But countries differ in so many ways: basic demographics, compliance and social networks, testing capacity and policy, health service characteristics and so on.”

We face a similar situation in the world of dog health; there are lots of examples of comparisons made between different breeds. Our main interest has, inevitably, been focused on breed health in the UK but, for some breeds, there have also been international comparisons.

It’s perfectly valid and useful to make comparisons of the prevalence of particular diseases across different breeds. Many of these differences can be attributed to genetics and/or conformation. Indeed, the fact that we have created so many different breeds makes the pedigree dog a really useful resource in the search for the genes associated with diseases that may have parallels in humans.

International comparisons within breeds can also be useful and breeds such as Irish Wolfhounds and Bernese Mountain Dogs have extensive databases that can be used to investigate different health issues across the world. Increasingly, there is also genetic data from Genomewide Association Studies (GWAS) that is identifying different geographical clusters within breeds. This information could be used to address the lack of genetic diversity in some breed population sub-groups.

In my breed, Dachshunds, we are often (rightly) criticised for exaggerated length and shortness of leg and the claimed association of this with Intervertebral Disc Disease (IVDD). It is argued by some that we need to amend the Breed Standard to encourage shorter bodies and longer legs with more ground clearance, similar to that specified in the FCI Breed Standard. Unfortunately, this ignores the fact that the prevalence of IVDD is little different between FCI registered Dachshunds and UK dogs. In fact, there is more variation in IVDD prevalence between the 6 Dachshund varieties despite the fact they all share the same Breed Standard. For those interested, Wires and Longs are the least likely to have IVDD and Smooths and Mini Smooths are about 4-5 times more likely to have it. The research into the conformational differences and their association with IVDD is also contradictory. Nevertheless, it is clear that some Dachshund breeders (and judges) need to remind themselves of the original function of the breed and the KC mantra of “fit for function”.

3 levels of benchmarking

When I run benchmarking skills workshops, we talk about 3 levels of benchmarking: Metrics, Process and Culture. Metrics tell you “what the performance is”; Process tells you “how that performance was achieved” and Culture tells you “why” those processes achieved the particular level of performance.

Just comparing the metrics (e.g. disease prevalence or mutation frequency) ignores processes (such as breeder education, testing protocols and recording systems) and the cultural issues such as leadership, teamwork, compliance and enforcement. 

There’s a quote I use in relation to organisation design: “All organisations are perfectly designed to get the results that they do”.

For breed health improvement: “all breeds are perfectly designed to get the health that they do”.

Whatever any government, kennel club, breed club or campaigning group says about its strategy for improving canine health and welfare, it’s worth remembering Peter Drucker’s quote “Culture eats strategy for breakfast”.

International resources

Benchmarking metrics is easy, but tells you very little about how to improve.  Benchmarking processes tells you how others do what they do.  Adding in an understanding of the “soft stuff” helps explain why they get the performance that they do and is probably the most difficult area to adopt/adapt for your own breed’s use.

Visitors to the International Partnership for Dogs website (dogwellnet.com) will find a wealth of resources supplied by Kennel Clubs and Breed Clubs from around the world. It is a unique resource of data and tools (metrics and processes) that have been freely given and then curated in a single, accessible format.

Among the data, you can find breed health survey results and information on registration statistics. Having led the Breed-specific Health Strategies workstream at the 4th International Dog Health Workshop, I’m particularly interested in the tools and techniques that are being collated. These include examples of Breed Health Strategy templates which any breed club could use to get a baseline picture of what’s going on in their breed. In the UK, these are our Breed Health and Conservation Plans. The KC has completed these for 51 breeds so far and each Breed Health Coordinator for the remaining breeds has been given a simplified self-completion template to help them make a start.

The IPFD has plans to develop a Health Strategies Database along similar lines to its existing Harmonisation of Genetic Testing database. This would be an interactive resource including health conditions where recommendations have been made by Health Strategy Providers (HSPs) including kennel and breed clubs and veterinary organisations. It will include information on prevalence, severity, screening tests/programmes, links to health data etc.

This would be supported by an IPFD Expert Panel who would provide collective opinions on key questions, e.g. the quality and utility of genetic tests, their application within breeds, geographical areas, etc. and in the context of the broader view of health in the breed.

It’s all about people!

Making these internationally-sourced resources available is great but their applicability will be very dependent on the cultural context in each breed and each country. For example, approaches that have been successfully applied in the Nordic countries where there are fewer breeders than in the UK may simply not be workable here. In the USA, things will be different again; we’ve seen from their Covid19 lockdown protests that some Americans don’t take kindly to being told what to do!

I also think there would be some value in categorising the various types of breed health improvement intervention (processes) using human behaviour change principles. I’ve written before about Susan Michie’s (UCL) behaviour change wheel which identifies 7 policy categories and around 90 different types of behavioural change technique. We will only improve breed health if individuals’ behaviour changes (breeders, buyers, judges, vets etc.). Behaviour change research in the field of human health (e.g. smoking and obesity) suggests that successful change typically requires around 10 different techniques to be employed. Incidentally, this explains why the reliance on “breeder education” has been consistently unsuccessful.

Returning to my initial thoughts on Covid19, some readers will be aware that Susan Mitchie is one of the advisors to the government on behaviour change associated with the pandemic. So, if you are interested to understand what’s been done in the past few months to shape your behaviour, I’d recommend you do some reading on behaviour change techniques. 

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