Health-tested does not mean “healthy” – My March 2020 “Best of Health” article

Best of HealthI’ve been involved in several conversations over recent months about where we should focus our efforts if we want to improve the “health of dogs”. In my breed, Dachshunds, we often focus on back disease (IVDD) as the most significant health issue facing the breed. The evidence suggests the breed is 10-12 times more likely to suffer IVDD than dogs in general. Our breed health surveys also tend to support the widely quoted figure of 25% of Dachshunds being likely to suffer an IVDD incident at some point in its life. However, that means, on average, 75% of the breed won’t have IVDD and in some of the Dachshund varieties, the risk of IVDD is lower still.

There are, no doubt, similar situations in other breeds; for example, heart disease in Cavaliers, cancer in Bernese Mountain Dogs and BOAS in brachycephalic breeds. In some cases, screening programmes exist which breeders can use to reduce the risk of breeding puppies that will be affected by a particular condition.

Screening programmes typically make use of 2 types of test; phenotype tests and DNA tests. Of the former, Hip, Elbow, Heart, Hearing and Eye tests are well-known and (mostly) well-established ways for breeders to test their stock. The Kennel Club’s recent paper Effectiveness of Canine Hip Dysplasia and Elbow Dysplasia Improvement Programs in Six UK Pedigree Breeds demonstrated good participation in Hip Scoring and a reduction in the prevalence and severity of Hip Dysplasia. In contrast, the Respiratory Function Grading Scheme for Bulldogs, French Bulldogs and Pugs is relatively new but offers a useful way to reduce the chances of breeding puppies affected by BOAS.

When it comes to DNA tests, most breeders are now familiar with what the genotype results of Clear, Carrier and Affected mean and can use these to avoid producing affected puppies. For example, breeders of Mini Wire Dachshunds have used the Lafora Disease DNA test to reduce the number of at-risk litters containing affected puppies from 55% to 2% since 2012.

The world’s healthiest dog?

More and more DNA tests are becoming available, so it will be increasingly challenging for breeders to decide which ones to use. This is particularly true where the test may not have been rigorously validated to demonstrate its link to a clinical condition. The issue of test validation was one of the emerging concerns from the 4th International Dog Health Workshop, held last year in Windsor. The arrival of panel tests potentially adds yet more confusion to the debate about healthy dogs. Just because a dog can be screened for 150 known genetic mutations and found to be Clear of all of them, doesn’t mean it is “the world’s healthiest dog”. Many of those mutations may be completely irrelevant to your breed in terms of clinical illness.

When we consider both phenotype and genotype tests, we are really looking at diseases, not health. It can, therefore, be potentially misleading to puppy buyers to hear a breeder describing their dogs as “health-tested”. At best, we can say we have screened our dogs for particular, known, conditions to reduce the risk of our puppies developing that condition. We can’t say anything about the risks of them developing other health conditions for which no test is currently available. In the case of phenotype tests, the risk of a dog developing a problem often has an environmental and lifestyle component.

An owner’s view of health

This is where I think it becomes interesting to talk about what we mean by “healthy”. In 2014, the VetCompass project published a paper on the Prevalence of Disorders Recorded in Dogs Attending Primary-Care Veterinary Practices in England. The top 7 conditions diagnosed by vets were: Otitis Externa, Periodontal Disease, Anal Sac Impaction, Overgrown Nails, Degenerative Joint Disease, Diarrhoea, and Obesity. For the owners of these dogs, “health” largely boiled down to issues with ears, teeth, and bottoms! 

Purebred dogs had a significantly higher prevalence compared with crossbreds for three of the twenty most-prevalent diagnosis-level disorders: otitis externa, obesity, and skin mass lesions.

According to the PDSA, vets estimate that around half the dogs in the UK are overweight or obese. A study published in 2018 found 65% of dogs were overweight and 9% were obese. The knock-on effects of dogs being overweight include a reduced quality of life as well as increased risk of diabetes, heart disease, and arthritis. 

Given this evidence about “health”, there’s a good case for investing time and resources into helping people to be better dog owners. In 2015 we carried out a Lifestyle Survey of Dachshunds with the specific aim of identifying any factors that might be associated with the risks of IVDD. This built on a 2013 study done by the Royal Veterinary College that found obesity was one of the risk factors for IVDD. We found, unsurprisingly, that dogs that were more active and given more exercise had a lower risk of IVDD. More surprisingly, we found that neutered dogs had an increased risk of IVDD and the younger they were neutered, the greater the risk.

2 routes to healthy pets

It’s pretty clear that simply using disease screening programmes (“health tests”) as a means of saying we are breeding healthy dogs is too narrow a perspective. Breeders, buyers and owners need information from 5 questions to make an informed decision about how healthy their dog is likely to be:

  • Is there a breed-specific predisposition to any particular health conditions?
  • What is the prevalence of those conditions?
  • What is the severity of those conditions (chronic or acute)?
  • How long might the dog suffer from these conditions (age of onset)?
  • What treatments are available and how effective (and expensive) are they?

There are probably 2 main routes to healthier dogs: breeding healthier pets and owning healthier pets. Firstly, breeders can use less conformationally exaggerated, more genetically diverse, and disease-screened dogs in their breeding programmes. Secondly, owners can implement choices such as life-stage appropriate diet and exercise.

The term “healthspan” has been used to define the length of time during which dogs (and other animals, and humans!) are generally healthy and free from chronic illness. Maybe we should be having more conversations with breeders and owners about how they can increase the healthspan of their dogs.

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Breeders and coronavirus – advice from the Kennel Club (19/3/20)

WHD PuppiesThe Kennel Club has answered a number of questions to support dog breeders through the COVID-19 pandemic. You can read these here: https://bit.ly/2J9VSe0

It covers:

  • I have a litter of puppies due. What is the advice about visiting families?
  • How can people socialise their puppies at this time?
  • We were planning a litter but should we now delay this? / is it still ok to breed from your dog?
  • How can I best take care of my puppies and dogs during this period?
  • What should I do if I need to get my puppies vaccinated or microchipped?
  • Is it safe for someone else to take care of dogs that I breed from if I’m taken ill or have to self-isolate?

Government guidance on self-isolation and social distancing is available on the GOV.UK website:

A world of unanticipated consequences

A few weeks ago, words like “self-isolation”, “social distancing” and “lockdown” were barely part of our vocabulary. The rate at which new information emerges on the progression of Covid-19 seems to increase daily and decisions that were logical and evidence-based one day, may be completely reversed or changed just a week (or even days) later. It’s so easy for the keyboard warriors to criticise those making decisions but I bet they would feel rather differently if they were part of the decision-making process or, worse, if they were ultimately accountable for those decisions.

In the world of business and leadership development, there’s a concept that’s been around for a while that describes the world we’re in. It’s VUCA, which stands for Volatile, Uncertain, Complex and Ambiguous. It originated in the US military to describe the “new normal” of extremism and terrorism which required a completely different style of leadership and response compared with the Cold War years. There are no simple solutions in a VUCA world; we need to understand that decisions made in one part of a system can have quite surprising and unanticipated consequences elsewhere. Often, those consequences will be counter-intuitive.

Let’s consider some examples from the world of dogs. The Kennel Club has seen a decline in registrations of pedigree dogs over recent years. What do we think Covid-19 will do to that trend? The “obvious” conclusion would be that registrations will decline further as people face a period of uncertainty about their jobs and are unwilling to commit to the costs of buying and owning a dog. Yet, within a week of some of the biggest changes to our working lives ever seen, there is emerging evidence that we might actually see an increase in demand for puppies. People find they have time on their hands and, instead of having to wait for the school holidays to find time for a puppy, they have time now.

Where will they get those puppies from, though? Well, another unanticipated consequence might be that they can only get a puppy bred in the UK. Puppy farmers from Eire and those trafficking from Europe will find our borders closed. Hopefully, their desire for a puppy right now doesn’t mean they buy from backstreet breeders or get conned with puppy-farmed puppies already in the UK. I know of several breeders who have seen an increase in demand for puppies but also an increase in demand for their stud dogs. People who might have been uncertain about breeding from their bitch might feel (a) they now have time to cope with a litter and (b) that the income from puppy sales could be very important to them right now.

Of course, when we think about the “dog system” we have to look beyond supply and demand. There are other consequences of new breeders adding to the supply of puppies. How will these breeders find out about health screening before mating their bitches and how will they learn about whelping and puppy-rearing? This could be an opportune time to signpost them to the resources available in the KC Academy.

Canine lifestyles

There are other unanticipated consequences of the current situation. Where we live, the parks and countryside are now swarming with people out walking their dogs (and people without dogs). Many of these are probably dogs that previously would have been stuck at home while their owners were out at work or, at best, benefitted from the services of a dog walker and doggy day-care. So, these dogs’ daily routines will be transformed both physically and mentally and their owners will benefit similarly (unless the novelty wears off). As I write this, it’s a sunny weekend and I wonder if these dogs will continue to get this exercise if we return to the seemingly endless rain of not so long ago.

We might, therefore, expect the health of these dogs to improve in the short-term and that can only be a good thing, given what we know about the levels of canine obesity in the UK. I hope there is not an unanticipated consequence that these dogs are given inappropriate amounts or types of exercise, particularly if they are young puppies. 

These owners may also realise that their dogs need more training to make them better-behaved pets. That means there may be opportunities for dog trainers to offer online services and to encourage people to attend formal training such as the Good Citizen Dog Scheme once things return to something resembling “normal”.

Spending more time with their owners may, in the short-term, reduce problems of separation anxiety which we know is a major issue for many dogs in the UK. We might have to consider what the consequences will be once people return to work; will their dogs be even more stressed when left alone after having had the company of their owners for several weeks?

What about Rescue?

It’s possible that, because people are likely to be out of work or on reduced incomes, they may be inclined to part with their dogs to the rescue charities. It must be a worry for these organisations (and breed rescues) that they will be inundated with dogs and also suffer from a reduction in footfall of people looking to re-home. The opposite might happen, though. People may decide it’s a good time to rescue a dog. Breed rescues may be at an advantage here as many have a network of coordinators and foster homes who can continue to help. 

The big rescue charities could perhaps take a more creative approach and pay people to keep their dogs (or give them vouchers to pay for food and vet bills). After all, these dogs’ owners almost certainly don’t want to give up their dog and the negative mental health consequences of doing so could add further to their problems.

Glass half-full

We certainly are in a volatile and uncertain world at the moment and the impact of the pandemic on individuals and the health service will, no doubt, be immense. It is understandable that the government is focusing on minimising the health impacts but we are already seeing far-reaching and deeply damaging impacts on the economy and people’s livelihoods. Most of the decision-making on strategies to address the pandemic seems to be based on epidemiological modelling. From a systems thinking perspective, I’d like to know what modelling of human behaviour has been done because we’ve certainly seen some unanticipated consequences in the panic-buying of toilet rolls (!) and people flocking to the seaside and National Parks. I’d also like to know about the economic modelling and modelling of other health impacts (e.g. people who have now had operations cancelled).

There are unanticipated consequences of any decision but my glass is always half-full and I am optimistic that we will come out of this situation stronger as a dog community. Remember: DOGS ARE FOR LIFE, not just for Coronavirus.

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Fighting the dog health infodemic – Our Dogs Best of Health article

Best of HealthAlong with the recent talk of a Coronavirus Pandemic, there has been a discussion of the parallel infodemic. The World Health Organisation (WHO) launched an online platform to combat misinformation and fake news which they described as an infodemic. It occurred to me that we could perhaps learn something from the WHO responses that would be applicable to the ways we tackle fake news and misinformation on dog health matters.

In the case of Coronavirus, misinformation was spread rapidly through social media channels and posed a threat to public health. “We’re not just fighting an epidemic; we’re fighting an infodemic”, said WHO Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference on February 15th. 

There has always been misinformation associated with health issues but the challenge with social media is that it is amplified and goes faster and further than ever before. That’s just as true in the world of dog health and the task for those of us in breed health leadership positions is to make sure dog buyers, owners, and breeders will do the right thing to improve the health of their dogs. We have to go further than simply providing information; we have to provide information that drives them to act appropriately.

We have to ensure people have access to trustworthy information, for example through data sharing and publication of peer-reviewed research. However, we know that such information has to be tailored to the needs of different audiences. For breed clubs, that means making their websites and social media channels the “go to” places for anyone who wants to find out about the breed. 10 years ago, all a breed club needed was a website with (at least) a few pages describing the characteristics of the breed, how to find a reputable breeder and information on the main health issues and what was being done about these.

Back in 2011, the late Philippa Robinson published her first Karlton Index Report summarising the work breed clubs were doing in the field of health improvement. Her second report in 2013 found 15 breeds with no online information at all and she scored 62 breeds (1 in 3) at less than 10 points out of the maximum possible 100. 

Mobile-friendly breed information

Today, numerous social media channels have overtaken static websites as the first port of call for many people. It’s not just the younger generation that is hooked to their mobile devices, there are plenty of silver surfers who are just as tech-savvy and whose access to information is primarily through a mobile device. That means as a minimum, your breed’s website needs to be mobile-friendly. I recently discovered that our “Tips for New Owners” web page which we had only just rebuilt in 2019, just wasn’t working on all mobile devices. Half the tips weren’t being displayed so I had to rebuild the page layout completely to make it work properly on phones.

All this points in the direction of breeds needing a social media strategy as part of their overall communication plans. Most breed clubs have a Facebook page these days and that’s obviously a useful channel for disseminating news. There are also, inevitably, numerous owners’ groups for most breeds and it makes sense for breed club and health committee members to join these so they can provide the best available advice in response to questions from buyers and owners.

Goodwill and volunteers

Of course, all that takes time and we are reliant on the goodwill of volunteers. The reality is that most breeds probably don’t have enough people with time to devote to offering help and pointing to the best advice across multiple social media channels and discussion groups. One way to address that is to develop a network of supporters and advocates who are “on message” and can act to amplify your messages. Your network could include nominated Pet Advisors (we have 3 on our Dachshund Health Committee) and subject matter experts such as vets or vet nurses. Another useful group to build bridges with is the Admins of pet owner  Facebook Groups. In some breeds, these people will have access to thousands of group members which is a far wider reach than most breed clubs can ever hope to achieve.

The other way is to make the provision of relevant information more efficient. Instead of providing a bespoke answer to every question, it’s far quicker simply to post a link to the relevant page on your website. That means, of course, you need to have pages with good quality information on the most frequently discussed topics. You could also build a list of Frequently Asked Questions (FAQs) and direct people to those.

Another way to improve the efficiency of how you disseminate information is to connect your various social media channels so that a post on one channel automatically gets posted on other channels. Many blogs, for example, enable you to cross-post to Twitter and Facebook without having to create new posts on these additional channels. 

The best source of up-to-date information

One of the approaches the WHO has taken to provide clear, simple advice on Covid-19 is to create a series of infographics that other people can use to provide accurate information. These can be downloaded from their Covid-19 website which is the single best source of up-to-date information. The breed health parallel is to have dedicated websites for specific health concerns instead of having this information “lost” in a general breed website. In Dachshunds, we have created a dedicated website for IVDD (back disease) information and this includes a series of infographics and FAQs. Other breeds might do something similar for Brachycephalic issues or there might be value in the various brachy breeds to collaborate on a single site.

“Mythbusters” can also be used to challenge the nonsense and fake news that so often does the rounds of social media. It is well-known that closely-held false beliefs can actually be harder to rectify and sometimes this backfires, resulting in the false news being reinforced (the so-called boomerang effect). Successful tactics include story-telling, rather than presenting facts (appeal to the heart, not the head). Fear-mongering, the use of threats and specifically trying to change peoples’ minds are all notoriously unsuccessful.

One study of factors that caused articles about human vaccination to go viral on social media showed the most shared articles contained:

  • Statistics demonstrating the case being made, plus…
  • A bottom-line message with clear advice for the reader

Both factors had to be present for maximum impact. Articles that were just stories or without statistics were least likely to be shared. Interestingly, articles that acknowledged both sides of an argument (such as acknowledging occasional adverse vaccine reactions) before coming out with a clear bottom-line message were also seen to have high credibility.

There may be no way to prevent a COVID-19 pandemic in this globalised time, but verified information is the most effective prevention against the disease of panic. We should apply the same common-sense approach to communicating the evidence about breed health.

“Falsehood flies, and the Truth comes limping after it.”  Jonathan Swift, 1710

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Health-tested does not mean “healthy”: my “Best of Health” article for March 2020

Best of Health

I’ve been involved in several conversations over recent months about where we should focus our efforts if we want to improve the “health of dogs”. In my breed, Dachshunds, we often focus on back disease (IVDD) as the most significant health issue facing the breed. The evidence suggests the breed is 10-12 times more likely to suffer IVDD than dogs in general. Our breed health surveys also tend to support the widely quoted figure of 25% of Dachshunds being likely to suffer an IVDD incident at some point in its life. However, that means, on average, 75% of the breed won’t have IVDD and in some of the Dachshund varieties, the risk of IVDD is lower still.

There are, no doubt, similar situations in other breeds; for example, heart disease in Cavaliers, cancer in Bernese Mountain Dogs and BOAS in brachycephalic breeds. In some cases, screening programmes exist which breeders can use to reduce the risk of breeding puppies that will be affected by a particular condition.

Screening programmes typically make use of 2 types of test; phenotype tests and DNA tests. Of the former, Hip, Elbow, Heart, Hearing and Eye tests are well-known and (mostly) well-established ways for breeders to test their stock. The Kennel Club’s recent paper Effectiveness of Canine Hip Dysplasia and Elbow Dysplasia Improvement Programs in Six UK Pedigree Breeds demonstrated good participation in Hip Scoring and a reduction in the prevalence and severity of Hip Dysplasia. In contrast, the Respiratory Function Grading Scheme for Bulldogs, French Bulldogs and Pugs is relatively new but offers a useful way to reduce the chances of breeding puppies affected by BOAS.

When it comes to DNA tests, most breeders are now familiar with what the genotype results of Clear, Carrier and Affected mean and can use these to avoid producing affected puppies. For example, breeders of Mini Wire Dachshunds have used the Lafora Disease DNA test to reduce the number of at-risk litters containing affected puppies from 55% to 2% since 2012.

The world’s healthiest dog?

More and more DNA tests are becoming available, so it will be increasingly challenging for breeders to decide which ones to use. This is particularly true where the test may not have been rigorously validated to demonstrate its link to a clinical condition. The issue of test validation was one of the emerging concerns from the 4th International Dog Health Workshop, held last year in Windsor. The arrival of panel tests potentially adds yet more confusion to the debate about healthy dogs. Just because a dog can be screened for 150 known genetic mutations and found to be Clear of all of them, doesn’t mean it is “the world’s healthiest dog”. Many of those mutations may be completely irrelevant to your breed in terms of clinical illness.

When we consider both phenotype and genotype tests, we are really looking at diseases, not health. It can, therefore, be potentially misleading to puppy buyers to hear a breeder describing their dogs as “health-tested”. At best, we can say we have screened our dogs for particular, known, conditions to reduce the risk of our puppies developing that condition. We can’t say anything about the risks of them developing other health conditions for which no test is currently available. In the case of phenotype tests, the risk of a dog developing a problem often has an environmental and lifestyle component.

An owner’s view of health

This is where I think it becomes interesting to talk about what we mean by “healthy”. In 2014, the VetCompass project published a paper on the Prevalence of Disorders Recorded in Dogs Attending Primary-Care Veterinary Practices in England. The top 7 conditions diagnosed by vets were: Otitis Externa, Periodontal Disease, Anal Sac Impaction, Overgrown Nails, Degenerative Joint Disease, Diarrhoea, and Obesity. For the owners of these dogs, “health” largely boiled down to issues with ears, teeth, and bottoms! 

Purebred dogs had a significantly higher prevalence compared with crossbreds for three of the twenty most-prevalent diagnosis-level disorders: otitis externa, obesity, and skin mass lesions.

According to the PDSA, vets estimate that around half the dogs in the UK are overweight or obese. A study published in 2018 found 65% of dogs were overweight and 9% were obese. The knock-on effects of dogs being overweight include a reduced quality of life as well as increased risk of diabetes, heart disease, and arthritis. 

Given this evidence about “health”, there’s a good case for investing time and resources into helping people to be better dog owners. In 2015 we carried out a Lifestyle Survey of Dachshunds with the specific aim of identifying any factors that might be associated with the risks of IVDD. This built on a 2013 study done by the Royal Veterinary College that found obesity was one of the risk factors for IVDD. We found, unsurprisingly, that dogs that were more active and given more exercise had a lower risk of IVDD. More surprisingly, we found that neutered dogs had an increased risk of IVDD and the younger they were neutered, the greater the risk.

2 routes to healthy pets

It’s pretty clear that simply using disease screening programmes (“health tests”) as a means of saying we are breeding healthy dogs is too narrow a perspective. Breeders, buyers and owners need information from 5 questions to make an informed decision about how healthy their dog is likely to be:

  • Is there a breed-specific predisposition to any particular health conditions?
  • What is the prevalence of those conditions?
  • What is the severity of those conditions (chronic or acute)?
  • How long might the dog suffer from these conditions (age of onset)?
  • What treatments are available and how effective (and expensive) are they?

 

There are probably 2 main routes to healthier dogs: breeding healthier pets and owning healthier pets. Firstly, breeders can use less conformationally exaggerated, more genetically diverse, and disease-screened dogs in their breeding programmes. Secondly, owners can implement choices such as life-stage appropriate diet and exercise.

The term “healthspan” has been used to define the length of time during which dogs (and other animals, and humans!) are generally healthy and free from chronic illness. Maybe we should be having more conversations with breeders and owners about how they can increase the healthspan of their dogs.

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