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Is One Health the New Veterinary Medicine?

One Health seeks to unite medical and environmental professionals and associations.

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Originally published in the October 2014 issue of Veterinary Practice News

An oversupply of veterinarians. Crushing educational debt. Noncommensurate salaries. Larger veterinary classes. More veterinary schools. We have heard the bad news.

The profession is in a point-counterpoint mode, with widely diverging opinions that range from “We are just fine” to “We have huge problems.” The good news is that we are able to gather and discuss with freedom of expression, both guaranteed by the U.S. Constitution. 

But now we also face climate change, deforestation, drought, melting polar ice caps, frightening shifts in ocean biology, increasingly violent storms, threatened municipal water supplies, global pollution and geopolitical conflicts. 

In many regions, human populations are being uprooted, crops do not get planted and animals cannot be raised. New population concentrations, human and animal, will continue to emerge, facilitating the transmission of many infectious diseases, increasing zoonosis risks and likely leading to social conflicts as well.

Without question, the veterinary profession will change, as the world is changing. But what does the future look like? 

Is One Health the Solution?

One Health is a movement designed to establish collaborative ties among the health professions and associations. It is not a new idea, but moving toward interprofessional health care at individual, population and societal (or species) levels is a new challenge for professions that tend to operate independently of one another.

What Now?              

The immediate One Health future in community-based health care lies in recognizing the potential for increasingly direct exposure to problems that result from global climate and social changes. 

The Ebola virus outbreak demonstrates that many health dangers are “over there” no longer. And, of course, we have tuberculosis, leishmaniasis, dengue fever, chickungunya, SARS, MERS, Nipah virus and Hendra virus, and we could list plenty of others to think about. 

All community health-care providers need to become aware of the signs of previously “foreign” infectious diseases. Aside from direct disease transmission, zoonosis-transmitting arthropods could move with moving humans and goods, with shifting populations of animals, or secondary to local climate effects.

But the One Health concept goes well beyond individual knowledge expansion. 

Many community health care providers, including veterinarians, serve on local or regional boards of health that can be effective venues for risk assessment, planning and education. Thus, we have some structure from which we can begin to act in more unifying fashion. 

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This is our good fortune because we cannot afford to separate local health care systems from their global counterparts for very much longer. 

The master’s of public health degree is a One Health veterinary avenue, and it seems clear that health professionals who have MPH-level training will be needed in the future.

Still, if considering this pathway, one first may wish to ascertain the present numerical, distributional and age demographics of MPH professionals in the USA and elsewhere.  Many jobs requiring the MPH are publicly funded and therefore under legislative control. Around the world, many MPH-type programs exist.

Multidisciplinary staffing of the MPH degree means that prospective employers will see viable candidates from other health professions. How many DVM/MPH personnel will be needed, and where? 

Changes in Education

Is veterinary medicine ready to be a One Health profession? In fact, are any of the North American health care professions sufficiently prepared for a One Health future?

Interdisciplinary educational programs will be important venues for new ideation and applied practices that will guide health-care delivery across species and geography.

For our part, we should be thinking with some urgency about significant changes in veterinary education, to prepare for a veterinary future that does not function by weight of numbers but by focused types of scientific expertise.

Why Now?

The need-and-supply question in health care actually goes well beyond the private practice sector of veterinary medicine. Biomedicine presently is oversupplied with Ph.D. scientists. Reductions of National Institutes of Health-sourced research funding over the past decade have worsened this oversupply problem by creating “hyper-competition” for shrinking resources. 1, 2

Obvious consequences have included a disappointing mix of hurried and error-ridden research, and more corrections or total retractions involving prominent, high-impact journals. 3-6

There are still other problems. 

Biomedical research as a business must rethink and reposition, as legal decisions limit the patenting landscape for biotech companies (rightly so, in my opinion).7 Government agency decisions have closed the NIH stem-cell funding program. Stem cell research is needed, but clinical applications require more thorough and tightly controlled double-blind studies.8 

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NIH also held up the huge planned National Children’s Study because of long delays, scientific criticism and budgetary concerns.9 This is critically important research, but it needs to be done rigorously and at a reasonable investment of taxpayer money.

Will business changes affect DVM employment pathways? Probably, but it is too soon to know.

If one needs to be reminded in "One Health population terms" of our proximity to the problems of a shrinking world, consider a discussion of the

14 million people worldwide who were diagnosed with cancer in 2012 alone, with a projected increasing future trend.10 Or, even more broadly inclusive, consider the biological complexity of long-term exposure to man-made chemicals in our environment.11 

We understand that veterinary patients live with us in environments that are being seriously damaged by humans—same air, same water and same earth. In fact, terrestrial and marine animals often are sentinels for events that may affect all species and ecologies. Are we watching closely enough, as a veterinary community?

Closer to home and, in my view, the most frequent problem in veterinary research is inattention to biological aspects of experimental design, resulting in poorly designed studies and, consequently, unreliable outcomes and overstated conclusions.

Practicing clinicians may feel that these problems areas are quite distant from their present concerns. Again, however, research does drive everything that we do as veterinarians.

Colleges of veterinary medicine continue to disgorge record numbers of small animal doctors into a market that already is debt-ridden for younger graduates and very highly priced to consumers, while not seriously addressing a mounting list of One Health-related warning signs. 

One must wonder: What will be the price of our love for the status quo? Should not clinician overpopulation give way to other needs: Training exact thinkers (in better-planned programs to meet newly recognized needs) with solid research training focused on pathology, microbiology and parasitology? 

Should not the profession’s community clinicians, who will be the first line of defense facing problems in animal health and zoonotic diseases of a not-so-distant future, leave their silos and speak out forcefully for educating biomedical innovators to deal more effectively with a polluted and warming world that will require different veterinary skill sets?

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Can We Do Early Interventions? 

I submit that the time is growing very short for veterinary academia to move to better prepare students to act on the veterinary obligation in a new context. 

We have, again to our good fortune, a current capacity to begin a new process. The future will rest with veterinary students who enter training in coming years.

At least some entering students should be sought and selected for interest in research, ability for analytical thinking and capacity to look at problems in population terms.

Curricula then should be structured to provide the necessary education to design, execute and interpret properly designed studies, both statistically and biologically. These changes will require academic commitment, space, programs and dollars. How should funding provisions change?

Ultimately, the only really lasting solutions to these complex problems will be voluntary exits from silos and participation in well-planned interdisciplinary collaborations. 

Life scientists from other disciplines, such as climate, conservation, ecology, field biology or biochemistry, are trained professionals, many of whom have great depth and breadth of understanding of their disciplines. 

Why have we not included other life sciences more directly in our deliberations about issues that require One Health planning? 

We are foolish to think that we will replace them. None of this may be to the numerical liking of many veterinary administrators, but we are wise if we focus on working more effectively with other scientific and clinical disciplines rather that thinking we are solving anything by ourselves in our silos. 

In my view, we can achieve the essential goals of One Health, but we must have the courage to make sweeping changes in veterinary education.

REFERENCES

1. www.pnas.org/cgi/doi/10.1073/pnas.1404402111

2. PhD Overdrive. Nature 511:2014.

3. STAP Retracted. Nature 511:2014.

4. Faulty drug trials tarnish Japan’s clinical research. Science 345:2014.

5. Leaked files slam stem-cell therapy. Nature 505:2014.

6. Doubts over heart stem-cell therapy. Nature 509:2014.

7. Biotech reels over patent ruling. Nature 511:2014.

8. NIH stem-cell programme closes. Nature 508:2014.

9. NIH puts massive U.S. children’s study on hold. Science 344:2014.

10. Global warning. Scientific American 311:2014.

11. Life in a contaminated world. Science 337:2012.

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