One Medicine: Improving Physician-Veterinarian Communication

By Laura H. Kahn

The medical community is devoting a lot of effort to researching bioterrorism agents and diseases that could become human pandemics. But in many cases, theyâre overlooking a potentially critical resource: veterinarians.

Zoonoses are diseases of animals that can be transmitted to humans. These diseases include: SARS, West Nile virus, HIV/AIDS, and recently avian influenza (H5N1). Many of the agents of bioterrorism are zoonotic in origin such as anthrax, tularemia, and plague. Veterinarians have long recognized the interconnectedness between human and animal health and gave it the term âOne Medicineâ to reflect this fact. Historically, human and animal diseases have largely been treated as separate entities since physicians and veterinarians do not commonly communicate or collaborate with each other. In the course of my research on emerging infectious disease outbreaks, I came to the realization of the importance of zoonotic diseases after reading the veterinary medical literature.

For example, the West Nile virus outbreak infecting both humans and animals might not have been recognized without the determined efforts of one veterinarian, Dr. Tracey McNamara who was working as a veterinary pathologist at the Bronx Zoo. Dr. McNamara was aware of the human cases of encephalitis that were reported in the newspapers. When exotic birds in the zoo were becoming sick and dying, Dr. McNamara performed necropsies (animal autopsies) on them and found their pathologies to be remarkably similar to those reported in the human cases. No one wanted to take her seriously because she was a veterinarian. Unfortunately, her experience is not unique.

Over the past months, I have talked with a number of veterinarians who shared with me their frustrations of not being considered colleagues by those in human medicine. This makes no sense because the requirements for getting a veterinary degree are as rigorous as those for a medical degree. Indeed, the competition to get into veterinary medical schools in the U.S. is fierce because there are only 28 accredited veterinary medical schools compared to the 125 medical schools. Veterinarians study the anatomy, physiology, and pathophysiology of many different species. They deserve to be treated as the highly educated professionals that they are by their colleagues in human medicine.

Physicians and veterinarians should work closely together not just in public health but in clinical settings as well. Their collaborative efforts would be extremely important especially for people who are immunosuppressed and want to own or work with animals. These individuals are more susceptible to acquiring zoonotic diseases and should be closely followed. In addition, their pets should be monitored for preventable conditions that might pose risks to their health.

Veterinarians are concerned that some animals, particularly dogs, can become immunosuppressed, and they donât know if their conditions and/or treatments might pose risks to their owners. For example, dogs commonly can get conditions, such as severe allergies, or immune-mediated hemolytic anemias, or inflammatory bowel diseases that require immunosuppressive therapy such as cortisone-type drugs. What would happen if an immunosuppressed human, such as an organ transplant recipient, had a pet that was treated with immunosuppressive drugs? Dogs with these conditions can develop superficial bacterial infections such as Staphylococcus intermedius and yeast infections like Malassezia pachydermatitis. Since physicians and veterinarians donât usually talk to each other, these potential zoonotic risks would likely go undetected and could possibly pose considerable risks to the individuals involved. The veterinarians couldnât possibly know their patientsâ ownersâ health status unless that information was shared voluntarily. These situations could be remedied if there was communication between the professionals. The challenge is to get the word out.

Zoonotic diseases are important enough that the journal Emerging Infectious Diseases devotes its December issues to the subject. In addition, the CDC has established a Center for Emerging and Reemerging Zoonoses, but the challenges these diseases pose should also be addressed in clinical settings for individuals as well as in public health.

For those interested in reading more, my recent paper in Emerging Zoonotic Diseases goes into more detail about the benefits of improving communication between physicians and veterinarians confronting zoonotic diseases. Also, two veterinarian colleagues and I have published op-eds in the St. Petersburg (Florida) Times and the Louisville (Kentucky) Courier-Journal.

The concept of âOne Medicineâ must be embraced by allâphysicians, veterinarians, public health professionals, and the public if we are to ensure that both humans and animals can lead healthier lives.

Laura H. Kahn is a physician and researcher at the Program on Science and Global
Security at the Woodrow Wilson School of Public and International
Affairs, Princeton University.