Firstly perhaps, a couple of quotes; from the magus of them all
Hippocrates who opined “science is the father of knowledge but opinion breeds
ignorance” and from the esteemed surgeon Sir Wiliam Osler; “it is much more
important to know what sort of patient has a disease than what sort of a
disease the patient has.”
For fear of appearing flippant, the challenges faced by a vet in
balancing competition with patient care lie largely in communication. This does not mean singularly that the vet
dictates to the owner/carer/trainer/jockey but, as in the trial of Mr C
versus Broadmoor which, highlighting autonomy, transformed the face of all
medical advice; defining that the owner/carer/trainer/jockey must both
understand and comprehend any medical information supplied providing “informed”
consent. Unfortunately, vets have
somewhat surrendered this and their Aesculapian authority on the bonfire of
their own vanities, removal of previous professional boundaries, and upkeep of
finances, and have also been pressurised by the equine owning publics’
cessation of understanding of the origins of husbandry (Rollin 2006)
where animals, not only horses, were viewed as greater than that of an object
to provide pleasure or work. Indeed
Immanuel Kant pointed out that one of the fundamental dictates of moral law is
to treat objects of moral concern as ends in themselves, not merely as a
means. This is an extremely valuable and
fundamental point and whilst attitudes are changing, as set in a prescient case
in 1979 in New York, Corso v. Crawford Dog and Cat Hospital, in which
the judge declared that a “pet occupies a place somewhere between a person and
a piece of personal property,” it is in this myriad of competing pressures that
we work, and this sorrowfully is before we even consider the horse. In this capacity we become and largely can
only be advisors to the competitor.
Whilst acute and traumatic injury (often related to repetitive failure)
is comparatively easy to manage and implement treatment, with owners actually
observing clinical improvements, it is here perhaps where we have already
failed. Our primary aim should be in preparatory
and prophylactic medicine requiring greater input at all stages of the equine
athlete’s life.
The financial and time pressures
placed upon however, a competitor or trainer means that such idealism is rarely
met or largely ignored, unless the horse has already achieved at an elite
level; even to the level where husbandry levels are insufficient (promoting
dental disease and lower airway disease for example), and this is conferred to
the treating vet who’s role is to return the animal to pre-injury levels of
competition with expediency. At a recent
course I attended, a highly respected Newmarket
“racehorse only” vet quoted “our role is not to get the horse better, it is to
get the horse back on the track.” I’m
sure he would add several caveats but the implication is inclement and
highlighted in Contemporary Issues in Bioethics (Benson and Rollin
2004). Although the aim is to return the
animal “healed” it is very difficult to always provide complete evidence of
true healing due to the lack of sensitivity of several routine techniques such
as ultrasonography of tendon or ligament tissues and radiography of bone, with
emerging techniques such as UTC and higher modality imaging (CT, MRI and to a lesser extent scintigraphy) both
providing evidence of true healing and more accurate diagnoses (and hence
therapies). That injuries such as SDFT
tears and SI desmitis have a relatively high recurrence rate presently, and
that medical issues such as LAD ,
EIPH and various myopathies and neuropathies still remain as an almost accepted
“occupational hazard” of the equine athlete shows just how far we still have to
go.
Despite all this our duty of care
remains paramount and is defined not only in our Hippocratic Oath, in the
Animal Welfare Act 2006 and highlighted, although only with “guidelines” in the
Codes of Professional Conduct. Whilst
the aforementioned pressures of finance (from owner and practice ownership),
societal distortion of a horse’s role, implications of rest and treatment on
short term career results and even on long term career advancement when
involved in team sports, impose parameters in which we work and balance care of
the individual with achieving competitive status; by careful, sensible and
reasonable communication and education of the client, advocacy can be
achieved. The only area of which we
cannot balance is that of long-term health of an aged or ageing athlete. That occupational related disease is expected
does little to affirm its acceptance and again the high incidence of for example,
metacarpo-phalangeal and sacroiliac osteoarthritis, questions whether our goals
are toward short or medium term health stability or to promotion of life long
(i.e. 25-30 years) wellness (Dunn et al 2007).
Practical and specific examples of
such dilemmas include the use of various joint therapies in an obviously
deteriorating joint to allow continuing competition, in the reluctance to
adhere to exercise regime for musculoskeletal exercise programmes to achieve a
“faster” return to racing, in the cost implications of non-use of supposedly
superior therapies such as stem cell treatment for tendon lesions or of medical
treatments for common conditions such as gastric ulceration, in the promotion
or “benign ignorance” shown when presented with unethical treatments such as
pin firing, through to pressure to vaccinate late due to competition
rules. In each situation our role as the
animals advocate in awakening moral awareness is key.
