Sunday, July 17, 2005

Vet Care Reaches Human Care Costs

The Washington Post, August 29, 2004

Whose Life Is It, Anyway?
by Mary Battiata

The good news: New trends in veterinary medicine can help extend the lives of pets.
The bad news: The costs, risks and complications increasingly resemble human medicine.


[The recognition that people are willing -- and want -- to spend money on their animals] is one small part of a sea change that began in the late 1980s, driven by technological innovation and the rising social status of the American house pet. At the country's leading veterinary teaching hospitals, surgeons now routinely perform procedures that were unavailable to the average house pet 10 years ago: kidney transplants, cancer chemotherapy, back surgery for herniated disks, titanium hip-joint replacements, radiation treatments for goldfish, MRIs for hawks. Even treatments once reserved for very expensive animals -- racehorses and champion purebred dogs -- are available at the sophisticated specialty hospitals that have proliferated in the past decade and that provide a range of care previously available only at the nation's 28 veterinary school teaching hospitals.

"In the 1980s, pet owners began to say, 'If medical science can remove my cataracts, why can't it take out my dog's?' " says Jack Walther, head of the American Veterinary Medical Association, the profession's primary membership organization. "And the answer was, we could. We'd just never been asked."

Until the 1940s, and through most of its history, veterinary medicine was devoted to helping agriculture manage its food animals. The creed of veterinary medicine -- to help society by helping animals (as opposed to helping animals themselves) -- reflects this. Until the 1960s, most vet students were men with a background in farming or animal science. As the United States suburbanized in the 1950s, small-animal veterinary practices began to proliferate, but pet cats and dogs still spent much of their time outside. (Try to picture Lassie sprawled lengthwise on the living room couch at Timmy's house. It can't be done.) As recently as the late 1980s, most pets were treated as second-class citizens by their owners.

The practice of veterinary medicine reflected this lowly status. Even now, most veterinarians carry little or no malpractice insurance, because until very recently, it was impossible for a pet owner suing a vet over loss of a pet to recover anything more than the animal's replacement value. The bigger part of the vet's week was spent administering vaccines and fixing the broken bones that were a common and unremarkable fact of life in the decades before leash laws. When a pet's medical problems became difficult or expensive to fix, the animal was "put to sleep," or euthanized.

"One of the most discouraging parts of my practice in the early days was having a dog come in with a simple broken leg and having the owner say, 'Well, it costs money and it's just a dog, so put him to sleep,' " says Walther, who began his practice in Nevada almost 40 years ago.

In the late '80s, however, pets began to fill the emotional and physical void created by rising divorce rates and growing numbers of single-person and childless households. "A pet may be the most stabilizing, permanent presence a child from a divorced home will ever experience," says Arlington vet Robert Brown.

Dogs and cats began to live longer, too. From 1987 to 2000, the life spans of the average dog and cat increased by more than one-third, thanks to better commercial pet foods and widespread vaccination, according to the AVMA. But longer life spans meant a jump in the incidence of the diseases of old age -- cancers, organ failure, crippling arthritis and other problems. With the family pet now ensconced on the bed instead of at the far end of the yard, the medical problems were easier to spot and harder to ignore.

Today, many people think of their pets as members of the family, and they want them to have access to the same medical technology they do, vets say. And this is possible, thanks to the same biomedical revolution that transformed human medicine in the 1950s and '60s. According to the Food and Drug Administration, which regulates drugs for the veterinary market, the pharmaceutical industry in recent years has begun shifting its energies away from the agricultural market and toward companion animals. The number of new drugs approved for veterinary use has increased dramatically in the past decade, with special interest in drugs for behavior modification and pain relief.

The focus on pain medication is a particularly significant bellwether. Until very recently, desensitizing veterinary students to animal pain was an important part of their education. "When I went to vet school back in the Stone Age, we didn't really talk about pain," says Stephen F. Sundlof, director of the FDA's Center for Veterinary Medicine. "It was, 'Do the surgery, and the animals will get along fine.' " Today, Sundlof says, there is a growing understanding of pain as a complication that impedes recovery and healing.

This gradual and ongoing "evolution in consciousness," says Elliott Katz, a veterinarian and founder of the advocacy group In Defense of Animals, has been spurred by the entrance of large numbers of women to the profession in the past 15 years, and by the demands of pet owners, whose economic clout is becoming a counterweight to the agribusiness interests that have traditionally underwritten much veterinary research at universities.

All of this has put new pressure on the ordinary neighborhood veterinary clinic. Vets, who 30 years ago needed little more than a stethoscope and an Army surplus field X-ray machine to set up a practice, now equip their clinics with an array of expensive diagnostic equipment, from blood-analysis machines to ultrasound scanners. Even setting up a small practice costs upwards of $500,000.

The average veterinary bill -- which has tripled in the past 10 years -- reflects this. The price surge was not an accident. It is the direct result of a half-a-million-dollar study commissioned by the leading veterinary professional organizations in 1998 to figure out why veterinarians' salaries lagged far behind those in human medicine and in such professions as law and engineering. The study, by the business consulting firm KPMG, cited federal statistics showing that veterinary practice incomes had declined during the 1990s, a decade when many other professional incomes rose.

The study concluded that veterinarians were failing to run their practices as the demanding businesses they had become. Pressed by competition, vets were mortgaging their practices to buy expensive equipment but charging clients prices that hadn't increased much since the 1970s. The veterinary profession called the study's findings a "wake-up call" and set up a national commission dedicated to encouraging vets to concentrate harder on the bottom line.

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