Biased journalism at its finest. Public funded "reporting" shoots for ratings over accuracy, surprised? The side of the cost of vet care you don't hear (or want to hear).

Conversation with Dr. Jean Dodds Hello ! I read with great interest and curiosity about your dialog with Paige. Perhaps you are unaware that I’m an OVC graduate – from the last DVM class to have receive degrees from the University of Toronto. That was 1964, and we are about to celebrate our 50th anniversary next summer !! FYI – I am a widely published veterinary clinician and research scientist – see attached full CV. I also hold many patents and have the appropriate number of refereed papers pertaining to the diagnostic services and other programs we offer at Hemopet. Only our newly introduced, patented NutriScan test data are awaiting formal publication, as I chose to accumulate the data on 250 cases that had follow up saliva-based food intolerance testing, after the initially identified offending food(s) were removed from the diet. Perhaps in future, before you verbally denigrate a colleague, you could enquire about the basis of his/her assertions and the evidence –based data in support of same. Respectfully, Jean [W. Jean Dodds, DVM] ______________________________ Let me acknowledge, that I was a harsh yesterday on Dr. Dodds; I don’t disagree. I want to apologize if you felt it was professionally out of line. Regarding vaccination, you can find more information here from here aforementioned publication: Twark L, Dodds J. Clinical use of serum parvovirus and distemper virus antibody titres for determining revaccination strategies in healthy dogs. JAVMA 2000; 217(7):1021-4. ABSTRACT: Objective—To assess whether serum canine parvovirus (CPV) and canine distemper virus (CDV) antibody titers can be used to determine revaccination protocols in healthy dogs. Design—Case series. Animals—1,441 dogs between 6 weeks and 17 years old. Procedure—CPV and CDV antibody titers in serum samples submitted to a commercial diagnostic laboratory were measured by use of indirect fluorescent antibody (IFA) tests. On the basis of parallel measurements of CPV and CDV serum antibody titers in 61 paired serum samples determined by use of hemagglutination inhibition and serum neutralization methods, respectively, we considered titers ≥ 1:5 (IFA test) indicative of an adequate antibody response. Results—Age, breed, and sex were not significantly associated with adequate CPV- or CDV-specific antibody responses. Of 1,441 dogs, 1,370 (95.1%) had adequate and 71 (4.9%) had inadequate antibody responses to CPV, whereas 1,346 of 1,379 (97.6%) dogs had adequate and 33 (2.4%) had inadequate responses to CDV. Vaccination histories were available for 468 dogs (468 for CPV, 457 for CDV). Interval between last vaccination and antibody measurement was 1 to 2 years for the majority (281/468; 60.0%) of dogs and 2 to 7 years for 142 of 468 (30.3%) dogs. Interval was < 1 year in only 45 of 468 (9.6%) dogs. Conclusion and Clinical Relevance—The high prevalence of adequate antibody responses (CPV, 95.1%; CDV, 97.6%) in this large population of dogs suggests that annual revaccination against CPV and CDV may not be necessary. (J Am Vet Med Assoc 2000;217:1021–1024) _______________________ It is inappropriate to send around a publication, but if you have access to academic journals, I encourage you to review it for yourself and make an informed decision. Here is my response to Jean : Hi Jean First and foremost I wanted to commend you on an incredible and diverse career as shown by your CV. It is nice to know that a fellow OVC graduate has made such an impact in the field of medicine. I wanted to spend this morning review the case series publication that you forwarded to me regarding serological evidence of vaccination. Although not a perfect study design for this question, I realize that it is a difficult, if not impossible task to acquire controls or unexposed individuals to vaccinations that would be appropriately comparable. Logistics aside, I was surprised to not see an analytical sensitivity or specificity reported in the publication. In addition, the use of a student’s t-test was underwhelming given that you noted that you would test for associations for breed, sex, and age of the submitted samples. I would have, at the minimum, expected to see a linear or ordinal logistic regression to assess such associations, in addition to controlling for many other important covariates that could estimate of serologic protection. Such systematic bias leads me to wonder about the validity of the outcomes. Now this is not to imply that the discussion is not valid. As an academic exercise for myself, it would be interesting to re-run your data in a more advanced model and see if the results change (or stay the same, which is perfectly acceptable as well; we can then agree that a more robust model supports the data). Stratification of the data may even provide an easy solution to this question. I also wondered about the method of acquisition of the samples and what you conceive the study base to be? And what about the fact that only 32.5% of samples had complete vaccination history (but that does not imply the proper vaccination series was followed). Would it not have been prudent to exclude those without appropriate vaccination history as to not inflate your estimates? Alternatively, how can you explain your results given substantial missing data? Last, how can you state “healthy” dogs when no inclusion criteria was given. It makes it very difficult to interpret this case series as presented. The conclusion drawn that “a large percentage of healthy dogs have adequate serum Ab titres…regardless of duration of the interval since last vaccination” is association with the previous comment regarding lack of complete data. How can one make such a conclusion when only a third of the population had vaccination histories? I completely agree that it is valuable to do serology for “at risk” breeds (however, there is limited to no evidence to support those claims as well); but sometimes we need to keep client’s happy and I respect that. Hand-in-hand there, would also have to be policy or legislative changes associated with the use of serology (in particular, for vaccination against rabies). I do worry about herd immunity by reducing the proportion of the population that is unvaccinated. In some instances, vaccination is intended to aid in the reduction of clinical disease, but continues to allow shedding of the pathogen. Alternatively, some vaccines aid in both clinical disease prevention and shedding. In particular, canid populations that are vaccinated also maintain the health of wild canids inadvertently through the reduction of both effective contacts (a beta value in SIR models), and thus the probability of transmission. I would like to see some studies that examine this as well (although not my, nor your responsibility - but that of the pharmaceutical companies if this is the direction we are to head, ie reduction of vaccination). I see such diagnostics as a long line of capitalistic investments by labs such as Antech/Idexx etc with limited evidence to support them (e.g. ProBNP is a great example of limited clinical utility and unfounded evidence as a biomarker). My primary concern comes down to the manner under which such recommendations or opinions were made on the CBC Marketplace without substantial or any qualification of evidence. AAHA recommendations are not only biased through their methodological approach to establishing such information (e.g. involvement of pharma etc; which can bias in either direction!), but is also represents the clinical practice of only a subset of Veterinarians in North America. Are you familiar with the Advisory Committee of Immunization Practices (ACIP) at the CDC? If you dig in to their methods of creating recommendations around immunization strategies, in addition to assessing economic benefit through health technology assessment approaches, you will find that their rigorous approaches lead to substantiated outcomes based on evidence-informed science. You can find more information here: http://www.cdc.gov/vaccines/acip/recs/index.html I am open to engage in a discussion about the direction of vaccination, but would like to see a qualification of the comments made on CBC. Regards -Tyler ______________________________________________________ Dr. Tyler J. O'Neill B.Sc., D.V.M., M.Sc.(Epi.) Ph.D. candidate, Division of Epidemiology | Dalla Lana School of Public Health | University of Toronto | www.dlsph.utoronto.ca

To Dr. Jean Dodds I was so incredibly disappointed that a fellow Veterinarian could slander the practice of colleagues in such an unfounded manner as you did on the CBC Marketplace show. Although I respect your non-profit blood bank concept, it is unfortunate that you leveraged the opportunity of an incomparable market of health services to promote your own self-interest (even inadvertently). Your comments on over vaccination are just as out of place as your promotion of such ridiculous “diagnostic tests” you offer on your website with no clinical evidence of efficacy or effectiveness. I would be thrilled to review the published and peer-reviewed clinical evidence available to support your claims. I doubt any Veterinarian in Canada would ever consider recommending your service if they use the most basic critical analysis of your services.

Engaging in discussion ! Here is a conversation from Facebook in response to my open (albeit sarcastic, I admit) letter to Erica: “Hahaha, what a ridiculous response, all that much sadder since you invested a lot of time in it.



Like others, you’re trying to infer something sinister about how they picked the offices to visit, while totally missing the point: they caught real vets pushing unecessary services. Who cares how they found them? Unless it was staged, you have no point.” So I responded: “Agreed, I did put a lot of effort in to writing that. I am Veterinarian, so it is important to me that a balanced perspective is provided to consumers of fee-for-service health care. In fact, I didn’t miss the point at all, which was to ensue in a biased debate that the cost of health care for animals is expensive. One must consider the method in which the CBC identified clinics as it may, in fact, not represent the general population of practicing Veterinarians in Toronto, Ontario, or even Canada for that fact. In addition, how are we to know that they didn’t interview 100 clinics and only presented the results from those that supported their pre-assigned thesis? I want to thank you for reading this response, however, and will actively engage in educating in the costs associated with pet ownership if you would be open or interested.” The user then edited his post once I responded to include: “"Point” #5: That’s probably not a unilateral declaration on her part, as any rational person could infer. She probably checked with the owner, who clearly looks after her pet. Award-winning dog and all that.



“Point” #7: They visited ten vets, so that’s why 8/10, you pedant. You know, if this report was SO flawed, you’d probably have more valid criticisms to make than these arrogant, pointless nitpicks.



Also, I can’t help but notice that your tumblr page blasting this “biased” report was created about 2 weeks before the episode even aired. Biased yourself much? Maybe this episode isn’t accurate, but you obviously have an axe to grind too.



“I could go on, but I must return to doing something that actually impacts the health of our animal population.”



Wow, get over yourself. You probably overcharge for your own services since you think you’re the Norman Bethune of vets.



With scorn,



*****(grumpy facebook user)“” And, of course, I happily replied: “And just to add after your editorial: Award winning pets do not always come from award winning clients, unfortunately. Just because one perceives health does not infer its reality. I fully acknowledge that my blog started before the CBC aired its programme. It was a call to action, if you had noticed from the initial posting. Entitling the episode "Barking Mad” predisposes a suggestive nature of a biased episode and I had simply requested that the CBC present a balanced perspective. And in fact, I don’t think I am the Norman Bethune of Veterinarians; in fact, quite the opposite. I am researcher primarily and don’t delude myself to think that I am much more than that. However, many of my mentors, colleagues, and peers are pretty close to it. However, I have conviction to stand up for what I believe is correct much like Dr. Bethune, so thank you for the compliment. Again, I openly invite you to engage in an active discussion regarding the costs of animal health care in Canada, rather than maliciously accost me for my professional expertise. With Thanks.“ Not sure where he got the chip on his shoulder, but I hope he has a dog or cat at home to make him feel better when he gets home this afternoon! -t ps - I should have acknowledged his compliment of being pedantic; I suppose we all should hope to be guilty of such a trait while practicing medicine in any form!

Dear Erica → The latest from Erica Johnson (@cbcErica). Co-host CBC Marketplace. Vancouver Dear Erica Johnson I came across your Twitter messages recently while taking a break from responsible research that is actually contributing to the health of society. But I digress to comment on your absolute lack of understanding of veterinary medical practice, and health care standards in general. Employment by the CBC does not make you an expert at any capacity (news flash! sorry to break it to you!). I just wanted to highlight a few great gems from recent Twitter discussions (if one can garnish anything relevant and informative from a character limited medium of communication). 1. There are different types of heartworm medications on the market; some of which can be deadly if a patient is infected. Thanks for creating a blanket statement from your misinformed opinion. As well, one individual does not imply experts (plural), but rather the opinion of one parasitologist who has not experienced practice himself and relies solely on published evidence to support his opinions (see below to enlighten yourself). You also need a schooling in prevalence .vs. incidence (I’m surprised you don’t know this based on my garnishing of “expertise” you appear to have on your Twitter account). 2. Lots of peer reviewed research is poor quality; trust me (see excessive letters behind name below…). There is a disparity between clinical evidence and research evidence in veterinary medicine, as there is in human medicine. An evidence-informed opinion is not just based on peer reviewed publications. In addition, many publications are laced with systematic and publication bias (including being published or sponsored by pharmaceutical companies with vested interest). I am actually thrilled to hear a colleague is actually using his or her academic training to critically analyze the literature and “guidelines”. 3. What qualified you or any of your “investigators” to actually assess whether recommendations were appropriate or not? Beyond CVMA or AAHA (which is a corporate policy advocacy board by the way…and you would have known that had you done your research), you didn’t consult practicing vets openly and inquire with unbiased questions such as “can you explain to us the costs associated with owning a pet?”. That would be TOO BORING for TV, so here’s to ratings and the continuation of your own interests as a “journalist”, right? [As an aside…AAHA just included in their “recommendations” that dentistry with extraction should be done under anesthetic…something vets have been doing for years. Wow. Really great source champ.] 4. Your comments to @OnVetMedAssoc for “reminding members of professional guidelines?”…hahahahaha. This kills me. See AAHA comment above. Get your facts straight you lunatic. The following are LABELLED (i.e. as regulated by Health Canada) for 3 year vaccination in dogs after 1 year of age, as long as the appropriate puppy series was followed: Rabies and DHPP. That’s it. But if you actually looked in to the literature, there is a paucity of evidence to support this recommendation based on limited clinical and challenge trials with insufficient power to support such blanket recommendations. Other important vaccinations such as 5-way Leptospirosis and Lyme disease are only annual and recommended for certain patients based on lifestyle (and increasing incidence of both diseases here in Ontario). This would still necessitate at least annual visits for (at a minimum) physical examinations and recommended (and highly valuable in terms of detecting early disease) health profiles. 5. What expertise do you, as a “journalist”, have in stating that the bull dog was “completely healthy except for dry eyes” (which, by the way, may also lead to Keratoconjunctivitis sicca - but of course you knew that (and if there are too many letters, I can help you sound out big words like this; just drop me a call))? I can’t recall when you graduated from a Veterinary College, but please let us all know how you garnished such a level of knowledge regarding canine health. Please don’t say she went to see an ophthalmologist - she would only be seen if there was a primary ocular problem even if she was the most obese dog in existence. Why would a ophtho recommend weight loss when it is a primary care veterinarian’s responsibility? And as for 9 out of 10 vets only recommended losing SOME weight .vs. 10kg (which was probably medically indicated), take this for an example: On CBC Radio today, a physician was talking about the “tough conversations oncologists have to have with lung cancer patients about smoking cessation during radiation therapy”. Is that awful of them to want the best for their patients? If so, and that argument follows suit, I suppose reducing weight off of a “clients” English bull dog also makes them awful in wanting them to have a long healthy life, no? I applaud the vet who had the integrity to suggest a progressive weight loss program for the health of her perceived, yet dubiously appointed, patient. 6. I’d like to know how you “randomly selected” your clinics to take your “pet” to? As an epidemiologist, I would have suggested a spatially distributed random sample (again, I’m happy to consult on such matters that are likely over your head). 7. “8 out of 10 vets recommend…” – well, if you actually wanted to make things mathematically appropriate, you would start off by saying “4 out of 5”, but regardless…I would still love to hear your methodological expertise that allowed CBC Marketplace to determine such information. Please expand! Can’t wait to see it! And as an expert in scientific study design, I’ll be sure to comment with a critical eye. 8. Familiarize yourself with the federal Veterinarian’s Act (re: “@tedfunkel @HRH_Frankie Not a problem if your pooch is on a preventative”); some may interpret this as practicing veterinary medicine without a licence. Would be a shame to have to bring you to court… 9. re: @“MartiniShotXo Sorry you felt that way. Yes, costs $ to run clinic - just don’t think pet owners should pay for stuff they don’t need.”…kind of like the Federal Government thinks about continuing to pay for the CBC…awkward. Hope your CV and LinkedIn are up to date for when you go searching for a new job! 10. Any decline in business as a direct result of your airing may also be viewed as slander. Would be awful to be pulled in to Civil litigation as well. One may even say you’d be too busy to continue this high quality journalism you claim to perform. 11. “re: @GreggFrench1 He was deemed healthy, so pt we’re making is, he didn’t need 2 switch 2 more expensive food. That’s the unnecessary charge…”. I didn’t actually catch what food fatty-mc-fatterson was actually on, but I’m sure its a winner given his size. In all reality, most Veterinary Rx diets (oh, Rx = prescription…fyi; but you probably knew that too) are comparable in price (if not cheaper) than commercial store brands that have outstanding marketing budgets and limited science to inform the quality of the diet or guarantee what is on the label (unlike brands such as Medi-Cal Royal Canin, Hills Science Diet, and Purina Vet). I could go on, but I must return to doing something that actually impacts the health of our animal population. Here is a question for you Erica: If your dog or cat was sick, would you be thrilled that you had a highly dedicated, educated, competent health professional available to you to ensure continued longevity of well-being, or a decompensated individual who was unable to provide appropriate treatment because biased journalism negatively impacted his or her business and therefore the quality of health care that could be provided? When can we anticipate a CBC Marketplace Expose on biased journalism? I hope you are focused on as well. I’m sure it will make you feel great. I can’t wait to tune in. With love, - Dr. Tyler O'Neill B.Sc., D.V.M., M.Sc.(Epi.), Ph.D. cand.

A Non-Vet's thoughts on CBC Marketplace's Barking Mad report... → The CBC recently aired an undercover investigation into veterinary medicine. I have been working in veterinary medicine for 7 years now, though I am not a vet. I spent five years at one clinic, about… It’s a long one, but a good one friends! - t

Trinh Theresa Do (TTDDOO) on Twitter → The latest from Trinh Theresa Do (@TTDDOO). Journalist at CBC bureau in Ottawa. Global affairs (politics, development) aficionado. Ideas woman. Ancora Imparo. Toronto/Ottawa Here is one of the “journalists” (or as she entitles herself, “Ideas Woman”) who was responsible for the shotty journalism from CBC Marketplace. Let’s hope she continues on the path of biased, unilateral journalism….

From CVMA Canada’s Veterinarians Provide Healthcare Options for Pet Owners October 5, 2013 A recent CBC Marketplace report claimed that veterinary costs in Canada increased by 90 per cent between 1997 and 2009. According to Statistics Canada, this is incorrect. The reported increase in pet spending includes kennel fees, grooming, pet care items and food, in addition to veterinary healthcare. The Canadian Veterinary Medical Association (CVMA) encourages Canadian pet owners to discuss healthcare options with their veterinarian and work together to make decisions that suit their budget and are in line with the level of care the owner expects. Just like clothing, groceries and gas, medical services can also be cheaper in the U.S. Pet owners who are thinking about cross-border shopping for veterinary services should keep their pet’s health and welfare in mind and ensure that they know exactly what the alluring price includes. “Pet owners should keep in mind that prevention is always better for pets and more cost effective for pet owners,” says Dr. Jim Berry, CVMA president. “Every pet is an individual, there are no one-size-fits-all solutions.” Vaccines play a very important role in controlling and preventing infectious disease in dogs and cats and reducing the risk of human exposure to zoonotic disease. The Canadian Veterinary Medical Association recommends that vaccines and revaccination intervals be individualized for each pet. The decision to administer any particular vaccine should be based on the risk of contracting the disease and protocols may vary depending on what disease entities are prevalent in any given area. In Canada, parasite prevention is dealt with on a case-by-case basis, as your pet’s risk of parasitic disease is taken into consideration. Your veterinarian will advise you on the recommended frequency of testing for your dog. Factors that may influence your veterinarian’s decision to test for heartworm may include your pet’s lifestyle, health status, your geographic location, any household considerations that may be relevant and the proposed preventive therapy. Pet obesity is a big problem for Canadian pets. In a recent study, Canadian veterinarians identified weight control as the number one thing a pet owner can do to increase the length of their pet’s life. Obese pets are at risk of developing serious health issues, such as heart disease, diabetes, gastrointestinal problems, high blood pressure and arthritis. To put things in perspective, an extra 2-4.5 kilograms (5-10 pounds) on a male English Bulldog would equate to being 7-13 kilograms (15-29 pounds) overweight for a woman of average height. For a man of average height, this would equate to being 8-15 kilograms (17-34 pounds) overweight. A pet’s weight is managed and maintained by eating proper amounts of nutritious food and exercising regularly. “A balanced and nutritional diet is important in pets’ overall health and that comes from the amount and the quality of food they receive,” says Dr. Jean Gauvin, president-elect of the CVMA. “Pets that eat high quality veterinary food generally have fewer medical problems and pet owners may find that the cost per serving of these diets is actually lower than store brands.” Many veterinarians also offer prescription diets, which can work the same way as medications and can be used as a first-choice therapy before medications are prescribed. A valid veterinarian-client-patient-relationship must exist before a veterinarian can prescribe or dispense a medication for your pet. This is referred to as the VCPR and it is required by law. The VCPR usually involves face-to-face communication and an exam of your pet, which allows your veterinarian to determine the health status of your pet before making any treatment recommendations. “Pet owners and veterinarians can work together to ensure Canadian pets stay healthy,” Dr. Berry advises. “We encourage pet owners to engage their veterinarians in a discussion about healthcare options to ensure they make a well-informed decision for their pet’s medical care.” For more information, visit www.canadianveterinarians.net

From PetSecure http://www.petsecure.com/blog/petsecure/2013/10/08/a-statement-from-petsecure Petsecure pet health insurance works hand-in-hand with veterinarians to ensure that Canadian pet families are able to afford the best medical care available for their cats and dogs. A recent episode of CBC Marketplace, “Barking Mad”, cast a negative light on veterinary practices in Ontario and has the potential to create untrusting relationships between veterinarians and pet families across Canada. A positive and open dialogue between the veterinary community and pet families is essential to ensuring Canadian pets are getting the customized care they need – and that pet owners are able to make informed decisions about their pet’s health. In 24 years of providing pet health insurance, Petsecure has time and again witnessed the extreme dedication of the veterinary community in advocating for individual patients, educating clients about the importance of dog and cat wellness, and volunteering countless hours of time in the pet community working for rescue shelters and charitable organizations. Veterinarians are highly educated doctors who act as the pediatrician, internist, dentist, radiologist, surgeon, and oncologist for a variety of animals. They are knowledgeable about the anatomy and physiology of several furry and winged species and, based on our experience, are dedicated to ensuring animals have effective and cost efficient customized care programs. Pet families are encouraged to initiate open conversation with their veterinarian about therapeutic plans, benefits of treatment, and associated costs in order to understand the range of care options available. Canadian veterinarians are a hard-working group dedicated to providing great care to pets across Canada. Petsecure strongly supports our veterinary colleagues as they continue to provide expert and ethical healthcare to our Canadian cats and dogs. Pet families who have questions for Petsecure can contact us by calling 1-800-268-1169 for more information.

OVMA response http://www.ovma.org/extra/response_to_cbcmarketplace_episode.html Response to CBC Marketplace Episode