Barbara Natterson-Horowitz: What veterinarians know that doctors don’t

Barbara Natterson-Horowitz: What veterinarians know that doctors don’t

Ten years ago,
I got a phone call that
changed my life.
At the time, I was
cardiologist at UCLA,
specializing in cardiac
imaging techniques.
The call came from a veterinarian
at the Los Angeles Zoo.
An elderly female chimpanzee
had woken up with a facial droop
and the veterinarians were worried
that she’d had a stroke.
They asked if I’d
come to the zoo
and image the animal’s heart
to look for a possible
cardiac cause.
Now, to be clear, North American
zoos are staffed
by highly qualified,
board-certified veterinarians
who take outstanding
care of their animal patients.
But occasionally, they do reach into
the human medical community,
particularly for some
speciality consultation,
and I was one of the lucky physicians
who was invited in to help.
I had a chance to rule out
a stroke in this chimpanzee
and make sure that this gorilla
didn’t have a torn aorta,
evaluate this macaw
for a heart murmur,
make sure that this California sea lion’s
paricardium wasn’t inflamed,
and in this picture, I’m listening
to the heart of a lion
after a lifesaving,
collaborative procedure
with veterinarians and physicians
where we drained 700 cc’s of
fluid from the sac
in which this lion’s
heart was contained.
And this procedure, which I have
done on many human patients,
was identical, with the exception
of that paw and that tail.
Now most of the time, I was working
at UCLA Medical Center with physicians,
discussing symptoms
and diagnoses and treatments
for my human patients,
but some of the time,
I was working at the Los Angeles Zoo
with veterinarians, discussing
symptoms and diagnoses and treatments
for their animal patients.
And occasionally, on
the very same day,
I went on rounds at
UCLA Medical Center
and at the Los Angeles Zoo.
And here’s what started coming
into very clear focus for me.
Physicians and veterinarians
were essentially taking care
of the same disorders in their
animal and human patients:
congestive heart failure, brain tumors,
leukemia, diabetes,
arthritis, ALS, breast cancer,
even psychiatric syndromes
like depression, anxiety,
compulsions, eating disorders
and self-injury.
Now, I’ve got a confession to make.
Even though I studied comparative
physiology and evolutionary biology
as an undergrad —
I had even written my senior
thesis on Darwinian theory —
learning about the
significant overlap
between the disorders of
animals and humans,
it came as a much needed
wake-up call for me.
So I started wondering,
with all of these overlaps,
how was it that I had never
thought to ask a veterinarian,
or consult the veterinary literature,
for insights into one
of my human patients?
Why had I never, nor had any of my
physician friends and colleagues
whom I asked, ever attended
a veterinary conference?
For that matter, why was
any of this a surprise?
I mean, look, every single physician
accepts some biological connection
between animals and humans.
Every medication that we prescribe
or that we’ve taken ourselves
or we’ve given to our families
has first been tested on an animal.
But there’s something very different
about giving an animal a
medication or a human disease
and the animal developing
congestive heart failure
or diabetes or breast cancer
on their own.
Now, maybe some of the surprise
comes from the increasing
separation in our world
between the urban and the nonurban.
You know, we hear about these city kids
who think that wool grows on trees
or that cheese comes from a plant.
Well, today’s human hospitals,
increasingly, are turning into these
gleaming cathedrals of technology.
And this creates a psychological
distance between the human patients
who are being treated there
and animal patients who
are living in oceans
and farms and jungles.
But I think there’s an
even deeper reason.
Physicians and scientists, we accept
intellectually that our species,
Homo sapiens, is merely
one species,
no more unique or
special than any other.
But in our hearts, we don’t
completely believe that.
I feel it myself when I’m
listening to Mozart
or looking at pictures of the
Mars Rover on my MacBook.
I feel that tug of
human exceptionalism,
even as I recognize the
scientifically isolating cost
of seeing ourselves as a
superior species, apart.
Well, I’m trying these days.
When I see a human patient
now, I always ask,
what do the animal doctors know
about this problem that I don’t know?
And, might I be taking better
care of my human patient
if I saw them as a human
animal patient?
Here are a few examples of the
kind of exciting connections
that this kind of
thinking has led me to.
Fear-induced heart failure.
Around the year 2000,
human cardiologists “discovered”
emotionally induced heart failure.
It was described in a gambling father
who had lost his life’s savings
with a roll of the dice,
in a bride who’d
been left at the alter.
But it turns out, this
“new” human diagnosis
was neither new, nor
was it uniquely human.
Veterinarians had been diagnosing,
treating and even preventing
emotionally induced
symptoms in animals
ranging from monkeys to flamingos,
from to deer to rabbits,
since the 1970s.
How many human lives
might have been saved
if this veterinary knowledge
had been put into the hands
of E.R. docs and cardiologists?
Some human patients
harm themselves.
Some pluck out patches of hair,
others actually cut themselves.
Some animal patients
also harm themselves.
There are birds that
pluck out feathers.
There are stallions that repetitively
bite their flanks until they bleed.
But veterinarians have very specific
and very effective ways
of treating and even
preventing self-injury
in their self-injuring animals.
Shouldn’t this veterinary knowledge
be put into the hands
of psychotherapists and
parents and patients
struggling with self-injury?
Postpartum depression and
postpartum psychosis.
Sometimes, soon after giving birth,
some women become depressed,
and sometimes they become seriously
depressed and even psychotic.
They may neglect their newborn,
and in some extreme cases,
even harm the child.
Equine veterinarians also
know that occasionally,
a mare, soon after giving birth,
will neglect the foal,
refusing to nurse,
and in some instances,
kick the foal, even to death.
But veterinarians have devised
an intervention to deal with
this foal rejection syndrome
that involves increasing
oxytocin in the mare.
Oxytocin is the bonding hormone,
and this leads to renewed interest,
on the part of the mare, in her foal.
Shouldn’t this information
be put into the hands of ob/gyn’s
and family doctors and patients
who are struggling with postpartum
depression and psychosis?
Well, despite all of this promise,
unfortunately the gulf between
our fields remains large.
To explain it, I’m afraid I’m going
to have to air some dirty laundry.
Some physicians can be real snobs
about doctors who are not M.D.’s.
I’m talking about dentists and
optometrists and psychologists,
but maybe especially animal doctors.
Of course, most physicians
don’t realize that it is harder
to get into vet school these
days than medical school,
and that when we go
to medical school,
we learn everything
there is to know
about one species, Homo sapiens,
but veterinarians need to learn
about health and disease
in mammals, amphibians,
reptiles, fish and birds.
So I don’t blame the vets
for feeling annoyed
by my profession’s
condescension and ignorance.
But here’s one from the vets:
What do you call a veterinarian
who can only take
care of one species?
A physician. (Laughter)
Closing the gap has become
a passion for me,
and I’m doing this
through programs
like Darwin on Rounds at UCLA,
where we’re bringing animal experts
and evolutionary biologists
and embedding them
on our medical teams
with our interns and our residents.
And through Zoobiquity conferences,
where we bring medical schools
together with veterinary schools
for collabortive discussions
of the shared diseases and disorders
of animal and human patients.
At Zoobiquity conferences,
participants learn how treating
breast cancer in a tiger
can help us better treat breast cancer
in a kindergarten teacher;
how understanding polycystic
overies in a Holstein cow
can help us better take care
of a dance instructor
with painful periods;
and how better understanding the
treatment of separation anxiety
in a high-strung Sheltie
can help an anxious young child
struggling with his first days of school.
In the United States and now
internationally, at Zoobiquity conferences
physicians and veterinarians check
their attitudes and their preconceptions
at the door and come
together as colleagues,
as peers, as doctors.
After all, we humans
are animals, too,
and it’s time for us physicians to embrace
our patients’ and our own animal natures
and join veterinarians
in a species-spanning approach to health.
Because it turns out,
some of the best and
most humanistic medicine
is being practiced by doctors
whose patients aren’t human.
And one of the best ways
we can take care
of the human patient is by
paying close attention
to how all the other
patients on the planet
live, grow, get sick and heal.
Thank you.

97 thoughts on “Barbara Natterson-Horowitz: What veterinarians know that doctors don’t”

  1. Content: Great!
    Presentation: Speed it up please!

    An emphatic pause should NOT be utilized after every couple of words.

  2. Every truly loving animal "owner" becomes something of a veterinary diagnostician.
    When bad and scary things occur in their lives- as they invariably do in ours – they react much as we do. The one big difference between animals and humans is that humans are foolish enough to believe that our lives are more valuable than theirs, across the board. The word "snobbish" is definitely applicable.

  3.  It's a sad irony that because animal life is seen as less valuable, veterinarians have more leeway & can be more experimental with their treatments, so they can improve upon what was taught in school.  When treating human patients, there is always the fear of a lawsuit if the doctor strays from 'by the book.'

  4. I agree to that vet's together with phyc's can understand that more stuff is bodily  and that soul stuff is bodily too. An animal isn't being blamed, it's being treated as is.

  5. Great talk.  I totally agree that vets are on the front line with knowledge that doctors should listen to. I've had a dog with diabetes that lived a long life with good vet care. I had a dog that had hind leg knee surgery that my vet got an orthopedic surgeon friend to help out with and the dog did great. They can work together to help all us animals. Make the world a better place for us all.

  6. Like the presentation. Didn't know that in the past there where no connection between all sorts of doctors. Be it animal or human. Yet, the lifestyle is so well compensated. Through time…

  7. Cross disciplinary communication is important. And the ego fueled separation of the sciences is detrimental to discovery.

  8. Great talk…she sounds sincerely interested in helping…
    unfortunately most physicians are only interested in pushing drugs for the pharmaceutical companies…

  9. There's been a few TED talks lately – like this one – where the speaker talks in the tempo, tone and cadence I would expect from a teacher talking to young children. Since TED conferences are attended by adults this is a bit strange. 

  10. Recognizing the close relationship between humans and animals and yet denying them basic rights is a wonderful example of cognitive dissonance.

  11. My dog has received quite unsatisfactory care from numerous veterinarians, including board-certified specialist veterinarians including ones at a top 10 school of veterinary medicine.  Physicians insist on a biopsy to confirm the diagnosis of cancer.  Veterinarians are willing to insist that cancer is the diagnosis, even when open bone biopsy X 3 and cytology X 2 are negative, and the dog has lived about 8 times longer than would be expected with the cancer diagnosis, especially given that treatment for cancer was not done, given the lack of indication based on biopsy and cytology results.  Given the experience of my dog, I will prefer to receive my own care from physicians.  I have not encountered a physician who approves of the care received by my dog from veterinarians.

  12. so clearly home girl never did animal research or went to a primary source on drug data which uses animal studies. I recently consulted a vet hospital up at cornell for a extra large humans and they refused the consult and refused the imaging study for legal reasons. so there goes your theory

  13. Oh please… Medical school is way harder to get in than Vet school with their aptitude tests and interviews.. I have a friend who is a pretty unintelligent person that is studying to be a vet at one of the best Vet universities in the world. He's not getting anywhere near my dog…

  14. 11:02 –> here is the real issue!  it takes a lot of courage for some one who has invested a lot of their time and effort… a lifetime, usually, into the highest scholar title a human can achieve, to humble themselves and admit that there is more that they can learn AND that the source, though carrying a less prestigious title, may have more practical knowledge about a particular subject.  I don't think this TED talk is particularly enlighening, but it is the white elefant in the room and I appreciae her pointing it out on behalf of better patient care.

  15. She keeps asking why this information wasn't put in the hands of physicians, but it has been available this whole time.  Anyone can go on a database like PubMed or Web of Science and read articles describing this information and these treatments.  As a pre-veterinary student, I read a lot of scientific articles detailing both human and animal medicine.  I keep up with medical news in both the medical and veterinary world.  And so do many other vet students and veterinarians I know.  If doctors would just pay attention to these kinds of articles, they would have known about the treatments as well.  It's not "Shouldn't this information have been put into the hands of physicians?" – as if it's the veterinarians' fault.  No, it should be "Shouldn't have physicians stopped looking down on the veterinary profession and actually taken the time to look up this information on their own?"  It's available after all.  (And I don't mean this about all physicians – or all veterinarians – for that matter.  I'm just generalizing.  I do know that there are some veterinarians who don't pay attention to medical articles and some physicians who do pay attention to veterinary articles.)

  16. An excellent point.  It is a pity that practical medicine gets buried by arrogance, perhaps required attendance at some kind of cross-pollination conference should be a requirement of maintaining one's medical license.

  17. In Italy we study basic sciences, 2 years of Physiology, 2 years of General Pathology and 1 year of Pharmacology along with Veterinary students.  Veterinarians often conferred with our instructors.  
     My medical diploma was signed by the Dean of my medical school, a Veterinarian.
    There is much to be said of traditional medical science.

  18. I don´t get the point of this talk is it to teach judgemental people that Veterinarians aren´t any less than a Doctor?

    Also no, we can´t just use knowledge we have from other animal species in humans it surprises me that a Physician is considering this, I´m a med student and one thing we learn is the history of medicine and how back in the day most of the studies were made in other species and then practiced on humans like we were the same no need to say that carried some problems in some cases we might have similarities but it isn´t safe nor scientific to do that.

    What I do agree on is to use the knowledge we have in the medical field from other species to start studying if it´s the same on us not just blatantly assume it´s the same.

  19. I'm a retired professor of Anesthesiology. One of the smartest anesthesiologists I know is a veterinarian at the College of Veterinary Medicine, Cornell University in Ithaca NY. He would clearly be a star in any traditional medical school.

    In addition I am always amazed at the challenges he handles on an almost daily basis. Patients ranging from a marmoset to a 500 pound tiger. As a physician I am humbled by his clinical prowess.

    Dr. Natterson-Horowitz has it absolutely right.

  20. There is a case in Brazil, Curitiba, where I live, that a woman was cured by taking a medicine indicated by a veterinarian. Physicians didn´t have an answer for any medicine to cure her.

  21. THIS is a person who really did a college, who learned to ratiocinate! She didn't said nothing difficult to think about, by the logic… but almost no professional thinks this way. Why, I don't know! Maybe they  don't like to explore what they studied so much to do!

  22. Ms. Natterson really makes one think. Combine this perspective with teaching evolutionary medicine to medical students and we have the beginning of a sea change in medical care and public health. It shall also mean breaking the stranglehold that all the  "for profit" drug companies and insurance companies have over the world. These ideas need to be advanced thru all physiology and biology courses.
     If you enjoyed this video read her book "Zoobiquity.:

  23. Lactation consultants have known this information for a long time, but who is listening? They have always known that infants should not be separated, washed, handled by others , injected, and given eye drops until the infant has had long periods of skin to skin time with his mother. It is when the oxytocin level is peaking and through suckling, the baby and mother benefit from the hormone shifts. People always say, "why is breastfeeding so difficult, I thought it was natural?" What part of birth these days is natural I say. We treat baby kittens and puppies better than we treat our own infants. At least we know enough that we don't interfere with animals, lest their own mother reject them or at the very least have suckling issues. I hope someone out there is listening……

  24. Don't forget, vets cured ulcers with antibiotics since the 1940's. Physicians just treated the symptoms with Zantac type drugs til they went over the counter in the 90's.

  25. I am a physician who has been learning from and working with veterinarians for over 20 years. I even have discussed my medical problems with a veterinarian, and received some good advice. I have attended a veterinary conference, and found it interesting.

  26. I'm a retired nurse and don't go near a doctor or hospital unless I absolutley have to (i.e for emergencies or if an infection has gone beyond what I can manage myself) – this is because their only answers are to pump you full of drugs or chop bits off your body – no knowledge of what is going on emotiuonally or psychologically in my body required nor adminstered. Personally I'd rather be treated by a vet.

  27. Wow,I see all these beautiful comments about veterinarians and can't be anything other than grateful.I am in the first year of veterinary college and have my doubts from time to time.All I can hear is how veterinarians are underistamated and how they shouldn't be with somebody as big as a doctor "in the same room".But I guess there are honourable people who think otherwise.
    So thank you all ❤

  28. We should all think of ourselves as human animals. Let's work on finding a way to help veterinary scientists and biomedical scientists communicate more readily.

  29. Que gran médico, espero que el futuro de la educacion nos lleve por este camino multi diciplinario de no solo estudiar a los humanos sino a los animales, eso nos ayudará a crear una conciencia más global.

  30. This was a complete waste of the last fifteen minutes of my life. We are animals too, pfft. I wonder who's cutting into her if she ever needs surgery. A surgeon md or a vet.

    I'd bet my paycheck she'll choose the md.

  31. IN 2016 A brutal negligent remorseless pet doc vet in OTTUMWA IOWA mistreated and mortally damaged my beloved senior companion pet,,,,,,,,my story will be told to american pet lovers.

  32. veterinarians know how to withhold life and death information,,,,legally its called dissimulation or non full disclosure or not getting informed consent.

  33. Kinda think all the positive comments come from vets who feel that don't get the respect they deserve
    Why is it so hard to get to vet school? There are less vet schools
    Why do vets need doctors to help with heart disease stroke etc? Because their training is more simplified. Diabetes care in any animals is so poor that if
    That care was provided by a physician we would be sued
    I did help a zoo vet with insulin management on a gorilla but treatment was so rudimentary I doubt I did much good.
    All off you out there want top of the line care when you're intensively ill if you had a stroke you wouldn't want a ct scan or a neurologist or a cardiologist?
    Look are there things you can learn from veterinary medicine or alternative medicine or folk remedies etc sure

  34. But nothing beats evidence based medicine of any kind.
    I will say one thing however today's doctors do have now in common to vets than they used to…they stopped listening to their patients

  35. Small-animal veterinarians actually have it harder than MDs, because they have to understand at least two separate species (dog/cat), often also one or two others (rabbit/ferret/birds,etc). Large-animal veterinarians? Horse/cattle/pig/goat/etc. Challenging! And, yes, I have seen the condescension the speaker mentions, in daily practice.

  36. Am a veterinarian who has for the first time developed unconditional respect for a human medic…Way to go Dr Horowitz!!. #ZOOBIQUITY, Let us interact, cognize and improve our two desciplines of Medicine

  37. As a retired family physician, I have ALWAYS admired the vets who have taken care of our family's pets through the years. The veterinarian's patient cannot tell him or her what its symptoms are, or how it feels. Veterinarians are at a great disadvantage compared to a physician, and their ability to diagnose and treat effectively is truly remarkable. (The closest human physician equivalent would be a neonatologist or a pediatrician dealing with only with the very young.) Kudos to all you wonderful veterinarians out there!!

    The rather sad thing about Dr. Natterson-Horowitz's lecture, however, is her obvious belief that there really is nothing "special" about human beings over and above the animal kingdom. She alludes to the awe and joy that she receives from listening to a piece of music by Mozart, yet she essentially dismisses the notion that there is anything inherent within the human soul that sets us apart of the animal kingdom. Anyone who is honest with themselves must admit that there in something in humanity than is not found in the other animals — a sense of awe, an appreciation of beauty, a desire for justice, an understanding that there are times when we must do something that is greater than ourselves, to name only a few. These qualities of the human species are not found in the animals and have they no evolutionary advantage. They do, however, set us apart. That "Divine spark" is there within all of us, whether we care to acknowledge it or not.

  38. yah, I say it all the time, I'll be better of going to vet then doctors like you….doctors treet me like an animal, so vet will treet me like human…ohhh yes they know a lot

  39. Simpsons Season 5 Episode 17 21:30: "Animals are a lot like people Mrs. Simpson, some of them act badly because they've had a bad life or have been mistreated, but just like people, some of them are… just jerks. Stop that Mr. Simpson."

  40. We being humans follow various religions and our religions forbid doing many things. Biologically we are treated or studied as advanced social animals but our faith in God, Adam, Eve, Angels, Divine Books, Prophets, Apostles, etc distinguish us from the rest. No doubt, we like or even rear animals, plants and other vegetation mostly by the training and education that we receive from our ancestors, parents, teachers, society, brotherhood, sisterhood, relatives, friends, etc. Treating humans and animals fairly makes us what we desire to become. Doctors and Veterinarians are equally important with regard to health and well being. May Allah Almighty bless us with the knowledge, skills, abilities, competencies, courage, etc. to treat, study and report lives fairly!

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