Dog health needs a decision-making revolution

The recent furore about the Dutch government’s legislation affecting 12 brachycephalic breeds has seen yet more polarisation of views on both the definition of the problem and the potential solutions. In summary, the legislation uses a single measurement; the craniofacial ratio to specify which dogs can be bred from. Consequently, the Dutch KC has said it will no longer issue full pedigrees for puppies from those breeds that don’t meet the criterion for the length of nose to skull.

The resulting conversations from interested parties have, perhaps, generated more heat than light. Meanwhile, in a parallel Covid19 universe, we have been told regularly that our government is “following the science”. The question I want to consider in this month’s article is “how can evidence be used more effectively to support decision-making for breed health improvement?”.

We know, from years of observation, that there are many problems with the way evidence is used (or abused). Policy-makers in government often talk about evidence-based policy but the reality is that politicians often simply want to be seen to do something. The result is (usually) flawed policies and ineffective legislation, often with unanticipated consequences that actually make things worse. We also know that, in some breeds, people have cherry-picked data from research studies either to support their own case or to try to undermine other people’s arguments. Scientists value sound methodologies and are trained to develop well-designed studies and to look for robust evidence. Readers of their studies may not have that expertise and, to be fair, many researchers make little effort to make their results accessible for the lay reader.

Since we’re unlikely to develop more dog people with scientific training (in the short-term), we clearly need some other options to enable us all to have better, evidence-based, conversations about the problems and solutions. 

Horizon scanning

Breed clubs often work reactively and get caught out when new studies are published or sensational stories appear in the media. In contrast, researchers regularly do “horizon scanning” to identify emerging issues. This might be as simple as a literature search for papers published in a particular area of interest. This probably isn’t a very practical option for breed clubs but it’s certainly something that Breed Health Coordinators do. In our BHC Facebook Group, we share newly published papers, regularly. These may cover breed-specific health conditions, general canine topics such as husbandry, behaviour and temperament, and genetics. The Kennel Club is also helping breeds to do this horizon scanning with the development of Breed Health and Conservation Plans, each of which includes an extensive literature survey of papers relevant to a breed.

Diverse perspectives

If decision-makers restrict themselves to their historical range of responses to a problem, they may overlook better options. We see this all too frequently in canine health projects; an assumption that yet more “education” or a “better website” will make a difference and change people’s behaviours. Campaigners can fall into this trap as well, with an assumption that “more legislation” or “bans” will solve a long-standing problem. We know from human behaviour change research that solutions based on compliance or punishment are far less likely to have the desired effect than incentive-based and positive-reinforcement options. We also know that successful behaviour change in areas like obesity and smoking often requires 10 or more, different interventions (single, simple interventions just don’t work).

So, in breed health improvement we do need to listen to a range of perspectives on the problem (and ways of solving the problem) because we know that diversity of thinking helps to generate new ideas for solutions. I probably shouldn’t mention Dominic Cummings but there is something to be said for his call for more “assorted weirdos” to be recruited! He was talking about the civil service; maybe we need the same on our breed club committees.

Ready access to data

It’s often hard for breed clubs and BHCs to get hold of research papers and published evidence in a timely way, to inform their decision-making. Finding and storing relevant papers is much easier these days with the various online tools that are available. You can set up a Google Scholar search for any papers containing keywords (e.g. “canine”, “genetic diversity”, “Dachshund”) and you will get regular notifications with links to the papers. Free tools such as Microsoft OneNote or Evernote are then great for storing, indexing and retrieving the papers of interest to you. Increasingly, BHCs are summarising key messages for their breed club members, buyers and owners in the form of infographics using free tools like Canva.

Not all “evidence” is created equal

I have written previously about the Trust Triangle which describes the different types of information you might come across and the levels of trust that can be associated with each. At the bottom of the Trust Triangle are non-experts with opinions. Facebook and social media are awash with these! Journalists and experts with a commercial interest also fall into this category. Next comes expert opinion; these are people who are widely acknowledged to be experts in their field. Many of them will know an awful lot about a very narrow field of science. They too come with their biases and personal agendas but, mostly, they will have years of experience and scientific data to back up their opinions. Moving up the Trust Triangle, we find primary scientific research. This is made public via “papers”, the best of which will be peer-reviewed, rigorous, well-reported and independent. At the pinnacle of trustworthy published scientific research are papers that present systematic reviews of multiple other studies. These publications dissect and critique a set of primary research papers in order to arrive at “the best evidence” to support a particular case (or to disprove it).

We all need to get better at understanding the quality of evidence presented to us, including issues such as bias, chance and risk. We have seen over the past few months that many people are completely hopeless at understanding risk. We see it in canine health screening too; people may not understand what a screening grade means in relation to a decision to breed or not, and the risk of producing “affected” puppies.

A final part of the revolution we need in breed health improvement is to make more use of collaborative group decision-making processes. Different groups lobbing data, opinions and solutions over the fence really isn’t conducive to transparency or consensus-reaching.

Returning to my opening comments about the brachycephalic issue, in 2016 I wrote one of these articles where I said “Overall, the good news is the problem is moving into solution mode” with the formation of the Brachycephalic Working Group. In 2020, we’ve got more than enough data; we still need more improvement.

You can’t change the bricks, and together, you still have to build a wall.

Chris Hadfield, Astronaut

Culture eats strategy for breakfast!

I’m not overly persuaded by the many comparisons of Covid19 testing and death rates in different countries. Statisticians David Spiegelhalter and Sylvia Richardson said recently:

…it’s tempting to link a country’s statistics to the measures they have taken to control the virus: for example, has Sweden’s more relaxed policy been as effective as lockdown? But countries differ in so many ways: basic demographics, compliance and social networks, testing capacity and policy, health service characteristics and so on.”

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We face a similar situation in the world of dog health; there are lots of
examples of comparisons made between different breeds. Our main interest has, inevitably, been focused on breed health in the UK but, for some breeds, there have also been international comparisons.

It’s perfectly valid and useful to make comparisons of the prevalence of particular diseases across different breeds. Many of these differences can be attributed to genetics and/or conformation. Indeed, the fact that we have created so many different breeds makes the pedigree dog a really useful resource in the search for the genes associated with diseases that may have parallels in humans.

International comparisons within breeds can also be useful and breeds such as Irish Wolfhounds and Bernese Mountain Dogs have extensive databases that can be used to investigate different health issues across the world. Increasingly, there is also genetic data from Genomewide Association Studies (GWAS) that is identifying different geographical clusters within breeds. This information could be used to address the lack of genetic diversity in some breed population sub-groups.

In my breed, Dachshunds, we are often (rightly) criticised for exaggerated length and shortness of leg and the claimed association of this with Intervertebral Disc Disease (IVDD). It is argued by some that we need to amend the Breed Standard to encourage shorter bodies and longer legs with more ground clearance, similar to that specified in the FCI Breed Standard. Unfortunately, this ignores the fact that the prevalence of IVDD is little different between FCI registered Dachshunds and UK dogs. In fact, there is more variation in IVDD prevalence between the 6 Dachshund varieties despite the fact they all share the same Breed Standard. For those interested, Wires and Longs are the least likely to have IVDD and Smooths and Mini Smooths are about 4-5 times more likely to have it. The research into the conformational differences and their association with IVDD is also contradictory. Nevertheless, it is clear that some Dachshund breeders (and judges) need to remind themselves of the original function of the breed and the KC mantra of “fit for function”.

3 levels of benchmarking

When I run benchmarking skills workshops, we talk about 3 levels of benchmarking: Metrics, Process and Culture. Metrics tell you “what the performance is”; Process tells you “how that performance was achieved” and Culture tells you “why” those processes achieved the particular level of performance.

Just comparing the metrics (e.g. disease prevalence or mutation frequency) ignores processes (such as breeder education, testing protocols and recording systems) and the cultural issues such as leadership, teamwork, compliance and enforcement. 

There’s a quote I use in relation to organisation design: “All organisations are perfectly designed to get the results that they do”.

For breed health improvement: “all breeds are perfectly designed to get the health that they do”.

Whatever any government, kennel club, breed club or campaigning group says about its strategy for improving canine health and welfare, it’s worth remembering Peter Drucker’s quote “Culture eats strategy for breakfast”.

International resources

Benchmarking metrics is easy, but tells you very little about how to improve.  Benchmarking processes tells you how others do what they do.  Adding in an understanding of the “soft stuff” helps explain why they get the performance that they do and is probably the most difficult area to adopt/adapt for your own breed’s use.

Visitors to the International Partnership for Dogs website (dogwellnet.com) will find a wealth of resources supplied by Kennel Clubs and Breed Clubs from around the world. It is a unique resource of data and tools (metrics and processes) that have been freely given and then curated in a single, accessible format.

Among the data, you can find breed health survey results and information on registration statistics. Having led the Breed-specific Health Strategies workstream at the 4th International Dog Health Workshop, I’m particularly interested in the tools and techniques that are being collated. These include examples of Breed Health Strategy templates which any breed club could use to get a baseline picture of what’s going on in their breed. In the UK, these are our Breed Health and Conservation Plans. The KC has completed these for 51 breeds so far and each Breed Health Coordinator for the remaining breeds has been given a simplified self-completion template to help them make a start.

The IPFD has plans to develop a Health Strategies Database along similar lines to its existing Harmonisation of Genetic Testing database. This would be an interactive resource including health conditions where recommendations have been made by Health Strategy Providers (HSPs) including kennel and breed clubs and veterinary organisations. It will include information on prevalence, severity, screening tests/programmes, links to health data etc.

This would be supported by an IPFD Expert Panel who would provide collective opinions on key questions, e.g. the quality and utility of genetic tests, their application within breeds, geographical areas, etc. and in the context of the broader view of health in the breed.

It’s all about people!

Making these internationally-sourced resources available is great but their applicability will be very dependent on the cultural context in each breed and each country. For example, approaches that have been successfully applied in the Nordic countries where there are fewer breeders than in the UK may simply not be workable here. In the USA, things will be different again; we’ve seen from their Covid19 lockdown protests that some Americans don’t take kindly to being told what to do! 

I also think there would be some value in categorising the various types of breed health improvement intervention (processes) using human behaviour change principles. I’ve written before about Susan Michie’s (UCL) behaviour change wheel which identifies 7 policy categories and around 90 different types of behavioural change technique. We will only improve breed health if individuals’ behaviour changes (breeders, buyers, judges, vets etc.). Behaviour change research in the field of human health (e.g. smoking and obesity) suggests that successful change typically requires around 10 different techniques to be employed. Incidentally, this explains why the reliance on “breeder education” has been consistently unsuccessful.

Returning to my initial thoughts on Covid19, some readers will be aware that Susan Mitchie is one of the advisors to the government on behaviour change associated with the pandemic. So, if you are interested to understand what’s been done in the past few months to shape your behaviour, I’d recommend you do some reading on behaviour change techniques. 

Breed Health Improvement Strategies – a webinar for the Danish Kennel Club

Ian Seath hosted a webinar on Breed Health Improvement Strategies for the Danish Kennel Club on June 11th 2020. An important subject that is more current than ever, where some breeds are faced with a difficult time in relation to health and considerations for the future of the breed.

Course content:
Part 1:
– What is a Breed Health Strategy?
– Why every breed needs one
– A process for developing a Health Strategy
– The role of human behaviour change in breed health improvement
Part 2:
2 UK case studies:
– The Dachshund Breed Council’s improvement strategy and achievements
– Addressing Lafora Disease in Miniature Wirehaired Dachshunds

Health-tested does not mean “healthy”

I’ve been involved in several conversations over recent months about where we should focus our efforts if we want to improve the “health of dogs”. In my breed, Dachshunds, we often focus on back disease (IVDD) as the most significant health issue facing the breed. The evidence suggests the breed is 10-12 times more likely to suffer IVDD than dogs in general. Our breed health surveys also tend to support the widely quoted figure of 25% of Dachshunds being likely to suffer an IVDD incident at some point in its life. However, that means, on average, 75% of the breed won’t have IVDD and in some of the Dachshund varieties, the risk of IVDD is lower still.

There are, no doubt, similar situations in other breeds; for example, heart disease in Cavaliers, cancer in Bernese Mountain Dogs and BOAS in brachycephalic breeds. In some cases, screening programmes exist which breeders can use to reduce the risk of breeding puppies that will be affected by a particular condition.

Screening programmes typically make use of 2 types of test; phenotype tests and DNA tests. Of the former, Hip, Elbow, Heart, Hearing and Eye tests are well-known and (mostly) well-established ways for breeders to test their stock. The Kennel Club’s recent paper Effectiveness of Canine Hip Dysplasia and Elbow Dysplasia Improvement Programs in Six UK Pedigree Breeds demonstrated good participation in Hip Scoring and a reduction in the prevalence and severity of Hip Dysplasia. In contrast, the Respiratory Function Grading Scheme for Bulldogs, French Bulldogs and Pugs is relatively new but offers a useful way to reduce the chances of breeding puppies affected by BOAS.

When it comes to DNA tests, most breeders are now familiar with what the genotype results of Clear, Carrier and Affected mean and can use these to avoid producing affected puppies. For example, breeders of Mini Wire Dachshunds have used the Lafora Disease DNA test to reduce the number of at-risk litters containing affected puppies from 55% to 2% since 2012.

The world’s healthiest dog?

More and more DNA tests are becoming available, so it will be increasingly challenging for breeders to decide which ones to use. This is particularly true where the test may not have been rigorously validated to demonstrate its link to a clinical condition. The issue of test validation was one of the emerging concerns from the 4th International Dog Health Workshop, held last year in Windsor. The arrival of panel tests potentially adds yet more confusion to the debate about healthy dogs. Just because a dog can be screened for 150 known genetic mutations and found to be Clear of all of them, doesn’t mean it is “the world’s healthiest dog”. Many of those mutations may be completely irrelevant to your breed in terms of clinical illness.

When we consider both phenotype and genotype tests, we are really looking at diseases, not health. It can, therefore, be potentially misleading to puppy buyers to hear a breeder describing their dogs as “health-tested”. At best, we can say we have screened our dogs for particular, known, conditions to reduce the risk of our puppies developing that condition. We can’t say anything about the risks of them developing other health conditions for which no test is currently available. In the case of phenotype tests, the risk of a dog developing a problem often has an environmental and lifestyle component.

An owner’s view of health

This is where I think it becomes interesting to talk about what we mean by “healthy”. In 2014, the VetCompass project published a paper on the Prevalence of Disorders Recorded in Dogs Attending Primary-Care Veterinary Practices in England. The top 7 conditions diagnosed by vets were: Otitis Externa, Periodontal Disease, Anal Sac Impaction, Overgrown Nails, Degenerative Joint Disease, Diarrhoea, and Obesity. For the owners of these dogs, “health” largely boiled down to issues with ears, teeth, and bottoms!

Purebred dogs had a significantly higher prevalence compared with crossbreds for three of the twenty most-prevalent diagnosis-level disorders: otitis externa, obesity, and skin mass lesions.

According to the PDSA, vets estimate that around half the dogs in the UK are overweight or obese. A study published in 2018 found 65% of dogs were overweight and 9% were obese. The knock-on effects of dogs being overweight include a reduced quality of life as well as increased risk of diabetes, heart disease, and arthritis.

Given this evidence about “health”, there’s a good case for investing time and resources into helping people to be better dog owners. In 2015 we carried out a Lifestyle Survey of Dachshunds with the specific aim of identifying any factors that might be associated with the risks of IVDD. This built on a 2013 study done by the Royal Veterinary College that found obesity was one of the risk factors for IVDD. We found, unsurprisingly, that dogs that were more active and given more exercise had a lower risk of IVDD. More surprisingly, we found that neutered dogs had an increased risk of IVDD and the younger they were neutered, the greater the risk.

2 routes to healthy pets

It’s pretty clear that simply using disease screening programmes (“health tests”) as a means of saying we are breeding healthy dogs is too narrow a perspective. Breeders, buyers and owners need information from 5 questions to make an informed decision about how healthy their dog is likely to be:

  • Is there a breed-specific predisposition to any particular health conditions?
  • What is the prevalence of those conditions?
  • What is the severity of those conditions (chronic or acute)?
  • How long might the dog suffer from these conditions (age of onset)?
  • What treatments are available and how effective (and expensive) are they?

 

There are probably 2 main routes to healthier dogs: breeding healthier pets and owning healthier pets. Firstly, breeders can use less conformationally exaggerated, more genetically diverse, and disease-screened dogs in their breeding programmes. Secondly, owners can implement choices such as life-stage appropriate diet and exercise.

The term “healthspan” has been used to define the length of time during which dogs (and other animals, and humans!) are generally healthy and free from chronic illness. Maybe we should be having more conversations with breeders and owners about how they can increase the healthspan of their dogs.

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Breed Health at the start of a new decade – What’s your vision for 2030?

It’s that time of year when New Year Resolutions have either already been forgotten or are well on the way to become good habits. It’s also the time of year when many Breed Health Coordinators (BHCs) will be reflecting on their achievements in 2019 and looking ahead to plans for 2020. One of my Christmas holiday tasks was to draft our Annual Health Report which is published by our Health Committee in January. Our first one was published in 2009, inspired by the good practice set by the English Springer Spaniel BHCs. It’s a task that has become easier every year because we now have a template to follow and access to plenty of data.

We also have a Breed Health and Conservation Plan which we agreed with the Kennel Club in 2018 and published last year. I’ve written about BHCPs before so I will simply restate my enthusiasm for this fantastic resource. The BHCP pulls together a wide range of information about a breed and, through discussion with breed representatives, leads to an action plan for improvement. Our initial BHCP was reviewed and updated in 2019 so we’re now into our second action plan.

The KC Health team is now working with the third cohort of breeds to produce their BHCPs and, to accelerate the process, issued a template to all the remaining breeds so their BHCs and Health Committees could make a start on the task. It’s probably quite daunting at first glance but, for many breeds, much of the information is already in the public domain (e.g. registration trends and health survey results). As usual, the challenge for all the volunteers working on breed health is how to find the time to do it.

A goal without a plan is just a wish

Our Annual Health Report includes a summary of what we have achieved in the past year and sets out what we want to achieve in the coming 12 months. We don’t succeed at everything we plan to do and that’s a reflection of the real world; some plans turn out to be unrealistic, some simply can’t be resourced and some just weren’t important enough to get done. It can appear, some years, as if the following year’s plan is just “more of the same”. That’s fine, too, as there are lots of things that we just have to keep on doing in order to achieve our overarching goals of breed improvement. These include fundraising, collecting health and death reports, providing information to buyers and owners, and running screening programmes.

I can’t help thinking that now that we’re in 2020, it’s a good time to set a 10-year vision. There’s a neat symmetry about having a vision for 2030. It’s also probably a realistic timeframe to think about because changing the health of a breed inevitably takes time. For example, it took us 9 years to reduce the proportion of litters at risk of containing puppies affected by Lafora Disease from 55% to 2%. That includes the time to develop a viable DNA test, to influence breeders to use it and to reduce the mutation frequency in the population.

My New Year challenge for BHCs is to define what you want to have achieved by 2030. It doesn’t matter whether you call these your Goals or Objectives. The important thing is to describe what will have improved in 10 years’ time. For most breeds, there will probably only be 3 or 4 objectives. For us (Dachshunds), we want to reduce IVDD prevalence, improve eye health and reduce the rate of loss of genetic diversity. There are other things we would like to achieve but it doesn’t make sense to set 10 or 12 objectives.

Note that objectives are what we want to achieve, not what we plan to do. In order to achieve our objectives we have to have committed breed club leadership, we need to develop evidence-based actions and we need to engage with buyers and owners. What we do each year may be new or more of the same but all of our actions are focused on achieving those objectives.

What do you want to improve?

There aren’t that many things that any breed might want to improve. Generically, they are likely to be several of the following:

  • Reduce the prevalence of particular health conditions
  • Improve temperament, behaviour or working traits
  • Reduce the effects of low genetic diversity
  • Reduce conformational exaggerations

You also have to be realistic about how much improvement you can achieve. If we were able to halve the prevalence of Dachshund IVDD in 10 years, that would be significant progress, albeit probably not enough. We have data on breed average Coefficients of Inbreeding so it’s possible to set targets for these as well.  Of course, if we reduce overall levels of inbreeding, we will automatically reduce the risk of diseases caused by recessive mutations. Reducing conformational exaggerations is also likely to result in health improvements.

How are you going to get there?

The 3 broad enabling strategies for achieving breed health improvement are described in the Kennel Club’s Health Strategy Guide:

  • Demonstrate leadership
  • Develop evidence-based plans
  • Engage breeders, owners and buyers

Bluntly, if there is poor leadership interest in improving your breed’s health, you’re not going to make much progress. BHCs typically need to build a team around them to provide support and additional capacity.

A breed’s plans should be evidence-based; that means using information from surveys, research papers and the other data contained in a Breed Health and Conservation Plan.

The final element in making progress is engagement with breeders, owners and buyers. They are the primary groups whose behaviour needs to be influenced if the plans are to be implemented. There are others to engage with (e.g. vets, KC, researchers, judges) but taking action on both the supply and demand side of the dog population is essential.

That’s probably a good place to end and remember something Dr. Dan O’Neill said at the conclusion of the 4th International Dog Health Workshop: “We need to stop saying it’s all about the dogs. It is clear that it is really all about the people”.

Happy New Decade.