Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr Jessica Vitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Barbara Natterson-Horowitz is a cardiologist at UCLA and a psychiatrist. In 2005, she was called to treat an unusual patient: an emperor tamarin at the Los Angeles Zoo. While examining the monkey’s heart, she learned that animals can die of a form of cardiac arrest caused by emotional or physical stress — a syndrome that also afflicts humans. She joined journalist Kathryn Bowers in researching the parallels between people and animals, and found striking similarities: golden retrievers can get breast cancer; gorillas experience clinical depression; and some wallabies abuse opium. Barbara Natterson-Horowitz and Kathryn Bowers talk about various health issues shared by humans and animals.
- Kathryn Bowers Journalist
- Dr. Barbara Natterson-Horowitz professor of cardiology, David Geffen School of Medicine, UCLA, member, medical advisory board, L.A. Zoo
Read An Excerpt
Excerpted from “Zoobiquity” by Barbara Natterson-Horowitz, M.D., and Kathryn Bowers. Copyright © 2012 by Barbara Natterson-Horowitz. Excerpted by permission of Knopf, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Barbara Natterson-Horowitz is a cardiologist at UCLA and a psychiatrist. She's also a consultant for the L.A. Zoo. She joined journalist Kathryn Bowers in examining the correlations between human and animal health issues, and the possibilities for new diagnoses, treatments, and cures. Their new book is titled "Zoobiquity." They are here with me in the studio.
MS. DIANE REHMI welcome your calls, comments, join us on 800-433-8850, send us your email to firstname.lastname@example.org, join us on Facebook or Twitter. Good morning to both of you and welcome.
MS. KATHRYN BOWERSThank you, good morning to you.
DR. BARBARA NATTERSON-HOROWITZThank you.
REHMGood to see you both here. Barbara and Kathryn, this title is just wonderful, "Zoobiquity." Who came up with it, Barbara?
NATTERSON-HOROWITZWell, Kathryn and I came up with it together. We'd been researching the potential, the possibility for human and veterinary medicine to be much more connected, and we were looking for a word that could encapsulate this new culture of bringing together the two fields. So we created a word "Zoobiquity" which has in part zo, which is Greek for animal, and ubiquity which is Latin for everywhere, and we brought them together to bring together two cultures, just as we were bringing together the cultures of human and animal medicine.
REHMAnd did you think, Kathryn, that that was truly a possibility?
BOWERSWell, I was surprised as a non-physician, and I'm not a veterinarian either, just how deep the connection goes. The longer we researched this, the correlations just kept coming up.
REHMAnd Kathryn, I gather it was you, Barbara, who had the incident at the L.A. Zoo. Tell us about it.
NATTERSON-HOROWITZRight. So I've been a cardiologist for 20 years at UCLA taking care of human patients, but I had the opportunity to go the Los Angeles Zoo and do some cardiac ultrasounds, what we call echocardiograms on some of their animals who had cardiovascular problems. One day, I was called by the veterinarian at the zoo to come and do an ultrasound on a Tamarin. Tamarin are these adorable Central and South American monkeys that live at the top of the canopy.
REHMHow big are they?
NATTERSON-HOROWITZLike a little baby.
REHMLike a little baby.
NATTERSON-HOROWITZLike a newborn baby.
NATTERSON-HOROWITZAnd on this particular day, we were, you know, getting ready to do the ultrasound. They were worried that the Tamarin had heart failure. So they were getting ready -- the patient ready to have an echocardiogram, and as she was receiving some sedation, I was crouching down and looking at her beautiful eyes and connecting with her the way I try to connect with a human patient, to kind of create a trust bond. At that moment, the veterinarian put his hand on my shoulder and said, please stop making that eye contact, you're going to give her capture myopathy.
NATTERSON-HOROWITZSo I did what, you know, I did what I was told and backed off, but I have to say I was very curious because I had never heard of capture myopathy.
REHMNever heard of that.
NATTERSON-HOROWITZMyopathy, yes, you know.
NATTERSON-HOROWITZLots of -- it means a disease of the muscle, and we have in human medicine heart myopathy and all kids of myopathy. I went home and I looked up capture myopathy, and I learned that animals, when they're being chased, when they're restrained, when they're under huge fear, when they're very, very scared, can release a huge amount of adrenaline, which can harm their muscles, including their heart muscles, and in some cases cause heart failure and even death.
NATTERSON-HOROWITZWell, that was very interesting to me, but what clicked almost instantly was that that sounded very familiar to a recently identified condition on the human side which was a stress-induced heart failure which was given a fancy Japanese name called Takotsubo cardiomyopathy by the Japanese cardiologist who found it, but essentially what Takotsubo cardiomyopathy was, was stress- for fear-induced acute heart failure.
NATTERSON-HOROWITZSo here was a form of capture myopathy, which was fear-induced heart failure in an animal -- in animals, and fear-induced heart failure in a human, and I began comparing the elements of them, and I realized that they were very connected and possibly one in the same.
REHMBut you know, it's interesting to me, and we should say that on the cover of the book are these beautiful green eyes, the animal is the Tamarin.
NATTERSON-HOROWITZWell, the cover actually it's -- that particular beautiful animal is not -- those are not the Tamarin eyes. It's a different monkey.
REHMBut, you know, it seemed to me that as I was reading that portion of the book, it seemed to me that if you are in an office with a physician, and that physician is looking you directly in the eye, that's the kind of contact you want to have, and yet by veterinary terms, and even in human terms, it may bring on some kind of stress problem, Kathryn.
BOWERSWell, it's interesting, because eye gaze can mean different things in different situations, and probably across species as well. Barbara's told me about something called White Coat Syndrome that people can get when they visit a doctor which is a sort of increase of stress when they're seeing a physician, so in that case it might not be the eye gaze, but it might the knowing that you're in a medical situation.
REHMAnd then the blood pressure shoots up.
BOWERSCorrect. Correct. But yes. Eye gaze can also, I mean, if it's within our own species it can be comforting and -- yeah, and it cannot always necessarily be a menacing situation, but oftentimes it is the result of you've been spotted by a predator.
NATTERSON-HOROWITZIn that moment that I -- when I realized there was a similarity, though, in terms of fear-induced heart failure, what was interesting wasn't so much the similarity, although that was interesting, it was the gap, the gulf. The fact that veterinarians have been talking about this diagnosis, it's in their literature, for decades, and it had only recently been identified with some fanfare on the human side, and that got me to thinking if I'm sort of accidentally noticing this gulf, what other gulfs are there, and that led us on the journey to ask well, how far -- how much of an overlap is there between human and animal disease.
NATTERSON-HOROWITZWhat do animals get that we get?
BOWERSWe started asking do animals get, and for just about every condition we looked at there was an animal correlate. We looked at do Cocker Spaniels get breast cancer, do Killer Whales gets Hodgkin's Lymphoma.
NATTERSON-HOROWITZAnd the answer was yes. For every -- the methodology that we used, if I saw a human patient who had a disorder at the hospital, we looked in the veterinary literature. So many breeds of dogs get breast cancer, some get prostate cancer. We found out about an Orca Killer Whale from Iceland who developed Hodgkin's Lymphoma which, you know, is a common human problem, or I thought was a, quote/unquote, "uniquely human problem."
NATTERSON-HOROWITZPaul Allen the co-founder of Microsoft successfully battled Hodgkin's Lymphoma as have many humans. I learned that the pancreatic neuroendocrine tumor that recently took the life of Steve Jobs is found in some dog breeds, including German Shepherds and others. So as we explored, it was cancer, it was heart disease, we learned about heart failure in many kinds of animals, both wild and domestic, cats, dogs, and diabetes, miniature ponies, and then even STDs.
NATTERSON-HOROWITZDo animals get STDs, and of course they do. They don't practice safe sex. And the Koalas in Australia are threatened with an epidemic of Chlamydia, and it went on and on including behavioral. So it was very exciting, those moments.
REHMYou know, what's so interesting to me is that this hasn't come together before now. If you've been seeing all these, and veterinarians have been seeing them, physicians have been seeing them, and nobody has said maybe vets and MDs need to go to school together, Kathryn.
BOWERSYeah. I -- again, as a non-physician, as a journalist, I was really surprised that veterinarians and physicians didn't know everything about each other's fields. It just seemed obvious. It seems like we've got similar raw materials, so to speak. In our bodies, we have hearts and blood and bones and it seemed to me that a comparative approach would be kind of a de facto base from which both of these fields would emerge, but I was surprised to learn it's not quite so at the moment.
REHMSo what additional insight lead you then on this trail to publish this book and to do it together?
NATTERSON-HOROWITZWell, we became -- the more we talked about these overlaps and learned about these overlaps, we were struck by what -- the question that you're asking. Well, how is it that this hasn't happened before?
NATTERSON-HOROWITZAnd we learned that for the last ten years or so there has been a movement in this direction by an organization -- well, it's an approach called One Health, which is kind of a recognition that veterinarians and physicians and public health and environmentalists have lots in common. One Health has been tremendous in advancing awareness for example of the fact that most of the emerging infections in the world are coming from the animal reservoir, so you think about the big pandemic threats, you know, West Nile, SARS, all of those have an animal origin.
NATTERSON-HOROWITZBut what we wanted to do was to advance that and look at conditions that I saw every day at the hospital in my human patients, cancer, obesity, sexual dysfunction, addiction, eating disorders, heart failure.
REHMSelf-mutilation is even in there in the animal world, which I think came as kind of a shocker.
BOWERSWell, self-injury certainly seems like such a human condition, but our research shows it's actually connected to something that animals do all the time that's actually good for them and important and that's grooming. You know, we've all looked at videos of primates, you know, picking lice out of each other's hair and other little bugs, and we've seen out cats and dogs licking themselves and keeping themselves clean, and it's a really important part of their social life. It bonds them. It also keeps them clean, and it releases endorphins.
REHMAnd the book we are talking about is titled "Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing." Short break. We'll be right back.
REHMAnd welcome back. The coauthors of a new book titled "Zoobiquity" are with me. The subtitle of the book "What Animals Can Teach About Health Care and the Science of Healing (sic) ." Barbara Natterson-Horowitz and Kathryn Bowers are both with me in the studio. Here's a first email saying, "The distinction between animal health care and human health care is arbitrary. In the movie 'Planet of the Apes' when Charlton Heston's character Taylor was injured, one of the chimpanzees said something like, it's a good thing I'm a veterinarian. Animals are people, too."
REHMNow, Kathryn, just before the break, we were talking about self injury and how that can be taken perhaps beginning with the self grooming that's taken to an extreme.
BOWERSThat's right. So we actually think of self injury as when it gets -- as a grooming behavior kind of gone wild. If it's -- if an animal is stressed out, they might start to try to make themselves feel better by doing some self grooming, but it gets dialed up and goes too far.
REHMAnd why does this happen? You talked about the release of endorphins, Barbara.
NATTERSON-HOROWITZWell, the connection that we made was between, yes, relief and grooming. And when you talk to human patients who self injure they say something that's seemingly paradoxical. They say they do it because it relieves them. It gives them a release which is kind of hard to understand. But if you take a step back and you say well, they're deriving some comfort, some self soothing from it and you step back from that you see that, as Kathryn said, grooming is a soothing behavior. All of us engage in little tiny grooming behaviors all the time. And as...
BOWERSI'm sorry, things like hair-twirling and maybe stroking your cheek or just these small little behaviors we do throughout the day.
NATTERSON-HOROWITZBut as stress may increase sometimes we amplify those behaviors. We may pick a scab until it bleeds and it hurts a little bit and then we feel some kind of a relief. So through the discussions of human patients and comparing it to animals who over groom, as the veterinarians say, we thought that there were linkages. And that's what that chapter is about.
REHMAnd thinking about what human physicians can learn about their counterparts in the veterinary world, what do you think comes to the top?
NATTERSON-HOROWITZWell, first I just want to follow up on your caller's comment. There's an inside joke among veterinarians. They say, what do you call a veterinarian who takes care of only one species? A physician.
NATTERSON-HOROWITZAnd, in fact, it's the fathers of -- both human and veterinarian medicine claim mutual fathers of the field, Sir William Osler and Virchow. So, you know, we are very connected. There are so many things that we can learn from veterinarians. I have personally become a better physician by working with veterinarians. My understanding of, well, how to approach patients and the nature of disease, and particularly mental illness, has shifted learning that animals have numerous behavioral disturbances that resemble the counterparts in humans.
REHMOkay. Take us back. You said you talked about how animals behave differently. Is it that the animal tells you more quickly how he or she is feeling even more so than a human is able to verbalize?
NATTERSON-HOROWITZYeah, you know, I mean, veterinarians have in many ways a harder -- much harder job than we physicians have. They -- first of all, they have to be pediatricians, adolescent medicine doctors and geriatricians. Depending on the kind of veterinary medicine they practice they need to know pathology and normal physiology of mammals, reptiles, birds, sometimes...
NATTERSON-HOROWITZ...even exotic insects.
NATTERSON-HOROWITZAnd they do all of it with patients who cannot tell them what's going on. I had a wonderful experience at the Los Angeles Zoo taking care of a lioness who developed a dangerous collection of fluid around the -- her heart in her pericardium. It's called cardiac tamponade. It's a medical emergency. We see it in human patients and we immediately use some high technology, some imaging to make the diagnosis and drain the fluid or create a pericardial window.
NATTERSON-HOROWITZThis lioness had developed actually what turned out to be the same problem. The vets called me to ask if I could come out and do an ultrasound. And of course she ended up having this diagnosis that they had properly identified. It was treated, she did beautifully. She went on. She's doing magnificently. But later on I was thinking about the fact that the vets made this diagnosis through observation. They watched her breathing, her patterns of breathing, her body posture, shifts in her behavior carefully over the course of hours and days. And, you know, I -- it was remarkable.
REHMWhy are they calling on you at all? I mean, that Tamarin was the first time. But why?
NATTERSON-HOROWITZRight. Well, veterinary medicine has -- is very evolved and there are many veterinary subspecialists at the highest level. We've had the privilege of collaborating now, in the process of writing the book and our conference, working with some of the top veterinary cardiologists in the world. But zoos around the country make use of medical advisory boards from time to time just to help with either advanced technologies or subspecialty concerns. And cardiac ultrasound is one of those areas that I was just lucky that that's what I do. And that's why they called me.
REHMAnd you are fortunate enough to be watching and writing about all this.
BOWERSIt's so true. I've learned so much. And again the biggest surprise for me has just been our deep connection with all other living things. And again, the physical ailments are fascinating and many were eye-popping and surprising to me. But for me the psychiatric conditions and our -- that our behaviors and the things that we think of as being maybe a component of our big human brains or our thousands of years of human culture might have roots that -- and behaviors that we share with other animals.
REHMHere is an interesting email from Christine in North Carolina who says, "My pet rabbit was diagnosed with uterine cancer three years ago. She had a successful hysterectomy. Then last January I noticed lumps on her belly, which turned out to be malignant mammary tissue. She's doing very well at age nine. Many people laugh and say, you mean rabbits get cancer? And I respond with, of course they do. Physiology is physiology." Now the question becomes having observed as you have, having written this book, brought it out, is your goal to bring the two studies together in a single study, Barbara?
REHMWell, yeah. Rabbit -- you know, rabbits have such a high incidence of uterine cancer that rabbit hysterectomies are very common -- prophylactic hysterectomies actually. But you bring up breast cancer which is a perfect example of how collaboration between human and veterinary medicine I think can advance the field. When we started this project, I had no idea that breast cancer happened in other mammals. Of course, all mammals have breasts by definition and breast cancer has been found in kangaroos and llamas and many different mammals. It turns out that big cats, including tigers and jaguars, have an increased incidence of breast cancer.
NATTERSON-HOROWITZAnd we learned interestingly that jaguars particularly have an elevated incidence of breast and ovarian cancer. And one of the researchers, a veterinarian who was looking into this questioned whether they might have the BRCA1 mutation. Now the BRCA1 mutation is found in women who are at elevated risks for -- it puts them at elevated risks for breast cancer. And it's common in a number of groups of women in Ashkenazi Jewish women and other groups.
NATTERSON-HOROWITZBut the fact that there's this elevated incidence of both breast and ovarian carcinoma in jaguars and in human women led us to think, well, you know, we really should be taking a comparative approach and a collaborative approach. And not only in terms of which animals have an elevated risk, but which seem to be relatively protected. We learned, for example, that the professional lactaters, which is what they call the dairy cows and the dairy goats, are quite protected from breast cancer. And that tracks with the human epidemiology that endorses breast cancer as being preventive or, you know, reducing risk of breast cancer.
REHMYou're saying that breast feeding in human beings is something that protects women from elevated rates of breast cancer.
NATTERSON-HOROWITZYeah, right. There are studies that have shown that.
REHMFantastic. That's really interesting.
BOWERSJust quickly, there was another thing that I learned from this is that not only is disease, and we're talking about cancer, not uniquely human. It's also not a contemporary phenomenon. There's fossil evidence of cancer in dinosaurs. So this is not just something of our own human making in the last couple hundred years.
REHMWell, and another issue that's come up certainly in the last few years is the problem of obesity. And what do you find in animals that is relevant to us humans who are also animals?
NATTERSON-HOROWITZRight. So yeah, I mean, it turns out there are parallel obesity epidemics that are happening right as we speak. Of course our human population is becoming fatter and dangerously so but it turns out our companion animals too are becoming dangerously overweight. Up to 40 percent of our dogs and cats now meet criteria for overweight. And remarkably it's not just companion animals. It also includes some population of wild animals who appear to be getting fatter, which opens up the possibility that it's more than just diet and exercise that's at play here. That there could be factors that we have not been looking at, which are species spanning that are affecting our body mass index.
REHMSpecie is spanning, Kathryn.
BOWERSWell, we'd always thought that wild animals never get fat. I'd always sort of assumed that they're out there running around. They're eating their healthy food that hasn't been sprayed.
BOWERSThey're not going through the drive-thru. But we found some studies that showed that marmots in the Rockies over the last four or so years have gotten chubbier. Blue whales off the coast of California are getting bigger and bigger. And it has to do with access and abundance to food. So those can be challenges to any sort of eater, whether they're human or nonhuman.
REHMBut are they related? Is the access and abundance of human food affecting what's going on with these creatures?
NATTERSON-HOROWITZSo there are two parts to that. First is whenever any animal human or nonhuman has access to abundant food, they will consume it. One of the veterinary nutritionists we spoke to explained that pretty much every species is hardwired to over consume when it has access, which is obviously relevant to the human case. But the...
BOWERSI'm sorry, and in the wild, your access gets cut off because seasonal availability comes and goes.
NATTERSON-HOROWITZWhich speaks to obesity as being really a disease of the environment. And that is true whether you're a wild animal, but of course it's also true for human populations. But beyond access and abundance, there may be other factors that are also playing a role, including light, dark cycles that affect our metabolism. Potentially, the microbiome, which is this trillions -- tens of trillions of organisms that live inside of our gut that have all kinds of regulatory effects. So veterinarians are aware of these and think about them when they look at the way fluctuations. We should too.
REHMAnd the book we're talking about is called "Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing." And you're listening to "The Diane Rehm Show." We're going to open the phones now. First, to Leonard in Newton, Mass. Good morning to you.
REHMHi there. Go right ahead, sir.
LEONARDThis is a wonderful show.
LEONARDI am both a veterinarian and a physician. And my entire professional life, excuse me, has been really devoted to the one-health concept and the commonality of disease issues in lower and higher animal life, including humans.
REHMGood for you.
LEONARDNow, my issue in question is the basis for one-health is evolution. And this is an issue that has been ignored perhaps deliberately because of its political sensitivity. But I'd like your guests to comment on it. And clearly the reason that animals react to disease in the same way that humans do is because they share common features of anatomy, physiology, pathology. And it's because of that common origin that they react in a common way.
LEONARDAnd I think that just as Galileo was scorned for his astronomical views, which were later accepted, I think it's really important that the issue of evolution be faced directly and recognized as a concept that is solidly based in science and multiple disciplines and is the basis of one-health.
REHMAll right, sir. Thanks for you call. Sounds as though you're even ahead of your time. Barbara.
NATTERSON-HOROWITZIt's wonderful to hear from you. The combination of MD DVM as a physician veterinarian is rare. We're delighted to meet you and we couldn't agree more. And when we started out some of our early teachers in this were the leaders in one-health. And as we learned about one-health and explored what we could learn from veterinarians and from animals, we quickly encountered the growing and emerging field of evolutionary medicine. And we've been privileged to work with Drs. Randy Ness and Steve Sterns, the leaders in evolutionary medicine.
NATTERSON-HOROWITZI have become involved -- quite involved with evolutionary medicine on a national level at UCLA. Dr. Dan Blumstein, who's the chair of evolutionary medicine and I held a conference -- it was actually evolutionary medicine month. And without a doubt understanding the why of why we get sick is key to understanding and developing new pathways to treatment.
BOWERSAnd you might be a little bit surprised to know like I was -- well, our caller wouldn't be surprised to know, but I was surprised that an evolutionary perspective doesn't inform the way physicians look at ailments more than it does. It -- yeah.
REHMAll right. Barbara Natterson-Horowitz is a cardiologist at UCLA and a psychiatrist. Together with journalist Kathryn Bowers, she's written a new book titled "Zoobiquity."
REHMAnd welcome back. The book we're talking about in this hour, "Zoobiquity: What Animals Can Teach Us About Health And The Science Of Healing" written by Dr. Barbara Natterson-Horowitz. She's a cardiologist at UCLA Medical Center and also a psychiatrist, as well as a consultant for the L.A. Zoo. Kathryn Bowers is a journalist who teaches a course on medical narrative at UCLA. And just before the break we were talking about evolutionary medicine, what it is and whether it is being introduced at medical schools, Barbara.
NATTERSON-HOROWITZRight. Well, yes, in order to understand human disease we must think about it in the context of evolutionary biology. Because if you go to a museum, right, sometimes people think, well, evolution is just about skeletons and bones. But of course every part of our body has emerged through natural selection. And so that includes everything, yes, from our physiology, our skeletons, our organs, including our sexuality.
NATTERSON-HOROWITZAnd so we actually, in the book, look at the evolutionary biology that underlies sexual behavior from erection and ejaculation and all of these things which are -- on the one hand you can say, well, it's comparative medicine. But it also is really about evolutionary biology. And so evolutionary medicine applies to every aspect of the body.
REHMAnd here's an email from Carol in St. Louis. "Do animals exhibit human psychological malfunctions like bipolar disease, depression, autism?"
BOWERSBipolar disease. We looked in our book at a variety of different psychiatric conditions from the species-spanning-comparative point of view. And you know people have these really serious issues, eating disorders, sexual performance problems, self-injury, even substance abuse challenges. So we did look at those. And we found that seeing those behaviors in other animals can help normalize them for human patients. They can help relieve some of the shame, maybe even de-stigmatize the conditions and help physicians come to maybe model the diseases in a more compassionate or in a new way, generate new hypotheses about why people might have them.
NATTERSON-HOROWITZYeah and when I see patients, you know, depending on what they're struggling with, in addition to the burden of illness they often have shame, guilt, self-blame. Cancer patients, for example, have a lot of self-blame, but so do many patients suffering from a variety of behavioral problems, including addiction and substance abuse. The reality of some of these syndromes or, you know, proclivities existing in animal populations does, I think, have the effect of expanding the perspective of what disease means in the first place.
REHMWhat does a drug-addicted animal look like?
NATTERSON-HOROWITZWell, we really looked at substance seeking, not really drug addiction per se. And we wanted to ask the question, by the way, from a very skeptical position, do animals seek substances in the wild? These of course, the drugs that are made synthetically and then sold to humans, many of them occur in the wild.
BOWERSAnd animals don't have liquor stores or drug dealers.
REHMRight. Of course not.
BOWERSOr pharmacists to serve them.
NATTERSON-HOROWITZBut it turns out a number of species of animals, broad groups of animals from birds to big horn sheep to...
NATTERSON-HOROWITZ...wallabies, right, seek out substances. And sometimes actually do become intoxicated.
REHMAnd continue to seek out those substances because they like the feeling of being intoxicated or...
NATTERSON-HOROWITZRight. Well, we don't know what they like.
REHMWe don't know.
NATTERSON-HOROWITZRight. We want to be very skeptical.
NATTERSON-HOROWITZBut the observation has been made by naturalists and others and yes, some animals do repetitively go back for the substance and others appear not to, which is interesting 'cause the same is true of humans.
REHMAll right. To Jacksonville, Fla. Good morning, Natalie.
NATALIEGood morning. I'm a physician as well. I actually have two comments to make. One comment was regarding the experience that the physician from UCLA had about diagnosing something by echocardiograms that the veterinarians were able to diagnose by observation and physical exam. And I think that's not necessarily just a veterinary medicine experience. I did my training in internal medicine with a gentleman who was a practicing cardiologist in Egypt.
NATALIEAnd he was able to diagnose valvular disease of our human patients based on, you know, auscultation of the heart, as well as the observation of the neck veins. Which all of us American-educated physicians had no idea how he was doing it because the art of exam is essentially extinct in American medical schools with so much reliance on diagnostics. And the reimbursement is really skewed towards diagnostics versus exam. And unfortunately that's a dying art, the physical exam.
NATALIEHowever, that being said, my other comment relates to how I became I feel a better empathetic physician to my human subjects after having a very, very sick dog. I had a dog who was 15 years old and suddenly became ill. And I just went to whoever was on call, as far as emergency vet. And this vet never met us. He had sort of (word?) bedside manner. He saw a 15-year-old dog. He basically wanted to put her down. And when the lab work came with her having renal failure he said, basically, you know, there's probably very little hope...
NATALIE...of making her feel better. And I couldn't explain to him in the time we had that, you know, a week ago she was a perfectly normal functional dog and she never had any kidney disease. And being an internist I just wanted to get a diagnosis. And after some tests came back it turned out she had E coli urosepsis with some acute renal failure. She also had some other pneumonia. And so from my standpoint of having taken care of sick people and urosepsis and pneumonia, I just knew that antibiotic IV fluids were gonna take care of it. And she did get better.
NATALIEHowever, I’m a lot less judgmental or I don't question the relatives of my patients who come in with their 90-some-odd-year-old grandmother who was functioning well last week and now seems completely delirious.
REHMThat's very interesting, Barbara.
NATTERSON-HOROWITZYes. Well, several things that you said I wanna comment on. The first is that we have worked with a number of veterinarians and veterinary oncologists and learned about how they deal with cancer patients and very sick animals. And you know I think that some of the most humanistic medicine that is being practiced is being done so by doctors whose patients aren't actually human. Veterinarians I think as a whole have a greater awareness of the importance of quality of life and really emphasize that in their approach.
NATTERSON-HOROWITZAnd you know, actually, the other comment that you made was so relevant. Watching veterinarians use physical diagnosis and observation to make diagnosis does underscore how important, as you say, auscultation, which is using the stethoscope to listen to the heartbeat and to the lungs and observing the neck veins to see if they're dilated or not. All of these things that had been a major way that doctors make diagnosis and now have sort of been relegated behind high technology are important.
NATTERSON-HOROWITZAnd when physicians work with veterinarians I think they relearn the importance of that.
REHMReally interesting. Thanks for calling, Natalie. Now to Kensington, Md. Good morning, Paul. You're on the air.
PAULGood morning, Diane. Thank you for taking my call.
PAULI have what I think is a really quick question. I've been confronting Parkinson's and dystonia for about 10 years now. And I was always curious if these two movement disorders and movement disorders in general also occur in the non-Homo sapiens world.
NATTERSON-HOROWITZRight. So, you know, I'm not a veterinarian and I'm not an expert on Parkinson's so I can't really answer that question. But when we embarked on this journey, we did ask, you know, consistently, do animals get -- and for, you know, pretty much all the diagnosis for which we asked that question we came up with an affirmative answer.
REHMHum. So you might look at a dog or a cat and see that sort of stiffness develop?
NATTERSON-HOROWITZYou know, again, I'm not a neurologist and I'm not a veterinarian so I don't know, but if it exists, I mean, how it exists in dogs.
BOWERSAnd there may be a veterinarian listening who knows the answer to this.
REHMExactly. Paul, thanks for calling. Here's an email from Larry in Dallas, Texas, who says, "Outstanding work by the two of you," and then goes on to say, "the short example of our physiological closeness to other animals is our bird flu and swine flu, but the leap here is quantum, seeing the possibilities of treatment correlation. Also, isn't there a possible conclusion to draw from the breadth of disease similarities that we have finally poisoned all of the environment?"
NATTERSON-HOROWITZRight. Well, the connections between human medicine, veterinarian medicine extend in lots of directions. And one of them is that, yes, we all do share the same environment and we're vulnerable to the same environmental threats. Animals do, you know, live with us and in the wild. And they can serve as sentinels. That is sort of early warnings to us that our environment has things that are threatening to us. That can be true and there was a case of a epidemic or an increased incidence of breast cancer among beluga whales in the St. Lawrence estuary up in northeastern Canada.
NATTERSON-HOROWITZAnd it turned out there was a comparable rise in a number of malignancies in human populations. And it ended up being connected to aluminum smelting facilities. So yes, animals can act as sentries. Interestingly, it's not just biological. In homes where domestic abuse is identified, where spousal abuse or child abuse is identified, it is common for animals to have been abused earlier.
REHMWait a minute. Expand on that.
NATTERSON-HOROWITZRight. That it seems as though the threshold for abuse is lower for an animal then for a human. But when there is an abuser in the home, that animals are abused first.
NATTERSON-HOROWITZAnd the unfortunate -- and there's so many aspects of that...
NATTERSON-HOROWITZ...that are challenging and unfortunate, but again, there have been not enough bridges between animal authorities and human providers for that information to connect. And so that's another example of how animal health and human health are connected.
REHMNow, as for treatment of bird flu or swine flu, what are your thoughts there?
NATTERSON-HOROWITZThe One Health folks and the global health community is aware that we need to very vigilant of the health of wild populations because in this day and age when we have viruses that can speed around the globe with an airplane flight and affect multiple human populations before we have a chance to develop a vaccine, the health of these animal populations it's very important that we're aware of them. And actually that we try to keep them as healthy as possible.
REHMBarbara Natterson-Horowitz and Kathryn Bowers, co-authors of the new book titled, "Zoobiquity." And you're listening to "The Diane Rehm Show." Now to Salt Lake City, Utah. Good morning, Mario. You're on the air.
MARIOGood morning, Diane. Thank you for taking my call.
MARIOThe one point that the authors may be interested in and I'm sure they're aware of it, is that for many, many years, for 25 years, we and many other scientists have been modeling human disease in a mouse in order to then find out about human disease and use it as a platform to develop new therapies for the human disease.
REHMMakes sense, Barbara.
NATTERSON-HOROWITZYeah, absolutely. I mean comparative medicine you know, of course is old and there's a long and strong tradition of learning from animals. In fact, you know if you ask most physicians what we can learn from animals, they will point to the laboratory because that's sort of been traditionally. What "Zoobiquity" is offering is an expanded way to understand what we can learn from animals. By introducing this idea and the reality, actually, that animals get many of the same diseases that we get and that by learning about that and by talking to the doctors who take care of them we can improve our understanding of our own diseases.
REHMNow, here's an email from a veterinarian who says, "Human patients tend to lie to their doctors about their symptoms or cover them up. Do animals tend to lie or cover up their symptoms?" Kathryn.
BOWERSI would imagine that animals have ways of masking their behaviors. I mean the emailer is a veterinarian so he or she might know this better than I would, but certainly when an animal is in pain many of them tend not to show it, at least in the way that we're used to reading it. We're used to facial expressions and you know, we might vocalize when we're in pain. And if you imagine an animal in the wild, that might make them at greater risk for predation or they might draw too much attention to themselves when they're in a compromised situation. But again, I can only speak from the human perspective.
REHMGo ahead, Barbara.
NATTERSON-HOROWITZWell, I mean, it's a wonderful question. And one of the interesting things that we learned about wild populations is that, you know, the young and the infirm tend to suffer higher rates of predation. So there could certainly be an evolutionary advantage to concealing, you know, weakness or illness.
REHMBut you know we've also seen examples of the young in wild herds being protected by the mothers or by the elderly parts of the herd. Kathryn.
BOWERSOne of my favorite chapters to research and write was our chapter on adolescence. And we called it leaving the nest. I had never really thought about animals having an adolescent period, having the wild teenage years. But when you think about it every creature has to go from birth to adulthood and there's a transition period in between when they might not have their full complement of adult defenses and, you know, physical and mental defenses. And so there's this neurobiology that underlies risk taking, even sometimes being drawn to peers and social interactions at that age.
REHMKathryn Bowers and Barbara Natterson-Horowitz. The book is titled, "Zoobiquity" and the subtitle, "What Animals Can Teach Us About The Health And Science Of Healing," is just perfect. Thank you both. And thanks for listening all. I'm Diane Rehm.
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