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TEDMED 2014

Barbara Natterson-Horowitz: What veterinarians know that physicians don't

September 16, 2014

What do you call a veterinarian who can only take care of one species? A physician. In a fascinating talk, Barbara Natterson-Horowitz shares how a species-spanning approach to health can improve medical care of the human animal -- particularly when it comes to mental health.

Barbara Natterson-Horowitz - Cardiologist
Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health. Full bio

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Double-click the English subtitles below to play the video.
Ten years ago,
00:13
I got a phone call that
changed my life.
00:14
At the time, I was
cardiologist at UCLA,
00:18
specializing in cardiac
imaging techniques.
00:22
The call came from a veterinarian
at the Los Angeles Zoo.
00:26
An elderly female chimpanzee
00:31
had woken up with a facial droop
00:34
and the veterinarians were worried
that she'd had a stroke.
00:37
They asked if I'd
come to the zoo
00:40
and image the animal's heart
00:43
to look for a possible
cardiac cause.
00:45
Now, to be clear, North American
zoos are staffed
00:49
by highly qualified,
board-certified veterinarians
00:52
who take outstanding
care of their animal patients.
00:56
But occasionally, they do reach into
the human medical community,
01:01
particularly for some
speciality consultation,
01:05
and I was one of the lucky physicians
who was invited in to help.
01:10
I had a chance to rule out
a stroke in this chimpanzee
01:16
and make sure that this gorilla
didn't have a torn aorta,
01:22
evaluate this macaw
for a heart murmur,
01:28
make sure that this California sea lion's
paricardium wasn't inflamed,
01:33
and in this picture, I'm listening
to the heart of a lion
01:40
after a lifesaving,
collaborative procedure
01:45
with veterinarians and physicians
01:48
where we drained 700 cc's of
fluid from the sac
01:51
in which this lion's
heart was contained.
01:55
And this procedure, which I have
done on many human patients,
02:00
was identical, with the exception
of that paw and that tail.
02:05
Now most of the time, I was working
at UCLA Medical Center with physicians,
02:14
discussing symptoms
and diagnoses and treatments
02:20
for my human patients,
02:25
but some of the time,
I was working at the Los Angeles Zoo
02:29
with veterinarians, discussing
symptoms and diagnoses and treatments
02:32
for their animal patients.
02:37
And occasionally, on
the very same day,
02:40
I went on rounds at
UCLA Medical Center
02:45
and at the Los Angeles Zoo.
02:49
And here's what started coming
into very clear focus for me.
02:52
Physicians and veterinarians
were essentially taking care
02:58
of the same disorders in their
animal and human patients:
03:02
congestive heart failure, brain tumors,
03:08
leukemia, diabetes,
arthritis, ALS, breast cancer,
03:12
even psychiatric syndromes
like depression, anxiety,
03:20
compulsions, eating disorders
and self-injury.
03:26
Now, I've got a confession to make.
03:32
Even though I studied comparative
physiology and evolutionary biology
03:35
as an undergrad --
03:42
I had even written my senior
thesis on Darwinian theory --
03:44
learning about the
significant overlap
03:48
between the disorders of
animals and humans,
03:51
it came as a much needed
wake-up call for me.
03:54
So I started wondering,
with all of these overlaps,
04:00
how was it that I had never
thought to ask a veterinarian,
04:04
or consult the veterinary literature,
04:10
for insights into one
of my human patients?
04:12
Why had I never, nor had any of my
physician friends and colleagues
04:16
whom I asked, ever attended
a veterinary conference?
04:23
For that matter, why was
any of this a surprise?
04:30
I mean, look, every single physician
accepts some biological connection
04:36
between animals and humans.
04:42
Every medication that we prescribe
or that we've taken ourselves
04:45
or we've given to our families
04:50
has first been tested on an animal.
04:52
But there's something very different
04:56
about giving an animal a
medication or a human disease
04:58
and the animal developing
congestive heart failure
05:04
or diabetes or breast cancer
on their own.
05:08
Now, maybe some of the surprise
05:15
comes from the increasing
separation in our world
05:17
between the urban and the nonurban.
05:21
You know, we hear about these city kids
05:25
who think that wool grows on trees
05:27
or that cheese comes from a plant.
05:32
Well, today's human hospitals,
05:36
increasingly, are turning into these
gleaming cathedrals of technology.
05:38
And this creates a psychological
distance between the human patients
05:45
who are being treated there
05:50
and animal patients who
are living in oceans
05:53
and farms and jungles.
05:57
But I think there's an
even deeper reason.
06:01
Physicians and scientists, we accept
intellectually that our species,
06:06
Homo sapiens, is merely
one species,
06:13
no more unique or
special than any other.
06:16
But in our hearts, we don't
completely believe that.
06:22
I feel it myself when I'm
listening to Mozart
06:28
or looking at pictures of the
Mars Rover on my MacBook.
06:32
I feel that tug of
human exceptionalism,
06:38
even as I recognize the
scientifically isolating cost
06:43
of seeing ourselves as a
superior species, apart.
06:48
Well, I'm trying these days.
06:54
When I see a human patient
now, I always ask,
06:57
what do the animal doctors know
about this problem that I don't know?
07:02
And, might I be taking better
care of my human patient
07:07
if I saw them as a human
animal patient?
07:12
Here are a few examples of the
kind of exciting connections
07:19
that this kind of
thinking has led me to.
07:23
Fear-induced heart failure.
07:27
Around the year 2000,
07:30
human cardiologists "discovered"
emotionally induced heart failure.
07:33
It was described in a gambling father
who had lost his life's savings
07:40
with a roll of the dice,
07:45
in a bride who'd
been left at the alter.
07:48
But it turns out, this
"new" human diagnosis
07:53
was neither new, nor
was it uniquely human.
07:58
Veterinarians had been diagnosing,
treating and even preventing
08:02
emotionally induced
symptoms in animals
08:08
ranging from monkeys to flamingos,
from to deer to rabbits,
08:12
since the 1970s.
08:18
How many human lives
might have been saved
08:22
if this veterinary knowledge
had been put into the hands
08:26
of E.R. docs and cardiologists?
08:29
Self-injury.
08:34
Some human patients
harm themselves.
08:37
Some pluck out patches of hair,
08:41
others actually cut themselves.
08:45
Some animal patients
also harm themselves.
08:50
There are birds that
pluck out feathers.
08:53
There are stallions that repetitively
bite their flanks until they bleed.
08:57
But veterinarians have very specific
and very effective ways
09:05
of treating and even
preventing self-injury
09:10
in their self-injuring animals.
09:14
Shouldn't this veterinary knowledge
be put into the hands
09:18
of psychotherapists and
parents and patients
09:21
struggling with self-injury?
09:25
Postpartum depression and
postpartum psychosis.
09:29
Sometimes, soon after giving birth,
09:34
some women become depressed,
09:37
and sometimes they become seriously
depressed and even psychotic.
09:39
They may neglect their newborn,
09:44
and in some extreme cases,
09:46
even harm the child.
09:48
Equine veterinarians also
know that occasionally,
09:51
a mare, soon after giving birth,
09:56
will neglect the foal,
refusing to nurse,
09:59
and in some instances,
kick the foal, even to death.
10:02
But veterinarians have devised
10:08
an intervention to deal with
this foal rejection syndrome
10:11
that involves increasing
oxytocin in the mare.
10:17
Oxytocin is the bonding hormone,
10:21
and this leads to renewed interest,
10:24
on the part of the mare, in her foal.
10:27
Shouldn't this information
10:30
be put into the hands of ob/gyn's
10:32
and family doctors and patients
10:36
who are struggling with postpartum
depression and psychosis?
10:39
Well, despite all of this promise,
10:47
unfortunately the gulf between
our fields remains large.
10:49
To explain it, I'm afraid I'm going
to have to air some dirty laundry.
10:57
Some physicians can be real snobs
11:02
about doctors who are not M.D.'s.
11:06
I'm talking about dentists and
optometrists and psychologists,
11:09
but maybe especially animal doctors.
11:15
Of course, most physicians
don't realize that it is harder
11:20
to get into vet school these
days than medical school,
11:23
and that when we go
to medical school,
11:28
we learn everything
there is to know
11:30
about one species, Homo sapiens,
11:33
but veterinarians need to learn
about health and disease
11:36
in mammals, amphibians,
reptiles, fish and birds.
11:40
So I don't blame the vets
for feeling annoyed
11:45
by my profession's
condescension and ignorance.
11:50
But here's one from the vets:
11:56
What do you call a veterinarian
11:58
who can only take
care of one species?
12:02
A physician. (Laughter)
12:08
Closing the gap has become
a passion for me,
12:11
and I'm doing this
through programs
12:17
like Darwin on Rounds at UCLA,
12:20
where we're bringing animal experts
and evolutionary biologists
12:23
and embedding them
on our medical teams
12:29
with our interns and our residents.
12:33
And through Zoobiquity conferences,
12:37
where we bring medical schools
together with veterinary schools
12:40
for collabortive discussions
12:45
of the shared diseases and disorders
12:47
of animal and human patients.
12:50
At Zoobiquity conferences,
12:54
participants learn how treating
breast cancer in a tiger
12:56
can help us better treat breast cancer
13:02
in a kindergarten teacher;
13:05
how understanding polycystic
overies in a Holstein cow
13:08
can help us better take care
13:13
of a dance instructor
with painful periods;
13:15
and how better understanding the
treatment of separation anxiety
13:20
in a high-strung Sheltie
13:24
can help an anxious young child
struggling with his first days of school.
13:27
In the United States and now
internationally, at Zoobiquity conferences
13:34
physicians and veterinarians check
their attitudes and their preconceptions
13:40
at the door and come
together as colleagues,
13:46
as peers, as doctors.
13:52
After all, we humans
are animals, too,
13:58
and it's time for us physicians to embrace
14:04
our patients' and our own animal natures
14:07
and join veterinarians
14:12
in a species-spanning approach to health.
14:14
Because it turns out,
14:19
some of the best and
most humanistic medicine
14:21
is being practiced by doctors
whose patients aren't human.
14:26
And one of the best ways
we can take care
14:32
of the human patient is by
paying close attention
14:35
to how all the other
patients on the planet
14:40
live, grow, get sick and heal.
14:44
Thank you.
14:51
(Applause).
14:53

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Barbara Natterson-Horowitz - Cardiologist
Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health.

Why you should listen
Barbara Natterson-Horowitz is a cardiologist whose patients include gorillas, lions, wallabies and humans. Her medical rounds sometimes take place at the Los Angeles Zoo, or might include veterinarians in a discussion of human health at the Ronald Reagan UCLA Medical Center, but always channel the perspective of Charles Darwin. A professor in UCLA’s Division of Cardiology and in the Department of Ecology and Evolutionary Biology, Natterson-Horowitz's medical specialty is cardiac imaging -- but her academic passion is the evolutionary connection between human and animal bodies and minds. In 2012, she co-authored the book Zoobiquity: The Astonishing Connection Between Human and Animal Health, advocating a “One Health” approach to medicine. She founded the Zoobiquity Conferences to bring veterinarians and physicians together for “species-spanning” debates and collaborations.
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