This was not the article I expected. My experience is that vets are like doctors yesterday for a different reason.
I tore my ACL this year. Last year, my dog tore his.
One thing I learned when talking to (UK) doctors about my ACL is that there has been a lot of recent evidence-based medicine about surgical interventions. As a result, surgeons are less gung-ho: it turns out, quite often, surgery just doesn't do much good compared to physio.
By contrast, when I looked at the literature for animal cruciate ligament treatment, it's... oh gosh. I went into depth on this. In 2003 there was an article pointing out that there was almost no scientific evidence for most of the existing treatments. Ten years later, there was a review article which essentially said "oh, now the evidence is much better, we can rest easy". It categorized the research into four categories, the best one being credible randomized controlled trials. So I looked at the top category. The only RCT I found had about 40 animals, with substantial dropout (very likely non-random). There's a lot of natural improvement, and tiny effects from treatment, with significant results for some (out of many!) measured dependent variables.
After reading the top category, I didn't bother with the rest. What a disaster!
Cruciate ligament treatment for dogs is a $1bn industry. But there's just no decent science being done. It's all tests of 8 dogs without a control group, done by some guy pushing his new methodology. Honestly, it's shameful.
By contrast, one of the strengths of the NHS is maybe that it can knock heads together , get large-scale RCTs going, and learn something.
there's actually a lot of evidence that cruciate surgery improves return to function, but you're right- a lot of vets unfortunately recommend surgery for the wrong reasons (unwittingly or not).
Surgery only really makes a difference in moderate to severe tears or those with meniscal injury. There's 4+ different ways to fix a cruciate. Half of them are useless (and evidence shows no difference c.f. conservative treatment) and if a surgeon recommend them I would see it as a red flag.
Interestingly a lot of pet owners could not go to surgery because of the recent COVID lockdowns, and it was found that a lot of those animals healed well with just some rest anyway.
The linked article looks like a way to skirt the use of Human Growth Hormone by athletes. Is it doping if it's to cure an ACL injury? Such a grey area...!
medecine is highly emotional, if you give people the choice of doing nothing vs doing something/anything people will, out of shame, do that thing. There has to be a strong cultural, evidence based, or other, justification to do nothing. Probably not the case most of the time, and it's going to stay that way, because as you mentioned, there's a boatload of money to be made out of it and careers depend on it.
Doing something, anything is very much the american school of thought. In Europe, people are often very happy if they can just do nothing. Incidentally, that's also the real reason why US healthcare is so much more expensive.
> if you give people the choice of doing nothing vs doing something/anything people will, out of shame, do that thing.
That’s an awfully broad generalization. Anecdotally I prefer to avoid intervention though I don’t mind going to the doctor in case that would be the wrong choice.
I am the child of a doctor so I wonder if that influenced my attitude.
The veterinary industry for pets in the US is about 100 billion dollars a year. I think assuming 1% of that is cruciate ligament treatment/surgery is probably a bit too high but it is a pretty common problem for dogs and surgery is a pretty expensive intervention so I am not sure. Its at least 100s of millions though.
I tore my ACL this year. Last year, my dog tore his.
One thing I learned when talking to (UK) doctors about my ACL is that there has been a lot of recent evidence-based medicine about surgical interventions. As a result, surgeons are less gung-ho: it turns out, quite often, surgery just doesn't do much good compared to physio.
By contrast, when I looked at the literature for animal cruciate ligament treatment, it's... oh gosh. I went into depth on this. In 2003 there was an article pointing out that there was almost no scientific evidence for most of the existing treatments. Ten years later, there was a review article which essentially said "oh, now the evidence is much better, we can rest easy". It categorized the research into four categories, the best one being credible randomized controlled trials. So I looked at the top category. The only RCT I found had about 40 animals, with substantial dropout (very likely non-random). There's a lot of natural improvement, and tiny effects from treatment, with significant results for some (out of many!) measured dependent variables.
After reading the top category, I didn't bother with the rest. What a disaster!
Cruciate ligament treatment for dogs is a $1bn industry. But there's just no decent science being done. It's all tests of 8 dogs without a control group, done by some guy pushing his new methodology. Honestly, it's shameful.
By contrast, one of the strengths of the NHS is maybe that it can knock heads together , get large-scale RCTs going, and learn something.