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A country boy in the big city

by
01 January 2016, at 12:00am

Gareth Cross heads out of the middle of nowhere for a run around some of London’s best tourist spots, experiencing a culture shock with the busy, voluminous and diverse offerings at London Vet Show.

“YOU can take the boy out of the country but you can’t take the country out of the boy” is an expression that was going through my head recently as I did a whistle-stop sightseeing tour of London at night.

As a trail runner who lives just outside the middle of nowhere I am used to being able to pee when the need takes me, but I discovered that in the well-lit and well-CCTV covered banks of the Thames in central London this is not so easy. Luckily some trees by the Tate Modern provided cover.

I had found myself in London as I was attending the London Vet Show and, with a night to kill, I thought a run round the sights was a good idea. (Online readers can view the route at https://connect.garmin.com/mod... activity/962235013). The biggest hazard was not muggers (they’d have to catch me first) but avoiding tourists with selfie sticks at every viewpoint. Even ones in a group took their own picture.

The whole two days turned out to be something of a culture shock as the LVS was extremely busy, both in the lectures and the exhibition hall. You could buy anything from a poo bag to an MRI scanner, and find service providers ranging from debt collectors to people to sell your practice to.

The sheer diversity and volume of different companies making a living from the veterinary sector always amazes me: how many livelihoods those few pence of profit from every worming pill or few pounds of profit from every transaction filter through into the wider veterinary industry.

I found it hard to believe what I was seeing could be sustainable until I did some back-of-an-envelope sums. The average turnover per vet in the UK is (or should be) a minimum of £200,000 per year. The 2014 LVS had just under 5,000 delegates and 2015 was busier so at a minimum estimate the vets trundling round the exhibition hall therefore represent £200k pa x 5,000. Which means that there was a staggering minimum of £1 billion of cash ow for the exhibitors to try and get a piece of just in that one conference.

A few things in the exhibition caught my eye, and in no particular order here’s a selection. A novel company called “Vetsec” which offers a service that will intercept engaged phone lines and unanswered calls and will answer them for you. It’s staffed by veterinary receptionists and nurses and they have access to your practice management system. Great for tackling that early morning rush or picking up enquiries lost to engaged lines.

There were some nice underwater treadmills including one that will come with its own ready-made outside cabin if required. Also a new drug, “Upcard”, a licensed torasemide which is similar to frusemide but better, and not just according to the people on the stand but also as discussed in the lectures.

A small company we have used for a while also had a tiny stand on an upstairs balcony with virtually no passers-by (I was annoyed with the organisers on their behalf). Called “Veenak”, it supplies non-licensed (i.e. human) medications a lot cheaper than the wholesalers.

At an evening function (where a drug company provided scanty portions of pizza) I met a non-vet who is an engineer and works in gait analysis. He showed me a photo of a gait analysis lab where horses were on treadmills and various large cameras were set up, all at huge hassle and expense.

“See all that,” he said. “I’m working on something that will do all that with an iPhone, and it will diagnose where a horse is lame.” As someone who has spent a few years as a horse vet and remembers the hazards of doing nerve blocks, I thought that sounded like a good idea.

Into the lectures and many were set up in halls curtained-off from the exhibition. Curtains provide no sound insulation so if you were near the edge there was a massive amount of background noise. Imagine attending a lecture in a Wetherspoons...

Some smaller rooms were utilised but some were so small that people queued and were turned away. The one ophthalmology lecture (it’s a dying art) had every seat full and every inch of carpet sat upon. Same for the dental stream. LVS is moving venue so I won’t go on about it but there were a lot of very disgruntled delegates who could not get into lectures they wanted to and because of the staggered start times could not then attend any others.

EBVM matters

I don’t have the space to recap any clinical details here but one theme emerged quite strongly this year that is worth exploring a little: that of using hard evidence to inform decision-making in clinical practice (i.e. evidence-based veterinary medicine or EBVM) and also the realisation from those giving the lectures that us out in general practice see far more cases of everything they see, and as such their evidence-base needs to take account of that. I attended lectures entitled “What’s the evidence for xyz” and found them extremely useful and quite an eye-opener as to the paucity of hard evidence for many of the things we do.

However, that isn’t always as bad as it seems. Adrian Boswood used the example of frusemide, and that there is very little placebo-controlled evidence for frusemide use in CHF in animals, as withholding it from patients for trials would be unethical.

The newly-licensed torasemide has led to some of the first clinical trials on frusemide for a long time as there is now a comparison drug. “Frusemide, like many other drugs we use, are like parachutes,” he said. “No one is going to do a placebo-controlled trial for jumping out of a plane with or without a parachute. We know it works and giving someone a placebo parachute would be unethical.”

Adrian should also be applauded for insisting he has a “right to publish” clause in any research he undertakes to ensure he can publish negative data. Fans of Dr Ben Goldacre will be aware of the scourge of publication bias.

Many of the lecturers across the board expressed the need for information and clinical data to ow up from GPs into academia, not just the other way. This was highlighted during Andy Sparkes’ talk on feline idiopathic cystitis, something us GPs deal with all the time and rarely get referred. This was a refreshing and entirely logical change from the old- fashioned approach of top-down lecturing. “Vet Compass” is one such project hoping to make this a reality and more about that later in the year.

There were also some review lectures, e.g. on NSAID use in general practice and on epilepsy treatment. It’s tempting to attend the most exciting whiz-bang cutting-edge stuff at these events, but the reality is that we all do dentals and prescribe NSAIDs every week, maybe see an epileptic every month, so attending a review on their use is of much more bene t to your patients’ health and welfare than listening to a half-hour lecture on a technique you may never use, and certainly shouldn’t after one lecture!

On the subject of whiz-bang exciting stuff, Noel Fitzpatrick had constructed a sort of gold sh bowl in the centre of his exhibition space and could be seen holding court on occasion. I am not being overly critical – I think his TV series is a great thing for the profession.

Conferences are also the ideal time to attend a few esoteric lectures you would never do a whole day’s CPD on: I remember one year at BSAVA congress one of the busiest lectures was the backyard chicken one.

London, like the conference, was good to visit but you wouldn’t want to live there. I bumped into a friend from uni who owns three practices a cycle ride from the LVS. “They are doing well,” he said, “but for all the hard work it’s a bit depressing that my house will have made more money than I will have done by the time I retire.” A conference is all about bringing people together and spreading new ideas, and generating discussion. So as it drew to a close and 5,000 vets from far and wide headed home, full of new ideas and knowledge, I thought that the ideal outcome from such an event could be best summed up in Philip Larkin’s words: ...and it was nearly done, this frail Travelling coincidence; and what it held Stood ready to be loosed with all the power That being changed can give.