Breeders have a very interesting tool these days
in the Internet and/or e-mail. Information gets out much faster than print
media can disseminate it. Among the accepted characteristics of such transmission
are slightly higher "I.Q." (inaccuracy quotients) and emotion levels. It
seems that these minor failings are forgiven in the informal tone of this
medium.
However, it still behooves anyone doing the work
of a journalist, commentator, or editor to be as accurate as possible,
for people tend to believe anything they see "in print". Recently, there
have been lively discussions on at least one list or website, excerpts
of which have been circulated to others. These deal with the latest development
in diagnostic-predictive techniques, and unfortunately fanciers have taken
sides based on less than complete information.
Understandable; I found in 35 years in chemical
marketing that people make decisions based not so much on logic or reasoning,
as much as on emotional leanings.
Here are some recent website quotes I've been
given, and my responses. I encourage you readers to make yourselves available
to one of my lectures.
Better yet, to schedule one. "Have slides,
will travel". E-mail me at Mr.GSD@juno.com for details. First, the
quotes and misinformation, then my answers.
Quote 1.: "(Some people) bought a dog and it turned out to be dysplastic at 2 years, when her (OFA) prelim at 10 months looked excellent. This may be an argument for using PennHIP, said to be more predictive. In the PennHIP X-rays, more laxity can be measured." This lister tries to be cautious yet seems to lean toward confidence in the newer (a decade now) method of screening dysplasia at younger ages.
Quote 2.: "... a bummer when that happens.
However, studies have not shown PennHIP to be more reliable in predicting
HD than OFA. In fact they show the opposite (JAVMA volume 21 #9 Nov
1, 1997); in referring to OFA: 'The study showed that a preliminary
evaluation of Excellent was 100% reliable; a preliminary evaluation of
Good was 97.9% reliable; a preliminary evaluation of Fair was 76.9% reliable...'.
Also, (Am J Vet Res 1993; 54: pp.1021 - 1042)
in referring to PennHIP:
'12% of the dogs evaluated as normal at 4 months
of age by the PennHIP method were later determined to have degenerative
joint disease. 48% of the dogs evaluated as abnormal at 4 months of age,
57% evaluated as abnormal at 6 months of age and 38% evaluated as abnormal
at 12 months of age by the PennHIP method did not have evidence of degenerative
joint disease at 24 months of age'. A second study on the PennHIP
method (Am J Vet Res; 1993; 54: pp.1990-1999) concludes that while a distraction
index less than 0.4 is 88% reliable for predicting normal hips, a
distraction index of greater than 0.4 is only 57% reliable for predicting
CHD. While no method would be 100% reliable, it would appear that the OFA
method is more reliable at early prediction of CHD. What bothers
me most about the PennHIP method is the very high percentage (38 - 57%)
of those dogs evaluated early where they predict CHD will develop, but
it doesn't.
Thus, if you use the PennHIP method for early
evaluation, you have a very good chance of eliminating a non-dysplastic
dog from your breeding program due to less than accurate results."
MY RESPONSE:
By
the way, while the veterinary community largely uses the abbreviation CHD
for Canine Hip Dysplasia, I use the lay practice of referring to it as
HD, since the context is always clear that we are talking about the disease
in dogs, not in humans or other animals. Now, as to the quote #2 above:
far from concluding that OFA is more reliable and accurate, the cited journal
references, which I have on the desk before me, can only logically lead
to the realization that the opposite is true, except for the Nov.1st, 1997
reference written by Al Corley and Greg Keller of the OFA. To be
fair, one must also read at the same sitting, the letter to the editor
on page 487 in JAVMA's vol. 212, #4, Feb. 15, 1998 which effectively refutes
those OFA conclusions. OFA statistics are skewed because not all films
are sent in; PennHIP requires ALL films, whether showing horrible hips
or not, be sent in and entered into the database. The OFA article did not
let readers know that apples were being compared to oranges --- that the
presumably higher rate of false positives PennHIP reports is a result of
different definitions. OFA says a dog is dysplastic if it has loose hip
joints, signs of arthritic changes or wear, or both. PennHIP diagnoses
frank HD on the basis of DJD (degenerative joint disease... bony changes
and remodeling). If they had included the lax-hip dogs not showing such
changes, the false-positive rates would be much lower. The PennHIP evaluation
not
only reports as dysplastic those with obvious
bone and cartilage abnormalities, but also gives an idea of the relative
risk of the particular dog developing such radiographic signs later. The
dog whose hip joint's femoral head looks tight and round on the OFA film
but shows considerable laxity on the PennHIP view is said by the latter
group to be at risk for later DJD. Which information would you want to
have?
Remember, the traditional position advocated by AVMA and OFA (as well as almost all other hip schemes of the past 35 years) is the leg-extended (hip-extended) one in which the ligaments of the hip joint capsule are wound tight like the rubber band in those toy airplanes we old fogies used to play with as kids. This tends to present an artificially tight appearance to all but the worst hips, and is certainly not representative of the forces at work in the standing or walking/trotting dog. The PennHIP scheme utilizes this hip-extended view in order to best see some features that might show DJD; by the way, if you want an OFA reading, the vet need only put two films into the cassette when taking this picture. The view with the dog's legs flexed in a position like standing, but upside-down, mimics actual forces. And when the hip joints are stressed in the distraction view (femurs and femoral heads pushed away from each other and the acetabulums) and then the difference in displacement measured from the picture given when they are pressed into the sockets, why then you have a numerical, objective value: something you can use to compare with others of the same breed, for example.
Now, let's look at the predictive value of OFA's
preliminary evaluations, and I won't go at length into why suddenly these
are supposed to be so accurate, when in 1972 OFA led the way to a 24-month
minimum for certification because of the inaccuracy of early diagnoses.
Let's assume that only the very worst hips will show bony changes, and
that the youngsters now being "prelim'ed" are judged primarily on laxity.
The OFA is happy to predict, on the basis of very tight joints IN THE HIP-EXTENDED
VIEW at a young age, that such an excellent appearance will continue to
look good at 2 years (minimum age at which to certify). But remember, the
view at 2 years is going to be the same type, that of an artificially wound-up
joint capsule. Surely, then, one would expect fairly good agreement between
the pictures at these two ages, especially if rated "Excellent" in the
AVMA position. However, if one applies the more stringent evaluation protocols
of the PennHIP method at the older age, one finds a disturbing number of
"OFA-normals" are indeed not normal in any sense that you and I would consider
so, such as compared with the mean or average in the breed. Even an unacceptably
high number of OFA-Excellents at 2 years will show up in the PennHIP view
to have worse hips than would otherwise be suspected. If you want to know
if a bridge can bear a load of 10 tons, you shouldn't expect to run a meaningful
test by driving your half-ton pickup over it. The dog also should be evaluated
in the strictest method in order to tell if the reading of "excellent"
has any validity. Otherwise, the breeder or the person driving a big truck
over a bridge may have a false sense of security.
Those
who look into professional journal articles should perhaps ask, "Where
are the data showing a link between OFA-defined laxity and later DJD?"
and "Where are the data on dogs diagnosed as dysplastic (based on laxity
at 24 months) but who never developed the bony changes?"
Since there is no such set of statistics,
one must conclude that hip-extended radiographic diagnosis (alone), even
at 24 months, is not "reliable" as the OFA's JAVMA article proposes, but
highly unreliable, or at best, unknown. Are you as a breeder satisfied
with repeatability (unfortunately described as reliability)? Suppose you
were William Tell's son, and you knew that your dad could shoot a dozen
arrows at the apple balanced on your head, with repeatability as to where
each would go --- would you be blithely unaffected by the concept that
his reliability (accuracy) might not be as good as his repeatability?
You would not want even the first arrow to fly,
would you? Diagnosing HD is not as threatening as that, but I for one would
want the most accurate as well as the most reliably repeatable evaluations
of my breeding stock's hips.
DJD
appears in some individual dogs and in some breeds at later ages than in
others. The breeder wants to know as early as possible, what the likelihood
is that his dogs might develop DJD, and therefore wants some sort of "marker"
or predictive evaluation before he sells or breeds. The panacea of gene
markers (looking at DNA and finding all the sequences that cause HD) is
not practical in our lifetimes (or at least not in our current dogs' lifetimes).
If anybody even were to come up with cheap testing of such polygenic traits,
this approach is still decades away.
The OFA study reported in that JAVMA article
did not include in its references any longitudinal studies to refer the
reader to, even though a year or so earlier such a report by Banfield,
Bartels, Hudson, et al showed almost no difference in dogs predicted to
develop degenerative changes and those described as having normal hips,
using the OFA-style methods. The 40 dogs described as "normal" at 2 years
of age all had some "minimal or mild degenerative changes" by 9 years of
age, and those 22 dogs diagnosed as dysplastic (lax joints in the hip-extended
view) at 2 years had the same mild or minimal changes. Why wasn't this
study included? Does it give you a warm feeling that you are using the
latest and most accurate diagnostic techniques by banking on the OFA readings?
We
shouldn't worry so much about false positives (a red flag that a dog might
become dysplastic, but doesn't) as we should about false negatives (the
dog is evaluated as normal, and later proves to be chock-full of "bad genes"
that his offspring inherit).
We would rather cull from the breed an occasional
good dog (there are many ready to take his place) than let some covert
fifth-columnist into the ranks to poison or sabotage the gene pool. In
the OFA system there are false-negative rates of about 83% in 6-month-old
German Shepherds, but in the PennHIP scheme, the rate is only 12% in 4-month-old
dogs and 0% at 6 months (as compared to the readings at 24 months). The
writer who complains about this 12% fails to acknowledge that using the
OFA approach on 4-month pups gave a false-negative rate of 24%, double
that of the PennHIP compression-distraction method. Even at 6 and 12 months,
the OFA-type predictive tests gave false-negatives of 15% and 12% and the
PennHIP stress-radiographic method showed zero false negatives for 6- and
12-month old dogs.
To rest one's case on the above-mentioned
"48% of the dogs evaluated as abnormal at 4 months of age, 57% evaluated
as abnormal at 6 months of age and 38% evaluated as abnormal at 12 months
of age by the PennHIP method" as not having "evidence of degenerative
joint disease" is to rest on the false positives. What of those dogs that
did not have DJD at 2 years of age, but more laxity than the average in
their breed?
Are you satisfied that they have as few bad genes
as do the dogs that were identified early as having a very low DI (distraction
index) and still do not have DJD in old age? The PennHIP method is a far
better revealer of genotype, and thus predictor of eventual DJD, in the
individual and its progeny.
It
should not be surprising to anyone that the looser the hips, the less accurate
that a prediction of a specific grade or severity might be. HD is
a developmental (DJD might not show up right away), progressive (it'll
eventually be worse), multifactorial (environment has a part to play in
the expression of the bad genes) disorder. Some dogs will get worse than
others even with the same DI at a young age. A DI of 0.4 is not all that
bad, nor all that good. You can pretty much guarantee your buyers
that the pup you sell them with a 0.3 will never have DJD (HD), but you
lose credibility with such a guarantee as that index creeps higher and
higher. You can think of an index of 0.4 as being "40% out of the socket"
if you want to oversimplify the picture, since the readings runs from a
hypothetical 0 (zero would mean no ability to move in the socket) to a
full luxation of 100% out of the socket, or DI of 1.0 (and of course in
the worst cases, the number can be over one, but those dogs will have bad
bone changes, too, so it doesn't take a rocket scientist to see they are
dysplastic). In many breeds, the mean or average laxity is around 0.4 and
it is worse in many other breeds. Some breeds can tolerate looser hips
than a GSD and have less development of arthritic degeneration in maturity.
The person who worried about the "38 - 57% of those dogs evaluated early
where they predict CHD will develop, but doesn't..." isn't adding
"at
two years of age",
and again ignores the much worse situation where
at least an equally high percentage of OFA-normal dogs might develop late-onset
DJD and/or pass on many bad genes to offspring. There is very good reason
to presume that dogs that have no signs of DJD but have an index higher
than the mean for their breed "represent a carrier state of the disease",
as mentioned in the second Am J Vet Res citation above. In other words,
it is a clearer picture of the genotype than the OFA approach gives.
Man has advanced over his prehistoric precedents
by using more tools, and we should progress in use of modern tools regarding
HD as we have from the Neandertal to the Stone Age to the Bronze Age to
the Machine Age, and to the Computer Age. PennHIP is such an advanced tool
for the serious breeder. The inescapable conclusions are that:
1. Tighter Is better;
2. Position and technique (better tools) can
discover covert laxity;
3. PennHIP is more accurate as well as reliable
and repeatable.
Most of the people on these Internet chat rooms and e-mail lists are not "professional people" by which in this context is meant trained veterinarians. Thus, it is natural that few would realize until pointed out to them, that there are significant differences between types of articles they read. Something that appears in a medical journal such as JAVMA are closely examined in a process called "peer review" before being edited and published. Both accuracy and logical reasoning are required, in addition to sound references and proper controls and procedures in the reported experimental work. On the other hand, articles that appear in newsletters, flyers, press or publicity releases, brochures, and the like, are not subject to such hurdles and requirements. The OFA press release that was carried by a number of breed magazines such as the Australian Cattle Dog publication in mid-1998 was a rather strongly biased advertisement for OFA business --- absolutely nothing wrong with that approach, by the way. The AVMA Journal version published Nov. 1, 1997 was what remained after the review process removed all the unsubstantiated claims. Now, such claims may be valid; it's just that in this case, they were not subjected to protocols regarding scientific method and therefore the "commercial version" may have been misinterpreted by some as having the weight of the reviewed version.
The
optimist in me sees the day when OFA leadership will have to admit the
superiority of new tools, adopt the PennHIP approach, and report such data
for the benefit of the breeder. The pessimist in me wonders if the parties
can put personalities aside and concentrate on science, and if I'll live
long enough to see this happen.
Fred Lanting, Canine Consulting: Mr.GSD@hiwaay.net
3565 Parches Cove Rd, Union Grove AL 35175-8422
Lectures & Seminars on
Orthopedic Disorders, Gait-&-Structure, Etc.