When consulting with people for medical advice (I emphasise medical because I am a biologist, which affects the story in ways that will become clear), I find myself in a mental state that I'm going to call "scientific entitlement." I could even use the phrase "scientific privilege" without stretching the bounds too much.
My reasoning is this: medical personnel have to simplify things in order to communicate with patients and patient families. That's just how it is. Biology is amazingly complex - I usually describe the study itself as the imposition of order on chaos (although more specifically I'm referring to taxonomy when I use that phrase). You do need background information to understand what's going on.
Really good medical personnel will take the time to use metaphors, draw diagrams and so forth, and make sure that patients have as much relevant information as they can be expected to usefully process. I tend not to tolerate anything less than this effort. I want to be involved in a dialogue for any relevant medical care.
Here's where my entitlement/privilege comes in: while I'm not a medical researcher (or, as will become relevant below, a vet), I do have a higher capacity to usefully process this information than the general layperson. I can process more of it, at a deeper level. In fact, due to the level of my biological knowledge, I can actually parse a limited (very limited) subsection of the primary scientific literature. I may not evaluate the quality of studies to the same standards, as I really am not an expert.
Here's where another valuable cliche enters the scene: a little knowledge is a dangerous thing. If I only know enough to draw broad conclusions, without a good grasp of subtlety, I'm going to miss the nuance of the situation, and come to the wrong conclusion. A really blunt example is how so many people think that rising levels of CO2 will be good for the environment because "it helps trees breathe." This completely overlooks the vast complexity of climatic systems, ecology, botany and so on and so forth. It comes to an entirely erroneous conclusion and the consequences (should this person be in a position of power) could contribute to catastrophe.
So! Because I know that a little knowledge is a dangerous thing, I have a strong tendency to trust experts in their field to parse information accurately. Other people have to trust me for information (obviously not medical information, and the stakes are somewhat lower, but I can't explain what I do from first principles every time someone asks me a question). I know how much work and study is involved in becoming useful in a lot of these fields - it's vast. It's not something I can reach with just a little cross-disciplinary reading, and it would be exceptionally arrogant of me to think that I could.
That trust there is important to me. However, we're back to scientific entitlement again: I want a basic mechanistic understanding of what's going on. I am never going to accept "Because I said so." I will accept "A whole whackload of peer-reviewed studies have shown..." and/or a list of pros and cons. I do not mean to disrespect experts in their field. I just have a high level of respect for my own independence and decision-making capacity. If someone else asks me why I have taken a particular course of action, I'm not going to just say, "Because the doctor thought it was a good idea." Unless I am very tired, that is.
Understanding situations - even in the ballpark way that a good medical expert can enable for a person outside that field - makes me feel safe and confident.
That's why I got very angry with the surgeon at the Royal Melbourne who wanted to perform a procedure on me with a local anaesthetic when I knew from fifteen years experience with the condition that the local would not be very effective. He said, "You won't feel a thing." This was a lie. It was an outright freaking lie to get me to cooperate and make their life easier. It also conflicted with what four other medical staff had said to me in the previous 24 hours.
And - finally we get to the point - it's why I am very, very angry with our vet (the older one. The younger one is alright so far).
I take veterinary care very seriously. I am deeply invested in the welfare of my puppy. Yesterday, we took little (22kg) Amos to the vet for what turned out to be gastritis from eating rocks (he's very intelligent. Really. Eating rocks. Hell). While I was there, I took the opportunity to ask various questions (His food is really expensive, we'll keep him on it if you think it's a good idea, but what other options would be acceptable once this critical growth period has passed?, also, Are his teeth coming in okay and when will he finish teething?).
I asked one other question - to be blunt, I asked if his testes were descending okay. He's at the stage where they are starting to form as little lumps, and I know that it's possible for hernias to happen in dogs (actually, in all mammals, thanks to my friend Josie for the tale of her poor little guinea pig who decided to keep his intestines in his scrotum, just for shits and giggles apparently. He's fine by the way). I don't know how that system is supposed to work as male pups grow up, so I asked.
She said he was fine - absolutely normal - and then asked the question, "Are you going to desex him?"
Put on your controversy hats, people.
I do not - at this point - plan to desex my dog.
I do not have a moral objection to it. I don't think it's cruel. I don't feel it somehow makes him less cool or macho. I don't begrudge the money for the operation (although putting him under a general makes me nervous, but I realise that is probably slightly irrational).
In fact, I think that male* desexing is a good tool for population control with the following caveats:
1) in cats
2) in dogs that roam
3) when owners are not able to keep their dogs inside
4) in the case of medical need
5) in smaller dogs where the negatives (aha, we shall see presently) are less apparent
6) when, for whatever reasons, the benefits outweigh the risks
(*just so you know: I refer to male desexing for specific reasons. It is a much less invasive procedure than female desexing, which appears to be good thing to do in some cases for health reasons - I have done much less research on this - and female desexing of dogs that do not roam is less of an issue of population control. The issues are not equivalent for both sexes. There's an interesting aside to this I'll mention later)
Right. So now that we've established I'm not taking this stance for stupid emotional reasons, let's look at why I am.
I was initially planning to snip the boy at six months, which is the standard (in Australia. This is relevant, by the way). The benefits of de-sexing one's male dog are generally supplied to us, the general, non-veterinary public, as a scientific consensus - much in the same way as the benefits of vaccination, the reality of global warming, and the link between smoking and lung cancer are supplied as scientific consensus. As it happens, I know what scientific consensus looks like, and these latter three items qualify.
Desexing your male dog as beneficial? Not so much. Especially not in the last decade, when a number of studies - largely observational and epidemiological, admittedly, but applied with a great deal of statistical rigour - have examined the long-term and short-term risks and benefits of a gonadectomy.
I was particularly concerned by a paper that came to my attention showing a ridiculously strong link between early desexing in Rottweilers and the development of osteosarcoma. In this case, they define early as "less than one year of age." Now, Rottweilers were the target breed for the study because they already have a genetic predisposition to osteosarcoma. The sample size was fairly good, although I am going to have to look into appropriate sample sizes for epidemiological studies (it's not my area, and standards vary - epidemiological studies tend to provide quite noisy data, so you need higher sample sizes. It's just under 700 animals, though, which sounds good to me, particularly with such a strong effect).
It turned out that rotties that were desexed were nearly four times more likely to develop osteosarcoma; this is suggested to be related to the link between sex hormones and bone deposition. Let me repeat: they were four times more likely to develop a condition that they already prone to develop.
For anyone who doesn't know - Amos, the canine apple of my dog-loving eye, is a Rottweiler. He's about five months of age and is at this moment developing beautifully.
I did look for other studies that criticised this one. I have so far found nothing conflicting with this result. In fact, a subsequent epidemiological study included a number of other breeds and found that the risk factor for osteosarcoma was related to (1) size and (2) neuter status. Large dogs are more likely to develop osteosarcoma. Large, desexed dogs are way more likely to develop osteosarcoma.
The potential confounding factor is this: maybe owners that are "responsible enough" to desex their dogs and more likely to follow up and biopsy their sick dogs. I think this could be controlled for by look at well-loved breeding line dogs - obviously not desexed, but still cared for.
So, I raised this point with the vet.
"Rubbish!" she said. "It's absolute rubbish. How many times can I say it? You can't just read websites, you have to go to the actual study."
I explained that I had, and that I was actually a PhD geneticist, so I did go and read the articles.
Her comeback? "I've operated on three dogs with osteosarcoma that were entire [not desexed]."
Alright. So first you assume I haven't done my research - fair enough, it may be not be that common - and then you give me anecdotal evidence.
That's like me saying "I know three old women who chain smoked every day of their adult lives and lived to be ninety-six with no sign of lung cancer." In no way does that mean there is no link between smoking and lung cancer. It's not a predictive model - it's a risk ratio. I know that, and she knows that (and if she doesn't, she shouldn't be a vet).
I said I wanted him to reach his full growth. She replied - and be prepared - that sex hormones were only for sex and reproduction, and had nothing to do with growth (or bone deposition).
Uh-huh. Soooo. Why are women at higher risk of osteoporosis after menopause? Why are women who started their menstruation very late at even greater risk of osteoporosis after menopause? Lower exposure to oestrogen = increased risk. Is the exact mechanism understood? I don't believe so. It's probably far more complex than that; correlation does not equal cause.
Why are desexed male dogs generally smaller and more slender than entire male dogs, regardless of breed? I know Rottweiler breeders who point out that desexed rotties look much more like bitches, which is not unexpected, and is a function of growth.
Either she's lying to me, or she's stupid.
Actually, that's harsh: what I suspect is that she is trying to simplify. The thing is that every hormone in your body probably has multiple functions and cascade effects. It is nowhere as simple as this "this hormone does this"; it has to be explained that way to an extent for understanding, but to present it as convincing truth is insulting (I am admittedly a population geneticist, but I have been to enough talks on gene expression to understand how amazingly complex and multifaceted any single gene product or biochemical pathway can be).
It also does nothing to alleviate my concerns. If she is trying to convince me to do something I am not inclined to do, that relies on trust. She has repeatedly damaged that trust already by using crap tactics to try and convince me.
If she had a problem with the basic hypothesis - that sex hormones are necessary for adequate bone deposition and that in larger dogs with dense bones the absence of those sex hormones can lead to bone problems - she should have explained why. And I don't care if she thinks she's too busy (the clinic was not busy); I don't care if she thinks it's beneath her. I've raised a concern.
Don't dismiss my concerns. Rebut them effectively.
But it gets worse, gentle reader. I stand my ground.
"Well, I just hope it doesn't backfire," she snaps. "Because I'm the one who's going to have to euthanase him when he bites someone from frustration."
Oh, you did not just do that. She's gone from "trusted expert" to "non-trusted expert" to "manipulative tool" in about five minutes of conversation.
Firstly, you've just implied that I can't adequately train my dog to not bite people unless we cut his balls off. Second, you've now said that you're going to have to kill my dog. And third, you've now implied that killing my dog is going to be most terrible for you. Look, I understand that euthanasing animals must be terribly difficult. I would find it heartbreaking. But I think it might be a tad worse for the owner who loves the animal. I think that they are the ones who will be mourning and grieving. I think that it's an unpleasant and upsetting part of your job. It's not comparable.
At this point I am distinctly less friendly. I have now moved on to explain that we have had three non-desexed Rottweilers and none of them bit anyone (this is not strictly true. Baron once bit my cousin Andrew on the backside under extreme stress and weird conditions. Andrew behaved in a way around the dog that he had been repeatedly told not to, and my Dad had a broken leg and was vulnerable which would have put Baron on edge. Baron thought he'd caught the burglar - he'd done Schutzhund training and had been taught that this was how burglars behave - and was very pleased with himself. He did what he was trained to do and I don't consider the example applicable to the discussion, although I disclose it in the interests of honesty).
The vet was visibly shocked by this report (I am shocked that she was shocked. What the hell do people do with their dogs? Don't they train them or socialise them? There is no way she should be expecting to euthanase a non-desexed dog of any breed on spec) and said, "Fine, I'll change my mind." I said, "Don't change your mind because of that. That's three data points."
And here we get to the nub of the matter: vets, like doctors, have an agenda of public health. That is, I've concluded, their primary goal. For that reason, they must assume - politely - that people are irresponsible, absent-minded and potentially a bit useless (unless demonstrated otherwise, please?).
A vet for this reason probably has to assume that the owner of a large, territorial male Rottweiler...
1) will not train their dog properly (so angry. We work so hard on this, and I do so much research, and we put our money where our mouth is twice a week, and I'm paying $120 to go to a seminar to improve my training skills because I think this is so important)
2) will not keep their dog restrained, which will result in aggression, and unplanned puppies (also angry. We plan to spend some extensive time and money reinforcing the fencing around our property because if my Rottie gets out, I'm going to have bigger concerns than whether or not he's located a convenient bitch in heat and produces unplanned puppies).
I'm not saying that, at the core of it, shit doesn't happen. Shit does happen. The bumper sticker would not fare so well otherwise. You can train a dog to near-perfection and they can still crack it in a particular situation. But desexing my dog is not guaranteed to help this.
Believe it or not, the jury is actually still out on whether desexing reliably reduces aggressive behaviour. I have read studies that show that it does, and studies that show it does not affect the behaviour, and studies that show the reverse trend (an increased risk factor for desexed male dogs to be aggressive). I have also noticed a fairly consistent trend that desexed female dogs are more aggressive on the whole than entire female dogs - not to the extent where I'd refuse to desex a bitch if I thought it necessary for other reasons, but it's worthy of consideration in the overall equation.
The fact is that I don't think this vet, who may well be quite busy, is keeping up with the research. I feel that she is lazily toeing a party line. I think that during the consultation I made it pretty clear that I love my dog, that I am a responsible owner, and that I consider research and evidence to be important in making decisions about his welfare. I don't think I deserved the assumptions shown above - initially, fine, because she's never met me, but five minutes into the conversation we should have worked out where I stood on the matter.
Maybe she's just prejudiced against people who like Rottweilers? That would be odd in a vet, but it does happen in the general public.
Since that interview, I've gone back to Web of Science and dug up more papers on gonadectomy, aggression, and associated health risks. Of course there are ways in which gonadectomy is beneficial for health. These are well publicised. The downsides, though, aren't well publicised. An increased risk of incontinence and lower urinary tract diseases (including cancers), an increased risk of osteosarcoma in larger breeds, and a greatly increased tendency towards cognitive impairment in old age (basically doggy dementia in the twilight years).
Multiple papers advise that, while desexing male cats is basically a clear recommendation, desexing female cats, and female and male dogs, should be weighed up for each individual circumstance, as the risks are going to be different in each case, and the benefits are less clear.
This is not brain surgery. One size does not fit all. Do not tell me that it does, regardless of having to deliver a homogenous public health message.
So now, I'm looking for a vet in my area who will not lie to me, fudge the facts, insult me, or imply that I'm going to have to euthanize my dog.
I'm not saying I'll never desex him. At the moment, the evidence does not recommend it.
