In Defense of Research

About that LMU accreditation lawsuit...

Lincoln Memorial University campus

As I write this, I’m sweating in a small studio apartment in West Philadelphia during a record-breaking heat wave, avoiding heatstroke through the heroic efforts of a tiny window AC unit that may die at any second. Why? This week I’m working at the University of Pennsylvania School of Veterinary Medicine. This august institution is one of the oldest vet schools in the US—it was established in 1884. Many of the buildings reference the founder and first president of the University: Benjamin Franklin. Working in such a historic setting has given me occasion to ruminate on tradition and standards in veterinary education.

Words of wisdom at the Penn bookstore. I try, Ben; I try

That brings me to the big news: Lincoln Memorial University (LMU), the largest vet school in the country, is suing the American Veterinary Medical Association over a feud about accreditation standards. Their main allegation is that the AVMA Council on Education (COE) is using research standards as a pretext to artificially restrict the number of vet schools in a conspiracy—the word is used 17 times in their complaint!—to restrict the supply of veterinarians, a classic antitrust violation. In their words:

“…the AVMA is using the AVMA COE to restrict the accreditation of new and existing veterinary schools by demanding that they meet arbitrary, unreasonable, and impossible-to-meet requirements entirely unrelated to the minimum quality of education necessary to graduate day-one-ready veterinarians with entry-level competency.”

I’m a little late to this story, you can read about the legal details at VIN News. My friend

William Tancredi, DVM

also wrote an insightful Substack post with his take on both the valid and the bunk parts of LMU’s claims:

Wild Accusations: LMU sues the AVMA

This is a touchy subject for me—I graduated from WesternU in 2012, the first of the new wave of vet schools. It too was controversial for its (then) novel Problem-Based Learning (PBL) curriculum and distributed clinical education model. Western also sued the AVMA on antitrust grounds in 2001, although the circumstances were somewhat different, and they ultimately withdrew the lawsuit. Besides that, my wife—and many friends—graduated from Ross University, one of several schools in the Caribbean. We’ve all been on the receiving end of condescending, sometimes degrading, remarks about our education, and even outright discrimination; though it is becoming less common, graduates from schools deemed “less prestigious” can have a harder time landing internships, residencies, or certain jobs.

So the last thing I want to do is turn around and denigrate the hard-working students and faculty at LMU; this lawsuit was a choice by their senior administrators, and in my opinion, it is not in the best interests of either group. My intention is to bring you my personal perspective about the value of academic research and why it should remain a critical piece of the veterinary education accreditation requirements.

The Evolution of Medical Education

Let’s start from the beginning. How did medical schools become the sprawling research campuses they are today? The main catalyst was the 1910 Carnegie Foundation report titled “Medical Education in the United States and Canada”, which came to be known as “The Flexner Report” after its lead author. Believe it or not, in the late 19th and early 20th century, there were over 155 medical schools¹, and many of them were poorly regulated diploma mills with inadequate facilities, unqualified faculty, and minimal admission standards. Most did not need a college education and some didn’t even require a high school degree! Plenty taught pseudoscience and quackery. Few states even licensed doctors to ensure their credentials or competency. It’s no wonder that nearly as many patients were harmed by doctors as helped!

Abraham Flexner (right) and his 1910 report (left)

For all of the low-quality programs, Abraham Flexner did find some admirable medical colleges. He praised Harvard, the University of Pennsylvania (you knew there would be a tie-in, didn’t you?), the University of Michigan, Wake Forest, and several others for their rigor, affiliation with busy hospitals, and strong scientific research programs. Flexner viewed Johns Hopkins in particular as a model, calling it a:

“…small but ideal medical school, embodying in a novel way, adapted to American conditions, the best features of medical education in England, France, and Germany.”

Flexner recommended multiple changes to the status quo:

1. Close poor-quality schools

2. Strengthen admission criteria and pre-requisite coursework

3. Implement research and training in the scientific method

4. Hire well-credentialed, full-time physicians

5. Put those faculty in charge of training in hospitals

6. Fund medical colleges publicly

7. Make physician licensing mandatory and robust

These reforms were swiftly implemented in both human and veterinary academia. Changes and tweaks have been made along the way, but Flexner’s vision formed the core model for modern medical education.

The Importance of Research

Far from being some impractical, abstract subject or an irrelevant luxury, biomedical research is critical to the success of veterinarians in multiple ways. Let’s dive into just a few…

It benefits animals AND people

Our pets are living longer, healthier lives than ever. This is due in large part to new tests and treatments we’ve discovered through research. In my previous post “Forgotten Medical Scourges,” I wrote about how veterinarians at UC Davis found the cure for the previously fatal viral infection FIP and discovered how to prevent cats dying from heart failure with a simple diet change. A team at Cornell’s vet school created the first vaccine against the terrible parvovirus that killed puppies.

Forgotten Medical Scourges

This research doesn’t only benefit pets! Veterinary pathologist James Thompson discovered how to make stem cells from regular tissues, which holds nearly limitless potential for regenerative medicine to treat conditions like spinal cord injury. He did this work at the primate center at the University of Wisconsin vet school. Faculty at Kansas State and other vet schools across the country contributed vital knowledge about SARS-CoV-2 during the COVID-19 pandemic, and to this day they are researching ways to protect ourselves from avian influenza. Many One Health researchers at CVMs are studying how to make agriculture more efficient and to mitigate the consequences of climate change.

These are but a few of the many, many breakthroughs that were made possible by research done at vet schools. As the LMU complaint notes, these efforts are expensive, labor intensive, and require elaborate facilities and equipment. But who else is going to do it??? Without institutions dedicated to studying animal health, this work would simply not get done. Giving schools a pass to cut their budgets and save money guarantees we will have fewer game-changing discoveries.

Scientific training teaches clinical reasoning

“Science” is not a set of facts set in stone, it is a process of investigation. It is de-centralized, self-critical, and continually updating what we know to be true. When new research data shows that a drug doesn’t work as well as we thought, and we stop prescribing it, that is not a failure of science, it is the process working as intended!

The scientific method shares many characteristics with medical problem-solving. Vets have an an educated guess to explain what is making Fluffy pee all over the house. Maybe it’s diabetes, or kidney failure, or a glandular condition? Scientists call that a hypothesis. In both cases, they need to be tested. Your vet might order bloodwork or x-rays as a first step to rule out some of those options. A research scientist conducts experiments, either in test tubes, animals, or increasingly in computer simulations, to try and prove their hypothesis right or wrong.

Both medical professionals and scientists learn about new developments in their field by reading studies in research journals. These are dense papers filled with data and statistics. Vet students participating in experimental projects get hands-on experience searching for this information and critiquing how reliable it is. This is necessary for them to be able to think critically on their own to dispel spin and marketing hype from drug and medical device companies that want you to use their products. Trust me, you don’t want either your doctor or your vet to be unable to read these studies!

Exposure to wider career opportunities

Vet students often have only a vague idea of what they want to do when they “grow up.” For much of their lives, the goal was just to get into vet school. Many have never heard about the myriad roles vets play in society besides small animal general practice. In just my own circle of classmates and friends, this includes full-time research scientists at the NIH, public health vets at the USDA, military vets deployed overseas, and pathologists who work in the pharmaceutical industry.

The only way people can discover these jobs is if they know they exist and can see if they’re a good fit. This is especially important if people find themselves burned out on clinical practice or wanting to pivot later in their career. Research rotations and externships in vet school are a critical bridge to these less common, but no less important, options.

My time working in the lab of Dr. Pedro Diniz at WesternU changed the course of my career. It turned me on to research, something I didn’t know I’d enjoy until trying it. Our study contributed to a change in the understanding of feline coronavirus biology and FIP testing. Other “alumni” of Dr. Diniz’s lab went on to become cardiologists, surgeons, critical care specialists, and wildlife vets, all of whom began their own research programs. My PhD work at Auburn with Dr. Curt Bird added novel insights to breast cancer in women and dogs and showed the potential of microRNA as a new blood test.

Where Do We Go From Here?

Look, I’m not saying there is no need for reforms in the current system. One of the requests from LMU is to separate the accrediting body from the AVMA itself, which is a large organization that combines many different functions, ranging from scientific research and publishing to liability insurance to political lobbying. There are arguments on both sides that have merit, I’m agnostic as to the exact solution.

If you read the current AMVA Council on Education policies and procedures manual, the research standards are vague! That certainly makes it possible to apply them differently across schools. Adding more objective metrics could improve transparency and fairness, although schools like LMU should be careful what they wish for: they might end up with black letter requirements they literally can’t meet.

What I hope we can all agree on is that scientific research is NOT “entirely unrelated” to graduating competent clinicians. Rather, it builds the foundation of veterinary medical education and has been instrumental in earning our profession the public trust we enjoy today. My grave concern is that substantially weakening these standards could undermine the very advances that protect our pets, secure our food supply, and safeguard public health.

Let’s hope the courts agree, or that the LMU administration decides to drop their suit.

—Eric

1. There are currently 195 medical schools in the US, despite the population being ~3.7x larger today than in 1910. A proportional number of medical schools in 2025 would be >700.