"I've never seen a dividing line between human and animal medicine"
A pioneering vet and star of Channel 4’s The Supervet, Professor Noel Fitzpatrick is using his profile to try to unite the fields of animal and human biomedical research
The Biologist 64(5) p26
Born in Laois, Ireland, Professor Noel Fitzpatrick specialises in neuro-orthopaedic veterinary surgery and has developed a range of bioengineering techniques – including stem-cell seeded bone implants and bone-anchored prostheses – that he believes should be used in human medicine. His clinic, Fitzpatrick Referrals, employs more than 200 staff at two locations in Surrey.
He rose to prominence in the 2010 TV series The Bionic Vet, after fitting two prosthetic feet to a cat called Oscar who had been injured by a combine harvester. After the operation, a world first, Oscar became known as 'the bionic cat'. Fitzpatrick went on to become 'the Supervet', the unconventional star of Channel 4's long-running show of the same name, known for his bespoke bioengineered devices.
The Biologist has come to Fitzpatrick's main clinic in Eashing, Surrey, to talk about his work and his mission to get the fields of veterinary practice, animal science and human medicine to work together and share data more.
Tell me about your initiative to encourage greater collaboration between veterinary and biomedical research.
I've never understood why my dog couldn't have the same medicines that were available to me. I've never seen a dividing line between human medicine and animal medicine. I got offered places to study them both, on the same day, and I just decided I had a better rapport with animals. I grew up on a farm, and felt more drawn to them and that I could make a difference.
I didn't hear the term 'One Medicine' until much later, but that embodied everything I was thinking and it became my central life goal. It's very simple: if we explain to society that it is important to look after animals, it brings out the best in humanity. Therefore we look after each other better. The Humanimal Trust [Fitzpatrick's One Medicine charity] is about exactly that – more trust between human and animal for the sake of the planet.
The concept of One Medicine and One Health has been around for a long time. However, the reality is that One Medicine in many places around the world is a polite term for animal models of human disease. There's no two-way street. It's to find cures and improvements for humans and it's considered a bonus rather than an objective if it benefits animals.
I'm writing a paper on shoulder replacement in dogs. It was first done in 1948 as an experiment for human hip replacement. And yet in 2011, when I performed the first one in an animal that clinically needed it, it was heralded as a massive first. Really? What happened in those 63 years?
By and large, the animal and human medical product sectors don't work together. Which is dumb. Everyone would win if they cooperated. The anatomy, biology and even things like heart rate are similar in dogs and humans. They live in the same environments and get the same cancers we get, they get similar arthritis and other diseases, and the threat from infection, such as MRSA, is exactly the same.
How do you think your work could be used in other fields?
You've seen my scanners downstairs. If I want to see an implant, I can look inside the dog and see the bone-implant interface in real time. I don't have to kill the dog to do that.
I can look at dosage and scheduling in a dog with real prostate cancer, real soft tissue sarcoma or real osteosarcoma. There are sporadic instances of cancer drugs – a good example is mifamurtide – where a dog trial directly informed a human trial. You take any form of dog cancer, and the genetics and the phenotypic expression are remarkably similar to their human equivalents.
I've never said you shouldn't have an animal model to test drugs, but it doesn't make sense to sacrifice more animals in a drug trial to work out what I already know.
The pharmaceutical industry is beginning to understand this, which is why they are actively looking globally at possible One Medicine paradigms. Because money talks and it will save them money.
If a pharmaceutical company wants to develop a new drug that has shown great efficacy in the petri dish and in a rodent model I should be able to say: "How about we do a clinical trial?" and offer it to 100 dogs with that cancer. With a Home Office licence and RVCS approval, of course. It is nonsense to think that this isn't a rational idea, with clear objectives and a good motive. I save them money and I get what I want, which is more preservation of life, and a quicker transit time to phase 1 trials in dogs and phase 1 in humans.
What is stopping this happening on a large scale?
The problem is the defined end point – ultimately, in trials, you kill the dog. That gives you your dosage, scheduling, toxicity. So we have to find a way within a reasonable time frame, say 18 months. The average survival time for many canine cancers can be six months to a few years. Plus we need to get consensus that this is a good and ethically well founded way forward.
What has kept human and animal medicine separate for so long?
It's precedent, historical reasons. For years, I would walk into various human hospitals and not be taken seriously even when I wanted to build bridges; I was turning up at medical conferences as the comedy speaker. Except now they see on television that I'm doing things that they haven't got yet. They are beginning to take notice. It's an interesting change in the zeitgeist, but it only came about because I made a TV show.
Which of the procedures that you have developed do you think could be used in humans?
One thing that straightaway should be in human medicine is a trabecular metal scaffold seeded with your own stem cells [see box, left] to regenerate bone. The regulations around this are tightening – and for good reason: we don't want unregulated stem cell use. But if you've had your leg dragged underneath your motorbike, you sure as hell want this technology. But you can't, because regulators aren't down here examining my data and saying: "Noel, can you help us get this into humans within a year?"
Limb amputation prostheses [see box, below] are another – for more than 10 years, I've been working with Professor Gordon Blunn at UCL to put them in dogs. They did a phase 1 clinical trial on a limb amputation prosthesis for humans, but we still didn't all work together in the way I would have liked with animal and human sectors learning from each other. Now that is changing. If I am doing something that's working, why would you not learn from that and apply it in the next animal and the next human?
Do you think the sentience of animals is underplayed or denied by people – and scientists even?
Yes, totally. It seems to me an undeniable truth. Prove to me a dog doesn't have strong feelings and needs. You can't.
Fitzpatrick has developed a number of orthopaedic techniques at his clinic, some of which are more advanced than the equivalent treatment in humans.
PerFiTS devices (percutaneous fixation to the skeleton) are custom made, 3D-printed prostheses that attach directly to the bone of the damaged limb (endoprosthesis) and help avoid total amputation of the limb after severe injury or excision of bone cancer.
Stem-cell seeded bone implants
Severe bone defects from post-trauma infection or cancer can be replaced with state-of-the-art implants that allow the patient's own bone to be incorporated into the implant. Seeding mesh implants with the patient's own stem cells can help generate new bone tissue.
3D-printed joint replacements
Extremely accurate metal and plastic replacement components can be 3D printed from CT scans to replace damaged and painful joints. These can be coated with porous bone-ingrowth surfaces to provide permanent solutions. A 3D-printed replacement bone implant
You use the word 'love' very often. I've interviewed hundreds of scientists and it is not a word I hear often. Do you think that's a problem?
I think it's a massive problem. I spent the last 18 months with an ethicist trying to submit a paper about the value of love in a professional medical environment. Scientists shy away from love, for various reasons. In human medicine, it is for fear of recrimination: in the scientific world, we fear people won't think we're impartial. I say nonsense to that. All innovation and scientific endeavour comes from a thought process that is deeply rooted in your love of whatever subject you are obsessed with and want to translate to the world. I also have zero issues saying "I love that cat" or "I love that dog" or ''I love that client for caring so much about their dog".
None of us wanted to be a doctor or vet without caring. We wanted to make a difference to the patient. Honestly, if I ever went into surgery or wrote a paper without love in my heart, I would hang up my scrubs.
How do you respond to critics who say you give an unrealistic impression of what veterinarians can do for animals, or even that your procedures prolong animals' suffering?
It's intensely frustrating. The vast majority of people who criticise the show haven't watched it. And others make a judgement based on one example of a procedure.
The current paradigm is it's fine for there to be suffering if you're doing routine things, but it's not fine for me to wade in with a new technology and the animal might suffer if I fail – which I might do with any procedure, average or advanced. My critics should look at some standard cruciate repair techniques for a large breed dog which are universally sold by companies to many vets and for which we have seen a number of catastrophic failures. These dogs can suffer considerably by comparison with application of a new procedure which we have often honed over years. They should be looking at the hundreds or even thousands of failures – the status quo – rather than the one big example where the dog had no other options, and I tried and failed and showed it on television.
Look at average recovery time of one of my procedures compared with that of a routine procedure, and then let's play ball, on a level playing field. How many of the people who criticised me have read my scientific papers or looked impartially at the data?
The next question is why would I do a massive endoprosthesis or joint replacement on an animal that's only going to live 11 months? Because I can give them a better quality of life. Do people think I don't have a line in the sand that I draw every single day? Do they think I don't fall asleep wondering what the right thing to do is? They would be wrong if they thought otherwise.
It does upset me because people don't really understand. I do it to make my patient's life better. I don't do it out of some egotistical drive to do something new.
So you're saying you are judged by the clips that are shown on TV. How does TV affect the way you practise?
The TV doesn't change anything about what I do, but it changes a lot about what gets through to the public. I did elbow surgery for more than a decade and published widely, but it made zero difference, except to academics. I didn't even influence the point-of-care delivery for the patient, because families are just not given the options. That's all changed since the TV show.
Now, a human can show their GP an episode of The Supervet and say: "Why can't I have that cartilage recapitulating biphasic polylactide-impregnated trabecular metal resurfacing unit?" I was invited to be on the steering committee of a One Medicine initiative to develop treatments for early onset osteoarthritis. Do you think I'd get that invitation if I wasn't on TV? Do you think I can help treat arthritis in the patient they're trying to treat? Damn right I can.
'One Medicine' and 'One Health' are phrases used to describe collaborative efforts seeking to achieve optimal health for people, animals and the environment in an integrated way – for example, through joint working and knowledge sharing between veterinary and human medicine.
More information on Noel's charity, The Humanimal Trust, can be found at humanimaltrust.org.uk