The algorithm will see you now

Deep Learning and the upcoming automation revolution

Turn on the radio or browse social media today and you’ll likely be bombarded with a slew of terms like big data, algorithms and predictive analytics. Amidst the frenzy of buzz words and hyperbole are a spectrum of opinions on the potential of such technologies, ranging from critical reviews of existing applications all the way to apocalyptical predictions of machines enslaving humanity.

At the time of writing, the hottest topic is an area of artificial intelligence called machine-learning. This is a process where computers can take a set of data, learn something from it, and then change their behaviour accordingly. In other words, they can act in ways without being explicitly told how.

Within the field of machine-learning, the area grabbing the headlines is that of deep learning, a technology proving itself in a number of fields with incredible performance on challenges that were once intractable to anything but the human mind.

Learning to See

The first sign of deep learning’s power came in 2012, when the winning team in an image recognition competition[1] used it to beat the previous accuracy record by a wide margin. Since then, deep learning has been unleashed on problems from self-driving cars[2] and language translation[3] to finding signals from extra-terrestrials[4].

In healthcare, deep learning is already making inroads into several areas, including drug discovery[5], treatment recommendations and personalised medicine[6]. However, perhaps the biggest area of impact so far has been in computer vision, with several studies now showing human-like levels of performance (if not better) in spotting disease in medical scans. Dozens of papers can be found in the literature, dealing with radiographs[7], CT scans[8], MRI scans[9] and cytology images[10], across applications such as disease detection and classification, to organ segmentation.

Under the Hood

The core concept underlying deep learning’s ability is something called a neural network. This is a mathematical model that takes a number of inputs along with a known outcome, combines them in certain ways and learns how much emphasis or weight to place on each input throughout the network in order to get the correct result.

As an example, take predicting whether or not a patient will respond to a certain type of treatment. The inputs could be things like their age, sex, blood pressure, etc. The deep learning network would be given training data comprised of many (typically thousands at a minimum) examples of patient information along with whether or not they responded to the treatment. The neural network would then attempt to incrementally adjust the weights for each input until it minimised the number of outcomes it classified incorrectly. This model, once trained, could then make predictions on future cases.

The Future

The industrial revolution took jobs away from people that involved manual labour. Deep learning is set to do the same for jobs involving mental labour. Exactly what this means for the future of any industry is unclear, but the best way forwards has to be for as many people as possible to be up to speed with the basic workings of whatever disruptive technology comes their way.

As a consequence, professionals such as vets can be on the inside of such events; understanding, reacting and guiding the process as much as the pace of change allows.

In short, deep learning is here to stay and the future of healthcare will have a level of systemic automation undreamt of today. The question is, what skills should the next generation of vets be focussing on that are the least likely to be affected by such a change?

Rob Harrand (pictured) is a data scientist at Avacta Animal Health, where he works on general data analysis, the development of machine learning algorithms, and helps the wider team to make better use of their data. He uses the R programming language and data management best practices to create an environment of reproducible research at the company. His background is in physics and engineering, with degrees from the universities of York and Leeds.

References

  1. ImageNet Large Scale Visual Recognition Challenge (ILSVRC) http://www.image-net.org/challenges/LSVRC/
  2. End-to-End Deep Learning for Self-Driving Cars https://devblogs.nvidia.com/deep-learning-self-driving-cars/
  3. Google Neural Machine Translation https://en.wikipedia.org/wiki/Google_Neural_Machine_Translation
  4. Artificial Intelligence Helps Find New Fast Radio Bursts https://www.seti.org/press-release/artificial-intelligence-helps-find-new-fast-radio-bursts
  5. The rise of deep learning in drug discovery https://www.sciencedirect.com/science/article/pii/S1359644617303598
  6. IBM Watson for Oncology https://www.ibm.com/us-en/marketplace/ibm-watson-for-oncology
  7. Deep Learning at Chest Radiography: Automated Classification of Pulmonary Tuberculosis by Using Convolutional Neural Networks https://pubs.rsna.org/doi/10.1148/radiol.2017162326
  8. Classification of CT brain images based on deep learning networks https://www.sciencedirect.com/science/article/pii/S0169260716305296
  9. Deep learning predictions of survival based on MRI in amyotrophic lateral sclerosis https://www.sciencedirect.com/science/article/pii/S2213158216301899
  10. DeepPap: Deep Convolutional Networks for Cervical Cell Classification https://ieeexplore.ieee.org/document/7932065

From veterinarian to entrepreneur

Stacee Santi, DVM, CEO/Founder Vet2Pet

He said “You’ll have to become an Apple Developer”.
I said, “I have no idea how to do that, but it can’t be harder than veterinary school”.
And so the journey began.

As a practicing veterinarian, working tirelessly to help animals be healthier, I was becoming very frustrated at the fact that the majority of my clients weren’t giving their parasite prevention monthly. The big reveal always came when I prescribed their summer 6-pack of parasiticide and they would disclose they still had some from last summer. I’m no infectious disease specialist but I do know that most medications don’t work if you don’t take them. I’ll be honest, I was bitter about it. If you’re a veterinarian, you know what I’m talking about.

I started to examine the facts of the situation and realised that my clients weren’t being ‘bad’, they were just being forgetful because let’s get real, giving something monthly almost never happens. And the current method of reminding them by applying a sticker to a calendar as recommended by the manufacturer, was pretty hard to do on my smartphone. I knew what I needed to do. The answer was right in front of me. I needed to be able to automatically send a reminder to my clients on their smartphone each month letting them know it was time to give their parasite prevention. I needed an app. I did what any normal person would do….I googled it.

To my surprise, there were no apps available for veterinarians to turn my idea into a reality. I stumbled upon a company in San Francisco building generic apps for small businesses like hairdressers and realtors. I reached out and asked them if they could help me. That’s when I learned that I would need to become an Apple Developer to host an app in the App Store.

Fast forward a few years later. By this time, my little app was solving lots of problems for me in my practice. I had added some new features to improve efficiency and loyalty. Clients could order medication by snapping a picture of the product, earn rewards for spending and share a pet selfie with us. I was sure there were veterinarians like me looking to connect with their clients more efficiently and effectively that would like to have an app too. I decided to start Vet2Pet in 2013. Looking back I was pretty naive. You have to understand that I knew a lot about running a veterinary practice and absolutely nothing about starting a company.

I started my business by turning on the website right before I went to bed one evening. I woke up in the morning and I had a customer. I could not believe it! I began working on apps when I would get home from my veterinary job (nights and weekends). The first year, it was a steady flow of about one customer per month. The second year, it doubled. The third year, I had to quit my veterinary job. Now, in 2018, 600 apps in nine countries later, I am the proud leader of an all-girl tech company dedicated to improving the lives of veterinary teams. Here are a few things I’ve learned along the way about core business principles that don’t seem to change much as you move into another vertical.

  1. Have your purpose. Every good employee I’ve ever had cares about making a difference, in addition to making money. If you can find something to believe in and communicate that vision and purpose to your team, they will be engaged on a whole new level.
  2. Listen. By listening, you will discover the secret to whatever you are working on, whether it be a happy customer, a sick dog, a motivated employee, or the direction for your business. The answer is almost always right in front of you if you can stop talking long enough to see it.
  3. Stay in your lane. It’s impossible to make everyone happy. It’s an assured outcome of disappointment if you start trying to make your product or service fit everyone. Find your lane then stay in it. And if you get lost temporarily and take the wrong road, stop the car, assess the situation and turn around to get back in your lane. You can’t afford to be distracted from your purpose.
  4. Enjoy the ride. Stop thinking happiness is yours just after you close the big deal, reach a money milestone, or worst of all, retire. The fun starts now. Be sure to take time to reflect on what you are doing and where you have been. Find the little things in the daily grind that inspire you and bring joy into your life.
  5. Surround yourself with good people. Team culture is the most important part of a company whether you are a leader or an employee. Hire SWANs (smart, work ethic, great attitude and nice) and be sure to resolve any “bad apple” situations quickly.

Dr. Stacee Santi (pictured) is a 1996 DVM graduate from Colorado State University and the founder of Vet2Pet, a technology startup that builds personalized custom apps for veterinary practices. With over 20 years of clinical experience in small animal and emergency practice, Stacee brings an “in the trenches” approach to innovation and solutions for veterinary teams. She has also served as a medical advisory consultant for NVA for 5 years, medical director for AAHA general/ER practice in Colorado as well as a member of the Executive Committee and Chairperson for the Telehealth Task Force for the Colorado Veterinary Medical Association.

epiCam V: Bringing Human Ophthalmic Imaging to Animals… and Back Again

Animal and human healthcare medicine are closely linked, in this blog we hear how the researchers at Epipole have learnt first-hand how overcoming technical challenges to re-purpose their specialised equipment for veterinary medicine, has led to improving their technology for Human medicine … so with each contributing to the other, where else can we adapt to improve both animal and human healthcare?

At Epipole we began our medical device journey back in 2011 with the aim of helping clinicians around the world to find blinding pathologies and thus to save sight. Save sight in humans, that is.

Working in this area over those years, we came to recognise that animals were quite poorly served in this respect.  Their eyes were in the care of a small number of highly qualified and dedicated referral vets whose expertise was immense and whose equipment was highly specialised. What we needed to do was build a device that could be used by all vets in practice and thus widen the diagnostic use of ophthalmology.

Having already built and proven the efficacy of two hand-held, low-cost, fundus cameras for human eyes we decided that we would take up the challenge of building a device for animals and see where that led us. Although epiCam M and epiCam C were designed to image the human eye at very high resolution – they can resolve detail as small as 10 microns – we knew that they were also “general purpose” enough that their core imaging technology could be re-purposed for veterinary applications.

The major challenge was that whilst humans have a fairly predictable physiology, the label “animal” applies to a massively varied population. Firstly, the simple geometry of the orbit of various eyes can vary in size by centimetres, from the guinea pig to the giraffe. And then there is the variation not only in pupil size but shape, from the bizarre multi-stage penguin pupil to the massive horse pupil – real levels of complexity. Moving on to the retina itself, there we also find an enormous range of shapes, sizes, structures, textures and what I can only describe as odd bits. Some bits are missing, in different places or at locations that seem to defy explanation. All of this has to be imaged and the device still has to turn out diagnostic levels of quality.

However, we always knew that we would end up with a much more complex device for animals than for humans. At its heart, a fundus camera is a microscope with on-axis illumination and a sensor in the place of the human eye. Much of our microscopy imaging technology was already complete and well tested, there was just the vexed question of illumination delivery and image formation to sort out.

As part of this, rather inconveniently, some animals have a tapetum lucidum that will massively over-expose a sensor even under low illumination. This, and the other issues, has meant that we had to give the device several more controls than we would need for humans – digital illumination control being just one of them.

Ironically, some of the technical challenges we had to overcome have meant that improvements and features have made their way back into the human imaging devices and for that we are immensely grateful. Neonate humans and small dogs turn out to be not that dissimilar after all.

Where next for digital veterinary ophthalmology? We are working hard to bring it to a wider audience, make it part of standard veterinary practice and provide an enhanced insight into pet health.

Dr Craig Robertson (pictured) is the founder of Epipole Ltd., an award-winning medical device company developing high quality, inexpensive video fundus cameras. Craig’s early background was as a researcher in mathematics and AI and since that he has spent more than 15 years in medical device engineering. He is the named inventor on many patents in retinal imaging and machine vision and has presented at over 50 conferences as well as being an invited speaker at TEDx Glasgow.

Opportunities in the changing European Veterinary Sector

Will Artificial Intelligence be a source of opportunities for veterinary medicine?

Everyone knows the difference between a dog and a cat. We’ve all seen hundreds of cats and hundreds of dogs. In fact when you see a pet, it is very easy to tell if it is a cat or a dog. But when it comes to explaining how we structure our reasoning to arrive at this classification, it is more difficult.

For Machine Learning programs it is the same thing. They learn from data sets and then develop their own predictors (keys generated to predict categorisation) that can then be used to categorise new data.

Thus the classification assistance on diseases begins to appear in human medicine. We already have PhD courses in Computational Medicine as in Finland. It is reasonable to think that the contribution of metabolomics, with hundreds of biomarkers that can be analysed in a single drop of blood, will accelerate the knowledge of animals and the way to approach their health.

The veterinarian, employee or entrepreneur?

It is not new to say that we are seeing a feminisation of the veterinary profession. We are also seeing the emergence of increasingly large veterinary structures and even chains of tens or even hundreds of clinics, as in the United States. These models meet certain expectations of both customers and veterinarians.

Customers have access to a standardised care offer and improved availability. They can spread the payment with monthly health plans.

Veterinarians can concentrate on care without worrying about stock management, team management, accounting, with even the possibility of flexible working hours, allowing the work-life balance they want.

In parallel we see veterinarian entrepreneurs who create new business models. It can be in technology to facilitate the daily work of veterinarians (ie VetSpire, FuturePet, Pronozia) or connected objects to monitor animal behaviour (Felcana, Petinsight project).

Most often they complete their veterinary courses with training on entrepreneurship in business schools or with massive open online courses (MOOCs) such as those on effectuation (the art of entrepreneurship in the unknown). They can create startups or simply invent new approaches. I think especially of a Parisian veterinarian who specialises in treating ‘new pet animals’. She proposes providing roaming services in clinics that do not have this expertise. As an example, you have a cat and a parrot that both need veterinary care. You make an appointment at the usual clinic that already takes care of your cat and she will come to deliver the care to your parrot at the same time.

To be consistent with the first topic, this text has been written in French and translated almost instantly in English using www.DeepL.com/Translator which is a translation engine using Artificial Intelligence (Machine Learning).

Claude Ecochard is a disruptive innovation senior leader at Royal Canin. His job is to support the company in terms of ‘Dream, Dare, Do’. A Master of Biochemistry and Food Engineering, he leverages his 30 years of R&D experience in the food industry to rethink the futures of the Petcare ecosystem. Passionately curious, he advocates the importance of empathy in the organisation, practices Design Thinking and effectuation principles to shape new opportunities.

He is fond of emerging Business Models in food, the cooperative economy and pet technology, looking at how to provide a positive impact on pet and pet owners’ lives. His buddy Frisko, a eight-year-old Border-line dog, is involved in most of his challenges.

Virtual and Augmented Reality in Veterinary Education

Anyone who has watched films such as The Matrix or the more recent Spielberg offering, Ready Player One, will be familiar with the idea of virtual reality and the potential of it to transform not only entertainment but many other aspects of our lives, including work and education.

Spatial computing, which incorporates both Virtual Reality (VR) and Augmented Reality (AR) – collectively referred to as Mixed Realty (MR) – is rapidly moving from the realms of science fiction into fact, providing those in healthcare with a range of exciting and interesting new tools. Whilst there are a number of case examples of MR being employed within the human medical sector, it’s use remains in it’s infancy within the veterinary sector, although I see that changing over the next few years.

According to recent survey data the level of enthusiasm for spatial computing as a potentially useful tool within the veterinary profession is high even though the level of practical experience with such technology remains low. Whilst VR has been around for decades it is only in recent years that the technology has advanced to levels that now enable a range of extremely useful applications and is gaining wider adoption as opposed to simply being the preserve of gamers and academics. Much of this drive in adoption has come from the advances in mobile technology. One can easily experience the magic of VR using a phone-based headset like the Samsung GearVR or engage with AR through their Apple iPhone, whether it be chasing after Pokemon or playing with dinosaurs as they run across a tabletop. The barriers to entry of truly high-spec VR are rapidly falling and it will soon be possible to experience full six-degrees-of-freedom VR, allowing users to directly engage and interact with a virtual world, without having to break the bank by buying expensive gaming equipment. Truly untethered, mobile headsets, such as those in development by companies like Oculus, will, I am certain, herald a wave of mass adoption of VR. As soon as more people get to try spatial computing for themselves the applications will start to be imagined and created, including many that will change how we, as veterinarians, train, educate ourselves and clients, and manage our professional lives.

I recently spoke at an industry conference in the US on VR in Veterinary, with education and training the most obvious areas for application at present. Human surgeons are already able to practice certain skills in VR, using programs like OssoVR, and the evidence supports the view that immersive systems that provide practical training scenarios do translate into effective learning. The airline industry has used VR systems to train pilots for years. Why not use the same principles to ensure that our surgeons, both of humans and animals, learn, practice and refine key skills in a safe, repercussion-free environment before they apply those same skills to real-life patients. If I had been able to graduate from vet school having carried out hundreds of (virtual) bitch spays – a feat that would simply not have been possible in the real world – even if the virtual scenarios only modelled very specific aspects of the experience, then I think my confidence as a new graduate and my progression as a clinical practitioner would have been significantly greater. Practical CPD in the future is highly unlikely to involve groups of people huddling round a single-use physical model or hard-to-source cadaver but rather take place in the infinite bounds of the digital environment, where specific training scenarios are but a virtual menu selection away and there is no limit to the ‘practice models’ available.

We are, I believe at the very start of this spatial computing journey in the veterinary profession, with many questions yet to be both asked and answered. I, as with many others, look forward to the day when donning a pair of smart glasses or a VR headset will be seen as a normal part of our professional experience.

For more information on the VR & AR in Veterinary survey and a full report, including a link to Dr Chris’ recent presentation in the USA follow the link below or head to his website at www.thenerdyvet.com

How do you envisage us learning in the future? Can you imagine using Virtual or Augmented Reality to learn new skills or improve existing ones?

Biography

Dr Chris Shivelton Queen is a small animal veterinary surgeon and all-things-tech enthusiast, writing and presenting under the moniker The Nerdy Vet. His tech achievements to date include being a co-developer on the award winning pet healthcare apps, Mucky Pup and Purrfect Paws, the first vet-developed healthcare apps on the market, and he is author of the highly acclaimed guide for those looking to apply to veterinary at university, ‘Vet School,’ which is available through his website www.vetschoolsuccess.com. Dr Chris has long been a proponent of both VR (Virtual Reality) and AR (Augmented Reality) and has presented at a number of industry conferences on their use in the veterinary sector, most notably Augmented World Expo, held annually in San Francisco, USA. When he is not practicing as a vet or getting excited by tech he can usually be found either skydiving or training for his next ultra-marathon.

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What’s your big idea?

As a Vet Futures student ambassador, I was fortunate to attend the first RCVS innovation symposium with other student ambassadors from across the country. The day was incredibly interesting and opened my eyes to innovations such as new business models, artificial intelligence and big data as well as how these developments will affect the veterinary profession. I also learned the importance of embracing innovation to ensure the role of a veterinary surgeon remains relevant and the need for veterinary professionals to be at the forefront of new developments to ensure there is a focus on improving the health and welfare of animals.

I must admit, before attending the symposium, I had never considered the extent to which innovation and new technology will reform my future career. This is something I am sure I am not alone in, as I believe it is easy for veterinary students to focus solely on the approaches currently taught in our curriculum without considering how these might change in the future. The day inspired me to encourage other students to become involved in innovation so I was keen to join the innovation project group when the opportunity arose at the Vet Futures training day.

After lots of brainstorming, the innovation project team have come up with a plan to introduce a ‘Dragon’s Den’ style competition to UK and Ireland veterinary universities in order to help realise the potential in the next generation of innovators. Student teams will be challenged with identifying an issue facing our industry and designing a new solution; then pitching their idea to a board of industry professionals. We plan to launch the competition in September 2018 with prize giving taking place at the RCVS innovation symposium in 2019. Teams will be encouraged to diversify their skill set and include students from outside the veterinary sphere with plans in place to reach out to business and technology schools at corresponding universities to determine if they would like to be involved.

We hope the competition will fuel an interest amongst our fellow students to embrace innovation and new technology and encourage them to learn about the changes it will bring to our profession. After all, using new technology in our daily lives has become second nature to our generation, so why can’t we embrace this in our chosen profession? I believe encouraging students to grasp the potential that innovation holds from the beginning of their veterinary education will produce graduates who are confident to be at the forefront of creating and embracing innovation, ensuring it is used in a way that that focuses on improving veterinary care.

Zoe Skinner (pictured), is a Vet Futures Student Ambassador from Nottingham University and has an interest in farm animal medicine, One Health and how new developments will shape the future of the veterinary profession. She describes the VF Student Ambassadors’ Innovation Team’s new initiative, designed to give more vet students the opportunity to get involved with veterinary innovation.

Field microscope enables pen-side diagnostics

Microscopes have been around for hundreds of years; yet good quality microscope images are still confined to the lab, since microscopes and large, heavy and delicate. Vets frequently have to collect samples in the field, then send them to the lab for analysis and wait a day or two for the results. The ioLight portable microscope changes this and enables good quality microscope images to be taken in the field.

As well as being portable, this digital microscope can be used by inexperienced people since it is very easy to use. The images and videos are viewed on a mobile phone, tablet or computer so it is really easy to send them via email or social media, or paste them into a report.

The ioLight portable microscope in the cattle shed at Red Oak Farm

The ioLight portable microscope in the cattle shed at Red Oak Farm

The microscope is currently being used by vets and a number of organisations in the animal health industry including Moredun, APHA, FERA, RVC, CEFAS and Bayer.

For example, a digital portable microscope is great for faecal worm egg counts. It can be used with a standard McMasters counting chamber at the pen-side, eliminating the need to take samples back to the lab and enabling immediate treatment. It also allows vets to discuss the images on the farm, which helps the client to appreciate why only the affected animals should be given worming drugs. This reduces drug use and the risk of the pasture and animals becoming infected with drug resistant worms. New Forest Equine Vets are a great example of a practice using the portable  microscope as seen here in this short video.

Equine strongyle eggs in a McMasters counting chamber viewed with the ioLight field microscope

Equine strongyle eggs in a McMasters counting chamber viewed with the ioLight field microscope

Aquaculture is another area in which the ioLight microscope is finding use. It is well suited for fish disease diagnosis and live feed identification on site. In his article on the ioLight microscope, Bill Manci of Fisheries Technology Associates said “other field microscopes just became obsolete.”

The microscope is also used for science outreach and training by the RVC, Oxford, Cambridge and other universities. They find that the small size, ease of use and presentation of images on a phone/tablet or large screen helps the students to concentrate on the science without difficulties using the microscope getting in the way.

An animal parasite at an RVC event viewed with the ioLight microscope

An animal parasite at an RVC event viewed with the ioLight microscope

There are clearly many other uses for a robust, easy to use portable microscope. What would you use a portable microscope for? Please let us know.

After completing a PhD in optics and lasers at Oxford University, Richard Williams continued research at Oxford in both the Engineering and Physics departments. In 1998 he moved to Southampton University and worked on optical fibres. When he left the University he had produced more than 50 academic publications. In 2003, together with Andrew Monk, he raised funding from venture capitalists and started a spin-out company. Richard was CEO of the spinout company for 8 years, then following a period of consulting he built a prototype portable microscope and teamed up back with Andrew Monk to form ioLight.

Innovate or die. Creating the perfect customer experience

At Onswitch we work every day with practices large and small; mixed, equine and small animal; at home and abroad. We see first hand the business challenges thrown up by the changing marketplace (more practices, animal care services increasingly available online and outside the veterinary sector, fewer opportunities for practice ownership and increased team turnover). Consumer expectations and behaviours are changing too, and with more choice the customer experience becomes increasingly important to commercial success – a proven fact that it appears many veterinary businesses either do not believe or are not willing to be influenced by.

Times they are a changin’, and so must we.

But real and positive change involves more than just doing things differently, it requires us to do things better. For me, the innovation required in the veterinary customer experience is simple but fundamental – we need to make a seismic shift in our attitude to service delivery. We must accept as normal the many aspects of modern life that consumers take for granted when buying goods and services elsewhere:

  • Very few people carry cash now – contactless payments, in-app purchases, card swipes to secure bookings are all commonplace everywhere else except the veterinary practice
  • Tracking parcels, rescheduling deliveries and use of secure lockers at train stations and in shopping malls allow seamless integration into the busy working week. Yet owners leaving their pets for surgery are told to ring in at 4pm for a progress report – imagine if they could log onto their practice account and see regular updates? This will become increasingly important to all those Millennials and GenZers who don’t like talking on the phone – why can’t we just send updates via text?
  • And why are we still dropping pets off at 8am when the surgery won’t begin until mid-afternoon?

In fact, the true innovation we need to make in veterinary customer care is actually not really innovative at all, it’s obvious – make it easy for clients to use your services, or watch them go elsewhere. But there’s more – because in a sector with so much available choice, access to great clinical care doesn’t just need to be easy, it needs to be enjoyable too. Sure, we can introduce technology to enable client contact quickly and easily, but in a service sector driven massively by emotion (it’s not just a dog, it’s a much-loved member of the family) we must always maintain human warmth. Online appointment booking and texting booster reminders deliver convenience; eye contact and remembering the dog’s name when he comes in show that you care and help bond the client to your practice.

Technology enables contact, but people enhance it.

Invest in processes and people that will deliver a truly outstanding customer experience – do what’s best for the client rather than what’s easiest for the practice, and success will follow.

For too long, the veterinary sector has seen change as a threat – innovators see change as an opportunity. Yet change is the new normal in every other sector, let’s make it so in ours.

Alison Lambert BVSc CMRS MRCVS, Managing Director of Onswitch, Associate Professor in Business, Nottingham Vet School. 

Alison is from Yorkshire and her family come from East Yorkshire where they have worked the land, raised pigs and wasted lots of money on horses.

Following qualification as a vet from Liverpool University in 1989, Alison worked in practice for several years before pursuing a business career with Hills Pet Nutrition and MARS, where she discovered the passion for the customer experience that her award-winning company, Onswitch, is renowned for today. Established in 2001, Onswitch promotes customer-centred practice so pets, horses and livestock receive best care; providing research, marketing, CPD and business consultancy with an effective, innovative, straight-talking and client-led approach.

Alison is Associate Professor in Business at The University of Nottingham Vet School, teaching Business skills. She is published widely and regularly speaks at key international veterinary congresses and events.

Visit the Onswitch website

3D-printing: A new frontier in veterinary orthopaedics

The basic principle of 3D-printing is these days familiar to most; very thin layers of material are sequentially printed, building up a potentially complex 3D object. An astonishing range of materials can be 3D-printed including most surgically implanted metals (for example stainless steel, titanium, titanium alloys and cobalt-chrome), many plastics (including biocompatible and autoclavable forms), and biological materials (such as cells and scaffolds including hydrogels hydroxyapatite). In veterinary orthopaedics 3D-printing is currently used predominantly for the creation of printed bone models and surgical guides, and in the manufacture of patient-specific or complex implants. There is immense potential for tissue engineering applications, although in veterinary orthopaedics these techniques are not widely clinical available at present

3D-printed bone models and surgical guides

The most basic application of 3D-printing in veterinary orthopaedics is the creation of printed bone models. The ability to directly visualise for example a bone deformity can facilitate surgical planning, as well as permitting surgical rehearsal. CT data is the starting point for model creation. The 3D data describing the bone itself is extracted from the complete data set, some CAD processing performed, with the 3D virtual bone model then exported to the 3D printer. Since the thickness of the 3D-printed layers is much less than that of a CT scanner (25-100µm vs. >600µm) the accuracy of the model is determined by the CT data rather than the printer, although this remains very high.

The ability to manipulate 3D virtual bone models in CAD software allows planning of surgical interventions including deformity corrections, vertebral stabilisations and complex fracture alignments. Patient-specific surgical guides can then be created which permit translation of the surgical plan to the patient in theatre. These guides typically incorporate a bone contact surface that accurately reflects the contours of the cortex beneath; the guide therefore fits onto the bone in a unique location, allowing accurate localisation of osteotomy guide planes and drill hole trajectories. Guides are typically printed in biocompatible, autoclavable plastic. Clinical benefits include consistent, accurate surgical outcomes, reduced surgical time, and the ability to place implants into narrow safe corridors.

3D-printed implants

3D-printing in metal remains a specialist process, requiring a significant investment in hardware as well as engineering skills and facilities. Patient-specific metal implants can be printed which fit uniquely into position in much as the same way as plastic surgical guides. Such implants are rarely necessary for routine interventions such as deformity corrections, but have significant potential advantages in more complex applications such as limb-sparing surgery and reconstruction of other large bone deficits. 3D-printed patient-specific joint replacement prostheses are used in human orthopaedics and have been applied in specific veterinary applications.

The second key use of 3D metal printing in veterinary orthopaedics is in the production of generic, but complex, implants. The key advantage over traditional manufacturing techniques is the ability to easily create complicated 3D shapes, and to incorporate specialised surfaces (e.g. for bone ingrowth) without the need for multiple engineering processes.

The future

What is the future of 3D-printing in veterinary medicine? As with all new technologies costs will come down, and accessibility to non-specialist users improve. Already dentists can use cloud-based software to create their own patient-specific drill guides which are printed and arrive a few days later; maybe before long vets will be doing the same. And the list of applications continues to grow, both in other surgical fields (e.g. 3D-printing of portosystemic shunts and tumours) and in non-surgical areas (e.g. customisable 3D-printed drugs). Will 3D printing alter the face of veterinary medicine? Not in the foreseeable future, especially in the context of high-tech applications such as tissue engineering. However, especially in specific areas such as orthopaedics many existing applications are already resulting in improved patient care at accessible cost, a trend that will certainly continue.

Bill graduated in 1997, and after a period in general practice undertook an orthopaedic Residency at Willows Referral Service between 2009 and 2011. Bill gained his RCVS Diploma in Orthopaedics in 2013, and RCVS Specialist status the following year. Bill founded Vet3D in 2015 to provide access for orthopaedic surgeons to CAD based surgical planning and patient-specific orthopaedic and neurosurgical guide systems.

The veterinary sector: an investor’s perspective

This blog represents the first of a series of blogs on how the investment community views and assesses businesses in the veterinary industry. It is intended to be informative at a high level but also thought provoking. The aim is to help veterinary professionals to understand how the broader investment community functions whilst dealing with its vast idiosyncrasies.

From an investor’s standpoint, veterinary businesses are rare and predominantly hidden gems. Thus far, few relatively specialised corporates have ventured into this space. The consolidation of operational structures for existing vets aiming to centralise services that are often seen as “getting in the way of taking care of the animals” appears to be a big driver. Realising locked values of relatively small businesses is often also sought. Larger scale sales, such as those of Specialist Referral practices are arguably very palatable to those corporates wishing to own more sizeable assets and goodwill (embedded expertise) directly.

Setting aside for now the substantial services associated with the pure veterinary world such as pharma, pet food, equipment/toys etc. which are arguably better covered in the investment world due to their respective sizes, the decade-long consolidation of veterinary practices does introduce the uninitiated investor to greater nominal (i.e. size), larger aggregate investment metrics (measurable profitability) and certainly access to what remains a very granular market.

Investors define attractiveness of an industry through the analysis of data and its characteristics. The characteristics of the veterinary industry are pretty straight forward to grasp. This however is greatly contrasted by a near complete absence of any meaningful publicly available set of performance and profitability data.

In the absence of long term aggregate data, investors can retrench to a bunch of assumptions based on those specific characteristics to understand how attractive an investment can be. The substantial barriers to entry such as qualifications required, technical equipment, knowledge, geographical targeting and relatively high margins, can be seen as hitting quite a few of the buttons that would make any investor very excitable.

One important characteristic is the industry’s relative insulation to financial crises. There is very little that suggests that pet owners / pet parents would stop entirely taking care of their pets in cases of equity (stocks and shares) market falls. Anecdotal evidence does suggest the opposite, if anything. Ironically, the same appears to apply to pubs and alcohol stocks. There could be something there!

Beyond the profitability aspects of the industry, that perceived lack of correlation to equity markets is of huge value to investors. Any asset that continues to perform whilst other parts of the investment spectrum fall is THE prized asset.

Investors can be seen as obsessively driven by profitability and therefore relatively fickle with short term objectives and little appetite for poor or sub-par performance against expectations. Set against highly ethically minded veterinary professionals with a long-term view of their personal careers, there is little doubt that this has and will continue to create frictions. A new reality of constant commercial pressures and the search for returns from investors, coupled with these caring ambitions of veterinary professionals, can make for uneasy bedfellows.

One attractive option, is for the entire veterinary industry to adopt policies and standards aligned to ethical or Socially Responsible Investment (SRI) principles. This could open the door to a rare breed of investors who have accepted that the sole search for profit and short timeframe may not be entirely beneficial to society and have accepted some of the perceived financial drawbacks associated with this view.

The fact is that these apparent financial trade-offs associated with ethical investments have not been fully verified and in some cases quite the contrary is true. Therefore, going forward, this type of investment approach could potentially make for a more suitable companionship between the two industries.

Rafe is the Head of Investments for Investec’s Private Office and has well over 20 years’ experience in Investment Management in London, Switzerland and Jersey. Rafe started his career as an Economist for the European Commission (Science Research Funding – DGXII-B) in Brussels.

Rafe is a Chartered Wealth Manager (Chartered MCSI), holds a number of professional investment qualifications (including as a US advisor) and undergraduate and postgraduate degrees in Economics from two of Scotland’s ancient universities.