The catastrophic injury that ended Barbaro's Triple Crown bid at Pimlico on May 20 - and the extraordinary effort by University of Pennsylvania surgeons to save him - have turned a spotlight on veterinary medicine in the United States.
Enjoying little of the attention that doctors of human medicine receive, veterinary researchers are using much of the same science to understand, prevent and treat animal injuries, and to fight diseases that affect agriculture and the food supply.
Veterinarians are also working on such illnesses as avian flu, West Nile virus, Lyme disease and mad cow disease in a joint effort with public health officials to safeguard human health.
"Veterinarians have been contributing to advances not just in veterinary care, but also human medical care, for years and years," said Dr. Lawrence E. Heider, executive director of the Association of American Veterinary Medical Colleges.
But the nation's 28 veterinary schools are at capacity and can't keep up with the demand for new doctors. They admit about 2,600 new students each year, but 600 others must seek their training abroad, Heider said.
"Right now, there is enormous demand for graduates from all vet schools," said Jeffrey Douglas, spokesman for the Virginia-Maryland Regional College of Veterinary Medicine. "The profession is playing a huge role in society, but it lacks the infrastructure and the money to do the job it needs to do."
'We need support'
Legislation before Congress would authorize $1.5 billion in grants over five to 10 years to expand and strengthen veterinary training programs.
"We need support for that," said Dr. Susan M. Stover, an equine researcher at the University of California, Davis. "Vets are critical to human health and food safety in ways that I don't think the public has the knowledge to have an appreciation for."
For many Americans, the sophisticated care that Barbaro received at Penn's New Bolton Center was a revelation. But vet schools across the country provide state-of-the-art treatment every day, even as they train young veterinarians and conduct cutting-edge research.
Stover's lab at UC Davis, under the authority of the California Horse Racing Board, conducts animal autopsies - called necropsies - on about 250 thoroughbreds that die at California racetracks each year.
Barbaro suffered "a particularly severe combination of injuries, but the most catastrophic happened to be the most common injury we see in California racehorses," Stover said.
That injury is a "fetlock breakdown," the hyperextension and rupture of the ligaments, tendons and bones that support the horse's fetlock, or ankle joint. Most animals with such injuries are euthanized.
The fetlock problem is a particular focus of Stover's research, and her conclusions are sobering.
"Inadvertently and unintentionally, ... I think we set them up for injury," she said of America's racehorses.
In general, a horse's muscles and bones are "overbuilt" by nature to sustain most of the load put on them. But racing pushes the envelope.
The necropsies have revealed evidence of previous, milder injuries. The tissues are temporarily weakened as they heal, and "there's a transient period during the healing process when they become at risk of catastrophic injury," she said.
That recognition is actually good news, Stover said, because "we have an opportunity to prevent and intervene, so that in the future we can reduce the occurrence of these injuries."
Advances in bone scans and magnetic resonance imaging, she said, "do allow us to detect milder injuries earlier, so horses can be appropriately rehabilitated."
At the same time, Stover's lab is conducting epidemiological studies to identify patterns in training and racing that put horses at greater risk. She is also studying the dynamics of racetrack surfaces. They can be inconsistent from track to track, increasing the risk to animals that have adapted to one surface, only to be raced on another.
On the other side of the continent, at Cornell University's School of Veterinary Medicine, scientists are helping to decode the equine genome. They are seeking new tools with which to fight such illnesses as equine herpes. The highly contagious viral infection, which struck horses at Pimlico Race Course this spring, can cause potentially fatal neurological complications.
"We don't have good vaccines for herpes viruses in animals or people," said Dr. Doug Antczak, director of Cornell's Baker Institute for Animal Health.
Baker scientists developed vaccines for canine distemper and parvovirus that are familiar to dog owners. They also have devised a test for a gene that causes blindness in Irish setters 3 to 7 years old. Breeders can use it to avoid matings that would produce puppies with the defect.
Antczak said a genetic therapy for another form of canine blindness has been so successful that Baker scientists are seeking grants from the National Institutes of Health to test it in people with a rare form of blindness called Leber's congenital amaurosis.
Dr. Thomas Inzana, a veterinarian at the Virginia-Maryland Regional College of Veterinary Medicine, has received a $1 million Defense Department grant to develop a vaccine for the bacterium that causes tularemia - a potential bioterror agent. That effort grew out of his vaccine work on a similar organism that infects cattle.
Meanwhile, a colleague at the regional college, Dr. Ansar Ahmed, is using animal models to investigate whether estrogens used to increase milk and meat production in cattle can be toxic to human fetuses whose mothers ingest the products.
Such crossover research "is very important to the future of veterinary medicine, because that's where the funding is," said Thomas Caruso, director of research initiatives at the college. He noted that the U.S. Department of Agriculture gets 1 percent of the research funding that the National Institutes of Health receives.
Outside the research lab, clinical veterinary care is also becoming far more sophisticated and high-tech. Many specialty animal hospitals are now equipped with CT scanners, MRI devices and linear accelerators for imaging and cancer treatment, Cornell's Antczak said.
Neighborhood vets might send their most difficult cases to these hospitals - animals they once referred to the state veterinary school.
Vet schools in need
"They can essentially do the same things for those clients that we can do here [at Cornell]," Antczak said.
On the downside for traditional research centers, this trend threatens caseloads - and revenues - at vet school clinics. And it reduces veterinary students' exposure to instructive clinical cases.
Another problem is finding vets to fill all the clinical care, research, government and corporate jobs that go begging. Heider, of the Association of American Veterinary Medical Colleges, said the Bureau of Labor Statistics counts 1,500 unfilled positions for veterinarians. The bureau projects 10,500 more openings by 2014.
"Especially in research and teaching, we always need more people," Antczak said.
Educators agree that the bottleneck is in the vet schools. The nation's veterinarians get their doctor of veterinary medicine degrees from 28 institutions. Some are private, such as those at Penn and Tufts University in Boston. But most are at public "land-grant" colleges, supported by diminishing state and federal tax dollars - and rising tuition.
In 1978, Maryland and Virginia established the Virginia-Maryland Regional College of Veterinary Medicine, whose main campus is at Virginia Polytechnic Institute in Blacksburg. Virginia's affiliated hospital is the Marion duPont Scott Equine Medical Center, in Leesburg, while Maryland's research facility is in the Avrum Gudelsky Veterinary Center at College Park.
Heider said vet school tuition nationally ranges from about $10,000 to $35,000 a year - normally cheaper for in-state students. Graduates leave school with an average debt of $78,000.
Veterinary students frequently say it is easier to get into medical school than into veterinary school, and Jeffrey Douglas, public information director at Virginia-Maryland, agrees.
"There are only so many seats in the entering classes," he said, estimating that his school receives 700 to 800 applications each year for 90 openings in the first-year class. Of those seats, 50 are reserved for Virginians, 30 for Marylanders and the remaining 10 for out-of-state students.
"One of the reasons we have so many applications is that there are so many from around the country competing for the 10 national slots," Douglas said.
Heider said the number of qualified students applying to veterinary schools nationally each year is about 5,500, twice the number of openings available. As a result, he said, "we are exporting U.S. citizens."
About 100 first-year students go to seven accredited schools in Britain, Australia and New Zealand. An additional 500 enroll in unaccredited veterinary schools in the Caribbean.
Nearly all come home again, but those from unaccredited programs must do additional work to become licensed in the U.S.
Despite the demand, there is no building boom at U.S. veterinary schools.
Although some schools have boosted enrollment, "it's a huge investment to create a new vet school, and the states have been strapped for cash for the last decade," Antczak said.
The last big wave of expansion was in the 1970s, when seven veterinary colleges were established. Now, private industry may be moving in to fill the gap.
In 2004, an international chain of veterinary clinics called Banfield, The Pet Hospital, joined with Western University of Health Sciences in Pomona, Calif., to build a teaching hospital for the university's new vet school - the first built in the United States since 1979.
Veterinary schools are now looking to the federal government in the form of legislation known as the Veterinary Workforce Expansion Act, now before Congress. If passed and fully funded, it would provide $1.5 billion in competitive grants to vet schools over five to 10 years.
The schools would use the money to improve capacity, infrastructure and programs to produce the clinical, research, government and corporate veterinarians the nation needs, Douglas said.
"We recognize it's not a real good state of affairs," Heider said. But "it's a good time, we think, for students to have an interest. ... There are now, and will be, very good job opportunities for veterinarians."