Wednesday 3 February 2016

Brachycephalic Obstructive Research Syndrome


I try not to piss off scientists. They are, in the main, friends of Pedigree Dogs Exposed. That's because the science supports the central tenets here (if not always the sledgehammerly way they are delivered.)

I confess I feel a bit bad about having a go at the chap on the right above - Dr David Sargan, senior lecturer in molecular pathology at Cambridge Vet School.  David is a nice man; our paths have crossed several times; he co-authored one of the key reports into dog-breeding following Pedigree Dogs Exposed, and he is now quite widely involved in the issues. There is much that we agree on.

David's team is also doing some really useful work at Cambridge - both in elucidating the extent of breathing problems in brachycephalic dogs and in finding an objective,  non-invasive way to measure them.

But I'm afraid I watched this video this morning and wanted to shake him warmly by the neck. (NB to the crazies out there... this is a figure of speech.)

In this clip above, Sargan starts off by telling John Bradshaw (author of the excellent In Defence of Dogs) that the Cambridge research reveals that half of all French Bulldogs suffer from respiratory distress - and that, actually, none of them breath totally normally. 

The top trace here is of a Beagle and it shows normal breathing - a smooth, undulating rise and fall.   The two traces underneath show a "normal" French Bulldog - much shallower. These dogs never experience the joy of a truly deep, unhindered breath of air into their lungs.



And here's what the breath traces look like for 50 per cent of French Bulldogs who suffer from Brachycephalic Obstructed Airway Syndrome (BOAS):



What does that feel and sound like? Something like this.



It's hideous, isn't it?  

John Bradshaw, on the left in the video above, says: "The obvious thing to do is to breed the dog with a long-nosed dog and to get rid of the face shape."

You got it!

But no. Instead of Sargan throwing his scientific weight and compelling research behind a campaign to argue for immediate change, he says:

"The problem is that the general public doesn't want a dog with a long face so what we've been looking at are the dogs with short faces that breathe well and can we find genetic differences between those and dogs that breathe badly."

Yep, Sargan wants to spend money trying to find specific mutations that code for bad breathing which, once found, would allow breeders to select against them, thus allowing breeders/owners to have the flat faces but without the problems.

Perhaps you think that makes sense? After all, half of all Frenchies breathe OK (ish) and the Cambridge research has also found  that there isn't an absolute correlation between muzzle length and affectedness (i.e. some dogs with shorter muzzles breath better than those with longer muzzles).

Certainly, the breed clubs for Frenchies, Pugs, Bulldogs, Pekes and other brachycephalic breeds love this idea. It allows them to congratulate themselves for donating money and DNA samples to researchers while continuing to breed dogs with very flat faces.

Let me see if I can convince you that it's a fool's errand.

• first and foremost, the clue is in the name - BOAS is a syndrome. It comprises stenotic (pinched) nostrils, an elongated soft palate and everted laryngeal saccules - all associated with a short muzzle/skull. Recent research from Dr Rowena Packer et al at the Royal Veterinary College found that thick necks are a contributory factor too (see here).  These are features that will be governed by hundreds, possibly thousands, of genes. We do not yet have a single useful genetic test for conditions that are controlled by multiple genes and the chances of developing one in the near future are extremely slim.

• Even in the very unlikely event that a useful genetic test could be developed before another 10, 15, 20 generations of Pugs, Frenchies and Bulldogs are born to to live compromised lives, that still leaves another problem that manifests as a result of breeding for a flat face:  brachycephalic ocular syndrome. This comprises the near-endemic chronic and acute eye issues that occur as a result of shallow ocular orbits. (Quite apart from the fact that dogs with very flat faces do not have the natural buffer of a muzzle to protect their eyes from injury).

• Short muzzles in Pugs, Frenchies and Bulldogs have resulted in the bunching up of skin/flesh on the outside. The wrinkling/rolls are a hotbed for chronic yeast and bacterial infections. 

• short muzzles cause the bunching up/overcrowding of teeth and the roof of the mouth, too, leading to mouth and teeth infections/disease. This is an area often overlooked in brachycephalics but is likely to cause many dogs chronic, life-long pain. 



• while there isn't an absolute correlation between muzzle length within a breed and the extent of breathing problems, a paper published last year very clearly found that the shorter you go, the more likely it is to cause problems:

"The research, which was co-funded by Dogs Trust, the UK’s largest dog welfare charity, and the Universities Federation for Animal Welfare (UFAW), involved two studies including over 850 dogs of over 100 breeds. The findings were reported in a paper by Drs Rowena Packer, Anke Hendricks, Michael Tivers and Charlotte Burn and published in the journal PLOS ONE. The researchers found that as muzzle length becomes shorter, risk of BOAS becomes ever higher, with over 90% of dogs being affected at the shortest extreme. This quality-of-life limiting disorder was only seen in dogs whose muzzles were less than half the length of the domed part of the skull." (Source)
Ergo, the longer you go, the less likely you are to condemn dogs to a lifetime fighting for air.

For the past couple of decades, David Sargan has been looking for the gene/genes for cancer in Flatcoated Retrievers. Flatcoat breeders have raised and donated thousands of pounds to facilitate this - and while they've been doing that (with no genetic test on the horizon yet), breeders have not explored other measures that could have helped - such as outcrossing to other breeds to dilute the poison (over 50 per cent of Flatcoats die of cancer by the age of 8/9 - and many far younger). 

Sargan is a gene hunter. It's what he does. His whole world is skewed to that perspective.  So of course he's going to focus on genetic solutions. 

My stance, however, is that it is morally and ethically questionable to give breeders this get-out clause when we know that simply selecting for longer muzzles, more open nostrils, slimmer necks, less wrinkling and a less extreme head shape would be the simplest and quickest fix. 

So, sure, hunt for genes. But not without insisting in the meantime that:

• breed standards need to change to introduce minimum/maximum measurements/ratios
• judges must start selecting for much healthier phenotypes
• the current level of suffering in pursuit of "cute" is unacceptable.

This is so important because registrations for these flat-faced breeds have gone through the roof and because the Kennel Club and breeders will wiggle and worm for as long as they can. Indeed, the KC's response to the recent peer-reviewed research which shows so clearly how much suffering is caused by short muzzles (which, let's face it, comes after decades of other research saying essentially the same thing) has been to dispute that the dogs in the studies were KC-registered and to maintain that the research, while "interesting", does not involve enough numbers to be in any way conclusive.

Here's how the KC sells itself these days:
"We are the largest organisation in the UK devoted to dog health, welfare and training. Our objective is to ensure that dogs live healthy, happy lives with responsible owners."
But this is palpably not true when it comes to the brachycephalics.  Because if it was really the organisation it wants us to believe it is; if it really wanted to ensure that dogs life healthy, happy lives it would do so much more to prevent the suffering endured by Pugs, Frenchies and Bulldogs.

In Sweden recently hundreds of vets signed a petition demanding change for brachycephalic dogs. The Swedish KC and breeders didn't like it much, but it's working. There is a key brachycephalic conference in Sweden at the end of February and significant changes in the breeding of short-faced dogs in Sweden looks likely as a result.

Actually, David Sargan is speaking at this conference... an opportunity, perhaps, for him to support the Swedish researchers and vets in their call for urgent action to address the problems.

Watch this space.

28 comments:

  1. This is a great PDE post. As a biologist myself, I am tired of "documenting the decline": researching problems without solving them. We need science, but sometimes we get stuck in this cycle of knowing what to do, and not doing it. So we keep throwing money at research, when the answer is as obvious as the nose on our face.

    Living things are like a house of cards; it's often hard to remove one card without sending many others falling down. And so it is with BOAS. Dr. Sargan and his ilk should stop trying to please the brachy dog fans out there by trying to breed a "BOAS-free" brachy dog, because it can't be done. Sure, you might improve a few thing here and there, but as Jemima pointed out, A) it likely wouldn't be enough, and B) there are still a lot of other messed up things about brachy dogs besides their breathing.

    In nature, other than frogfishes and higher primates (including humans), there are no flat-faced vertebrates. Besides higher primates, all mammals have snouts, and there are no carnivorans with naturally flat faces. Even cats and walruses, whose muzzles are naturally shorter, still have relatively long faces. And yet some brachy dogs and cats are bred to have faces that are as flat or flatter than those of humans. Such breeding is as ignorant as it is cruel. If you want to keep dogs and cats, quit tampering with them and accept them for what they are: domestic carnivorans, not silly putty.

    Dog fanciers just don't get this. They think they can screw around with animals without consequence, but no one can. What Dr. Sargan is suggesting is genetically engineering domestic wolves to have flat faces, and it just can't be done. Not only is such a project unethical, it's not even possible because the dog's carnivoran nature will always get in the way. Dog fanciers must understand the natural history of dogs, and biologists must stop pandering to the dog fancy. This has gone on too long, and it must stop.

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    1. So true.

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    2. "In nature, other than frogfishes and higher primates (including humans), there are no flat-faced vertebrates. Besides higher primates, all mammals have snouts, and there are no carnivorans with naturally flat faces"

      Owls are vertebrate carnivores...if not carnivorans.

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    3. Owls may have flatter faces than other birds, but their skulls are still pretty long.

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    4. Owl don't really have flat faces, they just look like their faces are flat because of the feathers.

      https://s-media-cache-ak0.pinimg.com/736x/1a/ba/cd/1abacd1fa7fa87ee1edf185908fa01bd.jpg

      http://cdn1.arkive.org/media/4F/4F592559-9DCC-4D1B-B1A1-D2E54DB590E1/Presentation.Large/Tawny-owl-chick-with-prey-in-beak.jpg

      http://www.wiresnr.org/images/Barn0wl-Mel%201.1.jpg

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  2. Well, the answer to the issues of high cancer rates is very simple: get rid of the notion of pure-bred and adopt a much smarter one like the livestock people have of true-breeding, that is offspring that are predictably like their parents: it only takes 3-4 generations of back-crossing to do that and they register cross bred animals both in their own right and for 'making up' to pure. Add another criterion of no dog being registrable if there's NO outcross less than 10 generations out in its pedigree and you have a much better situation all round.

    The brachycephaly problem is even simpler: just stop. There's no call for it.

    However, both these problems have a common denominator: for many people, it's broken just the way they like it and the ill-health and suffering of the animals just the price of business. In that context, I understand where Dr. Sargan is coming from -- see how well the situation can be ameliorated.

    What is really needed is a psychologist and a good marketing campaign to change the Zeitgeist. This is a social problem at heart, not a scientific one.

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  3. INFO re FCI, US and UK Breed Standard relating to French Bulldog muzzle

    FCI
    IMPORTANT PROPORTIONS: The length of muzzle is about 1/6 of the total length of the head
    Muzzle: Very short, broad, with concentric symmetrical fold

    US
    The muzzle broad, deep and well laid back; the muscles of the cheeks well developed. The stop well defined, causing a hollow groove between the eyes with heavy wrinkles forming a soft roll over the extremely short nose; nostrils broad with a well defined line between them.

    UK
    The skin covering the skull and forehead should be supple enough to allow fine wrinkling when the dog is alert. Well defined muzzle, broad, deep and set back,

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  4. Sorry, he is wrong saying "The general public doesn't want a dog with a long face." Has he got some poll somewhere that he has done to confirm this point of view, because that is all it is, his point of view.
    Where I walk my dogs and the beaches I go to, I can't remember the last time I saw a brachy dog, so there is a lot of us out their in general public land who are very happy to have dogs with long faces.
    He even shows that the best French Bulldogs cannot breath normally, but "can get by." So he is hoping to breed brachy dogs that can just "get by" breathing. That is very weird ideology, but I suppose it keeps him in a job and getting funding from the brachy breeds and KC.

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  5. So by his own addmitance, no French Bulldog breaths normally. The best he can hope for is that they 'get by breathing.'

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  6. Yes! Very well said, Second Thoughts. Completely agreed.

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  7. Sargan should not get public money to fund this research as it is flawed and based on cognitive dissonance and/or cognitive bias. Warped logic. Any grant applications should be binned by any reviewers who actually have clue what is going on here..Once again, Sweden are flying the flag for welfare and clearly have a more evolved attitude in society with regard to companion animal welfare than we currently do. Or, maybe they are actually just smarter than us...

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  8. Great post, Jemima. Thanks! Maybe you already have heard of it, but on the chance that you haven´t - the Swedish joint animal health and insurance organization, which has both insurance companies and private vet clinics as well as major animal health care providers for members, recently petitioned the Minister for Agriculture, handing a letter signed by 3 500 (mostly vets, I think)asking that something be done to stop breeding for BOAS.
    Bodil Carlsson

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  9. Dear Jemima,

    David here, very pleased that the problems of how to approach brachycephaly are being raised again, and admiring your style as a polemicist. But I feel I should defend my point of view a little.

    Before I get into the meat of your blog – "why not just stop breeding these dogs?" a correction on the raw data - in comparing beagle and French bulldog (FB) and concluding the FB can't draw a decent deep breath you have over-interpreted what you see. This will be clear if I say that had I shown data comparing a bulldog with a beagle, it would have been the beagle that you saw as not being able to draw a decent breath. The first animal in the picture I used was bigger than the second: when you adjust for body weight and average over a large group of beagles or other dogs with normal head shape compared with FBs we classify as not suffering obstructive airway syndrome (BOAS-) you can see some differences in breath shape, but they are not likely to be very significant to functional performance of the lung. In breathing when at rest (as in the charts you show) the FBs with their big chests actually have significantly larger(!!) lung tidal volume per unit of body weight, whilst the difference in total volume breathed per minute is not significant. These BOAS- dogs may not be canine Olympians, but they can outrun the great majority of their owners (See the Cambridge group's paper in PLOS1: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0130741).

    So how do we get rid of dogs that cannot breath properly? – why not just stop all brachycephalics breeding? My answer is that if you really think after your eight years or more of campaigning that this is going to happen any time soon in the UK or the US, then you are living in cloud-cuckoo land. Rather than joining you there, I prefer to deal in practicalities. So here are some:

    1) My work with the DAC showed me that the UK Government is never going to ban the breeding of dogs on the grounds of their conformation. This is just not an area where any UK government has money, time or inclination to go. I would be amazed if the US government is any different.

    2) Your correspondent who asks how I know what public opinion is, should notice that the number of registered French Bulldogs in Britain has gone up more than 30 fold in ten years, so that they are now the fourth most popular breed in the country - and the number unregistered is probably twice as big again. Other brachycephalics are increasing in popularity rapidly as well. There is no wide outcry here suggesting the public think this wrong. The public has already voted with its cash.

    3) Many of us have written about the issue with no success in terms of reducing breeding of these dogs. Benefactors have been sought for the advertising budget needed to change the zeitgeist, but none has been forthcoming.

    4) On the other hand, by developing breeder trust we have already persuaded the French Bulldog club to adopt our clinically assessed exercise testing into their health certification scheme, leading to real (& real-time) breeding improvement

    5) Analytical genetics gets more powerful by the month. It is likely that the skin thickening, overgrown soft palate, and cartilage abnormalities are all controlled by rather a few related loci. Skeletal and skull changes also appear to be controlled by just a few genes. In cattle & pig industries the genetics of a multitude of complex traits that control meat quality, food conversion efficiency, milk volume and so on are now understood and controlled through DNA based estimated breeding values. Not a yes or no test, but very very helpful in estimating outcomes. By starting off with large numbers of tested dogs and a great deal of rigour about their phenotypes, we hope and expect to arrive at the same point in only a very few years.

    So Jemima, it is great that you keep us on our toes. But get into the real world. Use your special energies on what is possible.

    With affection

    David Sargan

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    1. Well my real world, David, is one in which thousands of Pugs, Frenchies and Bulldogs suffer every single day. Right now.

      But I will respond in a slightly less knee-jerk way later... ;-)

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    2. David Sargan, the Estimated Effective population of the FB is only 132.3. So you are starting from a point with a breed that has a small genetic pool (most would agree that you need a figure for EEP of at least 200 to maintain a breed) and you are going to reduce it even further. That sounds like a really good idea. Duh!

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    3. David again, in response to you and to others.
      Lets get one thing straight. Neither I nor any of the Cambridge team are against breeding for longer faces - I am in favour of it, and indeed say early in the video that this would be the obvious way forward. I also recommended it on DACs Facebook page some time ago. But for years it hasn't happened.

      In talking about lung capacity I was really only responding to whether the dogs could take a deep breath or not. What we actually work on is the upper airway – we have measurements or scans both externally and for a smaller number of dogs internally for three breeds. And are trying to find the best way forward using these data.

      Where you and I differ is only in the quickest way to get to better dogs in the real world.

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    4. Extreme Brachy breeds are a fashion at the moment, which you are playing to. If people like you David Saragan were more proactive in spreading the message to the public, that it is not good for dogs to be bred with such extreme morphology, then maybe things would change for the better, but you take the easy route.
      You can go through history and see people like you, who rather fight for change, preferred to deal in practicalities. What are the practicalities?
      You encourage the breeding of these dogs letting the breeders live in 'cloud cuckoo land' thinking they can breed better breathing dogs, keeping the extreme look from an already small gene pool. Good luck with that!

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  10. Won't using EBV within a closed registry with an effective population of 132 decrease the effective population even more?

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    1. Well there's always selection - whether it's for genes that help protect against BOAS or physical features such as longer muzzles/smaller eyes/less wrinkling/slimmer necks.

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    2. My point is that adding more selection criteria (it won't EBVs to reduce BOAS or selecting for looks it would be for both) narrows the gene pool. Some closed gene pools just cannot handle additional selection criteria and remain viable.

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  11. So the real world is, if you can't beat them join them. David Sargan, you actually say the best French Bulldogs can 'get by' breathing. The definition of 'get by' is to be ​able to ​live or ​deal with a ​situation with ​difficulty, usually by having just enough of something you need, such as ​money' in this case it would be oxygen.
    Most dogs even with BOAS would at the start of running with a human outrun them, because they have a thing called 4 wheel drive. They drive off four legs, unlike humans who as you know only have two and most brachy owners tend not to be Olympian athletes do they?
    We are not talking about functionality of the lung. BOAS it is about functionality of the airway. I suspect most FB lungs are perfectly functional,but if the airway is restricted the about of oxygen that can be saturated in to the lungs with each breath taken will be less than a dog without a restricted airway. Call me thick, but why are you talking about lung capacity, when it is about the restriction of the airway?

    Some stats for you David Sargan from the top 10 breeds registered with the KC in 2014. Three brachy breeds appear in the top ten equaling 24,873 brachy dogs in the top ten breeds registered with the KC in 2014. So that leaves seven none brachy breeds in the KC top ten breeds for 2014, added together that makes 94,069 non brachy dogs registered with the KC in the top ten breeds. Nearly four times the brachy breeds registered in the top ten breeds with the KC. So by this data you could conclude that non brachy breeds are more popular than non brachy breeds. Nearly four times as popular. You can go down to the top twenty breeds registered with the KC and that is non brachy breeds 106,123 registrations against 50,310 registrations. Non brachy breeds still way ahead of brachy breeds though.
    No the breeds should not be banned, but neither should they be made to believe that they can carry on breeding dogs with such extreme morphology and it is okay.
    'By starting off with large numbers of tested dogs and a great deal of rigour about their phenotypes, we hope and expect to arrive at the same point in only a very few years.' I hope you don't end up with what has happened in farming, as having worked in the Dairy industry for over 30 years, that will be low fertility, bad feet, shit immune systems and a reduction in longevity then, but brach breeds already have that.

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    1. No doubt that brachy breeds are incredibly popular though - and despite my (and other) best efforts to educate people, registrations have soared.

      I find it interesting that the message re Cavaliers *worked* - far fewer registered today than before PDE. But it hasn't re Pugs and figuring out why would really help.

      I *think* it's a combination: the images of a Cavalier screaming in pain; and Clare Rusbridge's famous "brain too big for its skull" quote made a really big impact and it has stuck in people's memories. Showing images of Pugs fighting for breath has made much less impact though. Were they not strong enough? Or is that we are battling human psychology? My own theory is that in a society marked by a lot of family dysfunction/breakdown, we are increasingly turning to dogs that look like babies for our unconditional love fix.

      I am following what's happening in Sweden with real interest because there is *such* a head of steam (in a way not dissimilar to what happened post PDE) there that I think it will result in real change. And that could/should cascade to elsewhere.

      At the end of the day, we need a multi-factorial approach that comprises beating people over the head; more gentle education; breed standard changes; new ways of objectively (and easily) assessing brachy dogs for breeding; better judging; genetic research etc.

      As I say in my original post, Cambridge is doing some fab work. My concern is re the feasibility of finding a useful genetic test/s even in a world where gene mapping is getting so much more useful/quicker - and that offering this solution gives breeders the excuse to not take the action they could be doing now. As I've now added above, even if "in a few years" you could find useful markers for breathing, there's still the very real issue of their terrible mouths/teeth - a direct consequence of the contraction of that muzzle.

      That 50 per cent of Frenchies and a higher percentage of Pugs have real problems breathing is not acceptable.

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    2. I think the reality TV and the explosion of the internet with social media has brought about the upsurge in Pugs and French Bulldogs. The amount of extreme brachy photos and footage each day loaded up on social media is phenomenal. The rise in breeding of French Bulldogs is quiet astounding. These dogs though through being seriously debilitated by their extreme morphology make for easy dogs when it comes to exercise and doing any damage in your home, which is a real attraction for some. They don't understand that their lack of energy is lack of oxygen and think it is the dogs temperament to be lazy, sadly. Most of the people who have extreme brachys probably would struggle with owning a fully fit and functional dog and that is I'm afraid a big part of the attraction the debilitation the extreme morphology causes. Dogs gasping for breath, looking like they are acting stubborn and lazy and then fainting are a lot cuter than Cavaliers screaming in pain scratching at their neck. Very sad.

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    3. Goodness yes, Jemima I agree when you say that your "concern is re the feasibility of finding a useful genetic test/s even in a world where gene mapping is getting so much more useful/quicker - and that offering this solution gives breeders the excuse to not take the action they could be doing now." I think breeders and brachy fanciers need to be completely honest with themselves regarding this point: they are attached to the very flat face look. Attached to the point of wanting to retain that look to the detriment of the health of the dogs. By identifying genes that play roles in BOAS, the hope is to continue breeding very flat faced dogs who can just breathe better. It's one of those things that just boggles my mind - is this really something we need genetic tests for? Not only can you breed for longer muzzles, you can breed for deeper eye sockets and smaller, more normal canid eyes, less wrinkling, and better oral anatomy by selecting the less extreme dogs...solely based on phenotypes, to a large extent. You can choose to not breed dogs that struggle to breathe, snore, struggle to eat, etc., based on simply observing the dogs...

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  12. Fundamentally, the true problem is this picture, which I saw in the Tuesday 4th February 2016 edition of The Metro: https://www.dropbox.com/sc/bo2dolkomterb0d/AACZkXxEgUEPQqhYArCOtVtXa

    In it, Lewis Hamilton's bulldog (named Roscoe) is pictured sat in front of the Colosseum. The positive association of the bulldog with a very successful, prominent person, added to the trappings of nobility 'Emperor Roscoe', the using of the Colosseum as a backdrop and the fact that the picture is being auctioned off to raise money for the again, very noble cause of the Great Ormond Street Hospital all reinforce the idea of a bulldog as a *very* desirable animal to have.

    Until this is perceived as a monstrosity, there'll be no shortage of buyers and no shortage, alas, of breeders.

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  13. Umm... I absolutely support the idea that we should be breeding dogs with longer muzzles etc. But Sargan is a geneticist, not a dog breeder, or even someone who sets KC policy. I wouldn't have the thought that the research he is conducting will make a huge deal of difference to the practical breeding of dogs, particularly when these breeds are so popular that all kinds of breeders are producing large quantities of them willy nilly.

    I think actions like the CRUFFA campaign to normalise the appearance of healthier brachy dogs, and people like Paul O'Grady regularly featuring brachy dogs that need surgery on his programme (which he does), are more likely to improve pet dog health than preventing research into the genetics of muzzle length.

    I used to be a scientist, in fact a (human) geneticist, and I can tell you that for funding reasons there is a huge amount of pressure to justify in practical terms what is primarily blue sky research; research that will add to the sum of human knowledge in a good way, even if it doesn't result in the suggested practical outcome.

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  14. is there a test (aside from observation and sounds) that can be done on dogs to assess their ability to breathe? My SIL has two champion bred labrador retrievers, one breathes just fine - the other struggles to get air both in and out. She has been like this since gaining maturity - she basically sounds like a freight train, but her owners are not bothered despite me pointing it out. (one is a vet) so it isn't just muzzle length or size - on the other hand I know plenty of brachy dogs that breathe well by comparison.. also plenty that don't. So it's not quite that simple, although I am all in favour of lengthening the noses and increasing nostril and trachea size & substance by selection. Go David Argan.... go for it - if we can have snub nosed healthy dogs, that would be a big win. (nb not no nosed dogs..just shortish and cute, but still functional)

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  15. Kinda sounds like the same old. "Perfection must come through ............DIVISION!!"

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