Four years as a practising veterinary surgeon in mixed practice in East Anglia provided valuable experience in all aspects of veterinary practice in the UK. This included farm animal, equine and small animal practice, responsibility for local Ministry of Agriculture activity such as certifying live animal exports and TB testing as a Local Veterinary Inspector and slaughterhouse supervision as a trained Official Veterinary Surgeon.
A three-year clinical residency in small animal internal medicine at the Royal Veterinary College followed, during which the R.C.V.S. Certificate in Small Animal Cardiology and subsequently the Diploma in Veterinary Cardiology were successfully completed. During this time I was employed as a consultant cardiologist by two pharmaceutical firms.
Interest in veterinary cardiology which developed during the Residency was followed by a four year clinical PhD investigating aspects of the aetiology and pathogenesis of idiopathic, dilated cardiomyopathy in the dog in collaboration with the Heart Science Centre at Harefield Hospital. As a result of these investigations a PhD for a thesis entitled "Investigations into the pathogenesis of canine dilated cardiomyopathy" was awarded by the University of London.
Following a year as a lecturer in small animal internal medicine, experience working with a veterinary pharmaceutical firm resulted in a move to LEO Animal Health, employed initially as a Veterinary Adviser, then as the Technical Manager and finally as Divisional Director. During this time a Masters degree in Business Administration by distance learning was completed with Henley Management College. The Animal Health division of LEO Pharma in the UK is a subsidiary of a Danish pharmaceutical company, which markets prescription medicines and a range of diets for dogs and cats available only from veterinary surgeons. In the UK the prescription medicines include the market-leading treatments for infections of the eye, the ear and the skin in companion animals. Products for large animals include two well-established intramammary products used to treat and prevent mastitis in cattle. The UK division of LEO Animal Health comprises a sales force of 10 territory managers and 2 regional managers, a marketing department of 3 people and a research department of 2 people who are responsible for carrying out clinical studies in the UK and providing technical support for customers and colleagues. The role of Technical Manager involved significant project management and outsourcing of pharmaceutical development activities (with project costs often running to several hundreds of thousands of pounds) to a variety of contract research organisations on behalf of the UK organisation and the International Group. The Divisional Director has responsibility for achieving budgeted sales targets while keeping expenditure within forecast limits thus maintaining divisional profitability. On the basis of sales of products to veterinary surgeons from veterinary wholesalers, LEO Animal Health, at the end of 2004, were the 12th largest of the UK animal health companies (including pet food companies), recording sales of £10.4 million, which represented growth of 7.6% on the previous year and a share of the veterinary market of 2.5%.
In September 2005 moved back to academia to be part of the development of the new School of Veterinary Medicine and Science at Nottingham University. Currently Professor of Comparative Veterinary Medicine, Head of the Division of Veterinary Medicine and Deputy Head of School.
Malcolm Cobb holds a Foundation Chair in the School of Veterinary Medicine and Science where he is currently the deputy Head of School. He is Head of the Division of Veterinary Medicine and a Professor of Comparative Veteinary Medicine.
The School of Veterinary Medicine and Science (SVMS) is the first new veterinary school to be established for over 50 years in the UK. As the second member of academic staff to be appointed to the School Malcolm's principle involvement has been in the areas of strategy and planning taking a lead in developing much of the curriculum and delivery methods from the earliest stage of development of the School.
Following the arrival of the students, Malcolm has prepared and delivered material in a variety of formats (lectures, practicals, small group case-based sessions and directed group learning sessions) in many of the modules delivered in the first four years of the course.
Malcolm is also currently clinically-active, teaching final year students and carrying out clinical work at the Clinical Associate practices.
As well as our on-going interest in canine dilated cardiomyopathy we are currently investigating various aspects of the pathogenesis of cardiac valve degeneration and insufficiency in the dog and the… read more
As well as our on-going interest in canine dilated cardiomyopathy we are currently investigating various aspects of the pathogenesis of cardiac valve degeneration and insufficiency in the dog and the horse. It is now believed that the concept that the cardiac valves are passive structures that simply open and close due to haemodynamics of blood flow is an oversimplification of their role and that they possess contractile properties that fine tune their function resulting in a competent blood tight seal. This dynamic function of the valve is a result of the contractile phenotype of the valvular interstitial cells. These cells have a dual phenotype and may also play an important role in remodeling of the valve and ultimately in fibrosis and degeneration. The mechanisms that cause a change of cell phenotype from that of a contractile cell, which can alter valve function, to that of a synthetic cell, causing fibrosis have not been investigated.
In human and equine valvular interstitial cells, fibrosis can be stimulated by a variety of vasoactive substances that also affect valvular contraction. These mechanisms can also be stimulated by therapeutic agents, leading to drug-induced valvulopathies. However there are important species differences in expression of valvular receptors. Therefore investigation of factors that regulate proliferation, phenotype and fibrosis of canine mitral valve and equine aortic valve interstitial cells will identify mechanisms important in the pathogenesis of valve disease and may lead to the production of novel therapeutic agents to delay the progression of the disease in dogs, horses and humans with asymptomatic valvular regurgitation.
We are, therefore, currently establishing the means to characterize the cellular characteristics and mechanisms of fibrosis of the canine mitral valve and equine aortic valve to investigate the phenotypic response of the valvular cells to strain and document the signaling pathways responsible for these changes and finally to document differences in cell phenotype and signaling pathways in animals with valve disease. In addition, we are attempting to determine whether significant premature loss of autonomic innervation of the atrioventricular valve leaflets occurs in dogs with naturally-occurring valve degeneration. If we are able to demonstrate significant premature loss of autonomic innervation associated with the disease, this further supports the hypothesis that the valve is likely to be able to fine tune its movement through the actions of vasoactive, neuronal and hormonal mechanisms as previously described and that certain pathophysiological states may contribute to degenerative change seen in affected dogs, horses and other species including humans.
Previous work has focused on the pathogenesis of canine dilated cardiomyopathy (DCM). This condition probably represents a common end-stage myocardial failure resulting from a wide variety of insults and is characterised by impaired ventricular function and dilation of one (typically the left) or both ventricles. Evidence suggests that insidious systolic failure progresses gradually over a period of years with mild ventricular dysfunction and frequently cardiac dysrhythmias evident for months, even years before cardiac failure develops. Studies to date have included an assessment of the feasibility of using an entirely autologous extra-aortic counterpulsation system as a therapeutic option for dogs with severe congestive cardiac failure due to the disease, the role of anti-myocardial autoantibodies and previous parvoviral infections in the pathogenesis of the disease and an assessment of the changes in myocardial protein expression associated with the disease using two-dimensional protein electrophoresis. Other studies have included analysis of the pedigrees of Irish wolfhounds with DCM to assess the mode of inheritance of the disease. The results of these studies support the hypothesis that an immune-mediated process in genetically-susceptible individuals is involved in the development of DCM in the dog.
Other clinical research has included involvement in a number of international, multi-centre clinical studies designed to determine the therapeutic efficacy of a number of new treatments for heart failure in the dog, assessing the impact of therapy on electrolyte balance in canine cardiac failure, the use of interventional cardiology in clinical veterinary practice and the investigation and long-term prognosis in dogs presented with a history of collapse and/or exercise intolerance.
Evidence-based medicine (EBM) has developed over the past 15 years as clinicians, the general public and policymakers realise that, since resources are inevitably limited, decisions taken on the most effective interventions or treatments must be based on the soundest evidence available. Evidence-based working is set to become a more significant part of the veterinary profession and clinical audit is already beginning to play its part in this development (for example as part of the Royal College of Veterinary Surgeons practice accreditation scheme). Forming a knowledge base of 'what works' in animal health will require the compilation of a database of systematic reviews as well as the capacity to generate new data on clinical outcomes. This will need to be a collaborative effort and The School of Veterinary Medicine and Science is in the process of obtaining commercial sponsorship for the development of an International Centre of Excellence for clinical veterinary research within the School of Veterinary Medicine and Science which will act as a focal point of this initiative for the veterinary profession. This project will begin the process of generating data which will inform the establishment and activity of the Centre.
Initially, as part of this project we plan to investigate the current basis of clinical decision-making in veterinary practice in the UK. Specifically the project will aim to answer the following questions:
- What evidence currently drives clinical decision-making in the management of canine congestive cardiac failure in UK veterinary practice?
- How do UK veterinary practices carry out clinical audit?
- What is the best method of disseminating research findings if clinical veterinary practice is to be influenced?
In addition the School is capitalising on the opportunity to develop a new curriculum from scratch by developing a number of projects to assess the impact of the curriculum and its delivery with objective of developing, improving, evaluating and disseminating innovations in veterinary education. Areas of particular focus are evaluating student learning within the new curriculum and assessing the effectiveness of the use of a dispersed model for delivery of clinical experience in facilities not owned by the school.