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The Effects of Animals on

Human Health and Well-Being

Article in Journal of Social Issues September 2009

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Journal of Social Issues, Vol. 65, No. 3, 2009, pp. 523--543

The Effects of Animals on Human Health

and Well-Being
Deborah L. Wells
Queens University Belfast

Substantial sums of money are invested annually in preventative medicine and

therapeutic treatment for people with a wide range of physical and psychological
health problems, sometimes to no avail. There is now mounting evidence to suggest
that companion animals, such as dogs and cats, can enhance the health of their
human owners and may thus contribute significantly to the health expenditure of
our country. This paper explores the evidence that pets can contribute to human
health and well-being. The article initially concentrates on the value of animals for
short- and long-term physical health, before exploring the relationship between
animals and psychological health, focusing on the ability of dogs, cats, and other
species to aid the disabled and serve as a therapist to those in institutional
settings. The paper also discusses the evidence for the ability of dogs to facilitate
the diagnosis and treatment of specific chronic diseases, notably cancer, epilepsy,
and diabetes. Mechanisms underlying the ability of animals to promote human
health are discussed within a theoretical framework. Whereas the evidence for a
direct causal association between human well-being and companion animals is
not conclusive, the literature reviewed is largely supportive of the widely held, and
long-standing, belief that pets are good for us.

Pet keeping is a widespread and well-accepted phenomenon in todays society.

As a nation of self-confessed animal lovers, the British public now share their
homes with over nine million cats and six million dogs (Pet Food Manufacturers
Association, 2004). These companion animals can play an enormous role in their
owners lives. As well as providing a source of companionship, support, and
entertainment, there is now substantial evidence to suggest that such animals may
be able to promote their owners health (for reviews, see Friedmann, Thomas, &

Correspondence concerning this article should be addressed to Deborah L. Wells, Animal Be-
haviour Centre, School of Psychology, Queens University Belfast, Belfast BT7 1NN, Northern Ireland,
UK. Tel: +44(0) 28 9097 4386; Fax +44 (0) 28 9066 4144 [e-mail: d.wells@qub.ac.uk].
523

C 2009 The Society for the Psychological Study of Social Issues
524 Wells

Eddy, 2000; Hart, 2006; McNicholas et al., 2005; Wells, 2007; Wilson & Turner,
1998).
This paper reviews the evidence that companion animals can facilitate human
health and quality of life. The article examines the value of pets for physical and
psychological health and focuses on new developments in this field, including, for
example, the relationship between pets and allergic sensitization, and the ability of
dogs to serve as early-warning systems for human disease. The paper is based on a
comprehensive review of the literature and aims to assimilate the key findings and
conclusions arising from the work in this area. A diverse range of methodologies,
including surveys, interviews, physiological experimentation, and self-reported
case studies are represented by the work reported.

Companion Animals and Physical Health

The notion that pets are good for us is by no means a new one. It is only
relatively recently, however, that any scientific attention has been devoted to the
relationship between companion animals and physical well-being in humans. This
research has shown that pets can contribute certain benefits to our short- and
long-term health.

Companion Animals and Short-Term Physical Health

While not entirely conclusive (e.g., Grossberg, Alf, & Vormbrock, 1988;
Hansen, Messinger, Baun, & Megel, 1999; Katcher, Beck, & Levine, 1989;
Rajack, 1997; Straatman, Hanson, Endenburg, & Mol, 1997; Wilson, 1991), many
studies suggest that companion animals may be able to improve our short-term
physical health (i.e., offer health benefits lasting for seconds or minutes). Research
in this area has explored both the effects of physically interacting with animals
and being in the presence of animals on short-term measures of human health.

The effects of physically interacting with animals. The action of stroking or

petting an animal has repeatedly been shown to cause transient decreases in blood
pressure and/or heart rate (e.g., Eddy, 1996; Katcher, 1981; Katcher, Friedmann,
Beck, & Lynch, 1983; Shiloh, Sorek, & Terkel, 2003; Vormbrock & Grossberg,
1988; Wilson, 1991). Perhaps not surprisingly, interactions with a familiar animal
appear to serve a greater therapeutic benefit than those with an unfamiliar animal
(Astrup, Gantt, & Stephens, 1979; Baun, Bergstrom, Langston, & Thoma, 1984;
Schuelke et al., 1991). Also, the action of stroking a pet can have positive health
benefits for the animal itself, helping, for example, to lower heart rate (Feh &
de Mazieres, 1993; Lynch & McCarthy, 1969; McGreevy, Righetti, & Thomson,
2005; Vormbrock & Grossberg, 1988). The short-term health advantages accrued
from humananimal physical interactions could thus be considered mutually
beneficial for both partners.
Human Health and Well-Being 525

The effects of being in the presence of animals. Although direct contact with
an animal appears to have health advantages for humans, it seems that the mere
presence of a companion animal can also offer short-term health benefits, helping
to lower autonomic responses to conditions of moderate stress. Research has shown
transient reductions in the heart rate and/or blood pressure of participants exposed
to a wide variety of stressors while in the presence of an animal. For example,
in one of the earliest studies of this kind, lower blood pressure responses to the
stressor of reading aloud were found when participants watched fish swimming
in an aquarium, compared to when looking at a plant-filled aquarium with no fish,
or staring directly at a blank wall (Katcher et al., 1983). Around the same time,
Friedmann and associates (1983) discovered that the presence of a dog helped
to reduce the blood pressure increases that typically occurred in children while
reading aloud. More recently, Allen and others reported that the presence of a
pet dog or cat resulted in lower levels of heart rate and blood pressure relative
to the presence of a friend or spouse, in people exposed to the psychological
stressor of mental arithmetic, and the physical stressor of a cold pressor test (Allen,
Blascovich, & Mendes, 2002; Allen, Blascovich, Tomaka, & Kelsey, 1991).
The above studies point to the propensity of animals to serve as moderators
of stress, at least in the short term. Unfortunately, the use of real animals in
experimental or applied settings is not always practical, or for that matter desirable.
Allergies to, and phobias of, animals are common (see later). Moreover, care
and control of the animal involved in the study can present challenges and even
confound results. Evidence now suggests that videotapes of animals may serve
as a potential alternative to the use of live animals in stressful situations. Thus,
DeSchriver and Riddick (1990) reported decreases in the physiological stress levels
of elderly people exposed to a videotape of fish swimming in an aquarium. More
recently, Wells (2005) found that video recordings of fish, birds, and monkeys
buffered participants from the stressor of reading aloud significantly more than
exposure to moving images of people or blank television screens. While limited,
the findings from these investigations point to the potential value of videotapes
of certain animals to be used as transient mediators of stress. This mode of
presentation may offer advantages where the use of live animals is not feasible, or
indeed desirable.

Companion Animals and Long-Term Physical Health

Evidence for the ability of companion animals to improve our long-term

physical health (i.e., offer health benefits lasting weeks, months, or even years)
is more sparse than that of short-term health. Nonetheless, the few studies that
have been undertaken in this area seem to suggest that pets may hold long-
term therapeutic benefits, preventing us from becoming ill, and even facilitating
recovery from serious physical ailments.
526 Wells

Companion animals as preventers of ill health. A number of studies have

examined the relationship between pet ownership and physical well-being in an
effort to establish whether companion animals can prevent ill health. This work is
largely supportive of the idea that pet owners are a healthier cohort of individuals
than nonowners. Pet owners, for instance, have been discovered to visit the doctor
significantly less than individuals who do not own a companion animal (Headey,
1998; Siegel, 1990). Recent evidence, while not entirely conclusive, also suggests
that indirect exposure to pet allergens during childhood may infer a lower risk
of developing allergic sensitization to these materials (e.g., de Meer, Toelle, Ng,
Tovey, & Marks, 2004; Liccardi et al., 2005; Simpson & Custovic, 2005).
Owners of dogs appear to gain more general health advantages than owners
of cats. For example, Serpell (1991) found significant reductions in the frequency
of minor physical ailments (e.g., headaches, colds, hay fever, dizziness) for dog
and cat owners 1 month following their pets acquisition. Dog owners, however,
maintained this decrease in health problems 10 months later; cat owners, by
contrast, did not.
Pet ownership may not only help in the prevention of relatively minor physi-
cal ailments but may also reduce the chances of people developing more chronic
conditions. Anderson and colleagues, for example, discovered that the risk factor
for coronary heart disease was significantly lower for pet owners than nonown-
ers, particularly for males (Anderson, Reid, & Jennings, 1992). More recently,
Dembicki and Anderson (1996) found lower levels of serum triglycerides (high
levels of which are associated with increased risk for heart attacks, e.g., Stavenow
& Kjellstrom, 1999) in elderly pet owners compared to nonowners.
It must be noted that research exploring the ability of pets to prevent their
owners from becoming ill has produced some mixed results. For example, Parslow
and Jorm (2003) found no relationship between pet ownership and reductions in
heart disease. The association between pet ownership and health seems particu-
larly weak among the elderly (e.g., Raina, Waltner-Tuews, Bonnett, Woodward,
& Abernathy, 1999; Simons, Simons, McCallum, & Friedlander, 2000; Tucker,
Friedmann, Tsai, & Martin, 1995). Indeed Parslow and colleagues found that pet
owners aged between 60 and 64 years actually reported poorer physical health
and higher use of pain relief medication than people of the same age who did not
own a pet and concluded that pet ownership confers no health benefits for this age
group (Parslow, Jorm, Christensen, Rodgers, & Jacomb, 2005). Likewise, Pluijm
and associates (2006) found that the ownership of dogs and cats significantly
predicted recurrent falls and fractures in elderly people.

Companion animals as facilitators to recovery from ill health. A small body

of research has explored the ability of pets to facilitate their owners recovery from
ill health. In one of the most widely cited studies in the field, Erika Friedmann
and colleagues reported that pet owners were significantly more likely to still
Human Health and Well-Being 527

be alive 1 year after a heart attack than nonowners (Friedmann, Katcher, Lynch,
& Thomas, 1980). These results, however, have not been replicated by others.
Moreover, this work has been criticized for its statistical methods (Wright &
Moore, 1982) and lack of control for other potential risk factors, for example,
social support, personality type, and socioeconomic status (see Bergler, 1988).
More recently, Friedmann and Thomas (1995) replicated their earlier work
and extended it to a larger number of participants with improved measures of
cardiovascular physiology and psychosocial status. Interestingly, the study showed
that dogs may serve as stronger facilitators to recovery from ill health compared to
cats. Thus, dog owners were roughly 8.6 times more likely to still be alive 1 year
after a heart attack than those who did not own this type of companion animal.
Cat ownership, by contrast, did not reveal similar effects.

Companion Animals and Psychological Health

Companion animals may not only be able to facilitate certain aspects of

physiological health in humans but they may also contribute to the psycholog-
ical well-being of people. Research has shown that animals can ameliorate the
effects of potentially stressful life events (e.g., bereavement, divorce), reduce lev-
els of anxiety, loneliness, and depression (Folse, Minder, Aycock, & Santana,
1994; Garrity, Stallones, Marx, & Johnson, 1989), and enhance feelings of auton-
omy, competence, and self-esteem (Beck & Katcher, 1984; Kidd & Kidd, 1985;
Levinson, 1972; Robin & ten Bensel, 1985; Triebenbacher, 1998). This section
reviews some of the psychological benefits that companion animals can offer their
human caregivers.

Social Contacts

Companion animals can facilitate social interactions between people. Pets,

and in particular dogs, have long been noted for their socializing role. For example,
walking with a dog results in a significantly higher number of chance conversations
with complete strangers than walking alone (McNicholas & Collis, 2000; Messent,
1983; Wells, 2004). This so-called social catalysis, or lubrication, effect does not,
however, appear to be a generic one but rather is related to features of the animal.
Young dogs, with their endearing features and clumsy movements, are more likely
to evoke social responses than older animals. Likewise, dogs that are generally
perceived in a positive light, for whatever reason (e.g., reputed temperament,
color), are more likely to facilitate social interactions than those that are less
popular (Wells, 2004).
Whereas dogs may serve as particularly strong social lubricants, other
species can also facilitate interactions between people. Thus, Hunt, Hart, and
Gomulkiewicz (1992) found that an American woman sitting in a park received
528 Wells

significantly more social approaches from passers-by whenever she was accom-
panied by a rabbit or turtle, than whenever she sat alone blowing bubbles or with
an operational television set.
The ability of animals to serve as a social lubricant is perhaps most obvious in
individuals with disabilities who happen to have a service animal. Numerous
organizations now train dogs, and other animals (e.g., monkeys), to enhance
the visual, auditory, and/or mobility capabilities of their owners. In addition to
achieving the goal for which they were purposely trained, assistance animals have
been shown to act as strong social catalysts, helping to normalize relationships
with other people. Hart and colleagues, for example, reported that wheelchair
users received a median of eight friendly approaches from unfamiliar adults per
shopping trip when they were accompanied by their service dog, but typically
only one friendly approach if the animal was not present (Hart, Hart, & Bergin,
1987). Similar findings have been reported by others (e.g., Eddy, Hart, & Boltz,
1988; Guest, Collis, & McNicholas, 2006; Mader, Hart, & Bergin, 1989; Steffens
& Bergler, 1998).

Loneliness and Isolation

A substantial body of research now points to the idea that pets can reduce
feelings of loneliness and isolation. Some authors have explored the ability of pets
to reduce loneliness in the general pet-owning community (e.g., Headey, 1998;
Jessen, Cardiello, & Baun, 1996; Mahalski, Jones, & Maxwell, 1988; Zasloff &
Kidd, 1994); much of the research in this field, however, has examined the health
benefits for those living in institutional settings such as nursing homes and hospital
wards.
Corson and others (Corson & Corson, 1978; Corson, Corson, Gwynne, &
Arnold, 1975; Corson, Corson, Gwynne, & Arnold, 1977; Corson & OLeary,
1980) were among the first to assess the utility of animals for those residing in
institutions. In their original study, 47 withdrawn and uncommunicative patients
in a psychiatric unit were allowed to interact with self-chosen dogs on a daily
basis. Five of the patients were noted to have improved markedly by the end
of the study, and at least some psychological improvement was seen in all of the
participants. Whereas this study was heavily reliant on individual case histories and
lacked rigorous control, more scientifically robust experiments have subsequently
revealed similar findings to these earlier results. Salmon and Salmon (1982),
for instance, found that the presence of a residential dog in a nursing home
resulted in happier, more alert, and more responsive patients, as assessed
by staff reports. More recently, Bernstein and associates discovered that animal-
assisted therapy in the form of visits from rescue-sheltered dogs and cats facilitated
social interactions (particularly long conversations) between residents of nursing
homes (Bernstein, Friedmann, & Malaspina, 2000). Numerous other authors have
Human Health and Well-Being 529

reported similar patterns of positive results in settings such as residential homes and
hospital wards (e.g., Crowley-Robinson, Fenwick, & Blackshaw, 1996; Fick, 1993;
Francis, 1985; Kaiser, Spence, McGavin, Struble, & Keilman, 2002; McCabe,
Baun, Speich, & Agrawal, 2002; Moody, King, & ORourke, 2002; Schultz,
1987). The potential risks associated with introducing animals into health-care
settings cannot be overlooked (see DiSalvo et al., 2006); however, pet-facilitated
therapy programs involving dogs, cats, and even horses (i.e., hippotherapy; see
Burgon, 2003; Fitzpatrick & Tebay, 1998) are now relatively commonplace across
the UK, Europe, and North America (see Fine, 1999).
Lately, institutions such as prisons have also started to employ animals, in
particular dogs, in a therapeutic capacity (see Strimple, 2003). Like those residing
in other institutional settings, prisoners can suffer from feelings of loneliness and
isolation. Schemes have thus been introduced to various prisons across the USA
(e.g., Project Pooch in Portland, OR) in a bid to enhance the psychological well-
being of prison-mates and rehabilitate offenders. Participants in these schemes
are typically required to look after the animal in their care, and in many cases
train it for a specific purpose, for example, as an assistance dog for the elderly
or physically disabled (e.g., Hines, 1983; Walsh & Martin, 1994). Thus far, only
a limited amount of research has explored the potential benefits of such schemes
on the psychological well-being of participants (Bustad, 1990; Merriam-Arduini,
2000); that which has been carried out, however, seems to suggest improvements
in mental welfare, including increments in social interactions.
Although none of the above studies are without their methodological problems
(see Beck & Katcher, 1984), on the whole they tend to suggest that the presence
of an animal in an institutional setting can help to break the vicious cycles of
loneliness that many people experience and encourage social interactions and
communication.

Depression and Self-esteem

A number of studies have explored the effect of companion animals on de-

pression in humans, with mixed results. Some authors have highlighted a positive
relationship between pet ownership and reductions in human depression. Siegel
and associates, for instance, found that pet-owning men infected with AIDS, par-
ticularly those with a poor social support system, reported less depression than
those who did not own a companion animal (Siegel, Angulo, Detels, Wesch, &
Mullen, 1999). Elderly people with pets have also been shown to have fewer
symptoms of depression than those without pets (Roberts, McBride, Rosenvinge,
Stevenage, & Bradshaw, 1996). More recently, Guest and others showed that peo-
ple with hearing impairments exhibited significant, and long-lasting (i.e., up to
18 months), reductions in depression following the acquisition of a service dog
(Guest et al., 2006).
530 Wells

Other studies in this area have yielded less positive results. Thus, Siegel and
others found no relationship between pet ownership and depression in men infected
with HIV (Siegel et al., 1999). Similarly negative findings have been reported in
studies of people with Alzheimers (Fritz, Farver, Kass, & Hart, 1995), unmarried
men (Tower & Nokota, 2006), working and elderly women (Miller & Lago, 1990;
Watson & Weinstein, 1993), and psychiatric patients (Barker, Pandurangi, & Best,
2003). Perhaps more worrisome, some authors have actually reported higher levels
of depression in certain groups of pet owners (e.g., Fritz, Farver, Hart, & Kass,
1996; Parslow et al., 2005; Roberts, Horn, McBride, Bradshaw, & Rosenvinge,
1998).
The conflicting results in this area are likely to be a consequence of dramatic
differences in methodological design, e.g., attachment to pet (see Fritz et al.,
1996; Garrity et al., 1989), participants recruited, severity of depression, measure-
ment scales, etc. Further work is needed in this area, ideally using more consistent
methodology, before firm conclusions regarding the relationship between pet own-
ership and human depression can be established.
Information on the relationship between pet ownership and self-esteem is as
mixed as that on depression. Some studies, for example, have found a positive
correlation between exposure to companion animals and this particular measure
of psychological health. Thus, Bustad (1990) reported higher levels of self-esteem
in women who participated in a dog training program at a correctional center in
the United States. By contrast, Triebenbacher (1999) found no direct relationship
between levels of self-esteem and pet ownership in American schoolchildren. As
with other components of psychological health, there may be a relationship be-
tween levels of attachment to ones pet and self-esteem benefits accrued (Crawford,
Worsham, & Swinehart, 2006; Triebenbacher, 1999).

Mechanisms Underlying the Ability of Pets to Promote Human Health

One must question how animals can facilitate the types of health advantages
discussed above. A number of mechanisms have been proposed (McNicholas,
Collis, & Moreley, 1995), all worthy of exploration from a theoretical point of
view.
Firstly, it is possible that pets can contribute directly to human health and
well-being. The roles of attachment and social support need some discussion here.
Attachment theory was first put forward by John Bowlby (1969, 1979) in a bid
to explain the close bond of affection that typically develops between a parent
and child. Just as humans can develop close bonds of affection with other people,
so too they can develop strong emotional ties with their pets. Many owners, for
example, consider their pet to be a part of the family, treat it as a child, and speak
to it as they would a baby (for review see Archer, 1997). These attachments can
Human Health and Well-Being 531

lead to improved psychological health (see earlier), which in turn may bolster
physiological well-being.
Collis and McNicholas (1998) have suggested that it may be more useful to
look at the supportive functions of personpet relationships, rather than attach-
ment, as a framework for understanding the health benefits experienced by people
exposed to animals. Cobb (1976) described social support as information leading
one to believe they are loved, esteemed, and belonging to a network of mutual
obligation. In some respects, pets meet many components of this definition. For
instance, they are typically perceived as nonjudgmental, noncritical, and to be
there in times of trouble. The behaviors they display (e.g., the greetings rituals
exhibited by dogs upon their owners return to the house) create the impression of
unconditional love, faithfulness, and dependability. The social support provided
(or perceived to be provided) by pets may explain the health benefits experienced
by owners. Positive social relations are postulated to have protective effects on
health by protecting people from the potentially pathogenic influences of stressors
(Schwarzer & Leppin, 1991). Studies have shown, for example, that high levels
of social support (albeit human) can significantly predict emotional and physical
well-being after bone marrow transplantation (Hochhausen et al., 2007), facili-
tate recovery from coronary heart disease (for review, see Anderson, Deshaies, &
Jobin, 1996), and reduce the chances of future myocardial infarctions and strokes
in women (Andre-Petersson, Engstrom, Hedblad, Janzon, & Rosvall, 2007). Inter-
estingly, perceptions of social support may be a more important correlate of health
outcomes than actual support (e.g., Pierce, Baldwin, & Lydon, 1997; Ratnasingam
& Bishop, 2007; Smith, Ruiz, & Uchino, 2004); thus, the mental representations
of support that owners have of their pets may explain some of the health benefits
witnessed in this population.
Social support may also explain the short-term physiological health advan-
tages seen in participants exposed to animals during laboratory-based challenges.
The presence of a human audience raises a persons arousal levels when perform-
ing a task (e.g., Triplett, 1897; Zajonc, 1965), and the performers perception of
the audience plays an important role in determining the effect of this increased
arousal on the quality of performance. Participants who believe that the audi-
ence will evaluate their performance positively tend to perform better than those
who believe that their performance will be evaluated negatively (e.g., Sanna &
Shotland, 1990). Animals, unlike humans, are perceived as completely nonjudg-
mental; they may thus have the ability to serve as social facilitators, decreasing
stress and improving performance.
In addition to the above, animals can also offer indirect benefits to human
health and well-being. Watching fish swimming in an aquarium, for example,
may serve as a simple distraction, thereby buffering participants from the stressor
of testing. This indirect mechanism may also explain to some degree the greater
health advantages experienced by owners of dogs. Dogs, unlike other companion
532 Wells

animals, need to be walked, thereby resulting in increased physical activity (and

increased social contacts, as discussed earlier). The relationship between physical
fitness and long-term health is well established. The increased physical activity
that typically accompanies the ownership of a dog (Bauman, Russell, Furber, &
Dobson, 2001; Brown & Rhodes, 2006; Serpell, 1991) may thus explain to some
degree the greater health advantages experienced by the owners of such pets.
Obviously, the mechanisms underlying the ability of companion animals to
improve human health are complex and much further research is needed before
firm conclusions can be drawn. The possibility that there is a noncausal association
between animals and human health must also be acknowledged at this point in
time; thus, there may well be a correlation between the two variables, but pet
ownership per se may not necessarily be responsible for any improvements in
owners health status. It is possible, for example, that people who choose to
acquire a pet also harbor traits more likely to dispose them to enhanced health and
well-being (McNicholas & Collis, 1998; McNicholas et al., 1995).

Companion Animals as Detectors of Disease

Thus far, this paper has explored the evidence for the ability of animals to
facilitate physical and psychological health advantages. Lately, some attention
has been directed toward the ability of companion animals, and notably dogs, to
serve as early warning systems for certain types of underlying physical ailment in
humans such as cancer, epilepsy, and diabetes. This section discusses the scientific
evidence for the detection of these conditions by dogs and examines some of the
issues surrounding the training of animals for the diagnosis and treatment of human
health problems.

Cancer Detection

Cancer claims the lives of millions of people every year, often because symp-
toms of the disease are noticed too late for effective intervention. Lately, there
has been some suggestion that the domestic dog may serve as a useful early
warning, or screening, system, for people with cancerous tumors. Interest in this
area stemmed from research published in one of the leading medical journals,
The Lancet (Williams & Pembroke, 1989). The authors of this study reported the
case of a mongrel that persistently sniffed at a mole on its owners leg; the lesion
later turned out to be malignant. Similar anecdotal reports have since appeared
in newspapers (Dobson, 2003; Fraser, 2002) and scientific journals (Church &
Williams, 2001).
The mechanism(s) underlying the ability of dogs to detect human cancer has
not, as yet, been explored scientifically; however, it seems logical to assume that
such animals are picking up on changes in olfactory cues. Tumors typically produce
Human Health and Well-Being 533

volatile compounds (e.g., alkanes and benzene derivatives) that are released into
the atmosphere through routes including breath, sweat, and urine (e.g., Di Natale
et al., 2003; Phillips et al., 2003). The dog, whose sense of smell is thought to lie
anywhere between 10,000 and 100,000 times better than that of humans, may be
able to detect these compounds, even in minute quantities. Very recently, it has
been hypothesized that the olfactory detection of human cancer by dogs may be
based on major histocompatibility complex odor components (Balseiro & Correia,
2006).
Recognition of the fact that some dogs may have an inherent ability to detect
the smell of human cancer has led to experimental work aimed at establishing
whether dogs can be trained to perform this feat. The findings produced thus
far, while limited, are largely positive in their conclusions. For example, Willis
and colleagues (2004) successfully trained six dogs of mixed breed to identify
bladder cancer samples in a seven-choice discrimination task. As a group, the
dogs correctly identified urine samples from patients with bladder cancer on
22 out of 54 occasions, a mean success rate of 41%. Although this proof of
principle study has been criticized for methodological weakness and erroneous
conclusions (e.g., Leahy, 2004), other work has yielded relatively similar results.
Thus, Pickel and colleagues successfully trained a male Schnauzer and a female
Golden Retriever to reliably detect an unknown set of chemicals released by tissue
samples from patients with malignant melanoma (Pickel, Manucy, Walker, Hall,
& Walker, 2004). More recently, McCulloch and associates (2006) found that five
pet dogs of mixed breed (three Labrador Retrievers, two Portuguese water dogs)
could be trained to correctly and reliably identify the odors of lung and breast
cancers using exhaled breath samples from patients with these diseases.

Seizure Detection

It is estimated that 440,000, or 1 in every 133, people in the UK has epilepsy,

of which a quarter can have seizures which cannot be controlled by any available
therapy (http://www.epilepsy.org.uk/press/facts.html). Seizures can result in seri-
ous injury; however, their unpredictable nature is often a greater problem. Many
sufferers of the condition are unaware that they are about to have a seizure and
may show no outward signs that can be detected by even their close family or
friends. This can lead to demoralization, frustration, and anxiety, not only in the
person with epilepsy but also in those around them.
A system capable of autonomously detecting an impending seizure far enough
in advance to allow a person time to take some appropriate action (e.g., to stop
what they are doing, ask for assistance, etc.) has the potential to create a sig-
nificant improvement in the quality of life of many people. To date, almost all
of the research in seizure prediction has concentrated on the off-line analysis of
electroencephalographic (EEG) signals (Litt & Echauz, 2002). However, despite
534 Wells

the progress in this field, at present, the range of signal interpretation techniques
being proposed appears far from robust, repeatable, or generic enough to be used
in real-life settings and across different subjects. Moreover, the prospect of wear-
ing permanent, and even intercranial, electrodes for monitoring brainwaves is an
unpleasant one for many people.
Perhaps in stark contrast to the aforementioned difficulties, there is mounting
evidence to suggest that dogs can, relatively reliably, predict the onset of seizures
in their human owners, in some cases up to 45 minutes in advance (e.g., Brown &
Strong, 2001; Dalziel et al., 2003; Kirton et al., 2004; Strong et al., 1999, 2002).
This ability appears to be inherent in some animals; however, many dogs are now
being trained by specialist organizations (e.g., Personal Assistance Dogs, UK)
to monitor their human owners for outward signs of an imminent seizure and to
react in an appropriate manner (e.g., barking or pawing) if a seizure is predicted
(Brown & Strong, 2001; Dalziel, Uthman, McGorray, & Reep, 2003; Strong &
Brown, 2000; Strong, Brown, Huyton, & Coyle, 2002; Strong, Brown, & Walker,
1999).
The mechanism(s) underlying the ability of dogs to anticipate seizures in
humans is still unknown and needs investigation (Lawson, Wells, & Strong, 2004).
Olfactory cues may offer the most likely explanation; however, observations of
dogs by trainers indicate that seizure alerting may be primarily based on visual
signals such as facial expressions, postures, and general behavior (Brown & Strong,
2001). A recent survey of owners of untrained seizure alert dogs in Canada also
suggests that dogs use a variety of cues, with only a minority of owners believing
olfaction is important (Kirton, Wirrell, Zhang, & Hamiwka, 2004). That said,
it is possible that other physiological cues such as muscle tension, respiratory
signs, and perspiration might also be monitored by dogs using visual, auditory, or
olfactory senses.

Hypoglycemia Detection

Hypoglycemia is a common and potentially hazardous complication of di-

abetes, usually occurring in individuals with Type 1 (or increasingly Type 2)
diabetes on insulin. The condition typically results in physiological effects arising
from the attempt to restore glucose levels (sympathetico-adrenal response) such
as fear, tremor, tachycardia, and sweating, and a critical lack of glucose to the
nervous tissue (neuroglycopenia) leading to behavioral change, fits, or coma. As
the disease progresses, awareness of the warning signs of hypoglycemia often
wanes due to the effects of advancing age or complications of the condition such
as autonomic neuropathy.
The reliable detection of hypoglycemia has been a longstanding preoccupation
for diabetic patients and researchers alike. There is now evidence to suggest
that dogs may be able to detect the scent of hypoglycemia. Wells, Lawson, and
Human Health and Well-Being 535

Siriwardena (2008) recently discovered that almost two thirds (65.1%) of people
(N = 212) with Type 1 diabetes reported that their dog had, on at least one
occasion, shown behavioral responses to their hypoglycemic episodes. Similar,
more anecdotal claims, many involving case studies, have been reported by others
(Chen, Daly, Natt, & Williams, 2000; Lim, Wilcox, Fisher, & Burns-Cox, 1992;
Stocks, 2002).
Although it is unknown exactly how dogs may detect hypoglycemia, odor cues
have been proposed as the most plausible explanation (Chen et al., 2000; Wells
et al., 2008). For example, Wells and associates (2008) found that many dogs
exhibited alert behavior when their owners were going low while asleep, and
presumably emitting no cues other than olfactory ones. In most of these cases,
the dog slept in another room of the house, and in some situations the door of the
owners bedroom was closed, forcing the animal to scratch or paw at the obstacle.
Increases in sweating have been repeatedly noted in hypoglycemic individuals (for
review see McAulay, Deary, & Frier, 2001). As in cancer detection, it is possible
that dogs can detect these changes in the chemical composition of their owners
sweat using their acute sense of smell. However, it cannot be ignored that dogs
may respond to other cues besides olfactory ones, including, for example, subtle
changes in their owners moods (with people often becoming more irritable as
their sugar levels drop) or visual signals related to the owners behavior (with
some people trembling, becoming disorientated, losing consciousness, or having
seizures). The possibility that individual animals employ multiple signals, or that
different dogs utilize entirely different cues, equally cannot be dismissed. Research
is now required to determine whether dogs can be trained to alert their owners to
the onset of hypoglycemia in the same way that they can be trained to anticipate
oncoming seizures or sniff out cancer.
Taken together, the above studies provide fairly strong evidence to suggest that
some dogs can spontaneously detect certain types of underlying physical ailments.
Moreover, there is increasing evidence to suggest that many dogs can be trained
successfully to perform this feat. This, of course, opens the door to potentially
using dogs as a diagnostic tool. Many tests for chronic diseases (e.g., prostate
cancer) are extremely invasive, and hence any system that offers a less traumatic
method of diagnosis (or even screening) must be welcomed. Moreover, animals
utilized as alert systems, whether it be for seizure detection or drops in blood
sugar levels, have the potential to greatly enhance their owners quality of lives. As
touched on earlier, dogs trained to assist those with sensory impairments have been
shown to bolster their caregivers social confidence, self-esteem, independence,
and social identity (e.g., Allen & Blascovich, 1996; Delafield, 1975; Hart, 1995;
Lane, McNicholas, & Collis, 1998; Sanders, 2000; Steffens & Bergler, 1998;
Valentine, Kiddoo, & Lafleur, 1993; Warnath & Seyfarth, 1982). Dogs trained
for the purpose of alerting have the potential to offer exactly the same types of
psychological advantages.
536 Wells

It would be foolhardy at this stage to rely solely on the evidence provided by

dogs in the diagnosis of chronic conditions. For example, it is unknown if dogs can
actually detect the smell of cancer itself, or if they are perhaps picking up on a more
general underlying disease symptom, such as one that comes from inflammation
(Pickel et al., 2004). Further research is clearly needed before firm conclusions
regarding the utility of dogs as a diagnostic tool for cancer can be established.
Appropriate selection of animals and training is also important, particularly for
those dogs employed for the purpose of alerting. Not all animals react favorably,
or indeed reliably, to their owners oncoming seizures, and the danger of using
untrained animals as alert systems has been highlighted (Dalziel et al., 2003;
Strong & Brown, 2000).

Conclusions and Implications for Practice and Policy

This paper has discussed the evidence for the ability of animals to promote
physical and psychological health in humans and facilitate the diagnosis and
treatment of specific chronic diseases. Although the evidence for a direct causal
association between human well-being and companion animals is still not conclu-
sive, the literature reviewed above is largely supportive of the widely held belief
that pets are good for us.
Unfortunately, not all of the studies carried out in this area have been method-
ologically robust or allow for generalized conclusions. Many, for example, have
been solely concerned with short-term changes in well-being, and relatively few
have employed overly large, or randomized, samples. The lack of prospective
designs and standardized measures that assess diverse areas of functioning also
makes it difficult to draw finite conclusions and much further work, ideally longi-
tudinal in nature, is needed.
It must be remembered that companion animals, and in particular dogs, have
the potential to compromise human health, can spread zoonoses, cause allergies,
bites, and, in extreme circumstances, even death (e.g., Baxter, 1984; Baxter &
Leck, 1984). All of these factors clearly need to be considered, and risk assessments
conducted, prior to using any type of animal in a therapeutic capacity. This issue
aside, the findings from this overview suggest that companion animals can have
prophylactic and therapeutic value for people and, as such, have the ability to
contribute significantly to our health and quality of lives. Although animals should
not be regarded as a panacea for human ill health, they may, nonetheless, serve
a valuable, and currently underutilized, role in promoting well-being, whether
in their own right or in conjunction with more traditional forms of therapy. The
prospect of continued work in this area will advance our understanding of the
nexus between animals and human health, and hopefully facilitate the shaping of
future health care practice and policy.
Human Health and Well-Being 537

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DEBORAH WELLS graduated with a first class honors degree in Psychology

from the Queens University of Belfast in 1992. She proceeded to carry out a
PhD on the behavior and welfare of kenneled dogs, for which she was awarded
her doctorate in 1996 and her professional chartered status 1 year later. Deborah
is currently employed as a Senior Lecturer within the School of Psychology at
Queens. She is also Director of the Universitys Animal Behaviour Centre. Her
research is largely concerned with the behavior and welfare of captive animals,
although other areas of research interest include laterality, sensory perception,
and the relationship between pets and human health. In addition to her research,
Deborah runs a pet behavior therapy consultancy and routinely acts as an expert
witness for legal cases involving dogs and cats.