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Diabetic alert dogs are trained to sniff out life-threatening changes in blood sugar for people with Type 1 diabetes. But their image as smart and capable lifesavers may be widely overstated. Some companies that sell the dogs are increasingly coming under fire from unhappy clients. NPR's Robert Benincasa has the story.
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ROBERT BENINCASA, BYLINE: It's Sunday morning at Bethany United Methodist Church in West Jefferson, N.C. A few minutes before services, the handbell choir warms up, and an acolyte lights candles.
PEGGY LYNN GIBSON: Look who's here.
UNIDENTIFIED PERSON #1: Hi, Rocky.
BENINCASA: Church member Peggy Lynn Gibson walks in with her dog Rocky, a stout golden retriever. Her fellow congregants know Rocky because they came together to bring him here, holding a chili lunch and a silent auction to raise funds. Local musicians even held a benefit concert.
GIBSON: Who is that, Rocky? Who is that?
UNIDENTIFIED PERSON #2: How are you? You're a sweetheart.
BENINCASA: Gibson is one of more than a million Americans with Type 1 diabetes, a difficult-to-manage autoimmune disease. Those who have it face a constant struggle to control the amount of sugar in their bloodstreams. If it gets too low, it can lead to seizures, loss of consciousness or death.
Rocky, an honorary member of the church, was trained as a diabetic alert dog. Diabetics hope dogs like him will smell dangerous changes in blood sugar and let them know before the problem becomes serious.
GIBSON: Are we talking about you, Rocky? I'm always talking about you, aren't I?
BENINCASA: Gibson is 67 and a retired nurse. Back at her home just outside West Jefferson's picture-postcard downtown, she explains why she sought canine help.
GIBSON: In these senior years, it became harder to recognize whether my blood sugar was going too high or whether it was going too low. That was partly what prompted me to look into getting a diabetic alert service dog.
BENINCASA: But the price was steep.
GIBSON: The purchase price was $15,000.
BENINCASA: Gibson calls her community's response an outpouring of love. It was also hopeful. And if you do some basic research on diabetic alert dogs, you'll find some very encouraging information, especially from television news stories.
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UNIDENTIFIED NEWS ANCHOR #1: This three-pound ball of fur with butterfly ears is a lifesaver.
UNIDENTIFIED NEWS ANCHOR #2: Well, I'm a big dog lover, and I'm just so amazed.
UNIDENTIFIED NEWS ANCHOR #3: So heartwarming.
UNIDENTIFIED NEWS ANCHOR #4: It's much a story of science but also of love.
UNIDENTIFIED NEWS ANCHOR #5: It's an adorable dog.
UNIDENTIFIED NEWS ANCHOR #6: Yeah.
UNIDENTIFIED NEWS ANCHOR #5: That is amazing to...
UNIDENTIFIED NEWS ANCHOR #6: Remarkable. Amazing.
UNIDENTIFIED NEWS ANCHOR #7: Amazing, yes.
UNIDENTIFIED NEWS ANCHOR #5: It's amazing that animals can do that.
BENINCASA: But maybe it's not so amazing. The alert dog industry is largely unregulated, so trainers and dogs aren't required to perform to any particular standards. Several dog training companies have come under fire recently from consumers who bought diabetic alert dogs they say don't work. In Texas, a group of more than a dozen dog buyers sued a trainer for fraud and won a judgment for $800,000. In Virginia, the attorney general sued a dog vendor, saying it deceived consumers about the animals' abilities and cost. Gibson is among dozens of ex-clients of a Nevada company who've taken to social media to complain. Soon after Gibson got Rocky, it was clear to her that he wasn't cut out to be a service dog in public, especially in the windy High Country of North Carolina.
GIBSON: The first day that I had him out on my own, the wind blew up. He got so scared that he couldn't run fast enough to try to hide. It was just pure fear.
BENINCASA: That was right after she had to sign a series of disclaimers as a condition of getting the dog from a company called Diabetic Alert Dogs of America. One document said Rocky has a, quote, "free will" and wasn't guaranteed to alert her to blood sugar changes. More than that, he wasn't guaranteed to, quote, "perform any specific action at any specific time." That's a pretty low expectation for $15,000, and maybe there's a reason for that.
LINDA GONDER-FREDERICK: We really are rooting for the dogs, but we still have to be objective.
BENINCASA: University of Virginia psychologist Linda Gonder-Frederick tracked the performance of 14 diabetic alert dogs in a 2017 study. Their owners believed the dogs would prove more accurate than their glucose monitor devices. That didn't happen.
GONDER-FREDERICK: Overall, they really were not that reliable and accurate.
BENINCASA: Of 14 in the study, only three dogs performed better than statistical chance. That's similar to what an Oregon researcher reported in 2016. Dogs in that study detected low blood sugar events 36% of the time but also had false positives. Gonder-Frederick says some dog owners overestimate their dogs' abilities.
GONDER-FREDERICK: When you find a person who, you know, believes very strongly in their dog, but in fact, maybe the dog's right half the time.
BENINCASA: So it's something like confirmation bias.
BENINCASA: Her research also contradicted what some believe - or hope - is true, that the dogs can be a good safety net for those who worry about blood sugar dropping as they sleep. Some parents have turned to the dogs to safeguard their children during the night.
GONDER-FREDERICK: The accuracy just plummeted because dogs have to sleep, too. Obviously, a dog cannot work 24/7.
BENINCASA: Two studies that did find good performance by alert dogs were co-written by the dog suppliers. But authors of those studies tell NPR the arrangements did not bias their research. Edwin Peeples, who co-owns Diabetic Alert Dogs of America - that's the company Gibson got her dog from - says he has trained nearly 700 dogs, and more than 9 out of 10 of his clients are satisfied. And for dogs that don't work out, Peeples says he has a training guarantee.
EDWIN PEEPLES: They can bring that dog to my doorstep here in Las Vegas, Nev. Our response will be, I will do my absolute best to try to fix it. And if I can't, you'll get a brand-new dog.
BENINCASA: But Jessica Moye, an Ohio mom with Type 1 diabetes, had a long-running dispute with Peeples and now helps run a Facebook page dedicated to complaints about his company. She says the replacement dog guarantee can mean little when there's a child involved.
JESSICA MOYE: The child bonds with the dog, and then they have to choose whether or not to send the dog back and start over again, looking for that lifesaving alert, or if they just let their child go on with life with this dog, regardless of the fact that it isn't working for them.
BENINCASA: Moye's dog, Hachi, cost $11,000. He was supposed to paw her if her blood sugar was out of range.
MOYE: If I got in his face and asked for the paw, sure, he would give me his paw. But there was never any link to the scent of my breath and whether my blood sugar was high or whether my blood sugar was low.
BENINCASA: Moye says she's heard from dozens of other clients. Some are happy, but some have struggled with dogs that are too aggressive or have other problems. And while researchers have found little evidence that dogs can reliably sniff out blood sugar changes, they have encountered a kind of paradox - people who get them tend to do better with their diabetes. Here's Gonder-Frederick again.
GONDER-FREDERICK: They may just be more engaged with their diabetes. They may be checking their blood glucose much more often than they used to. The dog is sort of a pleasant reminder of diabetes.
GIBSON: Additional ice, and there's lime or lemon there.
BENINCASA: Sitting at her kitchen table with Rocky underneath at her feet, Gibson acknowledges he has helped her feel less alone with her disease, but, she says...
GIBSON: I felt sorry that Rocky as an animal was chosen to do a job he wasn't equipped to do. That's not fair to the animal. Neither is it fair to me, the recipient of a $15,000 specially trained dog that isn't capable of doing his job.
BENINCASA: Gibson says she plans to try to retrain Rocky herself. And despite his trainer's guarantee, she has no intention of sending him back. Robert Benincasa, NPR News.
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