The Doctor is In @ drwalt@petcareinsurance.com
Commentary on veterinary drugs
I am often asked to make comments on the treatment recommendations made by the veterinarians who are caring for your pets. Generally, these requests simply reflect the desire by most to reaffirm that the care they are receiving for their beloved family member is appropriate for the medical condition at hand. However (and to the frustration of many readers), I must refrain from making case-specific comments because the reality is that I simply do not have all of the information required to formulate and present appropriate recommendations. This information is contained in your pet's medical records that reside at the veterinary clinic you attend and, as such, your veterinarian remains the best source of veterinary information and advice. The professional relationship and trust that you share with your veterinarian, often termed the veterinary-client-patient relationship (VCPR), is the cornerstone of your pet's excellent health care. Never hesitate to pose your questions to your veterinarian or their health care team, as it is this open communication that supports each and every individual VCPR.
However, it is not uncommon for questions directed my way, while prompted by a specific case scenario, to be more general in nature, and on these I am happy to wade into the debate!
One such area of query has been with regards to veterinary pharmaceuticals - principally in trying to clarify both the suitability and value (i.e., cost) of the various products available. While a pharmaceutical product's suitability can only be answered under the VCPR, I would like to comment on the value question by providing a brief overview of the veterinary pharmaceutical industry, the current availability of pharmaceuticals for veterinary use and their costs, and various other pharmaceutical options.
Veterinary pharmaceuticals are governed by the same federal regulatory authority that oversees human pharmaceuticals; therefore, similar regulations apply. As such, for any pharmaceutical product to become commercially available, it must undergo stringent testing to demonstrate safety and efficacy for the specific species (e.g., dog or cat) and disease before the pharmaceutical company is granted a manufacturing license, demonstrated as a Drug Identification Number (DIN), which in essence, represents the federal government's seal of approval. This information is referred to as a product's label indication, as it appears both on the package label as well as being further explained by a more comprehensive package insert - a valuable document for all pet owners to be familiar with. Following licensing, the product is then manufactured under a federal audit and inspection program designed to provide quality assurance for the consumer (e.g., product content, potency, stability, etc.). This entire process ensures consumer protection, by providing the end user of a veterinary specific product sporting a DIN both quality assurance as well as insurance, with the latter applying to those rare situations where a licensed product results in an unexpected adverse outcome and where the pharmaceutical manufacturer will provide support to assist with its resolution. Unfortunately, the small size of the veterinary market combined with the high costs associated with bringing a licensed product to market, put the veterinary community and the patients that we treat at a relative disadvantage in that we simply don't have licensed products to address all of the various ailments and species that we treat. As veterinarians, we often have no other choice but to identify and use alternative sources of these needed medications and this principally takes two forms:
1. Pharmaceuticals that are licensed (i.e., sport a DIN), but not for the ailment or the species that we intend to use them in. The most common representation of this scenario is a pharmaceutical that is licensed for use in people but has also been studied for use in certain animal illnesses and this is termed "off-label use." Common examples include antibiotics, insulin, or anti-seizure medications. While not having had the same rigorous safety and efficacy testing as a veterinary licensed product specific to that ailment in question, quality assurance is provided by virtue of their DIN designation and clinical use has resulted in protocols that address issues of safety and efficacy. However, because these medications are not licensed for veterinary use, the manufacturing company cannot support them to the same degree as a veterinary licensed product.
2. Pharmaceuticals provided by compounding pharmacies. Compounded medications are pharmaceuticals that have been reformulated into an altered delivery vehicle, such as a liquid or transdermal ointment rather than a pill, or flavoured for easier consumption. Their benefit rests in providing access to non-commercially available pharmaceuticals and improving ease of administration. They are also often cheaper than licensed products with this cost disparity generally due to the fact that, as they bypass the aforementioned federal regulatory review and strict manufacturing protocols, they avoid the attendant costs. However, this lower cost comes at a potential price, and that price is an outcome of unregulated quality assurance, often resulting in potency and stability variability, and therefore no clear knowledge of product safety and efficacy. Several articles in the veterinary literature have clearly demonstrated these product limitations, especially for transdermal ointments. Again, as these products are not licensed, as in the aforementioned scenario the pharmaceutical industry cannot support these as they would a veterinary licensed product.
However, as the pet owner, the ultimate decision of pharmaceutical used in your pet is yours. It is your veterinarian's responsibility to make you aware of your options and the ramification of your choices, which can be clearly different depending on the product chosen. As a consumer, we always want to get the best value for the money that we spend and this applies to the veterinary pharmaceuticals that we purchase. Therefore, to ensure value and assure the best possible therapeutic outcome, current recommendations dictate that a veterinary licensed product be used first when one is available; if none exists, seek out a human licensed product and finally a compounded product. Again, the final decision rests with you.
