20TH ANNIVERSARY
Compendium December 1999
On the Horizon…
VeterinaryControversies D
uring 1999, Compendium celebrated 20 years of publication by examining how various fields of veterinary medicine have advanced over the past two decades and considering where they are headed in the future. Technologic advances, development of new drugs (or new uses for existing agents), scientific discoveries, and shifting public opinion will continue to affect veterinary medicine; as the field evolves, controversy will continue to arise regarding the benefits and dangers associated with new or changing practices. To wrap up our 20th anniversary celebration, this month Compendium looks toward the future and topics that are likely to be debated well into the next century. We polled various experts on current controversies, and their opinions are the source for this column. We do not propose to settle any disputes but rather to present both sides of some potentially contentious subjects.a
than the traditional focus on vaccinations—has arisen.
Vegan Vets? Many veterinary students who have entered the profession because of their fervent concerns about animal welfare are strongly opposed to food animal agriculture; such students and graduates are leaders in the fight against “factory farming” and promote vegetarianism. On the other side are veterinarians who are leaders in the food animal industry, are responsible for much of the industry’s expansion and adaptation of technology, and have lobbied for improvements in how the industry treats food-producing animals. The veterinary profession may be forced to address this issue, particularly in veterinary colleges where faculty need to present course material to all students, even those who find the subject offensive.
Vaccination Protocols For years, practitioners have relied on annual vaccinations as both a way to guarantee that animals receive routine health checks and a solid source of income. Recent recommendations that some vaccines do not need to be boostered as frequently as once thought have raised concerns. Whereas some veterinarians believe that the overall health care of pets will suffer if animals do not need to be vaccinated for some disease each year, others question whether data from a study investigating the duration of immunity conferred by a specific vaccine can be extrapolated to other vaccines. Supporters of the revised recommendations argue that the emergence of vaccine-induced sarcoma indicates that vaccinating less frequently is a prudent step; there is also a belief that vaccinating too frequently hyperstimulates the immune system, potentially leading to the development of allergies or other diseases. Amid the controversy, a new emphasis on educating owners about the need for yearly physical examinations and the long-term value of routine preventive health care—rather a
The editors of Compendium realize that many controversial topics are not presented here. Readers interested in preparing a column that discusses the pros and cons of a particular topic in more detail should contact the appropriate species editor.
Alternative Therapies As in human medicine, the main arguments against alternative therapies in the veterinary field are the lack of reliable scientific studies on the effectiveness of these therapies, the lack of standardized protocols for administering them, not knowing whether any inherent side effects are associated with such therapies, and the fear that using them may delay conventional therapy. Conversely, alternative therapies may complement conventional therapy, thereby minimizing the use of medications with known adverse effects. In addition, even if alternative therapy alone does not completely treat or cure a disease, it may ease an animal’s suffering. As owner interest in alternative therapies grows, veterinarians are being forced to offer this option to their clients or lose them to practitioners who do. The question then arises: Who is qualified to provide these therapies? Should such alternatives as acupuncture or chiropractic manipulation be administered by veterinarians only, or can trained
Compendium December 1999
lay people provide them? If the latter is allowed, how closely should lay people be regulated and/or monitored, and how much training, licensing, registration, oversight, and other restrictions should apply?
Is There a Dentist in the House? Should equine dentistry be restricted to licensed veterinarians? Those who answer “yes” argue that veterinary dentistry involves the practice of veterinary medicine and that many horses require chemical restraint or diagnostic procedures (e.g., radiography, nuclear scintigraphy) that are available only through veterinarians. Conversely, many veterinarians would prefer to let someone else do the work. Is Newer Better? When a new procedure becomes available, should veterinarians abandon traditional techniques in favor of emerging technology? For example, carbon dioxide lasers are being used to perform onychectomy in cats because of the improved pain and hemorrhage control seen immediately after surgery compared with conventional techniques. Some veterinarians also cite the potential for less stress to cats because the paws do not need to be bandaged when lasers are used. However, beginning approximately 3 days after surgery, tissue necrosis occurs at the site of the laser cut. Infection, hemorrhage, or dehiscence may occur in cats that are not properly confined and kept away from litter, and digital pad necrosis that results in a smaller weight-bearing surface can lead to late protrusion of the second phalanx. Trauma-Induced Cardiac Arrhythmia Many dogs develop cardiac arrhythmia from severe shock or trauma, and clinicians disagree on how—or whether—to treat this condition. Some clinicians provide aggressive antiarrhythmic therapy, often via constant-rate intravenous infusion, whereas others prefer to treat most
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of these patients with cage rest and “benign neglect” unless there is definite evidence of hemodynamic impairment. Among the reasons for this “hands-off” approach is the concern that antiarrhythmic agents may have proarrhythmic effects that actually aggravate or enhance existing arrhythmias. This phenomenon is a concern in humans, but whether it occurs in dogs is open for discussion.
Food Animal Medicine Events and pressures affecting the North American agriculture industry may shape the world of food animal medicine in ways that are difficult to predict. Production agriculture will be caught between the intense need for more food production in the coming decades and increased concern about the environmental impact of farming methods. As agricultural markets become global and concentration of the industry continues, many practitioners face potentially rapid reductions in their client base and changes in the types of services demanded. The profession is being caught in cultural conflicts (e.g., animal welfare, production systems, farm ownership, use of genetically modified organisms) about how food production should be organized. In addition, some have expressed concerns about the concentration of power in fewer marketing channels. These and other factors will place intense pressures on practitioners to address issues and participate in debates on topics that previously were never seen as the purview of veterinarians. Differing value systems (in producers, consumers, and practitioners themselves) will place a premium on the need for open, science-based consideration of the trade-offs that will have to be made to find a middle ground among these competing interests. Neither a Food nor a Drug Pet owners are buying nutraceuticals, herbal remedies, and other “natural” medicines for both themselves and their pets. Few studies have investigated
the efficacy of these products in any species, and at least one (i.e., colloidal silver) has been found to be highly toxic. How do veterinarians decide which products to recommend or discourage, and how do they counsel clients without alienating them?
Use of Medication in Performance Horses As horses age, injury and other insults can limit expectations for athletic performance and enjoyment as well as quality of life. Performance-enabling medications can assist horses and their owners in the controlled pursuit of pleasure use and athletic potential. However, medications that may mask an injury or illness have the potential to exacerbate the condition and put horses at risk of greater harm. With medication comes the risk of complications (e.g., phenylbutazone and ulcers), and the question is raised whether manipulating horses with drugs is serving goals that are not in the horse’s best interest. Endocrine Disease in Ferrets Adrenal gland disease and insulinoma are “recent” conditions in ferrets. Is this because of inbreeding, improper diet, or early spay/neuter (i.e., before 6 weeks of age)? Or are these diseases being seen more frequently because ferrets have become popular pets and are now exhibiting “old age” diseases never encountered in laboratory ferrets? Donors Wanted Veterinary medicine is becoming more sophisticated in its knowledge of transplantation techniques. The basic problem is the ethical and moral dilemma of how to procure organs. Kidney transplantation in cats, for example, is now routine; unlike in human medicine, however, organs cannot be obtained from a healthy and willing relative or a terminal accident victim. Instead, donor organs come from shelter cats or from other cats owned by the recipient’s owners. Some veterinarians question whether
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it is morally acceptable to put a healthy cat through a surgical procedure to save the life of a sick cat. Many surgeons insist that owners adopt the donor cat, and one could therefore make the argument that by removing a kidney from a shelter cat, the animal’s life has been saved—it has a home and thus will not be euthanized. This may be true with kidney transplants, but what about other organs? Although corneas are easily obtained from cadavers, what about hearts, lungs, and livers? Should one animal be sacrificed in order that another may live? These are the tough questions that the profession will have to face as veterinarians become more technically adept, new antirejection drugs emerge, and owners’ demand for such procedures increases.
Psittacines as Pets Pet birds commonly have behavioral problems that most veterinarians would categorize as severe: They pluck feathers until they are bald and self-mutilate to the point of needing medical attention. Not even people who are considered the “best” bird owners are immune from having these pickers as pets. Perhaps more research on the wild behavior of birds is needed so that owners and practitioners can better supplement the social lives of pet psittacines, or perhaps selective breeding to develop birds that are better adjusted to our society is the answer. Others would argue that these birds are not meant to be pets and society’s attitude that “if we can breed these animals, they can be pets” should not be allowed to prevail. Aminoglycoside Antibiotics in Cattle The Animal Medicinal Drug Use Classification Act (AMDUCA) allows the extralabel use of aminoglycosides (e.g., gentamicin, which is not approved for use in cattle). Generic gentamicin is very inexpensive and can be effective in cases of pneumonia. However, reliable research demonstrates that gentamicin residues can be detected in cattle kidneys for up to 24 months. Although the American Association of Bovine Practitioners, Academy of Veterinary Consultants, and American Veterinary Medical Association have all passed resolutions stating that veterinarians should refrain from using aminoglycoside antibiotics in cattle, such use continues today. Gentamicin residues could probably be detected in a large percentage of kidneys in some populations of slaughtered cattle, effectively giving animal agriculture another “black eye” in the press. This once again raises the question: Just because something can be done, should it? Reptiles: Harbingers of Disease? As concern over salmonella infection increases in human medicine, how should the veterinary community address the situation? Many people believe that reptiles are a source for human salmonella infection and thus are inappropriate pets, at least for the el-
Compendium December 1999
derly, families with children under 5 years of age, and immunocompromised individuals. Some even believe that ownership of reptiles as pets should be made illegal, and a few communities (e.g., New York City) have enacted laws to do so. Others question whether reptiles represent a greater risk of human salmonella infection than do other sources (particularly food) and suggest that client education regarding the potential for infection and how to prevent it is key.
What About All the Other Animals? Large animal veterinarians cite the need for more research of drug doses and side effects for minor species (e.g., sheep, goats, llamas). AMDUCA regulations have greatly assisted veterinarians in making treatment decisions regarding drug use in these species; these guidelines allow a wide range of drugs to be used but place responsibility for avoiding violative residues with the veterinarians administering the drug. However, limited market size and perceived lack of need may have slowed or stopped development of drugs labeled for minor species use. Thus drug dosages and withdrawal times are extrapolated from data derived from other species. The lack of scientific data and labeling can expose veterinarians to liability suits. The FDA’s minor species drug use program may need to be expanded to develop guidelines for various minor species. Acknowledgments The editors of Compendium thank everyone who contributed to this column: ■ David E. Anderson, DVM, MS, The Ohio State University, Columbus, Ohio ■ Colin F. Burrows, BVetMed, PhD, MRCVS, University of Florida, Gainesville, Florida ■ John Fetrow, VMD, MBA, University of Minnesota, St. Paul, Minnesota ■ Patricia Thomblison Franks, DVM, MS, Veterinary Learning Systems, Overland Park, Kansas ■ Robert Friendship, DVM, MSc, University of Guelph, Guelph, Ontario ■ Earl Gaughan, DVM, Kansas State University, Manhattan, Kansas ■ Elizabeth M. Hardie, DVM, PhD, North Carolina State University, Raleigh, North Carolina ■ Althea Jones, DVM, Veterinary Learning Systems, Trenton, New Jersey ■ Douglass K. MacIntire, DVM, MS, Auburn University, Alabama ■ Nora Mathews, DVM, Texas A&M University, College Station, Texas ■ William E. Monroe, DVM, MS, Virginia Tech, Blacksburg, Virginia ■ James N. Moore, DVM, PhD, University of Georgia, Athens, Georgia ■ M. Gatz Riddell, DVM, MS, Auburn University, Alabama ■ Karen Rosenthal, DVM, MS, University of Pennsylvania, Philadelphia, Pennsylvania ■ William S. Swecker, Jr. DVM, PhD, Blacksburg, Virginia
