Pressure from Industry?

[NStarz]

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Have you guys felt a lot of pressure from either the pharmaceutical industry or the "pet food" industry during practice/school? I'm a tad worried based on what I've been hearing lately about drugs being pushed despite awful side effects.

I was just wondering how much of an influence industry has on the way you're taught veterinary medicine or how day-to-day practice is run at a clinic.

 

[No Imagination]

I can assure you, that at least first year at MSU, industry pressure does not effect anything in respect to what you are taught... unless Hills had something to do with the damn large colon of a horse being the way it is.

My advice, deal with the problem of industry pressure once if becomes a problem for you, i.e. when you are a vet. I am sure others may have additional advice, like "its never to early to start considering such things", but my perspective "Get into vet school, Pass all your classes, Pass NAVLE, Get a Job, then worry about industry pressuring you how/what manner you practice.

my $0.02

 

[HopefulAg]

I think the only industry pressure we have is some free food, free backpacks, free heartworm medication/dog food, and some free nutrition book (from Hill's, so uh, take it with a grain). Other than that, I don't think there's much, none that I know of at least. A couple of students go to the seminars they host, but only for the free food.

 

[sumstorm]

Some of the seminars we have had were really good. But, I can't actually remember which company gave which seminar.

The book is excellent if you want a tome; it is very much data based from research, but very few people ever actually use it unless they are researching very specific nutrition things.

I am not sure what you mean by drugs with awful side effects being pushed in vet med. There aren't really a ton of drugs specifically approvied for vet med, and a lot of drugs are used off label. We take our nutrition class before vet school, so there isn't much influence there. My understanding is that pharm is a really memorization intensive class that we take next year. Reps aren't ever at the class. During lunches, food and gifts entice students, but a large percentage are also checking email and such. You really have to be presenting something interesting, or something that makes sesnse for students to retain it (if it goes against what you just learned in class, well...that next test is more important than a brand's speaker.)

So far the worst speaker we have had, by far, was a raw foods company. A lot of of folks in the classroom were into raw foods, and it felt like they sent the local PetSmart rep. She said things that weren't accurate, when questioned had no background or research knowledge, and couldn't do much than trumpet the product. It didn't turn raw foods advocates away from raw foods, but we questioned the judgement of the company in sending anyone that couldn't deal with specific questions about the product to a vet school.

 

[NStarz]

Thanks guys, you really put my mind at ease. I may be in the minority, but I'm not a fan of rimadyl. Any drug that has "death" as a side effect is not worth it, IMO. Neither are the many kidney or liver issues possible. It seems like it's pushed for everything though. I guess until there's an alternative...

Maybe I'll learn something in vet school to change my mind but that's where I stand as of now.

 

[david594]

Thanks guys, you really put my mind at ease. I may be in the minority, but I'm not a fan of rimadyl. Any drug that has "death" as a side effect is not worth it, IMO. Neither are the many kidney or liver issues possible. It seems like it's pushed for everything though. I guess until there's an alternative...

Maybe I'll learn something in vet school to change my mind but that's where I stand as of now.

No offense, but that sounds like an uneducated opinion. Rimadyl is a great drug, but like any other has to be used with some consideration. What are you seeing it pushed for that bothers you?

 

[NStarz]

It is an unedcuated opinion, that's the reason for the disclaimer 😉

Completely anecdotal, I have known at least 5 dogs that have died from Rimadyl-related causes. My 2 dogs are of a breed with known kidney issues (PLN and such), and I've had it pushed on me personally a number of times. Granted, not everyone knows every breed specifically. Specifically, though, one of my dogs is losing protein in her urine and the vet wants to give her a drug that can cause kidney problems??

I do understand that with any drug, there are side effects. But there has to be a cutoff point.

This website lists 107 deaths thought to be caused by Rimadyl. Not sure if these are veterinarian-support or not, again, just anecdotal.

http://www.srdogs.com/Pages/rimadyl.deaths.html

Here's another article.

http://www.healthyhappydogs.com/MoreOnRimadyl

I'm not saying that it's a horrible drug. Quite the contrary. It just seems like it is being used way too often despite its potentially deadly side effects.

 

[crittergal]

I'd like to counter that it is a very good drug with a wide range of uses. I have not reviewed your links and do not consider the majority of internet information as valid. Yes, ANY NSAID has serious potential side effects. That's why vets recc BW to evaluate renal/liver function prior to initiating long-term treatment, and often times even for short treatments in potentially at risk patients.

Try doing some internet digging on OTC meds in humans such as acetominophen (liver), ibuprofen (gastric ulcers, renal), or aspirin (coagulopathies, gastric ulcers) or any number of RX NSAIDS. Irresponsible use of these products can be equally as deadly.

 

[NStarz]

I'd like to counter that it is a very good drug with a wide range of uses. I have not reviewed your links and do not consider the majority of internet information as valid. Yes, ANY NSAID has serious potential side effects. That's why vets recc BW to evaluate renal/liver function prior to initiating long-term treatment, and often times even for short treatments in potentially at risk patients.

Try doing some internet digging on OTC meds in humans such as acetominophen (liver), ibuprofen (gastric ulcers, renal), or aspirin (coagulopathies, gastric ulcers) or any number of RX NSAIDS. Irresponsible use of these products can be equally as deadly.

Good points! I'd like to add this point:

Presumably, people are a lot more careful about giving drugs to children (in your example, ibuprofen, aspirin, etc.). (Or at least I would hope so!!!) One of the reasons this is done, at least IMO, is becaus children are a lot less likely to report severe side effects and get treatment ('my tummy hurts' can equal ulcer or it can equal indigestion). They are dependent on their caregivers, who are very careful in making decisions regarding their welfare.

Based on this, I would venture to say that the same restraint should be exercised in caring for pets. Dogs and cats can't tell us that they're uncomfortable. If any side effects are seen, it's either because the owner/veterinarian is very diligent in monitoring the animal, or the animal is in such severe distress that it can be seen in changes in the animal's behavior, dietary habits, mood, etc. Children even have an advantage in that they can at least point out that they don't feel right, whereas our animals don't communicate with us in the same way.

Animals can't give informed consent. Neither can children. It is up to the responsible parent in both cases to make decisions for their pet/child, hopefully in the best interest of their dependent party.

I guess what I'm saying is...
Shouldn't the same restraint seen in pediatric medicine be applied to veterinary medicine in the dispense of drugs that have potentially dangerous side effects?

 

[david594]

I guess what I'm saying is...
Shouldn't the same restraint seen in pediatric medicine be applied to veterinary medicine in the dispense of drugs that have potentially dangerous side effects?

But most of the cases of "adverse reactions" with rimadyl were geriatric patients. And as we always say on here atleast, human medicine and veterinary medicine are very different. In human medicine this subset of clients would minimally be having yearly bloodwork and probably additional bloodwork before starting an extended course of nsaids.

You see a lot more defensive medicine on the human side of things because they have insurance companies that will pay for it.

 

[HopefulAg]

Thanks guys, you really put my mind at ease. I may be in the minority, but I'm not a fan of rimadyl. Any drug that has "death" as a side effect is not worth it, IMO

Pretty sure most drugs have a 'death' disclaimer in there some where. Rimadyl certainly isn't the first.

Also, 107 dogs out of the scores treated with Rimadyl? Think I'll take my chances on that one.

 

[NStarz]

But most of the cases of "adverse reactions" with rimadyl were geriatric patients.

Yes, but children (especially young ones) and animals have the same dependency issue: they are dependent on their caregivers to make the right choices for them. That's where the child issue came up, it wasn't to say that young dogs are more at risk.

And as we always say on here atleast, human medicine and veterinary medicine are very different.

Yes, they are!

In human medicine this subset of clients would minimally be having yearly bloodwork and probably additional bloodwork before starting an extended course of nsaids.

Yes, they would, and that's my point exactly. If your example of ibuprofen is relevant, I would say that it's a dishonestry to the profession if we are pushing drugs that have dangerous side effects (similar to side effects in humans, as you noted) whereas children are getting similar medications with lots and lots of testing. Even if offered, many people would not pay for blood work. Dogs (and cats, sorry if I'm generalizing) aren't getting testing prior and following the medication, and therefore the dispense of medications should be done with MORE scrutiny, not less.

You see a lot more defensive medicine on the human side of things because they have insurance companies that will pay for it.[/QUOTE]

Yes, and that's a sad issue of the profession. But does that mean we should offer (and insist) on medications that have dangerous side effects without lab testing? Just because the owner doesn't want to pay for it doesn't make it NOT necessary. And therein lies my point with needing to hold back on medications, not because it's right or wrong or any number of things, but because it's a nature of the profession we work in (or will be working in).

 

[david594]

You keep making the comparison to human children and thats really not a fair case here because they are generally a healthy population to start with. A better comparison would be an older human with severe dementia. They cannot communicate either(like your pediatric example). But just like your website of geriatric dogs are all going to be very close to renal and liver failure unlike your children.

And regarding children, tylenol while not an nsaid, is used pretty extensively in young children without any screening.

 

[karmapple]

I can agree that there are some veterinarians that have become careless about NSAIDs and pass them out like candy, refilling meds for years at a time without ever physically examining the patient or performing routine bloodwork. There are also a lot of owners out there with the philosophy of "My vet said to only give one pill, but Fluffy seems really painful, so I'll give him five!" (Seriously, have seen how careless people are with giving NSAIDs to themselves? I don't care how bad your headache is, you don't need 1600 mg of ibuprofen!)

When used responsibly, Rimadyl is quite safe. Don't blame the drug when it's the people giving it who are usually to blame. I hate when people refuse to give it when their dog is obviously in pain because they said read some sensationalist "Rimadyl Killed My Dog" website. I give it to my dog quite often, and my rationale is this: If I don't give it, there is a 100% chance she will be in pain. If I do give it, the chances of side effects are much, much smaller. (yes, yes, Tramadol is great, but nothing works quite as well as NSAIDs in my experience for chronic inflammation/pain)

 

[squeegee]

to be fair, both of the links you posted has information from almost a decade ago. if this was a problem in 2000/2001 its always possible there have been some changes made to the formula since then....not saying there was or needed to be (as someone pointed out most of the dogs were geriatric, so who knows what complications were added to their situations) but it might be interesting to see what the statistics are now. i have seen rimadyl do some great things for some patients, but as always it's a drug that should have careful monitoring with bloodwork to be prescribed responsibly.

as far as your initial question goes, drugs haven't really been 'pushed' here at all. sure, companies come and sponsor lunches, so you get a free meal +/- taking away some information about the product...if your poor overworked brain tries to retain anything! there's really no point to them trying to push anything on us anyway, since many of us are years away from being capable of prescribing anything anyway 😛

 

[that redhead]

Pretty sure most drugs have a 'death' disclaimer in there some where. Rimadyl certainly isn't the first.

Also, 107 dogs out of the scores treated with Rimadyl? Think I'll take my chances on that one.

My two thoughts.

 

[VeganSoprano]

We require bloodwork before prescribing any NSAID and every 6 months if they are on it long term. Clients have to sign a waiver if they decline BW. It's a common sense precaution.

 

[cowgirla]

I don't even think my clinic carries Rimadyl. If we do, it's been ages since we dispensed any.

Nope, it's all about the previcox for us. Just about everything that walks in our door goes home on either previcox or doxycycline (or both!)

And in all those previcox patients, only seen one bad reaction. Routine spay, everything was normal post op. Sent dog home with instructions to start previcox the next day; dog presented six hours after meds, bleeding from the rectum, pale, gums tacky, labored breathing, and a number of other wacky symptoms.

Luckily, we do pre-op bloodwork on all patients... We repeated the bloodwork, compared to the "baseline" and contacted the drug company, and they covered all the dog's medical expenses, including follow-up lab work a month later 👍

We do require a PAP panel to be done every six months as well, although we don't always do bloodwork before starting the meds.

 

[Minnerbelle]

Nope, it's all about the previcox for us. Just about everything that walks in our door goes home on either previcox or doxycycline (or both!)

sorry if this is a dumb question... but i thought doxycycline was an antibiotic (didn't know it could be used as an analgesic/anti-inflammatory)?

edit: oops, nm. you were just saying that everyone pretty much gets it.

 

[cowgirla]

sorry if this is a dumb question... but i thought doxycycline was an antibiotic (didn't know it could be used as an analgesic/anti-inflammatory)?

edit: oops, nm. you were just saying that everyone pretty much gets it.

Hah, yeah. It does have some anti-inflammatory properties, but I just meant that pretty much everything in this area is either lame (previcox!) or has Lyme (doxy!) or both!

On that note, it's amazing how well some old, arthritic dogs do on doxy because of the anti-inflammatory properties Their owners tell us it's like going back in time to puppyhood!

 

[NStarz]

Hah, yeah. It does have some anti-inflammatory properties, but I just meant that pretty much everything in this area is either lame (previcox!) or has Lyme (doxy!) or both!

On that note, it's amazing how well some old, arthritic dogs do on doxy because of the anti-inflammatory properties Their owners tell us it's like going back in time to puppyhood!

That's so funny, because my 12 yr old was put on doxy a couple of months ago (for lyme 🙁 )and she's running around like a crazy dog.

 

[eventualeventer]

Yup, diagnosing Lyme is horses is problematic because you can't even count on the treatment trial when it's a vague or shifting lameness and the owner wants to try treating with doxy (and soooo many horses have been exposed and/or infected repeatedly that bloodwork is prone to false positives). I heard at a talk by some vets from New England that they had seen horses who got better when started on doxy, only to find out when the bloodwork came back that they never had Lyme to begin with!

 

[badcats]

Equine vet I worked with also loved to dispense the previcox. Did get busted for giving dog med to a horse when an older horse died and the crazy owner blamed the drugs since it was technically off label, but it was the same drug as the equilox, just at a much lower price. Sucks when someone ruins it for everyone else. Anyway the main reason it was given over bute and banamine is because it can be given over a much longer period without being as harsh on the digestion/kidneys. Saw good things with the horses that were on it

 

[Morganator]

Thanks guys, you really put my mind at ease. I may be in the minority, but I'm not a fan of rimadyl. Any drug that has "death" as a side effect is not worth it, IMO. Neither are the many kidney or liver issues possible. It seems like it's pushed for everything though. I guess until there's an alternative...

Maybe I'll learn something in vet school to change my mind but that's where I stand as of now.

Yes, I would agree you need to get through school first or at least get some more good information before making such statements. The argument you make as I see it has nothing to do about a certain drug and more to do about what drugs are appropriate for certain circumstances which is a huge topic that most people on this site are not prepared to handle. Not being a fan of Rimadyl because it may or may not be dangerous to your particular dogs shows that you are very short-sighted about the drug due to your particular experiences. I hope you don't find this too offensive but more of a challenge to do some more research before citing a website like the one you listed with the Rimadyl-related deaths. As Crittergal mentioned, do some research on aspirin or other human nsaid's. You might be very surprised.

 

[sunshinevet]

I'm surprised no-one has said what I'm about to say! Yes, pretty much any NSAID CAN cause liver and kidney dysfunction, and cause animals with these conditions to worsen. But they are some of the best long term drugs for assissting dogs and cats with painful, debilitating arthritis, and I think it is well worth the potentially shortened lifespan to give them back a good quality of life.

And to me, in geriatric patients, you go for quality, not quantity.

 

[VeganSoprano]

Very, very true. That's not to say one wouldn't try other options first (tramadol, glucosamine, Adequan, laser therapy, etc), but I definitely wouldn't rule out an NSAID for an arthritic dog just on the basis of preexisting hepatic or renal issues. If more liver- and kidney-friendly therapies fail to provide a patient with adequate QOL, then quality of life takes precedence over length of life and NSAID therapy is definitely worth considering.

 

[sumstorm]

You keep making the comparison to human children and thats really not a fair case here because they are generally a healthy population to start with. A better comparison would be an older human with severe dementia. They cannot communicate either(like your pediatric example). But just like your website of geriatric dogs are all going to be very close to renal and liver failure unlike your children.

And regarding children, tylenol while not an nsaid, is used pretty extensively in young children without any screening.

My mother's hobby is traditional fiber arts (wool rug hooking, spinning, etc.) Most of the individuals that participate in this hobby are over 60...many over 80yrs. Quite a few have severe arthritis...some to the point that any activity, let alone their favorite hobby, is affected. They can lose the ability to clean, cook, bath themselves, etc as their joints freeze up. When Vioxx was removed from the market, they were outrage. They felt, that at their age, they should be able to make the decision to take this drug and accept the risks. They woud rather have fewer quality years than a longer duraton of less quality. There other drugs that work on this condition are few, and aren't nearly as effective.

When my late husband was on dialysis, he took a drug that relieved the bladder cramps associated with dialysis. The drug was removed from the market because a handful (less than a dozen) people developed liver damage. The new drug (the only substitute on the market) was completly ineffective for him and everyone else we spoke to. Again, he would have preferred to take the risk since unproductive bladder spasms are incredibly painful.

I don't know of any drug that doesn't have some adverse side effect. We need to balance the risk, and to do that is complicated, will depend on the animal, the other meds, and the owner (are they reliable, do they want this drug for themselves), etc...not a job I am willing to second guess for another vet.

 

[eventualeventer]

Equine vet I worked with also loved to dispense the previcox. Did get busted for giving dog med to a horse when an older horse died and the crazy owner blamed the drugs since it was technically off label, but it was the same drug as the equilox, just at a much lower price. Sucks when someone ruins it for everyone else. Anyway the main reason it was given over bute and banamine is because it can be given over a much longer period without being as harsh on the digestion/kidneys. Saw good things with the horses that were on it

OTOH, why should anyone expect drug companies to do research and pursue approval for equine use for any drug if people are going to buy the off-label or generic version? It would be nice if it weren't true, but at the moment the main (although not the only) way that new drugs get researched, or old drugs researched in new species, is by drug companies footing the bill, and they aren't going to do so if no one is going to buy the drug. It takes a huge amount of money to get drugs FDA-approved (although maybe they would have more money for R and D if they spent less on direct-to-consumer advertising of prescription drugs, free food for vets, etc.). Wow, I sound like a big pharma shill here, but I feel like we're shooting ourselves in the foot given that the situation is unlikely to change anytime soon. It was a big coup for ulcer-prone horses who need to be on NSAID's for Equioxx to be brought to market, and I had never even HEARD of firocoxib being used in horses until Merial got it approved for horses, even though firocoxib was out there and vets COULD have prescribed it before.

Sumstorm, I agree with you. It seems to me that by being more restrictive with these drugs we are taking away patient and doctor autonomy and expecting everyone to fit in one mold.

 

[VeganSoprano]

Yes! That's the very nature of drug therapy. I can understand personal preferences, etc, but please don't take away the ability of clinicians and clients to decide the best possible option for a particular situation.

Another example: we don't carry Convenia where I work because of concerns about adverse reactions and the length of time the drug remains in the body. Now, I understand these concerns very well from personal experience. I had an allergic reaction to a different (and short-acting) cephalosporin myself and was covered in hives for more than six months. But when my cat had an oral squamous cell carcinoma and would not tolerate oral medication and only minimally tolerated injectable meds, we needed Convenia. There was no possible was I could get BID oral meds into her and as for injectable meds, I had to make her buprenorphine the higher priority (pain control being essential to QOL). There was absolutely no way I could have been compliant with a full course of abx and it would have been foolish to pretend otherwise. So I got Convenia somewhere else with a script from her doctor, because we both felt strongly that the benefits far outweighed the risks for her.

To me, good medicine depends on considering the *full* range of possible options, weighing the pros and cons of each one, and coming to a solution that best balances these for both client and patient. There is no one-size-fits-all solution.

 

[lizinwonderland]

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[VeganSoprano]

The main issue I'm familiar with is allergenicity. If the patient did have a rxn, there would be no way to stop the exposure. It's certainly valid enough that I would consider oral abx first and would almost definitely not use it in anyone with a hx of hypersensitivity to any abx. But for me, it's still an option to be considered.

 

[NStarz]

To me, good medicine depends on considering the *full* range of possible options, weighing the pros and cons of each one, and coming to a solution that best balances these for both client and patient. There is no one-size-fits-all solution.

I definitely agree with this.