JAVMA News Digest

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AVMA deliberating over medical services from a distance

A proposal before the AVMA's governing bodies would have the Association advocate for limiting use of telemedicine to follow-up care and consultation with patients or herds already seen in person.

The proposal, which includes exceptions for emergency services such as poison control center calls, was made in a January report from the AVMA Practice Advisory Panel. It aligns with a statement in the AVMA Model Veterinary Practice Act that the relationship needed to practice veterinary medicine cannot be established through electronic communication alone.

The American Association of Veterinary State Boards contends that, with a new patient, some medicine could be practiced from a distance, and the standards of care are more important than the tools used. Plus, AAVSB representatives said AVMA policies should be able to accommodate developments that could benefit veterinarians and their patients. Notably, restrictions on human telemedicine have drawn scrutiny from federal regulators.

The AVMA House of Delegates has recommended that the AVMA Board consider modifying the AVMA Model Veterinary Practice Act to state that telemedicine shall be conducted only within an existing veterinarian-client-patient relationship, as described in the panel report. The AVMA Board also approved in April spending $135,000 through 2018 on advocacy, member education, and public information on telehealth.

The AVMA Board could act on the panel and House recommendations early enough that it could send the matter to the House of Delegates for consideration during its regular annual session in July in Indianapolis.

About 40 states require a patient examination or premises visit to establish a VCPR, typically using language similar to that in the AVMA model, according to AVMA information. The Food and Drug Administration's definition, which applies in connection with some federally regulated practices, includes similar language.

Dr. George E. Robinson III, chair of the AVMA Practice Advisory Panel, said the panel and its working groups developed a reasonable working document, intended to guide a new area of medicine that otherwise could develop unchecked.

States will develop exceptions, such as accommodations for people living in isolated areas, he said. In the absence of AVMA guidance, companies have been developing their own interpretations of rules and regulations, some establishing a niche of helping pet owners avoid trips to a veterinarian's office or an appointment with a house call veterinarian.

James T. Penrod, executive director of the American Association of Veterinary State Boards, said the AAVSB board of directors sees potential for veterinarians to establish VCPRs from a distance when circumstances allow the practice of medicine performed this way to be consistent with traditional standards of care. Those situations would vary by clinical situation.

An FTC spokeswoman said the agency had no comment on the AVMA advisory panel's proposal to require an in-person visit prior to veterinary care.

In an August 2016 letter to the Delaware Board of Dietetics/Nutrition, FTC staff members wrote that a proposal to require face-to-face initial evaluations by dietitians or nutritionists “could unnecessarily discourage the use of telehealth for assessment and diagnosis and restrict consumer choice.” Telehealth could increase practitioner supply, encourage competition, improve access to affordable health care, and improve health care quality, the letter states.

Anticompetitive conduct in health care markets is a focus of FTC law enforcement, and many of the commission's recent comments to state governments have been responses to provisions intended to limit the procedures or services a practitioner can provide or keep a type of practitioner from competing in a market, the letter states.

Condensed from June 1, 2017, JAVMA News

AVMA looks to Congress for student debt relief

Nearly a hundred veterinary students and veterinarians traveled to Washington, D.C., to lobby Congress for educational debt relief as part of the AVMA's ninth annual Legislative Fly-In.

Over the course of the event, held April 23–25, 92 participants heard from veterinary policy experts and spoke to their elected representatives about two bills that offer some relief for veterinarians' educational indebtedness: the Veterinary Medicine Loan Repayment Program Enhancement Act and the Higher Education Act.

The VMLRP Enhancement Act is bipartisan legislation introduced in March that would repeal the tax on a Department of Agriculture program that pays off up to $75,000 in student loan debt for veterinarians who spend three years working in underserved areas of the country.

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William Willis (right), an Anchorage, Alaska, native attending Purdue University College of Veterinary Medicine, speaks with Alaska's junior U.S. senator, Dan Sullivan, about veterinary student debt and ways Congress can help. (Photo by R. Scott Nolen)

Citation: American Journal of Veterinary Research 78, 7; 10.2460/ajvr.78.7.760

Were Congress to repeal the withholding tax, the AVMA estimates enough money would be freed up for one additional veterinarian to participate in the program for every three already enrolled.

Fly-in participants met with staff of their congressional representatives in the House and Senate to educate staff members about the need for repealing the VMLRP tax and to ask that lawmakers support the bill.

Participants also addressed the Higher Education Act, which represents the greatest legislative opportunity to alleviate student indebtedness. The HEA was up for reauthorization in 2013, when Congress could potentially revise the terms offered on student loans and the repayment options available to borrowers.

Partisan gridlock has so far prevented the HEA from being renewed, however.

Learn more about the AVMA's work in the area of federal student aid policy at www.avma.org in the Advocacy section under “National Issues.”

Condensed from June 15, 2017, JAVMA News

Board advances items, some directly benefiting students

The AVMA Board of Directors met April 6–8 in Schaumburg, Illinois, and approved items relating to a new electronic accreditation system for veterinary colleges and veterinary technology programs as well as a handful of recommendations that pertain to veterinary students, among other things.

For one, the Clinical Practitioners Advisory Committee, which advises the Council on Biologic and Therapeutic Agents, will now have a student join its ranks after the Board approved its request for one.

Also, there was further movement on transferring the student chapters of the AVMA to the Student AVMA. The AVMA Board agreed to initiate proposed AVMA Bylaws amendments that would remove SCAVMA from the AVMA Bylaws and authorize SAVMA to establish its own chapters under the charter agreement between AVMA and SAVMA, whereby all chapters and their assets will be transferred to SAVMA, according to the recommendation background.

And finally, the Board voted to have its Governance Committee conduct a comprehensive review of the current and potential roles and responsibilities of the AVMA vice president, who is currently the AVMA liaison to the Student AVMA and student chapters, among other responsibilities. The committee said in its recommendation background to the Board that the review was needed, given current conditions.

The committee had received a request to consider extending the term of the vice president from two years to three years because of the large increase in the number of visits to accredited veterinary colleges and student chapters as well as the number of other appearances and opportunities available to support the development of veterinary students.

Condensed from June 1, 2017, JAVMA News

AVMA to deliberate on assistance animals, stem cells

Service, emotional support, and therapy animals provide therapeutic interventions and assist individuals with disabilities, but the growing number of animals being falsely identified as assistance animals has caused increased scrutiny of their use.

To be proactive on the matter, the AVMA Steering Committee on Human-Animal Interactions has proposed a policy to serve as a foundation for further educational and lobbying efforts to promote appropriate use of assistance and therapy animals and discourage misunderstandings or fraud, according to a statement by the steering committee to the AVMA Board of Directors.

During its 2017 regular annual session, July 20–21 in Indianapolis, the AVMA House of Delegates will consider a resolution to approve the proposed AVMA policy “The Veterinarian's Role in Supporting Appropriate Selection and Use of Service, Assistance and Therapy Animals.” The steering committee created the policy, and the Board voted April 7 to refer the resolution to the House with a recommendation for approval.

The HOD will consider another policy proposal, this one offering guidance to veterinarians concerning the use of stem cells and other regenerative therapies. The Board voted to refer the proposal to the HOD with a recommendation that delegates approve the policy.

The AVMA Council on Biologic and Therapeutic Agents wrote “Therapeutic Use of Stem Cells and Regenerative Medicine” with input from the Clinical Practitioners Advisory Committee. The proposed policy provides needed guidance to veterinarians and can be used to advocate on behalf of the AVMA's positions on the issue to policymakers and other stakeholders, the council explained.

Condensed from June 1, 2017, JAVMA News

AAHA narrows its focus to accredited hospitals

The American Animal Hospital Association is altering its membership model and annual meeting to focus on what leaders see as the association's foundation: the AAHA accreditation program for animal hospitals.

In October 2016, the association announced that it is discontinuing hospital membership for nonaccredited practices. Nonaccredited AAHA member hospitals had until June 30 to enter into an agreement to become an accredited practice or to have a staff member become an individual member. As of April 5, the association's membership encompassed 3,741 AAHA-accredited practices and 1,510 nonaccredited practices.

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A conference attendee visits the AAHA Cat Lounge during the annual meeting of the American Animal Hospital Association, March 31-April 2 in Nashville, Tennessee. The lounge raised $3,514 for Nashville Cat Rescue. (Photo by Mark Skalny)

Citation: American Journal of Veterinary Research 78, 7; 10.2460/ajvr.78.7.760

In March, the association announced that it is discontinuing the traditional annual meeting. Instead, AAHA will hold an interactive conference for attendees from accredited hospitals, starting in September 2018. The association also is partnering with the North American Veterinary Community to offer continuing education, activities, and a headquarters hotel at the NAVC annual conference in February 2018.

The final traditional AAHA meeting, March 31-April 2 in Nashville, Tennessee, drew a total of 4,361 attendees, including 1,549 veterinarians, 439 veterinary technicians, 351 practice managers, 270 veterinary assistants and other members of support staff, and 72 veterinary and veterinary technology students.

During the opening session, the association released results of a survey of pet owners conducted by Trone Brand Energy in fall 2016 as a follow-up to research that Trone had conducted for AAHA in 2013. The results indicated that appraisals of veterinary hospitals have declined in a number of areas, but awareness of AAHA accreditation has increased.

Condensed from June 1, 2017, JAVMA News

Heartworm infections, cases per practice on the rise

Heartworm transmission is expected to increase across the U.S. this year, a result of above-average precipitation and temperatures during 2016, according to the nonprofit Companion Animal Parasite Council.

The prediction follows an increase in heartworm cases over the past several years, according to separate survey results from the American Heartworm Society.

A CAPC announcement from April—which includes predictions about Lyme disease, anaplasmosis, and ehrlichiosis—states that above-average temperatures and rainfall have helped breed the mosquitoes that transmit heartworms. The organization forecast high heartworm disease activity for most of the country, especially western states.

The AHS survey results show the mean number of heartworm infections seen per veterinary clinic was 22 percent higher in 2016 than in 2013. The data also indicate 23 percent of respondents saw more heartworm cases, and 20 percent experienced a decline.

Distribution of heartworm cases has not changed dramatically since a survey of veterinary practices three years earlier, but the number of heartwormpositve cases per practice was rising, AHS President Christopher Rehm said in the announcement.

AHS incidence maps are available at www.heartwormsociety.org/veterinary-resources/incidence-maps.

The CAPC predicts more heartworm disease in the lower Mississippi Valley, where it already is rampant, as well as in the Rockies and westward, where heartworm “may not be foremost on the veterinarian's mind.” Heartworm activity also is expected to be higher than usual in New England, the Ohio River Valley, the Upper Midwest, and the Atlantic Coast states.

Condensed from June 15, 2017, JAVMA News

Women leaders continue to build their ranks

The Women's Veterinary Leadership Development Initiative started in 2013 as a Facebook group and has since turned into a national nonprofit dedicated to advancing women in the profession.

WVLDI not only is active on social media but also hosts networking events at major veterinary conferences and webinars. Among the topics that the organization tackles are practice ownership, career transitions and opportunities, and parenting and work-life balance.

WVLDI members' presentations at major conferences, too, have helped veterinarians better understand issues such as the gender pay gap and lack of representation among leadership.

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Dr. Lori Teller (center) is one of the founding members of the Women's Veterinary Leadership Development Initiative. She and Drs. Karen Bradley and Stacy Pritt, also founding members, now serve on the AVMA Board of Directors. (Photo by R. Scott Nolen)

Citation: American Journal of Veterinary Research 78, 7; 10.2460/ajvr.78.7.760

Leadership is always part of the discussion, particularly within the context of organized veterinary medicine. And WVLDI's leaders have walked the walk when it comes to that topic. Drs. Stacy Pritt, Lori Teller, and Karen Bradley—all founding members of WVLDI, though they have since resigned—are voting members of the AVMA Board of Directors.

Overall, about 42 percent of volunteer leadership positions within entities such as the House of Delegates, Board of Directors, councils, and committees were filled by women for the 2016 Association year compared with 14.5 percent in 1997 and 25.6 percent in 2007. And now, about one-third of House and Board members are women. Twenty years ago, about 10 percent of House members were women, and only one woman was on the 18-member Board—Dr. Mary Beth Leininger as president, the first woman in the position.

Condensed from June 15, 2017, JAVMA News

Polymer chip models may improve drug testing

Translucent polymer chip models, about the size of a AA battery, could provide drug candidate safety data with greater speed and accuracy than from testing in animals and cells.

Federal drug authorities will help develop and test those chips over the next few years, starting with those designed to mimic a human liver and animal livers.

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An Emulate organ chip that is used as a liver model. (Courtesy of Emulate)

Citation: American Journal of Veterinary Research 78, 7; 10.2460/ajvr.78.7.760

Food and Drug Administration officials announced in April plans to evaluate tissue chips—also known as organs-on-chips—produced by one company, Emulate. FDA information indicates the chips could be used to test the effects of candidate pharmaceuticals and biologics as well as pathogens, biological hazards, cosmetics, and dietary supplements. Future tests could involve chip models for kidneys, lungs, and intestines.

An announcement from Emulate indicates that, in the agreement, FDA officials will evaluate and qualify use of Emulate's organs-on-chips technology for toxicological testing in product evaluations. The studies will use Emulate's chips, instruments, and software, which the company claims create a predictive model with more precision and detail than other preclinical testing methods, including cell culture- and animal-based testing.

“In the collaboration, FDA and Emulate researchers will initially use Emulate's Liver-Chip from multiple species (Human Liver-Chip, Dog Liver-Chip, and Rat Liver-Chip), to conduct studies to assess the cross-species differences in toxicology data between humans and animal species,” the Emulate announcement states.

Condensed from June 15, 2017, JAVMA News

Accreditation appeal denied, Arizona plans to try again

The AVMA Council on Education has upheld its decision to deny a letter of reasonable assurance to the University of Arizona's Marley Foundation Doctor of Veterinary Medicine Program. The UA succeeded with seven of the 11 accreditation standards and will continue to work to earn the COE's designation, according to an April 27 university press release.

UA started the process to seek COE accreditation when the School of Veterinary Medicine conducted a feasibility study in 2013 and asked that year for a consultative site visit from the COE; the visit took place Jan. 13–15, 2014. Arizona filed a letter of application with the COE in 2014, seeking a letter of reasonable assurance of accreditation. A council site team traveled to Tucson for a comprehensive site visit Jan. 24–28, 2016. This past October, the council voted to deny a letter of reasonable assurance of accreditation.

Reasonable assurance does not confer accreditation but is a first step toward earning provisional accreditation and, ultimately, accreditation. The classification means the developing college has demonstrated that it has a realistic plan for complying with COE standards. A college granted reasonable assurance must offer admission to its first class of students and matriculate them within three years.

The UA appealed the COE decision this past December. In March, the council reversed part of its earlier decision and approved the program's plans for a research program, but issues with four other standards remain. These will be addressed in a revised submission, the release stated.

The COE had said it would allow Arizona to reapply as soon as June 14.

Condensed from June 15, 2017, JAVMA News

Perdue is first veterinarian to head U.S. Agriculture Department

Dr. Sonny Perdue was sworn in as the 31st secretary of the Department of Agriculture on April 25, becoming the first veterinarian to serve as agriculture secretary and as part of a U.S. president's Cabinet. The Senate confirmed President Donald Trump's pick to head the USDA the previous day by a vote of 87 to 11.

“Making sure that Americans who make their livelihoods in the agriculture industry have the ability to thrive will be one of my top priorities. I am committed to serving the customers of USDA, and I will be an unapologetic advocate for American agriculture,” Dr. Perdue said.

The AVMA welcomed Secretary Perdue's confirmation in a statement saying that with the country facing challenges and opportunities requiring veterinary expertise, such as animal health and food safety, having strong veterinary leadership at the department is more important than ever.

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Dr. Sonny Perdue. (Courtesy of USDA/Lance Cheung)

Citation: American Journal of Veterinary Research 78, 7; 10.2460/ajvr.78.7.760

“Veterinarians possess unique medical expertise that drives scientifically sound policy decisions,” the AVMA said. “Veterinary leadership at all levels of the USDA is crucial to creating and executing effective policies, and Secretary Perdue's appointment is an encouraging sign that veterinarians will continue to be valued at the agency.”

Dr. Perdue received his DVM degree from the University of Georgia in 1971 and served in the Air Force until 1974. After a brief stint practicing veterinary medicine in North Carolina, he returned to Georgia, becoming a small-business owner and a pubic servant. Dr. Perdue was elected Georgia governor in 2002 and reelected four years later by nearly a 60 percent majority.

Condensed from June 15, 2017, JAVMA News

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