Thoughts on humaneness

I have always enjoyed reading Dr. Carl Osborne's articles, whether complex research studies or homespun homilies, so I eagerly anticipated reading his commentary “What does it mean to be humane”¹ in the March 1, 2012, issue of JAVMA. Upon finishing the article, however, I was left with an uneasy feeling. I have always considered myself an ethical and humane veterinarian. I included the word “kindness” in my hospital name and have tried to live up to that sentiment. I have served on several institutional animal care and use committees, including as chair, and even briefly served on an institutional review board.

There were three areas in this commentary that I believe require more thorough discussion. First, Dr. Osborne writes “In addition to instinct, experience and training define whether children become compassionate, unselfish, self-sacrificing, and altruistic, rather than egoistic.” To me, however, egoistic is not the opposite of compassionate or humane. Our egos push us to succeed, endure, and persevere toward a goal that others recognize and reward.

Second, I am bothered by statements such as “Compassionate kindness, by definition, is not motivated by self-gain or profit.” Veterinarians can choose whether they practice for profit or not. Yet veterinarians who do not generate a profit cannot continue to practice without subsidies. I contend that veterinarians can treat animals humanely and with compassion while still returning a profit for their efforts.

Third, I believe animal-owning clients determine the level of care an animal will receive. Veterinarians can advise clients but cannot put themselves in an animal's exact situation. Veterinarians can be humane by providing procedures designed to avoid or minimize discomfort, distress, and pain, but it is the owners who must put themselves in their animals' circumstances.

Douglas H. Erbeck, dvm, phd

Crystal, Minn

The author responds:

In response to the letter from Dr. Erbeck, it appears he is asking for further discussion of the definition of egoism and how this definition can be applied to veterinary medicine and a definition of the term compassion as this term is applied to the human-animal bond.

Regarding the definition of egoism, Dr. Erbeck implies that I stated that the term egoistic has a meaning opposite the meaning of the words compassionate and humane. It is true that, as Dr. Erbeck suggests and in agreement with the definition in Webster's dictionary, our ego pushes us to succeed, but it is our compassion that pushes us to help others succeed.

Further, although profit is an important aspect of veterinary practice, the motivation for profit was not the main focus of my commentary, and I would refer readers to an earlier commentary discussing the different motivations for profit.¹ However, an organization that wants to be referred to as professional must have a service, rather than a profit, motive.

Finally, with regard to the term compassion and its application to the human-animal bond, the word compassion is derived from the Latin words passio, meaning to suffer, and com, meaning with. Thus, compassion means to suffer with and by definition encompasses feelings and emotions. To be compassionate, complementary feelings must be combined. First, a person must have an empathetic awareness of the suffering, distress, or troubles of another, and second, the person must have the empathetic desire to help correct those problems. Compassion is not a form of pity that is satisfied by mere expressions of sorrow. The feeling of sorrow does not transcend to a feeling of compassion until there is a strong desire to correct the causes of the distress or suffering of another. Meaning well is not enough. Compassion moves all veterinarians to come to the aid of those who need help. I respectfully disagree with Dr. Erbeck's definition and application of the word compassion. If not us, who? If not now, when?

To me all life is precious. I will not take a life for pleasure. Therefore, I do not hunt or fish. That is my compassion.

Carl A. Osborne, dvm

Department of Veterinary

Clinical Services

College of Veterinary Medicine

University of Minnesota

Saint Paul, Minn

Immune plasma for treatment of parvoviral gastroenteritis

I read with great interest the article by Bragg et al¹ in the March 15, 2012, issue of JAVMA regarding the use of immune plasma for treatment of canine parvovirus infection.¹ At Hemopet, we have supplied commercially available fresh-frozen plasma (FFP) for treatment of viral diseases such as canine parvovirus (CPV) infection ever since our canine animal blood bank, licensed by the California Department of Food and Agriculture, opened in 1991.^2–5

The protocol we routinely recommend is three doses of FFP (6.6 to 11 mL/kg [3 to 5 mL/lb], IV or IP), with the first two doses given 12 hours apart on the first day and the third dose given the following morning. Additional doses of FPP are given as needed. In instances when apparently healthy puppies have been exposed to affected puppies, we recommend that one or two doses (6.6 to 11 mL/kg) of FFP be given prophylactically. Over the past two decades, this protocol has been successful when used in conjunction with supportive care and fluid therapy, as needed.

In the study by Bragg et al,¹ IV administration of a single, 12-mL dose of CPV-immune plasma soon after the onset of CPV enteritis was not effective in ameliorating clinical signs, reducing viremia, or hastening hematologic recovery. As suggested by these authors in the discussion of their results, and in agreement with our experience at Hemopet, the failure of their treatment was likely due to an inadequate amount of CPV-immune plasma being given for an insufficient length of time.

W. Jean Dodds, dvm

Hemopet

Garden Grove, Calif

The author responds:

The authors thank Dr. Dodds for her comments on our recent article regarding the use of immune plasma for treatment of canine parvovirus infection.¹ Dr. Dodds reiterates some of the study limitations that we noted in the discussion of our report. It is interesting to hear of Dr. Dodds' apparent success using immune plasma for treatment of parvoviral gastroenteritis; however, we believe it is premature to conclude that higher doses or more frequent administration of immune plasma would be any more effective than administration of a single dose until such efficacy was proven in a properly designed randomized clinical trial. We look forward to published results of additional controlled studies to provide a more firm basis for recommending the use of immune plasma for treatment of parvoviral gastroenteritis in dogs.

Steven Dow, dvm, phd

Department of Clinical Sciences

College of Veterinary Medicine and

Biomedical Sciences

Colorado State University

Fort Collins, Colo

Potassium bromide products marketed for use in dogs

I read with interest the article¹ “A systematic review of the safety of potassium bromide in dogs,” which was published in the March 15, 2012, issue of JAVMA. The authors indicate that currently there are no commercially available potassium bromide products approved by the US FDA for use in dogs. However, for the past several years, I have been using a product (K-Bro Vet) from PRN Pharmical with the understanding that it is just such a product. The packaging contains the caution statement that “Federal law restricts this drug to use by or on the order of a licensed veterinarian,” and the package inserts feature National Drug Code numbers.

Kenneth M. Kornheiser, dvm

Countryside Veterinary Clinic

Plainwell, Mich

The authors respond:

Thank you for your comments, which draw attention to important concerns regarding marketed but unapproved animal drugs that may not be clear to other veterinarians.

The presence of a National Drug Code (NDC) number on a drug label does not mean the drug has been approved by the US FDA. Under the Federal Food, Drug, and Cosmetic Act, all drug manufacturers are required to register with the FDA and to provide a list of their marketed drug products. Each reported animal drug product is assigned a unique NDC number. This requirement applies to all marketed drugs, regardless of whether they are approved or unapproved.

The presence of the cautionary statement on an animal drug label is also not an indication the drug has been approved by the FDA. Under the Federal Food, Drug, and Cosmetic Act, animal drug products that can only be safely used under the professional supervision of a licensed veterinarian must bear the label statement “Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.” This requirement applies to all marketed drugs, both approved and unapproved. Therefore, inclusion of either an NDC number or a prescription statement on the drug label does not denote approval by the FDA of the firm or any of its marketed drug products.

There are other statements associated with marketed animal drugs that should also not be taken as an indication that the drugs have been approved by the FDA. These statements include “Registered and listed with the FDA,” “Made in an FDA-registered facility,” “Made in an FDA-inspected facility,” and “Made in an FDA-approved facility.”

Drugs that have been approved by the FDA have either a New Animal Drug Application number or, for generic animal drugs, an Abbreviated New Animal Drug Application number. The New Animal Drug Application number or Abbreviated New Animal Drug Application number and the statement “Approved by FDA” are usually on the label. Animal drugs conditionally approved by the FDA have a Conditional New Animal Drug Application number, which appears on the drug label as part of the following required statement: “Conditionally approved by FDA pending a full demonstration of effectiveness.”

There are several sources for determining whether an animal drug has been approved by the FDA. Most FDA-approved animal drugs are listed in the Animal Drugs @ FDA searchable online database and are also listed in a document called the Green Book. The Green Book is published in its entirety each January and updated monthly. Both information sources are available on the FDA website (www.fda.gov/AnimalVeterinary). Additional information regarding unapproved animal drugs can be found at the same site.

The FDA is aware that unapproved animal drugs are marketed in the United States, including the product referenced in your letter. The AVMA and FDA have both expressed serious concerns about the continuing presence of unapproved animal drugs in the marketplace. These drugs are not reviewed by the FDA and may not meet the FDA's strict standards for safety, effectiveness, and manufacturing quality. As part of its initiative to address this problem, the FDA has asked for public comments on strategies to address this issue.

As your letter highlights, access to reliable information about animal drugs is critical for veterinary prescribing decisions.

Laura Hungerford, dvm, mph, phd

A'ndrea Van Schoick, dvm

Hope Baird-Heinz, dvm

D. Lauren Ranivand, mph

Francis Pelsor, pharmd

Neal Bataller, me, dvm

Elizabeth Luddy, dvm

Janice Steinschneider, ma, jd

Center for Veterinary Medicine

US FDA

Rockville, Md

The future of the veterinary profession

In recent years, the leadership of our profession has been engaged in serious discussions regarding the direction of the veterinary profession over the next 10 to 20 years. The AVMA and Association of American Veterinary Medical Colleges, along with numerous stakeholder groups, have defined the numerous challenges we are facing and offered some well thought-out solutions designed to provide a roadmap for the future. Predictably, the solutions have been critiqued and challenged, fostering an environment that tends to favor the status quo. To my mind, however, defining goals that enhance the societal roles of the veterinary profession will perhaps allow for a greater focus on future directions.

A century ago, the veterinary profession's role was, for all practical purposes, married to agriculture, which provided the profession with a solid economic foundation. Since that time, however, there has been a shift so that companion animal practice now provides the largest part of the economic base of the profession today. Agriculture has evolved in such a way that although veterinarians still have a major role in managing animal health, the effort is more commonly as consultants than in hands-on treatment.

As a small animal practitioner for the past 35 years, I see vulnerabilities in this shifting of the economic foundation from a fundamental industry—agriculture—to a field supported largely by discretionary income—companion animal practice—and I worry whether our profession can be sustained on such an economic foundation.

Although most veterinarians are engaged in some form of clinical practice, many are engaged in various other areas related to animal health. I maintain that we do not adequately emphasize the contributions of those not in clinical practice.

Given the projected population and economic changes over the next 10 years, I wonder whether we are properly positioning the profession to adapt to hypothetical challenges and whether we can say with any degree of confidence that the forces that support companion animal practice will remain in place. What will happen if discretionary income comes under serious pressure? What will happen as the population demographics shift? Will the human-animal bond weaken or strengthen, and if it weakens, where do we look for economic sustainability?

I am not advocating deemphasizing the tremendous advances in companion animal medicine. I am concerned we are dangerously close to putting the profession at risk by focusing too much on a single mode.

Our prominence among the health professions is directly related to the value we provide in satisfying societal needs. There is a direct relationship between value given and value received. We need to construct a vision that incorporates our individual shared visions. Once we solidify a broad vision of our societal role, the task of mapping the future may be easier.

John Paul (Jack) O'Mara, dvm

Ellicott City, Md