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TAKING ON CANCER

Treatment increases, improves for companion animals

By Katie Burns

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Cancer treatment at Colorado State University in Fort Collins (photos 1 to 3) and at VCA Animal Diagnostic Clinic in Dallas (Photo 1 by Bill Cotton, photo 2 courtesy of CSU Flint Animal Cancer Center, photo 3 by John Eisele, photo 4 courtesy of Dr. Zachary M. Wright)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

Cancer is a leading cause of death in dogs and cats—particularly now that more pets are living long enough to develop the disease. At the same time, more pets are receiving treatment for cancer, and those treatments are improving, according to experts in the field of companion animal oncology.

Here, a handful of the many veterinarians who treat or study cancer in pets discuss their work and share their optimism about progress in the fight against the disease.

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“There is more motivation and dedication to try to prolong lives.” DR. LAURA GARRETT (Photo by Daniel Goscha)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

MEMBERS OF THE FAMILY

Overall interest in and experience with companion animal oncology have increased over the past several decades as people have placed more value on pets, said Dr. Laura Garrett, president of the Veterinary Cancer Society and a diplomate of the American College of Veterinary Internal Medicine's specialty of oncology. She is a clinical associate professor at the University of Illinois College of Veterinary Medicine.

It is much more common now to treat pets with cancer, Dr. Garrett said.

“Pets very much are members of the family for many people, and thus, there is more motivation and dedication to try to prolong lives,” Dr. Garrett said, adding “and then we can discuss how most of the treatments are very well-tolerated.” She explained that many pet owners fear cancer treatment will diminish quality of life.

Dr. Garrett noted that veterinarians have access, via extra-label use, to the growing armamentarium of chemotherapy drugs for humans. Some drugs started off being prohibitively expensive but became affordable as generic versions were released.

Back in 1976, a group of veterinarians formed the Veterinary Cancer Society. The society has developed from a conference organizer into an association of more than 800 members with an interest in veterinary oncology. The society's website at www.vetcancersociety.org offers a variety of resources, including information about clinical trials.

Over the years, oncology also has become a part of the curriculum at veterinary colleges and the continuing education program at veterinary conferences, Dr. Garrett said. As a result, many general practitioners are outstanding at treating cancer in pets, consulting specialists, or referring cases when necessary.

As an oncologist, Dr. Garrett finds it satisfying “to talk to owners about their goals and their expectations; their financial constraints and abilities, what have you, because that does become part of it; and then come up with a plan that is going to work for them. And as long as the pet feels good and the owner is happy with what is going on, then I think we're doing our job well.”

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“We can ask the important questions and then go figure out how to answer those questions.” DR. CHAND KHANNA (Courtesy of Dr. Chand Khanna)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

FINDING ANSWERS

Oncology is a rich scientific area where new knowledge translates quickly to the clinic, said Dr. Chand Khanna, who works in comparative oncology at the National Cancer Institute and practices at The Oncology Service in Washington, D.C., and Virginia. He is immediate past president of the oncology specialty within the American College of Veterinary Internal Medicine.

At the National Cancer Institute, Dr. Khanna studies osteosarcoma in dogs and children. Advances in cancer treatment have not yet led to meaningful improvements for patients with osteosarcoma, he said.

“The field of cancer is really, I think, an area where the perspective of veterinary training—which includes this comparative view of biology—is very important,” Dr. Khanna said. “We as veterinarians have a view towards problem solving that is really based in an understanding that we can ask the important questions and then go figure out how to answer those questions.”

Comparative oncology has gone through tremendous growth, he said. As one example, he pointed to his work with the new Comparative Oncology Trials Consortium of veterinary colleges to conduct clinical trials of chemotherapeutic drugs in dogs.

In his practice, Dr. Khanna has found that clients recognize that cancer is not a death sentence for pets. He talks with clients about the goals, risks, and costs of treatment options.

“As cancer therapies become more effective and as we become more able to discuss cure as an outcome, then the decision making around cost is really quite different, different than if you're discussing a treatment that is only going to make something better for a short period of time,” Dr. Khanna said.

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“It's just a disease; it's not magic, it's not evil.” DR. DAVID HAWORTH (Courtesy of Morris Animal Foundation)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

FROM TERRIBLE TO MANAGEABLE

Most of the knowledge and treatments in companion animal oncology come from the fields of human or comparative oncology, but research focusing on cancer in pets is progressing on a number of fronts.

Among other endeavors, the Morris Animal Foundation funds studies in veterinary oncology. Dr. David Haworth, president of the foundation, said, “Cancer is really where there are some fascinating questions that are being answered, and there are real improvements that are being made.”

Dr. Haworth said that when he was growing up in the 1970s, cancer seemed to be a death sentence even for people. He believes cancer has transformed from a terrible diagnosis to a more manageable disease, both for people and for pets.

Morris has funded more than 200 studies of cancer in dogs, cats, and other animals. The foundation has started the Canine Lifetime Health Project, longitudinal research of the sort that has led to many advancements in human medicine. The first study is the Golden Retriever Lifetime Study, which will follow 3,000 Golden Retrievers from birth to death looking at cancer and other conditions.

Dr. Haworth said Golden Retrievers appear to have a predisposition to certain cancers. The objectives of the lifetime study include identifying how factors such as genetics, environment, and diet affect the dogs’ risk for cancer.

Morris continues to seek study participants. Information is available at www.caninelifetimehealth.org.

When Dr. Haworth went into practice in 1999 after serving a fellowship in cancer biology, he felt as though he was the one guy who was willing to try chemotherapy in patients. Now, some general practitioners in every community are treating cancer in pets, he said.

CANINES AND CHILDHOOD CANCER

Studies of cancer in companion animals can lead to better treatment for humans. Companion animals also can impact the cancer treatment process for humans in another way: visits with human cancer patients.

On Oct. 29, Zoetis Inc. and the American Humane Association announced the launch of the Canines and Childhood Cancer study on the effects of animal-assisted therapy in pediatric oncology. The 14-month clinical trial comes on the heels of a pilot study that confirmed the feasibility of conducting a randomized controlled trial involving therapy dogs in multiple settings.

The full trial will involve approximately 100 patients receiving treatment at three to five sites. The first trial site is St. Joseph's Children's Hospital in Tampa, Fla.

“The remedial benefits of animal-assisted therapy for cancer patients have long been shared by doctors, patients, caregivers, and animal handlers, but there is limited quantitative data validating these claims,” said Amy McCullough, national director of animal-assisted therapy for the American Humane Association.

“We strongly believe in the human-animal bond and its therapeutic power,” said Vanessa Mariani, Zoetis director of academic and professional affairs. “Our goal is to advance the understanding and adoption of animal-assisted therapy in the treatment process, and to inform the care of these wonderful animals, through groundbreaking, sound research—while hopefully improving pediatric cancer treatment for both children and their families.”

Additional information is available at www.caninesandchildhoodcancer.org.

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“What I like about the job that I do is the ability to really help people through a critical time.” DR. RODNEY PAGE (Photo by Joe A. Mendoza/Colorado State University Photography)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

“We already have pretty effective ways to deal with most cancer, if you can catch it early enough and if you have owners who are willing to go through it,” Dr. Haworth said. “We need to learn as a profession to deal with cancer for what it is. It's just a disease; it's not magic, it's not evil.”

OFFERING HOPE

Dr. Rodney Page has always been amazed by the commitment and sacrifices that many pet owners will make to treat pets with cancer.

“What I like about the job that I do is the ability to really help people through a critical time, provide some reliable information for them to base a decision on, and to offer hope in a time when it's really a struggle,” said Dr. Page, who is director of the Flint Animal Cancer Center at Colorado State University and scientific leader of the Golden Retriever Lifetime Study.

One source of hope is new and emerging treatments. At Flint, these include radiation therapy that targets tumors precisely and use of patients’ genetics to predict the effectiveness of various chemotherapeutic drugs. The cancer center has a stand-alone unit for clinical trials, with 20 to 30 trials conducted annually.

“It's an opportunity for owners to think about how they can contribute, going forward, to new innovations in health care for pets as well as for people,” Dr. Page said.

He said studies of treatments for certain cancers in companion animals better predict safety and efficacy for humans than do rodent trials.

Flint also offers a free consultation service for pet owners and general practitioners. Dr. Page said the service provides about 3,000 consultations annually, with inquiries coming from around the world. Information is available at www.csuanimalcancercenter.org/consult-service.

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“I view cancer research as the last frontier.” DR. ZACHARY M. WRIGHT (Courtesy of Dr. Zachary M. Wright)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

LAST FRONTIER

“To me, a successful outcome is the clients at the end of the road, whenever that may be, are grateful and happy with the results, even it means three more days or three more years,” said Dr. Zachary M. Wright, an oncologist who treats patients and participates in clinical trials at VCA Animal Diagnostic Clinic in Dallas.

Dr. Wright has practiced in several locations and said his practice volume has increased everywhere he's gone as more pet owners are willing to have a conversation about treating cancer in pets. He attributes their willingness to the growing number of pets living long enough to develop cancer, pets’ value as family members, and improvements in the availability and affordability of many treatments.

He said one of the coolest new treatments is drugs that target cancer cells precisely, in place of the sledgehammer approach of most chemotherapy. Among these drugs are two that have received approval from the Food and Drug Administration for treatment of mast cell tumors in dogs.

The ongoing shortages of chemotherapeutic drugs on the human side also impact the veterinary side, Dr. Wright noted. Recently, three of five drugs for treatment of lymphoma were on back order for three months.

Oncology is not a field with one right answer, he said, but a field that lends itself to creativity.

“I view cancer research as the last frontier. We've explored Alaska, we've gone to the moon, but no one is curing cancer yet,” Dr. Wright said. “I don't think I'm going to be that person, but it's really exciting to just play even a small part in this great process.”

Policy changes for pet food, microchips

Executive Board approves, adjusts policies at November meeting

By Greg Cima

The AVMA is advocating for veterinarian involvement in the distribution of pet foods that make health claims.

The AVMA Executive Board approved that position in November 2013 as well as voted to adopt or modify policies on a variety of subjects, including pet microchips, pet health insurance, and aquaculture regulation. AVMA policies are available at www.avma.org/kb/policies.

Policy changes

Board members voted to amend AVMA policy to recommend that the Food and Drug Administration restrict access to cat and dog foods that make health claims but have not gone through the drug approval or efficacy assurance process. The change added the word “therapeutic” to the title of the AVMA policy “Therapeutic Pet Food Health Claims” and added the following sentence to the policy: “In the interest of pet safety, AVMA recommends the FDA require the product to be made available to the public only through licensed veterinarians within the confines of a veterinarian-client-patient relationship.”

In September 2012, the FDA said in a draft policy guide that the agency can regulate, as drugs, dog and cat foods used to diagnose, cure, mitigate, treat, or prevent disease. Even though many such foods are not approved as drugs, the FDA has exercised enforcement discretion on products that provide nutrition, that carry restricted label claims, and that are sold only through veterinarians in a veterinarian-client-patient relationship.

In deciding whether to act against manufacturers of such foods, the FDA will consider those factors as well as such factors as whether the products are available to the public, marketed as alternatives to approved drugs, labeled with a claim regarding a specific disease, or labeled in a false or misleading manner.

The AVMA had responded to the draft policy with a recommendation that the FDA require that pet foods with implied or explicit health or drug claims but no drug approval include statements on their labels that the claims have not been evaluated by the FDA. The comments also indicate the AVMA supports enforcement discretion on marketing of certain pet food additives, such as glucosamine, which is commonly used in managing osteoarthritis, that have not been associated with substantial safety concerns.

The FDA draft policy guide and comments are available at www.regulations.gov under docket number FDA-2012-D-0755.

The board members also edited the AVMA microchip use policy, which now provides more detail on where transponders should be placed and expresses support for the American Animal Hospital Association microchip database at www.petmicrochiplookup.org. The policy ‘s new name is “Microchips: The Objectives and Key Elements Needed for Effective Electronic Identification of Companion Dogs, Cats, Other Small Mammals, Birds, Fish, Reptiles, Amphibians, and Equids.”

The policy no longer expresses opposition to use of microchip registration databases as a source for marketing or referrals for products and services, a change recommended by the AVMA Council on Veterinary Service. The council indicated in a statement to board members that such marketing is a business decision, and animal shelters often receive free microchips in exchange for allowing the provider to market to animal owners.

The AVMA also made the following policy approval and changes:

  • • Approved the policy “Uniform Jurisdiction for Aquatic Veterinary and Animal Health Programs,” through which AVMA advocates that a single agency, rather than a mix of agriculture and wildlife agencies in state and federal governments, should have jurisdiction over the health of animals in aquaculture.

  • • Modified the policy “Pet Health Insurance” to state that a veterinarian should help in claims adjudication.

  • • Revised the policy “Veal Calf Management” to recognize industry progress toward moving calves into group housing at a younger age and to note the importance of attention to gastrointestinal health.

  • • Edited the policy “Service Animals” to reflect the inclusion of miniature horses in the Americans with Disabilities Act as well as to list more of the tasks performed by service animals.

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Dr. Kenneth E. Bartels (center), chair of the AVMA House (of Delegates) Advisory Committee, addresses Executive Board members Nov. 22, 2013. Drs. Gary S. Brown (left) and John A. Howe also are shown. (Photo by Greg Cima)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

More changes considered

The Executive Board members considered but decided against rescinding the policy “Controlled Substances Used in Euthanasia,” which says controlled substances that are regulated by the Drug Enforcement Administration and used for euthanasia should be used only under the supervision of a veterinarian.

The AVMA Council on Biologic and Therapeutic Agents, which recommended rescinding the policy, said in its recommendation that some states allow use of such substances without a veterinarian's supervision, particularly in animal shelters, and noted that the AVMA Guidelines for the Euthanasia of Animals provide guidance on controlled substance use and veterinarians’ roles in euthanasia.

In debate over the policy, Dr. Clark K. Fobian, 2013–2014 AVMA president, said that, even though states are letting nonveterinarians administer such controlled substances, he has no problem with keeping the policy that veterinarians should have authority over controlled substance use.

The Executive Board also voted against implementing a policy that would have said that valid scientific study shows lead from ammunition and fishing tackle can be toxic to animals.

In recommending the policy, the AVMA Committee on Environmental Issues cited studies that indicated such concentrated forms of lead have harmed U.S. wildlife, particularly water birds, raptors, and scavengers. The committee also described public health risks connected with eating game killed with lead ammunition.

The committee further cited legislation recently passed in California as a testament to the seriousness of the issue. In October 2013, state authorities passed a bill that will require use of nonlead ammunition for hunting in the state by July 2019.

The California bill stated that 50 years of research showed lead in the environment threatens public health and wildlife.

The U.S. Environmental Protection Agency also indicates several species of water birds—including ducks, wading birds, and shoreline feeders—are particularly vulnerable to lead poisoning through accidental ingestion of lead fishing sinkers.

Dr. John A. Howe, AVMA board member representing District VII, comprising Iowa, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota, said he did not think the issue was veterinarians’ fight, and he said after the meeting that the issue is handled in other avenues, including through regulatory bodies. Dr. John H. de Jong of District I, who represents New England and New York, said he would prefer that advocacy on the issue be addressed through the AVMA's “Toxicoses” policy. That policy states that the AVMA “supports education, legislation, regulations, research, and other actions that prevent toxicoses” in animals and humans.

Pending proposals

In January, the board will consider a proposal to rename the policy “Internet Pharmacies” to “Client Requests for Prescriptions” and edit the policy to state that veterinarians must, rather than should, honor client requests to prescribe rather than dispense a drug. The proposal was based on an opinion from the AVMA Clinical Practitioners Advisory Committee that honoring such a request is an ethical duty.

In April, the board will consider a proposal by Dr. de Jong to give stipends to Executive Board members. He said board members were committing increasing amounts of time and money toward service, and yearly stipends of at least $7,500 each would show appreciation and encourage participation by younger members.

AVMA supports bills on horse trailers, research

Executive Board adopts positions during November meeting

By Greg Cima

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(Photo by Greg Cima)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

The AVMA will push Congress to pass legislation that would forbid transporting horses across state lines in double-deck trailers.

The Association will also advocate for bills intended to improve career opportunities for researchers in the biomedical sciences and to allow creation of charitable agricultural research organizations.

On the other hand, the AVMA will work to defeat a bill that would forbid nontherapeutic use in animals of antimicrobials deemed to be important for human medicine, with exceptions for uses deemed not to risk human health.

The AVMA Executive Board voted in November 2013 to take positions on 12 federal bills. The AVMA will spend the most effort toward passage of three and defeat of one.

The Horse Transportation Safety Act of 2013, S. 1459, is among those the AVMA will try to help pass. The legislation would prohibit interstate transportation of horses that involves any trailer with two or more stacked decks.

The AVMA already opposes use of such trailers through its policy “Humane Transport of Equines,” which states that more horses are hurt in double-deck trailers than in single-deck ones.

The AVMA will also work in support of the Next Generation Research Act, S. 1552, which would require efforts from the National Institutes of Health to improve opportunities for researchers, improve workforce diversity, and help researchers gain renewal funding. And the AVMA will work in support of the Charitable Agricultural Research Act, S. 1280 and H.R. 2671, which would allow tax-deductible charitable contributions to agricultural research organizations connected with certain universities and colleges.

But the AVMA will work for the defeat of the Preventing Antibiotic Resistance Act, S. 1256, which would reduce the use in livestock of antimicrobials deemed to be important for human medicine. The bill would make the Food and Drug Administration withdraw drug approvals that allow uses of such antimicrobials in livestock in the absence of a documented disease or infection.

The FDA could make exceptions for uses determined unlikely to harm human health through increased antimicrobial resistance development. The bill also states that a veterinarian-client-patient relationship should exist when livestock receive antimicrobials considered to be important in human medicine.

In a recommendation that the AVMA pursue defeat of the bill, the AVMA Legislative Advisory Committee indicated to board members that four other AVMA councils and committees supported the requirement for a veterinarian-client-patient relationship but still opposed the bill. The recommendation said the bill would eliminate the use of some antimicrobials for disease prevention and control without scientific review by the FDA and that drug use safeguards already exist within the veterinary profession and drug approval process.

Dr. Mark P. Helfat, whose board district consists of Delaware, Maryland, New Jersey, Pennsylvania, Virginia, and Washington, D.C., had recommended that the AVMA soften its attitude on such antimicrobial-related legislation. He said not a month passes in which he does not hear veterinarians described in a negative way in connection with antimicrobial use in livestock.

“We are not looking good here,” he said.

He also noted that three AVMA entities recommended simply taking a position in opposition to the bill, rather than working to defeat it. The vote preceded the FDA's announcement in December that the agency was giving pharmaceutical companies three years to reduce livestock uses of antimicrobials important for human medicine (see page 151).

Expressing support

The AVMA also will express support for the following bills but expend less effort toward passage:

  • • The Strategies to Address Antimicrobial Resistance Act, H.R. 2285, which would create a new Department of Health and Human Services office to coordinate and plan efforts to combat resistance, study antimicrobial use, and make resistance-related recommendations.

  • • The Wounded Warrior Service Dog Act of 2013, H.R. 2847, which would establish a grant program to encourage assistance dog use by disabled military veterans.

Expressing opposition

The Executive Board adopted a position of “nonsupport” for the Pet Safety and Protection Act of 2013, H.R. 2224, which would restrict who could sell dogs and cats to research facilities and would effectively prohibit sales of random-source dogs and cats from class B dealers. The board's position means the AVMA opposes the bill but does not consider action against it to be a priority.

Dr. Helfat and four other board members voted to support the legislation. He had argued that the bill fits with AVMA policy that such dealers be used as sources of animals only in the absence of alternatives.

He also said the number of class B dealers—a Department of Agriculture designation for dealers who typically buy and resell animals—has decreased since the 1990s because of a reputation that such dealers sold stray or illegally captured animals. USDA information indicates more than 100 such dealers sold dogs and cats to research facilities in the early 1990s, and a USDA spokeswoman said only five such class B dealers were licensed as of December 2013.

Dr. Gail C. Golab, director of the AVMA Animal Welfare Division, said the Animal Welfare Committee, which recommended against supporting the bill, noted that the number of problematic animal dealers has decreased since the 1990s largely as a result of USDA enforcement of Animal Welfare Act requirements. She also said the availability of dogs for dissection varies among universities, and that some universities fill shortfalls through class B dealers.

The AVMA also adopted positions of “nonsupport” for the following bills:

  • • The Antimicrobial Data Collection Act, S. 895, which would have the FDA study antimicrobial use and resistance in food-producing animals; give the public data on volumes of antimicrobials used, separated into categories based on their importance in human medicine; and provide details on antimicrobials administered and recipient animals. The AVMA Legislative Advisory Committee recommended the position on the basis of concerns from three other AVMA entities about how much data should be gathered and how the data would be collected, analyzed, and used.

  • • The Big Cats and Public Safety Protection Act, S. 1381 and H.R. 1998, which would restrict who could possess or transfer wildlife. AVMA committees indicated the bill would weaken rules on wildlife possession by circuses and wildlife sanctuaries and reduce zoo accreditation options.

  • • The Expedited Departure of Certain Snake Species Act, H.R. 2158, which would allow transportation of yellow anacondas and four types of pythons through U.S. airports and out of the country within 48 hours, provided the snakes remained in secure containers and traveled only to airports. The AVMA Legislative Advisory Committee expressed concern that the bill could contribute to the spread of those snakes and allow diversion or trafficking.

  • • The Captive Primate Safety Act, H.R. 2856 and S. 1463, which would designate nonhuman primates “prohibited” wildlife that could not be bought or sold in interstate or foreign commerce, including as pets, with some exceptions for use in licensed and inspected facilities and uses as assistance animals. The latter exception conflicts with the AVMA policy that primates should not be used as assistance animals because of welfare, injury, and disease concerns.

  • • The Medical Waste Management Act, H.R. 2891, which would require that the Environmental Protection Agency develop regulations to protect human health and the environment from medical waste as well as regulations to track, handle, and dispose of such waste. The Legislative Advisory Committee recommended opposition to the bill out of concern that it would be burdensome for veterinarians and would usurp states’ medical waste regulations.

Board tweaks approach to member services, ethics

By Katie Burns

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AVMA Executive Board members Drs. Mark P. Helfat and Michael L. Whitehair, SAVMA representative Elise Ackley, and AVMA Vice President Walter R. Threlfall (Photo by Greg Cima)

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

The AVMA is taking a slightly new tack in how it addresses the areas of member services and veterinary ethics.

The Executive Board approved sunsetting the AVMA Member Services Committee in 2014 but is seeking to preserve two MSC objectives—promoting diversity in the profession and promoting wellness among veterinary professionals. The board also approved continuing the AVMA Judicial Council on an ad hoc basis, which will enable the council to complete revisions to the Principles of Veterinary Medical Ethics of the AVMA.

The board took the actions during its November 2013 meeting, following in-depth performance evaluations of the MSC and Judicial Council by the AVMA Governance Performance Review Committee.

According to the governance committee, the charge of the MSC is too broad, and most of its charge is being addressed by other AVMA entities or by staff. The charge is to promote organized veterinary medicine and AVMA membership, make recommendations on membership matters, review membership policies, promote diversity and mentorship, promote wellness, and advocate for veterinary students.

Dr. Douglas G. Aspros, AVMA immediate past president, said sunsetting the MSC does not mean that the Association is inattentive to member services, but rather, is a response to the fact that the functions of the committee are being addressed by others.

Dr. Ted Cohn, AVMA president-elect, said he wanted to preserve the MSC objectives to promote diversity and wellness. Other board members spoke in favor of expanding AVMA efforts to promote diversity.

The board voted to sunset the MSC effective July 2014 and instructed staff to reach out to committee members for input on approaches to diversity and wellness.

The work of the Judicial Council is limited, according to the governance committee. The council's responsibilities include investigating unethica conduct by AVMA members and advising on questions of veterinary ethics. The committee concluded that ad hoc committees, staff, and existing AVMA entities could fulfill the council's responsibilities.

Dr. Mark P. Helfat, District II representative on the board, said the council is hard at work revising the AVMA Principles of Veterinary Medical Ethics. He suggested allowing the council plenty of time to complete the project.

Sunsetting the council would require an amendment to the AVMA Bylaws, but the Association currently is examining the entire AVMA governance structure. The board voted not to sunset the council and voted instead to direct the council to meet on an ad hoc basis pending AVMA governance adjustments.

AVMA collaborating with women's initiative

The AVMA Executive Board in November 2013 approved establishing a collaboration with the Women's Veterinary Leadership Development Initiative as a pilot program for 2014, with the AVMA offering a range of resources to support the growth of the initiative.

Formed in July 2013, the WVLDI is a grassroots organization that seeks to bridge the gender gap in the leadership of the veterinary profession (see JAVMA, Oct. 1, 2013, page 918). As of Nov. 12, 2013, the organization's Facebook group had 557 members, and its LinkedIn group had 225 members. Members of the WVLDI Advisory Board have begun to make presentations at veterinary conferences.

The AVMA will provide the WVLDI with resources such as financial and business management services, sponsorship for WVLDI speakers to make presentations at four veterinary conferences, and co-branded promotion of these presentations. The AVMA associate director for international and diversity initiatives will serve on the WVLDI Advisory Board.

The WVLDI website is at www.womenveterinarians.org.

AVMA to help members travel to Havana

The AVMA plans to provide information and planning help for veterinarians who want to attend the 2014 Pan-American Congress of Veterinary Sciences meeting in Cuba.

AVMA staff members plan to give nonmonetary aid to members who need help obtaining travel documentation and arranging charter flights and accommodations in Havana for the October meeting. The AVMA Executive Board voted in November 2013 in favor of providing the service, which was recommended by the AVMA Committee on International Veterinary Affairs.

The AVMA is a member of the Pan-American Association of Veterinary Sciences, which is among the organizations sponsoring the congress. Dr. Beth Sabin, associate director for international and diversity initiatives, said the AVMA wants to make sure its members know about the congress, which offers an opportunity to attend continuing education sessions and meet colleagues from throughout the Americas.

The committee indicated in its recommendation to the board that the AVMA could start providing information and other services for members who want to participate in various international meetings, and the meeting in Havana could serve as a good trial for such a service, considering the restrictions on U.S. citizens’ travel to Cuba.

Information from the Department of the Treasury indicates U.S. citizens can apply for licenses to travel to Cuba to attend professional meetings or conferences organized by international professional organizations based outside the U.S.

Information on the Pan-American congress is available at www.panvetcuba.com. The AVMA had not yet produced additional resources on the event by press time, but questions can be sent to Dr. Sabin at esabin@avma.org.

Board makes appointments

The AVMA Executive Board made the following appointments in November 2013.

Committee on Veterinary Technician Education and Activities

Representing regulatory veterinary medicine—Dr. Pepi Leids, Bath, N.Y.

Convention Management and Program Committee

DVM interactive labs—Dr. Tam Garland, College Station, Texas; convention support activities—Dr. Stacy Pritt, Rowlett, Texas

Council on Education Selection Committee

Representing former COE members—Drs. René Carlson, Chetek, Wis.; and Shannon McGee, Collierville, Tenn.

Veterinary Leadership Conference Planning Committee

Representing the Executive Board—Dr. Michael Newman, Decatur, Ala.

AVMA liaisons

Mycobacterial Disease of Animals Multistate Initiative External Advisory Board—Dr. Brant Schumaker, Laramie, Wyo.; National Foundation for Infectious Diseases Annual Conference on Vaccine Research—Dr. Laurel Gershwin, Davis, Calif.; One Health Commission—Dr. Joann Lindenmayer, Uxbridge, Mass.; National Association of State Public Health Veterinarians Psittacosis Compendium Committee—Dr. Mary Grace Stobierski, East Lansing, Mich.; Veterinary Infection Control Committee—Dr. Chea Hall, San Luis Obispo, Calif.

Donate books, journals, and supplies

Veterinarians and students in foreign countries can make use of the unused textbooks, journals, instruments, equipment, and other supplies cluttering up many veterinary clinics in the United States.

The AVMA maintains a list of individuals and organizations that collect contributions for various countries. The list is available at www.avma.org/members/community. Potential donors should call or email contacts on the list directly.

Individuals or organizations that collect contributions may inquire about being added to the list or updating their listings by calling 800-248-2862, ext. 6754, or emailing asuresh@avma.org.

FDA restricting antimicrobial uses in livestock

Agency calls for cooperation, with threat of regulation

By Greg Cima

The Food and Drug Administration is giving drug companies three years to end the use of many antimicrobials to promote livestock growth or similarly improve production.

Although agency officials said they are asking that pharmaceutical companies voluntarily eliminate such uses for antimicrobials that are deemed important for human medicine, they announced in December 2013 that they will consider regulatory action against those who do not comply. With pharmaceutical industry cooperation, antimicrobials considered important for human medicine could be administered to livestock only to treat, control, or prevent a specific disease, and would be distributed only through prescriptions or veterinary feed directives, which are similar to prescriptions.

On Dec. 11, 2013, the FDA gave pharmaceutical companies 90 days to tell the agency whether they will comply with the request. Michael Taylor, FDA deputy commissioner of foods and veterinary medicine, said that, between the 90-day deadline on March 12 and the three-year removal deadline, the agency will evaluate drug industry participation and decide whether to start regulatory proceedings.

The FDA provided a list showing that the change would affect about 290 drug approvals used in making 420 products.

“I want to emphasize that what's voluntary here is only the participation of animal pharmaceutical companies,” Taylor said. “Once these labeling changes have been made, animal producers will only be able to use these products with therapeutic reasons with veterinary oversight.

“The two companies that hold the majority of these approvals, Zoetis and Elanco, have already declared their support and commitment to voluntarily removing these production claims from their products.”

Both companies issued statements confirming that they support the changes planned by the FDA.

Dr. William T. Flynn, deputy director for science policy in the FDA Center for Veterinary Medicine, said most of the antimicrobial uses targeted for changes involve products administered to livestock through feed. About 25 companies own the affected drug approvals, which cover products such as tetracycline, penicillin, and macrolide drugs.

But Dr. Flynn said antimicrobials in some drug classes, such as ionophores, will remain available over the counter, because they have no clinically important uses in human medicine.

Dr. Flynn also said that the three-year phase-out period is partly intended to give agriculture industries time to adjust their production methods as they move away from the use of affected drugs and develop alternatives to antimicrobial use.

Guiding and regulating

The FDA announced the changes with the publication of a guidance document, Guidance for Industry No. 213, on how the agency wants drug companies to ensure antimicrobial products are used appropriately in food-producing animals. The agency had published a draft version of the guidance document in April 2012, along with a final version of another antimicrobial use document, Guidance for Industry No. 209, which provides more information for agriculture industries.

Along with the new guidance document, the FDA published proposed changes to the rules governing veterinary feed directives. Those changes are intended to give veterinarians more flexibility in issuing VFDs.

Rather than requiring a veterinarian-client-patient relationship to issue VFDs, the proposed rules state that veterinarians must issue them in compliance with state and professional requirements. In addition, the FDA would remove an automatic drug categorization rule that otherwise could obstruct the supply chain, and the agency would reduce the amount of time veterinarians and others must keep VFD records from two years to one.

Dr. Christine Hoang, an assistant director in the AVMA Scientific Activities Division, said the AVMA appreciates the FDA's efforts, intentions, and considerations in its efforts to increase veterinarian oversight of antimicrobials.

“We are fully supportive of this move from over the counter to VFD,” she said.

The FDA is accepting comments on the VFD rule changes under docket number FDA-2010-N-0155 at www.regulations.gov.

Preserving human therapies

Taylor said the agency is working to preserve the effectiveness of antimicrobials important to human medicine.

“We know that the widespread use of antibiotics in animal production and human medicine can contribute to antimicrobial resistance, and we know that antimicrobial resistance has significant public health consequences,” he said.

The guidance documents together indicate that the FDA increased the rigor of its evaluation of antimicrobial resistance risk as it has received more information on that risk, and noted that some drugs approved in past decades were not evaluated in light of today's considerations. The FDA has not approved any over-the-counter antimicrobial uses in livestock since 1993, with the exception of generic versions of existing drugs.

The FDA is starting with a voluntary approach in the belief that cooperation will provide the fastest, most efficient method of removing uses that increase the risk of antimicrobial resistance development, as opposed to the years of product-by-product proceedings that would be needed to withdraw hundreds of drug approvals, Taylor said.

Dr. Richard A. Carnevale, vice president of regulatory, scientific, and international affairs for the Animal Health Institute, which represents pharmaceutical companies, said the FDA's plan has been mistakenly characterized as a voluntary effort.

“Guidance documents are the tool FDA uses to tell industry how the agency expects things to be done and can only be ignored by companies who don't want to get products through the agency's approval process,” Dr. Carnevale said.

Organizations such as the Johns Hopkins Center for a Livable Future have indicated that, rather than issuing voluntary guidance, the FDA should use its regulatory authority to prohibit production and disease prevention antimicrobial uses.

He said he would expect pressure from within the pharmaceutical and agriculture industry on holdouts. Those holdouts also would risk receiving the “wrath of FDA,” he said.

Dr. Carnevale said the AHI and its member companies intend to cooperate on labeling medically important antimicrobials for use in livestock only for therapeutic purposes.

Taylor said changes in the markets for animal products also provide an incentive for pharmaceutical companies to comply with the FDA's plan. He cited policies by retailers such as McDonald's and Kentucky Fried Chicken that favor eliminating production-based uses of antimicrobials important for human medicine.

Veterinary business program undergoes changes

The Veterinary Management Institute is getting an overhaul nearly 24 years after the program began.

This executive program started out as a collaboration between Purdue University's Krannert School of Management and the American Animal Hospital Association in 1990. Since that time, there have been more than 700 participants.

But the two entities parted ways in 2013 after Purdue faculty informed AAHA they would not renew the contract. Now, AAHA is joining forces with Colorado State University to offer a new version of the executive-level management program.

AAHA and Purdue made the announcement Nov. 25, 2013. As part of the new collaboration, the first of three live, on-campus sessions will run Jan. 30-Feb. 1.

The program offers 83 hours of continuing education over 10 months and will consist of the three in-person sessions plus monthly virtual classes, work groups, and discussions. The program is designed for veterinary professionals who are looking to become practice leaders and who are already well-versed in practice management. This applies to practice owners and particularly practice managers, said Kate Spencer, communications manager for AAHA.

Colorado State President Tony Frank said, “This move to offer the prestigious Veterinary Management Institute through Colorado State University leverages the strengths of our top-ranked veterinary medicine program and College of Business to benefit veterinary professionals and communities across the country.”

Topics to be covered include strategic decision making, financial management, services marketing, inventory and demand management, supervision and conflict management, and strategic entrepreneurship. Students will work with professors from CSU's business college, professionals who have led or consulted with successful veterinary practices, and experts who have served with Fortune 500 companies.

A certificate of completion will be issued by the VMI, and the program will qualify as a course for the CSU Online Professional MBA. However, the curriculum for this new program is being resubmitted for approval as certification to sit for the Certified Veterinary Practice Manager program, Spencer said. She added that they are in the process of getting this program approved.

Registration after Jan. 10 (the deadline for early registration) will cost $6,250 for AAHA members and $6,750 for nonmembers. Previous VMI students will receive special pricing for the program. For more information, visit www.aahanet.org/education/VMIReg.aspx.

Cattle veterinarians develop guide on drug oversight

A guide from the American Association of Bovine Practitioners is intended to help veterinarians ensure they establish proper oversight for drug use in cattle.

The AABP published in November 2013 the two-page guide on veterinarian-client-patient relationship practices that the organization endorses and that exceed regulatory requirements.

For example, the guide indicates veterinarians or veterinary practices should have written agreements that identify the veterinarian who is accountable for drug administration on a farm as well as who is responsible for duties such as drug inventory maintenance.

The guide, “Establishing and Maintaining the Veterinarian-Client-Patient Relationship in Bovine Practice,” is available at www.aabp.org/about/AABP_Guidelines.asp.

The document also describes AABP-endorsed practices of establishing a veterinarian of record, clarifying relationships among veterinarians and consultants on farms, providing treatment protocols, maintaining treatment records, and prescribing drugs.

The guide is intended to help veterinarians ensure they and their clients communicate and keep records in ways that ensure pharmaceuticals are used in a responsible manner, Dr. Keith Sterner of Ionia, Mich., said in an AABP announcement. Dr. Sterner was chair of the AABP task force that created the guidelines.

The AABP also is developing cattle well-being guidelines, the announcement states.

Accolades

New York State VMS

The New York State Veterinary Medical Society had an awards ceremony during its annual conference this past October.

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Dr. James F. Peddie

Citation: Journal of the American Veterinary Medical Association 244, 2; 10.2460/javma.244.2.140

Dr. James F. Peddie (COR ‘65) of Ventura, Calif., was recognized with the Daniel Elmer Salmon Award for Distinguished Alumni Service, given annually by the Alumni Association of Cornell University College of Veterinary Medicine.

He was one of the three founding members of the Conejo Valley Veterinary Clinic in Thousand Oaks, Calif. During his 23 years there, he mentored many veterinary students and recent graduates.

Dr. Peddie developed an interest in exotic animal medicine in the early 1970s. He volunteered at local zoos, becoming a pioneer in humane restraint and treatment techniques in a variety of exotic species. During this time he began a 30-year relationship with the Exotic Animal Training and Management Program at Moorpark College in Moorpark, Calif.

Dr. Peddie's interest in elephants led him and his wife, Dr. Linda R. Peddie (COR ‘65), to monitor and shape legislation and regulations for the appropriate care of these animals when kept in captivity. He is respected as a pioneer in wildlife medicine and in the humane use of animals in the entertainment industry.

Dr. Peddie was also active in organized veterinary medicine, serving as California delegate to the AVMA House of Delegates and as AVMA treasurer for six terms, as well as California VMA treasurer and member of the CVMA board of governors. He is currently treasurer of the Western Veterinary Conference and a trustee for the AVMA Group Health & Life Insurance Trust.

Dr. Linda J.M. Tintle (COR ‘81) of Wurtsboro, N.Y., received the President's Recognition Award, which honored Dr. Tintle for her work on behalf of the society and the veterinary profession in New York state during her presidential term in 2013.

Dr. Lawrence Bartholf (COR ‘65) of Greenfield Park, N.Y., received the Distinguished Life Service Award for his service as an NYSVMS member for 35 years. The large animal practitioner served as the society's president in 2005. He has won several animal welfare awards, including the first AVMA Animal Welfare Award.

Dr. Eric Bregman (UP ‘95) was honored as the New York State Veterinarian of the Year. He is owner of the Bregman Veterinary Group in Williston Park, N.Y., and was president of the NYSVMS in 2011.

Lisa Chelenza was honored with the Special President's Citation. Since 2003, Chelenza has been the face of Pet Pointers, a weekly segment on Syracuse station YNN that focuses on animal and pet health issues and offers advice from veterinarians on how to provide the best care possible for pets.

Dr. Daniel J. Fletcher (CAL ‘02) of Ithaca, N.Y., was recognized with the Outstanding Speaker Award for the 2012 New York State Veterinary Conference, which was voted on by attendees. Dr. Fletcher is an assistant professor in the Section of Emergency and Critical Care at Cornell University College of Veterinary Medicine. He is a diplomate of the American College of Veterinary Emergency and Critical Care.

American College of Zoological Medicine

Event: Annual meeting, Sept. 29, 2013, Salt Lake City

Awards: ACZM Student Manuscript Award: Dr. Natalie Hall, Orlando, Fla., for “Serum osmolality and effects of water deprivation in captive Asian elephants.” Honorable mention—Dr. Marion Desmarchelier, Charlottetown, Prince Edward Island, for “Evaluation of a fracture pain model in domestic pigeons.” President's Award: Drs. Rob Coke, San Antonio; Marion Desmarchelier, Charlottetown, Prince Edward Island; and Kathryn Gamble, Chicago

New diplomates: Eight diplomates completed the requirements for board certification by the ACZM in 2013. The new diplomates are as follows:

Paige Brock, Orlando, Fla.

Shannon Cerveny, San Antonio

Conor Kilgallon, Dubai, United Arab Emirates

Sylvain Larrat, Saint-Hyacinthe, Quebec

Kristen Phair, San Diego

Olivia Petritz, Woodland, Calif.

Marie Rush, Hoover, Ala.

Trevor Zachariah, Melbourne, Fla.

Officials: Drs. R. Scott Larsen, Denver, president; Sharon L. Deem, St. Louis, vice president; Kay Backus, Tulsa, Okla., secretary; Lisa Harrenstien, Portland, Ore., treasurer; and Mark Drew, Caldwell, Idaho, immediate past president

Obituaries: AVMA member AVMA honor roll member Nonmember

Frank G. Badame

Dr. Badame (ONT ‘52), 84, Oakville, Ontario, died Sept. 5, 2013. He practiced small animal medicine in Ontario at Oakville and Mississauga for more than 60 years. Dr. Badame is survived by four daughters and five grandsons. Memorials may be made to Kitchener Rangers, c/o Head Strong, Michelle Fortin, 400 E. Ave., Kitchener, Ontario, Canada N2H 1Z6; or Wellspring Cancer Support Foundation, 4 Charles St. E., Suite 300, Toronto, Ontario, Canada M4Y 1T1.

Ferrin B. Kinghorn

Dr. Kinghorn (COL ‘52), 92, Rigby, Idaho, died Sept. 17, 2013. A mixed animal veterinarian, he was the founder of Rigby Veterinary Clinic. Dr. Kinghorn served in the Navy during World War II, attaining the rank of lieutenant. His wife, Virginia; two sons and two daughters; 12 grandchildren; and 16 great-grandchildren survive him.

Matthew J. Murphy

Dr. Murphy (GA ‘89), 55, Scotland, Pa., died Sept. 22, 2013. He owned Keystone Mobile Veterinary Services. Dr. Murphy is survived by his wife, Brenda; two sons and a daughter; and six grandchildren. Memorials may be made to Chambersburg Baptist Church Building Fund, 3492 Turnberry Drive, Chambersburg, PA 17202.

Major A. Nilson

Dr. Nilson (WSU ‘53), 88, Carmichael, Calif., died Sept. 24, 2013. A mixed animal veterinarian, he established a practice in Carmichael in 1954, later expanding to include hospitals in California's Citrus Heights and Roseville. Early in his career, Dr. Nilson worked an as extension pathologist and was an associate professor at the University of California-Davis. In 1996, he received the Washington State University Alumni Achievement Award.

Dr. Nilson served in the Merchant Marine during World War II. He was a past president of the Carmichael Chamber of Commerce and a member of the Elks Club, Rotary Club, and Veterans of Foreign Wars. The Carmichael Chamber of Commerce twice named him Man of the Year and honored him in 2011 as Business Person of the Year. Dr. Nilson was also named honorary mayor of Carmichael three times in recognition of his community service. Active with the Boy Scouts, he received the Silver Bear and Silver Beaver awards.

Dr. Nilson's wife, Lucy; a daughter and a son; and four grandchildren survive him. Memorials may be made to the Perpetual Education Fund of The Church of Jesus Christ of Latterday Saints, LDS Philanthropies, 1450 N. University Ave., Provo, UT 84604, www.pef.lds.org/pef.

J. David Schaffer

Dr. Schaffer (AUB ‘44), 91, LaGrange, Ga., died Oct. 16, 2013. He practiced mixed animal medicine in south and coastal Georgia for more than 50 years. During his career, Dr. Schaffer also taught at the University of Rhode Island and Brunswick Junior College. In retirement, he was a relief veterinarian.

Dr. Schaffer served in the Army Veterinary Corps as a captain during the Korean War. He was a past president of the Rotary Club of McIntosh County. Dr. Schaffer is survived by his wife, Joyce; two sons; eight grandchildren; and five great-grandchildren.

Kevin M. Wright

Dr. Wright (FL ‘88), 50, Mesa, Ariz., died Sept. 26, 2013. An exotic animal veterinarian, he owned Wright Bird and Exotic Pet House Calls since 2012. Dr. Wright began his career as an associate veterinarian at South Kendall Animal Clinic in Miami. He later served as veterinarian at the Montgomery Zoo in Montgomery, Ala.; was contract veterinarian for the New Jersey State Aquarium; and served as curator and veterinarian at the Philadelphia Zoological Gardens. From 1999–2005, Dr. Wright worked at the Phoenix Zoo. During that time, he also served as adjunct professor of zoological medicine at the University of Pennsylvania School of Veterinary Medicine. Dr. Wright was an associate veterinarian at University Animal Hospital in Tempe, Ariz., from 2005–2007. He then founded Arizona Exotic Animal Hospital in Mesa, where he practiced until 2012.

A diplomate of the American Board of Veterinary Practitioners, Dr. Wright was a past president of the Association of Reptilian and Amphibian Veterinarians, a professional fellow of the American Association of Zoological Parks and Aquariums, and a member of the Association of Exotic Mammal Veterinarians and Association of Avian Veterinarians. In 2008, the ARAV named him Exotic DVM of the Year. Dr. Wright was named Exotic Speaker of the Year in 2009 and 2012 by the North American Veterinary Conference. He co-authored the textbook “Amphibian Medicine and Captive Husbandry.”

Dr. Wright's wife, Marlene, survives him. Memorials may be sent to C. Marlene Wright (with the memo line of the check notated to the Dr. Kevin Wright Memorial Fund), 2036 N. Gilbert Road, Suite 2-153, Mesa, AZ 85203.

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