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For example, a human generic paracetamol/codeine tablet costs approximately 3p at wholesaler prices.
By comparison, an almost identical licensed veterinary equivalent costs ten times as much.
The requirement for veterinary surgeons to prescribe expensive veterinary-licensed medications over cheaper unlicensed medications or drugs licensed for human use was first introduced though EU Directive 2001/82/EC in 2001, which the UK was legally required to implement in the form of the Veterinary Medicines Regulations 2013.
The main objectives of the EU directive were to safeguard public health by regulating medicines used in food-producing animals, to ensure the health and welfare of animals by requiring veterinary medicines to be authorised based on quality, safety and efficacy, to facilitate the free movement of medicines between member states and to encourage pharmaceutical innovation.
Whilst there is a strong rationale for the use of licensed medicines in food-producing animals, primarily to protect the public from medicine residues, the case for cats and dogs is weaker.
Furthermore, there is no evidence that legislators considered the increased cost to pet owners of implementing Directive 2001/82/EC, and the potential unintended consequences.
14 years later, this new research shows that the Veterinary Medicines Regulations 2013 may in fact harm companion animal welfare and stifle pharmaceutical innovation.
In terms of harm, the survey found that 38.8% of veterinary surgeons noted that owners are unable to afford the veterinary licensed drugs they are obliged to prescribe between 1-4 times per week.
Another 25.8% of vets said this happened very often, ie at least once a week.
Another 24% said it happened at least once a month.
From these figures, the authors calculated that 438,000 owners may be unable to afford vet licensed drugs over cheaper human-use generics.
In requiring vets to prescribe veterinary-licensed medications, there should obviously be a clear, measurable benefit to animal welfare.
For example, if it were possible to argue that the regulation has reduced the occurrence of adverse reactions to medication or inefficacy.
However, in the US, where no comparable regulation is in place and the same drugs are used, there is no evidence of this being the case, despite the very much larger population.
There is also evidence to suggest that the system may stifle, rather than promote the development of novel treatments, as pharmaceutical companies have prioritised the veterinary licensing of human use drugs over the development of new ones, because it costs them far less and carries less risk of failure.
Since the introduction of Directive 2001/82/EC, pharmaceutical companies have launched six novel veterinary medicines for companion animals in the EU, namely Frunevetmab, fluralaner, lokivetmab, bedinvetmab, lotilaner and pradofloxacin.
By contrast, over the same time period, there have been 13 human use drugs licensed for veterinary use, with no evidence to support the idea that they have become safer, better or more effective in animals than they were when the cheaper human-use variants were prescribed before the Directive was introduced.
David Mills MRCVS, lead author of the article, said: "It is incumbent on veterinary legislators and regulators to consider the impact of their legislation and regulation on the cost to the consumer and consequently on animal welfare.
"In this case, they need to consider whether the benefits of licensing are real and measurable, and that they outweigh any harm caused by impact of licensing on the cost of treatments.
"Whilst it is only right that pharmaceutical companies should be rewarded for developing novel treatments, removing the requirement for vets to prescribe licensed medication when a human generic exists, or even simply allowing discretionary use of unlicensed medication on the grounds of cost are all simple solutions that would better serve animal welfare, reduce costs to owners and promote research of new drugs."
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The survey was conducted following the recent RCVS Council decision to redefine ‘Under Care’ to allow vets to prescribe remotely.
692 veterinary surgeons took part in the survey, 88.7% of which worked in practice, 8.7% worked elsewhere and 2.6% are retired.
42.4% worked in corporate practice, 42.4% at an independent practice (spooky), 9.6% locum and 2.6% at a charity.
94% worked in first opinion practice, 5.7% in referral practice.
When asked: “Do you agree with the RCVS Council decision to allow veterinary surgeons to prescribe medication without having seen / examined the animal in person?”, 78.2% said no, 13.6% said yes and 8.2% said ‘ambivalent’.
This raises an interesting discussion about the role of RCVS Council, which the College has long said is ‘representative of’, but not there 'to represent’ the profession in self-regulating.
By any measure, this decision was not ‘representative of’ the wider body of opinion.
It could be argued that electorates vote for representatives to make more informed decisions than they themselves are able, and certainly MPs have voted in ways that are not representative of the wider body of public opinion.
But this is the veterinary profession. MPs have to represent a wide cross-section of society, some groups of which might struggle to field one working brain cell between them.
By contrast, veterinary surgeons are a highly intelligent, highly educated subset of the population, who you might assume are better qualified to make decisions on matters such as these.
So why this level of disagreement? We asked respondents to select any benefits and drawbacks they think remote prescribing will bring, from a list but with the option for them to write in any we hadn’t thought of.
When asked to select benefits of remote prescribing, the majority (70.9%) selected: “Reduced cost to the pet owner (driving/parking etc)’.
39.3% said it would bring an improvement to vets’ quality of life through more flexible working.
27.5% said animal welfare would be improved through increased access to veterinary services.
14.3% said it would bring an ‘Improved client/vet relationship’.
Of those people who selected a benefit, 49.9% said the biggest benefit of remote prescribing is a reduced cost to the pet owner (driving / parking etc).
Other benefits highlighted in the comments section were
Notably, in the comments section for the benefits of remote prescribing, out of the 104 comments, 33 actually commented 'no benefit' or negatively.
When asked to select the drawbacks of remote prescribing, 94.3% selected: ‘Harm to animals caused by misdiagnoses and missed diagnoses.
68% said: Worsened client / vet relationship
60.6% said: Threat to independent practice (corporates funnelling clients from online consults to their practices).
Other drawbacks identified by respondents were:
Amongst the written drawbacks, the biggest themes concerned abuse of drugs and antimicrobial resistance.
When those who had selected a drawback were then asked which was the biggest, 83.3% said ‘Harm to animals caused by misdiagnoses and missed diagnoses”
So in simple terms, in weighing up the pros and cons, it’s between the reduced cost to the owner on the one hand, cited by 70.9%, and harm to animal welfare on the other, cited by 94%. And the harm to animal welfare was selected by significantly more vets as the biggest concern, than reduced cost was selected as the biggest benefit.
In other words, vets think remote prescribing will make veterinary care cheaper, but at the overall cost to animal welfare.
British Veterinary Association President Malcolm Morley said: “New technology presents many opportunities to enhance existing veterinary services, with potential benefits for vets, clients and patients.
"However, we recognise there are concerns within the profession, particularly around the potential unintended consequences of the RCVS’s revised guidance on ‘under care’ in relation to animal welfare and access to veterinary services.
"This survey echoes these concerns as well as supporting the British Veterinary Association’s call for the RCVS to commit to a post-implementation review.”
For the survey, veterinary surgeons and nurses were asked: "Thinking about the last time you (or your OOH provider on your behalf) were called by a pet owner out-of-hours within the last fortnight, was the call ...
a) Something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)
b) A condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because - in your opinion - it could have waited till the morning).
c) A genuine emergency, which needed prompt attention to prevent the animal suffering.
475 members took part, 69% of which were vets and the remainder vet nurses.
Of the out-of-hours (OOH) calls they had taken:
28.2% were genuine emergencies, which needed prompt attention to prevent the animal suffering.
64.8% were about a condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because it could have waited till the morning).
6.9% were about something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)
So in total, 71.7% of the calls to veterinary surgeons OOH are unnecessary.
This raises a number of important questions, chiefly whether a profession struggling with a staffing crisis can afford to maintain the blanket requirement for all practices to make provision for OOH, particularly now that society places so much greater demands on the profession than it did when the rules were invented, demanding wormers in the middle of the night and then blackening the name of the vet on social media if they refuse. It happens.
Is it time to go the same way as some other countries and let the market meet the demand?
Or can anything else be done to relieve the pressure that OOH places on the profession? Ideas floating around include making all veterinary OOH telephone lines premium rate, charging at least enough to focus the caller's mind on whether it is actually necessary to renew their pet passport at 3:00am. Or perhaps a concerted effort by all parties to communicate the message that OOH is A&E. You shouldn't ring unless you really need to. But that message may not carry much weight when at the end of the day, it's the insurance company footing the bill.
Reducing the number of spurious calls doesn't, of course, help the staffing crisis. But it is surely pertinent to ask whether an obligation for 100% of general practices to make arrangements to service something which is 70% unnecessary is the most efficient way to operate.
Maybe the time has come for the profession to consider OOH and general practice as two very distinct things. Discuss.
The RCVS didn't want to comment.
With the profession currently suffering a staffing crisis, some now question the ability of the profession to provide a blanket OOH service, and whether it should remain a requirement for all practices.
A logical first step, however, might be to discover just what percentage of OOH calls really are genuine emergencies, and how many are simply the result of society's increasing demands for a 24 hour service, not just from the veterinary profession. Hence the survey.
The question is open to veterinary surgeons and nurses working in general practice only.
https://survey.alchemer.com/s3/6495987/Out-Of-Hours
In the week that Prince Charles has become embroiled in another row about the use of homeopathy in the NHS, British veterinary surgeons have denounced its use for the treatment of pets and other animals.
In a survey of 460 veterinary surgeons carried out on VetSurgeon.org, the preliminary results of which were announced at the end of last week, an overwhelming 83% said that there are no medical conditions for which homeopathy could be an effective treatment in animals. This figure included the 6.3% of participants who practice veterinary homeopathy themselves, without whom the figure would be even higher.
More specifically, when asked how they would best describe veterinary homeopathy, 4.5% said 'A reliably effective form of veterinary medicine', 8.7% said 'an occasionally effective form of veterinary medicine, 9.5% said: 'a rarely effective form of veterinary medicine, and 77.3% said: 'An ineffective form of veterinary medicine'.
The survey was carried with Alex Gough MA VetMB CertSAM CertVC PGCert MRCVS, Head of Medicine Referrals at Bath Veterinary Group.
So strongly did veterinary surgeons feel about the matter, 78.4% felt that their colleagues should not be allowed to practice homeopathy under their professional title of MRCVS. 73% said that whilst they are still allowed to do so, pet owners should be asked to sign a disclaimer that they understand that in trials, homeopathy has been shown to be ineffective.
However despite the almost universal denunciation of veterinary homeopathy within the profession, when it comes to directing their clients, it seems that many veterinary surgeons do not have quite the same courage of their convictions. Asked what would be the most appropriate response when asked by a client to refer an animal for homeopathic treatment, only 24% of vets said they would actively discourage them from seeking homeopathic treatment. 17.5% said they would explain that homeopathy does not work and advise the client to self-refer. 34% said that they would explain that homeopathy doesn't work and refer anyway, and 24% said they would just refer the case.
VetSurgeon.org visited a random selection of stands in the commercial exhibition at BSAVA Congress, and asked: "What's new and exciting?"
Here's what they said:
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