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Wednesday, April 27, 2016

When Helping People Gets Unethical

I came across an interesting article in one of my veterinary magazines, DVM 360.  You can read the full article here, but let me quickly summarize it for you.
 
A relief vet was working at a long-established clinic.  He discovered that the owner would do surgeries at no cost to needy clients, but was using recently expired drugs to do so.  The relief vet (Dr. Han) refused to do that and talked to the practice owner (Dr. Keets) about the issue.  Here are some quotes from that article.
 
Dr. Han was diplomatic—after all, he wanted to maintain a good working relationship with Dr. Keets. He said that he understood that Dr. Keets was well-intentioned but that substandard care of indigent patients was unacceptable.
 
Dr. Keets replied that the care was not substandard. All his patients were monitored during and after surgery. If any animals showed signs of pain or inadequate anesthesia this was addressed immediately. He went on to say that offering charitable services required realistic monetary considerations. If he could not use recently outdated medications, he could not afford to offer these much-needed services.
 
He went on to say that Dr. Han traveled from practice to practice assisting veterinarians and pets on a short-term basis. He on the other hand had a responsibility to a clientele that day-in and day-out needed services they could not afford. As a result, he had to be creative in order to assist them.
A bit frustrated, Dr. Han finally said that Dr. Keets’ practices were a violation of practice statutes. Dr. Keets’ reply? “I’ve never had a complaint, and I have scores of grateful pets and pet owners.”
 
This is a difficult situation.  Dr. Keets was doing what he thought was best for the community and was sincerely trying to help people out.  To be honest, drugs don't suddenly go bad or become dangerous at midnight on the day of expiration.  And most expired drugs would lose efficacy rather than become toxic.  However, those expiration dates are there for a reason, and they need to be followed.
 
I agree with Dr. Keets where he said "offering charitable services required realistic monetary considerations."  That's very true.  Veterinary practices can't routinely give away services for free and still expect to stay in business while maintaining high medical standards.  If he didn't use those medications, "he could not afford to offer these much-needed services".  Again, that's true.  The only way he could afford to give away these surgeries was to use drugs that were no longer valid.  If he used drugs that were still within their expiration date he would have lost money and not been able to provide these services.  I've written many times about how it isn't realistic to expect veterinarians to give away services, especially surgeries, and not have their business suffer.  So bravo to Dr. Keets for recognizing this.
 
However, was what he did ethical?  No.  And it wasn't even legal.  His reply of "I've never had a complaint, and I have scores of grateful pets and pet owners" is not a good defense.  It is an attempt at justifying an unethical behavior.  Just because someone doesn't complain about a behavior doesn't make that behavior right. 
 
Here is an analysis from the author of the article.
 
It is absolutely true that the use of expired medications is a violation of the veterinary practice act in every state. Dr. Keets was aware of this but chose to help those in need and also manage any complications that may have arisen from the use of the expired medications.
There is no doubt Dr. Keets was well-intentioned. But he could have solved his medication issues in other ways. Advising vendors of his charitable efforts and asking them to participate would have been an option, as well as soliciting his more affluent clients and enlisting them in an effort to help his good works.
Rules and laws exist to prevent abuse and protect our patients. Dr. Keets gets an “A” for effort but does not pass the profession’s ethical standards test.
 
Should a veterinarian violate ethical standards and state laws in order to help people?  Personally I don't think so.  While I'm absolutely not a "big government" sort of person, I also believe in trying to uphold the letter and spirit of the law.  It is wrong to break the law because it seems convenient or helpful to do so. 
 
It also puts that doctor on very shaky ground with his license and business.  Let's imagine for a moment that something went wrong when he was using these expired drugs.  The pet had severe complications and died, in part because the drugs were not effective and they were not able to administer proper medications in time.  The client learns that expired drugs were used and brings a lawsuit against Dr. Keets, as well as reporting him to the state board.  Because he knowingly used these drugs against state law he would have no chance of winning the lawsuit and would be facing big fines from the stat veterinary board, and possibly even be in danger of losing his license to practice.
 
To me it is not worth risking my ability to work and support my clients and family.  While I admire Dr. Keets' desire to help people, he is going about it the wrong way. 
 
Hopefully this gives pet owners some insight into the challenges of trying to help those who have few funds and are in need.  I'm not saying that vets should never make the attempt, but they need to make sure they are following legal and ethical standards.  If they have to break the law or violate ethics in order to help people, they shouldn't do so.

Sunday, April 24, 2016

"But He's Still Hungry"

Every day I have discussions with my clients about how much food to feed their pet.  Something that often confuses people is that they are following the amount recommended on the package, but their dog or cat still wants more.  "They're still hungry," the client says.  And because we don't want our pets to be hungry people tend to give them more food.
 
Stop and think about how many times you, the pet owner, eats when you're not hungry.  When you go to the movies are you really so hungry that you need that popcorn and candy?  When you're sitting at home watching Netflix and munching on that bag of chips, is it really because you have missed a meal?  When you've finished that meal at the restaurant are you looking at the desert menu because you feel hunger pains?
 
People and animals eat for two reasons.  First, they feel the sensation of hunger.  Second, they like the taste.  I'm sure that every person reading this blog has eaten something when they weren't truly hungry but just had a craving for that particular food or snack.  And I'm sure every person has continued to eat until far past the point of hunger sensations having stopped.  Did you ever reach the end of a meal and have been so full that you think back and realize that you shouldn't have eaten so much?  But you didn't think about that until after you were finished and your pants were too tight.  I've been in every one of these situations myself, so I speak from experience.
 
Animals are often the same way.  Yes, they eat because they are hungry.  But when that hunger has passed they will also eat because they like the taste of the food.  Since they are continuing to seek out food that can make the owners mistakenly think that they are actually hungry, when in fact they may feel quite full.  There is also an instinct that is retained in many pets where they will gorge themselves since they don't have a good long-term memory to know that they will get fed again tomorrow.
 
You cannot determine how much food to give a dog or cat based on whether or not they will continue to eat it.  If you try this method, you will end up with obese, unhealthy pets.
 
Instead, use the package directions as a starting point, and then consult with your vet on what your pet's body condition score is.  A highly active pet may need more than what is on the package.  Dogs and cats who are basically couch potatoes may need considerably less than that amount.  When I see a pet I look at their proportions and how much body fat they have on them.  If they are normal then I will let the owner know that they are feeding the right amount, even if the pet still acts "hungry".  If they are overweight I'll tell them to switch to a lower calorie food and decrease the amount fed, even if they are following the package and the pet wants to eat more.  Most people don't realize how many overweight or obese pets we veterinarians see who always seem "hungry".  If they weren't getting enough food, they wouldn't be overweight!
 
Pay attention to your pet and actually measure out the amount of food you are giving.  It's going to be much better for your pet's health.

Thursday, April 21, 2016

Critical Thinking About Pet Protector

Recently a reader asked my opinion about Pet Protector, a product designed for protecting against fleas and ticks.  I had never heard of it so I looked into it a bit.  From what I can see there seems to be a lot of rather bogus science behind it.

The company's website is www.petprotector.org, went there to try and learn about it.  The product is a metal disc that is worn on a dog's or cat's collar, and which gives protection against fleas and ticks for four years.  All without chemicals.  Sounds pretty amazing, right?  Here are some quotes from the company on how it works.

The Pet Protector Disc uses advanced technology to emit Magnetic and Scalar waves, creating a protective shield around your pets' body and repelling all external parasites.

Repels fleas, ticks, mosquitoes and all other external parasites including Australian paralysis tick

Produces Scalar waves and creates an impenetrable, protective shield around the animal's body

Officially tested and proven

The Pet Protector Disc is made of high quality steel alloys. It is charged with a specific combination of Magnetic and Scalar waves, which after being triggered by the animal’s movement (blood circulation), produce an invisible energy field around the entire animal’s body. Pet Protector’s Scalar waves are totally harmless to people and animals (they go absolutely undetected by humans and animals alike) and they are only effective against external parasites, repelling them from the shielded area. Therefore, the Pet Protector Disc acts preventatively; it drives fleas, ticks and mosquitoes away before they get the chance to infest your pet, versus all other anti-parasite products, which kill external parasites after they have already infested your pet.

Now that sounds like a pretty high-tech product, doesn't it?  And not having to use chemicals is so much better!

But let's not take this on face value or even just look at the testimonials on the website (which are always hand-picked for the best ones).  Let's spend some time looking into this effect and the claims.  And above all, let's use actual critical thinking (as we always should).

First, what the heck are "Scalar waves"?  I did a quick Google search learned a few things.  These kinds of waves have been researched since around the time of Nikola Tesla, and nowadays are firmly in the camp of pseudoscience.  When you find people supporting the idea of scalar waves you find them talking about conspiracy theories, ultimate healing, super weapons, weather control, and similar crackpot ideas.  Here are some choice quotes from some forums and websites.

In physics, a quantity described as "scalar" only contains information about its magnitude. In contrast, a "vector" quantity contains information both about its magnitude and about its direction. By this definition, a "scalar wave" in physics would be defined as any solution to a "scalar wave equation". In reality, this definition is far too general to be useful, and as a result the term "scalar wave" is used exclusively by cranks and peddlers of woo.

The main current proponent of scalar wave pseudophysics is zero-point energy advocate Thomas E. Bearden, who has concocted an entire pseudoscientific "scalar field theory" unrelated to anything in actual physics of that name. 

Bearden was pushing the medical effects of scalar waves as early as 1991. He specifically attributed their powers to cure AIDS, cancer and genetic diseases to their quantum effects and their use in "engineering the Schrödinger equation." They are also useful in mind control.

What is a “scalar wave” exactly? Scalar wave (hereafter SW) is just another name for a “longitudinal” wave. The term “scalar” is sometimes used instead because the hypothetical source of these waves is thought to be a “scalar field” of some kind similar to the Higgs Field for example.

Because the concept of an all pervasive, material Ether was discarded by most scientists, the thought of vortex-like electric and/or magnetic waves existing in free space, without the support of a viscous medium, was thought to be impossible. However later experiments carried out by Dayton Miller, Paul Sagnac, E.W. Silvertooth, and others have contradicted the findings of Michelson & Morley. More recently Italian Mathematician-Physicist Daniele Funaro, American Physicist-Systems Theorist Paul LaViolette, and British Physicist Harold Aspden have all conceived of (and mathematically formulated) models for a free space Ether that is dynamic, fluctuating, self-organizing, and allows for the formation & propagation of SW/LW.

I try to imagine what physics would be like without mathematics. I think it would be like this "scalar wave" business. A lot of guys coming up with ideas and swapping lies 'cause math is hard.

A scalar is just a number. A wave is a repetitive variation in that number. For example the altitude of each point in Wisconsin forms a scalar wave. Or sound waves, all you can hear is the intensity of the superimposed tones; the intensity is just a number (yeah, maybe a complex number) and it varies repetitively (i.e the cycles of the tones). 

You've asked about Bearden before and the answer is the same: while Greer is a second order crackpot, Bearden may well be certifiably insane - he is, at the very least, a liar and a fraud. 

Tom Bearden is a notorious crackpot. Has been for years. References available upon request. I kinda hate to go through this exercise again, but, if you are really interested in facts, I don't mind. He is a fraud, charlatan and temple priest of bad science. I hope I am not sugar coating this too much.

It seems that most reputable physicists don't believe in the various scalar wave applications that are touted by the fringes of science and medicine.  So to me this is one of the biggest strikes against Pet Protector, as it is the primary reason why it is supposed to work.

But for a moment let's assume that scalar waves really do exist in the way that they're stated.  Would this product work and is it backed up by studies?

Let's first look at one of the primary statements made by Pet Protector:  Pet Protector’s Scalar waves are totally harmless to people and animals (they go absolutely undetected by humans and animals alike) and they are only effective against external parasites, repelling them from the shielded area.  Does that make scientific sense?  No, not really.  I can find no information on the website on exactly why it affects parasites but not the host.  With typical topical chemicals a product works by affecting neurotransmitters found in insects and arachnids that are not found in mammals.  They are considered safe for most pets because they affect things that the hosts don't have.  I can't find anything about scalar waves that would cause them to be unnoticed by dogs and cats but not fleas or ticks.

Here is more from the website:
1. The Pet Protector Disc does not have the ability to eliminate existing parasites or their larvae 
2. The Pet Protector Disc can only repel new parasites from inhabiting your pet 
3. The Pet Protector Disc needs 7 to 20 days (depending on the pet’s size) to create a strong enough Scalar Wave field around your pet's whole body, protecting it from fleas and ticks successfully.

This is what I find interesting.  The premise behind the disc is that it actually and literally creates a invisible force-field around your pet.  Stop and say that out loud.  It sounds rather odd, doesn't it?  Somehow the disc creates an invisible bubble that doesn't actually touch the pet.  If it did, it would repel the parasites that already exist on the pet.  How does the disc do that?  Electromagnetic waves are supposed to emanate in a straight line from the origin source, and should spread out in all directions.  Magnets and gravity can change the direction of these waves, but you have to have pretty powerful equipment to make a noticeable difference.  Somehow a disc that looks like an ID tag has the power and ability to not pass through the pet but instead make a sphere around it.  Do you realize how strange that sounds?  And there is nothing on the website that gives details on how this might actually happen, or links to the science behind it.  You basically just have to trust the company that what they say is true.

Okay, so now let's assume that a product like this actually works and there are ones on the market who perform exactly as expected.  Does Pet Protector show evidence of actually repelling parasites?  For this we can go to the "Official Product Testing" part of the website.

The study was conducted over 4 years in the US, Argentina, Spain, and Australia.  The dogs and cats were selected randomly and were in homes with owners.  There were 22 pets selected in each geographical location, for a total of 88 over the study.  The animals were determined to be "100% free of any external parasites", had the disc attached to their collar, and were isolated for 15 days to give the disc time to fully activate.  On the 16th day they were released back to their normal environment and the owners were told not to do anything different.  The pets were examined weekly for four years, with only an occasional tick found during that entire time.

All of that sounds good, and if you look at the study document you'll see "Official" stamped in the corner of every page.  It certainly sounds convincing and scientific.  But this is far from being a true study of efficacy.  There are numerous unanswered questions, and this so-called study would be laughed at by any peer-reviewed scientific journal.
  • How were the pets determined to be parasite-free?  What methods were used and what was the expertise level of those doing the exams?
  • What were the baseline parasite levels in the various locations?  I don't know about the non-US locations, but in America the study was performed in California, which has one of the lower rates of fleas and mosquitoes in the country.  If they wanted to do a real study they should have come to the southeastern states.  Here in Georgia I never have a month go by where I don't see pets with fleas, even in the dead of winter.  
  • Did the lifestyles of the pets allow them access to parasites?  A cat that is strictly indoors is never going to have a tick, so making a claim of "see, our product prevented ticks" is rather pointless. Dogs that are hunting or camping are going to have a higher risk of fleas and ticks than a toy breed that only goes outside a few minutes per day to use the potty.  A pet owner who is doing routine treatment of the yard against insects is going to have a lower risk of fleas and ticks than one who isn't.
  • Did any of the pets chosen have a history of fleas or ticks being seen?  Even here in Georgia I have dog owners who aren't using any form of flea or tick control and yet we never see those parasites on their pets.  I routinely have clients who say "Oh, I've never seen any fleas so I don't need prevention", and despite my skepticism I can't find a single flea on the pet.  If one of these clients was using a Pet Protector the company would say "see, no parasites!"  Yet the pet never had them in the past, so why would they have them now?
  • Who was doing the weekly exams?  If it was the owners, I don't believe them.  I've had many, many situations opposite that I just mentioned, where they insist there are no fleas at all yet I glance at the pet and find a half dozen very easily.  Pet owners may not know how to examine the pet, may miss something, or may not easily recognize a parasite.
  • Where are the controls?  Here is one of the biggest problems with the Pet Protector data.  There are no controls.  If we wanted to test true efficacy we would have dogs and cats of similar breed in the same environment who used just a metal tag rather than the Pet Protector disc, and the owners didn't know which was which.  Having this kind of "blind" study with control removes bias from the people doing the routine exams.  You also have more validity in the data because if the control animals had fleas but the study ones didn't you could say that it was protective.  But if the control animals also didn't have any fleas then the lack of parasites had nothing to do with the product.  Pet Protector simply doesn't have this information.
Do you know how most flea and tick products are tested?  It is generally in a laboratory with research animals.  They are certified parasite-free by the researchers, who are usually specialists in parasitology.  A specific number of fleas ticks are placed on the pet (usually 100), and the same number are placed on every animal.  Counts are regularly made to see how many of those parasites placed are remaining, as well as the numbers on the control animals (who get the same parasites but not the product).  In some studies a new set of parasites is placed on the pet periodically to determine the duration of efficacy.  Can you see how this method is much more precise and valid that the one used by Pet Protector?

Hopefully you can see the incredibly numerous things wrong with this product, from the pseudoscience premise to the lack of anything that could be called a true scientific study.  There are many statements made by the company and their "study", none of which have solid science behind them.  

While this product is almost certainly harmless, I can't believe that it would have any real efficacy and would be a waste of the consumer's money.  I would not recommend buying it.

Monday, April 18, 2016

Parent, Guardian, Or Owner?

I recently read an article on the Veterinary Information Network questioning current terminology such as "pet parent" for those who have animals in their home.  It was something I hadn't given much thought about, but Dr. Chiara Switzer made some interesting points.  VIN is a subscription-only service so I can't link to the full article, but here are some quotes from it.
 
The terms “pet parent” and “fur baby” that are so in vogue these days bring the division to the fore. Some people love the terms, referring to themselves as the mom or dad of their pet and rejecting the concept of being owners or even caregivers of their beloved animals.
 
Other people find the term offensive because of its implication that animals would have equal status to human beings, or the suggestion that they are unemotional if they don’t consider their dog or cat to be like their child. The division can intensify if one side tries to impose its philosophy on the other; for example, if people who consider their pets as children criticize as uncaring those who don’t treat their animals as family.
 
There’s also something that strikes me as rather manipulative about it — when someone tells me that I became a “pet parent” when I got my puppy, it seems to me as if they are trying to define the relationship they think I should have with my dog, rather than the relationship I want to have with my dog (let alone the relationship my dog will choose to have with me, which unfortunately doesn’t always match our plans).
 
I also wonder if those who call themselves “pet parents” are just using a trendy term, or whether they truly have the same relationship with their pet as they do (or did, or will) with their children. Or do they imagine that’s the relationship they would have had with their children, had they had any? I hope not — I think it does a disservice to animals to treat them like children, and it does a disservice to children to treat them like pets.
 
Personally, I like the term “guardian.” It implies looking after something living and sentient, specifying my responsibility without specifying an emotional relationship. I do know that I’m not my pet's parent, even though I care for my pup and want to help her to grow up well, happy and safe. My relationship with my pet might change as we each age and grow, but she’ll never be my fur baby and I’ll never be her mom.

I'm old-fashioned enough that I still refer to my clients as "owners".  This is the term that has seen the most use over my lifetime and what I've become accustomed to.  I think that most of my clients are used to that term and don't think about it otherwise.  The term stems from the fact that in the US animals are considered a special form of property, just like if a couch, TV, or car were alive.  For better or worse most laws are based around this issue of pets as property, hence the tendency to say "owners".
 
But does that really properly classify or define the relationship?  Probably not.  A century ago people looked at dogs and cats more like they did livestock, though there has been a long tradition of keeping them as pets rather than as working animals.  Nowadays people have much different relationships with their pets, letting them sleep in their beds, buying clothing for them, taking them to "day care" and play dates, and otherwise treating them like a special kind of child or part of the family. 

I'll admit that I do that in my own home to some degree.  There are really no limits on where our pets sleep, and we snuggle with them every day.  However, I don't think I'd consider myself a "parent" as I absolutely look at them differently than I do my own children.  As much as I love my pets, I would chose my children over them without hesitation if the need called for it.

I don't know that I personally like the term "guardian", as my relationship with them is more than just that of a caretaker.  I have a truly emotional relationship with my dogs and cats and being simply a guardian seems to take that out of the equation. While Dr. Switzer likes the term because it doesn't define any kind of emotions, I think that those emotions play an important part of having a pet.

But "owner" seems somewhat cold and unemotional as well.  I'm used to the term and will likely continue to use it, but having a pet is more than merely owning them.  I feel a much closer bond to my pets than I do to my laptop, yet I "own" both. 

As I've been writing this I realize that to me none of these terms really properly defines what most people, myself included, feel about their pets.  While I've had some clients that really do treat their pets similar to children, I have others that tell me "it's just a dog".  I don't think that one term really properly encompasses everyone who has a pet, and I don't think the ones we've been using are completely adequate to describing what is happening.

I'm curious as to what you think.  For the first time in years I'm putting up a poll, and will leave it up for the next month.  I'm interested in how my readers define themselves.  I would also love to see comments on this topic, as it's one that hits right in the heart.
 
 
 

Friday, April 15, 2016

Canine Influenza Moves To Cats

By now most dog owners in the US know about the risks of canine influenza, especially people in the Chicago and Atlanta areas.  The most recent strain of "dog flu", H3N2, has proven to be a highly contagious disease.  Thankfully it is rare to have a dog die from it, though some can become quite sick.  But now it may not be just dogs that are at risk.

Here's copy from a recent article about some cats who contracted H3N2 in Wisconsin.  It's short, so I'm going to copy it here, but the original article is at this link.

Sandra Newbury, a clinical assistant professor and director of the Shelter Medicine Program at the University of Wisconsin School of Veterinary Medicine, tested multiple cats at an animal shelter in northwest Indiana, according to the release. The cats tested positive for the H3N2 canine influenza virus.

"Suspicions of an outbreak in the cats were initially raised when a group of them displayed unusual signs of respiratory disease," Newbury said in the release. "While this first confirmed report of multiple cats testing positive for canine influenza in the U.S. shows the virus can affect cats, we hope that infections and illness in felines will continue to be quite rare."

Right now that's pretty much all we have.  From what I can see this is rare right now.  However it shows that cross-species transmission is possible, and that worries me.  Last year the US veterinary community was taken by surprise when H3N2 influenza made such a rapid spread across the country.  I live and practice near Atlanta and I absolutely didn't expect what happened here.  So when we stay that cats catching this virus is rare, I take that with a grain of salt.  H3N2 was unheard of in the US until a little over a year ago, and it made quite the impact.  Could that happen in cats?

I know that I'll be watching this development with interest, and will be watching out for any signs like this in cats in my area.  I don't want to be blindsided like we were last year.

Tuesday, April 12, 2016

Pollen Season

Here in the southeastern US we see a LOT of pollen during early Spring.  Those who haven't lived in this area don't really appreciate just how much pollen we get.  It covers cars.  It runs in the gutters.  It fills the air.

To give you an idea of what we see every year, here are some pictures of my car.  And I've seen it worse than this!








Even the house isn't safe.  Here's a picture of my front porch.  I moved the welcome mat so you can see the accumulation of pollen.  We have footprints in the pollen on the porch!


This is one of the big reasons why this part of the country has so many allergic pets.  I've had several clients who moved from the western or northeastern parts of the US and never had any allergy issues with their pets until they moved here.  A big part of my business this time of the year is dealing with the suddenly itchy dogs and cases of allergic dermatitis.  Considering that I actually can't stand dermatology, this isn't a fun part of my job.  But as long as I work and practice here I can't avoid it.  



Saturday, April 9, 2016

Why Superman Is Super.....Poignancy In Comic Books

It is a great time to be a comic book fan.  Movies and TV shows with our favorite characters are breaking records and gaining ratings.  But it still goes back to the printed comics, the artists and writers.  Some writers are better than others, and us die-hard fans can talk about the stories of various people like David, Claremont, McFarlane, Miller, and Johns (if you're a true fan you'll immediately recognize those names).  It seems that some writers "get" a character better than others.  

For example, let's look at Superman.  He is arguably the single most recognized superhero on the planet.  While he's certainly not my favorite character, I admire some things about him when he is written correctly.  Many people think that the power of Superman comes from his invulnerability, strength, vision, speed, or any of his other powers.  But that's not the point of his character.  Though he is an orphaned alien and one of the most powerful beings in comics, his true power comes from his humble upbringing in Smallville, Kansas.  It's the humanity and morality instilled in him by the Kents that makes him such an amazing character.  This background makes him a true hero, and gives him the drive to keep control over his powers.

I want to share some panels of a Superman comic that is really powerful and illustrates this point clearly.  This is the kind of hero we need, not the gritty, dark tone set in recent movies.  (click here for a larger version)