Vet School 101 What the heck is evidence-based veterinary medicine and why should I care?

May 3rd, 2007  

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The one thing that squicks me out about evidence-based medicine is that it does not necessarily look for the REASON one method works better than another. We could have no clue how a drug works, we just know that it does, and that drives me up the wall. I don't like taking any medicines or undergoing any procedures I do not fully understand. If we don't know what causes the good effects of a treatment, how do we know that it's not also causing a half dozen undesirable side effects?

zandperl May 3rd, 2007 11:06:00 PM

I agree with zandperl about the assessment of EBM. A good example in human medicine and research that has been seriously flawed is that of controlling cholesterol (which like homocysteine and C-reactive Protein, are all indicators but NOT the causes of systemic inflammation).

Use of statins is richly promoted but problematic. It essentially attacks the messenger or symptom without getting to the underlying cause. Patients that begin the cascade of symptoms from unstable blood sugars/insulin resistance & hypertension, even if on statins will generally always progress to developing cardiovascular symptoms such as chronic heart failure, particularly if they are on insulin.

EBM? Statin drugs do indeed have some degree of little understood effect as anti-inflammatories, which is why they 'seem to help' - a little. Unfortunately statins also perform by derailing of normal metabolic activity needed for systemic functions, such as support for cellular production of CoQ10. So side effects of statins are essentially due to interferance with the body's attempt to heal.

Older patients often need to take quite a few other drugs and supplements to deal with some of the side effects of statin treatment. I know many on dozens of pills, that joke about 'this pill' being taken for the side effect of another pill. :(

Interesting paper from on how HFCS stresses the liver and sets up metabolic dysfunction that can lead to a symptom treating prescription to statins that doesn't address the source: http://www.chiro.com.my/syndromex.html

Semavi Lady May 4th, 2007 11:32:00 AM

I respectfully disagree with Zandperl. The medications that we take and give to our veterinary patients work because the studies show that they do. Their biochemistry is known, as is their pharmacology. It is well understood how drugs counter disease. Despite the plethora of info on many drugs, I remain dumbfounded that many clients refuse to take drugs and refuse drugs for their pets, even in moments of extreme pain or illness.

TorontoVet May 4th, 2007 06:19:00 PM

Torontovet, I was one of those who didn't want meds in my pet. For the most part, I still don't. I don;'t want steroids to mask allergy symptoms. I don't want yearly vaccines to overwhelm my dog's immune system. I also didn't want to poison my dog monthly with heart worm pills.

Then my dog got heartworms.

Thankfully, it was a mild infestation, a one day's stay at the vet, and $267 from my wallet.

The reason I didn't want the heartworm meds was because my standard poodle has three days of misery every time he took his Interceptor pill. He would pant NONSTOP, lay around, and have a definite wild-eyed look, like he was in pain,or scared. So I did lots of reading at natural vet sites, did a lot of reading on what exactly is necessary for the heartworm cycle to be active, and made my decision to get my dogs checked every 6 months, and THEN if they were positive, treat them with the same pill they would havegotten every month,whether or not they needed it.

My karma- this pitbull I rescued came up mildly positive. I felt like an abusive parent, a bad momma. Like I failed my dog.

So I had a talk with my vet. She assured me that here in southern Illinois, heartworms are everywhere.... and that we could put my standard on a different pill. We did..he is now on Heartguard and has no side effects.

I still want minimal drugs in my pets. But I also still trust my vet. She knows my views, and we work around both of our concerns.

What I really am curious about is-- are there any studies for medicines that are NOT funded by the very company that produces the medicine?

All I want is a neutral source that can advise us, that isn't dollar driven. I'm not totally convinced that evidence-based vet med is.

Agadore's momma May 4th, 2007 07:34:00 PM

I think vets use evidence based medicine all the time. They observe the side effects and outcomes of various drug regimes and tend to use the ones that work the best.

Studies on drugs are always funded by companies wanting to develop drugs. No one else has the money. What's always struck me about science is that if you ask the wrong question, you get the wrong answer. When an entitiy with financial interest does science, it's not untainted. They're after a result with a profit.

I don't think new is always better. Pharma companies have to develop new drugs to stay profitable as their intellectual rights run out on drugs currently on the market.

A successful outcome isn't based solely on drugs or drug regimes. It's the vet who listens to their clients and is willing to think outside the box that has the most success, combined with carefully considering which drug protocol or treatment to use in a particular situation.

CathyA May 12th, 2007 06:21:00 AM

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