Or the clerk at a local feed store who told me how hard it is to work Sundays because of the folks who come in looking for antibiotics for their dogs . . . who just happened to get into a fight with the neighbor's dog on Saturday night. Strange how many of those happen to be pits (a breed I absolutely adore). I really would like to see the dispensing of drugs to be tightened up, too. I wonder how many of those animals treated by uninformed, uneducated owners will suffer and die because the owners don't want to spend the money to have them seen by a vet.

dottie October 24th, 2009 08:03:28 AM

Having previously worked at a feed store for 4 years, I want to say that while manybe their are some feed store's that have employees willing to give false information. I never gave information that was out of my area of expertise, and even when I had the information I did not always dispose of of like avet would, just for leagal reasons. I know that many people would come in looking for horse products such as wormers and antibotics to treat a sick dog or cat. It was very hard to tell them the dosage for a dog or cat is very, ver different than a horse. My manger told me as long as I did not tell them how much to use it would not come back on the feed store or myself, so I made sure never to tell them how much they should or could use. I always said it is best to contact your vet or a low cost clinic.

J-Reno October 24th, 2009 08:30:22 AM

Meh.  On a breed-specific list that includes many farmers, we have an approximately quarterly go-round about the correct dose of ivomec per kilogram of dog.

It always starts with someone referencing some massive overdose (not enough to kill the dog, probably, but waaaay over the heartworm prevention dose).  Being corrected.  Objecting that "My vet told me this is the dose!"  Having the math laid out with extreme clarity, generally by a list member who is a chemical engineer and has a gift for precision and is a stickler for correctness.  Having the math dismissed as "Just your opinion, are you a vet?"  (Plus bristly suspicion about this communist "kilogram" and "microgram" stuff.)

It generally seems that the cow vet, casually queried about dosing for the dog, is looking up a dose of ivomec generally used to blast out a killer load of intestinal parasites and recommending that for monthly heartworm prevention.  But for some of the more stubborn-minded, the argument from authority always trumps the math.

I'm sure people come up with bizarre dosage lore from many sources, including their own fevered brains, but it's noteworthy how often the citation is to a member of the veterinary profession who is either lazy, ignorant, or inadequately communicative.

So is it the fault of the feed store for selling it?  The consumer for trying to fix something that she may not be able to afford to trot off to a vet for?  Or the "authority" who couldn't be bothered to know the facts or give clear instructions?

In a world where I nearly walked out of a Rite Aid with a friggin' homeopathic cough "remedy" because the labelling was so coy and the god-damned alleged "pharmacist" recommended it, the fact that feed stores sell many products that people use off-label is maybe the least of retail worries.  I'm more concerned about consumers being sold sugar pills as medicine in a "real" drug store.

And again, it comes back to the drug companies' overpricing of pesticides and medications for "pets," as opposed to the pricing for the same products for livestock.  That's true of OTC as well as prescription products.  By overpricing, Big Pharm drives consumers into ad hoc alternatives.

Sure, it's convenient to open an envelope of Panacur powder for a dog.  No measuring, and the dose will be sort of correct if the owner bothered to weigh the dog.  But those of us with multiple dogs to treat may be forgiven for reaching for a bottle of goat fenbendazole.  $34 to worm one German shepherd (that's OTC discount prices) versus less than $5 to use the exact same product, dosed absolutely correctly. Hmmm...

H. Houlahan October 24th, 2009 08:51:27 AM

Very interesting post, Doc. I'm glad you are trying to help whenever you can, and I agree people should be more careful about giving opinions about medical issues.

This may happen because every time our pets have any silly problem, no matter how ordinary, we have to pay a vet visit to be given an eye ointment or a pain med for a sprain. We humans can buy Advil at CVS, but there's nothing we can buy for pets without prescription.

This practice can be dangerous because people who cannot pay a vet visit all the time may get desperate and ask for anyone's help. Don't you think?

Daniela

Publisher

www.TheDailyTail.com

Daniela Caride October 24th, 2009 01:26:20 PM

I don't have a feed store real close by that I can 'secretly police' like Dr. K ;)  But like her I would step up and correct misinformation that I would overhear also without having to play the vet card. 

I don't really have a problem with the feed stores selling the afore mentioned items but I do think that consumers should be more responsible.  I have at times directed people to pick up a bottle of ivomec when say I had a rather large dog that I was treating daily for Demodectic Mange.  I am all for trying to find the most economic way for my client to treat their pet so that they CAN treat.  If someone wants to use ivomec for heartworm prevention I make sure I give them the correct dose (which usually surprises them how small a dose it actually is) and educate them so that no harm should come to their pet. 

If someone doesn't seek advice and trys to do it on their own then they must be held accountable for their mistakes.  (ie I am not going to treat their dog or cat for free just because I should feel bad they made an error in judgement)  Hopefully I am not to late......

J.C. October 24th, 2009 01:31:59 PM

I don't get the title of this one.

People dealing with livestock tend to need to handle much more, independently, than pet-owners often will/can/want to.  There certainly are pet owners who are more capable and educated--somehow many of them end up here ;)--but a lot of pet owners simply don't WANT to deal with much of the health and management issues that are S.O.P. for livestock managers.  Feed stores have needed supplies with legitimate uses.

So why would it be the fault of the feed store when someone who doesn't know what he's there for, or how to use it, shows up with his head in the clouds?  It's not their job to make sure people are educated before they buy, any more than it's the grocery store's job to make sure you know how to cook before you buy their food.  It's not their job to hold the hand of someone who came unprepared.  Are you suggesting that the feed stores shouldn't have this stuff at all?  Or that they should do a better job of policing it, somehow?  Or that they should spend half an hour explaining off-label dosaging to every person who should have figured that out for himself?

Why are you blaming the feed stores for (willful or not) ignorance on the part of a person who simply didn't do the right research...and possibly isn't even equipped to use it even if he does buy it?

Galadriel October 24th, 2009 02:31:06 PM

feed stores don't do harm. They might take away from your bottom line, and we all know that's important to you, but the consumer needs to be educated. Same as in a pharmacy where you can buy codeine cough syrup and formaldehyde. There is enough educational references that a person who wants to purchase and use responsibly can. They just need to make sure they do. IF you choose to assist while you are shopping, then good for you. it is basically the same as a dr. stopping at a car crash. They choose to be professional responsible. But the feed store isn't to blame if someone uses a product improperly. The items they sell are really no more dangerous or harmful then many OTC drugs that are given to pets or children accidently. IT's all about an educated consumer.

LorriM October 24th, 2009 04:46:14 PM

galadriel: I guess I was primarily referring to my own stress level as I stand in line (on the title). But I've seen a DOA that was treated with a feed store product for toad intoxication and another who's kidneys were irreversibly decimated by ginormous doses of injectable vitamins. They can do damage if people don't know any better.

And no, it's not the feed store's fault. Please don't misunderstand. It's no more their fault than it is the hardware store's when they sell you that rope you used to hang yourself with. Now, if they help you measure how much you need to get the job done right...

Dr. Patty Khuly October 24th, 2009 05:05:48 PM

I seem to recall a little pharmacy error and some dead horses in Florida not so long ago.  Come on now, animals die from mistakes by owners AND by their professionals' errors too.  You seem to have an issue with feed stores that's a bit out of proportion.  The feed stores and "gray market" sources could give us more information if the vets would just give up their stranglehold on the market.  (Oh, and those same people in lines often chat about law too.  Pros don't generally have to throw that "I'm a..." out there.  Usually they get it the moment we open our mouths :)

PJB http://pjboosinger.viviti.com/ October 24th, 2009 05:20:06 PM

OK so I can see messed up in what I said in my last comment. IF they provide veterinary information in error, they deserve our wrath. Otherwise, I agree with most of you that it's not the fault of the feed store if people do stupid things with their products––no more than it would be the supermarket's fault for selling you that Draino you killed yourself with (what is it with me and suicide today?). That what what I said in the post. More or less.

I happen to think feed stores offer a valuable service and I'm a patron because of it.

Dr. Patty Khuly October 24th, 2009 05:37:50 PM

I was always nervous that a drug/chemical in a feed store would not be up to purity standards.

Probably completely unfounded and silly of me, considering the fiascos of animal and human recalls/shutdowns (Teva pharma, etc) of contaminated products.

Barb A./NH October 24th, 2009 05:49:40 PM

PJB - What 'Stranglehold' do you refer to?

Dr. Mac October 24th, 2009 06:07:58 PM

Dr. Mac, You must be newer than me here :)  Do you carry products that don't actually require a script?  Did you sign one of those "exclusive" contracts with a manufacturer, the ones where only vets are allowed to purchase the items and can only sell to their own clients, thus participating in the restricted access of these products?  THAT stranglehold (but I could go further since I don't think many scripted items should be scripted either).

My shrink asked me once if I ever thought about suicide and I insisted he answer the question first.  He said "no" and I said I wasn't sure I wanted to see a shrink who had never "thought about" suicide at all.  I mean, that means he skipped some classes, doesn't it?  Then he admitted he had thought about it in abstract and rambling thoughts and maybe that didn't mean as much as he'd been taught; maybe he should rephrase that question in the future :)

PJB http://pjboosinger.viviti.com/ October 24th, 2009 06:19:06 PM

Having been an online volunteer in chat rooms and forms for over 10 years, I can sympathize with Dr, K's situation.  We get all kinds... the ones that want free veterinary advise and the ones that want to learn about caring for their pets.  If someone asks about a medical situation or treatment, the first thing off our fingers is "what did your vet say?".  I think this would be a good phrase for the feed store employees to parrot.  A number of years ago I had a clowder of cats and a flea problem.  My vet gave me a larger animal packet and wrote on the box the correct dosage to use for my animals.  It was a substantail savings.  It also meant I could afford to return to the vet's office for subsequent refills.  I have been asked in chats if someone can use such and such a product for dogs on their cats... I always say to consult with their vet as some are toxic if used on a different species.  But I am constantly aghast, even after all these years, of the people who want non-veterinary people to tell them a quick fix to their animal's medical problem instead of consulting a professional.  It's Saturday, so I am sure tonite we will have one or more "emergencies" looking for a free fix instead of a vet on call or an emergency service. 

Moira October 24th, 2009 06:57:59 PM

Moira, Those are the ones that show up over on Dr. K's Daily Vet more often than here.  You're both more patient than I.  I finally posted "Get off the internet and call your veterinarians!!!" in response to a couple of them.  Alas, it was probably already too late for at least one of them.  As much as I'll argue for owner's rights to access meds and care and argue over some stuff, GEEZ, there's times when you just have to suck it up and go to the pros!

PJBoosinger October 24th, 2009 07:10:09 PM

What a timely post.  Just tonight got a call from an owner who purchased Bordatella vaccines at her feed store and injected her dogs.  Only thing was, they were internasal.  Ruh-roh.  :P

KSAkemi October 25th, 2009 02:06:07 AM

Having previously worked at a feed store for 4 years, I want to say that while manybe their are some feed store's that have employees willing to give false information. I never gave information that was out of my area of expertise,

Linda October 25th, 2009 02:19:28 AM

PJB

I carry many types of products, both prescription and non-prescription. I sell non-prescription products - such as Frontline Plus or non-medicated / non-prescription shampoos to the general public....

Prescription items are only sold to my clients and patients...because, legally, since I (and almost all other general practice veterinarians) do not carry a pharmacy dispensing license which would allow me to fill scripts for non-clients with prescriptions written by other veterinarians... my practice license and state statutes permit me to fill scripts for prescription items only to my established clients and patients with a valid veterinary-client-patient relationship. Therefore, I can fill Frontline Plus to the person walking in off the street - but I cannot sell that same person Heartgard Plus, even if they had a prescription from their veterinarian, because they are not MY PATIENT and it is a prescription product.

Now, granted, some veterinarians seem to be either ignorant of this particular Pharmacy constraint, or they choose to willfully ignore it, but professionally and ethically I choose to abide by these restrictions.

I have not signed an exclusivity agreement and have never been asked to sign one. In fact, I am not aware of any private practice veterinarian who has entered into such an agreement of which you speak.

The agreement type to which you refer is more than likely one between the Manufacturer and the distributors - An example would be the exclusivity agreement from Merial - the manufacturer of Heartgard and Frontline- and a distributor such as Webster.... This agreement basically required that Webster, a veterinary products distributor, be required not to carry competitor product lines such as Iverhart Max or Advantage....Webster opted not to re-commit to such an agreement either last year or the year before and thus no longer is able to carry Merial products. I think that was a wise decision both business and ethically minded.

However. the agreement between the manufacturer and the distributor to engage in such exclusivity IS NOT AN AGREEMENT FOR THE PRIVATE PRACTICE VETERINARIAN TO CARRY ONLY ONE TYPE OF PRODUCT... it onlycreates a minor sourcing issue for us, if say, we want to us Webster as our primary distributor supplier but also wish to have Merial products in stock.... it requires my inventory manager to purchase products from another distributor supplier rather than getting all from one source.

That is hardly what I would say constitues a Stranglehold, nor some vast veterinarian conspiracy.

Based on your comments - Your information and basic understanding of the Manufacturer exclusivity agreements as well as how veterinary practices may dispense prescription items appears to be flawed.

And please, don't patronize me by implying I am 'new and naive' while cloaking it with an icon smile - Veterinary Medicine is my profession, I have the years of education, the academic credentials, the practice experience et al.... This is what I do for real.... While you dabble in understanding this Profession, I live it.

Dr. Mac October 25th, 2009 07:33:14 AM

Well said Dr. Mac!

Elizabeth - from Nova Scotia October 25th, 2009 09:27:11 AM

Now, in terms of marketing strategies - several Animal Health Product Manufacturers have utilized a form of segmented market introduction of their product lines through specific selective channels.

As an example, when Frontline, and then Frontline Plus (which have never been a prescription product) were initially launched out on the Animal Health Market, the manufacturer - Merial - decided they wished to use a marketing tactic to improve their product launch, customer awareness and a professional endorsement. Merial chose to promote their Frontline product by restricting their sales channel to Veterinarians / Veterinary Practices only - their product was not directly marketed to the general public and Merial elected not to put their product out in other marketing chanels. 

Why did they do this? There were likely a number of factors, but on the highly likely list are (1) At the time, most marketing schemes aimed at pet owners were either very costly mass marketing using television, radio and news print or they utilized the animal health experts - Veterinarians - to help promote their product based on it's benefits as well as the nature of the VPC relationship (2) Merial had a good / great product but wanted a much higher price point than the other major Flea / Tick OTC's on the market (Hartz / Sargebt's etc)... so it was probably determined that to overcome the low cost product market - they needed better product support and a higher level of promotion.

From my perspective, as a Veternarian and someone with some business background, this makes excellent sense for them to do based on what their specific issues were at the time.

Merial introduced Frontline to Veterinarians as a Great New Product and Merial informed veterinarians that they were making Veterinary Hospitals as their sole select marketing channel.

But there is no great conspiracy here either.

There is nothing illegal about marketing and sales through a specific or select channel - many, many products are introduced this way, some eventually transition to ubiquitous availability and some remain within the selected channel....

There are 'licensed retailers' for all sorts of products...

There is no written exclusivity contract agreement between individual Veterinarians and Manufacturers which states that legally a Manufacturer may only sell a particular product to a Veterinarian or that a Veterinarian may only carry that one specific brand and will exclude other brands of the same type....

In other words, Veterinarians have no legal claims to the exclusive right to carry and sell Merial's Frontline, Heartgard etc etc....That is an myth, an urban legend if you will....

Let me say that once more, with respect to Frontline or Heartgard or Merial or Virbac, there is no legal agreement or contract which states a Manufacturer may only sell to a Veterinarian and/or that the Veterinarian may only stock their one brand for that type of product...

Again, Merial has historically launched and marketed several of their products through Veterinarians and Veterinary Hospitals as solo retail chanel - they have done this with Heartgard, Heartgard plus, Frontline, Frontline Plus.... but they are not legal required to do so, and their is no legal agreement which says they must do this nor that they must continue to do this....

What some refer to 'Exclusivity' is actually more accurately described as selectivity on the Manufacturer's part.... they are not legally bound to continue this type of marketing channel - and, in fact, if you surf the web you will find that Merial products such as Heartgard and Frontline are available all over the place....

We can talk about the 'Gray Market' as the source of products such as these being made available through non-veterinary channels... as in the product is purchased in bulk volumes by a Veterinarian and resold to a third party to sell to the consumer - Now, some would claim these products in the 'gray market' could only come from Veterinarians.... but in the giant volumes these products appear to be available to the General Public by virtue of catalogue companies and internet retailers.... would lead to another possible conclusion... that these manufacturers may have elected to discontinue their 'selective market channel' strategy in favor of more of a mass market channel strategy... in other words, some of them are probably selling directly to these other sources...

Again, there is nothing illegal in these marketing strategies.... nor is it a difficult concept to understand.... products were launched with Veterinarians as a selective channel for many reasons... vVterinarians were quite happy to have the product to themselves because it meant they could sell these products and gain some profit from them..... now that it suits their purposes, it would appear that some manufacturers have switched to more of a mass market strategy....

So since the consumer can legally purchase Frontline OTC from an online retailer or catalogue company -or obtain heartworm preventions from these same types of sources provided the individual has a prescription for the prescription product - I fail to see how the consumer is being kept from acquiring these products by some type of exclusivity stranglehold created by the Veterinarians....

And, please refrain from suggesting that the prescription classification was created as just another form of access restriction motivated strictly by financial gain....

Dr. Mac October 25th, 2009 10:57:55 AM

Dr. Mac, I never said the "selective marketing" was illegal nor is it difficult to understand.  I will say that I consider it HIGHLY unethical for veterinarians to participate in such marketing "strategies" to their benefit and the detriment of animals.  Beyond that on this topic, you're beating a dead horse, go read the archives.

"please refrain from suggesting that the prescription classification was created as just another form of access restriction motivated strictly by financial gain"  OK, I won't suggest it.  I'll say it outright.  The prescription classification for ivermectin for dogs was sought specifically to restrict access by pet owners and jack the price up for SUBSTANTIAL financial gain to the benefit of manufacturers and veterinarians and to the detriment of pets and their owners.  (And don't tell me what to refrain from saying except on your own bloody blog!)

And I have no idea what state you practice in but I get to deal with Texas veterinarians.  We don't ask for scripts for fear of our animals being tortured in retaliation for the a mere and polite request!  And we have a veterinarian board that incredibly rarely takes action against its members no matter how abusive, how illegal their actions.  BTW: "There is no requirement in Texas law for a veterinarian to write prescriptions." and "Cost is not regulated in the State of Texas."  Vets are required to be licensed but not practices.  I'm just thrilled the AG got around to telling them they can't hold pets hostage for unpaid bills although that was only in 2001 and, in virtually the same breath, explained a rather sneaky way to do almost exactly what he'd told them they couldn't do.

"While you dabble in understanding this Profession..."  Oh, thanks to arrogant JA vets, I'm fast getting past dabbling!

PJBoosinger October 25th, 2009 12:01:18 PM

PJB,

You have surmised correctly that I do not practice in Texas.Texas is not the only state which does not have a requirement for Veterinarians write a prescription, at the owner's request,for any product they would be willing to dispense out of their own pharmacy. B

ut because there are a few states which don't legally require that Veterinarians write scripts.... this means what? that the entire Veterinary Profession is stupid? Corrupt, Incompetent, Malicious?

So while veterinarians in some states may not be required to write a prescription at a client's request... I have to ask the obvious question - if, as a client, I believe the veterinarian I am utilizing for my pets careis withholding THEIR ABILITY to write a prescription for which they are willing to sell me the same medication.... why would I condone this practice... why wouldn't I vote with my feet and go to a Veterinarian who does write prescriptions....

If this practice of refusing to write a script is substantually outrageous to clients, then it would seem to me that a Veterinarian who chose to write scripts for medications would have a marketable business advantage... and draw in otherwise disenfranchised clients from other practices.... 

I've already noted, despite the fact that it IS a requirement in my state, I also happen to think it's just good customer service and good business to write prescriptions for equivalent product when asked by the client....

It is "HIGHLY UNETHICAL" for veterinarians to have elected to carry Heartgard? To sell a product they recommend? Because the manufatcurer has selected to only distribute it through one channel?

I'm afraid I don't understand your logic - so a product, which has a proven benefit to my patients, and thus there owners, should not be carried in my hospital or sold to my patients because I am the only designated source of that product?

Or is it unethical because I make a profit off of it? So if I was the only source, but I gave it away at cost or for free - that would then make it ethical? Heck, I must be highly unethcial, because I charge more than it costs me to provide all of my services as well as my products..... so I shouldn't actually do or sell anything I recommend because I make a profit (a living) from it - instead I should just recommend it.... that's it, the perfect business model...I'll be a recommending veterinarian who does, in fact, nothing that I recommend.

or is ethics a matter of financial degrees - so a small mark-up on a product would be ethical but a large one would not.... And who, exactly determines what is a fair mark-up?

Incidently, since I am not the sole source of veterinary medical services or products in my state - there are somewhere between 500-800 active practicing veterinarians here and most of whom practice in independant private practices - that would mean that my clients can choose to go to another veterinarian to purchase goods and services. And I have no control over what those veterinarians choose to charge for those goods or services.... Oh, and since we write prescriptions, I guess my clients can choose to fill some things with brick and mortar pharmacies down the street, in Wal-Mart, Target, or Online.... hmmn, I guess they too must be in on the great consipracy....

So I'm hardly strangling the market on Veterinary Goods and Services, am I?

If you want to talk 'Stranglehold' on the marketplace - try AT&T and the iPhone or, historically, Microsoft and compatible software access....

"(And don't tell me what to refrain from saying except on your own bloody blog!)"

Touched a nerve I see.

You are also correct that it's not my blog.... so I am not constrained to be as 'nice' as Dr. K is when she responds to posters on her blog.

I am not "new" to Dr. K's blog, the fact that I happen to browse and rarely post isn't an indication that I don't follow it's posts or the comments threads.

PJB based on my long time observations of your exchanges with Dr. K which wax and wane between glowing praise and thinly veiled disgust... as well as many other nasty little venom spewing rants aimed at just about anyone who doesn't share your viewpoint of veterinary medicine.....Honestly, I find your commentary rather bipolar in nature. You have referred to my profession in what would be considered insulting and borderline vulgar terms.... implying Veterinarians to be - as a profession- incompetent, malicious, greedy, untrustworthy, gatekeeping Trolls.....

I find your use of that specific term rather humerous, almost ironic... giving the manner in which you choose to post and the methods you emplore to elicit responses.... rather like an "Internet Troll".... so frankly, since you've already been successfully classified for what you are here.... I find I don't really care how you feel about my responses....

Oh, and BTW, you choosing to refer to me as an arrogant Jack Ass is rather like the pot calling the kettle black....I'm just saying.

Dr. Mac October 25th, 2009 03:18:57 PM

"I must be highly unethcial"  You said it.  Don't think I'll disagree on that one.  "Touched a nerve I see."  Only the one for dealing with JA vets.

"glowing praise and thinly veiled disgust" Hm, not like any of the vets do that, huh?

"I find I don't really care how you feel about my responses"  And yet you spent how much time, how many lines defending and then just table pounding?

"I am not"new" to Dr. K's blog, the fact that I happen to browse and rarely post isn't an indication that I don't follow it's posts or the comments threads."  If that's true, then you know where I stand and you either intended to pick a fight or are just being a JA.  But, hey, if you think that highly of the vets in the other 49 states, well, you're actually worse than a JA but you know that from other postings here by those harmed in many of those states too.

PJBoosinger October 25th, 2009 03:37:38 PM

I am all to familar with the form of 'debate' tactic you are choosing to utilize here....

Deflect, deter, don't answer directly, critque the messanger rather than the message, repeatedly call them names, answer a question with a question.... I think that amounts to pretty standard operative procedure from one of the professions....generally it works in detering real debate in favor of one party just giving up and walking away... some folks might consider that a justification...other find it a waste of intellectual energy and potential. however, I do chose to respond, not for your benefit but rather so other readers see there those who don't see it your way.....your voice is not the only voice....

Yes, I do think quite highly of most in my particular profession....so I suppose that includes veterinarians from other states as well.

There are those whose actions or inactions I can't defend, but I wouldn't demonize an entire profession AND all it's members because of a few bad ones.... that would be as the saying 'throwing the baby out with the bath water"....

Within professional forums, I have advocated for years on behalf of a more thorough and more transparent Professional Review Board for our profession to both better police themselves AND to make it apparent we are doing so.... The fact that the VMB receives XXX complaints and acts on only y% of those does not make it inherently evil.... Many many complaints are filled because of Pricing Compliants, Customer Service Issues and the like.... the VMB's generally have NO STANDING on these types of cases ... they are still included in total case numbers.... but they aren't 'complaints' the VMB has the authority to pursue... nor should they....

One could see this for themselves if they decided to research it - In my state, the general public can write to the VMB and request copies of complaints filed and outcomes for individual Veterinarians... this is done at no fee to the public. Some states make this available online to the GP as well. 

In addition, a large number of complaints filed do not demonstrate neglegence or malpractice by the veterinarian.... The simple occurrence of a poor outcome (including death) does not, by itself, indicate malpractice....

That is not to say that there aren't valid complaints to the VMB which don't seem to receive just treatment... there are....however, some of the worst cases of malpractice I have ever had the misfortune to be aware of go completely unnoticed or unreported by the owner.

Certainly there are bad veterinarinas, but a blanket statement condeming the profession...that's laughable.

owners who feel they have been wronged can also purse a civil legal route. Granted the monetary penalties are limited by the 'financial value' of the animal.... but a Veterinarian 'in the worng' can feel the financial hitl' when egal fees add up ... especially when faced with the prospect of possibly having to pay both sides....

There is no evidence to suggest Veterinarians are any worse, with respect to ethics, malpractice or arrogance, than Physicians or Dentists.... In fact, there is anecdotal evidence the public feels we are more trustworthy... misplaced? Where others may see ignorance, I see awareness...

Table pounding? Seriously ....that is probably more of a lawyer thing to do....all drama, no substance.....not my style.... I've not even broken a sweat, I just happen to think and type fast....

I'm just laying things out there....I happen to be multitasking.... watching football, doing the dishes and laundry, responding to a blog....

Dr. Mac. October 25th, 2009 04:26:31 PM

Dr. Mac: I agree that the business arrangements between veterinarians and manufacturers are not in any way illegal nor are they constrained by law in any way. But to say that these marketing tactics have not come about or do not persist for the historic betterment of both groups is not quite the case. 

Merial, Hills, Pfizer, et. al. elected this vet-only route because it allowed veterinarians to benefit financially from their product recommendations. Nothing wrong about that...unless you're in the human medical profession which specifically excludes these arrangements between docs and manufacturers/marketers by way of protecting the consumer. 

It's also the case that the Merials of this world can do as they like and sell through whatever channel they choose. But they continue to disingenuously parrot their vet-only distribution policy (because they say veterinarians need to be present to explain to clients how products work) while selling outside this channel to mss market outlets as well. They can do as they like, I agree, but to lie about it is unforgivable and speaks to the entire vet-only system's corruption, top to bottom.

Then there's the issue of Rx vs non-Rx:

Take therapeutic diets, for example. They're OTC but we continue to treat them as if our clients must offer a script to buy them elsewhere. Why? Because the manufacturers like it this way. It means veterinarians are more likely to remain loyal to their products' recommendation due to the limits on distribution and, hence, competition.

Same goes for products like Revolution or Comfortis. The Rx is a boon for manufacturers because it confers exclusivity, allows for higher pricing and helps these products gain entry into a marketplace crowded by non-Rx meds.

I will agree with you on most of what you say but to argue that prescription product election is not an active consideration when it comes to marketing veterinary items like these is not exactly correct. In fact, for some borderline products/drugs, it can make all the difference between a boom or bust in sales. 

Dr. Patty Khuly October 25th, 2009 06:09:02 PM

PJB: Keep it civil, woman! I know you lawyers like a good spar, but take it easy on my peeps. ;-)

Dr. Patty Khuly October 25th, 2009 06:10:08 PM

PJB, I don't get it.

Deanna October 25th, 2009 06:19:55 PM

Dr. Mac:"One could see this for themselves if they decided to research it - In my state, the general public can write to the VMB and request copies of complaints filed and outcomes for individual Veterinarians... this is done at no fee to the public. Some states make this available online to the GP as well.

In addition, a large number of complaints filed do not demonstrate negligence or malpractice by the veterinarian.... The simple occurrence of a poor outcome (including death) does not, by itself, indicate malpractice....

 That is not to say that there aren't valid complaints to the VMB which don't seem to receive just treatment... there are....however, some of the worst cases of malpractice I have ever had the misfortune to be aware of go completely unnoticed or unreported by the owner.

 Wow, that is such a mouthful, generally not spoken by a Vet. How about it, Dr. Mac, would you volunteer a guest post?

What state are you in--WE will tell YOU what you may or may not know about your VMB !

Those cases you mentioned as "worst", why not take it upon yourself and colleagues to report them? It is all about protecting the public & safety of the client, is it not?

BTW, I'm not a lawyer, as you probably can tell. Just a hard-working Ms. Joe Public that loves her pets and feels there is no place for : fraud, cruelty, immoral & unethical behavior in the veterinary or any other profession.

Difference being: animals can't talk, pets are legally worthless, and most cannot afford or find legal recourse.

Pocket's Story from NH

 ps. I also like the excerpt of quoting licensing laws and patient/client relationship importance. Throw in a little federal rules, maybe! Thanks.

Barbara A. Albright/NH October 25th, 2009 07:42:36 PM

PJB: you do have that uncanny knack, I must say. Need to think about coming out of retirement!

Barb A./NH October 25th, 2009 07:58:58 PM

Dr. K,

Deep down you know that the Manufacturers don't engage in their behavior because it benefits Veterinarians - they do it because they will gain benefit.

If they did not gain some additional benefit by choosing to take their products selectively throuhg a Veterinary Channel.... they wouldn't do it.

They don't decide their strategy on what's good for the Veterinarian. The decide their strategy based on what's good for them - and if by going through  the Veterinarian it's better for them... then that's what they choose. If their is a side benefit to the Veterinarian - or one they can promote in order to gain support - then that works better for their original plan.

I think pet owners believe Veterinarians have some kind of say in how Manufacturer's elect to launch, market, dispense their products.... when, in fatc, we have very little influence on it.

Now we aren't completely out of the game with respect to veterinary products and how they are put into play in the marketplace, but we are probably closer to the 'Waterboy' than we are to the Coach or the Quarterback...

Dr. Mac October 25th, 2009 08:17:58 PM

Barb,

"Those cases you mentioned as "worst", why not take it upon yourself and colleagues to report them? It is all about protecting the public & safety of the client, is it not?"

In the state I current practice in there is no venue for one Veterinarian to file a neglegence or malpractice complaint against another Veterinarian. The Veterinary Medical Board only takes complaints from owner clients of patients for which the complaints arise from. There are reasons the VMB does not take complaints from veterinarians - mostly it is argued that it would result in frivolous and spurious charges being leveled by competitors.... While this may be a possible risk - I don't think this is the only reason for this block.

So while we are required to report instances of animal abuse and cruelty, the same stipulation does not apply to cases concerning possible malpractice.

In fact, few states thatI am aware of have a venue for Veterinarian based complaints process... fewer still mandate that action as a professional requirement of it's Veterinary licensees.

I am uninformed on the Human Medical side - but I am also under the impression that most states prohibit physician based reporting of other physicians.

So why not report them - honestly for several reasons -

(1) The VMB will not investigate these complaints

(2) Because there is a difference between believing malpractice has been committed and being able to prove beyond the pale that malpractice has been committed - and if you cannot do number 2... and if persay you could file a complaint, then you have lined yourself up for the mother of all slander countersuits for damage to professional reputation...which costs you money to defend... even if you are in the right....

So I report three veterinarians for malpractice... all three threaten or pursue legal action against me for slander / damaged to professional reputation.... My business attorney costs me $ 250/hr.... and I would need to get a separate one to address these countersuits... and my Professional License Insurance Trust policy doesn't cover these kinds of acts....

So I would spend thousands or tens of thousands defending myself even if I was 100% correct.

(3) Because all Veterinarians make mistakes at some level - the phrase 'there but for the grace of god go I" comes to mind. And while client complaints may come and go over a Veterinarian's career, a complaint filed by another Veterinarian lasts forever... and the reporting Veterinarian has to know... there will always be someone watching, waiting for even the most miniscule of oversights or mistakes.... Forgot to record the weight and temperature of the patient coming in for an annual physical - thats a violation, gave advice over the telephone to a non-client - thats a violation, failed to record the amount of the ampicillin injection you gave to the patient for the sixth time - that's a violation....

So the burden of filing the complaint falls on to the individual pet owner.

"feels there is no place for : fraud, cruelty, immoral & unethical behavior in the veterinary or any other profession."

I agree with the sentiment - however, I don't believe, nor have I seen evidence of, rampant gross neglegence, malpractice, immoral or unethical behavior across thespectrum in Veterinary Medicine. I also don't think you can legislate human behavior - some folks are just unethical or immoral.... professional degreed and licensed or not....

However, I alsothink, when folks stop talking about individuals who have violated the trust via their actions and start to say the whole profession is 'corrupt' or in some kind of cover-up conspiracy to protect the 'bad veterinarians.... they tend to lose their supporters within that profession. The message goes from let's get the 'bad' guys and improve how we pursue them to... Veterinarians are a horrible group.... and that just turns off theassistance one might receive from within the profession.

I also sympathize with pet owner's who have lost their companions - especially when it has occurred under less than clear circumstances as to what happened, how it happened, and why it 'had' to happen. And that feeling of loss is compounded when their concerns fall on deaf and unresponsive ears - when a simple explanation of what transpired, why and how things deteriorated would usually suffice to alleviate their concerns that their pet was somehow mismanaged or neglected.... but some Veterinarians do not come with advanced bedside manner or solid communication skills... they hide from these discussions, many times when they ahve done nothing wrong... but this leaves the impression they must be hiding something....

My own patients do not always have pleasant or expected outcomes, and I am certain that in my career I have had patients where my recommendations or advice may have precipitated their demise - Veterinarians refer to these patients at part of their professional "Bone Pile". However, simply because a patient dies during the course of recommended treatment or because we (the client and I) were forced to pick the lesser of two evils with respect to treatment options and it still goes sideways- does not make it malpractice or neglence....

I am well aware there are Veterinarians out there who commit malpractice on a daily basis with nary a thought or care about it- and it turns my stomach when some of these doctors are 'beloved' by the very community they are pulling it over on, because they are smooth talkers, play fast and loose with the rules, and do so with a smile and a warm personality....

I am aware of some of the shortcommings of my own state's VMB... They are not perfect by any stretch, but they are better than no system at all...where only the civil courtswould become involved..... 

I just don't support the conclusion that the entire profession is corrupt or in a conspiracy to defraud or commit malpractice on thepublic simply because there are a few bad Veterinarians in practice.....

Dr. Mac October 25th, 2009 09:08:58 PM

Dr. K,

Therapeutic diets - yeahhhhh so not prescription.

Because of this, I treat them as any other non-prescription product in my hospital... I will sell them to anyone who is knowledgeable to know to ask for them.... and if they aren't one hundred percent certain - we will even call their Veterinarian to ask what they are actually on.

In my area, there are few Veterinarians in Privately owned private practice that truly require a 'prescription'.... most just want to be sure the customer is buying what they actually really need - so they want to see something that tells them they are getting the right stuff.

I am aware of only one Veterinary Practice which routenly requires a written prescription to sell Thearpeutic Diets.... They aren't a Veterinarian owned practice...and they have lots an dlots off offices.... I think you know why they have these types of policies in place... and it doesn't appear to be in the pet owners best interest....

But, there is no requirement that they sell anything to anyone... so they can set their Internal Policies anyway they like... they will continue to hide that one under the guise of 'prescription law'.... but it ain't the Veterinarians calling the shots there...

***

With respect to the Vets-only distribution channel selected by the Manufacturer... are you suggesting that because company X makes the decision to sell only through Veterinarians... and because I choose to carry that product....that makes me somehow unethical? Simply because I carry a product I believe in the medical benefit off....

But I am to not carry a product because the manufacturer doesn't make it available through other non-veterinary channels - I'm sorry I don't see the logic in it. Because I carry products from Company A in my hospital - and Company A behaves in manner Z.... does that mean I behave in manner Z.... I don't think so.

I too believe some of the major manufacturers are being duplicitous in telling Veterinarians we will only sell to you and are also likely selling to mass market retailers.... personally I have no problem with the mass retailers selling - as long as we are all playing by the same rules AND the consumer and pet doesn't get hurt....

Dr. Mac October 25th, 2009 09:27:23 PM

Whew!  For once a contentious thread where I wasn't involved in the contention!  <wipes brow>

Dr. Mac -- I have to confess to having speedread your posts, so I will come back and read the rest of them in more detail.  But there is just one  thing I have to "fly by" comment on -- and I hoe to give you bon courage by so doing.

You said:

"few states thatI am aware of have a venue for Veterinarian based complaints process... I am also under the impression that most states prohibit physician based reporting of other physicians. . . . The VMB will not investigate these complaints"

I FOIA state vet board records for . . . er, um . . . fun.  And let me tell you that I've seen MANY complaints which resulted in disciplinary action in MANY different states that resulted from colleague or staff complaints.  I cannot tell you if your state is one of them, because I don't know what state you are in (did I speed right over it, or did you decline to say?).  But I can tell you that Florida, California, Idaho, are three I can think of off the top of my head where I can distinctly recall reading board disciplinary actions that were the fruition of a colleague complaint. 

If you tell me which state you are in, I would be happy to go through my voluminous records when I have time and see if I can find any.  (Although, I don't have reacords from all states -- some states just ignore public record requests or tell you that you have to show up in person to get them.  For example, Alabama ignores requests.  West Virginia tells you that you are welcome to show up and get them.  LOL.  Someday when I have all the time in the world I will show up.)

Also, you said:

"there is a difference between believing malpractice has been committed and being able to prove beyond the pale that malpractice has been committed - and if you cannot do number 2... and if persay you could file a complaint, then you have lined yourself up for the mother of all slander countersuits for damage to professional reputation...which costs you money to defend... even if you are in the right...."

I am pretty sure you are wrong about this.  If you file a complaint with a regulatory agency, I am pretty sure you cannot be sued for libel for the contents of that complaint/allegations therein.  I can't recall the proper legal term, but it's something like limited immunity.  You have a right to report to a government agency without fear of suit so long as your allegations go to the investigative body/regulatory board and are NOT printed elsewhere.   If you reprint them elsewhere, or repeat them to others (other than the regulatory agency) then you don't have immunity for that. But as long as the forum of "speech" is limited to the reviewing body/appropriate agency, you cannot be sued for their content.

No doubt your colleagues run around threatening libel suits any time they think you are going to do something like report them (in fact, I know they do, those of us who speak out about bad vet care are are not only used to be threatened with the words "libel" "slander" and "defamation" -- some of us have been sued.  And I'm here to tell you that those suits ain't going to well for the vets who file them.  Check out "Help! My Vet Sued Me!"

http://www.vetabusenetwork.com/myvetsuedme.htm

It's very interesting.  These vets drag clients through years of pretrial hell and then -- poof! Disappear on the proverbial eve of trial.  Guess that testimony under oath -- in public record forever -- is potentially worse than a griping former client.  Yes indeed, court transcripts are a beautiful thing.)

Then again, I think most vets who file libel suits aren't planning on prosecuting them to the finish, they are just hoping that the horror of the lawsuit itself will be enough to shut someone up, and sometimes it is).

Anyway, these vets who threaten you with libel/defamation suits are counting on scaring you - and looks like they are successful. 

Yes, it's important to have more than a "hunch" and more than a "feeling" and more than a "suspicion."  But if you've got evidence -- let's say you took care of a pet after a colleagues botched surgery, or one or more of his employees will go on record -- and you are pretty sure they won't bail -- then I don't think you shoudl let fear of a suit keep you from filing a complaint.  They can't sue you for a board complaint.  

Stefani October 25th, 2009 10:20:13 PM

Ahh Dr. Mac, and I was so happy with your post the other day...and now the true colors come out...how disappointing, yet not really surprising.

oh well...

Lorrim October 25th, 2009 10:22:05 PM

I'm coming in very late to what's been said here, but I have a question for PJ. I don't want to get you snarling and snarking at vets again, but I'm wondering about what you said -

"Dr. Mac, I never said the "selective marketing" was illegal nor is it difficult to understand. I will say that I consider it HIGHLY unethical for veterinarians to participate in such marketing "strategies" to their benefit and the detriment of animals."

When a company is using a selective marketing stategy for its products, are you saying that any place of business that sells those products is unethical?  For example, I would like to be able to buy product X at my corner convenience store, but it is only available at a specialty store 2 cities away from me.  Does that mean that the specialty store is unethical because they sell it?  It's obviously benefitting that store and its owners, and it is detrimental to the shoppers at and the owners of the convenience store.  Or is this same situation only unethical if it involves veterinarians?

KateH October 25th, 2009 10:27:19 PM

KateH, When a professional recommends a product over another product, it should be based on their objective opinion of that product.  It is difficult to be objective if one is also factoring in relationships and profit margins affected by those recommendations.  Accountants are advised to avoid improprieties and conflicts AND the appearance of these.  These exclusive marketing strategies have the appearance of impropriety and conflict to me.  No, not just vets.  In many states, doctors still have in house pharmacies and, for example, carry a limited number of birth control pills.  They tend to recommend those they carry.  I have exactly the same issue with them, it has the appearance of impropriety.

If I go to a specialty store or a Tupperware party, sure, I expect they're going to be touting their products as the "best", etc.  They aren't professionals upon whose specialized, independent, objective advice I intend to depend but I want exactly that from anyone who holds themselves out as a professional.

Barb, I'm thinking about it more seriously every day.

Dr. K, SORRY!

PJBoosinger October 26th, 2009 02:37:45 AM

Dr. Mac: You misunderstood me. Veterinarians did not build the system any more than we're in charge of the marketing these companies do. Most of us more newly in practice inherited a marketing system built by the manufacturers. Unfortunately, it's one we've come to rely on and one which makes the public look at us askance for...once they realize how it works. But while it's not of our original doing, many of us perpetuate it by refusing to write scripts, for example. 

I've written about vet drugs and products extensively and my opinion has always remained the same: veterinarians need to let go of the pharmacy and stock items for the convenience of the public...not because it's the only place for our clients to purchase them. 

In NO WAY are you acting unethically when you carry these products. Not if you do so for the convenience of the client when these are drugs and products you believe in. 

The reason it's been deemed unethical (indeed, illegal) for the human medical profession is because the consumer was historically treated to drugs the physician was benefiting from for selling. No one wants their doc to profit from selling them drugs. The financial interests of a physician would then be to sell you on a prescription item because they can turn a profit on them...not because it's in the patient's best interest.

We have not yet reached a point where the veterinarian is under that kind of scrutiny. but you'll agree that lots of vets sell Simplicef through their hospitals when a $4 Cephalexin script at the local big box pharmacy might be an even more appropriate choice. 

These are the consumer issues PBJ and others cite in their critique of our profession. If we weren't so wedded to our drugs and products as a profit center, if all vets sold drugs and products for convenience, giving consumers a choice in where they bought their drugs and products, and only carried drugs and products they believed in, we wouldn't be having this discussion in a thread on feed stores and their open access.

I believe that you have your clients'/patients' best interest at heart. Nonetheless, the system of drug and product sales doesn't always make it look that way from an outsiders perspective. 

Dr. Patty Khuly October 26th, 2009 06:04:10 AM

Our veterinarian will write an Rx with no apparent hesitation and also offers the specially compounded meat flavored stuff for convenience and speed.  If fact, he pointed out the difference in $ up front.  We've used both options depending on circumstances.  I think the group is so busy they don't have to rely on drugs and foods for a major part of their income.

Again, it's a matter of trust.  These people were recommended by people I do trust and they haven't said or done anything that triggers my just-under-the-surface paranoia (unlike a few M.D.s I could name).  I wouldn't be at all happy to be restricted to a closed system though;  I want choice even if I don't always use it.

Will October 26th, 2009 06:52:32 AM

Stefani,

I am sure you have done some research into how the VMB complaint process works - and have identified some states where what you list is true.

I am certain my state VMB does not investigate complaints lodged by other Veterinarians, nor do theyinvestigate Anonymous complaints - I know this because I've worked as an associate with a former VMB member-President and had this exact conversation with the Executive Director of the Board. I'm also in the position of being in pretty much daily communication with Veterinarians from all across the country - so I have the opportunity to hear on this issue from them. My state is not the only one which chooses not to accept complaints from Veterinarians (or staff for that matter).

With respect to the commentary on the risks of the slander / defamation - my point isn't really that the reporting Veterinarian will be -successfully- sued... it is simply that even when you may be in the right - it still requires you to have to spend money with an attorney whether or not the case ever actually hits the courts..... not to mention the psychological impact of having to go through the process... The 'threat' of litigation and it's associated costs is oftem just as problematic as to whether or not the case even ends up in court.

You might say I have some familiarity with the legal system - personally in a non-veterinary medicine related way. By virtue of some of my Veterinary friend colelaguse, I am also aware of how the VMB system operates here, as well as to how the legal system can be used to intimidate them.

I won't argue that some VMB intentionally make it more difficult to 'research' the backgrounds of individual Veterinarians - and part of that may be to protect the Veterinarians - but I think much of it is to reduce the amount of excess work the board employees would have to do if they had to respond to 10X the number of requests for Veterinarian files then they already have to now. Most VMB have quite a small resource pool, financially, and have a limited number of employees - thus who they have is frequently already pretty much committed to the workload they have on hand.... from one angle they simply couldn't afford to answer 10X the number of requests they have now.... We could argue that putting complaints online would then make it even cheaper for the board.... and likely it would, however the Board registers every complaint filed - no matter if it was an item they had jurisdiction to review or not, no matter how spurious...

So a Great Diagnostician of a Veterinarian who has terrible bedside manners or a Good Doctor who works in a very expensive hospital with lots of pricing complaints - may accumulate many many more lodged complaints than the hack down the street who give a shot of steroids and antibiotics to everything that walks through the door but has a smile on their face and fools their clients.

Dr. Mac October 26th, 2009 07:50:43 AM

Stefani: No, Dr. Mac did not disclose what state he resides or is referring to. Therefore we can not quote specifics and statistics, nor the probable immunity of statutes and VPA.

When a group of vets is privvy to clear & evidence based malpractice & fraud by a neighboring clinic and does not report it for the VMB to investigate and take action based on findings, well it only leads one to suspect the worst.

In other words, what sets those fine & ethical professionals apart? Certainly , confidentiality of both reports & investigations protect "both" parties?

It is just interesting to read that comment from one within.

Oh, and where or where did anyone lump together the entire profession as bad news, I hate when that happens!

Barbara A./NH October 26th, 2009 07:57:33 AM

Dr. Mac: Stefani can tell you that "pricing complaints" are virtually nil in every state.

People don't take up issues of money with a regulating board, unless it happens to involve fraud for whatever reason.

Barb A./NH October 26th, 2009 08:03:07 AM

Dr. Mac,

I am shocked about your state having a policy against investigation of complaints filed by vets.   I wish you would say where you work.

But I am confused by your mentioning the issue of complaints (including spurious ones) on the heels of discussing the workload of veterinary board staff's in responding to public records requests.  Because in most states, complaints that DO NOT result in disciplinary action are NOT subject to public disclosure, and they are NOT provided in response to a FOIA request.  There are a handful of states in which complaints are public (actually, I can count them on one hand and still have fingers left) and a couple more where complaints are public IF they result in action.  Do you live in one of those states? 

I assure you, however, that with the exception of Washington state, the states that give me the run around about FOIA are not the ones where complaints are public, so that's not a legitimate excuse. 

Workload notwithstanding, public records laws in each state REQUIRE a response to public records requests.  Boards can get in trouble at Sunset Commission etc. for failure to respond to legitimate requests for public records.

Also, their budgets are matters of public record as well, and that doesn't seem a very legitimate reason for failure to make records more readily available. 

If I can get all the consent orders/findings of fact from a state in a year and scan them all within a couple of hours, then put them online in about another day's work, I think they can do the same. 

Frankly, it would SAVE them time responding to such requests.

Stefani October 26th, 2009 08:19:35 AM

Example:

In South Carolina, the vet board came under some scrutiny for failure to release the Statement of Charges along with the consent orders.  This bad habit of theirs resulted in the legal requirements being er, um, clarified FOR them by elected officials.  They now make charging documents public for cases that result in action.  (Of course, dismissed complaints are not made public, which is how it is almost everywhere).

Stefani October 26th, 2009 08:25:03 AM

"I am certain my state VMB does not investigate complaints lodged by other Veterinarians, nor do they investigate Anonymous complaints - I know this because I've worked as an associate with a former VMB member-President and had this exact conversation with the Executive Director of the Board."  I'll suggest that may well be a true statement.  The State Bar of Texas is mandated by law to investigate all reports of member (and some non-member) misconduct.  In practice, they don't even come close.  They dismiss anonymous complaints automatically; they almost automatically dismiss complaints from other members of the profession (especially opposing counsels) and several other categories of complaints.  Let's don't confuse what a VMB is SUPPOSED to do with what it does.  I suspect this disparity exists in all professional boards (and it annoys me no end, most especially when it's a state bar).

PJBoosinger October 26th, 2009 08:44:33 AM

Dr. K,

I agree that it is unethical for a Veterinarian to make their drug choices based on the potential profit - in other words Drug A makes them $ 15 and Drug B makes then $ 25.... Drug A may be the better choice but they choose Drug B because they keep the $ 25. That's a gimme.

However, I don't think it is the moral responsibility of the Veterinarian, Staff or Hospital to price shop out the drugs they are prescribing - I think that onus should be placed on the client consumer. reasonably, I can't be expected to know the cost of every drug I prescribe at every possible source available.

I think it is Bad Business / Poor Customer Service to not inform the client that yoru drug choice is one commonly used in Humans and thus may be available at an outside pharmacy - and to inform the client you are happy to fill the meds in house OR if they would like a script so they can shop around to fill it elsewhere.

But, Pharmacies and online retailers aren't always cheaper - and I've ahd a client complain to us when they asked for a script, were given the script they requested, went to the pharmacy, waited for an hour and then were told it would be almost twice what we told them it would cost them through us.... They wasted their time and money... and this is my fault how?

I also don't think eliminating in house pharmacies is a real answer either - much of what we use isn't readily available dwn the street...and frequently I don't think we should be waiting a day to 5 days to get things filled through the mail....

Lastly on the financial aspect, I know you know where I'm going here - but I think it probably asists the blog readers to be aware - On some level our profession has discussed the issue of Med/Product pricing and profitability for years - decades in fact.

I believe the concientious members of our profession are conflicted about how this works out for the client - I really do - we have seen what has happened to the Large Animal veterinarians which, for decades, subsedized their very low medical services pricing and relied heavily on huge mark-ups on vaccines, feed additives and antibiotics.... Then the mail order catalogues came into play, along with the Feedstores.... and they priced these products considerably lower than the LA Veterinarians.... what happened over the next couple fo decades has not been pretty for the profession - yes it was a monster of their own creation but - the LA Veterinarians lost a sizable chunk of their profit income when they lost vaccines, feed additives and Antibiotics sales.... but have been unable to adequately adjust their professional service fees to address their lost livelihood.... so a lower 'adjusted real' income in one of teh reasons we are seeing such low numbers of LA Veterinarians coming out of school... which in turn hurts the consumer....

On the Companion Animal side, I think our profession has taken note of this and, based on my observations, many Veterinarians are attempting to slowly wean down their dependance on product sales and profits.... because they see the end game writting on the wall... product sales is not going to give them substantial profitability.... so they are slowly dropping the rate of mark-up even in teh face of rising prouct costs to them....In turn, these practicioners have been raising their professional fees on services....some times at noticably aggressive rate...

The arguement would be that if we, Veterinarians, eliminate product sales profitability by reducing mark-ups or by eliminating the in-house pharmacy entirely, then that profitability has to be made up elsewhere....in services.

So the General Public could get their drugs and products from Walmart at $ 4 / per..... but their Veterinarians fees for services would climb to offset the equivalent loss....

Thus members of the profession, whcih are trying to do the very thing you (and I) are advocating by reducing grossly exhaggerated mark-ups or by reducing their pharmacy stock in favor of scripting, are raising professional fees... the problem, then, is that it appears the very same people who decry the influence of product profitability on their veterinarian or the cost of drugs in general...are also they very same people who launch into tirades about how their Veterinarians service prices have gone up at a higher rate...

While the General Public may want Veterinarians to wean themselves off of Product sale as a method of generating profits - both because fo strict cost as well as a question on ethics - many also don't want to pay the associated rising cost in services fees...

Now you and I can debate the need for improved efficiencies in how the profession provides delivers medical services - and thus through improvements we could provide more services to more clients and pets... but do so at the same costs for owners  just being able to see and do more across the board and lowering our costs.... to see better profitability for the profession.... but that would require a pretty thorough dismanteling of how our profession practices medicine...and  the way we are taught how to practice medicine in the academic venue.

So under the current model, the G.Public can have cheap(er) drugs from teh Veterinarian with pricier services, they can have cheap(er) drugs from an outside pharmacy with even higher service fees or they can have the historical system....

In the end with whatever system gets put in place, the G. Public at larger doesn't see a large economic benefit...The may see cheaper drusg at Wal-mart but they pay more to the Veterinarian for other services...

The pharmacy may 'win' with a new revenue stream (but at $ 4 a prescription you have to believe this is a marketing scheme to get more folks into their store to buy a cart load of crap while they are waiting to get their script filled)...

The Veterinarian doesn't win... other than suplanting Pharmacy profit for servcie profit.... which may be a more palatably ethical way, in the publics viewpoint, for them to make a living btu ti's not like the profession suddently is on an income level par with Physicians, Dentsists or other equally qualified / motivated professionals....

The general public client doesn't win.... because in the end, the sum total of what they end up spending on medical care and products doesn't go down.... and the general public is now funding the pharmacys business instead of the Veterinarian... so they end up funding both.

Sure, you will get the one off person who will 'escape' on the cheap because they don't elect to pay for those higher service fees...and they can buy a $ 4 script at Wal-Mart.... but overall, the general public doesn't win out in cost savings...

This isn't a matter of 'competition' drives all product prices down for everyone....where more choices makes the net effect lower cost.... because we aren't talking a product versus product comparison....it is a matter of, with a loss in product profits going to the pharmacies.... then that lost profit which helped subsedize the medical service costs....gets tacked into the services pricing....

I agree it is an unpalatable and somewhat of a 'dirty' feeling to discuss the financials of how our profession works because we tend not to think of Veterinarians and "Money Matters" in the same sentence....but, this is the reality of what the General Public -and- your blog readers are asking for....

Which is great, as long as we understand what the tradeoffs are likely to be....

Dr. Mac October 26th, 2009 09:35:16 AM

Dr. Mac: Agreed: There will always be a place for vets carrying drugs not commonly available outside the hospital––especially when they're needed in a timely fashion...especially while non-VIPPS certified pharmacies continue to rule the roost on drug and product sales.

Also agreed: It is not my responsibility to know where they can get their products and drugs cheapest. but I do feel it is my responsibility to provide a choice, as you apparently do, too.

Dr. Patty Khuly October 26th, 2009 09:54:10 AM

Barb & Stefani -

The -investigated- pricing (and customer service) and supurious (as in not medically related) complaints may be pretty close to nil.... but the number of complaints voiced to the board, either officially via written compliant, or via telephoning to complian... is not a small number. These complaints do end up being registered / recorded in my state... they end up with a summary line items of 'dismissed'.

The fact that complaints such as these, which are dismissed due to lack of Board jursidiction if you will, but are still recorded...and without the complaint letter asssociated with it released...does little to vindicate the Veterinarian who now has a complaint and 'dismissed' entry in their record.... To the General Public, they can still see 6 dismissed complaints on their doctors record...

I don't argue that there are multiple reasons why the VMBs don't all make their records easily available... it does make it look to be protectionism...and in fact, it may be the case....

And yes, legally, the VMB may be required to respond to all requests... regardless of their workloads.... so they have put steps in place - policies - which make it just a bit more work for people to make these requests.... in part, I suspect, to reduce the number of requests made...and thus reduce their workload....that isn't a difficult thing to put together...

On the other hand, I submit that if the boards were to make it easier (barring posting opn access on the internet) for anyone at anytime to make a request for records for every veterinarian within the State... say a Channel 8 expose piece report decides they want to see everyones records so they contact the board and say hey I want Dr A, Dr B, Dr C,.... Dr X, Dr Y, Dr Zs records.... or that the General Public does this... that those records requests won't clog that office... pulling the staff from those offices away from actual case review....The VMB do not have an unlimited budget.... there has to be some balance.... and in my state, you can see any Veterinarians record - you just have to make a written request...and I don't find that an unreasonable burden to place on the consumer, 

I also am not truly infavor of Online Access to the General public - and it;s not because I think I have something to hide....I have had zero board compliants of any type... I think, rather than 'exposing' the bad veterinarians out there, we are more likely to draw suspicion upon and hurt those professionals who have had either spurious or truly minor violations with little to do with patient care directly become disproportionately penalized by the availability in the mass media internet today....

In other words, the entire list comes out online... and individual Veterinarians who are, by and large, good doctors who may or may not have made a legitimate minro mistake.... will be identified and vilified on internet sites by people who don't understand the actual issue, don't care what the actual issue was, make up their own issues or stories about the doctor... to feed their own agenda...where no one can truly call them to task or stop what they are doing - short of being able to identify them and legally shutitng them down...which can take months to years... all the while the individual doctor professional reputation gets stomped on...a retraftion a year later just doesn't cut it.

I, personally, have witnessed this very series of events happen to not one but two colleagues who commited not outrageous medical malpractice... but were sited for record keeping errors in connection to cases where the pet owner's complaint alleged gross neglegence and malpractice...which turned out to be wholly inaccurate.... but hey had failed to record a patients weight on a couple days during hospitalization and failed to record the timing of a medication injection on one of several administrations.... this resulted in a minor penalty from the VMB... but permitted the pet owner to continue to unleash their wrath on the Veterinarian via the internet.... damaging their reputation disproportionately to their actual 'transgression'...

***

All -

You are all correct in that I have not disclosed my state. I have no intention of intentionally making myself (and thus my practice) an obvious target for raving internet fanatics -present company excluded from that group- to wreck havoc upon my professional and personal life with little recourse for me. We need not deny that this can happen... because clearly it already does.

I am also aware, that Dr. K could easily deduce who I am with minimal 'research' simply because I am rather vocal with my opinions in one of our professional communities, of which she is a member, and my writting style - complete with typos- is fairly discernable.

I think it is enough that I choose to comment, offering my own observations, opinions and experiences...when it would be much safer for me, my business and thus my family, if I just didn't bother to comment at all....and went about my business.

I choose  to comment because I can appreciate the level of emotional and personal commitment - and sometime the anguish - that pet owners have when dealing with their animals, their illnesses and the problems they encounter with the Veterinary Profession, whether it be true real unethical behavior or malpractice, or just poor communication and understanding, or sometimes just poor luck of the draw in outcomes.

Little of that which is brought up by Dr. K or discussed by the thread posters escapes the Veterinary Profession - we've been discussing, debating and down right arguing about these topics for a long time internally. Sometimes these discussion and debates become much more heated than what goes on in this blog.

Some times it feels as though it is just tilting at windmills, sometimes like the lil' Dutch boy with his finger in the Dam, but overall, the profession has been moving towards a more open, more transparent, more progressive manner.... You all may not choose to believe that things are getting better in this regard.... but it is... and it's not just because the Consumer files VMB complaints -or- because the Consumer asks the Attorney General to step in.... It is also because, internally, we debate these things, we argue the ethics, the logic and the impact of our choices...

The most significant roadblock to making positive changes - ones for the better for everyone - isn't with the Professionals who engage in these discussions.... it's with the ones who don't....who don't think they do -anything- wrong, ever.... who don't bother to think through the possible ethical dilemas... they don't partake in the internal discussions within the profession because then they would either have to justify their practices or they would have to admit, to themselves, that what they do isn't agreeable to the majority of the profession...

So skewering those Veterinarians who come out into the open to discuss these same issues with the General Public - especially those who don't see things similarly to the 'group think' which develops in a public forum such as this... doesn't....help....you... (or me, or my profession)....what it does is just drives the folks who care about what's going on...back into their protected environment.... because they get tired of being held to task for the entire profession, get tired by being called names, get tired of trying to explain that there is more to how to move a mountain then just to light some dynamite......then they are lost to any cause which might have benefited from their input or their support...

Just because I, or another veterinarian, doesn't agree 100% with each an every viewpoint expressed, doesn't mean that they are against everything you say or think.... it also doesn't mean they don't see that the profession has problems that would benefit from being addressed.... but when they come out here into public pet care forums or public animal associated groups to discuss these issues, to debate, to perhaps give some insight into things which may not be readily apparent from the outside... and they get jumped on from all sides...being held accounatble for every bad experience (and sometimes client created ones) that have ever been had at a Veterinarians.... like a pack of starving dogs bringing down anything in their path.... there should be no question as to why such Veterinarians would choose to 'Close Ranks' and write off the public lynch mobs as the rantings of internet crazies....The message becomes clear... don't... get... involved... because you'll regret it.

Dr. Mac October 26th, 2009 10:36:07 AM

With apologies to Dr. K in advance...  SORRY.

"skewering those Veterinarians who come out"  "get jumped on from all sides... like a pack of starving dogs bringing down anything in their path.... write off the public lynch mobs as the rantings of internet crazies...."

While I fully understand Dr. K's general inclination to view her own profession and colleagues in a positive light.  This part gets annoying.  When we non-vets say something negative or critical or get into a debate along the vets v. non-vets lines, we are seriously criticized.  However, vets and other members of the veterinary community make statements like those I quoted (although those are more extreme than usual) and that seems to pass unnoticed.  We non-vets go "to far" and even if we're being egged on by a vet, Dr. K (or other vets) chastise us and let the vet slide.  I have no problem with a free for all but there does seem to be a double standard there because when the vet community and the non-vet community are divided in the debate with some on both sides, then a free for all is OK but when it lines up; not so much.  In the end, it's Dr. K's blog and she gets to make the rules but this is annoying at times.

PJBoosinger October 26th, 2009 11:21:26 AM

Well, if the purpose of this thread is to solicite feedback, it certainly has done the trick.  I sure do see a lot of posts here that have the objective of showing all readers how much more intelligent they are than others that are doing the same thing.  Furthermore, they seem to be using an tremendously large amount of words in pursuit of said objective.

PJB... while I am so sorry you feel the way you do about Veternarians impressing their knowledge on others in an attempt to show they are more knowledgeable (which I hope they are), they aren't all that bad.  Now if you really want to get your gears grinding by hearing a voice of unsubstantiated arrogance, you ought to chat with a lawyer sometime...

<JUST KIDDING!!!!>

EAB October 26th, 2009 12:22:33 PM

Dr. Mac, obviously you have thought a great deal about these issues.  There are just a couple of comments I'd like to make to your last post:

When I said that in most states, complaints are NOT public record, I meant this:  Not only are the contents not released to the public, but the fact that a complaint was filed against the vet is confidential.  If that is not the case in your state, then your state is one of the exceptions. 

Your concern that members of the public could see a dozen complaints had been filed against a vet -- without seeing the contents, and just assume that the contents must have been something awful in spite of the fact that they were dismissed -- well, that could not happen in MOST states because the even the FACT that a complaint has been filed against a vet is NOT public record, let alone the contents of dismissed complaints.  (I will refrain from commenting on how I feel about that . . .)

Also, I will reiterate that if vet boards made their final orders (and by this I mean disciplinary actions, not dismissed complaints) readily available online, they would not have to worry about the level of effort associated with fulfilling public records rerquests.

You say you are concerned that if this were permitted, or more widely done, it would potentially besmirch the entire profession.  3 points on that:

1.  These records are available online for Health Professionals in most states -- why should vets be exempted?

2.  It will only besmirch your entire profession if you let it.  If you let that lousy care speak for you, by covering up for those people, defending them, or taking the attitude "there but for the grace of God go I" -- then frankly, maybe the profession needs a little shakedown.  Because really, I've read lots of them, and it's usually not a case of "there but for the Grace . . . ".   I doubt you slam dogs' heads on tables, play fast and loose with ivermectin and collies, etc. 

3.  Right now, pet owners generally see vets as Godly Angelic beings incapable of error.  This is just not a good footing to start off a professional relationship on because it means they have suspended critical judgement.  They could use a dose of reality without having a personal tragedy to get it.

You may think the adulation is good for your profession but I don't, because if a pet owner doesn't critically assess quality of care (and to do so requires realizing that there is a vast difference in quality out there) then that client will not know the difference between the conscientious vet with highly trained staff who keeps up to date on the latest and greatest, and really and truly endeavors to provide the best care, vs. someone who is just phoning it in, long since lost the desire to really help patients, and takes an "oh well" attitude toward avoidable complications.

There are few things more valuable to me personally than a trustworthy, hardworking, quality, conscientious, honest vet.  There is a reason that I know that.

It may not be up to the Vet Boards, BTW, for long, whether or not their records are available online.  A consumer advocate in Texas has already FOIA'd all of them and made them available himself there. 

Also, FWIW, I have read so many disciplinary records where the vet was found only in violation of "record keeping."  That is usually bogus, I can read between the lines.  Most of the time, the board is just going easy on the vet when they take it down to "record keeping" but anyone who reads the facts with a critical eye can see that more serious things occurred.  There is really almost no such thing as "just a recordkeeping violation."

stefani October 26th, 2009 04:54:15 PM

This conversation is almost as if we'd rolled up four years of the most contentious kind of Dolittler into the last three posts. Kinda cool. And kinda stressful. So you know, Dr. Mac, these arguments preceded you. But then, I think you've gleaned that by now. ;-)

Dr. Patty Khuly October 26th, 2009 06:49:38 PM

uhh what was the point again? thank you

jim hall October 26th, 2009 07:39:28 PM

Well Dr. Mac, you are somewhat guilty of some horrible generalizations in your comments.

I do know of one state the "used" to keep an incoming log, but have quickly dispensed with that practice. And it wasn't my state.

As Stefani mentioned, this is the way states operate:

1. receive phone inquiry as to how to file a complaint

2. client is told to submit detailed complaint in writing to be reviewed

3. if complaint "rises" to level of investigation (and they ALL do), complaint becomes sealed from public view UNLESS discipline is taken (in the form of :reprimand, fine, or hearing.

4. 95% of complaints dismissed with form letter= the End

Consumer never becomes aware of: complaint, complaint contents, how many or if none ever lodged at all.

This system may have worked for the last couple of decades; but I am willing to bet it will not hold up for the next decade.

Why? Because people are fed up with lack of government transparency in general, lack of enforcement & policing within certain groups, and little to zero recourse for incompetence & unethical behavior.

"Closing ranks", as Stefani suggested above , does not distinguish the honest & hard-working professional from the bottom feeder in the barrel

Campfire Girls USA

WoHeLo !

Barbara A./NH October 26th, 2009 10:27:03 PM

WoHeLo Sister!

PJBoosinger October 27th, 2009 01:43:42 AM

holy cow   PJB is a WOMAN!    it's funny how after reading posts I associate a gender and almost a face and a voice to go with it...

as to the rest of this thread.....I am happy to get on here and read everyone's views....  I may not agree but I like to have the option to learn about different views.....

can we just agree to disagree and not be so persnickety ?   

agadoresmama October 27th, 2009 12:21:14 PM

"holy cow PJB is a WOMAN! it's funny how after reading posts I associate a gender and almost a face and a voice to go with it..."  I choose to take that as a compliment :)

I always find it interesting how much gender bias shows when the gender of the author isn't apparent :)

PJB October 27th, 2009 08:59:27 PM