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The AVMA is proposing an updated “Model Veterinary Practice Act” to its House of Delegates in the near future.  Included in the draft, which is not legally binding by any state unless specifically incorporated into the state laws, are issues involving the provision of veterinary care via telephonic or other electronic means.  As reported by AVMA in its JAVMA Nov. 1, 2018 publication,

The AVMA Model Veterinary Practice Act continues to state that veterinarian-client-patient relationship ‘cannot be established soled by telephonic or other electronic means’ . . .

As decided in Hines v. Alldredge, 783 F.3d 197 (5th Cir. 2015), “the requirement that veterinary care be provided only after the veterinarian has seen the animal, at a minimum, rational: it is reasonable to conclude that the quality of care will be higher, and the risk of misdiagnosis and improper treatment lower, if the veterinarian physically examines the animal in question before treating it.”  At least in Texas, the requirement for in person examinations by veterinarians of their patients must be conducted before diagnosis and treatment ensues.

Other issues included in the AVMA’s model act include:

  • Permitting a veterinarian to provide care to an animal during an emergency in the absence of a valid VCPR;
  • Incorporation of federal laws, including definitions and provisions of FDA’s Veterinary Feed Directive;
  • Rejection of a farrier exemption;
  • Discussion of the use of the term “veterinary nurse” and
  • The ability of lay personnel to provide veterinary massage services.

The model act will be presented to the AVMA’s House of Delegates for a vote this January.  Even if adopted, the model act is not legally binding, and its use will be individually determined by each state’s veterinary examining board.

Interestingly, in the same JAVMA publication, the results of a study of “Owner satisfaction with use of videoconferencing for recheck examinations following routine surgical sterilization in dogs” was reported:

Owners were equally satisfied with recheck examinations performed by videoconference and in-clinic appointments. Owners of dogs in the telemedicine group indicated that their dogs were less afraid during the virtual appointment, compared with what was typical for them during in-clinic appointments, but the difference was not statistically significant. Most owners who completed a postsurgical recheck  examination by videoconferencing preferred this method for similar appointments in the future.

The fact is, telemedicine has been utilized by veterinarians since telephones have been available.  Clients calling in after-hours have consulted with veterinarians across the country who have provided advice and direction when immediate in person examination was not deemed to be necessary, based on the information provided by those clients.

With the increasing deficiency of veterinarians available to service certain rural animal producers and owners, it seems inconceivable that such remote, digital provision of veterinary services would not be permitted.

The Food Animal Residue Avoidance Databank (FARAD) recently provided guidance to small ruminant producers and their veterinarians in an article titled “Extralabel drug use (ELDU) in small ruminants” in JAVMA, Vol 253, No. 8, Oct. 15, 2018, pp 1001-1009.

“FARAD is a university-based national program that serves as the primary source for scientifically-based recommendations regarding safe withdrawal intervals of drugs and chemicals in food-producing animals. As such, FARAD is a key resource for protection of our nation’s food supply, including meat, milk and eggs, against accidental contamination of animal-derived foods with violative residues of drugs, pesticides or other agents that could compromise food safety.”

FARAD regularly provides guidance to the food animal producing industry and veterinarians regarding “the use of therapeutic drugs, pesticides and other agents that improve overall animal health and promote safe, efficient and humane production practices.”

The purpose of its latest digest, as stated, “was to provide US veterinarians guidance regarding ELDU in small ruminants. The lack of FDA-approved drugs for sheep and goats frequently necessitates ELDU in those species. When the FDA approves a drug for use in a particular species, it establishes a tolerance or that drug in the various tissues or products (eg, milk or eggs) of that species that might be consumed by people. When a drug not labeled for use in a small ruminant is administered in an extralabel manner, there is a zero tolerance for residues of the parent drug or its metabolites in the edible tissues or products of treated animals, and detection of the parent drug or metabolites in any product marketed for human consumption is considered a violation and subject to regulatory action. Given the lack of tolerance and pharmacokinetic and tissue depletion data for many drugs administered in an extralabel manner to small ruminants, extended meat and milk WDIs are generally required to ensure that drug residues are undetectable. Veterinarians need to be cognizant of the requirements for legal ELDU in food-animal species to safeguard the human food supply while continuing to promote the health and welfare of small ruminants.”

As a former owner of a veterinary large animal practice in which 50% of my patients were small ruminants (goats, sheep, alpaca and llama), it was imperative to be able to prescribe or administer drugs in an extralabel manner to provide humane care and prevent animal suffering.

Extralabel use means actual use or intended use of a drug in an animal in a manner that is not in accordance with the approved labeling. This includes, but is not limited to, use in species not listed in the labeling, use for indications (disease or other conditions) not listed in the labeling, use at dosage levels, frequencies, or routes of administration other than those stated in the labeling, and deviation from the labeled withdrawal time based on these different uses.  21 CFR 530.3.

Some of these uses have included medications added to commercial feeds, that are now governed under the Veterinary Feed Directive that FDA enforces for use in major, but not minor species.

According to guidance from FDA, “many commercial medical feeds that require a VFD are not approved for use in minor species,” defined by FDA as all species other than cattle, horses, swine, chickens, turkeys, dogs, and cats.  Compliance Policy Guide Sec. 615.115 Extralabel Use of Medicated Feeds for Minor Species.  A veterinarian may consider ELDU of medicated feed in minor species if:

There are no approved treatment options available;

The health of the animals is threatened; and

Failure to treat the animals would result in suffering or death.

The veterinarian must provide a written recommendation that includes the medical rationale for ELDU of medicated feed.

Before a veterinarian can provide such professional guidance, a valid veterinarian-client-patient relationship (VCPR) must exist.  While state laws govern the practice of veterinary medicine, including such relationships, FDA has inserted itself in the equation by identifying which states do not require the elements of a VCPR that FDA considers sufficient for the purposes of enforcing its Veterinary Feed Directive and other federal laws.

These multilayered state and federal laws can be difficult for veterinarians and small ruminant producers to decipher—hence the necessity of FARAD and other agencies to provide more specific guidance.

As part of its Five-Year Plan for Supporting Antimicrobial Stewardship in Veterinary Settings—just released—FDA announced that it plans to shift from “educating” food animal veterinarians and producers about the 2016 Veterinary Feed Directive (VFD) to “ensuring compliance with the . . . regulation to further ensure the safety of animal and human health.”  In other words, producers, veterinarians, and VFD medicated feed distributors (e.g., feed mills, retailers) should expect enhanced enforcement by FDA inspectors.

Those regulated should keep in mind that FDA inspectors will “examine VFD orders, requirements for the parties involved, and recordkeeping” during inspections.

FDA’s overall plans include three broad-based goals:

  1. Align antimicrobial drug product use with the principles of antimicrobial stewardship;

  2. Foster stewardship of antimicrobials in veterinary settings; and

  3. Enhance monitoring of antimicrobial resistance and antimicrobial drug use in animals.

While described as a One Health initiative, FDA’s plans favor the preservation of medically important antibiotics for humans over animals, particularly food animals.  Also, while acknowledging that it does not regulate either veterinary medicine or farming activities, FDA has set forth plans that appear to attempt to extend their regulatory reach, through proposed expansion of inspection and testing of animals, including food animals, companion animals, animal feed, farm-raised seafood and retail meat.

FDA also plans on bringing the 5% of antimicrobials still available over the counter under veterinary oversight, including, for example intramammary treatment to prevent or treat mastitis.  Not only will this increase costs to producers (which will be passed along to consumers), but according to the AVMA, many farmers and ranchers in rural communities do not have access to adequate veterinary care because of veterinary shortages “in more than 180 rural communities across the country.”

Certainly, the issue of antimicrobial resistance is important.  However, the emphasis by some government officials and legislators too often focuses on limiting use of antibiotics important to maintain the health of animals.  And the collection and reporting of antibiotic use and test results are used by activists to eliminate the use of animals for food completely.

Testing of some food products, albeit for other purposes, resulted in the conviction of the owners and operators of the Decoster Egg Farms for “introducing eggs into interstate commerce that had been adulterated with Salmonella enteritidis,” even though the government admitted that it had not identified any personnel, including the defendants who knew that the eggs were contaminated.  United States v. Decoster, 828 F.3d 626 (8th Cir. 2016) (Beam, J., dissenting).

Keep in mind that preventing Salmonella enteriditis was the basis for the adoption of enlarged cage requirements for hens in California despite evidence that such measures do not decrease the prevalence of the bacteria.  Furthermore, California and Massachusetts have imposed their regulations on producers in other states—an impermissible extraterritorial regulation in violation of dormant commerce clause, which has been challenged.  State of Missouri, et al. v. State of California, No. 22O148 (2017); State of Indiana, et al. v. Commonwealth of Mass., No. 22O149 (201

A virulent form of Newcastle disease (vND), “a contagious and fatal viral disease affecting the respiratory, nervous and digestive systems of birds and poultry,” as described on USDA’s Virulent Newcastle Disease webpage has been confirmed in 93 cases in backyard exhibition chickens and turkeys by USDA since May 18, 2018.

The last outbreak of vND started in 2002 infecting 22 commercial premises and hundreds of backyard flocks, at a cost of over $180 million dollars to eradicate the outbreak, officially ending on March 26, 2003.  That outbreak, which started in California spread to four other states, but the majority of affected premises were in California.

Since May of this year, USDA has been regularly updating its stakeholders with information about the current outbreak, which to date, has not infected commercial poultry premises.

USDA reports that vND (previously called Exotic Newcastle Disease or END) “is one of the most infectious diseases of poultry in the world and is so deadly that many birds die without showing any signs of disease. A death rate of almost 100 percent can occur in unvaccinated poultry flocks. It can infect and cause death even in vaccinated birds.”

There are “three simple steps” USDA describes to prevent the disease from spreading to other flocks including:

Washing hands and scrubbing boots before and after entering an area with birds;

Cleaning and disinfecting tires and equipment before moving them off the property; and

Isolating any birds returning from shows for 30 days before placing them with the rest of the flock.

Bird owners are directed to contact state and federal animal health officials if their birds exhibit the following clinical signs:

Sudden death and increased death loss in flock

Sneezing, gasping for air, nasal discharge, coughing

Greenish, watery diarrhea

Decreased activity, tremors, drooping wings, twisting of head and neck, circling, complete stiffness

Swelling around the eyes and neck.

USDA also amended Veterinary Services Memorandum No. 800103 “Reissuance of Product Licenses for Autogenous Products and Guidance Concerning Restriction on the Production and Use of Veterinary Biologics,” seemingly related to concerns about the use of some virulent viruses in autogenous vaccines.

VS Memorandum 800.103 was signed on July 18, 2018, and cancels VS Memorandum 800.103 dated May 28, 2002. This memorandum provides guidance to licensees, permittees, and applicants concerning Animal and Plant Health Inspection Service’s restrictions on the production, importation, distribution, and use of autogenous biologics. This memorandum is effective immediately.

As described in Memorandum 800.103:  

APHIS restricts the importation and distribution of veterinary biologics from countries known to have exotic diseases, including, but not limited to, foot-and-mouth disease, rinderpest, highly pathogenic avian influenza, swine vesicular disease, Newcastle disease, African swine fever, and bovine spongiform encephalopathy if, in the opinion of APHIS, such products may endanger domestic animals, livestock, or poultry.

In addition, APHIS restricts the production and distribution of veterinary biologics, including, but not limited to, Brucella Abortus Vaccine, Vesicular Stomatitis Vaccine, and certain diagnostic products used in cooperative State/Federal/industry animal disease control and eradication programs, if it determines such products may interfere with disease surveillance and/or control and eradication efforts.

The instant amendments appear to be an attempt to prevent potentially virulent virus from inclusion in autogenous vaccines (a reasonable limitation).  Therefore, field isolates intended for inclusion in such products must be tested at an APHIS-approved laboratory before such use.

Hopefully, this outbreak will be resolved soon and without infecting more backyard or commercial-raised birds.

I have previously described concerns about the lack of validation of genetic tests to refute the pedigree registration status of purebred dogs.  As several courts have held, genetic testing is currently not dispositive of pedigree registration status.  See, e.g., Sandra Shines v. Furry Babies Stratford Square, Inc., No. 13-3592, slip op. at 9 (Ill. 18th Jud. Cir. Jan. 22, 2014) (finding DNA test results unreliable to support plaintiff’s claim that the Cocker spaniel in dispute was a mixed breed).

It looks like I am not the only veterinarian concerned about the injudicious use of genetic testing in animals.  As other veterinarians and scientists recently discussed in Nature’s “Pet genomics medicine runs wild:”

Genetic testing for dogs is big business.  It is too easy for companies to sell false hope, warn Lisa Moses, Steve Niemi and Elinor Karlsson.  They call for regulation.

These authors identify the following deficiencies in animal genetic testing:

  1. Weak science
  2. Lack of validation
  3. Imprecise results or interpretation
  4. Conflicts of interest

They propose the following logical five-step plan to help insure that genetic testing provides animal owners with validated, science-based and valuable information about their pets.

  1. Establish standards
  2. Create guidelines
  3. Share data
  4. Recruit tools and expertise
  5. Education counsellors

The International Partnership for Dogs (IPFD) a partnership of national kennel clubs, industry and non-profit organizations, whose mission (described here) “is to facilitate collaboration and sharing of resources to enhance the health, well-being and welfare of pedigreed dogs and all dogs worldwide” congratulated the authors on their commentary and noted that to their own initiative – the Harmonization of Genetic Testing for Dogs (HGTD) – was engaged in the development of oversight of these tools and emphasized “the phenomenal potential for genetic testing to support health, well-being and welfare in dogs, as well as aspects of human-dog interactions.”

The goal of HGTD is reportedly to improve standardization of, and access to, robust genetic  testing to support health improvements and a sustainable future for healthy dogs.

The use of genetic tests to assist animal breeders in selecting for desired traits is nothing new.

For example, in 2006, USDA’s Agricultural Research Service was studying the use of genetic tests for “beefing” up cattle breeding programs, as reported on USDA’s website.  Even before that, as early as 1998, geneticists, including Mark F. Allan was researching the “genetic regions linking to the twinning trait” in cattle.

Marker-assisted selection will allow breeders to increase the speed and accuracy of traditional assessment methods, but its advantages extend beyond the seedstock industry. Commercial cattle producers would be able to purchase bulls with superior genetics. The desirable characteristics in the livestock would ultimately translate into better products for consumers.

Genetic testing, when used judiciously, has helped animal and human health officials understand the spread of pathogens, such as avian influenza, so that measures can be implemented to prevent or mitigate such spread.

Undoubtedly, the use of genetic testing will continue to advance, and provide benefits to both animals and humans invested in their care.

 

Equine herpes virus-1, a sometimes deadly virus that can cause myeloencephalopathy in some infected horses (Equine Herpesvirus Myeloencephalopathy or EHM), has surfaced at one horse farm in Union County, NJ, as reported by the New Jersey Department of Agriculture on March 20, 2018 and in theHORSE on March 21, 2018.

The second horse had an elevated temperature and was showing respiratory signs, but no neurological signs were noted by the attending veterinarian.

The first horse was moved into the isolation barn on the property last week and the property was placed under quarantine. The finding of another positive horse has reset the quarantine clock and will delay the release date another three days. These are the first reported EHV-1 cases in New Jersey in 2018.

As reported by the UK Gluck Equine Research Center, designated as a World Reference Center for EHV-1 and EHV-4:

Over the past decade there has been an unexpected increase in equine herpesvirus neurologic disease (equine herpesvirus myeloencephalopathy [EHM]) incidence. Previous research by other scientists suggests a significant percentage of EHM or paralytic herpes outbreaks are caused by a mutant strain. A single mutation has been identified in the gene encoding of the viral replication enzyme, which seems to confer the power of enhanced pathogenicity (a pathogen’s ability to cause disease in an organism) or neurovirulence to such strains.

New Jersey is not a novice in managing EHM outbreaks.  As previously described, New Jersey Department of Agriculture in partnership with the New Jersey Racing Commission, private practitioners, horse trainers, and with assistance from USDA, issued and supervised a quarantine of horses boarding at Monmouth Race Track in October 2006 which lasted two months. See, Equine Herpes Virus Myeloencephalopathy-A Guide to Effective Response; and Infectious Diseases In Animals And Humans – What Is Your Legal Risk?

USDA publishes “A Guide to Understanding the Neurologic Form of EHV Infection” equine_herpesvirus_brochure_2009,  and explains  that “Equine Herpes Virus (EHV-1) infection in horses can cause respiratory disease, abortion in mares, neonatal foal death, and/or neurologic disease. The neurologic form of EHV-1 is called Equine Herpes Virus Myeloencephalopathy (EHM). The virus can spread through the air, contaminated equipment, clothing and hands.”

In USDA’s Equine Herpesvirus Myeloencephalopathy: Mitigation Experiences, Lessons Learned, and Future Needs, in which responders to the Monmouth Race Park quarantine were interviewed (including me):

Dr. Peter Timoney, Professor, University of Kentucky, Gluck Equine Research Center and Chair of the Infectious Diseases of Horses Committee of the United States Animal Health Association (USAHA), pointed out that ‘. . . within the past few years, a mutant of the wild-type of EHV-1 has been identified which evidence would indicate is very frequently associated with outbreaks of EHM. Also, this mutant has been identified among isolates of EHV-1 made prior to 2000. As the distribution of this virus mutant becomes more widespread in the equine population, the frequency and severity of outbreaks of EHM is likely to increase further unless measures to control its spread and occurrence of the disease can be developed.’

In addition to animal health issues, EHM outbreaks can result in lawsuits, as evidenced by the New Jersey Thoroughbred Horsemen’s Ass’n v. Alpen House U.L.C., 942 F.Supp.2d 497 (D.N.J. 2013), in which

Racehorse owners and association to which they belonged brought action for strict liability and negligence against owner of training facility that allegedly was source of outbreak of Equine Herpes Virus—Type 1 (EHV–1) that caused racehorses to be quarantined, which prevented them from racing.

Id.  After Alpen House lost its motion for summary judgment, the parties likely settled, but this has not been confirmed.

Research is still underway to develop a vaccine that will protect horses against the neurological form of EHV, and until completed, more outbreaks should be expected.

FDA’s recent announcement that it is “withdrawing draft Guidance for Industry (GFI) #230, ‘Compounding Animal Drugs from Bulk Drug Substances’” reminded me that pet owners can become confused about what type of medications are available for treating their pets.  For example, while serving on the New Jersey State Board of Veterinary Medicine, I recall a fair number of consumer complaints that alleged that a veterinarian provided substandard medical care because the medication prescribed to a pet was labeled “for human use only.”  Consumers therefore concluded that the medication harmed their pet.

However, the fact that medication is not specifically approved for use in animals does not mean that it would necessarily be harmful to those animals.

In fact, the use of an approved drug in a manner that is different than stated on the label, has been a fundamental tool used in veterinary medicine since drugs were first labeled.  This “extralabel” drug use was memorialized by Congress in the Animal Medicinal Drug Clarification Act of 1994 (AMDUCA).  See AVMA’s description of AMDUCA.

As AVMA describes on it’s website, “Compounding: FAQ for Veterinarians,” “compounding for animal patients . . . [is] a subpart of  [the] Extralabel Drug Use (ELDU) Rules.”

The ability to use approved drugs in species, for treatments, or at dosages, frequencies, or routes of administration that are not included on the label, is a tool that veterinarians use on a daily basis.  Since obtaining drug approvals for all uses in all types of animal species is cost-prohibitive, the only way some animals can be treated is through the use of drugs in an extra-labeled fashion.

When used properly and pursuant to the standard of care in veterinary medicine, such use should be considered legal.

While FDA has stated that “[c]urrent law does not permit compounding of animal drugs from bulk drug substances,” whether, and to what extent FDA governs compounding in the veterinary space has been the subject of legal debate.

However, FDA’s withdrawal of its guidance document related to compounding animal drugs from bulk substances creates even more confusion and uncertainty for the regulated community.  The now withdrawn guidance document,  Guidance #230, had set forth the situations in which FDA had indicated that it would not take regulatory action against a pharmacy or veterinarian when “an animal drug compounded from bulk substances may be an appropriate treatment option.”

Now, instead of finalizing the draft guidance based on comments received, “FDA intends to publish the new draft in early 2018 for public comment.”

So, the regulated community will be without guidance for a short period of time.

Hopefully FDA’s new guidance will continue to permit compounding from bulk substances when needed to provide adequate medical care for animals in need thereof.

 

Pet therapy programs have been expanding throughout the country, based largely on the increasing recognition that humans benefit from the human-animal bond.  The human-animal bond is defined by the American Veterinary Medical Association as:

a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and well-being of both. This includes, but is not limited to, emotional, psychological, and physical interactions of people, animals, and the environment.

While the IRS, in (PLR 201719018), has recently ruled “that a charity’s planned pet therapy program, which would bring trained therapy dogs to visit hospital patients and elderly nursing home residents, furthers charitable purposes under Section 501(c)(3),” that ruling does not consider or even mention public health concerns related to such programs.

“In support of its ruling, the IRS cited revenue rulings concluding that providing services to hospital patients and other individuals suffering distress in an effort to east that distress and provide them comfort furthers charitable purposes . . . [and] that activities designed to meet the special needs of the elderly may further charitable purposes.”  See Pet therapy program is a Section 501(c)(3) charitable activity, IRS rules (citations omitted).

However, no matter how well intended and “charitable” these programs are, there are serious potential public health risks from exposure of elderly, sick, immunocompromised patients to zoonotic diseases that pets can carry and transmit.  See, e.g., “Diseases you can share with your pets” previously discussed.

Those in the veterinary community understand these risks, as noted by Dr. Lucas Pantaleon, stating, the “[r]isk of zoonoses also arises with therapy dogs in human hospitals. The dogs go through screening but could bring zoonoses from the hospital back into the community.”  See “Speaker: Animal hospitals must practice infection control” reported by Katie Burns, June 1, 2017.

Researchers at Tufts University recently published the results of a “survey of United States hospitals, eldercare facilities and therapy animal organizations revealed their health and safety policies for therapy animal visits varied widely, with many not following recommended guidelines for animal visitation.”  See, “Could Therapy Animal Visitation Pose Health Risks at Patient Facilities?”, June 19, 2017.

The survey included “responses from 45 eldercare facilities, 45 hospitals, and 27 therapy animal organizations across the country on their existing policies related to animal health and behavioral prerequisites for therapy animals and Animal-assisted intervention (‘AAI’) programs.”

Alarmingly, researchers found that many programs had deficient preventive guidelines to at least minimize the potential exposure of zoonotic pathogens from pets to people, finding:

AAI programs have a potential risk of transmission of zoonotic disease—diseases spread between animals and people. This risk is especially high when health, grooming and handwashing protocols are not carefully used. Another potential risk could come from therapy animals eating raw meat-based diets or treats, which are at high risk of being contaminated with bacteria such as Campylobacter, Salmonella and Cryptosporidium. These pathogens may pose risks to both humans and animals, and especially immunocompromised patients.

Zoonotic disease transmission has also been reported in people contracting salmonella from backyard poultry, where almost one third of the 790 victims confirmed by the Centers for Disease Control and Prevention “are children younger than 5 years old.”  See “Salmonella victims from backyard flocks more than double,” Food Safety News, July 14, 2017.

The human-animal bond benefits both people and animals, especially the elderly and children, and should be encouraged.  However, proper protocols and controls should be in place to keep everyone healthy.

 

A proposed bill “authorizing the provision of health care services through telemedicine and telehealth” (S291) is now on the desk of the Governor of New Jersey for action.

The bill, which authorizes “the provision of health care services through telemedicine and telehealth” governs such services provided by veterinarians, as “[h]ealth care providers,” fails to acknowledge or provide for issues specific to veterinary medicine.  For example, several provisions require the “patient’s request” before providing health care services through telemedicine.  Clearly animal patients cannot request treatment or provide consent.  The bill fails to distinguish a “patient” from a “client” or “animal owner” or to permit such services at the request of a client/owner for the patient which is the fundamental way in which services are provided in a veterinary practice.

The bill also requires “[e]ach telemedicine or telehealth organization operating in the State . . . [to] annually register with the Department of Health” and submit an annual report providing

the total number of telemedicine and telehealth encounters conducted; the type of technology utilized to provide services using telemedicine or telehealth; the category of medical condition for which services were sought; the geographic region of the patient and the provider; the patient’s age and sex; and any prescriptions issued.  The commissioner may require the reporting of any additional information as the commissioner deems necessary and appropriate, subject to all applicable State and federal laws, rules, and regulations for recordkeeping and privacy.

Such information would be publicly accessible pursuant to the State’s Open Public Records Act, which may be of concern to biomedical research entities since reported information can reveal confidential information and trade secrets.

That said, the evolution of veterinary medicine necessarily involves telemedicine.  The American Veterinary Medical Association (AVMA ) acknowledges as much in its published “Final Report on Telemedicine” dated Jan. 13, 2017, drafted by the association’s Practice Advisory Panel (AP).

The AP concluded, in part:

Telemedicine is a tool of practice, not a separate discipline within the profession. The AP recognizes that using telemedicine in the delivery of veterinary medical services offers benefits to animal owners, animal patents, and the profession itself. The appropriate application of telemedicine can enhance animal care by facilitating communication, diagnostics, treatments, client education, scheduling, and other tasks within the veterinary profession. Practitioners must apply existing laws and regulations to the provision of telemedicine services in the state they have license to practice veterinary medicine.

The AP recommends that telemedicine shall only be conducted within an existing VCPR [veterinarian client patient relationship], with the exception for advice given in an emergency care situation until that patient(s) can be seen by or transported to a veterinarian. Without a VCPR, telemedicine should not be practiced, and any advice given should remain in general terms, not specific to an individual animal, diagnosis, treatment, etc.

AVMA’s Greg Cima outlined the issues involving telemedicine in “Defining relationships: AVMA considering what medical services can be provided at a distance” posted on May 10, 2017.

At issue is the line between advice and the practice of veterinary medicine, the very issue-in-suit in Hines v. Alldredge, 783 F.3d 197 (5th Cir. 2015) where “a Texas veterinarian . . . was found to have violated the state practice act by performing veterinary medicine without a physical examination or premises visit” when he provided advice via the internet.”

With the decreasing numbers of food animal practitioners across the country, issues of telemedicine will be increasingly important to ensure that livestock receive appropriate and timely medical care.

Companion and other animals will also benefit from the proper use of telemedicine by veterinarians, after the veterinarian-client-patient relationship has been established.

The U.S. Food & Drug Administration (FDA) regulates cancer drugs and devices, both for use by humans and pets. Such drugs and devices must obtain FDA approval or clearance before they can be marketed or sold to consumers, so that the FDA can ensure each product is safe and effective for its intended use.

Cancer treatment
Copyright: tashatuvango / 123RF Stock Photo

The FDA is concerned about the marketing and selling of products that have not been approved, particularly because such products may contain dangerous ingredients or may cause harm by negatively impacting beneficial treatments. Often such products are advertised as “natural” or are labeled as a dietary supplement, which may be a tip-off to consumers that the products have not been approved by the FDA.

We invite you to read Fox associate Elizabeth Patton’s post describing the agency’s recent efforts to combat these fraudulent advertising claims. For additional information and guidance regarding FDA-approved drugs for cancer in dogs specifically, see the FDA’s Consumer Update page.