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Wednesday, January 18, 2017

What Vets Know That Physicians Don't?

Barbara Natterson-Horowitz, M.D., is a cardiologist who has made a name for herself as a thoughtful observer of both veterinarians and the veterinary patients whose heart cases she occasionally consults on. It is not entirely surprising that an M.D. cardiologist (or, as another example,  a dental surgeon) might be asked to consult on a complex veterinary case, particularly one involving a mammal.  Those who ask her to consult believe that she  has something to add to the treatment team.

What makes her a bit more unusual is her observation that the veterinary treatment team may have something to offer the M.D.: insights often drawn from the close study of veterinary patients who demonstrate their physical or psychic pain or disease in ways that require keen observation across a breed and, even sometimes, between breeds. Wondering if certain symptoms or behaviors in humans, closely observed, might allow M.D.'s to tap into veterinary knowledge, Dr. Natterson-Horowitz has joined with a group of veterinarians and M.D.'s to pursue these interests.

You may have seen her TedMed talk or read her book.

Whether or not the "One Health" approach to clinical and veterinary medicine will lead us anywhere beyond the insight that vets and physicians might have somethings to talk about remains to be seen. But the entry of the Oncept canine oral melanoma vaccine into the animal health care market is thought provoking. Oncept is not a true  vaccine in that it is not a canine oral  melanoma preventive. Rather it is administered post-diagnosis in serial doses that appear to have some substantial success in prolonging canine lifespan post-diagnosis.  Interestingly, Oncept is reported to have been, at one point,  in joint clinical trials for possible human use. This joint canine-human drug development track is not a common story, though a number of drugs are tested on canines as a precursor to clinical drug trials involving humans. 

Oncept is not inexpensive.  The Los Angeles Times estimated in June of this past year that  a full series of four treatments cost approximately $2,800.  Clearly, many pet owners are likely priced out of this market. Pet health insurance is uncommon and, even when present, often excludes pre-existing  conditions and the coverage of older dogs.  It should be noted that these same pet owning individuals and households are likely also priced out of many of the other new cancer treatments now offered for pets (sometimes offered using medical equipment down-scaled from human cancer treatment clinics).

Just as you might imagine, households with higher incomes and greater wealth will often spend substantially more money  than low and moderate income households on a pet  nearing the end of life. A new paper by Liran Einav, Amy Finkelstein and Atul Gupta considers the expenditure differential in these situations.

Vets who deal with life-ending or gravely life-threatening illnesses like canine oral melanoma seem to have considerable experience with helping pet owners sort through the complicated issues of cost and benefit, both to pet and to household, in treatment decisions at or near the end of life.  Maybe this is what vets really know.

Posted by Ann Marie Marciarille on January 18, 2017 at 09:03 AM | Permalink

Comments

I would think that the most fruitful places for discussions, at least to start, would be with doctors that treat non-verbal patients -- babies, the profoundly mentally disabled, those far gone into dementia and so on.

Posted by: brad | Jan 18, 2017 11:47:42 AM

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