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Veterinary Controversies

Veterinary Controversies

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20TH ANNIVERSARY
Compendium 
December 1999
than the traditional focus on vaccina-tions—has arisen.
 Alternative Therapies
 As in human medicine, themain arguments againstalternative therapies in theveterinary field are the lack of reliablescientific studies on the effectivenessof these therapies, the lack of stan-dardized protocols for administeringthem, not knowing whether any in-herent side effects are associated withsuch therapies, and the fear that usingthem may delay conventional thera-py. Conversely, alternative therapiesmay complement conventional thera-py, thereby minimizing the use of medications with known adverse ef-fects. In addition, even if alternativetherapy alone does not completely treat or cure a disease, it may ease ananimal
s suffering. As owner interestin alternative therapies grows, veteri-narians are being forced to offer thisoption to their clients or lose them topractitioners who do. The questionthen arises: Who is qualified to pro-vide these therapies? Should such al-ternatives as acupuncture or chiro-practic manipulation be administeredby veterinarians only, or can trained
D
uring 1999,
Compendium 
celebrated 20 years of publication by ex-amining how various fields of veterinary medicine have advancedover the past two decades and considering where they are headedin the future. Technologic advances, development of new drugs (or new uses for existing agents), scientific discoveries, and shifting public opinion will continue to affect veterinary medicine; as the field evolves, controversy  will continue to arise regarding the benefits and dangers associated withnew or changing practices. To wrap up our 20th anniversary celebration,this month
Compendium 
looks toward the future and topics that are likely to be debated well into the next century. We polled various experts on cur-rent controversies, and their opinions are the source for this column. We donot propose to settle any disputes but rather to present both sides of somepotentially contentious subjects.
a
 Vegan Vets?
Many veterinary students who have entered the profession becauseof their fervent concerns about animal welfare are strongly opposedto food animal agriculture; such students and graduates are leadersin the fight against
factory farming
and promote vegetarianism. On the otherside are veterinarians who are leaders in the food animal industry, are responsiblefor much of the industry 
s expansion and adaptation of technology, and havelobbied for improvements in how the industry treats food-producing animals.The veterinary profession may be forced to address this issue, particularly in vet-erinary colleges where faculty need to present course material to all students,even those who find the subject offensive.
 Vaccination Protocols
For years, practitioners have relied on annual vaccinations asboth a way to guarantee that animals receive routine healthchecks and a solid source of income. Recent recommendations that some vac-cines do not need to be boostered as frequently as once thought have raised con-cerns. Whereas some veterinarians believe that the overall health care of pets willsuffer if animals do not need to be vaccinated for some disease each year, othersquestion whether data from a study investigating the duration of immunity con-ferred by a specific vaccine can be extrapolated to other vaccines. Supporters of the revised recommendations argue that the emergence of vaccine-induced sar-coma indicates that vaccinating less frequently is a prudent step; there is also abelief that vaccinating too frequently hyperstimulates the immune system, po-tentially leading to the development of allergies or other diseases. Amid the con-troversy, a new emphasis on educating owners about the need for yearly physicalexaminations and the long-term value of routine preventive health care
rather
On the Horizon
VeterinaryControversies 
a
The editors of 
Compendium 
realize that many controversial topics are not presented here.Readers interested in preparing a column that discusses the pros and cons of a particulartopic in more detail should contact the appropriate species editor.
 
lay people provide them? If the latteris allowed, how closely should lay peo-plebe regulated and/or monitored,and how much training, licensing, re-gistration, oversight, and other restric-tions should apply?
Is There a Dentist in the House?
Should equine dentistry berestricted to licensed veteri-narians? Those who answer
yes
argue that veterinary dentistry involves the practice of veterinary med-icineand that many horses requirechemical restraint or diagnostic proce-dures (e.g., radiography, nuclearscintigraphy) that are available only through veterinarians. Conversely,many veterinarians would prefer to letsomeone else do the work.
Is Newer Better?
 When a new procedure becomesavailable, should veterinarians aban-don traditional techniques in favor of emerging technology? For example,carbon dioxide lasers are being usedto perform onychectomy in cats be-cause of the improved pain and hem-orrhagecontrol seen immediately aftersurgery compared with conventionaltechniques. Some veterinarians alsocite the potential for less stress to catsbecause the paws do not need to bebandaged when lasers are used. How-ever, beginning approximately 3 daysafter surgery, tissue necrosis occurs atthe site of the laser cut. Infection,hemorrhage, or dehiscence may occurin cats that are not properly confinedand kept away from litter, and digitalpad necrosis that results in a smaller weight-bearing surface can lead tolate protrusion of the second phalanx.
Trauma-Induced Cardiac Arrhythmia 
Many dogs develop car-diacarrhythmia from se-vereshock or trauma,and clinicians disagree on how 
or whether
to treat this condition.Some clinicians provide aggressiveantiarrhythmic therapy, often viaconstant-rate intravenous infusion, whereas others prefer to treat mostof these patients with cage rest and
benign neglect
unless there is defi-nite evidence of hemodynamic im-pairment. Among the reasons forthis
hands-off 
approach is the con-cern that antiarrhythmic agents may have proarrhythmic effects that ac-tually aggravate or enhance existingarrhythmias. This phenomenon is aconcern in humans, but whether itoccurs in dogs is open for discussion.
Food Animal Medicine
Events and pressures affect-ing the North American ag-ricultureindustry may shapethe world of food animal medicine in ways that are difficult to predict. Pro-duction agriculture will be caught be-tween the intense need for more foodproduction in the coming decades andincreased concern about the environ-mental impact of farming methods. Asagricultural markets become globaland concentration of the industry continues, many practitioners face po-tentially rapid reductions in theirclient base and changes in the types of services demanded. The profession isbeing caught in cultural conflicts (e.g.,animal welfare, production systems,farm ownership, use of genetically modified organisms) about how foodproduction should be organized. Inaddition, some have expressed con-cerns about the concentration of pow-er in fewer marketing channels. Theseand other factors will place intensepressures on practitioners to addressissues and participate in debates ontopics that previously were never seenas the purview of veterinarians. Differ-ing value systems (in producers, con-sumers, and practitioners themselves) will place a premium on the need foropen, science-based consideration of the trade-offs that will have to bemade to find a middle ground amongthese competing interests.
Neither a Food nor a Drug 
Pet owners are buying nutra-ceuticals,herbal remedies,and other
natural
medi-cines for both themselves and theirpets. Few studies have investigated
Compendium 
December 199920TH ANNIVERSARY
the efficacy of these products in any species, and at least one (i.e., col-loidal silver) has been found to behighly toxic. How do veterinarians de-cidewhich products to recommendor discourage, and how do they coun-selclients without alienating them?
Use of Medication inPerformanceHorses
 As horses age, injury andother insults can limit ex-pectations for athletic per-formance and enjoyment as well asquality of life. Performance-enablingmedications can assist horses andtheir owners in the controlled pursuitof pleasure use and athletic potential.However, medications that may mask an injury or illness have the potentialto exacerbate the condition and puthorses at risk of greater harm. Withmedication comes the risk of compli-cations (e.g., phenylbutazone and ul-cers),and the question is raised wheth-ermanipulating horses with drugs isserving goals that are not in thehorse
s best interest.
Endocrine Disease in Ferrets
 Adrenal gland disease and insulinomaare
recent
conditions in ferrets. Isthis because of inbreeding, improperdiet, or early spay/neuter (i.e., before 6 weeks of age)? Or are these diseases be-ing seen more frequently because fer-rets have become popular pets and arenow exhibiting
old age
diseases neverencountered in laboratory ferrets?
Donors Wanted 
Veterinary medicine is be-coming more sophisticatedin its knowledge of trans-plantation techniques. The basicproblem is the ethical and moraldilemma of how to procure organs.Kidney transplantation in cats, forexample, is now routine; unlike inhuman medicine, however, organscannot be obtained from a healthy and willing relative or a terminal ac-cident victim. Instead, donor organscome from shelter cats or from othercats owned by the recipient
s owners.Some veterinarians question whether

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