Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Arlo Guthrie — Mon, 13 Jan 2020 09:19:14 GMT

[quote userid="9515" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218751"]So sorry for opening this can of worms.[/quote]

Sarah Keir - it's not a can of worms!!! It's a useful discussion about where we take things. And yes, I did realise I have to yet configured things so that it is clear what is what, hence why I said absolutely no criticism implied. With hindsight, I shouldn't have said anything - I just wanted others to know that when finished, these Expert Help forums won't allow comment from anyone and everyone! Meantime, any forum with 'Expert Help' in the title bar should be considered as open to only the original author and any referral practitioner / academia member only.

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Sarah Keir — Mon, 13 Jan 2020 09:11:18 GMT

So sorry for opening this can of worms. I had no idea this is one of your special 'ask the expert' questions. I saw the past listed in the main 'latest discussion' list and there was nothing obvious to say this was any difference. I do not have time to read all the posts been put up about the changes to the site.

You can make something fool-proof but then you have underestimated the biggest fool. (someone else's quote)

I will shut up and bow out now.

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Arlo Guthrie — Sun, 12 Jan 2020 12:02:04 GMT

[quote userid="4181" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218745"]And if it ended up being that only 'approved experts' can ask a question of the speaker, how does that alter the dynamic?[/quote]

That's not what I have proposed!

Anyone can ask question

Experts can reply

Anyone can then tangent question to discussion forum for open discussion.

If, by the approved experts, you mean the selection of GP vets approved as experts and able to reply in expert forums, they are there to give a GP take on the question, not to ask the expert further questions.

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Rob Loxley — Sun, 12 Jan 2020 11:57:51 GMT

[quote userid="8958" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218743"]then listen to a few polite questions at the end looking for clarification[/quote]

And if it ended up being that only 'approved experts' can ask a question of the speaker, how does that alter the dynamic?

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Neil Wheadon — Sun, 12 Jan 2020 10:57:20 GMT

[quote userid="2100" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218742"]

So this way we have:

Expert Help Questions: Where you pose a question and it is disseminated to experts in their field who will give you a reply, which you can read in the context of their qualifications and any evidence they point towards, and take it or leave it.

Discussion Forums: Where you can tangent a discussion point raised by an expert question for further, unrestricted discussion by anyone.

But by keeping these two sections distinct, I believe we create a much more welcoming and useful environment for experts and a much more practical tool for everyone. And you DO NOT lose the ability to challenge, discuss etc.

[/quote]

I pay £200/year on the London Vet Show for 2 reasons

Firstly I attend the lectures, listen to some fantastic speakers (those Americans are good aren't they) then listen to a few polite questions at the end looking for clarification.

Secondly I trawl the trade hall, chatting to companies, meeting up with friends where we debate and discuss anything from the latest treatment for heart disease to who had the fastest time on that static bike. In essence this is the place to challenge.

LVS is growing, it's a success, because it has all the ingredients. Arlo's idea here mirrors it and I would politely ask everyone else to 'leave the expert alone' simply because you can either take it in or ignore it, but to challenge it needs to be done in a certain way and an internet forum needs far more skill than a face to face as you loose all the nuance that body language provides. Am I typing this smiling or hunched over hammering the keys? Any experienced vet can tell you that from doing a zillion consultations.

Give it a chance.

Neil

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Arlo Guthrie — Sun, 12 Jan 2020 10:37:06 GMT

[quote userid="4181" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218739"]I thought you were a proponent of evidence based medicine, as opposed to just eminence based medicine? To suggest there is not much in our knowledge that is not open to discussion, questioning, searching for the evidence behind statements seems a little rash? PS this is no dig at Mark.[/quote]

Rob, I don't think of these things as black or white choices. I think there are three main factors here.

One is about the false equivalence that the internet gives the opinions of different people, and the lack of transparency online, which I wrote about here. It's not that I believe in eminence-based medicine. But I do believe that people who have studied a subject in more depth deserve to have their opinions and advice elevated above the hubbub.

Second is the massively important point that Neil alluded to earlier. There's something about posting advice or opinions online which seems to invite criticism; or the contrary view, almost regardless of the merit of the contrary view. ie being difficult almost for the sake of it. And the limitations of the written word mean that challenging / questioning etc can so often appear to be being just bloody minded, which can understandably be deeply off-putting for a specialist. Or, as I said earlier, they just don't have the time to engage in detailed discussion.

I feel strongly that we need to be pragmatic, to recognise these things, and make the Q&A forums a much more appealing environment for experts.

The third is the problem of subjects going off-topic. It is a BIG problem for those people who asked the question. I hear it all the time. It's annoying when you ask a question and it gets completely diverted off to steroids. This new Expert Help section is designed to be a useful professional tool, which practitioners can use to get a quick answer from people who know what they are talking about. Not a stream of: "Well I would have used steroids."

Oh, and another thing, the questions in our Expert Help Forums will form part of a knowledgebase, and if we have unfettered discussions going off right and left, it will reduce its usefulness (ie you search for the answer to a question, and this way you'll find it without having to read off-topic stuff).

but ... OF COURSE I agree with you that everything should be open to discussion, and I am not suggesting otherwise.

Which leads me to my third point, which is that I think you are thinking of the Expert Help Forums in isolation. As I said, they run in parallel to the normal discussion forums, and the idea is that you can tangent a Q&A from the Expert Help forum into a discussion forum, where the subject can be debated with everyone, and the expert can decide whether they want (or have the time) to engage further or not.

So this way we have:

Discussion Forums: Where you can tangent a discussion point raised by an expert question for further, unrestricted discussion by anyone.

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Rob Loxley — Sat, 11 Jan 2020 18:28:28 GMT

I thought you were a proponent of evidence based medicine, as opposed to just eminence based medicine? To suggest there is not much in our knowledge that is not open to discussion, questioning, searching for the evidence behind statements seems a little rash? PS this is no dig at Mark.

As for the question asked here, I remember when this came up before reading the licensing submission which provided some answers:
"No dose determination/confirmation studies have been performed by the applicant. The proposed oral dose of meloxicam (0.2 mg /kg body weight induction dose followed by a once daily dose of 0.1 mg/kg body weight for two additional days) was supported by expert opinions and published data from uncontrolled studies and case reports using doses ranging between 0.1 and 0.5 mg/kg administered once or twice daily. Safety and efficacy with respect to pain relief of meloxicam was not objectively evaluated in the studies provided.
Given that this application is classified as MUMS (minor-use-minor-species), the approach to dose selection was considered adequate. The efficacy of meloxicam when administered at the selected dose was evaluated in a single laboratory study" (which looked at feeding behaviour as a surrogate marker of postop pain).

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Arlo Guthrie — Sat, 11 Jan 2020 10:58:53 GMT

[quote userid="4181" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218733"]

Arlo Guthrie said:
Not a criticism

It does rather read as such I'm afraid...

[/quote]

Really - nothing could have been further from my mind. Hence the addition of the exclamation mark, and the stuff I appended. Sarah Keir If it read that way, I am extremely sorry, it wasn't meant to!

[quote userid="4181" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218733"]But if you navigate from the main forums page https://vetsurgeon.org/f/ to here it is very non-obvious that you wish to restrict who replies[/quote]

At the moment, Rob, yes that is very true. I haven't yet configured the Q&A page, or thought more about how I differentiate Q&A pages.

[quote userid="3169" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218734"]I thought you said originally that once the expert had replied it would be open for discussion. The 'experts' can be wrong too and being able to question or challenge what they say needs to be a part of this too, no?[/quote]

Yes and no. Yes, that idea was floated, but no, I had not said anything is yet cast in stone. Partly the reason for this discussion.

The first thing I wanted to establish is: Do you all like the broad principle of the Q&A format, where as a GP you can float a question in front of a group of experts, and as a referral practitioner, you get proper recognition for your help (with the addition of the logo / contact details in an verified.

Michael Woodhouse are you liking it thus far? Anyone else.

If good thus far, then we need to consider these other issues.

First, it is important to stress that these Expert Help Forums don't replace our normal discussion forums. You're not losing the ability to discuss things as before.

This is an additional feature that in my survey last year, I think it was 50% of you said you would like!

One of the problems in the past (and it is still is today) is that with the limitations of the written word, the act of challenging and questioning so often becomes adversarial, almost like bear baiting. I like the purity of the idea of: Here is my question, does anyone know the answer. Full stop. And for the only person to be able to engage in discussion about the answer being the author of the question. This keeps the tone friendly. The question author is after help (so will remain courteous). The Expert will have their logo attached, and you want your business to be associated with helpful, knowledgable answers.

This format keeps discussions more on topic too. Much less possibility of a diversion into steroids.

And finally, good quality scientific discussion means knowing the credentials of the people sharing their experience, advice, information etc. It will be a requirement for any referral practitioner taking part to complete their profile. Again, upping the standard in the Expert Help Forums.

BUT ...

Yes, I do agree with you that of course experts sometimes get things wrong, and stuff needs to be open to challenge.

So the way I think would work best is the other idea that was floated earlier. Which was that anyone could tangent a discussion from an Expert Help Forum into the associated discussion forum.

The Expert might or might not decide to engage. They've given their answer in the Expert forum and some might be minded to say 'take it or leave it' (maybe they just don't have the time to debate in depth, but just want to help by giving an opinion).

With a new platform, a lot of this stuff requires additional programming to achieve, which only becomes clear after deploying the upgrade (if I had all the money in the world, I'd have a bank of testers finding all this stuff out for me before I launched, but I don't).

At the moment, and after some discussions with software HQ in America, we do not have a way to restrict discussions automatically to the OP and experts (it can only be everyone or no-one), but it would be relatively easy to implement. Also, to tangent a discussion at the moment, you need to be able to reply to it. Again, I think we can close that hole and make tangent open to anyone.

And as I was writing this, I saw the thing flash up to say Neil was typing too (I like that!). And he's saying exactly the same as me, but in fewer words!

[quote userid="8958" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218735"]Better maybe to Tangent it without reference to the original expert and let it run it's course, so everyone wins?[/quote]

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Neil Wheadon — Sat, 11 Jan 2020 10:52:14 GMT

[quote userid="3169" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218734"] The 'experts' can be wrong too and being able to question or challenge what they say needs to be a part of this too, no?[/quote]

There in lies the problem. On the one hand we like a discussion, however the major thing I want to see is an informed answer.

In the case of Mark and hopefully? other vets that have a deeper knowledge the last thing they want is all of us saying 'you know what you're wrong on that' and the discussion spiralling away. All this will do will be to drive an expert opinion away. It's a bit like me as a dairy farmers son and a former large animal vet questioning why on earth would you toggle a displaced abomasum when in my day we 'rolled them' and that was that.

Better maybe to Tangent it without reference to the original expert and let it run it's course, so everyone wins?

Neil

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Michael Woodhouse — Sat, 11 Jan 2020 10:23:14 GMT

[quote userid="2100" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218720"]The idea (as it stands at the moment) is that you should not be replying in Expert Help forums! Only referral practitioners, and approved experts should reply in these threads. [/quote]

I thought you said originally that once the expert had replied it would be open for discussion. The 'experts' can be wrong too and being able to question or challenge what they say needs to be a part of this too, no?

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Rob Loxley — Sat, 11 Jan 2020 10:19:51 GMT

[quote userid="2100" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218720"]Only referral practitioners, and approved experts should reply in these threads[/quote]

But if you navigate from the main forums page https://vetsurgeon.org/f/ to here it is very non-obvious that you wish to restrict who replies

[quote userid="2100" url="~/001/veterinary-clinical/exotics/f/expert-help/28787/why-is-the-licenced-dose-of-metacam-in-guinea-pigs-far-lower-than-experts-suggest/218720"]Not a criticism[/quote]

It does rather read as such I'm afraid...

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Arlo Guthrie — Fri, 10 Jan 2020 16:57:51 GMT

Sarah Keir The idea (as it stands at the moment) is that you should not be replying in Expert Help forums! Only referral practitioners, and approved experts should reply in these threads.

Not a criticism, I'm just setting this all up, and finding my way as I go. It turns out that we don't currently have a way of restricting replies to experts. But we can add something that will do that, and in the meantime it will become clearer when i segregate Q&A from discussion forums.

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Sarah Keir — Fri, 10 Jan 2020 15:02:04 GMT

Non-inferiority trial?

RE: Why is the licenced dose of Metacam in Guinea Pigs far lower than experts suggest/

Mark Rowland — Thu, 09 Jan 2020 20:46:18 GMT

Its a get it licensed thing.

Firstly the work wasn't done in rabbits as they are food producing animals so the rules are different.

Trials were at a lower dose.

Safety was proved so thats how they got the license.

There is a discretionary clause in the data sheet to allow for a higher dose. I start at 0.5mg/kg bid.

Hope that helps