Maybe there is a God...(until you read the fine print)

Re: Maybe there is a God...(until you read the fine print)

Martin Atkinson — Fri, 14 Sep 2012 12:50:05 GMT

[quote user="Jane Adams"]Oh dear. That was my attempt at shining wit at 3am this morning after I'd just finished work. Just to be clear I do not think anyone is playing God. I promise not to subject anyone to my dreadful attempts at humour again[/quote] Surely you've been on this forum long enough to know that anything you write, especially if it is an attempt at humour or tongue in cheek, will open the proverbial can of worms. The nit picking over interpretation of definitions within the text goes to prove this. Some people are anally retentive (I don't necessarily exclude myself from this)

Re: Maybe there is a God...(until you read the fine print)

Jo Cobbett — Fri, 14 Sep 2012 12:03:33 GMT

I think the Animal Health Trust are offering fixed price spinal work ups and treatment, which includes MRI and surgery, and covers any complications/ongoing costs. They don't use the word guarantee, but in effect it's the same sort of thing. They also do something similar for cruciate surgery I think.

Re: Maybe there is a God...(until you read the fine print)

James Laidlaw — Fri, 14 Sep 2012 11:36:01 GMT

It actually says that if malignant they will be able to guarantee resection of the primary mass and guarantee against local recurrence, but not against new distant lesions as I read it.

I don't see this as being unethical, just slickly worded marketing, and a support crutch for owners who might otherwise leave something to develop as they have concerns with surgery - thereby maybe avoiding those masses that come in at the size of a football that can happen...

Re: Maybe there is a God...(until you read the fine print)

Rajat — Fri, 14 Sep 2012 11:24:55 GMT

[quote user="Martin Atkinson"]even the definition of cancer[/quote]

I looked again but didn't see this anywhere

basically what they are saying(to my eyes) is if we are removing a mass with the intention of curing your dog- if we screw up or do not remove it fully, we will pay for everything or refund you. So if the mass is a lymphoma enlarged lymph node- no we cant cure your dog. But if it is a solitary benign or malignant mass ( I did not see them make this differentiation that they will only guarantee benign masses) which they say they can remove in entirety (and hence cure the dog tho I agree bit emotional here) then they will bear the cost if the mass recurs.

For fine print it is,IMHO, actually in a normal font, if you get what I am saying!

Re: Maybe there is a God...(until you read the fine print)

Rajat — Fri, 14 Sep 2012 11:19:02 GMT

Oh I was just checking, sorry I didn't get the joke :)

[quote user="Jane Adams"]Personally my only issue is with the idea of 'fine print'. And it is purely a personal hatred for the concept. I've always felt that someone's been trying to pull the wool over my eyes when I see lots of fine print. I don't pretend it's a rational response [/quote]

I hate fine print too- reading this fine print, I don't think it is terribly unreasonable though, just my opinion.

[quote user="Jane Adams"]I'm also not entirely convinced that resecting a neoplasia with clean margins is 'curing cancer'[/quote]

I reckon it is if it does not recur (but very emotive- I agree) -but there are so many shades of gray from the simple lipoma to the horribly invasive liposarcoma.

Very innovative and a way to put people's mind at rest is the way I saw this - maybe allows for the decision to be made more easily for some ppl..?

Re: Maybe there is a God...(until you read the fine print)

Martin Atkinson — Fri, 14 Sep 2012 09:37:47 GMT

[quote user="Rajat"]I don't see a problem with this. It is a way of reassuring owners and putting the money where the mouth is. We know, that the lipoms/cyst/mast cell tumour (grd1-2) and other such masses fully removed should not recur if adequate surgical planning and margins are obtained.[/quote] This is exactly why I do have a problem, if you read the small print again they have covered themselves against virtually every eventuality, even the definition of cancer, so in effect they are guaranteeing benign lumps which are not likely to recur anyway, if they suspect it may recur even clause 1 doesn't apply. Sorry but I think it is sneaky.

Preoperatively, we must tell the owner that we are performing curative-intent

surgery. In other words, if we tell the owner we can cure the pet's primary

tumour, this guarantee applies and owners will receive a certiﬁcate.

• We may require a CT scan before initial surgery to determine if the tumour is

removable.

• This guarantee only applies to the return of the same type of tumour in the same

location, conﬁrmed by a specialist pathologist. If the biopsy indicates no

recurrence, the fees associated with the biopsy are borne by the owner.

Obviously, if there is tumour recurrence, the fees for the biopsy are borne by us.

• It is important to recognise that many tumours have two distinct behaviours, their

potential to recur in the same spot, and the possibility that they have already

spread microscopically to other parts of the body. The treatment of the primary

tumour does not affect the possibility that it had already spread by the time the

primary tumour is treated. This guarantee does not apply to spread of the tumour

to other parts of the body which may already have occurred microscopically by

the time of surgery.

• Mast cell tumour recurrence is deﬁned as a tumour or tumours which have

recurred on or within the original surgical scar

Re: Maybe there is a God...(until you read the fine print)

jd2008 — Fri, 14 Sep 2012 04:26:38 GMT

I'll explain:

I actually have no problem in general with this and agree it's a smart bit of marketing in a crowded market. I am simply intrigued because I haven't come across this approach being taken in marketing veterinary services before.

I don't actually know Dr Kuntz but it is clear that he is an extremely well qualified and accomplished surgeon and oncologist. I wonder if anyone would feel differently if it was a 'normal' GP vet using this marketing approach?

[quote user="Rajat"]I am a bit confused, and wondering what I am missing- -[/quote]

You're not missing anything Rajat. I am, genuinely, just curious. Simply because, as I said, I haven't come across a marketing technique like this before and the reaction to this amongst colleagues and non-vet friends has been very mixed. For my part I have absolutely no axe to grind.

Maybe I should have explained myself in my initial post but I didn't want to inject any sort of bias into the discussion.

Personally my only issue is with the idea of 'fine print'. And it is purely a personal hatred for the concept. I've always felt that someone's been trying to pull the wool over my eyes when I see lots of fine print. I don't pretend it's a rational response

I'm also not entirely convinced that resecting a neoplasia with clean margins is 'curing cancer' which is a very emotive phrase. (and yes, I know the fine print covers this) but hey-ho

[quote user="Rajat"]why do you think they are playing God here Jane?[/quote]

Oh dear. That was my attempt at shining wit at 3am this morning after I'd just finished work. Just to be clear I do not think anyone is playing God. I promise not to subject anyone to my dreadful attempts at humour again

Re: Maybe there is a God...(until you read the fine print)

Alastair Franklin — Fri, 14 Sep 2012 02:12:06 GMT

I think it all comes down to marketing spin and balance of probabilities & is not unethical or unprofessional. Personally, I think it's a smart marketing move; as Evelyn pointed out above, this may encourage more clients to go for surgery. To put it into a bit more perspective, the Melbourne surgery scene is quite competitive at the moment, so this may well help the practice.

(As a disclosure, I know some of the staff at the clinic, and they are a friendly, smart and skillful bunch)

Re the T/L spines - the fact they have excluded the deep-pain negative dogs puts them in a low-risk situation. Some of the wording though could be slightly concerning if you are being very pedantic - eg the issue of recurrent rupture at the same site. Recent papers have shown that this is more common than once appreciated, and furthermore that in a lot (most?) cases residual disc material may be left behind. So, if they were in a pet insurance company type mood, they could use the small print to exclude some cases. However, I think their integrity and honesty would mean they wouldn't do this - and anyway, this would uncommonly become a clinical issue.

I don't know their pricing structure, but if they encourage all patients to undergo physio, (from personal experience there is often unfortunately low uptake on this if you give the owners the choice), that is more income that could easily offset the rare cases that need to invoke the guarantee clause. Similarly, if they CT every tumour.....

Re: Maybe there is a God...(until you read the fine print)

Evelyn Barbour-Hill — Thu, 13 Sep 2012 23:26:34 GMT

It's one of those sayings in oncology that an excised tumour never recurs at the same site – if it grows again, it hasn't "recurred", it's regrowing from the bit you left behind. These people are obviously very confident in their surgical technique. I'll bet the surgery is done no-expense-spared and the cost of a rare failure can be absorbed. It seems perfectly ethical and professional and may well persuade an unsure owner to go ahead.

I'm not too knowledgeable about spinal surgery, but I'd guess the same applies there.

Re: Maybe there is a God...(until you read the fine print)

Rajat — Thu, 13 Sep 2012 20:55:38 GMT

I don't see a problem with this. It is a way of reassuring owners and putting the money where the mouth is. We know, that the lipoms/cyst/mast cell tumour (grd1-2) and other such masses fully removed should not recur if adequate surgical planning and margins are obtained.

Similarly for spinal surgery- obviously most of their dogs are walking by day 30. Now if 1 is not ambulatory- they may have to shell out the refund, but it may have convinced far more people to bite the bullet and have it done. So financially I don't think this will be a bad approach.

Not unethical either, to my eyes... I am a bit confused, and wondering what I am missing- - why do you think they are playing God here Jane?

Re: Maybe there is a God...(until you read the fine print)

Martin Atkinson — Thu, 13 Sep 2012 18:50:39 GMT

On the basis of the cancer one maybe I'll start guaranteeing that every animal I see will live forever. Unless it gets: cancer, heart disease, renal failure, shortness of breath etc etc in fact everything except being struck by lightening or hit by a bit of falling space debris. The spinal one seems a bit more reasonable.

Re: Maybe there is a God...(until you read the fine print)

Rob Loxley — Thu, 13 Sep 2012 18:33:50 GMT

I'm guessing they have the knowledge and expertise to make such 'guarantees' and know what their risk is. I'd advise the owner to understand the small print (and be prepared to pay for the CT scan, and are clear that it will be the referral centre assessing whether the tumor might be removable and whether they have complied to the letter with the spinal postop instructions); and to know what the upfront cost will be if the procedure is successful. But if they are somewhere you'd refer to anyway at a sensible cost with good outcomes then it seems a good proposition.

A few referral centres in the UK are doing fixed-price procedures including revision of complications (e.g. TPLO) but this seems to go further than what I've seen, particularly for procedures which might have a less predictable outcome - or am I wrong to be less confident in predicting whether a lump will never return or a dog always walk again?