Health plans/loyalty schemes

Re: Health plans/loyalty schemes

Anita Bates — Tue, 12 Mar 2013 10:58:24 GMT

[quote user="Marie Kubiak"]

Are these health plans managed by an external company completely impartial? Or do they promote a particular flea/worm treatment? If the brand used is the one that is endorsed by an external (non-vet) company or is chosen based on discounts provided by the manufacturer then this could be an ethical issue - choosing product on factors other than efficacy.

Marie

[/quote]

As a Direct Debit provider, may I interject to say that a Health Plan should only include the products and services that a practice currently recommends in their protocols for the species and lifestyle of the pet in the plan. So, if the practice recommends worming a dog as a preventative measure with a particular brand 4 times a year then that is what the plan is priced for.

Anita

Re: Health plans/loyalty schemes

David Mills — Thu, 28 Feb 2013 09:04:36 GMT

[quote user="Arlo Guthrie"]

I don't know about tylosin, but are you a parent, David? Your post suggests the fault lies with parents for not getting children to wash their hands properly. As a parent, I can tell you it would be quite impossible to make sure that a little child does not put their hands near their mouth without washing their hands first.

[/quote]

No, thankfully not (yet) but I take your word for it. I wasn't trying to apportion 'blame' - as I said previously this is done perniciously by the 'helathy household' pharma garb - but it was a general musing on what seems to me illogical targeting of populations for prevention when simple, safe alternatives exist.

The whole worming thing is built on a lack of information, or evidence, which is what makes me uncomfortable. We (well, I, I'm sure some people do) do not know: what the prevalence of zoonoses are in the dog (and cat) population; what he infective dose is, and, based of epidemiology, what is the regional distribution and risk of human infection; efficacy of worming - not lab-based or controlled experiments of efficacy but what actually happens in the real world; the numbers needed to treat to prevent one infection; dog lifestyle and relative risk of dogs kept for different purposes; how important the dog is in the spread of infection.

[quote user="Arlo Guthrie"]I'm not meaning to be argumentative for the sake of it. But do you not think that it is morally indefensible to own a dog and NOT make an effort to ensure it is not shedding Toxocara, not just in one's own garden, but in public places where children play, such as parks.[/quote]

I think the whole point is the massive assumption that worming your dog makes a difference beyond chance. Without that information I don't think you can take a strong moral stand either way.

[quote user="Arlo Guthrie"]The risk of ocular larvae migrans may be small (and there are other sources of infection, of course), but the consequences pretty awful.[/quote]

Agreed. However, there are plenty of examples across medical science that the NNT simply cannot support widespread use of prevention based on epidemiology. For example, those with heart murmurs used to be given prophylactic antibiotics before a dental procedure to prevent endocarditis but on assessment 1) there is no statitsitically significant increase in risk for HM patients; 2) the risks associated with adverse reaction to the antibiotics far outweigh any minor benefit. However, on the surface it seems like a good idea and was accepted as such for decades because the final reuslts - endocarditis - is a horrendous sequel. But to be consistent we need to assess the risk not hook our morals to a worst-case scenario

[quote user="Virginia Campbell"]

Trocoxil, as Anthony just mentioned - given for convenience

Convenia for a cat bite abscess rather than Synulox or Antirobe

Regumate in mares and sows

Giving kennel cough vax at same time as injectable to save a visit; giving any vaccine a bit early to synchronise with the owner's other pets.

Giving kennel cough vaccine at all to save kennels the trouble and therefore owners the expense of keeping all inmates in a separate airspace

Sedating anything for a procedure that may be able to be done unsedated after half an hour of soothing by a nurse.

And even the way we do things - looking at the ops list and starting with the ones that are barking, and the ones with very intense owners that you know are going to be ringing every 5 minutes till it's done, or who want to pick it up on the afternoon school run.

[/quote].

Yes, quite. Good examples all - and there are various ethical points to all of the above. I can only see how it can improve practise and ethical responsibility by examining these situations and the weighting given to non-clinical aspects of clinical decisions.

[quote user="Virginia Campbell"]Also, is it ethical to give an animal a drug that will benefit another animal...eg worming dogs in areas of Wales where hydatid cysts are a problem to stop the sheep suffering gid? [/quote]

Well, dog worming programmes may reduce incidence but they are woeful at eradicating it. However you cannot reliably alter sheep behaviour to reduce contact so it requires assessment of the risk to the sheep of cysts and to the dog of the worming product as a start and then a judgement - clinical and ethical - on whether this can be justified.

Re: Health plans/loyalty schemes

Virginia Campbell — Wed, 27 Feb 2013 15:14:36 GMT

[quote user="David Mills"]flea/worm control is a veterinary-specific area whereas much of the rest of the stuff is not[/quote]

OK then.

Trocoxil, as Anthony just mentioned - given for convenience

Convenia for a cat bite abscess rather than Synulox or Antirobe

Regumate in mares and sows

Giving kennel cough vax at same time as injectable to save a visit; giving any vaccine a bit early to synchronise with the owner's other pets.

Giving kennel cough vaccine at all to save kennels the trouble and therefore owners the expense of keeping all inmates in a separate airspace

Sedating anything for a procedure that may be able to be done unsedated after half an hour of soothing by a nurse.

Also, is it ethical to give an animal a drug that will benefit another animal...eg worming dogs in areas of Wales where hydatid cysts are a problem to stop the sheep suffering gid?

Re: Health plans/loyalty schemes

Anthony Dennison — Wed, 27 Feb 2013 13:27:56 GMT

Going with the owner convenience theme but taking it a slightly different direction, what are people's opinion on trocoxil? This is surely a drug designed around owner convenience more than anything?

Re: Health plans/loyalty schemes

Arlo Guthrie — Wed, 27 Feb 2013 12:27:13 GMT

[quote user="David Mills"]who are we to judge tylosin as wrong when we're deworming pets because our kids can't wash their hands properly?[/quote]

I'm not meaning to be argumentative for the sake of it. But do you not think that it is morally indefensible to own a dog and NOT make an effort to ensure it is not shedding Toxocara, not just in one's own garden, but in public places where children play, such as parks.

The risk of ocular larvae migrans may be small (and there are other sources of infection, of course), but the consequences pretty awful.

Re: Health plans/loyalty schemes

David Mills — Wed, 27 Feb 2013 10:40:23 GMT

[quote user="Virginia Campbell"]We keep animals - all domestic animals - for our convenience/pleasure/benefit, not theirs. [/quote]

Possibly. But there are obvious benefits to the animal within this. Flea/worming - jury's out.

[quote user="Virginia Campbell"]Forced to its logical conclusion, if we should not do anything to pets for our own convenience, then we should not keep pets.[/quote]

I think this is excessive. I'm not saying doing things to pets for our convenience is necessarily a bad thing, but doing things purely for our convenience (or indeed aesthetic pleasure) is difficult to justify ethically if there is no proven benefit to the animal. Therefore, the logical conclusion isn't as you say. Where there is benefit to the animal - even if this is a secondary consideration - then this can be justified. This is where the spey argument falls down in that spayed bitches don't get pyos or unwanted pregnancies and have less chance of mammary tumours - yes people doing it for convenience, fine, but there is some animal benefit. This is a consequentialist viewpoint, and its applicable to flea treatment I think in that cats(dogs) probably do benefit from flea treatment by being less pruritic, but the main interest is keeping fleas out of our houses. Worming? Beyond parasitic diarrhoea in kittens and puppies? Not convinced. To then to be asked to effectively sell this as a health benefit is, I think, ethically suspect. Just like joint supplements.

[quote user="Virginia Campbell"]

The laws in different countries draw the line in different places as to what we can do to them for our on convenience: in Norway, not OK to spay or castrate unless for medical reasons (and future-gazing in a bitch that has never had endometritis/pseudopregnancy does NOT count). However, drug administration - Ovarid or Delvosterone- is deemed OK

In the US, OK to declaw cats and de-scent ferrets.

Cosmetic tail docking here was deemed OK, not deemed not-OK.

Administering Copro-nil cos you want to stop your Shih tzu eating its own shit is deemed OK.

Pets at Home has a dazzling array of products to make your dog not smell like a dog.

[/quote]

Quite. It just goes to show how ethical consideration is necessary in all human-animal interventions to stop things from getting too far. Moreover, two wrongs don't make a right

[quote user="Virginia Campbell"]I think there are more things a lot less easy to justify than flea and worm control.[/quote]

Ah, but flea/worm control is a veterinary-specific area whereas much of the rest of the stuff is not. You have control over flea / worming dispensing. To not consider the ethics of such and then to be peeved at the rest of the stuff is hypocritical - who are we to judge tylosin as wrong when we're deworming pets because our kids can't wash their hands properly? The concepts are the same, that is, convenience interventions. We cannot justifiably wave people off with a smile and 6 months' of milbemax for an 8 year old dog whilst tutting and shaking our heads at scented dog shampoo and (anaesthetised) tail docking.

Re: Health plans/loyalty schemes

CatherineThomas — Wed, 27 Feb 2013 08:41:50 GMT

[quote user="Gillian Mostyn"]

[quote user="CatherineThomas"]I agree with the products they have chosen anyway. If an individual did require something different we can substitute within reason. [/quote]

Sorry- didn't make myself clear. As has already been pointed out, all practices, big and small, make decisions on what to stock. You can't stock everything! Therefore you will always have a 'standard' product that most owners get. The biggest difference, in my limited experience, between smaller independant and larger corporate practice is the option to order something different when the situation demands it.

I am not passing judgement at all- just giving an example of when clinical freedom may be dictated by economics.

[/quote]

That's only usually a problem with brands, is we have to use metacam rather than any other version which isn't really a problem, and we have to use protexin products so can't order vet plus or others. We have advocate so don't keep stronghold in stock but can order it in for a particular client if we need it.

The only thing which is annoying me at the moment is that we've had to change to use dermastel products and their hibi scrub is fragranced and makes me itch.

Re: Health plans/loyalty schemes

CatherineThomas — Wed, 27 Feb 2013 08:41:47 GMT

[quote user="Gillian Mostyn"]

[quote user="CatherineThomas"]I agree with the products they have chosen anyway. If an individual did require something different we can substitute within reason. [/quote]

I am not passing judgement at all- just giving an example of when clinical freedom may be dictated by economics.

[/quote]

The only thing which is annoying me at the moment is that we've had to change to use dermastel products and their hibi scrub is fragranced and makes me itch.

Re: Health plans/loyalty schemes

Virginia Campbell — Tue, 26 Feb 2013 20:03:17 GMT

[quote user="David Mills"]we are using products on animals for human convenience [/quote]

We keep animals - all domestic animals - for our convenience/pleasure/benefit, not theirs.

In the US, OK to declaw cats and de-scent ferrets.

Cosmetic tail docking here was deemed OK, not deemed not-OK.

Administering Copro-nil cos you want to stop your Shih tzu eating its own shit is deemed OK.

Pets at Home has a dazzling array of products to make your dog not smell like a dog.

You can buy tylosin-containing products on the internet to make your Bichon's face white not brown.

I think there are more things a lot less easy to justify than flea and worm control.

Forced to its logical conclusion, if we should not do anything to pets for our own convenience, then we should not keep pets.

Re: Health plans/loyalty schemes

Gillian Mostyn — Tue, 26 Feb 2013 19:17:59 GMT

[quote user="CatherineThomas"]I agree with the products they have chosen anyway. If an individual did require something different we can substitute within reason. [/quote]

I am not passing judgement at all- just giving an example of when clinical freedom may be dictated by economics.

Re: Health plans/loyalty schemes

Rob Davis — Tue, 26 Feb 2013 18:04:17 GMT

This is surely a potential issue with any medications as long as we are making any profit from sales. Hopefully none of us consider how much profit will be made as part of our decision making process, but we could be open to such accusations.

Re: Health plans/loyalty schemes

Thomas Johnson — Tue, 26 Feb 2013 17:24:31 GMT

[quote user="Gillian Mostyn"]

[quote user="Marie Kubiak"]If the brand used is the one that is endorsed by an external (non-vet) company or is chosen based on discounts provided by the manufacturer then this could be an ethical issue - choosing product on factors other than efficacy.[/quote]

Isn't this always an issue with large practices/corporates/chains where decisions may be based on available wholesale discounts rather than based on what is best for the individual animal?

[/quote]

Surely it can be just as much of an issue in small practices? Different manuafacturers may offer better discounts, being part of a buying group may get you a bigger discount on some products compared to others. Just because the absolute value of the discount is lower doesn't mean the effect on practice turnover is going to be any less significant.

Re: Health plans/loyalty schemes

CatherineThomas — Tue, 26 Feb 2013 15:59:05 GMT

[quote user="Gillian Mostyn"]

Isn't this always an issue with large practices/corporates/chains where decisions may be based on available wholesale discounts rather than based on what is best for the individual animal?

[/quote]

I work in a corporate practice. The health plan is run at head office. The products involved in it are chosen by the company but I think it is done by the top vets within the company. Due to the large number of practices they can get discounts for whichever products they want. So therefore I believe the products are chosen based on clinical decisions and then discounts arranged to suit. At least I hope that is what happens. I agree with the products they have chosen anyway. If an individual did require something different we can substitute within reason.

Re: Health plans/loyalty schemes

Michael Woodhouse — Tue, 26 Feb 2013 14:59:45 GMT

[quote user="Marie Kubiak"]

Marie

[/quote]

We designed our own with whatever frequency and whatever products we wanted to use.

Re: Health plans/loyalty schemes

Gillian Mostyn — Tue, 26 Feb 2013 14:51:14 GMT

Isn't this always an issue with large practices/corporates/chains where decisions may be based on available wholesale discounts rather than based on what is best for the individual animal?

Re: Health plans/loyalty schemes

Marie Kubiak — Tue, 26 Feb 2013 13:49:33 GMT

Marie

Re: Health plans/loyalty schemes

Birte Toft — Tue, 26 Feb 2013 13:11:58 GMT

Slightly more facetiously, 14th century Europeans would probably have had no issue with that statement, being far too preoccupied with trying to protect themselves from invisible pestilential fumes, planetary configurations, and/or the wrath of God.

Re: Health plans/loyalty schemes

Rob Davis — Tue, 26 Feb 2013 12:00:41 GMT

[quote user="David Mills"](fleas pose no threat to humans, per se).[/quote]

Slightly facetious, I know, but 100 or so milllion people who died in Europe in the 14th century from the plague may disagree.

Re: Health plans/loyalty schemes

Arlo Guthrie — Tue, 26 Feb 2013 07:47:43 GMT

[quote user="robloxley"]I don't know what David's personal view is, but I rather read it as (usefully for the OP) raising some of the ethical points relevant to the OP to consider/discuss in her essay[/quote]

Rob, yes, I read it the same way. I still happen to disagree.

[quote user="David Mills"]Now this sort of marketing speak makes me shake my head and smile ruefully. I admit I haven't really looked that closely into this. I think if the drugs companies want to go down this route - and I don't think they do, actually - then they had better have some good evidence to back it up.[/quote]

David, sorry, I didn't explain myself well the first time, and now in haste as heading off to London for a meeting. But in brief, I didn't mean my words 'healthy pet; healthy family' to be interpreted too literally, and healthy was probably not quite the right word anyway. Perhaps hygienic would be better?

My point was that sure pet owners (ie me) treat their pets for their own (ie the owner's and their family's) good health/hygiene. Fleas are the classic example. And I'm sure I can't be the only person that worms the dog for the safety of my family? I don't see anything ethically wrong in that, and therefore I think it is perfectly fair (and supported) to broaden the proposition to the owner. You are not just selling the pet's health. You are selling the owner something too. I need to give more thought to the precise words to describe it, as otherwise I'll be (quite correctly) hauled up by Mr Mills!

Re: Health plans/loyalty schemes

Michael Woodhouse — Tue, 26 Feb 2013 00:01:14 GMT

[quote user="David Mills"]People that buy flea control products largely do so because THEY THEMSELVES don't want a house full of fleas, not because of any distress they think it will cause the animal.[/quote]

I spayed my bitch because I didn't want her coming into season twice a year and bleeding on the carpets. I suspect many more people do so than to prevent mammary tumors/pyos. 100% for my convenience.

Re: Health plans/loyalty schemes

David Mills — Mon, 25 Feb 2013 23:16:50 GMT

Indeed. It was a muse more than anything. Just one of those strange people who tend to like ethics.

But. Having thought about this:

[quote user="Arlo Guthrie"]

People that buy flea control products largely do so because THEY THEMSELVES don't want a house full of fleas, not because of any distress they think it will cause the animal.

[/quote]

True. So we are using products on animals for human convenience (fleas pose no threat to humans, per se).

[quote user="Arlo Guthrie"]

Likewise, the strongest reasons for worming are perhaps more to do with the risk of toxocariasis, for example.I know that's why I worm my dog, and actually consider it irresponsible for other dog owners not to do the same.

[/quote]

I don't think this is true at all, in my experience. People worm their dog because they think its healthy for the dog. Unless things were different in your day, the adverts these days aimed at pet owners have nothing to do with public health (see Drontal, for instance) - there is an implication that you are doing it for the dog's health. Which is very debatable.

[quote user="Arlo Guthrie"]

So if you are worried about the idea of 'selling' pet health, don't. Broaden your proposition to: 'healthy pet; healthy household'.

[/quote]

Now this sort of marketing speak makes me shake my head and smile ruefully. I admit I haven't really looked that closely into this. I think if the drugs companies want to go down this route - and I don't think they do, actually - then they had better have some good evidence to back it up. This line plays on all sorts of self-perceived inadequacies in parents, including whether they are harming or at least making their household suboptimally healthy in not worming their dog (ergo not joining the health scheme). Subsequently, by signing up they are ticking a mental box - "I am making my pet and household healthier" - no overridingly strong evidence for the former (as far as I'm aware) or the latter. Indeed, extension of this 'health' concept to public health opens up all sorts of further ethical issues. Are vets well voiced enough in human health implications to recommend this course of action? What is the NNT? Are their other measures equally as effective (handwashing?) that do not involve a risk to animal health (idiosyncratic drug reactions occur, albeit infrequently) for little or no benefit to the animal concerned? Should another species be given drugs for the benefit of a different species?

I admit it is disingenuous for drugs companies to market things in this way, but nevertheless it is at times an exploitation of vets' general authority on animal health by anchoring this worming/defleaing message to this authority to coerce owners into buying products that they and their pets may possibly not need to be healthy. It certainly does not go any way to answering the ethical concerns - one is still selling health either way, but the pharmas would, on your scheme Mr G, have us going out on an even more unsupported limb.

Re: Health plans/loyalty schemes

Rob Loxley — Mon, 25 Feb 2013 22:56:46 GMT

[quote user="Claire Millington"]here are a few references here to the supporting guidance to the Code on advertising and publicity so I thought it might be useful to post a link to the guidance that people are asking about[/quote]

It doesn't make any of the points raised on this issue any more clear, however

[quote user="Arlo Guthrie"]David, I think that you are missing a big point here.[/quote]

I don't know what David's personal view is, but I rather read it as (usefully for the OP) raising some of the ethical points relevant to the OP to consider/discuss in her essay

Re: Health plans/loyalty schemes

Claire Millington — Mon, 25 Feb 2013 15:12:07 GMT

here are a few references here to the supporting guidance to the Code on advertising and publicity so I thought it might be useful to post a link to the guidance that people are asking about.

It’s here: http://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/advertising-and-publicity

Best wishes

Claire
RCVS Coms

Re: Health plans/loyalty schemes

Arlo Guthrie — Mon, 25 Feb 2013 14:04:28 GMT

[quote user="David Mills"]The first must be the concept of 'selling' health. Details of each plan will vary but you are essentially laying out the ideal for a healthy pet with respect to wroming, defleaing etc. But on what evidence is this based? Who says that most cats with fleas suffer? Or that a dog wormed every 3 months is healthier than one wormed every 6 or 12 months or veterinary months (i.e. never)? Of course parasite lifecycle and drug persistence will indicate such is a good idea but you're selling health i.e. that for optimal health animals require the products at the times you say. In promoting these healthcare plans you may be mis-selling something, and the fact it is coming from a VS brings influence to bear on the client as (most) clients trust what we say. [/quote]

David, I think that you are missing a big point here.

In my experience - doing the marketing and PR for Program flea control and Milbemax wormer - the health benefit to the pet of worming and flea control was usually not the big selling point. People that buy flea control products largely do so because THEY THEMSELVES don't want a house full of fleas, not because of any distress they think it will cause the animal (which is probably going to be minimal for all but the small percentage of FAD cases).

Likewise, the strongest reasons for worming are perhaps more to do with the risk of toxocariasis, for example. I know that's why I worm my dog, and actually consider it irresponsible for other dog owners not to do the same.

So if you are worried about the idea of 'selling' pet health, don't. Broaden your proposition to: 'healthy pet; healthy household'.

Re: Health plans/loyalty schemes

Bob Russell — Mon, 25 Feb 2013 10:34:46 GMT

Our health plan is pretty good value compared to Denplan (for example). I have just cancelled my denplan because I was getting nothing back from it. It was only going to save me money if I needed quite extensive work done. The veterinary schemes I have seen are really more budgeting plans and the commercial providers have credit licences anyway.

We have lost out to some degree because we included an inflation figure that Bayer and Novartis at least trebled (10% and 7.5% respectively. It now turns out that buying Milbemax in small boxes is significantly cheaper than in the big boxes!!! A case of buy in bulk and pay more!