Cascade confusion

Re: Cascade confusion

Hannah Wynne Richards — Fri, 29 Aug 2014 10:31:22 GMT

I just hope we'll get shot of a huge block of socialists.

Wynne

Re: Cascade confusion

Bob Russell — Fri, 29 Aug 2014 09:38:50 GMT

Alex Salmond is the main reason I would not consider voting Yes (if i had a vote!). I would not trust him to balance my cheque book (and I only write a couple of cheques a year).

The polls suggest that the Braveheart mentality is moving forward at the cost of commonsense!

Re: Cascade confusion

Hannah Wynne Richards — Fri, 29 Aug 2014 09:33:00 GMT

The rest of us should become far richer if they leave - because with a bit of luck it will mean never being cursed with a high taxing socialist government again!

Wynne

Re: Cascade confusion

Liz w — Thu, 28 Aug 2014 23:46:09 GMT

Alex will just tell us that the state will pay all vet bills because the scots are lovely salt -of- the earth people who will become richer than their wildest dreams because we are swimming in oil..

Re: Cascade confusion

Bob Russell — Thu, 28 Aug 2014 17:47:32 GMT

Pork? Cheapest meat in the supermarket as long as you are not concerned about the welfare of its production!

Re: Cascade confusion

Julian Earl — Thu, 28 Aug 2014 14:11:33 GMT

Martin,Have you seen the price of pork nowadays though? :)

Re: Cascade confusion

Martin Atkinson — Thu, 28 Aug 2014 13:05:55 GMT

[quote user="Sammy82"]Going off topic here, but as far as I am aware leaving the EU is not the plan for an independent Scotland. [/quote]It may not be their plan but those in high places in the EU have already said that an independent Scotland will not remain in the EU and will have no automatic right to entry.

[quote user="Sammy82"]What really annoys me about the cascade is, as mentioned before, when vet pharma companies obtain a vet licence for well established generics e.g. Amoxicillin+Clav or Metaclopramide and the only difference in formulation is added pork flavour, the picture of a happy dog on the box and of course the price, which has suddenly tripled! [/quote]That is already a well established argument on this thread.

Re: Cascade confusion

Beats — Thu, 28 Aug 2014 11:41:34 GMT

[quote user="Malcolm Ness"]

[quote user="Liz white"]On a topical note, could be interesting if Scotland go independent, and therefore out the EU. Would they then be able to 'lose' the cascade?[/quote]

They might.

They might remove the automatic right for Europeans (including the English) to work in Scotland.

They might also decide not to recognise graduates of foreign universities like London, Liverpool, Bristol, Cambridge and Nottingham.

Ask Alec!!

[/quote]

I thought a more interesting point was if Scotland voted for independence and remained in the EU it would be necessary to issue a pet passport to cross the Scottish border.

At the border crossing in Ireland no-one bothers to enforce this EU rule, but would the remaining-UK enforce it with the same level of enthusiasm shown to the "Cascade" for pets? Certainly the RCVS would presumably have something to say about any vet foolish enough to refer a pet across the border without a valid pet passport, rabies vaccination and 3 week wait.

Neither campaign really answered this question when asked:

http://www.bbc.co.uk/news/uk-scotland-scotland-politics-26620304

Re: Cascade confusion

Sammy82 — Thu, 28 Aug 2014 11:37:33 GMT

Going off topic here, but as far as I am aware leaving the EU is not the plan for an independent Scotland. A UKIP led remaining UK is more likely to do so imho.

What really annoys me about the cascade is, as mentioned before, when vet pharma companies obtain a vet licence for well established generics e.g. Amoxicillin+Clav or Metaclopramide and the only difference in formulation is added pork flavour, the picture of a happy dog on the box and of course the price, which has suddenly tripled!

In food producing animals the cascade is important as it has the very different purpose of protecting food safety.

Re: Cascade confusion

Malcolm Ness — Thu, 28 Aug 2014 11:07:48 GMT

[quote user="Liz white"]On a topical note, could be interesting if Scotland go independent, and therefore out the EU. Would they then be able to 'lose' the cascade?[/quote]

They might.

They might remove the automatic right for Europeans (including the English) to work in Scotland.

They might also decide not to recognise graduates of foreign universities like London, Liverpool, Bristol, Cambridge and Nottingham.

Ask Alec!!

Re: Cascade confusion

vetbl.locum — Thu, 28 Aug 2014 08:57:39 GMT

Really !!

I am going to vote YES now.

But will I still be a MRCVS?

:-)

Re: Cascade confusion

Hannah Wynne Richards — Thu, 28 Aug 2014 08:53:24 GMT

YES (among all the rest of the useless legislation they'll be able to ditch.

Wynne

Re: Cascade confusion

Liz w — Thu, 28 Aug 2014 07:48:04 GMT

On a topical note, could be interesting if Scotland go independent, and therefore out the EU. Would they then be able to 'lose' the cascade?

Re: Cascade confusion

Anthony Todd — Wed, 27 Aug 2014 18:11:49 GMT

[quote user="Malcolm Ness"] why is using cheap vets bad??[/quote]

Because they are ineffective trouble and not reliable.

The corporates don't yet seem to realise that!!

But, if I had used a "cheap vet" for 50 odd years [extreme, I know but for the analogy] and he/she was effective, trouble free, and reliable then I would use cheap vets too, but they ain't, mostly.

Er, and some of the "expensive" vets, with impeccable provenance, aren't too hot, but they are rare.

Re: Cascade confusion

Malcolm Ness — Wed, 27 Aug 2014 16:04:23 GMT

[quote user="Anthony Todd"]But I wonder why you quoted [quote user="Malcolm Ness"]Mexican, Egyptian, Algerian, Korean[/quote] when I certainly haven't met or heard of one working in practice in the UK, perhaps I'm wrong???...[/quote]

I think you are right. I quote them as they could be considered analogous to the unlicensed/generic drugs that we are discouraged from using while the Aussies, Kiwis, and South Africans (at least those who qualify for a work permit) are akin to the licensed drugs. If using cheap drugs is good, why is using cheap vets bad??

Re: Cascade confusion

Anthony Todd — Wed, 27 Aug 2014 13:14:27 GMT

[quote user="Malcolm Ness"]I was. to a large extent, being Devil"s Advocate. [/quote]

Yes. I did get that bit....

But I wonder why you quoted [quote user="Malcolm Ness"]Mexican, Egyptian, Algerian, Korean[/quote] when I certainly haven't met or heard of one working in practice in the UK, perhaps I'm wrong???...

I expect the Aussies Kiwis and South Africans will be upset when they realise they don't rate a mention!

I doubt if any vets coming from any country would have had many years of experience but perhaps I'm wrong.

Unless I'm totally wrong then, the argument is not paralleled by the cascade.

It's the regulation that is at fault and the monopoly re "unlicensed" generics with the compulsion to use licensed drugs at inflated prices that is impossible to justify.

To you think Dechra are actively marketing generics 'cos Lasix is better than frusemide?

Re: Cascade confusion

Malcolm Ness — Wed, 27 Aug 2014 12:13:43 GMT

[quote user="Anthony Todd"]

[quote user="Malcolm Ness"]Veterinary surgeons are also expensive - would those who are keen to have free access to generic drugs also support a move to allow clients to have free access to unlicensed vets?[/quote]

Not really a valid argument because the drugs that are "licensed" are, in most cases, drugs that have been used safely for years, there is no extra testing, no extra safety, no extra benefit at all, just rancid profiteering.

[/quote]

I was. to a large extent, being Devil"s Advocate. However, I tend to disagree with you. There are plenty of Mexican, Egyptian, Algerian, Korean and other vets who, it could be claimed, have acted safely for years and need no further testing, etc etc but they are prevented from working in "our" market.

It can easily look to an outsider that we are being critical of the drug companies for building and defending their monopoly while getting unduly shirty when anyone suggests that our own monopoly might be reconsidered. large extent, being Devil"s Advocate. However, I tend to disagree with you. There are plenty of Mexican, Egyptian, Algerian, Korean and other vets who, it could be claimed, have acted safely for years and need no further testing, etc etc.

Re: Cascade confusion

Martin Atkinson — Wed, 27 Aug 2014 11:19:51 GMT

[quote user="Jo Dyer"] I think it causes a low level of anxiety to most of us in the profession (except the ones who just ignore it and carry on regardless, if there are any). [/quote]As if!

It is my belief that they would not dare to take anyone to court over the use of medication outside of the cascade when the medical profession are actively instructed to use generic products when available. The newspapers would love a story of a vet being prosecuted for using a proven and safe generic drug on Tiddles when Mrs Smith couldn't have otherwise have afforded the treatment and Tiddles ended pushing up daisy's, just because some drug company has found the back door to profitability.

Re: Cascade confusion

Bob Russell — Wed, 27 Aug 2014 11:13:48 GMT

We are a profession held in low esteem by government IMO. We have little clout and very few seem interested in the views of vets. How much consultation was there before the PETS passport rules were relaxed?

I have to admit to not making much effort when cascade was discussed because I did not think anybody would be stupid enough to implement such rules. I ignored the talk of SQP's and the relaxation of POM supplies because I considered someone would stop widespread and poorly controlled medicines by post.

The first place government should go for information regarding animal health should be the Chief Veterinary Officer. Sadly we have a CVO who has no real practice experience and spends little or no time interacting with his profession.

Re: Cascade confusion

Jo Dyer — Wed, 27 Aug 2014 10:43:11 GMT

[quote user="Bob Russell"]

Going back in history:

http://www.vetsurgeon.org/forums/p/5626/21662.aspx#21662

[/quote]

Blimey, who knew? Not me that's for sure, or I'd have signed it! There really is no new topic or angle on vetsurgeon.org, is there?

[quote user="Malcolm Ness"]Veterinary surgeons are also expensive [/quote]

I agree, and remembering this I usually calm down in the end after getting mad about the cascade for the nth time. However, a) the same argument clearly does not apply in the NHS, b) the difference in cost of licenced vs generic drugs probably does sometimes make the difference between treating and not treating, especially in the charity sector, and c)...

[quote user="Bob Russell"]

the profession was bullied into full acceptance of the nonsense aspects of cascade.

[/quote]

Yes, it really does feel like bullying, and it is making people like anon in the OP, unnecessarily anxious in their everyday working life. I think it causes a low level of anxiety to most of us in the profession (except the ones who just ignore it and carry on regardless, if there are any).

[quote user="Bob Russell"]The head honcho at the VMD (Steve Dean) was almost rabidly supportive of cascade, lock, stock and barrel at the time.[/quote]

Yes, and one can only speculate as to why that might be.

[quote user="Colin Thomson"]As Prof Steve Dean, late head of VMD, used to repeatedly say, the cascade is a special dispensation to the rules, and if we don't abide by it, it could go, not to be replaced by a looser framework, but by a tighter one, with no dispensation to use non licensed drugs at all. [/quote]

So, bullying by implying that if we don't behave ourselves we will get something worse. Intimidation in the form of the letter that came out a while ago, purporting to be from the wholesaler, shortly after a licensed version of a generic was launched, with implied threats of sanctions if we continued to buy the generic. (Later the wholesaler dissociated itself, saying the letter came from the drug company and not them, but still leaving the question of how they were allowed to have access to our ordering history)

[quote user="Eamon McAllister"]the chairman at Dechra, writing in his annual report, boasted publicly that the company had sourced a new income stream which involved acquiring licences for pre-existing pharmaceutical entities by a simple bureaucratic process and then selling them at a premium.[/quote]

And there we have it. Unbelievable and outrageous.

Re: Cascade confusion

Eamon McAllister — Tue, 26 Aug 2014 21:50:34 GMT

[quote user="Anthony Todd"]

[/quote]g Correct. Just after the cascade regulations became law the chairman at Dechra, writing in his annual report, boasted publicly that the company had sourced a new income stream which involved acquiring licences for pre-existing pharmaceutical entities by a simple bureaucratic process and then selling them at a premium. I was taken aback by this admission and promptly penned a letter to one of the veterinary journals which after some pressure on my part was published but "redacted" rendering it somewhat incomprehensible. I supposed that they were reluctant to upset a company with a big advertising spend.

Re: Cascade confusion

Bob Russell — Tue, 26 Aug 2014 17:27:15 GMT

Going back in history:

http://www.vetsurgeon.org/forums/p/5626/21662.aspx#21662

This petition got absolutely nothing done! The head honcho at the VMD (Steve Dean) was almost rabidly supportive of cascade, lock, stock and barrel at the time. Many at the RCVS fell meekly into line and the profession was bullied into full acceptance of the nonsense aspects of cascade.

Nobody has been charged (as far as I know) through the court system and I would happily contribute to legal costs should it ever get there. I would doubt the legal system would be so cut and dried about the unacceptability of human generics being used for pet animals. I stand by cascade for animals potentially going into the food chain.

I would happily prescribe human generics for a pet but would get signed permission from an owner.

Re: Cascade confusion

Anthony Todd — Tue, 26 Aug 2014 15:55:31 GMT

We only ever used generics that were safe, effective, and useful to our particular animals and didn't need any extra testing or licences at all.

Somehow the VMD has managed to create the aura of a licensed POM-V,when we all know that metoclopramide has been around for years and very effective it is too, we all could have told them that.

Re: Cascade confusion

Malcolm Ness — Tue, 26 Aug 2014 09:00:34 GMT

Interesting discussion and I am not sure which side of the fence I am on.

As Colin and Michael suggest, disregarding a law you don't like is not without risk. Licensed drugs are perceived as unnecessarily costly by some clients and lots of vets (let's not overlook the fact that the wholesale cost savings on generics in many practices largely disappears when the meds are "marked-up" to a price only just less than the going rate for a licensed product when it is sold to the client).

Veterinary surgeons are also expensive - would those who are keen to have free access to generic drugs also support a move to allow clients to have free access to unlicensed vets? There are loads of vets qualifying in second and third world universities who could come to UK and offer veterinary services at a fraction of the current going rate.

Re: Cascade confusion

Jo Dyer — Mon, 25 Aug 2014 22:10:50 GMT

[quote user="Colin Thomson"]I think you'd have a hard time with this one Jo.[/quote]

Don't worry, I was only joking. This campaign has Beats' name all over it (whatever that name might be)

Michael - I think the profession is much more likely to be brought into disrepute with the public by sticking slavishly to the letter of the law and doing the complete opposite of the NHS as far as generics are concerned. They already think we are money-grabbers and if they knew about this it would just reinforce that viewpoint. My NHS-employed friends and family cannot believe we have to do this, I'm sure they think I'm making it up!