Cascade Nonsense again!!!

Re: Cascade Nonsense again!!!

Bob Russell — Thu, 26 Aug 2010 16:56:23 GMT

[quote user="Tanya Fielding"]

I have a client who works in the local doctors surgery and could just help herself to tramadol from the shelf for her dog I was very uncomfortable about this but nothing I could do to prevent her.

[/quote]

I would suspect instant dismissal would be on the cards if found helping herself to POM's at a doctors surgery!!!

Re: Cascade Nonsense again!!!

Tanya Fielding — Thu, 26 Aug 2010 16:46:33 GMT

I have a client who works in the local doctors surgery and could just help herself to tramadol from the shelf for her dog I was very uncomfortable about this but nothing I could do to prevent her.

Re: Cascade Nonsense again!!!

Colin Cameron — Fri, 20 Aug 2010 12:54:41 GMT

I do agree with many of the comments on this thread, including that the supply of veterinary drugs through internet pharmacies outside the EU with no control on importation has made a complete mockery of the current regulations. Unfortunately our profession is once again holding the wrong end of a very smelly stick.

Re: Cascade Nonsense again!!!

Colin Cameron — Fri, 20 Aug 2010 12:43:10 GMT

[quote user="Bob Russell"]He is allowed to give any medication he wishes to his own animal as long as it does not cause suffering.[/quote]

Even POMs not having a veterinary authorisation?

Re: Cascade Nonsense again!!!

Bob Russell — Fri, 20 Aug 2010 11:50:55 GMT

I suspect that the offence he is committing is that he is dispensing a POM product that he is not authorised to dispense - there are some medicines they can prescribe (morning after pill, viagra (apparently!!!!) some weight control products) but thyroid medication is not going to be one of these.

Neo-mercazole can only be dispensed against a valid doctors or veterinary prescription. He is allowed to give any medication he wishes to his own animal as long as it does not cause suffering. He is not allowed to prescribe this medication.

Big thing though is to decide if it is worth the hassle. It is possible to get almost any medication on the internet without prescription.

If we find someone is using 'POM's' obtained through unorthodox routes we have to decide if they can be 'trained' to do things right. We get a disclaimer signed but for those who choose to ignore all our warnings we suggest they may be happier at another practice. All details go onto the notes for the next practice to decide if they wish to take them on as clients.

If we were to identify the source of the drugs we would inform the VMD. They do not seem to serve much of a useful role but this is their responsibility.

Perhaps dropping a quiet line to the VMD would be in order.

Re: Cascade Nonsense again!!!

Colin Cameron — Thu, 19 Aug 2010 23:42:23 GMT

My last comments are that I do not agree with you. The pharmacist is still prescribing and dispensing a drug. I will stand corrected if the VMD can verify that he is acting legally. Read the regulations.

Re: Cascade Nonsense again!!!

Richard Carter — Thu, 19 Aug 2010 23:19:21 GMT

the law is quite clear on ownership - you are entitled to do anything you want to your own animal(s) as long as you do not cause any welfare issues. However should you lean over the fence and advise your neighbour, you have strayed onto the veterinary patch in making a diagnosis and if some of your own neomercazole makes its way down the alley to said neighbours cat, then you will (or should) be up to your eyeballs in the smelly stuff.

Re: Cascade Nonsense again!!!

Colin Cameron — Thu, 19 Aug 2010 23:08:07 GMT

[quote user="Richard Carter"]he can give it anything he wants[/quote] No need to get bolshie, I was only asking and making a light hearted comment! My reading of the law in question, the Veterinary Medicine Regulations, would suggest that you may not be wholly correct. It is my understanding that he cannot give his own cat anything he wants as only a Veterinary Surgeon is permitted to prescribe POM-Vet products or Non licenced ones under the cascade. Perhaps he has a prescription to that effect from his vet. What training has he had in veterinary medicine to make his decision? Why do you think he is being clever or are you happy to condone this loss of trade to a member of a profession who have wanted to have complete control of veterinary medicine dispensing for many years and who have stated publicly that they think they are ideally placed to advise on animal pet welfare despite their probable lack of appropriate training. So what are vets for? Whether we like the cascade or not we are legally bound by it under the aforementioned regulations. Unfortunately a number of vets seem to think that they can do what they like as well, but don't get me started on this one.

Re: Cascade Nonsense again!!!

Richard Carter — Thu, 19 Aug 2010 23:02:04 GMT

which law? - it's his own cat - he can give it anything he wants. It may be contravening some dispensing codes but otherwise it appears he is using his training to recognise generic products.

Re: Cascade Nonsense again!!!

Colin Cameron — Thu, 19 Aug 2010 17:43:32 GMT

[quote user="Michael Woodhouse"]Our local pharamcist gives his cat neomercazole from his shelf. [/quote]

As this is not a licenced vetetrinary medicinal product I am asuming that it has been prescribed by a veterinary surgeon under the cascade, in spite of there being two licenced veterinary products. Otherwise is he not breaking the law!

Re: Cascade Nonsense again!!!

Bob Russell — Sat, 07 Aug 2010 13:47:28 GMT

102 signatures from the vociferous minority now - some 'big' names - wow!!!!

Re: Cascade Nonsense again!!!

Kate Richardson — Wed, 04 Aug 2010 22:16:45 GMT

[quote user="Clive Ansell"]Wouldn't mixing with food or direct dosing be easier?, said cat may not always go on to shelf. [/quote]

Re: Cascade Nonsense again!!!

Clive Ansell — Wed, 04 Aug 2010 21:56:28 GMT

[quote user="Michael Woodhouse"]

Our local pharamcist gives his cat neomercazole from his shelf.

[/quote]

Wouldn't mixing with food or direct dosing be easier?, said cat may not always go on to shelf.

Re: Cascade Nonsense again!!!

Bob Russell — Wed, 04 Aug 2010 18:32:25 GMT

I wonder how he explains the shortfall when he does his audit!!!

Eaten accidentally by pharmacy cat?

Re: Cascade Nonsense again!!!

Michael Woodhouse — Wed, 04 Aug 2010 17:57:54 GMT

Our local pharamcist gives his cat neomercazole from his shelf.

Re: Cascade Nonsense again!!!

Clive Ansell — Wed, 04 Aug 2010 14:22:50 GMT

She is a little cost conscious to say the least, so would probably not pay for a prescription, and anyway this time around doses are unchanged which is easy for all.

My primary concern, along with my oath to the RCVS, is to act in the best interests of the animals welfare. That cannot be served by witholding drug dose information, so I feel I would give the doses but point out that I cannot prescribe or condone the use of these drugs. In any event she could buy a BSAVA formulary, or look at the NOAH compendium website and find the information herself if she wanted to.

Re: Cascade Nonsense again!!!

Kate Richardson — Wed, 04 Aug 2010 14:05:11 GMT

[quote user="i am ed"]

Is it illegal to 'aid and abet' criminal use of POM (non-vet) drugs? Advising on dosage could easily be construed as such if so. Are we obliged to report this kind of misuse (the fact that it's victimless notwithstanding)?

Perhaps I would give the client a legal prescription for the veterinary version of the drug. That way you've given the owner the dose rate advice in a strictly legal fashion and have no further responsibility in what the owner does after that. Covers the best interests of the dog and your arse, I think.

[/quote]

This is exactly why the current system is ridiculous. In whose interest is it that this is a criminal offence? Give the owner the advice, let her make the choice. Advise her on the correct doses. What benefit is there in forcing her to take a legal prescription or more expensive medications? The only one to suffer will be the dog. It is absolutely ridiculous that we should have to 'cover our arses' before looking after an animals welfare.

Although, I guess you could give the legal prescriptions to her, and give her a big wink and subtly indicate where the nearest bin is.....although maybe that's what you are suggesting anyway?! Although not very environmentally friendly, poor trees

Re: Cascade Nonsense again!!!

Edward Jones — Wed, 04 Aug 2010 13:52:48 GMT

[quote user="Clive Ansell"]Should I be advising her on dosages etc, or refusing because she is not using licensed veterinary products, or even using drugs prescribed by a veterinary surgeon?[/quote]

Re: Cascade Nonsense again!!!

Kate Richardson — Wed, 04 Aug 2010 13:47:40 GMT

Do what is in the dog's best interests. And change your name and leave the country.......

Re: Cascade Nonsense again!!!

Clive Ansell — Wed, 04 Aug 2010 13:38:11 GMT

I have had a client this morning, who works as a practice nurse at a local NHS GP practice, who has an aging CKCS which is being treated/managed successfully for cardiac disease with the human generic Enalapril 5mg uid and human generic frusemide 20mg uid. I didn't ask to closely, but I guess she gets these drugs through work one way or another. Should I be advising her on dosages etc, or refusing because she is not using licensed veterinary products, or even using drugs prescribed by a veterinary surgeon?. I have advised the drugs are not licensed for animal use, but she insists on continuing with the current regime citing the reason of costs.

Incidentally, the dog is fine and the drugs appear to be working well with no adverse effects. Recent routine blood work prior to a ga and dental work was all normal. it is difficult to argue a case with her as the dog is doing so well, and i wouldn't really want to change the drugs at this stage. From a costs only point of view it is a no brainer.

costs:

Veterinary (this particular practice): 28 x 5mg Fortekor = £42.37 , 28 x 20mg Furosemide = £8.91.

human generics (given by client) : 28 x 5mg Enalapril = £1.04 , 28 x 20mg Furosemide = £0.85.

Re: Cascade Nonsense again!!!

Paul Dowie — Wed, 04 Aug 2010 00:02:43 GMT

The cascade regulations are full of anomalies and contradictions .We can order for example from our wholesaler OXYCARE and if that is not

available they may send generic oxytetracycline .Are we then breaking regulations to prescribe this? Why also can we easily order Temgesic

instead of licenced Vetergesic or Buprecare for for less cost ? .It is the same product .

Obviously it is to help provide drugs for use in animals with some tests behind them but it is ridiculous to suggest that you are not looking after animals under your care if you use a non licenced product even if you have owner permission.. Will the RCVS change things ? Pray but do not expect.

Re: Cascade Nonsense again!!!

Bob Russell — Mon, 02 Aug 2010 11:02:55 GMT

I am reluctant to be critical about an individual but Steve Dean is one of those I have few worries about criticising. He is (I understand) a vet but has been working mainly in the pharmaceutical industry and from the tone of many of his comments in the past this industry seems more important to him than the veterinary profession.

This is a personal view as I do not know him and have been influenced only by the comments he has made that have gone on to be published in the Vet Record etc.

The VMD appears to me as a practising vet to be more interested in 'policing' because it can rather than because it needs to. The recent comments following practice inspections seems to mainly round very minor paperwork issues and the only real concern I have seen is related to correct temperature control of medicines.

Re: Cascade Nonsense again!!!

Kate Richardson — Sat, 31 Jul 2010 14:13:55 GMT

[quote user="Bob Russell"]ensuring the safety, quality and efficacy of veterinary medicines. [/quote]

I don't think anyone involved in this discussion is against this principle at all. We just want the opportunity to come up with a new solution to providing this and maximising animal welfare without the risk of being prosecuted for having stepped outside of the 'guidelines' in what is likely to be individual cases. Take the animal charities for example- how much money would they be able to save if they were legally allowed to prescribe a generic antibiotic for example? The owners/carers of these animals would need to be informed that the medication in question was not a veterinary product, but do the 'risks' significantly outweigh the benefits? Are these owners really in a position to demand a licensed expensive product when they will not even be paying for it in some cases?

What about Evelyn's point [quote user="Evelyn Barbour-Hill"]Interesting principle. So, better not prescribe a hypoallergenic diet food, because licensed prednisolone is available.[/quote]

If you take Steve Dean's letter's content at its word, our priority should be about avoiding prosecution rather than the welfare of our patients in some cases. Where is the criticism of Steve Dean? No-one has criticised him personally. Its a response to what I personally perceived as a threatening tone in his letter.

[quote user="Malcolm Ness"]

efficacy of veterinary medicines

I think this phrase is at the heart of the present spat

[/quote]

Of course medicines have to be efficaceous, but I disagree that that is what this present 'spat' is about. It is about the ability of veterinary surgeons to do the best for each and every one of their patients, each with different circumstances, without the threat of being prosecuted for doing what we have sworn to the RCVS to do.

Re: Cascade Nonsense again!!!

Malcolm Ness — Sat, 31 Jul 2010 13:37:04 GMT

[quote user="Bob Russell"]efficacy of veterinary medicines[/quote]

At the risk of opening another can of worms, I think this phrase is at the heart of the present spat. Nutraceuticals (including all the variations on the glucosamine/chondroitin theme) are regulated as nutritional supplements but marketed as drugs. The difference from a regulatory point of view is that foods need to be shown to be safe but drugs need to shown to be safe AND effective. Amongst its duties, VMD has a duty to the drug buying public and it is not reasonable to expect average joe punter to know that the product formed into capsules and dispensed by vet in the same manner as a proper drug is in fact a food supplement distinctly lacking in efficacy credentials.

I have never been the biggest fan of the cascade but I think that some of the criticism of Steve Dean is unwarranted and probably ill-informed.

Re: Cascade Nonsense again!!!

Hannah Wynne Richards — Sat, 31 Jul 2010 11:36:07 GMT

Roboxley I'm totally with you Axing VMD will lower my stress levels twice-once because I won't have to pay tax to support them, and once because I won't have to obey their insane directives

Wynne