More cynical manipulation of the cascade

Re: More cynical manipulation of the cascade

HERETIC — Thu, 03 Feb 2011 19:06:40 GMT

Pre Cerenia I used to give emequell, and when that vanished then generic metoclopramide to suspected obstructions. If they stopped vomiting it was just gastroenteritis, if they carried on it was x ray time. Cerenia is too good for its own good. If you give it to an obstructed dog it may well stop the vomiting dead for 24 -48 hrs This can result in a delay in diagnosis with less viable gut at enterotomy. (I assume you dont all routinely radiograph every vomiting dog)

Re: More cynical manipulation of the cascade

mariette asselbergs — Sat, 29 Jan 2011 18:24:17 GMT

Sorry but this seems strange to me because they have different indications and contraindications since they have totally different working mechanisms. Metoclopramide stimulates stomach emptying and intestinal motility, so it is contraindicated in suspected obstruction, whereas maropitant works centrally. And maropitant is no alternative for the preoperative use of metoclopramide in rabbits for example.

Mariette

Re: More cynical manipulation of the cascade

Rob Davis — Sat, 29 Jan 2011 16:19:38 GMT

[quote user="robloxley"]http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/veterinary/000111/WC500064974.pdf (MA now withdrawn)[/quote]

I was relieved to see that it had a withdrawal period of zero days! May be difficult to prevent use of generic oxygen....

Re: More cynical manipulation of the cascade

Rob Loxley — Sat, 29 Jan 2011 14:08:10 GMT

[quote user="Jon Bray"]I did ask VMD about the procedure for getting a veterinary specific formulation of dihydrogen monoxide licensed - the profession is after all very much need of a solvent, cooling agent, hand cleanser and dehydration treatment that has been proven. The problem was when they replied with an absolutely straight answer I wasn't sure whether I was just dealing with someone with a sense of humour. I really hope so (although a small part of me wonders whether I should just get on and license the bloody stuff)[/quote]

http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/veterinary/000111/WC500064974.pdf (MA now withdrawn)

Re: More cynical manipulation of the cascade

Rob Loxley — Fri, 28 Jan 2011 23:19:40 GMT

Just a regular prescription.

Re: More cynical manipulation of the cascade

Charlotte Marshall — Fri, 28 Jan 2011 22:07:12 GMT

Do you have to get an STC for specials if manufactured in England?

Re: More cynical manipulation of the cascade

Peter Ding — Fri, 21 Jan 2011 08:18:37 GMT

Apologies: a fault at our exchange.

The uk website apparently isn't complete yet, but will be shortly

Re: More cynical manipulation of the cascade

Martin Atkinson — Thu, 20 Jan 2011 16:21:05 GMT

I phoned yesterday and spoke to Dean on 0800 440 2471, his email address is dean.adams@svprx.ca. They are doing free samples of 30 tablets!

Re: More cynical manipulation of the cascade

Bob Russell — Thu, 20 Jan 2011 12:50:19 GMT

Website seems to work and it is the number listed there!

Re: More cynical manipulation of the cascade

Peter Ding — Thu, 20 Jan 2011 12:30:53 GMT

neither of the numbers indicated seem to work for Summit.

one gets "cudos" debt management the other no. unobtainable.

Could you perhaps double check and report Martin.

Re: More cynical manipulation of the cascade

Martin Atkinson — Thu, 20 Jan 2011 10:15:35 GMT

[quote user="robloxley"]

[quote user="Martin Atkinson"]

[quote user="robloxley"]

At a guess Summit are manufacturing/supplying unlicensed medicines as Veterinary Specials, which are used in accordance with the cascade.

[/quote]

I think you are right but they are in usefully smaller dose sizes than human generics.

[/quote]

Are they sensibly priced? When I looked into getting 'custom' sized tablets (<50mg cyclophosphamide) from a specials manufacturer (the Specials Lab or Nova, can't remember which) they were completely uneconomical for small amounts.

[/quote]

Just got a price list from Summit for example: amlodipine 0.625mg x 100 £28, cisapride 2.5mg x 100 £22, Tramadol 5mg x 100 £18, so quite a bit more than standard human generics but is it worth paying for the convenience of useable tablet sizes? There is a UK website www.svprx.co.uk where you can register your practice and freephone tel. 08004402471.

Re: More cynical manipulation of the cascade

Bob Russell — Wed, 19 Jan 2011 11:25:10 GMT

The nurses went to a diabetes cpd talk last night and spoke to the Intervet rep. Apparently she regularly visits our two larger neighbours but has never visited us despite the other practices being 1 and 6 miles away!

Apparently she looked rather blank when told which practice they worked in! Amazing in the age of the computer!

Re: More cynical manipulation of the cascade

Bob Russell — Tue, 18 Jan 2011 13:30:05 GMT

The RCVS will have to account to higher 'courts' if decisions are made and challenged. It would take a brave DC to tackle this one as a lot of cascade is a political issue. Human generics are used successfully and widely throughout the world and use would not IMO render a vet unfit to practice.

The thing I think could be an issue would be if owners were charged for expensive licensed medication but only received cheaper generics.

Conviction would be quite easy in court as use of generics outside cascade is illegal. This was the motivating factor behind my petition for changes to cascade. What would the sentence be? With a sensible, sympathetic magistrate probably very light!

I don't think any of the authorities would be daft enough to let this get to court but in theory it could and this seems wrong to me!

Re: More cynical manipulation of the cascade

Martin Atkinson — Tue, 18 Jan 2011 10:50:49 GMT

KateRichardson wrote: "Re Summit- the website appears Canada based- do they have a UK base as well?"

The rep who came to me had a Canadian accent but said they now have a base in the UK, the address is in Kidlington, Oxon and the telephone number if anyone is interested is 08004402417 or 01865824898. As for Rob's query on cost, I don't know, I haven't checked.

Re: More cynical manipulation of the cascade

Rob Loxley — Mon, 17 Jan 2011 23:12:57 GMT

[quote user="Eamon McAllister"]I suspect that it will be difficult to get a conviction for prescribing generics in the treatment of pet animals[/quote]

'Conviction' by the civil courts or striking off by the RCVS??

Re: More cynical manipulation of the cascade

Eamon McAllister — Mon, 17 Jan 2011 23:06:43 GMT

Is there a difference between cynical manipulation and corruption? I suspect that it will be difficult to get a conviction for prescribing generics in the treatment of pet animals. If such a case were to fail then the legislation would have to be amended or scrapped so the VMD is probably happy to bully and threaten the profession rather than face a challenge in open court and a PR disaster.

Re: More cynical manipulation of the cascade

Kate Richardson — Mon, 17 Jan 2011 16:02:05 GMT

Re Summit- the website appears Canada based- do they have a UK base as well?

Re: More cynical manipulation of the cascade

Rob Loxley — Mon, 17 Jan 2011 13:45:44 GMT

[quote user="Martin Atkinson"]

[quote user="robloxley"]

At a guess Summit are manufacturing/supplying unlicensed medicines as Veterinary Specials, which are used in accordance with the cascade.

[/quote]

I think you are right but they are in usefully smaller dose sizes than human generics.

[/quote]

Re: More cynical manipulation of the cascade

Bob Russell — Mon, 17 Jan 2011 13:34:41 GMT

I use licensed medication wherever possible just because it seems sensible to use a product with a picture of a dog/cat etc on the container and some technical back up if needed.

I don't have that much of an axe to grind as long as it does not block my preferred choice or make me feel 'ripped-off'. Remember we are the buyers of the drugs in most cases so in our way we are consumers!

I cannot for the life of me see how licensed frusemide passed me by but it did. I don't think my patients were any worse off for this gap in my knowledge (they still peed for England when I wanted them to!). I do quite a lot of CPD but speakers generally do not use trade names.

I am happy to provide a contribution towards the defence costs of a vet who is prosecuted solely under cascade legislation! Not sure if my legal insurance would cover this situation if I am the one prosecuted!

I doubt the CPS would consider a prosecution for dishing out generic human drugs v's licensed ones in a pet animal in the public interest but who knows?

Re: More cynical manipulation of the cascade

Derek Copeland — Mon, 17 Jan 2011 13:13:15 GMT

I should probably be posting this anon so the cascade police dont come and get me!

While I like to support drugs compnies for their R&D things have to be reasonable ! Their was a test in law for what was reasonable which considered what the" man on the Clapham Omnibuswould think was right and reasonable" I am going over ground previously covered but generics that have been used for the period that for example metoclopramide cimetidine in small animal practice it is ridiculous not to carry on their use as generic drugs.

Has anyone ever been repremanded , struck off or locked up over not sticking rigidly to the cascade? Not that i am volunteering to be the first!

We wil continue to use the generics we do.I am sure if challenged ,with most we will be able to find some spurious justification but bottom line they are cheaper for my clients and they are effective.

Re: More cynical manipulation of the cascade

Martin Atkinson — Mon, 17 Jan 2011 12:37:47 GMT

[quote user="robloxley"]

At a guess Summit are manufacturing/supplying unlicensed medicines as Veterinary Specials, which are used in accordance with the cascade.

[/quote]

I think you are right but they are in usefully smaller dose sizes than human generics.

Re: More cynical manipulation of the cascade

Bob Russell — Mon, 17 Jan 2011 09:23:16 GMT

[quote user="Gillian Mostyn"]

[quote user="Martin Atkinson"]Incidentally Bob, I'm also a small sole-charge practice but reps are falling over themselves to get through my door. Perhaps its: a) I employ attractive nurses which attracts the male reps and b) I'm nice to them all, give them time of day and a cup of tea and talk about things they're interested in. They seem to visit as much on a social basis as to sell me stuff but admittedly Intervet have been noticable by their absence.[/quote]

snap - we've always had lots of reps here. They have their uses - you really can get some good deals sometimes! To be honest we probably contacted most of them ourselves initially, when we started up, so they've known we are happy to see them. 'Lunch and learns' are really handy for the nurses too, bringing them up to speed on new products etc.

[/quote]

When we started up almost all of the companies came to see us (even before I had completed on the premises in some cases). They were generous and helpful (except Pfizer who took several phone calls and 8 months to come to see us) on the whole.

Now we hardly hear from them at all and have to watch the mailings and magazines carefully as this is now the only way we hear about new products in most cases.

It is possible that as we are New Forest we fall on the outer limits of the South West and South East regions but for some reason we clearly are not visible on the reps radar!

I have to admit it is a mixed blessing!

Re: More cynical manipulation of the cascade

Rob Loxley — Sun, 16 Jan 2011 12:44:12 GMT

[quote user="Martin Atkinson"]

Tim Mainland wrote: "Anyone give me odds on a licensed metronidazole coming next"?

Bob Russel wrote: "Tramodol after that"?

They're already here, but in usefully smaller doses along with cisapride and amlodypine: Summit Veterinary Pharmaceuticals Ltd, their rep dropped by the other day. Seems there is no stopping this trend now.[/quote]

Hmm, can't find a veterinary licensed cisapride/tramadol/amlodipine either on the VMD or EMEA list. At a guess Summit are manufacturing/supplying unlicensed medicines as Veterinary Specials, which are used in accordance with the cascade.

Re: More cynical manipulation of the cascade

Gillian Mostyn — Sat, 15 Jan 2011 21:47:57 GMT

Re: More cynical manipulation of the cascade

Bob Russell — Sat, 15 Jan 2011 10:51:45 GMT

More drugs companies that have not been to see us!

Bayer 2+ years ago, Boehringer 5 years (but do phone us regularly to try to sell us Metacam!). I must need a change of after-shave!

Is this the only practice in the UK that the reps miss out on?

I am still waiting for a visit to discuss an anti-arthritic drug that is given monthly - any ideas?