Polo-horse deaths fuel controversy - DVM
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Polo-horse deaths fuel controversy


Compounding the problem

Western U professor of equine medicine Joe Bertone, DVM, MS, Dipl. ACVIM, says a compounding pharmacy is essential to veterinary medicine, but it has to be used appropriately.

"The problem is that, although there are regulations, no one enforces them," he says.

"What the FDA and state pharmacy boards enforce for animal compounding pharmacies is minimal at best. I have been involved in several situations where the FDA wants to come in and do something, but the state or local courts can stop that effort, and it is unlikely that the FDA will continue the argument. Often the FDA does little because of costs and time."

The American Veterinary Medical Association (AVMA) policy on compounding urges veterinarians to seek out a compounding pharmacy that is accredited by an independent accreditation body, such as the Pharmacy Compounding Accreditation Board (PCAB).

Bertone sees the problem as veterinarians just being too comfortable using compounded drugs.

"When problems occur with compounded drugs, invariably the problem could have been avoided and almost invariably the risk was unacceptable," he says.

"It's questionable that the sometimes necessary risk in using compounded drugs was worth the benefit from what was used in the horses in Florida."

The question should be whether the risk outweighs the benefit. That question should have been asked before using selenium intravenously, Bertone says.

Most veterinarians believe there is a need for compounding medications, especially for those not FDA approved for use in animals. But the incident brings up a number of regulatory issues.

If in fact an Argentine veterinarian not licensed in the United States administered the drug, which was ordered for him by a Florida-licensed veterinarian, other issues arise.

"Was the Argentine veterinarian practicing without a license?" Bertone asks. "Did the U.S. veterinarian have a valid veterinary-client relationship?"

The way the drug was obtained in this incident is fairly common in the world of polo, Wollenman says.

"None of the barns I do work for employ Argentine vets, but they don't hang a shingle out and practice on everybody, either," he says.

"I think that it is legal. They need to rely on someone they can work with. The right hand needs to know what the left hand is doing. Everybody cries a little bit about it, but if you were going to a foreign country and taking a U.S. team, you would want a U.S. veterinarian."

The investigation likely will take several more weeks, according to McElroy.

"This was a terrible accident, a terrible tragedy, but it happened as a public tragedy," Wollenman says. "Good things tend to come out of bad things. The polo association is evaluating its drug policy as a result. Hopefully, we learn something and we pay a little more attention to compounding and how things get made."


Source: DVM360 MAGAZINE,
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