Holistic vs. FDA-approved: Two veterinarians take divergent approaches

Holistic vs. FDA-approved: Two veterinarians take divergent approaches

What would you do if your colleague prescribed natural supplements to your client while you were away on vacation?
Sep 01, 2013

Dr. Leon Hart has been in practice for 31 years. He was a practice owner until five years ago when a corporate practice purchased his veterinary hospital, and now he works as a veterinarian on the staff. He has a somewhat reduced schedule and is well-liked by clients and his six veterinary colleagues.

He recently saw Bentley, a 10-year-old golden retriever he has been treating for the past nine years. Bentley was in for his yearly checkup. Dr. Hart ordered a senior blood profile and scheduled pelvic and spinal radiographs. The owners, Mr. and Mrs. Higgins, always practiced preventive medicine and did not want anything to sneak up on their beloved dog.

Dr. Hart was leaving for vacation the next day, so he informed Mrs. Higgins that one of the other doctors would contact her with the lab results. The next day Bentley had his radiographs taken and the lab returned his blood results. The diagnostics showed an elevation of his aspartate transaminase and alkaline phosphatase levels. His urinalysis showed no bacteria present but displayed a urinary pH of 8.0 with scattered struvite crystals. His pelvic radiograph demonstrated mild degenerative joint disease in both hips and early lumbar spondylosis.

Bentley seemed to be feeling pretty good, but these findings, coupled with his senior status, did warrant some intervention. Dr. Kessler, a recent addition to the clinic, evaluated the findings and called Mr. Higgins to report the results. He believed that most of Bentley's issues were not uncommon in older large-breed dogs but that they should still be addressed, and he wanted to take what he saw as a safe, holistic approach to assisting Bentley. He ordered a glucosamine compound for the arthritis, some cranberry extract to acidify the urine and deal with the crystals, and finally some SAM-e for the elevated liver enzymes. Mrs. Higgins picked up the meds and began Bentley on his new protocol.

When Dr. Hart returned from his vacation and reviewed Bentley's lab results and treatment, he was incensed. This was not the way he would have treated Bentley for the pathology that was discovered. He did not think untested and unapproved holistic medications should be used just because they would not necessarily do any harm. When medication had been subjected to FDA trials and approved as efficacious, only then was he confident that he could use them on his patients.

Dr. Hart chastised Dr. Kessler for treating his patient "recklessly" and called Mrs. Higgins to tell her he wanted to modify Bentley's medication protocol, saying he was more comfortable with tried and true drugs. His longtime client deferred to his wishes but also mentioned that she felt Bentley was doing very well on the new pills.

Dr. Hart and Dr. Kessler then had a sit-down to clear the air. Dr. Hart said he appreciated Dr. Kessler's handling his patient while he was away but he did not expect that Dr. Kessler would institute an untested holistic protocol on some very real senior-related medical issues. Dr. Hart believed that using holistic preparations to complement mainstream medications certainly was acceptable in selected situations, but this was not the case with Bentley.

Dr. Kessler respectfully disagreed. His perspective was that the use of these medications revolved around full disclosure. He was a licensed veterinarian and as long as he discussed the use of holistic remedies with the client and informed her of their unproven yet anecdotal successes, he was within his ethical and professional boundaries.

Dr. Hart concluded that they would have to agree to disagree. He wanted some clear governmental verification of the products he was using on his pet patients, and in the future he would not enlist Dr. Kessler's assistance when he was not able to attend to one of his own patients.

Rosenberg's response

The question of holistic therapy vs. mainstream medications is not a new one. The pros and cons can be debated long after you've finished reading this dilemma. But Dr. Kessler is right: The pivotal issue is that of client disclosure. If a veterinarian is going to recommend an extralabel use of a medication or incorporate a non-FDA-approved product into a treatment regimen, he or she must discuss these facts with the pet owner. This way clients can ask questions and, based on the answers, decide if they want to utilize the medications suggested.

Dr. Kessler was well within his rights as a licensed practitioner to prescribe holistic medications for Bentley, as long as he also informed the pet owners that these were not FDA-approved products. This is not to say that they would not work but rather that they had not been subjected to the FDA scrutiny required to achieve approved status.

Personally, I use a combination of mainstream and holistic medications for my patients. I inform my clients of the differences among these drugs and we make the decision together as to whether they are the right choice for the pet.

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Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.