Prescription vs. natural: A clash over parasite products

Shutterstock.comDr. Edward Kline has practiced small animal veterinary medicine for 41 years. A well-respected practitioner and advocate, Dr. Kline has endeavored to give back to his profession by serving as an officer in his local veterinary association, taking leadership positions in other professional organizations and at his alma mater, and assisting colleagues whenever possible.

Over a span of two weeks, four of Dr. Kline's clients have come into his clinic to return their prescription topical flea and tick medications. When team members inquire about the reasons for the returns, all four explain that they feel the preventives are unsafe for their pets.

On further inquiry, two of these clients mention that they've recently accompanied a friend during her pet's first visit to another local veterinarian. They say the neighboring veterinarian, Dr. Eleanor Palm, examined the pet and recommended all-natural products to prevent and control flea and tick issues. She said she thought prescription oral and topical medications were dangerous and had even killed several of her beloved patients. She recommended that her client stop using prescription flea and tick preventives immediately, adding that she hoped irreversible damage had not already been done.

Dr. Kline absorbs these accounts, then tells his clients as tactfully as he can that the preventives he prescribed their pets are FDA-approved and he's never had any issues with them. But he also explains that he respects his clients' wishes and will be glad to recommend a natural alternative for flea and tick prevention.

Later, Dr. Kline feels unsettled and decides to call the source of his unrest. The conversation with Dr. Palm cannot be described as a collegial exchange of ideas. Dr. Palm says she thinks it's her duty to spread the word about the threat these mainstream prescription products pose, citing anecdotal evidence from her own patients. Dr. Kline tells her that such a hard-and-fast opinion is actually a disservice to her patients. Dr. Palm disagrees, and the conversation ends.

The call leaves Dr. Kline feeling aggravated and conflicted. He worries that Dr. Palm is putting the health and well-being of many pets at risk. Trying to reason with her hasn't worked. Although he's never officially complained about a colleague in 41 years of practice, Dr. Kline is convinced that the time has come.

He writes a letter to the state board in which he accuses his colleague of veterinary negligence. He describes the negligence as knowingly making medical statements to his clients that are not in the best interest of their pets and are not supported by documentable evidence. The complaint is received by the board and processed, and Dr. Palm is ordered to respond to the accusation.

Dr. Palm is indignant. She states that as a licensee, she has wide latitude to make recommendations to her clients based on her medical training as well as clinical experience. Some pets die from prescription medications, she tells the board, while zero pets die from her natural recommendations.

The board considers her response and determines that Dr. Palm hasn't been negligent, though it does find her approach to prescribing this category of medications unorthodox. She is advised to inform her clients that she is recommending an off-label use of the all-natural products and her reasons for doing so.

Who do you think is in the right-Dr. Kline or the board? Tell us at dvmnews@ubm.com.

Dr. Rosenberg's response

A veterinary license gives a practitioner considerable discretion to use his or her judgment when caring for the needs of patients. However, this discretion comes with great responsibility. Clients can offer informed consent only when all of the facts and alternatives have been placed before them. Dr. Palm has made definitive recommendations to her clients that, while well-intentioned, are far from comprehensive.

I agree with the board in that it responded with correction instead of punishment. Dr. Kline followed his conscience in contacting the board, and I don't find fault in that either. In the end, the process in place for dealing with these types of situations worked well.

Always give your clients enough information for them to make an informed decision. In this way the pets are the beneficiaries-just as it should be.

Marc Rosenberg, VMD, is director of the Voorhees Veterinary Center in Voorhees, New Jersey. In his private time, he enjoys playing basketball and swing dancing with his wife. Although many of the scenarios Dr. Rosenberg describes are based on real-life events, the veterinary practices, doctors and employees described are fictional.