The High Cost of Veterinary Ignorance

I have good news this flu season. And the good news is that the U.S. Government is not paying too much attention to Scott Weese over at the "Worms and Germs" blog.

His advice: Throw away all your medicines as soon as they hit their expiration date.

Instead, the U.S. Department of Health and Human Services (HHS), is listening to the FDA's Francis Flaherty and his team which have actually done the work on drug expiration dates.

So too is the Center for Disease Control (CDC), the U.S. Department of Defense (DoD) and the Department of Homeland Security (DHS).

Instead of tossing out billions of dollars worth of drugs, such as Tamiflu and antibiotics, the U.S. Government is keeping those drugs on the shelf, secure in their efficacy despite the fact that many are years past their "expiration" date.

Why is this good news for America?

Simple: Not only does this save tax dollars, but it may also save lives.

To put a point on it: If the U.S. followed Scott Weese's advice to throw everything down the drain as soon as a manufacturer's expiration date was crossed, we might not have the Tamiflu we now need as we enter this Fall's flu season.

How many American lives might that cost?

Who knows, but with up to 90,000 deaths now predicted by the CDC due to Swine Flu this Fall, I think the number "zero" is not in the mix.

Even when told about the FDA expiration date research and the Strategic National Stockpile of drugs kept by the Center for Disease Control, Scott Weese has not bothered to find out what kind of drugs are kept, or how long they are kept for.

Here's a hint: Thousands of TONS of antibiotics and other drugs (such as Tamiflu) are kept for YEARS past their putative expiration dates.

The fact that many common drugs, including Tamiflu, pill, capsule and caplet antibiotics, are safe and effective for years past the manufacturer's suggestion, is not closely held information.

As Johns Hopkins Health Alerts notes.

Think of expiration dates -- which the U.S. Food and Drug Administration (FDA) requires be placed on most prescription and over-the-counter medications -- as a very conservative guide to longevity....

In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. More recently, the FDA approved two-year extensions on expiration dates for a number of drugs, including the antibiotics Cipro (ciprofloxacin), penicillin, and tetracycline ....

If your medications have been stored under good conditions, they should retain all or much of their potency for at least one to two years following their expiration date, even after the container is opened.

The good news is that HHS has pre-positioned flu drugs, antibiotics, and other emergency medical supplies in 50-ton "Push Packs" around the nation. As The Richmond Times Dispatch notes:

The Strategic National Stockpile contains medications and supplies that would be needed in a mass disaster or other emergency. Examples of emergencies include a pandemic flu outbreak, hurricanes and terrorist attacks.

The stockpile includes such drugs as the flu medicine Tamiflu and the antibiotic Ciprofloxacin, as well as medical supplies, such as those for administering drugs intravenously or for keeping a patient's airway open.

Virginia, for instance, received 280,000 treatment courses of flu drugs from the federal stockpile in the recent H1N1 swine-flu scare. The state already had nearly 800,000 treatment courses of antivirals in its own stockpile.

A stockpile can consist of drugs on hand in an existing inventory, or it can be vendor-managed inventory that a state has contracted to purchase.

According to the U.S. Centers for Disease Control and Prevention, the federal stockpile is routinely checked to make sure the items are within their recommended shelf life. That's done by making quarterly checks on some items and an annual inventory, which includes inspections of environmental conditions, security and overall package maintenance.

Now that it looks as if the stockpile drugs sent to states might not be needed anytime soon [note: this article was written in May of 2009], what happens, for instance, to the 280,000 extra treatment courses Virginia received?

States will likely get to keep the drugs, a state official said.

The shelf life of some stockpile drugs can be extended beyond their expiration date under the Food and Drug Administration's Shelf Life Extension Program. That effort started as a way for the Department of Defense to save money by not having to throw away drugs that were still usable just because the expiration date had passed.

Tamiflu has qualified for that program. Batches or lots of Tamiflu in the stockpile that meet rigorous testing standards can have the shelf life extended from five years to seven years.

When drugs from the stockpile are used, it's done under FDA Emergency Use Authorizations. The FDA issues special letters to consumers and special prescribing instructions for health-care providers.

In fact, as the FDA web site notes, Tamiflu expiration dates, even for oral suspensions (liquid) are being extended by two years.

Tamiflu is not an antibiotic, of course, but the point is even more true for pill, capsule and caplet antibiotics, which have proven shelf lives that extend for YEARS past the manufacturer-contrived or pharmacy-invented expiration date printed on the side of the bottle.

As Dr. Francis Flaherty, Director of the U.S. FDA's expiration testing program noted a few years back:

"Manufacturers put expiration dates on for marketing, rather than scientific, reasons. It's not profitable for them to have products on a shelf for 10 years. They want turnover."

In short, short expiration dates are, for the most part, little more than a scam.

The fact that potent pill antibiotics are being stored for YEARS past the manufacturer's made-up expiration date is not a closely held secret. As the White House web page on the Strategic National Stockpile notes:

[Strategic National Stockpile] efficiency measure is focused on reducing the cost of replacing inventory by extending the shelf life of products that remain efficacious after their original manufacturer's expiration date through a Shelf Life Extension Program (SLEP). By extending the shelf-life of a product, the program does not need to spend money to replace that product as quickly or as often. The program's assets now include large amounts of antibiotics that cannot be rotated back into the market and chemical/nerve agent with no commercial use. Where possible, the program rotates stock in the market to avoid expiration of supplies through its vendor managed inventories. ... The program's annual efficiency measure is dollars saved per dollar invested in the Food and Drug Administration's Shelf Life Extension Program (SLEP) for available projects.

The Shelf Life Extension Program (SLEP) has found that cipro, a common pill antibiotic, is good for more than seven years past its putative expiration date.

Doxycyclin, amoxycillin, penicillin, and cephalexin are similarly long-lived if kept in a medicine bottle at normal room temperature.



It's not just Uncle Sam that stores Tamiflu and antibiotics for years at a time. The City of Los Angeles, for example, notes that its pre-positioned antibiotics have a shelf life of approximately four (4) years.

The National Institute of Health notes that the U.S. Department of Health and Human Services has a contract with Bayer, the maker of Cipro, to rotate its stock every three years -- two years longer than the expire date you will find on the same drug if you buy it at your local pharmacy.

This last point is not a small matter.

I find it hard to believe that Scott Weese does not know the difference between a manufacturer's expiration date (2-3 years) and the even more bogus date put on by dispensing pharmacies (typically 6-months or a year) which are designed to get patients to toss good medicines down the drain even faster.

I am going to be charitable here, however, and assume ignorance rather than malevolence.

After all, as pharmacist and U.S. Army Colonel George Crawford has noted:

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

And clearly no one tells you in veterinary school either. Scott Weese is living proof of that!

Bottom line: Just because a guy is a veterinarian does not mean he knows anything about drug expiration dates, generic drugs, drug manufacturing, or drug marketing.

No doubt Mr. Weese got into veterinary school by blindly regurgitating everything he was told.

If that's the case, I suspect there a few more medical mysteries he has yet to discover.

What? You say vaccinating every dog and cat every year is not needed and increases immunity disorders? How can that be true?

What? Branded drugs are no different than their generic analogs? That cannot be right!

What? A pet's generic drug needs can be filled for a few dollars at the local WalMart or Costco? There's no need to get your meds directly from the vet? Can that possibly be true?

What? Manufacturers have a financial reason to suggest you should toss out perfectly good drugs and buy more? Dispensing pharmacies have this same incentive? Unbelievable!

The good news is that on this last question, at least, the U.S. Government has voted with its wallet and with its eyes wide open.

As a consequence, perhaps a few lives may actually get saved this Fall. And wouldn't that be nice?!

A final note: A flu vaccine is the best way to make sure you stay healthy this Fall. If you are unlucky enough to come down with the flu, antibiotics will NOT help as the flu is caused by a virus.

Tamiflu might help to alleviate symptoms. That said, rest, a lot of hot fluids, and chicken soup will generally work wonders in a week or so. Give that a try.

• Related Posts and Information:
  ** Harvard Medical School Fanmily Health Guide: Drug Expiration Dates - Do They Mean Anything?
  ** Johns Hopkins Health Alerts
  ** The Medical Letter On Drugs and Therapeutics: Drugs Past Their Expiration Date
  ** The Wall Street Journal: Many Medicines Are Potent Years Past Expiration Dates
  ** Medscape: Do Drugs Really Expire
  ** Is the "Worms and Germs" Blogger Incompetent?
  ** Antibiotics for Less Without a Prescription

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Are You Throwing Money Down the Drain?

Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date.

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site.

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order. 

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.
.

Are You Throwing Vet Money Down the Drain?

Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date.

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site. Please note my advice to NOT use tetracycline on dogs

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order. 

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.
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For those looking for a low-cost source of generic doxycycline (used to treat Lyme, heartworm, and malaria), see this blog post to save thousands.

Stop Throwing Money Down the Drain

Are you throwing money down the drain? Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date.

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site.

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order.

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.

Your Expired Antibiotics are Still Good

Expiration dates on antibiotic pills, capsules and caplets are, essentially, a scam.

All you have to do is Google "expiration dates antibiotics" and the first citation given is from a Harvard heath letter entitled "Drug Expiration Dates - Do They Mean Anything?"

That post summarizes a 20-year study done by the FDA for the U.S. military:

"It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way."

The Wall Street Journal put this story on their front page a few years back.

But don't take my word for it: You can read the article, in its entirety, right here.

"Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

"In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful."

How can your doctor or vet not know this?

Well, to start with, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of variouus drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

You might think veterinarians and doctors would learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.  But do you have to be part of that? 

No, you do not.

The Drug Expiration Scam

Are you throwing money down the drain? Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date. T

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site.

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order. 

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.
.

The Drug Expiration Scam

Are you throwing money down the drain? Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date. T

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site.

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order. 

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.
.

Antibiotics Past the Expiration: Proving the Rule

A good comment came in to my original reply to Scotte Weese at the "Worms and Germs" blog who, without doing any research at all, and without contacting me, decided to blast this web site and blog for explaining how to get good antibiotics, without prescription, to treat dogs with small cuts and lacerations.

For those left scratching their heads:

• The original Terrierman.com post on antibiotics is here.
  
  
• My reply to Weese (written and posted only after he did not bother to read what was sent to him) is here: Is the "Worms and Germs" Blogger Incompetent?
  
  
• When Mr. Weese typed out more nonsense, I expained the danger of listening to this man in a post entiled: The High Cost of Veterinary Ignorance

So what was the good comment from a reader? It came from Mary who wrote to note:

While I agree with your post, I just wanted to mention that one of the drugs you name, Doxycycline, is one of the few that should not be used after its expiration date. Drugs in the tetracycline family can cause kidney damage when used after they expire.

Full credit to Mary who reads on her own. As I note in my reply to her:

"Tetracycline drugs are not drugs I normally use on my dogs (see original post ) and YES tetractycline and doxycycline are not drugs that can be kept for a decade past expiration, as most other antibiotics can, BUT it appears they too are good for quite a bit longer than their expiration dates.

As I noted in my reply, doxycycline is bought in very large amounts by the U.S. Government, and if it is kept at regular room temperature in a sealed container (as all antibiotics in your home are, I trust) it too is good for more than a year past its expiration date.

But don't take my word for it. Since so few people read anymore, I have pictures.

The following photos are lifted from a PowerPoint Presentation (PDF version) created by the Centers for Disease Control (CDC) and the U.S. Department of Health and Human Services.



This is the kind of warehouse where Strategic National Supply antibiotics and medical materials are stored.



These are a couple of doxycycline containers from the Strategic National Supply of antibiotics.



This is an original doxycycline label from the Strategic National Supply of antibiotics. Note that the drugs are to be stored at room temperature: 68-77 degrees.



This is an extended expiration date doxycycline label from the Strategic National Supply of antibiotics. Expiration dates on antibiotics are routinely extended for several years as part of the Shelf Life Extention Program (SLEP) as previously noted on this blog.

As I have noted on this blog in the past, doxycycline is a very useful drug to have in your home veterinary kit for two non-wound issues: Lyme disease treatment, and as an adjunct to effective and low-cost heartworm treatment.

Doxycycline, labeled for birds, can be bought from any veterinary supply place that caters to dogs, such as Doctors Foster and Smith, Revival Animal Health, Lambert Vet Supply or even Amazon.com.

This is the same medicine, made in the same factories, and at the same dosage, as antbiotics sold by your veterinarian or local pharmacy.

As always, follow directions and dose the right drug for the proper problem at the right amounts and for the required amount of time. Read the instructions and follow them!
.

Is the "Worms and Germs" Blogger Incompetent?

Is the author of the "Worms and Germs" blog incompetent?

That's the uncomfortable question I was left wondering after reading a recent post about antibiotics for dogs in which the author, Scott Weese, parades out his ignorance of antibiotics.

You see, it seems to come as a complete surprise to him that expiration dates on antibiotic pills, capsules and caplets are, essentially, a scam.

It also seems to be a complete surprise to him that most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs.

How can he not know this?

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years.

All you have to do is Google "expiration dates antibiotics" and the first citation given is from a Harvard heath letter entitled "Drug Expiration Dates - Do They Mean Anything?"

That post summarizes a 20-year study done by the FDA for the U.S. military:

"It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way."

The Wall Street Journal put this story on their front page a few years back.

But don't take my word for it: You can read the article, in its entirety, right here.

"Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

"In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful."

Medscape has a post here (PDF).

The U.S. Department of Defense has a post here.

The AMA has raised questions about how much medicine is being tossed down the sink.

And on the Government of Alaska's web site, they note that the supply of antibiotics they have on hand is good for five years.

So what's going on at the "Worms and Germs" blog? How can Scott Weese not know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of variouus drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

That's what makes the apparent ignorance of Scott Weese at the "Worms and Germs" blog so disturbing.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

Surely a "Worms and Germs" expert knows that pathogens are not building up immunity to drugs because people are treating real flesh wounds, urinary tract infections and ear infections with antibiotics given in the proper dosage and the proper duration? It's not that!

Instead, it's because tons of antibiotics are being put into chicken and cattle feed in order to promote weight gain in otherwise healthy animals.

And it's because huge amounts of antibiotics are being tossed down the drain for no reason other than drug companies have "short dated" them with phony expiration dates.

If Scott Weese does not know about expiration dates, how much does he really know about the epidemiology of zoonotic diseases?

This is a fair question.

You see, the military's work on antibiotic expiration dates relates back to the military storage of vast amounts of antibiotics in case of germ warfare, such as Anthrax -- a very serious zoonotic disease.

With over a billion dollars of antibiotics of every type in storage, the U.S. Department of Defense wanted to know if they really had to throw away all that Cipro, Doxycycline, Amoxycillin, Clavamox, and Cephalexin.

The short answer: NO.

For the record (and I trust you will think this is good news) there is also a civilian stockpile of antibiotics.

The CDC's Strategic National Stockpile (SNS) has a vast quantity of antibiotics to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquake) severe enough to cause local supplies to run out.

After September 11th, many states also decided to stockpile antibiotics in case the national supply chain was somehow interrupted.

None of these drugs are tossed out every year, every two years, or even every four years.

As noted, pills, capsules and caplets of antibiotics keep a very long time.

You would think someone who teaches about zoonotic diseases at the University of Guelph (where is that?) would know this basic information.

But you would be wrong.

The good news is that experienced dog men and farmers don't spend too much time listening to Canadian academics.

After all, who would ever go to a vet that was shocked to discover that Southern States and every dog supply catalogue in the country ( see here, here, here, here) and even Amazon.com (see here) has antibiotics for sale without prescription to treat common farm and kennel ailments?

That has been true our whole lives, hasn't it?

Someone tell the associate professor.

For the record, I do not advise using antibiotics thar are four or five years old.

What I do say, however, is that pill, capsule or caplet antibiotics "are going to be fine as long as they are no older than a year or so past the expiration date."

Is that a bold statement? No, not at all.

You see, antibiotic manufacturers typically short-date their drugs with an expiration date that is two years past the date of manufacture, and never mind if the drugs are still fine three, four, or five years later.

Pharmacists, however, short-date the antibiotics even further, putting on a phony expiration date that is only one year from the date of issue.

In short, a two-year time frame is generally within a few months of the pill or capsule antibiotic manufacturer's own recommendation. And it is always well within the full potency of any antibiotic sold in America or Canada today.

Update: 4The High Cost of Veterinary Ignorance

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