The Billion Dollar Heartworm Scam

This is a repost from this blog on this day in 2008.

PLEASE ACTUALLY READ THIS POST
BEFORE YOU START TO WRITE ABOUT WHAT YOU *THINK* IT SAYS:

Almost everything you have been told and taught about heartworm is probably an exaggeration or an outright lie, and this misinformation is probably costing you more money than it needs to.

Here's the truth:

• Heartworm is not a canine pandemic.
• In fact, heartworm is pretty rare in much of the country, and in very cold areas of the country a veterinarian may go his or her entire career without seeing a single case. Look at the map, above, put out by a major vendor of heartworm tests (Idexx) who has every reason in the world to overstate (rather than to understate) the problem. You will notice how low the baseline state numbers are -- 500 cases is the top of the color scale -- and that this map covers seven years of data collecting. You will also note that this map does not show adult heartworm infestation in dogs, but simply the number of dogs that tested positive for heartworm. More on that important distinction in a minute.
  . . . . Data on heartworm incidence rates at the local level reinforces how rare heart worm really is. For example, on the map above, California is coded red-hot with 500 cases. And yet, when a total of 4,350 dogs in 103 Los Angeles County cities coming from 21 participating animal hospitals were tested, only 18 heartworm-positive tests turned up. And yet, veterinarians are training their staffs not to talk about heartworm tests and medications as an option, but as a need, and for this "needs to be given" message to be bombarded on the customer 3-5 times per office visit.
  .
• Heartworm infection is NOT rapid and will not kill your dog overnight.
• It takes about three months for microfilaria (baby worms) to grow inside your dog to a larval stage, and even longer for these larva to mature into adult heartworms. If your dog is dosed with a simple Ivermectin treatment at any time during this period before adult worms are present (a period that lasts about three months long), the larvae will never develop into adult worms, and will die. Read that statement again: a single dose of Ivermectin will stop heartworm dead up to 3 months after your dog is first infected.
  .
• In most of the country, only seasonal heatworm "prevention" is needed.
• The short story here is that heartworm is a kind of nematode (dirofilaria immitis) spread by mosquitoes (and only by mosquitoes). The lifecycle of the nematode involves six stages, and a dog can get infected with heartworm only if two of these stages are fully completed inside the body of the mosquito, and those stages can only be completed inside the body of the mosquito if the temperature stays above 57 degrees for at least 45 days straight, both day and night. If the temperature drops below 57 degrees even once during that 45-day period, the lifecycle of the nematode is broken, and heartworm cannot be transmitted to your dog. What this means, in simple terms, is that a year-round program of Heartgard (sometimes spelled 'Heartguard") or some other "preventative" medicine is NOT needed in most of the country outside of Florida, the Rio Grande Valley of Texas.
  . . . . . Look carefully at the maps below (click to enlarge). These maps come from “Seasonal Timing of Heartworm Chemoprophylaxis in the United States” by Dr. David Knight and James Lok of the American Heartworm Society. Find your area on the map, and begin heartworm treatment on the first day of the month noted in Map A, and end treatment on the first day of the month noted in Map B. In short, if you are living in Virginia, you would begin treating your dog June 1st (top map) and end treatment on December 1st (bottom map).
  . . . . . This is a very aggressive treatment schedule -- more active than is really needed. After all, if heartworm larvae gets into your dog on June 1st, they will have NO IMPACT on your dog for months and months. In fact, if you are in Virginia simply treating your dog with Ivermectin (Heartgard) on September 1st and again on December 1st will give 100 percent heartworm protection for your dog. Even in areas where heartworm is a year-round vexation (Florida and the Rio Grande Valley of Texas), a once-every-three-months dose of Ivermectin will give your dog 100% protection.
  
  

(click on maps to enlarge)

Maps created by DH Knight and JB Lok

• There is no "preventive" medicine for Heartworm.
• Despite what your veterinarian may have told you, there is NO "prevention" for heartworm infection; there is only heartworm treatment. ALL heartworm medicines work the same way -- they kill heartworm microfilaria present in the body of the dog.
  .
• Heartworm "prevention" medicines are actually toxins.
• The drugs used to kill heartworm microfilaria are Ivermectin (Heartgard, Heartgard Plus, Iverhart, Merial and Verbac) or Milbemycin (Interceptor, Safeheart, Sentinal and Norvartis). Both drugs are nematode poisons, and in both cases a single dose will kill all microfilarial infection that occurred up to 90 days earlier (i.e. all Stage 3, 4 and young Stage 5 heartworm infections).
  .
• Humans cannot get heartworm.
• Heartworm cannot be passed on to humans -- we are the wrong host animal. Very rarely a heartworm-positive mosquito will bite a human and a small benign cyst may develop in the lung of a human, but this is NOT heartworm, and can be best thought of as a tiny scar showing where a bit of microfilaria attached to the lung wall where it was killed off by the human body.
  .
• Some breeds are more sensitive to Ivermectin.
• Some lines of collies and collie-crosses have sometimes fatal reactions to ivermectin, the most common heartworm preventative medicine. Though this is not common, and is even rarer today with low-dose Ivermectin such as Heartgard, and seems to only hold true for collies, serious thought needed to be given to dosing any collie, collie-cross, or herding dog with white feet. For these dogs, the safest heartworm medicine is Interceptor, though in fact the Heartgard box features a Border Collie on it face, and many working Border Collie folks dose their own dogs with a low dose of sheep drench 0.08% Ivermectin.
  .
• What about that wormy heart-in-a-jar at my vets office?
• Most veterinarians have a "fear bottle" in their office which shows a canine heart riddled with spaghetti-like heartworms. Nothing generates cash like a heartworm fear bottle -- a veterinarian will often place one prominently in his or her office as a kind of cash-generating machine since one look will sell a heartworm test and year's worth of Heartgard, no questions asked. So where do these fear bottles come from? I've been told by a pharmaceutical sales representative that most of these wormy hearts in these jars come from stray animals killed in Mexico, and that the heart specimens themselves (often decades old) were given out by pharmaceutical company representatives when they first began selling Heartgard back in 1986. One thing for sure: today, you can got to Maine and find a wormy heart in a jar even though the local veterinarian has never even seen a dog with this problem in the last 20 years.
  .
• Do I have to go a veterinarian to get Ivermectin?
• No. More on that in a second. Suffice it to say that it's not necessarily a bad thing to go to a vet for a prescription for Heartgard, especially if you are going to see your vet on another matter anyway. I would not buy Heartgard from the vet, however, without first checking prices online. Most vets price-gouge their customers by 100 percent or more for medicines sold in their offices, and in most states a veterinarian cannot charge you more for writing a prescription for a medically necessary medicine as part of an incidental visit.  In addition, be aware that former executives from Merial, the maker of Heartgard, are now making a generic version of this product, PetTrust, that is considerably cheaper.
  . . . . . Another cash-saving tip is to get a prescription for Heartgard for a dog twice the size of your dog, and then split the tablets in half. This trick results in considerable savings because the marginal cost between one Heartgard weight category and the next is often very slight despite the fact that one pill contains twice as much active ingredient as the next.
  . . . . . Finally, remember that, depending on outside temperature, you do not have to dose your dog all year long in large parts of the U.S.
  . . .Of course, if you want to dose your dog every month and do so cheaply and without going to a veterinarian for a prescription, there's a trick here too. Here it is:  Order Ivermectin in a pre-mixed solution from J.R. Enterprises. The cost is $25 for a 65-cc bottle of .05% Ivermectin, which is enough to treat five 20-pound dogs for 26 months. J.R. Enterprises even throws in a measuring spoon! Since this Ivomec and polypropelene gylcol solution is not FDA-approved for dogs, they sell it for experimental purposes only. That said, it works fine, and this is exactly the kind of heartworm preventative medicine used on all dogs all across this country prior to the advent of Heartgard and "the billion-dollar heartworm scam" in 1986.
  . . . . . .Finally, and if for no other reason that to explain how J.R. Enterprises does it, here's how you can treat a huge number of dogs with non-prescription Ivermectin for a dirt-cheap price. Whether this is cost-effective or not (and whether it is worth the trouble or not) really depends on how many dogs you have. In case you run a shelter, here's the scoop 1) Buy a 0.08 percent sheep drench online or at a feed store. Sheep drench is sold in various sized containers, but the smallest on Amazon is about $30 for 8 oz.  This will be high-grade Ivermectin made by Merial, an established veterinary pharmaceutical company. You will be giving only a very small dose of this sheep drench to your dog.  You dose by weight, and if you want to be very sure you have dosed enough, you can double the dose and the dog will be fine (but see the Collie warning at point #7).
  
  * up to 14 pounds: 1 drop (0.05 cc)
  * 15 to 29 pounds: 0.1 cc
  * 30 to 58 pounds: 0.2 cc
  * 59 to 88 pounds: 0.3 cc
  * 89 to 117 pounds: 0.4 cc
  * 118 to 147 pounds: 0.5 cc.
  
  • Do I need to have my dog tested for heartworm before starting Ivermectin?
  • Generally, no. Unless your dog is an older dog loaded with years of untreated heartworm (which you will know from the dog's long-term lethargy and chronic coughing), a dose of Ivermectin will not do your dog harm. A puppy, under six months of age, of course, will always test negative for heartworm because the microfilaria have not yet had a chance to develop and circulate. Testing a dog under age 6 months for heartworm is a common veterinary scam; do not fall for it!
    .
  • Is curing heartworm expensive and difficult?
  • No it is not. Any veterinarian who tells you otherwise is not keeping up with the literature. It turns out that even if your dog has adult heartworms, if the dog otherwise appears healthy (i.e. it is active, not lethargic, and does not have a chronic cough), a monthly dosing of Ivermectin at a dosage normally used to kill roundworms (a dosage that is 3 times higher than that used to simply prevent heartworm), plus a once-a-month 5-day dosing of Doxycycline (sold as Bird Biotic, and the same antibiotic used to treat Lyme disease) will kill all the adult heartworms if it is sustained for a period of 18 months. This treatment works better than previous Ivermectin-only treatments because the Doxycline wipes out the Wolbachia microbe that grow in the gut of the adult heartworm, essentially sterilizing all of the female heartworms. A round-worm strength dosing of monthly Ivermectin will not only prevent new heartworm microfilaria from taking hold in your dog, it will also work to dramatically shorten the life of any existing adult worms in your dog. Bottom line: after 18 months of treatment, your dog will be heartworm-free at very little cost compared to other remedies.
    . . . . . A repeated caution, however: if you have border collies or herding dogs with white feet that also appear to have full-blown heartworm, consult a veterinarian, as some lines of collies are very susceptible to Ivermectin toxicity. This is very rare, and the cause is unknown, but it is an area of concern among collies and collie-crosses.
  
  PLEASE BE ADVISED THAT I WILL NOT ANSWER QUESTIONS ABOUT DOSING YOUR DOG.   If you are too lazy to read this post or too confused and wrapped around your own axle to follow simple directions, I cannot help you.  Please go to a veterinarian.
  • Related Posts:
    ** Rimadyl: Relief From a Swollen Wall
    ** A Business Plan Based on Fencing Out the Truth
    ** Veterinary Billing Without Oversight or Regulation
    ** The Billion Dollar Lyme Disease Scam
    ** Lyme Disease: Hard to Catch and Easy to Halt
    ** Veterinary Trades Say It's Time to Rip-off the Rubes
    ** Is Your Veterinarian Clean? Don't Count On It
    ** A Season to Everything
    ** Cruciate Ligament Injuries in Dogs
    ** Vet Pricing Has Nothing To Do With Care
    .

Your Vet Has a Heartworm Medication Secret

In yesterday's post, I mentioned that folks are giving monthly doses of insecticide to their dogs to prevent heartworm, but that an every-other month dose in warm weather will do just as well, and that your dog does not need to be dosed at all during cool weather (night time temperatures of under 57 degrees).

I have, of course, written about all this before and I encourage folks to go read that now.

None of this is new, of course. In fact, it was spelled out in a 1998 article by David H. Knight, DVM and James B. Lok, PhD. published in Clinical Techniques in Small Animal Practice and entitled Seasonality of Heartworm Infection and Implications for Chemoprophylaxis. As Knight and Lok note in that paper:

The practice of some veterinanans to continuously prescribe monthly chemoprophylaxis exaggerates the actual risk of heartworm transmission in most parts of the country and unnecessarily increases the cost of protection to their clients.

The authors go on to say, in a nice under-stated way, that heartworm hysteria pays a nice dividend for vets.

There is also a tremendous financial incentive to veterinarians to promote heartworm chemoprophylaxis because they control distribution of these excellent products in a market that is already large but not yet saturated. Unfortunately, preoccupation with worse case scenarios imparted by the profession to our client's and what could be perceived as an obvious economic self interest for veterinarians to promote chemoprophylaxis has encouraged an insidious overuse of a good thing. The well-intentioned promotion of heartworm awareness and prevention may overshadow the fact that in the temperate latitudes, heartworm transmission is seasonal and chemoprophylaxis is not necessary on a continual basis.

Knight and Lok note that vets hide the truth from their clients because it is in their financial interests to do so.

[W]hat harm is there in liberally dispensing these drugs? The issue that needs to be considered is whether medical justification should prevail over entrepreneurial interests in dispensing drugs intended to prevent rather than cure disease? Because veterinarians are permitted to sell the drugs they prescribe, use may not always be based strictly on medical justification...

... [G]iven what is presently known, continued adherence to a policy of superfluous chemoprophylaxis is disquieting because financial expediency for the veterinarian conflicts with clinical objectvity, and client consent is predicated on unrealistic expectations. Clients mistakenly believe they are purchasing additional protection for their pets, but in reality they are not. If the truth were known to them, few clients would agree to unnecessarily double their expense for heartworm prevention.

Right.

But is this the kind of information your vet will tell you?

It is not! And why not? Simple: there's no money in the truth.

And so the vets beat the drum of dependency and over-medication, abetted by the "American Heartworm Society" which is entirely funded by companies that sell heartworm drugs and testing kits. It's a bit like Penzoil writing your car manual and advising you to change your oil every month. Your car mechanic would then point to this manual to justify his services and sales -- and yes he only uses Penzoil in a car like yours! Perfect!
.*

Your Vet Has a Heartworm Medication Secret

In a previous post, I mentioned that folks are giving monthly doses of insecticide to their dogs to prevent heartworm, but that an every-other month dose in warm weather will do just as well, and that your dog does not need to be dosed at all during cool weather (night time temperatures of under 57 degrees).

I have, of course, written about all this before and I encourage folks to go read that now.

None of this is new, of course. In fact, it was spelled out in a 1998 article by David H. Knight, DVM and James B. Lok, PhD. published in Clinical Techniques in Small Animal Practice and entitled Seasonality of Heartworm Infection and Implications for Chemoprophylaxis. As Knight and Lok note in that paper:

The practice of some veterinanans to continuously prescribe monthly chemoprophylaxis exaggerates the actual risk of heartworm transmission in most parts of the country and unnecessarily increases the cost of protection to their clients.

The authors go on to say, in a nice under-stated way, that heartworm hysteria pays a nice dividend for vets.

There is also a tremendous financial incentive to veterinarians to promote heartworm chemoprophylaxis because they control distribution of these excellent products in a market that is already large but not yet saturated. Unfortunately, preoccupation with worse case scenarios imparted by the profession to our client's and what could be perceived as an obvious economic self interest for veterinarians to promote chemoprophylaxis has encouraged an insidious overuse of a good thing. The well-intentioned promotion of heartworm awareness and prevention may overshadow the fact that in the temperate latitudes, heartworm transmission is seasonal and chemoprophylaxis is not necessary on a continual basis.

Knight and Lok note that vets hide the truth from their clients because it is in their financial interests to do so.

[W]hat harm is there in liberally dispensing these drugs? The issue that needs to be considered is whether medical justification should prevail over entrepreneurial interests in dispensing drugs intended to prevent rather than cure disease? Because veterinarians are permitted to sell the drugs they prescribe, use may not always be based strictly on medical justification...

... [G]iven what is presently known, continued adherence to a policy of superfluous chemoprophylaxis is disquieting because financial expediency for the veterinarian conflicts with clinical objectvity, and client consent is predicated on unrealistic expectations. Clients mistakenly believe they are purchasing additional protection for their pets, but in reality they are not. If the truth were known to them, few clients would agree to unnecessarily double their expense for heartworm prevention.

Right.

But is this the kind of information your vet will tell you?

It is not! And why not? Simple: there's no money in the truth.

And so the vets beat the drum of dependency and over-medication, abetted by the "American Heartworm Society" which is entirely funded by companies that sell heartworm drugs and testing kits. It's a bit like Penzoil writing your car manual and advising you to change your oil every month. Your car mechanic would then point to this manual to justify his services and sales -- and yes he only uses Penzoil in a car like yours! Perfect!

.*

Sympathy for the Devil

Lynn S. sent me a note a couple of days ago:

The most recent issue of Today's Veterinary Practice came at work today, and the cover story was questioning the practice of yearly heartworm tests. Since I didn't get to read it today, I checked the website to see what all's available to read without a subscription, and lo/behold: Doxycycline in the Management of Heartworm Disease.

Still have to find the HW test article, but haven't you been saying this for a while now?!"

Yes indeed. 

Yearly heartworm tests are simply not needed if your dog has been on a regular heartworm medication.  Your dog CANNOT get heartworm if you are simply a few weeks, or even a month or two, late.  Every vet knows this.  Yearly heart worms tests are simply part of a long-running scam in the the world of veterinary care -- a big dollar cash cow they will milk as long as we let them.


As for doxycycline combined with ivermectin, it remains a low-cost cure for heartworm, and this too is not closely held information.

Is curing heartworm expensive and difficult?  No it is not. Any veterinarian who tells you otherwise is not keeping up with the literature. It turns out that even if your dog has adult heartworms, if the dog otherwise appears healthy (i.e. it is active, not lethargic, and does not have a chronic cough), a monthly dosing of Ivermectin at a dosage normally used to kill roundworms (a dosage that is 3 times higher than that used to simply prevent heartworm), plus a once-a-month 5-day dosing of Doxycycline (the same antibiotic used to treat Lyme disease) will kill all the adult heartworms if it is sustained for a period of 18 months. This treatment works better than previous Ivermectin-only treatments because the Doxycline wipes out the Wolbachia microbe that grow in the gut of the adult heart worm, essentially sterilizing all of the female heart worms. A round-worm strength dosing of monthly Ivermectin will not only prevent new heartworm microfilaria from taking hold in your dog, it will also work to dramatically shorten the life of any existing adult worms in your dog. Bottom line: after 18 months of treatment, your dog will be heartworm-free at very little cost compared to other remedies.

On the upside, my heartworm, ivermectine and doxycycline post is read by a couple of hundred people a day and has helped a lot of folks save a lot of money over the years. 

On the downside, this post is also a magnet for illiterate, knuckle-dragging morons who are too lazy to read the post to the end, and/or who are too dumb to follow or understand directions. 

Of course, the doxy and ivermectin post is not the only one that seems to attract the hazy, lazy and crazy.

For example, earlier this week I got this question in an email written by someone who was so lazy and disinterested in her own dog that she did not even bother to type in a subject line:

Hello I know your not a veterinary but I have a dog that has a cut ( I think from a wild hog) on his upper back leg its about 3 inches long and I would say an 1 inch or 2 thick. Do you think putting glue would help? I have been cleaning it it myself every day but I want to make sure I'm doing something right. Its not bleeding anymore kinda looks like its healing. Thank you.

Notice the complete lack of information. No mention on the breed or size of the dog, no information on when this occurred, no pictures, etc.  

What am I supposed to do with stuff like this?

What I do is delete it and move forward. Life is too short to get in a discussion with a fool who has a dog deeply gored by a pig, and who has still not taken the dog to a vet. I feel sorry for the dog, but I managed to disenthrall myself of the notion that I can rescue every animal that is owned by fool some years back.  Rescue Ranger I am not.

Want another?  How about this email I got yesterday?

Hi there:

I just read the information you have posted regarding Ivermectin and dosing. I have a small terrier mix dog that was diagnosed almost 2 years ago with heart worms. He has been absolutely fine with no symptoms until recently. He coughs now, quite a lot. Is it possible to still treat him without him getting sick or dying? I don't want to kill the baby and the treatment from the vet is very expensive. They told me it was hard to treat after they've had them for so long. I have not had the money to do it and would like to try if possible. What do you think? I have 13 other rescues and want to try to treat them myself with Ivermectic as a preventative. I do all vaccinations myself. Is this also good for flea treatment?

Woo-eee!  

You want the gravy on this one? This knuckle-dragger had the stones to embed the contact information of the law firm that employes her on to the bottom of her email!

So, let me ask you:  What do YOU say to someone who has left her dog untreated with heartworm for TWO YEARS, and only now thinks to take action, even as she whines about treatment costs?   And does it matter that this person has 13 dogs?

Guess what I said?
.
. 
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The Veterinary Trade's Plan to Rip You Off

A repost from October 2010

From Veterinary News comes this report that the usual suspects (Ron DeHaven, CEO of the American Veterinary Medical Association, Hill's Pet Nutrition, Banfield Pet Hospitals, Bayer, and Brakke Consulting) are planning a full-on campaign to rip-off the American people.

As the article notes:

John Payne, CEO of Banfield, The Pet Hospital called on professional leaders to form a comprehensive strategy to build access to veterinary care.

"It's time to act," Payne told attendees at a recent Banfield Pet Healthcare Industry Summit, especially in light of sluggish economy and receding client visits.

.... The idea, however, is to build a broad coalition of practitioners, animal-health companies and associations to... boost the number of times pet owners see their veterinarian....

... Over the last several years, the veterinary profession has removed trip drivers, Payne says. "We have changed vaccine protocols, which is a good thing. We have products changing distribution. That's a trip driver. And you are seeing this constant bombardment of messages on television about saving money and saving a trip to the veterinarian. It's dangerous for this profession."

... Heartworm prevention represents a huge opportunity for practitioners, Payne says, especially if the profession can improve compliance rates and convert pet owners who are not currently giving heartworm preventives to their pets. In fact, he believes a wholesale push could offset losses from flea and tick product revenue for practices.

Right.

Information to consumers is "dangerous to this profession" says a leader in the veterinary trades.

I bet!

The problem, it seems, is that folks have been educating themselves about the Billion Dollar Vaccine Scam.

People are rejecting the dependency model of veterinary care.

What to do?

Well, clearly we need to flog the dog with year-round heartworm "preventative" even as we pray to Baby Jesus that consumers don't find out about the Billion Dollar Heartworm Scam.  What?  You can get heartworm preventative for less, without a veterinary visit, and you don't have to dose year-round?

For God's Sake, no one read Terrierman's Daily Dose!  

(Hat tip to Paul H. for sending me the Veterinary News article.)

• Related Links:
  ** A Business Plan Based on Fencing Out the Truth
  ** You Can Vaccinate Your Own Dog
  ** Over Vaccination Is Bad Medicine
  ** Year Round Dosing for Big Veterinary Profits
  ** Pearly White Profits From Teeth Cleaning
  ** Year Round Dosing for Big Veterinary Profits
  ** The Billion Dollar Heartworm Scam
  ** The Billion Dollar Lyme Disease Scam
  ** The Billion Dollar Vaccine Scam
  ** Vet Pricing Has Nothing To Do With Care
  ** Your Vet Has a Heartworm Medication Secret
  ** Heartworm In Winter?
  ** Puppy Mills, Veterinary Bills and the AVMA
  ** AVMA Says Fear Your Pet and Go to the Vet
  ** Veterinary Trades Say It's Time to Rip-off the Rubes .

Heartworm In Winter?

If your veterinarian has your dog on year-round heartworm medication, and you live in a state where the birds actually fly south for the winter, you might want to consider changing vets or at least not following his or her advice on this matter.

Here's why: heartworm can only be transmitted to a dog if the heartworm nematode has completed the first part of its lifecycle inside the body of a mosquito. The first part of that lifecycle can only be completed if the temperature stays above 57 degrees for at least 45 days straight, both day and night.

To read more, see "The Billion Dollar Heartworm Scam " and "Year Round Dosing for Big Veterinary Profits."
.

The Concern Trolling Vet

Do you know what "concern trolling? is?

Your vet does.

In fact, perfecting the art of concern trolling is actually more lucrative for most vets than anything they actually learned in veterinary school.

It's concern trolling that gets customers to:

• Vaccinate their adult dogs for diseases they will not get because that first-year round of distemper and parvo vaccines are actually good for life;
  x
• Put their dogs on heartworm medication all year long, even when it's snowing outside;
  x
• Buy their flea and tick medications from their vet rather than order online for half the price;
  x
• Run tests for parasites (worms) and diseases (Lyme) rather than simply treat for less.
  x
• Come in every year for a "teeth cleaning" (complete with anesthesia) and a "well dog checkup."

The concern troll is someone who is "concerned" that your dog is not "up to date" with yearly vaccines.  

He or she is "concerned" about your dog's weight -- and has special food to sell you. 

"It's standard practice," they will tell you, to have your dog's teeth "professionally cleaned" every year and for it to come in for a well dog "checkup" because that's what you do for yourself, right?

Can you feel the concern?

Concern trolling is such a massive part of the veterinary profit center that receptionists and vet techs are actually told that up-coding, cross-selling, and up-selling to patients is a core competency of their job.

If they fail at that, they are very likely to be shown the door.

If you are a dog owner, the proper response to being concern-trolled is to push back.

A vet pushing annual or every three-year parvo and distemper boosters should be asked if has been keeping up with any of the literature of the last 30 years. Surely he or she has read Ron Schultz, the leading expert on vaccines? Surely they know that parvo and distempter vaccines are  good for life?

Annual teeth cleaning? No, actually you do not get anesthetized every year to have your teeth cleaned, and you also do not have a full  blood workup to boot. That does not happen. And no, it's not going to happen to your dog either. Anesthesia is dangerous, dental cleaning and scaling for humans has not been show to be effective, and dogs are dead at age 15 not age 80 like people. Surely the veterinarian knows all this? And what dental school did he or she go to again?

And why would you test an asymptomatic dog for Lyme? If a dog is asymptomatic, the dog is fine. Leave it alone.

And why would you run a fecal worm test that, with the vet bill for it, is far more expensive than simply dosing the dog for worms with an over-the-counter wormer?  Surely the vet knows this too, right?  Right??

A heartworm test on a dog younger than 6 months? Surely the vet knows that dogs cannot get heart worm if they are that young? Right???

And surely they KNOW that heartworm cannot be transmitted if the temperature at night has ever fallen below 56 degrees any time in the last 30 days? No?  Then maybe the vet needs to read up on heartworm before prescribing anything?  Concern troll right back!

Now, does concern trolling work to sell nonsense?

Absolutely!  You bet!

Just listen to the concern trolling being used in this promotion for a veterinary marketing system.

Hey, Believe Me I Understand, It’s Not All About the Money!

But Without Enough Veterinary Practice Income How Long Will You Be Able To Provide The Proper Services and Products You Desire and Your Patients Need???

How Will You Pay Your Bills???

How Will You Grow Your Practice???

Yep that's how it's actually punctuated on the web site.

Concern-trolling at the Small Engine Shop

I take down and section enough trees that I have an opinion on chainsaw blades, and that opinion is that you definitely do NOT get what you pay for when you purchase chains in a local shop or specialty store.

My last experience was in the shop that sold me my chainsaw.  

That shop sells $18” chains for about $28 — the same price they sell them for at Lowes.  

When I mentioned I was buying chains for $4.75 apiece, the salesman said he had “concerns” about these cheaper Chinese-made trains.  They “stretch” he said. 

I looked at him weird.

“All chains loosen,” I replied.  “It’s why the saw comes with a wrench, and why there’s a bar chain adjuster.”

Apparently his normal clientele did not use their chainsaws enough to know how to actually put on and tighten a chain.  

It’s actually a common problem, but it’s not one at this house.

“Concern trolling” is a core competency in the world of sales. 

The most common manifestation is the phrase “you get what you pay for.”  

That might be true in some cases, but more often than not, it’s bullshit — the catch-phrase of the up-selling salesman.

What’s this have to do with dogs?  Quite a bit.

Dog breeders are big on the idea that the more you pay for a dog, the better it’s likely to be.  

That’s mostly bullshit

It’s also bullshit that the more expensive the dog food, the better it’s likely to be.  

Provably not true.

Then, there’s veterinary care, where a large part of the job of most “vet techs” is to upsell and tack on every nonsense service, test, and procedure they can think up.

Concern trolling is the most lucrative part of nearly every veterinary practice.

It's concern trolling that gets customers to:

* Vaccinate their adult dogs for diseases they will not get because that first-year round of distemper and parvo vaccines are actually good for life;

* Put their dogs on heartworm medication all year long, even when it's snowing outside;

* Buy their flea and tick medications from their vet rather than order online for half the price;

* Run tests for parasites (worms) and diseases (Lyme) rather than simply treat for less.

* Come in every year for a "teeth cleaning" (complete with anesthesia) and a "well dog checkup."

The concern trolling vet tech will say they are “concerned" your dog is not "up to date" with yearly vaccines.  

He or she is "concerned" about your dog's weight -- and has special food to sell you. 

"It's standard practice," they will tell you, to have your dog's teeth "professionally cleaned" every year and for it to come in for a well dog “checkup" because “that's what you do for yourself,” right?

Can you feel the concern?

If you are a dog owner, the proper response to being concern-trolled is to push back with your own concerns. 

A vet pushing annual or every three-year parvo and distemper boosters should be asked if he or she has been keeping up with any of the literature of the last 30 years. Surely he or she has read Ron Schultz, the leading expert on vaccines? Surely they know that parvo and distempter vaccines are  good for life?

You have concerns!

Annual teeth cleaning? No, actually you do not get anesthetized every year to have your teeth cleaned, and you also do not have a full  blood workup to boot. That does not happen. And no, it's not going to happen to your dog either. Anesthesia is dangerous, dental cleaning and scaling for humans has not been show to be effective, and dogs are dead at age 15, not age 80 like people. Surely the veterinarian knows all this? And what dental school did he or she go to again?

You have concerns!

And why would you test an asymptomatic dog for Lyme? If a dog is asymptomatic, the dog is fine. Leave it alone.  Surely they know this is the correct protocol?

No? You have concerns!

And why would you run a fecal worm test that, with the vet bill for it, is far more expensive than simply dosing the dog for worms with an over-the-counter wormer?  Surely the vet knows this too, right?  Right??

You have concerns!

A heartworm test on a dog younger than 6 months? Surely the vet knows that dogs cannot get heart worm if they are that young? 

You have concerns!

And surely they KNOW that heartworm cannot be transmitted if the temperature at night has ever fallen below 56 degrees any time in the last 30 days? No?  Then maybe the vet needs to read up on heartworm before prescribing anything?  Concern troll right back!

Of course, if you are too timid to push back, are a people-pleaser that avoids all confrontation, or are the kind of person that folds to any and all claims of authority (see the Milgram Experiment), you are free to carry on by flushing your money down the drain.

As always, do what you want.  It’s a free country, even if the upselling is all very expensive.

Saving Big Money With a Ball Point Pen

When a veterinarian submits a "prospective bill" before doing the work, look it over and see what you can cross out.

1. Are you being double billed? It happens.
2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
7. Is your veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).
    
    _ _ _ _ _ _ _ _ _Related Links

• A Business Plan Based on Fencing Out the Truth
• Is Your Veterinarian Clean? Don't Count On It.
• Veterinary Trades Say It's Time to Rip-off the Rubes
• The Billion Dollar Heartworm Scam
• Rimadyl: Relief From a Swollen Wallet
• Vet Care Reaches Human Care Costs
• SuperGlue to Close Wounds
• The Billion Dollar Lyme Disease Scam
• Veterinary Billing Without Oversight or Regulation
• A Season to Everything
• Cruciate Ligament Injuries in Dogs
• Vet Pricing Has Nothing To Do With Care

.

The King of Killers

What critter kills more people in the world than all others?

The mosquito.

The official mosquito-to-human kill tally:

• Malaria -- About 40% of the world's population is susceptible to malaria, and though DDT and other mosquito-control insecticides have helped reduce the problem, malaria still kills between one and two million people a year, while infecting 300 to 500 million people annually. .


• Yellow Fever - Every year about 200,000 cases of Yellow Fever still occur, killing about 30,000 people a year across about 30 countries. .


• Dengue  -- Dengue infects at least fifty million people a year and more than half a million people a year become seriously ill from the disease, with 12,000- to 25,000 people a year dying from the disease.
  

Other disease can also be transmitted by mosquitoes, including various kinds of Encephalitis,  Elephantiasis, epidemic polyarthritis, West Nile, and Rift Valley fever.

Of course, here in the U.S. the most common disease carried by mosquitoes is dog heartworm. 

Though dog heartworm cannot be successfully transmitted to humans, it remains a serious canine health problem in the southern U.S. among those who do not treat their dogs with any of the cheap, easy-to-get heartworm medications available over the counter from farm supply stores, and by prescription from veterinary offices.

• Related Links:
  ** Sharing Death and Disease Across Species

.

Saving Big Money With a Ball Point Pen

When a veterinarian submits a "prospective bill" before doing the work, look it over and see what you can cross out.

1. Are you being double billed? It happens.
2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
7. Is you veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).
    
    Related Links

• A Business Plan Based on Fencing Out the Truth
• Is Your Veterinarian Clean? Don't Count On It.
• Veterinary Trades Say It's Time to Rip-off the Rubes
• The Billion Dollar Heartworm Scam
• Rimadyl: Relief From a Swollen Wallet
• Vet Care Reaches Human Care Costs
• SuperGlue to Close Wounds
• The Billion Dollar Lyme Disease Scam
• Veterinary Billing Without Oversight or Regulation
• A Season to Everything
• Cruciate Ligament Injuries in Dogs
• Vet Pricing Has Nothing To Do With Care

.

What's Your Vet Charging You?

What's your vet charge for common services?

Is it on their web site? Is it posted in their office?

Why not?

Washington, D.C. is one of the most expensive places in America to live, and the Washington Humane Society charges (and openly lists) the following fees for comparison:

• Regular Spay/Neuter Package (includes surgery, pain medication, e-collar and complimentary nail trim) $130
• In-heat Spay additional $20
• Pregnant Spay additional $25
• Cryptorchid additional $20-$40
• Over 100 lbs. additional $20
• Aggressive Dog additional $20
• Frontline flea treatment per dose $10
• Distemper (DHPP) vaccination $10
• Rabies vaccination $10
• Nail trim $5
• Microchip $35
• E-collar $10
• Heartworm test $20
• Six months of heartworm preventative (under 50 lbs) $20
• Six months heartworm preventative (over 50 lbs) $25

For the record, my own vet, which was voted one of the "Best Veterinary Hospitals" in the Washington, D.C. area has a web site but publishes NO pricing.

Again, why not?  I would complain, but I only see them about once every five years, as I do my own vet work for small wounds, shots, flea and tick, worming, etc.

How about your vet?  Google them and let's see how many out there actually report pricing!

And no, pricing is not everything, but since "no one goes to a bad doctor," it's not a small issue either, is it?

• Related Post:
  ** Veterinary Pricing Has Nothing to do With Care
  ** How to Go to the Vet

.

Saving Big Money With a Ball Point Pen

When a veterinarian submits a "prospective bill" before doing the work, look it over carefully, and see what you can cross out.

1. Are you being double billed? It happens.
2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
7. Is you veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).
    
    _ _ _ _ _ _ _ _ _Related Links

• A Business Plan Based on Fencing Out the Truth
• Is Your Veterinarian Clean? Don't Count On It.
• Veterinary Trades Say It's Time to Rip-off the Rubes
• The Billion Dollar Heartworm Scam
• Rimadyl: Relief From a Swollen Wallet
• Vet Care Reaches Human Care Costs
• SuperGlue to Close Wounds
• The Billion Dollar Lyme Disease Scam
• Veterinary Billing Without Oversight or Regulation
• A Season to Everything
• Cruciate Ligament Injuries in Dogs
• Vet Pricing Has Nothing To Do With Care

.

Is Your Veterinarian Clean? Don't Count On It.

In 1847, Dr. Ignaz Semmelweiss, a physician working in a Vienna hospital, came to believe infections were being spread by doctors who did not wash their hands between patients.

Semmelweiss instituted a new procedure: all doctors and nurses had to wash in a chloride of lime solution after autopsies, and with soap and water between patients. Doctors also had to change into clean lab coats before examining patients.

The doctors protested: "Are you saying we are dirty?"

The protests were to no avail. Semmelweiss was a powerful hospital administrator, and the rule went into effect. As a result, hospital mortality rates dropped like a rock. Patients stopped dying.

I bring up this story as an introduction to the topic of conflicts of interest in veterinary medicine.

Conflicts of interest? What are those?

Conflicts of interest are the unseen dirt that lead to sickness in America's heath care system, both human and veterinary. The most obvious examples are kickbacks, payola, and incentives from companies to doctors or veterinarians in order to get them to use their products, even when those products and services are over-priced, inferior, or medically unnecessary.

Conflicts of interest may be disguised as "Continuing Education" courses paid for by drug companies, paid vacations to the Caribbean for selling a lot of "prescription" dog food, and quid pro quo arrangements in the form of extra "free samples" (that can be sold to patients) if a certain number of "legitimate" prescriptions for a product are written.

Am I saying that America's health care system -- human as well as animal -- might be unclean?

Yes, I am.

And the lack of cleanliness is one reason health care is so expensive.

In the arena of human health care, people naively think patient-support groups must be honest brokers. Yet, in the area of diabetes, insomnia, mental illness, and heart disease, we find clearly corrupt and conflicted relationships.

Most folks are so oblivious to how human health care works that they do not even wonder why their doctor put them on Zocor rather than Lipitor for cholesterol, or why their surgeon installed a Zimmer knee rather than a Stryker knee. Why would a psychiatrist prescribe Zyprexa for psychosis, when another drug has fewer side effects and is cheaper? Why does the ambulance turn left to deliver them to Mercy General, rather than right to deliver them to Baxter Hospital Center?

The answer, in nearly every case: kickbacks, payola, and other unnamed "conflicts of interest."

And this is human medicine, which is highly regulated, and where kickbacks, self-referral, upcoding, and prescribing medically unnecessary services are clearly illegal and punishable by fines that can rise to millions of dollars.

Does this kind of stuff occur in veterinary medicine as well? Of course. There is no magic line between human health and veterinary health.

Veterinary health is far less regulated than human health care, and as a consequence there is even less incentive to do the right thing.

The American Kennel Club has now gotten into the veterinary referral business, and both vets and the AKC are now in the business of selling veterinary insurance.

The veterinary insurance industry pays a kickback to the AKC and to referring vets, while the presence of pet insurance softens the economic blow from rapidly rising veterinary costs.

In essence, what you have here is a feed-back loop, in which the customer may be triple-gouged; first by veterinarians who bill-pad, and then by the insurance industry which is making a profit by simply monetizing high veterinary bills into monthly insurance premiums. Finally, the very presence of pet insurance means vets have less incentive than ever to hold down prices and a ready-made rationalization to suggest more testing, and more extravagant health care interventions.

But, of course, a vet will not tell you this. Vets like paid vacation packages to the Caribbean courtesy of Science Diet or Novartis.

Vets like free pens, posters, literature racks, and "samples" that can be sold to their clients.

Vets like pharmacy-sponsored open-bar receptions at their conferences, and low-cost continuing education credits.

If you have the temerity to ask if there might be a conflict of interest here, they will express outrage that you even raise the question.

"Are you suggesting my medical opinion can be bought for note pads and pens," one human doctor asked me.

Yes indeed. And I am not the first. Jamie Reidy, a former rep for Pfizer and Eli Lilly, puts it this way:

“[Doctors and pharmacists] are like pigeons. Only instead of bread crumbs, you toss them pizzas and sticky notes.”

As Newsweek has noted, 

"Almost every [human] doctor in the country has some type of relationship with pharmaceutical manufacturers, whose clear goal is to influence physicians to prescribe the company's newest, most expensive drugs. The companies offer physicians everything from scratch pads to trips worth thousands of dollars to attend medical conferences."

Veterinarians are no different from family physicians, hospital administrators, specialists in cancer clinics, or the folks that run nursing homes. All of them consider kickbacks, price-gouging, upcoding, and billing for medically unnecessary services a core part of their business plan, and an important profit center.

And, for the record, I am speaking here solely of those items that are actually illegal in the arena of human medicine. And since these things are generally not illegal in veterinary medicine, you find them there as well.

In fact, veterinary ethics sit on such a slippery slope that what is considered criminal behavior in human medicine is actually treated as a normal business practice for pets.

Take the business of dog food and veterinary medicine sales. As The Wall Street Journal reported back in 1999:

Over examining tables across the country, more pet doctors lately are trashing trusted brand names like Purina and Kal-Kan, calling them 'junk food,' and directing people to shell out an extra $20 or so for a month's supply of super-premium 'high science' foods.

The biggest beneficiaries: Hill's Science Diet lines, made by toothpaste giant Colgate-Palmolive Co., and Eukanuba and Iams brands from Iams Co. of Dayton, Ohio. Sold only through pet stores and veterinary clinics, the designer brands pack more calories per bite and promise higher-quality ingredients based on "pioneering research in animal nutrition" tailored to a pet's "life stage" or age.

The result: Vet suggestions ringing in their ears, many pet owners have switched brands - and the life-stage category has amassed a Doberman-sized $2 billion chunk of the market.

But few pet owners know just how far premium-market-leader Hill's has gone to sew up the vet endorsements.

Borrowing a page from the pharmaceuticals companies, which routinely woo doctors to prescribe their drugs, Hill's has spent a generation cultivating its professional following. It spends hundreds of thousands of dollars a year funding university research and nutrition courses at every one of the 27 U.S. veterinary colleges. Once in practice, vets who sell Science Diet and other premium foods directly from their offices pocket profits of as much as 40%.

Right.

And yet, most of these "super premium" dog and cat foods are the same old stuff, made in the same factories, as lower-priced grocery store dog foods.

Dog food sales by veterinarians are about more than profit-per-bag, however. They are also a way to keep you coming back to the veterinarian's office every month.

Each visit is a chance for the vet to "get you up-to-date on shots," to sell you more flea and tick medication, to enquire about teeth cleaning and grooming, and to "schedule an annual check up."

Vets know the more times you come in, the more they will be able to sell you, and the more they will be able to "market the relationship."

And how about prescription drug sales by veterinarians?

As a general rule, human doctors in the U.S. are not allowed to sell drugs directly; they must prescribe drugs sold by a third-party pharmacist. The one exception is in cases where a drug is administered directly to a patient in a doctor's office or hospital. Most of these are cancer drugs such Zoladex and Lupron, and the markups here are phenomenal. In fact, at one point 60% of a cancer doctor's income was likely to be coming from kickbacks from drug companies "marketing the spread" on cancer drugs.

So what are we to make of veterinary drugs and foods sold directly by prescribing vets? Are we being price-gouged? Are we being sold brand name drugs and fancy dog foods when generic drugs and off-the-shelf supermarket kibble would do just as well? Are our pets being over-prescribed expensive medicines? Are we being sold medically unnecessary foods and services?

The answer is "probably yes." How often this occurs, of course, will differ from, veterinary to veterinary. Not all vets sell "prescription" dog food. Not all vets load up on expensive tests for every vague condition.

But a lot do. And the number is increasing.

Of course, the veterinary trade will protest. Like the doctors in Herr Semmelweiss' hospital, they will protest they are not contaminated. They are running a clean operation.

But of course, the pharmacy and dog-food vendors know better, don't they? They know how easy it is for a doctor or veterinary to become self-deluded. As long as things appear to be clean on the surface, then it's only too easy for a doctor to believe he or she has not been contaminated.

"The trick is to give doctors gifts without making them feel that they are being bought," says former Pfizer salesman Michael Oldani. The trick is to make a gift feel personal so it does not come off as a bribe.

"Drug reps must try their best to influence doctors, while doctors must tell themselves that they are not being influenced. Drug reps must act as if they are not salespeople, while doctors must act as if they are not customers."

All of this, of course, is completely normalized. In the world of medicine, this is business as usual. And it's no different in the world of veterinary medicine.

For a new doctor or a vet entering an already established practice, it's hard to stay clear of the ethical traps. "This is the way it's done," they will be told. And the message is not just implied; often it is said overtly.

And so the new vet entering a practice that has swallowed the "let's rip off the patients" spiel of the American Veterinary Medical Association (AVMA) has to go-along to keep his or her job. It's just that simple.

And so the new veterinarian learns that every limping dog must be billed for an x-ray, that every 10-week old puppy should get a heartworm test, and that every dog or cat should be encouraged to have annual vaccines.

Never mind if this is bad medicine, it is good business.

Similarly, the receptionist is instructed to pressure every owner of a boarded dog to buy "extras," from additional walks, to toe-nail paintings to baths and "updates" for all shots.

At some vets, any surgery, no matter how minor, seems to require an overnight stay. To hear some vets tell it, every dog, no matter where they live in the U.S., should be on heartworm medication year-round.

And the teeth? They will require annual cleaning, and with it expensive pre-anesthesia blood work.

This is how a veterinary career starts today.

Never mind that canine dentistry is a scam invented about 15 years ago, and that dogs do not need annual vaccines.

Never mind that a 10-week old puppy cannot get heartworm and does not need to be tested for it.

Never mind that no dog north of the Mason-Dixon line needs to take heartworm medication year-round.

Never mind that most limping dogs have nothing wrong with them that time alone cannot fix.

As one doctor observed, marveling at how fast he slipped his own ethical tenets when he began his own medical career:

"It’s kind of like you’re a woman at a party, and your boss says to you, ‘Look, do me a favor: be nice to this guy over there.’ And you see the guy is not bad-looking, and you’re unattached, so you say, ‘Why not? I can be nice.’ The problem is that it never ends with that party. Soon you find yourself on the way to a Bangkok brothel in the cargo hold of an unmarked plane. And you say, ‘Whoa, this is not what I agreed to.’ But then you have to ask yourself, ‘When did the prostitution actually start? Wasn’t it at that party?’”

 

Yes it was.

So what can you, the dog owner, do about it?

Well one thing you can do is forget about the veterinary trade reforming itself. As I have noted in a previous post (Veterinary Trades Say It's Time to Rip-off the Rubes), the American Veterinary Medical Association, the American Animal Hospital Association, and the Association of American Veterinary Medical Colleges, all see their jobs as taking money from drug companies while instructing veterinarians on how to bill-pad, price-gouge, and recommend medically unnecessary services to customers. This is the core message of the veterinary trade associations today.

And, as noted, more and more vets are falling victim to this siren song. "This is the way you do it," young veterinarians are being instructed. This isn't fraud: this is a business plan.

So what can you do about it? Simple: Stop going to the vet so damn much. As I noted in a previous post:

The simple truth is that most of what a vet does -- and most of what they bill for -- you can do yourself.

Pet owners do not need to go to the vet for dog food, annual booster vaccines, regular teeth cleaning, routine worming, and "well puppy" checkups.

Not every mass needs to be biopsied, and not every limp needs to be x-rayed.

You can treat your dog yourself for ring worm and ear infections, and you do not need to buy flea and tick medicine from your vet at sharply inflated prices.

You are still in control of your own dog, and if you will only take the time to KNOW a few things, then you will soon know enough have a pretty good handle on when to say NO.

Let me make 10 recommendations right now that could save you many thousands of dollars over the life of your dog. Some of these are common-sense tips to help you avoid harming your own dog through carelessness or ignorance. Most, however, are simple tips to prevent you from being ripped off by the veterinary trade.

1. Control your dog. The simplest step to avoiding a high-cost problem is make sure you have solid and secure fencing, a garden gate that is self-closing, a good collar and tag on the dog at all times, and an old-fashioned leash when you go for a walk. If your dog is hit by a car, the cost of veterinary care can skyrocket through the roof. If your dog is an escape artist, you may need to install a hot wire at the top and bottom of your solid fence, or else run an invisible fence (aka radio collar fencing) alongside the solid fence. Be sure to add a spring to the garden gate so that it is self closing and self-locking, and if you have small children in the area, a keyed lock on the garden gate is a good idea.
   
2. Control what your dog has access to, especially when it is young. Young dogs will eat anything, and if you leave tennis balls, shoes, socks and plastic toys around the house, you are very likely to end up paying for surgery to get these same things removed from your dog's stomach. Not all dogs are chewers and swallowers, but enough are that veterinarians count this problem as a major profit center.
3. Say NO to annual teeth cleaning. Because dogs have much shorter life spans than humans, they do not require the same type of dental maintenance. Annual teeth cleaning is expensive, and anesthesia is dangerous (especially for some breeds of dogs). Say no to annual teeth cleaning, while saying yes to hard kibble and a weekly tooth brushing, and you will pocket at least $2,000 over the life of your dog while not reducing its lifespan one day.
4. Say NO to dog food sold by your veterinarian, and you may save another $1,000 or more over the life of your dog, and your dog will live just as long and just as well. As a general rule, avoid all the boutique-label dog food brands and simply serve a good bagged kibble from a company like Purina. And I speak as someone with working dogs. As Tony Buffington, a veterinary professor at Ohio State University, has noted, "The nutritional requirements of neutered, sedentary adult animals are so low that they could be met by anything." So stop feeding your dog like it's a race horse when it's actually a couch potato that sleeps 18 hours a day. Not only will your wallet be fatter, but there's a good chance your dog will actually be healthier as may be a little less likely to add on unneeded pounds.
5. Say NO to annual vaccine boosters and "well dog" checkups, and you will save another $2,000 over the course of the life of your dog, and your dog will be just as covered from communicable diseases and will live just as long. "Well dog" annual checkups make your vet economically healthy; they do not do a thing for the dog.
   
6. Research limp and tumors a litte bit, and you may save $10,000 or more on your dog. Does your dog's cruciate ligament injury really need treatment? Probably not if the dog is under 40 pounds, and maybe not if it is over 40 pounds. Does that lipomas tumor really need to be biopsied and removed? Probably not. What happens if nothing at all is done?
7. Buy your prescription drugs and your flea and tick medications mail-order and you can easily save $1,000 or more over the life of your dog or cat. If your veterinarian will not write you a prescription, change vets -- he or she is a price-gouger who clearly does not respect you as a customer.
8. Do not let the receptionist bill-pad. Most veterinary practices instruct their receptionists to add a lot of nonsense to "prospective" bills. Go through that bill and cross things out. You are in charge of the bill. Look for double-billing, the addition of medications you have not requested, unnecessary blood and lab work, and non-requested services. This is especially important to do if high-priced emergency services are being rendered, as this seems to be a time for full-scale price gouging. I have saved more than a $1,000 at a crack by questioning veterinary bills, and I have done this more than once.
9. Feed your dog less and run them light. Not only will your dog live longer and be more energetic, running your dog light will generally save you a lot on veterinary care as well since joint and ligament injuries are often weight-related, as are many kidney, liver, and heart problems. A higher quality-food is also not necessarily better for your dog, especially if it is a large breed. High-quality foods loaded with calcium tend to make large-breed dogs grow too fast too soon, and are implictated (along with too much weight, inbreeding, and slick floors) in the rising incidence of hip dysplasia. With small dogs, such as terriers, weight control is particularly hard and you may find you have to skip all meals one day a week; the dog will do fine under such a regime, I assure you.
10. Make your peace with death. Spending vast sums of money to prolong the life of a very old and sick dog or cat is a bit like shoveling sand against the tide. Every pet deserves a good life and a good death. If you are spending $4,000 to keep a 15-year old dog or cat alive another two months, your emotions are running riot over common sense. Just as seriously, your are probably doing a disservice to the animal, who deserves to die free from pain, in peace, and with some shred of dignity left. A good death is part of a good life.

Let me close by saying that not all veterinarians are money-grubbing price-gougers. In fact, most veterinarians enter the field because they genuinely care about animals and people. Veterinary prices, in general, have risen less steeply than human health care costs.

That said, a full-court press is going on right now in the field of veterinary field, and price-gouging practices first pioneered in the field of human health care are now crossing over into the world of veterinary care.

Conflicts of interest are now "baked in" to every veterinary practice, and vets are just as susceptible to marketing and the chattering voice of greed as anyone else. If you think veterinarians are more honest than car mechanics, you are wrong; they are in the exact same business, and have the exact same economic pressures.

For you, the pet owner, the only good defence is a good offence. This means that you need to become more proactive and less passive. The more informed you get about basic veterinary care, the more you will be able to do yourself (at considerable savings), and the better you will be able to push back when price-gouging veterinarians begin to pad the bills.

In sum: When you KNOW more, you will be able to NO more, and the savings, over the life of your dog or cat, will be considerable.
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