Tuesday, August 25, 2009

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


Viatecio said...

UG is in Ontario. I went up there with the school marching band a few times to perform.

The key question that never died: "What the hell does a gryphon sound like?" Seriously...does it caw, cluck, chirp, what?

Novus said...

This vet's probly a simple trade protectionist. Hard to beieve he does not know. Stock and kennel men have been ignoring their like since the beginning. How could your run a kennel or farm any other way? We use Albon and also bring Clavulanate over from France to treat small flesh wounds. We give the dogs their jabs ourselves, and we rarely need to see a veterinary as a consequence.

Keep up the good work!


PBurns said...

V. - I have no idea what a Gryphon sounds like, but I am pretty sure it sounds like fantasy ;) You would think a country with as much marvelous wildlife as Canada could find a real animal to name themselves after. Ah well, another rule for the book: "Never attend a school that is younger than you are." It's right up there with "Never trust a vet that has not yet buried a dog from old age."


PBurns said...

Novus -- Clavulanate is the same as Clavamox. A good all-purpose antibiotic for flesh wounds.

I do not use Albon myself, but know folks who do in the UK and the beagle pack boys over here use it. I think it's popular among folks who have large kennels as it's a good for Coccidiosis. See >>


HTTrainer said...

They (Alice & the Duchess) very soon came upon a Gryphon, lying fast asleep in the sun. (If you don't know what a Gryphon is, look at the picture.) `Up, lazy thing!' said the Queen, `and take this young lady to see the Mock Turtle, and to hear his history. I must go back and see after some executions I have ordered'; and she walked off, leaving Alice alone with the Gryphon. Alice did not quite like the look of the creature, but on the whole she thought it would be quite as safe to stay with it as to go after that savage Queen: so she waited.

The Gryphon sat up and rubbed its eyes: then it watched the Queen till she was out of sight: then it chuckled. `What fun!' said the Gryphon, half to itself, half to Alice.

`What is the fun?' said Alice.

`Why, she,' said the Gryphon. `It's all her fancy, that: they never executes nobody, you know. Come on!'

`Everybody says "come on!" here,' thought Alice, as she went slowly after it: `I never was so ordered about in all my life, never!'

retrieverman said...

As a dog person, I know a gryphon is not a griffon.

Connemara said...

Along these same lines: I have been using your "Antibiotics for less" program for a few years now. I have had nothing BUT success since. I am wise enough to recognize when a vet's true care is needed and in those times, I spring for the best of care. But all the other times, when in the past I would have been "raped" by their fees - I have taken your advise and my dogs are still as well cared for.
Once again, THANK YOU for your daily posts. More often than not, information I can use or great thoughts to ponder.

Mary said...

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.

PBurns said...

Tetracycline drugs are not drugs I normally use on my dogs (see http://www.terrierman.com/antibiotics.htm ), but ...

YES tetractycline and doxycycline are not drugs that can be kept for a decade past expiration as most other antibiotics....

BUT it appears they are good for quite a bit longer than their expiration dates.

DOXY is bought in large amounts by the U.S. Government, If you go to >> http://browardchd.org/services/Emergency/docs/TrainingFiles/SNSPreparedness/5_SNSFormulary.pdf (PDF file) you can see some of the Strategic National Stockpile formulary and you will not only see Doxy listed, but you will even see the Shelf Life Extension Progam (SLEP) program label being changed and extended for this drug (slides 32-38).

BOTTOM LINE: Even Doxy is good for a year or two past its expiration date.