In the dilemma discussed in the June issue of In Practice, David Williams described a scenario where you are presented with a puppy that has abnormal eye discharge which, on inspection with the Schirmer tear test, is confirmed as dry eye. The recommended treatment is topical cyclosporine, which is likely to restore tear production while alleviating the discomfort that is clearly a welfare issue for the animal. Without such treatment the quality-of-life for the puppy reduces dramatically due to chronic corneal pain. However, the owner is unable to afford this licensed treatment. You remember the days before cyclosporine ointment was licensed, when the oral formulation of cyclosporine used for atopic dermatitis was diluted in corn oil and worked perfectly well. (IP, June 2019, vol 41, pp 230-231). What do you do?
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The answer to this dilemma would seem to me to be very simple. The wording of the RCVS admission statement, if read in pure and simple English, states the welfare of the animal is ‘above all’. This comes after the promise to accept responsibility to the public and the RCVS.
This clear wording allows for no ambiguity in my eyes. If a situation means that an animal will suffer in its current state, and this can be alleviated through evidence-based medicine, then regardless of the cascade it is our professional duty to do so.
The cascade is, in my opinion, a barrier on many occasions to the treatment of animals in poorer demographic situations. While I understand the need to ensure responsible prescribing of effective treatments, one also has to accept the fact the cascade politically facilitates the lining of veterinary pharmaceutical pockets.
Everyday Ethics Poll
Last month’s poll asked:
You are presented with a rescue dog with dry eye. However, the client is unable to pay for licensed topical cyclosporine What do you do?
65% of respondents would treat the condition with the suboptimal tear replacement therapy.
35% of respondents would prescribe the unlicensed diluted oral formulation of cyclosporine, which has been found to work perfectly well.
0% of respondents would not treat the condition as the owner cannot afford licensed topical cyclosporine.
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