Author:
Leanne Lewis (Skiska)
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Date Posted: 03:09:05 10/21/02 Mon
Permission has been given to post this artical -
VACCINE DEBATE LEAVES PROFESSION IN DILEMMA
AVMA, AAHA positions attempt to ease contention
Dr. George Cameron knows canine distemper. He's witnessed rabies and
parvovirus.
So when this second-generation practitioner hears warnings of vaccine
overload, he scoffs: "I come from an era of having seen so much distemper
and parvo, until I see otherwise that groups of animals shouldn't be
vaccinated annually, I'll continue doing what I'm doing. I don't see harm
coming to dogs from vaccinations, I see harm coming to dogs from not getting
vaccinations."
Protocols like Cameron's are coming under attack as critics question
the need for recurrent vaccines, associating annual inoculations with cancer
or autoimmune disease. To allay dissension, the American Veterinary Medical
Association (AVMA) promises to soon release a vaccine position statement and
the American Animal Hospital Association (AAHA) anticipates canine vaccine
guidelines. (see cover story.) But their direction doesn't offer clear-cut
answers as federal regulators license vaccines based on up to a year of
manufacturer efficacy tests, leaving product's long-term side effects and
duration of immunity largely unclear.
So in the manufacturer's absence, academics have stepped in, studying
everything from immunization longevity to vaccine-associated sarcoma.
Researchers claim the profession vaccinates too often using too many
biologics, while vaccine supporters poke holes in their work. Their data, or
lack of it, leaves veterinarians facing an ethical dilemma: practice outside
the manufacturer's label, using personal judgment an limited research to
determine risk, or booster annually, exposing patients to alleged harmful
side effects.
NO ONE PROTOCOL
Suspicious of anti-vaccine "propaganda", Dr. Gary Norsworthy, a feline
practitioner in San Antonio, Texas, says he'll booster annually until he
sees "hard evidence" not to.
"I want to see more substantiation for these researchers' claims," he
says. "I agree with AVMA that there isn't enough data to know what the true
duration if immunity is for the vaccines we use in dogs and cats, so I'm
looking at my patients individually, doing risk assessments, I vaccinate
with what I feel is appropriate."
"I can do it the way I think it's right and my neighbor can do it the
way he things is right, and we may not agree."
Not quite a neighbor, New Yorker Dr. Mark Siebert considers yearly
vaccinations unethical. A practitioner for 10 years, it wasn't until Siebert
opened his own Manhattan clinic that he felt free to buck the norm. Now, in
most cases, he vaccinates, boosters once and beyond that, relies on
anti-body titers to determine patient immunity levels. His clients, he says
are pleased.
"I don't know veterinarians around here who titer like this," he says.
"But when I explain why I don't see the need to vaccinate yearly, they
understand. Ninety percent of my clients accept immunity levels as proof of
protection."
SARCOMA SPURS STUDIES
Veterinarians like Siebert have questioned the overuse of vaccines and
their side effects since their 1960 introduction to the profession. But it
wasn't until 1991, when DVMs began noticing a high rate of soft tissue
feline sarcoma developing at popular vaccination sites that the issue
sparked debate. Cancer reports spurred studies and in 1996, veterinarians
formed the Vaccine-Associated Feline Sarcoma Task Force (VAFSTF), which has
pumped money into proving vaccine-malignancy correlations ever since. The
research remains under way.
"Unless you're living in a cave, there's no veterinarian who's not
going to be concerned with at least the information on the feline sarcoma
issues," says Benjamin Cassutto, a practitioner in Delaware. "Even though I
would profit more, I do not recommend certain vaccines because I'm worried
about overstressing the immune system. This means you have to market better
so you don't lose clients or income."
GREEDY MOTIVES?
And profits are what vaccine critics believe is at the root of the
profession's resistance to update its protocols. Without the lure of
vaccines, clients might be less inclined to make yearly veterinary visits.
Vaccines add up to 14 percent of the average practice's income, AAHA
reports, and veterinarians stand to lose big, says Dr. Ron Schultz, a
veterinary immunologist at the forefront of vaccine research and chair of
the University of Wisconsin's Department of Pathobiological Sciences.
"I suspect some are ignoring my work," says Schultz, who claims some
distemper vaccines last as long as 15 years. "Tying vaccinations into the
annual visit became prominent in the 1980s and a way of practicing in the
1990s. Now veterinarians don't want to give it up."
Still, Cameron, who continues to vaccinate regularly, downplays talk of
greed.
"But veterinarians are people who, after eight years in a university, come
out with the lowest professional incomes," he says. "If it were just money,
we wouldn't be in business."
ASSOCIATIONS TAKE POSITION
To help DVMs make sense of the controversy, the American Association of
Feline Practitioners (AAFP) developed feline vaccine protocols based on
VAFSTF research.
Canine-specific protocols also are on the way, AAHA promises,
estimating their reports release by next spring. An AVMA position statement
is scheduled for publication in coming months.
For North Carolina State University Professor Dr. Richard Ford, who
worked on both the AAHA and AVMA documents, industry guidance couldn't come
soon enough. "What concerns me is the large number of vaccines coming into
the market, and the fact that there are veterinarians who insist on
vaccinating every dog and every cat with every vaccine every year," Ford
says. "We can not do this; it's too much. Are we vaccinating too often with
too many vaccines? I'm afraid the answer is yes."
Cover Story)
AVMA, AAHA TO RELEASE VACCINE POSITIONS
LEAD VETERINARY ORGANIZATIONS TAKE STANCE ON DISEASE PROTECTION
In response to public and professional demand, two of the nation's top
veterinary associations prepare to address the contentious topic of vaccine
use with unprecedented resolve.
But as the American Animal Hospital Association (AAHA) prepares canine
vaccination guidelines, which carry some political risks, critics question
why the American Veterinary Medical Association (AVMA), the profession's
largest representative, is content to release just a position statement on
the issue, seeming to ignore the need for real recommendations.
DVM Newsmagazine has learned the release of AAHA guidelines are
expected next spring. AVMA's position statement was being submitted to the
Journal of the American Veterinary Medical Association for publication at
presstime.
"I think AVMA should take a more profound stance; the profession
expects it." says Dr. Richard Ford, A North Carolina State University
professor working on both projects. Ford champions changing vaccination
practices. "The position statement is good, but it's not guidelines. I'd
like to know what the AVMA has to say, but since when do you remember them
doing anything controversial?"
SERVING A NEED
While the position statement isn't a "cookbook", it's far from sub par,
says Dr. Elizabeth Galvin, AVMA assistant director of scientific activities.
The statement stresses AVMA's stance on education, a reduction in the
profession's dependence on vaccine sales, which account for a significant
portion of practice income, and encourages practitioners to use their own
clinical judgment.
"This is a huge issue," Galvin says. "Vaccines have been incredibly
successful in curbing disease, and the optimal revaccination durations are
not known, this is true. But there just isn't enough information out there
for us to develop guideline.
"What we're saying is veterinarians have to continually educate
themselves with what's out there, and do their own research into the annual
vaccine environment."
LACK OF GUIDANCE
But even research-savvy veterinarians hunger for more direction. Aside
from following immunologists like Dr. Ron Schultz, a University of Wisconsin
professor who's performed duration of immunity studies since the 1970s, or
epidemiologist Dr. Larry Glickman, a vaccine critic at Purdue University
who's studying post-inoculation antibody development, DVMs have little
elsewhere to turn.
AAHA panel members are tight-lipped about contents of the group's
forthcoming guidelines, but the American Association of Feline
Practitioner's (AAFP) 1998 version for cats lends to speculation. While the
29-page document doesn't offer a cut-and-dry approach, it recommends
increasing one-year revaccination intervals to three years, speculating that
most vaccines last for at least that length of time. In conjunction, some
manufacturers have increased their rabies inoculation protocols to three
years as well.
Co-author Dr. Tomas Elston says writing the guidelines "opened up a can
of worms."
"The subject is just so controversial," says Elston, a feline
practitioner in Irvine, Calif. "The research that's out there has certainly
changed the way we look at vaccines, but there's just not enough
information. Vaccinating is a medical decision, and unfortunately with more
knowledge, we have more questions."
"You don't just grab a vile from the refrigerator, read the
manufacturer's label and use it. It's not that black and white."
LACK OF RESEARCH, SUPPORT
Speculation feeds the gray area of vaccines. Practitioners and
scientists like Glickman theorize the repeated use of vaccines breed
antibodies that can attack a host's own organs, causing autoimmune disease.
Schultz argues that many annual vaccines remain effective throughout a
lifetime; at least one of his reports successfully challenges a distemper
vaccine after seven years. But despite all the research, it wasn't until
veterinarians started noting soft-tissue sarcoma developing at vaccine
injection sites in cats that the issue sparked widespread debate.
That's when the Vaccine-Associated Feline Sarcoma Task Force began its
ongoing quest to prove the vaccine-sarcoma connection. AVMA admits that the
practice of annual vaccinations is based on historic precedent and not
research. But that research is expensive, requiring large numbers of animals
to be isolated and studied for long periods of time, says Schultz.
"That's why a lot more work doesn't come out," he says. "In the 1970s,
there were four vaccines for dogs and we weren't using them often. Now there
are 16 vaccines for dogs, and if they're not getting them annually, they're
getting them more often than that."
"I'm the only one in the profession who challenges the immunity of
vaccines. I'm really one among a total of three individuals who have
challenge studies out. With just a few of us studying them and more vaccines
on the market, how are we supposed to keep up?"
FRAMING CONCERNS
As AVMA continues to "circle the issue," according to critics, AAHA's
board members say the guidelines, still in draft form, aren't strict. Ford
says they are just what the profession needs.
"We're not dictating what you should vaccinate with, but a lot of
veterinarians want to know the protocols," Ford says. "The health
implications of vaccines are difficult to know because there aren't enough
studies to determine a cause and effect relationship between vaccines and
induced injury.
"Still, most authorities agree there's a likely correlation and a lot
of interest in the issue."
ON THE HORIZON
AVMA refuses to reveal much concerning its position prior to
publication, but according to Galvin, the statement offers advice for
veterinarians and proposed the following:
*Create and promote a national adverse reporting system, documenting
reactions to vaccines.
*Manufacturers should improve vaccine labeling, clearly printing all
that's known about a product.
*Three-year rabies vaccines should be promoted rather than the
traditional annual boosters.
*Veterinarians must promote the value of the exam and move away from
their dependence on vaccine income. Emphasize communications, customization
and learning the lifestyle of clients to attract patients to the practice.
"We're rolling together what we do know about vaccines, find in
published research and expert guidance," Galvin says. "I think this will
continue to unfold over the years as we improve on our information. All of
our ideas need to come together to make the profession move forward."
Regards
Leanne
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