September 15, 2010

 

 Delegates want AVMA voice in antimicrobial use

 
 
posted September 1, 2010

 

The AVMA wants veterinarians to help decide when antimicrobials will be given to animals, regardless of how the drugs are obtained.

But the Association will not push for a veterinarian-client-patient relationship with all such uses.

The House of Delegates voted unanimously July 30 to approve two resolutions. The first implements a policy favoring veterinary involvement in animal uses of antimicrobials, regardless of whether the drugs were obtained through prescriptions or as over-the-counter purchases. The second policy states the AVMA should be at the forefront of discussions that could impact regulations involving drug availability.

The Executive Board recommended passage of the two resolutions on the basis of conclusions reached by the AVMA Antimicrobial Use Task Force. The task force report is available at www.avma.org/AUTFreport.

The task force was formed in response to introduction of a 2009 resolution that would have amended the AVMA policy "Judicious Therapeutic Use of Antimicrobials" to indicate that the judicious use of antimicrobials should meet all requirements of a veterinarian-client-patient relationship. During its 2009 regular annual session, the HOD voted to refer this resolution to the Executive Board, with a recommendation that the board convene a task force on antimicrobial use.

The task force examined the role of veterinarians in antimicrobial use and reviewed scientific studies on whether there is a relationship between antimicrobial use in animals and antimicrobial-resistant infections in humans.

The 2009 resolution was again taken up by the HOD during this year's regular annual session, and after substantial debate, was ultimately defeated, with about 70 percent of delegates voting against the policy change. Opponents of the 2009 resolution voiced concerns as to whether the policy could have negative consequences, such as increased restrictions on extralabel drug use or conflicts between governmental and AVMA policies.

Dr. M. Gatz Riddell, American Association of Bovine Practitioners alternate delegate, argued that amending the language could have unintended negative consequences, such as creating conflicts between AVMA policies and what appears to be the FDA's current thinking on the future, streamlined Veterinary Feed Directive process. He said the VFD is the most likely vehicle through which the needed veterinary oversight will be applied. The VCPR was designed to be applied to extralabel drug use, not to the approved label use of antimicrobials in livestock feeds. There is no legal extralabel use of feed-additive antimicrobials. Dr. Riddell said AVMA policy needs to be consistent with the regulatory environment under which veterinarians will provide this oversight.

Dr. James Brett, alternate delegate from Mississippi, said the language of the resolution would have had a substantial impact on livestock and the way animals are managed, and he encouraged delegates to let veterinarians who work with livestock continue to use their own expertise.

Dr. Daniel E. Lafontaine, delegate from the American Association of Food Hygiene Veterinarians and chair of the Antimicrobial Use Task Force, argued against adoption of the resolution and asked delegates to consider that the language could have unintended negative consequences for AVMA members who work with food animals. He later explained that it is not realistic or possible for large animal practitioners to have a VCPR for all antimicrobial uses, as many practitioners act as consultants who visit farms and ranches on a periodic basis.

Dr. Lafontaine also later said that food animal practitioners would be in an untenable situation that would not allow them to act in a manner consistent with AVMA policy.

Dr. William L. Hollis, delegate for the American Association of Swine Veterinarians, stated that while he favors veterinarian direction and oversight for antimicrobial use, the profession is already engaged because of the action taken in another resolution passed the same day. He thought it would be inappropriate to implement the dramatic change that would occur as a result of passing the 2009 resolution.

But proponents said they think a failure to act could pose a risk to human health and endanger the veterinary profession's credibility. Dr. Robert Groskin, alternate delegate for the Association of Avian Veterinarians, said that while his organization understands the need for current antimicrobial uses to meet market demand for production, potential risks to human health require reexamination of those uses.

He said that, rather than defending current antimicrobial uses, the veterinary profession should work to find alternatives to antimicrobial use.

"Our options are to wait and defend a position based on debated science and urge more study, or accept the reality: The current practice needs to be changed," Dr. Groskin said. "The more we resist this change, the less likely we will have the financial and political support our profession and allied industries will need to implement these changes."

Dr. Mark Starr, who represents the National Association of State Public Health Veterinarians on the Advisory Panel to the House of Delegates, argued that amending AVMA policy to state that judicious use of antimicrobials should meet all requirements of a VCPR would incrementally increase veterinarian involvement in decision making while remaining consistent with other AVMA policies.

Dr. Mark P. Helfat, delegate from New Jersey, argued for passage of the 2009 resolution as well, indicating such action would help the profession fulfill its obligation to promote public health as well as preserve the sanctity of the veterinarian-client-patient relationship. He said that while the two resolutions passed by the House of Delegates are sensible and seemingly reasonable, he fears they arrived too late.

"This discussion, this analysis, this debate started some 40 years ago, and now it draws to its finale with or without the AVMA," Dr. Helfat said.

After the meeting, Dr. Helfat said the topic of veterinarian oversight for antimicrobial use will not go away, and he fears that decisions on the matter will be left to an outside entity. But he thinks restrictions along the lines proposed in the 2009 resolution will be approved by the HOD within the next several years.