The diminishing returns of your pet's healthcare

🔍 "The improvement in pet health care may not be the best thing for you and your pet." What?! Before you get the wrong idea, let me explain what's behind this statement.

1️⃣ First off, veterinary advancements like Apoquel and Cytopoint for itchy dogs are amazing but come with higher costs—sometimes prohibitively so for many pet parents. 2️⃣ Consider cruciate ligament disease: while TPLO surgeries have outshined older methods like lateral sutures, the cost difference can be staggering. 3️⃣ Oncology advancements have significantly improved, but at a huge financial burden with relatively smaller life expectancy gains for pets. 4️⃣ Overall, the low-hanging fruit in veterinary medicine is gone, leaving behind improvements that are costlier and less impactful. 5️⃣ Reflect on your own circumstances. Is spending thousands for an additional month or two with your pet worth it for you?

💡The key takeaway here is to balance the benefits and costs of advanced veterinary treatments with your pet's quality of life and your financial situation. Not all interventions, even the latest and greatest, guarantee what you would consider significant benefits.

Head over to the full show notes to learn more - https://ourpetshealth.com/podcast/diminishing-returns

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Transcript

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And I don't want you to get the wrong idea. I don't want you to think that I am against all of these developments. I'm not. I think it's wonderful that we have all of these options available to us now, but it's something that we need to be mindful of because, you know, often it's going to get to a stage where things plateau. And just because we can do something, the end result of that intervention, the end result of that treatment may not really make a huge amount of difference to your individual pet. Welcome to the Call the Vet Show, the podcast that helps pet parents understand and optimize the health of their furry family so they can live the full and happy life you want for them. And here's your host, veterinarian, doctor Alex Avery. Hello, Kia ora, and welcome back to another episode of the show. It's great to be here with you again. And I'm kind of continuing to explore the field of veterinary medicine, of pet health care as a whole, kind of looking at the bigger picture, and we've discussed how in some ways this system is is broken. In other ways, your vets' hands are tied in regards to what drugs they're able to prescribe for your pet. And today on, well, maybe not a similar theme, but I want to discuss how actually the improvement in pet health care may not be the best thing for you and for your pet. And the reason that I'm talking about all these topics is that there are things that have been in my mind recently. So I am using this as my platform to to to maybe work out my thoughts a little bit more clearly. But also, I think it's really important for everyone to be aware of some of the issues, some of the factors that are involved in decisions that get made and the care that gets provided in the service that you receive so that we can move away from from blaming, from pointing fingers. We can reverse the the gap, the gulf that is developing between pet parents and between the veterinary health team. Now, also, I'm very well aware that, that that many people have wonderful relationships with their veterinary team, and certainly I have many wonderful relationships with clients of mine. There are some clients who aren't happy with the care that they receive though and who voice their opinions online and are very vocal and and it is definitely a case of the the minority being the vocal minority. So I don't want to kind of skew the perception too much, but these are factors that are affecting the the people who work within the veterinary industry and are affecting you in your day to day care of your pet. So I'd love as always to hear your thoughts on these topics, on the topic today or any of the previous ones. If you jump back into the archive of which there are a 163 other episodes, I believe. As always, if you're subscribed, it's great to have you along and back with me today. If not, then consider hitting that follow button on whatever app you're listening to this on and share this with a friend or family who may gain benefit from it just so that I can help more pets and more pet parents no matter where you are in the world. And with that all out of the way, let's jump into the episode today. And now, on with the show. And today, I want to talk about the diminishing returns in pet health care, in the veterinary care that your pet could potentially receive depending on, you know, what befalls them in their life, what misadventure they get up to, what illness or or injury they suffer from, or even in a preventive health care point of view in some situations. So what do I mean by diminishing returns? So this is where additional input leads to progressively smaller increases in output. That's diminishing returns in general. When it comes to health care, the way I think of this is that it takes progressively more and more intervention or more and more complexity of intervention, and with that increased cost to get a smaller and smaller benefit to your pet. I mean, it's the same with us as well. So this isn't just a a veterinary issue. It is a human health issue as well. And how does this affect you? What's some some practical examples of this? Well, if we think, you know, back in the day, I've been reading James Herriot to to my kids recently. You know, they the the the bar was set very low, and it didn't take much to have a massive impact on improved care. So antibiotics came along, for example, and that made a a revolutionary difference to our ability to treat infections. Say we've got an itchy dog, we have something like steroids which we used, you know, certainly when I first graduated, they were when I first graduated, they were used very very frequently and they had a very good effect at reducing the level of itch. Yes. They came with side effects, but to get a drug that doesn't come with those side effects and is so more targeted, and we've got those drugs now. We've got Apoquel. We've got cytopoint. Those are significantly more expensive. Now they might still be within the the, the affordability for for lots of people, but they certainly have become unaffordable. So we get, yes, we get to benefit, but the benefit is much smaller because it's simply reducing the risk of side effects. Now those side effects were potentially very significant, certainly those dogs that needed high dose for long periods of time. So it's not that there's no benefit to them. I think they're wonderful drugs and they've allowed us to move away from the steroids, but the cost difference between these and the old treatment is very very significant. So perhaps that's not the best example, but I think you probably get the point if I think of something else. And I'm thinking of all these things off the top of my head while I do kind of try and do these podcasts, and I have a list of a list of points I want to cover. Oftentimes, I I think of it more as just a conversation that we're having together. So another example I'm thinking of maybe is cruciate ligament disease. So this is an ACL rupture, if we're thinking of it in in people terms. Very common problem, a very common injury in the the knee joint of our dogs, especially our larger breed dogs, and by and large, they they they they actually do much better with surgical correction of that injury. Now, back in the day, we used to do what we'd call lateral suture and there were a few other techniques but that was the main one. So we put on a a temporary false, false ligament if you like on the outside of the knee under the skin but actually outside of the joint rather than inside of the joint. It was a relative and it still is, and this is still a surgery that is performed. But it has it it it's a relatively simple surgery that can be performed in general practice without a huge amount of of kind of training needed if you like. And certainly something that I performed, a lot, a while ago. That surgery though has now been superseded in a lot of situations by, say the TPLO, so the tibial plateau leveling osteotomy, which is a little bit of a mouthful where basically we cut the bone, we rotate the the the lower bone of that knee joint, that tibia to change the angles within the knee. And it is felt that that is a superior surgery and has a better outcome for our dogs. But it while it while I do believe it does have a better outcome for our dogs and it is a superior surgery, the improvement in outcome between a dog who has no surgery and has a lateral suture, that difference is going to be bigger than, generally speaking, than a dog that has had a lateral suture versus a TPLO surgery, and that TPLO surgery often needs to be performed by, by a specialist surgeon or by a surgeon who is much more experienced and has undergone a higher level of training. And so that comes as a significantly higher cost. That's a 3 or 4 or 5 times cost difference potentially depending on where you are in the world and depending on who's performing that surgery, whether it's in first opinion general practice with an experienced surgeon as it is in the case in the clinic that I work in or if it needs referral surgery skills. And the final example that I can think of that springs immediately to mind is the field of oncology of cancer treatment. So not that long ago, really there wasn't a huge amount of treatment options for numerous different types of cancer. If you think of chemotherapy, something like lymphoma, which is actually a very common one there, there certainly has been treatment options for an awful lot longer, but the field of oncology has has evolved almost beyond recognition, since I started vet school at the the the start of the millennia, and graduated in 2006. The the potential options are huge compared to what they were before, but that all comes at significant cost because of the the drug regimes that are used. You're using multiple multiple drugs. We're giving them intravenously. They're involving hospitalization potentially, very close monitoring, so lots of blood tests. And the life expectancy change that we can get from some of these protocols is not as much as you would think given the costs involved. So that's not to say that it's not worthwhile, but to get a small increase in improvement in the care of these conditions requires a disproportionately large increase in complexity and costs involved in that treatment compared to changes that happened previously. Because ultimately, all of the low hanging fruit has gone. All of the simple fixes, simple and inverted commas, all of the the common conditions that we can treat more easily, all of those options have been covered. And now improvements that we are getting in veterinary care, and it's the same with our own health care by and large. The improvements are coming from very challenging drugs to research and develop and test and bring to market or techniques and procedures that involve incredibly expensive pieces of equipment that the actual kit costs a lot. The training is hugely involved, and the specialization required to perform them is highly significant, All of which bumps up the cost. And I don't want you to get the wrong idea. I don't want you to think that I am against all of these developments. I'm not. I think it's wonderful that we have all of these options available to us now, but it's something that we need to be mindful of because, you know, often it's going to get to a stage where things plateau and just because we can do something, the end result of that intervention, the end result of that treatment may not really make a huge amount of difference to your individual pet. Depending on your financial situation as well, it may make very little sense for you to spend 1,000 and 1,000 and 1,000 of dollars over and above the old fashioned standard treatment, if you like, if that is only expected to give you an extra one or two months with your pet. It's not going to cure their condition, for example. And so I think it's really important that we always have a few things in mind when it comes to deciding whether we want to pursue a diagnostic pathway, a specific intervention, a surgical procedure. We need to think, well, one, how much is it going to cost? We need to think what benefit is it going to have to our pet. Is it going to cure their condition? Is it going to massively improve their quality of life for a really significant period of time? Or is it just going to result in us being able to put a label on what that condition is and actually the treatment options are are not there. So, you know, what's the point in running really complicated tests if either we can't treat for the conditions that we're going to find because we've ruled out all of the other ones and we're left with some weird and wonderful, problems that we don't really fully understand or we don't have good treatment options for, or we have treatment options for, but for whatever reason, they wouldn't be something that we would pursue. So say for example, we have got a a particular problem. We've run some blood tests. They've all come back inconclusive negative. We've done some imaging, and again we've not really found very much. So the the the list of potential differentials, the list of potential problems has really been reduced, and maybe your vet is considering that the most likely thing, and we've ruled everything else out, is that they've is that the, unfortunately, is going to be a cancer diagnosis. If chemotherapy, referral to an oncologist is something that you will absolutely consider and you would follow through, then wonderful. Let's do some more tests to see if we can find out where that problem is. But if we have come to the end of the line in terms of financial means or you don't feel that your pet would be suitable for chemotherapy because they get really stressed at the veterinary clinic and they need to be sedated every time that they need an injection, you know, whatever it is, and chemotherapy isn't going to be in your wheelhouse, then there's nothing wrong with drawing a line at that point and not proceed proceeding with further tests and focusing on quality of life. Is there some palliative care that we can give to to maybe improve appetite to, you know, reduce any inflammation that's going on to to just improve your pets quality of life for the time that they are remaining with you. And so I guess these are all considerations for for you to to think about and discussions that you can have with your vet from the point of view of the veterinary industry as a whole. I think there's a few traps that we can fall into as well, and that is that our desire to provide the highest level of care possible, the the so called gold standard, although I know people don't, like using that phrase anymore, can drive up the cost of the lower levels of care. And that's because it may be that actually the the lateral suture say that I spoke about before, for a cruciate surgery, that may no longer be able to be performed in your clinic because they get so used to referring the TPLO option to specialist surgeons that they that the the clinic vets are no longer able to perform that lateral suture. They're no longer comfortable performing it and so that also has to be referred and that means that that surgery that used to be x dollars is maybe 50% on top of that, you know, on top of inflation and all that kind of thing. And so that lesser in inverted commas procedure also becomes unaffordable whereas, you know, back in the day, it used to be affordable. It may be that, your vet insists that you have monitoring blood tests for, a particular condition if your pet is on long term medication and, yes, that might be absolutely the best thing to do. It's going to help us reduce the risk of side effects to spot anything that's happening nice and early so that we can take action and not actually cause harm. But if that is going to stop you treating your pet with the medication because medication costs can be very significant, which I discussed I think in the last episode or the the last but one episode, then as long as you're aware of those risks and you accept them, then is a blood test absolutely essential? Should your vet withhold that medication if you elect not to run those blood tests? Well, no, I don't believe that. I think that involves a sensible discussion between adults but if as long as you're fully informed, that's absolutely a decision that you should be allowed to make because otherwise, we we basically add on the cost of all of this extra testing. And for for many of you out there, I I absolutely understand this. You know, these costs can be incredibly significant and can be a real struggle and ultimately can lead to the premature euthanasia of pets because their quality of life is suffering. They are struggling through the inability to access certain treatments. And of course, I guess at this point, it's easy to say, well, you know, that's just the greed of the vets. They want to make more money through these, blood tests, but it's that's not it. I mean, certainly, you know, with the corporatization, with a a bit more oversight maybe of the the the vets in the consult room, there may be more pressure to, you know, to run more bloods and things like that, but that's really not what drives the individual vet's decision making. It really isn't and and and hopefully, you don't think that. If you think that that is the case, then you need to find yourself a new vet because you're not doing yourself any favors and you're not doing the vet any favors. What's really driving a lot of this behavior is fear. It's fear of litigation. It's fear of having complaints against them from the, the governing body that can result in loss of license but takes 6 to 12 months or even longer to process those complaints and is huge hugely stressful even if the vet has done absolutely nothing wrong, but it's also the threat of online abuse of online complaints of bad reviews that drives this practice of defensive medicine and so making all of these recommendations where, you know, with a bit of discussion about your situation, your your expectations, your financial means, we would come to a different a different treatment plan or a different, yeah. Kind of a different plan going forward. And this I think is the art of veterinary medicine. That's not being lost, but is something that is hard to it's hard to teach, and it involves a good relationship between you and your vet to achieve. Helping your pet live the happy healthy life they deserve. So I'd love to hear your thoughts, on this topic. You know, that's really, I guess, everything that I wanted to talk about today. And as you can tell from kind of me jumping around different topics, my thoughts aren't aren't fully formed or fully formed in a way that allows me to communicate that maybe as effectively as I would like, but I think you get the idea. And I will certainly leave links in the show notes to, other podcast episodes and blog posts and videos that I've produced, about gold standard veterinary care and how that may actually be killing our pets on similar topics to what we've discussed today of, how your vet's hands are tied, when it comes to what drugs that they can prescribe, of the different ways that the pet health care industry is broken, and how that's affecting you, your pet, and the veterinary team. I'd love to hear your thoughts on all this. Please forward it to any friends or family. Post a link on social media just to help me spread the word and help and impact the lives of more pets and pet parents out there all across the globe. And until the next episode where I hope to see you back, I'm veterinarian doctor Alex. This is the call the vet show because they're family. That's it for this episode of the call the vet show. Be sure to visit call the vet dot org to join the conversation, access the show notes, and discover our fantastic bonus content. We'll see you next time.