What’s new and improved? It’s an appropriate question as we greet a new year. We asked some veterinary leaders to envision advances and other influences likely to affect veterinary practice in 2010 and beyond. Their insights covered considerable ground, from targeted therapies to regenerative medicine, diagnostic imaging to diet and nutrition. Collectively, the view ahead is not of giant leaps but of carefully placed steps, with advice to keep one eye on the economics and the other searching for that elusive target: the cutting edge. Our insiders didn’t have to strain to find reasons for optimism. “Looking at the big picture, I’m excited about 2010 and the future,” says Leah Cohn, DVM, Ph.D., vice president of the American College of Veterinary Internal Medicine. More Specialists Dr. Cohn’s first choice for an area of impact and expansion: specialization. She expects to see not only the number of specialists grow but also an acceleration of the shift from academic settings to private specialty practices. The trend is good for clients because we will see “vast increases in knowledge and treatment options,” she says. But it’s also good for practitioners, she adds, because while she sees generalists as excellent clinicians, “No one can be expected to know it all.” Cohn, a professor of internal veterinary medicine at the University of Missouri, is hopeful that a cooperative environment will pervade, with general practitioners increasingly referring to specialists and then seeing clients return for follow-up care. Among the specialized procedures she expects to see proliferate are minimally invasive techniques like tracheal stenting for tracheal collapse. The procedure is becoming an increasingly viable option when standard treatments such as medications prove ineffective. Other uses for stents are growing, Cohn says. A recent one-day session on stenting techniques at Animal Medical Center in New York was “packed, a sellout performance,” she notes. “The interest is tremendous. This is a really exciting field that will become more and more important.” Digital Imaging For Douglas G. Aspros, DVM, vice chairman of the executive board of the American Veterinary Medical Association, excitement surrounds the increasingly widespread use of diagnostic imaging. As more and more practitioners adopt digital radiography, “It means we get reports in a couple of hours—faster, if we need them,” says Dr. Aspros, managing partner of Bond Animal Hospital and Pound Ridge Veterinary Center, both in Westchester County, N.Y. The effect on diagnosis and treatment can be profound, the doctor noted. “At least in companion-animal practice, the pace of adoption is such that (digital imaging) is fast becoming the standard of care,” Aspros says. “I’m looking forward to the next five to 10 years, when we will make quicker, more accurate diagnoses, and more people will be able to afford even more advanced levels of care.” Aspros also hopes that new pharmacological options for the treatment of canine mast cell tumors might “be available to more than oncologists this year.” In June, the U.S. Food and Drug Administration approved Pfizer Animal Health of New York’s Palladia (toceranib phosphate), the first drug developed specifically to treat cancer in dogs. The prescription is approved to treat canine cutaneous mast cell cancer, which accounts for about one in five cases of canine skin tumors. Targeted Therapy Meanwhile, AB Science USA’s mastinib product has been approved by the European Medicines Agency, with Food and Drug Administration registration for dogs pending, says Albert Ahn, DVM, president of the Short Hills, N.J., company. Both the AB Science and Pfizer products are tyrosine kinase inhibitors and work via targeted therapy—destroying tumor cells without the kind of collateral damage to healthy tissue that accompanies chemotherapy or radiation treatment. Such therapy also shows promise in treating T-cell lymphoma, hemangiosarcoma, melanoma, hystiocitic sarcoma and osteosarcoma, Dr. Ahn says. “It’s a rogue’s gallery of malignancies, which is what makes this an exciting time in the biotechnology space,” Ahn notes. Inflammatory diseases also are being targeted, with clinical trials in the works at about 20 sites, focusing on atopic dermatitis in dogs, the doctor adds. “Many veterinary dermatologists have told me they would love to have additional weapons to treat what is often a lifelong illness of management,” he says. Another pharmacological area that has Ahn enthused is antiparasitics, where within two years he expects to see new technologies emerge, both for companion- and large-animal use. Then there is regenerative medicine. “Over the next several years, we will start to see a steady influx of products that will allow pet owners to treat some very serious conditions with stem-cell technologies,” Ahn says. Generating Interest Robert J. Harman, DVM, MPVM, CEO and founder of Vet-Stem Regenerative Veterinary Medicine in Poway, Calif., says regenerative medicine is starting to show up on programs at major veterinary conferences and meetings—a measure of the technology’s growing acceptance. The first University of California, Davis, North American Veterinary Regenerative Medicine Conference is scheduled for March 5 and 6 in Buellton, Calif. Vet-Stem first brought regenerative technology to veterinary medicine in 2003 and has had about 500 equine and 2,400 small-animal practitioners take its four-hour course in stem-cell therapy. More than half of the graduates are in general practice, Dr. Harman says. The predominant use is to treat osteoarthritis when other therapies have proved ineffective or patients haven’t tolerated nonsteroidal anti-inflammatory drugs, he adds. Typically, 50 to 100 grams of fat is collected and sent to Vet-Stem, which isolates and concentrates the stem cells, returning them to the veterinary clinic in two syringes. “The dog is his own donor,” Dr. Harman says. Two controlled, multicenter trials involving dogs—one on elbow joints and the other on coxofemoral joints—have been commissioned by Vet-Stem and published in Veterinary Therapeutics. Positive results were reported. On the equine side, Vet-Stem has amassed about 3,000 cases over the past six years. The rate of return to performance is about 73 percent, Harman says. He expects the therapeutic uses to grow, and he sees potential for regenerative medicine to “fundamentally change the way we practice medicine over the next five years.” Dietary Changes Nutritionist Sally Perea isn’t predicting fundamental changes in what we feed our pets, but she does see a trend toward diets that help support joint health. Joint treats and nutrition are not new for 2010, “But we are starting to see them move into the over-the-counter foods,” notes Perea, DVM, MS, Dipl. ACVN, senior nutritionist at Natura Pet Products of Santa Clara, Calif. “We’re also seeing more emphasis on omega-3 fatty acids,” she says, adding, “One of the things nutritionists are still debating is the ideal ratio of omega-6’s to omega-3’s in diets.” Quality and safety are increasing drivers of consumer choices these days, Dr. Perea says, as are natural and organic ingredients. And what about weight-control diets? There’s a low-tech innovation here, she notes. In 2010, pet owners may open their freshly purchased bag to find a scoop with a fill line of exactly one cup. “Sometimes it helps,” she says, “to remind people what one cup of food really looks like.” <HOME> This article first appeared in the January 2010 issue of Veterinary Practice News
