Jimmy Kimmel–oh, and some Doctors–Talk About Vaccination

I think we need a veterinary version of this video. Who’s with me?!

 

 

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37 Responses to Jimmy Kimmel–oh, and some Doctors–Talk About Vaccination

  1. v.t. says:

    Absolutely, but are you fathoming even more hate mail? 🙂

  2. Diane says:

    I would love to see that. But v.t. is sure right about the hate mail that would be sure to follow!

  3. kitty says:

    Would be great to see it. In all fairness, while I am all for vaccinations and both of my indoor-only cats and myself are current, the safety profile is far better for human vaccines and there is more data for how long immunity lasts – humans are not vaccinated every year except for flu and this is only because the flu virus mutates so much. Why don’t we have approval for 3-year use of Purevax yet? I bet if it had been humans, we’d have many studies done by now to confirm how long immunity lasts. Also, I don’t think any vaccine would’ve been approved for humans except during the major epidemic if sarcoma had been one of the risk with the same rate as in cats and if we had indoor-only humans.

  4. skeptvet says:

    Well, clearly we mostly agree, but you do raise some interesting and complex issues there. Do we know the safety profile is better for human vaccines? What evidence supports that claim? And where does the duration of immunity data come from? We obviously don’t do challenge studies in humans, so I wonder if the duration of immunity data really are better. Most of our information necessarily comes from observational studies in humans, and while they are often much larger than veterinary studies, they aren’t always as strong or reliable as experimental studies done in vet med.

    You may not know, but as it happens there is now a 3-yr Purevax rabies, which we’re using at my practice. But there is also some question as to whether the purevax actually reduces the incidence of fibrosarcomas (FSA). So far, these haven’t been in use widely enough and long enough to be certain, but there are reports of FSA following purevax (and lots of injections other than vaccines), so the cause and the best way to prevent these tumors isn’t a slam dunk.

    And whether three-year intervals would significantly reduce the risk of this is also unknown. The immunogenic simulation of a single vaccine is a drop in the ocean compared to the stimulation we get in ordinary life, so it’s not clear that the number of vaccines given is really the important issue. If, for example, adjuvants in killed vaccines were the main reason for FSA, then reducing the frequency of vaccinations wouldn’t lower the risk significantly since this would only happen if the adjuvants were removed (which, of course, is what we’ve done, but as I mentioned, it’s not yet clear if this has helped).

    Vaccine intervals and duration of immunity are also a complex topic. It’s true that most human vaccines aren’t given yearly, but then none of the guidelines for dog and cat vaccines have supported annual boosters for core vaccines for a long time. Most support 3-5 years at most. The problem here is more with vets adhering to the changing guidelines as the evidence grows, rather than a lack of evidence. I have no doubt that recommendations will continue to extend these intervals as the evidence accumulates, but we also will need to evaluate whether this has any real impact on health and disease, either in terms of increasing the risk of infectious diseases we are trying to prevent or decreasing the risk of vaccine-associated diseases.

    As with any medical intervention, decisions about vaccines have to be about balancing risks and benefits. We absolutely agree that more information is needed about both so the best balance can be achieved. Sadly, economics are against us. There isn’t nearly as much money to be made in the veterinary market as in human medicine, and so the research investment is much lower and we end up having to make decisions based on weaker evidence than we’d like. Frustrating for everybody!

  5. Amy Miller-Longson says:

    I’m in!!! I’m not very photogenic but I can swear with the best of them!

  6. kitty says:

    You make good points. But don’t you think that with billions of people getting vaccinations, we’d know if there had been as high a risk of something as serious as sarcoma as in cats? Thank you for telling me about 3-year Purevax, I’ll ask my vet the next time around. She didn’t mention it at last visit. When was it approved?

    “And whether three-year intervals would significantly reduce the risk of this is also unknown. The immunogenic simulation of a single vaccine is a drop in the ocean compared to the stimulation we get in ordinary life, ”
    A question here. Isn’t the issue in cats local inflammation and isn’t theoretically any kind of needle prick cause sarcoma? I had thought that was the case, and if it is why would the stimulation in ordinary life (outside of shots and blood tests and maybe wounds) matter?

  7. v.t. says:

    Skeptvet, are you using Merial’s 3-yr Purevax for cats? We aren’t, still using the one-year as I believe there is still some kind of worry for a 3-yr in cats. (don’t ask me, I was told only that there is still uncertainty about the 3-yr)

  8. skeptvet says:

    I think we’ve had the 3-year Purevax rabies for about 6 months, maybe a little longer.

    The problem is we don’t really know exactly what triggers the development of FSA. The studies that identified vaccine-associated FSA suggested both an increased risk following certain vaccines and also some unique characteristics to the tumors themselves that were different from other kinds of FSA. The leading theory was aluminum adjuvant as the main risk factor, but some more recent research has called that into question. As you point out, FSA also occur at sites where no vaccines have been given. These may be associated with other kinds of injections, based on timing, but we’re not really certain. Inflammation is thought to be another risk factor, which is one argument for the purevax. It induces a lesser inflammatory response than adjuvanted vaccines, and this seems likely to reduce the risk of FSA, but again that hasn’t yet been clearly demonstrated.

    So the question of frequency boils down to does having, for example, 5-6 rabies vaccines in a lifetime (initial, first booster in 1 year, other boosters every 3 years until say 16 years) significantly reduce the risk of FSA compared with having 16-17? Does this depend on what other vaccines or injections a cat gets, genetic risk factors, or anything else? We don’t know.

    In general, a reasonable principle in medicine is not to give anything that isn’t necessary, so if fewer vaccinations are just as effective, which they clearly are, then it makes sense to give fewer vaccinations. But we don’t actually know if this is reducing the incidence of FSA. And let’s bear in mind that the incidence reported for vaccine-associated FSA ranges from 1:5000- 1:15,000 vaccinations, which is still very small, and cats are still getting rabies when insufficiently vaccinated in the U.S.

    As for human vaccine safety, while I agree that vaccines are generally very safe, there are some potentially serious adverse effects. 1:40,000- 1:100,000 children who get the MMR can have a low platelet count leading to potentially serious bleeding. Of course, 1:3,000 children will get this from the measles, so obviously the vaccine is safer than the disease in this case. 1: 100,000 infants who get the rotavirus vaccines develop an intestinal obstruction that sometimes requires surgery. So such things do occur with vaccines in humans. I’m not sure if human vaccines are actually safer than those we give to our pets, or if we simply know more about the risks because there is more extensive study. Again, I absolutely agree that we need better evidence on lots of vaccine issues, it’s just a question of how we gather the resources to bring that about! 🙂

  9. kitty says:

    Thank you for detailed response. It’s very helpful and interesting. Of course, Rabies is very serious which is why I vaccinate my two young cats even if they are indoor-only on the slim chance they escape or a bat gets into my home. So is measles. I got chicken pox at 32 – only a couple of years before the vaccine came out – and it was no fun either. As I said, I’ve never questioned human vaccinations – in fact I just spent a fair amount of time arguing with anti-vaxxers on you tube – and only questioned the cats’ because of frequency, cancer risk, and their being indoor-only.

    Just from probability theory standpoint, it’s fairly easy to figure out the risk of an outcome happening after 5-6 independent events vs 15-16 events, but I do understand that there may be many other factors than pure probability. Thanks again for detail explanation. Now, I am pretty upset that my 2 cats weren’t given a 3-year Purevax in January instead of 1-year, but I guess, the clinic may not have known about 3-year vaccine yet. It really surprised me given they’ve always been fairly conservative about vaccinations. I sure am going to ask them about it.

  10. v.t. says:

    Personally, I’d like to see more info on the Purevax 3-yr, it hasn’t been out long, and why does the product label recommend primary vaccine, a booster after one year, then then again in three years?

  11. Art Malernee dvm says:

    Now, I am pretty upset that my 2 cats weren’t given a 3-year Purevax in January instead of 1-year, but I guess, the clinic may not have known about 3-year vaccine yet. >>>

    Merial has the 3 yr labeled purevax rabies priced about the same as human rabies vaccine. About 100 dollars for a rabies vaccine prices this vaccine out of the veterinary market. The so called “vaccine expert veterinarians” giving required by law continuing education when sponsored and paid for by Merial, promote to vets at the lectures “we should be vaccinating for something every year”. Vaccinating for something every year gets pets in for wellness visits. The high price for the three year purevac helps us get your pet back every year. We can justify the one year purevac because the three year purevac is priced out of the market. Many states such as florida also have laws that require a pet to have been seen within the last year to maintain a legal doctor patient relationship. Vaccinating for something every year can be used to maintain a legal requirement in many states that our patientsbe seen every year for us to help them. The Avma has reciently promoted annual pet visits are as important to your pets health as water so I suspect it will be a long time before unproven preventative annual veterinary medical care is questioned by anyone but a few evidenced based veterinarians. My own Physcian has a sign up in his waiting room that he needs to see you at least once a year. I’m not sure how he justifys this. He vaccinates me
    for flu every year so that may be how he keeps his patients current with their annual flu shots.

  12. skeptvet says:

    I checked, and it looks like the Purevax 3-year came out July, 2014.

    According to one an internist, felines specialist, and expert of vaccines and VAS that I have spoken with, the purevax rabies was tested for a 3-year label some time ago, and it did provide the necessary protection against challenge in the vaccinated cats. However, for some reason the mortality in the unvaccinated group was not sufficient (one cat didn’t die), so the USDA would not accept the trial because of concerns that the challenge was not adequate. This cost Merial millions of dollars, and ultimately they had to repeat the study. It is actually impressive that they did since they have to rely on gaining a larger market share as the only way of making back the money they lost on the trials and on selling fewer doses of vaccine, which is not guaranteed.

    A booster after one year is recommended for all core feline vaccines, whether modified live or killed or recombinant like the purevax. This is primarily because of concerns about incomplete immunity following initial vaccination due to interference from maternal-derived antibodies, though most jurisdictions that require rabies vaccination for cats require a booster at one year regardless of age at first known vaccination. Initial vaccination and subsequent exposure with induction of a memory response generate different levels of immunity regardless of the type of vaccine used, so even though the amount of antigen is greater in the 3-year rabies and it provides 3-year immunity when boosted, it is not clear that it would provide 3-year immunity after the initial vaccination, especially if given at 12-16 weeks of age.

  13. v.t. says:

    Art, I’m not sure that’s entirely fair – sometimes the industry actually listens to vets and their clients, and with new (albeit incredibly slow) studies showing longer DOI, it’s in the best interests of all involved to proceed with better/safer vaccines if the evidence supports their safety/efficacy.

    Of course vaccines are part of the overall picture for revenue, but they also serve a useful purpose (especially for those clients with pets rarely seen) – we’re seeing an increasing group of antivaxers in vet med comparable to human med, do you really want to see an influx of those common animal diseases in your practice?

    Question to you and Skeptvet – is the Merial Feline Purevax 3 YR rabies vaccine the same as the one year in terms of components and ingredients, the only difference being revised DOI approval? Have either of you seen the challenge study in full ? (I’ve only seen the abstract – http://www.ncbi.nlm.nih.gov/pubmed/23059358 ).

  14. skeptvet says:

    I suspect this depends a lot on where you live. We switched immediately from the 1-year to the 3-year rabies vaccine when it came out. It is priced in our market at 3 times the cost of the 1-year, so for our clients the cost is the same and they don’t have to have their cat vaccinated as often. Almost no one declined it when we started offering it, and now it is our default rabies vaccine. We do also encourage annual visits, and it does not appear that changing our rabies protocol has reduced compliance with this recommendation.

    And FWIW, I have NEVER heard a CE lecturer say that “we should be vaccinating for something every year,” so while I’m sure some do I don’t think you can fairly say it is common practice. I remember a lot of vets complaining years ago when the vaccine intervals began to change that nobody would bring their pets in any more and we would all be out of a job. But the mainstream recommendations and the practice of many vets changed anyway, and the sky didn’t fall, so anyone still making that claim is ignoring reality.

    I agree that there is not yet any evidence other than theory and anecdote that annual visits reduce morbidity and mortality in our pets, but it is plausible, and I think it should be viewed as an unanswered question. You seem to imply that economic motives are the ONLY reason for recommending annual visits, and I don’t agree. I certainly think money is the main reason the AVMA is pushing this, but such motives aren’t in themselves evidence that the recommendation is wrong. I’d like to see some controlled research on the subject in our patient population, but for now I tentatively believe annual exams in dogs and cats do some good. There is some evidence that annual physicals are not useful in humans with no symptoms of disease, but I think humans are a bad model since they can report early symptoms and our patients can’t, so I don’t think this evidence helps us much.

  15. v.t. says:

    Ok, Skeptvet, here’s my confusion according to their label – I fully understand the difference in initial and boosters for kittens or cats with unknown or sporadic vaccination history – can I safely assume the following example is true?

    An adult cat with sufficient annual rabies vaccination history (with Purevax 1 YR) can now receive the Purevax 3 YR vaccine without an extra booster?

  16. skeptvet says:

    Yes. I believe the recommendation for a booster at 1 year is only following initial vaccination for rabies, regardless of which product is used.

  17. v.t. says:

    Silly wordpress, guess I can’t just say a simple two-word, Thank you! 🙂

  18. Art Malernee Dvm says:

    Question to you and Skeptvet – is the Merial Feline Purevax 3 YR rabies vaccine the same as the one year in terms of components and ingredients>>>
    Some of the pet Rabies vaccine makers like Pfizer admitted to the wsj that their one year rabies vaccine was the same vaccine as their three year rabies vaccine. Same pfizer vaccine just a different duration of immunity label on the bottles. When I was vaccinating for rabies every year we used the three year labeled bottles every year until Florida changed the law allowing fla vets to vaccinate for rabies every one or three years. Then if Florida veterinarians wanted to continue to vaccinate for rabies every year we switched over to the rabies vaccine with the one year label or bought purevax1. Merial was smart enough or corrupt enough depending on your view of corporation ethics to not make purevax3 identical to purevax1 so they profit from sales of veterinarians who want to use annual re vaccination of pets as a way to force pet owner in to their office for unproven annual wellness care prevention. Since the two purevaxs are not identical the USDA is off the hook for not doing anything to protect the public and pets from corporate influence in government .

  19. skeptvet says:

    The 3-year vaccine is not the same as the one year. There is a higher quantity of antigen in the longer-duration vaccine.

  20. Art Malernee dvm says:

    Below is the wsj article were Pfizer fesses up and admits their 3 yr and 1 yr rabies vaccine is “identical” . Merials purevac1 and purevax3 do not have a identical formula but that’s not because the 3 yr needs a “higher quantity of antigen” to last longer than the one year. It’s made different strictly for marketing reasons not scientific reasons.

    Veterinarians Question Vaccination Procedures

    Vaccinations can have adverse effects, studies show
    By Rhonda L. Rundle
    THE WALL STREET JOURNAL
    July 31

    After receiving a reminder in the mail from his veterinarian, Jim Schwartz took his 11-year-old poodle, Moolah, for her annual rabies shot. A few weeks later she fell ill and was diagnosed with an autoimmune disease. As her suffering worsened, Mr. Schwartz put her down.

    THERE’S NO PROOF that the rabies shot killed Moolah and Mr. Schwartz didn’t immediately suspect any link. But when the retired financial planner learned that some veterinarians are vaccinating pets less frequently because of possible fatal side effects, he was furious. “No dog should have
    to go through what Moolah did,” he says. Evidence is building that annual vaccination of dogs and
    cats performed for diseases such as rabies, distemper and parvovirus may not be necessary and could even be harmful. Vaccines licensed by the U.S. Department of Agriculture are tested to ensure they protect pets against disease, usually for one year. But the tests don’t detect long-term side effects, or measure the duration of a vaccine’s effectiveness. Recent and continuing studies at several universities suggest that protection from vaccines may last for years, which would make annual shots for some diseases a waste of money at the very least.

    Fears of vaccine-induced diseases date back more than 40 years. But a sharp increase during the past decade in cancerous tumors among cats, between the shoulder blades where vaccines typically are injected, has spurred studies. Some have found a higher-than-expected incidence of side effects. “We see health problems in dogs for which we have no explanation. The classic one
    is autoimmune disease,” says Larry Glickman, professor of epidemiology at Purdue University’s School of Veterinary Medicine in West Lafayette, Ind., who is studying possible links with vaccinations. “We see an epidemic of hyperthyroidism in cats today, and we suspect that these are happening because we’re over-vaccinating our pets.”

    ACCUMULATIONS ARE THE DANGER
    Dr. Glickman and his colleagues theorize that repeated vaccination causes dogs to produce antibodies against their own tissue. The antibodies are caused by contaminants in the vaccine introduced in the manufacturing process. While the amounts are minuscule, they gradually accumulate with repeated vaccinations over the years. But Dr. Glickman cautions that more
    research is needed before a clear link can be established between antibody levels and autoimmune disease.

    Vaccination recommendations for cats and dogs vary around the country. Most states require rabies vaccinations every three years, while a handful of states as well as some individual cities and counties have mandated annual shots due to local problems with rabies in wild animals. Some other vaccinations are given only when a pet’s lifestyle or environment exposes it to a particular risk, such as Lyme disease.

    Pet diseases other than rabies aren’t a threat to people, thus vaccinations aren’t required by law. But veterinarians and vaccine makers have traditionally recommended annual booster shots against potentially fatal diseases such as distemper and parvovirus in dogs and herpesvirus in cats.
    In a policy statement last year, the American Veterinary Medical Association acknowledged that the practice of annual vaccinations is based on “historical precedent” and “not on scientific data.”
    The emerging evidence of health risks is prompting some vets to change their practices. “We’re now doing 40% less vaccinations than five years ago,” says Kathleen Neuhoff, a veterinarian in Mishawaka, Ind., and president of the American Animal Hospital Association, Lakewood, Colo.

    FINANCIAL REASONS?
    “My own pets are vaccinated once or twice as pups and kittens, then never again except for rabies,” Ronald D. Schultz, chairman of the University of Wisconsin’s Department of Pathobiological Sciences, wrote in the March 1998 issue of Veterinary Medicine.

    Some critics of annual shots accuse some vets of ignoring research about vaccine risks for financial reasons. “Vets are afraid they will go broke” without regular vaccines, which account for about 20% of their practice income, says Bob Rogers, a Spring, Texas, veterinarian and
    outspoken critic of current practices. Other vets deny that financial motives are involved. (“No one who is motivated by money would ever become a veterinarian,” Dr. Neuhoff says.) “The concern is that if we move too quickly to decrease vaccine frequency across the board, we may be opening the door for some animals to become infected when we could have prevented the problem,” says Todd R. Tams, chief medical officer of VCA Antech Inc.,in Los Angeles, the nation’s largest owner of veterinary hospitals.” No one truly knows how long protection from vaccines lasts. Vaccine
    makers say that proving their duration would be expensive and would require large numbers of animals to be isolated for years. One company, Pfizer Inc., decided to test its one-year rabies
    vaccine on live animals and discovered it lasted for at least three years. It sells the identical formula simply packaged under different labels Defensor 1 and Defensor 3 to satisfy different state vaccination requirements.

  21. v.t. says:

    Art, I’m respectfully asking – you want vaccines to be labeled and used in accordance with longer duration of immunity for pets, correct? So, now Merial is the bad guy for producing what everyone wanted because they have to recover the costs of their R&D and production expenses – if what Skeptvet said about the antigen is true, why shouldn’t it cost more? (although it sounds like the cost would even out comparable to 3 annual Purevax vaccines anyway, or, due to competition in the near future)

  22. Art Malernee dvm says:

    V.t.,
    Merial could have fessed up and done the ethical thing Pfizer did with their Defensor 1 rabies vaccine. Merial could have tested its purevax1 to show it last for 3yrs and sell the “identical ” formula simply packaged under different one year and three year labels. There would be no cost of development for purevax3 just the cost of testing in live animals beyond one year.

  23. Art Malernee dvm says:

    On second thought the ethical thing would have been to get purevax1 approved for longer than one year and stop selling purevax one year labels to avoid revaccinating fully immunized pets.

  24. v.t. says:

    You do have a point regarding the 1 YR, regarding studying for 3 YR DOI.

    I got nothin’. Unless they felt they could “improve” on a 3Yr? (putting cost aside and thinking for a moment more along the line of safety/efficacy).

    I asked before, did either you or skeptvet see their last challenge study in full?

  25. Art Malernee dvm says:

    no I have not seen it. The Peta people probably have smuggled out a video of it. ???? pet vaccines have what is called in vet medicine “a secret sauce”. What is met by that is the ingredients of a pet vaccine is called a trade secret and does not need to be disclosed to the public like human vaccine makers must do. So you really do not know what’s in a pet vaccine unless the maker,as in the case of Pfizer in the wsj article I posted above, wants to tell you. In human vaccine you could see that two vaccines with different duration of immunity labels are identical without the vaccine maker fessing up and telling you so.

  26. Art Malernee dvm says:

    The four ???? Was written as a smiley face.

  27. skeptvet says:

    I haven’t seen the full study. You could probably get it from USDA as a FOIA request, but I don’t believe it has been published. I’m not sure if the original study trying to get a 3-year label was for the high-antigen product now on the market or for the old 1-year product. We can’t assume that the 1-year product had a duration of immunity longer than 1 year. The whole point of purevax is that it is not adjuvanted, and non-adjuvanted vaccines usually generate a weaker immune response than those w/ adjuvants, so it may not be just a difference in the legal label but a real difference in duration of immunity.

  28. v.t. says:

    Thanks, it seems the better selling point is the non-adjuvant, especially where cats are concerned.

  29. kitty says:

    “About 100 dollars for a rabies vaccine prices this vaccine out of the veterinary market. ”

    I have a question about it. Is it the vet cost or is it the price for the client? If it’s the cost for the client, I am sure many people would pay it, at least in my area. I pay $45 for 1 year Purevax, so $100 for 3 years would be a bargain, $135 would be a fair price. As this is an expensive area with a large number of seriously rich people (not me, but I am comfortable), I’d suspect at least some of their clients would do the same.

    “My own Physcian has a sign up in his waiting room that he needs to see you at least once a year. ”
    Wow – I’d not be happy about this at all given that with humans there certainly zero evidence that annual wellness visits are needed, I believe USPSTF doesn’t recommend it. At least with pets one can justify it by pets not being able to tell us if they are hurting. As to flu – I get it at work ( a Fortune 500 IT corporation), I suspect many people working for large corporations do the same. We have a couple of days in fall where they invite several nurses from a local hospital or a medical center come and give free flu shots on site to anybody who wants, no appointment necessary, in a room right on the way to the cafeteria too, so it’s far more convenient than a doctor visit.

  30. Art Malernee dvm says:

    Vets on vin.com who are not using purevax3 say the cost to client would be 125 dollars if they used it in there practice. The vets on vin. Com also say Wallgreens now gives away a 1 year Defensor like rabies vaccine for free as a loss leader to get pet owners in to buy other annual wellness care at Wallgreen including annual exam, annual supply of worming preventative, annual supply of external parasite prevention, annual supply of dental products and some sort of teeth cleaning or brushing during the visit I’m not quite clear about and of course a bunch of other annual vaccines they tell the client are needed every year.
    So if the Wallgreens across the street from my practice can get my client in for the free loss leader one year rabies shot, palmbeach county animal care and control then sends the pet owner a notice next year they must get another rabies shot or pay a fine. I can run the vin. com posts through the paraphrase software if you want to see them.

  31. skeptvet says:

    Well, I don’t know what the cost to vets is (I don’t handle that stuff in my practice since I’m not an owner), but our charge is $75 for the 3-year and $32 for the 1-year purevax, and I believe there is some markup in there for overhead. The price probably varies by region and quantity purchased (we are a VERY large practice), but I don’t get the sense that the company is charging extortionist rates that price most clients out of using the vaccine.

  32. Art Malernee dvm says:

    75 dollars plus the cost of mandatory exam if the pet has not been seen within the last year?
    If so that puts it over 100 dollars ,which if 50 dollars for an exam makes it 125 to get a rabies shot. Exams with rabies are another controversy. some vets will not vaccinate for rabies without a exam and some vets say an exam with rabies vaccine is or should be mandatory by law in their state, depending on state board regulations . If the pet has not been seen by the doctor in the last year and the state vet board mandates an exam with in the last year to have a dr patient relationship, just giving the Rabies shot without exam could be a state board risk if complications occur. Mandatory annual visits to maintain a dr patient relationship I just found in my state vet laws a month ago when trying to read the 40-50 pages of state board regulations regulations. I wonder if most states have that regulation. If a client calls you and ask if fluffy is ” current” on vaccination or ask if she can give fluffy some Peptobismol but you have not seen the pet in the last year what do you say without breaking the law or refusing to answer a direct question the client I think deserves a answer to. Preventative medical care based on how long it takes the earth to go around the sun needs to stop.

  33. kitty says:

    $75 for 3 years Purevax is a bargain. Given that I now pay $45 for one year, even $125 for a year would be $10 less than 3*45, so I’d suspect a few people here – those who can afford paying this amount at once – would agree. I’d imagine many around here can.

    I pay over $100 for each of my two cats for exam+vaccine; and this has nothing to do with whether or not I was there last year, it’s just the ongoing price. But… everything is more expensive here, so I assume the vet clinic overhead costs are high given the land prices and taxes and/or rent and heating and stuff. Of course, not everyone here is rich or even comfortable, but there are lower cost options like Petco. I don’t believe we have state (NY) requirements for yearly visits (but as I am not a vet, I don’t know what the regulations are), but with one year Purevax, it’s not like I have a choice.

  34. skeptvet says:

    So what are you suggesting, Art? How should the vaccine be priced, and who decides? What is a fair price?

    We’ve already talked about the exam issue, and I’m not convinced that there is any evidence to suggest such exams are not beneficial to pets. I certainly see animals every single day with important health problems that their owners haven’t noticed. Of course, that’s just anecdotal, but where is the controlled evidence that there is or is not a benefit to well-exams? Scientific skepticism doesn’t mean, after all, saying something is false until proven true, but saying that no conclusion can be made until there is adequate evidence exist to justify one. You appear to have concluded that annual exams are an unnecessary scam, but I don’t see any research in veterinary patients to support that. Annual exams are absolutely arbitrary, but until there is some specific reason to choose a different interval or dispense with well-exams altogether, I don’t see any other choice as any less arbitrary.

  35. v.t. says:

    Art, why would you not want to give an exam before a rabies vaccination!! Sick pet? Don’t give vaccinations until the illness is treated and resolved! In many states, isn’t it also in the practice acts guidelines? Further, if a pet is to be licensed by the city, some ordinances may state the rabies vaccination must be accompanied by an exam. I believe most vets are not truly comfortable giving any vaccination without an exam.

    Kitty, I suspect owners who choose the 3-yr do so mainly due to the convenience (providing their vet doesn’t have a silly law that “requires” annual exams). I suppose we will see how this plays out with individual state law requirements.

  36. Art Malernee dvm says:

    Art, why would you not want to give an exam before a rabies vaccination? >>>>
    first read this from the father of EBM to understand my thinking about the arrogance of preventative medicine.

    http://www.cmaj.ca/content/167/4/363.full

    I am not against giving exams with rabies vaccination. I am against promoting annual exams with annual revaccination. I think this promotion is arrogant, stifles desent and is wrong headed like all unproven “prevention”except parachutes:)
    Sending out a reminder to clients for all the patients to come in to see the veterinarian for the same vaccine or the same exam that was given by the vet a year ago has been harmful to the profession in my opinion. For one thing these promotions have created state board and rabies vaccine laws that require it. Remember if your kitten gets a purevax3 your vet is going to send you a reminder to get another one in a year not 3 years. There’s no science for that.

  37. v.t. says:

    I respect your opinion, but don’t necessarily agree – especially where vaccinations are concerned. I think it only prudent to examine the patient prior to a vaccination – do human pediatricians give vaccines without examining the child? Isn’t the exam also a part of the veterinary-client-patient relationship? (meds aren’t prescribed without an exam either, nor are diagnostics, or some of those “preventatives” you speak of)

    I’m fully aware of the kitten initial and annual – the age/vax history of the cat “eligible” for the 3-yr is something the vet is obligated to explain to the client.

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