Lou Anne Wolfe
Dr. Lou Anne Wolfe practices at Marina Animal Clinic in Tulsa, Oklahoma. A graduate of the Oklahoma State University College of Veterinary Medicine, she previously worked as a business and political reporter at newspapers in Oklahoma City and as a special-projects writer at the University of Oklahoma Health Sciences Center.Read Articles Written by Lou Anne Wolfe
Spurred by the promise of cannabidiol (CBD) and the millennial population’s emphasis on wellness and preventive care, pet health supplements are enjoying unprecedented popularity, with U.S. sales growing by 5% in 2018, according to the market research firm Packaged Facts. Veterinarians and industry leaders say it’s time to get proactive about this previously downplayed treatment modality.
“Integrating these things into practice is the wave of the future, and anyone who doesn’t investigate it for their practice is really missing out,” said Sheila Dodson, DVM, of Mariposa Veterinary Wellness Center in Lenexa, Kansas.
“People want to know if there is a supplement they can give their pet instead of medication. They’re looking for it and doing it anyway,” said Dr. Dodson, a certified veterinary acupuncturist who combines alternative medicine with traditional veterinary practice. “Millennials are different from the clients of the past, and we have to support what they’re looking for when it comes to the care of their pets.”
Veterinarian recommendation of a specific supplement is the No. 1 purchase influencer among pet owners, but internet research is in hot pursuit, according to a 2019 Packaged Facts pet owners survey.
“Having a supplement line in your practice that you can confidently stand behind the quality of puts you head and shoulders above any online competition,” said Dr. Dodson, who favors Standard Process supplements. “I find clients want to use products their veterinarian recommends — if you have a good relationship with them.”
Dr. Dodson routinely sees clients seeking a second opinion.
“A lot of people don’t talk to their regular veterinarian about things they’re doing on the side, because they think they’re going to get a negative reaction,” she said. “There are a lot more people [buying pet supplements] than veterinarians realize.”
For People and Pets
People today are much more aware of the benefits of preventive care, not only for themselves but also for their pets. Clients know that a healthier cat or dog requires fewer veterinary visits and less spending on costly medications.
“As pet owners find benefits from taking supplements themselves, they naturally want to convey those same benefits to their four-legged family members,” said Robert J. Silver, DVM, MS, chief medical officer at RxVitamins for Pets. “Veterinarians who provide supplement sales in their practices and who are knowledgeable about pet supplements are sought after by owners, who have more confidence in veterinarians who are like-minded with regards to the benefits.”
Dr. Dodson said supplements “give me more tools in my toolbox.”
“Most veterinarians avoid the conversation because they don’t know what to recommend,” she said. “That’s where educating yourself on a good-quality product line can be your best friend. It also gives you something to do about disease processes before they get to the crisis stage and you have to reach for medicine.”
Clients Trust Veterinarians
A lack of clinical research comparable to that required for medications can be a stumbling block for veterinarians who would like to recommend supplements. Quality control and minimal regulation are other concerns.
The National Animal Supplement Council was formed in 2001 as a nonprofit industry trade association whose members work cooperatively for self-regulation.
“There is no substitute for a company that has knowledgeable people and a veterinarian on staff,” NASC President Bill Bookout said. “For example, if you have a cancer patient that is going through chemotherapy, you want to talk to somebody who can make a recommendation for a product as part of a comprehensive care program. You want to know who formulated the product, who you could phone or email with technical questions.”
Research shows that pet owners value their veterinarians’ advice above “Dr. Google.” But easy does it on the markups.
“The trust that pet owners have in their veterinarian is a sacred trust and should not be violated by profit-based objectives in the eyes of the veterinary client,” Dr. Silver said. “Veterinarians can use the trust invested in them by clients to make suggestions for products that could help their patients, but it’s important to not be too aggressive in upselling products, as pet owners are sensitive to that. “
Added Bookout: “If the veterinarian is selling a product for $30 and the client finds it on the internet for $18, they’re going to think, ‘If the veterinarian is overcharging for that, what if they’re doing the same thing for services, like dentals?’ ”
Clients Like Convenience
One of the newer supplement manufacturers, Veterinarian Recommended Solutions, sells veterinary-exclusive products and focuses on vet-to-vet education rather than direct-to-client advertising. A client-friendly product refill model — auto-shipping and direct delivery — is central to the company’s business strategy, said veterinary education manager Laura Zehnder Jones, DVM.
Started five years ago, the veterinarian-owned nutraceutical company ranked No. 300 on the 2018 Inc. 5000 list of the fastest- growing companies.
“Retail for veterinary hospitals used to be 30% of revenue, and that is now significantly down. [Internet] convenience is why,” she said.
The take-home message, the experts said, is that health supplements have caught the fancy of a significant proportion of pet owners. In a loosely regulated market, they said, veterinarians have valuable insights and a responsibility to advise clients about safe and effective products.
HIGH HOPES, BUT LEGAL QUESTIONS, FOR CBD
Maybe we’ll look back someday and marvel at the birthing process of CBD. Perhaps we’ll take cannabidiol for granted as one of the staples in our treatment arsenal for all creatures.
But for now, veterinarians can only stare through the shop window at an array of tempting cannabidiol remedies for pain, inflammation, anxiety and seizures.
“We’re in a bit of a purgatory,” said Josh Sosnow, DVM, chief medical officer of CompanionCBD, the maker of hemp-based products for people and pets. “That is to say the FDA has very clear guidelines and a very clear position on CBD, and we as veterinarians have more regulatory bodies to answer to than folks who are just in the business of making and selling CBD.”
In an online presentation hosted by VetMedTeam, Dr. Sosnow noted that “Technically speaking, everybody who deals in CBD is on the wrong side of the FDA at the moment, regardless of the form that the CBD takes.”
His presentation, “CBD in Veterinary Medicine: The Science and Clinical Application,” is RACE-approved continuing education. It delves into the chemistry and therapeutic actions of phytocannabinoids, and potential clinical indications for the use of CBD in dogs.
Briefly stated, the federal 2018 Farm Bill removed hemp, a cannabis derivative containing less than 0.3% THC (marijuana’s intoxicating ingredient) from the Controlled Substances Act. This simplified access to the product for biomedical research, but when it comes to veterinary medical use, CBD is essentially off-limits.
“Most companies assume that the safety profile, clinical applications and the rapidly expanding market will help to change FDA regulations,” Dr. Sosnow said.
CBD’s effectiveness in controlling seizures in dogs was the subject of a 2018 study published in the Canadian Journal of Veterinary Research by Stephanie McGrath, DVM, MS, DACVIM (Neurology), an assistant professor at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences.
“I realized that there wasn’t a lot of scientific evidence or controlled studies out there to tell us whether CBD really would be potentially effective or not,” Dr. McGrath said in a video on the American Kennel Club Canine Health Foundation’s website. “There weren’t studies even telling us what the pharmacokinetics were like with different routes of administration, and I also sadly realized there was really no regulation to this market.
“So, although it’s gaining popularity and showing up on shelves and online everywhere, it is a very unregulated substance,” she said.
Funded by Applied Basic Science Corp., Dr. McGrath’s research found a significant reduction in seizure activity in dogs receiving CBD, compared to control patients. However, the number of “responders” in the study, meaning dogs whose seizures were reduced by 50% or more, was not significant.
“It seems promising, but we’re not quite there,” she said.
Dr. McGrath is now studying 60 client-owned dogs that were diagnosed with uncontrollable epilepsy and are being treated with conventional anti-epileptic drugs. The goals of her research are to develop the appropriate dose of CBD, discover possible drug interactions with other anti-epileptic drugs, and monitor liver health over an extended period.
Studies on the efficacy of CBD on pet osteoarthritis have been completed at Colorado State and Cornell University, Dr. McGrath said in the AKC foundation video.
“There needs to be more research, certainly,” said Bill Bookout, president of the National Animal Supplement Council. “However, I think veterinarians, especially the professional associations, need to understand that consumers want CBD, and if they restrict veterinarians from talking about it, consumers are going to get it anyway.”
Preferably, pet owners will obtain CBD products via a veterinarian-client-patient relationship, Bookout said.
“Veterinarians shouldn’t shy away from CBD,” he said, adding that an absence of proactivity by the profession could result in well-meaning clients giving toxic doses of cannabidiol to their pets.
The U.S. Food and Drug Administration has sent warning letters to companies alleged to be selling CBD products that claim to prevent, diagnose, treat or cure disease, according to a paper published by the American Veterinary Medical Association. A recent warning letter addressed a product containing CBD that was marketed for use in dogs, the paper stated.
Under current law, CBD and THC cannot lawfully be added to a food or marketed as a dietary supplement, said Norman E. Sharpless, the U.S. Food and Drug Administration’s acting commissioner of food and drugs.
“While we have seen an explosion of interest in products containing CBD, there is still much that we don’t know,” he said at a May 31 public hearing.