Friendship Springs Veterinary Care serving Flowery Branch, Braselton, and Buford since 2006.
Your best friend's veterinarian and animal hospital.
Bravecto Safety Concerns
Many of you will no doubt have seen the news report from WSB-TV Channel 2 concerning the veterinary flea/tick product Bravecto. I have been asked by several of our pet owners to comment on this newscast.
In my opinion it is a case of irresponsible reporting, damaging to pets, pet owners, veterinarians, and the community at large, and fear-mongering plain and simple. In my mind this is a true case of “fake news.” Keep in mind the Latin phrase, Post hoc ergo propter hoc, which means "after this, therefore because of this." Essentially, it means event B happened after event A, therefore event A must have caused event B. For example, the rain came down after we did a rain dance, therefore the rain dance caused it to rain. The presumption and fallacy in this case is that several dogs died sometime after giving Bravecto, therefore the Bravecto must have caused their deaths.
However, this hasn't been proven, and the reporter in this case, Jim Strickland, goes so far as to say exactly that. In fact, he is very careful never to say in anyway that Bravecto is related to these problems. Further, Dr. Elizabeth Carney, who was interviewed in the first report, says exactly the same thing in a follow-up interview several days later, which is there is no proof of a connection. Strickland asks a lot of leading questions and he uses a lot of power words and phrases designed to get people to make a connection in their own heads where no connection truly exists. You will notice, though, he never makes the connection out loud himself. To do so would potentially make him guilty of slander.
He interviewed a couple of people whose dogs died after having been given Bravecto, but there are no reports of why they died, and no indication that Bravecto actually caused the problem. One dog apparently suffered for weeks before the owner had him euthanized. I would like to know the “when, how, and why” of what happened. Was his liver failing? His kidneys? Were other diseases excluded and, if so, how? Were there abnormal lab results? What medications were used to try to treat him, if any? Did the dog's veterinarian think it was caused by Bravecto, and if so why? What is the rest of the story?
Importantly, in these cases that were reported no medical examinations, no laboratory reports, no autopsy or pathology reports,and no toxicology reports were cited as showing a connection. Strickland does mention in his follow-up report that he has looked at "hundreds" of cases, but only in about 15% were any autopsies performed. However, in this handful of cases where autopsies were performed, causes of death other than Bravecto were specifically identified in spite of the initial report that Bravecto was at fault, and in the rest no conclusive causes of death were found. There was only the owner's suspicion that A caused B. However, just because B followed A doesn't mean the two events are connected. Interestingly, there is a test for detecting amounts of fluralaner (the active ingredient) in blood and tissue specimens. In none of these cases has the test been done, or if it has, no conclusions have been reported on that basis. Why not.
Interestingly, Jim Strickland is the same reporter who “exposed” Trifexis about three years ago in much the same manner. Nothing was ever found to be wrong with Trifexis. He slung a lot of mud and he caused a lot of harm to pets, pet owners, and veterinarians, but he never said Trifexis was bad. He just let people jump to that conclusion on their own after he lined up all the hurdles for them. I also find it interesting that this news report was advertised for days in advance to ramp up excitement, especially in light of the fact that this is one of the so-called “sweeps weeks.”
I happen to be a member of the Veterinary Information Network (VIN) which is some 40,000 veterinarians strong worldwide. Those of us who are members of VIN share information about many issues of veterinary medicine on a daily basis, including drug-related problems. In the three years since the release of the products Bravecto, Nexgard, and Simparica, all in the same family of compounds, no serious problems have been discussed related to these three drugs.
It is not a big surprise, however, that Dr. Carney, has heard many tales of problems with these products even though the rest of us have not. She maintains an internet blog that seems to be primarily dedicated to these products. So, while this is not bad in and of itself, anyone googling these products will easily come across her blog and may communicate their stories to her. This can make it seem to her that the relative number of cases is higher than it really is, even when it might not be. Unfortunately, Dr. Carney has also not substantiated Bravecto as a cause of death in any of these cases.
In order to determine if there really is a connection between the drug and dog deaths, we need a little more than presumption. If we are to conclude that there is a connection between any test, drug, surgery, or other medical intervention and illness or death, then we need to see substantiation in autopsy reports, histopathology reports, toxicology reports, evidence that other concurrent diseases have been excluded, consistency between the ways the dogs died, the times that dogs died relative to when the drug was given, and so on before we can draw such conclusions.
Right now, the dog deaths that have been reported seem to be all over the board regarding signs, symptoms and the specific organ failure that caused death. This doesn't make a very convincing case, particularly when you consider the sheer number of doses that have been prescribed without incident. According to Merck, the manufacturer of Bravecto, more than 34 million doses have been dispensed in more than 60 countries. According to Jim Strickland there have been 800 deaths. If there really is a connection, this is at most 0.01% incidence.
So, in conclusion consider this. An observation following a particular event naturally causes one to wonder if the event caused the observation. This should serve as a reason for further investigation, but it should not serve as a basis for conclusion. Am I saying Bravecto isn't causing a problem? No. I am neither saying it is or is not. However, at this time I have far more reason to believe that there is not a problem than there is. I give Bravecto to some of my dogs. For now I will continue to keep my finger on the pulse of veterinary medicine, and this issue in particular, but until and unless I see something substantiated to suggest there really is a problem, I am going to continue to give it to my dogs. Further, I am well acquainted with a veterinarian with advanced training who is an animal health pharmaceutical scientist who is involved in this kind of work everyday, and he is also going to continue to use it in his own dogs as are many of the other veterinarians with whom I am in regular communication.
Trae Cutchin, DVM
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