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Big brains v. common sense: how should snake bites be treated?

by
01 September 2014, at 1:00am

The Mercury Column, in which a guest columnist takes the temperature of the profession – and the world around.

LATET anguis in herba. I’m not sure of the situation which prompted Virgil to refer to snakes lurking in the grass and I rather prefer to say that it will have been lost in the mists of time than own up to my own sloth in tracking it down.

This expression is often used metaphorically to report the presence of a hazard which is concealed within a given context and on occasion we use it to refer to compliments that are received from interested persons. Such compliments may be acceptable but often hide ulterior motives, sometimes not entirely legitimate.

Whatever Virgil intended, within our own immediate context and as the springtime mists have burned off and warmer summer weather has arrived (and maybe even departed), the idea that, quite literally, snakes lurk in the grass is a real issue for walkers, farmers and dogs.

Cats are usually rather more circumspect but in many areas of the country, the risk of disturbing an adder basking in the sun is a very real one for holidaying dogs and their owners.

By the time anyone reads this, the glorious summer may indeed have faded to a distant memory but, during the current anti-venom veterinary supply crisis, many veterinary surgeons will have been faced with trying to find treatment options in an emergency situation and fine words are of little consolation to a desperate pet owner.

The supply problem stems from the decision made by the Institute of Immunology in Zagreb, Croatia, to discontinue production of common adder anti-venom and the absence of any easily accessible alternative source. 

It is possible for practices to source anti-venom through Biomed, which manufactures vaccines in Poland, but this requires a specific application to the VMD and an alternative Welsh development of canine anti-venom is still preparing for clinical trials in 2016.

The VMD will accept special treatment certificates for anti-venom intended for human use but that is expensive and a not entirely helpful solution to what is often an emergency problem.

Recent correspondence in the Veterinary Record has seen the pragmatic suggestion that time-expired stock of anti-venom may well have retained efficacious potency and should be retained by practices for emergency usage rather than be simply discarded.

Such a suggestion was endorsed, with some caveats, by the VPIS but the correspondence was met by a response from the VMD pointing out that the supply or use of time- expired medicines in a clinical context constituted an offence.

The reason cited was that, because quality and hence safety or efficacy may not be maintained beyond the authorised shelf-life, they could be harmful to the animal or fail to work effectively. As Terry Wogan used to say, “Is it me?”

Somehow, from nowhere, I’ve recalled a discussion I once had at a social event when a lofty emeritus professor and his wife were forced to engage me in conversation while the hostess made snail-like progress in our direction.

“He’s the one with the big brain,” the wife told me, “and I’m the one with all the common sense.” Perhaps, in later life, he was persuaded to work for a government department where hands-on experience of veterinary crisis management is not listed in the application criteria.

I suspect that Terry Wogan and I are well aligned in our questioning of the logic that, in extremis, no treatment is better than the application of evidence-based ingenuity that sits outside rigid diktat which was created and legitimised for the common good of more than 740 million people who are constitutionally incapable of making their own decisions. Bravo Brussels!

Yes, we understand that there needs to be a framework of statute for our protection but does the VMD accept that some of this crisis is of its own making, having been aware of this situation and the impending problems for several months during which it would appear to have maintained an unhelpful degree of radio silence?

Does the rigid adherence to statute and the apparent absence of any logical attempt to alleviate a signi cant and potentially lethal problem give the VMD some strange moral authority which would be questioned in any other business context?

No one suggests that juggling the collective ego of European politicians, navigating a complex fabric of statute and directive while trying dutifully to save the public from the attention of shysters, crooks and pickpockets is an easy task, but when did the defenestration of common sense become a good idea?

I absolutely applaud the persistence of International Cat Care in pursuing its aim to have the VMD review and revise the legal status of products containing permethrin for use in dogs.

For several years this excellent organisation has been asking practices for data concerning accidental permethrin poisoning in cats. They know it happens, we know it happens and very few veterinary practitioners have been spared the heartache of watching cats under their care die a distressing death as a result of contact with permethrin. Moreover, the VMD knows it happens but would appear to think that the ready availability of cheap, effective products for controlling fleas in dogs is an acceptable price to pay for the death of thousands of cats in the UK, let alone around the rest of the world.

One wonders if a cat product which could so easily kill dogs would ever have been awarded a GSL licence? As the emeritus professor would have said to me, had he had the misfortune to teach me, “Appears to work hard but could do better!”

I did learn something at school. Quis custodiet ipsos custodes? is a Latin phrase which has been attributed to the Roman poet Juvenal from his Satires which is literally translated as, “Who will guard the guards themselves?”

Ego mihi arbitror. If, like me, you cannot be bothered to look stuff up, that, literally translated, means “I rest my case.”