Vetted Information
The verb, to vet, has traditionally been used most frequently amongst veterinarians, particularly those vets who work in the horse world. Prior to purchasing a horse, a prospective horse buyer will ask for the horse to be vet-checked or vetted. The veterinarian, skilled at spotting any inconsistency in the horse’s movement or behavior, then passes judgment as to whether the buyer should proceed with the purchase.
When applied to things other than horses, and when performed by those other than horse vets, the term connotes a thorough going over to determine if there are any inconsistencies or underlying problems that are not readily apparent. That is what Veremedy does with information; in essence we are vets who vet-check information.
This constant scrutiny of information is important, particularly as it relates to evidence-based medicine. In human medicine, there are entire organizations dedicated to the scrutiny of medical information. (See cochrane.org in the links section) This is a highly valuable time saver for doctors who care for humans. More and more sources for veterinary caregivers are coming on line, but much of the work of medical information scrutiny still falls to each veterinary doctor.
So, each month massive amounts of information on pet care is published in journals, magazines, and websites. Much of this information is very valuable, and much is worthless. Which pieces of information provide the best evidence upon which to base clinical decisions for pet care? How do we judge the validity of each piece of information?
Most people already realize, that for human health care, the information published in the New England Journal of Medicine is more reliable than the information that is obtained by rumors at the barbershop. Based on this common-sense thinking, we use several criteria to vet check any piece of medical information by asking the following questions:
- Is the source publication a peer-reviewed journal?
- Is the study blinded, and preferably double-blinded?
- Is the number of patients in the study large enough?
- If not a peer-reviewed publication is the information from conference proceedings?
- If from a conference proceeding, was the information the opinion of the presenter, or was unpublished research presented.
- Who paid for the presentation or the research? Is there a possibility of bias from a conflict of interest?
- Is it advice given by a veterinarian with no research to back it up?
- Is it based on personal practice experience?
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In the perfect world, every clinical decision we make would be backed by not one double-blind study from a peer-reviewed journal, but several. To be frank, the research dollars allocated to veterinary clinical research are small enough to make such a perfect world completely unattainable. For example, searching the key word anesthesia at Pubmed Central, a web-based medical database, reveals 26,672 papers on the subject in human medicine. The same search for information regarding veterinary anesthesia reveals 1600 papers. So to, with knee surgery, the papers regarding human knee surgery listed in the database total 6,675, nearly 30 times the 282 papers listed for dog knee surgery.
So, we rely on the published record whenever possible, some conference proceedings when available, some lectures from learned colleagues, and when no other source is available, we rely on the clinical experience of our staff and fellow regional practitioners. We recognize, however, that the gold standard for medical information is still data that is presented from a double-blinded study that has a significant number of participants and that is published in a peer-reviewed journal. The other sources may, in fact, be helpful, but the validity of the data will always be suspect until confirmed by the gold standard.
It is important to remember that no matter what the source, one of the first things we look for is underlying bias. This can be hard to discover, and perhaps for obvious reasons; the organization that is promoting the information does not want a clear conflict of interest to be revealed. As an example, if a website or a publication is stating, emphatically, that a yearly heartworm test is essential to good health care for a dog, and we discover that the company that sells the most heartworm tests in the world is the sponsor of the website or the research, then we get suspicious about the claims.
When close examination is utilized, it turns out that many websites and pet health care publications that claim to be pet health advisors are, in fact, infomercials for various health care products or services. In many cases, large multi-national pharmaceutical companies sponsor the site and that fact is not openly displayed.
Obtaining the best medical information is only the first step in an evidence-based medical system. Once the information is in hand, important questions still need to be answered about how to formulate the best care for any given case.
