Pet-Specific Care for the Veterinary Team

One of the main advantages of blockchain is that it allows multiple permitted providers to access and append information in a medical record.

Blockchain tends to be much more secure than other forms of databases and while it is still theoretically “hackable,” it is much more difficult to do so than with most other systems.

Blockchain maintains an audit trail, so that it is immediately obvious to all when a provider makes an entry or change to a medical record.

The concept of blockchain may sound exotic, but it is already being very successfully employed within many physician networks.

The main disadvantage of blockchain is that it is of limited benefit until there are a critical number of medical professionals participating in the process.

Blockchain is more difficult to hack, and tends to be more secure than traditional systems, but with enough computing power it is possible that even blockchains could be hacked. So, it is considered very secure but not completely impervious to hacking. One concern in this regard is that since most blockchain networks run the same code, any vulnerability detected could potentially put the whole network at risk. To keep things in perspective, though, most other systems are much less secure and tend to be easier to hack.

To be fully effective, blockchain requires that a large number of providers participate in the process. Without such participation, it loses much of its benefits of multiuser access.

As with most systems, it is also important to determine that data are accurate when first entered into the blockchain ledger. Sometimes, such as when a medical record contains information from multiple sources, it can difficult to determine the “owner” of a piece of information in the first place (e.g., a laboratory result recorded in a medical record, but without the actual laboratory that performed the testing specified).

1 Ackerman, L. (ed.) (2020). Blockchain. In: Five‐Minute Veterinary Practice Management Consult, 3e, 660–661. Ames, IA: Wiley.

2 Casey, M.J. and Vigna, P. (2018). The Truth Machine: The Blockchain and the Future of Everything. New York: St. Martin's Press.

3 Drescher, D. (2017). Blockchain Basics. New York: Apress.

4 Geron, T. (2018). One remedy for high health costs: blockchain. Wall Street Journal: R14.

5 Kshetri, N. (2018). Blockchain could be the security answer. Maybe. Wall Street Journal: R7.

6 Murray, M. (2018). Blockchain explained. https://graphics.reuters.com/TECHNOLOGY‐BLOCKCHAIN/010070P11GN/index.html

7 Norman, A.T. (2017). Blockchain Technology Explained. Createspace Independent Publishing Platform https://books.google.com/books/about/Blockchain_Technology_Explained.html?id=Z_JcswEACAAJ.

Lowell Ackerman, DVM, DACVD, MBA, MPA, CVA, MRCVS

Global Consultant, Author, and Lecturer, MA, USA

The concept of placebo is well known in human medicine, but it often does not get the same sort of respect when it comes to the use of medications in animals. It might be inferred that pets are the best “blinded” controls when it comes to therapeutics since pets do not know if they are being administered active medications, and yet since it is pet owners that ultimately report on what works and what doesn't, placebo is an important topic in veterinary medicine as well.

Nocebo:A negative type of placebo effect in which being informed that there could be adverse effects associated with a therapy increases the likelihood that adverse effects will be experienced and reported.

Placebo:The beneficial effect perceived for a product without actual physiological impact.

The placebo effect is well recognized in human medicine, but it was once believed that animals could not cognitively appreciate that a medication would be of benefit to them and react accordingly. However, there are several reasons why this line of reasoning may not be correct.

A lot of work has been done on the placebo effect, including the concept of honest placebos (patients or caregivers know something is a placebo but they discern benefit regardless). It's an important concept in veterinary medicine, not because the animals can be fooled but because the owners may identify responses as positive. In our pet‐specific forum, it is important to realize that just because a pet responded, this does not mean that we made the correct diagnosis and selected the appropriate medication in all cases. We also need to account for placebo and nocebo in animals.

While animals may not be able to directly perceive benefits from placebo therapies, the same cannot be said of the caregivers who are administering the medications and/or assessing its effects. This includes veterinarians, who are often eager for their interventions to have documentable success. In fact, the caregiver placebo effect may be evident around 30–40% of the time regarding subjective evaluations, such as for lameness in dogs and cats.

Another manifestation of caregiver placebo effect can be seen as a feature of being enrolled in a study, or receiving an intervention perceived as new and potentially exciting – known as the Hawthorne effect. With the extra attention potentially shown by veterinary staff, and more scrutiny and monitoring, it is quite possible that pet owners will have expectation‐based placebo effects. Conceivably, they may approach their pet in a more positive manner, spend more time praising and having physical contact with it, and pets can respond to that increased attention.

If studies in human medicine are any indication, the placebo effect can also be enhanced if clients are told a medication is hard to get or expensive; the color of the tablet can also affect degree of perceived benefit. All of this supports the contention that a placebo is more than just an inert substance without physiological effects, even if those effects cannot be completely explained.

When treating chronic problems, such as arthritis, allergies, inflammatory bowel disease, and others, there tends to be a progressive nature to the diseases, but attitudes and clinical signs tend to wax and wane over time – there are good days and bad days.

When patients are having “bad days” and are clinically at their worst, this is the most likely time when clients are going to be most receptive to trying something new. Since waxing and waning of clinical signs is typical, it is also not unusual that a percentage of patients will be better following the administration of anything – be it a legitimate therapy or a placebo – just because that is the fluctuating nature of chronic disease.