A giant ship’s engine failed. The ship’s owners tried one expert after another, but none of them could figure but how to fix the engine.
Then they brought in an old man who had been fixing ships since he was young. He carried a large bag of tools with him, and when he arrived, he immediately went to work. He inspected the engine very carefully, top to bottom.
Two of the ship’s owners were there, watching this man, hoping he would know what to do. After looking things over, the old man reached into his bag and pulled out a small hammer. He gently tapped something. Instantly, the engine lurched into life. He carefully put his hammer away. The engine was fixed!
A week later, the owners received a bill from the old man for ten thousand dollars.
“What?!” the owners exclaimed. “He hardly did anything!”
So they wrote the old man a note saying, “Please send us an itemized bill.”
The man sent a bill that read:
Tapping with a hammer………………….. $ 2.00
Knowing where to tap…………………….. $ 9,998.00
Effort is important, but knowing where to make an effort makes all the difference! Just ask someone who lost a horse to EPM. If the wrong disease is diagnosed and then ineffectively treated, the horse is lost. Just what goes into the effort to give clinicians the tools they need to evaluate the horse? Veterinarians spend four years in college, they undergo a vigorous selection process that is followed by four years of post-graduate education. Some were fortunate enough and had a support system, some are still paying off those college loans. Armed with his academic qualifications, the veterinarian accrues knowledge one field case at a time. That is the art of practice. Practicing veterinary medicine isn’t learned from a book. Each animal is different and how it presents clinically and expectations on treatment effectiveness are a skill learned by putting in many years of work.
What does it take to root out diagnostics that give us a picture of what to fix? In our case, it took BS, MS, and two doctorate degrees (DVM, PhD), a total of 13 years. After that, seventeen years were spent in total immersion in the study of one parasite, Sarcocystis neurona. The outcome was an understanding of how the parasite lives and infects cells, what cells are infected, how to infect horses, and how to interpret the response of each cell in the body to infection. That was coupled with 30 years of field experience in equine medicine. Finally, putting that knowledge into a story that made sense to veterinarians by translating science to a successful outcome.
An experienced clinician has to understand our bench science and layer that onto his or her education and experience. Field veterinarians spend hours digesting the work we have done by reading our published work, and that isn’t easy. It took me 17 years of total dedication, 24/7, to work out a theory, test the model, and present the knowledge to field practitioners, giving them tests and a interpretation of test results as a starting point for them. No one can take a laboratory number and use that to cure animals. Most lay people don’t have the background to understand the work. We make it available and are happy to answer questions, but a few graduate level courses in immunology, parasitology, and molecular biology (biochemistry) are needed.
In addition to our milestones, we have a team of experts which also dedicated years to gaining background knowledge and experience in their fields. I learned to take a parasite from an animal, clone and express genes, and produce recombinant proteins to use in diagnostic tests, but there is more. Experts were needed at each step.
The cost of producing a licensed pharmaceutical for a horse is between five and ten million dollars. Obtaining FDA protocols takes 3 people many hours to perfect, studies cost two hundred and fifty thousand to five hundred thousand dollars to conduct. Manufacturing a tablet to use in studies cost hundreds of thousands of dollars (validating assays, testing the ingredients, testing the final product). Each step under the watchful eye of the respective expert.
Is this important to you? It should be. For example, we developed a drug to treat parasite mediated inflammation. Little did anyone know that tossing the drug into water for as few as four hours or mixing it into a paste changes the chemical into a pro-inflammatory molecule. It took us 4 years conducting many experiments in consult with a veterinary school to prove the effect that water has on levamisole. What are the effects of levamisole on the parasite? Our studies are almost ready to share. These are aspects of the experiments we conduct. Right now, we are possibly the only group investigating how to effectively treat and prevent relapses in horses with autoimmune polyneuritis. We present and publish our work, sharing it with those who are interested. We provide continuing education to veterinarians. The protocol for treatment of autoimmune polyneuritis won’t be worked out for another year or two but we are training veterinarians on the protocol we are finding effective today.
Most pharmaceutical companies keep their information in-house, preventing competition and perhaps hindering progress. Negative data is rarely published. Companies take the time to secure patents and license a product before the big rollout. That prevents competition from compounders. Compounders can provide a valuable service, unfortunately that has evolved into a business paradigm that is harmful and outside the intent of the services they can legally provide. Compounders use loopholes to provide meds that are similar to licensed products, thereby avoiding the development costs and expenses for all the science behind the work. They just change the flavor. They don’t validate the amount of active drug in the formulation or understand the ramifications of their product. Compounders are privy to information for which they invested neither time nor money in the science. When you shop for a drug to save a few dollars, you are making a choice in the future of drug development.
It is impossible to know what we will discover next and how it may affect your horse or even human medicine. We choose to try to do what we do by funding our own work and providing a direct pipeline to clinicians, via our consulting. The next time you think you may be paying us or your veterinarian too high a price for goods or services, please consider the people, time and expenses which went into our ability to successfully manage your horses. Without that background and the costs incurred in reaching this point, some of these animals would not be alive today. It takes a village.