CAM blogs

CAM Meets Dr Stephen Fox

Dr Stephen Fox MS, DVM, MBA, PhD

Dr Stephen Fox received his M.S. and veterinary medical degrees from the University of Illinois, and M.B.A. (entrepreneurialism and new ventures) and Ph.D. (pain management) degrees from Massey University in New Zealand. Dr. Fox served on the faculty of the veterinary teaching hospital at Mississippi State University, as product manager at Pioneer Hi-Bred International, senior lecturer in companion animal orthopaedic surgery at Massey University, senior veterinary specialist at Pfizer Animal Health, and Director of Pain Management at Novartis Animal Health.

Prior to his career in veterinary medicine, Dr. Stephen Fox graduated with a B.S. in mechanical engineering from the U.S. Naval Academy, and flew more than 300 combat missions as a naval aviator in Vietnam while serving concurrently as Officer of the Deck aboard the USS Enterprise. He enjoys dual U.S. and New Zealand citizenship, is a certified small animal surgical specialist in New Zealand, president of the Veterinary Orthopaedic society for 2004, an Adjunct Assistant Professor at the University of Illinois, advisor to the University of Tennessee Pain Center, founding member of the Companion Animal Pain Management Consortium Leadership Council and a Fellow of the New Zealand Institute of Management.

Dr Stephen Fox has authored more than 80 professional publications, 2 textbooks, 5 textbook chapters and 2 interactive CD/DVDs.


Dr Fox kindly agreed to answer the following questions:

How do you feel about how arthritis is currently managed in first opinion practice?

Current management tends to follow historical momentum, i.e., cheap pills!  NSAIDs continue to dominate treatment, although the new piprant drug is gaining popularity.  Nutraceutical sales are typically not tracked; however, this class of products is very popular; albeit, there is virtually no data to support their broad use.  Likely, they are so popular because they ‘do no harm’.  (Tongue in cheek)…that’s because they don’t do anything!  Keep in mind that the most expensive treatment is one that doesn’t work.  Also keep in mind that placebo effect is typically around 40-60%.  We practice in a culture of evidence-based medicine. This is Best Medicine in the interest of the patient.  Remember, “In the void of data, there is only opinion”!  [Tramadol is a perfect example of veterinarians ‘following the crowd’; not realising that Tramadol has a different mode of action in dogs than humans.]


What do you feel the future holds for managing canine arthritis?

The presence of so many ‘treatment options’ for OA gives recognition to the reality that there is no one panacea; resultant from the fact that we don’t yet fully understand the disease.  Further, most all pharmacologic interventions express their mode of action by blocking the nociceptive (pain) pathway.  Since there are a plethora of receptors along this pathway, there follows an equal number of potential receptor antagonists.  Hence, the theory goes that the more pathways you block, the lesser amount of each antagonist is required—Multimodal Management.  As more products come to market, the offerings for multimodal combinations will continually increase.  What will break this escalating potpourri from which to choose?  A disease-modifying intervention, which may or may not be part of an individual patient’s multimodal management regimen. Radiosynoviorthesis (tin-117m) may be a break through disease-modifying option for multimodal management.


What one tip would you give an owner if you were sat opposite talking to them now?

Whatever advisement you are given, ask the question, “what evidence do you have to support this recommendation?”.


[The ACCLAIM system has been developed to help clinicians rapidly evaluate a joint health product for identification of safety and efficacy.][ JAVMA, Vol 234, No. 11, June 1, 2009]