Vet P.O.V. Conflicts of interest in vet medicine: A response to PetConnection’s question of diclosure

March 23rd, 2008  

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I wouldn't feel too uncomfortable if I were you at the dinner this week.

I trust my vet to make decisions on the merits of the drug* itself, regardless of whether or not they got a dinner, or some free samples out of the deal. I feel that they are smart and ethical enough to make their own decisions without being swayed by a dinner of rubber chicken in some hotel banquet hall. If I didn't feel that way, I'd go find another vet.

*or pet food, or therapies, or procedures

Cindy March 23rd, 2008 05:28:00 PM

I totally agree with everything you said! (And I do notice who pays for lots of stuff at those chique vet conferences . . . . Hills, et al)

Re:

"My guess? People don't yet care enough about these things when it comes to pet medicine. “It's just animals we're talking about, after all” seems to be the prevailing sentiment.

Never mind that these “animals” are fueling a thirty some-odd billion dollar market in the US. Never mind that my profession lauds itself for the increasingly high emotional stakes it’s “earned.”

Bingo.

Here is the thing:

Even among those of us who claim to be absolutely bonkers for our pets, call them "family" -- even WE do not REALLY behave as though they are family, when you deconstruct and challenge it.

Would any of us leave our children in a cage alone overnight at a hospital where no staff were going to be there?

But we do it with our pets everyday, until one day something happens that makes us think about it.

Would any of us feed our family microwave dinners and convenience food each night?

Probably not. But even the best pet owners -- most of them do this with their pets. I live in a glass house here too -- did that for years till the lightbulb went on.

So, there is a lot of behavior that we need to look at in ourselves -- behavior that belies our claims that pets are beloved family members. Perhaps this behavior doesn't mean our feelings are not sincere -- it's just conditioned behavior. We've always fed pets this way; these are our expectations of veterinary care, etc. We never stop to really THINK about it because its the way its always been.

As for vets, I ran into some attending a conference on medical informatics primarily attended by human clinicians. They seem really to want to consider themselves part of the same club as people doctors . . . but yet they do not want to be held to the same standards.

So, everyone involved needs to take a good hard look at what they SAY vs. what they DO. There is some hypocrisy and lack of critical self-assessment all the way around.

It is probably a very confusing time to be a vet. It's almost like you need different vets for different classes of owners. There are owners like me -- what my friend calls "The 10th owner." We are that percentage that will run up plastic to get the best treatment for a pet -- I-131 for hyper T, chemo for cancer, subqs every day for pets with kidney problems, etc. We buy the best food we can get our hands on or make the food. When we look for a place to live, we do it wiith our pets needs in mind, etc.

Then you have "good" owners, that are just, good, run of the mill owners. They feed their pets good standard food, take decent care of them, but they probably won't be paying for chemo.

Then you have owners who just see pets as an accoutrement, something you should have around for the kids, or something that looks good on your couch or gets you attention from other humans, helps you get dates in the park, whatever. These people won't go too far for their pets. They take them to the shelter when they catch them scratching the couch or whining too much.

Anyway, all of us need to challenge ourselves on our own hypocrisy when it comes to pets.

BTW, this is one of the reasons I'm very confused about whether or not to give heartworm preventative to my indoor cats. My vet has been pushing it for the last year -- apparently because the company came out and did a presentation that put the fear into her. She keeps forgetting she's already asked me about this, and when my cats got their teeth cleaned in FEBRUARY, and she called me to discuss what she did, she ended the convo with: "Have I talked to you about heartworm preventative?"

Which, of course, she has. So I don't know whether she keeps bringig this up because she truly believes my cats could be at risk, or whether its got something to do with the drug co. ????

Stefani March 23rd, 2008 07:40:00 PM

Gees, one of my *favorite" pens and sticky note pads have the ugly Lamisil creature. how can one not enjoy all those little freebies?? How about all the human FDA approved drugs, now found to have serious unwanted side effects, after years of availability??

FULL DISCLOSURE:

#1 DEA license- whether one is possessed , particulary for schedule 11 drugs
#2 affiliation with a teaching facility, particularly if there is familial relationship between the two
#3 full written disclosure of your dogs diagnosis/prognosis, with updates every 24-48 hours, to include statistics of successful treatment at their clinic
#4 full written disclosure of the "monetary relationship" or otherwise to the clinic you "refer" to
#5 full disclosure of the drugs chosen and why

Is it true that "ampicillin" should never be used on an animal with kidney failure?
http://walnut-hill.bravehost.com Pocket's Story from NH visit resident page

Barb Albright March 23rd, 2008 08:48:00 PM

I'm a technical professional and some of the best AND worst continuing education programs I have been to have been sponsored by vendors. I think vendor sponsored continuing ed is to everyone's advantage, within reason. Vendor sponsored education means I get training on competing products and ideas to those that I am currently using. I (or my employer) certainly can't afford to pay for training on products I don't use, but when our usual methods are insufficient or inappropriate for some reason, that training often is the source of my solution. Hopefully, anyone who is a trained professional is capable of sorting out the facts from the sales babble. What we as professionals need to do is keep track of which vendors provide useful information and which are just looking for a captive audience for a sales pitch and avoid the later.

Juli March 23rd, 2008 09:44:00 PM

I agree with Julie.

Some of our reps are great. They come to our clinic and give continuing ed talks to the lay staff, which also act as a refresher for the doctors and techs. They remind us of how their products work and let us know about advances in the field and new products coming on the market. They provide written materials and aids for us to help clients understand their pets disease processes and makes them better able to monitor their pet at home. All of this helps us to educate our clients and help them choose appropriate products for their pets. The really good reps bring pizza :)

A few of our reps are only there to sell us stuff. They are pushy and don't provide us with many resources. They spend very little time with us and don't provide much customer support. They never bring food :( In some cases these reps might not spend much time with us because we don't sell their products- possibly because we don't like the product and we don't see good results with it. In a few cases (rare) we don't sell/use much product because we don't like the company- poor customer support and pushy sales tactics.

When I am speaking to clients I recommend the products that I find work best for my pets. And, my vets are smart, caring individuals that have their patients best interest at heart and no salesman is going to get them to change their treatment plans.

Meghan RAHT March 23rd, 2008 10:43:00 PM

http://www.nytimes.com/2008/03/22/business/22devic...

New Focus of Inquiry Into Bribes: Doctors

By BARNABY J. FEDER
Published: March 22, 2008

A long-running federal investigation into the orthopedic device industry’s suspected kickback payments to hip and knee surgeons now has the doctors in the spotlight.

Having reached settlements with the five leading makers of artificial joints last year over the payments, the government has been focusing on the many doctors who receive money as the companies’ paid consultants.

[snip]

From the government’s perspective, the investigation has already been successful. Even before the settlements with the device makers, those companies and others had sharply curbed entertainment, travel payments and other practices the government regarded as possibly influencing doctor’s medical decisions. And with the settlements, still tighter restrictions were forced on the companies.

[There's more of interest.]

M March 23rd, 2008 11:46:00 PM

*Shrugs* For those of us technicians who pay for our own CE, the free education provided by some of these drug companies has been pretty valuable to improving my skills. I'll sit through listening about some cardiac drug, so long as they also educate me on functioning of the heart, etc. I trust my doctors to let me know if something has been grossly skewed in the company's favor. I can't imagine them or myself recommending a product solely based upon their kickbacks. I recommend some products to clients that we don't even sell at our clinic! I would rather they purchase a competing product if it is what's best for their pet.

I guess we've never run into a situation where this is an issue. Perhaps we're too small potatoes of a clinic for the company reps to push things too aggressively.

Michelle Schwab March 24th, 2008 06:42:00 AM

Recently a survey of MDs showed they were depending on reps for basic information. I would expect any practitioner to listen politely, but then do their research to decide which drug/feed etc to use in various clinical situations. If they are willing to do that then I would feel quite secured regardless of who gave them what. If not it might be better to have a clean slate than half the story?

emily March 24th, 2008 08:22:00 AM

http://www.nofreelunch.org/ has some interesting data about how drug company freebies influence doctors' opinions and how drug companies can skew how they present their data.

I think it's naive to say that we aren't influence by the freebies. If they didn't improve revenues from drug companies, why on earth would they spend so much money on the swag?

Megan March 24th, 2008 09:24:00 AM

Stefani posted "Would any of us leave our children in a cage alone overnight at a hospital where no staff were going to be there? But we do it with our pets everyday, until one day something happens that makes us think about it."

I do not view my pets as children, or treat them as children. I do treat them as beloved pets. When my dog required eye surgery on 2 different occasions, I did not allow the vet to keep her overnight in an unstaffed vet office. I have to actually argue with the vet that I could take better care of her at home that she would receive alone at the vet's office. It seemed a no-brainer to me!

Susan G. March 24th, 2008 09:34:00 PM

Like Susan, I refuse to leave my pets in an unmanned office as well. One of my cats blocked, and I brought him home with a catheter and set him up in a cage with a lot of blankets and watched him very closely till I could get him back into the vet.

As for feeding junk till the lightbulb went off.. well we can only do so much with the info we are given. When there are only the manufactures out there touting how great their products are, that is all the info we are getting. then when those manufacutures start saying that anyone who talks about something different is a kook or off their rocker or plainly crazy, it makes it hard to know what is the right thing to do. Even today, raw diets are dismissed by a great number of vets for reasons that really don't hold water- why? I think it is because most of their nutritional info comes from the pet food manufactures. There are still vets out there that say that people should be giving their cats dry food to clean their teeth!!

(btw, I eat a ton of microwave dinenrs and convenience foods.. while my cats get the best food I can make for them, how silly is that?)

as long as my vet gets CE from ALL sources, I don't mind. If all they hear about pain meds is from Pfizer or a Rimadyl rep, then I have a problem. but if they sit in on lectures from all the available pain meds, and they know the benifits and the drawbacks of each, I don't mind if the prefer to prescribe x because they get a benifit from it. I can't imagine for a moment that a decent vet (notice the qualification there) would prescibe x medication ONLY because they get a benefit from it, and not take into account the side effecs for a particular animal. IE If a dr likes prescribing Rimadyl because they get free dinners, that is fine as long as they are very careful not to give it to labs..

So I hope you go to that dinner, and enjoy your meal, and absorb as much info on the product as you can, and go to every other dinner/ce/presentation you can and do the same.

connie March 25th, 2008 09:59:00 AM

Yep. I second the overnight thing. Most pet parents don't know there will be no one overnight to care for the pets--unless we tell them! All clients need to be made aware of the risks their decision not to have their pet watched overnight at the emergency facility entails!

Dr. Patty Khuly March 26th, 2008 08:19:00 AM

I hate to see that Pfizer has such a big stake in Petconnection now and don't see how they can retain their journalistic freedom in this situation. The site is branded with Pfizer now, and it reminds me of this situation.

http://www.kirotv.com/news/15189249/detail.html

Walt May 5th, 2008 01:57:00 PM

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