Conflicts of interest in veterinary medicine

In our syndicated feature, I wrote that the most striking feature of the recent Western Veterinary Conference, held in Las Vegas, was the focus on improving quality of life for pets. But that wasn't quite accurate.



The most striking feature was the wall-to-wall corporate sponsorship of everything from the lanyards holding our name tags to the shuttle buses that took us to and from our hotels. That's not unusual, of course. Sponsorship is the name of the game at every convention I've ever attended.



But sitting at a series of seminars about veterinary health and nutrition, led by researchers and veterinarians working for big drug and pet food companies, and sponsored by those companies, too, gave me something of an ethical headache.



I'm not naive. It's like this on the human side, too, where I got my start as a health writer in the early 90s. I know that the revolving door between industry, academia, and government spins at a dizzying pace, and the ties between the people investigating new drugs and foods and those regulating them are close ones.



This is certainly not news. For years, editors of scientific publications have been campaigning for better disclosure of conflicts of interest, with varying degrees of success. More and more attention is being paid in the scientific as well as the popular press about this issue, and multi-million dollar judgments have been made against companies for unethical practices involving scientific research and publication.



In fact, while we all might have forgotten it in the focus on how FDA handled the pet food recall crisis, there was another scandal in that agency just a year before. Lester Crawford -- a veterinarian -- resigned as head of the FDA due to undisclosed conflicts of interest:

Lester M. Crawford, who resigned mysteriously last fall just two months after being confirmed as commissioner of the Food and Drug Administration, will plead guilty today to charges that he hid his ownership of stock in food and drug companies that his agency regulated, his lawyer said.



The Justice Department charged Crawford yesterday with two misdemeanors for withholding the financial information, which included his ownership of shares in food and drink manufacturers Pepsico Inc. and Sysco Corp. and the drug company Embrex Inc.

Given the ever-increasing focus on this issue, what I saw at WVC perplexed me. I attended a number of scientific sessions, but saw exactly one presenter outline her conflicts of interest -- companies who paid her for consulting or other services, whose drugs or products she was speaking on that day. I asked a presenter who I knew personally if she'd been asked to disclose her conflicts, and she told me no, she had not.



In human nutrition, it's known that "Industry funding of nutrition-related scientific articles may bias conclusions in favor of sponsors' products, with potentially significant implications for public health." So, exactly how much faith am I supposed to have in someone who works for a big pet food company talking to a room full of vets about home made diets and food safety issues?



Let me ask you a question. Let's suppose that I get hired to consult for Best Ever Holistic Pet Food Company. They pay me, not a fortune, but let's say, enough to cover my mortgage for one year. And I don't tell you this, and I come here and write a serious investigative piece on pet food, and conclude that Best Ever is, in fact, the best ever.



Then you find out.



Would you trust me? Even if I absolutely assured you that my background as a journalist, my credentials as a pet lover, my reputation, all should be enough to keep me honest and objective on the subject of pet food, and the fact that I'm on the Best Ever payroll will not influence me in any way?



You would not. You should not.



Oh, and Gina would fire me in five seconds flat.



And yet, when asked -- not challenged, not accused, simply asked -- about their financial conflicts, some veterinary researchers, like their human counterparts, bristle and insist their scientific process is in no way affected or compromised by their industry ties.



Things aren't very different in the veterinary scientific press, either. For example, while the Journal of the American Veterinary Medical Association asks its contributors to disclose their financial conflicts when submitting work for publication, it does not make those public. I guess we're just supposed to trust them, just like we're supposed to trust those indignant scientists.



What can we do? The problem is at this point so huge, so inextricable from how our system of research, science, and medicine functions, that fixing it would require such a massive overhaul of our medical, economic, and educational structures that it's almost impossible to imagine will ever happen. The best we can hope for, and it's a piss poor best, is to see full and comprehensive disclosure become not just a good idea, but required.



Disclosure of any and all financial conflicts of interest needs be mandatory and thorough at all veterinary conferences, in all veterinary publications, and at every level right down to the local veterinary clinic. If industry is paying you, subsidizing you, sponsoring you, or giving you stuff, be it mugs and pens or trips to the Bahamas, tell me. Don't you decide that you're not influenced. Let me decide.



Things may be changing. The American College of Veterinary Internal Medicine did require full financial conflict of interest disclosures from presenters at its recent conference, and some of those who presented at WVC listed theirs at some point during their session, even if I only witnessed it once.



Sunshine, they say, is the best disinfectant. Disclosure may be more like a lightbulb, but it's better than making what can often be life and death decisions in the dark.

Comments

[slt]

I wholly support your desire to see *at least* full disclosure among Vets (and how about everyone else in the world while I'm at the wishing well). Since so many sources advise pet owners to "Consult your Veterinarian" regarding pet feeding, it would be great to see a plaque on the wall in Veterinary offices that says "My Vet School taught me about small animal nutrition using a representative from Hill's" if that were the case for that particular Vet. Might give the consumer some perspective when inquiring about pet feeding and the Vet recommends and sells them a Hill's product.



P.S. I know it would be a cold day in Hell before you'd take a payoff/bribe/consulting fee from "Worst/Best Ever Pet Food" but it did make me laugh so, thank you.

[Gina Spadafori]

Another issue on corporate sponsorship, as it relates to Pet Connection:



Since in the magazine industry it's common for preferential treatment of advertisers in articles and making sure no one writes critically of an advertiser in the publication, we wanted to make sure our sponsors here know we play by another set of rules. That's why we discuss and make them sign off on an agreement that sponsorship does not come with any entitlement beyond that Web banner.



To their credit, none of the companies we've dealt with -- and we have more coming online soon -- have had any problem with our stand at all.



Our veterinarians have at times served a spokesmen for products -- such as Dr. Tripp, who's currently a behavior consultant for Petmate. (The Tripps write the "On Good Behavior" segement for our syndicated pet-care feature.) And Dr. Becker has been a spokesman for many advertising campaigns over the years. He's a celebrity vet, and it goes with the territory. Our solution on that is that they don't write on any topic that involves a financial interest. So the Tripps don't write for us about crate use, for example.



Sometimes having a company like Petmate as a sponsor has the opposite effect -- I go out of my way to be sure I'm being fair in mentioning any kind of gear that happens to be in their product line. For example, I use crates all the time -- not only Petmate's crates, but also those from Midwest and Precision. But when I'm writing about crates, I say "crate" and since Petmate has a banner will people think that's an endorsement? In the end, they have to make up their own minds, because I'm clear in mine that I'm not going to avoid recommending the use of crates because someone might think I'm doing so because we have a Web site sponsor that makes them.



Christie and I have no celebrity endorsement deals of any kind, by the way, although I hear Zappos.com is interested in signing Christie. (Note: That's a joke. Christie's a shoe freak.)

[Marie Finnegan]

I was gonna point out the "vets selling food as a conflict of interest" issue. However I see others have done a far better job of it than I ever could have.



Thanks!!!!

[Colorado Transplant]

Thanks, Christie, for shining the bright light on this subject.

[Colorado Transplant]

Have to say this:



HAPPY EASTER, EVERYONE (including our animals)!

[Bernard J. (Bernie) Starzewski]

The day after I had Brandy put to sleep and her body was still wrapped in a tarp in the back of my truck I had a terse conversation with my (then) vet who blew off the possibility that her food was in fact the cause of her sudden accute illness saying that the lot number (on the first day of the recall) didnt match so it could not possibly be the cause. NOTE: The food came from someplease else and not her office.



But I could not help but notice that the room adjacent to the waiting room was a veritable grocery store of cat and dog food. In retrospect vertually all of the foods I saw on those shelves was eventually recalled.



Vets sell things. Thats a given. They sell the medicines and antibiotics and such that enable them to treat our friends. But, much like human medicine, its gone way beyond that.



Even in my own business (computer systems) Ive seen CPA firms go from declared neutrality in selecting systems for clients - opting to part of the evaluation and selecting process of competing 3rd party vendors - to first becomeing a vendor themselves while still collecting consulting fees to "aid" in the slection process (which always resulted in their product being "selected"). And then, after being exposed with some legislators began to look into it spun the computer systems dealerships off to other "profit centers" even though the checks were cashed to the same account and the reseller's address was the same as before and the people occupied the same desks.



The trend in this country is to follow the Milton Friedman theory of economics which states that the one and only control mechanism is "the market". The theory states that anything a seller has to do to make a profit is fair game and if what they deliver is not good they will loose business and a better one will take over and NO OTHER form of regulation is necessary.



But markets can be manipulated. Anyone aware of the mortgage melt down? What caused that is the repeal of the Glass-Stebal act from the 30s which prohibited banks from mixing their finances with the stock markets. When that wall was torn down banks bascially got out of the mortgage business and went from being manufacturers of loans to used car salesmen pimping loans that they simply sold off for a quick buck to none other than Wall Street who had no idea or way to assess the quality of those loans.



All of "Uncle Miltie's" bizarre proclamations assert in effect that the only tool is a hammer so every problem can be solved by a nail.



Here again like the pet owner who does not have a degree in bio-chemistry or even understand that other products may well be better competitors is left with nothing but trust to make inherently uninformed decisions about the care of their charges (and pretty much everything else).



To top it off one of the heads of the UW_Madison vet school, Dr. Sandy Sawchuk has repeatedly admitted on http://www.wpr.org call in shows that for years the ENTIRE nutrition program at Madison school of Vet Med was being run by a pet food company who sent "representatives" to conduct lectures. This is the same Dr. Sawchuk who still is mouthing the Michigan numbers for deaths in the Menu debacle.



As with the CPAs charging businesses money to sell them a forgone conclusion some boundaries simply do not need to be crossed. Either CPA firms are consulting or their are sales agencies. The same applies to Vets and your family Doc and your investment broker (who may well have steared you into mortgage back securities).



I like the line from the movie "The Princess Bride" "Life is pain. Anyone else who says otherwise is selling something."



Hey, is that a nail sticking out of your head? Or are you just unhappy to see me?

[Megan]

I'm a second-year vet student... we had a discussion in our professional skills course about an article in the Medical Journal of Australia (Volume 177, 2 Sept. 2002, pp. 263-265). Geared towards human physicians, the article described a Charter on Medical Professionalism, developed as part of the Medical Professionalism Project. We read the article and discussed how the charter does and does not apply to veterinary medicine.



One of the principles is a "commitment to maintaining trust by managing conflicts of interest." As a class, we agreed that this not only applies to vet med, but it probably more applicable to veterinarians than to human doctors because we run our own pharmacies and often sell pet foods in-house.



So, this is a topic of discussion, at least at one vet school...

[Ann H]

I have read at one blog where they have addressed veterinary community regarding the close ties to the pet food industry.

http://petfood-bad.blogspot.com/2007/05/pet-food-nutrition-necessary-review-for.html



What I believe most is that the vets are not cognizant of is the pet food industry's close ties to the animal feed industry and the ensuing ties to big agribusiness interests. (and would explain why Richard Sellers, would be advising pet food companies on recall procedures)



I feel the lack of separation of standards ( our companion animal health & nutrition in the same bucket as animal feed ingredients) is in direct conflict with the advertising & marketing campaigns.



Not only that, taht implies there is an underlying web of business interests which are contrary to and fighting the FDAAA and the AAFCO standards.



Maybe even, it's part of the stall in getting a national alert system up and running.



Would it show too quickly that cyanuric acid has been in pet foods for a very long time?



Would it show that many ingredients have been put in pet foods when they are intended only for livestock consumption?



(There is a premix made for the pig industry that is made of corn gluten/corn gluten meal and acetaminophen- PRACETAM 10 % Premix for pigs)



Would that system present a situation the agribusinesses don't want - like getting too close to disclosing the bare bones truth about pet foods & livestock food?



In fact, some livestock ingredient companies see the lure and will be producing some pet treats in the near future, according to the pet food industry magazine.



Either way, the conflict of interests the vets aren't paying close enough attention to are rooted a layer deeper than we are acknowledging.

[Marie Finnegan]

While livestock feed may be more regulated now, didn't mad cow disease begin because of tainted feed? Feeding slaughtered cows to other cows I believe. Correct me if I'm wrong. And there is a book out that cites the use of euthanised pets in pet foods in our country as well. (unsure if I am allowed to put that title on here so I won't) So I can't say I put much stock in government regulations.

[Bernard J. (Bernie) Starzewski]

Megan, I am very glad to hear that this is at least being discussed. My comments were made as a result of hearing the repeated dismissals by Dr. Sawchuk at UW Madison who aparently in her own words do not see the same things that you are now discussin. Perhaps the generation is turning.



But beware that once in practice the temptation to see pet food as just another profit center in a potentially lucrative career sometimes dims the optimism of newly graduated DVMs.



I do not agree completely with Ann H. In fact the connection to large agri-business and large animal vet practices is a pretty weak one at best. Vets typically do not get directly involved with feed sales although they might well consult on it.



While vets are certainly employed by feed companies, sales of this type are almost exclusively handled by cooperatives and other private feed producers. Medical supplies are a completely different matter although I am sure that exceptions can be found.



Also be aware that the standards for livestock feed are actually much tighter since the nutrients are intended for the human food chain and in this country at least Fido is not likely to be on the menu.



Pet food on the other hand is seen and not mattering much and who cares what the cow died of or what is added into it.... Its just dogs and cats, right? Right?

[Barbara A. Albright]

Full disclosure encompasses a lot more than interests from/in drug and food manufacturers.



Support for federal introduction of a bill requiring the veterinary industry to provide full written disclosure is an absolute must:



#1 whether clinic possesses valid DEA license to prescribe needed medications, particularly schedule11 narcotics

#2written disclosure of your pet's prognosis with treatment, including the success/failure rate at their facility & written updates every 24/48 hours

#3 any conflicts of interest or motivation for treatment of your pet, such as affiliation with a educational/teaching program and any enumeration derived from such

#4 any funding received from other than client based treatments

#5 why particular medication/drugs have been chosen for your pet and why

#6 If a referral patient/client relationship is made, what the clinic that refers derives from the "referral" whether monetary or otherwise



These are just a few "disclosures" that could have prevented tremendous harm and cruelty to myself and my pet.



details: http://walnut-hill.bravehost.com

Pocket's Story from NH

[emily]

Not tainted feed. Everyone knew meat by-products were in there and intended them to be in there, but did not know that they were dangerous. In fact many feeds still contain some kind of meat byproduct, often fish or blood.



I would be very, very surpised to find eutanised pets in any tyoe of feed and would assume that book to simply be dead wrong. Euthasia chemicals alone would bar them from being included in feed. They might be rendered for non-food products.

[Mark Bullock]

It's disappointing to hear so often that those who are supposed to be protecting our beloved pets are pushing unhealthy products on them instead. Unfortunately, I'm not so sure that nutrition is something that vets are aware of as they should be. After the pet-food recall, my girlfriend and I did lots of research on pet foods. We were surprised at the great difficulty we had in finding foods and treats that were both healthy for pets (human grade meat from one source, actual vegetables, no dyes, preservatives, or other chemicals, etc.), and not sourcing any ingredients from China). As a dogwalker in Chicago, my girlfriend has been instrumental in advising many of her clients on their dogs. She recently chose to expand her business to offer her clients some of the best products available on the market. I think it's pretty cool to see the changes and improvements that truly good quality food has had on our own and her clients' pets.

[Pam]

Hi,



Super article! What gets me is that for ears, I have always said, please give me a prescription! I can get it at half the cost on line.



This usually causes a look of *disbelief* on the part of the doctor, ROFLOL almost as though I just asked them for their first born son. I have seen this look so many times on a vets face, that now I almost laugh! They do give me a script, but all the wile they are doing it, you can tell they don't like it!



Thank you for bringing all this great info out.



I put a blurb on my forum with your link ! I hope everyone comes here to read this.

[The OTHER Pat]

Christie, I have heard of vets who either refuse to write prescriptions for drugs to be purchased elsewhere, or tack on a healthy service charge if they do. Do you happen to know whether this is ethical/legal? (And maybe if varies by state?)

[Christie Keith]

They cannot treat prescriptions that are filled elsewhere differently from prescriptions they fill. They can charge a script fee, but if they do, it has to be for ALL scripts, not just those filled elsewhere.

[Christie Keith]

Just to make this perfectly clear, I mean if they charge a script fee for scripts filled elsewhere, they have to charge the same fee for their own clients who are getting drugs from them -- no actual prescription form needs to be involved.

[Paul]

Interesting article Christie.



I am a veterinarian who very strongly believes that the veterinary profession needs to find ways to divorce themselves from corporate sponsorships that come "at a cost". All sponsorships have a cost.



My comment to you and Gina and all at Petconnection is that you need to figure out how to ALWAYS operate NOT needing any sponsorship.



The day you first accepted sponsorship is the day you lost your virginity.



The day you find yourself in need of sponsor $$$ to continue is the day you will have forever lost your independence and ability to look at your readers with certainty and say, "We have only one master -- you my reader".

[Ann Viera]

The AAMC has recently released a policy for human medicine on industry influence. It is at http://www.aamc.org/newsroom/pressrel/2008/080619.htm



A long-standing effort on the human medicine side to reduce the influence of industry, especially on residents, is the No Free Lunch campaign headed by Dr. Bob Goodman at Columbia

http://www.nofreelunch.org/. Veterinarians are among the medical personnel participating in No Free Lunch.

[Fiona]

Here too in Britain the veterinary schools have sold their soles to pet food companies and take funding from them and allow Hills and Royal Canin to teach nutrition to veterinary students. The Vets are betraying pets and pet owners by allowing this to happen and the Vets too should be stopped from selling any pet food and then perhaps they would stop telling us to feed this illness inducing food to pets. The Vets make money from the sale of the food and then from the illness feeding such terrible food eventually creates. It is time the veterinary profession en masse stood up for the animals and stopped taking funding and free pet food. The AVMA is apparently the biggest shareholder in Hills but the last thing they should have shares in is in a pet food or drug company. It is a huge scandal that Government in all countries should put a stop to.

[Liz Palika]

As a veterinarian technician, years ago in a galaxy far far away - well no, actually very close - I took the Hill's nutrition course. I got the course material and certificate of achievement.



Afterwards, knowing no better, I fed my dogs their food.



We won't go into the results but it did begin my decades long self education into pet foods so I do thank them for that!

[Dr. Tony Johnson]

IVECCS - the emergency and critical care conference requires presenters to disclose any conflicts of interest during a lecture session. I had a nice educational seminar and dinner paid for by a company that makes a hot new heart drug, so I threw that into the talk. I have lectured at lots of conventions and IVECCS is the only one that has imposed this rule.



I do voluntarily declare that same dinner when I have a talk mentioning that drug, but I have never been asked to do so.



ANY info, no matter the source, should be critically evaluated. Believe nothing, question everything.

[H. Houlahan]

Thank you, Dr. Hancock.



I have the Hills textbook that veterinary students get for free (I paid for mine).



I can only imagine the effect on a pack of 20-somethings with no time to educate themselves outside of the system, coupled with lectures from salesmen and a steady stream of bribes.

[Gina Spadafori]

Full disclosure: I WUV Dr. Tony.

[Dale Hancock]

As a professor in a veterinary college in the USA, I can confirm that serious conflicts of interest exist. Many of our students get free or heavily discounted food from 2 pet food companies during their 4 years of vet school. Each recipient of this largess receives gifts that are cumulatively worth hundreds or even thousands of dollars. Moreover the faculty of the college has turned over it's small animal nutrition teaching to persons affiliated with and indirectly paid by a pet food company. Many students and faculty continue to argue that these personal and institutional gifts are meaningless. No doubt any taker of bribes would argue the same: we were going to favor those interests anyway. Yet, meaningless gifts ought to be easy to refuse by people--and Universities--interested in their professional standing. A profession sets its own ethics, and thus one cannot say that such flagrant conflicts of interest are unethical. But one might hope for standards somewhat higher than used car salesmen in the veterinary profession. Pity that expectations are not reality. Where is the AVMA in providing leadership on this matter? On the take, that's where. Our College was recently reviewed for AVMA accreditation: nothing I saw mentioned on our lack of conflict of interest policies much less our flagrantly extant conflicts. Shame on us.

Dale Hancock, DVM PhD, Washington State University ([email protected]).