A time for introspection

Greet drug company influences with transparency

February 5, 2015 (published)
By Gary Block

The U.S. Supreme Court decision held in Citizens United v. Federal Election Commission is decried by many for allowing a small number of wealthy individuals to unduly influence our political process. Sen. John McCain, a longtime proponent of campaign finance reform, once said, “Money buys access, and access buys influence."

A recent Reuters article and The Indianapolis Star's "Pets at risk" series both questioned the role of corporate money on the American Veterinary Medical Association and its members.

It was an eye-opener for many.

Part of the reporting documented the millions of dollars the AVMA acknowledged having received from pet food and pharmaceutical companies. It is unclear if this amount includes one-time donations for special projects and initiatives, and it almost certainly does not include free products, samples, rebates, discounts and free continuing education that private practitioners are offered throughout the year by industry representatives.

Like most of our colleagues, I have taken advantage of the perks and largesse of many food, equipment and drug companies. I have stood in line at conference exhibit halls for a free meal, and I have sat through a flea-and-tick presentation to get a stuffed animal, textbook or chance to win an iPod. I did this in the steadfast belief that I was incorruptible. No free meals or heartworm preventatives for staff or fine meals at nice restaurants to learn about new products could ever influence my judgment.

I have read the letters from AVMA President Dr. Ted Cohn in response to The Indianapolis Star and Reuters articles. They are well-written and appropriate for his role in the association. His comments and many subsequent comments by some veterinary colleagues expressing their outright indignation at having their integrity questioned leads me to posit the following:

These for-profit companies are not giving millions of dollars to veterinarians and the AVMA out of the goodness of their hearts. They must believe that they are influencing veterinarians’ decisions regarding their products.

There is a reason that financial transparency via the Sunshine Act was put in place for human physicians — the increasing evidence of conflicts of interest impacting doctors' medical decisions.

Most veterinarians are highly ethical people with excellent judgment. That said, cries of "not me" and "I would never compromise my morals" miss an important point. Most of the time when we are influenced by these companies’ efforts, it is not a straight quid pro quo.

It is admittedly hard to disprove insinuations of impropriety, and both of these articles took liberties with their conclusions regarding the integrity of our profession and its members. Nevertheless, the lack of clear-cut examples where AVMA leaders or individual AVMA members compromised their ethics in exchange for financial gain should not absolve us of the responsibility of considering this possibility. Numerous studies of the interactions between physicians and the medical/pharmaceutical industry have concluded that physician-industry interactions seem to affect both prescribing and professional behavior, even subconsiously. The lack of such studies investigating a link between practicing veterinarians’ behavior and attempts by the large corporate players to influence us should not exempt us from considering the more subtle forms of coercion that come from free food, free books or even free doughnuts brought to your practice.

Most practicing veterinarians are in business to make money. Even if money is not a primary motivator for our professional activities, we cannot rationalize our discomfort with the role of corporate money on the basis that we own the moral high ground when it comes to business decisions involving money. Much of what we do on a daily basis involves financial decisions that are in our best interests and improve our net worth. The key — and where Dr. Cohn let an opportunity pass — is to acknowledge the potentially insidious role that such money could have on the AVMA and its members.

The AVMA must at least acknowledge that they may be more beholden to these companies than they realize, and take more aggressive steps divulging this information and/or divesting themselves of some of this money so as not to undermine the public's trust and the trust of its members. More open and honest declarations of these relationships, well-articulated disclosure policies and avoidance of real or perceived conflicts of interest are all steps the AVMA should consider.

About the author: Dr. Gary Block is a 1991 graduate of Cornell University College of Veterinary Medicine and a diplomate of the American College of Veterinary Internal Medicine (small animal). In 1997, he obtained a master's degree from the Center for Animals and Public Policy at Tufts University, focusing on veterinary ethics. He is past president of the Rhode Island Veterinary Medical Association and the Society for Veterinary Medical Ethics. Dr. Block is co-owner of the Ocean State Veterinary Specialists, a 40-doctor referral and emergency clinic in East Greenwich, Rhode Island.

Drs. David Ramey, an author and equine veterinarian in Southern California, and Melissa Goodman, a practitioner in Philadelphia who's board qualified in the American College of Theriogenology, have signed in support of Dr. Block's perspective. 

VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.

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