Are a vet’s business ties any of your business?
By Gina Spadafori
November 20, 2007
In this morning’s Wall Street Journal, writer David Armstrong’s Health Journal article really caught my eye. It’s about an orthopedic surgeon (of the human variety) who discloses to his patients that he is one of the designers of the artificial shoulder he will use, and that he gets royalties from the manufacturer, with a catch:
As is standard, Dr. Zuckerman doesn’t collect any royalties on the shoulders he installs himself, but the surgeon nonetheless thought his patients should know of his financial relationship with the maker.
“There should be a discussion between physicians and patients about financial involvements,” says Dr. Zuckerman, chairman of orthopedic surgery at NYU Hospital for Joint Diseases. “As time goes on, patients will add this to the list of questions they have.”
Dr. Zuckerman is unusual. Many physicians don’t volunteer information about financial relationships that might bear on treatment decisions. At the same time, patients often find the discussion of a doctor’s financial connections to be awkward and one they are reluctant to initiate.
That’s slowly changing as more information becomes publicly available about payments doctors receive for everything from consulting for drug makers to speaking to other physicians about the merits of a company’s products. Two states — Minnesota and Vermont — have laws requiring pharmaceutical companies to report payments they make to doctors. A proposal in Congress, called the Physician Payments Sunshine Act of 2007, would require companies to publicly disclose any payments of more than $25 to doctors.
Here’s the rest, but of course unless you’re a WSJ subscriber you won’t be able to read it, sorry. (For anyone with access to the print edition, it’s at the bottom of page D1.)
Now, of course, I’m big on disclosure, and I hope this is a trend that grabs hold and becomes widespread not just in human medicine but also in all kinds of other businesses, including — duh — veterinarian medicine. In public relations, they tell clients not to get involved in anything that you wouldn’t want to see on the front page of a newspaper. (Or these days, I suppose, on the home page of a major media site.) If you’re open about what you’re doing, you have nothing to fear.
And of course, for some businesses, these financial ties DO impact the way they do business. That’s why sunshine is the best disinfectant. Open information is good for consumers.
While I don’t believe a financial tie will make any difference in the work of a true professional, I think I have a right to weigh the evidence myself and make those decisions about which businesses I choose to use.
WSJ link works fine for me. It might be something to do with adblock/noscript but the story does load.
I think we might just need someone with a sub to get the link, then people can get there though.
Comment by Michaelk — November 20, 2007 @ 1:00 pm
Human MDs have got *nothing* on the DVMs for financial entanglements.
The small animal nutrition textbook that I keep as a basic reference (and for its suitably gruesome photos and case studies of nutritional disease) is apparently provided FREE to the veterinary students for their class on the topic.
A few comments.
I know graduate school. I was friends with graduate school. And you, Senator, are no graduate-level text.
The tone of the chapter on home-made diets is over-the-top patronizing towards the hysterical pet-mommies who just feel better cooking for their wookums even though they will surely kill them with all that unbalanced people food. Because a mere human who does not wear a lab coat on the teevee commercial cannot possibly feed a dog.
I cannot actually establish a cover price for this book. I got mine for about $30 at Half Price Books; they stated the list price at $120. I’ve seen it on Bookfinder for over $200 and under $20. Who can say?
Who provides this boon of indeterminate value to the fresh-faced gonnabe vets?
Why, the HILL’S CORPORATION, natch.
On our last extended SAR incident, someone from the Red Cross noticed that the dogs were sharing their handlers’ meals. (We had plenty of food for them — they just like what we were eating better, and there was always a lot left over.) So he thoughtfully ran out and bought a bag of kibble for all the SAR dogs, and even portioned half of it into baggies for carrying on tasks. I can see his thought process right now: “The SAR dogs are working hard, they need the *best* food out there, so I will buy the *most expensive* thing I can find.” The most expensive thing was a Hill’s product that is supposed to be for “performance.”
They made me take this home at the successful termination of the search, as I had rescue duties and was the last handler to leave. The first three ingredients are different forms of corn. The fourth is meat byproduct meal. It does not improve from there.
I never heard *any* pet nutrition expert advise that owners look for lots of cornmeal and the lowest-grade animal ingredient possible when selecting a feed.
Yet this is the brand of food that virtually every vet in the US sells and “recommends.”
Could that have anything at all to do with a financial entanglement that starts in veterinary school and continues unabated?
Comment by Heather Houlahan — November 21, 2007 @ 12:45 am
If you want to find the most polished and sexy women in industry, don’t look at clubs or even for models on runways, they are to be found in the drug rep business.
Not only are they beautiful, but they are well spoken and expertly trained selling machines. And they are hard working women. I can’t recall a single appointment I had with my Grandmother as one of her caretakers in the last years of her life that didn’t involve one, if not more, of these women (and one man, and yes, he was for a female doctor) coming and going.
Not only did these people all know the names of all the nurses and receptionists, they also got preferential treatment (we were bumped several times, waiting for a drug rep to finish her sales pitch with the Doctor) and had access to the office drug supply “I’ll just put this week’s samples in the fridge, I know where it is.”
In the smaller offices, it was easy to overhear the sales pitch with “informational meetings” in places that have either “palm,” “beach,” or “island” in the name.
You can almost hear the doctors saying,
“You know, I could really use some more information on the me-too drug you’re selling because the optical isomer version is just off patent or gone generic. I’ve only been prescribing the old one for 25 years, but of course I’ll attend your golf course getaway meeting to learn all about it. And in thanks, I’ll prescribe the new stuff, especially to all my government patients who have Uncle Sam pick up the bill for all of it.”
But perhaps my youth and testosterone have clouded my judgment of these ladies, or perhaps it’s my perfect record of failure trying to ask them out. It’s hard to win when they are better salesmen than you are and hang around Doctors all day. But these sales men and women ARE evil.
Legal drugs are not a free market. You need a prescription, and there’s the rub. The hot young salespeople are the tool used by Big Pharma to circumvent the efficiencies of free markets. What you don’t know will cost you, might hurt you, and will make them a lot more profit.
If you, like me, are tired of paying for some Doctor’s condo in Maui, or at least being the idiots who pay a premium for our Rxs that fund “informational meetings” at the beach, then yes, it’s time we ask about the generics, about who is paying for what and if those free samples are really free.
I disagree with the previous comment that Human MDs aren’t in as deep as vets. My age group is now in Med School and Dentistry School and Vet School… and I have gotten plenty of swag (really expensive sonic toothbrushes, emergency kits, branded backpacks and scrubs, etc) as gifts along with the remarks “I get so much of this crap, I have to give it away” from my friends now enrolled.
Human MDs are in just as deep and are seduced just as early.
Comment by Christopher — November 21, 2007 @ 3:38 am
I guess for me, then, the question would be: Are professionals morally obligated to disclose? Or should they be legally obligated to disclose?
Comment by Gina Spadafori — November 21, 2007 @ 7:47 am
Comment by Heather Houlahan — November 21, 2007 @ 12:45 am
“The small animal nutrition textbook that I keep as a basic reference (and for its suitably gruesome photos and case studies of nutritional disease) is apparently provided FREE to the veterinary students for their class on the topic.”
Did you notice the use of the singular here rather than the plural? It’s *one* class on nutrition. One. And it’s more in the nature of a seminar put on by - you guessed it - Hill’s. This is a nifty little niche Hill’s has carved out for themselves in pretty much all the vet schools in the USA.
On another board I used to frequent, there was a gal just entering vet school, and she asked the posters on the board what it was that they wished their vets had spent more time on while they were in school. I immediately posted about this little scheme of Hill’s and the fact that I wished there was more (and more balanced) nutritional training available as part of the normal coursework (and guess what folks - this was BEFORE the rolling recalls - I’ve been aware of this little Hill’s monopoly for well over 20 years now, so you can just BET they’re well entrenched).
She expressed some surprise as she had assumed that nutritional coursework would be part of her training, but after my post, she took a closer look at what her course loads would include for the next few years, and was quite surprised to find that I was right - that unless she sought out specialized training as a veterinary nutritionist, that there was essentially NO coursework being offered as a part of her normal curriculum other than the “nutritional seminars” (including the “free textbook”) offered by Hills.
During the rolling recalls, I sent regular updates to another vet student I know (who was working part-time in the company where I work) and she admitted that she was somewhat conflicted in how to respond. Why? Because she was part of a program - sponsored by Hills - where she distributed Hill’s information and coordinated some of these seminars. In return, she was receiving some scholarship assistance, and as she admitted to me - the money was important to her, and she was inclined to believe the reassurances Hill’s was giving to her that they were not impacted by what was going on (as well as another line they were putting out about how inconclusive the science was on what was actually causing the reported illnesses and deaths).
I was careful in how I talked with her about this as I sensed her defensiveness, but she was definitely shaken when the day came that Hill’s also found themselves on the recall list. She still wasn’t ready to foreswear the financial assistance she was getting from them, and I told her I understood that. What she promised me was that she’d be proactive in seeking out additional sources of information on veterinary nutrition as she moved forward in her career, and agreed she would treat vested-interest information (such as that which she was “peddling” from Hill’s) with a healthy dose of skepticism from that point forward.
Currently I’m dealing with an episode of FIC (Feline Ideopathic Cystitis) in my cat. When I took her in for her exam, I brought information on the food she is eating (I haven’t got her on homemade - yet - but I DID switch her to a food sold by a small niche manufacturer whose owner personally assured me that he periodically does online checks at the manufacturing site and who requires written pre-approval before ANY ingredient changes, substitutions, or changes in supplier). My vet - who’s a good guy - took a look over the information on this food and then said “Well, I’m not a veterinary nutritionist and it’s hard to tell a lot from the way foods are labelled, but it looks pretty good to me”. And that was the extent of the professional expertise he was equipped to offer. I don’t fault for this - how can I blame him for not being trained in an area that even his own vet school didn’t feel was important enough to offer coursework in? But it was a renewed reminder of what I already knew - vets are NOT routinely provided with coursework on nutrition unless they decide to extend their own education and specialize. Aside from that, all they get is what was provided by Hill’s.
And like the two vet students I mentioned, most of them never even stop to consider the “vested interest” slant on that information until and unless it’s pointed out to them. Perhaps many of them are starting to realize and consider that now. We can only hope . . . . . . . . . .
Comment by The OTHER Pat — November 21, 2007 @ 9:21 am
I can only speak for one vet school, but here’s my experience:
-we take a principles of nutrition course first year, which includes learning the basics of both small and large animal nutrition. It’s a short class, only one credit, but for comparison sake our genetics course is one credit as well, while courses like anatomy and physiology are five credits.
-people who track large animal go on to take a large animal nutrition course third year, while those who track small take a small animal clinical nutrition course. That one is 2.5 credits.
-we have the option of taking a nutrition rotation at four years.
-all of our classes are taught by PhDs or clinicians in the teaching hospital, including nutrition.
-it’s easy to miss that we cover a lot related to nutrition in other courses (i.e. nutrient storage and mobilization in biochem, digestive physiology in phys, nutritional deficiency or toxicity related diseases in pathology, etc).
-yes, Hills gave us Small Animal Clinical Nutrition.
— there are five or six feeding programs through which vet students can get free or cheap food- Hills, Iams, Purina, Natura, Oxbow Hay, Harrison’s Bird Food, and possibly some horse companies (I don’t have horses so I don’t keep track of those).
Schools, and the vet profession in general, are slowly waking up to the importance of nutrition, but even human medicine lags behind in this arena. But I wouldn’t fault schools for not providing specialized training in nutrition, as we don’t get specialized training in *anything*. We are meant to come out as general practitioners. I need to know just as much about cat and dog food as I do about formulating a cattle ration. Once you have your DVM, you can go on to an internship or residency that allows you specialized training, but before that, we all have to pass the same board exam. I want to practice on rabbits, but will only get one (elective) course on non-traditional pets. It’s going to up to me to take continuing education classes, study on my own time, or do a residency in exotic species to get the specialized knowledge that I want.
As for making business ties known- absolutely. Transparency indicates trust. Like researchers who should disclose where their funding is coming from because that will determine how valid I find their results to be, clinicians should disclose if they’re getting money from a product they’re recommending as it will influence my opinion of their recommendation. And hey, if they disclose that information to me, I’m way more likely to trust them than if they hid it and I found out some other way.
Comment by Megan — November 21, 2007 @ 12:02 pm
Huh, I dunno why that one line ended up crossed out… it shouldn’t be!
Comment by Megan — November 21, 2007 @ 12:03 pm
I couldn’t see why it was doing that, but I was able to fix it anyway. :)
Comment by Gina Spadafori — November 21, 2007 @ 12:11 pm