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Conflicts of interest in veterinary medicine
By Christie Keith
January 28, 2010
I sat down to read Jennifer Fiala’s Veterinary Information Network News Service article on conflicts of interest in veterinary medicine last night. It’s a subject in which I’m very interested, and I was a little disappointed at first, when the piece seemed to be veering towards a justification for vet med’s even-worse-than-human-medicine attitude towards this prickly subject:
To determine what role, if any, potential conflicts of interest play in veterinary literature, the VNS recently contacted a handful of veterinary medical publications.
All the veterinary journal editors reached by the VNS said that they were aware of … the growing awareness of the conflicts problem in human medicine. They noted that there is no similar effort underway for veterinary journals.
Nor is there as much of a need, the majority of the editors stated.
Why? Because the large, Big Pharma-sponsored clinical trials that populate human medicine are uncommon in veterinary medicine, they said. In fact, most veterinary-related studies are funded by government entities like the National Institutes of Health, various foundations or not at all. Even when funding comes from grants or industry, the trials tend to be small with less at stake, they added.
What’s more, it is much harder to hide conflicts of interest in veterinary medicine than in human medicine, noted Dr. Kurt J. Matushek, JAVMA’s editor-in-chief. Considering the veterinary research community is relatively small, reviewers are usually familiar with authors and their clinics or laboratories.
“It can be self-policing, up to a point,” he said.
Same old, same old… right?
Wrong. Because, yet again, VIN co-founder and president Dr. Paul Pion cuts through the crap and points out that conflicts of interest are far more pernicious than such an analysis allows:
Dr. Paul Pion, a boarded cardiologist, published author and president of VIN (the parent company of VNS), said it is a “crock” to suggest that veterinary research is devoid of potential conflicts. The question, he said, “is not the size or nature of what triggers the potential conflict. What matters is that it exists at all. If there is a potential conflict, it must be disclosed explicitly, no exceptions.”
[....]
Pion continued: “We all believe we are immune from influence. Well, we are not. We are human. We all want to ‘do right’ by those who are nice to us. So, it is up to the profession and especially the journals to do more to help authors recognize potential conflicts of interest to protect authors from criticism for not revealing what others might consider potential conflicts of interest.”
[....]
“We are all human; most of us are honorable and nice people,” Pion explained. “But I also believe that we are all influenced by that mutual niceness and desire to find positive results (investigator bias) that can lead to the subconscious desire to not publish a bad outcome about a drug that we believe works and is produced by a company that has been good to us. This creates a very dangerous situation where we think we are immune from this form of potential conflict of interest and bias. The fact that our colleagues checked ‘none’ when asked about potential conflicts demonstrates that they don’t recognize the potential for a conflict of interest inherent in this type of gift from the maker of the drug under study.”
[....]
Pion believes that, in general, veterinary medical journals are too cavalier about potential conflict reporting statements. He does not buy the argument that there is not enough money in veterinary research to bias scientists. “We’re not talking intentional cheating or fraud. We’re talking about investigator bias that we all need to work hard to defend against for ourselves and each other.
“We can’t pretend it isn’t a factor” he added. “It doesn’t really matter whether the funding or donation was $5 or $1 million. What matters is how receiving a gift affects us. We are all full of potential conflicts, and we owe it to the profession to acknowledge that fact.”
This is a problem for journalists, too. When Dan Rather gave the keynote address at the South by Southwest conference in Austin in 2007, he talked about the fact that just knowing the name of the grandchild of someone in government can be enough to color our coverage of that person.
It’s very true. It’s extremely hard to be as tough on someone you’ve met and come to see as a person with feelings and a family as on a stranger. I’m not talking about going all tabloid and paparazzi on them; I’m saying that it’s only human nature to want to soften the way you present something to avoid causing someone pain.
That’s why when vets gasp in outrage when I ask them about their conflicts of interest, as if I’m suggesting they’re taking money to lie about drug studies, I get incredibly frustrated. Dr. Pion absolutely nailed it: the conflict might be about money, but it doesn’t have to be. It’s about the effect of a relationship — even just a simple human connection — on the work.
Read the rest of Fiala’s terrific, lengthy piece here.
And by the way, Dr. Pion; I just put you in the company of Dan Rather. It doesn’t get a whole heck of a lot better than that with me.
Photo of Dan Rather at SXSW 2007 by Clint Gilders.
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It’s not just meds & pharma. Look around your vets office. Bet it’s full of Science Diet dog food. What’s the payoff & what’s the cost.
I love my vet. He takes better care of my dogs than my doctor takes of me. But. I am very disturbed by the relationship between his office and SD and any number of producers of pharmacuticals.
Comment by schnauzer — January 28, 2010 @ 6:09 pm
I’ll tell you, vets make very little selling pet food. I honestly believe the conflict there is far more of the kind Dr. Pion mentioned, that Hills teaches their vet school classes, has its name on their books, and donates food to vet students and vet hospitals, thus making vets feel as if they’re part of their community and thus, being better disposed to Hills than to the other manufacturers of “prescription” diets (which, btw, don’t exist. Many vets feel loyalty to Hills.
Comment by Christie Keith — January 28, 2010 @ 6:59 pm
But to me, it’s not about what the vet makes selling pet food. Or meds, or…
It’s about what the pet food maker makes on their cozy relationship with vets. Of course the vets feel loyal to SD and it causes them to push SD food regaurdless of it being in the patients best interest. My vet, a self professed “old guy” admits he know next to nothing about canine nutrition, and even less about feline nutrition. It’s easy to “just trust” SD. I don’t believe Dr. T. is getting rich selling SD, or any of the meds he carries. But I do believe SD and Pfizer are getting rich because they are cozy with lots of vets.
As for prescrition diets that only Science Diet produces yeah. So? If those were the only foods the vet carried I might not be so irked, but when I took my new puppy for his first checkup the office staff was shocked when I told them thanks but no to the SD Puppy pack. Plenty of good choices for a healthy puppy don’t need this stuff shoved down the babies throat.
When my corgi need to loose weight I asked for suggestions, “just use the RD.” “What about such or such.” “Well RD is great…”
Comment by schnauzer — January 28, 2010 @ 7:18 pm
1. Well, read my book, MARK OF THE BEAST HIDDEN IN PLAIN SIGHT available on Amazon.com and I explain a lot of the conflict of medicine both human and veterinary. This problem is VERY HUGE, why do you think our animals are so ridden with dis ease in the first place? Almost all of the cases we treat are actually internal medicine cases that exist due to the fact they are vaccine induced! Nothing in veterinary medicine is more conflict ridden then the fact that vaccines, the gold standard of western medicine is actually the best job security program going. Medicine in humans and animals is nothing but conflict! Just go to a National Veterinary Conference and you will see, the veterinarians hardly ever think for themselves, most vaccination protocols are based on conflict information from the drug companies, dinners of disinformation are put together where vets gets free food and liquor and hear about a drug companies products. Many of the drugs are unsuccessful trying to get to the human market and then pawned off into the veterinary one. Nutrition which is the foundation of health is not taught in our veterinary schools except my Hills….this is CONFLICT. Vaccines and drugs are so conflicted and yet they even grant CE hours to vets for listening to conflict and marketing from drug companies. I heard at a conference recently the push to sell the idiotic Canine Influenza vaccine, of course that lecture was sponsored by Pfizer…..NO CONFLICT THERE? Lepto vaccines are dangerous and incapable of protecting the dogs from the disease or man from the zoonotic transfer and yet hand in hand there are the vets marketing this danger alongside with Pfizer and Intervet. Lyme vaccines, the same they will actually deliver the pathology tot he dog and are not successful at protection, yet they generate income for the drug company and for the vet, so much vaccine induced disease. Rimadyl, the truth is that product is incapable of doing what most of the vets prescribe it for and despite the facts written up in human journals, this Pfizer product continues to be pawned off in the veterinary clients. Fort Dodge, the most adverse effects on the market from their vaccines but as the cheapest, this is what most “business vets” jab your dogs with. Fraudulent and conflicted research is the UNDERPINNING of veterinary medicine. Our professors in school do get funding from drug companies and if they don’t push the spin of the drug company….they don’t get money to do research. Drug companies control the outcomes and if derogatory outcome results, the results are never even published. Industry hires off the successful researchers as they did with Dr. Larry Glickman who made the case in private financing of the fact vaccines are the origin of autoimmune disease and immune mediated diseases. We are so…..conflicted in veterinary medicine, the Advanstar free mags that go out to all parts of the veterinary staff have the mantra on their home page that they “have the entire animal health team trapped” for their clients whom “sponsor” the publications through their advertising. I was working for a time for VCA who hired me under the guise that they would not dictate medicine to me…..well that was only in speech. The fact is that they dictated and harassed me immediately for prescribing Interceptor instead of Heartguard. Heartguard was the less superior product and left my patients unprotected from he frequent whip worm infections that we saw. But VCA wanted Heartguard sold as Merial the parent company “sponsored” the Healthy Pet magazine that VCA clients were sent for free. MAKE NO MISTAKE……Veterinary medicine is full of corporate whores the disease is everywhere and we are no better than the “other family doctor”, I feel that we are worse….because the push for western medicine is a push for the same snake oil salesman and quacks that permeate human medicine. Even the research published, they will say no conflicts and the way the material is published, I see immediately there is no longer much honor to be found in either of the two branches of medicine….medisin.
Comment by Dr. Jordan — January 29, 2010 @ 7:31 am
Comment by Dr. Jordan — January 29, 2010 @ 7:37 am
I think Science Diet has earned its keep in vet office’s premium shelves. Christie, is it just in my neck of the woods or doesn’t Science Diet give free started bags of food to newly adopted animals from shelters and they also heavily discount food for the pets still at the shelters?
Note: I am not biased to Science Diet just because I am a Humane Society volunteer. Personally, I use Purina One for my 8 cats and 4 dogs. Why? convenience and cost.
Comment by ericka — February 2, 2010 @ 12:37 pm
Seems like an easy fix to me, but I am sorta simpleminded.
If you publish, list your backers. Readers can see if you have any associations that would possibly nudge your moral compass one way or t’other.
Personally, when I read a journal article, or help students read them, I look at who the authors are, where they are coming form. I look at most skeptically anyway, so I am starting from a position of ‘convince me what you are saying is valid’.
I think seeing a vast conspiracy is overstating the fact a bit. People are easily swayed, but they need to weight the evidence and think critically. Most vets are not dishonest. They don’t get up every morning, rub their hand together and think of ways to defrock people or keep animals sick.
Comment by Dr. Tony Johnson — February 2, 2010 @ 1:07 pm
Ericka, you’d be hard-pressed to find a dog food manufacturer that does not have a program for shelters.
They also have programs for breeders, and some of them for pet stores that sell puppies. And puppy-packet programs for vet hospitals.
It’s called marketing.
(Except for the small manufacturer of ultra-premium kibble that donated a tractor-trailer load of great feed for our Montana puppymill rescue and asked not to be identified. That’s not marketing, that’s charity.)
It doesn’t get anyone off the hook for the quality of their products or the rest of their business practices.
I look at the label on a bag of Science Diet, cringe, and think “There is a place in this world for really cheap dog food, so that people on a tight budget can feed their dogs. But why should any consumer pay $50 for something that is just as cheaply produced as the $15 Old Roy?”
Seriously, here’s the start of the ingredient list for Science Diet:
Ground whole grain corn, ground whole grain sorghum, ground whole grain wheat, chicken by-product meal, soybean meal, animal fat, corn gluten meal, brewers rice
Will it keep a dog alive? Apparently. People can eat off the dollar menue at the drive-through and survive, too.
Is there any way to justify it costing a dollar a pound? Feed corn is about twelve cents a pound retail.
And don’t even get me started on their “prescription diets.”
Comment by H. Houlahan — February 2, 2010 @ 1:21 pm
H. Houlahan- Science Diet had the wool over my eyes. Ugh, and I thought they were so nice. duh.
BTW,I just watched Food Inc. movie last night.
Well, after reading the list of ingredients you just wrote about for Science Diet food…and joining this with the horrible corn information I learned about during the film Food Inc. I am now p.o.’ed.
Corn is fed to cows, so we eat corn meat basically. Not cows eating grass and other nutrients meat. Corn meat.
Corn companies genetically modify corn (which I first thought was cool as I am a Molecular Biology major)then the companies patent it -corn!- and put farmers who want to use organic natural corn out of business.
Corn is used as a filler in so much food.
Basically we eat corn, our dogs and cats eat corn.
Dogs descended from Wolves, right? Wolves didn’t go to a corn field and say, “Yum!, Corn!”, did they?
Thanks for opening my eyes. Going now on Google to look for coupons for better pet food with meat as first ingredient.
-Ericka
Comment by ericka — February 3, 2010 @ 10:04 am
Dr. Jordan
You sound like a person who puts no stock in scientific literature. For someone who is so obviously pushing alternative forms of “medicine” to use the term “snake-oil salesmen” is fairly rich. The fact is that vaccines save lives, in both human and veterinary medicine. I am disappointed in the school that gave you a DVM while you still hold these ridiculous idead about vaccines. My grandmother spend the majority of her life in a wheelchair after being infected with polio. Did she need acupuncture? Did she need heavy metals or any other crazy non-evidence-based medicine? NO, she needed a vaccine. As did millions of children who had to live their lives in iron lungs. And many more who died of smallpox. Please use your head before you speak as a representative of the veterinary profession. We are a profession of scientists and our advice must be centered on evidence, not gut feelings.
Comment by Michelle Clayton — March 7, 2011 @ 10:24 am
I’m not sure why everyone commenting on this post is harping on Hill’s. Firstly, it is a good quality pet food backed by good and sound feeding trials. Secondly, as a veterinary student I can tell you that “Hill’s” does not come here to teach us nutrition. The Mark Morris Institite takes part in our learning about nutrition. Although the MMI may have been started by the founder of Hill’s, they in NO way tell us how great or bad one brand is over another. It is about the ingredients included in pet diets, how to read labels, what the information on the packaging means, etc. We are exposed to a number of different brands and one is not touted over another.
Comment by Laura — March 9, 2011 @ 6:51 pm
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 profeessional 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 (popmedcurmudgeon@gmail.com).
Comment by Dale Hancock — April 30, 2011 @ 10:41 pm
The first time I heard that courses on animal nutrition in veterinary medicine teaching colleges were being taught by pet food companies (Hill’s in particular) rather than by college faculty was in the 80s, so this has been going on for a long, long time.
I think that what I found even more shocking than the fact that pet food company was teaching (and influencing) our future vets about how to feed our animals was the fact that the colleges were not taking that role on THEMSELVES. There WERE no courses on small animal nutrition even being offered. Hill’s saw the void and stepped in to fill it.
Dr. Hancock, do you have any thoughts on what accounted for this kind of an abdication of responsibility by the veterinary teaching community - one that has been in place for so many years now as to be pretty well institutionalized? (as is evidenced by the reference to Hills’ “Mark Morris Institute” in the post immediately preceding yours).
Comment by The OTHER Pat — May 1, 2011 @ 11:47 am
For folks reading this who perhaps remain unaware of the Infludence of Hill’s Science Diet company’s influence on the way many of our animals are fed, here’s more on the “Mark Morris Institute” - responsible for teaching veterinary college courses on animal nutrition to probably pretty much every veterinarian you’ve ever met:
From http://www.markmorrisinstitute.org/faculty.html
“Faculty
The individuals providing this professional education program are the equivalent of an academic faculty of clinical nutrition. MMI faculty are involved in veterinary nutrition health studies, clinical service, publication, education, and continuing education.”
You will find the following:
Debbie Davenport DVM, MS, DACVIM . . . . She is currently the Director of Professional Education at Hill’s Pet Nutrition and the Executive Director of the Mark Morris Institute.
S. Dru Forrester DVM, MS, DACVIM . . . . She joined Hill’s Pet Nutrition in 2005 in the Department of Scientific Affairs and is a Mark Morris Institute Fellow.
David Hammond DVM, MS, DACVIM . . . . Dr. Hammond was a faculty member at the University of Pennsylvania before joining Hill’s Pet Nutrition as a Veterinary Affairs Manager.
Michael S. Hand DVM, PhD, DACVN . . . . He was the Vice President of Research at Hill’s Pet Nutrition Center until his retirement in 2000 . . . . He is a co-author of the textbook, Small Animal Clinical Nutrition III and editor of Small Animal Clinical Nutrition, 5th Edition.
Claudia Kirk DVM, PhD, DACVIM, DACVN . . . . . Dr. Kirk joined Hill’s Pet Nutrition as a Veterinary Clinical Nutritionist in 1994.
Comment by The OTHER Pat — May 1, 2011 @ 12:11 pm
Thanks T.O.P.
I worry that a veterinary student, who has presumably had four years in the natural sciences at the university level before admission, is so fatuous that she defends the Hills’ propagandizing with what sounds to me like a quote from the first lecture.
I guess there’s no time between orgo and cell biology to teach some critical thinking.
I can’t conceptualize a curriculum on reading pet food labels and evaluating ingredients that would not send Hills products to the bottom of the heap, among offerings that cost less than one quarter the inflated sticker price. Mad Science Diet, Dad’s Econ-o-mets, Ol’ Roy, etc.
Unless, that is, the information presented was complete self-serving “better living through chemistry” BS.
I’d be interested in vet student Laura sharing with us some brand names for “good” pet food and “bad” pet food based on what she’s learned in class.
Or is the lesson that they are all the same, and all “good?”
Comment by H. Houlahan — May 1, 2011 @ 2:18 pm