A stroll in the park.

CONFLICTS OF INTEREST 

IN 

VETERINARY MEDICINE

Every profession has the potential for its members to be, or perceived to be, in a conflict of interest and prone to put their own interests ahead of those of their clients or the system they serve. Some lawyers tip the balance in their own favour when billing for hours worked; some dentists recommend procedures that more likely pad their own bank accounts, rather than benefitting their patients and some doctors can misuse a healthcare's billing system to their own advantage. Every professional has this type of temptation. I would suggest therefore that the veterinary profession is no worse and no better than other professions when it comes to dealing with conflicts of interest in its industry. What are some of the conflicts of interest that might exist then in the veterinary world?

 

Industry influence in veterinary research.

 

The areas where conflicts of interest might arise in the veterinary profession are widespread.  One of the areas that has received attention over the years is the pharmaceutical industry's influence on clinical trials and how those trial results are reported in veterinary journals. An article in VIN discusses this topic and correspondence in the Canadian Veterinary Journal looks at the different issue of marketing of medications to the veterinary industry by big Pharma.

Industry Influence at Academic Centres

There have been many allegations over the years of industry influencing various curriculums at North American Veterinary schools and also the academics that teach them. Those allegations have been levelled at the Pet Food industry in particular and a recent article focuses its concerns on three US universities. It makes for interesting reading.

Laboratory Contracts:

Veterinarians in private practice frequently sign longterm contracts with laboratory providers for the blood work or other diagnostic tests that they order for their clients. Some of these contracts contain clauses obligating the practice to perform a certain number of tests per month or per year. In return for performing these obligated number of tests or procedures, the veterinary practice may receive price discounts for the tests they order or alternatively they may receive free or discounted equipment, as a sweetener for signing the contract. To any outsider this would appear to be a blatant conflict of interest as contracts, containing those incentives, raise the question as to whether some of the tests ordered are being requested to fulfill contract requirements, as opposed to being truly necessary for patient care.  

Medications:

 

As discussed earlier, medications dispensed at veterinary clinics are generally far more expensive than if dispensed, by way of a prescription, at a human pharmacy. If veterinarians are failing to offer pet owners a prescription, as opposed to just dispensing the medications at their clinics, then this is an obvious conflict of interest, especially if owners are not even aware of the option of obtaining a prescription. A few years back, a Reuters report documented the misuse of antibiotics in the livestock industry. It also revealed the relationships between the pharmaceutical industry and veterinarians and the conflicts of interest that those relationships created. 

 

 

Production based pay:

Production or commission based pay is common in the veterinary industry, with about seventy five percent of veterinarians in the USA receiving some form of it. Increasing numbers of veterinarians are voicing concerns about this method of payment because of the effect it is having on their work environment, as it tends to promote an "every man for himself" attitude rather than collegial team work, which promotes better patient care. It also creates a potential conflict of interest if veterinarians have an incentive to generate more tests and procedures, especially higher paying ones, from which they may benefit financially. 

 

Duty to whom?

 

Veterinarians often have to balance the obligations they owe to the animals they are seeing  and their obligation to owners. Sometimes these obligations are in conflict, such as may occur in the horse racing industry. Ultimately doing what is best for an animal may reduce a veterinarian's income. This is because doing expensive invasive procedures is not always in the "best" interest of a particular animal at any given time. This principle applies also to the widespread use of vaccinations in companion animal practice. According to both the CVMA and the ABVMA, core vaccinations for companion animals are needed at the most every three years after their initial course has been completed. This still doesn't stop veterinarians from recommending annual core vaccinations for adult dogs. One has to wonder why veterinarians continue to do this in private practice.

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