Thursday, January 28, 2010

Conflict of Interest? What Conflict of Interest?

But your vet is not!

Christine Keith has written a very good piece on Conflicts of Interest in Veterinary Medicine (read the whole thing).

I have been talking about conflicts of interest in veterinary medicine for a while.

In a post from 2008, entitled Is Your Veterinarian Clean? Don't Count On It, for example, I note that vets are upcoding, prescribing medically unnecessary services, collecting kickbacks, and engaged in self-referral all the time.

In a post from 2007 entitled Veterinary Trades Say It's Time to Rip-off the Rubes, I note how publications like Veterinary Economics serve as a virtual cheering section for selling medically unnecessary services and bill-padding.

So why was I a bit amused by Christie's piece?

Two reasons.

The first is that the Veterinary Information Network (VIN) News Service initially decided it was going to gauge the depth of veterinary journal chicanery (i.e. "conflicts of interests in veterinary literature") by asking the veterinary journals whether they were (perhaps) a bit ethically challenged and compromised.


And while they are at it, they might ask the fox if it is stealing chickens, and what kind of shotgun the farmer should use to protect his chicken coop.

To his credit (as Christie notes), VIN co-founder and President Dr. Paul Pion comes out swinging and says that whatever the journals say is probably an understatement of the problem.

All good, but I suspect even he underestimates what is really going on in the field of veterinary medicine.

After all, Merck (the maker of the Merck Veterinary Manual, went so far as pay science publisher Elsevier --the publisher of Health News Daily, The Gray Sheet (coverage of the medical device industry), The Pink Sheet (coverage of the prescription drug industry) and The Green Sheet (a publication for pharmacists) -- to publish a fake peer-reviewed scientific journal called Australasian Journal of Bone and Joint Medicine.

You think Merck would not pay a veterinary publication for a product endorsement?

Surely you are joking? They would if they thought they could get away with it!

The drug companies already pay the American Veterinary Medical Association outright -- companies like Merial, Idexx, Hill's Pet Nutrition, and MWI Veterinary Supply. Drug, food and device companies underwrite Continuing Medical Education courses at which their drugs are plumped, and they sponsor booths at conventions.

This is all done above the table.

What is done below the table?

I have know no idea, but I can guess.

One clue is as current as this morning's breakfast cereal; it seems the AVMA, is so scared of the world finding out what they are doing when it comes to veterinary school accreditation, that they are threatening legal action against VIN because some "internal documents" may have fallen into a reporter's hands.

Hmmmmmm..... I really do wonder what they are so scared of? I cannot imagine. All we know for sure is that you can smell the stench of terror from more than 100 miles away.

Smoke does not necessarily mean fire, but it's the way they bet down at the firehouse.

So back to conflicts of interest.

How widespread is the presentation of marketing material as "science"?

In human medicine, the practice is so widespread that former New England Journal of Medicine editor Marcia Angell says "it is simply no longer possible to believe most of the clinical research that is published or to rely on the judgment of trusted physicians or authoritative medical guidelines."

You want some specific examples to brood over?

No problem. The Journal of Bioethical Inquiry recently published a paper entitled, "From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents" which offers a small window into the scene.

Do you think this kind of chicanery only happens in human drugs and human medicine?

If so, I have some swamp land to sell you.

You see, it's illegal for a doctor who accepts Medicare or Medicaid to take kickbacks.

It's illegal for a drug company or hospital to pay kickbacks for human business.

But you know what? It's not illegal for a veterinarian or a veterinary journal.



But in a self-policing industry, ethics does not really mean much, does it? To use a tired metaphor, the dog here does not bark, much less bite.

So why else was I amused by Christie's piece?

Well, it turns out she thinks the "seal of the prophet" on how the world slithers around like a snake is none other than Dan Rather.

As it turns out, Dan Rather Reports was in my office less than two weeks ago to interview me about how the U.S. health care system has been gimmicked by liars, cheat and thieves. Though the video is a bit long (24 minutes), it's up here for those who are interested.

And yes, Dan Rather is asking all the right questions! He always has.


Gina said...

"I suspect even [Dr. Pion] underestimates what is really going on in the field of veterinary medicine."

Knowing Paul as well as I do and for as long as I have, I would suspect that you are wrong. I suspect Christie would say the same. (She and I met when we were both working for VIN.) Dr. Pion is smart, tenacious and courageous as hell.

He also can be very hard to work for, which is why neither of us still do!

PBurns said...

Yes, you are probably right. After I wrote that, I read the stuff that the AVMA claims he has -- 3,000 pages of documents on what *might* be problems and conclict in veterinary school accreditation by the AVMA. Knowing what I know about how the payola and back-scratch train works at these academic accreditation places -- and assuming Dr. Pion actually has the papers in question -- I think he might be sitting at the head of the cyncis table by the time he reads through them all. Think I might be right ;)


aficat said...

"Know" idea, huh? :)

PBurns said...

A typo on my part, but I think I will leave it in ;)


Seahorse said...

Disturbing report re: health care fraud, but you got the last, and most cogent, word. It's all enough to make you a little unconscious!