The American Veterinary Medical Association (AVMA) functions mostly as a lobby and PR organization for veterinarians. It is a membership organization and, as such, is beholden to whoever its members are, and the organization is very keen to avoid conflict within the profession or any suggestion of forcing vets to do anything in particular. The wild political drama surrounding a simple resolution in the AVMA House of Delegates to acknowledge the demonstrable uselessness of homeopathy demonstrates this quite starkly.
The AVMA does make some attempts to promote standards “within the family,” generally in the form of non-binding position statements. These are often pretty lukewarm compromises between competing interests, but they have some utility. The AVMA also has a Principles of Veterinary Medical Ethics, and the organization is currently asking for comments from members on a proposed Code of Conduct based on these principles.
This document does offer some acknowledgement of the importance of evidence-based medicine for ethical clinical practice, and it seems possible that this could be strengthened somewhat, though I am not extremely optimistic. Nevertheless, I encourage any readers who are AVMA members to participate in this comment period, and anyone else to consider encouraging any members you know to do so.
Here is the draft code of conduct.
The commenting period will close at 11:59 p.m. Central Time on March 4, 2024.
Here are the comments I made
Section B
subsection 1
paragraph d
“A veterinarian does not have an ethical obligation to deliver care requested by a client that they believe would cause unnecessary pain and suffering for the patient and that is unlikely to be beneficial.”
A veterinarian has an ethical obligation to prioritize offering evidence-based care that is most likely to be beneficial and that maximizes the ratio of likely benefit to potential harms.
Recommendation:
I recommend adding the language in bold to this section.
Rationale:
The purpose of a code of conduct is to articulate “specific types of behaviors that are either expected or required of members of the veterinary profession,” not merely those behaviors that are not expected. This section indirectly indicates that veterinarians should prioritize care that is likely to be beneficial or with likely benefits that outweigh potential harms, yet it does not clearly articulate a positive expectation for the corresponding behavior. The section should indicate that the ethical behavior is to prioritize and offer only care which is expected to have benefits greater than its risks.
Section B
subsection 2
Evidence?based Medicine
“A veterinarian should prioritize the delivery of evidence?based medicine and should inform the client when a therapy does not meet this standard.”
A veterinarian should eschew practices that do not meet a reasonable standard of evidence for safety and efficacy.
Recommendation:
I recommend adding the language in bold to this section.
Rationale:
The guidelines recognize that there is an ethical obligation to “prioritize evidence-based care” because this is the type of car most likely to benefit patients. If this is true, it is not sufficient to simply inform clients when we are offering care that does not meet this standard and then offer care that is not evidence-based or not likely to be safe and effective anyway. Veterinarians should be expected to eschew practices that are unlikely to have benefits greater than their risks based on a reasonable standard of evidence.
Dr. Arthur Malernee
@artmalernee
does the ama code say anything about evidence based medicine
Grok
@grok
The AMA Code of Medical Ethics does indeed mention evidence-based medicine. The Code emphasizes the importance of evidence-based practice and the responsibility of physicians to provide care based on the best available evidence. In fact, one of the fundamental principles of the Code is to “promote the health of the patient” and to “base recommendations on the best available scientific evidence.” This means that physicians are expected to stay up-to-date with the latest research and to use this knowledge to inform their clinical practice.
Not to disagree with Grok, but I can’t find the actual phrase “evidence-based medicine” in the AMA Ethics documents. There are a few references to “scientific evidence,” but they don’t seem much stronger than the language I the AVMA document.
Gork does make stuff up but usually gives references that i may have edited out. “Stronger language” I agree by the AVMA and AMA should help to move health care along. What these professional organizations really need to do is not just preach EBM but practice it by removing their paywalls, open source their journals and the letters to the editor so the chatboxes can go through them and report back.
Dr. Arthur Malernee
@artmalernee
can you give me references for policy statements of the ama about EBM
Grok
@grok
Sure, I can provide you with some references for policy statements of the American Medical Association (AMA) on Evidence-Based Medicine (EBM).
“AMA Policy: Evidence-Based Medicine” – This policy statement outlines the AMA’s support for evidence-based medicine and its role in improving patient care.
“AMA Principles of Medical Ethics: I, A General Principles” – This section of the AMA’s Code of Medical Ethics discusses the importance of evidence-based medicine in the practice of medicine.
“AMA Policy: Clinical Practice Guidelines” – This policy statement discusses the development and use of clinical practice guidelines, which are based on evidence-based medicine principles.
“AMA Policy: Health Information Technology” – This policy statement discusses the role of health information technology in supporting evidence-based medicine and improving patient care.
“AMA Policy: Patient Safety and Quality Improvement” – This policy statement discusses the role of evidence-based medicine in improving patient safety and quality of care.
These policy statements can be found on the AMA website at http://www.ama-assn.org (http://www.ama-assn.org).