The potential bias introduced into research, medical education, and individual clinician judgment by relationships with commercial entities is a perennial and serious issue in medicine, including the veterinary field. While critics of mainstream veterinary medicine frequently raise this issue when challenging the claims made for conventional diets, medications, and other healthcare interventions (e.g. 1, 2), alterative practitioners and organizations are no less involved with industry (e.g. 3). While financial bias is only one potential influence on the judgments and practices of veterinarians, and by no means the biggest problem we face, it is a source of bias that can be limited and monitored through transparency and rules concerning the kinds of interactions between veterinarians and industry.
The American Association of Veterinary Medical Colleges (AAVMC) has published a new set of guidelines addressing this issue specifically for veterinary schools, and it provides a sensible list of principles for minimizing the potential bias created by relations between industry and academia: Guiding Principles and Considerations: Ethical Interactions Between Schools/Colleges of Veterinary Medicine and External Entities. Though the document is not intended to be comprehensive, and AAVMC specifically recommends each institution develop their own rules appropriate to their unique circumstances, these guidelines identify many of the key areas in which inappropriate industry influence can arise, and they make reasonable suggestions for preventing this.
AAVMC begins with, “the expectation that educational, clinical, research and outreach programs will be based on the best, current and unbiased scientific knowledge. That information must be free of biases or inappropriate influences that may result from interactions with external entities, especially with companies that provide goods and services of value within veterinary medicine.” The same should, of course, be true for private practices. While it is clear that research and the development of new and better therapies cannot happen without the resources provided by commercial organizations, it is equally clear that it is all too easy for these organizations to inappropriately influence the content and outcome of research and the practice of individual veterinarians, and strict ethical guidelines are needed to control for this source of bias.
The document then details many of the ways in which industry can attempt to influence the veterinary profession through veterinary medical schools, including:
- Gifts of goods and service to students, faculty and staff.
- Gifts to individuals in the form of scholarships, research grants, and other forms of financial support.
- Gifts to the institutions themselves, in the form of money, products, services, land, etc.
- Remuneration for speaking, consulting, and other activities.
- Funding and organization by commercial entities of educational events.
One of the key principles identified in this document, and often not clearly understood, is that the size or specific nature of gifts from commercial organizations to individuals is not relevant to the potential for such gifts to introduce bias. It is not simply a case of crass, direct buying of influence. Sales representatives, who often genuinely believe in the products they are marketing, build relationships and trust and a sense of personal rapport, which subtly bias the decisions of their customers through a sense of personal obligation, through a greater awareness of the products one is most frequently reminded of, and other mechanisms not requiring any malfeasance on any individual’s part. Pens and coffee cups and pizzas are laughable as bribes, and most individual veterinarians are ethical and not likely to accept deliberate bribes anyway, yet the evidence from studies of physicians shows quite clearly that interactions involving even such trivial gifts do influence the behavior of recipients even when those recipients don’t believe it does.
The principles suggested by the AAVMC for minimizing the bias introduced by relationships between industry and academia are not very detailed, but they do touch on a couple of key elements in such an effort.
- Transparency and the disclosure of any and all relationships with commercial entities, regardless of how trivial or legitimate they may seem.
- Managing any and all gifts to the schools, financial or otherwise, centrally so that individual faculty, students, and staff are not directly receiving such gifts from commercial organizations.
Specific rules promulgated by individual schools will need to be considerably more specific. And in many cases, it seems to me that it would be appropriate to ban outright many of the gifts students and faculty receive from commercial entities, including food, medicine, sponsorship of events, and all the innumerable trinkets marketing departments devise. If industry wishes to contribute resources to the advancement of veterinary medicine, financial support filtered through the school administration, or better yet through independent non-profit organizations supporting research and education, would be more useful and ethically less problematic than these sorts of gifts.
What is more, similar ethics policies would be appropriate for private practices as well. I personally no longer attend continuing education dinners and other such events provided to our practice by vendors of veterinary products and services because I have come to believe the risks of such relationships outweigh the benefits, even though I personally have no influence on the product choices made by the management where I work. And while I cannot see how most clinical research could happen in veterinary medicine without industry funding, since government and private non-profit funds for small animal research are incredibly scarce, I would love to see industry support such research indirectly, through grants made to independent organizations which distributed such funds according to pre-defined and transparent criteria of scientific merit. This would allow industry to continue to support the development of needed therapies without such a risk of biasing the outcome of research studies. Such would be a truly philanthropic activity, rather than just a form of marketing.