In the USA, in 2016, a new USFDA policy will ensure that veterinarians play a key role with respect to the use of antibiotics by farmers. Whereas people doctors prescribe antibiotics, in the farming industry and in food companies they can buy very similar antibiotic drugs over the counter and add them to feed. This, arguably, has led to an overuse of antibiotics which has resulted in a surge in antibiotic-resistant superbugs.
On the face of it, the new policy should be welcome because it places the veterinarian in the role of gatekeeper to the purchasing and use of antibiotics.
However, there are neither laws no regulations which require veterinarians in the USA to disclose any financial connection that they might have with drug companies. It doesn’t matter how much they receive from drug companies or how influential the connection between drug company and veterinarian is, they are not required to disclose that information to either the FDA or the public.
Therefore, we have to conclude that veterinary medicine when compared to human medicine is under-regulated which has led to conflicts of interest which in turn undermines ethical integrity and excellence in veterinary practice.
What is a conflict of interest? It can occur when a person has more than one goal; primary (this is usually the standards required in their work) and secondary goals. A conflict of interest occurs when in trying to achieve the secondary goal the person makes it harder or impossible to achieve the primary goal.
The influence of the drug companies can extend to the training that veterinarians receive and it even reaches into high schools where, for example, a company called, Zoetis, donated $50,000 as a contribution to funding a week-long Perdue University veterinary camp for 10th, 11th and 12th graders.
The big pharmaceutical companies also influence the training that current and future veterinarians receive in the USA. They regularly suggest topics and recommend speakers under the continuing education program that veterinarians must participate in.
This conflict of interest extends to beyond the individual veterinarian to their representative, non-profit organisation, American Veterinary Medical Association (AVMA). The AVMA benefits from contributions from the pharmaceutical industry. Although the AVMA code of ethics make it obligatory for veterinarians to divulge all potential conflicts of interest (to who?), it was only after Reuters requested information that they disclosed that they had received $3.3 million from drug companies over the preceding four years.
In the above introduction, I am simply making the point that it must be very difficult for a veterinarian to make decisions about a companion animal’s welfare in an entirely neutral way. In addition to the conflict of interest referred to above, the veterinarian servicing the general public is providing his or her service to the owner of the animal who is being treated.
Therefore, the veterinarian ultimately has to follow the instructions of the cat owner or if the owner fails to provide instructions they must be influenced by what they think the animal’s owner wants and demands or indeed can afford to pay.
What I propose, therefore, is that the veterinarian has at least two conflicts of interest when diagnosing and treating the illness of a companion animal: the influence of drug companies and the influence of the animal’s owner.
There is, in fact, a third conflict of interest namely the products that veterinarians sell in their clinics (other than drugs). In all the clinics I go to there are a healthy number of products on sale, the most prominent of which is dry cat and dog food. This is often Hills. We know that Hills has somewhat of a stranglehold over the cat food that veterinarians sell.
We, the public, don’t know what sort of commission the veterinarian receives on selling cat food at their clinic. But we know it exists and we also know that dry cat food provided as an exclusive food for a cat is not healthy and therefore on this occasion the vet’s conflict of interest works against his stated oath.
I wonder whether the declawing of cats is in part driven by the drug companies. We know that declawing causes massive pain and therefore requires a lot of post operational painkilling drugs. I wonder if the drug companies have an influence over whether a veterinarian declaws cats because of any commission that they might receive as a result of using their painkilling drugs.
At the end of the day what veterinarians end up prescribing depends on who they’re getting paid by. These are the words of a cattle rancher in Colorado. And he’s correct.
American veterinarians say that they use and distribute drugs (a dual role) because there are no pharmacies and in any case it is more convenient. They also say that the profit margins in selling drugs are usually small.
And that is another point, veterinarians who treat companion animals, as we know, sell drugs over the counter to the owners. We don’t know what sort of commission they receive on a sale or even if there is a commission but you can see the potential for a compromise in ethical standards.
My impression is that antibiotics are overprescribed to companion animals by veterinarians. This is partly because they are prescribed as a precaution due to the fact that the veterinarian isn’t quite sure whether the dog or cat has a secondary infection or not and possibly partly because they are influenced by the pharmaceutical companies.
Actually, vets are losing their grip on pet medications here since most human pharmacies will fill the prescriptions now, and at a lower cost than a vet clinic. I’ve heard that some vets are reluctant to write a prescription knowing that a pahrmacy will fill it; but, I haven’t heard of any vet refusing yet.
Dee, are you saying that pharmacies for people provide drugs to cat owners for cat treatments? Are you saying that vets prescribe drugs (without actually completing a prescription slip) and then the cat owner goes to a pharmacy to get hold of the drugs? I must have that wrong.
Michael, I know that in the UK if your cat requires a prescription only medication, flea treatments etc., which can be be purchased cheaper elsewhere from a reputable source, you can ask the vet to write a prescription. Some vets will charge to do this. I guess that’s to compensate them in some small way because you’re not buying the medication from them.
In Cyprus they had limited access to many veterinary medicines and would often substitute human ones to treat animal ailments. Poor Merlin was in a terrible state when we found him and I can remember the vet giving me a prescription for Giardia medication which I had to get filled at my local pharmacy.
Thanks Michele, interesting information.
The procedure is that the vet writes a prescription that the caretaker can take to any number of human pharmacies to be filled. This is especially beneficial when it comes to some antibiotics, because some paharmacies, like Publix, fill those prescriptions at no cost.
This has been one of the most exciting consumer driven actions of this decade. Why should I pay a vet one dollar per Amoxil when I can get it for free at Publix or even only pay 10 cents per at some other pharmacy?
It’ pretty much a big FU to the vet world!
http://virtuavet.wordpress.com/veterinarymedicalcoaching/publixfreeantibioticslist/
Thanks for educating me on this. I don’t think we can do this in the UK. I have never heard of this before.
Ofcourse it can be done.
All it took here was for people to grow weary of paying more for their pet meds than their own, especially, when they realized that, no matter what name the vet world gave to a med, there was an equivalent available at their own pharmacies most of the time. They were mad to realize that they were being ripped off at their vet clinic. And, the pharmacy chains heard them and came forward with a solution. Ofcourse, they make money with this aspect because they have broadened their scope of practice. So what? It’s a win-win.
I’m of the opinion that all vets who declaw know exactly how disabling it is to the patient. They know it’s an extremely painful amputation, which often causes long term pain and the early onset of arthritis. We’ve been thinking only of the money vets make for the actual surgery, but the horrific effects on the cat lasts a lifetime. This more or less guarantees the vet a lifetime of repeat vists, for pain relief and a whole other host of health problems resulting from the surgery.
Vets in the US also seem especially keen to prescribe psychoactive drugs to treat behavioural problems. That may be in part because they know little about cat behaviour or the owner wants a quick-fix solution, but I’m sure the pharmaceutical Companies offer fantastic incentives to encourage vets to prescribe drugs whenever possible.
I agree with your assessment. I think the pharmaceutical incentive element is something that a lot of people don’t consider when visiting a vet. It does create a clear conflict of interest. The tendency of US vets to prescribe mood enhancing drugs may also be driven in part by commission payments.