Buying influence in the early stages of veterinary careers.

 I found a commentary in the latest issue of JAVMA by a second year veterinary student at Colorado State University who is also a lawyer. The commentary addresses the wide variety of free goods, pet foods, medications and industry sponsored seminars provided to veterinary students. When I attended Colorado State 20 years ago, I remember a handful of pharmacy company sponsored seminars and a few coupons for free dog food over the entire 4 years. The seminars were unusual occurrences and there was usually some post-seminar commentary by faculty discussing where the company line may have diverged from the scientific evidence. It would appear things have changed drastically since then.

Here is Michelle Dally's description of the flow of swag that starts the first day of freshman year;

Every first-year veterinary student at Colorado State
University is assigned a small desk in a dingy warren
in the Anatomy building affectionately known as
“the cubes.” These desks are unremarkable in all ways
but one: when students first arrive, they find their desks
piled high with a variety of freebiespens, notepads,
backpacks, notebooks, highlighters, academic calendars,
pet treats, pet food bowls, reference books, and
more—all emblazoned with pet food, pharmaceutical,
and other corporate brand names from across the veterinary
industry. And that is only the beginning.
As the year unfolds, students discover that they are
entitled to free and sharply discounted dog, cat, and
horse food; free heartworm preventative; a free laboratory
coat; and a free clipboard for use in their gross
anatomy laboratory.

 In addition to all of the gifts, students are also invited to "work" as student representatives for many of these companies, often for fairly significant amounts of money;

Soon, first-year veterinary students
are receiving e-mails through the official veterinary college
e-mail distribution list encouraging them to apply
to be corporate student representatives for a variety of
companiespositions that typically involve little more
than distributing additional freebies to their classmates
and organizing one or two free lunchtime lectures. In
return for their efforts, these student representatives are
generally paid between $750 and $2,000 per semester.
Some companies employ as many as two student representatives
in each of the 4 veterinary college classes,
whereas others employ only a single representative for
each class or a single representative for the entire college.
Regardless, the upshot is that there are typically
one or two corporate-sponsored free lunches each week
for veterinary students, and the corporate presence in
the veterinary college is palpable.

In addition to the conscious and unconscious effects these gifts and sponsorships may have on students ideas and practices far beyond veterinary school (which is discussed well in the commentary) it leaves the profession as a whole open to other criticisms. Often one of the first accusations used to defend alternative practices or denigrate any science-based treatment which is produced by a pharmaceutical company is that veterinarians are just shills for "big pharma" or "big pet food". The same companies often sponsor veterinary conferences and seminars for veterinarians as well. The alternative veterinary industry really should not throw this particular stone, as their conferences are sponsored by supplement manufacturers and other companies to a similar extent.

The things that I found particularly disturbing about the commentary were the discussion of how these practices are tacitly and actively supported by the veterinary school with very little time spent educating the students on how they may be influenced by them. This is yet another way that veterinary schools are failing to teach their students critical thinking skills and how to evaluate evidence. This type of corporate influence may be even more insidious than teaching alternative practices which are not evidence based in a credulous manner. Students really should be taught how to critically analyze the claims of all of the players in the veterinary industry, from the pharmaceutical companies to the promoters of supplements and alternative treatments. Increasing the access companies have to students as described in this  commentary really does open the door for legitimate criticism, as well as giving charlatans something to point to to distract from their own lack of evidence.

I commend Michelle Dally for her commentary and for drawing attention to this topic.

Citation;  

Journal of the American Veterinary Medical Association

June 15, 2011, Vol. 238, No. 12, Pages 1551-1554

doi: 10.2460/javma.238.12.1551

Ethical considerations raised by the provision of freebies to veterinary students

Michelle Dally, JD

College of Veterinary Medicine and Biomedical Sciences. Colorado State University, Fort Collins, CO 80523. (Dally)

Ms. Dally was a second-year veterinary student at the time of submission.

Cognitive Dissonance

Recent discussions on the alternative veterinary medicine e-mail list and on Pet Connection have made me think more about Cognitive Dissonance and the other ways humans can deceive themselves. Prometheus at Photon in the Darkness coincidentally has an excellent post up about cognitive dissonance today.

Unfortunately, Narda Robinson seems to be an excellent example of cognitive dissonance as well. For those of you who are not familiar with Dr. Robinson, she is the Director of Colorado State University's Center for Integrative Pain Medicine. While she seems to be very skeptical and science based in her analysis of many alternative modalities such as homeopathy, herbal medicine, and others, she often credulously endorses Reiki and possibly therapeutic touch, and teaches a $4,400 dollar course in acupuncture at CSU. She has studied the "neuroanatomical" approach to acupucture for many years. There is no doubt that sticking needles into living bodies causes a reaction in the nervous system. This reaction seems to include an effect on nerve transmission and can cause the release of endorphins in the central nervous system. The question is, does this have any significant clinical effect? Increasingly, the answer seems to be no.
Detailed and well-referenced discussions of the scientific evidence for the efficacy of acupunture are available here, and here. The acupucture archive at Science-Based Medicine is well worth a look as well. In short, the development of sham acupucnture procedures such as placing needles in random points, the use of fake needles that do not puncture the skin but appear to and tricking patients into thinking they are being needled by using things like toothpicks to create an illusion of being needled all seem to be as effective as "real" acupucture. This would indicate that the act of inserting needles has a potent psycological effect that can induce a placebo efect in humans, and possibly animals as well. (My previous post discussing the placebo effect in animals and their owners shows how thismight happen.) People often like to do something, indeed anything to help alleviate their animal's suffering. Unforunately, using an inefective or minimally effective treatment may convince the owner and veterinarian that they are helping, but the animal may still be suffering.
This is my foremost concern with the promotion of veterinary acupuncture. It is quite common for the proponents of veterinary acupuncture to claim that acupucture can reduce the need for anesthetic drugs, or help with postoperative pain and chronic pain. This may result in the use of inadequate doses of other, effective analgesic drugs and techniques. Veterinary pain relief has come a long way in the past few decades, and acupuncture to me seems to be a step backward rather than an improvement.
The reason I think that Dr. Robinson is an excellent example of cognitive dissonance is because she tries to force unscientific isdeas into her inconsistent idea of what the evidence shows. A true scientist and skeptic will put all their ideas, no matter how treasured, to the test of the evidence. While acupuncture is more plausible than homeopathy, the results of the best trials do not show much effect. Dr. Robinson and CSU are making a lot of money from their courses in acupucture and from treating pets with acupucture and other therapies with weak evidence. It is their responsibility to produce good evidence or effectiveness or to stop deluding themselves and others.
M