March 01, 2017

 

 Delegates discuss ethics of vendor incentive programs

Posted Feb. 15, 2017 

The Principles of Veterinary Medical Ethics of the AVMA adequately cover transparency in acceptance of sponsorships, rebates, equipment, and free goods by veterinarians, concluded the AVMA House of Delegates. During discussion, however, some delegates suggested developing additional guidelines. 

According to the principles of ethics, “A veterinarian should consider the potential for creating a conflict of interest (or the appearance thereof) when deciding whether to participate in vendor incentive programs or other arrangements where the veterinarian receives a benefit for using or prescribing a particular product.”  

Delegates discussed transparency in acceptance of sponsorships, rebates, equipment, and free goods as a topic of the Veterinary Information Forum during the regular winter session of the House, Jan. 13-14 in Chicago. 

Dr. Sandra Faeh, Illinois delegate, provided an introduction to the issue. She said the question is whether the veterinary profession needs to do more.

Dr. Ashley Morgan of the AVMA Governmental Relations Division said studies in human medicine have found that physicians change behavior as a result of vendor incentives. During the previous Congress, a member of the U.S. House of Representatives discussed proposing a law requiring manufacturers of drugs and devices to disclose incentives to veterinarians, similar to a law in human medicine. 

“Last summer, I was invited to spend the night at the casino with the introduction of a new veterinary product, and I just find some fault with that,” said Dr. Stephen Steep, Michigan alternate delegate. “So can we just address this issue ethically while preserving the support that we desperately need for continuing education? I certainly would hope so. I suggest that we at least create some ethical guidelines for accepting support from Big Pharma.”  

AVMA POLICY
Principles of Veterinary Medical Ethics of the AVMA, section 1a.
I. A veterinarian shall be influenced only by the welfare of the patient, the needs of the client, the safety of the public, and the need to uphold the public trust vested in the veterinary profession; and shall avoid conflict of interest or the appearance thereof.
a. A veterinarian shall not allow any interests, especially financial interests, other than those mentioned above to influence the choice of treatment or animal care.
i. A veterinarian should consider the potential for creating a conflict of interest (or the appearance thereof) when deciding whether to participate in vendor incentive programs or other arrangements where the veterinarian receives a benefit for using or prescribing a particular product.
ii. The medical judgment of a veterinarian shall not be influenced by contracts or agreements made by their associations or societies.
iii. A veterinarian shall not offer or receive any financial incentive solely for the referral of a patient (fee-splitting).

Dr. Cathy Lund, Rhode Island alternate delegate, spoke against putting a law in place to require disclosure in veterinary medicine. While physicians receive public funding through programs such as Medicare, she said, private veterinary practices do not receive public funding.

Dr. Elizabeth Hardie, delegate for the American Association of Veterinary Clinicians, said veterinary colleges do receive public funding, and, therefore, have had to put guidelines in place on accepting incentives from vendors.

“Coming up with some guidelines for how you might approach this as a profession, I think, probably would have some merit,” Dr. Hardie said. “I think it is coming down the pike. When it happened at the college level, it happened very, very quickly. We all had to scramble to develop guidelines.”

Dr. Michael Bailey, Pennsylvania alternate delegate, said part of the issue is “the ethical treatment of our patients and how the influence of receiving benefits from a corporation or something is going to affect the best treatment, the well-being of our patients.”

Dr. Courtney Rebensdorf, Rhode Island delegate, said there is more to the question. She said, “We utilize discounts to keep our costs down, to pass the savings on to our clients, to pay our staff a living wage, and to keep current and to purchase new equipment.”

Dr. Charles Freeman, Oklahoma delegate, does not see an obligation for private practitioners or the AVMA to create a policy to keep veterinarians from receiving rebates. Ideally, though, he’d rather have better prices.

Dr. Robert Groskin, delegate for the Association of Avian Veterinarians, asked how companies are spending money on incentives. What portion goes to livestock versus small animal pharmaceuticals?  



Dr. Fred Gingrich, alternate delegate of the American Association of Bovine Practitio­ners, speaks about how the AABP is approaching ethical concerns in the prescribing of pharmaceuticals. (Photo by R. Scott Nolen)

In March, the American Association of Bovine Practitioners board of directors will consider guidelines on the ethics of accepting rebates for prescribing or selling pharmaceuticals. Dr. Fred Gingrich, AABP alternate delegate, noted that food animal veterinarians profit from prescribing antimicrobials but also have been charged by the Food and Drug Administration with judicious oversight.

Dr. Gingrich added that the AABP does not accept corporate sponsorship for scientific sessions, only for meals and functions.

The House reference committee assigned the topic of transparency did not recommend any action. Dr. Faeh, committee chair, reported afterward to the full House, “The committee felt that the Principles of Veterinary Medical Ethics are sufficient in guiding veterinarians in the issues of transparency.”

The principles of ethics are here.

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