Wednesday, October 7, 2009

Medicine's Public Scandals = Veterinary Medicine's Shameful Secrets

In 2008, three new books revealed how the esteemed medical establishment actually works. All three (1) explored the profitable alliances among medical schools, teaching hospitals, and pharmaceutical companies that distort the teaching, research and practice of medicine.

In brief, billions of dollars of drug company profits are invested in seducing medical students with gifts, free meals, free samples, and chummy visits to their schools. Many studies show that, when they graduate, their prescribing practices with patients are heavily influenced by relationships with drug companies, forged during their training.

More billions of dollars of drug company profits are invested in medical research to win approval for new drugs and to extend the uses of existing drugs. Too often drug companies design the studies, conduct the analyses, and report favorable results, simultaneously supressng any negative outcomes. Medical researchers' role is merely to obtain patient participants and gather data, which drug company employees spin to their advantage. Negative studies, even those reported to the FDA during a drug's approval process, are never published.

Pharmacuetical companies recruit leading medical educators at leading medical schools and pay them millions of dollars in consulting fees to promote drugs under development and to promote other uses for drugs previously approved. This obvious conflict of interest is receiving congressional attention, and new legislation may result.

Pharmacuetical companies are major sponsor of continuing medical education, which is required for most physicians to maintain their licenses. Too often CE credits are awarded for indoctrination into alleged benefits of drug company products.

In January 2009, Marcia Angell, MD, longtime editor of the New England Journal of Medicine, wrote a stinging essay on the medical morass, of which few Americans are aware (New York Review of Books, January 15, 2009).

"No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine US drug companies that it comes to tens of billions of dollars a year. By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease."

Commercial interests in drugs, medical devices, and other treatment modalities have insinuated themselves into medical training, research and practice to such an extent, the credibility of medicine is at stake.

"A few decades ago, medical schools did not have extensive financial dealings with industry, and faculty investigators who carried out industry-sponsored research generally did not have other ties to their sponsors. But schools now have their own manifold deals with industry and are hardly in a moral position to object to their faculty behaving in the same way. A recent survey found that about two thirds of academic medical centers hold equity interest in companies that sponsor research within the same institution. A study of medical school department chairs found that two thirds received departmental income from drug companies and three fifths received personal income."

A medical student organization has protested for a decade the undue influence of pharmacuetical companies on their training, medical research, and the practice of medicine. Just now are their protests about massive conflicts of interest in medicine coming to public attenton.

So, what do these relevations about medicine's corruption imply for veterinary medicine? Same issues, smaller enterprise.

Pharmacuetical companies spend millions to seduce veterinary students, pay faculty consulting fees, sponsor research that favors their products, and distort how veterinarians prescribe drugs and treat pet illnesses. Differences are the size of the enterprise and the patient population. The veterinary establishment is a fraction the size of the medical goliath, and patients are pets, whose legal worth is small, compared to human patients. Keep in mind, however, that 75% of the antibiotics prescribed in the US are for livestock, so drug companies have financial reasons to influence veterinary medicine.

Unlike physicans, veterinarians profit from additional conflicts of interest. Physicians are prohibited by law from selling or profiting from the sale of drugs, medical devices, laboratory tests, infant formula, and baby foods. Veterinarians make substantial profits from selling the drugs they prescribe, selling medical devices they recommend, requiring expensive in-house laboratory tests, and selling pet foods they stock in their clinics.

For veterinary medicine, pet food is the BIG ONE. Although it is impossible to get accurate numbers, it appears from my examination of finacial data from several veterinary schools that pet food companies contribute more millions of dollars to veterinary schools, conferences, and continuing education than even pharmacuetical companies do.

Giant pet food companies, such as Colgate-Palmolive (Hill's), Proctor & Gamble (Iams, Eukanuba), Mars (Pedigree, Royal Canin), and Nestle-Purina (Purina) sell $15 billion of pet food in the USA alone. Because these are global companies, their worldwide sales totaled more than $50 billion in 2008. These pet food giants, second-tier players, such as Nutro and Heinz, and wannabes, such as American Pet Brands (see Blog September 2009) invest millions of dollars annually to influence veterinary education, research and practice -- from the cradles of new vet students to the graves of millions of pets.

Just as medicine is dominated by the disease model (treat sickness, not promote health), so has veterinary medicine sold its soul to manufactured diets and treating the illnesses they create. Physicians and veterinarians are not paid to keep patients healthy; they are paid to treat illnesses with phamacueticals and, in the case of vets, with presription diets that often make pets even sicker. In both medical and veterinary schools, students are taught molecular biology, pharmacology, and diagnoses of diseases. They are not taught how to keep patients healthy.

Fortunately, for people there are countervailing voices to promote health through diet, exercise, and a healthy lifestyle. Unfortunately for pets, there are only pet food ads that promise health and create chronic illnesses.

The collusion of pet food and pharmacuetical companies to distort veterinary education, research, and practice will eventually be exposed, just as the medical establishment is currently under public attack for gross conflicts of interest. But who will speak for pets and their owners?

To their everlasting shame, the major animal welfare organizations are equally compromised by reliance on pet food company dollars to fund their activities, so they cannot be counted on to expose lies about manufactured pet foods. The American Kennel Club is a particularly egregious example of selling out to commercial interests, to the detriment of dogs' health and welfare (See Blog in August). The few veterinarians who oppose pet diets of kibbles and canned mush are marginalized and ineffectual to fight the veterinarian-pet food alliance.

Change may come from grassroot pet owners, who realize their cherished pets are being sickened by the "100% complete and balanced" foods their vets recommend and sell. That's my story. On the Internet they may find rawfeeding groups and raw pet food purveyors (who miss the boat on the importance of food texture to clean teeth and keep mouths healthy). Perhaps, they will find books and advice on how to feed species-appropriate diets.

It is outrageous that veterinarians promote the very foods that make pets sick -- perhaps unwittingly, because they have been indoctinated to trust manufactured diets. Surely, as they have seen so many cancers and chronic diseases in their practices, many vets have recognzed the connection to manufactured pet foods. But where are they? I am afraid they are paying off their vet school debts by selling Iams and Hill's prescription diets.

Corruption and conflicts-of-interest in veterinary medicine are begging for exposure, if we can find enough people to care.

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(1) Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial by Alison Bass, Algonquin Books of Chapel Hill, 260 pp., $24.95

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs
by Melody Petersen, Sarah Crichton/Farrar, Straus and Giroux, 432 pp., $26.00

Shyness: How Normal Behavior Became a Sickness by Christopher Lane, Yale University Press, 263 pp., $27.50; $18.00 (paper)

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