Veterinary Medical Ethics Déontologie vétérinaire Ethical question of the month — June 2015 Feral cats are reported to kill large numbers of song birds and other wildlife and thus disrupt ecosystems wherever they exist. In addition, feral cats are a source of infectious disease for domestic cats and a reservoir of zoonotic disease for people. Elected officials and policy makers know that killing cats is unpopular with a large proportion of their constituents. Trap, neuter, and release (TNR) programs are being promoted as a more humane method of limiting or eliminating feral cat populations. To date, such programs are reported to reduce or stabilize feral cat populations but not to eradicate them. How does one balance the welfare of wild birds, rodents, and the native predators that depend on these species with the welfare of feral cats? Can one compare the properly performed euthanasia of a feral cat to the comparatively painful death cats often impose on their prey?
Question de déontologie du mois — Juin 2015 On signale que les chats féraux tuent une grande quantité d’oiseaux chanteurs et d’autres animaux sauvages et qu’ils perturbent ainsi les écosystèmes où ils habitent. De plus, les chats féraux représentent une source de maladies infectieuses pour les chats domestiques ainsi qu’un réservoir de zoonoses pour les humains. Les représentants élus et les décideurs politiques savent qu’il est impopulaire de tuer des chats auprès d’une grande partie de leurs électeurs. On fait la promotion des programmes de piégeage, stérilisation et remise en liberté comme étant une méthode moins cruelle de limiter ou d’éliminer les populations de chats féraux. Jusqu’à maintenant, on a signalé que ces programmes réduisent ou stabilisent les populations de chats féraux mais qu’ils ne réussissent pas à les éradiquer. Comment peut-on équilibrer le bien-être des oiseaux sauvages, des rongeurs et des prédateurs indigènes qui comptent sur ces espèces avec le bien-être des chats féraux? Peut-on comparer l’euthanasie bien gérée d’un chat féral avec la mort douloureuse que les chats imposent à leur proie?
Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.
Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire p arvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du D r Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected]. Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs. CVJ / VOL 56 / JUNE 2015
541
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Ethical question of the month — March 2015 The prescribing and selling of appropriate pharmaceuticals for the treatment and prevention of disease are key components of a veterinarian’s professional activities. Regular communication between pharmaceutical companies and veterinarians is important to ensure products are being used appropriately and are working effectively. Veterinarians also play key roles in evaluating pharmaceuticals in terms of safety and efficacy. Associations between antimicrobial use in livestock production and the development of antimicrobial resistance in human pathogens have brought the relationships between veterinarians and pharmaceutical companies into question. One article addressing this concern is available from: http://www.reuters.com/article/2014/12/23/ farmaceuticals-vets-idUSL1N0U60Y220141223 (Last accessed April 20, 2015). Can academic and practicing veterinarians maintain a professional working relationship with the manufacturers of important veterinary medical compounds without appearing unduly influenced in their professional judgements?
Question de déontologie du mois — Mars 2015 La prescription et la vente des produits pharmaceutiques appropriés pour le traitement et la prévention des maladies représentent des éléments importants des activités professionnelles d’un vétérinaire. Une communication régulière entre les compagnies pharmaceutiques et les vétérinaires est cruciale en vue d’assurer que les produits sont utilisés adéquatement et qu’ils agissent efficacement. Les vétérinaires jouent aussi des rôles clés dans l’évaluation des produits pharmaceutiques en ce qui a trait à leur innocuité et à leur efficacité. Les liens entre l’utilisation des antimicrobiens dans l’élevage du bétail et le développement d’une résistance antimicrobienne des pathogènes humains ont remis en question les relations entre les vétérinaires et les compagnies pharmaceutiques. Un article abordant cette préoccupation est disponible au : http://www.reuters.com/article/2014/12/23/farmaceuticals-vets-idUSL1N0U60Y220141223 (Dernière consultation le 20 avril 2015). Les vétérinaires travaillant en pratique et dans les universités peuventils entretenir des relations professionnelles avec les fabricants de préparations médicales vétérinaires importantes sans que leur jugement professionnel ne semble indûment influencé?
An ethicist’s commentary on veterinarians and drug companies As stated in the articulation of this case, “regular communication between pharmaceutical companies and veterinarians is important to ensure products are being used appropriately and are working effectively. Veterinarians also play key roles in evaluating pharmaceuticals in terms of safety and efficacy.” That assertion is an accurate thumbnail sketch of the ideal relationship between veterinary practitioners and pharmaceutical companies. A good relationship between veterinary practitioners and, indeed, human medical practitioners, and drug companies is essential to effective development and deployment of pharmaceutical advances. However, affirming that a good relationship should exist between medical practitioners, human and veterinary, and drug companies should not be taken to mean that these parties should be sleeping together. Similar relationships are required throughout a broad range of professional life for society to function, for example, between police and prosecutors. Until quite recently, human medical practitioners and drug companies were far too intimately connected. Drug companies would bestow upon friendly physicians extremely lavish gifts in the form of junkets to the Caribbean or other all-expensespaid vacations. Overly expensive honoraria and consulting fees were routinely paid to physician conference speakers who enthusiastically supported company products. In January 2009, in a review article published in The New York Review of Books, Marcia Angell, former editor of The New England Journal of Medicine, highlighted some of the more unsavory aspects of the relationship. She recounts numerous examples of corruption between highly respected senior academic physicians and drug 542
companies, and estimates the amount of “payoffs” from drug companies to physicians in universities to total tens of billions of dollars per year. Despite the fact that well-known academic physicians are generally the best paid faculty members in universities, this did not insulate them from corruption. This process begins in medical school, with medical students accepting gifts such as stethoscopes and meals from drug companies. Precisely the same process, albeit on a much smaller financial scale, takes place in veterinary schools, with veterinary students being treated to pizza by pharmaceutical companies, rather than to steak dinners. My son, a psychiatrist, has attended a regularly held drinks and dinner affair sponsored by drug companies, entitled “drinks for shrinks.” If anyone doubts that this can have a corruptive influence on medical practitioners and universities, I would be happy to sell them a bridge in Brooklyn. Corruptive bribery is right up there with prostitution as a major modality for making friends. The corruptibility of senior medical faculty mentioned above provides an unnecessary reminder of the old adage that “one can never be too thin or too rich.” In the face of this unfortunately ubiquitous human tendency, why would anyone believe that veterinarians, who make considerably less money than physicians, would be any less subject to having their allegiance purchased? In fact, given the vast amounts of money available to fund human medical research, and the relatively small amount of money supporting farm animal research, most of which comes from pharmaceutical companies, we can clearly surmise how vital drug company CVJ / VOL 56 / JUNE 2015
V E T E R I N A RY M E D I CA L E T H I C S
money is to the well-being of a career. One of my colleagues tells a vivid story of what happened to him when his research yielded results inimical to the interests of the drug company that funded him. And one of the major recommendations developed by the Pew Commission on Industrial Farm Animal Production was the suggestion that corporate research money into farm animal welfare be replaced by public money. How can this situation be corrected? Much as I despise ever-increasing government intervention into our lives, I see no choice but to recommend regulation of the relationships between drug companies and veterinary practitioners, even as has occurred with physicians. This is a paradigmatic example of where failure to articulate necessary professional ethics for one’s self inevitably leads to more onerous, externally imposed societal regulation.
Bernard E. Rollin, PhD
CVJ / VOL 56 / JUNE 2015
543
Question de déontologie du mois — Juin 2015 On signale que les chats féraux tuent une grande quantité d’oiseaux chanteurs et d’autres animaux sauvages et qu’ils perturbent ainsi les écosystèmes où ils habitent. De plus, les chats féraux représentent une source de maladies infectieuses pour les chats domestiques ainsi qu’un réservoir de zoonoses pour les humains. Les représentants élus et les décideurs politiques savent qu’il est impopulaire de tuer des chats auprès d’une grande partie de leurs électeurs. On fait la promotion des programmes de piégeage, stérilisation et remise en liberté comme étant une méthode moins cruelle de limiter ou d’éliminer les populations de chats féraux. Jusqu’à maintenant, on a signalé que ces programmes réduisent ou stabilisent les populations de chats féraux mais qu’ils ne réussissent pas à les éradiquer. Comment peut-on équilibrer le bien-être des oiseaux sauvages, des rongeurs et des prédateurs indigènes qui comptent sur ces espèces avec le bien-être des chats féraux? Peut-on comparer l’euthanasie bien gérée d’un chat féral avec la mort douloureuse que les chats imposent à leur proie?
Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.
Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire p arvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du D r Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected]. Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs. CVJ / VOL 56 / JUNE 2015
541
D É O N TO LO G I E V É T É R I N A I R E
Ethical question of the month — March 2015 The prescribing and selling of appropriate pharmaceuticals for the treatment and prevention of disease are key components of a veterinarian’s professional activities. Regular communication between pharmaceutical companies and veterinarians is important to ensure products are being used appropriately and are working effectively. Veterinarians also play key roles in evaluating pharmaceuticals in terms of safety and efficacy. Associations between antimicrobial use in livestock production and the development of antimicrobial resistance in human pathogens have brought the relationships between veterinarians and pharmaceutical companies into question. One article addressing this concern is available from: http://www.reuters.com/article/2014/12/23/ farmaceuticals-vets-idUSL1N0U60Y220141223 (Last accessed April 20, 2015). Can academic and practicing veterinarians maintain a professional working relationship with the manufacturers of important veterinary medical compounds without appearing unduly influenced in their professional judgements?
Question de déontologie du mois — Mars 2015 La prescription et la vente des produits pharmaceutiques appropriés pour le traitement et la prévention des maladies représentent des éléments importants des activités professionnelles d’un vétérinaire. Une communication régulière entre les compagnies pharmaceutiques et les vétérinaires est cruciale en vue d’assurer que les produits sont utilisés adéquatement et qu’ils agissent efficacement. Les vétérinaires jouent aussi des rôles clés dans l’évaluation des produits pharmaceutiques en ce qui a trait à leur innocuité et à leur efficacité. Les liens entre l’utilisation des antimicrobiens dans l’élevage du bétail et le développement d’une résistance antimicrobienne des pathogènes humains ont remis en question les relations entre les vétérinaires et les compagnies pharmaceutiques. Un article abordant cette préoccupation est disponible au : http://www.reuters.com/article/2014/12/23/farmaceuticals-vets-idUSL1N0U60Y220141223 (Dernière consultation le 20 avril 2015). Les vétérinaires travaillant en pratique et dans les universités peuventils entretenir des relations professionnelles avec les fabricants de préparations médicales vétérinaires importantes sans que leur jugement professionnel ne semble indûment influencé?
An ethicist’s commentary on veterinarians and drug companies As stated in the articulation of this case, “regular communication between pharmaceutical companies and veterinarians is important to ensure products are being used appropriately and are working effectively. Veterinarians also play key roles in evaluating pharmaceuticals in terms of safety and efficacy.” That assertion is an accurate thumbnail sketch of the ideal relationship between veterinary practitioners and pharmaceutical companies. A good relationship between veterinary practitioners and, indeed, human medical practitioners, and drug companies is essential to effective development and deployment of pharmaceutical advances. However, affirming that a good relationship should exist between medical practitioners, human and veterinary, and drug companies should not be taken to mean that these parties should be sleeping together. Similar relationships are required throughout a broad range of professional life for society to function, for example, between police and prosecutors. Until quite recently, human medical practitioners and drug companies were far too intimately connected. Drug companies would bestow upon friendly physicians extremely lavish gifts in the form of junkets to the Caribbean or other all-expensespaid vacations. Overly expensive honoraria and consulting fees were routinely paid to physician conference speakers who enthusiastically supported company products. In January 2009, in a review article published in The New York Review of Books, Marcia Angell, former editor of The New England Journal of Medicine, highlighted some of the more unsavory aspects of the relationship. She recounts numerous examples of corruption between highly respected senior academic physicians and drug 542
companies, and estimates the amount of “payoffs” from drug companies to physicians in universities to total tens of billions of dollars per year. Despite the fact that well-known academic physicians are generally the best paid faculty members in universities, this did not insulate them from corruption. This process begins in medical school, with medical students accepting gifts such as stethoscopes and meals from drug companies. Precisely the same process, albeit on a much smaller financial scale, takes place in veterinary schools, with veterinary students being treated to pizza by pharmaceutical companies, rather than to steak dinners. My son, a psychiatrist, has attended a regularly held drinks and dinner affair sponsored by drug companies, entitled “drinks for shrinks.” If anyone doubts that this can have a corruptive influence on medical practitioners and universities, I would be happy to sell them a bridge in Brooklyn. Corruptive bribery is right up there with prostitution as a major modality for making friends. The corruptibility of senior medical faculty mentioned above provides an unnecessary reminder of the old adage that “one can never be too thin or too rich.” In the face of this unfortunately ubiquitous human tendency, why would anyone believe that veterinarians, who make considerably less money than physicians, would be any less subject to having their allegiance purchased? In fact, given the vast amounts of money available to fund human medical research, and the relatively small amount of money supporting farm animal research, most of which comes from pharmaceutical companies, we can clearly surmise how vital drug company CVJ / VOL 56 / JUNE 2015
V E T E R I N A RY M E D I CA L E T H I C S
money is to the well-being of a career. One of my colleagues tells a vivid story of what happened to him when his research yielded results inimical to the interests of the drug company that funded him. And one of the major recommendations developed by the Pew Commission on Industrial Farm Animal Production was the suggestion that corporate research money into farm animal welfare be replaced by public money. How can this situation be corrected? Much as I despise ever-increasing government intervention into our lives, I see no choice but to recommend regulation of the relationships between drug companies and veterinary practitioners, even as has occurred with physicians. This is a paradigmatic example of where failure to articulate necessary professional ethics for one’s self inevitably leads to more onerous, externally imposed societal regulation.
Bernard E. Rollin, PhD
CVJ / VOL 56 / JUNE 2015
543
