ETHICS IN VETERINARY MEDICINE
that is, treatments that are neither the stan- dard of care nor based on evidence. As a general rule, the right of patients and par- ents to decline treatment has few exceptions; however, patients generally have no right to demand treatments that a physician consid- ers contrary to good clinical practice.48 For example, a competent patient may choose to decline antibiotics to treat strep throat, but a physician has no obligation to prescribe antibiotics to treat a viral infection. I imag- ine that similar rules of thumb are useful in guiding clinical practice in veterinary medicine.
(5) The first step to sensible rule-making is to clarify to whom your primary fiduciary obli- gation exists. Veterinarians are in a tough position, analogous to the position of pedia- tricians. The person communicating with you and paying bills is your client but not your patient. Your patients do not sue; your clients can. Your patients will not go to an- other veterinarian; your clients can. These are facts that can shift allegiances away from your patients.
In discussions of ethics, there are rarely easy an- swers, but I do believe that deep and realistic con- sideration of the tensions between the interests of the provider, client, and patient is the starting point for any sound business ethic within veterinary medicine.
References and Footnotes
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6. Berenson A. Indictment of Doctor Tests Drug Marketing Rules. New York: The New York Times; 2006.
7. Blackwell T. MD Faces Kickback Allegations. National Post; 2007:A1.
8. Poses RM. Neurosurgeon Admits Kickbacks From Medical Device Manufacturers. Health Care Renewal: Newstex LLC, 2008.
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11. Associated Press. NY Eye Doctor Admits He Cheated Medi- care by Performing Unnecessary Surgery on Mentally Ill. New York: The Associated Press; 2003.
12. Associated Press. Doctor Sentenced for Bilking Insurance. Chicago: The Associated Press, State & Local Wire; 2002.
13. Armstrong D. Harvard Researchers Fail to Report Drug Payments. The New York Times Company: Wall Street Journal Abstracts; 2008.
14. Campbell EG, Gruen RL, Mountford J, et al. A national survey of physician-industry relationships. N Engl J Med 2007;356:1742–1750.
15. Campbell EG, Weissman JS, Ehringhaus S, et al. Institu- tional academic industry relationships. JAMA 2007;298: 1779–1786.
16. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373–380.
17. Moses H, Dorsey ER, Matheson DHM, et al. Financial anat- omy of biomedical research. JAMA 2005;294:1333–1342.
18. Tereskerz PM. Research accountability and financial con- flicts of interest in industry-sponsored clinical research: a review. Accountability Res 2003;10:137–158.
19. Yank V, Rennie D, Bero LA. Financial ties and concordance between results and conclusions in meta-analyses: retro- spective cohort study. BMJ 2007;335:1202–1205.
20. Cram P, Vaughan-Sarrazin MS, Rosenthal GE. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospi- tals. BMC Health Serv Res 2007;7:155.
21. Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 2001;110: 551–557.
22. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252–255.
23. Katz D, Caplan AL, Merz JF. All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioeth 2003;3:39–46.
24. Institute of Medicine. Conflict of Interest in Medical Re- search, Education, and Practice. National Academies Press: Washington, DC 2009:1–45.
25. Studdert DM, Mello MM, Brennan TA. Financial conflicts of interest in physicians’ relationships with the pharmaceutical industry: self-regulation in the shadow of federal prosecu- tion. N Engl J Med 2004;351:1891–1900.
26. Goldstein J. Senators Probe Cardiologists’ Ties to Stent Makers. New York: Wall Street Journal; 2008.
27. Kamen A. At the NIH, Conflicting Stories of Conflict of Interest. Washington, DC: The Washington Post; 2010.
28. Stein R. NIH Proposes New Funding Rules to Prevent Con- flicts of Interest. Washington, DC: The Washington Post; 2010.
29. Sullivan T. Physician payment sunshine provisions: Pa- tient Protection Affordable Care Act. Policy Med 2010:1–4.
30. Johns Hopkins Bans Free Drug Samples, Gifts From Indus- try. New York: The Wall Street Journal, Dow Jones & Company; 2009.
31. JAMA Sets New Policy in Wake of Disclosure Flap. New York: The Wall Street Journal, Dow Jones & Company, Inc; 2009.
32. Association of American Medical Colleges. Industry Funding of Medical Education. Washington, DC: AAMC; 2008:1–43.
33. Association of American Medical Colleges. Report of the AAMC Task Force on Industry Funding of Medical Education to the AAMC Executive Council. Washington, DC: AAMC; 2008:1–43.
34. Association of American Medical Colleges. Protecting Pa- tients, Preserving Integrity, Advancing Health: Accelerating the Implementation of COI Policies in Human Subjects Re- search. Washington, DC: AAMC; 2008:1–87.
35. Association of American Medical Colleges. In the Interest of Patients: Recommendations for Physician Financial Rela- tionships and Clinical Decision Making. Washington, DC: AAMC; 2010:1–46.
36. Pharmaceutical Manufacturers of America. Code on Inter- actions With Healthcare Professionals: Washington DC. 2008:1–36.
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