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Tuesday, December 3, 2013

A Perspective on 20/20's Vet Segment You Won't Read Anywhere Else

The Segment and Its Backlash

You probably know that 20/20 aired a segment on alleged dishonest practices within the veterinary field.  A veterinarian named Dr. Andrew Jones (who had left the profession) tried to discuss some issues I've addressed over the last 3 years in Ethical Veterinarian.  Among these were over-vaccination, "upselling" of unnecessary procedures, and the potential for veterinarians to put business interests above animal well-being.

Firstly, I never expect a media piece to report accurately on science topics.  This was obviously a shaming attention-grabber, not the effective educational piece it could have been.  Any compelling scientific comments that the interviewed vets made, if they existed, probably ended up on the cutting room floor.  Let's face it, they wouldn't have been alluring to the average TV viewer or easily interpreted by a TV journalist.

So yes, trying to incriminate a vet for recommending a dental cleaning, of all things, was lame.  Conducting an undercover investigation was also lame...we're not the mafia or an illegal prostitution ring. And since I do not know Dr. Jones personally, I can't even say with certainty what his motive was for doing the interview.

But I have to point out that throughout the segment, 20/20 did say that "some veterinarians" engage in unethical business practices.  It never generalized this to the entire profession. Nonetheless, this approximately 7 and 1/2 minute piece still incited the biggest emotional uprising of veterinarians I've seen for any reason.  A factual correction or two about dental cleanings and lumps would have sufficed. However, an astounding number of vets were galvanized to start reactionary blogs, or at least their posts seemed to be shared like never before.  Contained in these posts was an overflow of outrage, defensiveness, melodrama, self-validation and calls for professional solidarity.  It was as if a national tragedy with pervasive loss of life had occurred.

I'll be the first to state that the veterinarian job is no picnic, and most people criticizing vets could never fathom the stresses and impossible situations we have to deal with in a given day.  Even the most honest vets are inevitably misconstrued and disrespected at some point.

However, our defensive backlash still irked me more than anything about the 20/20 piece itself. Why? Because it was the same unproductive, in-unison, knee-jerk reaction vets seem to show whenever someone else implies they may be wrong.  After the segment aired, vets immediately set to work trying to refute everything about the 20/20 segment, even the parts that were accurate or could have been legitimate in certain instances.

Also, I've been expecting a TV expose on the vet industry for years, so I'm not on board with the shock. (I knew it was coming for sure when the plaintiff in the Corpus Christi cat vaccine case personally contacted me. After losing the life of her beloved cat and the case, the flabbergasted plaintiff stated, "I lost my veterinarian lawsuit because "if all veterinarians adhere to the same standards then it's not negligence.")

I never wanted to see veterinarians tossed into the sensationalist media ring, but that's why I and a handful of others in the field have been working to engage vets in a professional, internal setting on these potentially explosive issues---for years.  I would have never taken my concerns to TV news. But, on the other hand, can I tell you what response I've gotten from other vets using professional appeals rather than the silly mainstream media? Almost nothing.  A frustrating, empty silence.  One closed-minded VMA after another.  An ongoing belief that the veterinary status quo will be just fine---permanently.  An insistence that we don't have to evolve at the pace of society in our decisions about animals.

Dr. Jones said he needed to say things that "weren't being said." Again, I think he used some examples that were too vague and situational to be considered valid. But his sentiment was justified - there are problems in this profession that it refuses to address internally. Business practices that conflict with animal (and veterinarian!) welfare are among those. You quickly hit a wall inside this profession if you disembark from the collective view, even with compelling evidence in hand. If you're a vet and don't think so, maybe it's because you've never disembarked from the collective view. Have you? I've done it, both as an associate and as a practice owner, and you should see the juvenile behaviors I'm met with. They shock me much more than the 20/20 piece.

Vets are not bad people, and most are not greedy.  But vets often have unexamined allegiances; they think they're right even when they are so, so wrong... just because a huge number happen to be wrong together.

I call this "pig farmer syndrome."  If you tell people running a swine factory farm they're engaged in animal cruelty, they tend to act appalled.  They'll assure you that no one in their facility is punching, beating or molesting any pigs.  Most truly don't think that keeping sows in lifelong movement restriction (the industry standard) is inhumane--- precisely because it is legal, that's "the way it's done" and it's conditioned within that industry.  Nevermind what science and common sense tell us-- that inside the gestation crate lies one of the most tortured of tortured animals.

I have seen that same kind of groupthink running amok in the veterinary industry.  The majority of exasperating things in this profession happen not out of malevolence, but rather because some obscure voice is always saying "this is the way it's done."  And almost everyone does it.

Are vets particularly susceptible to groupthink?  Well, do you think vets aced 8 years worth of multiple choice exams and collected countless glowing professional recommendations, by challenging other people or refuting their ideas? Veterinarians, in general, are an obedient, cautious, even neurotic lot. There is very little trailblazing going on in this profession. I even had difficulty getting vets to sign initiative petitions stating all animals deserve to have access to food, water and exercise. It's not that they personally disagree with this. But they've been conditioned to think I'm trapping them in some kind of hidden agenda that is in violation of their rigid profession's rigid views. They fear their colleagues will scorn them for associating with a vet who's volunteering with an non-vet organization. After all, that non-vet organization might have one time endorsed something that was potentially in disagreement with what their local VMA learned from the AVMA they are expected to support. You see what I'm saying.

Everyone's experiences are a little different, but after working at 7 different practices and interacting with numerous others, I've seen my share of incriminating things in the veterinary profession. More than I ever imagined I'd see. Even when I have witnessed vets hitting dogs to get them to "behave", vets on a commission biopsying a dog's elbow calluses, or vets doing the 6-vaccines-in-one-visit bit, it's still been due more to groupthink than criminal dispositions. But we all know from history that groupthink can have sad consequences.

Most veterinarians are well-meaning people who do what they think is best for their patients... and work extremely hard at it. But our profession does not engage readily with other fields (journalism, politics, philosophy, law), and can take itself way too seriously. The AVMA Executive Board is all too often viewed as a panel of gods, whose every word is assumed perfectly accurate, unbiased and infallible. The current generation of vets (age 40 and younger) didn't actually make any of the veterinary business "policies." However, vets tend to follow them religiously, because much of the profession has been convinced that's always best for animals, even when it's just what's best for the industry and allied industries.

So yes, most vets doing the things Dr. Jones criticized are just dutifully adhering to a barrage of "rules." Only sometimes are they impractical rules from a textbook. Often they are rules imparted by pharmaceutical/vaccine companies and the pet food industry---who go over the top to sway vets, aggressively imparting revenue-driven recommendations that are in turn passed on to clients. Other vets are following outdated recommendations set decades ago by their employers. Most of all, vets are taking their cues from the AVMA, the force that most influences the profession.

What few realize is that even the most far-reaching AVMA policies are ultimately decided by a frighteningly small group of voting Executive Board Members. And despite our demographic changing to young, female vets centered on the human-animal bond, it's worth mentioning that every one of these voting members happen to be white males over the age of 50, who are tied to industries known to put animal welfare on the backburner for economic productivity. Historically, that was the foundation of the profession.

What this means is that the touted views and ingrained habits in the veterinary profession are not generated by the average associate vet clients meet in an exam room---the one who gushes pure love on their cat or dog---the one who is more concerned with honest medicine than having a booming business at the expense of honest medicine. Very few people realize how disgruntled the younger generation of vets may be, or why. We're not the ones setting the mill-like pace of the profession; we're just running to the point of exhaustion trying to keep up with it, and in a framework we didn't create. The emotional exhaustion this can cause is worse than the physical.

Veterinary medicine is like a well-meaning but dysfunctional family... so when things get noticeably contentious inside (which is going to increase), people from outside are going to come knocking. Maybe with more cameras. After all, before the 20/20 piece, we had been implicated for having the highest suicide rate, a high rate of mental illness, the fifth most unhealthy profession, and the number one most exclusively white profession. Don't laugh --- the latter is important, because homogeneity is not particularly conducive to open-mindedness. While we persist in our insular ways, others are noticing. (Please read my previous 20-something blog posts for specific examples.)

The Glazed-Over, Overvaccination Topic

I used to keep a stack of scientific journal articles on my desk at work. They all concluded that yearly distemper vaccines were unfounded and needlessly exposed millions of animals to risk of adverse effects. (Did you know that a veterinarian, armed with decades of scientific facts and the most current professional guidelines, actually attempted to sue other practicing vets in his state to call attention to this issue?) Yet annual vaccines are still being administered left and right.

Why is this not a bigger deal? We continue defending bad policy by saying that despite a closed scientific debate, "it's ultimately up to the discretion of our fellow doctors." We can demonize the Dr. Jones character to no end, but we won't acknowledge the shortcomings of so many among us who insist on thoroughly debunked practices? Clients should not be in a buyer-beware situation when visiting a doctor, and it's not their fault they don't know vaccine science. Over-vaccinating vets are completely out of line, given that they've had over a decade to get the memo that these additional shots serve no purpose. Eventually, people have to assume they are either ignorant or just trying to put more money in the cash register.

So not surprisingly, one veterinary professional in the 20/20 segment stated, "Distemper is typically an annual vaccine." When research confirmed that immunity from the distemper vaccines actually lasted for at least 5 years (if not the life of the animal), the information arose inconveniently. After all, the industry had annual vaccinations as a cornerstone of its income and a basis for drawing clients. (To correct the Chicago journalist who implied vets don't make much money off vaccines, a single shot may not cost much, but hundreds of thousands of shots arguably bring more revenue and vet visits than anything else.) To limit the financial fallout, veterinary associations devised a compromise "every 3 year vaccine" policy, currently recommended by the AVMA, AAFP, and AAHA.

Still, in the wake of this 20/20 piece, vets are continuing to defend the "discretion" to ignore these already business-placating vaccine guidelines. The consequence is that many dogs will receive this and other vaccines every year... at a rate potentially 10 times more often than what is medically warranted or effective. If we're worried about pets being adversely affected by 20/20's short-sighted reporting, we should also be worried about pets adversely affected by our downplaying of overvaccination.

Sometimes I wish I had a banner-flying blimp that could debunk dozens of such myths propagated to veterinary clients. Among them are the pharma-driven myths---the kind that assert indoor cats should be on heartworm preventative through a New York winter. Does a New York mechanic say that one should have snow tires on for the summer, emphasizing it could mean a life-or-death safety issue if one of those July blizzards came along? If so, we shouldn't forget to wear a helmet while walking to our mailboxes, either. You never know what might fall on you and cause a concussion.

Conclusion

This 20/20 piece did what journalists wanted it to do - it caused a stir.  But it also might have been the only thing that brought words like overvaccination into people's living rooms. It also forced vets to say something about these concerns. At this point, I'm glad for any conversation starter. When millions of animals and a profession of suicidal people are at risk, silence is not an option.

The 20/20 piece also brought this profession's collective insecurity to light. Again, most of the criticisms in the segment weren't strong ones. However, we all know there are vets who do (deliberately or unthinkingly) put their business interests ahead of animal well-being. But how many lip-syncing singers, dishonest politicians or rough-handed police officers have also been exposed on TV? Does their entire profession instantly take umbrage? So why does ours? If you're a good vet operating on examined values and solid knowledge, this shouldn't damage you or your relationship with your clients at all, should it?

If anything, I hope it inspires you to become more involved in ensuring that your profession does everything it can to come to the rescue of animals, clients, and not withstanding---itself.