The effect of free stuff
| April 24, 2015 | Posted by Melinda under Most Popular |
Let’s start our topic discussion with a quick show of hands.
Raise your hand if accepting free stuff alters your perception of the company or product.
How does your answer change if the free thing is as small as a pen?
What if it is something more valuable such as a as a saddle?
What I have to say today will probably surprise you.
It sure as hell blew my mind.
When I started vet school it was the start of my university’s modified vendor program. Gone were the days of free stuff – no new backpacks, free supplies, flea products, pet food, and other medications. I also don’t receive free veterinary care through the clinic. Small vendor gifts – those valued under $5 and available to everyone in the class – are allowable, which means a plethora of pens and plastic coffee mugs get handed out.
I was bummed. One of the “perks” of being in vet school that everyone talked about was that you could basically own a dog or cat for free while you were in school and I was looking forward to it! I wasn’t naive – these were companies hoping for an “in” and early loyalty but having spent my previous career bombarded with vendors and promises (and yes, free products), I felt that I was well prepared to be a skeptical and discerning professional in the veterinary world too.
I mean really – who doesn’t realize that by giving you free stuff that company is hoping to gain some sort of elite access to your dollars or your recommendations? They wouldn’t keep doing it if it didn’t work.
I thought that with this acknowledge came a sort of immunity from the effect.
So I bitched and moaned with everyone else how stupid this new policy was.
Until in first year I overheard a conversation between some other classmates which started to change my opinion.
We were working on a project that included a diet recommendation for a imaginary client. Imagine my horror when I heard “Let’s recommend Hill’s or Purina, because they give us *free food and really support veterinary students”.
*For awhile we still had access to free food by paying a “membership fee” to be part of a food program. The specifics of that program have now changed.
My mouth literally dropped open.
Ok Ok Ok. Perhaps the new policy was in place because more people than I realized lacked basic common sense.
But surely my awareness of who was giving out free stuff, and being really self aware of any potential biases protected me?
Except…the research just doesn’t support that.
I’m going to quote heavily from a commentary article that was published in JAVMA, “Ethical considerations raised by the provision of freebies to veterinary students”, by Michelle Dally. It is available for free here. JAVMA is considered a very reputable journal in the veterinary world, but I still back-checked many of the citations. However instead of sending you half a dozen links to the primary research, I’m sending you to this article because it’s well written, understandable, and is a good starting point if you want to research this topic on your own.
I looked up this article after a veterinarian I worked with on an externship told me there was evidence that a gift as small as a pen could influence someone.
WHAT? NO WAY. Not me.
Except that is exactly what social science research shows. “Research has suggested that gifts, no matter how insubstantial, do indeed bestow the giver influence over the recipient…even when the gift is as incidental as a pen…” Specifically when it comes to what is being prescribed and how.
Scary? But surely *I* wont do this….except…
“…the impulses generated by gift-giving are neither rational nor totally conscious…Research demonstrates that recipients of small gifts tend to be unaware of any effect the gift might have on their behavior…the fact that recipients are generally unaware of any bias is what makes it so difficult to correct for its effects or to avoid conflicts of interest in the first place”.
Here’s what I find exceptionally disturbing. I fundamentally believe that I am not unduly influenced by (*corporate/company) gifts. Certainly not something as small as a pen or a coffee cup. Not even a larger gift. Which in some ways makes me wonder whether I am the most vulnerable of all. Because I do not acknowledge a potential bias, and thus being unaware, fall into the trap of believing one cannot exist.
*Personal gifts of wine and other necessities of life still accepted from friends and family and WILL influence the production of positive thoughts in your direction. I promise…
Of course the majority of this research is occurring in human medicine. However I think there is compelling evidence that the veterinary world is not so different from the human medical world.
What about endurance? In a sport where we are making decisions for animals that cannot advocate for themselves, we are bombarded with conflicting information from other endurance riders, vets, trainers, farriers, companies, reps…and on and on and on. We as riders are the ones sorting through this information and “prescribing” treatments/food/routines/supplements.
Now add to the mix a whole lot of people in this sport that are receiving free products and being sponsored by companies. And many of them aren’t always upfront about these relationships, or at least don’t post those relationships in an easy to find place as they tout, recommend, blog, and post about using those products.
The result is a tangled web of biases – both others (acknowledged or unacknowledged) and your own (mostly unacknowledged) – that makes me wonder just how many of my decisions of what/when/how/why in endurance are truly the result of me making the “best” and most “informed” decisions.
Fortunately over the years it seems that my horses are none the worse for wear (most of the time) regardless of how those decisions came about.
But here’s what makes me cringe and get out the soap box and write this post.
Now knowing how influential “gifts” can be, even in someone that thinks they have considered such bias and determined they are NOT being biased, I want to know whether the advice I’m being given *may* contain such a bias. Put in another way, I want to know whether the advice I’m being given MAY have been influenced by accepting a gift, or otherwise being compensated by a company.
Which means complete transparency of who is receiving what from where. We in the endurance world, especially those of us that have put ourselves in positions of giving others advice either directly or indirectly such as blogging our experiences need to be clear about what we have received for a reduced price or free, if we are going to either recommend it or talk about it or blog about it.
Students may be particularly vulnerable to influence, as “evident suggests that the habits medical residents develop during their training persist into practice. ” What about our endurance Greenbeans?
Here’s the good news as endurance riders. Unlike doctors and vets whose potential conflicts of interest are having to be evaluated by non-docs and non-vets who want to utilize their services, endurance riders are in a good position to make decisions about OTHER endurance rider’s conflicts of interests.
At the very least we should educate ourselves on the potential implications of gift-giving. That is the point of this post. I’ve given you the information, now it’s your choice to decide. I was skeptical when I started school. Now? I’m much more convinced. Not that I’m being influenced by that pen, but that I might be influenced by the pen and not know it. So I’ll error on the side of caution and continue to be open about what my potential biases might be, and continue to disclose where I got products and how much I paid for them when talking about any kind of products here on the blog. I encourage you to do the same and advocate for others to follow suit.
Here’s a good link (thanks Funder!)for bloggers that provides a starting point of what sorts of things you need to disclose if you are being responsible.
Nicely done.
This is why my blog is not monetized and never will be. And why I will never sell advertising or take free stuff in exchange for a review. I’ve worked in the grant-making industry for a long time and I’ve seen what all those little influences can add up to and I want no part of it. Kudos to you for taking the time to analyze the situation and reflect on it and then write about it. I don’t think it’s easy for people to admit that certain things can change their desire to be objective and the more aware we are of the possibility, hopefully the better we can address it.
Like you,I’m considered myself impossible to influence by the gift of a pen (or you name it). I don’t get any free stuff, (which is no longer disappointing after reading this post). I hadn’t considered the possibility I could be influenced while still being aware of exactly what companies are doing. We decided to take our dog to Davis for a work up, a long drive, when he has a perfectly good GP vet. The vet was recommending a specific prescription food (they get free stuff from company), because he needs a diet low in fat. I asked her to check the fat percentage, which she happily did. She was shocked to realize she was recommending a food formulated for dogs with pancreatitis that was borderline too much fat. He was already on a diet with 4% less fat than is ideal for dogs with this condition. She’s aware of the problems of free stuff, and thought she was immune also. Really good, thought provoking post!
I think that food in small animal medicine is one of the biggest problems. It’s absolutely infuriating as I listen to faculty members and other people in positions of authority around me engage in conversations that show how openly they ahve bought into the “big three” food companies that do the most “veterinary hospital/staff support” and do not even seem to think about it twice.
I’m no longer disappointed about not receiving free stuff through vet school either – although I will probably still thoughtfully pursue opportunities that make my horses and running cheaper. BUT I will do it recognizing it puts me at risk for bias and some people may choose to read my list of potential conflicts and see bias even if I disagree with the persence of one. That is the price of accepting a freebie.
I think what this research did for me is make me more thoughtful about accepting freebies. I will still do it (and disclose COMPLETELY) and if someone wants to advertize on this site, that is fine…but it won’t be an automatic yes, and even as up front as I feel like I’ve been over the years, I will make DARN sure there isn’t any question of what potential biases could be and I’ll make that information very easy to find. I just spent the morning updating my FAQ page and added a new section right at the top – “Potential conflicts of interest” – as well as continueing to state within posts what specific biases could be.
Important topic, thoughtfully considered. My mother is a nurse, and all of our scrap paper and pencils growing up was pharmaceutical. An absolute avalanche of Stuff. Even if they’re not giving you something of real monetary value (ie that pen), you’re seeing the company name all the time when you use it, and there’s a decent chance you’ve had an interaction with a rep in order to get that pen. It’s an awareness game as much as anything else.
What Amanda said is one of the reasons why my old work used to give out heaps of pens – if a person is holding on to (I used to work in scientific sales) one of your pens on a regular basis, they see the name and when they try to think of a supplier, we are the one that is most recently seen, so they call us first.
It’s a very interest topic will be interested to see what it is like here if I qualify for vet school. (and on that note I will go study more chemistry!)
Great post. I have seen the damage done by this mentality on many occasions. Seeing some of the big names out there shouting the wonders of Purina makes me feel sick. I know they’re being sponsored, but that doesn’t make it ok in my book… and you just know the less informed horse owners are feeding that junk because XYZ Big Name Eventer feeds it…. UGH!!!!
My financial support comes from my day job…where I frequently attend conferences and collect pens, cups, posters, book bags, and even books…and give most of them away in a big potlatch for the peeps who didn’t get to attend the conference. Also, I guess this stuff doesn’t “work” as much on me because I’m rarely in a position to buy stuff from conference vendors–one of the “benefits” of working in a place where those decisions aren’t mine to make. So I’ve got heaps of coffee cups advertising databases and barcode readers, but I will probably never need to buy any of that stuff!
I have a lovely little backpack with the Arabian Horse Association on it…but I don’t think that will ever get me to switch breeds….nice try though. I gotta say that AERC had some nice giveaway pens at the last conference–sturdy, good ink, no blobbing. I sometimes “loan” those to people like my farrier, whom I’m trying to convert to the true faith of endurance.
Dear Melinda,
“I mean really – who doesn’t realize that by giving you free stuff that company is hoping to gain some sort of elite access to your dollars or your recommendations? They wouldn’t keep doing it if it didn’t work.
“I thought that with this acknowledge [sic] came a sort of immunity from the effect.”
When I read these lines from your article, my mind IMMEDIATELY jumped from vets, horse supply companies, and riders to politicians, campaign contributors and voters. As I continued reading, I kept mentally substituting “campaign donations” for “gifts” and “legislators” for references to veterinary/medical personnel and “legislation” for “recommendations.”
Therefore, I would like to rewrite your article with politically inspired substitutions. I will also follow up on your links to be able to include and cite the research in my rewrite. I will let you review my “new” piece before I share it with anyone else and you will receive credit for and a link to your article here on Boots & Saddles. Can we discuss this “project?”
You can reach me at dt-bas AT wakerobinranch DOT COM.
Thank you for your thoughtful and elucidating article.
Diane Trefethen
Mariposa, CA
AERC #2691
The link to the UC Davis site no longer appears to bring up Ms Dally’s article. It is available as of 29-Apr-2015, at http://www.terrierman.com/javma.238.12giftstoveterinarystudents.pdf
Nicely done. Puts a whole new spin on why we are not allowed to receive gifts & can’t spec single supplier products.